Establishing burn centers

Chief Minister Mahmood Khan has agreed to the proposal of establishing burn centers at Divisional Level Hospitals. Currently burn centers are functional at few teaching level hospitals which are now run under the not-so-comprehensive MTI Act and necessary rules and regulations have been codified thereon. It is pertinent to mention that the functional burn centers at MTI hospitals are confronted with the deficiency of state-of-the-art equipments, trained surgeons and supporting medical staff. Therefore, serious burn cases are shifted to Pakistan Medical Institute Islamabad and burn center at the Combined Military Hospital Karian. However, the proposal of establishing burn centers at the Divisional Level Hospitals is worth appreciation if it does materialise.

The Chief Executive of the province may be well aware of the inefficiencies in the secondary healthcare system and perhaps it seems to be the primary driver behind the decision of extending the extent of enforcement of MTI Act to the district level hospitals and formation of District Health Authorities against which the doctors had protested as in the absence of well documented rules and regulations the existing MTI Hospitals are functioning in vacuum and that too with remote control system and hooch-pooch Board of Governors constituted on pick and choose.

At present none of the Divisional Level Hospitals have standard clinical laboratories that have the required equipments and chemicals. Neither the vacancies of clinical Pathologist have been created in these hospitals nor are high caliber technologists available there. Even the clinical tests that pertain to patients other than body burns from these hospitals are being refereed for clinical investigation and results to Agha Khan, ShaukatKhanum, RMI and North West Hospitals’ labs. The burn centers would need highly trained surgeons of burns specialty and nurses to look after burn patients of burn injuries. The highly talented and trained surgeons prefer their postings in the hospitals at the Provincial Metropolis Peshawar and the government will find it extremely difficult to either recruit or transfer the required surgeons and nurses to the burn centers in divisional hospitals if at all these facilities are created with the necessary technical infrastructure.  Proper home work will have to be done before making investment for creating burn centers in the secondary healthcare system, notwithstanding inevitability of this facility.

Another pressing and chronic issue is the abnormal delay in the release of budgetary allocations to the district and divisional level hospitals. The allocated amounts for the purchase of medicines, chemicals, instruments’ repair and replacement are released in the last quarter of fiscal year. Bulks of released funds are not judiciously and honestly utilised.

Before the enforcement of MTI Act, the codified rules and regulations facilitated the smooth disposal of administrative and financial matters in government hospitals. In case of any ambiguity, the departments of establishment, law and finance at the provincial secretariat used to do the required trouble shooting and provide necessary expert opinion and guidance in the interpretation and application of relevant rules and regulations. Now the legal and institutional frameworks of teaching hospitals are suspended in the air. Why the government is disinterested in the codification of uniform set of rules and regulations that can be applicable to administrative and financial functions in each MTI hospital? How long the tertiary healthcare system shall be run on hit and trial basis, no doubt that patients’ treatment facilities at this category of hospitals have been significantly improved?

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