Daily Times

Matters of heart are matters of life. Heart issues and heart tissues are matters of high priority, high specialty and high complexity. When one of the most specialised institutions in the country, the Pakistan Institute of Cardiology (PIC), fails to save patients suffering from heart problems at an unprecedented rate, it is a matter that needs immediate attention. The death rate of patients during cardiac surgeries at the PIC has increased by 10 percent compared to last year. This is a very critical area as the PIC is the only hospital for poor people in Punjab that treats heart patients at subsidy, which in private clinics is impossible the for majority of the population to afford. This institute has come under observation due to complaints by a patient’s family who approached the Punjab Health Care Commission. The report of the commission reveals that one of the main surgeons at the PIC has a 50 percent failure rate on surgeries, which is not just bad it is horrific.

Imagine that if one of the top healthcare facilities in Pakistan has such a shameful record what state of affairs must be prevailing in ordinary hospitals. With population growth affecting most countries in the world an unhealthy and uneducated population is a breeding ground for violence and unrest. Every day stories of children dying of lack of medical facilities and poor healthcare are reported, becoming a norm that no longer surprises us. Thus a who-cares-for-healthcare mindset prevails from top to bottom. Governments in developed countries spend maximum time, money and effort on ways to keep their people healthy. Whether it is ObamaCare in the US, or National Health System in the UK, governments know that if they do not deliver on health they will not be able to win the voters. If these appear to be extreme examples, just compare the figures in South Asia. Pakistan spends by far the lowest on health in the region. Pakistan has allocated 2.8 percent of its GDP on health, while smaller countries like Afghanistan and Nepal are spending 8.5 percent and 5.5 percent on health.

Public hospitals are overcrowded, neglected and treated by medical professionals as training grounds to establish private practice. Support staff is untrained and politically hired with no accountability for performance. There are 85 physicians for every 100,000 persons in Pakistan, or in other words, one doctor for 1,225 people. 35 percent of Basic Health Units in Punjab are not operational. Maternal mortality and infant mortality rates are the highest in the region with a woman dying every 20 minutes just due to lack of facilities available for delivering the baby. Pakistan is a signatory to the Millennium Development Goals, but has missed all goals for 2015 by a long distance.

Aside from poor financial and infrastructural management of public hospitals, human resources management of this sector is almost non-existent. Every week there is a strike of the Young Doctors Association, nurses or para-medical staff. The problem of service structure not being implemented to their satisfaction results in disrupting the hospital routines, and we witness the sad spectacle of hospital emergency units having patients in critical stage being left unattended. Rest of the staff is untrained, while mid and top tiers lack professional management. The heartrending news of a crippled young girl in a hospital raped by an attendant just shows what state of moral and medical decay our health system has stooped to.

Medical professionals especially doctors and pharmaceutical companies have become simply money-minded in their approach. Gone are the days when becoming a doctor was considered a noble profession and a way to save life. These days doctors have exploited this failure of health system to their advantage. Most doctors treat their jobs in public hospitals as training ground and contact-development centres. Senior consultants put in hardly a few hours of their time in hospitals, and focus on private practice and establishing their own private hospitals. These private hospitals, though exorbitantly expensive, do not have the range of facilities a proper hospital needs to take care of all emergencies.

Another example of commercialisation is the ruthless pharmaceutical industry. The pharmaceutical industry has become notorious for using various unethical ways of promoting their products to hospitals and doctors. They offer all types of luxurious tours to foreign countries under the guise of medical education to doctors. They sponsor clinics and equipment to help doctors set up their private practices, and in return they convince doctors to prescribe only their medicines to patients.

Sponsoring conferences and events is still a softer way of marketing to healthcare professionals. Some companies go to the extent of footing bills of family weddings and paying for summer shopping. These are considered unethical practices in the industry and are strictly forbidden. But unfortunately the industry is rife with them with the result that substandard medicines take many innocent lives. Earlier in 2012 the same ‘prestigious’ PIC became the centre of a huge scandal when nearly 150 patients died due to fake medicines being delivered to them. It was estimated that up to 46,000 patients had been harmed by those medicines. In any other country these deaths would have been considered as mass murder, resulting in the closure of the institute. However, the PIC continues to survive while patient survival ratio continues to decline.

It is this criminal negligence that makes life savers look like life takers. Regulating agencies like the Drug Regulatory Authorities of Pakistan and the Pakistan Medical and Dental Association are mired with scandals and corruption, and are accused of letting the PIC and other institutions get away with every malpractice. Deaths of 150 patients in the PIC in 2012 were followed by an enquiry and removal of a few non-essential people from their jobs. This lack of accountability has made the institution all the more resolute to keep on playing with the lives of innocent and sick people. The recent case of failed heart surgeries was also followed by an enquiry and the doctor responsible for it has been removed. The explanation given by the PIC was that he was just an honorary doctor and not on formal pay roll. Is this a justification that a doctor has been allowed to treat poor patients as guinea pigs to experiment his incompetence?

When a crime is justified and it goes unpunished it becomes a standard operating modus operandi. When criminals are not caught or given nominal penalties they become confirmed gangsters. When society at large stops debating about these issues because they feel nothing is going to come of it nations lose the will to progress. What we need to revive is the spirit to fight for these causes no matter how small, how repetitive, how mundane or how hopeless they are.

The writer is a columnist and analyst and can be reached at andleeb.abbas1@gmail.com