Islamabad - Allah Rakhi could barely stand due to stomach pain but she queued up for an hour along with other patients to get a computerised outpatient department (OPD) slip to see a consultant. But upon her turn the clock ticked 12:30pm and computers turned off.

“The timing to get an OPD slip has finished, come tomorrow,” said the computer operator to Allah Rakhi, 45, who had travelled from Murree to get herself examined by a specialist.

Her young daughter, who was holding Allah Rakhi’s arm to help her stand and move, requested the staff to make a slip, saying her mother vomits whatever she eats and needs to see a specialist. But the refusal of the staff led to exchange of harsh words. “They even do not know how to talk to women,” she mumbled.

Behind Allah Rakhi was waiting a pregnant Maryum Bibi for her turn. “You should have gone to the OPD of Maternal and Child Healthcare Centre. But that too would have been closed now,” she was told after waiting for hours in a congested and suffocating place as the central cooling system of the hospital has been dysfunctional for years.

In front of another counter for male patients, Dilshad also requested the staff to issue an OPD slip for him as he had come from Chakwal and could not afford another visit. Another octogenarian man, standing with the patients in overcrowded OPD, joined the call for help. But the staff closed the OPD slip counters and left the place chattering and laughing with one another.

Thousands of patients visit Pakistan Institute of Medical Sciences (PIMS) - a leading hospital in tertiary care that serve as a national referral hospital to the community of Rawalpindi/Islamabad, Khyber Pakhtunkhwa, northern areas of Punjab, areas of Gilgit-Baltistan and Azad Jammu and Kashmir - but many are returned because of limited timings for issuance of OPD slips.

In routine the OPD at PIMS is functional between 08:00am to 02:00pm but OPD slips are issued till 12:30 p.m. only. And, due to Ramazan the timings of OPD have been reduced further to 01:00pm and slip timings till 12:00pm, exacerbating the problems for the patients.

According to hospital officials, about 9,000 patients visit different OPDs including Children’s Hospital and Maternal and Child Healthcare Centre of the PIMS daily for healthcare services and about 2,000 visit main OPDs of the hospital.

Dr Mutahir Shah, Director OPD and Coordinator Hospital Management Committee at PIMS, accepted that he received patients’ complaints about OPD timings and absence of consultants; however, he could not produce any data showing any action taken by the administration to discipline the staff.

According to information, a medical OPD used to remain functional from 2:00pm to 08:00pm. It was set up at the place where Liver Transplant Centre was established. However, it was closed after the establishment of the Liver Transplant Centre. Despite complaints of patients and directions by the federal ombudsman, the evening OPD was never made fully functional again.

If the timings of OPD slips are extended at least to 1:15pm and the consultants come on time and complete their duty hours, the patient load can be managed, health experts say. This will also lessen the routine patient load on emergency unit. About 1,000 patients, most of them routine patients, visit each emergency unit of the hospital daily, according to hospital data, making difficult for the staff to deal with trauma patients in severe emergencies.

But there is a strong lobby of consultants and doctors who turn against the management whenever someone tries to extend the slip issuance timings, informed officials on condition of anonymity. “They do not let the slip issuance timings extend so that they could leave early, get some rest at home and practice in the evening at their private clinics,” remarked an official when questioned about the hurdles in extending OPD slip issuance timings.

A specialist is paid Rs 100,000 to Rs 250,000 monthly, besides housing facility and other perks and privileges, from the government exchequer. But they all practice privately and do not complete their duty hours at the hospital for which they are paid, according to officials and patients.

“Principally, the vice chancellor of Shaheed Zulfikar Ali Bhutto Medical University, PIMS, should do the rounds to make the medical and administrative staff regular but no one is ready to share the responsibility here and no one bothers about patients’ care,” the official commented.

Dr Sania Nishtar, founder and president of Heartfile - a non-profit think tank of an NGO – talking to this scribe said that Pakistan’s tertiary care hospitals in large cities are overloaded because of two factors. “One is the increasing population size that outstrips service capacity, while the second factor is the absence of or poor quality services in peripheral hospitals and primary healthcare sites, as a result of which the entire burden of service delivery falls on major tertiary hospitals that should ideally be dealing with referrals only,” she explained.

When reached out for comments, Dr Javed Akram, vice-chancellor of Shaheed Zulfikar Ali Bhutto Medical University PIMS, maintained: “Instructions were given to the concerned officials to cater all the patients even if the slip timings are over. Nobody should be refused medical care but if the instructions have not been followed, I will again ask the officials.”