Governments need to come to terms with young doctors’ legitimate demands
The healthcare sector in Pakistan started its decline in eighties and one can assign multitudinous factors for its diminution. Foremost is the archaic attitude of political leaders and planners, who overlooked ad infinitum the ever increasing health care needs and costs of unplanned and uncontrolled population growth. As a consequence, the entire healthcare sector went haywire. According to the world economic forum, Pakistan’s overall ranking in health and primary education is 108 among 125 countries. Recent advances in medical science and technology mandate innovative teaching methodology and skill development, but unfortunately lack understanding and appreciation. The entire health care system has been left to the mercy of functionally and medically illiterate managers. Many discordant issues confront us today, ranging from shortage of qualified physicians, paramedical personnel and nursing staff, with the added caveat of exodus of those who aspire to improve their knowledge and skills to practice state of the art medical care. Unfortunately the substandard environment, poor working conditions, sprinkled with political maneuvering, keeps them at bay despite the desire of fairly good number of specialists who wish to return.
This article addresses only one aspect of health system which forms the foundation of entire sector in the face of continuous debate raging in the media about abysmal failure of entire health care system. At present young doctors are on the receiving end, being abused and vilified for declining their services to patients. Mostly, it has been a one-sided narrative, which is highlighted ad nauseam, witnessing frequent walk outs, protest marches and road blocks. Views expressed here are not in defense of any particular side, and merely highlight some facts, out of concern for suffering sick people and creating unnecessary frustration among the future generation of physicians.
Let us define the basic reasons behind this turmoil? Foremost is a lack of prioritisation of two major aspects of human resource development and wellbeing of masses at large, that is, education and health. We, as Pakistanis, must feel ashamed when only a pittance is allocated for these very important millennium goals. Punjab government’s health allocation is about five per cent of the budget; despite its burgeoning population and even then only a fraction is spent on actual provision of treatment at public hospitals. In fact more is spent on securing the “vote bank” than on welfare of masses. Exacerbating the situation is the inaccessibility of medical care due to understaffing despite long duty hours.
Do the young doctors know that upwards of two to three million rupees are invested by the government for one student to complete medical education and training?
Now I turn to the present acrimonious saga of government’s health care machinery and the doctors — especially the young doctors. Before we demonise the latter, let’s look at their side of the story. On an average, an aspiring student has to obtain high marks in premedical studies and then appear in an entrance examination prior to qualifying for admission to a medical college. Upwards of 35,000 students take UHS entrance test (by the way approximately 65 per cent or more seats are secured by female students). After five or six years of rigorous education one is awarded a medical degree (MBBS) and appointed as a house officer; for compulsory one year of service. Young graduates are subsequently required to take yet another examination prior to application, to be eligible for a training position as an MO (medical officer). Subsequently, if they are lucky enough to be selected, they become a victim of long grueling hours of duty; providing care to a large number of patients; at times in a very hostile environment; without much supervision of senior faculty and meager remuneration. He needs another four years of training for specialisation. Many, especially female doctors, for various reasons drop out, during this long drawn out process. The quest is not yet over; they need to clear examinations conducted by Pakistan College of Physicians and Surgeons. They are now looking for a permanent appointment in the medical field. Quite a few of them find their way to various countries. Those who join the domestic rat race become frequent visitors to the department of health, but that is another story.
The other side: Do the young doctors know that upwards of two to three million rupees are invested by the government for one student to complete medical education and training? A doctor must also know that in most countries the money spent on education binds him to return the “loan” or get a waiver of repayment, by serving in medically deprived areas for a certain period of time. I mention this not as a reprisal but an obligation. Add to this another prick, for a small number of doctors who opt for provincial service commission examination; to qualify for services which do not commensurate with their education and training; especially in the face of shortage of physicians. It is equally disturbing to note that no more than twenty per cent of all female doctors may be in practice of medicine after graduation. Can we label this another wasteful investment? Then we have exponential mushrooming of private medical mills, that is, colleges (there are about 23 in Punjab), to fill in the “gap” left by “shortage” of doctors; now that’s another story! In addition there are medical graduates (number unknown) returning from different countries, for example, Russia, China, Central Asia, Afghanistan, etc, and the dubious role of PMDC registration of their qualification and verification of credentials.
Now let’s talk turkey. All of the above does not give any government functionary a cause to thrash, abuse and arrest young doctors. They are not demanding perks, privileges and plots. But at the same time, they do not deserve pennies. Governments need to come to terms with young doctors’ legitimate demands. Most important is to provide them safe environment to learn and provide good medical services and a comprehensive service structure in which they can grow and be adequately reimbursed. There is a need to envisage all aspects of the healthcare system. If leaders and organisers of healthcare, public or private, remain in a state of denial and self-induced ignorance, we all stand to be adversely affected and in fact the entire health system will crumble ending up in mare’s nest.
