Daily Times

We were told in Medical School that a doctor, a teacher and a politician have no caste. Later, we found another common ground with politics from Rudolph Virchow (1948): “Medicine is a social science, and politics is nothing else but medicine on a large scale.”

Most doctors are prisoners of their medical education and are shackled by professional ethics. They are content with the knowledge they have and the power that comes with it. They have the license not only to poke and prod people in private places (without offering a ring) but also charge them heavily for this privilege.

A doctor is obviously influenced by personal experiences and background. He may unconsciously bring biases, religious beliefs, and even political discourse into his interactions with patients. This is like walking a tight rope at conscious level where he is bound by medical ethicson one side and healing a sick mind and sick body on the other.

A Parsi doctor, Jal Patel, treated our Father of the Nation for lung cancer. He took this secret to his grave; otherwise, its public knowledge could have been a disaster for the creation of Pakistan. His last physician, Ilahi Bakhsh, wrote a book, which gives us valuable insight into Jinnah’s last days. Similarly, Allama Iqbal sought medical advice from doctors (Jamiat Singh, Abdul Qayyum, Ameer Chand) and Hakeems (Nabina, Qurshi) in his later days and benefitted from their diverse input. All these medics have recounted anecdotes, which give a dynamic snapshot of Iqbal’s life and politics.

Ghulam Muhammad was the Governor General of Pakistan from 1951-1955. He had hypertension and then suffered mini-strokes from 1950, which resulted in a worsening paralysis. Dr Sarwar, Dr Hafeez Akhtar and his beautiful private secretary-cum-nurse Ruth Borel kept him quasi-functional during his tenure. Since then, we have had a history of doctors providing life and/or career saving medical support to prominent politicians including Farooq Leghari, Pervez Musharaf, Nawaz Sharif, Shehbaz Sharif and Imran Khan.

Psychiatry somehow features heavily in the medical histories of Pakistani politicians. Its possible reasons may include genetic overloading, their premorbid personalities, and lack of ability to cope with stress. The list would be exhaustive if we include informal knowledge; but there is documented evidence to suggest that our leading politicians received psychiatric consultations. They include Ghulam Muhammad, ZA Bhutto, Benazir Bhutto, Asif Zardari, Altaf Hussain and Bilawal Bhutto Zardari.

Leaving personal opinions aside, most physicians focus on their patients. Staying neutral is hard though in the intense current political debate in the country about governance, corruption and accountability vis-à-vis 2018 elections. Politics also affects doctors in terms of health budgets, service/pay structure and health service delivery. The state of our economy and political events have pushed these concerns into overdrive. It no longer makes sense to distinguish between events in Islamabad and the woes of patient sitting in front. It is also ridiculous to block the roads repeatedly to improve medical service structure/conditions.

Psychiatry somehow features heavily in the medical histories of Pakistani politicians. Its possible reasons may include genetic overloading, their premorbid personalities, and lack of ability to cope with stress. The list would be exhaustive if we include informal knowledge; but there is documented evidence to suggest that our leading politicians received psychiatric consultations

Avoiding politics seems unethical, and may be unprofessional for doctors. They may find political advocacy uncomfortable, but it is a part of their job description. As physicians, they advocate for patients and fight the red tape on daily basis. They need to embrace this ethos on a macro level by lobbying their MNAs/MPAs, joining activist groups and running for office. They, as technocrats, should argue that laws affecting human lives should not be made along party lines, but by an evidence-based policy. As healthcare providers, advocating for patients is an ethical imperative and a professional requirement, whether it comes in the form of pill or policy.

Doctors may take their theatre-gloves off and aspire for public service more often. They have great examples of Che Guevara (Bolivia/Cuba), Mahathir Mohamad (Malaysia) and Ram Yadav (Nepal) to follow in politics. Those who took the plunge, graduated from medical politics mostly. The latter is difficult because it is easier to herd cats than unite doctors, especially when the issues are resources and money. Fatima Jinnah and Dr Khan sahib made a great name in the Independence Movement but never received the honours they deserved. DrIshrat-Ul-Ibadremains the most successful doctor-politician followed by Arbab Rahim, Zulfiqar Mirza, Firdous Ashiq Awan and Saira Tarar. Safdar Abbasi and Aasim Hussain got “retired hurt” after playing their innings. Farooq Sattar is fighting for his political life as head of MQM while Yasmin Rashid and Saeed Elahi are waiting for the next chance.

The Church banned Machiavelli’s works because he argued that being a good Christian was incompatible with being a good leader. He writes that we cannot be good at all things so we need to let go of some. We have to sacrifice kindness for effectiveness, and lie in order to keep a relationship. We may have to ignore feelings of the workforce to keep a business alive. This is the price of dealing with the world as it is, and not as we think it should be. I have similar fears about doctors entering politics and also because “the trouble with the rat race is that even if you win, you’re still a rat.”

The writer is a Consultant Psychiatrist and Visiting Professor. He tweets @AamerSarfraz

Published in Daily Times, December 31^st 2017.