Democracy in Medicine

Author: Syed Kamran Hashmi

Being both, a physician and a Pakistani, nothing hurts me more thanrealizing that suddenly the medical training of our country has been denied accreditation, years ofour hard work have gone wasted, our career trajectoryjeopardized. Not too long ago though, this is exactly what happened to a group of Pakistani doctors working in Saudi Arabia.

The smaller Arab states such as Bahrain, Qatar and the United Arab Emirates (UAE) took the lead from the Kingdom and followed suit. Because of theiraction, many physicianswill lose jobs and be forced to return back.On the other hand, similar degrees from India, Bangladesh and Egypt will continue to be accepted.

If you only read the headlines, which most of us do, it would seem that all doctors would meet the same fate, the graduate degree of every Pakistani medical school beingquestioned, disregarded or discredited. This, of course, is not true. All hell would have broken lose had that been the case. In fact, this would have been a bigger dagger in our backs than the dagger Arab countries have thrusted upon our spines on Kashmir by calling it a regional conflict and not a matter of the wholeMuslim community (Ummah). That prestigious place, the top spot for the concern of ‘Ummah’ is kept for Israel Palestinedispute alone! But let me leave that topic of Arab Nationalism and hypocrisy for another day and keep our discussion limited to doctors.

As with every other matter in life, the devil here too lies in the details. Should you scroll down the news it becomes apparent thatthe problemis limited to specific diplomas only, namely the Doctor of Medicine (MD) and the Master of Surgery (MS). Our flagship medical degree, Bachelor of Medicine and Bachelor of Surgery (MBBS) along with the post graduate training program FCPS (Fellow of College of Physicians and Surgeons) stay unscathed and fully accredited.

Dig a little deeper, and you will realize that may be Kingdom is not to be blamed for their action at all, the Brutus in this case can be found within: The College of Physicians and Surgeons Pakistan (CPSP), who allegedly in a recent visit to Saudi Arabia promoted their certification alone, giving an impression to Arabauthorities that the Masters diplomawas not as well structured.

If you were a Saudi official would you have not believed them? Would you not want your people to be taken care of by properly trained staff? If it was me, I would have also jumped totake similar actions.

Now let us turn to the crux of the matter, after agreeing that it was probably not Arabs who should be held responsible for discrediting the Pakistani doctors and surely not the doctors who pursued their career in that direction since individuals can’t influence policy decisions on their own.

Backed up with evidence, the Health Department, under the leadership of the Federal Minister of Health, either could have implemented the new rules on its own or got it approved by the National Assembly making it the law of the land

In an ideal situation, if CPSP had found anything of concern with other diplomas, which it could have, as these programs contain many loopholes. To clarify, I do not mean that the FCPS program is perfect or does not contain any loopholes. Then, CPSP should have brought its concerns up to the Ministry ofHealthproviding proper guidelines to alternative specialty training routessetting clear milestones and laying basic expectations.

Backed up with evidence, the Health Department, under the leadership of the FederalMinister of Health, either could have implemented the new rules on its own or got it approved by the National Assembly making it the law of the land. Meanwhile, people whole already held the Mastersdegree could have been fathered in through a standardized Board Exam.If that did not work, even the MS or MD could have merged into FCPS with appropriate changes in the curriculum. Whichever route was adopted, there could have been multiple solutions to the problem.

But none, of the aforementioned steps were taken (or reported). Instead a particularly dangerous course was pursued, a course thatwas, first,probably illegal, and second, carried the risk of embarrassing the whole nation, which it eventually did.

Let me add that this reckless and vicious behavior is shown by the people who being well accomplished and very well educated themselves like to alsobrag as being the ‘cream of the nation.’On a personal level they might not have intended to bring shame to the country. They might also actually also have a great respect for the hardworking physicians who lost their jobs and livelihoods. Then, what is it that these well- educated and well accomplished individuals do not understand? The answer is: Democracy.

In general, Pakistani bourgeoisie does not comprehendthe fundamentals of democratic principles. Imagininga functionalcommunity based on those rules is like asking a blind man to imagine color blue and then differentiate itfrom green. They limit its purpose to elections and a day of voting every five years, not as a way of life, a way to address national issues, a way to build consensus, a way to proceed towards solutions, from health to finance to defense to education.

The goals that CPSP might have wanted to achieve could be obtained in a better way through consultation with the representatives of all the involved parties. Bringing everyone on the same page would not have come easy, and trust me, the process would have been messy, disorganized and confusing- the beauty of being a republic. On top, it mightnot have resolved every issue or closed every loophole. But, had they believed in strengthening the system, and had they followed the democratic principles and agreed upon a common agenda, both FCPS and MS programs could have worked out an acceptable solution. But they did not.

The writer is a US-based freelance columnist

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