Ashfaq Yusufzai
PESHAWAR, Jun 3 2006 (IPS) – Pakistan s health care system is hamstrung by an acute shortage of nursing professionals the result of poor training facilities and an extremely difficult work environment.
There are a mere 46,331 registered nurses for a population of 150 million people, stated the Pakistan Economic Survey, 2005. The number of doctors, including dentists, is 108,062. As a mainly female profession, nursing ranks lower in status than medicine.
Parveen Rais, vice-president of the Pakistan Nurses Association (PNA), said that an overwhelming majority of nurses join the profession because their parents cannot afford to send them to university.
Poor parents are unable to pay the roughly 100 dollars a month fee for graduate classes, and enrol their daughters in nursing schools where they receive a stipend of about 50 dollars per month.
More than 100 nursing schools in Pakistan have neither syllabus nor proper teaching staff, adds PNA chief Nazir Abdur Rehman in Peshawar, capital of the North West Frontier Province (NWFP). Senior nurses act as tutors. In some subjects, teachers are hired on a daily salary, which money is deducted from the students stipend, she added.
Concerned doctors have time and again appealed to the government to upgrade training programmes for nurses and to boost salaries in government hospitals.
We have been complaining about the lack of nurses education and skills, but it has fallen on deaf ears. We acutely miss the presence of trained nurses it s a matter of patients care, said Dr Muzaffar Tareen, who teaches at Peshawar s Khyber Teaching Hospital.
According to general surgeon, Dr Zahid Aman, an assistant professor at the Lady Reading Hospital in Peshawar, half the nurses in his hospital are unable to insert intravenous tubes for patients.
NWFP Health Minister Inayatullah Khan insists the government has a strategy to improve the skills and status of nurses. We are already working on a plan to promote about 2,000 staff nurses to the posts of charge nurses, he said. Also in the pipeline is a scheme to increase the stipend of student nurses to attract more qualified candidates, added the minister.
Dr Jalilur Rehman, director-general of Pakistan s Health Services, said 13,000 nurses were recently appointed as lady health visitors (LHVs) on better salaries (to support) the government s polio, mother and child health and family planning programmes .
LHVs provide primary health care at the village level and are often the only qualified persons available to handle health concerns. According to Dr Rehman, the new recruits have been trained by behavioural experts to tackle social prejudices against nurses.
The PNA would like to see improvements in nurses conditions of work, including protection from sexual harassment.
The majority of patients and their relatives regard us as sex symbols. About 13 of our colleagues were sexually assaulted in 2005. One nurse was stabbed in the back by a student because she refused to spend a night with him, said PNA Press Secretary Hameeda Bano.
We need training facilities and respect, said Nausheed Alam, a second year student at the College of Nursing in the Khyber Teaching Hospital.
She said that one night she heard a patient who d had an appendectomy screaming in pain in the recovery room. She followed a doctor s orders and gave him a painkiller. Half an hour later, the patient called for her.
When I approached him, he held my hand and tried to force me on to his bed, but I ran away and complained to the registrar the next morning, she recalled. No action was taken, according to Alam. An emergency ward doctor who raped a student nurse also escaped punishment, forcing her to leave the profession, added Alam.
Another nurse, Gul Meena, shared her story of being jilted by a doctor who used her for years, pretending he was in love with her. But one day, to my shock, he said he couldn t marry me because he was already married, the nurse said.
Meena still dreams of wedded bliss. But not even paramedics are prepared to marry her, she pointed out. Colleagues at the hospital think I am a prostitute, she said, condemning herself for her situation.
Social prejudice against nurses runs deep in the marriage market. Educated men with jobs do not want to marry nurses, who either remain single or find uneducated men who live off their salaries.
Enrolments at Peshawar s biggest undergraduate nursing school, Hayatabad, fell by 10 percent this year, according to principal Shamshad Begum. On average, the school admits 250 aspiring nurses annually.
Dr Omar Ayub Khan, president of the Pakistan Medical Association (PMA), said the body has urged the government to launch a campaign in the print and electronic media to sensitise people about nurses.
An outdated curriculum and poor quality teaching have lessened the importance of nurses in Pakistan. Most of their duties are performed by the doctors themselves, asserted Dr Khan. The Pakistan Nursing Council, which should be revising the training courses, has done nothing, he added.
Health Secretary Abdus Samad said the syllabus would be revised, while the director-general of health services, Dr Rehman, said the government has sent 67 nurses to Britain for postgraduate training.
