Who is to blame for negligence towards patients at military hospitals?

Published: September 2, 2016
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There is a large void when it comes to treating insulin dependent diabetics in Pakistan. PHOTO: AFP

Lately, I have heard the army has become the solution to every problem in our society. The problem I am about to reveal is very close to our homes. And trust me; it’s a very serious problem and people will suffer if it’s not rectified.

Army institutions have always been considered an epitome of quality, excellence, and class in Pakistan. Whether its housing blocks, shopping malls or hospitals – if being governed by armed forces, they are thought to be the best.

My sister-in-law, the daughter of two retired army officers and the wife of a retired army officer, is an insulin dependent diabetic. She has told me stories of how there is a lack of treatment and support for insulin dependent diabetics, with reference to her personal experience. I used to doubt her claims because she was always treated at army hospitals, which I thought, were the best this country had to offer.

A couple of days ago, I got a call from my wife informing me that her sister is not feeling well. Unfortunately, I was in Karachi while the patient was in Rawalpindi, so I took the role of an online clinician.

After speaking to my sister-in-law, I learnt that her blood sugar had rapidly risen above 580mg/dl. She was feeling extremely nauseous and had been vomiting constantly. She tried her best to regulate her blood sugar by taking additional doses of insulin, but instead of stabilising, her sugar level kept rising.

I put on my physician’s hat and analysed the situation; after a while I ascertained that she was suffering from Diabetic Ketoacidosis, which is known to be a life-threatening condition. This is common in insulin dependent diabetics; moreover, if not treated properly, it can be potentially fatal for young patients.

I was about to ask her to go to the hospital, but to my utter surprise, she was already at the Military Hospital (MH) in Rawalpindi when I called her. I was astonished because she’s the kind of person that has to be pushed into going to a hospital.

I thought she had reached a state-of-the-art hospital and things will start getting better from there onwards. However, after a few hours, I received a distressed call from her mother telling me that she had been seen by a junior doctor after a four hour wait – who has now put her on slow intravenous fluids. I asked her if any blood tests had been conducted, but nothing had been done till then.

A young patient was facing a life-threatening condition in a military hospital, in a big city, but nothing had been done to treat her for four hours since her arrival. She wasn’t reviewed by a senior doctor and was left in casualty with a bag of fluids. As disgusting as it sounds, this was the harsh reality. I had to take charge and dictate the treatment and diagnostic procedures via phone call.

Unfortunately, the army doctors are trained in a similar way to soldiers. So, the person on the other end of the phone wasn’t compliant to take my advice as I was not his supervising officer. She would rather let the patient deteriorate than take advice from a civilian who is a qualified practicing emergency medicine specialist. At least she sent the blood investigations that I requested, and that finally confirmed my diagnosis.

Thankfully, the patient’s mother was a retired army doctor herself and had connections, so they finally managed to get hold of a senior doctor 10 to 11 hours later who categorised her as ‘dead-in-line,’ which translates into dangerously ill, and initiated the right treatment regime.

She was moved to the high dependency unit. Throughout the night, she suffered from hypoglycaemia (low blood sugars) which is lethal. Luckily, she had recently bought herself an insulin pump and glucose sensor that would alert her before things went completely out of hand. She managed her blood sugar herself the entire night, and was not reviewed by any one.

I was speaking to her mother the next morning and she informed me that the patient has improved. I wanted to speak to the trainee doctor and further investigate the international treatment protocols. I was told that Brigadier Sahab had said otherwise and they had to follow his orders. I asked them to discuss it in their clinical rounds but the answer was not very reassuring.

If this is what happens to a critically ill patient that’s taken to MH Rawalpindi, especially one that is affiliated with the army, I don’t even want to imagine what the decorum of treatment for a civilian or a non-commissioned officer would be if taken there.

If the army is training doctors as per Brigadier Sahab’s textbook of medicine and evidence-based medical journal, we can expect the death of quality medical practices in Pakistan. Doctors are innovators and their thought process shouldn’t be tied down to a rank. International evidence based protocols and guidelines need to be implemented, even if it’s the army who details the guidelines of other peoples’ lives.

There is a large void when it comes to treating insulin dependent diabetics in Pakistan. The medical training bodies need to further stress its importance. These are potentially salvageable young people who, if treated properly, will bounce back to a healthy life.

Mustafa Mahmood

Mustafa Mehmood

The author is an emergency medicine specialist, practicing in Republic of Ireland.

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Farhan

    Competence of Pak Army Doctors, senior or junior, is a big question mark. I am a victim and have also heard so many stories of their incompetence. My advise is to stay away from Army doctors and Army hospitals in case of any emergency.Recommend

  • Amir

    One can NOT question the military in Pakistan. Whatever they do is good good good.Recommend

  • imran

    What if they had given the fees of the brigadier sb. It is extremely unfortunate that Army doctors are the most greedy doctors I have encountered in my career. Moreover senior doctors start their private practice early in the morning till late night without bothering to see a single entitled pt. using all government funds and equipments. Their is no accountability at all and everyone from top to bottom in Army medical core gets their share for remaining shut up. And it is so unfortunate that civilians doctor are exploited to see all the entitled serving and retired Armed personnels in the name of training and continuous medical education. Recommend

  • Fareed Malik

    Where VIP culture prevails and there is death of merit..these outcomes are a harsh reality
    Recommend

  • Amb

    The Army doctors are not well trained as they dont have the exposure of diseases in community as they dont cater to masses neither they have a foreign degree . They are just a bunch of mediocres that join the Army to get benefits like house and car at an early age unlike the doctors who work with masses and dont get these benefits . Recommend

  • RedHulk

    So her mother didn’t do any thing as she was also a doctor tho a retired one? :/ The doctors who can’t treat them selves at home o.O sounds strangeRecommend

  • Noor

    True n I totally agree..we have experienced the same situation when my mother was admitted in CMH..though i’m from fauji background but the reckless n lousy behaviour of trainee doctors made me write this. I was shocked as there was no senior doctor to come n check their patient.After morning round getting connected to your concerned senior doctor was the toughest thing on earth( no matter the patient is about to die). The helpless patients are left in the hands of snob army trainees n staff.i lost my mother due to the negligence of brigadier Sahab not coming for 2 days to attend his patients. Always wanted to complain but never could do it.after reading this article some harsh realities came back.Recommend

  • Jamal Qadir

    Your sister in law was still lucky being daughter of two retired officers and married to an army officer. Think of the plight of the family members of an NCO or actually NCO himself. Go to CMH Peshawar or Rawlpindi and see how the returnees from the high altitude are being treated for their neurological disorder. I bet the situation is no different for any NCO patient even if they are war-ounded.
    Just walking through CMH or MH Rawlapindi, one wonders if they are in GHQ or a military hospital as every other board says General So and So. Is there actually a need for that many senior ranking officers?Recommend

  • DocAli

    There is no awareness among the medical professionals with regards to Insulin Dependant Diabetics. And training bodies like CPSP and PMDC dont give a darn about it. Recommend

  • naj

    If u r sooo much experienced, better come to pak n serve this nation instead of making moneyRecommend

  • MSA

    This is pretty normal in military hospitals. Doctors considered them as god. My dad was a junior commissioned officer and POW in India after the 1971 war. His name was missing from the POW list and we did not know if he was alive or not. One night my mother stared to get nausea attacks and I had to take her to Jhelum Military Hospital on bicycle around 2AM. We waited all night for the doctor and he never showed up. According to one of the enlisted jawans on duty,” Doctor Sahib was having fun with one the female doctor”. The Doctor showed up after 6am and when I complained he started to act real rude. When I threatened to report the matter to GHQ, he came back to his senses real quick. By that time my mother was felling OK and we left without getting treatment. I have seen doctors kicking army jawans while visiting regiments for daily treatment and abusing them and treating them like an animal.Recommend

  • MSA

    This is pretty normal in military hospitals. Doctors considered them as god. I like to share one of my experiences at a Military Hospital. My dad was a junior commissioned officer and POW in India after the 1971 war. His name was missing from the POW list and we did not know if he was alive or not. One night my mother stared to get nausea attacks and I had to take her to Jhelum Military Hospital on bicycle around 2AM. We waited all night for the doctor and he never showed up. According to one of the enlisted jawans on duty,” Doctor Sahib was having fun with one the female doctor”. The Doctor showed up after 6am and when I complained he started to act real rude. When I threatened to report the matter to GHQ, he came back to his senses real quick. By that time my mother was felling OK and we left without getting treatment. I had seen doctors kicking army jawans while visiting regiments for daily treatment and abusing them and treating them like an animal.Recommend

  • Zahid

    so what do you think is the reason . extra work load ,incompetent doctors , lack of motivation ,national character, low salary and benefits .let me tell you best of brains go to army medical college .army doctors used to best few years back till the time they were taken care .now the case is different .no respect ,no money ,no promotions,no release on fullfilling bonds .ARMY MEDICAL IS GOING TO DETORIATE AND DETORIATE TILL IT VANISH Recommend

  • Adeel Gardezi

    Well that’s one side of the picture. Before making any opinion, a chance should be given to “Brig Sahib” as wellRecommend

  • Farrukh Akhtar

    It’s very easy to comment upon doctors in institutions of Pakistan when your majesty is serving people outside PakistanRecommend

  • https://about.me/bishart Dr BiShArT

    this happens more commonly and in big setups as well…health sector is deteriorating as no one cares …Recommend

  • https://about.me/bishart Dr BiShArT

    and the lady SURVIVED 11 hours of DKA “without being managed properly” that could not be trueRecommend

  • Asad

    Nicely written, the first few paras, i felt like she was going to die but as it turned out
    The patient got better, did not die, and got discharged…..
    Too much masala if u ask me….. that’s the usual attitude of doctors who see 15 patients per day….
    The brigadiere sahab was right and treated the patient correctly…. your patient decided not to give the devil his due and took all the credit…..
    If you’re patient is healed you thank god
    If you’re patient is not healed you blame the doctor…

    If military hospital is so bad… please tell the lady to give up the treatment there…. surprisingly she will not…. all that free medication… who wouldRecommend

  • A Sepoy

    Arrogance is the name of this profession in Pakistan, civilian or military. Somehow they feel that they have been thrown from heavens and people should not seek their treatment but obey their commands.
    Someone mentioned that they are not well trained and have no foreign exposure. That is not true. They are competent people but just full of themselves. Someone also mentioned that it is the junior doctors or trainees who do not care about the patients. You have see their high-ups particularly those with red-tapes on their collars. They are just so-consumed by the grace that their shoulders and collar-tapes. All other things are secondary.Recommend

  • Ali Amar

    As per my knowledge, there is a system in military. If anyone goes through a situation like this, there is a channel of reporting the complaint. And the commanding office always take serious note of any negligance.
    The problem is that after seeing this blog, all those who sufferd negligance have written comments but in reality, army doctors have the highest pass percentage in FCPS 2 (inrespect of no. of attempt)exams conducted by CPSP which is an autonomus body. Moreover not all trainee doctors in mil hosp are FAUJI. As a matter of fact, 3-4: 1 civil to army doctor ratio in mil hosp. Its not appropriate i think to raise finger on FAUJI doctors before looking into stats. Plus one should report any negligance to the chain of command of the hosp, which to my experience are easiest to approach in military with their personal cell no.s displayed all around the hosp.
    A humble opinion. Regards to allRecommend

  • Barangai

    lol,army doctors are incompetent?the army doctors pgship training is done in military hosp and the only institution where the training is structurally organized are either cmh or agha khan hosp.part 2 fcps passing ratio in army is several folds higher than civilian because of the structurally oriented training we get in cmh unlike in the civilian hosp which is topi drama.

    the doctors in the west are not exposed to many infectious disease and other common disorders but does it makes them less skilled.

    The fact is that army doctors are the most well trained doctors in Pakistan with exception of those in civilian line having foreign training.Recommend

  • Asim

    I can well imagine the irony of an Irish physician here.. interestingly, when he’s raising issues about poor management, his patient is being seen, investigated, treated, and finally got well … Nd still he’s taking credit for being the ultra professional online physician. Let me tell u Mr Ireland, ur patient or any patient treated at army hospital is getting treatment at priority, which is triage based, Nd with responsibility. They treat thousands of patients every day, which all get well, Nd return home safely, like they do in Ireland, .. few get complicated and eventually suffer, like they do in Ireland.. but ur one incident is meager enough to cast shadows on institutions being run for years with credibility Nd confidence… I’m a neutral person telling u, the state is far better than govt hospitals Nd many ‘state of art’s hospitals, which charge more Nd treat less. Health is most important, Nd if they were so negligent in past, ur people would not hv been rushing there again and again… so plz, don’t make these great institutions meager by ur incident, which is nothing but a publicity stunt…. adios, Recommend

  • Concerned Diabetic

    How convenient of you Asad. Like all other fellow country men, give right to do what ever army wants to do. That’s is why our nation is prospering so quickly. Does she necessarily have to die to prove that what ever happened was wrong? I pity people like you. Just because Army is giving free medication they have the right to do what they please, Is that what you mean? Perhaps even the right to kill the patient to satisfy your desire? It is because of people like you who think right if it is nor working for you go to another place but lets not change the system. I am an Insulin Dependent Diabetic. I have been there couple of times, trust me it is Allah who saved me, If i was left at the mercy of those MH doctors, i would have ended up dead. I know more about my disease and have literally got to dictate the treatment because if we wait for the Briadier we might as well start digging up our grave mean while.Recommend

  • Imran gul

    I think the dr saab is just naraaz because his telephonic advice wasnt given due importance..if I were so concerned about the mistreatment of a loved one..I wudve flown to rwp from karachi at least the next day..rather than keep on enjoying my vacations…and writing stupid blog..Recommend

  • Dr rabia

    I don’t think half of it is true. 11 hours of unmanaged dka with recurrent episodes of hyper/hypo glycemia and the patient still survives. Plus we recieve calls for any patient and respond to them accordingly. We have always sent abgs or urine for ketones for every patient presenting with high blood sugar levels n vomitting. House officer,on call trainee everyone has been taught about dka. I remember dka being discussed repeatedly till the ‘new’ treatment guidelines have been imprinted on our minds. We even have a screenshot of the table regarding its treatment in our cell phones. Junior or senior doesn’t really make a differnce as long as you know what’s going on with the patient. We know the sops. We don’t spare a jawan, this was an officer’s family we are talking about.The writer himself is a practising physician in ireland. If hethinks our system is lacking so much why doesn’t he bring his sorry face back to his country and make ammends.
    Recommend

  • Dr rabia

    I don’t think half of it is true. 11 hours of unmanaged dka with recurrent episodes of hyper/hypo glycemia and the patient still survives. Plus we recieve calls for any patient and respond to them accordingly. We have always sent abgs or urine for ketones for every patient presenting with high blood sugar levels n vomitting. House officers,medical officers, on call everyone has been taught about dka. I remember dka being discussed repeatedly till the ‘new’ treatment guidelines have been imprinted on our minds. We even have a screenshot of the table regarding its treatment in our cell phones. Junior or senior doesn’t really make a differnce as long as you know what’s going on with the patient. We know the sops. We don’t spare a jawan, this was an officer’s family we are talking about.The writer himself is a practising physician in ireland. If he
    thinks our system is lacking so much why doesn’t he bring his sorry face back to his country and make ammends. Recommend

  • Muhammad Rizwan

    This is just not true…if u r so concerned about plight of patients in pakistan why dont u bring ur face back to pakistan and serve here…11hrs without attending a patient is totally false accusition…trainees are trainees…thyr not sepcialist….why dont thy go to some civil hospital if thy have so much complaints against army docs…coz there thy have to pay some money…if a person cant purchase ten tablets of paracetamol from pharmacy and tarvel two mile to get paracetamol thn…stop this non.sense….there are hundred of patients who survive in army hospitals…Recommend

  • Ahmad Bilal

    i did my training in mh and even house officer can manage dk better than you almost every body used up todate protocols. they want only ranks that brigadier and general should treat them and again why you were calling and interrupting doctor while he was doing treatment.is it possible in other countries.Recommend

  • http://Zubariajan.blogspot.com/ Zubaria Jan

    I completely agree if the person has to say the patient wasn’t treated for 11 hours because my sister recently lost her baby, getting treatment from a renowned military hospital of Islamabad, just because of the negligence of the doc (who is also the HOD there) and even after the baby was dead the surgeon didn’t come and operate my sister because it was 1 am she couldn’t lose her sleep over someone’s dead baby that too because of her own faulty checkup. She kept the dead baby in her womb till 9 in the morning, and only then when the surgeon (Dr. Sadia from PNS Hafeez) came, they operated her. It was life threatening but of course people don’t seem to care and won’t believe in such ‘stories’ until it happens to them.Recommend

  • NKAli

    Surprising and indeed very shocking! I least expected to read about such carelessness. The ‘big bang’ general and ISPR should take a note and make amends because it’s the civilians that ALSO matter in this country and not the guttersnipe politicians. Salams Recommend

  • Mza

    I am working in Ireland for the last four years.
    I agreed they gave lot better system as compared to Pakistan but bear in mind how much Pak got spending upon health system and its related research.
    To my surprise lot of patients are being neglected too in Ireland in spite of ” high standards” being set.
    Where I worked or anywhere in Ireland the normal waiting times are increasingly high and patient awaiting for hours before being seen by a doctor and many times we know what is happening with patients from Gp’ ‘s to Emergency or outpatients.
    I can write a lot on this comparison but as we all know pros and cons off all health systems , no one can blame one persons mistake to whole system knowing we came from same system .
    Complications are happening everywhere in spite very high standards and we all know things won’t improve in Pak till our got won’t spend properly on health system.Recommend

  • Mza

    Every health system has pros and cons.
    I am working in Ireland for number of years, I could argue for hours about problems in West health system too.
    If I compare health system in Pak, I could see one great issue that Govts has no interest in patient welfare. We can blame doctors in Pak to some extent but not for all as we working in West to become “specialised” doctors are also from same background too .
    Patients in West are awaiting to be seen by a doctor’s for hours until they are really sick or fell more sick in emergency department otherwise they have to wait many hours.
    Ideally CMH hospitals should not treat civilians but because of poor health system governed by our govt ,CMH are sharing health burden.
    To cut short I can debate on pros and cons of west health system as compared to Pak health system , the only difference is the Government rather than doctors competency.
    Only one example I would like to coat I saw one lady with post breast cancer in emergency depth in Ireland , was being seen every 3 months for mammogram but no one examined her abdomen, she came to me with abdominal pain , she has hard palpable liver—- multiple liver mets/ brain mets– none of surgeons mentioned in patient file about that for the last one year except doing mamogram every three months.so she was being neglected in high standard western hospital too.
    I was too sad for that patient while I was in western health system
    I still feel sorry for what happened with lady in CMH but I would blame health system in Pak rather than to single out doctors back home.
    So complication/ problems could happen any where so we should pray and and give suggestions rather than criticising our country.
    ThanksRecommend

  • Meshayam Arshad

    – Hey everyone, I am just at loss to understand why are we all even responding to this pakistani irish doctor’s story who just wants to malign pakistan army and especially pakistan army doctors
    My dear specialist from ireland, give us the detail of the case, name of the patient, date of admission and discharge, bed number and ward of the specific hospital if you are interested to apply any meaningful correction instead of things in air. Let me also tell you when i asked one of my own relatives who is a diplomat American board in medicine pulmo and critical care serving in Shifa international he just laughed at his story, as per his assessment a patient of DKA getting discharged only after two days of treatment even after substandard treatment in a hospital please note everybody. Recommend

  • Ali Muhammad

    it’s more of a fake story than the reality. MH is a prime institution where such like incident is not possible, the PREJUDICE against ARMY of the writer/ publisher is evident from few points in the complete article. EXPRESS TRIBUNE has a long history of narrating MISLEADING STORIES before, I still remember few years back this new paper narrated a fake story of CUTTING THE JUNGLE IN GILGIT FOR JUDICIAL COMPLEX, for which I m witness to be false/fake storyRecommend

  • Ali Muhammad

    I suppose u instead of false accusation try to talk some sense, if at all u r left with someRecommend

  • Amin Ullah Shah

    Its so true all you said Doctor and they r many more stories like that at every part of our daily living in Pakistan. But the worst and sad part is when you see people still talking in a wrong/negative way in the comments not trying to realize the fact that they r going/suffering through so many things.
    Some are asking the author to serve back in Pakistan if he is so much concerned. Even from the article you can say that the author is so much concerned thats y he is sharing it with you sleepy heads, n i bet all of the pakistani abroad are concerned as they see the difference and life of both extremes and they r more than happy to serve or live in their own country but once they come to a stage that can bring some change not just going back to pakistan while still being at a excelling process and join the same flock, system, HOD n bosses again .
    So for God sake if somebody picks out some flaws or point in a system even if u r a part of it, just take it in a positive way and try to think how it could improve rather than making it worse by ur false thoughts and ideas. Better to give some positive feedback to improve or bring some awareness atleast .Recommend

  • Fazali Raziq Mirza

    Hi! I’ve gone through the complete discussion and to put everyone at ease, I have some points: 1. Why do we always think that its only gods or angels in the Army? It comprises the products of this nation! When so called learned people are minting money abroad, the not so learned are left to run the affairs here! 2. Once everyone starts dictating the doctor, it’s pretty natural that he/she would not listen to you because in the end its his/her responsibility. And after all whether trainee or specialist, he/she is a DOCTOR. 3. Doctors are humans too! For you your patients are very dear but a doctor can’t afford any emotional attachment as it will undermine his/her professional responsibilities. Moreover, life and death is only in Allah’s hands. A doctor does not have the capability to counter that.
    So friends I would request you to avoid becoming part of any misinformation unless and until you have seen it with your own eyes!Recommend

  • mia

    and what does that mean? Should the faults of a system not be pointed out especially where lives are concern.Recommend

  • Farrukh Akhtar

    This means his majesty should come back and contributeRecommend

  • Farrukh Akhtar

    If at all concerned, they, whoever is complaining must put in his efforts instead of complainingRecommend

  • Farrukh Akhtar

    So TrueRecommend

  • Farrukh Akhtar

    So Damn TrueRecommend

  • Farrukh Akhtar

    Would you serve in army ?Recommend

  • Farrukh Akhtar

    Does it bother youRecommend

  • Farrukh Akhtar

    the word senior means senior.
    Try any hospital, senior Will not come as per your orders, he will come only if patient is unmanageable by a trainee. The trainee will decide when and whether to call senior or not Recommend

  • Farrukh Akhtar

    You are misinformed.
    Army doctors pay ALL the expenses. Almost half of their income. Do you do that also ? Wherever you work.Recommend

  • Farrukh Akhtar

    Logical and very appropriateRecommend

  • Farrukh Akhtar

    Truly saidRecommend

  • Prince Anees

    Yeah. I totally agree with you. The army doctors are literally negligent to the patients. They are not doing there duty right.
    My father was martyred in Pakistan army.
    I ev happened to go Cmh for many times but the doctors there are so negligent with me.
    I had a skin problem. Probably it was pox or something alike. I went to CMH mangla. The doctor didn’t even asked me to show my body and wrote the prescription.
    Today I went again to cmh. The skin specialist came on 11 : 33 pm. Wherin we were waiting for him since 8 am.
    After getting the prescription I went to pharmacy . There again I ed to suffer a lot. I stood there for 3 hours to get my medicine. After he gave me medicine I checked it was 5 days medicine wherin the doctor had write 2 weeks .
    Army hospitals are literally not that good as they were supposed to be. There is no care of time.Recommend