Hooliganism is rampant at the Civil Hospital, Karachi, and has corroded almost every functioning body of the institution. Is the political might behind all this really beyond reproach?
Some weeks ago, an unusual incident of violence at the Civil Hospital Karachi — widely reported in the daily papers — told the story of a senior consultant doctor at the hospital who was severely beaten up by a group of ‘resident ruffians’ (i.e. the junior doctors called house officers) in the parking lot within the hospital compound. He had simply asked two individuals to remove their car blocking the doctor’s own vehicle. The respected member of the CHK staff and head of the Emergency Operation Theatre, after a prolonged pounding at the hands of eight or ten members of the general thug brigade — with many bystanders either apathetically or helplessly looking on — was eventually locked up in a back room.
Investigations reveal that political hooliganism is rampant at the Civil Hospital premises and has corroded almost every functioning body of the institution. In this particular case, the good doctor was totally apolitical but the ‘Bhai’ faction was just itching to make their might felt. Further scrutiny exposes that amongst all political factions, an ethnic group reigns supreme at the CHK and even the lowest staff can get away with the severest of law breaking, besides having the leeway to dial a call to the head ‘Bro’ whenever and whatever the need be. Politics is wrecking this hospital designed to give free succour to the needy.
Politics begins at the crucial level at the Dow Medical College attached to this hospital. Many back entrants not qualified for the medical seat, coerce their way through college to attain degrees at the point of a gun, backed with political influence. There is no need to waste words in describing the qualified worth of such individuals who then proceed as house officers at the hospital and soon become resident medical officers applying the same tactics. The death of a woman because of negligent surgical procedures during a simple gall bladder operation some weeks ago is proof of inept medical practice at work.
In another recent incident, a house officer prescribed medication contradicting the specialist doctor’s order and was left to face the wrath of the attendants by being beaten up. Besides the house officer’s credibility being in doubt, the state of security where even attendants can resort to violence reveals yet another malady afflicting the hospital. Reports of car lifting from within the compound and the outside parking area are plenty. The security breach too appears to be part of the politicized setup where some member of the group is ever present to facilitate such offences for some personal gain.
It is also said that till the gates were erected outside the female ward, no female patient was safe at night and there are many incidents of molestation. Some cases are still reported but the culprits are hardly ever taken to book. Interviews with cautious staff members and administrative staff — who, for fear of their lives, insisted on assurances for maintaining their anonymity — disclose that something is definitely rotten at the goings on at CHK.
Politics has corrupted the very core of this institution attached to the most prominent and earliest medical schools of the country, and from where some of the finest medical minds of international calibre have emerged. The political might is so lethal that no administrative power has the courage to amend this trend, which began some two decades ago during the time of General Zia-ul-Haq.
In the mid-nineties, there was a brief spell of disciplinary actions being taken and accountability came into practice when Professor Shafi Quraishy — a doctor of high repute, commanding honest respect — became the Health Secretary, Sindh, after being promoted from the post of Principal at the Dow Medical College. But honesty has never gone very far for this nation and Dr Shafi Quraishy was promptly and brutally silenced with bullet shots from which he physically and emotionally never recovered, and chose to depart from this country altogether after struggling for a considerable time between life and death.
One main factor hindering accountability is the division in administrative powers, says one authority figure. There exist two hierarchical setups which make for a conflicting reporting line and hence the overlapping of authority. At the hospital side, the medical superintendent (MS) is the highest authority who is supposed to have control over the total running of the hospital and the hospital staff, which include the lower staff as well as the general cadre doctors/consultants, house officers (HO) and resident medical officers (RMO). But the professors, associate professors and assistant professors too are attached to the hospital but they are part of the Dow Medical College faculty and come directly under the principal of the college, who is a higher authority than the MS. Then the junior doctors who come under the MS are actually working with/for their ‘guide teachers’, who are the professors at DMC and who have the power to make or break the new doctors’ careers.
Hence, what ensues is a conflict of interest and the result is mutinous attitudes of the juniors who become part of the power politics being subtly played among the professors as well. The hospital running is compromised in the process as the junior doctors blatantly deny transfer orders issued by the MS if it does not suit their career choice, and in this their ‘guide teacher’ aids them.
One of the senior authorities at CHK suggests that a common administrator might be the answer as has been done in some medical hospitals and colleges in the Punjab. The administrator must have the hiring and firing power, and hold direct accountability.
Probe into the medicine usage reveals a new ball game altogether, where misappropriation takes place in many ways. The CHK funds have divided control between the CHK management and the Ministry of Health. At the Ministry, the funds are allocated to the hospital under various heads — staff salary, stationary, medicine, maintenance, etc. and then a part is forwarded to the hospital and for the remaining, the Ministry can give supply contracts to any company through its Import and Inspection Depot (IID), as outlined by the budget heads.
There is another simpler method in practice as well where the attending doctor at the hospital writes a particular medicine of a particular company, which is an order that MUST be followed or else! Even if the said medicine is not available at the hospital dispensary, a substitute medicine with the same efficacy can NOT be administered and medical help stays on hold till that particular brand of medicine is procured by the patient.
With such strange machinations and an infirm system at work, it is no small feat that medical aid is still being provided to a large number of people who stream in from all over Sindh in search of relief at this hospital which houses 1700 beds and 66 departments. And though power-hungry individuals resorting to petty, as well as weighty, politics have defiled the sanctity of the establishment, there are those also who have taken it upon themselves to ensure the smooth running of a few departments by devising a system of donation to smoothly dispense mercy and aid for the miserable. Batches of ex-students have channelled resources from corporates, expatriate class fellows, pharmaceuticals and individual Samaritans to make some departments self-sufficient in medicines, besides installing state-of-the-art equipment.
A new project of building a hospital complex for free medical aid is in the offing, which will be totally funded through donations from individuals and organizations. The SIUT — the accomplishment of Professor Adibul Hassan Rizvi — is already a great example.
Perhaps, the newly-appointed and enthusiastic Health Advisor to the Chief Minister, Mr Noman Sehgal should take a page out of these philanthropists’ books to organize the CHK’s administration. In his neo-zeal, he has already ‘inspected’ the hospital numerous times (with the Press in attendance!) and is having a room prepared for himself over there to monitor the going ons. At the moment, he says that it is to equip the hospital ‘under strict supervision’ for a Sars outbreak. It is early days yet to make a judgment call on the man’s motives as well.
Surprisingly, despite the awful environs of the hospital, the daily turnover of help seekers is phenomenal. Even if the percentage which receives honest care is extremely small as compared to the potential numbers who would if the affairs were in better shape, it must be acknowledged that free of cost emergency services are available 24 hours over here. In case of large calamities in Karachi, victims are either sent to Civil Hospital or Jinnah Hospital where immediate aid without financial documentation is given.
This procedure should technically be followed by all private hospitals as the law states that medical assistance is not to be denied to any victim. But private hospitals never admit casualties without substantial down payments (despite the fact that one of the largest private hospital was allotted free land for its huge complex!).
It is customary to brush off discrepancies in government-run bodies, as that is what we have come to expect from them. But with the present government’s claims to give special attention to the area of health, there is little excuse for shoddily run government hospitals, specially since the military in our country can be very organized when it wants and the many Cantonment areas are proof of that. But if the task is too much for our uniformed heads to handle, who are presently busy grappling with domestic politics and its ‘framework’, then, perhaps, the government’s privatization agenda should include institutions like the CHK on a contract basis to work things out like the philanthropists are currently doing.
Hooliganism is rampant at the Civil Hospital, Karachi, and has corroded almost every functioning body of the institution. Is the political might behind all this really beyond reproach? 
