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Social Welfare
Democratic System

As usual, I have read with keen interest your ‘Off the Record’ column about the chief guest of the SAARC Congress of Ophthalmology. You have rightly stated that conference organizers appropriately selected Prof Saleh Memon, an eminent devoted and dedicated ophthalmic surgeon as the chief guest of the conference. You have been stressing since long that the medical profession should Honour its own seniors and hold conferences at the medical institution spending least amount of money. This may then reflect eventually on reduction of burden on the patients through uncalled for raise in prices of medicines. It is heartening to know that Prof. Saleh Memon is serving the poor and the marginalized with missionary zeal. Such devoted  healthcare professionals are not many in Pakistan. They are sources of inspiration and role models for the younger generation of doctors.

Equity and equality is crucial for the efficient running of the health care system. In Pakistan 60% of people live below the poverty line or just above it i.e. they cannot afford even two square meals a day. Then there is a lower middle and middle- middle income group class who cannot afford expensive treatments and need cost effective treatments. Real Pakistan lives in the rural areas and the slums of the cities and not in Clifton’s, Gulberg’s, DHA’s and Bahria’s of Pakistan. In its philosophy, the primary and secondary health care should cater for the needs of the large majority of the people (nearly 99%) and only 1% are to be served at tertiary care.

A journalist from the USA, Mr. Nicholas Kristoph working for the prestigious New York Times went on his annual study tour with American university students to Nepal. He observed Nepalese Dr. Sanduk Ruit working in the rural ophthalmological center performing a single cataract operation using a microsurgery technique that cost $ 25 per operation with success rates equal to the far costlier methods, used through complex machines. The cataract surgery took only five minutes. By then Dr Ruit had done over 100,000 operations successfully. Picked from there, this Nepalese method is now taught in USA medical schools and practiced in poor third world countries in Africa and Asia. The American Journal of Ophthalmology published a study of a randomized trial finding that Dr. Ruits technique had exactly the same outcome (98% success at 6 month follow up) as the more expensive surgeries done in the West, which ironically also took longer. Dr Ruits ophthalmological center also manufactures 450,000 tiny lenses a year keeping the cost to $3 as compared to $200 in the West. The quality is excellent and they are exported to 50 countries. The center also manufactures a realistic looking prosthetic for those needing artificial eye, costing $3 compared to $150 for an imported prosthesis.

This example can be emulated by Pakistani professionals. Medical research (similar to that conducted in Nepal) should be aimed at solving people’s problems rather than securing promotions, self-aggrandizement and personal gratification. In the same vein, Prof Saleh Memon has raised the all-important issue of common people’s health care and has appropriately alluded to community based health care in Pakistan as a solution to our woes. Extravagant tertiary care projects at the cost of neglect of primary and secondary care are a luxury we can ill afford.

We can extend the argument further into virtually all fields of medicine and surgery by a greater emphasis on detailed history taking and meticulous physical examination. This will help in undertaking only the most pertinent lab tests. Use of cost effective generic essential medicines could then combine with these measures in scientific yet cost effective health care in line with Dr Ruit’s model of ophthalmic care. Unfortunately none of these obviously advantageous and sensible measures are in place in Pakistan.

To add insult to the injury we are perhaps the only country in the region that does not follow the WHO recommended ‘Essential Medicines’ system. Prof Saleh Memon has rightly exhorted health care professionals in the SAARC countries to persuade their governments to adopt social welfare democratic system to provide people with free of cost universal health care and education to their people. It is pertinent to point out that Sri Lanka is pursuing a social welfare system providing universal health care and education. It is no surprise that the country enjoys a 100% quality literacy rate. Everyone is able to express clearly in their native language as well as English. Sri Lanka’s health indicators are also as good as its education stats. The infant mortality rate is 8 per 1000 births (going down by the day) and other health indicators are equally praise worthy. More relevantly it is a major supplier of corneas, the world over and in particular to Pakistan.

Sri Lanka’s per capita income is more than twice of Pakistan. There is dire need that Pakistan becomes a social democratic welfare state as envisaged by the founder of the nation. Prof. Saleh Memon should be congratulated for raising health issues pertaining to suffering humanity. Kudos to you for raising people’s issues in your publication unlike our mainstream media who only indulge in non-issues to improve their ratings.

Prof. Emeritus Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General Army/ DGMS (IS).

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