PESHAWAR: A top intensivist has resigned as an assistant professor of the Lady Reading Hospital, Peshawar, citing the administration’s inability to draw plan for providing care to Covid-19 patients by deploying inexperienced and inadequate staff to treat the critically-ill patients as the reason.

Dr Aisha Mufti, a brave lady, who has been the first to act as a whistleblower against the powerful architects of the Medical Teaching Institutions Reforms Act (MTIRA), 2015, under which the teaching hospitals are run by the board of governors free of the health department’s control, has said being in charge of the Intensive Care Unit, she was ordered by the irrelevant people on medical matters, who had no knowledge of medical care whatsoever.

She joined the LRH less than a year ago and had been instrumental in improving intensive care, especially after the onset of the Covid-19, but the unbecoming attitude of the administration forced her to take the extreme step of quitting the job, it emerged.

There is a consensus among top consultants at the city’s hospitals that the MTIRA 2015 had ruined the healthcare system in the province, leaving the now autonomous medical institutions without oversight and scrutiny by the government that continues to pump billions of rupees into these tertiary-care hospitals without asking a single question.

Insists she was ordered by irrelevant people on medical matters

Of the total 291 deaths from Covid-19, 172 were reported in Peshawar-based three MTIs with the LRH accounting for 128, according to the data available with Dawn.

Insiders say there is no standard treatment and clinical protocol and every MTI is following its own operating procedure.

Through an amendment, a clause was incorporated in the MTIRA 2015 in October 2019 to set up a policy board to introduce uniformed guidelines, including treatment protocols to all the MTIs.

However, the principal architect of the MTI Act and its chairman, Prof Nausherwan Barki, has been in the US since the pandemic and as a result, there is no meeting of the board.

Those familiar with the situation say Mr Burki jealously guard MTIs autonomy that doesn’t take even “suggestions given in good faith” lightly. Officials dither to cross swords with him, due to his close relationship with the prime minister.

All MTIs are pursuing their own treatment protocols for an international pandemic, which is resulting in the loss of lives, many of which could have been saved in the presence of standard guidelines, senior consultants said.

The situation forced Dr Aisha to call it a day, her colleagues, say.

“The hospital was completely unprepared to deal with Covid-19 epidemic as there was no planning. Even if there was any, the ICU and Anesthesia were never informed because they were not considered important parts of the hospital.

“We were caught by surprise when ordered to intubate and ventilate a Covid-19 patient inside old causality where an old ventilator was kept with no other facilities which obviously resulted in a disaster,” she wrote in her resignation letter on Thursday.

The intensivist, who has double postgraduate fellowships to her credit, said the next day of starting the Covid-19 management, they were ordered to vacate two ICUs immediately and patients were shifted from there along with experienced and trained staff and medical officers and she was left alone.

She, however, said she was supported by anesthesia department and they acted as front-line fighters against Covid-19 as well as guiding the hospital about wearing and removing PPEs, transporting patients, etc.

Dr Aisha said initially, five patients had recovered from Covid-19 but later inadequate nursing care in ICU, poor quality care, unhygienic conditions and the mortality rate kept rising.

She tried to communicate this but instead of physically inspecting the situation, LRH dean Prof Abdul Lateef Khan called her explanation over petty issues upon complaint of the nursing director.

“Our repeated requests that non-invasive ventilation (NIV) and high flow nasal cannula (HFNC) in high dependency unit (HDU) was needed which went unheard. The basic purpose of HDU was tackle less serious patients. But the HDU used to call the ICU because of lack of NIV and HFNC due to which patients ‘condition continued to deteriorate,” she said.

The intensivist said the patients’ turn-over was rapid while there were only six consultants in ICU , although the admin knew this is our maximum capacity, (yet) they opened opened a second ICU in thoracic unit but the at thoracic unit refused to take over the job and instead took over the allied building ICUs.

“I am still unable to understand that a team that is incapable of running Covid-19 thoracic ICU, how is it capable of running allied building ICU and a team incapable of running Covid-19 thoracic ICU, should they be allowed to run allied building ICU?”

The intensivist said irrelevant doctors visited and questioned ICU management over arterial lines, central venous pressure (CVP) measurements, humidifiers and ted stockings, despite having no idea, she said. In daily zoom meetings we were made to answer to questions asked by such irrelevant doctors with absolutely no concept of critical care.

“I understand that some other departments of LRH were also destroyed in a very similar fashion. We asked for labs which were never provided and wouldn’t be provided because it wasn’t the administration’s priority,” she said.

Dr Aisha, a senior intensive care specialist in public sector hospitals in the province, said that she made a request for adapters for ventilators but no response had been received yet. She added that the head nurses weren’t willing to go to the ICU despite her repeated questioning over poor nursing care.

Sources claimed that Dr Aisha was being pressured to withdraw resignation.

She was not available for comments despite repeated attempts by this correspondent.

Published in Dawn, May 16th, 2020