The Healers

A messiah on earth, a living angel, bounded by the Hippocratic Oath for the service of humanity, is the common image of the ‘doctor’ who by virtue has been branded a symbol of dedication in our society as in any society.

No wonder that sometimes the people implore them to just place their palms on the place of ailment to heal it, and they used to accede to their request with positive effects. With the centuries old traditions of dedicated, service and loyalty to the cause of the sick and by serving humanity, they have crowned this profession with trust, dedication and honour.

In-advertent medical errors involving wrong medicine, of wrong strengths, surgeries at wrong sites, mishaps during surgeries or complications thereafter occasionally tested that trust, but honour and dedication mostly remained un-challenged. Many of us have at one time or another read a frightening story in national newspapers, or themselves faced scary that left us sufficiently unnerved. After all, as they say, to err is human.

The problem in our part of the society is compounded by extreme poverty and ignorance where the state constantly fails to provide basic health facilities for one reason or the other. Matters are made worse by the high cost of private medical care compared to the general ability of the common man to pay.

On the one hand, lack of proper facilities as well as ineffective medical management in our government hospitals which seem to be veritable death traps, persuading people towards private hospitals and clinics. On the other, the high gravity of consultation fees and private hospital charges push towards ‘quacks’, many of them in the garb of ‘alternative medicine’ specialists calling themselves Hakeems, Veds, Homoeopaths and herbal medicine doctors.

On looking closely, most of them are practicing Western medicine without any training in it.

The quacks are involved in every type of medical treatment including surgery and thus play havoc with the health of the masses.

Another category of these ‘quacks’ includes people who have worked in hospital para-medical services, learnt some of the basic techniques and have a willing and ready clientele in the Mohallas and shanty towns.

Condemning the quacks is right. But the questions that come to mind are; who and what circumstances help them flourish? Why do people go to them? Which reasons are actually behind the mushroom growth of quacks and fake Hakeems? How people can disregard cheap quacks and fake Hakeems, if they barely earn enough in a month to survive and cannot afford to visit a doctor in private hospitals and clinic.

Detailed enquiries revealed that a single visit to a specialist or consultant whether of any faculty throughout the country, involves an expenditure of anything from 1000/- to 3000/- depending on how successful the specialist is. At times it may appear to be too much. “A teaching hospital consultant being in greater demand, certainly commands a higher fee”, a general practitioner says.

However, it does not generally depend on the prominence of health centres, rather most doctors themselves enhance it by skills and experience in their respected fields regardless of whether people can afford it or not. Besides, prevailing cost of medicines, drugs and pathological tests are subsequent miseries adversely affecting the majority of underprivileged section of society.

Moreover, what breaks the proverbial camel’s back (read here the patients back) is the high cost of surgery which sometimes does not include the surgeon’s fee alone, though he gets most of the blame. Major share of the hospital bill is gobbled up by the cost of services supposedly provided by that hospital. An internal source of a renowned hospital said, “Commercially expensive localities apart, there are many economically less well to do areas, also confronting the high jingle of charges in respect of consultation and surgery fees in private institutions”,.

A patient around 45 years of age within a distinctly belligerent personality posed me an example relating to himself, “I have suffered from ‘Myocardial Infraction’ (life-threatening heart problem) and subsequent condition would necessitate for ‘open heart surgery’ that normally costs Rs. 300,000 to 500,000 in diverse hospitals”. He maintained, “In view of the unaffordable health cost, what should I do to get relief despite the horrendous condition offered in our state’ hospitals”.

Another man sitting nearby gently improved, “It is obvious that many people are living with acute heart problems and variety of other diseases urgently requiring significant treatment, but even they do not get by the private institutions due to the high cost of treatment”.

If truth be told, both the people and the country are beginning to look weaker by the day. What currently occupies in mind of the masses is the rising graph of unemployment, the soaring prices of atta and ghee, the increasing cost of gas and electricity – the list is endless. Even worse are environmental factors, multiple infections and meagre expenditure on the health sector by the government. The gap between the need and the demand in the health sector is indeed alarming.

According to the Economic Survey 2021-2022, Pakistan spends only 3% percent of its GDP on health is indeed a joke and travesty of the value of human life in our country. The people from varied backgrounds conceive that keeping in view the concept of an Islamic social welfare state, as envisaged by our founders; provision of basic health care must be the responsibility of the state. Conversely, it doesn’t matter whether it’s health or anything else – there has just been a failure to invest in the right things at the right time!

I had a word with some of the people working in various hospitals and found that there are diverse customs associated with numerous consultants and surgeons in the absence of any guide lines, the charges being usually based on how much they are in demand. If a surgeon is perceived to be over-charging, why do people go to him? Maybe because they are brainwashed into believing that expensive is necessarily better!

A senior surgeon said, “It is observed that there are very small surgeries done under local anesthesia in few minutes and it is unjust to charge Rs. 20000 to 50000 by number of surgeons”, According to him, some operations such as Thyroidectomy, Cholecystectomy and Prostatectomy etc., consumed over an hour’s time of surgeons while Fihrectomy, Appendicectomy, Haemorrhoidectomy, Herniotomy etc., also done under general anaesthesia, take 10-15 minutes. All these operations under GA fell within the purview of major operations and being charged sometimes as Rs. 50,000/- to 200,000/-”.

Though, hospitals are supposed to be among the most significant institutions and medical practitioners among the most trusted professionals, but this is always not the case. What reveals an egoistic image of the profession is the practice by some doctors who join hands with diagnostic centres and pharmaceutical companies to enrich themselves at the cost of patients’ welfare.

For instance, there are several doctors reject diagnostic test results even if they have been carried out from a renowned diagnostic centre and insist that they be carried out again at the centre they promote. For their part, diagnostic centre’s owner pays the doctors a monthly commission depending on the number of patients referred to them. Thus, unnecessary procedures either diagnostic or surgical and subsequent complications worsen the already unbearable health cost

Another practice to be strongly discouraged is when the surgeon takes on a case which is not really of his specialty. Common human errors take place all over the world. These unfortunate occasions don’t ever damage the loyalty of good institutions and professionals. A good and loyal surgeon would intervene while a waiting the arrival of the relevant specialist, but, if it’s a matter of life and death.

However, the like of self-seeking errors by the doctor merely for ‘greediness’ revealing an ‘egoistic’ image of the medical profession.

I remember the dire incident when somebody very close to me was hit by a foreign body in a bomb blast which penetrated his left eye. He was immediately taken to the Casualty Department of a well known hospital where after first-aid, he was referred to an Ophthalmologist who operated him for several times during two months for removal of foreign body from his eye, but thoroughly failed to get something done. “This surgeon is not appropriate to deal with the problem, you have suffered from”, disclosed an internal staff of this hospital secretly. We then forcibly transferred the case to consult another ophthalmologist who was indeed a ‘retina specialist’ in the same hospital once attempted and achieve to throw out the F.B in the same day. He later operated for ‘Retinal Detachment’. But unfortunately, his sensitive eye fell prey to the repeated attempts and lost his left sight eternally. This only happened of due to the greed of that doctor who opted for money – we spent in lacs – which resulted in tragedy.

One academic person who often interprets various situations that take place in this society pronounced, “We have other and many priorities that related either to survival or to greed”.

Lawsuits against doctors and hospitals that are generally considered a mixture of curse and blessing are rampant in developed countries. For a less developed country like ours it would be more of a curse than a blessing, as it would result in malpractice insurances, and unnecessary testing and diagnostic procedures that do not cause only death and suffering but increase the health cost.

To cut a long story short, by penning down of this episode, it is not intentionally meant to raise the eyebrows of valued professionals. Doctors, if I could repeatedly announce are living angels on earth. They deserve more even than our country’s MNA or MPA does. However, enormity of the financial problems in our country can be determined from the facts that the vast majority of people are underprivileged and living below the poverty line more often go to bed with an empty stomach!

In these times of gross and overwhelming poverty, can something be done by the medical fraternity to reduce the charges of consultation and surgery in our private hospitals and clinics? The real answer to the problem is more public hospitals and health centres. The percentage of our gross GDP as spent on the health sector is pathetic.

Otherwise, some more notifications should also be issued by the relevant Societies like SSP, PMA, CPSP, SOGP etc., in rest of the provinces in which the plenty of high charges to be constrained by qualifications only. This pace would certainly confirm the existence of such Societies!

Name of the people are being withheld in the interest of privacy

Feroz Sadruddin is a freelance blogger and translator associated with the Department of Community Health Sciences and the Center of Excellence in Division of Women & Child Health at Aga Khan University, Karachi