By Aflatoon
I wrote yesterday that fourteen families went to a hospital with a baby and came home without one, and that they were owed a name, a finding and a consequence.
Today we have some numbers instead. I want to look at them, because they were available before the fire and nobody looked.
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The Mother and Child Health Centre at PIMS was given one billion and sixty-nine million rupees for this financial year. That is up from eight hundred and fifty-five million last year, so somebody will tell you it has been increased by a quarter, and they will be telling the truth.
Now the breakdown.
Salaries: three hundred and fifty-six million. Allowances: three hundred and thirty-two million. Operating expenses: two hundred and seventy million.
Repair and maintenance: eleven million.
Machinery and equipment: seven million. Building and structure: four million.
Add those last three together and you get twenty-two million rupees. Against a budget of one thousand and sixty-nine million. That is a little over two per cent, to keep an entire maternity and neonatal complex standing, wired, cooled and functioning for twelve months.
Two per cent. For a building that the federal health minister says was put up in 1984 and cannot accept a sprinkler system.
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I want to be scrupulous, because there is a cheap version of this column.
Nobody stole this money. These are published budget documents, approved by parliament, and the split is entirely typical of Pakistani public hospitals. Sixty-five per cent to salaries is what you get in a labour-intensive public service, and the people drawing those salaries are doctors and nurses in a hospital that sees nine and a half thousand people a day. I am not going to argue that they are overpaid.
Nor did eleven million rupees cause the fire. An oxygen device exploded beside an incubator. The report says the smoke then travelled through the pipes and into the babies’ breathing systems, which is the detail I have not been able to put down since I read it. The machine that was keeping them alive delivered the thing that killed them.
But consider what eleven million rupees a year actually buys in a building of that size. It is not a maintenance budget. It is a repair budget — the money you use when something has already broken and somebody has complained. It is enough to fix, in sequence, whatever fails loudly enough.
An air conditioner that is about to fail does not complain. It simply runs, in August, in Islamabad, at forty-plus degrees, in a sealed room full of pressurised oxygen and newborn children.
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Here is the part where I have to be fair to Mustafa Kamal, which surprises me.
He said accountability should start with him. Ministers do not usually say that, and the ones who do usually say it in the certain knowledge that it will not.
He then explained the locked gate. It had been open until three years ago. It was secured after three newborn babies were stolen from PIMS.
Read that again. The door was locked because people were stealing infants from the ward.
That is not an excuse. It is a description of an institution choosing between two ways of losing children, with the resources it had, and choosing the one that had already happened. It chose to prevent the abduction it had experienced rather than the fire it had not. Any of us would have.
And it is the whole thing in one detail, isn’t it. A hospital so under-resourced that the security measure and the death trap were the same object.
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Punjab has now ordered a fire safety audit of every public hospital in the province, to be completed in twenty-four hours, with rectification in a week. Extinguishers, exits, hydrants, wiring, air conditioners, monthly drills.
Every item on that list is correct. I hope it is done properly and I suspect some of it will be.
But the thing the audit will find, in hospital after hospital, is a building from the eighties with two per cent of its budget for upkeep. And a deputy commissioner cannot rectify that in seven days, because it is not a maintenance failure. It is the accumulated arithmetic of forty years of allocations, each individually defensible, made by people who were not being asked about neonatal wards.
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Saudi Arabia has sent condolences. So have Iran, Turkiye, China, Spain, Britain and Nigeria. Our actors have posted, and they are right to, and Muhammad Ahmed said the truest thing anybody has said this week: we will forget these fourteen also, as we forgot the others.
I would like to give him an argument. I have been sitting here trying to construct one.
The best I can offer is this: the budget document was public in June. Anybody could have read it. Nobody did, including me, and I write about this country for a living.
It will be public again next June. The line will say “repair and maintenance”, and it will have a number next to it, and by then we will have moved on to something else.
That is the only accountability available to people like me. Read the line before the fire.
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Aflatoon is a satirist and observer of the Pakistani condition. His column, Intellectual Voices, appears in The Pakistan Daily.
