Diary of a Young Doctor(part 3)

(published in The Friday Times on 29th June, 2012)

Diary of a Young Doctor III

"Please guide us, doctor. We have come back because the local dispenser [quack] refused to administer the injection you wrote for our son, saying it is too 'heavy'." 

I was busy making the 'discharge form' of a patient when that couple came towards me and said those lines. Their teenage son had been discharged yesterday upon their request, and I had prescribed an injection that he needed every day for the next week. The couple said they would get their son the shot through a dispenser in their locality. And they were back the very next day.
A doctor can, just by clicking on the computer screen, get free medicines for needy patients


This is not a unique situation. Apart from managing patients feigning abdominal pain in the emergency ward and waking up during the "on call" nights after every hour to change a transfusion bag, this is what young doctors do in "routine". A routine day comprises duty of about 6 hours, from 8 in the morning to 2 in the afternoon. We start the day by checking patients on the beds allotted to us and by writing down the DPNs (Daytime Patient Notes). This is followed by a survey of our work and additional examination by our immediate seniors, the Medical Officers. After that, there is the ward round by any one of the designated consultants/specialists. During the round, the consultants listen to the medical history of patients from house officers or medical officers and look through the investigations carried out previously. Then, according to the situation of the patient, investigations or different drugs are advised which are added later to the charts by House Officers.

If the patient is newly admitted and can't buy medications on their own, there are two ways of getting them free medicine. There is a list of medications that are provided to our wards every day by the hospital. They include most of the commonly required drugs, and a doctor can, just by clicking on the computer screen, get free medicines for needy patients. Another way is through the Medical Superintendent (MS) of the hospital. For that, the patients' file has to be signed by the MS himself, which is not a hard thing to do. Then there is the problem of urgent investigations. For that, house officers have to counsel the attendants and sometimes have to get involved themselves to get those tasks done through the emergency department. At times, the bureaucracy of it all can get in the way and frustrate patients.
I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy


As in the rest of Pakistan, a patient is likely to get sufficient attention (which mostly means more than normal) if they know someone in the hospital hierarchy. This doesn't mean that doctors don't care for their patients; it's just that we find it difficult to divert our energies where they are not required.

This 'protocol' business can turn ugly. Many a times I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy. It happens particularly frequently in the hospital where I work because we have to deal with all kinds of government employees and their kith and kin. According to one of my seniors, even if the gardener of CM house brings a patient to the hospital, he expects to get 'protocol' equal to that of the CM himself.

Hospitals are great places, not only for learning medicine but also for learning about the different shades of life. I would like to mention some of the most interesting cases I have seen in my brief clinical career.

The fiancee with the headache before her FA exams brought to the emergency by her very concerned fiance, the CA student who had not eaten anything for a month due to some kind of love affair; the 65 year-old woman patient who insisted on smoking despite the disease in her lungs; the helpless relatives of a 70 year-old woman who had to get dialysis but couldn't find the hospital where it was urgently available; the 50 year-old woman with tuberculosis of the meninges (brain coverings) and an untiringly colorful vocabulary; the madrasa student who sat for his Dars e Nizami exam while he was admitted in the hospital; the women loudly reciting Quranic verses around a very sick patient and freaking out the doctors; a 15 year-old boy spending most of his time around his ailing mother in the ward and running around taking her samples for laboratories; the young patients (mostly girls) with acid/bleach intake for suicide purposes and the attitude of their families towards them; and all those patients who are never satisfied when they are prescribed pills and demand injections and drip infusions just to feel medical; and all the drug mules who are accompanied by police or custom officials and deny any wrongdoing until the last minute.

There are also issues among various departments in the hospital that cause unnecessary delays in diagnosis and treatment of patients. The Radiology and Pathology departments provide services to all the rest of the Hospital, and are indispensable in the management of patients. If the same tests are to be done from private labs, the cost is not affordable for most of our patients, who belong to the lowest strata of the society economically.

I would also like to mention that there are almost no holidays for young doctors during their house jobs. In the department where I work, we only get 2 holidays in a month, both Sundays. Apart from that, we only get one emergency leave per month.

 

Diary of a young doctor (part 2)

(published in The Friday Times, on 15th June, 2012)


There was a frantic knock on the door of the doctors' room. A half-asleep lady came in abruptly. It was 2 o'clock in the morning and there was absolute silence in the rest of the ward. The lady gasped and said, "Dr Sahib, the condition of my patient is serious, can you please come and check her?" I had no option but to get up from the couch I was lying on, get my stethoscope and accompany her to the bed of that patient. As it turned out, the lady was a patient of liver failure and was having pain in the abdomen. After a brief checkup, I wrote down a simple ant-acid and asked the patient to take some water. Problem Solved. Sleep be damned.

The above-mentioned scenario is one of the many that we have to endure during our 28-30 hour long ward duties, also known as "long calls". After a regular day at work, the whole ward becomes the responsibility of 4-5 doctors who are said to be "on call" while the rest of the doctors go home. This duty has to be done once a week and at a weekend once a month. The regular tasks that we are required to perform during our calls include noting down blood sugar levels of diabetic patients, monitoring blood pressures of any serious patients, doing a routine checkup of patients in the ward, dealing with occasional complaints (like the one mentioned above) and lastly, to oversee casualties that occur on our watch. We are required to be present in the ward at all times during duty hours, and it basically means little rest and little to no sleep. After every 5-10 minutes, there are knocks on the doctors' room and one attendant after another barges in to get the required "attention" for their patients. In many cases, the condition of the patient is "irretrievable" and it is difficult for both the doctor and the attendant to see the patient suffer. Most of the patients admitted in medicine wards are suffering from either chronic liver disease (due to very high prevalence of hepatitis in our population), tuberculosis in its various forms, stroke (known as 'brain hemorrhage' in popular culture), kidney failure, meningitis (infection of the coverings of brain), chronic pulmonary disease (due to long-term smoking) and fever due to infections. Patients are checked twice daily, once in the morning and once in the evening.In a country with so many health-related issues, negligible amounts of money are being spent on patient care in public hospitals. A lot of patients can be saved by provision of simple ventilators but the number of ventilators across hospitals in Lahore is no more than 100-150! Similarly, dialysis units and liver transplant facilities, which are considered routine in developed countries, are not easily available in most tertiary care hospitals in our country. The human aspect of being a doctor can be seen during ward duties, as doctors give their best efforts and energies to save the patient without having any relation with the patient. In many cases, young doctors work out of their comfort zones to treat the patient as well as is humanly possible.
Young doctors are the wheels upon which the health care system is working
The culture of attendants in our country is not only cumbersome but also problematic at times. Due to socio-cultural beliefs, more people are willing to stay with the patient than is necessary. The problem arises when doctors are inconvenienced by attendants craving attention, leading to neglect of other patients. Even when forced to leave the ward during rounds, the attendants are back as soon as the restriction is over. Last year, a team of doctors were visiting from the United Kingdom for a project and they were surprised to see so many attendants in our wards. They recounted that in the UK, attendants are allowed to visit the patients only during scheduled hours and even at those times, so many attendants were not allowed to visit the ward, ultimately avoiding the mess that we have to face. At this juncture, I would also like to point out that the running of emergencies and the wards is primarily done by the young doctors and they are the wheels upon which the healthcare system is working, despite all glitches. It is an unfortunate reality that most doctors working in public sector hospitals are not even paid for their jobs, making their work more worthwhile than it already is. As I wrote earlier, there is acute shortage of bed space in public sector hospitals. Last year, during the dengue outbreak, when the Chief Minister visited many hospitals including the one I work at, he was appalled to note that two and in certain cases three patients were present on one bed. Based on his instructions, patients were adjusted but it was a short-term measure and the situation remains the same. I personally have had to discharge patients at times because of acute shortage of space. I felt extremely bad doing that but the patients themselves wanted to go home and be comfortable. The toughest aspect of ward duty I found was the time of casualties. The usual scenario goes like this. Doctors are mostly aware of the patients who are having a really bad time and they try to counsel the relatives beforehand. When a distraught attendant comes running in, calling for attention, the concerned doctor rushes to assess the patient. When the patient is critical, the doctor calls his batch mates for help and combined efforts are done to resuscitate the patient. If the patient can't be revived, the protocols are followed and the attendants are informed about their patient's demise. The response of the attendants to the news depends on various factors including the age of the patient, disease of the patient and the quality of counseling done previously. In case of young patients, the reaction of the relatives is quite severe and I have seen my colleague's collars ripped off by an angry relative. Due to their inability to cope with grief, many attendants blame the doctors for the casualty of their patient, without acknowledging the work done by the same doctors when that patient was alive.
At the end of the day, it is not a fair world and a doctor can do only as much.   

Goodbye,Dr House

(published by Express Tribune Blogs on 6th June, 2012)

As the saying “all good things come to an end” goes, “House M.D.”, the brilliantly written show, ended last week. There have been numerous television dramas over the years based on doctors and hospitals including “General Hospital” from the 60s to “Scrubs” and “Grey’s Anatomy” during the 2000s. “House M.D.” embarked on a journey to create its own presence and niche when it first aired in 2004.

It is based on an ingenious but misanthropic doctor who is willing to cross all boundaries to solve a case. His actions are seen to be driven by his passion for medical puzzles and mysteries, instead of a general feeling of care and well-being for his patients.

The character is loosely based on Sherlock Holmes, the fictional character created by a Scottish physician and writer, Sir Arthur Conan Doyle. Dr House is a graduate of Johns Hopkins school of medicine and has served fellowships in nephrology and infectious diseases. In the series, Gregory House heads the Diagnostics Department at Princeton Plainsboro Hospital (PPTH), in New Jersey. The department takes only one patient at a time with barely any criteria for selection. Usually patients with atypical symptoms are dealt by the Diagnostic Department. Both the department and the hospital are, however, fictional.

In the first three seasons, his team includes Eric Foreman, a neurologist, Dr Chase, a cardiologist  (later head of surgery and then the department of diagnostics) and Dr Allison Cameron, an immunologist. Other important characters include Dr Lisa Cuddy, the administrator of PPTH and Dr James Wilson, an oncologist and the only friend of Dr House. House abides by one golden rule about patients and life in general – “everybody lies”. That is the reason he seldom talks to his patients or even believes in what they tell his team about their medical history.

Hugh Laurie, a British actor, plays the character of Gregory House and his acting attracted nothing but praises from the general viewers and critics. Despite his British accent, he effortlessly adopted the American accent throughout the show.The show was popular not only amongst people with medical backgrounds but also for aficianados of acting and drama. The character House is famous for his witticisms and there is a whole website dedicated to “House-isms”. I would like to mention some of the quotes here for all of us to enjoy and reminisce the intelligent humour we all will miss the most.

House: “Me and humanity, we got together too young.”

Patient: “How do doctors get this idea that you are better than everyone else?”

House: “Probably because of all that ‘pulling people back from the brink of death’, but its just a guess.”

House: “Treating for wrong diagnoses can result in side effects, like death.”

Chase: “The dream doesn’t mean anything. Can we start acting like it doesn’t mean anything?”

House: “Sure. We can also act like walls don’t mean anything. But then we’d hurt our noses.”

House: “Evolution does not work that way. You can’t talk legs onto a fish. If we’re going to go extinct, we’re going to do it drinking Scotch and driving muscle cars.”

House M.D. means more to me than a simple drama for the purpose of  entertainment, which it definitely provided its viewers with. I started watching it when I was in medical school and even now, when I am undergoing my clinical training, I still watch it. It evokes so many memories that I feel difficult to let it go, like many of its fans.

House M.D. will live on, even after it goes off air. It will and may have already inspired countless people towards the medical profession. It showcased the much-neglected human side of doctors emphasising on their human errors. With teary eyes, I bid farewell to one of my favourite television shows, House M.D.

My Tuesdays will be emptier without another episode of the show and if I ever develop any atypical disease, I would want someone like House M.D. to treat me. He may dismantle my hopes for living but at least he would not let me die due to a lack of effort.

Diary of a young doctor(part 1)

(published in The Friday Times on 1st June, 2012)
I felt as if I could not move my legs. It was as if my body was disobeying my mind.It was 4:45 a.m. and my alarm bell was piercing my eardrum. I did the only thing I could do at that time: I pushed the snooze button. I knew I had to get up in a few minutes and by then my legs probably would have enough energy to crawl out of bed and move. It was a Saturday morning and I had to be in the 'Accidents and Emergency Department' for my 12-hour duty from 6 a.m. to 6 p.m. I had returned the previous day after doing a 28-hour ward duty which included very little sleep and quite a bit of leg work. The reason my body was temporarily refusing to obey my mind was my tiredness and lack of energy. In the end, I made it to the emergency department and performed my duties as a House Physician for 12 hours straight. This is how the life of a young doctor unravels.
A lot of patients visit the emergency ward because they want "urgent" treatment of things that can be easily dealt with on a regular scheduleI am a medical graduate undergoing my first year of medical training known commonly as House Job. Being on the junior-most rung in the ladder of the public health care system, we are the first point of contact for the people coming to public-sector hospitals. We have to perform emergency duty once a week and twice every other week. In the emergency department, we treat the patients who require urgent consultation with a physician. The patients come in, we examine the patient and write medications for them accordingly, their attendants get the free medications from the medical store located inside the department and those drugs are then administered to the patients by the nursing staff. This chain is the usual protocol followed in most public sector hospitals. In some cases, some drugs are not available in the medical store inside the department so the attendants are asked to get them from any nearby store.In the hospital where I work, we have the Hospital Management Information System through which we enter medications for patients using laptops and they can get their medication from the medical store without any hassle. On a regular basis, we treat patients suffering from gastroenteritis (caused mostly by unhygienic food and water consumption), fever and body pain, and patients who are already on medication for chronic conditions like diabetes, kidney failure, liver disease or heart disease. Patients are charged only for the minimal admission fee; laboratory tests and radiological investigations, including X-rays, ultrasound and CT-scans, are done without any charges.
I return home with an aching back, an empty stomach and pain in the balls of my feetEmergency Duty is mostly spent by us while moving from bed to bed and not being able to sit for more than five minutes. There are very few seats available in the emergency department and most of the work is done without much respite. During the duty hours, more time is spent by us counseling the patients and their attendants than actually treating people. Everyone wants to get our attention first and it can become hectic very fast, with beds filling up to twice their capacity and still more patients streaming in. Things can get heated as well and incidents of fights between the doctors and patients have been noticed in the last few years. There are no security guards in the emergency rooms, leaving the duty of self-defense to the doctors themselves.Incidents of bullying by attendants led to the formation of the Young Doctors Association 5 years ago.The facilities that I have described above are at par with almost any private hospital in the city. But the only people who tend to visit public sector hospitals are of the lower-middle class or the lower classes. One reason for this is that there is a shortage of both space and personnel in public sector hospitals. We cannot refuse treatment to any patient and this puts a strain on our already scarce resources. A lot of patients visit the emergency ward because they want "urgent" treatment of things that can be easily dealt with on a regular schedule. I have personally seen patients of sinusitis, occasional headaches, acid peptic disease and increased blood pressure in the emergency ward while all of them are theoretically out-door department cases.In the emergency room, a house officer examines patients, takes blood samples, passes nasogastric tubes or folley's catheters, checks blood sugar levels and blood pressure and has to write prescriptions on discharge of the patients. These few tasks are repeated from the start of the duty till the duty finishes after 12 hours. There are times when the inflow of patients is very high and it becomes extremely difficult to shuttle between patients based on the severity of their symptoms; and there are times when most patients are stable and the doctor can catch his or her breath for a while.Apart from fulfilling our duty, we also receive many prayers and good wishes from patients who are successfully managed. The road is not full of roses, though, and patients complain if the treatment is not working. The toughest aspect of the job is to face the incidents of mortality in the emergency. In most of the cases I have seen, attendants raise a hue and cry at the death of their loved one, and that frightens the rest of the patients. In those moments of grief, all the doctor can do is to inform the attendants and get signatures from them on the death certificate.As for me: at the end of the 12-hour duty, I return home with an aching back, an empty stomach and pain in the balls of my feet. I try not to walk much after I reach home and after a few hours of rest and some dinner, go to sleep, ready for another day at work.

On Prophecies and their veracity

(an abridged version was published in Pakistan Today on 23rd May,2012)

Prophecies and their veracity

A lecture titled “A Longer view on dreams and prophecy” was organized by Lahore University of Management Sciences at the start of April, 2012. In that lecture, Professor of South Asian History, Manan Ahmed spoke at length about various aspects of prophecies.

Professor Manan explained the significance and methodology of prophecies. Prophecy is always in the past, but it is applied in the present. Another aspect of prophecies is that they appear at times of crisis, to 'rationalize' those crises and to point towards a better future.

Professor Manan gave example of Qudratullah Shahab's book 'Shahab Nama', the last 2 chapters of which, contained prophecies. Similar rhetoric was used by Shahab's contemporaries, Wasif Ali Wasif,Ashfaq Ahmad and Bano Qudsia.

Prophecies of Shah Naimatullah Wali, which have been used by Zaid Hamid recently, were published first after 1857(end of Mughal Empire),then 1948(Serious problems faced by the new nation), then 1974,1975((Loss of East Pakistan), 1988 and then 2008.

Interestingly, such prophecies are not only propagated by Zaid hamid but also spread via columnists such as Javed Chohdary, Haroon Rasheed and Amir Hashim khakwani.

Other examples of famous prophecies at the times of crisis include the time when Tatars invaded the Muslim territories. The “sages” of those time started saying that the Tatars were actually “Yajooj Majooj” and that the day of judgment was approaching soon.

The prophecy I want to discuss in this post is the one allegedly made by Molana Abul Kalam Azad, the famous Congress Leader and Ideologue. That prophecy was recently highlighted in the show Khabar Naak and in Kamran Khan show.

The long prophecy is based on an alleged interview of Abul Kalam Azad when he visited Lahore in March 1946, conducted by Shorash Kashmiri. In that interview, Abul Kalam Azad said,

“I feel that right from its inception, Pakistan will face some very serious problems:

1. The incompetent political leadership will pave the way for military dictatorship as it has happened in many Muslim countries.

2. The heavy burden of foreign debt.

3. Absence of friendly relationship with neighbors and the possibility of armed conflict.

4. Internal unrest and regional conflicts.

5. The loot of national wealth by the neo-rich and industrialists of Pakistan.

6. The dissatisfaction and alienation of the youth from religion and the collapse of the theory of Pakistan.” (The complete interview can be read here).

Previously, this interview was published in an Indian magazine named “Covert” with the headline, “Maulana Abul Kalam Azad: The Man Who Knew The Future Of Pakistan Before Its Creation” catapulting Mr. Azad’s status from a senior politician to that of a modern day Nostradamus.  Based on some analytical evidence, I shall try to prove that the interview never actually happened and the whole “prophecy” is a work of fiction created by Mr. Shorish himself.

1. The interview is supposed to have taken place in March 1946 when Abul Kalam Azad was visiting Lahore for negotiations about a possible Congress-Unionist Party coalition which ultimately led to All India Muslim League being left out of power despite being the majority party.

2. Shorash Kashmiri was a committed member of Majlis e Ahrar, founded by Ataullah Shah Bokhari, a firebrand speaker and religious scholar. Majlis e Ahrar was famously against the formation of Pakistan. It should be kept in mind that Shorash was a famous for his oratory skills and as a political worker, not as a serious journalist. This interview was not published by Shorash Kashmiri until 1969, when he joined Awami League, which was at that time quite anti-Pakistan in its outlook.

3. On the topic of  Pakistan and creation of Pakistan/division of India, Abul Kalam Azad wrote a whole book, titled “India wins Freedom” which was published in 1958 while Azad was alive. This particular “prophecy” is not mentioned or even hinted about in the book devoted to this topic. Some people assume that the re-print of the book which occurred in 1989 and included additional pages, contain anything related to this, which is completely wrong.

4. The publication of this interview in the Indian magazine “Covert” was a blatant attempt at glorification of Azad and historical revisionism. The aim was to degrade Mr. Jinnah by painting him as short-sighted while simultaneously increasing the stature of Abdul Kalam Azad at his expense.

( Please Note that this post is about the prophecy of Azad that I have mentioned above and not his views about partition of India and formation of Pakistan.)

Hello, its Goebbels Speaking

Hello, Its Goebbels

(Joseph Goebbles was a German politician and Reich Minister of Propaganda in Nazi Germany from 1933 to 1945. As one of Adolf Hitler's closest associates and most devout followers, he was known for his zealous oratory and anti-Semitism.

Goebbels earned a Ph.D. from Heidelberg University in 1921, writing his doctoral thesis on 19th century romantic drama)

Hello,
 
Its me, Dr. Goebbels, writing from my grave, where I am turning with agony upon getting the news of a flowery diatribe launched by a pen-warrior, a key-board jihadi, with penchant for the word “paladin”. See, this is what happens when instead of making them learn by experience, you force your children to cram the SAT word lists, the whole “Word Smart” books and their likes. Just like a rotten apple causing explosive diarrhea, that cramming can lead to an emotional outburst from the yet-green mind of the average Pakistani Child. My advisors told me that exactly Nine hundred and Eleven SAT words were used in the beautiful blog written by the author. I, for one would have jumped upon the bandwagon to find the “hidden meaning” of the number 911 but since my untimely death, that mantle has been handed over to Zion Hamid and Shahid Masood. The writer has shown extremely good skills of copy/pasting from a thesaurus and he should be hired in the first instance by an Urdu newspaper as soon as he turns 18. It is easy to ride on the high horse, on the pulpit, if you allow me to delve into similar verbosity shown by the amiable writer, and pass silly judgements on people without coming up with any facts or agreeable data. This trend is not new and will never cease to exist. In our time, with the mighty Nazi Party at the helm, we cut out all voices of dissent and under the guidance of the supreme leader--a hero of war--reached the technological and sociological heights that were unparalleled by comparison in that era. We were self-sufficient, hard working, hated our neighbours with a passion, believed that we are the best nation in the world and sent the dissenters to camps where we used their labour for the greater good. Sounds familiar? Oh, I digress.

Despite my poor English language skills and scant interest in the happening of far off countries like Pakistan, I still keep tabs on major players in the news arena. Express Tribune as a Pakistani newspaper is one of the few that I am interested in. It is not exactly “Der Angriff” in terms of propaganda-spewing but it certainly has an agenda: An agenda to cater to the English-reading population of Pakistan and to project a progressive image of the country. While my opinion on this matter does not mean much to you dear reader, I have one simple Question, Who doesn’t have an agenda? Name one newspaper in the world without an “agenda”. The rhetoric against Express Tribune is a spin-off of the video created by the modern day crusaders at Pakistan Cyber Force(How I wish we had developed Internet in our time.!!!). 

While the whole blog peiece was a piece of art and I would highly recommend the Lahore Museum to store its manuscript,
the most enlightening parts were
 
“Today Imran Khan is like a classic hero who has emerged as a paladin of nationalism, baptised in the waters of public opinion, made great and filled with courage”

and

“He who is conscientious enough to prefer steep heights of truthfulness, selflessness, patriotic spiritedness over the primrose path of least resistance, of timid appeasement, of petty self seeking, always gets pilloried by the forces of status quo and inertia, so goes another law of history. Imran Khan has committed no crime, violated no law, breached no trust, betrayed no cause, wrecked no chariot-merely that he was guilty of sticking to his guns and having the courage of his convictions, courageous and cognizant enough to chart a different course, sing a different tune, and write a different script” and

“Granted that these writers always ran low on writer’s ink and that logic and profundity were never their forte, but have they become so sterile, jaded and pathetically predictable as to be unable to write a single article without hurling mud at a celebrated national hero? History is replete with examples of once high and mighty writers, eventually running out of ideas and becoming clichéd and banal towards the fag end of their careers, but what to talk about the desultory and vapid ways of these writers who seems to have met their waterloo even before a Toulon?”

I am tempted to ask the amicable writer (Did you notice how I  changed the words, while saying the exact same thing ?) about his knowledge about the Great Khan beyond watching Television Anchors swooning over the “change” initially(and later eating a humble pie) and posts on his party’s official Facebook page but I won’t. It would be cruel of me to remind the young gun of all the “turn-coats” becoming the faces for the “Change” promised by the 59(or is it 60?) year old leader of the youth. I will not invite inevitable curses and trolling by the party faithful by suggesting a change in temperament with regards to the party and its “supreme leader”. I would also not waste your and my time advising the previously apolitical youth to read “actual books” or to attend “actual protests” if they want a political education. Why should they come out of their schools, colleges, coffee houses and air-conditioned cars(Glass Houses?) to find nothing but dismay? This would all be in vain. Nobody changes parties or opinions after debating their merits and de-merits. Proponents of such deluded mind-set should look at how democrats/Republicans in the United States and Conservatives/Labor Supporters in the United Kingdom always vote for their respective parties. As the last man standing for the once-great Nazi party, I see potential in the uprising of the youth of Pakistan. 

May the Shadow of Fuhrer remain upon us forever, 

Yours Faithfully,

Jospeh Goebbels

Magdeburg Cemetry   

Its not the Corruption, stupid

(an abridged version was published in Pakistan Today on 18th May, 2012)

It’s not the corruption, stupid

The mantra of corruption and eliminating corruption has gained increasing popularity after the historic Lahore “Jalsa” by Pakistan Tehreek e Insaf. The politicians of that party and the supporters have raised hue and cry over the issue of corruption by the politicians and bureaucrats. This, interestingly, is not a new phenomenon. There has been an undercurrent in the socio-political discourse about this issue and for the last 30 years, corruption is hailed as the root cause of most of our problems. Their solution to this problem seems to be a “technocratic” government, a model which has been tried at least twice in this country and failed to change anything.  I beg to differ with this point of view and I want to explain why do I think that? (Spoiler Alert: I am not on the payroll of any party).

To start with, I would like to quote some facts and figures.
According to Pakistan Public Opinion survey 2009, 45% people said that the single most important issue facing Pakistan was Inflation, 26% said it was Unemployment, 17% said it was Terrorism, 15% said it was Electricity and water, 10% said it was poverty and only 8% said it was Corruption.

This does not mean corruption does not exist on a large scale in our country. Unfortunately, the only corruption being highlighted is the one done by the elected representatives of the people while the other institutions keep on looting this country without a second thought. As Mohammad Haneef once wrote, “Pakistan's army is as corrupt as the politicians from whom it wants to save the country. It's just better at paperwork.” Corruption is deep-rooted in our society and eliminating it would require more than sloganeering or a single regime change.

Columnist Umair Javed, explained how Corruption is now an intrinsic part of our society and why the current discourse against corruption is based on forgetting a few basic tenets,

“Whilst I generally agree to the harmful effects of corruption in so far as it induces low levels of efficiency, wastage of scarce resources and promotion of incompetence in merit-based situations, I am more concerned with this fetish of treating corruption as an alien disease. If the premise of their solutions relies on the extraneous nature of the problem itself, then the situation can be made a lot more interesting and complex if the primary assumption is discarded and a new one is set in place, i.e. corruption is not alien to the system, it is an inherent code of practice that has evolved over time in certain parts of the world, primarily from the experience of the public realm undergoing certain forms of social organization and re-organization such as colonialism, kinship associational modes and a cultural continuity of sorts that has synthesized these varying social experiences.”

We need to understand the dynamics behind corrupt practices and how ordinary people are equally responsible for a corrupt society than a politician or a bureaucrat. Bringing an end to corruption will take at least a generation which would be brought up on the agenda of honesty and belief in hard work rather than nepotism and paying your way out of trouble.

We may love to hate them but we should learn some lessons in this regard from our neighbors, India. Last year Anna Hazare in created a stir in the Indian society and media by launching a crusade against “the corrupt practices” of politicians. It was idealistic, utopian and ultimately failed to reap any rewards.
 Pankaj Mishra, wrote the following about that movement in the NewYork Times,
“Led by Anna Hazare, the movement was presented by sections of the media as a long overdue political awakening of the middle class, even as India’s second freedom struggle.
With a mostly urban constituency in mind, Hazare’s vision was narrowly focused on the alleged misdeeds of elected officials—above all those in the ruling National Congress Party, which has traditionally sought votes from the Indian poor—and bureaucrats. Among other things, he called for the establishment of an unelected anticorruption agency, which, lavishly budgeted, would have extraordinarily wide powers of surveillance, policing, and prosecution—and, by implication, make the state more efficient and technocratic and less encumbered by the
unruly and lengthy processes of parliamentary democracy.”

After all the above mentioned points, I should also mention what in my humble opinion is the biggest problem facing Pakistan. It’s the population explosion and  the aspect that makes it more alarming is that it is not considered among the top Five or Ten challenges facing Pakistan. None of the major political parties in Pakistan has focused its policies or plans on how to control the population problem
With more than 180 million people, Pakistan has nearly six times the population of Afghanistan (or Iraq), twice the population of Iran, and almost two-thirds the population of the entire Arab world put together. Rapid increase in population has led to decrease in the efficiency of the infrastructure that was established for lesser number of people. It has also led to a gross income disparity, decrease in natural resources, youth bulge and unemployment on massive scales.
To some extent, hypocrisy is also one of our biggest problems and it has been given no attention as well. A 59 year old leader of the youth, flying to a city on a private jet to lead a rally demanding a change in status quo, how much more cliched can it get.