Published by : PROFESSIONAL MEDICAL PUBLICATIONS
|January March 2006||
Attitudes of attendants and visitors at the
National Institute of Child Health (NICH):
Problems and solutions
Farzeen Khalid Hashmi1 & Sohaib Khalid Hashmi2
A survey of two hundred patientsí attendants and visitors to National Institute of Child Health, Karachi showed that majority of them belonged to the low socio economic group. Seventy percent were satisfied with the cleanliness in the hospital while fifty percent were satisfied with the overall arrangements. Rude behaviour of the guards and inadequate washroom facilities along with inadequate supply of drugs were some of their complaints. Their suggestions included issuance of visitors pass to attendants, improvement in the attitude of the guards in particular and health care professionals in general and efficiency in health care services by keeping to the timings. These poor and desperate people need sympathy and understanding. Routine internal surveys by hospital administration to evaluate effectiveness of the services will help improve the situation.
Key Words: Social Medicine, Patientsí attendants, visitors, public hospitals.
Pak J Med Sci January-March 2006 Vol. 22 No. 1 94-96
1. Ms. Farzeen Khalid Hashmi
Student of Class A Level,
2. Mr. Sohaib Khalid Hashmi
Student of Class IX
1-2: Karachi Grammar School
Boat Basin, Karachi
Ms. Farzeen Khalid Hashmi,
73/II, 5th Street,
Phase-VI, Defence Housing Authority,
Received for Publication: July 4, 2005
Revision Received: August 15, 2005
Revision Accepted: August 22, 2005
Patient satisfaction and attitude of health care workers are important considerations when one judges performance of hospitals and health care facilities.1
One of the problems encountered in the hospitals in Pakistan is dealing with the large number of attendants of every admitted patient. Due to joint and extended family systems everybody gets involved on occasions like sickness, death or marriage. A large number of people can be seen in the hospital compound throughout the day. Attendants of the patients do not have adequate facilities for their stay at these public hospitals. Handling so many people can be a problem for the hospital administration but in most cases nothing can be done as the patients usually come from large poor families. Studies have been carried out to judge consumer satisfaction, which is helpful in choosing between health care providers.2 The objective of this survey was to find out whether those crowding the hospital compound were genuine attendants and to investigate the problems the visitors face during their stay in the hospital compound.
Subjects and Methods
A questionnaire based cross-sectional survey was conducted on 200 randomly selected people in the compound of NICH (National Institute of Child Health, Karachi) during the peak hospital hours during the month of July 2004. It was a part of our voluntary work at the Child Aid Association. The survey was conducted in Urdu with the help of a questionnaire (Appendix-1).
Of the 200 people interviewed 78 were males and 122 were females with a M:F ratio of 1:1.56. About 45% of the people were between the age of 25-50 years, 42% between 15-25 years and 13% were of fifty years or above. 158 (79%) were residents of Karachi. Of those from outside Karachi, 8% were living with friends or relatives while 13% had no place to live. Most of the women were housewives while a few were working as domestic servants or teachers at government schools. The male interviewees were either self employed, laborers or had other professions like drivers, farmers or mechanics. Majority of the people staying in the hospital compound were family members of the patients and relatives (aunts, uncles, grand parents and in-laws). Many were the siblings of the patients admitted who were being looked after by the elders as the parents were with the sick child. Around 55 people were those who were either waiting to collect X-ray or lab reports. They included relatives of patients who were waiting in the OPD. Rest of the people interviewed were relatives or parents of the patients admitted in the hospital.
One hundred and forty two people (71%) were satisfied with the cleanliness of the hospital compound and 50% were satisfied with the arrangements for stay of attendants in the hospital compound. Their major complain was about the attitude of the guards. The other problems they faced are given in Table-I.
Generally people did not mind answering our questions. There were a few cases where people either refused to talk or could not speak or understand Urdu. A few individuals were reluctant to give their names; some did not know their ages and very few of the attendants sitting in the compound were aware of the section of the hospital where their patients were admitted. Majority of those interviewed felt that the greatest improvement was needed in the behaviour of the guards towards patients and attendants. The administration has to check and control bribes taken by guards to allow visitors inside. Many also felt that they should be allowed to sit in the seating area in the compound at night since they cannot afford travel expenses back and forth each day while their patients are admitted. Those who came from outside Karachi suggested some place where they could stay at night. At present they stay in the hospital compound during the day and spend the nights on the roadside outside the hospital.
Some people also felt the need for better water facilities and arrangement for food. Many expressed the need for more and cleaner bathrooms for visitors. Improvement in the attitude of the nursing staff and timely dispersal of patients on given day by the health care providers was also suggested. Failure to abide by the timings creates lots of difficulties and is also inconvenient for the parents. This leads to additional travel costs, which adds to their already heavy financial burden. Issuing a visitorís pass to the attendants could help solve some of these problems.
Most people visiting public hospitals have a very low standard of living,3 many are illiterate and already overridden with a lot of problems so rudeness and inconsiderate behaviour will only ignite them further giving rise to unpleasant situations. These poor and desperate people need help and sympathy. In order to improve health care internal surveys should be routinely carried out by hospital administration to evaluate effectiveness of the services provided. Such surveys are useful to measure service expectations.4
1. Fitz PR. Survey of Patient Satisfaction: Important general considerations. Brit Med J 1991; 302 (6781): 887-9.
2. Verbeek J, Van Dijk F, Rasanen K, Piirainen H, Kankaanpaa E, Hulshof C. Consumer satisfaction with occupational health services: should it be measured? Occup Environ Med. 2001; 58(4): 272-8.
3. Hashmi SK. A socioeconomic and service audit of oncology unit at the NICH, Karachi. J Pak Med Assoc 2003; 53(5): 205-7.
4. Artz J. Internal Surveys, an ideal way to measure service expectations. Health Hum Resour 1994; 3(8): 7-9.
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