Shabina Mustafa, an energetic 62-year old, claims she had never seen a sick bed in her life until four months ago when she went to a renowned hospital for a regular hysterectomy. A highly recommended surgeon conducted the surgery and then left her students to stitch up the patient.

“Where do I begin,” says a livid  Mustafa. “First, they prescribed me an antibiotic which did not agree with me due to which I developed an infection in my stitches. When I was finally discharged I discovered to my horror that my wound was leaking profusely; I went back to the hospital but they sent me back claiming that this was normal.” Four days later, when the surgeon finally gave Mustafa time at her clinic, the ordeal took a turn for the worse. “She poked forceps into my stomach wound — the result was spurting blood and an injured bladder.”

Mustafa then had to undergo bladder surgery and she has been unable to go back to her normal active routine till date. “My stomach is hard as a rock and I have to live with a constant burning sensation. I can’t do even simple things like travel in a car or go shopping.

“Instead of admitting her mistake, the doctor had the audacity to say that my healing was not normal because of excess stomach fat”, claims Mustafa, who, let it be noted, is not at all overweight for her age bracket. “This hospital is such a big institute that I can’t think of suing them”, she fumes.

This is but one of the few ways in which a faulty prescription, unthinking diagnosis or unprofessional conduct can aggravate a seemingly straightforward problem.

Mrs Mairaj, mother of four, had begun to suddenly suffer from high fever. Two weeks and an assortment of expensive tests led to no diagnosis even though she was admitted in one of Karachi’s leading hospitals. “My mother kept trying to tell the doctors that she felt some soreness in her throat but they were not willing to listen. It was only in the third week that a doctor examined the throat and suggested a thyroid test.” says Mairaj’s eldest daughter. Mairaj’s thyroid levels were revealed to be extremely high and that had been the cause of her torment. “In these big hospitals you have to beg the doctors to come to the patient’s bed-side and take a moment to listen. Those three weeks took an intense toll on our mental and economic conditions,” says her now-relieved daughter.

Saima’s mother was under the care of a psychiatrist when she was admitted in hospital and administered medicine which was Lithium based.” Saima says that her mother’s psychiatrist did not tell her about the side effects of Lithium nor did she send her mother’s case history file to the hospital in time. “She passed away in three days because the doctors were unable to flush out the Lithium from her body.”

Her mother was not the only victim of negligence in the family; when Saima’s seven-year-old son broke his wrist she rushed him to the emergency department of a high-end hospital but they sent in a novice doctor to treat him. “They put him through 20 minutes of excruciating pain and even then were not able to set the bone properly.” When she brought her son back to the hospital after a week, the doctor proclaimed that the bone was in such a state that they would have to break it and reset it. “Imagine that trauma for a child,” says the aggrieved mother. “There is no check and balance in our country, I tell you. And all these doctors band together — it’s a medical mafia!”

And sometimes a hospital’s practice leaves loved ones reeling and scarred for life. Mona’s bright, 10-year-old daughter Alizeh was an asthma patient. One August day, while Mona was out of the house, Alizeh got an attack and was rushed to the hospital.

“When I came back I found out that Alizeh had been taken to the emergency department and the doctor had administered a 350 volt charge to revive her — he applied this charge 29 times. When I reached the hospital, I was told that she was no more,” says a distressed Mona as she relives the events of that day four years ago. “Alizeh had a burnt chest from the constant voltage — I found out later that even to an adult such a shock shouldn’t be given more than thrice.” Till date, Mona doesn’t know if her vibrant daughter passed away from asthma or from the unprofessional attitude of the medical staff.

Be it seemingly trivial medical misdiagnosis or major life-altering errors of judgment on the part of doctors, medical malpractice or negligence is unfortunately, not uncommon in Pakistan. By definition it is an act or omission by a health care provider in which the care provided deviates from accepted standards of practice in the medical community and causes injury or death to the patient.

This also includes over-testing, over-medication and conducting excessive surgical procedures for commercial gain as well as more serious misdemeanours like forgetting a gauze or sponge in the stomach during an operation and covers any action, or lack thereof, that causes harm to the patient.

According to Muhammad Hanif Shiwani (Barnsley General Hospital, University of Sheffield, UK) and Amin A. Muhammad Gadit (Memorial University of Newfoundland, Canada) in an article in the Journal of Pakistan Medical Association, the quality of medical education, lack of professional ethics, concurrent private practice, faulty health policy and non-application of professional laws has much to do with this scenario of medical negligence in Pakistan.

Dr Sakina who has served in both private and tertiary care hospitals agrees that the state of the health sector is dismal. “The check on trainee doctors in government hospitals is still strict as they are under the vigilant eye of their supervisors. However, the load of patients and the comparative lack of facilities and equipment results in what one may call negligence.”

Dr. Huma, a senior gynaecologist, says that the low pay of junior doctors is also a dire contributing factor to the bleak state of affairs. “These doctors work 24 hours, hopping to and from three hospitals a day. Can we expect efficiency from them? Can we expect them to listen to the patient’s suffering — which is the key factor to diagnosing any ailment? These young doctors have the burden of supporting a family as well as appearing for expensive post-graduate exams — of course they will make blunders.”

Dr Huma says that this vicious cycle of negligence starts with untrained and callous paramedical staff, moving onto over-worked and under-paid junior doctors to doctors who have been hired via the back-door. “Good senior doctors have been lost to the brain drain while many of those who remain only have textbook knowledge but no hands-on experience.”

All said and done, this sorry state of affairs will only heal once the laws on malpractice and negligence are tightened and implemented. This has to work, hand in hand, with internal systems and standard operating procedures being enforced vigilantly by hospitals, associations of doctors and other medical professionals. Negligence cannot be swept under the carpet any longer.