off record
Shaukat Ali Jawaid

Different types

Dr. Saad Khalid Niaz is a well-known gastroenterologist of the country but what is more special about him is that he is a good human being, kind hearted physician who not only believes, promotes but also practices ethical medicine. Despite the fact that he is not in government service, in collaboration with Prof. M. Saeed Qureshi the present Vice Chancellor of Dow University of Health Sciences he has been doing commendable job of providing free service at Civil Hospital Karachi for the last many years. Prof. Saeed Qureshi with the help of Dr. Saad K. Niaz and other colleagues has established this state of the art unit where all sort of complicated gastroenterology interventional procedures are performed free of cost. The unit is equipped with latest equipment and instruments most of which has been arranged through donations’ and they have over the years trained a large number of specialists in this field.

Last week Dr. Saad K. Niaz posted the following mail on the social media which I found very interesting and true reflections of feelings of many and it did attract lot of comments. I am taking the liberty to reproduce that rare disease which he has named as “EXPATITIS” with its classifications and it also gives signs and symptoms of this disorder:

“Do you live in UK, US, Canada, Europe but are an expert on everything that happens in Pakistan?

Do you constantly explain the way things work in Pakistan to resident Pakistanis? 
You might be an “expatsplainer”* or suffering from EXPATITIS

How to recognize the symptoms of EXPATITIS
EXPATITS-A = American resident, strange accent, convinced fintech will solve Pakistan’s problems
EXPATITIS-B = Britain resident, hates Southall for “ruining” atmosphere
EXPATITIS-C = Canadian resident, tries to convince you Justin Trudeau is Muslim
EXPATITIS-D = Dubai resident, talks non-stop about price of studio apartments, calls Emirates flight attendants “friends”
EXPATITIS-AU = Australia resident, unintelligible accent, married to kangaroo for Australian nationality
EXPATITIS-E = European resident, pretends to not speak English, argues against circumcision”
Get help now: Call 1-800-EXPATITIS

Someone added, there is another type which is REPATITIS -F: Frustrated Resident Pakistanis, who are suffering from a state of National Depression, Shortsightedness, and Deprived of a Nationhood.

It is absolutely true that many Pakistanis living abroad think themselves experts who can solve all the problems which we face in Pakistan but they are neither interested to live here nor work here. On the contrary those who went abroad for post-graduation and other higher studies came back to serve their motherland are thousand times better than these overseas Pakistanis and their services needs to be commended and appreciated. I have already written that Americanization of Pakistan’s Health Services is not a solution to our problems and we need to find indigenous solution which is also cost effective. Our health planners and managers need to look at how our neighboring countries like Sri Lanka, Iran and Bangladesh solved their health problems, brought down infant, maternal mortality, checked the population growth, established best primary healthcare but our planners are more interested in visiting Europe and America and then come back with ideas borrowed from there and try to transplant them without realizing that it is Pakistan and not Europe or America.

Our generation was also lucky as we who were taught while sitting on the Tats had very good teachers who knew the art of teaching. I remember while in Class VI one day our teacher told us a story which goes like this.” There were two very dear friends and they loved each other so much that none of them could see his friend in pain, agony or discomfort. Once they were travelling to the nearby village. On way they decided to rest for a while under the shadow of a tree. One of them went to sleep while resting and the other waited till he gets up to resume their journey. He also noted that a fly was constantly hovering over the face of his friend and would often sit on his nose or other parts of face. He tried his best to ensure that it flies away but it would come back again and again and sit on the face of his dear friend. He got upset, took a wooden stick and killed the fly sitting on the forehead of his friend. During this process, he hit his friend so hard that he had brain hemorrhage and also died later. The moral of the story, we were told was that be careful of your foolish friends.” Today I pray the same for our present government.

As medical Editors we also know that even if the objectives are very noble, if the methodology used to achieve those objectives is not correct, one cannot ensure the desired positive results and often such papers get rejected. No one will disagree with the present government’s desire to improve the health services, medical education but the method being adopted is foolish to say the least. Instead of coercive measures, there is a need to appeal to the conscious of the healthcare professionals, medical teachers. To begin with just provide them comfortable working environment, security, good remuneration so that they can live an Honourable life alongwith their family and are also able to arrange education of their children. Give them respect and recognize their good work.

The numerous medical and dental colleges which have been established all over the country should be persuaded to look after the healthcare needs of particular districts. After talking to all the stake holders, they can be asked to take responsibility for preventive as well as curative services of their designated districts where they can set up a proper referral system and are linked with the Basic Health Units, Rural Health Centers, Tehsil and District Hospitals. In return the government must give them some incentives, concessions and facilities. Consultants from these institutions can be asked to visit their affiliated secondary healthcare facilities if need be on rotation. Medical students can also be exposed to the real world where most of them are going to practice after graduation. Maternal and Child healthcare services can be strengthened, vaccination against communicable diseases improved and accelerated. Medical students can also be effectively used for imparting Health education to the masses and all this will go a long way in reducing the rush to big cities and particularly at the teaching hospitals in public sector which can then concentrate on serious cases which need their expertize much more.

Services of renowned physicians and surgeons enjoying good reputation, known for their intellectual integrity who have known academic accomplishments to their credit can be acquired. Since they enjoy respect of their colleagues junior as well as seniors and there is no dearth of them in every specialty, if they say something, they are likely to get an overwhelming response. Healthcare professionals will not only listen to them but will also be prepared to accept their advice to help improve the medical education. Constant assessment of the medical students throughout their studies and giving them feedback at frequent intervals will help them become good doctors. They can learn a lot as regards ethical medical practice when they see some good role models. Opting for yet another exam is not the solution. If we cannot check cheating in FSc exam and to overcome this, we introduced entrance test a few years ago hence what is the guarantee that there won’t be problems with yet another exam which the rulers wish the doctors to take before starting house job and practice. Would they then recommend yet another exam to overcome the problems, where are we going to stop all this?

We must remember most often it is the highly talented students who join medicine but the way the media is currently engaged in malicious campaign against the doctors whereby they are painted as butchers, thieves and dacoits, men with no heart who have no sympathy for the poor etc., the situation is going to change for the worst. At present the number of boys opting Medicine has already declined to a great extent and we see girls being enrolled in medical and dental colleges who occupy almost 70% of the seats. After graduation, at the most only 20% will practice medicine and they too won’t be interested to serve in small towns what to talk of rural areas due to the prevailing situation and culture. Hence, what is going to happen in the next few years is that we will find it difficult to fill jobs of doctors even in cities as many of those boys who will graduate, will leave the country overseas where they find better job opportunities, security of service and comfortable working environment. Even within the country boys find other professions i.e., business, information technology, banking, finance more rewarding and one can find a good highly paid job after four to five years of studies while on the other hand, the doctors have to study much longer and even after that they need to continue studies to keep themselves abreast of latest developments in medicine. Those who wish to opt for specialization, have to spend many more years doing Fellowship, second fellowship in different specialties, some go abroad for higher studies. Those who wish to do PhD or Masters have to spend still some more years and even after all that their salaries structure being offered is no match to other graduates. Children of many doctors who see their parent’s busy all the time, are not at all interested to take up medicine as a profession. Hence, it is time that our economic manages, health planners and above all the rulers and politicians in particular wake up before it is too late. No one will disagree that those found involved in criminal negligence should be punished, there should be some system of monitoring and accountability in place but the malicious campaign currently run by the media against the doctors which has also resulted in increased violence against the healthcare facilities and healthcare professionals in the country are going to have very serious consequences and all those concerned should take some effective measures before it is too late.

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