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Punjab hospitals’ ICUs in bad shape

April 07, 2014

LAHORE: Muhammad Usman Khan is a relationship manager at a bank in Sahiwal. He recently went looking for something as basic as a bed in an intensive care unit (ICU) in a hospital and a ventilator to save the life of his 54-year-old mother who was suffering from acute pneumonia. He searched desperately for it in his hometown and then went calling at various hospitals in Lahore, around two and half hours drive from Sahiwal.

Usman and his mother arrived at the government-run Services Hospital in Lahore on March 18. The patient was admitted and referred to the ICU, but all the ventilators there were already occupied. A ventilator was urgently needed for the fast weakening body of the patient, and her son was left with no option but to look for a private hospital with the facility after an unsuccessful round of some other public sector facilities.

All he could ultimately find in a private hospital was an ICU bed without ventilator, because he lacked resources required to get his mother admitted to a ‘medical centre’ at Rs60,000 per day plus expenses on medicines.

His mother died five hours later and soon afterwards Usman was handed a treatment bill of Rs75,000.

Not only is there no critical care specialist available in any government institution in Punjab, the ICUs are being run either by a professor of medicine or anaesthetics. The public and private hospitals do not have sufficient number of trained and qualified nursing staff for ICUs and ventilator is a major component of intensive care.

Up to 5,000 patients are estimated to visit the outpatient department (OPD) and emergency of a government teaching hospital every day. Dr Abubakr Gondal, a specialist associated with the Jinnah Hospital ICU, tells Dawn that on an average one out of every 10 patients visiting the emergency requires ICU care.

By comparison, according to information gathered from the administration of 12 major tertiary care hospitals in Punjab, the number of ICU beds in all of them adds up to only 250.

The 1,250-bed Jinnah Hospital in the Punjab capital has 34 ICU beds and 54 ventilators. The 2,200-bed Mayo Hospital, which receives at least 4,000 patients daily in its OPD and emergency department, has only 48 ventilators. The 1,200-bed Services Hospital has only 43 ventilators.

Away from Lahore, the 1,450-bed Bahawal Victoria Hospital in Bahawalpur has a six-bed ICU.

The World Health Organisation (WHO) recommends a 50:1 ratio of general ward to ICU beds and there should be a trained nurse for each bed in the ICU.

But medical experts cite reports which say that at present one nurse is staffed for three patients at an ICU in both the public and private hospitals.

An implementation strategy report of the WHO Global Code of Practice on International Recruitment of Health Personnel says the ratio of nurses to population is estimated to be one nurse to 3,626 people in Pakistan. It says there are 19 teaching hospitals with only 12,000 beds.

The hospitals are also blatantly lacking in other staff for ICU, including physiotherapists, nutritionists, laboratory technicians, biomedical technicians for repairing equipment, pharmacists and counsellors. They are mostly arranged on the basis of an emergency call.

As intensive care is believed to be a major source of income for private healthcare providers compared to any other format or method of treatment, a majority of leading hospitals in Punjab have come up with very odd ICU treatment packages.

According to a survey carried out by Dawn, the cheapest ICU package in an average private hospital starts from Rs40,000 for 24-hour treatment. This includes only service charges and doctors’ fees. Expenses incurred on medicines -- which are generally costlier in case of critical patients --, surgical and disposable items and laboratory investigations are besides this.

Under the Pakistan Medical and Dental Council’s Medical and Dental Institutions Recognition and Accreditation Standards Regulations 2012, 15 per cent (22.5/125) marks are assigned for critical care beds, which include intensive care, coronary care and neonatal care. Without these marks, a hospital cannot get accreditation, on paper, but there are frequent allegations that these rules are flouted at will.

Rule 17 of the regulations envisages: “There shall be separate medical and surgical ICU beds, separate paediatric and neonatal intensive care and separate intensive care beds.” Moreover, 15pc of the total bed strength shall be intensive care beds.

“At least 15 ventilators should be available for a 500-bed hospital,” according to the PMDC criteria. Out of the 500 beds, 10pc should have cardiac monitoring facilities.