HYDERABAD: One thing that is lost sight of in recent July 22 Akbari mosque transformer tragedy is ad-hoc management of entire burns ward by untrained staff in Liaquat University Hospital (LUH) of Hyderabad.

The ward’s doctors and staff hardly manage burn patients with 20pc or above burn wounds. And that was why patients with over 25pc burn wounds of total body surface area (TBSA) are instantly advised to leave for Karachi.

Information obtained by Dawn revealed that all critically injured were referred to Karachi in the recent two tragedies in which two children and a young man died as a result of June 18 fire in a transformer in Islamabad Mohalla and then seven persons, including two children, breathed their last in Karachi after July 22 Akbari mosque transformer blast.

Critically injured do not find space even in burns ward of Civil Hospital Karachi (CHK) and intensive care unit (ICU). They end up in private hospitals which exposed them to financial burden given high cost of their treatment. The CHK being located in a huge urban centre caters to needs of such patients from other cities as well as Balochistan. Then comes Hyderabad’s LUH which deals with patients from upper and lower Sindh.

It is a long and painful story as to how burns ward has been managed in over almost two decades. The ward is still working in isolation. It had started working in a building opposite to Deewan Mushtaq cardiology unit when Akbar Hyder Soomro was LUH’s medical superintendent where present building of surgical and medicine ICU stand today.

The old burns ward building was then declared dangerous, prompting its shifting. It had to be set up in old private wards premises. It was shifted again to third floor or present cardiology building after coronavirus isolation ward was set up in its place last year.

The ad-hoc management of burn patients in the LUH ward is too evident. Staff in burns ward is borrowed for duties or always called from other departments. They lack training, knowledge and interest for treating patients.

The staff do not get response from other departments for expert opinion whenever necessary in emergency cases due to involvement of co-morbidities.

On one hand burn patients are hardly managed while on the other healthcare of patients in other departments is undermined when strength of staff gets curtailed in view of its makeshift arrangement.

A small operation theatre works in burns ward, making everything difficult. It does not have its own laboratory. Since ward does not have facilities like x-rays on its premises, patients are sent to x-ray department which is a time-consuming job and irritating for burn patients, inviting ire of attendants.

“Currently, burns ward is run through ad-hoc arrangement till we get fully fledged burns unit developed. Its building is complete but machinery’s import and human resource availability is awaited with government’s approval,” admits MS Dr Siddique Pahore while talking to Dawn on Monday.

Prof Dr Tahir Ahmed, who retired from Liaquat University of Medical and Health Sciences (LUMHS) and was heading the burns ward until retirement, said that co-morbidities and delay in tests reports jeopardized patient’s lives. He worked for establishment of ground-plus-three fully fledged independent burns unit in the LUH.

“Burns speciality has evolved as a separate entity the world over. When I was there I trained doctors and staff from other wards, who had shown interest in this field after being posted there. Once they got knowledge of patients’ management, they were transferred, leaving us high and dry,” he said.

Every patient with 30pc burn wounds often needs the ICU which doesn’t exist. Critical burn patients needing ICU are not allowed in medicine and surgical ICUs,” said burns ward staff. Ultimately, they are advised to go to Karachi.

“Even ambulances are not arranged in time for patients’ shifting,” said a grieving woman relative of a deceased of Akbari mosque tragedy in Latifabad Unit-8. She said they somehow arranged an ambulance to leave for Karachi.

LUMHS’s professor of medicine Dr Imran Ali Shaikh points out that plastic surgery was a rare speciality whereas burden of such cases was huge as entire Sindh looked towards the LUH first. “Superficial burn injury can be treated by a doctor from other departments. Severe burn wounds, however, always require intervention by plastic surgeon to avoid critical patients from being defaced in view of nature of wounds,” he argues. He says that “burn patients need extra care, nutritional support and dressing. So a fully fledged [burn] unit is a must”.

In case of any emergency in hospital, attendants rush to the ward. It was witnessed in burns ward on July 22, causing panic in doctors who found themselves handicapped in treating patients amidst presence of mob. “You can’t prevail upon attendants as they feel as if we are not doing anything. Attendants removed furniture from doctors’ room and shifted patients’ bed for want of AC,” said a burns ward staffer.

The building of independent burns unit with 64 beds and 16 beds ICU has been built at a cost of Rs93.361m on the old doctors’ hostel premises opposite the present OPD. With Sindh health department’s procurement committee’s nod machinery as revenue component is to be procured at a cost of Rs67.941m, taking total cost to Rs161.302m.

After its arrival, the LUH would require sanction to appoint trained human resource, including doctors, technicians, nurses and anaesthetists in line with PC-I for unit’s independent working. And if HR is not sanctioned by the government, even this independent unit would be all set for another ad-hoc management of patients.

Vibes are there, too, that the hospital management might spare two floors of under-construction new unit for the ear, nose and throat (ENT) ward. It would be great injustice with burn unit.

The ENT ward does not confront kind of emergency that is regularly seen in burn cases. Sufficient space is available in the same hostel to be utilized for ENT and other wards.

Published in Dawn, July 27th, 2021