PIMS in deplorable condition

Pakistan Institute of Medical Science (PIMS), the largest public hospital of the federal capital, is in a pathetic condition because of the unhygienic environment, lack of burning incinerators and basic facilities like beds, latest medical equipments and an adequate amount of staff.

Talking to Pakistan Today, patients complained that many sick and injured people were not getting the care that they needed because of a massive shortage of medical equipments, beds and doctors, which undermined the quality of healthcare in the hospital.

A senior member of the Young Doctors Association (YDA) told Pakistan Today that there was no burning incinerator in the hospital while the MRI machines and oxygen flow meters of medical wards were dysfunctional since the last three years.

“The patients here are advised to approach private outlets for common medical tests,” he said.

He admitted that because of the shortage of beds, patients are usually discharged prematurely and thus face the danger of relapsing.

“Over 80 percent of the people have no medical aid, and have no choice but to seek treatment at PIMS which lacks basic facilities of beds, medicines and staff,” he maintained.

Ramiz Mugal, a 70 years heart patient from Mianwali said that the hospital’s laboratory had no proper equipment and was unable to carry out reliable tests.

“We are compelled to go to private laboratories in the blue area,” he added.

The YDA leader further said, "There is no proper ventilation system for the air-conditioning system in the emergency ward. This results in emanation of a bad odour. The toilets were in a deplorable condition and were source of infection. Scores of patients use them daily and these are not even cleaned twice a week"

The General Report Section, where only three staff members were setting, told Pakistan Today that doctors work on 12-hour shifts and had to treat around 1,700 patients in this time. Many patients in the emergency wards were not given proper care due to lack of proper facilities.

A huge number of people from far flung rural areas of Punjab could also be seen at every section of the hospital, particularly outside the X-ray and ultrasound rooms where only two out of four X-ray machines were operational in the evening due to lack of staff. Therefore, patients and their attendants had to wait for hours to get their test report.

A shortage of staff such as nursing assistants, cleaners and porters meant that nurses often had to carry, wash and feed patients, which kept them from nursing responsibilities.

Meanwhile, all the wards and departments of the largest public hospital in Islamabad gave a dirty look due to irregular cleanliness, while Out-Patient Department (OPD), Orthopedic and Neurology Departments, Gyne Ward, Emergency Centre and the laboratory needed urgent attention of the higher authorities.

PIMS spokesman Waseem Khawaja confirmed that there was no burning incinerator and added that the waste was sent to the Holy Family Hospital in Rawalpindi for disposal. He said the emergency wards, including the operation theater, was equipped with latest machines.

“Nevertheless, it has yet to be determined why these desaturation events occur,” Dr. Brinkman added. “One suggestion is that it may be due to decreases in cardiac output, so we sought to determine its relationship, if any, with cerebral desaturation.”

Dr. Brinkman and his colleagues enrolled 23 patients into the trial, each of whom was undergoing surgery with one-lung ventilation. Cerebral oxygenation was monitored using a cerebral oximeter (Fore-Sight, Casmed) and cardiac indices were measured with the FloTrac system (Edwards Lifesciences).

Each participant underwent a standard anesthetic regimen, with an FiO2 of 1.0 for the duration of the case. Anesthesiologists provided positive end-expiratory pressure and continuous positive airway pressure to the nondependent lung to maintain peripheral oxygen saturations of at least 90%. Serial blood gases were drawn before induction and then every 15 minutes for two hours. A cerebral desaturation event was defined as a decrease of at least 10% from baseline, which was defined as the highest recorded saturation on two-lung ventilation with an FiO2 of 1.0.

As Dr. Brinkman reported at the 2012 annual meeting of the Canadian Anesthesiologists’ Society (abstract 1310840), data from 18 patients were analyzed; 10 of these patients (55.5%) had significant cerebral desaturation events.

“We didn’t find a statistically significant difference between groups in terms of cardiac output, blood pressure or heart rate,” he told Anesthesiology News. Similarly, there was no correlation between cardiac output, mean arterial pressure, stroke volume, or cardiac index and cerebral desaturation events.

“We also calculated the area under the curve for the amount of time patients were desaturated,” Dr. Brinkman added. “And we showed that heart rate would go down in patients with longer desaturation time, but stroke volume would increase significantly to maintain cardiac output. It was something we didn’t expect to find, but it’s an interesting reflex that hasn’t been shown before, as far as I can tell.” No correlation was found between peripheral arterial saturation and cerebral oxygen saturation.

Dr. Brinkman suggested that future research should focus on outcomes of patients who sustain cerebral desaturation. “And if down the road we show that there is potential for harm in these individuals, then maybe a device like the Fore-Sight needs to be a more standard monitor, even if it’s just in selected high-risk groups.”

Bruce D. Spiess, MD, professor of anesthesiology at Virginia Commonwealth University, in Richmond, said physiologic effects of one-lung ventilation are farther reaching than merely a reduction in blood flow to the nonventilated lung.