The issue of the young doctor’s strike is the latest in the string of crises that seem to hit the health system in Punjab with worrying regularity.
This time there is a three-way tie between the government, the young doctors and the poor patients. While the patients retain their unchanging position as the hapless victims, the villain this time, in a change from established pattern, is not the government but the doctors, who are being painted by the government and the media as greedy and cold-blooded. Messiahs turned killers.
At the risk of being on the wrong side of popular opinion, I would like to speak up for the young doctors. Better still, let me try and not take sides at all but instead look dispassionately and objectively at the issue.
Some facts:
Punjab currently has no written health policy document. The Punjab government spends around 0.5 percent of its GDP on health, which is very low considering that the average expenditure for all low- and middle-income countries is roughly two percent of GDP. The government lacks the capacity to even spend the budget that is allocated.
For the past two years, the actual expenditure has been less than 75 percent of the budgeted amount. Moreover despite the fact that big hospitals and specialised services get the bulk of the resources, the crises repeatedly hit the big cities.
It should also be noted that only 20 percent of health care is provided by the government, while the rest is provided by the private sector, yet the quality of care at government hospitals has progressively deteriorated.
The demand for a service structure for health professionals is totally legitimate and one that is long-standing. Radical restructuring of the health system is required and not cosmetic gestures. Instead the health system is in a shambles and all we get are attractive slogans of mobile health units, free dialysis, air-conditioning in major hospitals (though how that is working without electricity is another question), free parking etc.
Our health indicators are amongst the worst in the world and falling. Pakistan may soon be the only country in the world that still has polio, and yes the virus has been detected in Lahore as well. So clearly the government is failing in its constitutional role of providing health care to all its citizens.
What about the doctors? With the decline of the rest of the society, the standard of medical education and ethics has deteriorated as well. As the public health system has collapsed, the private sector has begun to mushroom, and it has grown unregulated, exponentially and at the cost of the public sector almost like a parasite.
Health has become a business and a very lucrative one at that.
Senior government doctors have all got roaring private practices where they fleece the patients without mercy. Labs and the pharmaceutical industry are all part of an exploitative netwrok.
Those who cannot become or choose not to become part of the racket, leave. Doctors are leaving Pakistan literally in droves.
But the young doctors are a different breed. In a country severely lacking in heroes, if I had to vote for someone, it would be the young doctors.
The only reason the government health sector is limping along is because of these foot soldiers of the medical profession.
The brightest of the students, with the highest merit opt for this field. Still young and idealistic, they go through one of the most tough and demanding academic course, at the end of which, and unlike other professions, they find themselves at the bottom-most rung of a long ad difficult career.
They look forward to progressively harder exams not to mention extremely long and punishing hours of duty,
a duty which is not just physically and mentally rigorous but emotionally taxing as well because they have to deal continuously with sickness, misery and pain.
They are the ones who choose to stay and serve. They are the ones on duty when the senior doctors are at their private clinics.
They are the ones who are holding hands, taking histories, helping from their own pockets, staying up all night, even singing lullabies to babies in the nurseries (I know because I’ve seen it). They are the ones running from pillar to post arranging blood, medicines, referrals, ambulances when their patients can’t afford them.
As for the patients not being attended to, I can bet anything that even without a strike, if the media were to go to any public hospital, they would find patients complaining of absent doctors, bad attitudes, unavailability of medicines, long queues and hospital lower staff asking for bribe for the simplest of things.
The media should not fall for the cheap tactic of feeding on misery and creating a false impression. T
he poor patient in Pakistan is suffering, at the hands of poverty, loadshedding, illiteracy, lack of transport, high prices of drugs, poor sanitation systems, unregulated private health care and so much else.
Let’s not put all the blame on young doctors just because it provides an issue to raise ratings or it is politically expedient. I would urge some basic research and objectivity.
Out-patient departments are for walk-in patients. Any able administrator should be able to juggle senior doctor’s schedules and cover OPDs. Emergencies and wards are still working and the young doctors are continuing to do their duties where lives are endangered. There would be no crisis if the government could learn to manage...anything.
You cannot call doctors messiahs, and treat them like criminals – raiding their hostels and arresting them. You have to treat them with the dignity and respect that their title deserves before expecting them to behave like messiahs.
In defence of young doctors - Dr Narmeen A Hamid
