Medical community: The noble profession

17 Jan 2016


Doctors stage a sit-in in front of the Khyber Pakhtunkhwa Assembly building in Peshawar
Doctors stage a sit-in in front of the Khyber Pakhtunkhwa Assembly building in Peshawar

Mine was the last name on the merit list. After appearing in the FSC examination for the second time, I was able to get the first division but being at the bottom of the ladder, I still could not get admission in any medical college in Sindh. We were 13 students of the Karachi Intermediate Board who were left without any hope of becoming doctors, a profession which we considered the best in the world. But on the instructions of Mumtaz Bhutto, the then chief minister of Sindh, two students, who had passed the FSC examination in third division, were given admission in Dow Medical College (DMC).

One of the newspapers in Karachi wrote an editorial on this violation of merit and a campaign began for the admission of the remaining 13 students who had passed in the first division and the chief minister’s recommendation was also questioned. The campaign gained momentum and all the 13 students finally got admission in the DMC. In all fairness, we did not deserve it, because even if merit was followed, we should have gone to Chandka Medical College, Larkana.

During my six-year stay at the DMC, I paid a total of Rs1,225 as tuition fee and Rs1,440 as examination fee to the University of Karachi. This includes extra payment of Rs240 as the supplementary examination fee as I had failed in anatomy in the first professional examination. I stayed at the hostel for six years and paid a tiny amount for boarding and lodging while enjoying all amenities — electricity, water, and subsidised meals.

The community pays taxes to help run government medical colleges, but when it comes to payback time, the doctors go on strike

I passed my final year exams and took a house job at the Civil Hospital, Karachi. I worked very hard during my house job because I planned to go to the UK for my postgraduate education and training; also my senior friends advised me to learn as much as possible before leaving Pakistan. I owe my learning to the poor patients who were admitted to the CHK. For all practices, these patients had no rights, neither were they aware that we were not trained doctors. Yes, we wore the white coat, but we were getting our training through their bodies.

I learned how to give intramuscular injections, pass intravenous lines and naso-gastric tubes and did urinary catheterisation. I learned how to do lumber puncture, drain ascetic fluid and liver biopsy during my house job in the medical ward. Some of my friends passed CVP lines after getting instructions from books without supervision. My friends in surgical ward were doing minor procedures like draining abscess, stitching wounds and injuries, circumcisions, dilatation and curettage, etc. Some colleagues, with good “connections” with those who mattered in the wards, were doing appendectomies and even lower segment caesarean section. No first-year resident can do these procedures in the first six months of his training in any postgraduate programme in any civilised country.

I went to the United Kingdom, and then to the Republic of Ireland and completed my training in obstetrics and gynaecology. I passed my postgraduate exam after failing a few times till I satisfied the examiners of the Royal College of Obstetricians and Gynaecologists, UK. I was trained in a few good institutes under the vigilant eyes of my trainers who did not allow me to do anything or carry out any procedure without guidance and supervision. Even when I had passed my examination, my supervisors and seniors kept guiding me to make sure that the patients received the best care. I became a safe surgeon but not a fast one. I came back to Pakistan and joined a government hospital where again I had the opportunity to sharpen my skills by treating and operating on poor Pakistani patients. I developed my skills by operating on them, and learned by examining and treating them. Because of them, I became a good doctor and a surgeon. I started my private practice and began to earn more than needed.

It is a common story of all those doctors educated in public sector medical colleges and who worked as junior doctors. Those who were trained here in Pakistan used poor patients to improve their skills and expertise by treating patients as guinea pigs. We paid next to nothing for our medical education compared to those who were acquiring medical education abroad in those days. Our fee was highly subsidised, thanks to the taxes collected by the government from the sale of cigarettes, toothpaste, soap, rice, water, lentils, etc., all over Pakistan. We owe everything — from our education to our skills — to those who are the unfortunate citizens of this country where they have no right to life and health.

Young doctors of Benazir Bhutto Hospital hold a demonstration in support of their demands in Rawalpindi
Young doctors of Benazir Bhutto Hospital hold a demonstration in support of their demands in Rawalpindi

As junior doctors, we go on strike for an increase in salary benefits; when the health minister is rude to one of our colleagues; when the paramedic staff misbehave with a doctor; or because the government is not providing facilities such as residence, etc., to doctors. A doctor friend in Lahore told me that when doctors went on strike in recent days, one of the junior doctors took out a running drip from the arm of a patient and said that the health minister would put this drip back. Strikes by doctors have become a recurrent and routine affair in our country. Whatever the circumstances a general strike by doctors is neither acceptable nor defensible. Doctors who go on strike and use this method to achieve their goals should have not been in this profession.

Many of us, as senior doctors, are looking at our posts as part-time activity. We come late, leave early and treat our patients half-heartedly. In public- sector hospitals in Sindh, doctors have made their own duty rosters to enable them to stay away from work. By this mechanism, a doctor usually comes for one week a month and gets paid for the whole month. There are many senior doctors working in the health department who are getting paid without coming to hospitals at all.

Medicine is not a profession about power and money. Using the medical profession to make money by cheating patients, and indulging in corruption by manipulating health projects is not what the medical profession is about.

Doctors working in different government projects are more interested in their travel and daily allowances; and are busy in attending different meetings, training programmes and workshops. They exploit government resources for themselves. We all are aware of the collapse of various projects like the polio eradication programme, family health project, anti-HIV/Aids and the malaria programme in Pakistan. The government is not interested in evaluating why these projects are not successful in our country.

Our colleagues working in medical colleges and universities are all part-time faculty members. They have an active private practice, are ready to travel anywhere with expenses paid by unethical pharmaceutical companies and enjoy their hospitality, and in return prescribe their medicines without any ethical considerations. Unfortunately, they are not able to take decisions on the basis of principles when required. What is more, medical students follow these role models.

Medicine is not a profession about power and money. Using the medical profession to make money by cheating patients, and indulging in corruption by manipulating health projects is not what the medical profession is about.

Good doctors don’t go on strike, neither do they make money by manipulating government resources. The community trusts them. They do not have a lot of money but they enjoy the respect of people. When treated patients come back to see their doctor and say ‘thank you’, they mean it. No other profession enjoys this kind of respect from their clients and that is the reason why this profession is considered noble. But in Pakistan, it is losing its nobility because of the total violation of the Hippocratic Oath.

The government will do nothing because it has no interest in the lives of the poor people. We, the doctors, should realise that we have destroyed our profession and now we should come out for the restoration of the best profession without thinking about money and power. We should compel our rulers to create a system in which we develop people-friendly institutes by empowering regulatory bodies like the PMDC. We should compel them to introduce merit everywhere in the healthcare system from the postings at the Basic Health Units to the appointment of vice chancellors, from secretaries of the health department to project directors of different national programmes. Without honesty and merit, it will not be possible to address the challenges we are facing in our healthcare and medical education system.

The writer is ex-secretary general of the Pakistan Medical Association (Centre)

Published in Dawn, Sunday Magazine, January 17th, 2016