Nowadays there is huge increase in number of unsatisfied patients of government hospitals in Lahore . Many articles and news have been published about the poor performance of government hospital. In this research the focus will be about the facts and reasons behind the unsatisfied condition of government hospitals. For that purpose two Hospitals has been chosen. 1) Government General Hospitals 2) Services Hospital. The significance of this study is to bring forward the problems of Hospitals in the Emergency wards. This research will let people decide who is responsible for these problems the Government, the Doctors or the patients itself?
Acknowledgements First of all we would like to thank Lahore School of Economics for giving us the chance to conduct research. We are also very grateful to Ms. Rameeza Aslam in helping us in the project by guiding us. We are very grateful to Dr. Muhammad Iqbal (Lahore general hospital) and Dr. Javed Ali Butt ( Services Hospital), for giving us the permission for the research, for taking interview from the patients and having discussions with the doctors. We are grateful to Mr. Qaddafi (Deputy Medical Superintendent) for giving us his precious time for the interview.
We are thankful to Mr. Syed tanvir for giving us an interview and giving his points of view towards the hospital. We are grateful to Dr. SanaAhmed(Services hosp) , Dr. Waqas (LGH) , Dr. Ali Hassan (LGH). andDr. MohsinRasheed (LGH) for giving us the information related to the topic and giving us some facts and figures. We are thankful to the staff of Emergency and Emergency wards for cooperate us in getting the surveys and the having the interviews. Mr. Arslan Malik and MR. Usman Omer is focusing on the infrastructure andManagement. Mr. Nasir Butt is focusing on the doctor’s attitude.
Mr. Fahad khurram is focusing on the problems of Patients in Emergency wards. PROBLEMS OF EMERGENCY WARDS OF GOVERNMENT HOSPITALS A government hospital is a hospital which is owned by a government and receive government funding. This type of hospital provides medical care without charging any cost, the cost is recovered by the funding which hospital receives. A government hospital is a place in which the entire sum of money that is required in constructing a public hospital comes from the local government. The private hospitals are managed by a single person or a group of people.
Therefore, a single person or a group manages the entire hospital, the government has nothing to do or say as regards the funding or administration. Private hospitals are preferred by most of the people. From Lahore Services and General Hospital is selected . Services Hospital Lahore is a well known hospital of Lahore which is located at Jail road. It was established in 1958, In 1960, this was converted into a 50-bedded hospital and named as Wahdat Hospital. In 1986 various additional building were constructed and bed strength was raised to 904.
It was later renamed as Services Hospital Lahore General Hospital started its journey of helping the poor in 1958. It is a huge autonomous Hospital with 612 beds, spread over 32 acres and providing free facilities and treatment . | The budgetary allocation for the Health Sector in 2010-11 was increased by up to 32% (compared to last year) to sixteen billion rupees. The total size of the health budget amounts to thirty eight billion rupees. Provision of free medicines for patients in Government hospitals is one of the top priorities of the Chief Minister. In this regard it is stated that an amount of Rs.
500 million was allocated for the provision of free medicine for the patients in Government hospitals. The study will target the doctors behavior to the patient. Doctors and beds were sufficient or not. Availability of free medicines for the outdoor patients in the hospital pharmacy. The patients and doctor problems regarding the infrastructure, and facilities available. Do Poor peoples have other option for their checkup except government Hospitals. The limitation of this research is that geographically it is only Restricted to Lahore, government hospitals only and specifically emergency wards of government hospitals.
| This research will focus on the causes and consequences of the problems at Emergency Department in Governments Hospitals Lahore in the year 2012. ” The significance of this study is to bring forward the problems of Hospitals in the Emergency wards. This research will let people decide who is responsible for these problems the Government, the Doctors or the patients itself? Questions Primary Question: This study will evaluate different perspectives concerned to the problems of Emergency ward of Government Hospitals Lahore. Subsidiary Questions:
The subsidiary questions of all aspect are as follows: 1. How the Emergency Wards work in the Govt. Hospitals? (arslan malik) 2. What is the infrastructure of the hospitals? ( arslan malik) 3. What are the problems doctors are facing while doing their duties? ( nasir butt) 4. What kind of behavior Patients want from the doctors? ( fahad khurram ) 5. What is the level of satisfaction of the patients in the Govt. Hospitals? ( fahad khurram) 6. What are the main problems that are faced by the patients in Emergency wards? ( fahad) 7.
Are the patients and doctors satisfied with its infrastructure? (usman omer) 8. What is the role of Management and administration in these wards? ( usman) 9. How can emergency wards condition can improve? ( arslan ) Literature Review A total of 50 doctors participated, out of which, 19 were males and 31 females. Out of all the reasons listed, 84% doctors favored the reason of inadequate salary to doctors & paramedical staff by government while other two reasons favored by 80% doctors were lack of facilities and security for doctors, illiteracy and poverty of patients.
This hospital based study showed that the causes were related mainly to hospital management, doctors’ attitude and responsibility and also to patients’ illiteracy and poverty. This calls for adequate measures by higher authorities to rectify the situation (JPMA 55:45;2005) On the directions of Chief Minister, Rs 878 Million were raised to provide free medicines to all government hospitals (Nation,2009) but still government fails to provide free medicines due to mafias operating inside government hospitals that used to steel those medicines (Nation,2010).
According to Nations (2011) Chief Minister was very unhappy about the cleanliness of government hospitals. He directed his health minister to submit recommendations in this regard including establishment of a monitoring system. Chief Minister pays surprise visit to services hospital after and inquired about patients affected by substandard drugs and he was quite happy about the management system of services hospital (Nations,2012). From all these articles, it came to know that the infrastructure of the hospital regarding beds is very poor.
The doctors are not satisfied with their jobs. They want a raise in salary and complete security of their life in the hospital. The condition of the Emergency ward must be improved. The doctors want a good behavior from the management towards them. From these articles it can be referred that the pays of the doctors must be increased and they must get complete security in the Hospital and the Management should behave with them in a good manner. The condition of the Emergency should be improved because it is the place which is helpful for the Victims of any Disaster.
The steps should be taken to solve these problems soon because it is effecting the treatment of patients both inward and outward. Emergency rooms are on the verge of extinction. Uninsured Americans and illegal immigrants are jamming the ER’s for routine healthcare because federal laws prohibit hospital emergency rooms from denying healthcare regardless of ability to pay. The National Center for Health Statistics (NCHS), reported that 27% of patients seen in the emergency room are children who do not need immediate attention, while 12% are boomers over the age of 65 who are often in medical duress.
The hierarchy of who receives prompt treatment is unstable as doctors attempt to balance the critical care patients with the non-critical. A shortage of physicians opting to specialize in ER medicine is significantly shrinking. That leaves many ER’s staffed by residents-in-training, with no senior specialist on site. ( Hardy . M,2010) Each day ER’s are forced to make decisions that are not in the public’s best interest. Ambulances are often rerouted to hospitals farther away. With this inefficiency and negligence of doctors death rate is increasing in emergency wards. ( Hardy. M,2010) Research Tools.
To get the maximum material for this research, not only articles, news, information on internet were taken, but the questionnaires and interviews were also conducted. The samples for the questionnaires are 30, which includes general public, doctors and patients. Analysis of Data and Discussion Doctors Attitude (Nasir Butt ) The Government Hospital are playing a vital role in the treatment of patients in Lahore. All the police cases have been handled. All the victims of the blasts, killing and the accident brought here for the treatment. For it there is a special department which is medical legal cases (MLC).
Well the hospital is meant for the treatment of patients. For this the doctors, management of the hospital and the staff are playing a vital role in it. Everybody have some problems. It might be because of some personal or some other reason. The media, the writers and the people are raising too many news that the problems faced by the patient are because of the doctors, the management and the staff. The doctors do not pay attention to the patient. According to the survey questionnaires result only 45% people agreed that the doctors are paying attention to the patients (See Appendix C, Q2).
The behavior of the doctors with patient is not good. They do not treat in a manner from which they got full satisfaction. It is not because of the doctors, it might be because of the thinking of patients. May be the disease that the patient got is not curable in an hour or in a days because the doctor knows better than us. It might take more than two to three days to get rid of it. Then why it is said that all is because of the doctors. They are here to serve the humanity. Few says that “doctors are in hospitals just for the sake of money only”. The doctors are also the very important personality in the society.
Are they mad? Are they out of mind to give wrong medicines? They are not the enemy. They are like friends. They are the most educated people in the society then any others. They have faced many hardships to reach their destiny. At the age of 32 they become a senior doctor. Then how can they do bad thing which might be harmful for their future. It can be imagined that the doctors are there to earn money in the private sectors not in the government sector. Then how can we say that they are creating problems for the patients in the government hospitals where the come to learn.
Everybody must have to see the picture of problem at the deepest level of it. We have no right to give comments on anyone by listening other people. Before saying anything to anybody he must have to see and meet him/his personally. Significant number of people said that the doctors are very rude with the patients whenever they ask them anything about their treatment. Mr. Ahmed (Personal communication 10 March, 2012) in the emergency said that “we know that the disease of our patient is curable from the doctors but the way they are talking to us is not good”. How easily it can be said.
But in the same mean it had seen that there are 5 attendants with the patient and all of them were around the doctor when he was monitoring the patient. Instead only one attendant is allowed with the patients in both wards. The doctors have to explain the disease to all of those who are with the patient. It is very difficult for the doctors because in emergency there are 8 house officers, 7 medical officers, 1 registrar and 5 senior doctors in a unit and each unit have the duty of 24 hours and in the emergency about 50 patients are treated in the emergency at a time.
So, according to the scene, it was very difficult for the doctors. At a time he has 5 files in the hand. One came to him and said “what are you doing here you are not paying attention to my mother”. In the meanwhile he was examining the other patient then how can a doctor manage? It will be very difficult for a person to do duty of continuous 24 hours. So, the management and the government must have to see the whole problem and must take steps to solve the problem. The doctors in the Emergency ward are very good with the patients according to their attendants.
So, it can be concluded that the doctor behavior depends upon the doctor duty. For how long is he working? Strikes also create problems for the patient in the outwards as in the Emergency ward. “When the doctors were on strike there was no one to attend us” ,patient said. In the article the writer said that “the doctors close the emergency ward for half an hour”. The patients who came there for their routine checkup were unable to meet doctors. Muhammad Afzal (Personal communication 10March, 2012) the patient of Emergency ward was discharge from the hospital last month came to the hospital in the outdoor for his routine checkup.
He got fracture in his left arm, he was treated by the surgery and came there for his routine checkup but the doctor was not available there. He said that “this was his third visit and isn’t got checked by the doctor because the doctor was not available. The writer and the whole media criticize it in a manner that the doctors are responsible for all it. They do not know their responsibilities. They just want to have there rights. They are not caring about the feelings of the patients. The management and the government officials said that “they want their rights at any condition”.
But for God sake please does not narrow your mind we have to take this Pakistan and touch the peak of progress. We have to make our mind broad and stop blaming each other. Doctors are human beings and they are part of our society. As they are the parts of our society they have right to raise their voice which is against them. As they are the most educated and responsible person of the society they know the problems of the patient. Then how can it be said that they are not seeing the problems of the patients. They have a family to whom they have to look after.
It’s a request to the informers, who gave information please don’t be biased please and comment on anything by remaining unbiased keeping all aspects in view. The actual problem behind the strike according to Dr. Ayyaz and Dr. Mujahid (Personal communication 10 March, 2012) was that, they were on strikes because the management is firing the house job student without any prior notice. They were also on strikes because the pay of medical doctor pay was insufficient. The medical doctor’s age is around 30. At that age everybody has his own family like wife and children. Young association hold protest for 4 hours.
They blocked jail road for the private and public transport. They said that they want to increase there salaries. Due to this protest there salaries where raised to Rs 60,000 from Rs 30,000. The authority member said that “the Government should pay attention to increase the salary of the doctors, there must be a pick and drop service for the doctors”. Another problem behind the strikes is that the doctors want security for their life and for their goods. The security for them in the hospital is insufficient. According to the questionnaires survey only 30 % agreed that the security is good (See Appendix C, Q8).
Anybody came in the Emergency wards and do any harm to them. According to the Dr. Mujahid on March 10, 2012 an incident was occurred in the medical emergency ward. Some people react very badly with a lady doctor. There patient was expired before coming to the hospital. They catch the lady doctor from her hairs fell her in the emergency and she got injured badly. These are the incidents which happened often that the doctors got injured by the reactions of the attendants. So, they want complete security of their life in the hospitals now there are guards in emergencies. Another problem according to the Dr.
Seerat (personal communication 15 March, 2012) is the entitlement of the families of the medical officers. The entitlement means that their family got treated from the hospital without any charge of payment. The last problem was that the behavior of the management with doctors is very rude. No check and balance is there for the admitting of the doctors. So, we all have to see the doctors not just as a doctor we have to see them as a human being and do the thing with them which we want to do with a human being. So, everybody cannot blame just the doctors we have to see the problem as a whole.
Where the things are going wrong, it might be a default in the management, might be in the behavior of patients. The person who is doing a duty for 24 Hrs. must get rude and tired. As the doctor who was on his duty for 48 Hours . So, it’s the government and the management duty to take steps to increase the respect of doctors in the society because they are the main part of any society. Patients Problem (Fahad Khurrram ) “Life is a gift, and it offers us the privilege, opportunity, and responsibility to give something back by becoming more” (Anthony Robbins).
With the birth of man, diseases for him were also created. In the early stage of human history, people suffered a lot because of many fatal diseases. However, with the passage of time, man used his wisdom and knowledge and developed health-caring centers which ultimately assumed the form of hospitals. These Hospitals are considered as the curing places for the patients. A person suffering from any kind of disease can hope to be cured in the hospitals. Hospital is considered as the place where one can find treatment immediately by the kind treatment of the doctors.
These hospitals are considered as those places where one can guarantee good care, sympathetic attitude of the doctors, good nursing staff and ward boys, availability of medicines, high standard of hygienic conditions and less amount of money required for getting all these facilities. But this dream shatters when you enter “Government Hospital” of Lahore. When the research team was entering the hospital, they had a very good picture of it. However, the inside world of the hospital is entirely changed from what appears from the outside.
As said before, hospital should be a place of comfort and good hygienic conditions and solving all the problems of the patients. But here various patients associated problems were found specifically when “Emergency Wards” were visited. Some of the major problems which were noticed over-crowdedness of the Emergency wards; lengthy administrative procedures to admit a patient; MLC issue; unavailability of medicines; lack of doctors; untidy conditions and lack of trained medical staff. The most important and noticeable problem which is directly associated with the patients is Lengthy administrative procedure to admit any outdoor patient.
Emergency ward is the place where there should be no delay to admit a patient who is brought there in very critical stage. The relatives of the patient are already in very confused state of mind. But they are given a complicated form of fill up. According to the management of the Services Hospital, such kind of procedure is very essential for the record-keeping and data formation for future use. Another noticeable thing is that less help is provided in the procedure. The relatives of the patient remain blank about what to do. It does not mean that the patient is altogether neglected.
The on-duty doctor in Emergency ward attends the patient and gives him necessary treatment. But the complete treatment is started after the completion of paper work. This administrative procedure is even quite hectic in the Emergency ward. No special attention is paid towards the patient as he is not in a very critical situation. Moreover, the doctor and nurses in the Surgical ward are less active as compared to the Emergency ward. Here, one fact should be kept in mind that the relatives of the patient should have a bit know how to go through this administrative procedure and should co-operate with on-duty staff to get the things done.
Another note-worthy issue is the problem of MLC i. e. Medical Legal Case. This issue is related to those patients who get injured during some accident and fight. This MLC issue is directly related to the Emergency ward. In this situation, when the patient is brought in the Emergency ward, he is given initial necessary treatment. The doctors are very careful with the patient and they have to wait for the police department to take some necessary action. Unless and until any person from the police comes, the medical staff cannot take any further step.
In such cases, delay by the police may cause some great loss on the part of the patient. This has been observed that in some cases this MLC issue is not handled properly. When the admission form is filled for such patients, these three letters “MLC” are written at the corners of the form so that necessary legal procedure can be done afterwards. However, the doctors and the medical staff don’t mention MLC on the forms of some of influential patients who have strong background. This is done to save them from the long legal procedure or some other political issues.
The Emergency ward remains away from such MLC issues because the patients here are not like those involved in some accident and fighting. However, if the medical staff does so it is because of their own job-safety. Doctors avoid themselves from becoming part of this investigation. Next problem in the line associated with the patients is “Lack of Doctors”. Services Hospital of Lahore is one of the biggest hospitals of the city. All the departments of the Services Hospital are quite large with good capacity for the patients. In emergency good numbers of patients are brought daily for the treatment.
In total, about 200 beds are available for the patients in the ward. But unfortunately, there are only 6 to 7 doctors for attending twenty-seven patients daily which is not encouraging thing. Keeping in view the capacity of the patients of this hospital, more doctors should be allocated for the patients. This problem of lack of doctors causes serious threats to the lives of those patients who need immediate treatment. This is an important issue which needs immediate action on the part of the hospital management. More and more doctors should be given job opportunities by creating more vacancies.
Their salary package should be good enough to attract them. As you enter the Government Hospital it seems as if you have dived into the sea of people. People and patients are seen moving here and there by holding different prescriptions for medicines. Some patients are waiting for their turn outside doctor’s rooms. Some patients are in search of medicines. Some patients are seen disappointed about their fate. In short, a gigantic crowd is seen inside the hospital. People other than the patients ought to be accompanied their patients. They need to stay with their patients.
It is unimaginable to think that only the patients should be given entry in the hospitals. Thus, this situation makes the hospital over-crowded. Though, hospital authorities have done something to accommodate these people but this is not sufficient. Inside the Emergency ward especially, there is lack of seats for sitting. Most of the people remain standing which makes the place over-crowded. Moreover, outside of these wards less space has been allocated for the people to sit. But hospital is not merely responsible for this state of the things. There should be limited people coming with the patient.
Usually 3 to 4 people come along with the patient. It must be discouraged. Apart from the care and attention of the doctors and the medical staff, medicines play a major role for the treatment of the patients. If medicine is readily available, the patient can be saved from serious disease. Here in the Government Hospital, one major issue is the “Unavailability of Medicines” which is a grand issue. Though a Medical Store is located inside the hospital but it is without some vital medicines. When a patient is brought in the Emergency Ward, initial treatment is given by the staff.
However, it has been observed that some of the medicines are lacking here as well which may be very dangerous. When any of such medicines is not available from the Hospital medical store, the relative of the patient has to run out of the hospital to search for it which may delay the treatment of the patient. This situation of lack of medicines is more serious in the Emergency ward where hardly any medicine is found. The on-duty staff all the time forces the patient to get the medicine from outside(Appendix A,1. 1Q6). One of the patient said that he bought most medicines form outside.
There must be a regular check on the stock of medicines in these both wards to avoid any problem. Infrastructure (Arslan Malik) The infrastructure of Services and General Hospital Emergency is satisfactory. The patients and doctors have to face many problems regarding the infrastructure. The Emergency wards of hospitals has been visited many times to monitor these problems. The management has claimed in the interviews that the infrastructure of hospital is good. Some of the patients and staff members were also agreed with that, but many of them strongly disagree with it.
In order to know the reality and truth, views of different doctors, patients, staff members, and patients’ attendants, through interviews, surveys and questionnaires. This aspect of the research will put light on the infrastructure of the Emergency Wards of the Government Hospital. There is no appropriate division system for gents and ladies medical emergency . The ladies and gents are shifted where the bed available. The ladies have to face many problems regarding this. The Emergency of Government hospital is very crowded because there are many people with one patient.
There is the permission of only one relative with one patient but everyone enter the emergency. If the guard stops them to enter, they start fighting with them “Each patient is accompanied by four to five attendants on average, which increased the load of visitors up to 1,500 people in the Emergency Ward alone. ”(Mr. Butt, 2012). By this huge crowd in the Emergency, the patients are distressed and could not rest for some time to recover soon. The child Emergency is facing many problems regarding infrastructure. There are no toys for the children.
When the children are in pain, only toys can divert their attention. So the management should bring in some small toys for the children. The paintings of different animals and cartoons should also be displayed on the walls so the child will be attracted to that. Emergency of services hospital is of normal size but the beds available in it are only near about125. The total numbers of patients that are treated in an emergency daily are 700. The young doctor said that the beds available in the emergency are not sufficient.
So they have to discharge after the treatment when they see that the patient will recover at home but not completely sure about that. Mr. Ali who was sitting outside with great tension said that his son fell off from bicycle and need small dressing but the doctors refuses him and advised Mr. Ali to wait for some time (Personal communication, (10March, 2012). The outdoor patients also come into the emergency unit and occupy the beds and the patients that have emergency have to bear pains. In this situation, it is very difficult to handle the Emergency if any mishap happens.
The Rescue 1122 also brings patients to thus Emergency and the short of beds happens often. The beds are also not in good condition (See Appendix C, PIC E), the back cannot be pulled up or push down, until the bags are put or pull out from the back. Even the wheel of the bed is not available. This take a lot of time to adjust and still not satisfies the patients. The sound of various types comes out when the patient slightly moves or bends. The machineries available in emergency are not sufficient for the treatments for the various diseases and emergencies.
The facilities of Government hospitals especially in emergency ward, are not satisfactory, as it has to be. Emergency means unexpected facts happened for whom you are not well prepared but you have to give treatment as early as possible or within time. So for his instance especially facilities in such must be fast, modernized and up to date. But when it has been observed that the emergency ward of services hospital in Lahore we were strange to see such atmosphere, which was not only poor, but also out dated.
First of all when patient arrives he has to take slip which is time consuming and patient have to wait very long. Patient have to stand in long queue for slip and person who is sitting on that desk is not that much educated as he should be, he is also not able to advice patients where they have to go for specific doctor. There are two kinds of emergency ward, one is Surgical Emergency wards and second one is medical emergency ward, but for both patients have to take slip before going there.
For medicine emergency as patient is dying from pain he has to pass from whole procedure which is that after taking slip, , after that patients have to wait a lot for their turn because they don’t have enough staff or facility to facilitate patients well and in good manner. When the research team talked to MO (medical officer), he tells us that they have enough staff and they are able to handle any emergency situation. As team were in hospital very long and observing different patients they saw one patient with pain in his stomach but he have to stand in queue for slip and then in MO office for his turn.
These things seem to be improved by increasing more staff in their emergency ward. It has been observed that with one patient three or more person are coming along him with no reason, without checked by doctor or any stuff member in emergency ward. When the team in emergency ward even that time no one asks us that why we are here and for what purpose, we stayed there for hours we went to many places in Emergency such as Operation Theater, X- Ray room, on duty doctor’s offices but everything was opened and there was not even one responsible person who asked us.
Record of patients was openly available on table of doctor even its flying in air and no one was checking that records or taking interest. So to avoid such kind of problems and mishaps they should fit security cameras, security machine or give proper instruction to guard to check every person before coming in and exit so that good system of check and balance should be avail to avoid unexpected misshapes. The staff in the emergency ward that is also not sufficient according to the rush of patients all day.
Due to which they can’t handle well enough and more causes of fight and threats from the patient relatives occurs which can not only disturbed the patient itself and also the environment. No one knows when these small matters become serious problems. This is due to the reason that in emergency they don’t have required staff available; therefore for doctors also have a lot of work to do without any special pay and facilities. One more thing is that doctors have lack of facilities such as they don’t have pick and drop facility available which causes sometime headache for doctors and also they can’t reach hospital at time.
If somehow in emergency case and any expert doctor is not available and hospital needs him, doctor’s have to come by himself there is more chances to get late, the management should have to start pick and drop facility that doctor can come on time and treat their patients well. Moreover when the team enters in emergency ward . No, doubt cleanliness was satisfactory when asked the doctors in emergency they also told us that they are satisfied by the cleanliness and hygienic process in emergency they hired a private company and it’s their job to maintain the cleanliness in ward. But specially their dustbins was full with used inje.