The pronounced lack of interest in the public health system in Pakistan is not difficult to explain. Public opinion in a country as stratified and uninformed as ours, is created and moulded by the so-called privileged classes, comprising those members of society who have the means to pay for private health care. Hence they are not affected by the abysmal state of health care in the public sector on which the poor depend.
The general attitude is: what is the role of the poor in our society? They are useful only for domestic labour in the homes of the rich or for menial work in public places and factories. And, of course, to vote at election time. A higher birth rate among the impoverished ensures there is never any shortage in the labour force. If they fall sick, they are easily replaced. With limited skills and training, none are really indispensable.
That is why the health sector is not designed to cater to the needs of the underprivileged. There is no hue and cry when the price of pharmaceuticals is jacked up. ‘Dounumber’ drugs flood the market and the private health facilities keep mounting their charges while public hospitals become more and more dysfunctional.
Indian scholar Noor Zaheer, an advocate of the healthcare rights of citizens, spoke about the predicaments of the poor in terms of health at the Sindh Institute of Urology and Transplantation (SIUT), a public sector institution that provides treatment free of cost to all. ‘Free with dignity’ is its logo and it proclaims that it does not let anyone die because they cannot afford to live. Being on such moral high ground, it is ideally suited to promote the concept of health care as a basic right of all citizens.
Noor Zaheer, the youngest daughter of Sajjad Zaheer, the co-founder of the Progressive Writers’ Movement, is a social activist who champions the cause of the underprivileged. She was in Pakistan in February for the Karachi Literature Festival where her latest book, the English translation of Ismat Chughtai’s Kaghazi Pairahan, was launched. Having heard of the SIUT and its director, Dr Adibul Hasan Rizvi, she expressed a desire to meet him and visit this inspiring institution which amply proves that free healthcare is possible even in settings that are far from Utopian.
Noor Zaheer’s talk came as a forceful reminder of what the battle against poverty entails. One reason why many well-intentioned humanitarians are failing in their mission is their inability to take a comprehensive and holistic view of human development. They have to grasp the symbiotic relationship between health, education, housing and employment. They also fail to strategise their moves to counter the obstacles from vested interests.
Noor Zaheer understands this link clearly. She was very cogent in her speech on this count. She recalled her experience at the turn of the century when she and her colleagues undertook a yatra to break the Indian government’s resistance to the National Rural Employment Guarantee Act that provided for hundred days of paid employment for unskilled labour. As a result the Act was passed in 2005. Later, it was renamed the Mahatma Gandhi National Rural Employment Guarantee Act.
The story did not end there. There were three offshoots of this Act which demonstrated how improvement in one sector impacts favourably on the others. Those who benefited from this piece of legislation first of all enrolled their children in school. Secondly, they stopped going to the quacks and began visiting qualified doctors for treatment. Thirdly, this sense of well-being encouraged women to take up work outside the home.
But those working for the poor should not fail to see the challenges they face. The most formidable is the upsurge of globalisation in its present form. Noor Zaheer was spot on when she stated that globalisation is not a new phenomenon. It is, however, new in its present form.
As Noam Chomsky, the American political activist points out, today’s globalisation is corporate-driven. According to Noor, reform now does not imply change to improve the conditions of the poor, but change is designed to benefit the rich minority.
One has to look around to confirm the veracity of what the speaker said. Labour rights no longer take a comprehensive and all-inclusive view of the rights to health, education and employment. Since the collapse of the Soviet Union and the resurgence of capitalism, the powers-that-be have blatantly neglected the social dimension of their populations. One cannot be certain how long this state of affairs will last.
As poverty grows due to ill-advised neo-liberal policies, human tolerance will reach its limits paving the ground for chaos, if not a revolution. A characteristic feature of the present configuration of world societies is that the one per cent elite from all over the world share common traits, and international boundaries dissolve when they network together in a globalised endeavour.
The other side of this coin is the collective and worldwide oppression of the poor. Exploitation takes place on a global scale and now the rich of the world join hands with one another to oppress the poor of the world. It is a vulgar paradox to have two masses of humanity – one in teeming numbers but deprived and impoverished and the other small, elitist and well-endowed – living side by side in interdependent proximity.