Over two months ago Muhammad Nazir had his leg amputated due to diabetes. He had to travel over 100 kilometres to a public hospital in Rawalpindi for the procedure.
He was told to get monthly transfusions for three months. However, after multiple visits to the District Headquarters (DHQ) Hospital, he has failed to get the required blood.
On his last visit, he was told to either go to a private facility or make the trip to Rawalpindi.
For Nazir and many other patients, the phrase 'take him to Pindi' has become a repeated refrain at the DHQ Hospital. They say the practice has taken deep hold, with healthcare providers resorting to 'referrals' even in simple procedures 'to keep their workload at a mini- mum and divert patients to their private practice'.
Aqsa Rabab, another such patient, suffers from chronic back pain. She says she was sent back after a painkiller shot every time she went to the hospital.
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When she told the orthopaedic at the outpatient depart- ment (OPD) that the shots weren't helping with the pain, he told her to go to a private healthcare facility or one of the public hospitals in Rawalpindi.
For Rabab, it was an expensive trip. When the family insisted that she go through further tests at the DHQ Hospital, one Dr Zeeshan told her to get an MRI. She could only afford it at the public hospital in Rawalpindi and was left with no other alternative.
The DHQ Hospital is the only secondary care public healthcare facility for a population of two million. The majority cannot afford to go to a private hospital. Meanwhile, at the primary government facility, they are met with a shortage of staff and services.
Patients complained that they often had paramedics looking after them with doctors unavailable for long periods - even in cases of emergencies. One attendant said that he went through the entire hospital in search of a surgeon and couldn't find one despite the require- ment to be on-call.
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The situation, they say, is worse in the surgery depart- ment. This has happened to a patient who suffered a bullet wound, said another attendant.
"How can you transport a patient with severe injuries to a hospital two hours away?" asked Ali Riaz, who was at the hospital with his family.
One member of the hospital staff, speaking on the condition of anonymity, said he knew cases where pa- tients had died during transportation.
The staff member said that a separate counter should be set up at the hospital to track referrals.
"It will soon emerge that only people with fevers, colds, and other minor illnesses are treated here while the rest are given referrals."
Healthcare providers resort to 'referrals' even in simple procedures 'to keep their workload at a minimum and divert patients to their private practice'
Another patient claimed that when he went to the hospital with a sore throat, he was first told to get a test done at a private laboratory. After that, the doctor re- viewed it 'for a second' and told me to go to Rawalpindi to find out if he needed surgery.
According to one regular visitor to the hospital, the hospital had a better reputation before the current medical superintendent (MS), Dr Asif Arbab Niazi, took charge.
One hospital insider said that Dr Niazi's 'poor performance' had been rewarded with a promotion to the post of chief executive officer while Dr Anjum Kabeer would take over from him.
"Even the MS has a private clinic, as do most of the doctors working in the hospital. That is why they prefer referrals so that their clinics could benefit," the hospital source continued.
During Dr Niazi's tenure, they said, the hospital was perennially short of medicine - including insulin and dog bite vaccine - a claim that was made by multiple patients as well.
"In all of this, those with influence and connections got the medicines as well as the treat- ment," they claimed.
The hospital has also been marred with claims of mis- management with equipment often dysfunctional or lacking technicians and operators.
At least one attendant told The Express Tribune that er- roneous test results left the patient in their care, Sarah Zahoor, battling for her life. She is currently admitted at the DHQ Hospital only.
The hospital is underequipped. In some cases, two pa- tients were sharing one bed at the 200-bed facility. The staff also complained of being overworked due to staff shortage.
This was despite the hospital spokesperson, Dr Muhammad Haleem, claiming that the 118 doctors and roughly 150 nurses and healthcare providers were adequate to deal with the daily influx of 6,000 patients.
According to the hospital source, nurse Musarrat Yasmeen had applied for leave on account of ill-health a few weeks ago. It wasn't approved due to the 'dictato- rial' nature of the MS. She has since passed away, said the hospital staff member.
According to the staff member, Dr Niazi was removed from the role of MS on the orders of the deputy com- missioner, Quratulain Malik, following protests from healthcare providers.
"He was reinstated four days ago," they added while insinuating that was connected to powerful individuals.
Because of Dr Niazi's 'influence', visits by ministers and other high-ranking officials fail to identify any problems at the hospital, the anonymous staff mem- ber insisted.
For patients and their attendants, the situation re- mains dire. They are tired of seeing their loved ones suf- fer at the hospital with the sword of 'referral' hanging on their heads. They also want the hospital to provide the numbers and explanations for patient referrals made by the hospital.
"The reason due to which the patient was referred and why he was unable to receive the services here should be addressed," said Muhammad Nazir, who couldn't get blood at the DHQ Hospital.
Dr Haleem, the spokesperson, was dismissive of the complaints and called it 'targeted propaganda' without specifying who would do it and why. He insisted that the hospital was providing the best possible facilities.
"Only 22 patients were referred to Rawalpindi out of the more than 80,000 patients who benefited from the services at the hospital in September," he claimed.
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