HYDERABAD: The Paretabad cylinder blast and fire incident that claimed lives of many people, most of them children, lays bare weaknesses and incapacities of Liaquat University Hospital’s burns ward yet again. The death toll in the May 30 tragedy rose to 14 on Monday while many more of the no fewer than 45 injured are still fighting for life.

LUH burns ward is catering to the healthcare needs of patients from Hyderabad alone, but other adjoining districts of lower Sindh. It looks as if the ward itself is fighting for its survival.

Even after completion of the ground-plus-three storey building’s construction, it is devoid of important component – an intensive care unit (ICU) exclusively for burns patients. Other equally important components are non-existent though they may have been reflected on papers like project cost-I (PC-I) of the unit, whose work was initiated when the burns unit was headed by Dr S.M. Tahir, who retired from LUH back in 2018.

The unit has been working under an ad hoc arrangement for as long as one could remember. Around two decades back, it used to work in a building that was declared ‘dangerous’ to live in. Then the unit was shifted to a two-storey building comprising old private wards. “When we were shifted to the private wards buildings, I had objected that what kind of treatment the hospital management expects in this environment for burn victims,” said Dr Tahir, who remained associated with the burns unit from 2000 to 2018.

Essential component still missing

“A state-of-art autonomous burn unit was my dream. I remember having included basic necessities and components in papers for the burns unit but when it was nearing completion, I retired. Today, burns ward still remains an incomplete set-up with no ICU and related facilities. Still victims are referred to Karachi that we used to do two decades back,” he said.

The May 30 tragedy again exposed vulnerabilities for burn victims if they end up in LUH’s burns ward. Almost same old ad hoc mechanism reigns supreme in the burns ward where staff was drawn from other units and disciplines. Since ICU remains non-existent, some serious patients had to be kept in medicine and paediatrics ICU, raising possibilities of infection for other patients of the ICU.

When an LUH paramedic staffer, Ravi Tanvoli, went through a similar tragedy as he lost seven of his family members in a fire in his house, he had to face same kind of issue. He took them to Karachi’s civil hospital as LUH doctors advised their shifting.

“Adult patients with above 33pc burn wound struggle for survival if their face, chest and neck have wounds and survival of children with 10pc wounds is undermined,” said a burns ward doctor. The LUH doctor said that over 30 patients had to be shifted to Karachi’s hospitals because there was no ICU or high dependency unit (HDU) in practical terms.

Twenty-three patients were admitted in the HDU/ICU of Civil Hospital Karachi on May 30. Six were admitted to Patel Hospital as well. Only 10 stable patients could be accommodated in LUH burns ward while two patients in paediatrics ICU and one was admitted in the medicine ICU.

Cost of facilities

Record shows that the three-storey burns ward has 64 beds inclusive of 16-bed ICU provision built at a cost of Rs67.941m. With the inclusion of Rs67.941m cost of machinery, the total cost stood at Rs161.302m. Otherwise a dedicated burns ward, half of the premises was handed over to dental ward around 2022 by then medical superintendent and director administration.

“A daycare component is not available. ICU is nonexistent for want of machinery and trained human staff. How are we going to handle patients sans technicians and trained staff. Burn is a speciality a normal paramedic can’t handle. Department of plastic surgery is also shifted to our building. These departments were shifted to burns ward even when the building was incomplete,” confided a doctor. When human resources remain unavailable, the ICU is not going to run,” he said.

According to Dr Tahir, he had proposed that the burns ward should be autonomous so that it should not have to rely on others for staff, doctors and other necessities relating to ward. “I always objected to LUH administration that whenever we train staff they are shifted to elsewhere, leaving us to start from scratch,” he remarked. He said that he had proposed a separate laboratory so that patients should not have to be shifted to other area for pathological investigations, adding he had proposed separate department of physiotherapy, nutritionist, anaesthiast, etc but today these facilities are not available there.

Accommodating other sections

In new building — located outside LUH’s premises opposite outpatient department (OPD), thirty burn victims could be admitted on ground floor. The first floor space was available for four dental patients from dental department and remaining space was given to plastic surgery operating theatre.

The second floor has space for seven peads burn 10 female burn patients. Another 10 each of male and female plastic surgery could be kept there. Eight beds are meant for “Oral and Maxillofacial Surgery” including four of oral cavity cancer patients on the third floor thus squeezing space for this otherwise fully fledged burns ward.

There was a plan to shift ENT ward from LUH as well. A combined OT of Reconstructive Surgery and Maxillofacial surgery was set here. “Before we are as unit shifted to this building, maxillofacial colleagues shifted themselves,” said a burns ward source. “Burn patients are prone to infection and they need extraordinary environment in ICU which our burn ward can’t offer simply thus victims’ families run from pillar to post to shift patients to Karachi,” said a doctor.

No tendering process

According to LUH’s Medical Superintendent Dr Aijaz Abbasi, ICU of burns ward was part of ‘tender’ and it was an old scheme. “We have checked papers but we don’t find ICU’s component in tender papers of the ward. Secondly, dental

ward was shifted on verbal orders of then director administration Sattar Jatoi to burns ward,” Abbasi told Dawn. He said neither equipment of ICU nor trained staff was available in ward.

Published in Dawn, June 4th, 2024