off record
Shaukat Ali Jawaid


Cost effective management
of Hypertension


According to the National Health Survey of Pakistan conducted many years ago about 18% of adults in Pakistan suffer from High Blood Pressure but the factual position is that the number may be still higher. Since hypertension is not detected at an early stage, many of the patients in the rural areas in particular, come to know about it when they suffer some complications like acute myocardial infarction or stroke. Ideally every patient visiting a doctor for any disorder should get his blood pressure checked and it is also the duty of the healthcare professionals to check the blood pressure of every patient they examine but it never happens which has made the situation worse.

Professional specialty organizations like Pakistan Cardiac Society and Pakistan Hypertension League have done very little in the field of prevention and not many seems to be interested in this. Most often these organizations are content with holding their meetings at  Five Star Hotels in the country on regular basis all paid for and funded by the pharmaceutical industry  which makes the situation still worse for the poor patients. The conference organizers demand millions of rupees from the Pharma companies which in return pass it on to the patients in the shape of high cost of drugs, procedures. Thus healthcare professionals instead of becoming a part of the solution have unfortunately become part of the problem. Either there should be complete ban on funding of such events at Five Star Hotels by the Pharma Industry or the organizers should be asked to keep their expenditures to a bare minimum, restricting it to registered delegates only and refusing to sponsor lunches and dinners so that it does not reflect in the shape of higher cost of drugs.

Speaking at the World Hypertension Day meeting held at Karachi on May 7, jointly organized by Pakistan Hypertension League and OBS Pakistan, Prof. Khawar Kazmi an eminent cardiologist from the Aga Khan University Hospital who in the past too has been talking about prevention of cardiovascular diseases and upholding professional ethics came up with a very practical, feasible and workable cost effective solution to control ever increasing menace of Hypertension which has now become an epidemic. He suggested that the only solution to the problem we face was in setting up a chain of Hypertension Clinics all over the country in each and every healthcare facility. This is something which has been done by some other countries facing situation similar to Pakistan, he added. Having set up these clinics, it must be ensured that economically priced Amlodipine and diuretics are easily available. The objective should be to first control the high blood pressure and prevent complications. These Generics will be very economically priced and affordable for a vast majority of the patients. All antihypertensive drugs are effective and they lower the blood pressure. Once this is achieved, then one can talk about different classes of antihypertensive and what should be used in which situation. Since these Generics will be used in great quantity, many drug manufacturers will also find it economically feasible proposition.

It is indeed heartening to note that we still have among our ranks conscious, ethical and right thinking healthcare professionals like Prof. Khawar Kazmi. The suggestion is excellent but what we need is how to implement it?  It again comes under the domain of healthcare professionals to implement it and put it into practice if they are serious to control hypertension and not interested in their own personal welfare of asking undue favour from the Pharma industry and uphold professional ethics. One hopes that Prof. Khawar Kazmi’s suggestion will wake up the conscious of healthcare professionals. Let the Pakistan Cardiac Society and Pakistan Hypertension League take up this issue jointly and after meaningful discussions with the pharmaceutical trade and industry, chalk out a plan of action for setting up these Hypertension Clinics which can be easily accomplished without any finances.  It just calls for one or two rooms at the healthcare facility and appointing a dedicated staff to man and run these Hypertension Clinics from among the army of doctors working at these facilities. Pharma industry will be too glad to sponsor running and maintenance of such facilities if they are spared from the ever increasing demands of “Bhatta Collection” by various groups in the medical profession.

There is no dearth of ethical, kind hearted, God fearing healthcare professionals who think on the same lines like Prof. Khawar Kazmi. Let us pray that we have many more  people like Khawar Kazmi, Lt. Gen. Mahmud Ahmad Akhtar, Prof.Kh.Saadiq Husain,  Dr. Alaf Khan, Prof. Hasan Aziz just to name a few. On our part we have always tried to highlight all those who speak for upholding professional ethics, care for the poor patients and are genuinely interested in the welfare of the patients, by showing the mirror to all the stake holders, at times at a great personal cost.

Tail Piece: Success is a numbers game and setbacks a part of it.

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