Daily Times

The emirate of Abu Dhabi is the wealthiest in terms of oil resources and Dubai is the port, tourist destination and financial center. The country also holds significance for Pakistan as around 1.2 million Pakistanis live and work in UAE.

Dubai has considerably developed in health care and health tourism. Dubai’s underground Health Care City is accessible to everyone. The Dubai Healthcare City Authority is responsible for ensuring compliance and enforcement of international quality standards for clinical and non-clinical facilities. It grants licenses to healthcare professionals, educators and operators, and maintains its quality according to international standards. Notable achievements, as claimed, are a response time of 4 minutes for air ambulance for trauma cases. This year, the UAE authorities established regulations to govern organ transplantation to prevent organ trafficking. Although Pakistan had initiated the legislative process for organ transplant in the year 2007 but despite Pakistan’s abundant and well trained health force it is not making the strides it should have commensurate with its health expertise in transplant procedures and health tourism.

What we should be concerned about also is the plight of the expatriates working in UAE.As is generally known an expatriate can live or work in Dubai till his contract lasts and there are instances of people working in the Emirates for decades along with their families. Some of the children know it to be their only home. No one has visualised so far, and with the first generation of Pakistani expatriates having reached the age or passed the age of retirement and employment in Dubai or any other Emirate as to how they will cater for their own old age related health care. In Pakistan rapidly altering lifestyles are closely followed by changes in the health profile of individuals and Pakistani’s living and working abroad also do not maintain healthy life styles.

The Global Burden of Disease 2010 data indicates that NCD’s are responsible for around 77 percent of age consistent deaths in Pakistan. Analysis of individuals affected by NCD’s in Pakistan reveal that many have multiple diseases like high blood pressure, heart disease, obesity, cholesterol related issues, diabetes and mental health disorders

Traditionally maternal, child health and infectious diseases have remained highlighted since a decade but now the incidence of non-communicable diseases (NCD’s) has significantly increased in Pakistan. These NCD’s cover cardiovascular diseases including stroke and heart disease, diabetes, mental health disorders, cancers, and chronic airway respiratory diseases with such chronic conditions afflicting a significant number of individuals in Pakistan. The Global Burden of Disease 2010 data indicates that NCD’s are responsible for around 77 percent of age consistent deaths in Pakistan. Analysis of individuals affected by NCD’s in Pakistan reveal that many have multiple diseases like high blood pressure, heart disease, obesity, cholesterol related issues, diabetes and mental health disorders.

The encumbrance in terms of disability is significantly higher in Pakistan and generally attributable to stroke or injury induced cases. It is projected that in the years 2018 to 2025 around 3.8 million citizens of Pakistanis may die due to NCD’s only, without factoring in the economic burden to the state of disabilities and mental health conditions, with accompanying expenditure to the state. The situation of expatriates is precarious as they delay attending to their health issues whether due to financial issues or, as medical leave is not easily available.

Healthcare in Dubai is available, accessible, standardised but exorbitant. Yet parents of children residing in the Middle East and requiring rehabilitation or therapy services including hearing impairment and related speech disorders prefer to shuttle their children on regular basis to Pakistan as rehabilitative health services are prohibitively expensive in the Middle East. Another option is for the Pakistani expatriates to sell their property there and move to Pakistan with a relatively affordable health tag. But dislocation with family has an economic cost. This is more so for the manual or low skilled class which does not have any savings or investments to tide them over in their advancing years. The labor class has more serious health issues due to the rigorous conditions under which they have toiled and worked and remitted their hard earned money to Pakistan.

The authorities should initiate measures for ensuring their smooth transition back into the country’s mainstream and arranging for their adequate and affordable healthcare. A possible solution could be to have a Overseas Insurance Card on the likes of the NICOP (Overseas identity card) which could be issued on an annual premium and would be affordable by those working abroad. This scheme could be extended to the workers in the other Gulf countries which are a significant source of remittances and could be paid or recovered at the time of remittance. Although Pakistan possesses an extensive public sector health service delivery network comprising of 1167 hospitals, 5464 basic health units and 184,711 doctors the healthcare system is not adequate to cater to the additional needs of the returning expatriates .

The public sector hospitals and healthcare facilities in Pakistan do not have the capacity to cater to the returning countrymen and the next best option is to avail the private sector health care facilities. Unfortunately geriatric care and old age rehabilitation is neither well developed nor available in Pakistan. The remittances being sent by immigrants are to a large extent being utilised towards the shelter, food and healthcare of the frail and aging patients left behind in Pakistan. No organised system of healthcare for this class of elderly exists and no senior and old age homes have been established where professional healthcare providers ensuring quality healthcare service are available. In Pakistan there is a severe lack of organised care for the parents of workers toiling abroad and a dearth of acceptable health service at dedicated health centers. Transiting into this category of the ageing and elderly are now the expatriates who have started moving back to Pakistan as their productive days gradually end.

To compound matters in the coming decade there will be a surge of Pakistani’s making an exodus for better opportunities abroad as domestic business and development activities are unlikely to give rise to any significant job creation. The parents of such workers exiting Pakistan will develop old age related health issues requiring geriatric care and assisted living and another vicious cycle will ensue. Instead of shuddering at this burden a systematic approach can create opportunities for establishing a healthcare system for the workers and their parents as this class of workers has sufficient financial means. Such a healthcare system would give rise to an industry of healthcare givers, nurses and geriatric care facilities in addition to standard medical care and promote health tourism.

In the present living conditions it is not feasible and prohibitively expensive for the workers living and working in the Middle East to tend to the health needs of their family members left behind in Pakistan. Workers moving to certain Western countries may be the beneficiary of a universal healthcare system yet in the USA the insurance costs of elderly parents is exorbitant.

On the other end of the spectrum, the Middle Eastern countries do not permit the workers to bring their parents with them. In order to tackle this looming health crisis of the workers whose health is deteriorating and productive years diminishing, it is imperative to develop a healthcare system expeditiously if only to recognise their contribution to maintaining Pakistan’s foreign currency reserves. As an initial step a task force may be constituted by the Ministry of Health at the federal level and replicated by the provincial health authorities to examine available options exhaustively and to jointly recommend the future course of action in this matter.

The writer is PhD in Rehabilitation Sciences, and has done Fellowship in Clinical & Research Neuro Rehabilitation, Department of Rehabilitation Medicine from Seoul National University Hospital, South Korea. She has several publications in academic journals

Published in Daily Times, March 18^th 2018.