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A harsh remedy

April 21, 2013

Strikes may prove futile but public-sector doctors in Sindh feel they have no other option but to resort to them, reports Mukhtar Alam.

Talking about the problems doctors face, Dr Mohammad Idrees Adhi, president of the Pakistan Medical Association (PMA), Karachi, says, the biggest issue nowadays is security. Time and again, medical personnel are attacked by mobs while the hospital administration, despite reassurances, has failed to take any measures to protect the medical staff.

He further says that doctors have used all possible channels, like meeting the governor, chief minister, police chief, health minister/secretary, law minister, home minister and even the military corps commander of Karachi regarding the security issue, but to no avail.

Other problems faced by doctors, according to Dr Adhi, are their inadequate pay structure, lack of service structure and structured training, problems of health insurance for doctors and their families, legal cover while on duty, exploitation of doctors and paramedical staff by the private sector, etc. He points out that there is no service structure for the thousands of doctors coming out of private medical colleges where they pay Rs3.5 to Rs5 million to become doctors, and then are offered Rs7,000 to Rs8,000 — an amount even less than the salary of a cook or a driver.

Agreeing that strikes mostly remain pointless and futile, he, however, maintains that the PMA does not support strikes. “Strikes only give an opportunity to [the system] responsible for [the situation] to tarnish the image of doctors in the eyes of patients and the nation … but, honestly speaking, circumstances where doctors are coerced into paying bhatta, abducted or killed and are not provided with any security despite raising the issues at all fronts… compel them to put down their stethoscope and white coats.”

Highlighting the problems of doctors in the rural areas of Sindh, president PMA Sindh, Dr Samrina Hashmi, says, “Doctors in rural health centres and tertiary hospitals have to remain on-call for 36 hours at a stretch. This is exhausting and sometimes results in mistakes and blunders. At times the doctor is so exhausted that they cannot attend a call. This results in violence in health centres.”

Dr Hashmi further says that doctors are attacked and beaten up, but the hospital concerned often does not report the incident to the police and so the culprits remain unpunished.

She points out that there is no schedule for promotions of doctors. The promotions two years ago were given after 19 years. Moreover, the postings are not based on merit, rather on political affiliations, influence and money, which creates a sense of deprivation and frustration.

Dr Hashmi agrees that it is the patients who suffer in case of a strike, but she argues that doctors have no choice as the government will not listen until pressure is applied. However, the pressure- building exercise mostly fails, as doctors cannot go on indefinite strikes; the government takes advantage of this and gives false hopes.

In this regard, the director of the National Institute of Child Health, Prof Jamal Raza, says that as administrative head of a public-sector hospital, things are  worse for him too. “As part of the medical community, in some ways we sympathise with our professional colleagues for being upset at the killing of doctors, etc., but being part of the administration we have a duty not to let the service suffer in any way. The officials of the health department sitting in their offices do not have to confront the suffering patients.”

In a personal capacity as a physician, he is of the opinion that anybody joining the medical profession is under oath to serve the people and to keep the interest of patients above everything else. However, he also agrees that, “Health is one of the lowest priority areas for our government with a budget allocation of less than one per cent. There exists no system to provide doctors, nursing or paramedical staff with a structured career plan and security.

“The system is designed to favour the bureaucracy and has a paradoxical set of rules for doctors and equivalent grades of bureaucrats,” Prof Jamal continues, saying that instead of brushing these issues under the carpet “we should, once and for all, do away with the band-aid and aspirin approach and try to find and address the root cause of the problem.”

Secretary Sindh health department, Dr Suresh Kumar, however, says that the department was handling the problems of doctors as per the rules and policy applicable to civil servants. “At present, no strike is in process, while the earlier ones pertained to regularisation of services and release of salaries, which had no relevance to the health department,” adds Dr Kumar, saying that his department had proactively taken positive steps to facilitate doctors and paramedics in terms of their promotion and financial benefits.