Medical Care in Punjab and Zafar Iqbal Jhagra
By Syed Kamran Hashmi
Westfield, IN
With a bulky gauze dressing taped across his right temporal area, I saw Zafar Iqbal Jhagra, the secretary general of the Pakistan Muslim League Nawaz (PML-N) lying straight on a medical stretcher, his eyes closed, his mouth half open, his hands folded on his chest and an intravenous cannula inserted in the back of his hand, its tubing filled with blood. While driving back from Multan, he was injured in a motor vehicle accident a few weeks ago near Doli Shaheed and suffered a head trauma (sub dural haemorrhage) along with a fracture in his arm.
His snapshot, as shown on television from the District Headquarters (DHQ) Hospital in Jhang where he was taken after the accident for initial evaluation and treatment, is worth a thousand words, elucidating the quality of medical care he received in that facility: he was not wearing a hospital gown, his shirt was buttoned up instead of being cut open, there was no oxygen mask on his face, no electrodes were attached to his body to monitor his heart rate or rhythm and no sensor was placed on his fingers to evaluate his oxygen saturation. His chart (hospital notes) was placed on the head side without any privacy and at least five non-medical attendants were standing around the stretcher looking at him as if he were a circus animal. His blood pressure seemed to be unmonitored, his pulse unidentified and his level of consciousness unclear.
I am sure the computed tomography (CT) scan would not be available in the DHQ to look inside the cranium (skull) and diagnose bleeding inside the brain, or to view the cervical bones (neck vertebrae) for any fracture or life threatening dislocation. Maybe my expectations are too high, and a CT scan is too expensive to afford in a medium sized town of Central Punjab serving at least a four million population of the district. However, how about an oxygen mask, a cardiac monitor, a hospital gown, an electronic blood pressure machine or even privacy of medical information, anything that can show we live in a country where the practice of medicine follows at least one-tenth of international guidelines? I am saying one-tenth because I realize he was wearing a cervical collar to protect his neck vertebrae, a standard procedure in the care of almost every trauma patient.
Let us be clear that I am not talking about a disturbed location in the Federally Administered Tribal Areas (FATA) where 30 years of international war have wrecked the infrastructure and may provide some justification for the absence of necessary medical equipment. I am not talking about certain pockets of interior Balochistan either where we face an active insurgency, or a remote area of rural Sindh where the local landlords have supposedly resisted every initiative by the federal government towards modernization. And, for sure, I am not referring to the isolated districts of southern Punjab where illiteracy and lack of resources hamper progress. Instead, I am talking about central Punjab, the stronghold of the PML-N, an area under the renowned, strict and incorruptible administration of Khadim-e-Aala Shahbaz Sharif who has just launched a metro train project for Lahore after a failed metro bus project in the same city without paying much attention to the basic healthcare of his people.
Let us also be clear that I am not talking about the suboptimal and substandard care provided to an ordinary person like you or me; it is the secretary general of the ruling political party, a well-known politician, a close associate of the chief minister of Punjab and a friend of the prime minster of Pakistan, a VVIP if ever there was one. If he gets this quality of care then what should we expect for ourselves other than an indifferent (or rude), incompetent and ill-equipped medical staff unhappy with their jobs and frustrated with the systematic corruption at every level in the management?
Perhaps many affluent Pakistanis think that when they get sick they can get admitted to private hospitals — another dubious and unregulated place to get medical care — and will not need to be admitted in a small government district hospital. They may also reckon that if push comes to shove they can go abroad and get their treatment from the best possible team in the most advanced countries of the world. Certainly, this is the case with rich politicians and powerful bureaucrats who twist the system in their favor to pay for their extraordinary medical bills, way beyond the combined annual income of an ordinary citizen. However, they should always remember that there is a long list of time-sensitive medical conditions including heart attack, which can change the prognosis altogether if it is not diagnosed and managed within the window of opportunity. The simple delay of a few hours in these cases can result in permanent disability or, in some unfortunate circumstances, death. So, even when one is rich and prosperous, he still depends on the competence of paramedic staff in the ambulances, the care of nursing staff in the triage on medical floors and the ability of the attending physician for his proper evaluation, stabilization and treatment in Pakistani hospitals before any arrangement can be made for appropriate transfer.
In that regard, it is in their own interest as well to pay close attention to the quality of care in the remote villages and distant areas because who knows if one day their lives depend upon the competence of local staff before they can fly abroad. With that, we all pray for Mr Jhagra’s uneventful and complete recovery; he has now been transferred to Islamabad for advanced care.
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