Daily Times

Reportedly, Prime Minister (PM) of Pakistan Mian Nawaz Sharif is recovering well from his open heart surgery. I hope and pray that he recovers completely and suffers no complications. Having said that, I have quite a few questions about the nature, the timing and the press coverage of the entire situation surrounding this operation. Now that the PM is doing well then perhaps these questions can be raised and discussed frankly. Before I proceed any further I must inform my readers that I have in my professional life performed a few thousand open heart operations of almost every sort.

One of the things that I found particularly difficult to understand was the secrecy surrounding the operation. Once the decision to proceed with the operation was made, it then was necessary to provide the people of Pakistan with adequate information about what, why and when of the situation. After all, the PM is the chief executive of the country besides being the head of the eponymous Pakistan Muslim League-Nawaz (PML-N), which is the majority party in the National Assembly as well as in the Punjab. As such whatever happens to the PM is of great importance to the people of the country, and because of the unnecessary secrecy surrounding the operation all sorts of conspiracy theories were floating around all day on the day the PM was having his operation. Even now almost three days after the operation the name of the surgeon or the name of the hospital where the operation took place is not being told to the public. In most western countries after a major leader undergoes a major operation like this, the operating surgeon faces the press and answers questions.

Besides the secrecy the other problem I have is the exact diagnosis and why the PM underwent this operation. At the present time having a coronary bypass operation for artery blockages is very unusual, and in a person that has a previous operation on the heart almost every attempt is made to avoid an open heart operation. Most coronary blockages are treated with stents, which are placed through catheters without an open operation. There are exceptions to this rule. The major exception is a ‘critical’ blockage involving the major heart artery called the ‘left main’. However, patients with such severe blockages rarely go gallivanting around the Pakistani countryside addressing public meetings or the day before the operation travel to the Pakistani embassy to address the Pakistan federal cabinet. Any physician that allows a patient to do such things would be severely criticised for exposing the patient to a tremendous risk of developing a major heart attack.

Since the PM was considerably active till the night before the operation, that would suggest he did not have a ‘critical’ blockage of his left main artery. That leaves a few other common reasons why an open operation is needed. The commonest among them is that he required some other heart procedure along with the bypass operation. It is possible that the PM needed some added procedures for the heart rhythm problem he has had in the past, or possibly even needed repair of a leaky heart valve. The other most common reason for proceeding with an open bypass operation is that he might already have stents put in for heart artery blockages and that these stents closed down. Going back to the ‘secrecy’ problem we have no idea when the PM had heart studies done to find out the nature of his heart problem, and if he ever had artery stents placed in the past. In short, I at least find it puzzling that the PM was advised to go through an open operation for heart artery blockages. But then I am not privy to any ‘facts’ about the PM’s heart problems and can only speculate based upon my experience with similar patients in the past.

About the timing of this operation, the PM’s family has said that the operation was suggested much earlier but the PM was being ‘brave’ and avoided going through with it. Why then now and not a few months later? Many in Pakistan are of the opinion that the timing for the operation was related to the ‘Panama leaks’ scandal involving the PM and his immediate family. It seemed that the timing was determined by a political calculation that a major operation would divert the attention of the people of Pakistan away from the PM’s involvement in the Panama leaks scandal, and at the same time, garner the PM much sympathy. Sadly, the secrecy surrounding the operation reinforced the political aspect of the timing in the minds of many Pakistanis while mitigating the sympathy aspect.

The press coverage of the operation bothers me too. A few years ago when President Asif Ali Zardari developed some medical problem for which he went abroad for treatment, the press was all over the situation and severely chastised the president’s inner circle for trying to hide the president’s medical problems. However, in the present situation it seems the Pakistan’s free and independent press has no interest in investigating the medical problem of the PM who is the chief executive of the country and is the leader of the majority party that might well win the next general election and return the PM to an unprecedented fourth term as PM. Facing such a possibility the PM’s health, both physical as well as mental is of major concern to the people of this country.

As far as privacy is concerned, the health of political leaders is a matter of national importance. Any health issues that can have an impact on the ability of a leader to govern effectively must be openly discussed in the press and the public must remain fully informed. In this day and age of extensive and often unreliable information available through social media it is imperative that traditional media provide reliable information and counteract rumours and unfounded speculation.

The author is a former editor of the Journal of Association of Pakistani descent Physicians of North America (APPNA)