islamabad - Asima Bibi was playing in the kitchen when she suddenly fell into the cauldron filled with boiling water her mother had just removed from the fire.

Asima, two years old, sustained severe burns on her back, buttocks and lower limbs. Cursing themselves for inflicting pain to their only child, the parents shifted Asima to a private hospital of Hangu, Orakzai Agency.

But misdiagnosis of the severity of her burn injuries and inappropriate burn care deteriorated her condition. The treatment cost was also a financial burden for the poor father, Muhammad Arif, who is a khateeb in a local mosque of Hangu. So, the worried parents shifted their child to Civil Hospital Hangu, where doctors, after examining her wounds, referred her to the Department of Plastic Surgery and Burn at Lady Reading Hospital, Peshawar, for specialised burn care.

But despite claims of having the first burn unit of Khyber Pakhtunkhwa, providing state of the art burn care, as claimed on the hospital website, the hospital staff further referred Bibi to Burn Centre of Pakistan Institute of Medical Sciences (PIMS) in Islamabad, saying that ‘the hospital in Peshawar has no facility to treat burnt patients’.

The Burn Centre of PIMS, which has a limited capacity, was already teeming with patients when the distressed parents, along with their ailing daughter, reached Islamabad. Their ordeal was not over yet. Their daughter was refused admission in the centre.

The poor parents, who had reached the federal capital all the way from the war-stricken region of FATA, sat on the road in front of the centre, refusing to go back.

“This country has no place for us? Where should we go?” Mohammad Arif, Bibi’s father, said. “The ambulance has also gone back now and I have no money to go back. It does not matter if she dies here or at home.”

Finally, doctors, on humanitarian grounds, finally admitted Asima Bibi in intensive care unit where two children were already admitted, accommodating her in a bed with another burnt child against the protocols. She was lucky. Most of the other patients are forced to go back to their native towns and villages.

Bibi’s predicament is just a tiny glimpse of the pain and agony patients with burns and their families go through due to dearth of specialised burn care facilities. There are only a couple of burn centres offering acute burn care for the general public in north Pakistan but most of them are non-functional, putting the patient load of the whole region on PIMS centre. PIMS burn centre has the capacity to admit about 24 patients but on average over 28 patients are accommodated against its capacity, says Dr Ashar Pervez, clinical and therapeutic nutritionist and burn centre’s spokesperson. “Still protests and using political influence to pressure the staff for admissions is a routine here,” he said. 

Though, PIMS’ burn centre receives patients from Azad Jammu and Kashmir to Lahore, even from South Punjab, but majority of them are from Khyber Pakhtunkhwa, due to its close proximity, severe weather conditions and its precarious law and order situation, doctors say. 

With the advent of winter season, the number of burnt patients has increased due to gas loadshedding and cylinder blasts.  

According to centre’s data, nearly 15 to 20 patients with burns come daily to the emergency, most of them from KP with totally unattended wounds, without even a basic dressing.

In the last week of December, a family of five, including a woman and two kids, who were severely burnt in a gas cylinder blast in Peshawar, was shifted from Lady Reading Hospital to the burn unit of PIMS. Officials say they were under immense pressure from a PTI MNA to admit the family. The family was admitted but it still led to scuffle and protests. Later, the whole family expired.

Shaukat Ali Yousafzai, secretary information of Pakistan Tehreek-i-Insaf and former health minister KP, maintains that the burn unit of Lady Reading Hospital does not offer specialised care. A 100-beded burn centre is under construction in Hayatabad, which is funded by the federal government. 

Though health is now a provincial matter after devolution, still the provincial minister blamed the federal government for not supporting health projects in the province. 

“The development work on Hayatabad centre is stalled because the federal government is not fulfilling its commitments,” Yousafzai said.

The other burn unit that caters to the whole north region is Burn and Reconstructive Surgery Department at Jinnah Hospital, Lahore. But it is also not fully operational.

Prof Dr Moazzam Tarar, head of Burn and Reconstructive Surgery at Jinnah Hospital Lahore, insisted that the department is functional except its intensive care unit. He refused to comment further when asked about the patients referred to Islamabad, saying ‘only one unit is not sufficient for a city with a population of 12.5 million’.   

Although Combined Military Hospital, Kharian, and Nescom hospital have small burn units yet they charge heavily from civilians.

People in rural Pakistan suffer tremendously because they are unable to find appropriate burn care on time, said Ihtasham Akram, a health policy expert. “Burn care is neither a priority of the governments nor it’s a part of health reform initiatives because such reforms are not need-based rather technocratic driven.”

Every province should have at least five burn centres at equal distances by dividing districts into clusters, he said, especially the KP and FATA, which have endured the highest number of terror attacks and still reeling from it.

Bibi’s wounds had gangrened with infections and she was severely dehydrated when she reached at the centre, after almost 15 days wrapped in unclean blanket. Most of the patients reach the centre after 24 hours totally unattended with dehydration, infection and hypothermia and at that point not much could be done to treat them, said Dr Ashar.

“At least doctors working in the primary healthcare centres must be given some basic trainings to give initial burn care if the governments cannot build more burn centres,” he said.