Pakistan’s health burden

By Zubeida Mustafa
Source: Dawn

THE government has ingenious ways of naming evils in our society. A ghost school is termed as a dysfunctional institution. Quacks are called “unlicensed medical practitioners”. The National Assembly was informed by the health minister last Friday that Pakistan has 200,000 — bluntly termed — quacks who are posing a serious threat to people’s life.

This unpleasant fact of our health system has been known generally for long. But what has not been fully known so far is that conventional wisdom regarding the flaws of our health delivery infrastructure needs to be updated.

It is generally believed that quacks flourish because health facilities are not accessible to the common man who is forced to visit the so-called unlicensed medical practitioners when he falls ill. The government is held responsible for this failure since it has not opened enough dispensaries, clinics and hospitals to address the health needs of the ailing population.

The data released by the federal health ministry for 2006-07 is quite dismal. With the ratio of one doctor to population being 1,475 and one health facility catering to the need of 11,413 people, we cannot really expect the scenario to be satisfactory.

Besides, national averages present a distorted picture. For instance, if the health facilities are concentrated in the urban areas when the bulk of the population lives in the countryside, most people would be denied easy access to healthcare. Thus there are only 595 basic health units in Pakistan which is said to have 45,000 villages.

It can be said that people are forced to turn to quacks. And that is why the government does not even bother to crack down on them because it knows that it does not have the capacity to provide the service, howsoever spurious, the quacks are providing — while posing a serious threat to the lives of many people.

However, an uneven picture emerges in the urban scene. Many low-cost primary health facilities catering to the needs of the common man have sprung up in big cities like Karachi and Lahore. parchi

Those set up by the private sector charge a fee, but a nominal one (ranging from Rs30 to Rs100), which people pay willingly if they are assured of good professional care. Besides, some departments of the public-sector hospitals offer excellent services while charging a few rupees — the fee as it is called since Gen Ziaul Haq deemed the people to be undeserving of any free healthcare whatsoever.

In the government hospitals the services offered depend on the head of the department concerned. If he is an honest, compassionate and dedicated medical practitioner with a vision he manages to uplift his department notwithstanding the constraints a public-sector institution faces.

There are quite a few such examples, the Sindh Institute of Urology and Transplantation being a notable one. With an OPD attendance of 700,000 patients per annum, the institute has come a long way from its humble beginnings. It has grown into a leading urology/nephrology centre in Pakistan that does not charge a penny from its patients and has an international standing.

All this is not enough. Many people have remained outside the pale. That has benefited the quacks. Cracking down on the quacks will drive them underground if alternative facilities are not provided. In this situation it is shocking to see how minimal the government’s role has been in the area of preventive medicine. Reducing the incidence of disease would automatically reduce the burden of the health sector. This has always been the Achilles heel of our public health system.

It is well known that sanitation and the supply of potable water would cut down phenomenally diseases, especially diarrhoeal disorders and parasite-borne illnesses. The dissemination of health education can also help people lead healthy lives without visiting hospitals and doctors to obtain treatment.

Why is it not being done? We do not know where the funds for sanitation, the malaria control, AIDS prevention and family planning programmes and immunisation drives go. These efforts do not appear to be paying the expected dividends although none call for great expertise. But they do call for commitment, integrity and dedication that have been eliminated instead of the parasites and viruses that cause disease.

Another neglected area is that of public health education. The electronic media which should have been an excellent instrument for the dissemination of knowledge on health has apparently forgotten its social responsibility and is more concerned about the rat race. If a health message is linked to an ad — as one exhorting children to wash their hands — it will receive much air time because it generates revenues. But not every message has a commercial dimension.

Health professionals should seek to fill this gap by arranging for trained volunteers to talk to people who visit hospitals and clinics. The waiting room of any hospital or private practitioner is jam-packed. Here many patients would benefit from a health talk. This can be done by volunteers who could be briefed about the kind of information they should disseminate.

Given the prevailing state of ignorance on health matters — even the educated are not always well-informed — and the constraints on time that doctors are faced with, it would make a difference if enlightened and educated volunteers talked about health issues as patients await their turn.

This would certainly help to reduce the disease burden in the country and lighten the load on the health sector. It would also improve the quality of life, enhance productivity of the labour force and upgrade the academic performance of students.

A study estimates that childhood and infectious diseases (most of which are preventable) account for 66 per cent of the burden of disease in Pakistan. Chronic diseases and injuries were among the top 10 causes of HeaLY (Healthy Life-Year) loss. With health education, the spread of disease can be minimised.

3 thoughts on “Pakistan’s health burden”

  1. This article has raised very pertinent issues.The registration of young people who are interested in health awareness in fora and health organisations should be undertaken. These people can then spread awareness on all these issues.

    1. @Dr Meher Zaidi

      I fully support your idea that awareness must be spread. Health concern should importantly be a individual concern and hope you, being a Doctor, will support my following suggestions meant for all on this earth and not merely for Pak or Indian nationals. Definitely these suggestions will keep Doctor, Govt help away if not completely but to greater extent:

      a. Daily bath.
      b. Morning walk before bath, little rest after lunch and moderate walking after dinner.
      c. Proper sleeping manners.
      d. Proper reading manners.
      e. Punctuality: Remain punctual and on time for working hours, sleeping hours etc. etc.
      f. Food habits: Select quantity to generate required calories, food items as per your taste and season, and eating time and one will feel very healthy. In 1970 my senior was a Retired Military officer and was very particular about these. He has fixed quantity of food and drinkable and would intake at fixed band of times.
      g. Nature is very generous and have produced each and every food elements and minerals not in one item but in many items enabling us to meet our taste. So utilize this blessings.
      h. Proper tooth paste also keeps tooth strong.
      i. Bare foot walking on dew drops keeps body fresh and cooling effect can be felt in eyes.
      j. Make it a habit to have forced walking though in office and/or home and/or even in train when on long journey.
      k. Dress habits also be selected keeping in view weather and skin conditions.
      l. Keep your mind free from any type of Jealousy, tit for tat option, irritation.
      m. Say what you wish to say to your friend and relative and do not allow them to settle at heart. One of my colleague told me that he fears that our all four brother employers are at the brink of separation (separation means no chance of job) as daily there are verbally fighting. I told him it will never happen as all four brothers are clearing their mind daily so no pile up of any ill will. It happens so they never separated but due to death.
      n. Keep your finances under control and minimize your mental stress.
      o. Always try to help others.
      p. Start reducing intake of all types of Oils, Salt and Sugar as soon as 40 yrs are complete.
      q. While at Social functions or at family gathering avoid to taste each and every item. The host arranges too many varieties so that no one may return without food. But too many consider that within 100 or 120 minutes they have to taste every item.
      r. Use of alcohol be restricted up to a dose like medicine but not to swing your head.
      s. Tobacco items never keeps us healthy and fit.
      t. Lastly I take SEX actions. A disciplined and regular sex keeps a person healthy. Wee hours are best when hormones are fully active and no chance of any manual disturbance. A couple of 70 known to me are still fresh on sex level and they proudly say that since their marriage, they have considered 'sex energy' like a bank balance, and its withdrawal was planned so that it lasts for a longer years. Qualified Doctor can only authenticate this statement. I can not authenticate this statement but I am sure having a wild sex ultimately is an injurious to health.

      More health tips can be added……..Welcome please…

  2. The comments of Dr Meher Zaidi took me to this WRITE UP. You have rightly and perfectly aired your concern over the Health. Likewise all other Post you say Pakistan's health burden' and like wise every time I say though the WRITE UP is in the context of Pakistan but ironically it is applicable in many parts of this earth. The Govt., Health Workers & Professionals, Civic Societies and citizen should combine to have a healthy nationals.

    No doubts Quacks (Neem Hakim Khatra-e-Jaan) could prove fatal to even a healthy person. But it has its own characteristic value also. Some Quacks by their prolonged experienced have gained access to some ailment and are curing without conducting any lab tests. In our childhood there was a Hakeem who would tell perfectly by looking at urine if lady is pregnant or not. The once I happened to shake hand with the so-called Quack and he immediately told me correctly that your stomach is not functioning to its optimum. A friend of mine who was tested with puss in his semen was further told by MBBS MD Doctor to have cultural analysis to know the PUSS cells. He happened to visit Hakeem he gave medicine and within next 20 days his semen was PUSS free.

    There is a film named as THE QUAKE produced in Poland. The hero an unlicensed medical practitioner runs away from home to escape the Police and Court Action. But he was specialist for some treatment. After several years her daughter faced the health problem for which he was specialist and all educated doctors failed to cure her. The hero comes to know it and decides to cure her daughter by taking the risk of Police and Court. Police also sensed that QUACK will contact her daughter in order to cure. Daughter was cured and he was in Police trap. But the Court decides to honor him after consulting with other educated Doctors.

    So we must be well able to differentiate between Hakeem, Neem Hakeem, Quacks, Qualified Doctor, Friendly Doctor,costly Doctor and kidney racket Doctor etc.etc.

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