THERE are many good Pakistanis amongst us, out here and abroad, ordinary citizens of the Republic, who live under a succession of uncaring, selfish and inept governments. Twentynine have responded to the tale of Tailor Fayyaz Fida Hussain (my last column) who died as a result of a traffic accident last month, many of whom have offered financial help to the bereaved family.

One response was received from Dr Seemi Jamali, In-charge, Accident & Emergency Department, Jinnah Postgraduate Medical Centre (JPMC), Karachi, which I reproduce below :

“May 16, 2006.

I have been most dismayed to read the adverse reference to the casualty department of Jinnah Postgraduate Medical Centre in your column (Dawn, May 14, 2006). Mr. Fayyaz Fida Hussain, the unfortunate tailor of Kadda Market, did indeed come to JPMC following a motorcycle accident but this was at 00.35 hours on April 4 and not March 20... He had horrific lower limb injuries with one leg virtually severed and the other severely crushed. He was not refused treatment as your column alleges but rather he was promptly attended to and resuscitated. When his family members arrived an hour later, they were advised that bilateral amputations were necessary. The attendants elected to transfer him to a private facility and left against medical advice. Mr. Hussain was brought to JPMC from the accident site by a passing good Samaritan, Mr. Kashif, and these details may be verified from him.

“Sir, the emergency department of JPMC is visited, on an average day, by 600 patients of varying means with medical conditions of varying degrees of urgency and we practise a uniform policy of offering treatment to all. The volume of patients at times does stress our capacity to do justice to their needs, but unlike other hospitals of the city, both public and private, no patient is ever turned away for any reason. We take pride in our service to the city and rather than unfounded criticisms, we expect altruistic citizens such as yourself to morally and materially assist our facility in coping with the ever increasing demands on our services.”

This was in response to my having written what has subsequently turned out to be incorrect. A visit to the JPMC casualty department and conversations with actual witnesses reveal the following facts.

The ‘good Samaritan’ referred to in Dr Jamali’s letter was a student of the National Academy of Performing Arts, Kashif Raj. Just before midnight on April 3, he alighted from a bus at Korangi Crossing and seeing a crowd of people standing around a water tanker went to see what was happening. He found a motor bike stuck under the tanker and a man, bleeding profusely from both his legs. He decided to help. The rider of the motor bike was Tailor Fayyaz and he was carrying with him two pillion passengers (one his brother-in-law), both of whom had minor injuries to their lower limbs.

The bleeding man was extricated, and the three were taken off by Kashif to the JPMC casualty department. On arrival, Fayyaz, semi-conscious, was put on a drip and administered Haemaccel and Ringer’s Lactate, he was given tetanus cover, antibiotics and a pain killer (normal procedure for such patients). The wounds of the other two men were dressed and one of them then left. Kashif was asked to go to the blood bank and collect blood matching that of Fayyaz.

In his absence, apparently a doctor had been called from the orthopaedic department to examine Fayyaz’s legs, one of which was described as ‘hanging by a thread’. After cleaning what could be cleaned the doctor told the tailor that there was no alternative to the amputation of both legs and that this could be arranged within a couple of hours. At this the semi-delirious Fayyaz exclaimed ‘Get me out of here or I will die, get me out.’ The doctor departed to deal with the medico legal formalities. (When he returned, he found the patient had gone.)

When Kashif returned with the bags of blood, the tailor grabbed his shirt and violently demanded to be taken elsewhere. He asked him to ring one of his customers, and request him to come and get him out. Kashif did so and in due course the man arrived, Fayyaz was loaded on to a stretcher, put into an Edhi ambulance and transported to a clinic in Nazimabad, run by a doctor made famous by his television appearances and his claim that he can cure rather than amputate. Neither the tailor, nor Kashif nor the customer having the ready cash demanded in the middle of the night, Fayyaz had to be taken elsewhere, this time to the Civil Hospital, where his legs were amputated after a wait of over five hours (medico legal no.1286, 4/4/06). He subsequently died of septicaemia at the Liaquat National Hospital.

Had the tailor opted to stay at Jinnah his life could probably have been saved. He would have been taken for the amputation procedure up one floor in a lift to one of the new state-of-the-art operating theatres most professionally run by the Accident and Emergency Foundation (AEF), directly above the casualty department. This is the normal procedure.

The casualty departments of our hospitals have no disclaimer forms available for patients to sign when they decide to forgo treatment and leave of their own volition. They should have, as this would dispel much confusion and protect the hospitals.

Another improvement that could be made : before I wrote my first column, I rang the federal government-run JPMC to recheck with the casualty department. The operator told me he was connecting me, but kept me waiting. I also got no joy from the Sindh government-run Civil hospital.

The reaction of the tailor to the news that his legs would have to be amputated was not abnormal, nor was his fear of it happening in a government hospital. Public perception of Jinnah, Civil, and other government hospitals is miserable. People do not expect to get timely attention or treatment. This is unfair in certain cases, as right now the casualty department of the JPMC, together with the AEF operating theatre complex, when it comes to dealing with accidents and other injuries is as good as any privately-run institution.

Now, how can the functioning of the public sector hospitals be improved and how can the foregone conclusion that they are dangerous and lethal be dispelled?

We need to have indigenously developed institutions, systems and ‘models’ which are based on the existing ground realities, financial and human resource constraints, and the prevalent corrupt culture at all levels (corruption in this context being not only in financial matters and pilferage but the more common lack of devotion to duty). What passes for ‘culture’ these days lacks the old values, such as ‘pride of profession’ which used to be the main motivating force in most spheres of life.

The public sector hospitals in Pakistan should develop and test ‘models’ which, if proven successful, should be replicated (it is tough going as the federal ministry of health takes up to three years from the start to sign MoUs). The young generation of doctors can be inducted in these programmes and they would, hopefully, then bring about a change in future medical care.

Two tested models exist and function successfully at the JPMC. One is the Accident and Emergency Foundation’s Emergency Theatres Complex which was constructed, equipped and maintained by donations from anonymous donor families and has been running now for two years. Four thousand emergency operations have been performed. Patients are neither charged nor do they have to contribute anything (drugs/disposables) towards operations.

The second is the Marium Ali Mohammad Tabba Foundation’s Labour Rooms and Gynaecological Theatre Complex, constructed and equipped by the Foundation, which has been running successfully for the last five years. A quality care facility, it has successfully managed 12,000 deliveries and 3,000 operations.

The concept and planning of these two models is indigenous, not ‘imported.’. All plans were approved by the parent institution and the federal ministry of health. The capital cost of the building and equipment was provided by the donors, whose agent appoints its own manager and assisting staff, attends to maintenance of the equipment, air-conditioning, etc, ensures the safety of the equipment and prevents pilferage. The manager of each unit works under the direction of the departmental head of the unit concerned. There is no interference in the administrative functioning of the JPMC. Maintenance expenses are either given by one donor or are generated by continual donations from NGOs and the public. There is no financial load on the government.

E-mail: arfc@cyber.net.pk