We Let Him Die: A Reflection on Chitral’s Healthcare System – By: Ihsan Ullah Meer
In 2020, I witnessed a profoundly distressing incident at a healthcare facility in Upper Chitral. A middle-aged man was brought into a center unresponsive and on the brink of death. Despite the presence of a senior doctor and nursing team, their response was alarmingly inadequate. Rather than providing the essential, life-saving interventions needed, the staff focused on irrelevant treatments, and vital medications like adrenaline were either unavailable or unknown to them.
The senior doctor’s command, ‘Avil, solucortef dedo,’ continues to jar my memory, like a sudden electric shock. How could he prescribe that for a collapsed patient? My efforts to save the patient were in vain due to the lack of necessary resources & support and ultimately, we lost him. The scene was heart-wrenching: his young daughter wept inconsolably, while a ward boy callously asked the grieving family to reduce the commotion, and the staff members dispersed as though it was just a routine day with another patient. I left the scene with a heavy heart and a deep sense of shame, feeling that we had failed in our duty.
I share this to express my grief and attempt to come to terms with this tragedy. However, a deeper, more troubling concern has plagued my thoughts since that day. How many individuals, like the man I witnessed dying, have lost their lives simply because they were in remote, neglected areas like Chitral? How many could have survived if they had been in cities such as Islamabad or Peshawar, where they might have had a chance to live a few more years with their families?
Another question that haunts me is whether the government is taking meaningful steps to provide us with basic life-saving facilities. The answer seems to be no. Are they ensuring that well-trained doctors and nurses are available? Again, the answer appears to be no. While my expectations from the government remain low, I hold on to a glimmer of hope that positive change is possible. The situation is dire not just in Chitral but across Pakistan, and yet, there is always a hope.
What other options do we have? Are there private hospitals in Chitral? No. Cardiologists? No. Gastroenterologists? No. Renowned neurologists? No. Do we have a single ventilator or ICU in Chitral? No. Do we have MRI and CT scan machines? Yes. Do these machines make a meaningful difference in our healthcare? Unfortunately, no, because we often refer cases downtown without treating the findings ourselves. The answer to every critical healthcare question is a resounding no.
So, what do we have? A well-established non-governmental organization (NGO) with a vision to improve healthcare in marginalized communities like ours? Yes, the Aga Khan Health Services Pakistan (AKHSP). Does AKHSP provide funds and infrastructure? Yes. Do they hire locals to run their setup? Yes. Do we have the right leadership with healthcare administration expertise? Probably. Do they meet our actual needs? Partially. Is there potential to maximize the use of their resources for our community? Yes, there is room for enhancement.
How can we address these issues and make the most of the available resources? The solutions may not be simple, but they are certainly within our reach. Firstly, the district health administration needs to step up and take responsibility for providing basic facilities, at least within their current scope of services. Secondly, while AKHSP deserves recognition for advancing basic healthcare facilities beyond what the government offers, it is crucial for them to extend their efforts further.
They need to address the specific unmet needs in Chitral. Although foundational services are in place, there is an urgent requirement for more advanced healthcare provisions to fully meet the community’s needs. The focus should now shift to acquiring specialized medical professionals, such as pediatricians, microbiologists, neurologists, and gastroenterologists, among others. Additionally, establishing an Intensive Care Unit (ICU) and high-dependency units is essential for providing more advanced care. Moreover, AKHSP should invest in staff development by hiring individuals with up-to-date healthcare knowledge, rather than relying on retired professionals from other organizations. It represents our primary hope for improving healthcare in the region.
The leadership of AKHS’P Chitral must embrace this responsibility and strive to make a significant impact, much like their counterparts in Gilgit. While I do not wish to draw direct comparisons, the success of similar initiatives elsewhere highlights the potential for positive change that it can achieve. By addressing these critical gaps, it can lead the way in transforming healthcare for the better in Chitral.
Lastly, we must unite as a community, setting aside sectarian, clan, territorial, and geographical differences. In these challenging areas with limited resources and infrastructure, it is crucial that we come together with collective effort. By uniting for a common cause, with health as a top priority, we can bring about meaningful change and improve our circumstances.
