Accountability cells to be set up at federal govt hospitals
KARACHI, June 30: Taking note of the complaints about the quality of services and alleged inapt behaviour of the hospitals' staff towards patients, the federal health ministry has ordered constitution of “accountability cells” in all its health care facilities to ascertain facts and take required action in this regard.
This was stated by the Federal Health Minister Mohammad Naseer Ahmed prior to the National Institute of Cardiovascular Disease (NICVD) Governing Body's meeting here on Thursday.
Such accountability bodies had already been established at the Pakistan Institute of Medical Sciences (PIMS - Islamabad), he said adding that the government was committed to provide quality health care to the people.
The federal minister observed that complaints along with suggestions forwarded by the patients as well as people visiting the health facilities would prove to be a source of guidance to bring about changes in accordance to the actual needs.
This, he further said was extremely essential for making judicious use of massive investments being made by the government in the health sector and the government medical facilities.
The minister, in this regard mentioned that the federal government had allocated Rs11.8 billion in the health sector for the fiscal 2006-07 as compared to Rs9.5 billion in 2005-06.
“Apart from the annual health budget worth Rs11.8 billion we have also earmarked Rs2.57 billion for hepatitis prevention programme and another Rs2.75 billion for blindness eradication during 2006- 07,” the federal health minister said.
With regards to the National Institute of Cardiovascular Diseases (NICVD), he said allocation for its running expenditures had been raised from Rs150 million to Rs240 million during 2006-07.
Appreciating the leadership qualities of NICVD Director Prof Azhar Masood Farooqui, the federal minister said that an additional amount of Rs600 million was being approved for NICVD for refurbishment of the facility and replenishment of its equipment.Answering a question, Prof Azhar Masood Farooqui said that half a million people were attended only at the out-patient department of the NICVD, while another 100,000 were provided the required medical support at its emergency unit annually - 100,000 is the annual load of in-patients.“NICVD shares an annual turn out of 700,000 patients which is the highest around the world,” the NICVD director said.
The federal minister assured all-out support for the proposed heart house in Karachi, forwarded through the platform of the Pakistan Cardiology Society and approved by the prime minister.
At the end of the meeting, he said a special package for paediatric surgery would be created at the NICVD and PIMS. He approved constitution of a committee headed by Prof Azhar Farooqui, to hire and train human resources to help optimum functioning of paediatric cardiac surgery at the NICVD.—
(Dawn-19, 01/07/2006)
Hepatitis patients in Sindh
THIS refers to the letter by Altaf Hussain Qureshi (June 25) on a recent statement made by the health minister of Sindh. Although I have not seen the report personally, “5,348 hepatitis patients in the province” is an extremely gross underestimation of size of the problem. I personally know that the minister is a very sincere, honest and competent politician and, therefore, suspect that he may have been misquoted. However, it is the duty of his staff to clarify his position and correct any mistakes of the media in this respect.
It is obvious that one needs to have a very good idea of the size of the problem and also know some basic facts regarding it before one is making any viable plans to combat it. Hepatitis means inflammation of the liver, and viral infection is perhaps the commonest cause for it. There are various types of viruses that can cause it and they are named after English alphabets. Among them the common five are A, B, C, D and E.
Viruses A and E are spread mostly by faeco-oral route and as such contaminated water supply is an important source for their spread. For this and for various other reasons, Mr Qureshi has very rightly pointed out the importance of providing clean and safe water to the public. Virus D only causes illness when it occurs with virus B.
Viruses B and C (but not A or E) are responsible for vast majority of chronic liver disease leading often to cirrhosis of liver, and sometimes to primary liver cancer after several years of acquiring the infection. They both are spread by blood and by bodily secretions. In a study conducted recently at our teaching hospital, we found that 69 per cent of all patients who tested positive for having the exposure to hepatitis C virus reported having received injections with used syringes at some stage, and this remains a major cause of this deadly disease at least in rural Sindh.
Other sources of disease included unscreened blood and blood products transfusions, use of contaminated surgical instruments in diagnostic and therapeutic procedures, re-use of razor blades at barbers (this is especially prevalent in rural Pakistan), unprotected and promiscuous sexual practice, etc. This is of course completely preventable. It is the duty of all sectors of society, including media, medical professionals and their bodies, government and also the public to take measures to stop such practices. Mass awareness via all sources of the media is urgently needed.
The Pakistan Society of Gastroenterology’s (PSG) guidelines on “Management of Hepatitis B and C” suggest that the prevalence of hepatitis B in Pakistan is 3-4 per cent and that of hepatitis C is 6 per cent. So nearly 10 per cent of Pakistani population is exposed to either of these two viruses. However, this varies widely from region to region. A study conducted of apparently healthy blood donors found that over 17 per cent of them had evidence of exposure to hepatitis C alone. Every fourth patient admitted to our medical wards has this problem which is also responsible for the death of every third patient in our medical ICU.
So the scale of the problem seems to be much higher than what has been suggested by the PSG —- at least in rural Sindh. However, even accepting these figures of PSG, the 31,746,503 population of Sindh (quoted from Pakistan Demographic Survey 2001) may include an alarming 3,174,650 patients of hepatitis caused by either hepatitis B or C – this is well over the entire population of Hyderabad city. The problem of course would be even bigger if we also take other causes of hepatitis into account.
Treating patients with hepatitis B and C present serious problems. Only about half of our patients can afford the cost of tests. The government should provide a subsidy for these tests. The treatment is even more expensive and less than 10 per cent of patients can bear the cost.
Beyond certain stage of the illness, the drug treatment is no more an effective option. For such patients, liver transplant is the only hope – but this is not available in Pakistan.
Prevention is, therefore, a preferred option. And for this the government, NGOs, medical professional bodies and the public must work together.
DR S. ZAFAR ABBAS, Mirpurkhas
(Dawn-6, 02/07/2006)
Man back from 19-year coma
NEW YORK, July 4: A man woke up from coma induced by his fall from a pickup truck 19 years ago, says a medical journal report. Terry Wallis’ ‘resurrection of sorts’ has rekindled hope for such patients’ recovery.
Doctors now, armed with latest brain-imaging technologies, think they may know part of the reason he revived, says the Boston Globe in which the story appeared first.
Mr Wallis showed few outward signs of consciousness, but his brain was methodically rebuilding white matter, the infrastructure necessary to interact with the outside world, researchers reported in the Journal of Clinical Investigation on Monday. “It’s a … very slow self-healing process,” said Henning Voss, lead author of the study and a physicist at Weill Cornell Medical College’s Citigroup Biomedical Imaging Center.
Mr Wallis emerged from a minimally conscious state in 2003 at the age of 39 and his first word since Ronald W. Reagan was in the White House was: ‘Mom.’ Since then, the one-time mechanic from Big Flat, Arkansas, has regained the ability to form sentences and recovered some use of his limbs, though he still cannot walk or feed himself.
In a minimally conscious state, a patient shows intermittent signs of awareness but is generally unable to interact with the outside world. It is a less severe condition than a persistent vegetative state.
Researchers found that cells in relatively undamaged areas had formed new axons.
(By Maqsood Haider, Dawn-1, 05/07/2006)
Plentiful supply spurs demand for Gutka
KARACHI: Imports of different kinds of Gutka into the country have replaced the ancient tradition of paan chewing with Gutka chewing. In order to try something ‘new’ consumers have, over the years, turned towards Gutka and today, whether branded or unbranded, this product is witnessing steep growth in its demand with more and more people getting hooked to it.
Approximately 45,000 kilograms of Gutka is being supplied to the market daily, giving the numerous announcements by the government of banning the sale and purchase of the product a lie.
Because the revenue Gutka sales generate for the betel nut industry is too great, its import is not prohibited and is easily accessible at all paan shops. In fact it is registered as an important import item from countries like India and Indonesia.
The industrial and site areas and downtown vicinity of Karachi is where the importers or wholesalers store thousands of packs of Gutka. Besides, several chemical factories in the city also continue to produce Gutka and so far no action has been taken against them because these manufacturers represent business interests and are powerful enough to resist such moves.
What tempts one to purchase imported Gutka is its packing that falsely portrays it as being made of hygienic ingredients. Dr Mahmood Haider, Dental Surgeon at Baqai Hospital, says that more than the import the government should monitor the marketing of Gutka and its by-products on the electronic media. “With fancy and attractive sachets of imported Gutka and a variety of catchy names, its consumption is bound to increase and associating celebrities with such products would only add to its massive sale and consumption.”
Apart from the elderly, the shiny packets of Gutka on display attract youngsters as well who are not only active buyers but also sellers of Gutka. The betel-sellers usually disregard the age group their customer belongs to; their only target is profit maximization. Moreover they claim that Gutka selling generates a larger slice of profit than selling other tobacco products like paan and cigarettes.
Ghulam Sajid has been supplying Gutka at a kiosk in Sachal Goth for the past six years and he sells 7-10 kilograms of Gutka daily. One sachet of Gutka earns him between 20-30 rupees. Since this is his only source of income, he his reluctant to give up his trade. “Why should I or any other retailer feel responsible when the government is not doing anything about it? The trade will eventually stop once it imposes a ‘serious’ ban, meanwhile I can’t stop making a living,” he says.
Furthermore, unlike tobacco, Gutka comes without a health warning and due to lack of awareness in the lower stratum of society, where the addiction of Gutka largely prevails they tend to be completely ignorant of its grave consequences and impact on oral health.
In a sample study conducted by the Department of Microbiology, University of Karachi, last year, out of 32 different types of Gutka 28 were found to have narcotics — a killer for human life. The study also revealed that there were 18 different types of fungus in Gutka and other forms of betel nuts. It also contained methadone — an opium derivative.
As far as government stance on the issue is concerned, it was only in 2003-04 when betel nut import was prohibited when laboratory tests proved that it was infected by aflatoxins, a fungus, and was pronounced unfit for human consumption. Tons of betel nut was confiscated then and orders were passed by the court to destroy the betel nuts that were seized but this could not be brought into action due to the strong influence of importers. In turn this resulted in an increase in its smuggling.
Importers manage to violate the set rules of inspection at the clearance stage at the port of Karachi by paying graft. They also develop links at the local level to get their infected betel nut cleared and certified at the customs stage without any check. According to a leading importer: “If you pay Rs55,000 per container the customs authorities would not go for a physical examination of the consignment. An almost equal sum is needed to bypass the group inspection.” During the fiscal year 2004-05, the country imported around 47,229 tons of betel nut cleared by Karachi’s customs appraisement.
This ascertains the pressure betel nut importers exert on government officials and here one can clearly observe the irresponsible role of the latter. Steps taken by the Karachi Municipality for Food Control to deal with the issue are also insufficient.
However some genuine importers also feel that due to the flow of low-priced and inferior quality betel nut into the market, their trade of high quality betel nuts is being sidelined. But health advocates at Pakistan Dental Association and Pakistan Medical Association say whether or not the betel nut is of inferior quality, the government should strictly ban all the brands of the addictive nationwide.
(By Aroosa Masroor Khan, The News-2, 05/07/2006)
Doctor steals kidney from patient
KARACHI, July 6: When a man who went to a private hospital for the removal of his gal bladder found that he was instead deprived of his right kidney, he had a case registered on Thursday night against the doctors and paramedics he believed were responsible for the act.
Mohammad Kashif, a shopkeeper and resident of Gulistan-i-Jauhar, felt pain in his abdomen. He went to different doctors and after medical tests, he came to know that stones had developed in his gal bladder. The doctors advised him to get his gal bladder removed.
Having consulted different doctors, he decided to get admitted to a private hospital in Block-L, North Nazimabad, where he was under treatment of Dr Syed Kashif Mateen. The patient and his family were told that the operation would take 90 minutes.
The surgery was performed on Mohammad Kashif on May 7 in the hospital but its duration stretched to four-and-a-half hours. Kashif’s family was shown a gal bladder containing stones, and after a few days he was discharged from the hospital. Kashif said he felt pain and went to the doctor again. Being dissatisfied with the treatment, he consulted other doctors and after medical tests, to his horror, he came to know that he was deprived of his right kidney whereas the affected gal bladder was in its place.
After it was confirmed by medical reports, he went to the Taimuria police station and got an FIR (280/06) registered under section 334/406 of the PPC against the relevant surgeon and paramedics.
(By Arman Sabir, Dawn-17, 07/07/2006)
120,000 babies born with congenital heart disease annually
KARACHI: With the Pakistan population at 140 million, there are 120,000 babies born each year in the country with congenital heart disease. Ninety percent of these either die or are detected so late that they are beyond surgery.
Presently only 1000 operations, mainly palliative procedures, are performed in Pakistan due to lack of either trained staff or infrastructure. Karachi alone has about 12,000 children born each year with congenital heart disease. Only the parents can understand the plight of these helpless children, said Dr Muneer Amanullah, Paediatric Cardiac Surgeon at the Aga Khan Hospital, in a telephonic interview with The News.
Dr Amanullah, who trained over the last seven years at the Freeman Hospital in Newcastle-upon-Tyne, said that Pakistan had one of the highest incidence of congenital heart disease with eight out of 1000 children suffering from some form of the disorder or the other.
At present, parents of children with congenital heart disease who need open heart surgery are forced to travel outside Pakistan for corrective surgery. This is because Pakistan has only a limited number of trained paediatrics cardiac surgeons who can perform corrective cardiac surgery. This service is offered at the National Institute of Cardio-Vascular Disease in Karachi, the Children’s Hospital in Lahore, and the Armed Forces Institute of Cardiology in Rawalpindi. These parents must have heaved a sigh of relief as now the Aga Khan University Hospital (AKUH) in Karachi has started paediatric cardiac surgical programme using the latest technology and state-of-the-art equipment.
Paediatric cardiac surgery at the AKUH programme was initiated after many months of planning and training of personnel. With Dr Muneer Amanullah joining the faculty at AKUH paediatric open-heart surgery program was initiated in June 2006. It was imperative that for the success of the programme, help be sought from more experienced paediatric cardiac centres. AKUH utilised the expertise of a team from the Freeman Hospital in Newcastle-upon-Tyne in England. The team comprised Dr Asif Hasan consultant paediatric cardiac surgeon, Dr Kelly Dilworth paediatric cardiac anaesthetist/intensivist, Mr W Watson paediatric cardiac perfusionist and Mr. T Redhead Specialist Surgeon’s Assistant. This team spent two weeks at the AKUH to help initiate the programme with the experts at the AKUH, i.e. Dr Muneer Amanullah paediatric cardiac surgeon, Dr Mansoor Khan paediatric cardiac anaesthetist/intensivist, Mr. Ijaz paediatric cardiac perfusionist, the operating room nurse specialists along with the team of highly trained, dedicated and motivated nursing staff of the pediatric cardiac intensive care unit.