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KARACHI, April 2: Of all the hospitals in the province, the only centre working towards counselling and screening pregnant women against HIV/Aids has stopped functioning due to the allegedly “uninterested attitude” of the authorities concerned.
A source privy to HIV/Aids control activities in Karachi told Dawn that the Prevention of Parents To Child Transmission (PPTCT) Centre, which started operations a few months ago at the Civil Hospital Karachi (CHK), had virtually stopped functioning since one of the project’s partners, Unicef, did not find it viable to maintain its support.
Unicef, however, blames the hospital for failing to fulfil one of the commitments it made towards the establishment of the PPTCT centre at the CHK gynaecology department. Under a memorandum of understanding (MoU) signed last May, the hospital administration agreed to provide space/rooms in its Gynaecology/Obstetric department that were exclusively for the use of the PPTCT centre, but it failed to meet this commitment.
The PPTCT centres work towards minimising the risk of a newborn being HIV-positive. Under the programme, pregnant women visiting health care centres are counselled and asked to consent to an HIV test. If they test positive and prefer to carry the pregnancy through to its full term, they are provided drugs to minimise the chance of the virus being transmitted to the infant, said a source. The centres also help prevent unintended pregnancies in HIV-positive women and spread awareness about the risks of and safeguards against the deadly virus.
Of the five PPTCT in the country, 3,318 pregnant women – including 220 at the CHK centre – were given pre-HIV test counselling in 2007. Of these, 3,249 consented to being tested and 3,212 – including 202 at the CHK – later visited the centres to receive their reports. Of these, only seven women – including one at the CHK – tested positive to the virus, some of whom had already confirmed the HIV-positive status.
The counselling and HIV/Aids test is not routinely offered to every pregnant woman visiting the CHK. Women are first asked to respond to a checklist and they are treated under the PPTCT centre’s protocols only if they are married to injection-administered drug users, Pakistanis working abroad or are sex workers.
No room for negotiation
The PPTCT centre at the CHK was established through an MoU between the hospital, Unicef and the Sindh Aids Control Prevention Programme (SACP). Unicef accepted the responsibility to train staff, provide supplies and communication material, bear the staff cost of the PPTCT coordinator and sensitise the CHK Gynaecology Department staff on the importance of its work. The hospital administration agreed to provide office space at the out-patient department of the Gynaecology and Obstetrics department, while the SACP was to provide furniture for the centre.
On March 18 this year, the officer-in-charge of Unicef, Sindh, Dr Jabeen Fatima Abbas, sent a letter to the CHK medical superintendent pointing out that despite her organisation’s best efforts and repeated meetings with the administration and various stakeholders of the CHK, the exclusive space promised by the hospital in the MoU had not been provided and Unicef had finally decided to withdraw support for the PPTCT centre at the CHK.
According to a source in the CHK, the coordinator engaged by Unicef – Dr Shumaila – started performing duties about six months ago in the OPD of the Gynaecology Department, sharing space with some of the existing offices.
However, the coordinator found that her services required confidentiality. She did not find it appropriate to handle women suspected of being HIV/Aids-positive or otherwise seeking special guidance in the middle of an out-patient department crowded with other women. She therefore asked to be provided a separate room, said the source, but this was considered unacceptable by a couple of influential persons at one of the three units of the Gynaecology Department.
Reportedly a couple of medical practitioners, including a senior professor, who are believed to have political connections also refused to countenance the allocation of a room to the PPTCT centre since this would have compelled them to surrender their own temporary or additional accommodation in the OPD.
Insiders said that the quest for a room received a set-back when the BOG and the CHK medical superintendent decided to confide in a senior gynaecology professor in terms of the issue.
The professor reportedly opposed the PPTCT centre and the creation of a private space in the OPD, even after a decision was taken to redesign some of the rooms or open up some store rooms located in the area. A source privy to the process told Dawn that the professor “made the matter an ego issue and went as far as to say that such changes would be possible only over her dead body.”
Dept head unaware of issue
The head of the CHK’s Gynaecology and Obstetrics Department, meanwhile, appears to have remained unaware of the controversy.
Professor Ghufrana Umer Memon told Dawn that she had been associated with the training process related to the establishment of the PPTCT centre but she had not been consulted by Unicef or the hospital’s medical superintendent about the room issue. “Had that been the case,” she said, “I would have come up with a solution since I personally feel that the PPTCT centre is of immense importance and aims to attend to all the pregnant women visiting the three gynaecology units in the hospital.”
She maintained that the facilities and rooms in the OPD were not the property of individuals and were meant for all three units of her department on different days of the week. “We want the centre to be reinstated since it will benefit patients from all parts of the province,” she commented.
Meanwhile, a doctor in the OPD told Dawn that the PPTCT centre coordinator, Dr Shumaila, had not been coming to the hospital for the past two months. The CHK has also been informed that supplies meant for the PPTCT centre, which have been lying in the hospital’s store, are to be returned to Unicef while the furniture is to be returned to the SACP.
Nevertheless, Dr Anees-ur-Rehman Siddiqui, the HIV and Aids officer of Unicef Sindh, remains optimistic about the centre. He told Dawn that the centre had not been withdrawn as yet, although Unicef was considering the move. “I understand that the CHK administration would also not like to give up the centre,” he added, maintaining that the coordinator had stopped going to the CHK on March 10 since her employment contract with Unicef had expired.
In the same breath, however, he said while waiting for a final reply from the CHK medical superintendent, that he and the SACP had also been evaluating the merits of shifting the PPTCT centre to the Jinnah Postgraduate Medical Centre or Abbasi Shaheed Hospital.
The medical superintendent of the CHK, Dr Kaleem Butt, said that he would “certainly move the high-ups to make Unicef revert to its old decision and continue supporting the CHK centre instead of closing it. Such a centre is one of the most important strategies for the control of the HIV epidemic,” he commented.
Dr Butt added that the latest written communication from Unicef was a source of concern for him and all the other health workers in the province, particularly when no other large, public-sector teaching hospitals in the province offered comparable facilities for expectant mothers falling into high-risk groups. “Some of the senior doctors failed to be supportive on the issue,” he stated.
