Blatant violations, compliance go hand in hand at PIMS

Islamabad

Blatant violation of the anti-smoking law by doctors and attendants alike, coupled with irrational placement of ‘No Smoking’ signs in lobbies leading to the medical wards and their deficiency at various strategic locations where smoking is rampant, describes the sorry state of implementation of the Prohibition of Smoking and Protection of Non-Smokers Health Ordinance 2002 in the Islamabad Hospital wing of the Pakistan Institute of Medical Sciences (PIMS). The Children’s Hospital, on the contrary, offers a complete smoke-free environment.

These observations were jotted down by members of the Federal Enforcement Committee on Tobacco Control during a visit to the country’s premier teaching hospital here on Tuesday. Notified by the Ministry of Health on January 8, 2008, the enforcement committee has been entrusted with the task of ascertaining the extent to which the anti-smoking ordinance is being complied with in Pakistan.

Led by Director General Implementation of the Framework Convention on Tobacco Control (FCTC) Shaheen Masud, the 11-member enforcement committee paid its first ‘surprise visit’ to PIMS, and was itself surprised to observe absolute non-compliance of the anti-smoking law within the Islamabad Hospital, and 100-percent compliance in the Children’s Hospital located within the same boundary. The adage ‘Where there is a will, there is a way,’ befittingly describes the sharp contrasts that were observed at PIMS.

As far as the Islamabad Hospital is concerned, doctors and consultants are themselves the key culprits. Unable to resist the temptation of smoking within the hospital premises, they find refuge either in their Rest Rooms, or more visibly, in the Doctors’ Cafeteria. The cafeteria does not have a single ‘No-Smoking’ sign, not because it was never affixed, but because the doctors remove it each time they see one.

“The doctors are not willing to quit. There have been numerous instances when I have myself seen them removing the ‘No-Smoking’ signs from the cafeteria. In fact, doctors are the ones who smoke the most,” a young female doctor pursuing house job at PIMS shared with this correspondent. From window panes to corridors, there was hardly any place that did not have cigarette butts strewn all over.

In the Administration Block, the atmosphere of the deputy executive director’s room, although vacant at the time of the surprise visit, was laden with cigarette smoke. The presence of ash-trays in the rooms of high officials in the administrative block did not remain unnoticed either. Similarly, the ‘out-of-bound for public’ area within the same block also betrayed the presence of smokers. There were no lit cigarettes, but the dustbins had butts in them.

The Accounts Department had a relatively smoke-free environment. “There was a time when we used to freely smoke within the hospital; not any more. And we do not allow any outsider to light a cigarette either,” a staff member responded on being questioned.

While smoking by doctors is an unrestricted practice within the hospital building and signifies misuse of the authority that comes from wearing their white gowns, patients and their attendants are just a step behind - they satiate the urge for tobacco use by puffing cigarettes in the open - be it the parking lot, the outdoor cafeteria close to the Filter Clinic, the walkways and lawns, or more visibly, in the shady area opposite the hospital’s pharmacy, where a huge ‘No-Smoking’ sign is affixed. Many visitors were typically seen smoking right under this sign!

Irrational placement of ‘No-Smoking’ signs was commonly observed at PIMS. These signs appear to have been put up merely for the sake of fulfilling a formality. Interestingly, 7 signs prohibiting smoking were visible in the lobby leading to Private Ward No. 2 (in the area where the Diagnostic Centre is located). On the contrary, there are no signs in numerous corridors and within various wards. Moreover, the stench in Medical Ward 3 made it difficult for the team members to stay on for inspection. Some rooms have half-torn ‘No-Smoking’ stickers pasted here and there, but these are unlikely to create the desired impact.

The Children’s Hospital, on the other end, generally does not have any ‘No Smoking’ signs but offers a 100 percent smoke-free environment. Even the Doctors’ Cafeteria located in this wing of PIMS was smoke-free; it also had a smoke detector installed. Both the management staff of the cafeteria, as well as the security personnel, told the committee members that they are trying their level best to ensure that nobody smokes within the Children’s Hospital and its premises. Although located within the same boundary, the very culture of the Children’s Hospital is poles apart from that of the Islamabad Hospital.

The enforcement committee was unable to detect any instance of cigarettes being sold inside the hospital premises. And this had to do with the very efficient wireless system through which news of the surprise inspection traveled from one nook of the hospital to the other like wild fire, so much so that all the cigarette butts scattered around the area where the inspection committee assembled for a relatively longer time span, disappeared within the wink of an eye.

Earlier, during a meeting with the enforcement committee prior to the physical inspection of the hospital, the Executive Director of PIMS Dr. Abdul Majeed Rajput conceded that the Implementation Committee at PIMS has, in the past, confiscated several cartons of cigarettes from canteens and tuck shops located in the hospital.

Dr. Rajput agreed that PIMS needs to take a stricter view of implementation of the no-smoking ordinance. He assured that necessary instructions would be given to heads of departments, doctors, nurses, contractors of canteens, and the hospital’s security staff; and that sensitization sessions would be organized for all those who can help make PIMS an environment-friendly hospital.

Dr. Rajput also promised to convene a meeting of the hospital’s Task Force on Tobacco Control, led by Dr. Anjum Khawar, and to take stock of the tangible measures, if any, taken by it to enforce implementation of the Ordinance. Shaheen Masud requested the ED to consider establishment of a smoking cessation clinic or a helpline for those wishing to quit the habit.

The members of the enforcement committee include Shaheen Masud, Deputy Secretary ICT, Ministry of Interior Nazeer Ahmed, as well as representatives of WHO, Journalists Health Forum, TheNetwork for Consumer Protection, and the Tobacco Control Cell. The committee’s next stop will be at the Federal Government Services Hospital.