About a dozen men are on the stairs, in between sitting, standing and leaning against the wall. Their discomfort is eclipsed only by the nauseating reek of paan, cigarettes, urine and antiseptic. A security guard is pushing away people who are trying to get past him through the iron gate that leads in to the gynaecology ward of Civil hospital.
More than a thousand people visit this section of the hospital every day. They are the attendants of the women who are either giving birth.
“It has been like this since I brought my wife here two days ago,” said Ziaullah, a fruit salesman, as he gestured to the continuous rush of people coming up the stairs. “But I am still very satisfied. They haven’t charged me anything.”
For those who cannot afford private hospitals, institutions such as Civil and Jinnah hospitals are a lifesaver.
But these public hospitals, especially the National Institute of Child Health, are sprawling establishments where, even though it is free, the healthcare’s standards are not the same as those offered at the private alternatives. Patients sometimes pay dearly - as was demonstrated by the case of the baby boy who was kidnapped by a trainee nurse at NICH on November 4. She was arrested on Sunday and the baby was rescued, but the incident exposed the holes in the systems in place at the government hospital.
At least five infants have been reported kidnapped so far this year, from Civil hospital, the NICH and Sindh Hospital, Liaquatabad. In most of the cases, nurses were to blame.
On the face of it, the administrations at these public hospitals have taken the right steps. At Civil hospital, 40 private security guards have been hired to check people entering wards.
However, there is hardly any audit of their performance. “The paramedics don’t wear their identification cards and even doctors don’t all wear their white coats,” said one staffer there, who did not want to be named. “This is particularly disturbing in hospitals like Civil, which are very big. Hundreds of people spend the night in its lobbies, on the stairwells and outside. No one really cares if they really are with the patients or not.”
Part of the problem at government hospitals are the sheer number of patients, far more than even the biggest private hospital at least in Karachi. It thus comes as no surprise that Mohammad Sohail, the security manager at the NICH’s children’s nursery from where the baby was stolen, said that it is nearly impossible for them to keep an eye on everyone.
“The nurse told the guard she was taking the baby out for a check-up,” he told The Express Tribune on Monday. “She knew the drill. She had the baby’s medical file and was with a woman pretending to be a relative.” According to him, there are 40 incubators in the nursery and around a hundred people ferrying in and out. “How could we have stopped that?”
He has a sympathizer in Dr Bari of Indus Hospital, who used to work at Civil hospital at one point. “To be honest, there can be no real comparison between the public and privately run facilities,” he said. “You are dealing with five deliveries in a private hospital and 50 at a public hospital.”
Nursing staff at NICH were too scared to comment on the case, which has also put all of them on the defensive. The ones who spoke off the record, blamed miserable salaries - a trainee nurse gets Rs13,000 a month. And while low pay was the motivation for the NICH culprit Sobia Saleem to kidnap and sell the baby for Rs40,000, the mere fact that she could leave with one signals a management system problem.
Another challenge to security is the aggressive behavior of visitors. Several cases were reported this year in which visitors beat up doctors and staff after the death of a patient. “We have been thrashed so many times just for asking someone why they are visiting,” said NICH’s Sohail. It is here that the hospital staff find themselves in a Catch-22 situation; even if they want to enforce security and restrict entry or check identities they face the risk of violence.
“It’s all about the training,” said the head nurse at an upscale hospital in Clifton that charges top dollar for its services. “A trainee nurse here gets pretty much the same salary being given in public hospitals.”
Stealing a child is not an everyday crime, she said, especially for the health professionals. “This reflects poor ethics. In any case, this is where a good hospital management plays its part.”
At this hospital, staff assigned to a specific section cannot even venture into another area. “We immediately stop them and question them,” the head nurse explained.
The nurses have to pass through a security check before entering and exiting the hospital. Their bags are checked even for stolen medication. A biometric thumbprint-scanning system helps the management keep track of their movement. If a baby has to be taken out of the nursery a nurse will accompany it along with the mother or relative.
Otherwise, the minute a baby enters this world, a little tag is snapped on their wrist and the mother’s name is put on it, ironically the only time in this society that a person is identified by their mother’s name.
At AKU, even the mother is tagged. And mother and child are both checked to match before the baby can be taken out. According to AKU’s director of safety and security, Col. (retd) Saleemur Rehman, they actually send in a woman in a burqa with a baby doll to discover in a monthly drill if they have any security loopholes. “In the NICH case, it was trainee nurse who took the baby,” he said. “We have authorised nurses who can deal with a baby.” Staff can only get in with electronic cards and closed-circuit cameras work round the clock.
Rehman dismisses the argument that security becomes a challenge if the numbers are big. He argued that AKU sees 21,000 visitors a day with about 12,000 vehicles entering the premises. “The [difference] is that we have made proper protocols and we have to follow them.”
Published in The Express Tribune, November 15th, 2011.
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