HYDERABAD: Below par coordination between Liaquat University of Medical and Health Sciences (LUMHS) faculty and Liaquat University Hospital (LUH) staff, caused by a variety of reasons, is depriving Covid-19 patients of quality care and telling on efficient management of the deadly contagion.

Two major reasons appear to cause this. Firstly, an acting medical superintendent is looking after the hospital, and secondly LUMHS administration has not yet fully ‘taken over’ the hospital’s Covid-19 isolation ward for round-the-clock management of the disease in line with Sindh chief minister’s directives issued two months back.

The chief minister’s April 6 directive reads: “CM has directed that concerned faculty members of universities (professor to senior registrar) should take charge of ICUs designated for coronavirus patients and Covid-19 treatment wards of respective teaching hospital, for proper health delivery to affected and admitted patients, round the clock”.

Twenty-two Covid-19 patients have, so far, died in LUH as of June 7. But management of the patients is increasingly becoming difficult at the hospital also referred to as Civil Hospital Hyderabad (CHH) — the only tertiary care government facility in Hyderabad that handles patients from 13 districts of lower Sindh — because of stop-gap arrangement under which the hospital is being run for last one and a half months.

Hyderabad has already crossed 1,000 mark of coronavirus patients ever since the outbreak of pandemic in February but still the two institutions — LUMHS and LUH — are far from providing an impressive healthcare service to patients affected by deadly contagion.

Perhaps to strengthen the elusive coordination and improve management of the disease, LUMHS registrar formed a new team of its faculty headed by Prof Iqbal Shah on May 28 to oversee the LUH Covid-19 ward. The first team formed on May 9 was led by Prof Shoaib Ansari.

The doctors and paramedics working at the hospital say LUMHS faculty members and LUH doctors and paramedics have yet to perform to their full potential. “They both appear reluctant and scared,” commented a doctor dealing with Covid-19 assignment.

Given LUH’s below par performance, the CM secretariat had to post an officer, Shakeel Abro, in addition to deputy secretary of health Najeeb Brohi tasked to oversee and supervise the hospital’s working. However, sources in the hospital disclose that it has done little to improve management of Covid-19 patients.

“The hospital needs a fully fledged MS for its smooth functioning. Otherwise, given spike in Covid-19 cases after easing of lockdown it will be increasingly difficult to handle them. LUMHS management also needs to put its foot down to make sure that quality treatment is provided to Covid-19 patients,” said a doctor.

“Our genuine concern is that a medical officer can’t deal with critical patients of this new disease. We always need input from senior level consultant [from LUMHS] and they are unavailable round the clock even during this time of national emergency,” he said.

For example, he added, Prof Shoaib Ansari, who was allegedly reluctant to work in LUH before he was made head of the team, used to pay visits twice a day to the ward and then junior team members or postgraduate students (PGs) used to coordinate with LUH’s doctors on phone.

“There is no change in the pattern even after formation of new team and no one — except for PGs — from faculty is in the hospital in case of emergency. Why LUMHS doesn’t take over Coivd-19 ward as per April 6 directives of the CM in letter and spirit is anybody’s guess?” he quipped.

Prof Iqbal Shah said that faculty members visited wards thrice a day. Subsequently, they remained ‘on call’ for assistance. “The rest (PGs) remain on duty in Covid-19 ward for assistance to discuss patients’ condition in case of any new development,” said Prof Shah.

But the hospital’s acting MS Dr Shahid Junejo explained: “Inside the Covid-19 ward only LUH medical officers [doctors] are posted. LUMHS consultants, including professor, associate professors, pulmonologist pay visits in different timings. PGs are not posted inside the ward but they are available in hospital’s different wards. So the hospital doctors basically deal with patients inside high dependency unit in addition to the isolation ward,” he said.

Outgoing MS was reportedly transferred after a tussle with his colleague over exercise of financial authority and both ended up getting transferred. The MS was, however, posted as Hyderabad’s district health officer shortly afterwards.

LUH has 40-bed HDU equipped with 20 ventilators and as many monitors. Luckily, 468 out of 516 active patients as of June 7 have been quarantined at home (90.70pc) as per government’s policy of allowing ‘stable’ patients to stay at home in siolation instead of keeping them in hospitals.

“God knows what would have happened had this policy not been announced because even LUH doesn’t have that much capacity to keep that huge a number of patients. LUH is the only public sector health facility in Hyderabad that has ventilators for Covid-19 patients. A few private hospitals do have the facility in their general medicine ICUs but only for patients afflicted with diseases other than Covid-19,” said an official.

Apart from existing Covid-19 HDU, establishment of a 60-bed isolation facility is being considered at the hospital’s Jamshoro branch. This will obviously sap more human resource from the faculty and the hospital.

Considering CHH’s ongoing issues, Deputy Commissioner Fuad Ghaffar periodically pays visits to the hospital to take stock of things. He also keeps private hospitals’ managements in the loop to ensure ventilators for critical coronavirus patients are available if such need arises.

Meanwhile, LUMHS laboratory is currently partnering with National Institute of Blood Diseases headed by Dr Tahir Shamsi in clinical trial of Covid-19 patients through plasma therapy the idea of which was presented by Dr Shamsi. So far, 12 patients have been given plasma and many have recovered successfully though a few could not survive even after being administered plasma.

LUH management has not yet provided kits for plasma therapy although the hospital is said to have received Rs70 million from Sindh government like other eight tertiary hospitals on May 6. A kit costs around Rs30,000 per patient and the university’s lab arranges it from its funds to provide free of cost service to patients.

Published in Dawn, June 9th, 2020