By Farkhanda Qaiser
When I heard a common man cursing the doctors and endorsing the brutal acts of the Punjab police against these saviors of life, I skipped a beat. I’m not a member of YDA neither am I yet a doctor. I’m simply a medical student who was at first intrigued by the entire issue and then alarmed when the Punjab government started the crackdown of doctors as if they were criminals.
I turned to the media channels to get the true story but was highly disappointed at the sensationalized and politicized version that greatly masked the true demands of the doctors. In the meanwhile, I kept getting text messages from my seniors that were diametrically opposite to the news updates on media. If media said that doctors are bowing down to the pressure of the government and returning to the hospitals, the text messages immediately denied these false claims. I was highly perturbed by the situation so I switched on my ‘Shahbaz Sharif’ laptop and logged onto facebook. And VIOLA…! The young doctors and their supporters had spammed every group and page condemning the actions of the Punjab government and reporting about the critical condition of the doctors who had been tortured in the police crackdown. And this is what made me turn my head. Ever since the crackdown, I had been dogging the news channels and listening to the rowdy talk shows but never once had I heard about the doctors being brutally beaten up. Why were the facts being manipulated by the media? Could I no longer trust the ‘Azad Media’ of Pakistan to deliver me the news as it really is rather than presenting a partial picture? Thus I began my own search for the truth. And there were astounding revelations along the way. I’d like to share them with my readers.
Another new demand?!
I realized that the prime allegation against YDA is that ever since its inception in 2008, it has come out on the streets multiple times and used pressure tactics to get its demands accepted. People believed that similarly this time the YDA again had a new demand for which it was making the poor patients suffer. However this was no new demand and neither were there any casualties due to the strike.
Last year when the doctors ended their 37-day OPD strike, the Punjab government assured them that not only will their salaries be increased but a comprehensive service structure will also be devised. A special committee was then constituted consisting of all stakeholders for revising the service structure of doctors and paramedics of the health department. Then followed 23 meetings of this committee over the span of a year, in which YDA scaled down the financial impact of its demands from Rs. 423 billion a year to just Rs. 4 billion; all the incentives were to be given in phases during the next five years.
Moreover in February 2012, during suo moto proceedings of the Punjab Institute of Cardiology medicine scandal, a Supreme Court bench headed by Justice Tassaduq Hussain Jilani and Justice Mian Saqib Nisar also directed the Punjab government to give a career-oriented service structure to doctors. But throughout all this time, the Punjab government has stubbornly refused to keep its promises on the grounds of financial constraints. This is the feeblest excuse on earth because we all know how this same government spends billions of rupees on foreign tours and perks and benefits for its MPAs. Can’t these greedy politicians spare a mere Rs. 4 billion for a better healthcare system?
I suppose not.
OPD strike and casualties?
After having failed in all their attempts to get their rightful demands accepted, the YDA was left with no other choice but to resort to a lock-out in OPDs. This strike started on 18th June 2012; that’s when the media’s malicious campaign started. Images of patients crying were shown and doctors were dubbed as killers without even investigating into the facts. As anyone with the minimal knowledge about the healthcare system would know that closing OPDs cannot result into any deaths because patients coming to OPD, i.e., out-patient department are not critical. Moreover these patients were being treated in emergencies and indoors which were fully functional even during the strike. So in fact the workload of doctors had increased in the days of the strike. To understand further we must look into the duties of a House Officer (a doctor doing house job). He does a 30-hour ward day once a week, 12-hour emergency once or twice a week and the rest of the days are spent doing a 6-hour indoors duty. On the other hand, OPD duty hours are very less. Hence, while the media was crying itself hoarse saying that doctors are neglecting their duty, those same young doctors were sacrificing their day and night serving their patients!
Is the doctors’ strike justified?
Yet another question has arisen time and again in media regarding the ethical value of a strike by doctors and its precedents in other countries of the world. In the past 20 years there have been strikes by medical doctors in Australia, Belgium, Canada, Chile, Finland, France, Germany, Ghana, India, Ireland, Israel, Italy, Korea, Malta, New Zealand, Peru, Serbia, Spain, Sri Lanka, Romania, USA, UK, Zambia, and Zimbabwe to name but a few. The usual causes have been pay and working conditions of doctors. Some of these strikes have led to improvements in healthcare systems, whereas others have caused lasting damage due to delayed action by the respective governments.
On the face of it, it sounds very cruel that patients are being denied treatment for their ailments albeit minor. It reminds me that not long ago, lawyers of our country carried out similar protests and closed down courts adding to the sufferings of the poor clients. However the entire civil society and media supported the lawyers in their cause of supremacy of law and independence of judiciary because they believed that a short-term inconvenience such as a strike would be balanced against a long-term improvement of the system. Now drawing an analogy between the doctors and the lawyers’ situation, we see that the doctors are also trying to achieve a better healthcare system. This brings us directly to the demand of the YDA: the service structure.
What is a service structure?
What the demand of a better service structure mean is that there should be a proper code of conduct for the induction, promotions and transfer of doctors. In its absence and without the right connections, many doctors who start their service as BPS-17 officers also retire in the same grade. Some of them are transferred to district health facilities at the whims of a grade 16 section officer. In April this year, when 691 doctors were transferred to primary and secondary healthcare centers, YDA opposed the move saying that it is not against the transfer but it believes there must be some rules and regulations governing these transfers. Moreover YDA also campaigned for the appointment of Medical Officer directly in Grade 18; for the stipend of post graduate to be made equal to that of a Medical Officer and for bringing health professional allowance equal to basic pay.
The long-term benefits:
All these measures would eventually stop the massive brain drain that is occurring at present. Medical students who study from public sector colleges see no future in staying in Pakistan unless they have a strong ‘sifarish’ to back them for promotions year after year. Thus they opt for higher studies and subsequent jobs in US, UK, Australia, Canada and even Middle East. It’s not just a matter of higher pay rather it’s about job security. If even after studying assiduously all your life and completing your graduation with flying colors, you are still dependent on a BPS-16 section officer or a fake-degree holder politician for the continuity of your job, then you’re bound to spend sleepless nights fearing for the future of your family.
And if somehow a doctor cannot manage to go abroad then he turns to the private sector, which obviously is out-of-reach for the general public. Thus improving the service structure would also serve to retain the trained staff in public sector ensuring quality healthcare for all and sundry. Here I would like to clarify a point regarding private practice. Many common people seem to believe that YDA is being very greedy by asking the poor government for financial favours when in fact these young doctors earn thousands in their private practice. Well that is clearly not the case; because it takes decades and graying-hair experience to reach that Rs. 1000 per walk-in-patient-at-private-clinics state. And of course the young doctors haven’t yet reached that state. So they’re entirely dependent on the government to cater to them.
Therefore the government should stop its high-handed behavior with the most educated cream of the nation and focus instead on solving the problems at hand.
Also YDA should not be seen as a greedy insatiable body forever protesting only for its rights but rather as a body that envisions a Pakistan with better healthcare system. In the past, YDA has also given valuable suggestions to the government of Punjab, which if implemented could radically improve the public healthcare sector. One of these suggestions is a refer system between primary healthcare (found in rural areas), secondary healthcare (found at district level) and tertiary care hospitals in cities. This means that a patient with appendicitis doesn’t have to come all the way to Jinnah hospital for his treatment. Rather he can get himself checked at DHQ Gujrat or any other primary or secondary healthcare.
For improving medical facilities in far flung areas, YDA proposed that private medical colleges owned by MNAs of political parties could be directed to supervise district hospitals, which are in abysmal condition at present.
Support us Please!
In the end I would appeal to the civil society to please support the doctors in their cause and stop cursing the noble souls who spend their lifetimes serving the poor and ill; who have continued to serve them through thick and thin whether it be bomb blasts or earthquakes or floods; who have sacrificed their countless nights to answer the call of duty; who treat their patients without caring for their own health. Please reject the negative propaganda of the Punjab government that is spending millions on doing character assassination of doctors rather than fulfilling their demands.
I would also request the media to please stop sensationalizing this issue and present an unbiased view to the public. We have high hopes from the ‘Azad media’ some fractions of which are finally realizing who the real killer is. In the 3rd July show of ‘Aaj Kamran Khan k sath’ the anchorperson admitted that not a single death had occurred during the peaceful OPD strike of doctors in the first 12 days until the use of force by the Punjab police against the doctors on the eve of 1st July after which the doctors were threatened with arrests if they returned to hospitals and some of the doctors were brutally beaten up and arrested. Since then dozens of people have died due to lack of medical staff in hospitals and only the Punjab government is to be blamed for these deaths…! Moreover city42 unveiled how false FIRs had been lodged against a couple of doctors to attain judicial orders for their remand. Similarly many anchorpersons and column writers are also presenting impartial views. However there are still many who continue to shout at doctors and showcasing them as gluttonous and callous.
Over 20 years ago, a detailed ethical justification for doctors’ strike was published in the New Zealand Medical Journal. According to this article, “what is right should result in the greatest good for the greatest number of people.” If a strike would enable doctors to have better work conditions resulting in them being better rested and thus being able to do their job better then it is fully justified. Doctors sometimes must have the courage to do unpopular and difficult things for the greater good of the public.
And this is exactly what the YDA is doing and paying heavily for.