It is heartbreaking to hear about children dying in any circumstances but for them to die in a hospital where they come to get better is for me at least the saddest. There are recent reports about children dying in a District Headquarter (DHQ) Hospital in Sahiwal because the air-conditioning unit in the children’s ward malfunctioned.

Before I go any further I do want to emphasise that patients in a hospital are there because they are sick. And however much we might want it, all sick patients will not get better. That said, when a ‘cluster’ of bad outcomes occurs, even in the best hospitals in the world, the reason for it has to be investigated.

It is important to realise that babies don’t die just because it is too hot outside. If they did, Pakistan would not have a population problem. Babies die from neglect. They die from malnutrition or because they don’t get enough water to make up for what they lose from the heat (dehydration). And they die because they are too sick to start with and might not get better even with the best possible treatment.

About the heat problem any parent can tell you a wet cloth and may be some ice around the baby in a crib with a fan above can create an ice and cool environment within the crib. But somebody has to be there to do it and to give the baby enough water to drink. I will repeat that it is neglect and not the heat that most likely was responsible for most of the deaths.

Surely a high powered commission of some sort is on the job to find out who is responsible for this tragedy. A few low level functionaries will be blamed for the malfunctioning air conditioners and some senior officers reprimanded. But the nurses and the doctors actually responsible for providing care will avoid any personal responsibility for these tragic events by blaming everything on the lack of air conditioning.

Air conditioning is of course a great gift when available in the heat of summer. However, up until a few decades ago most public and private buildings in the Punjab were built for the hot summers without any consideration of air conditioning, but no more.

I grew up in a house in Lahore that was probably built about a hundred years ago. It had thick walls, high ceilings, windows across the rooms for cross ventilation and the skylights (roshandans) that were opened up in summer to set up an upward draft in every room. Today I live in a very nice ten-year-old house which was made for air-conditioning and I could not be writing this article without the air-conditioner in my study.

When I first started working in Mayo Hospital some fifty odd years ago I was impressed by how the hospital then almost a hundred years old had been built to withstand the heat. Walls were thick enough to survive direct artillery fire; ceilings in the patient wards were probably more than twenty feet high, there were large windows facing each other with open verandas on both sides of the wards and those skylights, one above each window.

Yes it would get hot in summers. I remember that our operating theatres were also not air conditioned. And when patients returned from major surgery, they would often have very high body temperatures (hyperpyrexia).

So we had an ‘ice’ room next to the ward where I was a house surgeon back in 1971. The hyperpyrexia patient was placed in the ice room and the family was asked to bring in a few large blocks of ice and the patient was surrounded with that ice. In more than ten months that I worked in that department back then I do not remember losing a patient because of the heat.

Thirty three years later I returned to the same ward as the head of the department of cardiac surgery. The ward was changed. Now it had a false ceiling only ten or so feet above and all the windows were permanently closed and of course the high skylights were excluded by the false ceiling. And yes it was now supposedly ‘fully’ air-conditioned.

It was the beginning of winter when I took over the department but when it got warmer I found out that the air-conditioners did not work. Having come from the United States I was not too familiar with split air-conditioners. What I found out was that the split parts inside the ward were still there but the parts outside on the roof were gone-stolen.

We managed to get new air-conditioners from donated funds and made sure that their outside components were placed in locked cages. But then somebody stole the metal tubing that connected the two systems. The six years I ran that department was a constant struggle to prevent theft of different components. Of course every time there was loadshedding, the backup generator could not provide the power to turn on the air-conditioners.

Interestingly, I also found out during my service in King Edward and Mayo Hospital that to have an air-conditioned office you had to belong officially to at least grade twenty which fortunately I was as a professor and chairman of the department.

So, I do not have much faith in individual air-conditioners in public hospitals. However, I must admit that some of the more modern hospitals now have central air-conditioning with big enough backup generators to take over during loadshedding or when feeders trip.

Having lived in the US for more than three decades and having lived through a few major storms, I never heard about feeders tripping. Trees would be uprooted and damage electrical wires but tripping feeders, never heard that phrase until I came to Pakistan.

That then is one of the great mysteries of my life in Pakistan. Who or what exactly are these ‘feeders’ and what do they feed on that keeps making them trip?

That said, many of the public hospitals built more recently especially in the rural and semi-rural areas do not have central air-conditioning and are definitely not built to withstand the heat. They have thin walls, low ceilings and few windows, all that makes them heat traps in summer without air-conditioning.

Another major problem with these newer public and some private hospitals is that when they were built, they were not provided with electrical systems that could take on the load of air-conditioners in summer and space heaters in winter. But adding on these facilities puts an extra load on the wiring.

Unplanned extra load on bad wiring often leads to fires in hospital wards and the sickest patients are the most vulnerable especially adults as well as children in intensive care units (ICUs). Many ICUs unfortunately have no fire exit plan and most exits are blocked to keep out unwanted family attendants.

And now back to where I started. Newborn babies are indeed vulnerable to heat but some care of the sort I mentioned above in the absence of air-conditioning can be lifesaving. And that sort of care was sadly not available.