Tag Archives: young doctors

Aftermath of Doctors’ strike

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By Farkhanda Qaiser

“Baji aap ko tu mehanga kapra dunga main…!” The shopkeeper said maliciously.

“Hain Bhai sahib? Magar kyun?” The lady was bewildered.

“Kyunki aap doctor hain…!” came the reply.

This incident occurred recently with a friend’s aunt who happens to be a dentist-turned-housewife. And I fear more such incidents as an aftermath to the young doctors’ strike and the successful negative propaganda by Punjab Government. (I call it successful because it achieved its desired result – turning majority of the civil society against doctors).

However the matter is not so simple. It will have long-term effects. This defaming media hype has created a trust deficit between the physician and the patient. The patients have been made to believe that doctors of today are purely greedy souls who would go to any limit for their pay hikes. When in fact, the truth is quite different. The issue is not about increasing salaries rather it’s about job security via a proper service structure. It’s about diminishing bureaucratic and political influence from the induction, promotion and transfers of doctors. This measure would ensure the promotion of merit as opposed to a ‘sifarish culture’ which is prevalent in our society at present. Hence, the opposition from the Punjab Government can be explained by this simple fact.

Nevertheless the sacred trust that exists between a physician and his patient must be preserved at all costs. So now it is our responsibility to bring back that lost faith. Or else we could suffer a similar fate as that of Indian doctors.

Yes, our Indian counterparts have also resorted to strikes countless times. Theirs had been an old story spreading over the course of almost 10 years. The demands were – pay hike and time-bound promotions. The response of their government was very similar to that of Punjab Government but minus the brutal crackdown i.e. appointment of ad-hoc doctors and adoption of delaying tactics to sabotage the just demands of doctors. However the public reaction was very alarming. There were innumerable cases of assaults on doctors along with token-protests by social organizations like Gujars and trade associations of Rajasthan.

Let’s hope the situation doesn’t get this bad in Pakistan.

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Role of Media in doctors’ alienation from the society

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By Farkhanda Qaiser

“The Lahore High Court ordered young doctors on Saturday to end their strike and resume work in outpatient and inpatient departments of all government hospitals from Monday morning,’’ reads a headline in today’s local newspaper.

Photo credits: Dr Osman Zia

By now, thanks to our vibrant electronic media, most of you must have heard this news already. However special attention must be paid to the phrase ‘from Monday morning,’ which means the court has given the doctors a deadline till Monday to return to their duties. Until then they can’t be accused of contempt of court if they don’t start their work. But our Azad Media wants us to believe otherwise. Infact I was at first shocked and then angered at the way our channels very conveniently omitted the above mentioned phrase and kept on opining in breaking news how the doctors were not following court orders as they were still on strike in OPDs and indoors…!

This is just an illustration of how the facts can be twisted by media and how doing so can color the emotions of the general public. Don’t get me wrong, I’m not about to start a debate on the conspiracy theory that most of our media has been sold off to the Punjab Government on the doctors’ issue. Being an optimistic Pakistani, I don’t want to believe in this theory because I’ve seen this same media standing up for its freedom countless times. I remember how it reported in detail the visits of the Chief Justice to various bar associations during the lawyer’s movement much to the displeasure of the then government; how the Musharraf regime pressurized the Cable Operators Association of Pakistan (CAP) to take GEO and Aaj TV off their network for criticizing the Pakistan Army; how the Zardari-gilani led elected government wanted gag orders for media in the NRO implementation case…but the media showed persistence throughout and stuck to the principals of free and independent reporting.

On the other hand, we have also seen examples of how the media over-sensationalized simple news items to increase their TRP (Target rating points). The on-going doctors’ strike is sadly such an issue. In the first few days of the peaceful OPD strike, visuals of patients crying due to their sufferings were shown again and again without even mentioning the fact that these patients were being duly treated in the emergencies and indoors…! As the strike progressed, anchorpersons kept on bemoaning that patients were ‘dying’ due to the doctors’ stubbornness. However as I mentioned in my previous blog, an anchorperson on GeoTv admitted the fact that no death had taken place during the first 12 days of the OPD strike until the crackdown on doctors by Punjab police after which doctors were forced to take shelters in their homes to avoid arrests. Moreover the brutal torture of doctors was also not widely reported so much so that when this was brought up in discussions on Social Media, many people refused to believe so. Now in the culmination of the issue when the Lahore High Court has intervened and issued direct orders, we again see how the media is misreporting the facts.

I don’t know why the media is doing this neither am I interested in finding out but all I can see is that due to this irresponsible behavior of the media, the common man is turning against the doctors. He is forced to believe that doctors are selfish souls who are making their patients suffer just for monetary gains. When infact the truth is not so simple and not so gruesome!

Before the situation worsens any further, the media must stop and re-analyze its strategy in unbiased reporting of the facts. Or else we may see mass shunning of doctors by civil society and social organizations as happened in India. During the Junior Doctors’ strike in Rajasthan last year, the milkmen discontinued the supply of milk to doctors while the trade associations closed their shops to show displeasure against the Residents. Thankfully the state of affairs in Pakistan has not reached that level yet but it could soon be heading towards the social alienation of doctors if the media does not watch itself.

Having said that, I also believe that the doctors must re-define their policy as well. They shouldn’t at any cost disobey the orders of LHC because doing so will further tarnish their image in the eyes of the general public which firmly believes in this independent judiciary. However this doesn’t mean that the doctors should give up their just demand of service structure. Instead they should find an alternative way to lodge their protest. For instance setting up free medical camps outside government hospitals; wearing black armbands to show their displeasure with the Punjab Government for reneging on its promises and also doing awareness seminars all over Pakistan to explain to the civil society how a proper service structure for doctors would eventually improve the healthcare system. What purpose would this serve? It would unite the doctors, civil society and media against the government. Because under the present circumstances, the doctors can’t hope to win their battle alone. And even if they do, it’ll be a very uphill task in which the respect of this noble profession may be lost. Are the doctors willing to pay that price?

P.S. I would clarify here that I’m not against doctors’ strikes in OPDs as long as they are serving a purpose and are for a long-term benefit to the healthcare system. But in the present scenario, a continued strike would further alienate doctors and that’s why I think it should be called off.

The Doctors’ strike: Sifting the myth from the facts

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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.