The doctors’ strike in the Punjab, which is alleged to have caused the deaths of 10 patients, has led to the throwing off the lid that had been hiding both doctors and the government as part of the capitalist system, in which there is no higher value than the benefit that can be gained from someone else.
The Punjab government not only asked the army to provide doctors, which it did, but also placed at the disposal of hospital medical superintendents police officers with medical degrees. The government wishes to stop from paying the doctors, or providing them the facilities they demand, so that they can provide the present facilities without spending any more money.
Why are the doctors striking? The real reason is basically because doctors have been trained to look on their purpose as the making of money, not the curing of people. They end up having to deal with people when they are at their most vulnerable, when they are ill, often at the point of death. It is because of this that they are courted even by the high and mighty. It is, perhaps, apposite to note that when borrowings took place from previous civilisations, when Muslims engaged in the translation movement from Greece, the primary interest was in the medical texts and discoveries.
When Europe wanted to revive the ancient Greek learning, they did it by translating back from the Arabs, and translated some of the Arabic medical texts back. Modern medicine was introduced into the subcontinent by English doctors, and they soon enough realised that if they trained natives to become doctors, they would not want for anything. Thus, they opened medical colleges, where initially the course was four years after matriculation, a kind of doctor’s diploma, which was supposed to train assistants. However, the natives went to the UK for the full-fledged MBBS course, and for ensuing specialisation, and by the time of independence, those courses were replicated in the newly-independent countries.
However, there was only a short time after the creation of Pakistan when it was enough to get a medical degree. Specialisation was usually the next stage.
Specialisation means passing an examination, but it means doing the donkey work of the wards, the house job, or being a Young Doctor. There are two reasons for specialisation. The first is that there is not enough general practice, for which no specialisation is required, and where a medical degree is enough. The second is that, even where the general practitioner is successful, he does not make as much money as the specialist.
Before the decision to specialise comes the decision to get into medical college. It is apparently very desirable, though not as desirable as engineering. It seems that all schoolchildren take science at Matriculation, but whereas there is a tendency for the best (the ones with higher marks, which is not necessarily the same thing) to take up pre-engineering in Intermediate rather than Pre-Medical, at no stage is there any career counselling, or any testing of the student to determine if he is, indeed, suited to the life that has been chosen for him. (And ‘has been chosen’ is accurate, the prospective engineer or doctor is generally just carried along by events.) Thus, the medical colleges accept a bunch of 18 year-olds, who are bright, good examinees, and after five annual exams, administered in about seven years, hands them degrees allowing them to practice medicine, surgery and obstetrics, and throws them out.
Not all stick to medicine. Quite a few turn to writing. Sir Arthur Conan Doyle was knighted for his literary career, not medicine. Somerset Maugham was also a doctor. Closer home, Colonel Shafiq Rehman the humorist, Dr Enver Sajjad the playwright, and nowadays Dr Younas Butt are examples of mixing literature and medicine. However, doctors moved into the civil services, quite a few doing well in the competitive examinations, with this proving that aptitude apparently did not count in their choice of profession as much as did their general brightness, which allowed them to do well at exams.
Parents have always wanted the best for their children, for them to maximise their abilities into doing well in life. That has meant sending a child to medical college if he does well in exams. As a result, former Sindh Home Minister Dr Zulfiqar Mirza, and his wife National Assembly Speaker Dr Fehmida Mirza, respectively children of a Sindh High Court judge and a newspaper owner and Cabinet Minister. Both are doctors. As the saying goes, hunar hai (there’s a skill).
It is because of this skill that doctors have been an important export to the UK, the USA, the Middle East and indeed throughout the English-speaking world. This makes the brain drain doubled. Not just are a lot of bright young people going abroad because they are doctors, but Pakistan is losing a lot of doctors.
Though medical educations are now being offered by some private medical colleges, the average Pakistani still only pays a small sum for one.
There is, thus, not the pressure of a large student loan on the new doctor. The drive to specialisation is, therefore, because he or she can see how well the consultants are doing in their private practices, and because not just family, but the whole atmosphere of medical college, has convinced the young doctor that his main purpose in life is to make money, a whole lot more than the Punjab government is paying him.
The Young Doctor is caught in a bind. He has to be a consultant at one of the hospitals attached to the medical colleges, and thus a teacher at one of them. For that, he must be selected as one, and to be eligible to apply, he must have the requisite qualifications. That does not necessarily mean going abroad as it once did, but it means providing the manpower needed by consultants, as one of the preconditions is a certain number of years of experience in the specialty, demonstrated by having held a junior job in a ward of the chosen specialty.
Another complication has been in an issue which was not raised during this strike, or in previous ones. Rivals to allopathy apart, like hikmat and homeopathy; there is also a surprising amount of simple quackery. That has meant that general practice has been taken over by salesmanship, not curative skills. In this situation, the Punjab government has tried to run its hospitals on the basis of paying the Young Doctors just enough to have a salary bill, so as to be able to keep its hospitals running.
The strike that just ended has not been the first, and will probably not be the last, not while the doctors see their job as making money. The appeals to their messianic side will falter, mainly because this is a myth doctors sell the public to justify their moneymaking. At the same time, the Punjab government should realise that strong-arm methods will not work, because nothing can compel the end of strikes. The best and brightest are not supposed to have the police after them, and they should have promises made to them kept.
n The writer is a veteran journalist and founding member as well as Executive Editor of TheNation.