Experts urge govt to train doctors in ear surgeries

Published December 10, 2019
A team of UK-based surgeons performs an operation at a local hospital.
—Fahim Siddiqi/White Star
A team of UK-based surgeons performs an operation at a local hospital. —Fahim Siddiqi/White Star

KARACHI: While cases of complicated ear infections requiring costly surgical intervention are on the rise in Sindh, treatment in the public sector is available only in Karachi and that, too, just at two government-run hospitals.

The city has a handful of ear-nose-throat (ENT) surgeons having an expertise in ear surgeries. The government must intervene and improve the situation by training young ENT surgeons in this particular field.

These observations were shared by a UK-based surgeons’ team that was in the city recently to conduct free ENT camps at the Hashmani Hospital in Karachi and the Bhitai Medical Hospital in Mirpurkhas.

During the visit organised by the International Medical Relief Agency (IMRA), a charitable organisation, the nine-member team operated on 37 complicated cases.

The team comprised seven surgeons of Pakistani origin and two British trainees.

Ear surgeries in public sector done only in Karachi

“There is a real shortage of ENT surgeons in Karachi with a population of over 20 million. This means that the poor, most of whom report the disease belatedly, would suffer a lot when it comes to treatment,” said Dr Junaid Hanif leading the team.

Dr Hanif regularly comes to Karachi to hold ENT camps.

A major barrier to developing relevant expertise in the public sector in Karachi has been the availability and maintenance of highly specialised equipment required for ear surgery, he added.

“The team has brought its own equipment, including microscopes and ear drilling machines from the UK, and will donate them to the hospital here.”

Answering a question about the risk factors for ear infections, Dr Hanif explained that anyone could be infected. The difference, however, was that people in the developed world had the opportunity to immediately contact a specialist and start treatment.

“In resource-constrained settings with low levels of education, the poor report the disease when it has spread, making chances of complete recovery challenging,” he said, adding that at times surgeons could only save a life and fail to restore full hearing ability depending on the severity of the disease.

He underscored the need for government intervention and said development of surgical skills in this particular area was a lengthy process but possible only when basic surgery tools were made available.

Ear surgeries only in Karachi

Dr Shoukat Malik, a senior doctor at the Hashmani Hospital, who facilitated the team, said ear surgeries were conducted only in Karachi (in the public sector) and the city received patients from across Sindh.

“I have a whole list of poor patients reporting from different areas of Sindh. Patients requiring immediate surgery are either treated in Mirpurkhas or Karachi at the two camps held free-of-cost annually,” he said.

According to Dr Malik, the discharging ear not only damages tympanic membrane (eardrum) causing deafness but may spread to other areas, including brain, facial nerve and internal ear.

“This is usually due to cholesteatoma, a bone-eroding disease of the ear which may cause brain abscess, meningitis, facial paralysis and total deafness. In these cases early surgical intervention can save a life. In less severe diseases, if not taken seriously [it] will result in deafness and damaged eardrum, a constant source of repeated ear infections which again may lead to complications,” he said.

Dr Malik admitted that two ear-surgery camps in a year were not sufficient to treat a growing number of patients and said: “You can imagine the severity of the situation that currently only two public sector hospitals, the Jinnah Postgraduate Medical Centre and the Civil Hospital Karachi, are offering ear surgeries. The Abbasi Shaheed Hospital has stopped doing it for two years for some reasons,” Dr Malik said.

Sharing his experience, Dr Waseem Ahmad, who was on his first visit to Karachi, appreciated the fact that the medical staff here had “developed engineered solutions” to overcome shortages in resources.

His colleagues, Dr Ketrina Mason and Dr Selda Boztepe, both trainee surgeons, also praised the Pakistani staff they worked with at the camps and described them as “committed, responsible and thorough professionals”.

“It was a great learning experience which helped us see how different systems work in two countries [the UK and Pakistan] in the public sector,” she said, while appreciating that the allied medical staff in Karachi was able to perform multiple tasks at a time.

Dr Boztepe said: “The cases were pretty complicated which I wouldn’t have the opportunity to see and operate in the UK.”

Speaking to Dawn, parents of six-year-old Adnan hailing from a village in Mansehra, Khyber Pakhtunkhwa, and 10-year-old Iqra from Baldia Town, both operated on a few days ago, shared the troubles they faced while finding the right treatment for their children.

“Adnan’s ear had been discharging on and off for more than two years and the family spent a lot of money on his treatment before coming here,” said Shakeela, mother of seven whose husband works as a chowkidar in Karachi, where the boy was finally brought from Mansehra for treatment.

According to experts, chronic ear infections, especially in children, are very common in Pakistan. Its symptoms include foul smelling discharge and impaired hearing.

They discouraged removing earwax as it provided protection from all kinds of germs.

Also, mothers should feed their children in an upright position to prevent ear infection from milk.

Published in Dawn, December 10th, 2019


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