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

I don’t want to imagine what the decorum of treatment for a civilian would be if taken to MH Rawalpindi.

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.