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Healthcare Challenges in Gilgit Baltistan: The Way Forward: Amimah Fatima Asif
Healthcare Challenges in Gilgit Baltistan: The Way Forward: Amimah Fatima Asif
Review Article
1
Lady Medical Officer, District Headquarter Hospital, Skardu, Gilgit Baltistan.
Correspondence: Amimah Fatima Asif . Email: [email protected]
Abstract
Quality healthcare delivery is the bedrock to exponentially accelerate the development of a country. Unfortunately, in
Pakistan healthcare has been neglected since a long time, with the common man bearing the brunt of this acute
situation. There are critical challenges in health care, with paucity of trained human resource and deficit of regulated
infrastructure and service delivery being the predominant dilemmas. Primary and secondary healthcare are in an
unseemly state, to say the least. Maternal and child health care, accident, and emergency departments and mental
health are among the most undermined and forsaken areas of healthcare, primarily in the far flung Gilgit Baltistan
region of Pakistan. The only way forward is if the political regime, administration and the medical personnel work in
concurrence to revise the health infrastructure of the country.
The Gilgit Baltistan Demographic and Health Pakistan include Pub Med, Google Scholar, and Google
Survey 2008 also shows noteworthy statistics, revealing Web search. The references include journal articles,
that women delivering in a health facility are only 39% government surveys, private sector and non-
and child mortality rate for both sexes is estimated at government organization (NGO) reports, information,
92/1000 live births. Furthermore, contrary to World and data from international development organizations
Health Organization (WHO) recommendations only a websites.
little more than one third (37%) of children are Problems in Healthcare Delivery
exclusively breast fed in GB, with high prevalence of There is a wide spectrum of issues in the heath sector in
micronutrient deficiencies such as Vitamin A deficiency GB, some of which are the ubiquitous lack of doctors,
in infants. The prevalence of all types of diarrhea among trained paramedical staff, laboratory technicians, state-
children under five years of age during the two-week of-the-art equipment for diagnostic, and treatment
survey preceding the study was found to be 22% (7). purposes. People who have the means to reach the
The prevalence of mental health disorders is relatively big cities, Gilgit and Skardu, for treatment are
also an unchecked realm of health care in Pakistan in seen swarming and choking the outpatient clinics and
general but particularly in GB. Pakistan is a developing emergency rooms, where specialist doctors are sparse
country, with GB largely constituting of a population with and the treatment options are limited. Patients then
orthodox views and limited horizons of thinking. Hence inevitably have to travel to major cities down south for
seeking help for psychiatric and psychological disorders better treatment options (12). As for the hefty population
particularly, is associated with a social dogma of bracket that is unable to access and afford tertiary care
conservatism, which makes people resist, or decline hospitals in Gilgit, Skardu and the south of the country,
help for mental illnesses. On the other hand in health are mostly residing in far flung towns and villages
care settings, psychiatric illnesses are commonly under bordering areas as rangy as K2 and Siachen. They are
diagnosed and under treated by health care providers. left to wait for divine intervention or to quietly succumb to
These hurdles are a few reasons as to why accurate suffering and decadence.
national indicators of psychiatric morbidity are scarcely The DHQs, THQs, BHUs, and dispensaries are
available and only a handful of studies are documented of negligible benefit to the community since doctors are
to have examined this facet. rarely available, a handful of laboratory investigations
A study conducted in district Ghizer shows age are being performed, there is a serious shortage of
specific suicide rate in females of 61.07/100,000 per trained laboratory and operation theater technicians and
year, which is the one of the highest in the world (8). trained nursing staff, and no basic medicines are
Another article published in Passu times has revealed procurable. Accident and Emergency departments are in
statistics that show substantial increment in suicide rates dismal state with limited availability of lifesaving drugs
throughout Pakistan, specifically in the Gilgit Baltistan (13).
region; 23 suicides were reported in Gilgit in 2012, with Hospital set ups lack standard operating
gender breakdown of 10 females and 13 males (9). A procedure for hospital laundry segregation, collection,
cross-sectional study conducted in Chitral and Khyber and disposal. Additionally hospital waste management
Pakhtunkhwa (KPK), which is a region ethnically and policy is almost nonexistent. Some hospitals also have
culturally similar to GB, uncovered that the suicide rate serious issues of water supply shortage, making patient
in females is almost double than that of men, of 168 care, hospital cleanliness and maintaining even basic
suicide cases studied, 68% were women and 38% are hygiene extremely difficult (14). Winter season is harsh,
men. The leading causes identified were family issues, with patients trickling into hospitals and other facilities
lack of confidence, mental health problems, and continuously nonetheless no well-regulated, round the
academic failures (10). clock heating system for pediatric and adult patients in
Depression is the most common mental health wards and for attendants in waiting areas is being
disorder, which has its origin in our society's social and provided.
cultural dogmas. A pilot study conducted to determine The silver lining in this crisis are the Lady Health
socioeconomic factors of depression in females of Visitors (LHV), Lady Health Workers (LHW), and Dai
district Ghizer, GB showed results that identified (Traditional Birth Assistant, TBA), they are the
domestic abuse (verbal and physical) and poor relation caretakers of maternal and child health at the grass route
with in laws as principal causes of depression. Non level. They offer door to door antenatal checkups and
cordial relations with in laws were found to be a strong assisted home deliveries. Despite of this there are many
predictor of depression in females (11). reported cases of complications during labor and
Methodology delivery such as obstructed labor and postpartum
This review article aims to analyze the healthcare crisis hemorrhage, due to the unskilled management of
in the Gilgit Baltistan region in an attempt to find practical patients by untrained health workers and TBAs.
solutions to improve the healthcare delivery system and
achieve health for all. The web links searched for Time and again donations by international non-
research statistics and data on the northern region of government organizations (NGOs), donor
organizations, and public-private collaborative projects healthcare coverage plans, such as in the United States,
to health facilities have been made. With laboratory and have made state-of-the-art healthcare delivery the
equipment, examination apparatus, dental chairs, chief indicator of their burgeoning economy. On the other
examination couches and other hospital essentials hand we have chosen to ignore the alarming state of our
being donated (15). But the scrupulous use of all these healthcare sector and the suffering of the
donations is crucial otherwise they have been wasted in underprivileged among us. Health constitutes 0.9% of
the paste due to lack of use or improper use. Pakistan's gross domestic product (GDP), provincial and
Conclusion federal combined, making it one the smallest
Resonating with a lack of accountability and expenditure heads (18). This meager number is
professionalism, it is often claimed that there is a sheer unequivocally depicting the apathy and lack of
lack of funds responsible for the unfortunate condition of importance the government holds for healthcare. The
health facilities; it will not be incorrect to assume that state of government hospitals all over the country is
commensurate with the population load the funds dreadful, with the well-off relying mostly on private
available or allocated to the respective health hospitals; it seems that the poor are left to suffer in
departments are adequate, if utilized judiciously and silence and eventually wither into oblivion.
honestly.
On the other hand it is also pertinent to highlight References
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