Daily Times

On the eve of Ramzan, I was bombarded by hundreds of WhatsApp messages (most of them from unknown numbers) wishing me ‘Ramzan (or Ramadan) Mubarak’. The next morning, my wife informed me that our maid, who has worked in our house for over a decade had come crying to her. Apparently, her brother had been in a serious motor vehicle accident,suffered multiple broken bones and was admitted in one of Lahore’s large public hospitals. He needed surgery which was being refused until they paid Rs 20,000, an astronomical sum for a poor family.

Thinking that perhaps the doctors were asking the family to buy medicines or other surgical supplies for the operation (a common occurrence in public hospitals which are perpetually starved of essential medicines and other supplies), I made some calls. My contact at the said hospital informed me, though, that the payment was a bribe which was being requested to go ahead with the surgery. This was also a way to ‘encourage’ the family to take their business to the private clinics of the doctors handling the case, who could then order expensive tests and charge full price for the surgery rather than doing it at the public hospital where it would be free.

A couple of days later, another incident served to highlight the utter bankruptcy of our medical system, both public and private. I had just finished my shift at my evening clinic and was on my way home to join my wife and mother for Iftar when my phone rang. It was my secretary who informed me that a patient’s family had just shown up at the clinic and were insisting on seeing me. I turned my car around and headed back to clinic. Upon arrival I found a family holding on to an emaciated, wild eyed young woman, obviously pregnant who appeared very disturbed.

We spend less than one percent of our GDP on health. Our ‘free’ public health system, which consists of large public hospitals in major cities, reflects this pitiful amount

She at first refused to come into my office to see me, then when she did come in, she refused to sit down and when she did talk, it was mostly gibberish. The family told me the story briefly. She was, apparently, highly educated, a Masters in Science and had just gotten married a few months back. The marriage had not worked out and she had separated from her husband although not before getting pregnant. She was about eight months along now, heavily pregnant and for the last few days had hardly eaten anything, had not slept, had been agitated and hallucinating and earlier in the day, had tried to set herself on fire resulting in serious burns on her stomach and back. But that was not the worst part.

She had been admitted to a local private hospital for a day or two and from what I could tell, had had a number of (expensive) tests done. She had even been seen by a psychiatrist. However, her mental state had continued to deteriorate and the hospital had finally, in a panic, simply discharged her and told the family there was nothing else they could do! They had pointed the family to one of the large public hospitals and washed their hands of them (after, no doubt, making a substantial amount of money from their misery). The family took her to a public hospital but were turned away from there as well and finally, late that evening, stumbled into my clinic.

It was clear to me that the girl was extremely sick and, if something was not done immediately, she would lose the baby and, possibly, her life. I prescribed some medicines, gave the family my cell phone number and told them that they could admit her to another hospital under my care if she did not improve in a day or two. The next day, I got a call from the hospital that the family had brought her there.

These two incidents serve to demonstrate the nightmare faced by most of our population in case of serious illness. The poor, of course, are used to being mistreated in this country and our public hospitals are no exception. We spend less than one percent of our GDP on health (for comparison, India currently spends 1.2 percent on health and is planning to raise it to 2.5 percent by 2025; Bangladesh spends 3.8 percent). Our ‘free’ public health system, which consists of large public hospitals in major cities, reflects this pitiful amount. People are packed like cattle into small rooms, doctors routinely have to see hundreds or thousands of patients a day and there is a complete lack of availability of life saving tests or medicines. This system also generates corruption and theft. For a suitable ‘fee’, you can jump to the front of the line in the hospital or for a slightly larger fee, you can simply go to the duty doctor’s private clinic in the afternoon or evening and be provided prompt service. This is not to say that all doctors working at public hospitals are corrupt. Far from it. If it were not for the honest, ethical doctors and staff working at these places, our pathetic public health ‘system’ would have collapsed long ago. It is only by their heroic efforts that the poor continue to receive any semblance of healthcare at all.

Private hospitals and clinics which have mushroomed all over the country in the last 2-3 decades are another story. Their main focus is on making a profit for their owners and shareholders. There is a common joke that the first scan a private hospital does on a patient is a ‘wallet scan’ to see what they can afford. Horror stories abound of unnecessary, expensive tests and surgeries and it is quite common for a private hospital to even refuse to release a dead body until all their bills have been paid in full. Again, honest, ethical people do work at private hospitals too, but the system, as a whole, is geared against them.

As for my two patients, the young man in the public hospital has now had some of the surgery he needs and I am still trying to make sure he gets the rest without having to pay bribes. And my pregnant woman patient is now back to her senses, sleeping and eating better; she is in a lot of pain from her burns but, thanks to a senior Obstetrician colleague who is helping me with her pregnancy issues, she should make a full recovery.

We are still in the middle of Ramzan though. And those patients who don’t have a relative working in the house of a senior doctor or don’t know the ‘right’ person are on their own. Every time I receive a ‘dua’ or a ‘Ramzan ki fazeelat’ message on my phone, I can’t help but wonder how many of those people are suffering this Ramzan. And not because of their ‘sins’ but because of the cruelty and avarice of their fellow human beings, some of whom maybe the ones sending out those ‘Ramzan Mubarak’ WhatsApp messages.

The writer is a psychiatrist practicing in Lahore. He taught and practiced Psychiatry in the United States for 16 years. He tweets @Ali_Madeeh

Published in Daily Times, May 29^th 2018.