In a rare development in the field of medical science in Balochistan, a team of doctors at Sandeman Provincial Hospital (Civil Hospital) Quetta have carried out two successful open-heart surgeries. The poverty-stricken people of Balochistan term this welcome news for the least well-off people to have this facility within the provincial capital.
This milestone achievement is not only a great success for the doctors at the hospital, often working in very trying circumstances with inadequate facilities and paramedical staff but also a great relief for hundreds of thousands of cardiac patients in the province.
Hitherto, cardiac patients had to travel to Karachi, Lahore and other cities for heart bypass surgery costing millions of rupees over and above other costs for traveling, accommodation, and subsistence.
“We took our father to Rawalpindi, Karachi, Sukhur and other cities for cardiac treatment and spent hundreds of thousands of rupees in terms of travelling, accommodation and other related expenses but yet the cardiac problem was getting complicated,” said an under treatment cardiac patient son from district Noshki. “After bypass surgery, I’m glad my father is recovering now,” the son said.
Cardiac Surgeon Dr Asmatullah Achakzai, a member of the first team who operated open-heart surgery, said, “The patients we operated here had travelled to many cities for treatment purposes, spending an estimated Rs350,000 each in terms of travelling and accommodations and other related charges.”
“Few days ago when one of the two recovered patients visited the hospital, his condition was complicated and we recommended him for a bypass surgery. When he came to know that the hospital has a bypass facility, he wasn’t ready to go home back, was insisting to admit him and conduct surgery as soon as possible,” Dr Achakzai recalled. The patients had spent hundreds of thousands of rupees on visiting Karachi and Lahore and other cities for treatment, the cardiac surgeon informed.
This development has been a milestone achievement in the medical history of Balochistan at the provincial level. In this regard, Naseerullah Khan, a local resident, said, “We are proud of the team of doctors who made this possible for the poverty-stricken people of the province to get free of cost quality treatment within their province.”
This development could be made possible with the special interest shown by a team of dedicated doctors, hospital management, and provincial health authorities, according to the statement issued by the hospital management after conducting two successful open-heart surgeries.
The team of doctors, led by Dr Arif ur Rehman Dr Syed Dawood Shah, Dr Aftab Ahmed Khatri, Dr Asghar Ahmed, cardiac surgeons Dr Asmat Achakzai, Dr Abdul Wasay, Dr Aqeel and others took part in the operations.
Sandeman Provincial Hospital MS Dr Amin Khan termed the development a rightly described success, adding that this achievement is a result of joint effort by medical and para-medical staff, pharmacists, perfumers and other relevant personnel.
Dr Amin Khan further said the sustainability of the cardiac facility depends on the availability of resources now as we have acquired a trained and trained doctors teams at the hospital now, adding that the hospital has a number of challenges including acute shortage of nursing staff and other resources.
Dr Amin expressed fear that lack of financial resources and shortage of nursing staff can damage this noble cause if not addressed in time. He went on to explain that the cost of disposables per patient is estimated at Rs130,000 adding that, “We need continuous assistance from the government as well as donors and administrative autonomy.”
According to Cardiac Surgeon Dr Abdul Wasay, “Our province was lacking in the field of cardiac surgery, when I was doing my house job after MBBS we were sending lots of patients to Karachi and other cities for open heart surgeries, and many of them died in our hands because they couldn’t afford to make it possible. This gave me a push to go and achieve specialisation and excellence in this field to serve our people back in my hometown.”
Dr Asmat Achakzai added, “A bypass package has different rates ranging between Rs500,000 to Rs800,000 in different hospitals. We are here providing state-of-the-art treatment free of cost in this hospital.”
The cardiac surgeon said that the disposables used during operations are expensive and are to be afforded by patients. “If we can have financial support and a regular supply of disposables and other logistics our 90 percent patients requiring heart surgeries will be treated in home town with best care and at least equal to if not more than sister provinces,” he said.
“We are hopeful that the government will continue provision of resources to continue this process free of cost to the poverty-stricken people of Balochistan,'' Dr Wasay expressed hope.
“Earlier, we were short of trained staff, anaesthesia doctors and surgeons. Since we returned after completing specialisation, we made a team of dedicated doctors, who took them to NICVD Karachi for training and after that such open-heart surgeries could be possible,” Dr Asmat added. Initially, we were provided resources for three patients’ surgeries, which we had done, he said.
Dr Abdul Wasay said, “We have a well-trained team of doctors but it would not be sufficient to provide treatment to a large number of cardiac patients in Balochistan. Thousands of people are forced to travel to Karachi, Lahore and other cities for treatments.”
Currently, the hospital has a list of 72 patients for open heart surgery, who will be operated in the coming days.
However, the hospital still needs a mass level awareness campaign to inform people about the state-of-the-art facility as people who don’t know about this facility are still travelling to other cities for treatment.
“For the initial start of the program we have basic requirements to continue open heart surgeries but to entertain the large volume of patients that we have in our province and to operate complicated operations we need much more support from officials to make it possible for the poor masses of Balochistan,” added Dr Abdul Wasay.
Balochistan Secretary health Saleh Muhammad Khan said the health department will try its best to manage resources to continue the heart operations in the hospital and in this regard the department has not only allocated special funds of Rs 30 million but is in talks with donors in order to increase further resources. Terming it a milestone achievement in the history of Balochistan health sector, he said the team of medical staff will also be honoured as well as cash prizes and this regard named list has been dispatched.
He said so far seven open heart surgeries have been conducted at the Civil Hospital Quetta and the process is continuous, adding that a single case needs almost Rs400,000 investment and Rs200,000 are kept in savings for any post-surgery complications so that the patient's life could be ensured. Secretary Saleh further said the government has decided to allocate an estimated Rs46 billion for the health sector in terms of development and non-development budget, out of which Rs30 million will be allocated for Civil Hospital’s cardiac units.
Regarding the initiative, he said that a group of qualified doctors who have completed their specialisation from NIVD Karachi arrived in his office and asked for finance to start open-heart surgery and shared details of an estimated amount and requirements for surgery, which was provided to them within a few days.
No One Should Die of Heart Diseases
“Being a native of Balochistan, this success [for me] is like a dream comes true,” said Dr Abdul Wasay, adding that “some five years ago we travelled to NCIVD Karachi with the mission to give back to the native people after completion of this specialisation. And our mission was to ensure quality cardiac services to patients at initial stage and later to bring the hospital at par of hospitals of developed cities of the country,” Dr Wasey informed.
“After a long journey when I completed my qualification, I worked to learn how to establish a new setup in an area where people are completely unaware of this specialty; I took guidance from our mentors, many founders of institutions there in Karachi and also in Quetta, and started contacting concerned government officials and put my cause before them,” Dr Wasay recalled his years long efforts to achieve this milestone.
“Initially it was considered an impossible project by all of us, but due to our continued efforts finally we got to have some support (in terms of logistics and human resource and their training in NICVD Karachi which is a renown and an established institute in the field) from hospital management and health department to prove ourselves if we could really make it happen,” he said.
“We had to work in bare minimal circumstances but to prove that it can happen so that we can have their full support for the cause,” Dr Wasay maintained.
“Today we are so happy for the dream to come true,” Dr Wasy said proudly, adding “We have performed at least six to seven bypass operations so far and they are doing well and having smooth recovery. We have our initial team very strong, dedicated and capable of doing every kind of heart surgeries, we have to extend the program and our wish and vision for the future is to extend the program to other cities of the province, and the slogan is ‘No One Should Die of Heart Diseases’.
The 83 years journey of struggles
The Sandeman (Provincial) Hospital, Quetta was established in1939 after the earthquake of 1935 on Jinnah Road, Quetta for a population of 50,000 with bed strength of 50 comprising 7.38 acres of land with a covered area of 268134 Sq. feet.
In 1973, Sandeman Provincial Hospital, Quetta affiliated with Bolan Medical College Quetta as Teaching Hospital. In 2001, after the completion of Bolan Medical Complex Hospital, all the Department units of Sandeman (Provincial) Hospital were shifted to Bolan Medical Complex Hospital.
Soon after shifting, it was realised that Bolan Medical Complex Hospital alone cannot fulfill the requirements of patients from all over Balochistan. After that 50 per cent of each major unit of every specialty and some minor specialties along with teaching staff were shifted back to Sandeman Provincial Hospital.
Currently, the government is also planning to shift the cardiac unit of the hospital to another place. The hospital managements and doctors are feared that shifting an operational unit to another place would not only damage this noble cause but also increased shortage of medical and para-medical staff in the hospital. Being centrally located in the city, the hospital is easily approachable to the common people. Post Graduate Medical Institute Quetta was established in 2003 for various medical diploma courses affiliated with Sandeman Provincial Hospital, Quetta. The Clinical Section of Dental College is also established in Sandeman Provincial Hospital, Quetta. The hospital provides treatment facilities in 18 areas and it is 850 bedded hospitals.
Non-Availability of Cardiac Patients Data
When this correspondent asked for statistics of heart patients from the hospital management and the provincial health department, they said thousands of patients visit hospitals both in government-run and private hospitals in the province. However, neither the health department nor the hospital management have established database to maintain record of the patients. The provincial health secretary said there is no database system to have exact statistics; however, he said heart diseases take thousands of lives in Balochistan every year. According the hospital to the latest WHO data, published in 2019, 251,220 deaths occur per year due to coronary artery disease that is 20.28% of all cause deaths. And also Pakistan is ranked 3rd in the world for rheumatic valvular heart disease and rural and poor areas such as Baluchistan are more prone to succumb to this disorder as compared to other provinces. And every patient needed open heart surgery had to be reoffered to other provinces due to lack of a functional department. The age-adjusted death rate is 193.56 per 100,000 population ranks Pakistan 30 in the world.