I HAD been invited to the Marriott Hotel in Islamabad for a seminar on Sept 20, but I did not go. If I had.… Let our leaders think of the unthinkable. The stark facts are that terrorists are as capable of bringing truckloads of explosives to government installations in Lahore as to a posh hotel in Islamabad to take the lives of hundreds of people at will.

The local Taliban have been threatening such attacks and several of them — including the one in Wah and one near Peshawar earlier this month — have also been owned by them.

It is, therefore, somewhat foolish to keep up the rhetoric of the ‘foreign hand’ when homegrown militant groups are obviously involved. Also, let us remember that even if foreign elements supply the money or weapons for such deeds, it appears to be locals who have their own agenda and who carry out such attacks. They would continue to do so even if there were no foreign support. This is also true for India where the Indian militants have their own agenda (probably inspired by the frustrations of the under-employed Muslim youth) which makes them seek vengeance.

They could be backed by some Pakistani groups with or without the knowledge of state functionaries but that does not mean that such attacks are not India’s internal problem. Similarly, the Pakistani Taliban and other Islamic militant groups are a Pakistani problem even if some sections of them at some level are backed by India through Afghanistan.

It is true, however, that if the Americans had not fought the Afghans the Taliban would not have shifted to Fata. But then, if the Americans had not fought a proxy war against the Soviets after 1979, the extremist Arabs and Chechens would not have come to Afghanistan in the first place. Al Qaeda would not have been created and both the United States and Pakistan would have been safer. The American war of 1979-1988 was not Pakistan’s war. Gen Ziaul Haq made it our war in order to perpetuate his personal interest and consolidate his rule or out of folly or perhaps as a mixture of all factors. The present war against Al Qaeda and the Taliban would not have been our war if they had not endangered Pakistan. But they are fighting us.

Unfortunately, if scholars like Ayesha Jalal (Partisans of Allah) and Ahmed Rashid (Descent into Chaos) and a number of others are to be believed Pakistan has been following disastrous and suicidal policies whose terrifying results are now being felt. Pakistan had been using trained fighters to fight a proxy war with India in Kashmir in the hope that if there was sufficient bloodshed, India would let Kashmir go.

This did not happen and these fighters being Islamists the whole Kashmir question came to be seen in a religious context. Local groups in Kashmir demanding freedom such as the Jammu and Kashmir Liberation Front were suppressed by Pakistan’s intelligence services and the ones in India so that the secular aspect of this struggle for self-determination was choked off.

The Islamists who waged a covert war in Kashmir also kept killing members of the Shia community in Pakistan. Eventually, the Shia community retaliated in kind leading to a civil-war-like situation in our cities. Other instances of the Shia-Sunni conflict can be seen in the Northern Areas and the Kurram Agency.

The Pakistan Army’s obsession with Kashmir and rivalry with India also inspired our disastrous Afghan policy. Seeking depth in Afghanistan meant protecting certain militant groups while handing over others to the US without a trial. Thus, the ‘war on terror’ has been fought by Pakistan with its arms and legs tied; with duplicity and double-dealing and with maximum loss to the country.

Our people were never told that aspects of this war affect us and are, therefore, part of our war. Many among the media kept commenting on each attack on our cities as the work of foreign agents (‘no Muslim can do such a thing’ was a common refrain). Meanwhile, girls’ schools kept being torched, CDs kept being destroyed, barber shops were gutted and the Taliban abducted people with impunity. Nobody spoke up and if they did it was with such reservation and uncertainty and such repetitions of the mantra about this being America’s war that the common people were totally confused.

Also, our elite lives in such luxury and has such an unfeeling attitude towards the people’s real problems — spiralling prices of food and utilities, the lack of justice, deteriorating law and order — that the people have lost all faith in it. Now even if officials tell the truth—as the interior ministry keeps doing regarding the danger from within — many are hesitant to accept their words.

This is because previous policies which were known to have been wrong are never openly condemned by those in power. Those who created and administered such policies have never been made to answer for their lack of judgment, or worse. In short, it appears as if there is no concerted effort to say which policies have led to this religious militancy and what is the solution to ending it.

As for America, it is responsible for destabilising much of the Muslim world. Had it reacted to 9/11 by removing its forces from the Middle East, by giving justice to the Palestinians and by giving help to educate Fata and lifting its people out of the dire poverty they are mired in, we would have seen a stable Pakistan and a safer America.

This did not happen, but even now the Americans can help us by not attacking inside Pakistan; not giving statements that disregard the feelings of our people and by keeping a low profile. If they do not do all this, our government will not be able to fight even its own war against the Taliban. And if that happens will Pakistanis, Americans or even the Indians be safer than they are now or far more unsafe? Let them decide.

ONE really radical and somewhat ambitious way of dealing with the enormous problem created by the growing electricity demand-supply gap is to bring in the provinces into the energy sector.

In Prime Minister Yousuf Raza Gilani’s maiden address to the newly elected parliament it was indicated that his government would grant greater autonomy to the provinces in economic matters.

If that were to be done, he would have kept the word given several years ago by the then Prime Minister Zulfikar Ali Bhutto who promised that the provinces would have a larger role to play in the new Pakistani federation. He was prepared to yield more authority to the federating units in return for their support for his constitutional draft.

The support was given but the word was not kept. Bhutto, by temperament, could not easily share power with others. This was the case with his cabinet colleagues. This also became the case with regard to Islamabad’s relations with the provinces. Bhutto dismissed the two administrations headed by the opposition — one in Balochistan, the other in the NWFP — once the 1973 Constitution was promulgated. Under the two military presidents who held power after Bhutto’s removal, Pakistan became a progressively more centralised state.

As Pakistan now grapples with an economic crisis of unprecedented proportions the grant of provincial autonomy may be part of the solution Islamabad is seeking. Not only should the promise of the 1973 Constitution be fulfilled, it may also be a good time to go beyond that by focusing on what could be achieved by transferring to the provinces the subjects listed in the Concurrent List.

By transferring greater authority to the provinces in three areas — international trade, financial resource generation and energy — Pakistan may be able to lay the ground for solving not only its current economic problems, but also bringing about structural changes that would strengthen both the economic and political system. Today, I will deal with the role the provinces could play in the solution of the energy problem.

Over time the institutional underpinning of the management of the energy sector has changed significantly. Initially, two government-owned entities had total control over the electricity sector. Of these, Wapda was the dominant player responsible for generating, transmitting and distributing electricity to all areas of Pakistan other than Karachi. For Karachi, this was the responsibility of the Karachi Electricity Supply Company, the KESC. However, under pressure from the donor community, the government decided to privatise the KESC and split Wapda into several components.

Two separate operational units were set up within Wapda to manage thermal and hydel power generation while distribution was divided among eight district companies that were to become financially autonomous over time. A separate agency was established to manage transmission. Regulation of the power sector including tariff determination was handed over to an autonomous entity. The purpose of this institutional restructuring was to lessen the control of the government over electricity and subject its generation, transmission and distribution to the rigours of the marketplace.

That has not happened. For instance, the tariffs recommended by the regulator were not initially accepted by the government. It continued to subsidise the sale of power to all categories of consumers thus increasing the burden on the budget.

At this time I would suggest a radically different approach to the solution of the energy problem. The government should split the responsibility for power generation into three parts. Large projects generating more than 1,000MW should remain with Wapda, while smaller units should be allowed to be established either by the private sector or by the provincial governments. The private sector should continue to work within the policy framework determined by the central government.

The provincial governments should be permitted to establish their own generating companies with the support of the private sector. One more feature of this arrangement would be to allow the provinces to trade electricity with one another. The sale price would be determined through negotiations. It would not be fixed by the central regulator. This approach will allow each province to tap its own resources.

Sindh would most likely concentrate on coal and natural gas; Balochistan also on these two sources while developing the potential of wind power as well; the NWFP will work to develop its enormous hydel potential; the Punjab could develop small hydel units on the many canal heads that are part of its large irrigation system.

Each province could develop solar power abundantly available to all of them. The revenue generated through the sale of power to domestic users or traded with other provinces would provide capital for investment.If Punjab were to rely on natural gas as fuel, it should procure it at the market price from the provinces where it is produced. If it decides to use imported fuel oil that too should be obtained at market prices. If the province decides to subsidise the use of power by some category of consumers, it should do so by providing support through the budget rather than by distorting the price structure.

Such an approach has many benefits. It would establish a market for trading electricity, which was one of the objectives of the reform effort launched a few years ago. It would deal with the resentment of such relatively more backward provinces as Balochistan and the NWFP that they have not been adequately compensated for the use of their rich resource base by the more developed parts of the country. It would encourage the efficiency of resource use by making electricity an openly traded commodity. It would create incentives for the provinces to do research and development in such new technologies as solar, wind and waste products’ utilisation. It would ease the burden on the central government for increasing generation capacity. And it would produce healthy competition among the provinces.

Once this three-tier system is established and has created an operational track record, some of the larger units could also be handed over to the provinces. At this point while central Punjab is the largest consumer of electricity, large amounts of the power it receives are produced in the NWFP (at Tarbela), in Azad Kashmir (at Mangla) or in the gas-fired plants in various parts of the province. By purchasing power from the provinces, the economic grievances of the country’s more backward areas could be reduced.

MEDICAL education and the future of doctors in Pakistan have been in the doldrums since long. There was a time when there were very few medical colleges in the country and those were in the public sector. Getting admission in a medical college was considered prestigious. First-year medical students cherished the title ‘doctor sahib” and felt pride in wearing their white coat with a stethoscope around their neck.

Things changed and the private sector established medical colleges. We now see many of them. With open merit, girls are opting more for medical studies though few take up medicine as a career. But overall deterioration in medical education and no structured career planning — unlike the situation in India — have led to doctors looking at alternative career paths.

Most of the private sector medical colleges are devoid of a full-fledged hospital to meet the minimum standards set by the Pakistan Medical and Dental Council. The public sector has large hospitals with many patients but the complaint is that teachers are not motivated and do not provide individual attention to medical students. The undergraduate years are thus full of academic stress.

After graduation, young medicos face a number of problems: internship, residency, post-graduation, marriage, income. Many girls marry and disappear from the medical horizon. Pressure continues to build up on the boys.

After internship, we have the huge problem of finding postgraduate placement. There are few training slots for the large number of medicos. Getting into a desirable training programme is a nightmare. If one is lucky, then the remuneration is below expectations. Post-graduation is a tedious process involving expenditure. Sometimes it takes years before a doctor gets his or her certification.

Settling down in practice is a big challenge. General practice is full of risks considering the law and order situation in the country — one was also distressed by the spate of ‘doctor killings’ which haunted the country earlier. In the golden days, young doctors would dream of going abroad for higher studies and were welcomed. Britain has now become a pipe dream for aspiring doctors as with its new rules and the revamping of the education system, there is practically no room for our doctors to be absorbed into its higher medical training programmes.

The United States was and is another option, though one with multiple complexities. Sitting and studying for their entry USMLE exams takes students a long time besides posing a burden in terms of expenses and being without a job while studying. Once they have passed the exams, they have to face the hurdle of obtaining visas which can be a tricky procedure, especially after 9/11; in fact doctors already in the US feel discriminated against in these times.

Australia and New Zealand are not easy options as yet for Pakistani doctors but India has a special arrangement for its medical graduates to be placed in Australia. Canada is self-sufficient in non-specialist resident doctors and looks to western-trained postgraduates for recruitment. Those doctors who go to the West without first acquiring a job suffer tremendously, with many having to take up small jobs in restaurants, railway stations, factories etc. to meet living expenses. They face an uncertain future and many undergo psychological trauma. In fact, there have been reports of how some experienced nervous breakdowns and committed suicide.

Some male doctors finally find a position but those with wives who are doctors find their spouses having to give up their career to become fulltime housewives — many feel depressed under the circumstances.

The option of working in the Middle East is a lucrative one and countries like Saudi Arabia and Oman are quite liberal when it comes to accommodating doctors from Pakistan. But these countries have a package that is different for Pakistani-trained doctors in comparison to those who qualify from elsewhere. Also, as with many other professional expatriates, Pakistani doctors find themselves at the receiving end of the Saudis’ repressive approach — their passports are kept by the employers which curbs their freedom to travel.

Moreover, in these countries doctors appointed to a particular position do not get promotions. Those doctors practising in western countries may come across prejudice and subtle discrimination but there is no outright violation of their rights.

What about those who are well-settled abroad but remain deeply attached to Pakistan emotionally? Some have tried to come back but finding it difficult to operate here professionally and at a social level have preferred to go back.

Under the current circumstances, many doors have closed for Pakistani doctors. A number of them enter into private general practice and work late hours to make ends meet. They have to move from institution to another for better salaries. The environment at many private institutions leaves much to be desired and several doctors end up labelling their jobs as ‘seth ki naukri’.

Others who are specialists and lucky enough to get government jobs are happy only for a while as with the passage of time they experience a number of problems: undesirable transfers to outlying areas, blockage of promotions, prejudices and politics.

In view of this scenario, young doctors are not finding the profession attractive. The word ‘doctor sahib’ does not attract them any longer and many are making use of their other talents by opting for careers in the media, pharmaceutical companies, business administration and the fine arts. It is about time this problem was taken seriously and a new path laid out for the coming generations of doctors whose services are badly needed by an ever-growing population that finds itself without proper medical services.

amin.muhammad@med.mun.ca