February 10, 2005

A visit to a reputable hospital in Rawalpindi turned out to be a nightmare for the writer. Zahrah Nasir writes about her experience

The rambling old buildings are freshly whitewashed, the paint-work sparkling clean. Pots of multi-coloured chrysanthemums line driveways and footpaths. Highly polished brass planters full of healthy looking spider plants hang decoratively from second floor balconies and the carefully tended outdoor sitting areas are meticulously clean.

The facade of the hospital is indeed something to write home about. It has some of the best doctors and specialists in the country, many of them with impressive lists of qualifications from both American and European medical training institutions.

As an out-patient, with or without army connections, it is very hard to beat, but, if you are admitted for treatment then it is, sadly, a very different story indeed. Cash up front is the rule, no credit cards, no cheques just cash, even if it happens to be the middle of the night. No cash then no treatment is the cruel reality.

I personally came face to face with this in October 2003, when I was admitted for emergency surgery following a road accident in which the taxi I was travelling in was involved in a head on collision with an army jeep near Murree.

First aid was given in a Murree hospital and then I had to take a cab down to Rawalpindi, where I was immediately admitted as my upper left arm and shoulder were badly damaged and it was necessary to insert a metal rod to replace the shattered bone.

Forewarned is forearmed and I did have the admission/deposit of Rs 20,000 but, three hours after being admitted I was totally shocked when, at 11pm a gentleman came demanding payment of Rs 19,700, the price of the implant, before 7.30 am when I was scheduled to be taken to the operating theatre. No money, no operation. Now I ask you, where on earth are you supposed to find such an amount at that time of night. I thank God for friends who were able to raise the sum and help me out.

On this occasion, I was lucky enough to have a relatively clean two-bedded room to myself, the bathroom shared with a similar room on the other side. This was in the section for ‘officers families’ which, I presume, is supposed to be top notch. The centipedes in the bathroom outnumber the nursing staff by at least 1,000 to one as female nurses are in shockingly short supply.

Early the next morning I was helped into a not too clean gown and shalwar, a difficult process due to the mess I was in, escorted down two flights of stairs then squashed into a pick-up ambulance along with lots of other people and whisked off, at high speed, to the operating theatre at the other end of the hospital compound. After struggling out of the vehicle I was stunned to be shown into a waiting room already occupied by women and children in outdoor clothes, having a picnic on the floor! Where was the sterile atmosphere one expects in such circumstances?

Uncomfortably perched on the edge of a grimy armchair, shivering in cold and fright, I felt as if I was participating in a horror movie and only a reassuring visit from the orthopaedic surgeon managed to calm me a little. If I hadn’t had faith in him I would have been off and running.

What I saw of the operating theatre appeared clean and reasonably up to date, but when I woke up, briefly, in the recovery room I couldn’t understand why a nurse was wiping blood off my mouth. The anaesthetist had somehow managed to smash an upper front tooth. Along with the agony in my arm and shoulder I now had dreadfully swollen gums too.

Still on the trolley on the way back to my room and falling in and out of unconsciousness, it was difficult to comprehend why a young man kept insistently shoving a piece of paper in my face. I should have realized that he wanted money to replace whatever medicines had been used in the operating theatre. Stupid one, I should have known, even though I was half conscious.

Signs at various places in the hospital remind you that personal attendants are not allowed and, as my husband was unable to spend more than a short time with me due to the distances involved and we don’t have relatives in the area, other than one male friend, I was completely at the mercy of the hospital staff, this on the rare occasions that I saw them.

No good ringing the bell, which was out of reach anyway, as it didn’t work. The embarrassed tea boy was the one who ended up helping me to get out of bed when necessary. By the way, the food, when it comes, is largely inedible, cold and congealed. Water and tea must be bought and paid for, except for two cups of lukewarm stuff, one in the morning and one in the afternoon, from the canteen. But first you must find someone to go there and obviously pay for the privilege. Never have I been so glad to go home.

Unfortunately the saga did not end there. Follow up visits to the surgeon were all fine, trips to get my teeth sorted were expensive but necessary, then the news that I needed more surgery, this time to remove the implant as it was giving problems, was petrifying to say the least.

Thus, on December 20th, 2004, I found myself heading back, fighting through the first snowstorm of the season in a vehicle with chains on the wheels, for round two. Fully prepared, bottles of mineral water, flask, coffee, biscuits, novels, this time and with the correct amount of cash plus extra for medicines, I entered the hospital trying to be brave.

No reasonable room this time, but a six-bed general ward which was freezing. The gas fire at one end did little other than provide a night-time gossip point for the ayahs on duty and the holes in the high ceiling room let freezing draughts of air in. The single bottom bed sheet was filthy, the one red blanket threadbare and requests for others were denied. I was thankful for my own sweater, thick socks and woolen shawl.

Each bed was in its own little cubicle with partitions about four feet tall dividing it from its neighbours. The first problem here was the neighbours attendants and visitors, many of them male and some staying overnight, who cannot resist peering into the adjoining cubicle. Then there are the row of latrines and separate washrooms.

How on earth is a female patient supposed to go to the toilet when strange men are using it both day and night? Even worse, what are you supposed to do when you find a man urinating in the shower drain?

Being taken to the theatre followed the same routine as previously, though, this time, it was extremely difficult to obtain a gown and I had to wear my own trousers. The waiting room hadn’t altered except for the presence of a bunch of workmen drilling holes in the plaster and filling the air with unhygienic dust and nerve shattering noise. Walking to the theatre, along a corridor where your feet left tracks on the linoleum is not a reassuring process either. I had been asked to walk barefoot but refused and left my shoes at the theatre door instead.

Returning to the ward was something I don’t remember much about though I distinctly recall the cockroach which had taken up residence in my bed during my absence! It was impossible to get tea or water for my flask without paying over Rs100, impossible to get anyone to help me to the toilet, and then a battle to get there myself with one arm immobilized and a drip in the other, but one has to do what one has to do and count your lucky stars that you are still alive.

The operation was not a success as when the surgeon attempted to remove the bothersome rod, the upper arm fractured again so he had to stop. I don’t blame him at all as these things can happen. So the rod remains for life and I will learn to live with it and, once this fracture has healed, I will get on with my life as best I can.

However, one thing I fail to understand is why such top line doctors and surgeons do not have more say in hospital hygiene and overall conditions. If the hospital was clean which one expects in an army-run place, then surely patients would recover faster and, if correct aftercare existed then everyone would benefit. Surely it is long past time to tackle these problems. Excellent healthcare for all means excellent surgeons, doctors, nursing staff and strictly hygienic conditions.

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