Imran Ahmad Sajid-Medical Social Work in Lady Reading Hospital, Peshawar, Pakistan

17-sep to 18-oct-07
Contents Internship Report
Internship Report
Social Work in Lady Reading Hospital
From 17-September
To 18-octuber, 2007
Submitted by:
Imran Ahmad Sajid
By: Imran Ahmad

17-sep to 18-oct-07
M.A Final (evening)

Class No. 22
DEPARTMENT OF SOCIAL WORK

UNIVERSITY OF PESHAWAR
Acknowledgement
First of all, greatness, sanctity and glory to Almighty ALLAH, who blessed
me to complete my field report
I will acknowledge the assistance, guidance and continuous feed back from
Sir. Abrar Anjum, social medical officer, Zakat cell, LRH Peshawar.
The continuous and persistent encouragement and appreciation of Jahangir
Khan has given me the energy to work hard.
By: Imran Ahmad

17-sep to 18-oct-07
The outstanding efforts of Dr. Ali Haider and their professional approach in
clarifying the concept of the topic have contributed markedly in completing
this report.
It has been pleasure learning from all my group members.
Finally I will thank to all the staff members of LRH specially the Ardalees of
Zakat cell.
Imran Ahmad Sajid
Summery
Lady reading hospital is the largest hospital of the province. It was given the
status of PGMI in 1982. The specialists of every specialty are available here.
Opd is the place for initial treatment to the patients. It deals with those
patients who do not need hospitalization.
Zakat and social welfare services cell is working under RMO ad social
medical officer. It provides free treatment expenditure to the needy and
deserving people. Main objective is to handle unclaimed patients and dead
bodies.
Accident and emergency department is the busiest department of the
hospital. This department is to deal with major and minor incidents,
traumatic situations such as RTAs, bomb blast, burnt cases etc. there are
By: Imran Ahmad

17-sep to 18-oct-07
two types of emergency patients. Acute emergency patients are those who
needs immediate treatment and are directed to trauma room. The normal
emergency patients are to meet the CMO first.
Triage is a system of sorting patients according to need when resources are
insufficient for all to be treated. It is a system of response to a major
incident. There are two types of triage i.e. triage sieve and triage sort.
First Aid is an emergency care for a victim of sudden illness or injury until
more skillful medical treatment is available. First aid is provided in those
conditions when you have no treatment apparatus and any other helping
thing.
A proper communication network, coordination, behavioral training, more
new hospitals, medical social workers, field work system, and a quota for the
management of unclaimed cases in each department and wards are few
recommendations for the hospital.
Some people have the spirit to help others. They are ready to donate their
blood.
The social workers have to work extremely hard and selflessly in the field of
social work in accident and emergency.
Table of contents
Contents
Pages
By: Imran Ahmad

17-sep to 18-oct-07
1. Introduction to the Institution ………………………………..……………....1-3

Introduction to LRH, History of LRH, Chronological
Development, Services, Administrative Setup,
2. Out Patient Department

(OPD)…………………………….…………………4-5
3. Social Services Unit………………………………………………………………6-

10
Introduction, Main objectives, Baitulmal fund, Endowment fund,

Zakat Cell, Prime Minister Programme fund,
Admin Setup, Source of fund, Hepatitis ―C‖, Unclaimed Cases,
Zakat fund,
4. Accident and Emergency………………………………………………………11-

15
Introduction, History, Departmental Layout, Staff Setup, Nomenclature, the
process in A&E, COW, CSW,
CMW, Minor OT, COT, Purchee Counter, Mass Emergency Hall, Trauma Roo
5. Triage System………………………………………………………………….16-18
Triage Sieve, Triage Sort, Main
Categories, Methane message,
Social Work in Casualty
6. First Aid…………………………………………………………………….….19
7. Recommendations…………………………………………………………….20-21
By: Imran Ahmad

17-sep to 18-oct-07
For improvement
8. Case Histories………………………………………………………………….22-28
Four case histories
9. Voluntary Blood Donors List………………………………………………….29

A collection by Imran Ahmad Sajid
10. Bibliography……...……………………………………………………………30
-31
11. Map of LRH……………………………………………………..…………….32
By: Imran Ahmad

Internship Report LRH 17-sep to 18-oct-07
Introduction to the institution
Introduction of Lady Reading Hospital
Government Lady Reading Hospital is one of the oldest and largest

Teaching Institutes of the country which provide state of Art, excellent
curative and preventive services to the ailing humanity of the Frontier
Province. It is also called loye (big) huspatal (hospital) and Gernali
Huspatal. It was established in 1924 and it is just 200 meters away in the
south of Grand Trunk Road, behind the famous historical Qila Balahisar.
Famous Masjid Muhabat Khan, Ander Shehr bazaar, Qissa Khawani bazaar
and Khyber bazaar is across the road of LRH. LRH is just outside historical
wall in the jurisdiction of cantonment board.
History of Lady Reading Hospital
The foundation stone of LRH was laid in 1928 by Miss. Lady Reading, who
was the wife of the viceroy Lord Reading (1921-1926). The anecdote of
the hospital of its coming into being is that His Excellency Mr. Lord
Reading, viceroy of the subcontinent from 1921 to 1926, happened to
visit Peshawar. He was accompanied by his spouse Lady Reading. She
was fascinated by the view of the city from Balahisar where they had
lodged.
By: Imran Ahmad, M.A. Final 7

She expressed her desire to see the

city. She was provided horse in
compliance with her desire. She
visited the city. As she was
returning back to the fort the horse
took the fright causing fall of the
Lady from the horse back. This
resulted in some injuries to the Lady
Reading. Non-availability of medical
aid instantly made her unconscious.
She was rushed to Agerton Hospital
where the facilities were scanty.
Uncomforting to cater for the
requirements, she was shifted to the Royal Artillery Hospital now called
CMH Peshawar where she was given proper treatment. The immense
impact of this incidence on her made it imperative to construct a hospital.
On retirement of Lord Reading in 1926 she came to Peshawar from Delhi
and campaigned to construct a standard hospital in place of Agerton
Hospital.
Chronological Development
This new hospital was subsequently named after her as Lady Reading
Hospital. Later on the hospital was given into status of District
Headquarters hospital with 150 beds and in 1930 it was 200 bedded
hospital. In the beginning there was only medical ward working in the
hospital. Medical ward was responsible for providing all kinds of services
to all patients. The surgical and Gynea wards were added next to the
medical ward. After these three wards the emergency department was
established in LRH. It was near the Mazar in LRH

After partition in 1955 Khyber Medical College Peshawar University was

established and the hospital assumed the status of the teaching hospital.
Then it had four wards consisting of Medical, Surgical, ENT and T.B wards.
Doctor Khan Bahadur Abdul Samad Khan had been the first Medical
Superintendent of the hospital. Doctor Muhammad Ayaz Khan was
appointed the first Administrator of the hospital in 1973. This hospital
became affiliated to Khyber Medical College in 1973 with medical,
surgical, ENT, Eye & T.B wards. In 1982 LRH was raised to the status of
Post Graduate Medical Institute ----PGMI. The students of the health do
their specialization in this hospital.
O.P.D is going above 2000 patients per day and the casualty attendants
of A & E departments is more than 1000 or 1200 per day. Every machine
of this hospital is running round the clock and so are the doctors and
nurses
Services Available at Present
Now at present time every specialty of the health sector is available in

this institution. These specialties include the following;
1 ENT 11 CARDIOTHORACIC
2 Eye 12 Cardiovascular
3 Medical 13 Neuro Surgery
4 Surgical 14 Gynecology
5 Orthopedic 15 Peads surgery/ children
6 Psychiatry 16
7 Skin 17 Drug Addict
8 Chest 18 Leprosy
9 Urology 19 Nephrology
10 Cardiology 20 Neurology

Administrative Setup
Chief Executive
The chief executive is the head of the hospital. He is a scale 20 officer. He

is often a professor or a doctor. But this seat is not reserved for the
doctors. The political people can come on this seat. Since few years the
generals of army has occupied this seat. Now a days Dr. Hafizullah, the
cardiologist is the chief executive of the lady reading hospital. He is also
incharge of the cardiac unit. Initially just the MS was the head of the
hospital but now the powers has been distributed between the MS and
chief executive.
The chief function of the chief executive is to formulate policies for the
uplift and development of the hospital. He has to make planning for the
development of different departments of the hospital. It is not his duty to
run the administration but he has to make effective policies and
procedures.
Medical Superintendent (MS)
MS is the head of hospital administrative machinery. He is also given a 20

grade. His main duty is to implement the policy formulated by the chief
executive. The MS has divided the hospital into 6 zones. Every zone has a
deputy medical superintendent (DMS).
Deputy Medical Superintendent (DMS)
DMS is the head of each zone. There are 6 DMS of the different Zones
and one DMS Admin. Therefore there are seven 7 DMS in LRH. But the
A&E department has two heads; one DMS and one Director.

Staff Hierarchy in Wards
The hierarchical structure of any department is like the following;
1. Professor
2. Associate Professor
3. Assistant Professor
4. Senior Registrar
5. Registrar
Each professor is the incharge of his ward. All the admissions and
discharges are made by him1.
OUT PATIENT DEPARTMENT

Lady Reading Hospital
Patients who do not require an overnight hospital stay receive outpatient

care in out patient department or in OPD. LRH Outpatient Center is
located on the hospital's ground floor, making it easily accessible to
patients and families. A designated outpatient parking area is located just
outside the Center's entrance.
Facilities provided at Out Patient Department in Lady Reading Hospital are
as follow:
1
Jahangir Khan ”Social Medical Officer” Zakat Cell. LRH Peshawar
 Experienced & highly qualified doctors are present from 8:00 a.m till
1:00 p.m in all specialties work 6 days a week.
 Welfare activities to poor & unknown patients and also family
welfare services loke counseling.
 Daily 2000 to 3000 patients are treated in OPD in Lady Reading
Hospital.
 All the diagnostics & therapeutics & rehabilitative services like X-
rays, Ultra Sound, psychotherapy, Physiotherapy, occupational
therapy, Laboratory Services, & Orthopedic Workshop (prosthesis &
orthotics).
 Provision of general medical services to out patients on scheduling
and unscheduling basis.
 Provision of preventive and pro motive services like health
education, immunization,
 Screening, antenatal, wallaby clinic and family planning.
 Curative services like consultation, investigation, therapeutic
procedures and specialists services
 Follow up services of discharged patients, chronic illnesses, and
postnatal cases and post operated cases.
 Training and education of doctors, nurses and paramedics.
Let me introduces all the structure of the opd;
OPD consist of
 counter  Pharmacy
department
 Record Room
 Social guides,
 X-Rays department
Ardalees
 Eye department
 Doctor
 Laboratory

1. Counter
The purchee counter is the place where the hospital and the patient
interact for the first time. The patient is registered through purchee which
worth 5/ Rs- the patient is referred to the concerned physician or surgeon
through the purchee e.g. ENT, eye, chest, medical or surgical etc. the
counter is divided into two parts for the convenience of the patient. One
for male and one for female but the condition seem to be not satisfactory.
Because there is a huge influx of the patients who wait for their turn to
get a purchee. They often stand in 10 meter long lines.
2. Record Room
The record room is simply to keep all the records of the OPD.
3. X-Rays department
X-rays department is a big place and it is a large department. The x-ray

fee is 35/ RS each. Ultrasound section is also included in x-rays
department. There are two ultrasound rooms; One for in-patients and the
other for out patients. The timing of x-rays department for opd cases is
till 2:00 PM.
4. Eye OPD
It is a separate section from the general eye opd. Three eye specialists
are being hired for this section.
5. Laboratory
There is an attached lab in OPD which charges very minor costs for
different types of tests. The lab timing is till 12:00 AM.
6. Pharmacy department

It seems to me as a separate and not related to the OPD. Because this

department provides free medicines to all the units of the hospital. Free
medicines are provided to the in-patients.
7. Social guides
The social guides are to provide help to the helpless patients. Their duty is
to provide stretcher facility to the severe ill patient.
8. Doctors
There is a variety of physicians and surgeons available in OPD. The OPD

doctors include both lower and senior. I found the following major types
of health specialties;
Medical Eye Cardiovascular Skin
Surgical Nephrology Neurosurgeons Urology
Dental Cardiology Neurology Pediatricians
2000-3000 patients daily visit the opd.2
OPD Administrative Setup
The administrative setup of the opd in LRH is given below;
1. RMO  The head of Out patient Department in

LRH
2. Additional RMO  He is to assist RMO
3. Senior Social Medical Officer
4. Social Medical Officer
5. Steno Typist
6. Computer Operator
7. social guides
2
Mr. Innam, LDC, Zakat Cell, LRH Peshawar
8. Ardalee
SOCIAL SERVICES UNIT
The first social services unit in LRH was established in 1967. Before that
year there was no system of providing social services to the patients. But
the question here is that why this unit was established? This was due to
the unclaimed patients and dead bodies—Lawaris. The social services
unit was established to deal with such cases.
The first social medical officer, on the other hand, was appointed in 1982
who was Sir. Ibrar Anjum. The social services unit is headed by RMO—
Resident Medical Officer.
Major objectives
 To financially assist the poor patients through Zakat & other funds,
during treatment
 To deal with unclaimed patients & dead bodies –Lawaris Patients
 Administration of the OPD
 Revenue collection
Zakat cell
The section in which the social medical officer is working is called Zakat
and social welfare cell.

Total Zakat fund for the year is 82, 50,000 /Rs. This is a fixed fund,
neither increases nor decreases. The fund is provided in two installments
per year.
Administrative setup
Zakat cell is headed by RMO who is also the head of OPD.

Social medical officers 3
LDC ---lower divisional clerk 1
Social guides 2
Ardali 4
Major areas for funds delivery are
 ENT  Appliances, e.g. hearing device

 Eye  Lenses
 Orthopedic  Rods & screws, all the operation cost
 Peads surgery  GIA (an implement worth 30, 000/ Rs
 Neoro-Surgery  VP shirts
What are the sources of funds to the patients?
There are three main sources of funds with the social welfare section.
These are
 Zakat fund
 Baitulmal fund
 Endowment fund
Zakat Fund

Zakat fund is given by the federal Government to help poor patients for
their treatment.
Procedure for Indoor Patients
When the patient is in treatment in the ward and he is so poor that he can
not afford the treatment expenses, then he comes to the Zakat cell with a
Zakat Istehqaq form duly signed by the chairman local Zakat committee
and district Zakat committee. The photo copy of NIC is compulsory to
attach with the form. The patient shows the form to the incharge of the
concerned wards who makes a list of all necessary medicines and other
necessary implements of treatment on a pro-forma and gives it to the
patient.
Now these four forms, Zakat form + prescription pro-forma + NIC

photocopy, and Local Purchee move on to the social welfare cell of LRH.
The form is signed by
 Incharge Zakat cell

 Senior Social Medical officer
 RMO (Resident Medical Officer)
 MS (Medical Superintendent) & sometimes
 Chief Executive (if necessary)
When all the documentation requirements are met by the patient then the
approved contractors for the year, who come through the tenders, take
the prescription of the doctor and gives medication to the patient. The
contractors give discount to the Government on the medicines. It can be
5%-10%.
Indoor patients can have treatment expenditure from Zakat cell up to 20,
000/ Rs. The amount can be raised in special cases.

Procedure for out-door Patients
The procedure for out door patient is the same but the doctor’s pro-forma
is not needed in these cases. The out door patients can have a treatment
expenditure of up to 1, 000/ Rs from Zakat cell.
The medicines to the long lasting diseases patients are given on monthly
bases. The dosage of one month is given to the patients. Room # 65 is
the medical store for Zakat cases.
Bait-ul-Mal Fund
The baitulmal fund is also a system developed for poor patients to have a
free treatment. This fund is given by the federal Government.
The process is somewhat the same as Zakat process. The patients who
come for baitulmal fund bring a printed pro-forma from the provincial
baitulmal office. This pro-forma is signed by the doctor of the concerned
ward. The doctor also writes the expenditure of the treatment + the type
of medicine, or device + its market price.
Social welfare unit is the next place for the form. Here in the office, the
form is signed by
 MS
 Senior Social Medical Officer
The form then moves on to the pharmacist in the pharmacy department

for verification of price + dosage + quantity.
The form is taken to the regional baitulmal office for the next step. The
regional baitulmal office in NWFP has its on procedure, according to which

they deal with it. The baitulmal office sends the form to Islamabad. A
cheque of national bank is issued by the name of the doctor and patient.
The cheque goes to the Almoner of the hospital. The almoner is the
person from the administration, who gives medicines for the month
according to the doctor’s prescription.
Endowment fund
This fund has been started just few years ago. This fund is also called
hospital fund. This fund is given by the provincial Government. This fund
is only given for the Hepatitis ―C‖ cases. Only the registered patients are
given the help through endowment fund.
This fund is generated through the interest of the Government funds in

the banks. The Government distributes the interest in different sectors.
So health sector is one of them.
Prime Minister Programme for Hepatitis “C” Fund
This fund is expected this year or may be the next year.
Hepatitis “C” patients
Hepatitis attacks the lever of the body. It damages it. Some of the
symptoms of the hepatitis patients are as the following;
 Permanent fever 99-1000

 Permanent pain in the body
 Exertion, fatigue and tiredness
 Swelling of lever
 Digestive system is disturbed

How it is diagnosed?
The hepatitis is diagnosed initially through HBS and HCV (Hepatitis C
Virus) tests. The charges for these tests in Peshawar are 165/ Rs. But this
test is not enough. So another test which is called PCR (Polymerase Chain
Reaction) test is taken for a complete diagnose. This test shows the
severity, extent and the nature of the hepatitis, i.e. whether it is A, B, or
C.
Hepatitis is a life long disease and cant be cured completely. After

treatment the virus can attack again during lifetime.
Treatment
The complete course of the treatment of hepatitis c is for six 6 months.
This course is called INTERFERONE THERAPY. 72 injections with tablets
are injected in the body. The patient needs 12 injections per month, And
3 injections per week.
Now coming back to the social welfare side, the Zakat fund for the HCV
patients is very limited. Therefore the Zakat cell just provides them some
help in their treatment expenditure. The Zakat cell provide them half of
the treatment expenditure e.g. the patient needs 12 injection per month,
one injection worth 900-1000/ Rs. Zakat cell give them 6 injections per
week.
Other expenses can be met through the endowment fund or the prime
minister programme for HCV.
UNCLAIMED (LAWARIS) CASES

How to deal with unclaimed patients?
Before going into the details the first question is how the LAWARIS
patient reached to the hospital? It is simple that most of the road and
traffic accident—RTA- cases are unclaimed.
When an unclaimed patient is brought to the A & E department in LRH,
the DMS of the department writes a CALL letter to the social welfare unit
of the hospital. In the letter he mentions that we have an unclaimed
patient and he needs such and such medicines, food, and clothing. The
social welfare unit send a social guide to the patient. The social guide
takes care of the patient’s food, medicine, and clothing. The guide also
provide social support to the patient.
The expenditures of food and clothing are met by the welfare fund while
the medication expenditure is met through Zakat fund.
When the patient becomes conscious he is then transported to his area.

The transportation expenditures are also met by the social welfare unit.
How to dispose off an unclaimed died body?3
When a patient dies in casualty department, the deputy medical

superintendent of the department writes a CALL letter to the social
welfare unit. The social welfare unit (SWU) takes the photo of the dead
body and publish it in the news paper. Mostly the daily Mashriq and AAJ
provides free advertisement of the unclaimed dead bodies. The swu
calculates all the expenditures on the dead body e.g. food, medicine,
clothing, picture, and transportation.
If the exact address is known through some source then the body is
transported to that address. If just the district is known then the Police
3
Abrar Anjum, Senior Social Medical Officer LRH, 26-sep-07
Station of the district is informed. But when there is no address and no

source for finding the area of the dead person then the social welfare unit
have only one option. The body is transported to the Khyber Medical
College where they keep the body safe for 10 days or may be a few days
more. After that time if no one claims for the dead body, then the
students of the medical college are free to make their experiments and
practices on the dead body.
Accident and emergency
Department
The emergency department (ED), sometimes termed the emergency room

(ER), emergency ward (EW), accident & emergency (A&E) department or
casualty department is a hospital or primary care department that
provides initial treatment to patients with a broad spectrum of illnesses
and injuries, some of which may be life-threatening and requiring
immediate attention. Emergency departments developed during the 20th
century in response to an increased need for rapid assessment and
management of critical illnesses
Upon arrival in the ED, people typically undergo a brief triage, or sorting,
interview to help determine the nature and severity of their illness.
Individuals with serious illnesses are then seen by a physician more
rapidly than those with less severe symptoms or injuries. After initial
assessment and treatment, patients are either admitted to the hospital,
stabilized and transferred to another hospital for various reasons, or
discharged. The staff in emergency departments not only includes doctors
and nurses with specialized training in emergency medicine but in house
emergency medical technicians, radiology technicians, Physician
Assistants (PAs)/Healthcare Assistants (HCAs), volunteers, and other
support staff who all work as a team to treat emergency patients and
provide support to anxious family members Since a diagnosis must be
made by an attending physician, the patient is initially assigned a chief
complaint rather than a diagnosis. The chief complaint remains a primary
fact until the attending physician makes a diagnosis.
History
The first specialized trauma care center in the world was opened at the
University of Louisville Hospital in 1911 and developed by surgeon Arnold
Grishwold during the 1930s.
Department layout
A typical emergency department has several different areas; each

specialized for patients with particular severities or types of illness. The
departmental structure of the A&E in LRH is given below;
1 REGISTRATION ROOM 8 MEDICINE CORNER

(PURCHEE COUNTER)
2 Waiting lounge 9 ECG room
3 CMO office 10 DMS office
4 Registrar office 11 X-rays room
5 Female examination hall 12 Casualty Lab

6 Casualty Medical Ward Male 13 Trauma room

7 Casualty Medical Ward Female 14 Casualty Cardiac Unit
The A & E in LRH is a two storey building. On the ground flour the
following wards, offices, and other places are found by the social worker;

The first flour setup is somewhat like the following;
1 DIRECTOR A & E OFFICE 6 PLASTER ROOM

2 Casualty Operation theater 7 Casualty Surgical ward
male
3 Waiting lounge 8 Nursing room
4 Casualty orthopedic ward 9 Casualty surgical ward
male female
5 Casualty orthopedic ward
female
The setup of the trauma room
1 NURSING COUNTER 4 DOCTOR’S OFFICE

COMPUTER OFFICE
2 Nursing supervisor 5 Store room
office
3 Oxygen supply room
Staff setup
 Director A&E 1
 DMS—Deputy Medical Superintendent 1
 Senior Registrar 1
 CMO 3
 TMO 4
 MO 5
 Cardiologists 3
 House officers not confirmed
Nursing staff

NURSING STAFF SUMMERY
SPR H/N C/N N/A S/N

SPR Supervisor 1
H/N Head Nurses 2
Medicine 4 1
C/N Charge Nurses 32
counter
N/A/ Nursing 3
CMW/ male 4 1 5
Attendant
CMW/ female 5 5
S/N Student 19
CSW + COW 1 7 5 Nurses
COT 1 4
TOTAL 57
Trauma Room 1 4 1 4
CCU 4
Other staff
Total Ardalees in mornig shift 28
Sweepers 15
Police Men 10 all shifts
Flying Squad
Supervisor 1
Dispensers 3
Drivers 2
Beds and other stuff

BEDS
CMW/m 9
CMW/f 9
COW/m 10
COW/f 4

CSW/m 10
CSW/f 10 Stretchers 14
TOTAL 52 Wheel chairs 5
Ambulances 2
A & E -LRH
No
menclature
In Australia and New Zealand, the department is usually referred to as

the emergency department. In the United Kingdom, Hong Kong,
Singapore and Ireland it is usually called the accident and emergency
department (A&E). The popular term casualty is no longer considered
appropriate by emergency physicians in Australia, the United Kingdom
and Ireland. Leading journals consistently use the term Emergency
department.
In the United States an emergency department is often referred to by

laypeople as an emergency room (ER). Medical professionals typically call
it whatever its name is within their specific hospitals, or simply
"Emergency.".
The Process in A&E4
There are two types of emergency patients
4
Dr. Muslim Khan “DMS A&E” LRH

 Acute Emergency Patients
 Normal Emergency Patients
First of all the patient is registered through purchee counter. AEP are
directly guided to the trauma room where the first aid treatment is
provided to the patient and then he is shifted to the concerned ward.
The NEP on the other hand are guided first to the Casualty Medical
Officer- CMO, who, after initial interview and checkup, refers the patient
to the concerned casualty ward, e.g. medical, surgical, orthopedic etc.
These wards provide one day care to these patients. Next they are
transferred to the main wards if necessary.
Casualty Orthopedic Ward
The patients with bone injury or broken bone are treated in orthopedic
ward. The initial treatment is given in casualty orthopedic ward. This ward
is divided into to sections; male and female. This ward consists of
fourteen beds. Often the RTA cases visit this department.
Casualty Surgical Ward
This ward is on the first flour of the A & E department in LRH. The
patients who need some kind of operation or surgery are treated in
surgical ward. The casualty surgical ward consists of twenty beds; ten
male and ten female. The patients stayed only for some hours in this
ward.
Casualty Medical Ward

The casualty medical ward is on the ground flour in & E department in

LRH. This ward consists of twenty beds; ten male and ten female.
Minor OT
Minor OT means, Minor Operation Theater. This section is to do minor

kind of operations like stitching a wound, heeling the injuries etc.
COT
COT means Casualty Operation Theater. The patients who need
immediate operations in the department are operated in this operation
theater. The operation theater is on the first flour of the department.
Purchee Counter
Here the purchee counter is similar to the purchee counter of opd. The
computerized purchees are issued to every new patient. The purchee
counter is the first place of interaction for the patient in A&E.
Mass Emergency Hall
This hall consists of more then one hundred beds and sub-beds. This is on
the ground flour of the department. All the casualty facilities are available
here. This hall is very busy when there is a bomb blast or some kind of
fire or flood make casualties. During this internship time, one bomb blast
happen in Peshawar at Nishtar Abad. It causes two persons to death and
twenty eight injured5.
5
Daily Express, 9-oct-2007

What is trauma room for?
Trauma room is an important section in any emergency department

where the trauma team is ready to deal with any traumatic situation e.g.
bomb blast, RTA—Road and traffic accidents, burnt cases, severe injuries
etc. First aid and other emergency treatment are provided at this place to
the AEP. Two neurosurgeons consultants, two orthopedic consultants, and
two general surgeons are present in trauma room.
In the A&E all the treatment expenditure is met by the Government. the
medicine and other stuff is provided free of cost to the patient. 1500-
1800 patients are daily registered in A&E LRH. When the patient enters
the trauma room in a traumatic situation, within 5-10 minutes he is given
treatment of 500-1500 /Rs.
What is Triage?
Triage is a system of sorting patients according to need when resources

are insufficient for all to be treated. It is a system of response to a major
incident. The term comes from the French tri (meaning sort). There are
two kinds of triage:
 Triage sieve &

 Triage sort

Triage Sieve6
The primary triage of patients has been called the ―triage sieve‖ and is
based on the Simple Triage and Rapid Treatment method of ―START‖. This
technique can be used at the scene of the accident and also subsequently,
e.g. on arrival at the Casualty Clearing Station (CCS). This method can be
used effectively and reliably by appropriately trained laypersons.
Casualties who can walk are assigned to the Delayed category. The
remaining patients are sorted following an ABC (Airway, Breathing,
Circulation) assessment.
The patency of the airway is then assessed. If the airway is not patent it
is opened using a simple airway manoeuvre (chin lift of jaw thrust). Those
patients who are found to be not breathing following this procedure
should be declared dead (remember this is a mass casualty situation).
The respiratory rate is now assessed. If the respiratory rate is low (less
than or equal to 10) or high (greater than or equal to 30) the casualty is
triaged to the Immediate category.
If the rate is between 11 and 29 breaths per minute the circulation is

assessed by determining the capillary refill time. This is done by
squeezing the casualty’s fingertip for five seconds. On release of this
pressure the normal response is for the nail bed to relish within two
seconds. If the capillary refill is less than two seconds the patient is
assigned to the Urgent category. If the capillary refill is more than two
seconds (indicating the presence of shock) the patient is put in the
Immediate category.
The capillary refill time may be prolonged in conditions of low ambient

temperature or be difficult to assess because of poor lighting. In such
6
Dr. Bob Mar, “Non but Ourselves” Frontier Medical Co. UK

situations the pulse should be assessed and a rate of more than 120 bpm
considered being the upper limit of normal and equivalent to a prolonged
capillary refill time.
At any stage in the triage process another first aider can be assigned to
the patient to carry out life saving measures such as keeping the airway
open or controlling external hemorrhage (extreme bleeding).
The triage category can then be displayed on the patient using a triage
label (see below). Primary triage of the patient will determine priorities for
treatment and evacuation to the
CCS.
Triage Sort
Triage sort is the secondary triage. It is more prolonged process and can
take place after initial resuscitation. It is started in trauma room.
Main triage categories
• Deceased (Black) are left where they fell, covered if necessary;

note that in S.T.A.R.T. a person is not triaged "deceased" unless they are

not breathing and an effort to reposition their airway has been

unsuccessful.
• Immediate or Priority 1 (Red) they need advanced medical care at

once or within 1 hour. These people are in critical condition and would die
without immediate assistance.
• Delayed or Priority 2 (Yellow) can have their medical evacuation

delayed until all immediate persons have been transported. These people
are in stable condition but require medical assistance.
• Minor or Priority 3 (Green) These people are able to walk, and may
only require bandages and antiseptic.
What is METHANE Message?
When you wetness to see a major incident, what will you do?
You will deliver a METHANE message to the control room. METHANE

message is a system of informing the control room about a major incident
at some place. The abbreviation stands for
M: MAJOR INCIDENT
E: Exact Location
T: Type of incident
H: Hazard, present and
potential
A: Access in emergency
N: Number of casualties
E: Emergency services
7
required
7
Fazl-E-Hakeem, “Nursing Supervisor” LRH Peshawar

Social work in casualty
The patients and family don’t know where to go and get help. For
example where is ultrasound, where to go for ECG etc. We social workers
have to direct the patients and families to there concerned spot of help.
We have to provide guidance to them. Social worker has to deal with the
social aspects of the casualty. For example if a patient is severely injured
due to fighting with someone, now what the social worker has to do here
is to find out the causes of fighting. Social workers have to rehabilitate
the patient back in their community8.
First Aid
First Aid is an emergency care for a victim of sudden illness or injury until
more skillful medical treatment is available. First aid is provided in those
conditions when you have no treatment apparatus and any other helping
thing.
When you wetness to see a road or traffic accident, what will you do with
the casualties?
First of all clean the mouth of the person if he has some thing in mouth,
e.g. a piece of cloth etc. the person can’t move him self therefore you
have to clean his mouth so that he can keep breathing continue.
88
Dr. Muslim Khan “DMS A&E” LRH Peshawar

If a person is unconscious, don’t hold him from the neck. We suppose that
every unconscious person in the accident situation is with a damage neck.
Always hold them from the shoulders.
In case of vessel injury, tide the body from such place so that the
bleeding could be stopped. Tide it very tightly because we have to save
the life here.
If his leg or hand, for example, is broken then give it a slab so as to keep
it straight and protect further damages.
If the patient is not breathing then place him straight on a place and hold
his leg up in the air for some time. Do not force a person to sit who is in a
state of fit. During fit don’t give any water to the patient so that he can
breathe freely9.
Recommendations
For Improvement
There is no communication system in allover the hospital between the

departments. All the departments are working at their will. First of all in
this situation, a communication network should be established between
the all the departments and sections of the hospital. So that the time and
energy could be saved.
9
Ali Haide, Neoro-Surgeon Consultant, A & E LRH Peshawar

There is a lack of coordination in all the departments of the hospital. A

proper coordinated system should be devised for all the departments.
How to bring coordination? this is the headache of the hospital
authorities.
Behavioral training should be given to all the staff members of the

hospital. This must includes the lower level members such as the ardalee.
The technicians and all the paramedical staff should be trained in
behavioral science. So that they can deal with the patients in a good
manner. For this purpose the in-service training should be arranged every
year.
As this hospital is the largest hospital of the province so there is no need

to further extend it. Now the burden of the patients visiting daily is
unbearable for the hospital. It is very difficult to ménage them
appropriately. So more and more new hospitals should be established
with all the facilities. Or the existing district hospitals should be provided
with all the necessary facilities.
The role of the Medical Social Worker is Nil in the hospital. The concept
which we have studied is not present in a minor amount here. So this is a
recommendation here that the medical social work should be applied with
its true spirit and nature. The medical social worker should be given only
the social job not that jobs which do not relate to his profession.
All the departments should have a direct contact and immediate

communication system with the casualty department because the
casualty department is the heart of the hospital. It needs more and more
reinforcement.
There is no system for the field work of the social work students. A
proper system hasn’t been devised still. So a well developed system

should be devised for the university students to have their field work
training in this institution. A separate room and a field supervisor should
be allocated for them. The existing social workers in the hospital have
more work to do, and they have very rarely sometime to give to the
students.
The number of the medical social workers are nil in the hospital. One
social worker at least is required for each ward. They are more
concerned with the socio-economic position of the patients. This has been
felt during the internship period that we need more social workers for all
the wards of the hospital. The social workers should be appointed for
those places where the staff has a direct dealing with the public.
The management of the unclaimed cases is the one of the duty of the
social welfare section of the hospital. The social welfare unit should be
given a separate place where such cases could be dealt or the quota
should be given to the social welfare unit in each ward for such cases.
Due to the non-availability of such place the unit authorities are getting
troubles in performing their duties.
Case histories
Our group in the agency consist of eleven members. The group was
divided by the authorities into three sub-groups. One group was sent to

the orthopedic ward, one to the medical –A ward, and one to the
Accidents & Emergency department. Our group was working in the A&E
department. Now therefore all the case histories given below have been
taken in the A&E department of the hospital. There is a number of the
case histories which have been collected by the group but for the sake of
our report only four of them are being presented here.
Case no. 1
Department/ Ward: A&E

Case type: Orthopedic
Name: Riaz Ali
Age: 37
Resident: Serchina Sawabi
Educational qualifications: M.A. B.Ed
Occupation: principle of a school in sawabi
Major problem: an injury in right foot
History of the patient

The social worker meet with the patient in palaster room of the casualty
orthopedic ward. the doctor prescribed him injection and an X-ray. He
himself was facing difficulty in moving. Mr. Riaz was all alone and he had
no respondent at that time. He was guided by the training social worker
to the nursing room for injection. When the injection was given to him by
nurse then he was guided next to the Casualty X-Ray room. The X-Ray
technician has an X-Ray just within few minutes.
Now the training social worker show and guide him to an easy way to get
back to the doctor. When the patient reached to the doctors room, he was
busy in bandage of a child. So we wait for some time.
During this time the social worker interviewed him and took a complete
history of Riaz.

How the injury occurred?

(In the words of Riaz) I am a principle of a public school in sawabi. Today
I came to Peshawar to the high court due to some case. While coming
down via the stares in high court, my leg slipped at a stare and I feel
extreme pain in my leg. My lawyer arranged a Riksha for me which
brought me to A & E. I got the purchee from the counter and then come
to the orthopedic doctor up here.
Diagnoses of the doctor

Dr. Gherat after assessing his x-rays said that the injury is not severe and
the joint of the leg has got some pressure. He prescribed him some
medicines and a crack bandage.
During this time he called a friend on cell phone. His friend Mr. Maqsood
arrived after some time to A & E. but he was unable to find palaster room.
So the social worker went out and searches him and brought him to his
patient. Mr. Maqsood fetches the crack bandage and other medicine.
Riaz’s leg was bandaged. And they both move to their home back to
sawabi.
The role played by social worker

The patient Mr. Riaz was helpless and all alone. He really needs
someone’s assistance to guide him. So the social worker provides him
guidance. He needs someone’s company and counseling. So that he can
pass the time of stress and anxiety in an easy way. The social worker
provides him company and has tried to divert his attention from the
illness so as to reduce his tension and anxiety. The social worker also
makes the situation more clear to him and his respondent.
Case no. 2

Department/ Ward: A&E

Purchee No: LRH0907-080970
Nature of the case: surgical
Name: Noor Mohammad
Age: 75
Respondent: none
Marital status: married
No. of Off-springs: 6 - (3 daughters and 3 sons)
Financial position: dependent upon his sons
Occupation of the supporters: drivers
Resident: Pajagee Road Peshawar
Educational qualifications: nil
Major problem: urine problem
History of the patient

The social worker met the patient in casualty surgical ward. The doctor
prescribed him injection, an X-ray, and urine test. Although the patient
was an aged person but he was all alone and he had no respondent. He
was guided by the training social worker to injection. When the injection
was given to him by nurse then he was guided next to the Casualty X-Ray
room. The X-Ray technician has an X-Ray just within few minutes. Next
the patient was guided to the casualty lab where his urine sample was
analyzed by the lab assistant within 15 minutes.
Now the training social worker show and guide him to an easy way to get
back to the doctor.
Why the help was sought?

According to patient he feel some swelling in his urine but sometimes it
become intense and severe, and sometime he became normal.
Diagnoses of the doctor

Dr. Ayub after assessing his x-rays and lab report said that the case is not
so severe. The doctor prescribed some medication and said that he should
drink water in large amount.
The role played by social worker

The patient was an aged person and all alone. He was really in need of
assistance and help. So the social worker provided him guidance. He
needed someone’s company and counseling. So that he can pass the time
of stress and anxiety in an easy way. The social worker provides him
company and has tried to divert his attention from the illness so as to
reduce his tension and anxiety. The social worker also makes the situation
more clear to him.
Effect of social work

The patient was very much amazed of the guidance and assistance of
social worker. He was very happy and thankful to social worker. He asked
social worker that why he is helping him in a situation when his children
have left him alone. It was due to the social worker that the time and
energy of the patient was saved. He prayed for the social worker’s
success. The patient prayed that such social workers may be available to
all the patients.
Case no. 3
Identification
Purchee no. --------------------

Name: Niat Meer
Age: 75
Nature of the case: Neoro-Surgical

Ward: Trauma Room

Family system: joint
Respondent: Abad Meer = brother
Zubair =
Hassan = step son
Marital status: he has a second wife who is also near
death
No. of siblings: 1 son who has died 14 years ago in
the age of 25, 2 step sons
Financial position: independent
Resident: Pir Qala, Shabqadar Dheree
Chief Complaint: severe Head injury
___________________
Present History
According to all the respondents, the baba has been beaten on the head
by the brother of his Bahoo whose name is Bilal / 20y. he was beaten
when he was taking care of his cow. The patient him self don’t know that
who beat him
Past History
His son was fired down by mafroors 14 years ago. Due to this trauma he
has got a severe shock. Bcz he was his only son. This traumatic event
makes him irritable minded. The baba has distributed the property among
the stakeholders. He has a house as a property on his name. the bahoo
want to sell the house but the baba is not ready to do so. The relationship
between them are very constraint.
According to the respondents they have a quarrel just few days ago. The
reason was that the bahoo has stayed in someone’s home for 20 days
without the permission of the baba.

Financial Position
The baba took his care and meet all his expense by him self. He has 15
goats and a milk cow, which is his major source of earnings. He has also
poultry hens in home.
Socio-cultural situation
This is a very complex case. Pir qala is the are of pukhtoons near
mohmand agency. Socio-economically the area is very backward and less
developed. There is mass illiteracy and lack of educational facilities and
other services. The people are very poor though they have their own
properties.
Diagnoses
Why a poor baba who is near his medical death has bean beaten by his
bahoo’s brother?
There can be many reasons for this case. One major reason is the
property distribution. The second is the generation gap. The third can be
that the character of the bahoo may not be normal, which has caused the
incident.
Hospital history and social worker’s role

The baba was brought to the A & E by his brother Abad Mir on 23-sep.
The patient was given some initial treatment in trauma room. The patient
was transferred to the neurosurgical ward on 24-sep. the social worker
has interviewed them on the same date in trauma room. All the social
history has been given in the above lines. The social worker has visited
him in the ward on 25-sep. the baba was conscious and talking in a good
mood. He provided the information that he has 15 goats and some hens
and one milk cow. He was talking about them only.
But when the social worker visited him on 26 of sep, he was discharge by
the incharge of the ward. The doctor has discharged him just by

examining his physical conditions. The social situation of the patient in his
community and family is still not in his favour. He has to live with the
same Bahoo who is responsible for his being here in the hospital. Now the
baba can again come to the casualty in the emergency situation.
Recommendation
We have to develop a system for the rehabilitation of such patients whose
family environment is against them. The bahoo of the baba haven’t been
contacted by any one, this is just bcz there is no social worker or
counselor in any ward. The social worker has just tried to contact her but
during this the patient was discharged. So the social worker has lost the
case. There should be at least one social worker appointed for each ward
or department, who can make some rehabilitation processes for such
patients.
Case no. 4
Identification
Purchee no. LRH0907-091797

Name: Hameed Khan
Age: 25
Nature of the case: Neoro-Surgical
Ward: Trauma Room
Family system: joint 25 members live in one house
Respondent: Farzullah Khan = brother
Fazal Dad = brother
Rahmat = nephew
Marital status: unmarried

No. of siblings: 5 brothers and 7 sisters

His position: he is the youngest of all
Occupation: zamidari
Resident: Bela Neko Khan, Dalazak Road,
Peshawar
Chief Complaint: severe Head injury
___________________
Present History
According to all the respondents, the patient has been beaten on the head
by three persons. There names are Haider, Gohar, and Awal Gul. The
main stakeholder is Gohar. They have beaten him at 8:00 am when the
people were busy in saying their prayers.
Past History
Mr. Hameed has a joint family system. They are 25 members living in one
house. They have enough manpower to maintain and to threat others in
the village. But this time the other party was more strong then them.
About half of the village belongs to the other party. The reputation of the
Hameed’s family is not good in this regard.
This time the dispute begin, according to the respondents, bcz Gohar and
Hameed have an agreement of zamindari and mazdoori. But Gohar
refused to work with him just a night before the work has to begun. Now
it was due to this refusal they have a little bit quarrels at that time. But
Gohar plan after this and beat him with the help of his brother and friend.
Socio-cultural situation
Bela Neko Khan is situated on Dalazak road. It is a typical rural area. This
area is included in Khalisa, which is famous for its greenery and Sugar
Cane production. Most of the people belongs to agriculture. Agricultural

disputes are the daily routine of the area. So the above case is. Similarly
an agricultural dispute. The people of the area are generally less
developed and illiterate.
Diagnoses
Mr. Hameed has a family background which is full of such incidents,
quarrels and disputes. His family is not in a mood to resolve the current
dispute. Although they have a jirga system in their area but it is not so
much effective. The current incident is due to the cultural pattern of the
area.
Hospital history and social worker’s role
The patient was brought to the hospital on 24 of September. He was
given the first aid in the trauma room of A&E. when the social worker met
him he was laying unconsciously on the bed. So the interview was taken
from the respondents. As they have a joint family system so there was a
number of respondents available on the spot.
Next day the social worker visited him in the neurosurgical ward. The
family was busy in taking care of him. There were at least ten
respondents available at that time. So it was difficult to interview them in
this crises situation. So the visit was made again on the next day. When
the social worker met him he was unconscious. But the social worker was
amazed to here that the hospital concerns have discharged him.
Remarks
Now this is the case where the real social work is needed. The disputes of
Hameed are still present. No jirga has still been conducted. The
environment of his community is not favourable to him. But he was
discharged. --- now it could happen again that he may come in the same
condition to the hospital.
We have to develop a system for rehabilitation of such patients. There is
an urgent need of professional social workers in hospitals.

Voluntary blood donors
A collection by Imran Ahmad Sajid
There are some situations in our life when we are completely helpless and
in a very crucial condition. In this situation we need the help of other
people. One such situation is when somebody gets a life threatening
illness. The other such situation is a sudden casualty such as bomb blast,
traffic accident. In these incidents some people go to death while some
are extremely injured. These people can be saved if they are given the
necessary treatment immediately. The injured people need immediate
blood. But sometimes the blood group of the case is not available in the
blood bank. So therefore we have collected some of the voluntary blood
donors who are ready at anytime to donate their blood for the needy
people. You just call them and they will be available. Some of the donors
name and their contacts are being given below;
S. BLOOD CONTACT
NAME F/NAME ADDRESS
NO GROUP NO.
0332- Garhi Baloach

1 A+ Bilal Siddiqee M. Siddique
9124774 Peshawar

0345- Garhi Baloach

2 A+ M. Yousuf Gul Rehman
539592 Peshawar
Bilal Ahmad 0321- Garhi Baloach
3 AB+ Khaista Gul
Sajid 9021277 Peshawar
Department of
0333-
4 B+ Asim Nawab Nawab Khan Environmental
9317506
Sciences UOP
Syed Haroon Ali Syed Yousuf 0300- Garhi Baloach

5 B+
Shah Shah 5955868 Peshawar
0334- Thandee Khoee

6 B+ Momin Khan Abdul Qayum
9204705 Peshawar
M. Mustafa 345- Garhi Baloach
7 O+ Khaista Gul
Sajid 9163441 Peshawar
Department of
0346-
8 O+ M. Tariq Environmental
9810631
Sciences UOP
0321- Garhi Baloach

9 O+ Younus Javed Gul Rehman
9056048 Peshawar
0334- Thandee Khoee

10 Amaanullah Abdul Qayum
9204704 Peshawar
Malak M.
11 Malak M. Bilal Yakka Toot Peshawar
Sharif
Bibliography
Social Services Unit Staff

1. Jahangir Khan ”Social Medical Officer” Zakat Cell. LRH Peshawar
2. Abrar Anjum, “Senior Social Medical Officer” Zakat Cell. LRH Peshawar
3. Innam Khan, “LDC”, Zakat Cell, LRH Peshawar
A & E Staff
1. Dr. Muslim Khan “DMS A&E” LRH
2. Dr. Ali Haide, “Neoro-Surgeon Consultant”, A & E LRH Peshawar
3. Fazl-E-Hakeem, “Nursing Supervisor” LRH Peshawar
4. Kifayat-ul-llah, “Chief Dispenser”, A&E, LRH Peshawar
5. Khalid, “Head Ardali”, A&E, LRH Peshawar
NEWS PAPER
1. Daily Express, 9-oct-2007
INTERNET
1. Emergency Department, wikipedia the free encyclopedia,

http://en.wikipedia.org/wiki/Emergency_department
2. Triage, wikipedia the free encyclopedia,

http://en.wikipedia.org/wiki/Triage"
3. Dr. Bob Mar, “Non but Ourselves” Frontier Medical Co. UK

http://frontiermedical.co.uk/resources/NoneButOurselves.pdf
LRH WEBSITE
4. Dr. Jahanbaz Afridi, “History of Lady Reading Hospital”, Lady Reading Hospital
Peshawar
http://www.lrh.gon.pk/ohms/frmhistory.aspx
5. Dr. Jahanbaz Afridi, “Out Patient Facilities”, Lady Reading Hospital Peshawar
http://www.lrh.gon.pk/ohms/frmoutpatient.aspx
6. Dr. Jahanbaz Afridi, “Welcome to LRH”, Lady Reading Hospital Peshawar

http://www.lrh.gon.pk/ohms/frmdefault.aspx
7. Dr. Jahanbaz Afridi, “Accident & Emergency”, Lady Reading Hospital Peshawar
http://www.lrh.gon.pk/ohms/frmaccidentemergency.aspx

Map of lady reading hospital


Imran Ahmad Sajid-Medical Social Work in Lady Reading Hospital, Peshawar, Pakistan

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Imran Ahmad Sajid-Medical Social Work in Lady Reading Hospital, Peshawar, Pakistan

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17-sep to 18-oct-07

Contents Internship Report

By: Imran Ahmad

M.A Final (evening)

DEPARTMENT OF SOCIAL WORK

By: Imran Ahmad