PAKISTAN has given me citizenship and an autoimmune disease. This is my assessment, not my doctor’s obviously. I am aware of my privilege and how it gives me access to doctors — in Pakistan and abroad. However, I am cautious because so much remains unknown about the cause of autoimmune diseases and, as I grow older, I worry about being overmedicated, personally and as a society.

I do not believe mine is the first time you’re hearing of someone with an autoimmune disorder — there are at least 80 reported disorders that impact wide body parts, with some common ones being celiac, lupus, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes. An autoimmune disorder, according to Harvard, occurs when the body’s natural immune system cannot distinguish between its own cells and foreign cells, causing the body to mistakenly attack normal cells.

The rise in autoimmune diseases speaks to the advancements in medical research that allows us to diagnose and treat them but we still don’t really know why this is happening. This is why I am wary about my diagnosis. I am reflecting on what it means to be unwell, as well as the role of the healthcare industry in our well-being.

According to a May 2023 report in Lancet, one in 10 people are impacted by autoimmune disorders, the majority of them women. We don’t invest in research in Pakistan to understand how or why our immune systems are being attacked.

Policymakers need to find ways to reduce health inequities.

Research by Johns Hopkins shows that while we don’t understand what causes autoimmune diseases, we’ve learned about their pathogenesis, ie, their natural history, how they progress and what kind of damage occurs. Genetics alone do not play a role in the pathogenesis of autoimmune diseases; the immune system and the environment contribute as well. “Pollutants, medications, dietary components, viral infections, and stress” have been linked to autoimmunity. The research notes that autoimmune disorders are chronic conditions that may take years to become “clinically evident” and can last for decades, even a lifetime, once diagnosed.

The common thread among a lot of the research I have read so far — by no means exhaustive — is that autoimmune is hard to study and diagnose. Yet, it is not hard for doctors to write out a prescription and send you on your way.

Is prescribed medication the only way to seek treatment for any illness? Could eld­e­­rs from the Global South, who used plant me­­dicine to treat ailments, have some ans­wers to what ails modern society? But, more importantly, why isn’t access to healthcare universal? Shouldn’t this disparity be the most pressing issue of our time?

I don’t want to use this space to indulge in or promote conspiracy theories — of which there are plenty, especially around the role of gluten, dairy or microplastics in contributing to a rise in diseases. For every study that shows a promising new treatment — like using regenerative cell therapy to put lupus in remission — there is a YouTuber promising a cure. These practitioners — like the doctors posing as journalists — must be avoided. As should most physicians motivated by currency not care. Not everyone has those options.

The pandemic, which caused at least 15 million deaths worldwide, exposed how ill-equipped public health was everywhere, a result of a decline in the focus on quality of healthcare on offer. WHO head Dr Tedros Ghebreyesus said the pandemic should teach governments that health was not a cost “but an investment that is the foundation of productive, resilient and stable economies”.

Policymakers in healthcare need to find ways to address and reduce heal­­th inequities. I can, for example, afford to cut gluten out of my diet to reduce joint pain but imagine saying this to the vast majority of Pakistanis who don’t have access to a doctor.

Pakistan spends less than three per cent of its GDP on health. Can we hope the new government will understand that good health increases future earnings capacity? Can they take a radical approach and invest in new technologies improving healthcare? Two public hospitals in Australia last year became the first to implement an AI system that “predicted 73pc of medical emergency team calls more than one day in advance”, according to a story in The Telegraph.

I can afford to weigh my treatment opti­o­­ns — a mix of modern and traditional medicine, as I practised when living in Vietnam, whose healthcare system, based on socialist values, can teach us many things. Viet­n­­am was hailed for containing the spread of Covid, despite its proximity to China. Poli­cy­makers credit this to their investment in their public health system, good governance and citizen cooperation. I believe most Pakistanis will want to get behind a socialist-based system that does not differentiate between citizens and break barriers that prevent the country from getting well.

The writer is a journalism instructor.

X: @LedeingLady

Published in Dawn, December 31st, 2023