October 15, 2023, remains a haunting memory for Moon Shahzad, who experienced the loss of his wife and newborn child on that day.

A 31-year-old resident of Ladhay village, a suburb of Narang Mandi town in Sheikhupura district, Moon Shahzad’s daily routine involves collecting milk from his village on a bike and selling it in Narang Mandi city.

Moon Shahzad took his wife to a private clinic in Narang City for her expected delivery that day. Both his wife and the newborn lost their lives during the operation.

Moon Shahzad says that he had been married for a year and a half, and the child he was expecting was his first. He brought her to the Narang Mandi rural health centre for a routine check-up during his wife’s pregnancy. Dr Tariq Saif, who was present at the centre, informed him that the facilities were insufficient. He advised Moon Shahzad to take his wife to a private clinic where she could receive proper treatment, including access to operation facilities.

“We visited the private clinic of the same doctor, who works in the government sector, along with his wife, Dr Amara Saif. Throughout four months, we had regular check-ups for my wife. During each check-up, the doctor reassured us that both the mother and child were in perfect health, minimising the risks of complications during the operation. On the day of the scheduled operation, my wife was in perfect health,” Moon Shahzad says.

Moon Shahzad alleges that the negligence of the doctor led to the death of his wife and child, speculating that an incorrect injection might have been administered.

Additionally, Moon Shahzad claims that during the emergency at the private clinic, there was a lack of oxygen in the cylinders, further hindering efforts to save the patient’s life.

“I witnessed the scene at the clinic where the staff, amid chaos, took three cylinders one by one to the labour room. Later, a cylinder was requested from the rural health centre, but by then, it was already too late,” Moon Shahzad says.

Moon says that due to the alleged administration of the wrong injection, his wife faced breathing problems and timely oxygen was not available to her.

Dr Tariq disputes these allegations, asserting that the patient had a pre-existing respiratory condition, which had been communicated to the family in advance.

“We also conveyed that there could be complications during the operation, suggesting it would be better to take the patient to Lahore would be better. However, the family members insisted on proceeding with the operation here.”
According to him, he also possesses the form signed by the woman’s husband in this regard.

Moon Shahzad says such forms are a standard requirement before any operation in every hospital.

“I wanted to save my wife’s life, so I decided not to take the risk of transporting her to Lahore. But she still did not survive.”

He says that he wouldn’t have had to visit the private clinic if the rural health centre had adequate facilities. If the private clinic had experienced staff and access to oxygen, his wife and child would still be with him today.

The doctors running the clinic are unwilling to admit the accusation of having insufficient oxygen. They say that there were two oxygen cylinders in the clinic at that time, and an additional cylinder was requested as a precaution because the amount of gas administered to the patient was high, i.e., 10 ml/min.

Narang Mandi is a large town in the Muridke Tehsil of Sheikhupura District, situated near the borders of Lahore and India. As the sole rural health centre for medical services in the villages near the Indian border, Narang Mandi plays a crucial role in providing healthcare. The local population estimates range between two and a half to three lakh, including Narang Mandi and its surrounding villages.

Established in 1974, the rural health centre in Narang Mandi underwent major upgrades in 2013, including the construction of a new building and the expansion of the bed capacity to 43. However, locals say that, historically, these beds have never been used. According to local reports, there has been only one instance where two dengue patients were briefly admitted to the facility.

According to the rural health centre staff, there are six doctor positions, with five currently filled. However, the position of the women’s medical officer is presently vacant. The hospital employs 51 staff members, including five doctors, eight nurses, and five dispensers.

According to the latest census, the population of Sheikhupura district is approximately 40 lakh 49 thousand, with over 70 per cent residing in rural areas, totalling more than 30 lakh people. The district has only eight rural health centres, indicating only one rural health centre for every three lakh 75 thousand people.

According to local residents, the X-ray and ultrasound machines in the rural health centre are not functioning. While the ECG machine is operational, few individuals can avail themselves of its services.

Hamza Ishaq, the head of this rural health centre, states that X-rays are not conducted here due to the absence of X-ray machine film. This issue has been brought to the attention of the Chief Executive of Health.
“Perhaps due to a lack of budget, they are not providing us with the film.”

He says that the ultrasound machine is operational and has no issues. The ECG machine is used less frequently, as many patients prefer private clinics. According to him, individuals with heart conditions tend to avoid using this facility to save time, as a treatment for heart diseases is not available here.

The distance from Narang Mandi to Muridke Tehsil is 32 km, Sheikhupura City is 77 km away, and Lahore is 73 km from this location.

Imran Rasheed, a resident of Narang Mandi and an official of the Traffic Police Department, reports that the rural health centre lacks treatment and medicine for snake bites.

He says that the majority of the residents in the area are farmers, and people affected by snake bites and other poisonous insect bites are referred to Lahore for treatment.

He says, “Doctors here only examine patients; the rural health centre does not have medicines for common ailments like colds. Many times, there is a shortage of medicines even in emergencies.”

He says, “If a serious patient comes for examination, they are told to take them to Lahore. In our view, this is an injustice to the millions of local people.”

Dr Tariq Saif, serving as the Senior Medical Officer of this rural health centre, explains that the facility lacks positions for gynaecologists and cardiologists. Therefore, it is recommended to refer patients coming here to Lahore.

Saeed Ahmed Farooqui, a member of the local health council formed to oversee the rural health centre’s management, highlights the hospital’s economic challenges due to the lack of facilities. He says that the funds received from the government are exhausted within ten to fifteen days.

“For the remainder of the month, emergency medicine is procured by local residents and supplied to the rural health centre.”

“In Narang Mandi, philanthropists have established a board that collects donations and supplies them to a medical store. This ensures that whenever the rural health centre requires emergency medicines, they are readily available, and the bill is settled every month.”

According to Saeed Ahmad Farooqui, it is crucial to establish a hospital in the area equipped with basic medical facilities, a trauma centre, and a gynaecology ward. The lack of timely medical assistance in everyday accidents has resulted in many lives lost. Similarly, it is impractical to transport a maternity patient to Lahore.

He says that two years ago, 22 people suffered burns due to a gas cylinder explosion during a traffic accident here. As there was no burn treatment or medicine available at this centre, they had to be transported to Lahore, resulting in 18 casualties.

Saeed Ahmed Farooqui raises questions about the health infrastructure in Pakistan, which has set a single standard for all rural health centres. In his view, this is unfair to overpopulated and remote areas.

In his view, the patient load in each rural health centre varies, and the Narang Mandi health centre, receiving up to 600 patients daily, contends with only two or three available doctors.

“The patient load at the Kalashah Kako rural health centre is many times less than here, yet nine doctors are posted there.”

Former Member of Provincial Assembly (MPA) Chaudhry Hasan Riaz, who belongs to the Pakistan Muslim League-Nawaz (PML-N), also agrees that the rural health centre in Narang Mandi does not have the facilities that a town with such a large population should get.

According to him, he had tried to increase the number of doctors and nurses in this health centre during his previous administration, but the rules and regulations of the health department did not allow it.

Saeed Ahmad Farooqui, a member of the health committee, and local people disagree with this ‘logic’ of Chaudhry Hassan. They say that laws or procedures are made for the betterment of people, and what is the purpose of a law that increases people’s difficulties?