Dire Health Situation in Sindh

Reflection by: Sindh Monitor – Translation by: Dr Khalid Zaman

The health situation in the Sindh province of Pakistan, specifically pertaining to those epidemics preventable and manageable, reflects a general lack of concern and commitment to the Sindhi people by the central Pakistan government. Using government reported facts, clear levels of inadequate health funding are shown. To demonstrate this point, the following article highlights cases of Hepatitis and Dengue Fever currently raging across the Sindh province and then reports on the general dismissal of these scourges by the Pakistan government. It then summarizes inadequacies in accepted health care standard measurements. Devaluing the lives of Sindhi people is a clear form of discrimination, and the handling of these epidemics requires international review.

I. Hepatitis

2.96 Million people are said to have contracted hepatitis in the Sindh province of Pakistan. 75,000 patients are expected to be treated under Sindh Chief Minister’s Heath plan, but only 11,000 patients have received treatment so far. Only 0.6 million people have been vaccinated. These numbers were released by the Department of Health, Sindh few days ago. The Health Department reported that hepatitis cases are rapidly growing in the province of Sindh and soon may become a huge public health problem. Another report released by the Federal Health Ministry indicated that there may be as many as 40,000,000 cases of Hepatitis B and 7,840,000 cases of Hepatitis C in the country. In the province of Sindh alone there are 1,000,000 cases of Hepatitis B and 19,60,000 cases of Hepatitis C. Using these numbers, 2.5% of population of Sindh province suffer from Hepatitis B and 4.9% from Hepatitis C. At this time, one-fifth of these cases are considered chronic.

A survey has discovered that more residents of Sindh receive medical treatments with injections than the residents of the other provinces. The average injection rate in Sindh is 13 per head per year. This method has major harmful health related results and is not an ideal form of vaccination or treatment. More than 47% of these injections are given under substandard conditions without taking recommended medical precautions. About 90% women in the province do not know that reusing syringes can spread hepatitis. 9.84% of cases are acquired by the infected needles, 1.09% cases occurs from used blood products and 4.37% cases are result of blood transfusion. Federal and Sindh governments are said to have taken initiatives for the disease control but the claimed and available resources are inadequate to meet the needs of this major public health problem.

Under the Prime Minister’s Federal Disease Control Program, 50,000 vaccines and 36,000 screening kits are distributed among the public every year. 800 patients are tested by the Polymerase Chain Reaction (PCR) method each month. The Federal Health Ministry has reported that 1,740 patients of Hepatitis B and 2,500 patients of Hepatitis C are treated in the Sindh province every month. The Federal Health report admits that only one person out of 800 receives the vaccine, only one out of 86 patients was supplied with a screening kit, and only one out of 6000 Hepatitis B and 450 Hepatitis C patients are receiving treatment under this program.

The Sindh Government started its own disease control program in October 2008 to deal with the hepatitis outbreak. The Sindh Government has allocated 2,704,600,000 rupees to be spent over a three-year period. Under this three-year plan, the hepatitis vaccine is supposed to be made available to 4.2 million newborn babies, 30,000 citizens, 58,500 high-risk people and 35,000 prison inmates. In addition, 70,000 patients with Hepatitis C and 7,500 patients with Hepatitis B will be treated as well. Under this program PCR laboratories are to be set up in the district headquarters of Mir Pur Khas, Sakkhar and Larkano. Cold chain facilities for diagnosis and storage are to be established in Hyderabad, Sakkhar, Larkano, and Jamshoro districts. Free treatment camps are to be installed in the areas where the infections are spreading rapidly. The estimated cast of providing diagnostic test is 3,000 rupees per person. Treatment costs of 40,000 rupees per patient for Hepatitis B and 40,000 to 50,000 rupees per patient for Hepatitis C have been approved.

Under this health plan 0.6 million people are projected to be vaccinated against Hepatitis B in a year. To date 0.45 million citizens, 150,000 children and 7,000 prison inmates have been reportedly vaccinated. Under this provincial plan 2,696 patients with Hepatitis B will be treated this year. To date, only 310 patients and 820 inmates have received treatment. 14,860 Hepatitis C patients are targeted to be treated this year; about 10,000 patients have been reportedly treated.

An honest review of the government-issued health reports suggest that government has not been able to take adequate measures to control this public health problem. Even if we combine the federal and provincial figures, clearly only a small fraction of estimated 2.96 million patients have been attended – only 0.6 million citizens have been vaccinated and about 15,000 patients treated. Additionally, the credibility of the figures provided by government sources has not been confirmed. Some sectors are recommending independent data collection to ensure that treated patients are, in fact, disease free and no longer infectious to others. Many public health experts in agree that the infection can spread exponentially in Sindh in the coming years if aggressive prophylactic and curatives measures are not taken immediately.

II. Dengue Fever and the Steps Taken to Deal With It

The first case of Dengue fever was identified in 1994 in Karachi, Sindh. Several patients with this illness died because of the lack of sophisticated diagnostic and curative means. Dengue fever emerged again in October 2006. During the 12 year lapse, little has changed regarding the region’s ability to combat the illness.

Dengue fever is caused by several related viruses (four different arboviruses) . The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower-pots, plastic bags, household water reservoirs and terra cotta pots year round. One mosquito bite can inflict the disease. The virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito- to-another- person pathway.There are two presentations of the viral illness in Sindh, Dengue fever and Dengue hemorrhagic fever.

Dengue fever begins with sudden high fever. The other signs and symptoms include: headache, especially behind the eyes, muscle and joint ache, red rash, increased sensitivity of skin, nausea, vomiting, swollen lymph nodes, fatigue and dizziness. Tests that may be done to diagnose this condition include: antibody titer for dengue virus types, complete blood count, serology studies to look for antibodies to dengue viruses. The condition generally lasts a week or more. Although uncomfortable, it is not deadly. Full recovery is expected.

A small number of these patients develop into Dengue hemorrhagic fever. Patients with Dengue hemorrhagic fever experience additional symptoms of: restlessness, irritability, small bleeds under skin, in severe cases bleeding from the nose and ears, blood in the urine and stool, and a shock-like state characterized by cold, clammy extremities and sweats. Shock may cause death. Patients lose blood components and become prone to other infections and easy bruising. Treatment of Dengue hemorrhagic fever iconsists of not only treating the symptoms and vascular shock, but antibiotics and replacement of depleted blood constituents. The mortality, or death rate, with Dengue hemorrhagic fever ranges from 6% – 30%. Most deaths occur in children and infants.

The Sindh government has established emergency centers in tertiary hospitals and bigger districts hospitals to provide care for patients with this infection. The majority of patients are treated in hospitals in Karachi and Hyderabad, Sindh. Very few hospitals in Sindh are able to isolate blood constituents from whole blood. Expensive machines called platelet agitators are available in only a few hospitals in Karachi and Hyderabad. This offers little medical support to those contracting the illness in rural areas. It has been estimated that 40% of Dengue patients treated in Hyderabad’s Main Hospital came from area out side Hyderabad district.

Because this virus can be transmitted from one person to another via mosquito bite, it is important to isolate the patients until they are no longer infectious. Not many hospitals in Sindh have stringent isolation units to prevent the spread of the virus to other patients.

Clothing, mosquito repellent and netting can help reduce exposure to mosquitoes. The large-scale prevention of dengue requires control or eradication of the mosquitoes carrying the virus that causes dengue.

The Sindh Governments Health Division has directed hospital staff to identify the villages from where dengue patients are coming. They are instructed to work with malaria control teams (another common infection spread by mosquitoes) to help with mosquito abatement programs. They are required to report dengue cases to the District Health Office and the Directorate of Malaria Control.

Sindh Government’s initiatives to decrease mosquitoes in this province plagued by dengue fever have been thus far ineffective. The government of Sindh has issued a report stating that 700 patients with Dengue fever arrived in various hospitals in Sindh since January 2009. Nine of them did not survive – eight died in Karachi hospitals and one in Hyderabad. Even though the mortality rate is a little more 1%, the main reason for these preventable deaths is said to be delay in diagnosis, according to hospital’s spokesperson Dr Abdul Rasheed Memon.

III. Health Care Funding, Maternal Mortality Rates and Declining Quality of Government-Run Facilities

Sindh’s Health Ministry’s official report is a confession of the fact that the Health Department’s multi-faced initiatives to prevent various diseases have not yielded satisfactory results. Some independent sources believe that Health Department of Sindh’s performance has deteriorated in recent years. Numerous reports from international agencies have indicated that mortality rates of newborn babies and mothers are higher in the province Sindh than other regions of Pakistan. Statistical figures of various infectious diseases such as HIV and Hepatitis in Sindh are also worse than other provinces.

The Sindh Government has allocated 16,000,000,000 rupees for the health department in the current fiscal year’s budget. 10,560,000,000 rupees are for ongoing projects while

5,230,000,000 rupees are for new programs.

The government claims that 17 large-scale projects at federal and provincial level are underway for vaccination, disease control and overall health improvement. Independent observers are taking the government’s figures with grain of salt. They wonder why Sindh has the highest infection and mortality rate if the governments are spending about 20,000,000,000 rupees each year on health projects in Sindh.

Sindh Government’s report in connection with the health policy for years 2010 – 2015 has confirmed that the health situation in Sindh was much better than other provinces in 1980s. Surveys conducted by international and local agencies show that the health situation in Sindh started deteriorating in the mid – 90s. The World Bank’s report of 1996 declared high infection rates in Sindh.

According to Pakistan’s Public Health and Demographic Survey (PPHS) 2006 – 2007, the maternal mortality rate in the country was 27.6 deaths per 1000 live births, while the rate in Sindh was 31.4 per 1000 live births. Infant mortality rate overall in Pakistan was 78 per 1000 live births, while in Sindh it is 81 per 1000 live births. The neonatal mortality rate in the country is 94 per 1000 live births while the same rate in Sindh Province is higher at 101 per 1000 live births. Only 38% of babies are born in hospitals or at home with the help of trained nurses or midwives in Sindh. More than two- thirds of babies are born at home without the assistance from properly trained midwives in rural Sindh, with 23% of babies born with help of untrained midwives in urban areas of Sindh. 37% of children fewer than 5 years of age are reported to be under weight or undernourished in Sindh.

Only urban areas like Karachi have technologically advanced hospitals, while more than two-thirds of the Sindhi population live in rural and remote areas in dire need of these facilites. It is noteworthy to fully understand the significance of this (and other statistics) that a significant number of Karachi inhabitants are settlers who have moved to Karachi from other areas, and not indigenous Sindhi people.

The above-mentioned survey reported the highest number of HIV positive and AIDS cases in Sindh. Only 772 AIDS patients have been registered with ‘Sindh AIDS Control Program’, out of a total of 45,000 patients. 30-34% patients are known drug abusers who share needles. 1.2% of the patients are young men and 10.2 % are eunuch beggars. This report admits that fewer patients prefer to go to government facilities for treatment. This speaks to the bad reputation, substandard amenities and lack of trained staff at government hospitals. Similarly representative of this trend, of pregnant women who need and can afford to go to a hospital, 49% pregnant women use private hospitals while 36% go to government centers for treatment. Overall 75% of people seek treatment at private clinics and hospitals rather than use government run facilities.

Some experts believe that one of the many reasons for declining quality of healthcare in government hospitals is lack of trust and communication between direct health care providers and administrative officials. There is huge need for well-trained medical personnel, especially women at all levels – from basic health units to secondary and tertiary facilities. Some disadvantaged rural areas do not have health facilities, while others are severely under staffed and under budgeted. Because of the lack of trained medical personnel, quacks and non-qualified people have filled the void. These untrained providers do not take proper precautions or use aseptic techniques and thus worsen the spread of infectious diseases. Public campaigns additionally are not utilized to combat preventable diseases and death. Efforts not been made to educate rural populations about public health issues, such as the ill effects of reusing syringes in clinics and razors at barber-shops.

Social factors such as pressure of poverty, low education rates in the province, and political favoritism pose significant resistance to improvement in the health department’s functioning and fair allocation of resources. The influx of outsiders to the Sindh province is also seen as a factor in compromising the available resources for the people of Sindh. The effectiveness of the health system in Sindh faces many challenges: insufficient personnel, inadequate medical supplies and equipment, lack of quality control, flawed infrastructure, poor administration, operation, planning and execution to name a few.

IV. Conclusion

The public is raising eyebrows at the failure of the Health Department to provide the minimum necessary health care to the people of Sindh, in spite of claims of huge expenditures of about 15 to 20 billion rupees every year. Infectious diseases are spreading like wild fire, mortality rates are on the rise and poor people in rural areas are dying every hour due to lack of proper health care facilities. The people of Sindh have lost trust in the Health Department. The people of rural Sindh perceive a lack of sensitivity by Health Department officials. Only a revolution in the provision of health care in Sindh can address this crisis. When the government itself acknowledges the inadequate outcome of their efforts, one wonders where is this money being spent? There needs to be a fair appraisal of the situation and that those people involved be held accountable.

[1] The following is a response to a health report originally printed in the Daily Kawish, a Sindh newspaper available in print and online at http://www.dailykawish. com/. The article was found January 30th, 2010, and prompted this discussion piece. All opinions are those of the Sindh Monitor and independent of Daily Kawish stances.

About the Translator: Dr. Khalid Zaman has a strong interest human rights. He was a charter member of the World Sindhi Institute, has emceed fundraising events and networked with Sindhis in the United States and abroad. He has participated in human rights vigils and demonstrations, and attended the United Nations Human Rights Conference in Geneva in the spring of 2008. He currently resides in Hawaii and serves on the Board of Directors for the Sindhi American Political Action Committee.


Courtesy: 4th Edition, SINDH MONITOR, Compiled by Munawar Laghari, Sindhi Human Rights Activist

5 thoughts on “Dire Health Situation in Sindh”


    Assalam o Alaikum,
    It is my pleasure to have this correspondence with you .I am really impressed by your stamina , motivation, will and desire along with the practical work to make a change in the society because this is the actual meaning of comrade to help human beings ,where as Waalis are meant for the service of the Allah ,to whom there are many besides human beings to serve the flora and fauna besides all the living creatures including man.
    I am also trying for the last 20 years working for the implementation after studying the definition of health which is “state of complete mental ,spiritual ,social ,economical, psychological and physical well being and not merely absence of disease or infirmity. Unfortunately due to our mistakes we cannot blame others we are now faced with the mammoth of disasters. Every day a new occur and previous one is forgotten in our memory .It is not the disasters but the total indifference to act upon them which is being more disturbing. True that almost 90% of Pakistanis are now fighting for their survival on day to day basis just to fill the coffers of the ruling elite but still some of them from both sides like ‘sagar’ poet from the 90% and we can also have people like Rockefellers from ruling elite like edhi who according to him is the largest real estate owner in Pakistan.
    Your endeavours are really remarkable like feeding internally displaced families the number does not matter but it is the spirit which does matter. Similarly working on the Islamic jurisprudence is and writings in international arbitration is also worthwhile because after the fall of the Baghdad By the Genghis khan’ son we As Ummah have totally being disintegrated and our destiny is totally lost so as our moral and code of conduct with no conscience, only destination is accumulation of wealth by whatever means not knowing that this world is just a transitional phase .As a consequence of this we have lost our integrity very few are there who still possess it and envision nation building apart from leadership qualities .With a loss of integrity we are losers in every field we are taking pride in have sania mirza as our bhabi from india who is ranking 92 and with elbow injury will stay there forgetting that once we ruled the world in squash and number 2 option was not in our mind.We are proud of Shoaib malik who is on one year ban forgetting that once our players like hanif mohammed ,fazl mehmood who was also deputy inspector general of police fought for country pride and used to come on bicycle to play matches. Like hockey in which world cup we secured 12th position in 12 countries we are also professionally almost finished in every field .Our degrees are not recognized in any country .comparing with the neighbouring country where liver transplants, knee joint surgeries are taking place we are in the place where even the primary health care goals that is the millenium development goals are lowest in the region and go down even further because even the basics are not provided to the implementers or the grass root level workers in terms of logistics, finance or technical support but only beaurocratic hurdles are being created by the depts as well as the community to whom the grass root level working for taking in mind that once gold was RS200 per tolla [1973]and the take home salary of every class 1 officer not just few elite was Rs 1500 apart from decent accommodation ,health and education facilities for his or her dependents. Your aptitude towards teaching is also worthwhile because Allah has said there are three fathers or mothers of a person , one who procreates ,the other who teaches and finally the last one whose home a person goes as bride or who gives a person his daughter.
    For the past20 yrs I have also been involved in serving the nation which is now a population called Pakistan . I simply started planting trees in the govt land instead occupying it which is a common trend these days. That was in front of my house where my grand father some 50 yrs back started community tennis centre to inculcate the sportsmanship in community. Now every Friday people which are no less than 500 in number pray in shades of trees ,near a mosques whose idea I floated and which started all by the mobilization of the community .Now a Chartered accountant person working in the Dawood Hercules factory conducts the tarawee prayers in the Ramadan. Another gentleman took interest in the park which requires constant maintenance and care like a child developing walking track and took care of empty plots and now flowers are blooming in it . I used to keep a tank of cold water in summers outside by home with changing its ice every 4 hours now in our neighbourhood there are no less than 5 water coolers which are working outside people residences .Similarly my working as a professional in slums in shadman colony, mian mir colony as well as Tajpura /Dugesh behind rangers headquarters was equally rewarding every time helping hands were sent by Allah .In the official capacity which I volunteered for going to Kashmir 2005 people just start pouring with help but I felt ashamed that volunteers from west were there ahead of us and that included women of 60 years of age while what happened to earthquake supplies can be judged by audit reports of national disaster management cell.
    Coming back to some thorny issues you can change people life by quality management and the best resource to work upon is human resources so that cases of crimes like huma waseem akhtar does not occur. They occur because the problem is with the whole myriad of pyramid college of physicians and surgeons Pakistan was being headed by [Osman farooqi brother of famous NRO obtained farooqi] now it is being headed by once retired professor Zafarullah who had his own cardiac by pass being operated from united states, and whose son was mocked by former Principal of king Edward medical college prof mumtaz that how he got first position in pharmacology ,well this is another story that mumtaz Hassan son got 11 gold medals and a procession against that was carried at mall road Lahore but as we said we are now spiritually a dead nation , hats off to governor gillani efforts of having 10 cardiac centres from 10 km radius of Punjab institute of cardiology. you can decide yourself what level of fellowship our candidates are getting where things like pediatric ventilators are not available /or ISO certified operators are not available at the tertiary available and at the primary health care level even after 62 years of independence let alone electricity or ambulance we do not have a single glass of safe drinking water keeping in mind that our smallest union council in the rural Lahore which is now under city district govertment and there is no urban or rural Lahore is 12,000 which was the population of the whole city of Lahore in 1800 . Despite numerous programmes and committees formed for the uplift of masses what bitter irony is that the school from which Malik Miraj Khalid studied does not have science classes for girls after 62 years of independence perhaps malik sahib was too busy with the Haji Iqbal Baig ,mentor of chief of very important political party which comes after ruling party in which clanship and personal loyalty matters rather than loyalty to state, which is our recognition in the world ,making Pakistan the biggest laboratory of the world .Even our brother Arab countries are paying our fellowship graduates SR 15,000 where as their ordinary security guards are earning far more .Once we designed the tallest building in seattle now we cannot even design a Golf course in Defence society in Pakistan or Wapda house as a matter of fact let alone dams .The signal free corridors in Karachi has no provision for people on foot like in all defence societies excellent works by Nazims and administrators because they see the world through their bullet proof prados/land cruisers. This is our recognition in the field of the medicine and all other professions. Education starts from the day a sperm combines with egg in the mothers womb and it is from cradle to tomb but the most important time frame is from the one to 5 years and this is the year when a child learns most .
    Yesterday one daily paper should secretary health presiding over a new body of safe food committee. Well by the petty gains of all our superiors in every field we are getting 97% water contaminated with pesticides, fertilizers and arsenic .Bottled water of multinational company which was present in front of the secretary health table is a source of carcinogens perhaps he was oblivious to the fact that people from Rajanpur are stationed at charing cross for last 07 days due to non availability of single drop of pure water in their land.Due to land erosion our canals and rivers are murky with survival of fish even impossible. Our air is 100% impure with the lead and other toxic elements thanks to national policy of deforestation and as a result we are witnessing collapse of monsoon system and shrinking glaciers which by 2050 will be a past. We already have 7 degree rise in temperature in a single year 2009 and 2010.
    Our statesman ship can be judged on both sides be judged from the statement of the governor of Punjab that if chief minister stop telling lies I will stop telling the truth.
    The crux of the whole matter is that we should endeavour to revive our leadership qualities through moral and spiritual solitude and learn that our history of subcontinent not starts from mohammed bin qasim invading sindh or simply go to the google and expand our soul, mind and heart and spirits.
    Thanking you in anticipation
    Yours sincerely

    Dr noman shahid

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