“We lie on the precipice of an impending public health catastrophe,” explains Dr Dilip Modi, when asked to comment on the increasing tendency of Pakistanis to indulge in the practice of self-medication.
There are several factors at play when we try to fully understand and analyse the reasons behind the reluctance of people to consult with a licensed medical practitioner for correct diagnosis and preventive action. Several healthcare professionals point to the increasing socioeconomic disparity as a major cause behind this. With erosion of real income, inflation and a general dearth of job opportunities, people are now more hesitant than ever to utilize their income in what may be perceived as ‘non-essential’ expenditure.
The proliferation of ‘quacks’ and the rapid expansion of dubious clinics in low-income areas means that some unsuspecting members of the public are duped into thinking that they are receiving proper medical care, when the reality is actually very different. Such quacks have usually served as understudies or helpers at registered medical clinics and now feel that they possess enough medical acumen to strike it on their own. The unfortunate reality is that such practitioners operate in full impunity of the law, with police often showing a blind eye to their activities, despite existing statutes which state that no person will be allowed to depict him or herself as a healthcare professional until and unless they have registered themselves with the Pakistan Medical and Dental Council (PMDC).
The PMDC, which is a statutory body, has stringent guidelines that any applicant has to meet before they can be registered with the organization and gain a license to practice medicine. Unfortunately, an increasing number of people are flouting its rules which does not auger well for the existing state of healthcare in the country.
According to Dr Modi, who is a physician primarily involved in helping disadvantaged people gain access to quality healthcare, the major problem lies in Pakistan’s rural areas. In such far-flung towns and villages, only the state has the capacity to provide essential services, but fails to do so. The private system is almost non-existent in such localities, he explains, as those people who have invested their time in acquiring a medical degree usually remain in the cities in order to gain some returns on their investment. As a consequence, most people consult with local pharmacies to advise them on the appropriate medicine that should be administered. This results in further dysfunctions in the system as symptoms are treated under generic conditions and there is no degree of specialization.
The proliferation of the internet and social media has only caused to accelerate the practice of self-medication. Educated urban people who are normally predisposed towards relying on the internet and social media groups as their primary source of information routinely flock to resources such as WebMD to attain feedback on their symptoms. While this is acceptable for mild problems, any patient suffering from more serious symptoms should avoid such practices at all costs, argues Dr Modi. This is because doctors need to examine a patient carefully, as well as determine each case’s unique history before making a diagnosis. No web-based resource is capable of such a thorough analysis, he points out.
Furthermore, with the plethora of information available online, and the open-source nature of the internet, judging a websites’ authenticity can sometimes be a challenging task. The likelihood of duplicity remains in the meanwhile, which can aggravate the problem. “The essential need to visit a doctor will always remain in place,” asserts Dr Modi. “Even telehealth services decline to diagnose patients in moderate to severe cases and maintain a database of available doctors for referral purposes.”
The prevalent reliance on antibiotics to treat a variety of conditions is by far the most damaging development that currently afflicts a large number of Pakistanis who opt for such a practice. The readiness with which a large quantity of antibiotics is used to treat undiagnosed symptoms is endemic of the failure of the state to educate the public in the risks of such decisions.
It is well known amongst the medical community that antibiotics, while generally deemed to be very effective, are usually prescribed in relatively severe cases, and only after initial attempts to treat the disease have failed. This is because such medication severely affects the immune system and weakens the capability of the body to fight disease on its own accord considerably. Some of the stronger antibiotics have such frightening impact that their use means that the body will take several years before it can restore itself to a similar level of functionality.
Antibiotics work by killing off both ‘bad’ and ‘good’ microbes in the body as they do not discern between the two organisms. As a healthy immune system functions on a ratio of both ‘good’ and ‘bad’ microbes, such devastation causes ripple effects, which cause our bodies to decay at higher-than-normal levels.
The failure to implement laws in their letter and spirit is also one of the main reasons behind the rapid dissemination of antibiotics nationally. While legislation exists that does not allow for medication stronger than mild painkillers to be sold without a prescription, these are poorly implemented. Neither pharmacists nor the state seem to be interested in regulating the drug trade, which is informally estimated to be worth several billion rupees.
In most parts of the Western world, strong antibiotic drugs are tightly controlled and regulated, despite their non-addictive nature. As a matter of fact, most doctors go to great lengths in order to not prescribe such medication at all. Conversely, in third world countries such as Pakistan, drug manufacturers are quick to introduce the updated versions of their medicine.
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