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.