Saturday, 15 September 2012

Doctors Strike: The Aftermath

Doctors’ Strike: The Aftermath

It has been two months since one of the largest strike by doctors shook the province of Punjab. It all started with the closure of Outdoor Patient Departments (OPDs) in all major hospitals across the province as a gesture to protest against the attitude of the Government of Punjab in provision of a better service structure for Doctors. It was a move designed to be of minimal impact because only ‘stable’ patients visit OPDs and there was no threat to patients’ lives. Last year similar protests by doctors led to a commitment by the Chief Minister to provide a new service structure and committees were formed to pave the way for formulating an acceptable formula. The closure of OPDs happened after one year of useless meetings with the representatives of Punjab government.

Last year, government was unable to control doctors and the chaos led to loss of many precious lives and ended with a truce. This time around, Khwaja Salman Rafiq (brother of Saad Rafiq and Special Assistant to Chief Minister on matters of Health) was designated the responsibility to ‘deal’ with the situation. Punjab Government started giving half-page advertisements in all major newspapers stating it had already done too much for the doctors and that doctors were essentially getting too big for their own boots. An estimated Rs. 1.6 million per day was given to newspapers and Rs. 450 million of public money was spent on advertising by ‘Khadim e Aala’s government. In addition, Essential Services Act was enforced by the govt, making it mandatory for doctors to do their OPD duties or else receive legal proceedings.

On 1st July, 2012(after 21 days of OPD closure), a police raid was conducted at Doctors’ Hostel, Services hospital Lahore, resulting in arrest of numerous doctors. The same night, hundreds of other doctors were arrested from their homes. There was another raid at Doctors’ Hostel, King Edward Medical College on the night of 2nd July. A total of 360 doctors were kept in Jails including Kot Lakhpat, Attock and Mianwali for four days. As a result of all this, emergency services were withdrawn from all major hospitals and any negotiations were made subject to release of all the doctors.

I want to recount some of the ‘stunts’ pulled out by the government during all this, apart from ‘Advertisement’ money from the public exchequer.  

1. ‘Medical Martial Law’:

As a ‘contingency’ plan during the closure of OPDs, Punjab government requested help of Army Medical Corps (AMC) to decrease patient overload. This was an unprecedented act of desperateness and expediency shown by the big-wigs of Punjab Government. This ‘experiment’ did not work out though. It failed miserably. Senior Doctors said it on record that the Army doctors were not trained to deal with such situations. Additionally, those doctors were paid Rs 2000 per hour of duty and special police contingents were employed outside hospitals where the Army doctors worked. For comparison, government of Punjab was paying Rs 800 per day to junior doctors and Rs 1400 per day to seniors whose places the Army doctors took for few days.
There were reports of those Army doctors misbehaving with the senior doctors and the ‘flexible’ duty hours practiced by our 'Jarri Jawans'. At the start of the Strike, Zaid Hamid's Baloongra's alleged that YDA punjab is actually “NGO funded Young Animal Association” and they work for money, not for saving lives. The 'Brave' Army Doctors that came 'to the rescue' didn't work for free though. This is the characteristic selective Amnesia practiced by Qibla Zaid Hamid and his followers.  For the Record, only 200 Army Doctors were deployed.!!!

The PCO Doctors

During the strike by Junior Doctors, Government hired around 500 new doctors (in place of around 5000 doctors) on ad-hoc basis. Those individuals are known these days as ‘PCO doctors’. They mostly include foreign graduates (who can’t normally get jobs at Government Hospitals as per orders of Chief Minister) and people who could not get job in ordinary circumstances. Some people, who had not practiced medicine for more than 10 years, joined the service just to get a paid Job. Chief Minister Punjab is fond of parroting the mantra of ‘Merit’ but these blatantly out-of-merit inductions did not gain his attention. All these people were hired against the rules and on ‘paid seats’ while more than 50% doctors work in government sector without getting any pay.

The legal Front

Apart from hundreds of doctors arrested without any justification, four doctors from Mayo Hospital were charged with Murder of a child that died in the Pediatrics Ward on the night of 1st July, 2012. The Strike was also challenged in court and it resulted in involvement of Lahore High Court in the matter. The court ordered to release all doctors who were arrested without any legal reason and granted bail to the four doctors alleged to be involved in the Murder. It was further ordered that matters pertaining to Service Structure should be solved amicably by the Punjab Government.

Lies and Damn Lies
Throughout the strikes, there was a continuous propaganda mongering done against the ‘Cream of Nation’. Government Officials lied on Television programs and press-conferences about doctors being greedy, selfish, hooligans etc. The entire Advertisements campaign consisted of Jacked up figures that were used to fool people.

The Aftermath

On 2nd August, one month after the strike, a follow-up meeting was called up by Young Doctors Association in Services Hospital Lahore. Dr. Amir Bandesha, member of the committee delibrating the future service structure, explained at length about the proposed changes to the existing structure and the points on which a consensus had been reached between Punjab Govt and YDAP. ‘PCO Doctors’ are still working in the hospitals despite resumption of services by young doctors and it is the demand of YDAP to transfer them to DHQs and RHCs.  After the meeting of general council of Young Doctors Association on 29th August, 2012, province-wide protests were held on 5th of September to exert further pressure on the Govt to solve our problems. Committees have failed to provide us any relief and even the Lahore High Court has been unable to enforce the writ of law. Another Protest/Dharna is planned for 19th September and a March to the CM Punjab House after that. Is another showdown between doctors and State on the way?

Friday, 14 September 2012

Brain Drain-1

(Published in The Friday Times on 14-09-2012)

,703 candidates appeared in the entry test for medical colleges in Punjab last year, competing for 5,271 seats in 40 public and private medical and dental colleges. Nearly 3,500 seats are available in 15 medical and 3 dental colleges in the public sector, while 1,850 seats are available in private medical and dental colleges. This suggests that the top 3,000 candidates would be able to secure admission in the public sector and around 2,000 more will get admission in Private Medical Institutes.

These figures raise the question: What about the rest of the 28,000 students who passed FSc (Pre-Medical) with more than 60% marks but were deemed not good enough to get admission into a medical college, either due to merit or financial issues, as Private Medical Colleges charge almost half a million rupees every year only in tuition fee? 

As the saying goes: where there is a will, there is a way. And that's another way of saying that students who want to become doctors should make use of opportunities to study medicine abroad.

Medical education in developed countries such as USA,UK, Australia and Canada is much more expensive than in Pakistan, so the options for most Pakistani students are either China or the ex-Soviet states such as Kazakhstan or Kyrgyzstan. Medical Education in these countries is imparted in English, so there's no worry about language barriers. Browse through any English or Urdu daily in Pakistan and you'll see advertisements for institutes in these countries. 

This trend of going abroad to get a degree in medicine started in the 1990s when Central Asian colleges became a destination for students who lacked good marks. It should be pointed out that the minimum eligibility criteria for the Medical Colleges Admission Test (MCAT) is 60% marks in FSc. Initially, students with marks as low as 35-40% were able to secure admissions in Central Asian colleges. It was a dream come true, a shortcut bypassing the system in Pakistan. Chinese medical institutes offering medical courses in English started in the last decade.

At present, around 2,000 Pakistanis are studying medicine in
various medical schools across Kyrgyzstan. According to the
United Nations, a July 2006 survey of medical students at nine
institutions in Kyrgyzstan rated their level of knowledge
between 2 and 2.6 on a five-point scale. In China, there are 6
 medical colleges and 1 dental college recognized by the
Pakistan Medical and Dental Council (PMDC). Each of these
medical schools has around 150-200 Pakistani students per
session. Nine hundred Pakistani medical students are presently
studying medicine in Cuba on scholarships awarded by the
Cuban government after the 2005 earthquake. But PMDC does
not recognize Cuba's medical colleges and the living conditions
of our students there are pathetic. Around 100 Pakistani
students are studying medicine in Bangladesh.

Vulnerable students are duped into some of these places with
fancy titles like 'WHO Recognized Medical Institute'. The fact
remains that WHO (World Health Organization) "has no
authority to grant any form of recognition or accreditation to
schools of medicine or other training institutions. Such a
procedure remains the exclusive prerogative of the national
government concerned." (This is WHO's own clarification.)

The Pakistani state has done little to stall this "business".
Pakistan's embassies in the respective countries do not own
the students if they face any difficulties regarding the whole
process. In Cuba, students live 15 Kilometres away from the
city in which their college is located. In China, many
universities which are not officially recognized enroll students
using paid agents in Pakistan. Every admission gets the agent a
fixed amount of money and the unsuspecting student can't get
out of this maze easily.

The big problem facing Pakistan's health system is the influx
of these Foreign Educated Doctors and their integration into
the system. These medical graduates are not at par with their
counterparts from Pakistan-based institutes and that creates a
chasm in their ability levels. In almost all the foreign
universities, clinical training, the backbone of undergraduate
programs, is seriously lacking because of obvious language
constraints. You can teach students in English but you can't
teach them all the required nuances of the local language in
such a short period of time. Without the necessary knowledge
of the local language, how can anyone get a good medical
history from a patient? (Around 70% of clinical diagnoses are
based on a patient's medical history.)

PMDC has made it compulsory for all international medical
graduates to pass a specially designed test to practice medicine
in Pakistan. This is the only intervention done on a
governmental level for these doctors. A lot of those who can't
pass the test end up working for private hospitals, as they
can't get jobs in the public sector. This alternate pathway for
medical education is going to flood Pakistan with a lot of
substandard doctors very soon.