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Unlike most Pakistanis, who lack access to adequate healthcare, President Zardari is fortunate to have access to the finest healthcare services available in Pakistan. If the physicians and the medical facilities in Pakistan do not measure up to the Presidential needs, he can be flown to the state-of- the-art facilities in the Middle East or beyond.

While the rich-and-famous in Pakistan enjoy almost the same quality of healthcare as one would receive in a developed economy, the overwhelming majority of Pakistanis are severely underserved in health and wellness services. The healthcare spending in Pakistan accounts for fewer than 3 per cent of the GDP.

Further compounding the problem is the migration of trained physicians from Pakistan to developed economies. While Pakistan graduates several hundred physicians each year from medical colleges and universities, a large number of these graduates leave Pakistan for specialization abroad. Many never return to serve in Pakistan. The physicians’ brain drain has resulted in only 0.74 doctors per 1,000 persons in Pakistan. Israel, on the other hand, boasts 3.8 doctors per 1,000 people. Even with a population base of over a billion, China reports 1.5 doctors per 1,000 people. By 2020, the doctors shortfall in Pakistan is estimated between 58,000 and 451,000.1 At the same time, World Health Organization estimates a global shortfall of 4 million doctors.

The total number of physicians in Pakistan is estimated at about 120,000. However, a large number of Pakistani doctors have emigrated from Pakistan. Saad Shafqat and Anita Zaidi in 2007 estimated that there were at least 10,000 Pakistan-trained physicians serving in the United States alone.2 Other estimates put the total number of Pakistani physicians serving in the US and Commonwealth countries at around 14,000.

Some elite medical schools in Pakistan are known for their graduates to leave Pakistan in large numbers. For instance, by 2004, 900 out of the 1,100 medical graduates from the Aga Khan University left Pakistan for specialization. Reports suggest that only 40 doctors returned after completing specialization abroad.

Australia, New Zealand, the United States, and UK are known for aggressively recruiting medical professionals from abroad to meet the demand for physicians. One in four of the 780,000 doctors in the United States holds foreign qualifications. Furthermore, 64 per cent of the foreign trained doctors in the United States emigrated from low-income countries to the US.3 Similarly in UK, 92,000 of the 245,000 physicians were foreign trained.4

The supply lines providing foreign trained medical professionals to the US and UK have their origins in the Philippines, India, and Pakistan. The US alone absorbs 15,000 nurses annually, half of which come from the Philippines.5 Similarly, half of the 12,000 nurses absorbed in the UK were either from India or the Philippines.

The poaching of highly trained medical professionals by the rich countries plays havoc with the healthcare systems of low-income countries. At one point, the Philippines had shipped off so many nurses abroad that it could not keep wards operating in certain facilities. For some specializations, the resulting shortage is acute in home countries. Rachel Jenkins and others report that compared to the 315 psychiatrists serving in Pakistan there are 1,473 Pakistani-trained psychiatrists who serve abroad.

The sustained demand for foreign-trained doctors in the US, UK, Australia and New Zealand is known to most medical students in Pakistan who start preparing for foreign licensing exams while they complete their medical diplomas in Pakistan. Surveys of final-year medical students at King Edward Medical University in Lahore, Aga Khan University and Baqai University in Karachi, reveal that most students would prefer to travel abroad for specialization. More specifically, 95 per cent of the graduating class in Aga Khan University, 65 per cent in Baqai University, and 60 per cent in King Edward revealed their plans to travel abroad for specialisation.

Many medical professionals/students who travel abroad for specialization believe that they would one day return to Pakistan. Most in fact never do. Saad Shafqat and Anita Zaidi reported that of the 10,000 Pakistan-trained physicians in the United States only 300 doctors are known to have returned to Pakistan. Again, only 40 of the 900 Aga Khan University alums, who had gone abroad for specialization, made their way back to their motherland.6,1 Only 14 per cent of the respondents at King Edward Medical University indicated that they would like to return soon after completing their specialization. The rest had plans to stay for longer periods abroad or for never to return.

Young physicians however have sound reasons for their lack of enthusiasm in serving within Pakistan. Saad Shafqat and Anita Zaidi report that young medical interns are paid approximately $150 per month, which is no longer a decent pay in the inflation-stricken Pakistan. Young doctors cited poor pay, poor quality of training during internship, and poor work environment as the primary reasons for their lack of enthusiasm for serving in Pakistan.

Violent protests by young doctors on the streets in Lahore in March and April of 2011 are signs of young doctors’ frustration with their work environments. Should the federal and provincial governments continue to ignore the plight of young doctors, the brain drain will continue unabated.

TELE-HEALTH: REVERSING BRAIN DRAIN THROUGH TECHNOLOGY

Given the worsening of law-and-order situation in Pakistan and the structural collapse of the economy where power and fuel shortages have imposed a state of paralysis on the society, it is unlikely that a large number of Pakistani physicians will return to Pakistan in the near future. The challenge therefore is to find ways to obtain service from Pakistani physicians in diaspora without having them to relocate. Fortunately, the advances in communication and information technology (CIT) make it possible for the willing physicians to extend their practice to Pakistan from their homes and offices in US, UK, and elsewhere.

Tele-health allows physicians in North America and elsewhere to deliver health-related services using the CIT. For instance, physicians are able to observe and treat patients in remote locations by using computerised sensors that deliver patients vitals to the physician using the CIT. Thus blood pressure, temperature, and other observations from a remotely located patient are made available in real time to the doctor located in a clinic or a hospital.

A much simpler version of a tele-health model can be established for Pakistani physicians who are settled in the West to treat low-income patients in rural areas and small towns in Pakistan. Take the example of the 10,000 practising Pakistani physicians in the US who can pool their resources to establish a not-for-profit (charitable) organization in the United States. The organization will generate resources in the US to fund the establishing of basic health units (BHU) in underserved areas in Pakistan. BHUs can be staffed by a nurse or a pharmacist whose primary responsibility will be to maintain a computerised link with the physicians in the US using free service, such as Skype.

Patients in underserved areas in Pakistan can visit BHUs to obtain medical advice from highly trained Pakistani physicians in the diaspora, who will donate their time to the cause.

The morbidity burden in Pakistan is exacerbated by complications resulting from untreated conditions related to diabetes, blood pressure, and cholesterol. Patients in underserved parts of Pakistan will be able to get sound advice from foreign-based doctors over Skype or other modes of communication. The early interventions from such interactions will help prevent treatable ailments from turning into chronic diseases that impose significant burden on the poorly-funded healthcare system in Pakistan.

Technology now exists that allows surgeons to remotely operate on their patients. I am proposing a very simple application of tele-health to improve access to basic healthcare in the underserved parts of Pakistan. I know that our doctors in diaspora are keen to serve their motherland and are desperately searching for opportunities to donate time and money. By creating not-for-profits to raise funds to establish BHUs, expatriates (doctors and others) can join hands to turn the brain drain into brain gain.

1. Nazish Imran and others. 2011. Brain drain: Post graduation migration intentions and the influencing factors among medical graduates from Lahore, Pakistan. BMC Research Notes. 2. Saad Shafqat and Anita Zaidi. 2007. Pakistani physicians and the repatriation equation. The New England Journal of Medicine. 442-443. 3. Nadir Ali Syed and others. 2007. Reason for migration among medical students from Karachi. Journal of Medical Education. 61-68. 4. Rachel Jenkins and others. Feb 2010. International migration of doctors, and its impact on availability of psychiatrists in low and middle income countries. PLoS ONE, Volume 5, Issue 2. Pp. 1-9. 5. ibid. 6. Nadir Ali Syed and others. 2007. Reason for migration among medical students from Karachi. Journal of Medical Education. 61-68.

 

Murtaza Haider, Ph.D. is the Associate Dean of research and graduate programs at the Ted Rogers School of Management at Ryerson University in Toronto.  He can be reached by email at murtaza.haider@ryerson.ca

The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.


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Murtaza Haider is a Toronto-based academic and the director of Regionomics.com.

He tweets @regionomics


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


Comments (30) Closed



Nasir Dec 14, 2011 05:41pm
A wonderful article and even wonderful Idea! If implemented successfully, this can save thousands of lives. As a next step, our successful engineers/entrepreneurs can offer consulting services to younger generation in Pak? a
Shakeel Ahmed Dec 14, 2011 06:09pm
No doubt Pakistan produces some of the most able and gifted students. It's a shame there is a limit to what they can achieve at home and hence a need to excel their minds makes them move to greener pastures. The hospital conditions in Pakistan in which they work appear pathetic in terms of infrastructure and equipment and we must salute the doctors for their unflinching dedication in spite of the odds. Clearly there is more respect and reward abroad. The current excitement of the Higgs-boson discovery at CERN takes us back almost sixty years when a bright young man from Pakistan was making a mark in this uncharted and unknown territory with his mathematical prowess. Another sad reflection of brain drain
Ahmad Zubairi MD Dec 14, 2011 07:21pm
Great article. I am a Pakistani American although I did not go to medical school in Pakistan. I think it is a great idea which many among us have talked about. I recently did a brief telepsychiatry work from my home in MIchigan seeing patients in rural missouri. It was easy to do. I know many of us will be willing to put in few hours a week free in different specialities. The task is to find a soild platform. In Michigan the Universities are taking lead to provide treatment in rural areas. This can be something that medical schools in Pakistan can take. Another Platform we can raise this issue is at APPNA.
RP Dec 14, 2011 08:36pm
This is one area where Pakistan and India can collaborate meaningfully.
Asif Dec 14, 2011 09:05pm
It is almost funny that the blogger is decrying brain drain and he is blogging from Canada!!
Chaudhry Dec 14, 2011 09:16pm
Well , I am working in the west as a physician because I could not get a job in Pakistan , I was an honorary registrar (without pay) but there were incompetent Medical officers reporting to me , they were appointed by high level safarish. I tried repeatedly but couldnt get a decent job......now I am in North America , I have a staff position , Director of teaching and I am Examiner for Board Examinations. Its a shame my country dod not make use of me........on my final flight out of Pakistan , the mighty MS for my hopital in Pakistan was there and I went to him and told him that I am leaving Pakitsan for good , and he "showed" his surprise. I amy go back now.....but only for the love of my country........as for the govt policy to mitigate the sittuation......there proiorities are somewhere else...which is a shame
KHAWAJAHREHMAN. Dec 14, 2011 09:33pm
I am a bordcertified psychiatrist.In addtion to direct one to one patient care I am very well experinced in telemedication.I love the idea presented by the writer.It isvery practical and not expermential AND I AM READY TOGIVEANY AMOUNT OF TIME.
Amer Dec 14, 2011 09:33pm
As a physician of Pakistani origin living in the USA I have considered the option of seeing patients via teleconference, and so have many other physicians. However, it is easier said than done, with practical issues limiting its usefulness. Until we can have reliable power supply and internet services in Pakistan that work when we want them to, not on their own schedule, and we have reliable means of exchanging money internationally for billing patients, and most improtantly, until we can develop partenrships between physicians overseas and physicians locally in Pakistan, the idea will still remain an idea.
Fahad Dec 14, 2011 11:30pm
No doubt Pak has great talent but what is the use if it cannot be put in productive environment? The doctors,physicians and Surgeons can treat the patients in the rural areas of Pak ,and I think skype is the best tool for that. The doctors ,physcians and Surgeons in West can communicate with patients in rural areas using skype .
saad Dec 15, 2011 03:02am
Tele Health is already a part of health services in remote India and is proving its success. Of course, there is political and social awareness, which lacks in Pakistan.
aziz Dec 15, 2011 09:54am
Its the voice of Young doctors of Pakistan.. Indeed we are paid only USD150-200 in the Pakistan while the person who is selling fruits can earn more then this.. I found most of my fellows ( who are unable to Migrate abroad ) are mostly in Depression.exceptions are always there.... Now compare health care situation in Pakistan as to India .. India is producing Minimum 150,000 doctors every year. Pakistan is hardly producing 15,000.and India is paying USD 1000 to there young Graduate since last 2-3 years..So the serge of doctors abroad will increase and tendency of our Doctors to migrate will increase. as most of the market demand of docs are filled by Indians 1 out of 6 doctors in USA is Indian.
Afzal Dec 15, 2011 10:32am
Health services in Pakistan are the most under-paid sector.A doctor works 36 Hours a day and earns Rs.15000 per month which is far less than a maid salary.Unless government doesn't increase its health funding and stop filling their own pockets unfortunately nothing is going to change.
Bhola Khan Dec 15, 2011 12:22pm
I am a Pakistani doctor working overseas. I worked for 10 years in Pakistan and then decided to migrate. The foremost reason was doctors didn't enjoy respect as professionals in Pakistan. Best student make doctors in Pakistan and lead worst lives. A country without a decent healthcare system doesn't deserve doctors. I struggled to get into postgraduate training but couldn't.Now I hold highest qualifications in my field of specialty which wouldn't have been possible in Pakistan. How can doctors stay in a country where a corrupt SHO can snub a doctor.They are humiliated day and night by politicians,bureacrats and patients & their relatives alike. It's not doctors duty to provide healthacre services,It's bloody government & politicains duty to provide healthcare services which includes decent pay & allowances for doctors in order to retain them and prevent brain drain. The way Shabaz Sharif is dealing with healthcare professionals,one day, will lead to extinction of this entity called "doctor" in Paunjab at least. What about doctors graduating from private medical schools? When they have spend hefty amounts of money in fees,how will they get it back by living in Pakistan? Pakistan is simply not LIVEABLE for professionals. It's a country good for bureacracy and politicains.
Bhola Khan Dec 15, 2011 12:35pm
Telemedicine in Pakistan is not feasible. I was into it back home.They will not let it happen.System corrupt to it's core!!!
imtiaz Dec 15, 2011 03:40pm
I am wonder why our overseas respected doctors forget that Pakistan is still a underdevelop country of third world which granted them the basic medical degree with minimal cost. Pakistan and peoples of Pakistan should not be punished for the deeds of corrupt politician. I am in Pakistan now after 10 years working in UK and facing some hardship to settle but have established basic healthcare facility in my village for the peoples in need from my own resources. I believe if my other overseas colleagues are sincere with their country and have will they still can do a lot instead blaming and cursing. ZARA NUM HO TOO YEAH MUTTI BOHUT ZARKHAEEZ HAY...
Mohammad Ali Khan Dec 15, 2011 06:04pm
Overseas Pakistanis have difficulty in finding a good motivated team in Pakistan to operate projects to advance education and other philanthropic activities. The projects,besides being legal,should be accountable,verifiable,sustainable.A feed back system is needed regarding progress of the project.Pakistani team should organize a pool of members in Pakistan as a renewable source of leadership.They should keep the system open and inclusive.Maintain transparency. A movement "Apni madad aap" is desperatly needed.
AHA Dec 15, 2011 06:35pm
How ironic!!!
SamIam Dec 15, 2011 06:37pm
Exactly my point:)
Agha Ata Dec 15, 2011 06:41pm
Murtaza, you said: "....advances in communication and information technology (CIT) make it possible for the willing physicians to extend their practice to Pakistan from their homes and offices in US, UK, and elsewhere . . .” But what about the preparation in Pakistan? How would the facilities of ultra sound and x-rays, and hundreds of kinds of blood tests would be performed in rural areas, besides, where would they get pure medicines from? (Please don’t tell me that medicines are available. I have first hand experience of this thing. My wife literally died of this mal practice.
Saleem Dec 15, 2011 06:56pm
Theoretically a good idea. Practically unworkable for several reasons specially in corruption infested countries like pakistan.
MD Dec 15, 2011 07:02pm
a. Kindly note the difference in the fee structure b/w countries like Pakistan and the West. While we are pooling all our resources to 'train' these students, the moment they graduate they are off to greener pastures. b. Telemedicine has been started in Pakistan in which rural patients have access to facillities in a tertiarry care center. Kindly plz highlight that as well
Sardar Uddin Dec 15, 2011 09:57pm
Go Excuse!!! but Excuse non the less. There is a will there is a way. If all of us sitting in west starting saying this is bad and that is not good then who is going to fix it . Someone has to start somewhere...
Sardar Uddin Dec 15, 2011 10:01pm
The Easy Way Out!!! I agree to your statements but what is the solution. Run and run as far as you can ... Is this really the solution. Life is not just about making money it has many more dimensions to it.
Mohdudul Huq Dec 15, 2011 11:20pm
All Muslim countries.
Asad Dec 16, 2011 06:02am
Telemedicine, a great idea! but like just before the French revolution the queen seeing the hungry crowd outside the palace said "if they don't have bread,feed them cake."
D786 Dec 18, 2011 10:59pm
Nice Article!
Atta Hussain Dec 18, 2011 11:10pm
Telemedicine , a modern phenomenon for world but for Pakistan especially at small villages,cities, towns, where basic infrastructure is not so effective to be linked with doctors at other end . This also require a dedicated team of volunteers to initiate and run smoothley. Anyway a nice article for sharing some hopeful idea.
shalu Dec 21, 2011 07:20pm
What about the author? Surely not a doctor but aren't you blogging from overseas? Do you intend returning to your country for work or living? Easy to observe most bloggers in 'Dawn' are not based in Paksitan either. Do not throw stones at others sitting in a glass house, from the safety of your own universe.
M Baig Dec 25, 2011 05:32pm
You have good advice, give it to politician and pakistani people who elect them for money. You deserved it all ! Corrupt people elect corrupt leaders from among them.
Salman Khan Jun 23, 2012 09:29am
No Care for Doctors in Pakistan,why shud we live here...