Faraz had not been feeling well for some time and, despite taking medicine from a doctor, his condition showed no signs of improvement. Sometimes he felt as if it were becoming worse. One day he collapsed and was taken to a hospital, only to discover that his problem had not been diagnosed properly. The doctor he was consulting was administering medicine to him without any laboratory tests done. The doctors at the hospital suspected that the medicines may have caused more harm than good, and the so-called doctor may not even have been a qualified doctor but a quack.
According to estimates, there are over 600,000 quacks in Pakistan providing primary and basic healthcare to poor people in rural and urban areas of the country. They are not only posing as physicians who treat minor problems, such as coughs and colds but also claim to specialise in cancer therapy, as well as liver and renal failure. These specialist quacks are especially known also for treating infertility and impotence.
Then we have the so-called healers providing care to patients with mental disorders around shrines and in graveyards. There are many faith healers who use different religious methods including prayer, amulets and holy water, different stones and strings to wrap around the wrist. These treatments are cheap but the patient is required to visit the healer regularly for the treatment to take effect.
Quackery is deep-rooted in our society and cannot be eliminated unless the public is educated and a proper healthcare system is put in place
A large number of people are treated by these ‘experts’ who also allegedly practice black magic. Their practice has flourished over decades and one can find third and fourth generations of quacks providing services to the lower socio-economic classes.
Despite the increase in the number of medical universities and graduates from public and private medical colleges, massive investments in campus buildings and hospitals, purchase of state-of-the art medical equipment and liver, heart and bone marrow transplants being carried out in the country, the number of quacks has also increased and the public seems to place more trust in them and prefers to go to them rather than to a hospital.
People prefer quacks over qualified doctors and hospitals because they are cheap, easily available, and have time to give attention to their patients. Being friendly, they customise their method of treatment as per the suitability, requirement and demand of their patients. They are very good in winning over the confidence of the patient to the extent that the patient or his or her family are willing to do whatever the quack advises them.
The families of patients suffering from mental illnesses visit shrines and other holy places where there are no charges. Patients with psychiatric disorders chained and tied to the walls of a shrine or a tree on the premises is a depressing, painful but a common sight around shrines because the families of these patients have no money to afford the alternatives that medical care offers.
In a majority of the cases, patients suffering from common health problems benefit from the treatment provided by quacks, which enhances their faith in them. In complicated cases where they usually fail, the quacks somehow manage to satisfy the patients and their families about the disease and treatment using brilliant communication skills. If the patient dies, they attribute it to God’s will instead of medical negligence. It’s amazing how successful quacks are at making money by treating through mumbo-jumbo and are still respected by the community.
Quacks specialising in infertility and impotence are very expensive and treat their patients with special medicine that they develop themselves. Some of these medicines are so dangerous that they may cause renal and liver failure and, in most cases, the patients lose their lives. Unfortunately our medical system fails to protect people from this lethal management.
It hardly comes as a surprise that quacks also maintain a referral system. If they see complications arising with the treatment of a patient, they either refer them to another quack colleague or a qualified surgeon who are doctors who participate in this criminal business for money and get a regular commission for these referrals. There are not only qualified and competent surgeons but even well-known diagnostic centres involved with these quacks and referrals. It’s an organised system that runs parallel to our health care system. A large number of qualified and unqualified health professionals are involved.
WHY CAN’T IT BE ELIMINATED OR CONTROLLED?
Though there are laws against quackery, it is not possible to eradicate it from the country just by making laws against quacks, or forming health commissions, motivating police or investigation agencies to take action against them or giving power to Pakistan Medical and Dental Council (PMDC) to act against them. The fact is that these quacks have deep roots in our society. As long as the public is uneducated, quackery is here to stay along with our unregulated and disorganised health care system.
In the present health care system, the regulatory bodies and organisations such as the PMDC, College of Physicians and Surgeons Pakistan (CPSP) and Pakistan Medical Association (PMA) have failed to control the malpractices of qualified MBBS doctors with postgraduate qualification from Pakistan and abroad. In a society where money is everything, corruption is acceptable and a way of life, while doctors and health professionals are least bothered about ethical practice of medicine in the community. They are the ones who take commissions, charge enormous fees and accept expensive gifts and air tickets from pharmaceutical companies. The junior doctors go on strike leaving their patients unattended.
Medical students are paying fees in millions of rupees but their main goal remains to make money fast and at any cost. Unfortunately, they have no ethical role models. In fact, ethics is not a part of their curriculum and morality is not an issue with them as far as the patient is concerned.
The poor and needy will continue to suffer, and the quacks will continue to cause death of their clients. The law will not be able to blame the quack and ignorant people will continue living with the belief that Allah has decided this for them.
SO WHAT SHOULD BE DONE?
The first step to eliminate quackery would be to make preventive healthcare available and accessible to every citizen of the country. Our basic health units, rural health centres and taluka hospitals should be active and provide treatment to patients who otherwise are forced to go to tertiary and teaching hospitals for the management of conditions such as diarrhoea and acute appendicitis. Highly qualified doctors are not needed to run BHUs, RHCs and THQs (tehsil headquarter hospitals).
While the government has failed to organise a healthcare system for poor people living in city slums and rural areas of Pakistan, the policy-makers are not interested in the lives of poor patients despite tall claims.
Institutes such as PMDC and Pakistan Nursing Council fail miserably because of intervention from political parties, military leaders and judiciary who act for the benefit of vested interest groups. It seems that, despite the good intentions of the Supreme Court and claims of political parties, nothing will happen unless authorities become serious about the health of the nation, instead of giving way to well-organised quackery and unethical and inhuman practices of hospital owners and doctors.
The writer is ex-member PMDC and secretary PMA
Published in Dawn, EOS, November 4th, 2018