Lack of Standards in Medical Care
By Syed Kamran Hashmi
Westfield, IN
Drenched in corruption and shrouded with incompetence, District Headquarter Hospitals (DHQ) are supposed to provide ‘advanced’ medical care to the rural communities. Yet, they lack both the equipment and human resources to serve their purpose.
Earlier this year, after a roadside accident, Zafar Iqbal Jhagra, a prominent leader of Pakistan Muslim League Nawaz (PMLN), too, had to receive initial treatment at a DHQ. He had sustained a head injury. Being an influential person, he was transferred to Islamabad after the initial workup, and from there to London to get specialized care (as expected). Since the available information sheds little light on it, I am not sure about the quality of care he received in the DHQ. But, without a specialized team of neurosurgeons, latest CT scanners, dedicated operation theaters and the trained ancillary staff, it is not hard to figure out specially if he had required an urgent craniotomy (brain surgery). Just imagine his progress had he not been moved to England. Nevertheless, we pray for his uneventful recovery hoping to welcome him back in active politics as the secretary general of PML-N. No doubt he is a well groomed and polite person, a dedicated democrat and an asset to his party. May be after his experience he will take personal interest in improving the condition of these facilities.
As sad as it is, lack of resources represent only one part of the story. What is more disappointing is that when you believe you deserve a better quality of care in a private university hospital, you still receive suboptimal treatment. It holds true despite the size of your medical bills which may run in hundreds of thousands of rupees and the number of consultations obtained for expert opinions. Muhammad Raheel, a 33-year-old private contractor, squirmed back to life after going through a similar experience. He was admitted in the Agha Khan Hospital few months ago with Acute Renal (kidney) Failure, a life-threatening condition that may lead to long-term requirement for dialysis. Yes, I am referring to the most reputable institution in Pakistan, the leading medical center which will charge you your lifetime savings if you are admitted there for few days.
Before he got sick, Raheel promised himself to lose weight. Determined to melt the extra fat, he followed an intense plan with more than ninety minutes of exercise every day. On top of that, he self-prescribed some over-the-counter protein supplements, a common practice among youngsters. Notwithstanding their claims as being safe, we know these ‘nutrients’ may still inflict damage to the kidneys even when they are authentic and not counterfeited by a local manufacturer. Under pressure from his workout in the simmering heat of Karachi or as a side effect of medicines, his muscles broke down releasing toxic chemicals into the blood. These enzymes, when spilled in low amount, are excreted with no problem through the kidneys out of the body. However, if their number crosses a certain threshold, the filtering tubules get clogged up and stop working. This condition in medical terms is called Rhabdomyolysis which can lead to the abrupt shutdown of the kidneys requiring dialysis. However, patient receives aggressive treatment, dialysis can be avoided. All one has to do is to provide vigorous and urgent intravenous hydration to the patient. Some authorities recommend up to two to three liters of saline pushed through a drip every hour in the initial period. Raheel, however, was not fortunate enough. Can you imagine that instead of getting five to ten bags in the first twelve hours, he just received one liter after being treated in the emergency room for hours and evaluated by a medical specialist in the hospital?
I talked to the resident (trainee) physician myself to convince him about the urgency of the matter. But, nothing could I say that would persuade him to change the management. That too was not surprising as we realize in Pakistan that physicians do not pay heed to the family requests. In response to a question from the patient, they get defensive, rude or personal, as if their authority has been challenged. Not only that, they do not share the pertinent medical information with the patients either, brushing off the family's concerns by embarrassing them: “Well, we know, and we do not expect you to understand how the body works.”
Anyway, his kidney functions deteriorated without appropriate care. Over the next twenty-four hours, he just received one more liter of saline instead of multiple infusions and had to go for dialysis the following morning. Once discharged, his bill for not getting the treatment in forty-eight hours was a resounding six figure, an enormous amount that only few people can afford for a short stay in the hospital.
Lady luck being on his side, Raheel was young with no other co-morbidities. As a result, after few sessions of hemodialysis he did not require anymore. The absence of any preexisting health condition also enabled him to go back to work in a few weeks. We do not know how much damage to his kidneys is reversible and how much will be permanent. We also do not know that ten years down the road at the age of forty-five if he would require permanent dialysis. Only, time will tell.
I know I have picked a simple case with positive outcome. My point is not to malign a hospital, rather to indicate far bigger problems overlooked by the society. First, even when we go to the advanced medical centers and get the opinion of renowned specialists, the system does not ensure internationally recognized standard of care. Second, the certifying agency does not hold the practitioners responsible at all. Like any other department, accountability does not exist in medicine too, even when doctors show criminal negligence. And third, the last, the hospitals do not guarantee the rights of the patients to voice their concerns. The medical profession just shuts them up.
