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Nephrologists’ shortage at public hospitals hits patients

September 18, 2012

LAHORE, Sept 17: Though it is good on the Punjab government’s part to provide free-of-cost dialysis facility to those suffering from kidney failure even at tehsil level, it should also take notice of the increasing dearth of the medical experts in the province who could help prevent the ailment at an earlier stage – nephrologists.

Nephrology, that concern diagnosis and treatment of different renal diseases, is among the most neglected areas as far as the provincial health system is concerned. Medical experts attribute this to apathy of the health authorities as well as medical institutions.

Experts find it alarming that the number of nephrologists at the state-run hospitals in the province is decreasing, mainly because of a dearth of nephrology departments there while, on the other hand, the number of renal failure cases is on the rise.

The seriousness of the situation could be gauged from the fact that Sheikh Zayed Hospital, Lahore, is the only health facility in Punjab which has an independent and full-fledged nephrology unit, training doctors in the discipline, besides tackling the growing number of patients having chronic kidney diseases. Other medical institutions only offer dialysis facility to kidney failure patients or renal surgeries.

Senior medical experts told Dawn the Punjab government did not establish separate nephrology unit in any health institution since the discipline was introduced here in 1985. Resultantly, they said, no public sector health institution, except SZH, could produce any nephrologist for the last 25 years or so.

At present, there are nearly 100 trained nephrologists in the country for a population exceeding 160 million, compared to the United States which has more than 5,000 nephrologists for a population of about 300 million.

They said the situation in Punjab’s public sector teaching hospitals was rather pathetic where only 18 nephrologists were working. In Lahore, Mayo, Sir Ganga Ram, Services and Jinnah hospitals have one nephrologist each.

Even the King Edward Medical University, the oldest medical institution in the country with 150 years history, has no nephrology department.

The only nephrologist at the Mayo Hospital, Astt Prof Dr Muhammad Anees, was working in urology department for the last eight years.

Similarly, in the Sir Ganga Ram Hospital the only nephrologist is working in medical department and there is no separate bed strength for nephrology patients there.

At Services Hospital, which is also without nephrology unit, Dr Zahid Rafique, who was recently promoted as assistant professor of Nephrology, is working in urology unit. Similarly, both LGH and Jinnah Hospital have no separate nephrology departments.

A senior doctor said because of dearth of nephrology services at the state-run institutions in Punjab, the local kidney experts had started looking for better opportunities abroad.

He cited example of SZH-trained nephrologists, including Dr Adil Manzoor, Dr Muhammad Abid, Dr Zaffar Iqbal, Dr Farooq Ahmad, Dr Ghulam Abbas and Dr Nayyar who had left the country.

Recently, a visiting Saudi Arabia delegation interviewed two more senior nephrologists who almost finalised job agreements with their foreign employers and would be leaving the country in the coming weeks.

Meanwhile, he said, Punjab health department is spending millions of rupees, besides encouraging philanthropists to donate for the purpose, every year on establishing and running dialysis units, especially in underdeveloped areas.

Quoting some studies, he said every year nearly 20,000 to 25,000 people suffered from chronic renal failure in the country and the number might increase in the coming years owing to dearth of nephrology facilities.

Interestingly, he said, the hemodialysis, that needs expertise of a nephrologist was being routinely conducted by urologists at the teaching hospitals owing to acute shortage of experts.

“Dialysis services were not the ultimate solution to the problem,” the senior medic said, adding: “Dialysis does not mean that you just put patients on machine without trying to improve their quality of life. The average age at which local patients need dialysis is 40-45 years which is far less than that in the develop countries where it is 70-80 years”.

He said in a poor country like Pakistan, where per capita income is less than $300, most of the people could not afford lengthy and expensive procedures like dialysis. So, it becomes all the more necessary here to produce and employ nephrologists to help the patients in controlling the disease and leading a healthy life.

Major reasons for the kidney failure among local patients are diabetes mellitus and hypertension, he added.

He said treating kidney failure is an unaffordable proposition for local public health system that received only 0.8 to 4 per cent of the gross national product (GNP) as compared to the developed countries where 10 to 15 per cent of the GNP in spent for the purpose.

So, he said, there was a need to avert such condition among the kidney patients by offering them early treatment facilities through nephrologists.

Punjab Health Secretary Arif Nadeem was not taking calls when this reporter tried get his version.

Chief minister’s special assistant Khwaja Salman Rafiq said he would be able to comment on the situation after consulting health department.