PESHAWAR: Muhammad Ali stands in a pensive mood outside the Tetanus Ward at Sifwat Ghayyur Shaheed Memorial Children Hospital (SGSMCH), where his son has been admitted due to severe tetanus infection.
Hailing from Charsadda, Ali, 32, earns a paltry Rs.600 daily as a menial labourer. More than Rs.25,000, including my savings, have already been spent on the purchase of Tetanus Immune Globulin (TIG) vaccine for my son`s treatment, says Ali with a sigh.
When the illness struck him, Alis son experienced a fit and subsequent collapse. Doctors back in his home town diagnosed the boy with tetanus and referred him to hospitals in Peshawar due to the absence of vaccines at local hospitals in Charsadda.
Dr. Qayyum Khan Aurakzai, child specialist at Sifwat Gahyyur Shaheed Hospital, says that tetanus is a serious infectious disease caused by the bacteria Clostridium tetani usually found in soil and manure, which produces a toxin that affects the brain and nervous system.
The toxin leads to stiffness in the jaw muscles as well as other muscles of the body. The infection can cause severe muscle spasms, breathing difficulties, and can also prove fatal, said the doctor.
According to Dr. Musharaf Khan, medical superintendent at the children\’s hospital, infant mortality rate has risen over the years due to the unavailability of Anti-Tetanus Serum (ATS) in three major government hospitals at the provincial capital, namely Lady Reading Hospital, Hayatabad Medical Complex and Khyber Teaching Hospital. While ATS is unavailable throughout the province, alternate vaccines like TIG are expensive.
After being referred to hospitals in Peshawar, Ali visited Lady Reading Hospital. However, doctors there further referred him to Sifwat Ghayyur Shaheed Children Hospital, the only facility dealing with tetanus in the whole province.
58 children died this year due to tetanus
The hospital record shows that 225 children infected with tetanus were brought to the children hospital over the last seven months, out of which 138 were neonatal tetanus infected babies. Eighty of those recovered, while another 58 did not survive.
Dr. Musharaf explained that the government had previously removed TIG, a life-saving drug against tetanus. The drug was removed through the consent of Medicines Coordination Council (MCC), a council on provincial government level responsible for issuing approved list of medicines to be procured by the hospitals operating within the respective province. This eventually caused an increase in the mortality ratio and badly affected the performance of the hospital.
However, this year, the district government has allocated five million rupees for the purchase of TIG.
We collect donations from individuals and pharmaceutical companies to run the day-to-day affairs of the hospital, said another doctor at the hospital.
High priced vaccines hurt the poor
Yasmeen, a female nurse at the tetanus ward, said that some parents of newborn children cant even afford travel expenses, while TIG vaccine alone costs around 25,000 to 30,000 rupees.
She mentioned that infected babies were usually delivered at home by untrained midwives and the umbilical cord is often severed by unsterilized instruments. Another reason for the spread of tetanus was the lack of awareness among mothers about immunization during pregnancies, she added.
Dr. Musharaf also informed that Pakistan had one of the highest infant mortality rates in the world, with widely prevalent maternal and neonatal tetanus. The factors associated with tetanus are usage of unsterilized instruments for cutting cords during delivery and lack of knowledge regarding immunizations.
Dr. Aurakzai mentioned that according to World Health Organization (WHO) recommendation, a three-dose course of anti-tetanus vaccine provides protection for five years, whereas five doses safeguard women throughout child-bearing period. He said that despite gynaecologists advice, uneducated women in villages do not take the complete course of tetanus vaccines during pregnancy.
Tetanus patients require isolation, silence and darkness
The tetanus ward of the children’s hospital houses nine beds where woe-stricken mothers sit in the dark, looking extremely nervous. These women come from different parts of the province due to lack of treatment facilities in their areas. According to Yasmeen, sometimes the number of patients in the ward increases to 15 and in such cases they have to accommodate two children to a bed.
When Alis wife was asked about immunization and anti-tetanus vaccines necessary for the mother during pregnancy, she said that she was not aware of them as they had not been prescribed by doctors.
Symptoms of tetanus
According to health experts, tetanus symptoms usually surface about 10 days after the initial infection, however, this can vary from four days to about three weeks and, in some cases, may take months.
At the tetanus ward, Faqeer Jan, a tractor driver and resident of Bara, Khyber agency, lamented that he had to purchase 12 TIG injections for Rs.25,000 for the treatment of his newborn son.
Faqeer Jan said he only had Rs.4,000 in his pocket, but was thankful to his friends who had helped him out with loans to save his son\’s life. I am worried for my son and all those children who are suffering from tetanus, and the parents who neither have the money nor can find the vaccine in the market, thanks to the governments apathy,” he sighed.
