| 14 January 2004 | Wednesday | 21 Ziqa'ad 1424 |
New rules for hospitals not being implemented
The day will probably come when encounters between the leaders of India and Pakistan will no longer be deemed historic because they will no longer be uncommon. The day will come when citizens of both countries will need no more than a valid passport to cross the border, when bustling trade between the neighbours will edge out clandestine smuggling operations, when the Indian and Pakistani cricket teams will routinely visit each other for regular fixtures, when Kashmir will once again be synonymous with natural beauty and placidity rather than conflict and bloodshed.
There's no saying how soon that day will come. And there's no denying the possibility that it may not come at all: after all, over the past five decades and a half, Pakistan and India have displayed an amazing propensity for defying logic, common sense and mutual interests. But if the generally bleak and unfortunate past can indeed be transcended and a new era launched, will historians tend to trace its origins to a couple of crucial days in January 2004?
That will depend on a number of factors, particularly the trajectory of progress in relations from this point onwards. Serious hiccups along the way, which could necessitate yet another new beginning, may well relegate Atal Behari Vajpayee's Islamabad trip to a realm of relative inconsequence.
That would be a tragedy. The visit was not an effortless triumph: both sides tried very hard to make it work. And they largely succeeded. Inevitably, the requirements of diplomacy necessitated a fudge on contentious matters. Clichis were flung about almost with reckless abandon. But the atmosphere of bonhomie and mutual accommodation offered a pleasing contrast to the cantankerous point-scoring of the recent past.
What lies ahead cannot, of course, be forecast with any degree of certainty. But there are several hopeful signs, not the least of which is the apparent intention to move forward step by step. Although a great leap would not be without merit, the exercise would be fraught with risks that are unnecessary at this point. Limited goals mean that any failures would be proportionately small.
Initial measures towards a broader rapprochement are likely to revolve around trade. The scope for progress in this sphere is immense: India and Pakistan have barely had an economic relationship of any sort over the years. This politically motivated anomaly can rapidly be remedied without exposing industries in either country to any serious threat.
The South Asian Free Trade Area (Safta) accord signed at the Saarc summit last week leaves room for protection in sensitive areas - and, sensibly, demands less in terms of tariff reduction from the association's less-developed countries.
It would be wise not to forget, though, that free trade in its current context is far from universally popular - and not without cause. The 10th anniversary this month of Safta's North American model, Nafta, has been marked in a rather subdued manner, because the treaty does not have too many fans outside the United States. Such agreements tend to favour larger economies and richer nations, and American corporations have never been shy of ruthlessly exploiting opportunities for improving their bottom line.
India boasts by far the largest economy in South Asia. This immutable fact of life can be of considerable benefit to its neighbours, provided India does not attempt to establish on a regional level the sort of economic hegemony associated with the US.
Saarc's stress on the alleviation of poverty is most welcome, provided it proves to be something more than a catch phrase - and provided South Asian governments recognize that free trade isn't by itself a panacea in this context.
As India well knows, giving free rein to large corporations can actually compound deprivation. And regardless of the IMF's insistence to the contrary, untrammelled privatization is liable to provoke similar consequences. One of capitalism's most baneful aspects is the tendency of the profit motive to mutate from an incentive into an obsession. That helps to explain why, in profit-driven societies, growth in wealth is inevitably accompanied by an increase in economic disparities.
In the context of the Indo-Pak thaw, meanwhile, it is important not to lose sight of the nature of the two governments. For one, the wish list outlined at the outset could be expanded to incorporate the hope that in future Pakistan and India will both be represented at the highest level by elected leaders.
Elections do not of themselves guarantee good government, but whatever the shortcomings of bourgeois democracy - and they are legion - in most circumstances it is decidedly preferable to dictatorship as a form of governance. India has persevered as a democracy since 1947. Pakistan is a different story.
The Bharatiya Janata Party intends to bank upon the hopes generated by Vajpayee's Islamabad visit, plus a supposedly booming economy and a symbolic opposition, to test its strength in an early election. Which suggests, among other things, that the prospect of improved relations with Pakistan is broadly popular in India. Going by the available evidence, the sense of relief and expectation is reciprocated in most quarters in Pakistan. Unfortunately for Pervez Musharraf, he cannot look forward to any sort of an electoral harvest.
Musharraf may not be a tyrant, but the recent legitimacy-garnering exercise has neither added to his credibility nor affected his status as a military dictator. It remains to be seen what will happen when - and if - he keeps his promise to the Muttahida Majlis-i-Amal to shed his military accoutrements by the end of the year, but thus far the general's only party is the armed forces of Pakistan.
That may appear to be a useful position for negotiating any sort of settlement with India. But an autonomous civilian leadership, based on popular support, with a politically subordinate army determined to abide by, rather than rewrite, the national Constitution, would potentially be a more reliable interlocutor on the international stage.
Notwithstanding its populist stature, the nature of the BJP government in New Delhi also arouses certain misgivings. Its support was initially based on an appeal to Hindutva, and its bedfellows include some of the most deleterious elements in Indian politics. Which means, in part, that the BJP can exchange concessions with Pakistan without arousing sectarian outrage (although it's hard to say whether a post-Vajpayee BJP would be equally inclined towards rapprochement).
Another point worth pondering is whether that leeway would extend to Kashmir - an issue on which both sides have hinted at an unfortunate degree of inflexibility. The Indian leadership has said it is willing to discuss the subject but would not countenance any change in the territory's status. Musharraf has noted that it would be out of the question for Pakistan to accept the Line of Control as a permanent international border.
The degree of open-mindedness required for a lasting solution to the conundrum has yet to be generated. A spurt in trade, cultural exchanges and tourism could vastly improve the atmosphere and enhance the spirit of mutual accommodation. But nothing thus far can be taken for granted.
Notwithstanding repeated denials from both sides of the fence, the growing bonhomie on the subcontinent is to a certain extent the consequence of pressure from Washington. That does not necessarily devalue the goodwill, but any progress will endure only if it is attempted in the best interests of the two nations, rather than to solicit brownie points from a superpower.
In Pakistan, the fundamentalist (and now crumbling) MMA, which helped Musharraf in his quest for a veneer of legitimacy, has been critical of recent development, especially the president's assurance that he won't permit Pakistan's soil to be used for any terrorist activity. Sadly but not too surprisingly, that absurd reservation has also been echoed by Nawaz Sharif's faction of the Muslim League.
The Pakistan People's Party has been altogether more positive - hopefully for the right reasons. Several Kashmiri leaders have also endorsed the initiative, but militants have shown no interest in suspending their activities. Which means that there is unlikely to be a let-up in the Indian army's repressive operations.
So, while India and Pakistan talk trade and play cricket, Kashmiri suffering will continue. This is not to suggest that they shouldn't pursue commercial openings or arrange sporting fixtures. And it certainly does not imply that they should try to settle the Kashmir issue by means other than purely political and peaceable ones. But they should try harder. And more selflessly.
A highly dramatic gesture could add a great deal of momentum to the incipient peace process. Musharraf said last week that Pakistan would be willing to give up its nuclear weapons, provided India were to do the same. It would be both wise and courageous of Vajpayee to take him up on that. A more effective confidence-building measure is hard to imagine.
Apart from liberating South Asia from the oppressive shadow of the mushroom cloud, it would set an excellent example for the rest of the world. Washington won't take the hint, of course. But it won't be displeased either. What more could Musharraf and Vajpayee ask for?
New rules for hospitals not being implemented
The working of the Punjab Medical College and the teaching hospitals attached to it could not be put in order due to the indifferent attitude of the health department and alleged violations of the Punjab Medical and Health Institutions Rules.
Earlier the government after a heated debate and protest over the formation of boards of governors of teaching hospitals, disbanded the BoGs and framed new rules named the Punjab Medical and Health Institutions Rules, 2003, on the recommendations of the commission appointed by Chief Minister Pervaiz Elahi to pacify the protesting doctors community.
However, the health department failed to implement the new rules in letter and spirit which caused many problems for medical students on the one hand and senior doctors and teachers on the other. Medical superintendents of both the Allied and DHQ hospitals could not be appointed in consonance with the new rules.
Under the new rules, only a grade-20 officer is eligible to be appointed as medical superintendent of a hospital like the DHQ and Allied. But these important posts are being held by junior persons in grade-18. Medical superintendents of these institutions reportedly have links with the political hierarchy of the province.
Under the service rules of government servants, the MS has vast powers to command the teachers and doctors attached with the teaching hospitals. He can write their annual confidential reports and evaluate their performance. Over 98 per cent teachers and doctors of these hospitals are senior by two to three steps to the present medical superintendents. It is ridiculous that seniors are forced to take orders from juniors and also to get their performance evaluated by them.
Significantly, the MS, under Schedule-I of the Punjab Medical and Health Institutions Rules, 2003, has been made responsible for managing the institution according to the highest standards of professional and ethical competence and integrity, ensuring provisions of health care facilities to the satisfaction of the public, utilizing their capability to the best, ensuring adequate resource-building, both financial and intellectual, for efficient management of the institution and performing surgical and teaching audit of the staff on a half-yearly basis. Medical superintendents have also been made responsible for improving the health care services and equipment to international standards.
Similarly, under the Punjab Medical and Health Institution Act, 2003, the medical superintendents are also members of special selection boards and executive committees. Under Article 8 of the Punjab Medical and Health Institutions Rules, 2003, a medical superintendent for a hospital or an institution shall be appointed by the government from a panel of three general cadre doctors of BS-20. However, the Punjab government appears to have failed to implement this rule in its true spirit and find eligible persons for appointment as MS.
Likewise, the new boards also appear to be involved in continuous violation of rules pertaining to appointment of medical superintendents. According to rules, they are required to recommend a panel of three eligible candidates for filling the post of MS on the basis of seniority-cum-fitness.
Apart from this, the boards constituted by the health department failed to take steps for institutional private practice as envisaged in Rule 20 which clearly laid down that the government and the board shall endeavour in establishing and augmenting the infrastructure of medical and health institutions for establishing an effective system of the institution and private practice.
vigilance committees are also required to be appointed by the board under Rule 21 for checking and preventing unscrupulous practices in transfer of general ward patients to private wards and inquiring into complaints of coercion and harassment of any patient. This committee is also empowered to oversee the working of institutions and check malpractices like institutional private practice. Steps are also not taken for developing a clearly defined mechanism for protection and free-of-cost treatment of the poor and constitution of welfare societies for receiving donations from philanthropist associations.
The duty of evaluation of performance of employees is also not being carried out by the board as required, under the law. The government has also failed to exercise its powers to implement various directives in furtherance of the objectives of the Punjab Medical and Health Institution Act, 2003.
The present administrators of the Allied and DHQ hospitals, including the chief executive of PMC, seem to be spending a huge amount on furniture and fixtures increasing the recurring expenditure.
A visit to both the hospitals revealed a deplorable state of affairs. Outdoor patients were being forced to wait for hours and the claim of providing 100 per cent free treatment to emergency patients seemed to be a farce. The standard of sanitation was poor. Suffering of patients was unabated. There seemed none to protect their rights. There is no independent system for finding out the truth.
How serious are the wizards of the health department and top hierarchy of the province who claim that merit and good governance are on the top of their agenda can be judged from their silence on this state of affairs.