KARACHI: Similar to what several patients narrated at the chest ward of the Jinnah Postgraduate Medical Centre (JPMC) are Ghulam’s personal experiences. A taxi driver in his early 50s, Ghulam has recently been advised to undergo surgery for one of his ailing lungs though both have developed pus-filled cavities. But, in the case of one, the infection has become worse and requires immediate intervention to clear the condition.

With tubes attached to his chest on both sides, he rests on the hospital bed where he is being looked after by his young son. For Ghulam it is not the idea of going under the knife which is bothering him. Rather, it is the fact that the hospital doesn’t offer any surgical procedure in the relevant field.

“I am a poor man with eight children. How can I get my surgery done at a private hospital,” he asks, hoping that the medical staff may help him find a charity hospital where he can get the procedure done.

Mohammad Ibrar, father of a 17-year-old suspected of suffering from tuberculosis in the same ward, faces a similar predicament. “My son has been diagnosed with sepsis in a bleeding lung. The doctors are saying that he is likely to be recommended for surgery once his detailed tests are done,” he said.

A rickshaw driver, Ibrar has already spent Rs35,000 on the treatment of his son who was treated at three hospitals before being brought to the JPMC. “I am already into debt and there is no way I can afford the surgery from my own expenses,” he lamented.

No chest surgery for four years

According to sources, the thoracic (chest) surgery department at the JPMC closed down in 2012 after its entire faculty left the hospital. The head of the department retired while the other three doctors found jobs with better salaries at other health settings.

A major grievance of doctors, sources said, was linked to the confronting situation that emerged following the devolution process, leading to a tussle between the then-hospital administration (earlier working under the federal government) and the provincial government. The latter went to court which issued a stay-order on all hiring and promotions. The case is still pending.

“You can’t treat all lung diseases with medication and there are conditions in which the patient has to have surgery else he will die sooner or later. Since our department has closed down, we have no choice but to refer our patients to the Ojha Institute of Chest Diseases of Dow University of Health Sciences,” explains Dr Nadeem Rizvi, senior chest physician heading the JMPC chest department.

The institute was the only public sector hospital in Sindh and Balochistan which provided chest surgeries to poor patients free-of-cost, he added.

“The JPMC was the only institution in the two provinces to train chest surgeons and with the closure of its thoracic surgery department, the training process also ended,” he observed, adding that the ward was providing the best possible treatment with its limited resources.

There are many cases in which chest tube insertions are required to drain air, blood or fluid from the lungs but if any of these conditions get complicated, surgery is necessary.

Only two chest surgeons

“Given the fact that the Ojha institute is burdened with too many patients and surgeries get delayed for months, we have to continue to help patients with tube insertions, at times for more than the time required to use the method. But, this shouldn’t be the standard procedure because patients could get infection.

“Secondly, in some cases, we have to discharge patients whose condition is stable with the inserted tube because the bed is needed for a more deserving patient. Those who leave for home are called for a regular follow-up but we can’t adopt this strategy for patients coming in large numbers from interior Sindh,” said Dr Rizvi, explaining the challenges the staff faces.

Regretting how patients have to suffer due to lack of relevant facilities, he said lung cancer at early stage was potentially curable but patient may die if medical support was not available on-time.

Out of around 150 to 200 patients admitted to the chest ward every month, 20 patients require surgery at a given time; a private chest surgery can cost between Rs100,000 and Rs200,000 depending upon the complication.

As to why health professionals are not inclined towards this field, Dr Niaz Soomro, who is one of the two chest surgeons working [in the public sector] at the 22-bedded Ojha institute, said there was no training institute for chest surgery in Sindh; also a majority of people who develop chest problems belong to the disadvantaged sections of society.

“They can’t give hefty treatment fee. I came here because the DUHS offered me a better service structure but my commitment to the poor hasn’t changed,” he said, with a smile.

He admitted to delays in surgery and said currently 200 patients were on the waiting list. “We have four operation days. It usually takes two to three months when a patient’s turn finally comes. We, however, make an effort to attend to critical cases on priority basis.”

According to him, the facility receives patients from all tertiary care district hospitals of the province as well as small private clinics. “They come to us after exhausting all their resources and getting their immunity levels highly comprised. Sixty to 70 per cent patients have tuberculosis complications.”

The number of patients at the facility has grown over the years and, at times, the staff has to face a lot of pressure from influential people who want their patients to be treated first.

“We are working in a challenging environment. The patients’ sufferings can only be alleviated if there are more surgeons,” he said, adding that the institute had submitted an application to the College of Physicians and Surgeons Pakistan (CPSP) to allow it to function as a specialised training centre for surgeons.

About the efforts of the JPMC for providing chest surgery facility to patients, chief executive officer of the JMPC Dr Anisudding Bhatti said he had recently notified the creation of a thoracic surgery department. “We have also hired three surgeons. But, the department can only become operational once the stay order over hiring is removed by the court which is expected next month,” he said.

To the question whether the hospital will need a new approval from the CPSP to restart chest surgery training, he replied in the positive.

Published in Dawn, June 27th, 2016