Recent news and media reports about ongoing protest and boycott of doctors, nurses and paramedical staff reminded me an exceptional nurse i met at the NICH afew years back
“I can leave my family, even my children, but not these little angels in pain.” It was Ishrat, a nurse on duty in the Burns Ward of the National Institute of Child Health, Karachi, who was talking about the fourteen (14)patients solely and simultaneously attended by her in the 16-bed ward. In white nursing uniform, Ishrat seems a thin figure in her early thirties. Married, with a husband working in the Navy, she has two daughters aged two and one year respectively. At times it’s difficult for her to balance her domestic and professional responsibilities. Her children are still young and need attention. But not for a moment, she ever considers leaving nursing since it’s not just a profession but a passion to her.
Before joining NICH ten years ago, she did three-years professional nursing training at Jinnah Medical College besides one-year midwife course. When she got married, four years ago, she made it clear to her husband that she wouldn’t leave her profession as most of the nurses do after marriage. For last ten years, Ishrat has been working at the NICH Burns Unit and two years back, she became the head nurse of the ward. She loves her work and her patients. And one can see the same affectionate expressions in the eyes of severely burnt children for their sister__ Ishrat.
Fourteen years old Akbar was brought here in a public bus from the Interior Sindh with his younger brother. Both were badly burnt. The younger one died one hour later after reaching the hospital. While the elder one survived and was admitted for grafting (skin surgery). He was going through a painful experience since he burnt badly. Her mother said that the boys were alone in the house when fire broke out caused by an oil lamp. The distressed mother constantly covered half of her face with her dupatta during conversation, trying really hard to hide her misery from a stranger.
Angel-faced Fareeda, aged seven, was in the same ward with her aunt cum adopted mother. She lived in SherShah, studied in class five and had an accident when her frock caught fire while she was playing with match box. Fire burnt the abdominal part of her body. Akash, six and Kiran, ten both were burnt by a stove. During my visit, Akash was constantly crying in pain. Kiran, an orphan living with her blind grandmother and father, was though relatively calm. She was hospitalised two months back for the treatment of lower body and genital area burns.“I was making tea when my dupatta caught fire . I tried to extinguish it with my hands, they were burnt too. I hope I will be fine soon and go to school.” she said with a glittering face and childish innocence in her big, bright eyes.
The NICH Burns ward is usually over-crowded with patients, especially in winters when water and stove burning are common. In Sindh, NICH is the only children hospital which offers a full range of facilities for the burnt patients with its separate AC plant and arrangements for grafting and dressing in operation theatre. According to hospital records, a large majority of patients in the Burns ward are taken from distant rural area and urban slums. In these localities, coal, wood and biomes fuels burn indoors as the facilities for piped gas and electricity are not available. There is no provision for open recreational areas for children living in these congested housing settlements and mostly they are near open nallas, railway-lines and motorways so children face tragic accidents when they come out of the over-crowded homes to play.
Use of non-permanent, often inflammable, building material poses an added risk. In such a scenario, occupants are exposed to the dangers of burns, scalds, accidental fires and extremes of weather. The problem is compounded by the lack of adequate supervision when all adult members of the family have to go out to earn a living, When these accidents occur, the lack of adequate facilities and first aid information further increases fatalities. In case of a fire incident, first the victim should be covered with a blanket, sheet or anything else to extinguish the fire and then immediately taken to hospital for further treatment.
Nurse Ishrat told me that mostly patients are brought to the hospital in very severe condition, quite often several hours after the incident. On an average, 4 out of 10 patients can survive. There is a very little chance of survival for patients with chest burns. While mostly deaths occur due to infections developed afterwards. Generally poor and illiterate people come to the NICH as it provides free medical treatment. Most of them are completely ignorant of the basic health and hygiene measures. The doctors and especially the nurses try to educate them how to look after their children and give them proper diet. Some of the attendants do cooperate but the rest are simply impossible, creating problems both for the administration and the patients. Quite often the visitors misbehave with the nurses and abuse them verbally.
Mostly visitors at the Burns, neonatal and other wards in NICH are satisfied with the nurses and doctors but there are exceptions too. Some of the relatives complain that the nurses are short-tempered and give more attention to the patients who give them money or have contacts. Pressure on the hospital is immense. With only about 32 nurses and 30 doctors, NICH is providing services to hundreds of patients ( around 500 to 700) in O.P.D. daily. In wards, the situation is also intense and the number of admitted patients is almost double the actual capacity. Due to a ban on recruitment in government services, resulting from unfair quota system, the hospital can’t appoint nurses and doctors. The immediate victims of the policy are nurses and lower staff. In the Burns Ward, one nurse has to attend 14 to 16 patients at a time with one or two technicians and trainees. Nurses work in three shifts, each is of six hours. And then everyone expects them to give individual attention and exclusive services in return of a nominal salary, pathetic working condition and disgusted public attitude.
Three doctors are responsible for the NICH Burns Ward. But it is mainly the nurses who normally look after the patients, thus establish a close bond with them.Neither Sister Ishrat nor Matron Mussarat are satisfied with the public participation and the social workers’ role in the welfare of NICH patients at least in their wards. “No one does anything for these poor, miserable children except the Child Aid Association.” This is the welfare organization, founded in 1979, run by Prof. Nizamul Hasan and his dedicated team and provides free medicines, blood equipment and supplement food for the sick and the needy
Patients suffering from burns need high protein diet like fish, meat, eggs, fruits which can’t be afforded by most of the poor people. Ishrat and Musarrat urge philathropist to provide generous food and blood donations for the quick recovery of the burnt children at NICH.
When I finished my visit to the ward, Ishrat clasped my hand and said,” I hope you will come again. Write about these poor little souls. They really need help and more than that affection and attention from the society.I left the hospital with a promise, a thought and a hope. Promise to visit the children again; thought that the majority of the fire accidents are preventable as they are simply the result of someone’s ignorance or negligence; and a hope that as long as the dedicated people like Ishrat are present in our society, fire can never defeat the little souls’s passion to live.