off record
Shaukat Ali Jawaid

Improve the System to
avoid such tragic mishaps

It was in December 2019 that the word became aware of the COCVID19 Pandemic and many countries started seeing patients infected with this virus. It was well known that it is going to spread the world over hence many countries had started taking necessary precautions but those countries which took it lightly in the beginning had to pay a very heavy price for that in the shape of increased morbidity and mortality. We got couple of months to prepare and that was the time that authorities in Pakistan should have taken some important steps including arranging the PPEs for the healthcare professionals, preparing for Quarantine facilities, Isolation Beds, Ventilators and above all the training of healthcare professionals working in Emergency and those who could be called up to treat these patients in High Dependency Units, Intensive Care Units, Isolation Wards and above all in Emergency. The heads of the healthcare facilities should also have taken steps to prepare themselves to receive patients in critical condition.

However, what happened. The government refused to wake up and took it very lightly. They did not realize the gravity of the situation. In fact confusing statements from the government also lead to confuse the public which did not take it seriously either. The results are now before us. Healthcare facilities all over the country have almost choked, ever increasing number of healthcare professionals continue to get infected and test positive and they have to work at great personal risk as well as risk to their family members. However, what is still more tragic is the death of healthcare professionals due to alleged negligence of their own professional colleagues. Instead of blaming any one, it is the failure of the system that we have in place. We need to improve the systems to ensure that any one coming in emergency is immediately looked after and given appropriate treatment. Had such a system been in place, the tragic incidents that took place at Services Institute of Medical Sciences and Nishtar Hospital Multan which resulted in the death of two young doctors could have been avoided.

First let us go through the story of Dr. Salman a postgraduate resident in Cardiac Surgery. According to reports he is said to have presented in Services ER with acute abdomen and told his seniors that he had acute and distended abdomen and had also aspirated vomits and needs laparotomy. He was forcefully sent to medical ward saying “yeh medicine ka case hai”. He went there told them everything, they kept him for some time and sent back to surgery. He kept deteriorating and no one touched him because he was having breathing issue. He told them he had negative report of COVID19 and symptoms are because of aspiration but they didn’t believe even after seeing report. He was having bradycardia and sepsis and kept asking “sister ‘report ‘ attach kar dain please and doctors were not even coming close to him”. After eight hours surgery ward left him in emergency and went back and handed over his case to next team who joined ER. They also kept him waiting that he could have Covid. In acute abdomen urgent surgery is needed always but he waited for more than 12 hours. Kept requesting he didn’t have COVID and go for operation but no one accepted. Ultimately he collapsed and on anesthesia machine he was kept as such for four to five hours. No ICU bed was provided in that time because they were still suspecting COVID. Ultimately medical opinion was sought and they told them it’s not Covid and delay was nothing but negligence. He was operated while he was in septic shock after delay of over 18 hours and he could not come out of that shock. Was shifted to ICU where he eventually died”.

The second tragic incident relates to Dr. Ghazala Shaheen who also died due to COVID19 infection while admitted in Nishtar Hospital Multan. Her sister has alleged that” the seniors with whom she had worked for two decades were only giving instructions on phone while no senior doctor bothered to intubate. Poor trainee doctors were on the front lines. She blamed the senior ICU staff, the anesthetist for mismanagement, carelessness and their arrogant behaviour”. Had the staff been properly trained to manage such patients, the outcome might have been different.

Now as usual when these cases have been highlighted, enquiries will be ordered, reports prepared and then after some time every one will forget these tragic incidents till such time that it is the turn of someone else. It has been going on in this country since long and perhaps it will go on like this. Think for a while who is responsible for these tragic deaths? It can happen to anyone if we fail to improve the systems and particularly Emergency Service at our hospitals. We in these columns have always advocated self-monitoring and accountability of the medical profession but so far no such system has been in place. Criminal negligence should never go unpunished. Leadership of the medical profession must wake up before it is too late. All such cases of negligence must be properly investigated and those found guilty of criminal negligence must be punished. It is extremely important to regain the trust and confidence of the public in healthcare facilities as well.

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