June 29, 2003

The Emergency Wards at the Civil and Jinnah hospitals are the most stretched, and overworked departments servicing the sprawling metropolis of Karachi. They are in dire need of expansion

IN Today’s Karachi,of 13 million denizen, the bustling life, the stress, lack of time, traffic jams all culminate in health issues and accidents. Most victims head to the accident and emergency departments of the two major hospitals of Karachi, the Civil Hospital which falls under the jurisdiction of the Sindh government and the JPMC which falls under the federal government.

General practice is to look down and belittle the contributions of the government-run hospitals. The purpose of this feature is to introduce a certain understanding of government hospitals, and discussing their foibles offer a few suggestions for improvement.

In 2002, 1,37,120 patients were brought to the JPMC emergency unit. Civil deals with a stupendous load of casualties with cases brought in from the interior of Sindh including cases of burns.

Lets look at the functioning of the emergency departments.

Civil Hospital Karachi: About 550 patients are lugged to the CHK each day. The refurbished accident and emergency department has 35 beds: 10 for females, 15 for men and 10 for trauma. Bedside oxygen & B.P. apparatuses have been installed for convenience. In a city like Karachi, the 10 beds for cases of trauma are not sufficient. The much used, burnt down area of the old emergency operating theatre lies unused as a new E.O.T. is functioning. This place has been given to the accident and emergency department to transform the place into a trauma section to treat more patients. However the idea is in a state of suspension till funds are available. Perhaps the “Triage” could then be applied according to which the injured are categorised for action by the emergency team. A common scheme of assessment isas follows:

1) Critical: needing medical attention within seconds,

2) Immediate: within minutes,

3) Urgent: within the “golden hour”,

4) Deferred: As soon as possible.

This way attention could be focused first where it is critically required.

The department has its own X-ray room which functions 24 hours a day. Nevertheless, the department is in want of its own laboratory. Currently, the main laboratory of the CHK caters to the emergency department as well. It receives samples from 8.00 am till 1.00 pm; after this time, the lab performs basic routine investigations. A doctor in the ER wished that a few more tests be done after 1.00 pm. He added that poor patients expect free treatment. Getting their investigations done from a private lab placed an uncalled for burden on them.

A CT Scan is available for Rs 1400 at the CHK till 8.00 pm. A doctor however at the ER felt that the poorare unable to afford this amount. More disturbingly a CT Scan at a private facility is done for Rs 800 to Rs 1000. So doctors advise their patients to get a CT Scan from outside the CHK! When a patient arrives at the CHK Emergency he is first seen by a CMO (casualty medical officer). His history, examination and routine investigations are done. A call is placed to a RMO of the relevant ward (Medicine, Surgery and Orthopaedic), whichever, ward has its emergency that day . There are six medical units and six surgical units. If the patient has a blunt abdominal trauma , the CMO provides the initial treatment and informs the MLO. There are 2 MLO’s per shift.

Many patients donot recieve prompt attention. A doctor in the ER reported the recent case of a diabetic with a hand injury who was brought to the CHK emergency. The hand had to be amputated and the blood sugarregulated as soon as possible . It was the duty of thethe medical unit to contract his blood sugar and of the Orthopaedic unit to amputate, either of the units could have admitted the patient to their ward but neither did!

The Medical unit explained that the Orthopaedic should take him in, while the Orthopaedic felt that diabetic with his hand should be admitted into the medical ward. As a consequence: the patient was left stranded in the emergency for several hours before any action was taken.

A loophole that allows for procastination in the shifting of a patient from the Emergency to a ward is because of the system which is as follows. When a RMO arrives in the Emergency to check a patient, he/she orders more tests to be done before he will shift the patient to the ward. Those extra tests are actually specific tests which are not urgently required and can be done after the patient is in the ward. Only the non-availability of beds in the ward could perhaps be a legitimate reason for any sort of delay in the shifting process. All other reasons are just excuses which cause the patient immense vexation.

A doctor in the Emergency suggests that one RMO from each of the departments of Surgery, Medicine and Orthopaedics should sit in the emergency department (on the day of their call). Since, they would already be present in the ER when the patient arrived there would be no unnecessary delays in the efficient transfer of the patient to the ward. This was the custom a few years back. It could be implemented once more.

JPMC is another prodigious hospital which is run by the federal government. The emergency receives about 450 patients per day. Cases range from road traffic accidents, suicide attempts, gun shots, dog bites. The emergency has its own X-ray room and laboratory — a 24 hour facility. It has 26 beds. APatient shuttle to shift the patient from the Emergency to the respective ward is also available . There are 4-5 nurses pershift, 10 paramedics, 2 CMOs and 4 house officers.

The emergency department is quite spacious and well ventilated but lacks bedside oxygen and Blood Pressure apparatuses.

A house officer in the emergency revealeded that they have to rush for oxygen cylinders if a patient with hypoxia arrives.

There have been complaints of patients being made to wait for three hours for the patient’s shuttle to arrive and move the patient to the ward.

So what can be done and why are things so? The doctors are overworked and understaffed. The postgraduates, those who have cleared not only their MBBS and housejob but have also given their FCPS part I, have to work for free. In the process of completing their part II requirements, the doctors have to work for 4 or 5 years (depending on their field of speciality) in the hospital. Most PGs are unpaid! So what level of professionalism does the society expect from them? The government alone cannot provide for and maintain such huge setups. Civil Hospital has a capacity for nearly 3500-4000 patients! Some times, there are two patients on one bed! Hence, privatisation may be mandatory. Philanthropist donations would contribute in rendering these hospitals more efficient. SIUT, after all, does exist in the settings of CHK. Charitable contributions and endowements are hence imperative to ameliorate conditions.

Please Visit our Sponsor (Ads open in separate window)