By Salam Afridi

Peshawar: In the general ward of Khyber Teaching Hospital (KTH), Peshawar, a lady from Waziristan waiting for her turn for a routine check-up, nurses and doctors treated her as routine offering no special treatment and emergency. This means she’s on a normal routine check-up with a gynecologist.

As everyone wants to visit the best doctor for treatment no matter far or near, or some prefer a doctor recommended by other people. Some stick with their tried and trusted physician despite the fact that the doctor is not very qualified.

The issue is when people like the lady from Waziristan arrives after more than 7 hours traveling for a routine check-up.

When we ask the nurses, they respond that she is normal as a routine with no serious condition even her treatment can be done with any of her nearest health centers. It’s not necessary for this kind of condition to visit here unless the treatment facilities for her are not available at their nearest health facility.

This is not the first routine case found in KTH but on daily basis many patients with no serious health concern flood the major public hospitals or health centers of Peshawar which burdens the main hospitals in Peshawar.

Despite getting the same treatment and prescription at the remote area, locals strongly believe that hospitals in their area are not good as this line of thinking is persisting for a long time.

As further inquiry in detail to dig out the actual figures of people who come from remote areas, found hard as different hospitals do not have those records in practical.

An attendant of a patient in KTH from Bannu told Pak Voices that we are here for better treatment, the one which is not found in our hospitals, as it is a big hospital which can help us in case of emergency occurrence.

A Christian nurse Cecilia, who has been working at Lady Reading Hospital (LRH) for 29 years, told Pak Voices about last night cases which were referred from Mardan to LRH but after detailed diagnosing, they were found as routine patients which can be curable at the place from where they came.

Zulfiqar Ali Khan, the spokesperson, LRH said that people insist to come here regardless of the nature of the injury. He gave an example a car incident during the last Eid al-Adha in Malakand division when a man was brought to LRH in critical condition. He explained that his condition was critical and demanded urgent assistant from nearest hospitals, but people did not take into account that his condition did not allow him to travel.

Mammoth upsurge in health outlay

Research on health data shows that Khyber Pakhtunkhwa government in the year 2017-18 allocated around 74.4 billion rupees for health, which means KP government daily spending is 7 rupees on each person of KP, the estimate of populations taken from the recent year 2017 census details.

According to District Health Information System (DHIS) KP data of the year 2016 shows that total numbers of health institutes are around 828 and a total number of beds in all health centers are around 19849, which means that in average each bed of health centers is available for 15 hundred persons in KP on one time.

Further data reveals that a total number of health centers’ staff is around 25 thousand, in which around four thousand professional doctors and around seven thousand nurses are working in KP.

According to the same year’s data around seven thousand new health staff have been hired since KP new government taken control of charge, but the strange situation found in total numbers of professional doctors which have decreased from 3932 in the year 2012 to 3644 in the year 2016, further same data reveals that the dental surgeons also decreased from 171 in the year 2012 to 122 in the year 2016 and radiologists from 42 in the year 2012 to 10.

But in contrast to all figures of decreasing, a huge increase is found in ‘other paramedic staff’ like in the year 2012 the figure was 7674 which is almost doubled in the year 2016 with 13446. This means in every ten number of employees four newly hired till the year 2016.



Distrust and Misapprehension    

The tension about the local hospitals that they are failing to provide basic health facilities, Zulfiqar told Pak Voices that due to a huge number of patients visiting OPD daily, in which it’s not possible to meet the standard time for diagnosing per patient with piling numbers of patients is not possible to meet. As a huge number of patients have to wait for their turn, complaining about delays.

And as we see most of the patients visiting for a minor issue which can be treatable at their own area’s small public health centers. Nurse Cecilia described a situation where more attendants like four to six persons of one patient ask the same question again and again, annoying and interrupting with the work of the doctors and the paramedic staff.  Even we have actively continued a campaign for two years called “One patient one attendant”.

Overloading Hospitals

Further, Zulfiqar reiterated that last year around 2.3 million patients had visited LRH, which means that on daily basis around 6 thousand patients visited LRH. But in normal routine, 4 to 5 thousand patients visit LRH on daily basis with almost 10 thousand patients visiting the hospital on Monday only.

Official data of different hospitals, like LRH 2017, Khyber Teaching Hospital (KTH) 2017 and Hayatabad Medical Complex (HMC) 2016 shows that the maximum number of patients reported in LRH with average 6 thousand 4 hundred daily and KTH around 6 thousand on second, and around 3 thousand reported in HMC on daily basis visits of patients for routines and emergency.

With detailed research on data of DHIS year 2016-17 shows that a massive number of patients visited in District Swat with numbers around 91 thousand, Nowshera 86 thousand and Charsadda is on third having a more daily patient in their different health centers. The below graph further explains in detail about daily patients in top ten districts of KP during the year 2016-17.

So this further evidence shows that the people living in Swat need more attention in health as they have a surging number of daily patients in their local hospitals for different reasons despite many of them have visits of main hospitals of Peshawar too.



The data of LRH shows that 50 percent plus of the cases fall into basic minor issues, which can be remediable with their nearest accessible hospitals doctors. So this clear evidence that most of the patients visiting main city hospitals for minor issues despite their treatment from the nearest accessible hospitals as possible which affects other serious patients at times and it also adds to the shortage of beds and other treatment facilities at the hospital.

The data of DHIS in the distribution of specialty further reveals that most of the visits recorded in General OPD, Emergency and Pediatric as shown in the graph below. In the distribution of gender wise data shows that in every ten persons six are female and four male reported in daily visits in different public hospitals. This is further clear evidence on women health issues which is growing over the time in KP province.



Every year many of the children are dying due to Diarrhea and Dysentery across the globe and in Pakistan, and a massive number of patients recorded in KP in which the most of numbers of patients reported in the year 2016 available data. The graph below shows in details about top ten diseases, in which most of the patients visited public hospitals in KP in the year 2016.



Countless Diseases

As further data of DHIS shows distribution about communicable and non-communicable diseases which is explained by Dr Shahidullah Afridi in detail, like most of the patients coming to the hospital for treatment in which different kind of diseases term found like CDs and NCDs. CDs are also known as infectious diseases or transmissible diseases, some ways in which communicable diseases spread from one person to another through a variety of ways that include: physical contact with an infected person, contact with blood and bodily fluids; breathing in an airborne virus; or by being bitten by an insect. NCDs are a medical condition or disease that is not caused by infectious agents.

So in the distribution of CDs and NCDs percentage in KP are different, most of the reported cases in CDs which is 58 percent of total reported cases and 42 percent in NCDs. This means in every ten number of reported cases 6 are reporting in CDs and 4 in NCDs, the graph below clearly shows in detail about patients of both types have visited hospitals in KP.



From Misapprehension to in Practical Certainty

Unnecessary visits and remote patients coming to main cities hospitals for normal check-up create a mess in the hospitals. Zulfiqar says that the awareness of citizens is the prime necessity to resolve complexities in hospitals.

Further for the basic treatment before visiting main city hospitals check with the nearest one if it is not remediable or not satisfying you then you may visit the big hospitals.