Turkish Delight: Grand Bazaar

(I traveled to Turkey for vacation during first half of July,2014. Following is an account of my experiences in Istanbul. This is the Eleventh installment of the series, focusing on a missed opportunity to visit Topkapi Museum and things I learnt about Turkey. I hope you enjoy it.)

Cumartesi, On Ikinci Temmuz

(Saturday, 12^th July)

I had planned to visit Topkapi palace but as soon as I exited my hotel after breakfast, I felt intense pain in my upper back, just below the shoulder blade.I ignored it initially and took a morning stroll around the half-empty Isteklal Street. During the walk, I bought one of the only English-language newspapers published in Turkey (Today's Zaman) from a small store. During the walk, I noticed the inability to move my neck sideways. It was probably a strained neck muscle, so I visited the nearest Eczane (Turkey's answer to Walgreens) and got some painkillers. Thankfully, I was able to find the right tablets despite the language-barrier.  

I decided to continue with my plan and boarded the Taksim Tünel followed by a tram to Gülhane. I found Meltem and her fellow volunteers Gülhane station. They were guiding tourists about the Istanbulkart Refill machines. I spent almost 30 minutes assisting the volunteers. I wasn’t able to walk comfortable so I decided to postpone the Topkapi visit and walked towards Blue Mosque. My interest was piqued by a sign pointing to a place that used to be Hurrem Sultan's hamam. Initially I ventured towards the ladies' side of the establishment but I was then guided by a lady towards the entrance for gentlemen. At the entrance, I received a brochure for a ‘Royal Message Service’. It felt like a godsend but a) It was expensive and b) I wasn’t looking forward to jumping in the sauna with a loincloth.  

I continued my journey to to Blue Mosque’s gate A and caught up with Hatice and Bayzanur along with their fellow volunteers. Went inside the mosque and sat with Doğukan and Ahmet in the

Shady courtyard of the mosque. It was there that I learnt about traditional Turkish dishes from Sinem, and took some absurd photographs of different varieties of hair. Discovered that Today's Zaman is published by Gülen party sympathizers and they had started criticizing the Erdoğan government since the 17th December crackdown on Gülen sympathizers (Hizmet Movement) in judiciary and police.

I confessed to my volunteer friends that I had already tried etliekmek, kurimpi, simit, börek, patso, doner, Turkish delights, Turkish coffee and baklava among traditioal Turkish cuisine. They asked me to try Iskander, Mantı and Dolma apart from Turkish Pizza. Sinem and I talked about medical education in Turkey and she mentioned that Istanbul University was probably the best medical university in Turkey We also touched upon the cost of braces for teeth. As a former "sufferer" of braces, I empathized with her and reminisced about the difficulties faced by people in braces after eating any regular meal. She explained the education system of Turkey (8 years primary school, 4 years high school, entry exams and then University). I discovered that possessing a Turkish passport was only slightly better than having a Pakistani passport, as people with Turkish passports could only visit a handful of countries without visa.(Being a third world citizen really sucks!) We scattered on sight of Miss Cansu, the supervisor and landed near German fountain.

It was there that I had a good chat with Ertugrul (his name reminded of Chilean midfield player Arturo Vidal) about religion and politics (I learnt that ISIS was called "Ishit" in Turkey). He confessed about his "virtual relationship" with someone in Torino, Italy. Kaan joined us after a while.

We talked to a Ukranian family that wanted guidance regarding a place that was quite far from Fatih and the patriarch of that family was really funny. They were visiting from Kiev and supported the Euromaidan protests. They were amused by my reference to "the Chocolate King"(nickname of Ukraine's current President, as he owns chocolate factories). Kaan made a cheeky comment about him supporting Yanukovich (the deposed Ukrainian president who fled to Russia) which didn’t amuse them and they branded him a “risky boy”.

I was supposed to get a shoulder bag for my younger sister, so I sought help of Sinem in this venture.We walked to Grand Bazaar (called Kapali çarşı in Turkçe) with Kaan and Ertugral in tow. En Route, We encountered a very animated Turkish girl who knew three languages (Turkçe, Italian and Spanish with some knowledge of English). She was interested in our “group” due to the “Ask Me” shirts worn by volunteers. We did a grand tour of the Bazaar focusing on shop that sold bags but the prices were quite high, due to what Ertugrul called the "Grand Bazaar effect". Sinem informed that she could get bags of similar quality from market near her home.

As a last resort, we visited the nearby flea market and finally found a decent bag. On our way back, a restaurant worker recognized me as a Pakistani and tried to tempt me by offering Biryani with kebabs (I would’ve accepted his offer but I was not hungry and am a vegetarian anyway). On our way back, we had to make two stops as Sinem wanted to get bracelets for herself. During the return journey, we talked to a German couple from Dusseldorf who wanted to know directions to the Galata Bridge.

I wanted to get some balance charged in my account and wanted the volunteers to help me interpret it to the sales person. They took me to the nearest “Avea” franchise. To my surprise, one of the sales people was a former musician and knew Nusrat Fateh Ali Khan (one of Pakistan's finest Qawals/sufi musicians).I had to sing a stanza from NFAK’s "Dam Mast Qalandar" to convince him that I knew and revered Nusrat. I later roughly translated "Dam Dam Ali Ali" to the guy, who was pleased to entertain us.

Upon reaching the hippodrome, the group split up and I talked about Ataturk, his dictatorial tendencies and effects of "forced secularization" with Kaan and Ertugrul. We were approached by two boys doing a metropolitan survey regarding political choices in the upcoming Presidential elections. I encountered an ex-volunteer (she volunteered last year) named Rabia. She was studying English Literature at the university, favored socialism over the existing political system and had't read any socialist literature (which did surprise me). It was another day well-spent in Istanbul.

Of Protocols and Parchi System

Published on 04 January, 2012 in The Friday Times

"Kindly admit our patient, Doctor Sahab. We have talked to the Medical Superintendant and your Head of Department. They have sent us here."


I was sitting in the ward, making discharge slips for patients when someone got my attention by uttering these words. I checked the papers and found that the man was right. He had been sent to our hospital by a top office-bearer of the ruling political party in the province. I was reluctant to oblige such commands as I don't personally think political workers are any more deserving of a doctor's attention than the downtrodden people who fill government hospitals. By sheer luck, there was no vacant bed available in the ward. I explained the situation politely to the man and the hospital employee sent by the "Protocol Office" (designated to oblige influential people, their relatives and lackeys). They tried to reason with me by pointing out that the M.S. had talked to our professor twice and he had written on a slip that these people should be accommodated. I asked my immediate superior about this, and he was also of the view that we have no spare beds and can't accommodate someone just because they have better connections. He talked to my interlocutor himself and in the end the party left without the bed. This was one of those rare times when we resisted the protocol patients, as we have come to call them. Most of the time, however, anyone designated as a protocol case gets preference over ordinary patients.
At the public hospital where I work, there are special VIP and VVIP wards specified for senior bureaucrats, political figures, judges and their families. In spite of that, countless patients are referred by political figures to the hospital with small slips on their letter pads. This is true for almost every public hospital in Pakistan. As we are based in Lahore, we get most of our "slips" from party affiliates or government officials employed by the ruling party of Punjab. In other provinces, only the names change and the "slip system" remains the same. Underlying this whole culture is the belief that unless you are influential enough, you won't get good treatment from public service providers, be they doctors or engineers or policemen. This understanding breeds a more-than-bearable nepotism for any society.

The worst abusers of public service systems are public servants themselves. Senior bureaucrats consider government property as their personal fiefdom. To ensure that every whim of the politicians and bureaucrats is fulfilled, most appointments on the post of Medical Superintendents are politically motivated. Subservience and acquiescence are the requisite qualities desired by the higher-ups for the highest posts in public hospital administration. 

Doctors themselves are no less culpable. It is usually said that doctors make the worse patients. I would like to add to this axiom that they not only are the worst patients, they usually are the worst attendants as well. I distinctly remember one time when a classmate of mine at medical school brought her grandmother over to our ward for admission. We provided her with the best care that we could. After two days, she passed away. Since then my classmate has not talked to me, as if it was my fault. She herself is a doctor. 



I have worked in the Intensive Care Unit (ICU) and a lot of times we've had undeserving patients brought in by other doctors. The ICU is supposed to be for patients whose lives can be saved by intensive care and who are on the brink of death. This is true unless you happen to know a doctor; then rules and regulations can be thrown out of the window. The tragedy of public hospitals in Pakistan is that unless you know someone working there, you are not awarded any extra care. As a doctor, I always try to provide equal care to my patients, irrespective of their status. I am not alone in behaving like this. We feel ashamed when resources are diverted for the sake of "sifarshis". We are sick of tending to the favored ones. We believe that our healthcare system is already neglected and needs no further roadblocks than the ones it already confronts. My request and plea to the people at the top: kindly stop pulling your rank to make us care for your cronies. Thank You.

Brain Drain(Part 2)

(Published in The Friday Times on 12th October, 2012)

Dr. Adnan was the best graduate of his MBBS session three years ago. He had achieved the highest marks in almost all the annual exams during his five years of medical school. He completed his house job of one year and spent almost 6 months in preparing for the entrance exam to a Residency program in the United States (the USMLE or United States Medical Licensing Exam). He cleared the first two stages (it's a three-stage exam) with ease and applied for a visa, so that he could visit the United States and take the third and final exam of USMLE. But he was denied a visa for the United States. He has spent almost 300,000 rupees in fees for the tests, and it has taken him a year for him to reach this stage. But his efforts have been in vain.

126,931. That is the number of Registered Medical Practitioners (people who have obtained MBBS degrees and have completed a house job of one year) in Pakistan, according to the Pakistan Medical and Dental Council. Every year, some 8,000 fresh medical graduates join this list. A vast majority of Pakistan's medical graduates want to move to either the United States, the United Kingdom, Australia, the Middle East or other green pastures in the world beyond Pakistan. According to a report aired on Geo News on 8th August 2012, Pakistan has become the largest exporter of young doctors to Britain's state-funded National Health Service (NHS). The number of Pakistanis registered on the GMC (General Medical Council) data stood at 8,552 on 7th of August, 2012. Similarly, according to a research paper titled 'Pakistani Physicians and the Repatriation Equation', published in the New England Journal of Medicine, Pakistan has contributed approximately 10,000 international medical graduates (IMGs) to the United States. In a research conducted in 2007 titled 'Reasons for migration among medical students from Karachi', it was revealed that Over 95% of Aga Khan University (AKU) and over 65% of Baqai University (BU) final-year medical students intend to go abroad for their postgraduate training.

And all this while Pakistan is facing an acute shortage of trained doctors, according to reports by the World Health Organization (WHO).Pakistan cannot meet its needs for healthcare, given the current levels of production and dependency on physicians in the organization of the system. Although out-migration contributes to the problem, it is the growing demand for healthcare from increases in population and adverse conditions that generates ill-health. The most important question to ask about this mass migration is: Why are all these people leaving their country?

The answer is manifold and, speaking as a health professional myself, painful to state.

The survey done on medical students of Karachi's elite Aga Khan University and Baqai Medical University revealed that the two most important factors behind this intent as pointed out by the students are poor salary structure and poor quality of training in Pakistan. I can vouch from my personal experience that as soon as a medical student enters the medical school, the next big question regarding his/her life is the "plan" or path he/she intends to take after graduation. Even during the one-year training of the house job - something I am currently pursuing - the queries about the "future" are among the most frequently asked questions by one's seniors and family members.

It is an absolute travesty that in Pakistan the practice of "Career Counseling" for medical professionals is practically nonexistent. Most middle-class parents only have three or four career options for their kids: Doctor, Engineer, Banker/Accountant and if all else fails, Army. In a similar fashion, when a medical student enters medical school, it is from his/her seniors that guidance about any future plans is acquired. Traditionally, there are four ways to pursue post-graduation for Pakistani students. The first one is the FCPS (Fellow of College of Physicians and Surgeons, Pakistan) route, which involves four years of clinical training at a tertiary care hospital in Pakistan. After completing four years of training and passing the FCPS exams, you are considered a specialist in whichever field you chose to pursue. The second and most attractive option is that of obtaining a residency in the United States, where the training standards are the highest in the world. For that route, a candidate has to go through the three stages of the USMLE exam (the examination fee for each step is more than 1.5 lakh rupees), the third of which can only be done in the United States.

After the residency and an exam, the candidate becomes "Diplomat American Board" for the chosen specialty. It should be noted that the ratio of people who get their desired residency after passing the exams is around 50-60%, which means that despite getting excellent marks, you are not guaranteed to get your favored specialty (for example Anesthesia or Neurosurgery) in 50 to 60% cases. The time required to complete this whole process ranges between 3 to 5 years.

The third option is that of pursuing post-graduation in the UK. To follow that route, one first has to pass the PLAB (Professional and Linguistic Assessments Board) exam, which is a two-stage test. The examination fee for each stage is also more than one lakh rupees. After completion of PLAB, post-graduation courses are taken, based on available spots in the preferred specialty. The whole process of completing this route takes around 5-7 years. An alternate route to acquiring British certification is the MRCP/MRCS (Member of Royal College of Medicine/Surgery) route, which is a two-stage route, but the training can be obtained in Pakistan while exams have to be taken in the UK.

The fourth and latest addition to the options is that of post-graduation in Australia. For that, a candidate has to pass the entrance exam of the AMC (Australian Medical Council), which also has two separate tests. The examination fee for each step is in the range of the fee for USMLE. There is no guarantee of getting a post-graduate education in Australia even after getting excellent marks in the first entrance exam.

Most medical students in Pakistan don't know which path they will take, even whether they will be able to work in their desired field or if they will get a job where the salary is adequate after about ten years of medical training. And this, I am sorry to say, is the primary dilemma of the medical community, the so-called "cream" of the Pakistani nation.

Brain Drain-1

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

33,703 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.

Diary of a young doctor(part 6)

(Published in The Friday Times on 17th August, 2012)

Medical Science, like other disciplines of science, is a constantly evolving subject. New discoveries are being made, new ways to treat and look at diseases are being researched and newer drugs are being introduced on a daily basis. But the medical profession in Pakistan is lagging far behind the rest of the word in innovation and research. Very little, if any, research is being done by public sector hospitals and medical colleges. Apart from the Aga Khan University and Shaukat Khanam Hospital, there are no recognizable research centers in the country. Due to this issue, most of the books we consult during MBBS are written by Western or Indian authors.
It may come as a surprise to the reader that doctors in Pakistan are required to do research as part of their curriculum, both at the undergraduate and post-graduate levels. The ground realities, though, are very different. Very few of the "researches" done by Pakistani authors are published in international publications. On the undergraduate level, the research is mostly very basic and does not require much critical thinking, nor is it up to an international standard. The Community Medicine departments (responsible for overseeing research) ask students to choose from a particular list of topics on which research can be done. No funding is provided for the purposes of research. Students usually take shortcuts just to fulfill the academic requirement, and the matter is over after the final exams.
On the post-graduate level, where research is an important tool in the rest of the world, Pakistani doctors do not spend enough time on research topics. Most of the topics are re-hashed versions of the same old 'traditional' things. A grand sum of Rs 2,200 can get you a good synopsis on your chosen topic. Plagiarism is not thoroughly checked, so liberties can be taken in that regard. I questioned some of the senior doctors about this trend and they pointed out a few factors responsible for this problem.

The foremost issue is financial. Most post-graduates do not have job security and often have to work at multiple hospitals. In addition, they do not get any kind of funding for the sake of research. In such conditions, all they do is look for shortcuts to fulfill the academic requirement. In Shaukat Khanam Hospital, doctors are paid handsome salaries and have job security, resulting in some serious research work being done there. The proposed Service Structure that was the demand of doctors during their recent strikes is a much-needed step as it would at least provide job security, if not lavish pays.

The second most important reason for lack of research is the absence of critical thinking from our curricula. Research is borne out of questions about persisting problems and requires finding solutions to problems. We, on the other hand, learn and see throughout our academic life that 'he/she who crams the most, achieves the maximum marks'. From nursery school all the way to the final year of MBBS, we learn how to rote-learn particular texts and then regurgitate them in our exams. Questions are discouraged at almost every level and many teachers think it a disgrace if they do not know the answer to a student's question. In addition, there are almost no research societies working in medical colleges. The only one that I encountered was a small society working out of Punjab Medical College, Faisalabad.

The third factor in this regard is the lack of teachers and instructors who can guide students about research. This problem is present both in medical schools and in the College of Physicians and Surgeons, the premier body that awards specialization degrees in Pakistan. In many cases, the supervisors for research are not well-versed in the art of evaluating a research paper as it is very different from an examination paper.

Despite all these problems and glitches, there are still some success stories. Pakistani doctors, particularly surgeons, have developed many indigenous solutions to the problems they have faced over the years. The need of the hour is to promote critical thinking and research among the medical community so that Pakistani doctors can compete on an even keel with their international colleagues.

Diary of a Young Doctor(part 5)

(published in The Friday Times on 27th July, 2012)


"I am really thankful to you doctor sahiba, you saved my daughters' life today," said the mother of a young woman to one of my female colleagues.

The very next day, another attendant had this to say,

"You doctors are murderers. You don't know how it feels when your loved ones die. You have killed our young brother. We will never forgive you."
Both of the above-mentioned statements reflect a common misconception in our society, that doctors are supposed to be messiahs who save lives. I may have to face the wrath of some of my fellow professionals for saying it out loud, but this can't be farther from the truth. During the five years of medical school, followed by countless years of medical training, all we learn are a set number of protocols to follow. There is no subject or even a chapter dedicated in any of our books on 'How to Save a Life' (excuse me for the reference to a song with the same name by the band The Fray). The main problem with this assumption is the immense responsibility it places on the shoulders of the attending physician/surgeon. Doctors, in general, safeguard the best interests of their patients but having the mantle of 'saviour' placed on their shoulders is more than a little unfair.
As a result of the 'messiah' label, doctors become the automatic fall guys when a tragedy occurs. Doctors are obliged to do their best, regardless of the expected results, and when their efforts fail, the first impulse of the attendants is to blame the doctor for the demise of their loved one. I am not saying that medical science is guesswork; but why is the medical profession considered a "calling from God"? It is high time we learned to differentiate between a profession and a calling from God. Doctors are "working" in hospitals. They aren't on a divine mission to save everyone who comes their way. They provide a service and in return expect to get paid for it. (And we know how that's gone done in our country.)
When doctors announced a strike to demand for a better service structure, the widespread reaction was that doctors should be philanthropists who put others before themselves and don't ask for a compensation package in return for the time they have invested.
To quote the columnist Ayaz Amir: "The young doctors' strike was not about doctors versus ailing and suffering humanity. In the Islamic Republic suffering humanity is a handy cliche, readily invoked to score a political point and as readily consigned to the upper layers of forgotten memory when the need passes. If anything, this strike was doctors versus a hidebound bureaucracy, one of the most ossified bureaucracies in the lands which can claim descent from the British Raj."

During the strike by doctors, one of the major objections was that doctors were supposed to provide health services in any condition, as they have taken an oath to do so. Let me make it absolutely clear that in the original Hippocratic Oath that was formulated around the year 425 BC, there is no provision that makes it mandatory for a doctor to provide health services to anyone who wants them. In the revised Hippocratic Oath, constituted by the British Medical Association, one of the points declares: "I will do my best to help anyone in medical need, in emergencies. I will make every effort to ensure the rights of all patients are respected."
Similarly, according to PM&DC (Pakistan Medical and Dental Council) Ordinance of 16th July 2011, Section 9, Sub-Section 2 (a) : "A medical or dental practitioner shall be free to choose whom to serve, with whom to associate and lay the timings and place of professional services to be provided."

While Sub Section 2(b) reads: "A medical or dental practitioner shall not be bound to treat each and every person asking his/her services."
In my opinion, one of the underlying causes of outrage against doctors during the strikes was the "messiah" proposition. How can someone who is supposed to "save lives" go on strike? As a nation, we are prone to miracles and magical rescues; we are always hoping for some messiah to come and save us from the "mess" we are in. This messiah complex has in the past led to acquiescence to dictators and demagogues. We, as a nation, need to mature and start believing in processes and institutions, not saviours. Bottom Line: Doctors are not messiahs; they are ordinary professionals doing the best that they can.

Reflections from Pakistan India Social Media Mela 2012

(an abridged version published by Express Tribune Blogs on 16th July, 2012)

Question: What is the one common thing between a writer from Mumbai, a Journalist from Delhi, a famous film maker from India and a Junior doctor from Lahore?

Answer: The fact that all of them loved hearing Iqbal Bano(it was actually Meesha Shafi, as pointed out later by Jugal Mody) sing 'Dasht e Tanhai main' on the radio, at wee hours in the morning while waiting to get CNG at a gas station in Karachi. 

For me, that one moment captured the spirit of Pakistan India Social Media Mela 2012. No wonder the slogan of the event said, “Faasla Na Rakhen, Pyar ho Jaanay Dain’(Translation: Overcome distances, Let love happen)

Organized in Karachi by PeaceNiche, in collaboration with the United States Consulates in Lahore, Islamabad and Karachi, it was supposed to be a gathering of social media enthusiasts from India and Pakistan. This being Pakistan, the criticism leveled at the event started much before the event itself. It was an invite-only affair and most people who were invited were recommended by other people. Participants from Lahore and Islamabad were sponsored by U.S Consulates in Lahore, Islamabad and Karachi for their travel and accommodation.

It was my first visit to Karachi and I was really excited by this opportunity. I boarded the plane from Lahore airport on the evening of 12th July, along with the rest of participants from Lahore. The visit was not only an opportunity to interact with new people but also to get a respite from the hectic schedule at the hospital. During the flight, I had a good, long chat with my seat mate whom I discovered to be a fellow participant. I got some flak after the plane landed, from assorted uncles who were unfortunate enough to have gotten seats around us. The first thing that I noticed after landing in Karachi was the wind. We were transported to Avari hotel and allotted rooms. When I reached my designated room, I had to pinch myself to judge if I was not dreaming. The rooms were spacious, comfortable and had attached baths separated by glass walls.

We were offered BBQ dinner at the top floor of the hotel. That was where we first met fellow participants from India including Onir, Karuna John, Jugal Mody, Venket Ananth, Sabbah Haji, Annie Zaidi, Raheel Khurshid and Sanjay Rajoura. I immediately struck cordial notes with one of them because of me being a vegetarian. Later, I took part in an interesting discussion about Marxism, Class Struggle and Pakistan Movement taking place at an adjacent table.

The next two days were one of the best that I've had.  Despite being an adopted Lahori, I didn't miss Lahore for a moment. I wouldn't have met many of favorite people at one place if I had not come to the mela, including Nadeem F Paracha (one of my mentors), Ali Chishti, Marvi Sirmed, Beena Sarwar, Mohsin Sayeed, Muhammed Hanif, Faiza S Khan, Musharraf Ali Farooqi, Declan Walsh, Amir Mughal, Murtaza Solangi, Hassaan Belal a.k.a mighty, Sana Saleem, Ali Arqam, Zebunnisa Burki and the wonderful people from across the border. At the start of first day's session (around 9 a.m. which was an inconvenience for many people) Senator Rehman Malik, usually at the receiving end of mockery by social media people, was generously praised for urgent attention to the visa problems faced by guests from India.

The sessions were mostly insightful and informative but I personally enjoyed the off-session activities where I got the chance to interact with some amazing people.

Some of the memorable sessions dealt with online activism, role of social media in education sector, use of non-profit for non-profit organizations, online activism, Pakistan-India relations, ‘Slactivism’, impact of party politics on Social Media, Internet Censorship, Cyber-Bullying and Twitter as the new Newsroom. 
 I was a panelist at the session 'Fight Club:Rise of the Troll' alongside Bina Shah, who had come fully prepared with research, Mohsin Sayeed, star of our show and a delightful presence throughout the mela, Raza Rumi and Rab Nawaz, editor of the magazine Laaltain and member of Khudi Pakistan. Some sessions were, indeed, boring but that is how things work usually. Due to my involvment in the recent doctors' strikes, I had plenty of questions to answer. I was branded 'the revolutionary doctor' by Sher Ali, an Express Tribune reporter and 'Hartaali doctor' was my nick name. After the first day, the event was declared open to everybody because of the quips about elitism and exclusion.

There was a Qawalli session after first days’ proceedings and it featured Fareed Ayaz and Abu Muhammad, the best Qawwals in Asia. They enthralled the crowd with their renditions from Sufi poetry.
There was a standup comedy act on the second day by Sanjay Rajoura and he left the audience rolling on the ground with his observational comedy about Facebook albums, Indian Cricket and some social peculiarities. He received a standing ovation at the end.

Contrary to popular expectations, the event did NOT offer a solution to the Kashmir Problem, brought an end to killing of Shias and Hazaras in Pakistan, decreased the level of radicalism in Pakistan or ended the hostility between Pakistan and India. Kashmir was mentioned, but only as a barter for Coke Studio by Sanjay in his stand up act. The issue of persecution of minorities was discussed in detail and panelists included members from Ahmedi, Hazara and Christian communities. It was a social media event, not a Track 2 diplomat meeting. There were many Hazara participants there as well, which was encouraging. It was not a kitty party and for the record, only two women were actually wearing Sari(Even if they were, Whats wrong with that?), so over-generalizations have to be avoided.

 It was a unique coming together of people who know each other mostly by twitter names and such events should take place at least once a year. It was a tremendous effort by Sabeen Mahmood and her team at PeaceNiche, and I would like to thank and congratulate the team at PeaceNiche and the U.S Consulate staff for their co-operation and hospitality. I would also thank my new friends from Karachi and India, for their love and company. I left the event with a heavy heart, new friends and acquaintances and countless good memories.  

A big shout out to my new friends
Faizan Lakhani, FurSid, Aroosa Shaukat, Sheru, Tuba, Shiraz Hassan, Osama, Faheem(@smokenfog), Yasser Latif Hamdani, Shahab(@UncleFu), Rab Nawaz, Sara Muzzammil,  Awais Aftab, Bilal Tanweer, Salman Lateef and Zeeshan Haider. 

Diary of a young doctor (Part 4)

(published in The Friday Times on 13th July, 2012)

Pay Up
"Please give me some money, I'm hungry and don't have any money to buy food," said the beggar.

"I wish I could, my friend, but I earn less than you do," was my reply. And I was not bluffing. 

There is a simple basic rule that governs almost all professions in the world: you work and that earns you money. There are strings attached to this simple fact according to diferent fields but the basic notion remains the same. Soldiers claim to fight for the country, police officers risk their lives for maintaing law and order, public servants work (or at least they are supposed to work) to provide services to their countrymen. At the end of the day, however, they all get paid for it. From the highest offices of the country to the lowest, from generals to chowkidars, from CEOs to clerks, the maidservants that work in houses, sewage workers, technicians, sales boys, they all get paid for doing their job. But in present-day Pakistan we are making one big exception to this rule: doctors.

I have chronicled the lives of young doctors and have described the trials and tribulations associated with their job. It is hard to believe that despite all this hard work, most doctors working in public sector hospitals are not paid. Imagine a person with 17 years of education, working 28 days a month, doing 30 hr/48 hr duties, and earning a grand total of zero rupees per month. 

Imagine a life with no pay, no job security and no health insurance (given that we deal routinely with HIV positive and Hepatitis C infected patients). All that keeps us going are the 'thank yous' of patients and a hope that someday, things will be better. 

After the doctors' protests last year, pays were increased. This does not mean that everyone is getting that pay. In the department where I work, there are 28 people working as House Officers and around 30 as Medical Officers/Post Graduate Trainees (PGRs). Out of 28 House Officers, only 8 are on the paid seats while the remaining 20 are working on 'honorary' basis (there is not much honor involved; it is a euphemism). Similarly, out of 30 Medical Officers, only 15 are getting paid. The situation is similar or worse in other departments and hospitals across Punjab. People working on honorary seats perform equal duties, do everything as others do, the only difference is that they are not paid for doing that work. This is a unique and frankly disgusting way of treating a professional, and there is no precedent for it anywhere in the world. Apart from interns at offices, everyone gets paid for their jobs. At times, even the Senior Registrars, after 10 years of medical training, have to work on honorary basis. 

There is an inside story to this practice. Theoratically, the seats in wards of teaching hospitals are preferably given to the graduates of the institute that the hospital is attached to. This results in unequality at times because graduates of other institutes opt for institutes in bigger cities. In the case of Punjab, graduates from all over the province prefer to do their clinical training in either Lahore, Multan or Rawalpindi. There is also the issue of non-residents. If a resident of Lahore got admission in Rawalpindi Medical College or Nishtar Medical College, he/she would prefer to complete his/her post-graduate training in the native town. Due to this shuffling, there are more candidates for less seats and departments employ different people on honorary basis. The merit list for giving a job for post graduate training starts from graduates of the same institute. Second on the list are graduates of other government institutes and lastly, the graduates of private medical colleges, including the ones in China and Russia.

There are ways that people bypass the merit system, because in Pakistan there is a single key for every lock: Sifarish. If you have the requisite Sifarish, you can bypass the merit and get a paid seat in your desired department. 

To cope with the economic pressure due to lack of any pay, doctors from public hospitals look for jobs in the private sector which forms 80% of our health sector. As a result, most of the unpaid (and in some cases, even the paid ones) do jobs at private hospitals in the evenings and in public hospitals in the morning. After living for more than 25 years on the largesse of your parents, if you still do not earn anything on your own, it reflects poorly on you. Also, during post-graduation, a lot of doctors are tied in the knot of marriage and it is difficult to ask your parents for sustenance of another person while you earn nothing. I personally know some people who delayed their marriages because they did not have the means to support a new member of the family. In some other cases, the young doctors were the only source of income for their families and had to wait till completion of their post graduation to marry. 

This system of 'honorary' jobs should end as it is nothing but a kind of slavery.