| September 11, 2005 | Sunday | Sha’aban 6, 1426 |
Striking odd notes
HOW far is this society going to make its medical facilities private and commercial, and thereby, as a matter of implication render them beyond the purchasing power of the common man? How far are we going to hear slogans and rhetoric that health cover is being expanded on countrywide basis?
One’s thoughts turned to this kind of a broad spectrum theme when last weekend there was the enigmatic appearance of an advertisement from the Islamabad-based National Institute of Health, Ministry of Health, published in a Karachi English daily.
From the text of the advertisement it is evident that the NIH has gone commercial. Given the macro context within which the public sector is being privatized steadily, if not swiftly as well, this announcement should not surprise anyone. It didn’t. However, it was depressing!
The ad reads: “National Institute of Health. We excel in experience and expertise like nobody can. Now serving you under the most modern facilities. Seven days a week from 7.30am to 9pm at costs you can afford. Safety and accuracy is what we excel in.”
As one contemplates this print media advertisement what strikes one is the NIH contention that its facilities are “at costs you can afford”. Who is the target audience? Do the poor of the country reside in Islamabad? Or is the NIH intending to target the poorer sections of society who dwell in rural Pakistan? That Islamabad is not real Pakistan is not even argued about now. That’s the way it goes now.
From the frequent or rather repeated emphasis that comes from official statements, health ministry’s commercials, and VIP pronouncements and commitments of health care for all by the year 2007, one implication is that the government cannot go it alone. The private sector has to play a larger role, as the public sector shrinks in size, and contribution. That is the kind of future that awaits the poor when they become ill. Here, I want to talk about the three-year-old daughter of a young gardener, who suffered and battled for 20 days with gastroenteritis, and miraculously survived. The family lives in a low-income part of Karachi, somewhere near Punjab Colony, bordering the affluent Defence Housing Authority.
The child, Ateeqa, became ill three weeks ago. Her father, Ejaz, does several jobs to keep the family income “decent”. Now decent it may sound, but not enough to enable him to afford the treatment of his child. For the first few days, the child was taken to a doctor in the neighbourhood. He gave her some medicines and I am told that he did not check her temperature or blood pressure. Whatever the diagnosis and the prescription, and whatever the quality of the effort was the child did not recover.
Each time I would run into Ejaz, an ever-smiling gardener, was no more smiling. Polite, friendly, but appearing worried. As I inquired about Ateeqa, he said that she was being treated. Whenever I asked him details he had no real answers. He reflected faith (or was it fait accompli) in the system, and did not appear to comprehend what was going on. Besides, his daily grind was so tiring and time consuming that he had no time to take the child to the doctor. That was being done by his wife, Shameem, a far more of a simpleton in matters such as these. How would she know what treatment the doctor was giving her, and whether he was diagnosing her accurately? What medicines was he prescribing her and could the family afford the medicine?
This was one important question, one realizes. Days went by and Ateeqa carried on with her battle against sickness. She stopped playing and running around. She began causing anxiety to her mother, till one fine day, on a weekend Ejaz smiled to say that his daughter was alright. At least so she appeared to be, and he felt relieved. Come another weekend as a matter of a follow-up, after the local bodies polls, I was told that the child was back to illness that was an interim period of perceived relief It was a kind of illness which had become dormant, she was still throwing up, and had gone off eating altogether. “Then what does she do all the day?” I asked. He said that she just lay in her cot, almost lifeless, clinging to her frail mother, and crying occasionally in discomfort, while her four-year-old brother Ayaz bounced around in their one room house.
I asked Ejaz whether the child had undergone any blood tests or any lab tests or whether she had been administered any “drips”. He mumbled that the laboratories were far away, and that the doctor was giving some “syrups in a plastic bag” and that even the prescriptions were with the doctor not the patient. All other questions that came to mind I asked. The answers were vague and depressing. It makes one angry.
The reason for the anger was the result of an awareness of the contrast that exists, and is growing in this society, between those who can afford the best healthcare here and abroad, and those citizens who cannot. The reasons are numerous and the reasons are humiliating.
Someone I know made arrangements to send the three-year-old child to a nearby welfare trust hospital, where within 24 hours of a stable decent system of diagnosis and treatment, the little girl became alright. The anxiety that had come in had been eliminated. Within a few days, she was almost the same child, and in fact she enjoyed having a banana and biscuits, I am told. The cost of this treatment was about Rs1,200 and who paid that is really not quite the issue. Or is it?
Many thoughts come to mind about such a profile. It reflects the vast majority of people who suffer when they become ill, or when their kids fall sick. Lack of awareness, resources, initiatives and so on.
Initiative! That’s the word that the government wants the private sector to show. It will. But can the poor Pakistani afford the costs involved.
The picture of health care facilities that exist is both discouraging and encouraging. Private doctors operate clinics and chemists shops, they own, and those who can afford are able to visit the doctors. Those who cannot, one can imagine what they do without. Of course there are quacks, who operate. Perhaps they are a cheaper option.
FRIDAY was another one of those days when leaders on both sides of the political divide let the people down. Bickering over who did what to make the opposition’s strike a success or failure continued all day. Where, you wondered, did the people and their problems figure in such a scheme of things? Thankfully, for many, the strike was only a partial one and no violence or coercion took place in the city as was being feared.
The failure of the opposition parties to get the kind of public response they expected reflects the failed expectations of the people at large, who have come to believe that nothing that they do will make a difference in their lives. The lack of cohesion among the opposition and the lack of focus on the issues that could mean something to the people resulted in the lukewarm response the strike got in the city, as was the case elsewhere.
For its part, the government’s knee-jerk reaction to the expected shutter-down and wheel-jam was just as pathetic. Deliberate attempts were made to create the impression that the opposition would cause much trouble which could lead to violence. Those who didn’t risk sending their children to school on Friday only blamed the government for fanning fear when none was due.
The same was the case with the traders who kept their shutters down; the Punjab government had announced the day before that it would compensate businesses for their losses if violence broke out. This obviously sent jitters down the market, and the wholesalers and jewellers decided to take the day off. Retailers across the city, however, did business as usual.
It is time the opposition parties also did a bit of soul-searching. If, as they claim, the local elections were rigged on a massive scale, why are they still part of the system that is so susceptible to manipulation by the government? The same is the case with the legislatures, where, it is agreed, the government often pushes the opposition against the wall. What, then, is the solution, you may ask.
Counting on the hapless voter to take to the street to push for an obscure agenda that the opposition itself has failed to accomplish is hardly the way out. And, in the end, what will the people get out of the whole deal? Also, you may ask, where is that one leader who can inspire confidence in the people and give them hope for better times ahead? Those in government, too, have failed on this count.
The responsibility for the people to stay calm and not resort to street agitation rests firmly with the government. The claim about an economic turnaround in-the-making only makes for good copy which, unfortunately, is not true for the actual reality on the ground. Anyone who has a family to feed and a house to run knows better. The beneficiaries of the apparent construction boom and the growth seen in real estate, for instance, are only a handful of property speculators, and that too at a gross expense of the middle class.
This development pattern is as flawed as the democracy we have tailored over the years.
THE story of the now trimmed and squeezed Ring Road being ‘constructed’ is one laced with greed and profiteering on the part of many having a vested interest in circumventing the original plan. Acres upon acres were acquired by land-hoarders along the original path of the Ring Road skirting the city on the southern side. The land was then plotted and sold at exorbitant prices, with the promise that the new road would make travel to and from the city a comfortable one.
The real estate boom thus seen gave those in charge of the project and those overseeing it a better idea: why build the road where we promised it to be when we can sell that land at a much higher price while the boom lasts, they said. It was as simple as that, and the next thing you knew was that there would be no ring road, at least for now, in the true sense of the term.
For the most part, the revamped plan will now concentrate on upgrading the Bund Road, Johar Town’s main boulevard, Ferozepur Road and the Defence Road; the only portion that will need to be actually constructed being the one connecting the last two roads. The rest of the so mistakenly called ring road will only entail connecting the existing roads through improving the respective interchanges.
This will not solve Lahore’s congestion or traffic problems with regard to the expected and rising number of vehicles in the near future. But, of course, there is a contingency plan on the part of those calling the shots at present. This includes the eventual construction of the promised Ring Road further south of where it was supposed to be, provided the same people remained in power until then. If not, then it’s really not their problem, so why bother about it now?
THE fit is on to privatize many profit-making trains as well as those seen as a ‘liability’ by Pakistan Railway. These include 11 passenger, express and freight trains, which will henceforth be managed and run by the PR Advisory and Consultancy Services (Pracs). The privatization, thus, does not necessarily mean competitive fares for commuters or for the cargo because a solitary company has been handed over all the trains in question, which will replace the state monopoly with that of the private company.
The lack of interest by other private players in what is actually a job of cleaning the railway’s dirty tracks can well be cited for all the trains going to one bidder. Pracs has promised run the trains more efficiently and provide better service to commuters. But handicaps remain, largely owing to the rustic railway infrastructure. It is hoped that the Railway, after washing its hands of several trains, will now have more time to concentrate on upgrading its tracks, signals and allied services to make rail travel a desirable proposition again. — OBSERVER