KP lack cardiovascular treatment facilities

PESHAWAR: The cardiovascular disease has been declared an epidemic all over the world, but successive governments in Khyber Pakhtunkhwa have never bothered to upgrade the cardiovascular facility established two decades ago at the Lady Reading Hospital (LRH).
Being the only cardiovascular facility in the public sector, it is always overcrowded and is unable to cope with the growing number of patients.
It is more alarming is that there is 6-bed cardiovascular ICU to cater to the needs of patients from the province and Fata.
It was set up several years ago when the population of the province was not high and the disease was not very common.
More alarming is that there is only a 6-bed Coronary Intensive Unit at the cardiovascular ward to cope with population of the whole province and the seven tribal regions.
Sometimes even Afghan patients are admitted to it, which is always overburdened due to lack of space and the increasing number of the patients due to a host of factors.
The cost of cardiovascular procedure was already very expensive for the common people, but now poor patients cannot afford to opt for it as the LRH administration started the so-called institution-based private practice (IBP) in collaboration with staff of the cardiovascular department.
The poor patients needing cardiac surgery have to wait for months and even years for their turn in some cases if they don’t have ‘sifarish’.
Senior physicians and cardiologists in Peshawar say that full-fledged cardiovascular facilities should have been established in every tertiary care hospital in the province.
They argue that it would have helped reduce burden on the lone cardiovascular facility in LRH.
Unfortunately the patients have to wait for months to be operated on or pay a huge amount for treatment at a private hospital in the city.
Mostly the influential heads of various departments create hurdles in upgrading or expanding similar facilities to other hospitals as they think it would break their monopoly.
In some cases, heads of departments even don’t allow second unit of the facility, though bed occupancy in their ward remains 200 percent throughout the year.
In LRH, according to officials, the waiting list at the cardiovascular ward is presently 2017.
“If a patient comes to LRH and wants his surgery should be performed as per rules, he would have to wait till 2017. Even then, the patient would have to arrange all items used in the procedure but the surgeon would not charge him,” a cardiovascular surgeon of same ward told The News.
Pleading anonymity, he said, they had to operate two days a week. “Imagine, there is the whole KP, Fata and Afghanistan, and we have a two-day operation theatre and therefore patients have to wait for years,” he argued.
Dr Riaz Anwar, head of cardiovascular department at LRH, however denied that their waiting list had reached up to 2017.
He said they usually gave two months time to the patients for surgery.
Interestingly, they are required to share same operation theatre with another overcrowded ward, namely cardiothoracic, which is also the only one in the whole province. It is not only dangerous but involves a lot of risks for the cardiovascular patients as cardiothoracic patients are mostly infected.
In the developed countries like the United States, mortality rate of infected post-operated cases is almost 80 percent, according to doctors.
“In the LRH, cardiovascular surgeons unfortunately use same operation theatre and same table. Germ is a hidden enemy but there is no other option,” stated an official of the hospital.
He said the government should set up another cardiovascular unit at the Hayatabad Medical Complex (HMC) as it would help reduce burden on LRH.
In almost every corner of the world, as per protocol, when cath lab is set up, cardiac surgery is established, according to cardiovascular surgeons in Peshawar.
“If cardiac cath is set up, then it is mandatory to establish cardiac surgery, otherwise it is considered a crime. As per protocol, if a patient develops any complications in cath lab, a cardiac surgeon is immediately called in for supervision. The patient is even operated on in the same OT, if needed,” according to doctors.
The previous government had done one thing positive in health by establishing a state-of-the-art second cardiology unit at the HMC.
Luckily, Pakistan’s first electro-physiologist and a foreign qualified cardiologist, Dr Zahid Aslam Awan, runs the unit in HMC, but the services are inadequate as they don’t take patients with high risk for angiography or angioplasty procedures apparently due to lack of cardiac facility there.
“It is the only recognised centre in Pakistan that provides postgraduate training in electrophysiology and Dr Zahid Aslam is the lone supervisor in this specialty but there is no cardiac surgery unit to help the patients requiring cardiac surgery,” a cardiologist at the HMC told The News, when reached for his comments.
Pleading anonymity, he said that some influential doctors had initially opposed creating the second cardiology unit in HMC, saying there was no need of it as work was going on at the Peshawar Institute of Cardiology (PIC).
“Construction work on PIC began in 2008 during the Muttahida Majlis-e-Amal (MMA) government and it couldn’t be completed during the Awami National Party and Pakistan People’s Party-led government. Even the work is taking place during the Pakistan Tehreek-e-Insaf-led government. In the meantime in Punjab, they established four major cardiac facilities such as the Punjab Institute of Cardiology, Rawalpindi Institute of Cardiology and a full-fledged facility at PIMS,” a cardiologist said.
Though it is not clear when PIC would be operational, doctors say it would be choked off due to growing number of cardiac patients.
“Twenty-five percent people are suffering from coronary disease. The government would need to establish more such institutes to cope with cardiac patients in the province,” Dr Riaz Anwar observed.
In Pakistan, people at the age of 35 start developing cardiac related disorders, and according to research, surgery is far better than multiple stents.
According to health experts, the government should establish the second cardiac unit at HMC where infrastructure is already available and would not require the government to spend huge extra fund.
“I think it can cost Rs160 million if they start it at HMC, where they should begin with one table and would easily do six procedures a week and two small cases a day,” an expert said.