KARACHI, Jan 20: Civil Hospital, one of Pakistan’s largest, is chronically understaffed, with a doctor-patient ratio of one to 25. This is in clear contravention of a Pakistan Medical and Dental Council rule which obligates hospitals to maintain a proportion of one doctor to five patients.

Doctors working at the state-owned hospital say the administration needs to appoint another 1,200 doctors and an additional 1,000 paramedical staff to adequately meet the needs of the hundreds of patients who throng the hospital every day.

The hospital urgently requires some 400 house office doctors — available on call round the clock — and 530 resident medical officers (RMOs), doctors added.

S. Ahmed waits for a doctor to check up on his mother, who was admitted to the hospital’s Burns Ward ten days ago. “My mother was admitted 10 days ago, but in all these days, only one doctor examined her for a check-up.

Doctors counter that they are overworked and unable to attend to each patient every day. “There is a shortage of doctors as well as paramedic staff to assist doctors,” said one harried senior doctor.

“If the doctor-patient ratio improves, all complaints regarding the lack of attention could be properly settled,” he said, adding that many doctors are performing their duties 24 hours a day without taking a break.

The state-owned hospital’s expenses are supposed to be borne by the provincial Sindh government for providing low-cost healthcare, but hospital sources told SADA the bulk of financial assistance comes from private donors and the city’s philanthropists.

Private donations contributed Rs109.8 million for 28 projects, mainly dealing with repair of existing facilities and upgrading equipment, with the government chipping in with only Rs21.88 million, the sources said.

The hospital is also supposed to provide free or subsidized medicines to poor patients, but this service is negligible.

Saleem brought his mother to Karachi from rural Sindh. He complained that he was a poor man, but had to buy all the medicines from outside pharmacies at full price. “Even when staff have the medicines, they are reluctant to give it to the people who need it,” he said.

Civil Hospital paramedics have formed the Sindh Paramedic Staff Foundation on their own initiative. An office holder of the Foundation said they had established a fund for which they raise money themselves. The fund is used to provide free medicine and treatment facilities to poor people.

“If the government provides more funds, the Foundation can enhance its services. Paramedics can better understand the problems of patients, especially their financial problems,” a paramedic said.

“We deal with them every day and patients tell us their problems.”

A pregnant woman sat outside the blood bank in despair. She said she had been told by the doctor she needed blood, but the blood bank simply refused her, telling her to provide a bottle of blood in exchange for the group type she needed.

The hospital is also grossly overcrowded. Sources said that Civil Hospital had 1,740 beds, while the average of patients admitted at the hospital stood at 35,393 patients per year, most of whom are admitted for a rough average of five days each. This creates a massive shortage of beds at the hospital. The overflow of patients is accommodated by placing them on foam mattresses on the floor or on sofas meant for attendants.

In Pakistan, it is a common practice that each patient is escorted by a relative who has to arrange medicines. These attendants then sleep on the floor in the hospital’s corridors, say hospital workers. The problem is exacerbated in the Gynae and Burns wards. Attendants frequently make their way to the X-Ray department where they can sleep at night.

According to the official statistics, 1,452 deaths were recorded at Civil Hospital till Dec 28, 2001. During the same year, 26,498 patients were admitted in different units of the hospital.

The Out Patient Department (OPD) treated 617,328 patients at a flat rate of ten rupees per person. Incoming patients referred to the emergency wing numbered 171,180. At least 16,154 patients underwent surgical procedures; operated upon by different surgeons and 3,734 babies were born.

The Cardiology Department treated 1,300 heart patients who were admitted. Of these, 300 patients were operated on in the Cardiac Surgery Unit, which was constructed with the help of a private philanthropist at the cost of Rs35 million, to provide free treatment to heart patients.

The hospital maintains some 37 wards, 11 operation theatres, 15 OPDs and 30 other departments including CT Scan, Mortuary and X-Ray.

But statistics don’t reveal the dilapidated condition of the hospital and its facilities. While the public areas are still in better condition, the less-accessed areas are a disgrace. Betel stains disfigure the walls, the floors are filthy and hygiene is non-existent. Cats and vermin are all too obvious. The hospital administration, however, says that a major cleanliness campaign has been authorized and funds earmarked for painting the walls.

Of 28 proposed schemes to improve the hospital, 18 have been completed, the sources said. These include construction and renovation of different units and departments, they added, such as the Emergency Operation Theatre, Cardiac Surgery, Paediatric Unit-1, Paediatric Emergency, Rehabilitation Centre, Orthopaedic Unit-II, Neurology Coma Care Unit and Neurology Ward, Casualty Department, Gynae Unit I, II and III, the Labour Room, Cardiology, Medical Unit, Surgical Unit-II, Cold Storage, a cafeteria for doctors and repairs of X-Ray machines.

Civil works for the construction and renovation of the Burns Centre, Paediatric Unit II, Medical Unit II, painting of the whole hospital, construction of five attendant waiting sheds, renovation of the three main gates, repair of Operation Theatre equipment, Central Clinical Laboratory, the General Kitchen and Surgical Unit-I of the ICU are still under way. The expected completion date is August this year, said a senior official of hospital.

The government allocated just over Rs240 million for the year 2000-2001, said a well-placed source, explaining the breakdown of the budget, as Rs167,338,600 for Establishment including salaries of doctors, paramedical staff and regular staff, Rs42,711,000 for medicine, Rs4,479,200 for Diet (food provided to patients), Rs2,946,300 for X-Ray, Rs2,545,000 for instruments, Rs197,800 for stationery, Rs1,298,000 for miscellaneous expenses, Rs140,200 for printing, Rs2,506,100 for oxygen gas for patients as well as gas utilities and Rs19,676,500 for consumables, including utilities.

All the statistics are meaningless for Mateen Khan, a patient waiting in the semi-constructed waiting sheds. “The administration is only appointed to accumulate funds. They don’t even think of the improvement of the hospital or the welfare of the patients.”—SADA