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Protest against entire system

July 16, 2012

THE recent strike by young doctors in Punjab has thrown up some uneasy questions for all sides. Do doctors have the moral right to take such extreme steps? Is it a question of ethics or professional rights?

Does a government — in this case, the government of Punjab — have the moral responsibility to call out the police and make arrests after having repeatedly gone back on its words?

The only thing on which there is no confusion was the public outrage because regardless of whether the government or the striking doctors were at fault, it is the masses who suffered for no fault of their own. They suffered and they suffered seriously.

Doctors should never go on strike. They cannot refuse patients at any time and for any reason. The medical profession has its own dynamics. It deals directly with human lives, and when people do their job properly and professionally, they get direct appreciation from their patients. The community of medical practitioners cannot behave like any other professional body.

The problems highlighted by the young doctors are simply indicative of how unchanged things have remained over the years. It is the same set of issues that we used to grumble against in our youth though without resorting to strikes.

The demands are genuine and the exploitation of their services is condemnable. All these years, no government in — federal, provincial, civil, military, permanent, ad hoc or whatever — has given serious consideration to the problems of doctors or patients.

The patients have stuck it out for lack of opportunities, but doctors in their thousands have left the country for better working conditions. And who has replaced them? The ever-growing menace of quackery in Pakistan may have an answer to that question.In India, the federal government from the very beginning decided to provide a career structure for doctors, and initiated a system of medical education and training based on merit and audit.

The Indian Medical Council was set up and was made responsible for the regularisation and standardisation of medical education and training with merit as the guiding policy. Over time, this resulted in the establishment of a system which now produces brilliant doctors who are providing the highest quality of healthcare in the country.

No wonder India is now one of the most popular spots for medical tourism and people from all over the world go there for medical and surgical procedures. This would not have been possible had the system not recognised the significance of the career structure and ensured a process of growth for its young doctors.

The Indian government also organised its alternative health system by putting in place an authority to monitor various health practices. This went a long way towards eliminating quackery from society. And all this happened because there was a vision dictating the political commitment of the government.

Because of such an attitude, the vested-interest group of doctors and business people there were compelled to follow rules and regulations. They do have problems there, but also mechanisms to deal with them.

Malaysia has not done too badly on this count either. Therefore, we do have relevant examples before us to set things right in our own midst.

The authorities must understand that the medical profession is not a part-time entity. A system of medical education run by part-time faculty members and consultants will only produce half-baked, glorified MBBS quacks with no ethical considerations.

That is what is happening in Pakistan. The recent episode in Punjab is not just about career structure, but a protest against the entire system. It is time the government looked into the matter and introduced revolutionary changes in the existing medical education and professional conduct. Unfortunately, as things stand, this may prove next to impossible.

This government, like its predecessors, has little knowledge of the sensitivities of the medical profession and medical education. It has already abolished the federal health ministry and there is nobody or no authority to ensure uniformity of policy at any tier and in any direction. Nobody knows what the country needs and what resources it has to fulfil those needs.

The only way out of this mess is for the government to put in place a high-powered commission to review the entire system of healthcare and medical education for the two are intertwined.

From the basic health centres in the rural areas to major teaching hospitals in the cities, the whole structure needs a critical, professional and sincere review without the interference of vested interests.

It is time to get rid of the part-time mentality because it has already played havoc with the system. There is only one medical university in Karachi which operates as a full-time facility like elsewhere in the civilised world, and the results are there for all to see.

Pakistan, and, indeed, Pakistanis deserve a healthcare system where doctors should work on a full-time basis without having to worry about their private practice.

We should have a system where these doctors can continue with their own professional improvement in the shape of continuous medical education (CME) in the interest of their patients. We need the system to work for the patients, and not for the benefit of the mighty, wealthy doctors.

Healthcare is not on the priority list of most political parties. It is not even an election issue. It is time for the political parties to show some commitment by highlighting their vision on this key issue in their manifestos. If this doesn’t happen, those who can will continue to leave the country. The rest will continue with their strikes.

The writer is a former secretary general of the Pakistan Medical Association.