OTR

Print
off record
 
Shaukat Ali Jawaid
 

Running Health Ministry
should
not be a joke?

In the civilized countries, all over the world the political parties have Think Tanks and Experts Panel on different subjects which help them in formulating policies. When in opposition, they have a shadow cabinet which keeps working and getting ready so that when time comes and they form Government, they do not have to struggle finding resource persons. However, this does not happen in Pakistan. Here whenever any party comes to power, they appoint friends of the party leadership or party loyalists to run and manage the affairs of a highly technical health ministry and most often tries to learn by making different experiments. That is what we have seen in Pakistan all these years.

However, one thing is common with all the political parties in Pakistan that during their tenure in office, they all have done their best to humiliate distinguished members of the medical profession. One of the reasons also being that perhaps the doctors are the most impotent professionals in Pakistan who lack sincere, dedicated honest leadership which can look after the interests of this profession and ensure that healthcare professionals get due respect and recognition which they deserve. Starting with Prof. Col. Ellahi Bakhsh Principal of King Edward Medical College who also had the unique distinction of serving the Quaid-e-Azam as his personal physician the list is quite long of those who were humiliated, defamed and their character assassination through the media went on un-checked. Some of them were even arrested and put in Jail for months and years together on cooked up corruption charges or fake cases. After months and years of investigations nothing was proved against them but no action was ever taken against those who had maneuvered it or were the mastermind behind all these cases.

Gen. Burki the Federal Health Minister in General Ayub Khan’s military government is alleged to have misbehaved with Prof, Col. Ellahi Bakhsh in a meeting of Medical Reforms Commission. He could not tolerate it and what happened later is now a history. PPP Government headed by Mr. Z.A. Bhutto in early 70s removed about thirteen hundred senior government officials and it also included three senior professors of Dow Medical College i.e. Prof. A. Rahim (Orthopedic Surgeon, Prof. Salar Akhtar Aziz, Prof of Obstetrics & Gynaecology and Prof. of Surgery Dr. Kishwar Nazli without any reason. Later all of them were reinstated as there was no charges against them. However, Prof. Rahim and Prof. Salar Aziz refused to rejoin but preferred to resign. No self-respecting person will tolerate such a humiliation. Prof. Rahim told me that till today he was trying to improve the Civil Hospital but now I will build my own private hospital and he did build the OMI. He refused to step into Civil Hospital again throughout his life despite numerous requests while Prof. Salar Akhtar Aziz left for United States.

In the recent past Prof. Eice Mohammad was sentenced to rigorous imprisonment by a Summary Military Court and spent over a year in Jail. On retrial of the case, he was found innocent and he was lucky that he was reinstated with full Honours thanks to the efforts of people like late Prof. Iftikhar Ahmad, Punjab Law Minister Ch. Ghafoor, honest bureaucrats like Mr. Pervez Masud the then Punjab Health Secretary and Mr. Anwar Zahid Punjab Chief Secretary. Late Mr. Mustafa Sadiq Editor of an Urdu Daily WAFAQ in fact played a vital role in his reinstatement and convinced Mian Nawaz Sharif the then Chief Minister Punjab to sign on his file for his reinstatement since the file sent to his office by the Health Department was lying pending unattended for quite some time.

Prof. Saeedul Haque Chaudhry a paediatrician who as Project Director of Children Hospital Lahore worked day and night was put in jail on cooked up corruption charges when he refused to oblige a dealer of electro medical equipment who wanted to supply all the equipment to the hospital. Since Prof. Saeedul Haque refused to cooperate, a character assassination campaign against him was run in the media before he was arrested. He remained in jail for quite some time and detailed enquiries proved him innocent and he was eventually set free. When I talked to him, he could not control his tears while narrating his story. Having suffered too much humiliation, he was completely shattered and died after some time.

Military dictator General Pervez Musharraf soon after the coup removing Mian Nawaz Shareef removed Prof. Shahryar Sheikh Executive Director of Punjab Institute of Cardiology since he was thought to be very close to the Sharif family. He had used his contacts with the government and used to visit the Secretariat too often getting the development files of PIC moved from one official to the other, requesting the section officers to forward the development files so that all the development plans could be completed in time. He would not mind even going to the most junior officials in the health department to find out the movement of the files. He worked tirelessly to complete the PIC. And while the government in Pakistan humiliated him, defamed him, ran character assassination campaign against him in the media, he was honoured by the world community of cardiologists when he was elected President of World Heart Federation a unique honour which no other Pakistani cardiologist has earned so far. He was thoroughly investigated, the investigating agencies used to call him from time to time at the behest of military dictator Gen. Pervez Musharraf and tell him “Doctor Sahib, we know you are innocent but we have to obey the orders. We will call you from time to time, you come have a cup of tea, spend some time with us and then we will issue a press release that you are still being investigated. It will go on for some months and then we will close the case”. Little did they realize the mental torture, agony the distinguished cardiologist of Pakistan was going through all this time. Eventually after months of enquiries nothing was found against him and the case was closed. Mian Shahbaz Sharif as Chief Minister Punjab had also established a state of the art cardiac Institute at Rawalpindi as well, Rawalpindi Institute of Cardiology. Headed by Maj. Gen. Azhar Kayani former Commandant of AFIC. This institution had earned a name and fame. The distinguished experienced faculty which he managed to recruit started making many new innovations in cardiac care, even undertaking interventions in stroke patients who were brought to the facility immediately with good results. The institute was making remarkable progress in cardiac care but this government, it is feared might destroy this institution as well due to poor administration.

Prof. Iftikhar Ahmad who served as Principal of Allama Iqbal Medical College as well as King Edward Medical College besides occupying the coveted post of Punjab Health Secretary was made Official on Special Duty (OSD) and suspended numerous times during his professional carrier as he was very critical of the role of bureaucracy and its dealing with healthcare professionals. Once he was made OSD because he did not support the Entry Test to medical colleges. He was of the view that we need to strengthen and make the FSc examination transparent so that it has credibility instead of going for another test. He had expressed apprehensions that if the result of entry test becomes controversial what will happen then. What has been going on in the country regarding entry test to medical colleges during the last few years which has only promoted corruption is now an open secret. Now after the drama of PM&DC vs. PMC, a final exit examination for all fresh medical graduates has been proposed. And if that also becomes controversial and loses its credibility, will we go for yet another examination?

Yet more recently Prof. Saeed Akhtar renowned liver transplant surgeon the Project Director of Pakistan Kidney and Liver Research Institute (PKLI) in Lahore had to face the music. Instead of recognizing his efforts to build this state of the art healthcare facility, he was humiliated by the then Chief Justice of Pakistan Mian Saqib Nisar in his court. Mian Shahbaz Sharif Chief Minister of Punjab had helped him a lot by not only providing the land but also funding to accelerate the construction of this facility with the result that it was completed in two years instead of planned three years and this is also one of the allegations against both of them why it got completed in two years. He was eventually forced to resign. One fears PKLI may not meet the same fate as that of many other institutions in public sector. It is not the job of government to run institutions, instead working on the concept of Public-Private Partnership it should help facilitate these institutions. It is still time that the Government apologizes to Prof. Saeed Akhtar, recalls him and hands over the PKLI to him to run and manage the way he had planned with the help of his team and through donations.

The case of Prof. Junaid Sarfraz is yet another story which is extremely painful. The former Vice Chancellor of University of Health Sciences faced lot of humiliation, a character assassination campaign was run against him by the vested interests that had the patronage and support of some doctors as well. He was arrested and put in Jail. During the so called investigations, one of the Secretaries is also reported to have misbehaved with him. He had to undergo lot of mental torture and his elderly parents had to spend days and nights praying for his health while in Government custody. Eventually he was found innocent after months of investigations and set free but again surprisingly no one from amongst those who planned all this was ever punished. At the end of the day the Supreme Court gave him a clean chit but can it help him or his parents to forget the miseries they had to undergo. Even at that time I had suggested that let the Chief Minister Punjab Mian Shahbaz Sharif personally apologize to Prof Junaid Sarfraz and go to see his elderly parents to console them as he had failed to protect one of his senior officials. What about the time he had to spend in Jail, who is responsible for it and will they be ever punished? UHS lost a distinguished faculty member, medical educationists as he had plans and had plans to starts to train PhDs in Medical Education. Even till today UHS has failed to find his replacement but his services are now being utilized by an army institution, National University of Medical Sciences (NUMS) where he is serving as Registrar and also looking after the Dept. of Medical Education.

While track record of most of the political parties while dealing with the medical profession and healthcare facilities is not good but the trophy has been won by the PTI as it was during its Government in Punjab that a mob ransacked Punjab Institute of Cardiology, damaged and destroyed precious electrometrical equipment, the patients had to be taken out of ICU, CCU and Emergency to save their lives though some deaths also occurred. The institute itself remained closed for few days. It was very courageous on the part of Prof. Yasmeen Rashid the provincial health minister to have rushed to PIC to control the situation where she also faced physical harassment. However, it would have been much better had she resigned on that day. Such an ugly incident has perhaps never occurred before anywhere in the world and particularly in Pakistan and this is going to stick with the PTI for a long time to come. If that was not enough, the recent Raid by NAB on NICVD Karachi which has earned a name and fame for providing free cardiac care including primary angioplasty round the clock at numerous centers in the province has also brought a bad name to the PTI government. It has been rightly condemned by the PMA and representatives of Civil Society.1 Earlier guards of PTI Health Minister in KPK had attacked and injured a faculty member of Khyber Medical College, again something very unusual which has never happened in Pakistan.

Unethical practices are rampant not only in the medical profession but also in the pharmaceutical trade and industry. National Bioethics Committee (NBC) had prepared comprehensive Guidelines which takes care of all these things if implemented in letter and spirit. Surprisingly its implementation does not need any funding just few administrative measures. I had personally handed over a copy of these Guidelines to Ms. Saira Afzal Tarrar the Federal Health Minister in Nawaz Sharif Cabinet with a request to look at it and get it implemented but I am sure she never had a chance to read this document.

Now availability of free drugs in public hospitals and in Emergency in particular has been stopped, free dialysis facilities have been stopped, provision of free drugs to cancer patients at a few designated hospitals in cancer wards had been stopped leaving the poor patients at the mercy of private hospitals. Sehat Cards are not going to be of much help in the long run. Just imagine if a patient gets sick, becomes serious and needs to be admitted to an Intensive Care Unit. The amount sanctioned with this Health Card is not going to last for more than a week or ten days. What will happen after that to the family? It will also open doors of corruption. Private hospitals trying to get enrolled in this scheme. Ideally we should improve the facilities available at the public hospitals, take measures to improve primary healthcare by engaging the Family Physicians, GPs by enrolling families in their respective areas so that they do not have to rush to the cities to teaching hospitals. On the contrary the measures being taken by the authorities will promote private hospitals and insurance companies.

Till today we do not have a National Formulary based on the WHO concept of Essential Drugs List. Pakistan is perhaps one of the only a few countries which does not have that EDL. An attempt was made in 80s and in fact a National Formulary was prepared with input from representatives of all the professional specialty organizations during a two day meeting held at National Institute of Health Islamabad. Lt. Gen. Mahmud Ahmad Akhtar an expert on Clinical Pharmacology who served as Principal of Army Medical College and later Surgeon General of Pakistan Army had made tremendous contributions in this project. The Formulary was published when Prof. Imdad Baloch was DG Health in PPP Government headed by Ms. Benazir Bhutta but as usually happens, it was never implemented. Pharmaceutical Industry has also supported this concept and according to Mr. Zahid Saeed a former Chairman of PPMA, we just need sixty billion rupees to provide all the essential drugs free of cost at all the healthcare facilities throughout Pakistan He had also suggested that let the Federal Government allocate Rs. Thirty billion and ask the provinces to contribute the remaining thirty billion rupees and the dream of supplying free drugs to patients can be realized which will also bring lot of good name to the Government. However, no one paid any heed to it as well.2 Institutional practice at public healthcare facilities is a good idea but before it could be implemented we need to develop proper infrastructure, i.e. proper waiting area for patients, their attendants and bathroom facilities which are essential and almost non-existent at present.

We keep on moving in the dark with no sense of direction hence there is no danger of our reaching a destination. But everyone must remember, a Nation which humiliates, defames and does not respect and recognize its professionals will never and cannot make any progress.

References

  1. Civil Society comes out in support of NICVD over NAB raid. Daily DAWN Metro South. November 3, 2020. Page 13-14.
  2. Zahid Saeed. Rs. 60 Billion are needed to provide essential drugs free to the whole population. Pulse International 2020; 21(7):1-5.
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