The healthcare system of Pakistan, and its tie in with COVID-19 influx

Hospital staff pray before begging their work shift outside a hospital for coronavirus infected patients in the capital of Balochistan, Quetta on March 26, 2020. Arshad Butt, AP

Throughout the world, Healthcare workers are fighting with the pandemic like the front-line soldiers in a war. Pakistan is more prone to the transmission of the disease both due to its neighboring countries being the main center of the disease and its geostrategic location. The country has a multifaceted healthcare system that is subdivided into various domains. All these domains including the public sector, private sector, parastatal, and donor agencies work to provide the people of Pakistan a healthy lifestyle.

Health is primarily a measure of each person’s ability to do and become what he wants to become.

René Dubos

American Microbiologist

A healthy population will provide the country with a better Human capital resource. Although the healthcare system of Pakistan has improved over time, but still it is a far cry from attaining the standard that the developed countries have set. Pakistan spends only 3.1% of its GDP on healthcare. More than three-quarters of the population has to take care of their medical expenditure by themselves, among them too, 75% are dealt with under the private sector, the public sector serves the remaining only. Pakistan is not yet ready to deal with a nation-wide emergency like the current pandemic. At present, there are only 15 testing facilities, a total of 8,718 beds available in quarantine, 2,058 beds in isolation, and 35 designated COVID-19 tertiary care hospitals for a population of 200 million, which is like a drop in the ocean.

Influx of pandemic and its spread

Pakistani rescue personnel take part in drill exercise as a preventive measure for the spread of the of COVID-19 coronavirus, in Peshawar on March 1, 2020, as Pakistan has detected two new cases of the novel coronavirus. AFP

The first victim of the coronavirus was seen on the 26th of February in Karachi, a student who recently returned from Iran. Within one month this ominous disease had spread all through the four provinces and the capital of the country. Thereupon, more than 44,000 confirmed cases have been reported to date, with the death tole touching one thousand almost. Although the symptoms and the danger of its contagion were known to the masses even before the disease entered our country, yet people are reluctant to take the precautionary measures. The government ensued lockdown throughout the country to keep the interaction among people to the minimum. People were told to home-quarantine themselves for the sake of their own lives and the lives of their loved ones as the disease are more lethal towards the elders. Malls and markets were closed except for the essential shops, offices, industries, and all the educational institutions were closed until further notice. Unlike the developed countries, Pakistan doesn’t have enough resources to feed that part of the population which earns daily wages. Lockdown was nothing but the declaration of famine for those families.

If we shut down the cities [… ] we will save them from corona at one end, but they will die from hunger on the other side.

PM Imran Khan

17 march 2020.

Charity based aid of such families was started and is still being done. Despite that, the quarantining is not obeyed by the people, which is why there is constant stress on the hospital and healthcare workers who are pleading the public to stay at home. Thus, the number is rising every day.

The oppression of the decrepit health system by COVID-19

The healthcare system of Pakistan is in a serious crisis due to the current pandemic. We, in the first place, didn’t have enough medical facilities, especially in the public sector, to give proper care to our patients. Some of our hospitals are still not equipped with modern instrumentation. Even though there are enough medical institutes throughout the country, yet due to the brain-draining of our young doctors to foreign countries, a lack of medical personnel is also observed. Due to the fear of getting infected, some of the senior doctors are not attending a patient that is a suspect of Covid-19.

Your healthcare system is not equipped to support you, and if the system does not support its own staff, do you think it will support you? Take care of your health; stay at home and keep your children at home.

Dr Shobha Luxmi

infectious diseases specialist at Dow University of Health Sciences, Karachi

The medical personnel is facing extreme stress and trouble these days. Hospitals are unreasonably crowded with panicked people. Everyone wants to get tested even for the slightest of the symptoms they feel. This behavior in the public is not only creating unrest in the hospitals but also increasing the risk of exposure. Tele-medicine is introduced by various public sector hospitals to guide the patients online while they stay safe at their homes.

Due to the lack of provision of PPEs, doctors are restraint from attending the patients, for obviously, if the doctors themselves are not protected, how are they going to treat the patients? If by any chance a doctor who isn’t properly covered, gets exposed to the virus and unknowingly continues to treat the patients in the ward, he is rather a death-note in disguise, than a doctor to them. Up to 1500 doctors and paramedical staff are infected and quarantined. The dilemma is the long incubation period of the virus, due to which the disease doesn’t appear too soon and the victim continues to spread the disease. There is an acute shortage of testing kits, so only those patients are tested who show critical symptoms while the people who are silent carriers are unknowingly infecting others. Few tests mean more undetected cases and the risk of their infecting others because of not being isolated Even the doctors, who are at the highest risk of exposure can have only a limited number of tests because each test costs up to 9000 Rupees to the government.

Our hospitals aren’t prepared to deal with such a situation. There are no built-in isolation centers in them, not enough resources to create them. The private sector hospitals are not doing anything to share the burden. Most of them are not even admitting a patient that has a slight fever. Separate quarantine centers are set up at different hotels and state buildings. The darkest part is the lack of ventilators in the intensive care units and emergency departments of the hospitals throughout the country, which makes it very difficult to manage those patients who depend on intubation to continue their breathing. The healthcare system is managing to plan out other ways to ventilate patients in case of severe break-out of the disease. More ventilators are also being installed by the government.

It is reported that even a deceased patient can be contagious for others, it adds another burden over the healthcare workers, who now have to arrange the burial of the dead, too. Handling the emotional trauma of the attendants is just another responsibility.

Negligence in the treatment of other diseases

Patients waiting outside OPD of a DHQ Hospital. File Photo | Dawn

The OPDs of almost all the public hospitals are closed and those that are working are crowded with all kinds of patients. People who have any other medical emergency are finding it very difficult to find a doctor to get their treatment. Old-aged people who have certain heart conditions or any other morbid diseases are silently suffering at their homes because their hospital visit may load them with a deadly virus that will shatter their already dilapidated immune system. Tele-medicine is useful but only for those who just need a consult or a prescription. Critical patients of hemorrhages, infarction, etc are in dire need of a clean hospital environment and there is nothing that can be done for them. The government is advising public sector hospitals to open the OPDs for the general public with appropriate precautionary measures but the danger of getting infected is still there.

Treatment of COVID-19 in Pakistan and Recovery

The number of recovered patients in Pakistan is 12,489, to date. Severe trial treatments are being carried out to help cure the disease, but they are still waiting for their approval. One of the treatments with an infusion of plasma of a recovered patient to the sick patient has claimed to be successful. This method called IVIG (Intravenous immunoglobulins) is safe and has low risk. But researchers desire to devise a safer method that doesn’t involve the infusion of other unnecessary blood products from the plasma. It is also claimed that antibiotics can reduce the contagiousness of the patient. Trials of making a vaccine are still underway.