KARACHI, March 29: The casualty ward of the Civil Hospital Karachi is perhaps the most neglected department as far as equipment and facilities are concerned, but despite bottlenecks the department is serving the general public round-the-clock.

On a monthly average, around 21,242 patients are examined at the emergency ward which is faced with severe shortage of paramedical staff. The cases are not limited to the city, but patients from interior of Sindh as well as from different parts of Balochistan are also given treatment at the ward.

The X-ray machine, one of the basic equipment of an emergency ward, is out of order for the past several years. The machine after undergoing several repairs had now been rendered irreparable. A new X-ray plant is expected to replace the old machine soon.

“Over the years, the number of patients has increased drastically, but the resources have lagged behind,” said a senior doctor of the ward. He said that no new appointment had been made especially in paramedics during the last 10 years, which had further compounded the situation. Patients have to wait in emergency ward for a doctor sometimes, as a few doctors cannot cater the needs of hundreds of patients daily.

As far as cleanliness and hygiene in the ward is concerned, these conditions are still far from satisfactory. The emergency ward is ill-located as several sewerage lines pass through the ward. Sweepers too in few numbers add to the miseries of patients.

Talking to Dawn, Dr Shershah Syed of the Pakistan Medical Association said that apart from the gynaecology cases, any other case was hardly properly dealt with. For instance, he said, if a case of an eye injury went to the emergency ward, there were more chances that the patient might lose his or her sight rather than getting a proper treatment.

However, he added, things had shown little improvement as a new block for emergency cases was being constructed.

In case of power breakdowns, he said that the emergency ward plunged into darkness as it had no power backup system unlike some other units where generators had been installed with donations and official grant.

When contacted, Civil Hospital’s Medical Superintendent Prof Mohammad Saeed Qureshi acknowledged the shortcoming of the emergency ward and said that the needful would soon be done.

He said that the government was keen to uplift the ward and lying of the foundation stone of the new casualty block at Chand Bibi Road in December 2004 was a step in this direction. If everything went according to the plan, he said, the new block would be commissioned in 30 months. The new emergency ward would be equipped with a pathological and sterilization unit. With the commissioning of the new emergency block, things were expected to improve drastically as the present ward is not ideally located, the MS added.

Besides, he said that the hospital would soon have its generator at an estimated cost of Rs18 million. Efforts were being made to install the generator during the current fiscal year, he said, adding that once the generator is installed in the switch room it will cut the cable cost as well.

Nonetheless, the hospital does not house any centralized intensive care unit. Though some four to five years back, a proposal was floated to establish the medical ICU and even space for the unit was allocated, but things did not move further, said senior doctors of the Civil Hospital.

Underlining the need of medical ICU in the largest public sector hospital of the province with over 1,703 beds, the vice-chancellor of Dow University of Health Sciences Prof Masood Hameed told Dawn that the cases of poisoning, stroke, brain haemorrhage, lung diseases, end-stage case of liver failure and other acute medical emergencies were generally referred to the Civil Hospital. He pointed out that a well-equipped ICU was required for the proper care of all such cases. He said that though different medical wards had allocated one or two beds for the ICU, unfortunately none of these wards had ventilators or other facilities.

“Without ventilators there is no concept of ICU and hospital such as the CHK should be equipped with a centralized medical ICU,” Prof Hameed added.

Another senior professor of medicine, Prof Zaman Shaikh, said that different medical wards had one or two bedded units but they could not be termed proper ICU. He continued that the Surgical ICU to some extent handled medical emergencies, but that too had its own limitations.

In absence of a fully equipped ICU, a significant number of serious cases have to be referred to private hospitals, said a senior doctor.

However, the Civil Hospital’s Medical Superintendent described the Coma Care Unit of the Neurology Ward as the proper ICU where eight ventilators were operational. He pointed out that all the eight ventilators were in constant use of patients. Another eight ventilators were in Surgical ICU, he added.

About centralized medical ICU, Prof Saeed Qureshi said, “We have to work within the available resources and funds.” He said that private donations were utilized for the proper functioning of the eight ventilators at the coma care unit.

A senior official of the CHK’s administration was of the opinion that initiative in this direction was lacking because nobody was willing to take extra pain. People (hospital administration and doctors) were contented with the things as they were and wanted to drag on and pass their duty timings, he added.

Nevertheless, like several other departments, the dentistry department of the Civil Hospital too was in pathetic condition.

A visit to the department showed that seven dental chairs were out of order. Treatment such as root canal and scaling was not being offered these days. Two scaling machines were also repairable. Patients of dental ailments are only offered facilities of examination and removal of tooth at the department.

The department has an obsolete X-ray machine which is out of use due to the non-availability of X-ray films, a doctor of the department confided to Dawn.

As far as hygiene is concerned, any patient can easily get infected, as dental instruments are sterilized without autoclave. Sources in the department said that two sets of instruments were sterilized without autoclave which could not be rendered as 100 per cent safe. Following each examination, the dental instruments are dipped in dettol and used on other patients. This practice is followed for 150 to 200 OPD patients, said a senior physician of the CHK.

In addition, the Civil Hospital Karachi has no isolation ward. It is also non-existent in any other government hospital. Serious patients of dog bite, tetanus and rabbis are supposed to be admitted to the isolation ward. Some two years back, the isolation ward was wind up by the hospital management for the reasons best known to them.

Most of the patients complained that doctors did not examine them properly. The Civil Hospital’s Medical Superintendent also agreed to the fact that some senior doctors did not give enough time to patients in the OPD.

In paediatric surgery unit, some attendants told Dawn that mostly cases were referred to the National Institute of Child Health apparently to keep the work load at the minimum.

The psychiatry department of CHK is a classic example of neglect and political interference over the years.

Officials of the CHK requesting anonymity said that the department was usually used as resting place by the under trial prisoners having political connections. They were admitted to the ward without any genuine sign of psychiatric illness. “Of course they come posing or complaining of sleep disorder or some other psychiatric ailment, but usually instead of being sent back, often such cases are given admission,” remarked a senior official.

This facilitation could not take place without the connivance of some senior doctors of the department, said a senior official of the CHK administration.

On the other side, the unhygienic condition of pathology department or laboratory of the CHK creates serious doubts regarding the results of tests conducted and examined here. Still poor patients had no other option but to rely on the results of blood CP, urea, stool, and sugar tests.

Besides, some important posts such as chief pathologist and blood bank officer were lying vacant. Out of 29 sanctioned posts of lab technician five are vacant while one post of blood bank technician is also vacant.

It is pertinent to note that a total of 289 vacancies are lying vacant at the Civil Hospital Karachi out of 1,654 sanctioned posts from BSP (1 to 20) for the past several years. From BPS-1 to BPS-5, 246 posts are vacant against the sanctioned strength of 1418. Forty-three posts are lying vacant in BPS (16-20), data obtained from the CHK showed.

Many important posts including chief dental surgeon, senior dental surgeon in charge chief casualty medical officer, maxillofacial surgeon, deputy chief physiotherapist, anaesthetist, intensive care supervisor, nursing superintendent and radiologist are lying vacant.

In addition, four posts of senior registrar, two of trainee registrar and nine of nursing sisters are vacant.

The data showed that one out of three technical posts from BPS (1-15) such as CT scan receptionist was lying vacant. Out of the three posts of coma care supervisor, one is vacant. Similarly, 34 posts of nurse aid and 57 posts of sweepers have not been filled so far.

WATER SHORTAGE: The Civil Hospital Karachi is faced with a serious water shortage. The shortage often affects the normal functioning of the hospital sometimes leading to the postponement of the scheduled operations.

According to Medical Superintended Prof Saeed Qureshi, water shortage is amongst the most serious problems hospital is facing for quite some time. A continuous supply of water was necessary for the hospitalized patients, operations, the paediatric nursery, the labour room and intensive care unit as well as for the toilets, he said.

Prof Qureshi said more than 20 wells had been dug in the hospital through the efforts of the donors to meet the shortfall, but they were drying up. He said that there was also a problem of unequal water distribution within the hospital premises. “Some departments get water to such an extent that it over flows while others remain totally dry. We have taken up the problem and some technicians are being employed to rectify the water distribution problem, at least we should have a better in house water distribution system,” the MS said.

A senior doctor said that different departments had resorted to boring and building their own tanks, but at times there was shortage of water due to mismanagement and power breakdowns.

A PC-1 for the CHK has recommendations for the development of laundry and the casualty ward but nothing was done to meet the water shortage, said a senior doctor adding that the infection rate increases with the shortage of water.

NETWORKING: In such a deteriorated condition, officials describe networking of departments and administration block through computers as a positive step towards better management of hospital affairs.

With the assistance of Sindh IT Department, patients’ history will soon be available on computer monitor. It is hoped that the patient identity number will replace the old “Parchi” or slip system, the MS remarked.

Apprising about the project, Medical Superintendent Dr Saeed Qureshi said that in the first phase accounts department and administration block would be connected through computer networking. He expressed hope that the administration block would be fully automated by June. “Once implemented it would be expanded to the other wards and each patient being admitted to the hospital will be given an identity number,” he added.

Referring to some other development projects, he said that out-dated sewerage lines of the hospital were replaced last year.

The replacement was under taken for the first time since the establishment of the hospital in 1896. After some recent repairs, things had improved to a great extent as seepages had been controlled. Moreover, waiting sheds were erected for patients and their attendants at different places in the hospitals.

The CHK administration also under took a paint job colouring the walls half red. Citing the reason of choosing red colour, Dr Saeed Qureshi told Dawn that the colour was opted due to spitting of beetle net on the walls. At least the red colour would absorb the beetle spit, he added.