In a diseased state

By Zubeida Mustafa

THE health sector in Pakistan is in a crisis. Various reports and surveys paint a bleak picture which is not surprising given the breakdown in the healthcare infrastructure.

If the country has a high infant mortality rate, if polio cases have taken an upwards turn and the state of health is abysmal, prompting observers to warn that the Millennium Development Goals are unachievable, the root causes are obvious.

siut-educationIn every sector of life, human resources are central to performance. Qualified and well-trained manpower (and also womanpower) with professional commitment and motivation can overcome many barriers that can come in the way of success.

A look at the state of the human resources in our health sector is quite revealing. Dr Shershah Syed, ex-secretary general, Pakistan Medical Association, and ex-president, Pakistan Society of Obstetricians and Gynaecologists, is articulate when shedding light on what is ailing medical education and planning.

Having been an inveterate champion of the people’s right to healthcare, he has immense capacity to identify the cause of a problem and to fearlessly call a spade a spade.

He identifies three basic causes for the malaise in human resources in the health sector. First, the poor quality of medical education which has hit rock bottom, the exception being the few pricey institutions in the private sector. Second, there is an intense shortage of doctors and surgeons in the country.

Third, the poor planning of health manpower has resulted in a lopsided structure that is inadequate for our needs.

In some ways, this reflects a grave paradox in the system. Why should a country with 129 medical colleges face a shortage? One reason is that the medical graduates being produced are generally of poor quality and unemployable.

The better ones form the brain drain that is robbing the country of its best talent. Those who choose to stay in Pakistan and work are not necessarily the best stuff that goes into the making of a competent doctor. Many, especially women, who study medicine do not practise.

The fact is that the recently dissolved Pakistan Medical and Dental Council that supposedly regulated medical education was not doing its job honestly. The medical community demanded the abolition of the PMDC which had become virtually a mouthpiece of the private sector whose interests it had begun to scrupulously safeguard.

Eight years ago, Dr Shershah tried to correct the balance in the PMDC’s composition when he was elected to the council as the representative of the doctors from Sindh. But he was not allowed to participate effectively in its proceedings despite a ruling of the court.

Over the years, medical colleges mushroomed all over the country many of which did not even meet the specified criteria but yet managed to obtain the PMDC’s recognition. Nineteen of them are reported to have paid Rs50 million each to get registered. It is unbelievable but the fact is that many of them do not even have the 150-bed hospital that is mandatory for a medical college to function.

Other requirements such as a full-time faculty for the basic sciences and laboratories are also missing. Some of these institutions were functioning as evening colleges and charging exorbitant fees. Some parliamentarians are said to be involved and at one stage NAB was asked to look into the matter.

The medical community’s persistence has paid off. In February, there were reports of 24 or so medical and dental colleges on the hook as they lacked the basic conditions prescribed for them.

In March, the federal health minister went further and dissolved the controversial PMDC and announced the formation of a seven-member committee which has been given 120 days to hold fair elections for a new PMDC.

Given the representative composition of the committee, hopefully the new body will resolve the crisis.

The new PMDC may play an efficient regulatory role. What, however, needs to be addressed urgently is the lopsided health manpower planning. No need assessment has ever been carried out. Rational estimates call for 10 paramedics/nurses for every doctor produced.

Instead, Pakistan produces one nurse/paramedic for 10 doctors. This reflects the class biases in our society: paramedics and nurses do not enjoy the same social status as doctors. And we know how our education system is skewed against the underprivileged.

The private sector is not interested as nursing schools do not earn as much profit as medical colleges.

In that context, the Sindh Institute of Urology and Transplantation’s move to launch courses to produce physician assistants is a bold step in the finest tradition of social justice. Some medical universities are following suit now. But their high fees — SIUT does not charge a penny — may yet erect barriers for the not so affluent.

Source: Dawn

9 thoughts on “In a diseased state”

  1. "——Why should a country with 129 medical colleges face a shortage? One reason is that the medical graduates being produced are generally of poor quality and unemployable. >>"

    They are unemployable because the have not been given high quality practical studies >>> at the bedsite !!

    "…. The better ones form the brain drain that is robbing the country of its best talent. Those who choose to stay in Pakistan and work are not necessarily the best stuff that goes into the making of a competent doctor. Many, especially women, who study medicine do not practise…."

    "—-Instead, Pakistan produces one nurse/paramedic for 10 doctors. This reflects the class biases in our society: paramedics and nurses do not enjoy the same social status as doctors. And we know how our education system is skewed against the underprivileged….."

    The private sector is not interested as nursing schools do not earn as much profit as medical colleges. …"

    In any case private sector nursing/medical/para-medical schools are too expensive for ordinary folk.

    If the private sector can not do it , let the GOVERNMENT establish a country-wide chain high quality NURSING SCHOOLS.

    So, make a rule which stipulates that every medical student will be allowed to leave the country only after 8 years of working for and in the country. That will plug the BRAIN DRAIN.

    Please look up :
    http://www.aacn.nche.edu/publications/white-papers/hallm... : "
    Hallmarks of the Professional Nursing Practice Environment

    See also the complementary brochure:
    What Every Nursing School Graduate Should Consider When Seeking Employment

    The work environment for the practice of nursing has long been cited as one of the most demanding across all types of work settings. Nurses provide the vast majority of patient care in hospitals, nursing homes, ambulatory care sites, and other health care settings (AONE, 2000). The first objective of the professional practice environment for nurses is to put the patient first. Nurses and health care organizations must focus on patient safety and care quality and always ask the question, "What is best for our patients?"
    In recent years a variety of factors have converged to challenge the work environments of contemporary nurses. Rapid advances in biomedical science, improved disease prevention and management, integration of new clinical care technologies, and shifts in care delivery to a broad array of clinical sites have contributed to the rapidly increasing need for well-educated, experienced nurses. Additionally, population demographics are changing as the public ages in growing numbers and becomes increasingly diverse in culture and language.
    The charge of this AACN task force was to identify those environmental characteristics or "hallmarks" of the practice setting that best support professional nursing practice and allow baccalaureate- and higher degree-prepared nurses to practice to their full potential. These "hallmarks" may inform students and new graduates, nurse educators, executives, and practicing nurses about key characteristics of health care settings that promote professional nursing practice.

    Background
    Current Environment for the Practice of Nursing
    Health care delivery has changed dramatically and rapidly. The Board of the American Hospital Association's Society for Healthcare Human Resources believes that the attractiveness of careers in health care, especially hospital care, is markedly different than twenty years ago. "In a single generation, health care has moved from a favored to a less favored employment sector" (AHA, 2001). Significant drivers of this change have been economic constraints resulting from changes in reimbursement for care, rapid advances in clinical technologies and care modalities, and corporatism of health care systems. Hospitals and health systems have been forced to focus on cost control and restructuring of operations to achieve maximum efficiencies. Many cost savings in health care have been realized at the expense of direct caregivers, including downsizing of the professional nursing workforce, restructuring of nursing services, changes in staffing mix, rapid movement of patients to alternative care settings, and decreased support services for patient care. Furthermore, poor collaboration among health care providers hampers efforts to provide quality care in today's health systems. Many nurses describe the current work environment as highly stressful and professionally unfulfilling (Josiah Macy Foundation, 2000).

  2. Related closely to the state of HEC and private universities who are cheating,in connivance with bogus/worthless degree holders.I speak from personal knowledge.Money,money money!!That is the game.

  3. Pakistan needs to have proper medial manpower and health care needs assessment. In the meantime there are several steps that can be taken to alleviate the terrible shortage.
    1. Every medical college should be required to have a nursing school. Ratio to be determined.
    2. Decrease the 5 years of medical school to 4 years. This will reduce the cost of training physicians.
    3.The 5th year should be spent providing services to the state. Location of service to be determined by lottery.
    4. Standardized computerized testing for medical examinations. Three step exam similar to US. Eliminate oral exams to remove any examiner biases. These results should be published every year so that this can be used as one of the tools for grading medical schools.
    5. Develop endowment funds in medical schools to provide need based scholarships.
    6. Ask communities or cities/villages to sponsor a medical student who in turn would serve the sponsoring community for the stipulated term.

  4. Most of our Doctors are absorbed by Arabia & the Gulf States…money is our ultimate god….

    ii. Female Doctors do not like to go to the rural areas, as they have to undertake autopsies , on murdered women. Tough duty.

    Nurses…I agree are frowned upon in our class & caste ridden mind set.

  5. Your WRITE UP give up the impression that Medical Services are itself a PATIENT lying unattended outside ICU.

    Please note that I am not making any comments in case of Pakistan but many years ago I have viewed a Cartoon in Indian Newspapers describing my above commetns.

  6. The issue is deep rooted. Two nations in one country , The rich and the rest. There is no meaningful relationship between the two. The rich mostly less than honest, treat the poor as lepers and other than ordering them about do not even talk to them.
    The poor are busy finding enough to feed their families. Then a class of landless destitute who have given up the struggle.
    Here is a country where rich parents buy their daughters a medicine degree as dowry.They send their daughters to a medical school which has no pretentions of a teaching institution. It is a shop for granting degrees without competence. Most of the Medical colleges are run from big buildings without adequate laboratories, without decent libraries or decent equipment to train doctors to learn the work of a doctor.
    I have seen some graduates of such colleges who have never seen the most equipment that is necessary to diagnose basic diseases. Even the X-Ray machines are candidates for the museum.
    The rich go to the western countries for medical intervention. There is not even one medical college in the Punjab that is imparting medical education at par with western standards. Why ?
    Our poor old Prime Minister , looking at his photograph looks seriously ill. He is obese for sure and suffers from high blood pressure , this is apparent from the photo. He is grossly over weight and will be unable to run a hundred yards to save his life. I am eighty and without a shadow of doubt can beat him in a hundred yard race. If he was the only one it would not be a problem. The problem is that all rich men and most of the " bagemat" are over weight, obese and suffer from blood pressure but never think of basic exercise.
    Our Mullahs with big beards and equally large stomachs have not got a clue what should they do if they need to keep the pretention of walking in the footsteps of our prophet. Our holy prophet often missed meals and made do with the minimum. Our religious leaders do the opposite. Most of our rich is an ailing fraternity, indulging in everything un-Islamic, they are mean while giving to the poor and the have-nots. You must have seen a basket of Paisas on Thursdays in front of wealthy "Saith Sahib's Shop", which is to give to the beggars, one paisa each . That is ,they think, enough to look after the sick and the poor and destitute. . That is the measure of our following our holy Prophet. They do not think it a blasphemous act. They are ready to blame others.
    The proper medical attention to all of us can only be solved if the rich and the poor have the same source of medical attention. Any pain, to rich or the poor affects us all the same way. Sooner we realise that, the sooner we will begin to look for the answer.

  7. The issue is deep rooted. Two nations in one country , The rich and the rest. There is no meaningful relationship between the two. The rich mostly less than honest, treat the poor as lepers and other than ordering them about do not even talk to them.
    The poor are busy finding enough to feed their families. Then a class of landless destitute who have given up the struggle.
    Here is a country where rich parents buy their daughters a medicine degree as dowry.They send their daughters to a medical school which has no pretentions of a teaching institution. It is a shop for granting degrees without competence. Most of the Medical colleges are run from big buildings without adequate laboratories, without decent libraries or decent equipment to train doctors to learn the work of a doctor.
    I have seen some graduates of such colleges who have never seen the most equipment that is necessary to diagnose basic diseases. Even the X-Ray machines are candidates for the museum.
    The rich go to the western countries for medical intervention. There is not even one medical college in the Punjab that is imparting medical education at par with western standards. Why ?
    Our poor old Prime Minister , looking at his photograph looks seriously ill. He is obese for sure and suffers from high blood pressure , this is apparent from the photo. He is grossly over weight and will be unable to run a hundred yards to save his life. I am eighty and without a shadow of doubt can beat him in a hundred yard race. If he was the only one it would not be a problem. The problem is that all rich men and most of the " bagemat" are over weight, obese and suffer from blood pressure but never think of basic exercise.
    Our Mullahs with big beards and equally large stomachs have not got a clue what should they do if they need to keep the pretention of walking in the footsteps of our prophet. Our holy prophet often missed meals and made do with the minimum. Our religious leaders do the opposite. Most of our rich is an ailing fraternity, indulging in everything un-Islamic, they are mean while giving to the poor and the have-nots. You must have seen a basket of Paisas on Thursdays in front of wealthy "Saith Sahib's Shop", which is to give to the beggars, one paisa each . That is ,they think, enough to look after the sick and the poor and destitute. . That is the measure of our following our holy Prophet. They do not think it a blasphemous act. They are ready to blame others.
    The proper medical attention to all of us can only be solved if the rich and the poor have the same source of medical attention. Any pain, to rich or the poor affects us all the same way. Sooner we realise that, the sooner we will begin to look for the answer.

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