Mushrooming substandard maternity clinics, laboratories and diagnostic centres operating unchecked in the peripheral areas of the city are playing havoc with public health. Participants of a session titled ‘Problems during pregnancy and its awareness’ organised by Liaquat National Hospital’s Department of Obstetrics and Gynaecology demanded urgent measures for curtailing the trend.
They also referred to the trend of monetary benefits offered to general physicians for referring patients to maternity homes, laboratories and diagnostic centres providing substandard services.
The participants, comprising family physicians, nurses, consultants and senior gynaecologists, complained that these clinics often run by poorly qualified people or those with little regard for ethics have resulted in severe harm to women, many of them in the prime of their youth. Dr Gauhar Rahim mentioned the trend of ultrasound training courses offered to lady health workers and health visitors by many unscrupulous elements.
“They, with their established facilities across the city, get advertisements published in major dailies to attract unassuming individuals,” he said. Inviting people with inadequate educational qualifications for training in an essential filed of diagnosis could have severe repercussions, warned the expert in the field of reproductive health.
He was supported by other senior physicians and experts who mentioned cases brought to them of people who were compelled to undergo unsafe surgeries on the basis of exaggerated size of even benign tumours or fibroids.
Dr Zehra Naqvi referred to instances where young women were put on treatment for infertility, including surgical interventions, without necessary assessment of hormonal levels that might have been easily addressed.
In her elaborate presentation titled ‘Introduction to women’s health and role of family physician’, Dr Haleema A Hashmi said that family physicians are in a better position to help expecting mothers due to their availability, affordability and the trust they enjoy of people.
“They can easily identify any unusual development during pregnancy and refer the women concerned to any properly functioning secondary level or tertiary level hospitals in accordance with the need,” she said.
Hashmi also identified paucity of time, lack of updated knowledge about reproductive health matters, little interest in patient counselling coupled with inadequate communication skills as some of the weaknesses identified among family physicians.
“Consequently, we find that despite their capacity to play a leadership role in a team of healthcare providers, they are unable to prevent pregnancy related complications through early detection and timely referral,” she said.
The senior doctor also regretted their inability to guide couples about importance and relevance of birth spacing.
In her presentation on ‘Care of pregnant women at primary healthcare and family physician level’, Dr Salma Batool Naqvi said that ideally, antenatal care begins at the preconception stage through health education.
She said that effective antenatal needs must be focussed on what should be achieved at each key stage of pregnancy, that is, the three trimesters.
Naqvi said that unlike antenatal care and pregnancy related assistance in the West, in countries like Pakistan, they are provided at community level and by family physicians.
“This is absolutely practical. However, those attending pregnancy related cases ought to be adequately skilled and trained,” she said.
Dr Shagufta Tahir highlighted the relevance of tertiary care, and at the very onset of her presentations, said that only complicated cases need to be referred to tertiary care level hospitals.
“In our context, we often find basic health units to be nonexistent with secondary healthcare centres and tertiary hospitals as options for women,” she said.
Dr Quratul Aman and Dr Zehra Naqvi shared with the participants case scenarios comprising women brought in critical conditions from different hospitals and clinics in the city.
Time, they said, was essential and delayed referral had severe implications for women passing through the process of giving a new life, said Aman.