Jpmc to receive latest facilities: pm


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JPMC to receive latest facilities: PM

KARACHI: A Rs 3.3 billion medical complex will be added to the federal government-run Jinnah Post Graduate Medical Centre soon.

The Prime Minister Shaukat Aziz said this during a news conference at Governor’s House Wednesday.

The prime minister said that the “state of the art and most modern” project had already been accorded approval by the government. The project would add to the existing federal government medical facilities in Karachi, he said.

This project would be equipped with latest technology and highly qualified personnel. The federal government hospitals in Karachi include National Institute of Cardiovascular Diseases and Institute of Child Health.

Aziz said that the federal government hospitals in the country were limited in number and needed to be improved. He referred to the government’s programme for providing safe drinking water to the people and said that a number of steps had been initiated to increase awareness among the people about various diseases.

APP adds: The prime minister said that the federal, provincial and city governments were fully focused on the development of Karachi.

He said that despite the fact that the provincial government was quite self-sufficient and had Rs 20 billion in its reserves, the federal government was also playing its role in developing the city that had an annual population growth rate of five and a half percent, and a vehicular increase of 11 percent. Referring to schemes such as the K-III 100 mgd water supply project and the Lyari Expressway, the prime minister said that these had been implemented with federal government’s funding to meet the city’s water and traffic needs.

Meanwhile, speaking at the Eid reception hosted at the Sindh Governor House Tuesday, the prime minister said that he had toured the city and saw a lot of hustle bustle, which was indicative of the development taking place in Karachi. He pointed out that the focus was on the improvement of the city’s electricity system, cleanliness and the law and order situation. “The law and order in Karachi has been improved a lot, but as yet, much is left to be desired as Karachi is a city of 15 million people and deserves a lot more.”

He congratulated Sindh Governor Dr Ishratul Ibad Khan on completing four years, and lauded him for having worked very hard to benefit the people of Sindh as well as Karachi. He extended Christmas greetings to the Christians and said that interfaith harmony was the need of the hour in Pakistan as well as the entire world, which is also what Islam teaches. “Islam is a religion of peace, brotherhood and tolerance with no space for extremism, terrorism and sectarianism. The Muslim Ummah needs unity and Pakistan will play its role in creating uniting the Ummah.”

Dr Ibad said that both the president and the prime minister visit Karachi quite frequently and takes keen interest in the development of the city. “It is for the first time that the prime minister is celebrating Eid-ul-Azha in Karachi and also the first time that any president or prime minister had visited the mausoleum of the Quaid-e-Azam Muhammad Ali Jinnah on his birthday to pay homage.”

Brother of the king of Bahrain and chief of National Guard Bahrain Shaikh Muhammad Bin Khalifa, federal and provincial ministers, diplomats, high officials, leading businessmen, top bankers, sportsmen, artists, senior journalists and social workers were present on the occasion.

(Daily Times-B1, 04/01/2007)

HIV rate in addicts alarmingly high
KARACHI, Jan 5: Facts and figures given in an official document of the National Aids Control Programme show alarming increase in proportion of HIV infection among Injecting Drug Users in Karachi.

Officials believe that the country faces a shift in HIV epidemic in the country from low level to ‘concentrated’ among the Injecting Drug Users in Karachi.

According to an NACP report developed with collaboration of UNAIDS – Pakistan, the fact showing the rise of proportion of HIV infection among the IDUs was also validated by several studies reporting an increase in prevalence from 0.4 per cent in January to 7.6 per cent in August 2004 and to 23 per cent and 26 per cent in January and August 2005 respectively.

“This increase in levels of HIV indicates a shift in HIV epidemic in the country from low level to ‘concentrated’ among the IDUs in Karachi,” it says.

According to the report, Pakistan with a population of approximately 157 million occupies an important and strategic position especially in reference to two of its neighbors China and India where HIV and AIDS has graduated to epidemic proportions.

Currently, Pakistan is categorized as ‘Low-Prevalence High Risk’ country for HIV infection. The National AIDS Control Programme/ Ministry of Health using WHO/UNAIDS model estimates the number of HIV infections in country between 65,000 and 70,000; with a prevalence of less than 0.1 per cent among general population.

First case of AIDS was diagnosed in Pakistan in 1986. Since then sporadic and isolated cases have been reported from the provinces. The report says in addition to the regular passive surveillance mechanism, a number of studies on size estimations, behaviour and biological aspects have also been conducted among the various high-risk groups in recent years. These are a good pointer of the trends; however generalization could be an issue.

In July 2003, an outbreak of HIV infection was identified among the jailed Injection Drug Users in Larkana. Over a 10-month period (August 2003 to June 2004) the number of reported HIV cases increased from 19 to 69 among the IDUs. During the same period similar trends were observed in Karachi where seven per cent (57) of IDUs were reported as HIV positive against the total 800 screened by the Sindh AIDS Control Programme. This indicated a rise in proportion of HIV infection among IDUs in Karachi.

The HIV prevalence among IDUs in number of cities in Punjab and Sindh also reported increasing trends; 26 per cent Karachi, 2.5 per cent in Lahore; 12 per cent in Sargodha; 0.5 per cent in Rawalpindi; one per cent in Sialkot; and 9.5 per cent in Faisalabad.

In view of the changing HIV situation among the high-risk groups, the NACP with the support of development partners undertook two major activities to study the trends and set baselines: A comprehensive national study of reproductive tract and sexually transmitted infections in Lahore and Karachi in the first phase and covering the NWFP, Balochistan and bridging populations in the second phase. Besides, a pilot study under the HIV and AIDS Surveillance Project; the first round of active surveillance has already been conducted in eight cities; preliminary reports and data are under analysis.

The findings from both the survey and pilot study for active surveillance corroborated findings for each other. In line with experience from other countries, after IDUs, similar HIV trends are noticeable among men having sex with men and Hijras (transvestite) in selective geographical areas.

On the modes of transmission, the data illustrates sexual transmission to be the commonest mode (37 per cent) followed by sharing of the infected needles (21 per cent); however definite mode of transmission could not be ascertained in 34 per cent (due to either misreporting or stigma). Thus both trends as well as characteristics of the epidemic are following a “typical Asian model of HIV”.

“It is now required to undertake nationwide estimates of the high-risk groups, their behavorial patterns to ascertain the magnitude of the problems and also do modeling for future projections. This would help the government in further strengthening national response to address the emerging threat in comprehensive manner,” said the report.

(By Hasan Mansoor, Dawn-17, 06/01/2007)

Dog-bite victim dies at JPMC

KARACHI, Jan 9: A 52-year-old dog bite victim from Frontier Colony, SITE Town, who was brought to the Jinnah Postgraduate Medical Centre for treatment on Tuesday, died within five hours.

According to in-charge of the JPMC Accidents and Emergency Department, Dr Seemi Jamali, the victim, Banaras Ali was rushed to the casualty of the hospital with a history of severe hydrophobia and fits. After initial inquiry the patient was shifted to Medical Ward-6 for treatment in isolation, but he succumbed to the full-blown rabies only within four and a half hours stay at the hospital on Tuesday.

Mr Banaras was bitten on his left leg by a dog in Orangi about eight months back, but neither he told his family members about the incident immediately nor received any vaccination against the bite, Dr Seemi stated while quoting wife of the deceased who along with a son, brought her husband to the hospital.

According to the victim’s wife, the incident of dog biting was revealed to family after 6-8 days after which she started trying some home remedies, including use of kohl on the wound, which gave no result and increased the complexities. At home he used to have fits and jerky movements and lately had started getting frightened miserably during urination, the wife added.

At JPMC though the patient behaved normally and talked to doctors reasonably, but when tested for hydrophobia, Mr Banaras showed positive symptoms, said Dr Jamali. Normally it takes two days to two years for incubation of rabies in human bodies. She said dog bite victims should report to the JPMC or any other health care facility for snit-rabies vaccination at the earliest irrespective of the depth of the wound.

Experts say that 95 per cent of animal-bite cases involve stray dogs, therefore there was a dire need for launching campaign to create awareness about dog bite problems and control over the growing population of street dogs.

As precaution, children should not be left alone with a cat or dog and people should avoid making any attempt to intervene in fight between animals or come close to sick animals.

(Dawn-19, 10/01/2007)

A commendable decision
The recent decision taken by the Supreme Court of Pakistan regarding different cases against the Pakistan Medical and Dental Council (PMDC) should be appreciated by all those who want the country to prosper.

The decision will have a long-term impact on medical education in Pakistan. It has provided an opportunity to all those stakeholders who want regularisation of medical education in the country.

It is good to know that the federal health ministry recently had a meeting with PMDC officials and both have agreed to implement the decision of the Supreme Court. On its part, the PMDC should not waste time and must take all the necessary steps to implement the decision.

Before moving to discuss what is needed to be done, it is pertinent to look back and see where we went wrong in this crucial area. A bureaucrat who was not even a doctor was running the affairs of the PMDC for as long as 25 years only because he had very good connections at every level of governance. He remained PMDC secretary for more than 25 years by soft-soaping different director-generals, federal secretaries of health, politicians concerned and military leadership. He destroyed medical education and training in Pakistan by collaborating with members of the medical council and owners of private medical colleges. The majority of these members were doctors, principals of medical colleges, and deans. He had the gift to exploit dishonesty present in such people. He started a system through which the PMDC stopped holding elections in medical colleges for council membership. Principals of medical colleges became members of the council automatically without any election being held. He also made sure that vested interests represent the provinces in the PMDC. He never advertised the notice of elections in the PMDC in national newspapers. He was able to select doctors from provinces as members of the PMDC through conspiratorial methods.

It’s time the PMDC took advantage of the current situation and improved the way medical education is imparted in our country

During that man’s tenure, provincial governments were able to increase seats in medical colleges out of proportion and were also able to open medical colleges without a standardisation process. The PMDC was not able to challenge the government.

The phenomenon of mushroom growth of medical colleges started in the private sector after the establishment of the Aga Khan University in Karachi. Powerful doctors in collaboration with vested interests started the business of medical education. It was an easy way to make money. All kinds of students were allowed to get admission to medical colleges. They were ready to pay any amount of fee provided they would receive an MBBS degree recognised by the PMDC. Medical colleges were opened in residential bungalows, apartments and on poultry farms. The PMDC criminally became a party to this business of exploitation.

At the same time, the PMDC did not bother about the faculty situation in government sector medical colleges. The provincial governments and the principals of medical colleges increased the number of seats violating rules and regulations. The worst example was the Sindh Medical College (SMC) Karachi. In the SMC, the principal of the college, in collaboration with the department of health and some corrupt people in the University of Karachi, were able to admit hundreds of students without merit, all of whom became doctors registered by the PMDC. Instead of stopping this illegal admission process, the PMDC became a beneficiary of this business.

Then this official was also involved in the bizarre racket of recognition of diplomas in different fields of medicine from different countries. Doctors with substandard diplomas were able to get registered and declared equivalent to FCPS, and became professors in different medical colleges of Pakistan.

Members of the PMDC with its secretary were busy making money and obliging friends. They were not bothered about the deteriorating medical education and training process in the country. They did not start any programme for continuous medical education of doctors. They did not even plan re-licensing of doctors depending on their competence and knowledge. They were not worried about patients’ rights and the ethical conduct of doctors.

The corrupt official was finally sacked by the new government of General Pervez Musharraf. The new secretary PMDC had a clear cut agenda. He started resisting the council’s wrong decisions as soon as he took over. The council soon realised that the new secretary of the PMDC would follow rules and regulations. The federal ministry of health also found itself in deep waters. The mafia of private medical education was stopped and told that it had to follow rules and regulations.

Despite all that, council members took some wrong decisions regarding some medical colleges in public and private sectors for which the council has to take responsibility. They tried to please the government as the majority of its members are from the government.

The Pakistan Medical Association pursued the government to come up with a new act to make the council more democratic and autonomous, benefitting patients. Unfortunately, a legal war was initiated against the PMDC by vested interests.

It was against this backdrop that the battle was fought in a court of law. Now with the federal ministry of health and everyone else concerned agreeing to implement the decision, it is an opportunity that has never been there before. In this regard, the following steps need to be immediately taken:

• The closure of all those medical colleges in government and private sectors that are functioning without permission of the PMDC.

• The closure of all those medical colleges that will not be able to fulfill the requirement of the PMDC within six months of the Supreme Court decision.

• The relocation of students from unrecognised medical colleges as per instruction of the Supreme Court.

• The recognition of provincially recognised medical colleges and the holding of election of members of the medical council in these institutes. The election should be held by the PMDC as per rules and regulations.

• The election of representatives from the Sindh, the NWFP and Balochistan.

• The election of representatives from public sector medical colleges and universities as per rules and regulations of the PMDC.

Doctors should never let their patients down. So, the PMDC must act fast to restore the dignity and honour of doctors in the community. This will only be possible if the PMDC is strict in implementing rules and regulations in the light of the Supreme Court’s decision without any fear. Once the PMDC achieves its independent role there will be a need to address the following issues in the interest of patients and the medical profession:

A strong disciplinary committee should be made within the PMDC to deal with doctors’ misconduct in relation to the management of patients.

A strong ethical committee should be made within the PMDC to deal with unethical conduct of doctors in relation to patients, the pharmaceutical industry, research work in hospitals, and teaching in medical institutes of Pakistan.

A strong education committee should be made for planning of continuous medical education in Pakistan for doctors in public and private sectors. There is a need to develop a system for re-licensing our medical graduates according to the advancement of medical knowledge and the need of patients in Pakistan.

There is a need to change the structure of the PMDC. A new act is required to decrease the number of council member. There should be more representation from outside the government through an election procedure. More power and more independence should be given to the council to act freely in the best interest of the profession.

(By Dr. Shershah Syed, Dawn-Magazine-5, 14/01/2007)

Poor healthcare for children

ALTHOUGH symposiums on child healthcare, like the one recently held in Karachi, are welcome, they do not always achieve the goal of prodding health officials to take action. Children in Pakistan, especially those living in rural areas, continue to be deprived of proper health facilities. This is borne out by UN statistics that paint a grim picture: the infant mortality rate at 80 per 1,000 live births is among the worst in the region, while the number of children who die before attaining the age of five is 101 in 1,000. Meanwhile, malnutrition and disease are responsible for 38 per cent of children, not yet five years, being underweight. Even the coverage of the Expanded Programme on Immunisation is far from satisfactory. Figures show that only 67 per cent of one-year-olds have received the necessary vaccinations. A closer statistical survey reveals that certain groups of children are more disadvantaged than others for reasons of gender and poverty.

Correcting these deficiencies will require more than awareness-raising actions. Many issues relating to child health are underscored by the UN’s Millennium Development Goals to which Pakistan is a signatory. But the progress the country has made towards meeting these goals by the 2015 deadline is negligible. In order to improve the healthcare system, the government needs to first identify the stumbling blocks and then to review its own performance in overcoming these. If it does so, it will find that one of the main factors that is keeping it from achieving positive results is skewed priorities which attach little importance to social issues such as health. This together with the lack of political will to implement health goals as identified by the international community is preventing it from providing proper healthcare to millions of children across the country.

(Dawn-7, 15/01/2007)

When painkillers become killers
KARACHI: A recent survey has shown that more than 70 percent of people taking medicine do so without either a prescription or a doctor’s consent. It is a trend that worries health experts, as many of those surveyed were using medicines unnecessarily or taking the wrong amounts of dosage. Pharmacists should not be selling medication without a valid prescription, but willingly do so to increase sales.

Health experts warn that this is a dangerous trend, and that many are unaware of the long-term effects of excess medication. They have expressed concern over the matter, and argued that it needs to be addressed and stopped in order to save lives.

Dr Mahmood Zuberi, Administrator, Baqi University (Fatima Hospital) said that excessive doses of painkillers usually create acidity in the stomach and the intestine, which could cause ulcers if used in the long run. He added that medical stores need to start refusing requests for such medicines without a doctor’s prescription. He feels that people do not seem to understand that it is important to visit their doctors before buying medicine from the chemists, and are unaware that the correct dosage of medicines (quantity in milligrams) is very important and should be prescribed only after a patient has been examined. Even a slight mistake in the dosage can create a serious risk.

According to Dr F A Abdalli, a general physician, excessive and continuous use of painkillers will affect the circulatory system and the blood’s productivity, as well as damage the nervous system.Dr Abdalli, who practices in Gulistan-e-Johar, added that while most painkillers are not particularly strong (in terms of milligrams), their continued usage weakens the human body over time. In most cases, the signs or symptoms of health problems relating to the use of painkillers come at a later stage, although serious damage could be done well before the user becomes aware of it.

Some chemists, based in the Old City, said that most of their customers asked for Disprin, Panadol or Ponston, and they used these medicines without any prescriptions.

Paracetamol is the most commonly used painkiller for general aches and pains, while customers tended to buy Cataflom and Voltron for headaches. Other chemists, based in Gulshan-e-Iqbal, explained that painkillers such as Paracetamol are the cheapest on the market and the most widely purchased. They said that customers seem to believe that by taking them they were addressing the actual problem and would save themselves a trip to the doctor. These pharmacists said that many customers preferred these because they were cheap, and if they did not help they could easily switch to a different and affordable painkiller.

Several chemists said that sometimes there was a shortage of painkillers on the market, though such shortages hardly last for more than fifteen days.

Dr Muhammad Rafiq Khanani, Associate Professor, Dow University of Health Sciences, said that heart and kidney failure might be linked to the excessive use of such drugs and it tends to happen only when a patient uses these medicines without consulting a professional.

According to him, heart and kidney failure are two of the long term observable effects of the overuse of such medicines, and the best way to stop this is to combat the misconception amongst the general public that these medicines are harmless.

(By Muhammad Zeeshan Azmat, The News-2, 15/01/2007)

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