Perspectives from the *other side* on Software, Management and Life

Sunday, November 25, 2012

Careless, cross that, criminal negligence in Pakistan's Doctor fraternity

The events and characters covered in this article are real. No synonyms or pseudo names are used, its the real deal. If you believe I'm being unfair, I don't care. In Pakistan we're blessed with more than a decent share of black sheep, and what I'm about to narrate is something that will render most individuals speechless.


My wife has had two Caesareans at the National Hospital in DHA, Lahore. The first Caesarean was unnecessary as the labor was artificially induced even when the term hadn't been completed; we'll classify this as incompetence on the Doctors part. Now incompetence beats criminal neglect, since incompetence mixed with dedication yields successful, although non-optimal outcomes. Having your first kid and some painfull stitches isn't the kind of experience that does justice to parenthood.

Moving on - we were on our third child pregnancy and my wife insisted she wanted a normal birth. We read a lot on the internet, by that I mean my wife become the encyclopedia on medical practices in pregnancy and in that process she had me pick up a few pointers on how pregnancy is dealt with in the developed world. So now we needed an expert gynecologist. This was going to be no normal pregnancy, we needed the best. 

Chapter 1 - unlucky

The process of finding a good doctor in Pakistan is that you talk to a few friends and relatives to come up with a list of potentials. We attempted this and in Lahore we couldn't find anyone other than the old generation of gynecologist, and since they were like really old, we couldn't go with them. So we decided to go with the head of Gynecology in a hospital that came highly recommended. Like I stated earlier, I'm not going to hold back any names. Fatimah Memorial is the hospital and our ill picked Doctor was Fozia Manoo Khan. She's specialized from somewhere in the US. I wish I had digged deeper into her degree, I fear she might have specialized from Harlem (a low ranked Hospital in NY) although doctors even there have some humanity in them.

On our first visit we laid it out to her i.e. we're not the standard case she's handled. We're going for a normal delivery after 2 C's even when its fairly rare in Pakistan. And we needed her to help us. She responded with the expected lecture, i.e. very rare in Pakistan and that she would give us a trial if we so demanded. 

Chapter 2 - the journey

The pregnancy progressed with a hiccup. After all, Pakistan didn't become a nation of 190 million magically, the nation has seen so many babies that we might as well make the baby our mascot! I digress! 
Dr Fozia M. Khan isn't the cheap doctor, she charges Rs 1,500 per visit, and we probably had over 10 visits easy. Each visit had us wait around 40 mins for a 10 min session. On most visits we'd bring up the following subjects:

1. I, the husband, want to be in the delivery room. She would typically respond that there in an LDR room that we can avail. Something of a rarity in Lahore, I guess most men think its honorably to be dead farts siting in the waiting room for the mother to do the 'womanly thing'. But in the late 8th month of the pregnancy she said the room had been broken down to make way for some renovations since it wasn't being used. Crap!

2. We want this to be a normal delivery. She would generally respond to this by saying that its high risk but would let us try it. 
So all was going well, until we hit the last week…..

Chapter X-1 week. Storm before the storm

On the last visit to her clinic, we ended up waiting 30 minutes for Dr Fozia or her nurse to arrive. Her nurse took some basic tests and then asked my wife to wait further for Fozia to arrive. I felt bored out of my wits in the waiting room and made the mistake of asking my wife if it was ok for me to check up on office stuff for a bit since my office was close by. I received a call 30 minutes later that I should come back from office to pick her up. My wife was extremely emotional when I arrived. On her last visit before the big day, Fozia M. Khan decided to SCARE by wife. She used every scare tactic she could, from describing how her uterus could shear and her organs splatter, to her taking 'NO RESPONSIBILITY' for her safety. Holy #$@$. On the only solo visit by my wife and the last before term completion, she decided to put on the witch costume! 

We were vested in her too much to change gynaes now. We prayed, we browsed the internet for more similar cases, and we prayed some more. My wife decided the next day that she's not changing her mind, she's going for the normal. Everyone who knew what was happening had their guts sticking in their throats but we all acted with confidence, and with confidence in her. What kind of a crazy doctor decides to scare a patient at the worst possible time when confidence can mean the difference between life and …. 

Chapter X! 

Somewhere up above, a decision was made to send a new life to this world. My wife had read enough to know that being in the hospital too early is bad for deliveries. She had us walking in a park during the labor pains and having me time them. I was scared. When is it too early and when is it too late to start the trip to the hospital. Why can't things be more simpler! In the evening my wife finally said, lets go, but on the condition that we would come back if the labor wasn't in its final stages. The drive took 40 minutes to the hospital. They checked, stated labor had begun but my wife said it wasn't in the final stages and we went home after discussing it with the nurse. Then at midnight, we went again. This time she was admitted. I was asked to wait outside in the waiting room. My mother in law accompanied my wife, thank God she had come by when she did. 
The next part of the story has two angles to it, one that I experienced and the other of my wife. Fozia M. Khan was busy with her dreams if you're wondering about her experience.

Me: I was in touch with my wife every 30-60 minutes via cell phone. 4:30 am was expected to be the moment by my wife's calculations.
Wife: Took no epidural or spinal. Doing so could complicate an already complicated labor. Duty Doctor who was suppose to check regularly was sleeping. The Duty Doctor needed to be woken up after every hour just so she can do her job, which she felt was a favor.

Me:  Time stops in moments such as these, and when 4:30am came …. it stopped for longer than I'd wanted. Than at 5am, my mother in law called, asked me to pray and from her voice I could tell something was off. At 6:15am I got another call from my mother in law, she said they were taking my wife to the delivery room
Wife: At 6am, ready to push. No Fozia M. Khan. Even the Duty Doctor is now ignoring me. Telling me to lay on the side and not to push until Fozia comes. Babies don't wait on Doctors! The pain was off the charts, and it wasn't the pain thats associated to prepare for the delivery, its the kind of pain thats telling you to push. I go ballistic, throw away the baby monitor. They finally move me to the delivery room. 
But instead of guiding me to push my child out, now I'm alone. No one is with me. Not even the Doctor. I wait for what is eternity. A rude nurse is now my sole guardian. The pain of not pushing is extreme. I beg the Duty Doctor, who was clearly avoiding me, to guide me in pushing so I can deliver. She says ONLY Dr Fozia can do it, to which I respond that I don't want her. I can feel my Caesarean stitches being stretched and the baby has come down. Another Doctor inspects and says the baby's crown is visible. BUT DO NOT PUSH - MUST WAIT ON FOZIA

Me: At 6:45 am, I'm worried. Something is not right. Why haven't I heard the 'good news'. I call my mother in law and she says the Doctor hasn't come! I call her assistant (the doctor never gave her own number), and she says that Fozia is on her way. I'm in a state of numbness …. my brain is sending too many signals at this point, some of anger, others of frustration and the rest of fear. I just say in a calm voice, what happens if there is a complication right now? Why is she not here. Little do I know that things have already unfolded that required Fozia to be there 30 minutes ago (6 am) at the minimum. A Doctor with some conscience would have been at my wife's side by 4:30am. 

At 7:15 am Fozia arrives. Delivers and then leaves not to be seen until 32 hours later. Some dedication by a Doctor for a case that even she, i.e. Dr Fozia, described as being extremely complicated and rarely carried out in Pakistan. 

Chapter - The End

I had a few choice words with Fozia when she finally came to check up. Her parting thoughts to me, "Take your wife to a foreign country for your next delivery then". 
I then complained to the MD of the hospital, who seemed frustrated at the state of affairs as well. His every attempt to try to figure why Fozia wasnt in the labor room were dead ends. In the end his opinion was, you cannot find replacements for doctors - better to have something than nothing. 

Charges for a delivery, one where the Doctor was MIA, Rs 60,000. 
Of which Rs 36,000 as direct fees going to Fozia. 


Dr. Fozia Manoo Khan was late by 3 hours per any decent standard, and criminally late by an hour in which two lives were put in danger. Incase you're wondering if its possible that Fozia was unaware as to how things were unfolding, let me clarify. Fozia was called by the staff at midnight and she was the one who had asked the staff to call her at 4:30am to update the status. Rather than rush to hospital given the level of dilation at 4:30, Fozia just waited until 6am for the dilation to complete, and only THEN have the hospital ambulance sent to her home in DHA. Did I mention, I live in DHA as well and even under no-traffic conditions you're looking at 30 minutes one way! So an ambulance leaving the hospital at 6 can only bring her back by 7! 
Ok - maybe there is still some wiggle room, possibly that she had some urgent matter at home. In my confrontation with her, her classy words were "my sleep was ruined and you're still ungrateful for having a healthy baby!"


Both mother and child are doing fine. The purpose of this post is not to count my lucky stars, but to ensure that I do my part in highlighting criminal negligence. And if you're thinking of having Dr Fozia as your gynae than at least I've done my little part in trying to highlight her record.

So if you've been thinking I sound cynical these days on how bad things are in Pakistan, you're right.