Americanization of Pakistan’s Health Services will prove disastrous for the poor

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Post COVID19 Pandemic will be a different World
Americanization of Pakistan’s Health
Services will prove disastrous for the poor
Clinicians lead groups are preparing to take on the
MBAs running health services in USA to put an end
to administrative technocracy which they believe
has destroyed medicine
HCPs all over the world protest and complain about
non provision of PPEs while they work on the
frontline putting their lives at risk

ISLAMABAD: Post COVID19 Pandemic which has so far claimed over one lac deaths all over the world with millions of people remain infected will result in a different World altogether and things are not going to be the same in every country. This tragedy has tested the health services even in the most developed world which could not stop the death of thousands of patients where the elderly were at greater risk. The richest country in the world like United States of America has also been one of the worst affected countries which have seen over a thousand deaths daily in the first week of April 2020, New York remains the worst affected city. The number of deaths in United Kingdom, European countries particularly Italy, Spain and France has also been in thousands what to talk of the situation in the Middle Income Less Developed countries with meager resources, lack of adequate health services and trained healthcare professionals. In the days to come, we will see lot of economic recession, millions of people face the threat of unemployment and all this is going to increase depression and manifold increase in medical disorders.

Healthcare professionals all over the world are protesting on the non-availability of Personal Protection Equipment’s (PPEs), N5 masks and testing kits for Corona Virus are in short supply and the number of Ventilators available to help manage serious patients are too little to save precious lives. Even they are not available. China from where the Corona virus initiated has however, managed to control the situation well with exceptional lockdown of Wuhan city which has now been opened and they have also accelerated the production of PPEs, Ventilators and Testing Kits which they are supplying to the world.

COVID19 has thoroughly exposed the myth of American Health Services in particular the richest, developed country where the Clinicians lead groups are now planning to take on the MBAs which have been running the health services putting an end to the administrative technocracy. They now believe that COVID19 will prove to be a catalyst which will burn this broken health system in United States to the ground. In USA they feel, the profession is run by MBAs getting ridiculous salaries without even touching the patients. In this system, it is the business persons which have turned this sacred calling into Dollars and Cents. We are determined to wash this filth back into the Sea from where it has oozed. Healthcare professionals in United States have been very vocal saying that when the crisis happens and they are called to sacrifice their lives in service of this calling, they are not provided any PPEs and when they protest, they are fired saying you have no voice. They have decided to hold each and every one accountable. Once this COVID crisis is over, they have already chalked out plans of an organized protest to demand security of service, safe working environment. If they fail to get their demands fulfilled, they plan to initiate a protest movement in collaboration with other professional organizations in different segments of the society to create the desired work environment which offers them safety and security. If a country like America was found not prepared to face such a Pandemic, it also sends a message to other countries who are very fond of American health services and wish to follow that.

It is not only the doctors but nurses and paramedics and in fact everyone associated with the provision of healthcare is facing a very difficult situation. The nurses are asked to take care of the COVID patients in ICUs without protective equipment which has put their life at risk. A large number of nurses and doctors have died in many countries managing these serious COVID patients. Pakistan is currently going through a very critical phase. Here too the healthcare professionals are crying for provision of PPEs and instead of providing that, they are being beaten by the members of the law enforcing agencies and arrested. The recent incident which occurred in Quetta in the first week of April where hundreds of police personnel lathe charged the protesting doctors, beat them and put them in Jail has been condemned not only by the medical profession but by representatives of the society including parliamentarians. This Video became viral on the social media which has tarnished the government image and it is also going to have serious repercussions in the days to come. Imran lead PTI Government should have been more careful while dealing with the medical profession because earlier incidents like what happened in the Punjab Institute of Cardiology which was ransacked and destroyed, a provincial health minister in KPK with the help of his guards had seriously injured a senior surgeon, have already damaged its reputation. Strangely no action was taken against both the Chief Ministers of Punjab and KPK as well as the former provincial health minister in KPK.

Medical profession all over the world is now demanding an end to non-clinical leadership telling them how to take care of the patients. They are demanding an end to this non-professional leadership and this voice will be heard with more determination all over the world once this crisis is over. Health services, the doctors believe should be run and managed by those who are sitting at bedside of the patients. These so called health administrators, they believe are in fact parasites. The EHRs should no longer be treated as cash registers and they also demand an end to Nurse Slavery. Nurses are neither slaves nor commodity but they are important members of the healthcare team who help doctors in managing patients. Many things, procedures which these health administrators ask the doctors to do not only increase the healthcare cost but it does not help the patient either. In fact a large number of the patients need not come to the hospital and they can be effectively managed to Tele-Health for which the healthcare professionals should be paid. On the contrary the HCPs need to concentrate on providing quality care, evidence based professional services, ensure patient safety and look at everything with a critical scientific eye. Patients they feel should also be held accountable as at present they expect a magic pill for everything. The society, medical profession believes, has misused their altruism and need for professional ethics.

Authorities in Pakistan will also be well advised to desist from making any further experiments of Americanization of our health services through schemes like MTIs and Governing Boards. Instead take all the stake holders including the healthcare professionals into confidence, provide them conducive comfortable working environment, concentrate on preventive strategies and improvement of primary healthcare ensuring treatment of common diseases at Dispensaries, Basic Health Units, Rural Health Centers which should be properly equipped and staffed. Once these healthcare facilities are strengthened and made fully functional, it will reduce the workload at secondary and tertiary healthcare facilities to a great extent. Introduction of a proper referral system is what we need to put into practice. The current crisis has also made it abundantly clear that it is not possible even for the richest countries of the world to provide curative services to the entire population.

If on one hand, there is a need for looking after the needs of the healthcare professionals, it is also important to educate the public and hold the patients accountable besides monitoring the media, the electronic media in particular. At present it takes pleasure in tarnishing the image of the medical profession and running breaking news of death of patients due to alleged negligence of healthcare staff. If motorcyclists do not wear helmets and come with serious head injury which most often prove to be fatal, it is not the fault of the doctors but the patients themselves. If we lack proper antenatal services and pregnant women do not consult the healthcare facilities in time for regular proper checkup so that serious cases are referred to the hospitals in time, it is again not the doctor’s fault. When such un-booked patients land at the doors of hospitals at the last minute and deliver the baby there, it becomes breaking news for the TV channels. The public in general and patients in particular needs to be educated as regards their responsibilities as well not only their rights. Change in life style, use of healthy balanced diet, regular exercise, reduction in salt intake and cessation of smoking will reduce the burden of dreaded diseases like hypertension and diabetes mellitus tremendously eliminating or reducing the need to consult doctors and visit to healthcare facilities to a great extent.

In the current COVID19 crisis first the federal government did not handle the situation well at the Taftan Border where the Zaireens coming from Iran were not properly screened, tested and provided Quarantine facilities. They were allowed to go to different parts of the country which spread this infection. Secondly ban on international flights was also not implemented in time and thirdly its failure to convince the Tableeghi Jamat to postpone its Ijtimah has helped spread this infection. Advice by the renowned religious scholars to stay at home, offer prayers at home and refrain from gathering in large number in mosques was also not heeded by some which lead to some unfortunate events. All these issues need to be seriously looked into by each and every member of the society not only by the Governments alone. They must come forward and contribute their share in overcoming this crisis. However, the government needs to give preference to provision of PPEs to healthcare professionals, arranging Testing Kits and other much needed equipment and instruments to strengthen health services. It has taken some positive steps lately and it needs to intensify its efforts. Efforts are also under way to find effective drugs to cure COVID19 Pandemic while research to find a vaccine has also been stepped up. Lot of literature is coming in daily and we will see more research activity, drug trials in the days to come. In Pakistan too there have been lot of developments particularly at University of Health Sciences Lahore where numerous research projects related to Covid19 have been initiated besides starting Telemedicine service. Telemedicine has also been started by quite a few other healthcare facilities as well as medical institutions. President Dr. Arif Alvi himself visited UHS and commended the academic and industry liaison to ensure that research output is also translated into practical use through industrial production. He also commended the use of Telemedicine for patient care.