It’s an emergency

Published November 2, 2014
Hospitals are soft targets in times of mass emergencies./Photos by Fahim Siddiqi / White Star
Hospitals are soft targets in times of mass emergencies./Photos by Fahim Siddiqi / White Star

KARACHI: The man on the stretcher in the emergency room at the Jinnah Postgraduate Medical Centre (JPMC) frantically pointed to his jacket pocket as he struggled to say something, which the doctor tending to his injuries couldn’t make out at first until he managed to mumble, “Grenade. Take it out.”

“My surgical scissors then came in handy for cutting around that pocket with the explosive first, which I quickly handed over to the bomb disposal squad,” says Dr Seemin Jamali, head of the JPMC emergency department.

“We never deny medical help to anyone, even someone with such harmful intentions of hurting others,” she adds.

“In the case of mass emergencies the hospitals become soft targets. Anything can happen here then as it has happened in the past when after a bomb blast in the city there was another attack carried out right here at our emergency department where the victims, their families, emergency services and media had gathered. We have become very careful after that.”

JPMC readies itself for casualties after hearing about a disaster./ Photos by Fahim Siddiqi / White Star
JPMC readies itself for casualties after hearing about a disaster./ Photos by Fahim Siddiqi / White Star

On the wall next to her desk is a big display screen with several smaller windows of live scenes of various locations within the hospital.

“We are monitoring and recording all areas 24 hours a day. That’s how we identified the man involved in a firing incident here, too,” she says. “We are the front-line hospital for handling emergencies such as the Oct 18, 2007 blast at Karsaz, the Ashura blast, the Nishtar Park blast, the Abdullah Shah Ghazi shrine blast, etc. There are about 100 members of staff with paramedics, doctors and nurses at the fore at all times. Helping others in times of distress, God has also helped us and kept us safe till now.”

JPMC’s own ambulances shift patients within the hospital./ Photos by Fahim Siddiqi / White Star
JPMC’s own ambulances shift patients within the hospital./ Photos by Fahim Siddiqi / White Star

Knowing the looming dangers well now, the hospital has taken more precautions by building a wall around its Accident and Emergency Department with a Rangers and a police checkpoint at the entrance, too. “We have also built a wall to cordon off the kutchi abadi side because you never know who among the bystanders may be here with harmful intentions of hurting more people during a mass emergency,” she says.

“Everywhere in the world, the person or people in need of urgent medical help are taken to the nearest hospital but here most, even from as far away as Lyari, Manghopir, Nagan Chowrangi, etc, turn to the JPMC.”

All ER staff have developed a deep sense of duty./ Photos by Fahim Siddiqi / White Star
All ER staff have developed a deep sense of duty./ Photos by Fahim Siddiqi / White Star

The doctor with 25 years of experience at the Emergency Rooms (ER) alone has built up the JPMC’s emergency department over the years.

Most of it has been done through philanthropy.

Today the state-of-the-art facility that treats patients free of charge has a three-bed high-care unit with three ventilators, a 12-bed step-down area, which has everything but ventilators, a backup area with another 12 beds plus a 20-bed each emergency ward for men and women, a trauma room inside the emergency, a walk-in patients area, an orthopaedic plaster room, a four-body morgue, extra beds, stretchers, wheelchairs, sheets, first-aid boxes, units of blood and kits, crash carts, round-the-clock MRI, CT Scan, X-ray facility, operating rooms and enough drugs and medicine for 500 casualties.

Also two of the hospital’s own ambulances are always available for shifting the patients to the wards, etc.

Dr Jamali says that the hospital has a six-hour shift each for morning and evening and a 12-hour night shift. And the staff works on rotation. “But in the case of a mass event, we call in extra staff. Frankly, all our staff have developed a deep sense of duty and are ready to handle all emergencies which come without any warning,” she says.

But even on regular days, the JPMC is the busiest hospital receiving around 1,100 emergencies daily, which even increases up to 1,500 on holidays such as Eid. “There are accident, gunshot and dog-bite cases coming in all the time. The government hospitals are able to help properly in times of distress on holidays as private ones may be short-staffed with several facilities closed,” she says.

An emergency at the Abbasi Shaheed Hospital. / Photos by Fahim Siddiqi / White Star
An emergency at the Abbasi Shaheed Hospital. / Photos by Fahim Siddiqi / White Star

At around noon, Nazia Aslam, the charge nurse, says that they have immunised 54 old and new patients since morning. The hospital on average gets some 5,000 new patients for vaccinations annually.

An attendant with a man on a stretcher brought in says that he took his brother to a big private hospital after his blood pressure dangerously shot up. “But we waited there at the hospital’s ER for over two hours without getting any attention. Someone suggested we bring him to the JPMC, so I rushed him here,” the man says.

There is a wall full of bright sunflowers at the ER entrance. It was Dr Jamali’s idea to make people feel slightly better and not be too overwhelmed by the fact that they are at a hospital. She also makes sure they have enough bottled drinking water. “The first thing most patients as well as their attendants ask for is water, so I make sure we have plenty of drinking water available at all times,” she says. There are several copies of the Holy Quran and religious text available for anyone who wants to recite and pray. “Many attendants often ask for these while waiting here, so I have got plenty printed so that they can also take these with them if they like,” the doctor says.

There are several other free government hospitals with well-equipped ERs and trauma centres in the city, too, but the next hospital with the most patients turning up at their ER happens to be the Civil Hospital.

A casualty medical officer at the hospital, requesting anonymity, points to their under-construction new trauma centre, the Shaheed Mohtarma Benazir Bhutto Accident Emergency & Trauma Centre & Ancillary Services Complex. “It will start work soon and then we can close down this ER,” she says pointing towards the chaotic place people with all kinds of emergencies coming in.

“The big new building will also have ENT, eye and other facilities and will open in June next year hopefully,” another doctor, also requesting anonymity, says.

Ahead of the Ashura holidays, meanwhile, the hospital is gearing up and preparing itself for all emergencies. “Our ER has 35 beds and we can add some five more to go up to 40 but right now we are also putting up a shamiana near the out patient’s department (OPD) as a backup,” the casualty medical officer says.

As with the JPMC, Civil Hospital, too, deals with road traffic accidents and gunshot wounds on a daily basis. “Just like other hospitals, we also have a road traffic accident (RTA) department, which works with us. We have printed forms for the various kinds of emergencies coming to us in order to facilitate the patients with free medicine and services. Our staff goes out of its way to help the people coming here like even providing free food,” she says.

The hospital also has three shifts of six hours each for morning and evening and 12 hours for night. “We have at least six to seven doctors available and ready in each shift to deal with all kinds of emergencies. Apart from the regular emergencies, we also get the seasonal ones, like during rains there are cases of electric shock also coming in,” she adds.

The civil hospital, too, prides itself in extending free facilities such as X-ray, snakebite serum and a CT scan facility provided by Abdul Sattar Edhi. “All tests can also be done here absolutely free of charge,” the woman says. “Of course we are ready and willing to help at all times but sometimes I’m surprised to be getting patients here from such far away places as New Karachi, Liaquatabad and Shah Faisal Colony. There are other government hospitals in the city also and I wish the authorities post good staff there so that the burden on us eases somewhat. Many problems can be covered easily when the burden eases,” she says.

An ambulance driver outside the hospital, when asked how he decides where to take a patient in an emergency, says: “Look, we have also grown up in this city. We know it well enough to know that taking every patient to the nearest hospital during an emergency doesn’t work out here. So if the patient in my ambulance is Urdu-speaking, I try to turn to the Abbasi Shaheed Hospital first as he would be better taken care of there. For Pakhtuns, I try to turn to the JPMC and likewise for the civil hospital.”

Meanwhile, at the Abbasi Shaheed Hospital’s ER no one is willing to speak or show one around. The doctor who is said to know all to answer the questions is always out on a round and is said to be returning not before two to three hours. If the junior doctors are asked anything, they first turn to the administration to get clearance to talk but then return with a “sorry”.

Still a nurse at the nurses’ station at the ASH says that they are always equipped to handle emergencies involving 100 people at least. “Many of us nurses, and doctors, too, live right here in the residency at the hospital from where we can always rush for duty in case of bigger emergencies,” she adds.

Published in Dawn, November 2nd , 2014

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