Listening with care

June 7, 2020

As Khyber Pakhtunkwa’s major hospitals exceed capacity amidst an eased lockdown close to Eid, the government needs to pay attention to doctors’ advice and grievances

Khyber Pakhtunkhwa’s hospitals are running short of facilities. According to some doctors, by the start of this week, there was no vacant bed at the isolation center for Covid-19 patients at Hayatabad Medical Complex, one of the three major hospitals in Peshawar and Khyber Pakhtunkhwa. The administration was asked to admit the new patients to another facility. According to doctors, there are 145 beds at the isolation ward of Hayatabad Medical Complex for Covid-19 patients while 14 beds were reserved in the ICU.

There are similar scenes at other hospitals where more people are coming with symptoms and need to be tested but they have to wait for their turn. There were cases in which people were refused tests, probably for lack of test kits, saying these were symptoms of flu but they were tested positive when they approached private facilities.

The number of cases in KP especially Peshawar is already concerning: one in every five deaths in Pakistan due to coronavirus is from only one district, Peshawar. The number of Covid-19 patients has been increasing since the relaxation of lockdown close to Eid. As tens of thousands of people flocked to markets for shopping ahead of Eid in markets, socialising on Eid, and attending funerals, hardly a few were seen to be following social distancing SOPs like wearing masks or keeping a safe distance from others. These occurrences fueled concerns that the number of Covid-19 patients may increase further in the coming weeks.

The situation is not just alarming for the government or concerned citizens but the health staff as well. Some doctors have asked the government functionaries to let them attend their press conferences to request people to follow government SOPs regarding social distancing or the health staff will stop treatment since an increasing number of people are being admitted on a daily basis.

Daily reports suggest that despite many doctors, nurses and other care-workers tested positive, the government was yet to provide proper facilities at hospitals. Apart from acute shortage, many even questioned the quality of the PPEs provided to doctors. The provincial doctors’ association has expressed concern over the increasing number of Covid-19 cases among the doctors and health staff across KP.

A huge embarrassment for the government amid the pandemic was the resignation of the in-charge of the intensive care unit of the biggest hospital of KP along with another colleague. The resignation of two doctors in ICU has caused concern amongst the doctors and other staff. The in charge of the ICU Dr Ayesha Mufti, an assistant professor, is said to be the only qualified intensivist and lone FCPS of acute medicine in KP. Dr Ayesha and Dr Mazhar were serving in ICU department of LRH when they decided to quit.

In her resignation letter, Dr Ayesha Mufti accused the LRH administration of “completely unprepared to deal with corona epidemic”. She stated there was no planning and even if there were a plan, the ICU and anesthesia department were never informed because they were not considered important part of the hospital.

The resignation of two doctors in ICU has caused concern amongst the doctors and other staff. The in charge of the ICU Dr Ayesha Mufti, an assistant professor, is said to be the only qualified intensivist and lone FCPS of acute medicine in KP.

“The number of nursing staff was highly inadequate inside the ICU, the quality of care was poor, hygienic conditions were very bad, we tried to communicate at various levels but instead we received an explanation by [the] dean over some minor issues. It was never ordered by any senior to physically inspect what was going on inside the ICU. After recovery of first four patients the remaining could not recover, poor nursing care has a huge role in it,” the doctor mentioned in the resignation letter.

Dr Mufti mentioned that the ICU was being run by six consultants only when the patient turnover was very rapid, the burden was huge and despite the fact that the admin knew this was the maximum capacity they opened a second ICU in thoracic unit. According to her, despite their maximum effort to run the general ICU with minimal and inexperienced staff, they faced criticism. In her letter, she highlighted that irrelevant doctors visited the ICU and questioned ICU management over arterial lines, CVP measurements, humidifiers and ted stockings. She added that they tried to advise anesthesiologist over setting of tidal volume for the patient.

“In daily Zoom meetings, we were made to answer questions asked by such irrelevant doctors with absolutely no concept of critical care. Some other departments of LRH were also destroyed in a similar fashion. The laboratories we asked for were never provided because it is not the priority of the hospital. I made a request for MDI adapters, and so far, no one has updated me about it. The head nurses were not going inside the ICU despite repeated questioning of poor nursing care,” stated the letter by Dr Mufti.

There were reports that many doctors and health staff at different hospitals in KP are planning to quit for lack of facilities for patients, and doctors.

The administration of the hospital denied these charges, saying there were a lot of deficiencies in protocol set for Covid-19 pandemic. The management said Dr Nausherwan Burki had to personally monitor each and every Covid-19 patient from the US and give suggestions. The management said Dr Burki had called an intensivist from Shaukat Khanum Hospital who also expressed his dissatisfaction over the ICU services in LRH.

A couple of weeks back, Taimur Jhagra, the provincial health minister said that the doctors are with the government are on the same page. “We will win the corona fight with strength of mind, courage and unity. Representatives of doctors’ associations that have had complicated relationships with government all sat together to give one message that we will shun aside differences and work together to win this,” he said.

But there have been a number of complaints by the doctors of neither providing sufficient and better-quality PPEs, masks and other facilities to those fighting this war on the frontline.

People in cities, suburbs and villages all need to be educated, or even forced to stay home and strictly follow SOPs to prevent the spread of Covid-19. For this reason, various influentials from prayer leaders in mosques of KP and the rest of Pakistan, parliament members, local government representatives, teachers, elders and anyone who wields power and has a say needs to be involved an in both countering negative propaganda and convincing people to follow social distancing SOPs to stay safe and keep their loved ones safe. Just a few ads and few social media posts cannot work in isolation unless serious and holistic efforts are made with the understanding that there are rural areas where social media, internet access and literacy are challenges. At the same time, the government needs to listen closely to doctors’ grievances and respond to the challenges that they are facing in real-time ranging from ensuring supply of PPEs to all kinds of technical facilities and support to the health staff to enable that they can safely and better test, treat and save patients.

The author is former president of Khyber Union of Journalists and covers conflict, political, social and human rights issues in KP and Fata. He may be reached at Tweets @JavedAzizKhan

Coronavirus: Govt needs to pay attention to doctors advice as lockdown eases