Hazardous hospitals

Right outside the main gate of JPMC, visitors are greeted by an open sewer, or as locals call it, ‘khula gutter’

The fundamental mission of public hospitals is pure. To provide care to the masses and to ensure that the most fundamental of human rights, access to health, is delivered regardless of any discriminatory criteria is the noblest of missions. But the purity of the mission is not translating into the purity of premises. Recently, as I was visiting Karachi, I had the opportunity to stay close to Jinnah Postgraduate Medical Centre (JPMC). I am not sure about the quality of care provided there since I did not have any reason to seek treatment. But right outside the main gate, for each day that I passed through the campus, the visitors were greeted by an open sewer, or as the locals would call it, “khula gutter” (open gutters). Those who were entering or leaving the premises were exposed to filth, disease and disgraceful levels of sanitation. Not too far from the hospital are trash heaps, with both solid and liquid waste, where not only people dump their trash, the men also use the space, close to the wall, as a toilet.

Perhaps the open sewer, heaps of trash and general hygiene at a level far below any acceptable standard may not be the main problem facing our cash-stricken hospitals, but our acceptance of status quo certainly is. As I spoke to shopkeepers and residents around the area, I recognised a tacit acceptance of the situation with the standard ‘it has always been like this’ response. First, this is not true. It has not always been like this. Second, just because it has been like this for a while does not make it right. These days, the challenges of being sick and poor in Pakistan are not just to find access to a hospital, especially when the doors can be locked any moment and life can be elusive because of a powerful politician visiting, it is also to make sure that you do not catch another disease because of the raging filth, or develop a complication because of an infectious pathogen lingering in a sewer at the doorstep of the hospital.

The filth in and around hospitals is also problematic for society at large on another level. With our impulse to take an antibiotic the moment we sneeze, lack of any prescription system to buy antibiotics and the suspect quality of drugs in the market, having an open bacterial culture close to one of the biggest hospitals in the most populous city in the country is like playing the Russian roulette, with worst possible odds. Those who could not care less about social justice, travel in cars with rolled up tinted windows and conditioned air that make the pedestrians look sub-human. They should also realise that infections have little regard for gated communities and make little distinction between those who speak Urdu at home and those who speak accented English.

The problems at JPMC are, unfortunately, not isolated but it is even more disturbing that it is also an institution of learning. What is the lesson here for the students? The response given by those who I spoke to was one that we have all heard before. It was not an argument, but passing the blame to the other. The ‘other’ is usually (in that order) the federal government, party in power, management of the hospital. Not surprisingly, not once did I hear any argument about ownership, responsibility or self-reflection. Not only is there a common sense reason to save our hospitals from collapse, there is a strong economic reason to do so as well. A clean hospital will be more efficient, effective and less likely to deal with recurring infections and high costs associated with those. But more importantly, a drive to clean the environment of the hospital will build inspirational capital that is so desperately needed.

The lives of all people are sacred, and safety should not only be measured by the decrease in gun violence. As we strive for a Karachi that is safe from extortion and targeted killings, we also need to strive for a Karachi that protects life and health of its citizens by providing them safe and clean places of diagnosis and treatment.

Published in The Express Tribune, January 12^th, 2016.

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