KARACHI: Almost two thirds (65.6pc) of healthcare providers in the city have either experienced or witnessed some kind of violence while one third (30.5pc) have been either attacked verbally or physically over the past one year, according to a report launched on Thursday at the press club.

Titled ‘Violence against healthcare: results from a multi-centre study in Karachi’, the study highlights the violence against healthcare providers that is often unreported with the chief perpetrators of violence being patient attendants and ‘unknown persons’.

The report was prepared by the Appna Institute of Public Health of the Jinnah Sindh Medical University in collaboration with the Jinnah Postgraduate Medical Centre (JPMC), the Ziauddin Medical University and the International Committee of the Red Cross-Pakistan.

“The objectives of the study were to document the frequency and nature of violence, identify the reasons of violence, explore its impact on stakeholders and recommend measures to address the issue,” said Prof Lubna Ansari Baig, dean of the Appna Institute and the principal investigator of the study.

Sharing its findings, she said around 1,000 people that included doctors, nurses, paramedics, security guards, ambulance service drivers and law enforcement agencies were interviewed for the study from Jan 2015 to Aug 2015.

Pashto-speaking healthcare providers suffered more violence

“Verbal violence (30.5pc) was experienced more than physical violence (14.6pc). Major forms of violence included abusive language (82.2pc), pushing and pulling (40.6pc), threats (34.7pc), beating (20.8pc) and facility damage (13.pc).”

Often the chief perpetrators of violence, according to her, were not people directly or indirectly linked to the patient but were identified as people who were at the health facility to create violence.

“The ambulance staff told us that patients and attendants are abusive in the ambulance, particularly when they are stuck in the traffic. They also said people do not give way or don’t know how to give way to ambulances,” she pointed out, adding that Pashto-speaking healthcare providers had been found to have suffered more violence as compared to other communities.

The research showed that emergency department and wards were the most common sites of violence. Almost 82pc incidents were reported within medical institutions.

Thirty-nine per cent of physicians, security staff and ambulance staff had faced violence, which was the highest as compared to other staff.

In comparison to public sector hospitals and ambulance services, there was less likelihood of violence in private hospitals and NGOs.

Violence impacts self-esteem

The top five reasons of violence reported were unreasonable expectations (56.1pc), communication failure (55pc), human error (53.7pc), unexpected outcome (42.6pc) and substandard healthcare (35pc).

Only three per cent of the victims took legal action against the perpetrators, more than half didn’t do anything and the remaining reported to their managers.

Majority of the victims reported having nightmares after they experienced some form of violence, feeling insignificant resulting in low self-esteem and depression. Some reported that their colleagues who suffered violence left their job.

Research fellow associated with the Research Society of International Law, Pakistan, Saad-ur-Rehman Khan, who carried out a legal review of the legal framework available to healthcare professionals, said the present legal framework didn’t adequately address the issues plaguing the healthcare sector in Karachi and there was a need to amend or enact new laws to safeguard the rights of healthcare professionals.

Suggesting a number of measures to improve the healthcare situation, he also underlined the need for making the Sindh Health Commission Act operational.

Dr Seemin Jamali, a senior physician heading the JPMC’s emergency section for 25 years, said that though there were gaps in the performance of ambulance services, all being run by the private sector, the government should step in and launch an ambulance service according to public needs.

Published in Dawn, November 13th, 2015

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