People standing outside the Dow Corona screening clinic in Karachi.

Pakistan's dilapidated health system bent double with COVID-19 scare

With healthcare facilities stretched thin, doctors ask people to self-isolate to stop the virus from spreading.
Updated 14 Apr, 2020 05:01pm

After Pakistan joined the countries with coronavirus deaths, it is becoming increasingly clear that self-isolation and distancing is the only way to keep the virus at bay.

"Your healthcare system is not equipped to support you," pronounced overworked and sleep-deprived Dr Shobha Luxmi, an infectious diseases specialist at Dow University of Health Sciences, Karachi (DUHS).

"And if the system does not support its own staff, do you think it will support you?" she asked and then in the same breath added: "Take charge of your health; stay at home and keep your children at home!"

But then Pakistan's healthcare system was never designed, even on paper, for emergency response preparedness. "Our hospitals are not planned for it, people are not trained, isolation facilities are not there and there is no contingency plan. The system is as old as 1947 and we never thought to revise or improve it," Dr Luxmi said, not mincing any words.

The private hospitals are no better, she said. "Those are merely commercial organisations."

"We are not prepared for this type of public health emergency and we will never be prepared if our health expenditure remains static at 3%," points out Dr Ahsan Jamil, deputy general manager, clinical affairs, medical directorate at The Indus Health Network.

"The ground realities clearly indicate that our capacities are restricted and something on a war footing is needed as a desperate measure," he adds.

A drop in the ocean

For now and according to a recent report from NDMA, across the country there are 15 testing facilities, a total of 8,718 beds available in quarantine, 2,058 beds in isolation, and 35 designated COVID-19 tertiary care hospitals. For a country of 200 million, this is a drop in the ocean.

The National Disaster Management Authority has compiled a list of healthcare facilities dealing with the COVID-19 outbreak in Pakistan.

Coupled with a dismal healthcare system infrastructure, the social indicators also do not favour addressing COVID-19 easily, points out Dr Jamil. He says issues of "funds disbursement, lack of availability of testing kits, but above all, a dearth of human resource in the health system" remain huge barriers. He gave the example of the government’s performance related to "containment and isolation of pilgrims at the Taftan border" terming it "sub-optimal".

A complete lack of "background knowledge" and "investigation expertise" coupled with "absolutely no passion" to serve makes the situation all the more depressing for Dr Luxmi.

Residents wearing facemasks as a preventive measure against the COVID-19 coronavirus, wait for their turn at a coronavirus registration and screening counter at the Pakistan Institute of Medical Sciences Hospital in Islamabad on March 19, 2020. — AFP
Residents wearing facemasks as a preventive measure against the COVID-19 coronavirus, wait for their turn at a coronavirus registration and screening counter at the Pakistan Institute of Medical Sciences Hospital in Islamabad on March 19, 2020. — AFP

At a training she carried out just a few days back, of 52 doctors from the Sindh government, whom she asked if they were willing to serve the public, not a single person raised his/her hand, she said. "And they had sent all the junior doctors when the world over, the lead is being taken by seniors."

She suspects the seniors from her fraternity will not go near a potentially sick patient out of fear of getting infected.

The system is burdened

With over 400 people visiting the lungs diseases ward at the DUHS handled by just a dozen or so staff, to get screened and tested, she says there is complete chaos.

"If we refuse, based on their history, they turn around and get angry and some even get downright abusive," says Dr Luxmi. "People are counseled but they don't maintain social distancing," she adds.

In addition, companies and offices — local, multinationals, offices, government offices — are sending their staff to get a clean chit so they may be permitted to come to work. "Why burden the hospital for that; instead they should just close their offices and ask the staff to work from home," says an irate Dr Luxmi.

People standing outside the Dow Corona screening clinic in Karachi.
People standing outside the Dow Corona screening clinic in Karachi.

She says results of the tests take between six to seven hours and they are able to carry out tests for between 30-40 people. Of these, they are usually getting three to four positive cases daily.

The government with help from the World Health Organisation has procured testing kits from the US, UK and Korea. "Just because these tests are free for the people, they tell us we cannot refuse them. We have 1,200 kits right now and each test is costing the government somewhere between Rs8,000 to Rs9,000," says the DUHS doctor. "People need to act more responsibly as these kits are also in limited supply and must be saved for those whom health practitioners think need to be essentially tested."

Other screening centres in Karachi are established at The Indus Hospital, the Jinnah Postgraduate Medical Centre (JPMC), Dr Ruth K M Pfau Civil Hospital, and the Aga Khan University Hospital.

Not enough microbiologists to screen the population of Sindh

Sindh government's spokesperson, Murtaza Wahab, says availability of kits was not an issue nor was there a dearth of resources. "And even if we get more, we need to understand that we have limited testing capacity. There are just not enough microbiologists to screen an entire population of Sindh," he says. That is why, he says, people should show restraint and help stem it by staying home.

Wahab also said that if people cooperate in this time of adversity, and not panic and head straight for health facilities, many issues can be overcome. Giving an example of a family's cooperation, he said: "A family of six tested positive and they volunteered to go into isolation in their own home. There is police outside their home to ensure no one leaves or goes inside."

Isolation wards are set up to separate those infected from the general public and it is no picnic. "It's quite boring being in there and it's not that they are getting any special medicine that can only be given in the health facility," he says, adding that the same regimen can be applied at home and in more comfort.

Isolation or quarantine

This is supported by Dr Luxmi who says that with an already compromised healthcare system, people should seriously think of both home quarantine and home isolation and explains the difference.

Quarantine is done when coronavirus is suspected. The person may not have the disease but there is suspicion that he may be a carrier because he has recently travelled, has been in touch with a traveler, or has been in close contact with a coronavirus positive person. A person is in isolation when his tests results are confirmed positive

A woman speaks on her cellphone next to a banner of a coronavirus registration and screening counter at the Pakistan Institute of Medical Sciences Hospital in Islamabad on March 19, 2020. — AFP
A woman speaks on her cellphone next to a banner of a coronavirus registration and screening counter at the Pakistan Institute of Medical Sciences Hospital in Islamabad on March 19, 2020. — AFP

"If doctors send someone for home quarantine and isolation, the doctor must also ensure that the patient is well enough to take care of him/herself, or there is someone at home to take care of them," she says.

In addition, it can only work if there is a separate room and washroom for that person or all those (in that home who have tested positive).

"For those in isolation (which means they are definitely tested positive), the 14-day stay-at-home period does not mean they are out of danger for others but need to continue taking precautions. Each person gets tested every fifth day and only after their two samples (one each in 24 hours) come out negative can they step out of isolation. But sometimes it can take anywhere between three to four weeks till the results come negative. And if that happens the patient should continue to observe isolation.

"I understand that two weeks in isolation is not easy and it may cause a lot of anxiety to many people," says Dr Luxmi. "But there is no way out"

"Take care of your nerves, stay happy, take up reading, do some yoga or exercise, stay in touch with friends over your mobile, watch movies on TV, maybe even get some work done and attend meetings virtually or via video conferencing," she says.

"And quit smoking," she adds.

Dr Luxmi also emphasises that one should "use hand sanitisers or alcohol wipes and swabs to keep gadgets clean and wash one's own plates and cups and glasses with warm water and detergent. But if you cannot, whoever does it, should wear gloves".

Dr Luxmi's day does not end with seeing and screening patients. "The test results start coming in by 7:00 - 8:00 pm and I have to send the list of all the positive patients with their details to the Sindh government which then takes over from there."

She takes in queries from the government sometimes till 2:00 am and gets a few winks before getting back to work at 7:00 am. "If I slack, so will those working under me," she says.

Those who test negative are not informed. They can either call or come and get the reports from us anywhere between 24 to 48 hours and get counseling.

All tests are free of cost but the AKUH charges a registration fee as well as an admission fee if a patient gets admitted for treatment there. DUHS and the Civil Hospital treat the patients for free.

Dr Luxmi, for now, is satisfied with the two isolation wards set up at the DUHS. "Each room can accommodate up to nine patients. There is a clean washroom and minimal furniture and healthcare providers wear specialised gear to protect themselves from getting infected."

But under the circumstances and with all the inadequacies, she says the Sindh government was doing "a good job".

The same was endorsed by Dr Jamil. "I think Chief Minister Sindh's energy is infectious and uplifting in these depressing times," he says, adding that in times such as these, "mutual cooperation, collaboration and coordination paves the way and dire emergencies are controlled with team work".

With more pilgrims returning and over 2,700 quarantined in Taftan (with over 700 to be moved to Sukkur), over 700 at Dera Ghazi Khan, 300 plus in Sukkur and Gilgit Baltistan each, and over 130 tested positive, the game is far from over. And that is where media comes in, says Dr Jamil. "Media should review and monitor the situation and without creating panic must highlight the gaps and deficiencies in the implementation process," he says.


Author Image

Zofeen T. Ebrahim is an independent journalist based in Karachi.

She tweets at @zofeen28.

The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.

Comments (62) Closed

Ravi Bang
Mar 19, 2020 08:14pm
Lastly reigion doesnt matter ...see who is saving life...
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Mar 19, 2020 08:26pm
Pakistani healthcare system is the best!!
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Mar 19, 2020 09:05pm
Great dedication!
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Mar 19, 2020 09:33pm
Why can not PM appeal to overseas practicing Medical men and women to comeback to Pakistan for a month to help the system? If appeal can be made for fund for dam, this is more appropriate, patriotic and humanitarian. When Pakistani doctors can opt to go to Wuhan to help brotherly china, why not they help their own country at this moment of need?
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hamza khan
Mar 19, 2020 09:36pm
@gghh, better than india's.
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Mar 19, 2020 09:48pm
Folks in Pakistan please understand US acted much earlier but here as of today March 19th it is still increasing. Take the example of Italy today. This disease will spread before it goes down. Just follow the precaution. There is no medicine to cure it right now. Blaming the govt. will take us no where. In the most advance country like US testing us not being done on everyone but only on the most sick. The best thing is to quarantine.
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Mar 19, 2020 10:11pm
World should waive all loans of Pakistan!
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Mar 19, 2020 10:32pm
@ABCD, Ask your Chinese brother's to help in this hour of need.
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Mar 19, 2020 10:37pm
@ABCD, "When Pakistani doctors can opt to go to Wuhan to help brotherly china, why not they help their own country at this moment of need?" Because for Pakistan's leaders, China is more important than Pakistan!
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Mar 19, 2020 10:39pm
Still Pakistan is Managing better then Italy ,Spain, US etc. Affected people and number of deaths is quite Minimum. Imran has controlled this very well. Just cannot imagine how the previous Governments could have handled this.
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Mar 19, 2020 10:39pm
Kudos to Dr Shobha Luxmi - his brutal honesty is a welcome change. Our health system is so bad that it can't even evaluate whether you have the virus let alone help save your life. Protect yourself and your family - isolate yourself!
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Mar 19, 2020 11:10pm
Imran Khan was too busy helping out Iron Brother when his own country is falling apart at the seams.
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Mar 19, 2020 11:25pm
Hope for the best.
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Mar 19, 2020 11:32pm
It is not a scare. It is very real.
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Mar 19, 2020 11:37pm
Pakistan need to get help from world health org. IK should not waste any time as more cases are coming up.
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Yousuf Aslam
Mar 20, 2020 12:03am
You get what you pay for. As Pakistani’s don’t pay tax, what did they expect? The rich get richer, the poor get poorer! Pay your taxes and stop asking people from abroad to support you every other day.
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Mar 20, 2020 12:12am
Interesting to see the comments from doctors. I wonder if they are waiting for some magical power to come and save the hospitals and health systems. It is us in our respective fields who have to make things happens.
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John Hanoi
Mar 20, 2020 12:17am
A nuclear power with no microbiologists to work the test kits?
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Mar 20, 2020 12:36am
Thank you Mr. Sharif and Mr. Zardari for building this superb factlity during the ten plus years your parties were in wonder Mr. Sharif is sitting in London for his health.
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Mar 20, 2020 12:40am
Just close the Iran border.
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Mar 20, 2020 12:43am
no country in the world is ready to handle this scale of epidemic, that is why other countries have implemented shutdowns to avoid it from spreading
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Mar 20, 2020 12:51am
people need awareness as still peoples' reactions seen non seriously on corona virus. we all need to work on it as this is our responsibility too.
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Siraj Ahmed
Mar 20, 2020 12:52am
Pakistan healthcare is the best in the world
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Mar 20, 2020 01:11am
@ABCD, IK is only Interested in loan write off. Does nor care about Pakistani people. .
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Riaz Haq
Mar 20, 2020 01:13am
Pakistan's health care system is typical of that of any developing country. Even a well-developed public health system in Italy, a rich European country, is overwhelmed by rapidly growing Covid19 pandemic. The best way to handle the situation is to cut the infection rate by keeping people about 6 feet apart. This is being called "social distancing".Based on what the United States has learned from what is happening in Italy, major cities and states in America are taking steps to reduce large gatherings of people. Offices, schools, restaurants and shopping centers are closed with shelter-in-place orders in Silicon Valley and the larger 6-county San Francisco Bay Area.
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Peace lover
Mar 20, 2020 01:36am
Country with more than 100 Nuclear bombs , it’s unbelievable That Pakistan doesn’t have enough facilities to tackle medical emergencies. Hope at least from now onwards leaders may focus on development of basic facilities and infrastructure instead arms race.
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Mar 20, 2020 01:38am
@paarth, Pakistan's health care system is the legacy of failure that is the past governments of PML(N) and PPP and to ask Imran khan to produce miracles to turn health care that nawaz sharif himself refuses treatment and runs away from is mere folly.
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Waheed Rehman, USA
Mar 20, 2020 01:47am
Now, unfortunately India will close the border with Pakistan to prevent a COVID-19 spillover into the rest of the Sub-Continent that originated in Iran. Currently, India is thoroughly screening all Indians returning by air or sea from the ME, especially pilgrims from Iran.
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Mar 20, 2020 02:29am
The article is right. The elite which includes hyped up IK enjoys luxury while 95% of population does not have access to proper health care. China wont come to help here. We need something tangible to come from government, but are they listening? to compound, at this time we have wheat and sugar crisis and government is busy snoozing
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Mar 20, 2020 02:39am
Best wishes to all and Keep up the good work
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Mar 20, 2020 03:08am
It seems that the majority of the cases are imported .. mostly from Iran.
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P L Bakhshi
Mar 20, 2020 04:26am
All praise for Dr. Shobha Luxmi and her likes world over for their highly commendable empathizing service to the scared victims of Covid-19 that has put the entire globe in a spin. Inspite of her busy tight schedule as evinced from the above news story she has meticulously responded to media queries with self confidence and assurance that too in demanding situation. There are lot many Pakistani physicians all over the world, it would be in the interest of Pakistani nationals if PM Imran Khan would make an appeal to them to provide their assistance to not too robust medical fraternity of their country of origin in the current scenario, a real testing time. That will bring immense solace to the victims of the newly cropped up enemy having made horrendous assault in the length and breadth of the globe and seemingly in no immediate sight of being tamed.
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Mar 20, 2020 05:03am
The government should make an early appeal to the retired health workers, and they need to order about 1000 ventilators now. Any delay in ordering ventilators is going to be fatal and too late as the Europeans are picking up all the available ventilators from China.
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Mar 20, 2020 06:04am
The Tsunami is coming and IK is marveling the scene, instead of running.
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Nick, NY
Mar 20, 2020 06:14am
Given the state of distancing is the key to preventing spread of virus! Hope cool heads prevail!
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Mar 20, 2020 06:16am
@ABCD, Do you understand what you are asking? If overseas medical professionals come back to pakistan in the midst of a pandemic they will surely lose their jobs. Even if some do, what then? The infrastructure isn't there to absorb and retain more medical personnel. So these people will have nothing after the pandemic is over.
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Mar 20, 2020 06:26am
Follow Modi. do curfew for few daya
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Mar 20, 2020 07:02am
Pakistan healthcare is poor it's 1 of 2 countries that still hasn't solved polio issue. If covid 19 spreads I can see huge scale of deaths. Imran Khan should have paid attention to this and closed border to Iran. Also the treatment of those people in the camps is a farce. Total embarrassment
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Mar 20, 2020 07:22am
Figures are increasing like 20-20 cricket. Seems like the agenda is to get the write off from the debt. Nothing else.
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Asif Ali
Mar 20, 2020 08:52am
We should help our kashmiri brothers.
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Syed Hussain Akbari
Mar 20, 2020 09:55am
But no government to date has laid any importance to the health system of the country nor any in future will. It will continue like this and we have to live like this. And blame game of the politician will continue.
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Amitava Ghosh
Mar 20, 2020 10:12am
Great to learn about medical practitioners who rise well above any religious affiliations !!!!
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Mar 20, 2020 10:58am
Lockdown in IO Kashmir should end!
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Mar 20, 2020 11:05am
What's new? Pakistan has had a poor health system way back when it came into existance. When the minority population was running the show in Kareach - it was the best. Once the Parsi, Goan and Anglo communities started to leave and left in drones to other countries like Canada, USA, Australia& Britin everything in Karachi fell apart. Maybe there a big malls built now in Karachi but the quality of normal people is low. The Rich bungalow people are enjoying life in their barricaded bungalows. These rich have their one leg abroad and one leg in Pakistan. If the mullahs light a fire up these rich people behind see how fast they will flee abroad cause they have dual citizenship.
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Mar 20, 2020 11:08am
@hamza khan, Both India and Pakistan have poor health system. They both need to start first with better/proper sanitation.
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Mar 20, 2020 11:09am
@Raza, Stop looks ng at Italy and Spain. Look at your own country.
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Mar 20, 2020 11:14am
@John Hanoi, What's so great being a nucler power when u cannot even have propr sanitation. Both India and Pakistan should be ashamed of themselves cause they cannot meet the basic needs of its people i.e water, electricity & sanitation.
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Ravi Bang
Mar 20, 2020 11:45am
Comparing other countrys for specific ....doesnt put water on fire in own backyard ...better to make yur own identity ..
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Mar 20, 2020 11:46am
@Asif Ali, for hep yourself
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Mar 20, 2020 11:49am
@hamza khan, yes best in the world
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Mar 20, 2020 12:09pm
@hamza khan, please show facts and statistics to support your statement because WHO and basically every organization would like to disagree with you.
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Mar 20, 2020 12:42pm
Imran Khan is a genius
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Mar 20, 2020 01:35pm
@Raza, wait for 2-4 weeks and we will talk how IK controlled it. U won’t even know what hit you?
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Mar 20, 2020 01:36pm
Did even one Chinese doctor came to Pakistan to help?
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Mar 20, 2020 03:12pm
@Asif Ali, yes forget Pakistan as of today Kashmir should be the priority. Coronavirus will come and go but Kashmir is really important
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Mar 20, 2020 03:13pm
@Md, so is your debt.
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Mar 20, 2020 03:58pm
@hamza khan, best in the world !
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Mar 20, 2020 03:59pm
@hamza khan, better than US, UK or anywhere.
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Mar 20, 2020 05:29pm
@hamza khan, that's why Pakistani comes to India for treatment.
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@Who cares
Mar 20, 2020 09:15pm
@Asif Ali, Help yourself first
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@Who cares
Mar 20, 2020 09:16pm
@Jhakki, Save Pakistan first
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Feroz T. Jhantawala
Mar 20, 2020 11:26pm
@candy, Shobha Luxmi is a lady doctor; not male.
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