Wednesday, June 13, 2018

Why I will be voting for PTI in this general election

Before we get started, let me just make a few things clear. I am NOT a PTI or even Imran Khan fanboy. I would just be laying down (and countering) a few arguments as to why PTI is the best option in my opinion. Feel free to disagree and/ or debate.

Like most people who grew up in Punjab, I had accepted the fact that we will forever be governed by the Sharifs even if they were corrupt gangsters. I was one of those who were content with the "khata hai to lagata bhi hai" (even if he's corrupt, he works for development too) argument. In the 90's when Imran Khan had just started raising his voice, I had no particular reason to believe in him. More so, I knew Pakistani politics was a dirty game and a cricketing playboy had no business jumping in. The only admirable thing I do remember from back then is that he refused to join Nawaz Sharif when he was asked to join PML. That showed integrity.

As the years passed by and we were governed by Gen. Musharraf and the Chaudhrys, like most Pakistani youth back then, I couldn't care less about politics. Of course, one did feel bad for democracy as military dictatorship once again showed a comeback. But to be honest, I did not feel any different. In fact, the Musharraf era was one in which all the private news channels took flight and I heard the words "freedom of press" the first time. Although I don't remember any major development projects from that time, I do remember there were no crises and we even had a very friendly relationship with India.

But of course, it was the calm before the storm. No major power projects were started despite the growing need, motorways were not expanded at an optimal speed and biggest of all, we became a pawn in the USA's war in Afghanistan. That put Pakistan on the Taliban's list of enemies and we are still reaping the fruit of that decision. While I'm all for uprooting terrorism, it was well-known that Afghanistan was an unwinnable affair for the US (as we are painfully aware 17 years down the road).

During all this time, I saw Imran Khan's views changing pretty much the same as my own. Initially he was supportive of the Musharraf regime but was hostile towards the 00s. Again, in 2008, when he boycotted the elections because he refused to contest the election as long as Musharraf was president, it showed integrity. The way Nawaz Sharif and Asif Zardarti swung back and forth before and after the election, I grew more and more disgusted by them and knew we needed to change as a nation. My disapproval of Musharraf peaked when he signed the NRO, which surprisingly people don't talk about anymore. That is the single most disgusting piece of legislation I have ever witnessed in my lifetime. As Imran Khan's narrative was making more and more sense to me, I was completely behind him when he was the only one who stood by his promise not to contest the election as long as Musharraf was the Chief Executive. Nawaz Sharif backed out of that promise and Asif Zardari reconciled with Musharraf as well. That was the point of maturity in Imran Khan's career as a Pakistani politician. His boycott was enough to make me boycott the 2008 election as well.

What followed was another phase of maturity as he stood on the sidelines and prepared for the 2013 elections while PML-N and PPP locked horns with unbelievable hypocrisy. How can we forget when Shehbaz Sharif used to sit in a tent in Minar-e-Pakistan to protest loadshedding when PPP was in power, something he never repeated when his brother was the prime minister. These disgusting tactics and promises of "dragging on the streets" made me realize we needed a third option, badly. I was super-pumped and excited for the 2013 elections. I was confident that if everybody had seen this ring around the rosie the way I did, we would surely turn to the next best option, Imran Khan.

However, it was not meant to be. As much as I'd hate to admit it, in 2013 I thought may be we don't deserve democracy. If a PML-N, PPP amalgam is what we were always choosing, we needed to stop wasting resources on an election and just go with a coin toss instead. In terms of performance, I must admit that PML-N was slightly better than their predecessors but overall it was much of the very same. Major issues like health, education, poverty and power remained pretty much the same. We continued to drown in the quicksand of loans and our international relations are no better, if not worse. Hence, I firmly believe that PML-N or PPP should be never be allowed one more day in public office ever again.

Brace yourselves PTI supporters, this is where it went downhill for Imran Khan. The whole sit-in in Islamabad was a gigantic failure of energy and resources, which would have better served his cause if he had worked harder in KPK. Don't get me wrong, I agreed with his notions of investigations into the election and accountability in the Panama leaks case but that does not justify the extremes to which he pushed his protests. There were other ways to keep fighting and he chose the worst option. I actually thought he would be a healthy opposition after losing the 2013 elections but he was anything but. I wish he would one day admit he was wrong there, again something he is not that good at.

Thereafter, I am not quite sure what convinced him to compromise on his principles but I like to believe it's the fact that he knew to be prime minister, he needed to win Punjab. And to win Punjab, he had to accept the feudal lords of the land. The massive influx of turncoats that followed was supremely disappointing and in stark contrast to the reasons I had supported him all these years. The fact that he welcomed with open arms a number of people with shady pasts did not resonate well with me, as I'm sure is the case with most PTI supporters today. This is not to say that PTI dropped to the same level as the other big two. This was just like Imran Khan borrowing some bad apples from two piles of garbage. Please note that garbage is still garbage.

However, there were some positives that derived from this process as well. People who had been in PPP or PML-N for decades with no accountability were suddenly scrutinized for everything that maligned their past. I was astonished the way PTI supporters were criticizing Imran Khan and co for welcoming goons (especially the convicted rapist from PML-N). It showed that even though most of the PTI supporters were still behind Imran Khan, they were quick to raise their voices when it started to hit the fans. It was something completely alien to Pakistani politics; supporters criticizing their own political party. It was a pleasant surprise and I am glad they set this trend of accountability, although my confidence in Imran Khan dropped further and further.

Now, I am not a strong believer in Imran Khan's politics and definitely don't have an angelic outlook of him as many of his fans do. I just don't feel that confident that he would perform as well as I had once hoped he would. I am still hopeful, just not confident or overzealous. Thus, it is with a heavy heart, a lot of reservations and significant doubt that I will vote for PTI this election.

Tuesday, May 1, 2018

All that glitters

The year was 2016. I had just been accepted into an internal medicine residency program in the US; or in other words, made "it". I felt like I was on top of the world. Like I had finally achieved what I was looking for and could see myself very close to being a successful physician. I was welcomed into the program with an orientation event organized for all freshly inducted interns. I had high expectations. Even higher, as I was told, were the expectations set by the university in charge of my program. I listened closely to all the presentations about different aspects of the US healthcare system and was intrigued by the strategies shown throughout the event.

I was most impressed by one particular idea which was completely new to me: running healthcare as an HRO. If you're not familiar with an HRO, it stands for a high reliability organization. Wikipedia defines it as "an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity". What this essentially means is that the entire organization works as a synchronous unit and any problems are analyzed and rectified by identifying its root causes. The best example of an HRO is the airlines industry which uses this root cause analysis method to its fullest. Imagining healthcare being run by the same principles sounded too good to be true.

And it was, as I will illustrate.

Using logic and reason helped me shape my personality in a very methodological way. Granted I became less and less emotional all my life, but it enabled me to be a better doctor. I was able to make better decisions for my patients and used to lead my interns very well during my residency back home. I had always been a problem-solver. I was always looking for "the next best step in management" of all the problems in my life and while helping others. Knowing I would be practicing in such an organization made be believe I would have the perfect environment to grow; like Staph Aureus on blood agar, if you will.

The first few months were amazing. I had the pleasure of working with outstanding attending physicians in the intensive care and inpatient settings. I, myself, was able to demonstrate good medical knowledge and was appreciated for it. At times I did feel overworked but seeing my superiors working just hard, always kept me pushing myself harder. I had the pleasure of being involved in making patient care decisions and was almost always up to the mark.

But this time was not without fault. Being someone who was always mystified by the curiousness of medicine, I was at times guilty of missing details of less importance. My documentation, which was criticized almost always for being too short, needed a lot of work. But I believe I was told about it early enough that I was able to overcome this problem to a great extent. For my benefit, I reviewed my notes multiple times and used good notes by other residents as standards to look forward to. It took some time, but I was able to be later appreciated for the quality of my notes.

However, that was not all. My tendency to argue for what I believed to be right got the better of me. I never did this to portray myself as a genius but only to tailor the best management plan with discussion. This particular trait was appreciated by the more experienced colleagues but not so much by the competitive ones. At times, I was made painfully aware of how critical thinking was not welcome by some. This was accompanied by stricter scrutiny of my documentation and clinical skills. Most of the time, I was up to the mark but at times I was found to be short. For example one particular attending grilled me for writing "Cranial nerves II-XII intact" in my notes (which was from the template used by all interns) and also accused me of committing fraud when I documented "no murmurs" in a patient with tricuspid regurgitation (although the patient was in rapid ventricular response when I had examined him).

I was failed in all clinical competencies by that attending, which never happened before or after that rotation. That included medical knowledge, which again had been appreciated by almost all before and after that. Nevertheless, this resulted in an immediate letter of probation from my program. But I didn't take this criticism lightly. Although I had been doing what most residents do, technically I was responsible for every word written in my note and they should have been accurate to the highest degree. The "he/ she did it too", although valid, is the worst kind of defense. Being a perfectionist, I spent days creating my own templates for notes for both the inpatient and outpatient sides. Thenceforward, I did not have a major problem with my documentation.

However, a general air of arrogance was perceived by others around me and I had no way of disproving it. I asked other people for advice and the most common suggestion was "just try to be invisible and do what you're told quietly". While this did make the most sense to me, it was not what HRO's stand for. This was the polar opposite of the scientific method. I knew that I needed to control myself to survive but whenever I was told to do something because "I said so" or "just to be sure", I was triggered. 90% of the US health budget is spent on the last ten years of life. I used to argue for the best course of action because at many occasions, I was concerned about patient harm or the cost-effectiveness of something. At times I was caught between internal struggles like "save yourself or this patient's kidneys" and I always chose to risk myself, which was the logical option in my mind. One time, I remember, a resident signaled me to stop from behind the attending when he thought the attending was getting irritated. That, I believe, was my biggest weakness. The lack of that sixth sense, which could tell me when to shut up just for the sake of avoiding confrontation. Still, most attendings and residents were really appreciative of me and applauded me for always aiming for perfection.

This, however, could not stop the avalanche that had started. Since I had been getting good evaluations even before the probation, it was no surprise that they could not make a difference afterwards either. Although I was promoted to second year, I was still on probation. This flipped a switch in my mind that no matter what I do or how hard I try, I would not be able to escape what was coming. I begged my attendings for feedback and they always said my performance was perfect/ near perfect. What followed was a vicious cycle of anxiety, depression and absentmindedness that I could not control. I was summoned by my PD multiple times a month about one problem or another. No matter how logical my explanation was, they were not satisfied and always reminded me of the fact that I could be dismissed.

And then it happened. I was called into the PD's office and told that they had decided to dismiss me. I was told that there was no sudden event that caused this, rather the continuous reporting of minor events. I was devastated. It felt like I had been sprinting in a marathon all my life and someone hit me with a chair in the face just before the finish line. I even thought about hurting myself and spent a day in a crisis center. A psychiatrist gave me happy pills and I started seeing a therapist. The perfect illusion of happiness, in modern terms. Residents and attendings alike were shell-shocked and started calling me to ask what happened. I could not explain. I had no answers for my parents either, who had sacrificed so much for my education. Attendings said they would vouch for me if asked by the reviewer while residents said they wanted to support me but were afraid of losing their own jobs in fear of retaliation.

I was told I had the option of appealing the decision twice, which I did. Both times, the attendings supporting me said this is all a big misunderstanding and it will be reversed. Both times, however, I was told that the "process was carried out according to the policy". This phrase was repeated as an answer to all my questions. A process that was supposed to take two weeks, took four months. And I was not told why. But I did not have the right to ask that question, nor request transparency.

And that's the sad ugly truth. No matter how hard you work and no matter how honest you are, being a resident in the US is a lot like the bullying before entering a fraternity. They will make you dance to their music and jump through hoops till you fall to the ground. If, however, you even dare to speak up, you're out. It does not matter how hard you worked all your life or how determined you are in doing what's right, it comes down to being likeable by those who matter.

What followed was an intense internal struggle. Whether to gamble myself into residency again or to go down fighting. A few of my colleagues who shared the same background, offered to pool money for a lawyer as they believed the dismissal was so unfair. But I knew better. I knew that this injustice was the worst kind of itself, i.e. legal injustice; whereby a private organization can prove they "followed their policy" somebody signed on, no matter how ridiculous the whole process seems to common sense.

So I chose a third option- committing myself to make sure someone else does not have to go through what I did. I wish to raise awareness about the trials and tribulations residents have to go through. I hope to break the sickening silence everybody assumes when talking about the mistreatment of residents. Roughly one-third of residents in the US suffer from depression and resident suicide is not that uncommon either but nobody talks about it. Even if a resident brings it up, its disregarded as an excuse (as it was in my case). I know that my medical career in the US is most likely over, but I have taken a solemn vow to do everything in my power to prevent what's happened to me from happening to someone else.

Tuesday, April 12, 2016

The Punjab Health system is a joke. And it’s not funny.

Every summer the beloved Khadim-e-Ala makes Punjab dance the dance of dengue. It involves massive expenditure on spraying the city, creation of specialized units with ICU’s, surprise visits to buildings and of course, banners boasting the efforts with his portrait in that oh-so-smug smile.

If only people knew what a joke this actually is. The sprays are of very little benefit against the mosquitoes, the specialized units and ICU’s overburden the already full infrastructure but of course, you can’t doubt the effectiveness of those banners. But that’s not the problem. The dengue fiasco is given attention only because of the hype attached to it. If the government really wanted to do something about preventable deaths in Punjab, dengue would be much, much down the order.

For instance, the first infection they should be concerned about is Hepatitis C. It infects between 2.2 to 14% of Pakistan, depending upon different populations. 80% of these people develop chronic hepatitis and while about 15% remain asymptomatic, 65% develop chronic active hepatitis C. These patients are heading towards miserable life leading to a painful death. If you take a mean infection rate of 8.1, that makes the number of patients around 1,05,30,000. That’s more than 1 crore people who are going to die a miserable death from Hepatitis C in the next 20 years. Now compare that to the fuss created about dengue that has a mortality rate of less than 1%.

You must be thinking, “why don’t we hear about this?”. And that’s where the joke lies. You don’t see or hear about them because we, the doctors do. These people come to ER’s in scores and bleed out in our hands. You don’t hear about it because they die a slow miserable death, which even their relatives seem to expect with time. That makes it a bad story for the media and where’s there’s no media coverage, there’s no government action.

But that’s not all. The number of patients who die from other chronic diseases like heart disease, lung disease, kidney disease and strokes is unimaginable too. Among these, deaths from kidney disease are the most preventable ones. These patients require regular dialysis and since the poor population cannot afford it, they simply accept their fate and die. Now they don’t die of their kidney disease, they die of their poverty. If we were a poor country, one would accept it. But knowing that the Punjab government is willing to spend billions on roads but none on dialysis centers, you cannot use the “poor country” excuse. Again, these are the preventable deaths we deal with every day, knowing there is nothing we can do about them.

If you argue that well, chronic diseases kill people either way, there is more. There is such a massive shortage of supplies and machines in hospitals that people die of benign diseases everyday too. People from as far as Afghanistan come to Lahore expecting the best care for their loved ones. But only we know the sad state of affairs of public hospitals. The ER they present to has ONLY one ECG machine for about 100 patients who are already stuffed on each other usually two on a bed (if they’re lucky). That leads to very late diagnoses of heart attacks and poor management of patients requiring cardiopulmonary resuscitation. Moreover, there is immense lack of drugs. The poor people come to these “free” hospitals expecting that every treatment is free of cost. But the reality is that only the medical expertise they get from doctors is free. And by free I mean actually free as up to 30-40% residents in training hospitals work without salaries. But that doesn’t matter, since what we want best for the patients is never going to happen. All of the guidelines go down the drain when the only antibiotics available in the hospital are Augmentin and Flagyl. When we make the patients buy a few of the drugs privately, they tell us they have exhausted their resources and wish to go home, again accepting their fate. Along with that, average wait time for elective investigations like an ultrasonogram is one week, a CT scan two weeks and an MRI twenty days. Of course, usually these patients die well before they’ll ever get to their appointment.

Every now and then, young doctors go on protest for better facilities for the patients and better incentives for themselves. But the government doesn’t seem to care since good hospitals don’t get them votes, good roads do. But the faces don’t remain the same. Most of the people fighting this battle have disappeared to better worlds with a vast majority going to Ireland, UK and USA. There’s more respect, better infrastructure, higher pay and quite honestly, less depression.

As for me, I had always been a strong advocate of staying in Pakistan and serving the poor. But after training unpaid for a year and knowing I wasn’t respected either way, I realized I was fighting a lost battle. I had been a straight A’s student in O and A Levels, studied on self-finance in a public medical college, passed national and international postgraduate exams and got a year of disappointment for it all. On the other hand, many of my peers (and now me too) were offered attractive resident positions in the US. While saying goodbye, I just wanted everyone to bear witness that I tried my best to stay in this system and fight for it. But the cruel truth is that nobody cares, not even me now.

Friday, December 19, 2014

My USMLE Step 1 testimonial

I recently took the USMLE Step 1 and got a good score by the Grace of God. A lot of people have been asking me about my preparation so I thought I should write a blogpost about it to help others.

What I used (I'll explain the brackets later):
2. First Aid
3. Pathoma (redundant)
4. Kaplan review books (redundant)

Total time: 7 months (effectively 5 months)

Kaplan period: (~2 months)
I started off in April with a late November plan to take the exam. Initially I sat down with the Kaplan review books for Step 1 because that's what everybody tells you to do. I completed Biochemistry and Anatomy in about a month each. Halfway through Physiology, I realized I was chewing more than I could swallow. I made the decision to abandon Kaplans altogether. These 2 months I regretted.

UWORLD: (~3 months)
I then started solving UWORLD questions for the sole purpose of learning. It was really tough for me since I usually got 40-50% right per block. But I didn't fret. I spent a lot of time on the explanations and studied UWORLD as my primary knowledge base. Once completed, I revised them completely a second time briefly (and a third time after my first FA read). Here I would like to mention that while UWORLD is a very good learning tool, I would not recommend it as an assessment tool. It is much harder than the actual exam and tends to ask questions in a very different way.

First Aid: (2 months till exam)
First Aid is the best prep you can get. Almost all of the exam is from First Aid. At first it may look like a strange jumbled up piece of crap but with repetition, you come to realize its greatness. It tells you everything you should know for the exam.The biochemistry part might be a little hard to fathom if your old knowledge is dusty. That's the only part where studying the biochem Kaplan felt relevant: to ease the transition to First Aid. I studied Pathoma for the system part of FA too but felt it was redundant and left it as well. The first read of First Aid is very important. You need to make sure you understand each and everything written there, even if you don't remember it later. I spent an average of one day per chapter for my first read, just making sure I understood everything. The second read should be to identify your weak points and stuff you tend to forget. With each subsequent read, you'd realize the problematic stuff gets smaller and smaller and you feel more comfortable with the book.

NBME's are the best representatives of the actual exam. I took my first NBME 35 days out (NBME 11) after feeling a little confident with FA and got a 234. It was okay but I believed I could score higher. Still, I booked 27th November for the exam, being confident that I'd make it better in that time. 5 days out, I took NBME 16 and got 237. I was devastated. I felt like running around circles. I really thought I was going to improve but a score of 237 felt like I wasn't doing enough. My performance charts for both NBME's are shown. Then I had a Eurika moment when I was going through the explanations of questions. I realized that the exam is only as difficult as you make it to be. There was a question in NBME 16 that sounded like one of those that you feel like you have no idea about. And when I found the right answer, I realized that it demanded the simplest possible explanation for it. Bearing this in mind (and the thought that 240ish wasn't a bad score either), I gathered my confidence and went for the exam.

Exam day:
Naturally, I was extremely anxious but confident too. I took a lot of chocolates with me and some Panadol Extra tablets. I did the first two blocks in one go because I was feeling very confident. I did each question as quickly as possible while marking the doubtful/ difficult ones. Almost everybody I knew had problems with their timing and this is the best strategy to deal with it. With this strategy I always had 6-10 minutes surplus after the first go in each block. NEVER spend any time trying to confirm the answer in the first go, do it in the surplus time. My first block was really tough but the second one was okay. I took a 5-7 minutes break and did two more blocks. Then two more and then the final one. Briefly, blocks 1, 6 and 7 felt really tough and I had to mark 13-16 questions per block. Blocks 2, 3, 4 and 5 felt very easy and I marked 6-7 questions per block. After the exam I wasn't sure how I performed but I was confident I wouldn't get a bad score.

General advice:
1. Confidence is key. You should be confident that you know everything and are ready for the exam. Keep a date in your mind and stick with it. I had planned for the last week of November from Day 1. I got the triad of October-November-December but never once thought of delaying the exam.
2. Don't listen to people too much, believe in yourself. When I decided to go ahead with my last score of 237, a lot of people tried to convince me to delay my exam. Some even joked that I should leave the exam half-completed if it felt too difficult so I could reappear.
3. Never be afraid of a question. Always tell yourself that you know the idea behind the question and it's only a matter of getting there. You should never feel like "Oh my God, I never studied this/ forgot this". Most of the times, you can easily get the right answer in such questions just by simplifying it.
4. Try reading the last line of each question before reading the full question. It tells you what to look for before reading the question. This is very very helpful.
5. Keep yourself positive no matter what i.e. don't think you can't do anything but study. In the last month leading to the exam, I took a week off to study for FCPS Part I and went out with friends on several occasions including going to the cinema once.
6. People had scared me that anatomy is really tough on the exam and I should have studied a separate book for that. I did not feel so. While there were really tough scenarios, the questions were really simple. Most of it I knew from my knowledge of first year anatomy. You may study a separate book for it if you like but I wouldn't recommend it.

Eventual score and conclusion:

My actual score was 251 which I had a lot of trouble believing. It was definitely much higher than I expected. It shows that while NBME's are an essential tool, you should never let them keep you down. That being said, I would also like to emphasize that what's true for me, might not be true for you. Feel free to post any queries, I'd be happy to reply.

Best of luck!

Wednesday, July 4, 2012

A poem from a brilliant young doctor

The best graduate of Allama Iqbal Medical College for the session 2002 to 2007, Muhammad Zaman Khan expresses his feelings in a poem.

It is a great honor for me to introduce Dr Muhammad Zaman Khan, one of the most idealized personalities of Jinnah Hospital. Here is a glimpse of his excellence.

He expresses his feelings about the current situation in these words:

Aey Khadim-e-aala rehney de, is khidmat se bezaar hain hum
Gar jeena marna aik sa he, merney k lia tayyar hain hum
Ho malik arbon kharbon ke, aur 'Khadim' bhookhey nangoun ke?
Ye shaubada bazi rehney de, be-haal sahi, baidaar hain hum
Auroun ki to wa’da shikni par, cheekhay bhi bohat, chillaey bohat
Kuch yaad dilaya ham ne agar, to keh daala “ghaddaar hain hum”

Hum tairey a’qoubat khanoon main, goonjey hain hila kar bunyaadain
Hum cheekh nahi majbooron ki, Aa ghour se sun lalkaar hain hum

Ye ehl-e-sitam ham se larr kar, khud haamptay kaamptay phirtey hain
Lapkey to jala kar rakh dain gey, ae barq! Subak raftaar hain hum

Haan tuj se shikayat na-haq he, han tuj se taqaaza khoob nahi
Hum ne hi diye they vote tujhe, is zulm k bhi haq-daar hain hum
Wake up, Pakistan.

Tuesday, July 3, 2012

Salute to the Punjab Government

When doctors are emotionally blackmailed to work and arrested for non-compliance, it's time for them to go.

I am a medical student of Final Year in a public medical college. I scored straight A's in both O and A Levels and have been passing my annual professional exams in first divisions. So you can safely presume that I'm not retarded.

Not long ago, I made the very tough decision to enter this profession. Now, I was facing the very tough decision whether to serve my country or go abroad and earn a worthwhile salary. But this decision has been made for me, thanks to the Punjab Government.

Lets take a quick round-up of the doctors' strike:

  • Doctors went on strike for a service structure last year but the government merely increased the existing pays to cool the doctors down and promised a proper service structure.
  • February 2012: Supreme Court orders Punjab Government to give the doctors a service structure.
  • May 2012: Doctors continue to pursue the government to give the doctors a service structures or they'll call a strike.
  • 15th June, 2012: Doctors call an OPD strike. This doubled their duty as instead of dealing OPD patients in office hours, they were dealing with them 24/7 in the emergencies. Wards and Operation Theaters were running as normal too.
  • Media gives the impression "Doctors are on strike and patients are dying". The public and the government are convinced.

  • 1st July, 2012: YDA calls a meeting of it's general body to discuss the future of the strike.
  • 11.30 PM: Police raids the Services Hospitals hostels and arrests all doctors in their sight. Remember, these were the doctors who were resting after their Emergency shift and were going to work the next shift.
  • After this treatment, all doctors from public hospitals flee. 

Now let's answer a few questions in the minds of the public.

Where is the injustice?
In Pakistan, doctors do not have a service structure. What this essentially means is that after 5 years of MBBS, about 50% of the doctors will get a paid house job of Rs 22,000 per month (Yes! In contrary to the blatant government lie that doctors earn at least 60,000!). The rest will work as honorary house officers, not earning a dime for their 36 hours shifts. After the house job, he'll have to pass FCPS Part-I to get employed as a trainee. If he is lucky enough to get a paid seat, he'll earn Rs 44,000 per month. Otherwise, he'll have to work honorary till a paid seat is vacated. Once he completes 4 years of his specialization, his contract ends and he is unemployed again. Again, he can start working on an honorary post as a Senior Registrar till a paid seat is available. Yes, 5 years of MBBS, 1 year of house job, 4 years of FCPS and there is still no guarantee of a paid job. I personally know a Senior Registrar working for free, tell me and I'll tell you the correspondence.
So who are the senior doctors? Out of about 34,000 young doctors in Punjab, only 200 will get from grade 17 to 20 via Public Service Commission. Wonderful prospects there, you see.
If there's one thing the doctors are fighting for, it's equality. Equality with other professions of this country, if not any special treatment.

What about the taxes spent on doctors?
Hardly any money is spent on doctors in reality. The medical teachers don't earn much, and facilities are in alarming state. Regardless, first the 90% female doctors who don't even practice after graduating should be held accountable instead of the ones working tirelessly in the wards. So please, think before you speak

Isn't this country too poor to afford this service structure?
No. Healthcare is a top priority in all developed countries. But we are an unfortunate lot where the state has failed to give the doctors a service structure for the past 65 years. Here, Rs 2 billion are spent on laptops to support political campaigns but we are too poor for an efficient healthcare system.

What do doctors earn in other countries?
Doctors mostly go to the gulf, US, UK or Australia.
KSA- 4,000 riyals onwards.
USA- $10,000 onwards.
UK- 2,000 pounds onwards.
Australia- $7,000 onwards.
And just for interest, Indian doctors earn 1,70,000 Indian rupees. That's more than PKR 2 lacs.

Why don't they leave then?
This, just like our Ex-Prime Minister, is the million dollar question. The doctors are putting their patients- the poor Pakistanis ahead of their prospects to earn abroad. But they are frustrated now. They want a better future in Pakistan, or else other countries will sweep this country of it's finest minds.

As for me, I don't see how things are going to get any better for doctors in this country. Naturally, I have planned to apply abroad. And I'd like to salute the Punjab Government for helping me and many others like me to make this decision.

Thursday, May 5, 2011

Shh... Don't tell the Taliban

While contradicting statements keep coming, it's not that difficult to make out the actual story behind Osama's death.

Let's analyze the story at hand. The following are a few key points we're told:

1. Osama lived nearby the Pakistan Military Academy for years where every nook and cranny is cleared.

2. ISI, rated among the top intelligence agencies in the world didn't have any clue of his presence in such an area.

3. Four combat helicopters entered the Pakistan airspace up till the PMA (about 300 km assuming they came from the Afghan border) and Pakistan didn't have any idea.

4. There was a 40 minutes' operation near the PMA and still, Pakistan didn't have any idea until after they left.

5. All this happened while PAF didn't have any idea, though with all their state-of-the-art technological equipment, their response time to an airspace violation is 5 minutes.

6. The government, army and ISI, all made public statements/ apologies about their ignorance.

The response in Pakistan:
  1. Confusion and insult for the majority.
  2. Protests, funerals and tears by some religious parties.
  3. Terrible threats by the Taliban to attack Pakistan in every way.

Now, I'd like to bring to your attention a tweet of a journalist in the Guardian.
"Pak diplomat just told me: we have to play to our people's sensitivities. of course we were involved but we can't admit it"

Add that to the possibility that we were told about our involvement and imagine what the response would have been. I rest my case.