Pakistan's healthcare system

Lifestyle Relationships
1

Introduction

From the most modern technology and equipment in big cities like Lahore, Karachi, Islamabad to the lack of even clean drinking water in the rural areas, Pakistan’s health care and education system is like in many other fields a paradox to many and too many. An obvious disadvantage being that numerous people will lack proper medical care; however, this vast segregation allows you to have a better eye for the development that has taken place in previous years, and it allows you to see the horizon of the future and get an indication what to expect.
Let’s go through the various aspects of the Pakistani health care system step by step:

From where we started

One doesn’t need much imagination to realize that back in '47 there wasn’t any health care system at all in Pakistan. Even the most prosperous of Pakistanis could barely manage hospital care, if there was any available. Although various university and hospital buildings remained from the colonial era, it would need a huge effort to ensure these buildings were used properly and were connected with each other through a solid virtual infrastructure. In other words, transforming a building of a university to a university building was a big task.
Apart from this, the whole health care system had to be started from scrath: the financing, the coordination, the availability of trained personel and public support all had to be linked together through a framework that required both national and international support.
In light of this starting point, one has to give credit to the development that has been made so far without losing sight of the work still required.

Rural areas

Starting of with the ‘negative’ points one quickly stumbles on the fact that still too many people don’t have access to the basic life necessities (food/water, house, clothing), let alone to basic medical needs. However, both internationally and nationally various projects have been started to tackle this problem. For example, the World Health Organization is providing a lot of countries with polio vaccines to prevent a disease with the eventual aim to eradicate it altogether as was done with the pox-virus. Such programmes are also started for Tuberculosis and various other child’s diseases.

[thumb=H]mcmain25742_3315597.JPG[/thumb]

Additionally, various European countries have started exchange programmes in which students/professionals visit rural areas and not only support the ill, but also train locals to provide essential basic life support. Despite such efforts infectious diseases are still killer number one in rural Pakistan. Malaria, Tuberculosis, Cholera are among the top 5. Perhaps a bit presumptuous but the AIDS-epidemic, that is rising in other countries, seems to be within bounds at the moment in Pakistan. This can be seen as a plus point.
More and more the mentality of the people is changing. Whereas first they let everything happen to them, nowadays they want and have a more active role in disease prevention and education. More so than expensive drugs and treatments, mentality change is the single most important factor that determines the future of these people.

2

The big cities

Moving on to the big cities, it is a great achievement that there are a total of 33 medical schools in Pakistan, of which quite a few have gained international acclaim. The complete list is as follows:

*Abbottabad International Medical College
Aga Khan University, Faculty of Medicine
Bahuddin Zakaria University, Nishtar Medical College
Baqai Medical University, Faculty of Medicine
College of Physicians and Surgeons Pakistan, Karachi

[thumb=H]b5742_8374761.JPG[/thumb]

Frontier Medical College, Abbottabad
Gandhara Institute of Medical Sciences, Peshawar, Kabir Medical College
Hamdard University, Hamdard College of Medicine and Dentistry (HCMD)
Islamia University, Quaid-e-Azam Medical College
Islamic International Medical College, Rawalpindi
Isra University, Margalla Institute of Health Sciences Margallah Medical College
Karachi Medical & Dental College
People's Medical College
Quaid-e-Azam University, Army Medical College
Shaukat Khanum Memorial Cancer Hospital and Research Centre
Shifa College of Medicine
Sir Syed College of Medical Sciences for Girls
University of Balochistan, Bolan Medical College
University of Karachi, Dow Medical College
University of Karachi, Jinnah Medical and Dental College
University of Karachi, Sindh Medical College
University of Peshawar, Ayub Medical College
University of Peshawar, Khyber Medical College
University of Sindh, Chandka Medical College
University of Sindh, Liaquat Medical College
University of Sindh, Nawabshah Medical College For Girls
University of the Punjab, Allama Iqbal Medical College
University of the Punjab, Fatima Jinnah Medical College For Women

[thumb=H]fjbldg25742_4238723.JPG[/thumb]

University of the Punjab, King Edward Medical College
University of the Punjab, Punjab Medical College
University of the Punjab, Rawalpindi Medical College
Women Medical College Abbottabad
Ziauddin Medical University*

This list shows there isn’t a lack of expertise and opportunity in Pakistan; however there are some big stumbling blocks: First of all, the ‘brain drain’. It is still normal practice that the upper layer of the graduates migrates to foreign countries. This export of valuable knowledge and expertise is neither replaced nor paid back for. However though, in recent years a trend can be noticed the other way around: Foreign based Pakistanis, who have experience in various medical fields, are coming back to Pakistan and thereby importing high standard quality and know-how. This has led to the development of a basis from which future generations can profit from. Whereas few years back a MBBS-graduate in Pakistan could only manage to become a General or a Medical Practitioner and for further training needed to go outside, in recent years various specialist training programmes have been developed in Pakistan: Internal Medicine, Surgery, Ophthalmology, Infectiologist, Psychiatrist to name a few.
Second point worth mentioning is the high percentage of girls in medical schools. Although this is a big step towards full emancipation of women in the Pakistani society, fact remains that an overwhelming majority of these girls eventually do not become practicing doctors; thus priceless and irreplaceable knowledge is not used for the sake of society.
Third and final point, that I will mention, has decreased in impact over the course of years, but it is still not gone: corruption, still the biggest enemy of Pakistan’s. Great effort has been made to reduce bribing exams, admissions and transfers. If this can be kept up, we can look forward to an era in which even the poorest boy/girl from the poorest area will have the opportunity to get the professional training s/he desires.

Medical research and development

It may come as a big surprise to anyone that Pakistan has a total of 41 (!!) medical journals. Agreed, qualitatively they are not all up to standard, but this number proves that the will and effort is there to ensure that the medical community in Pakistan is brought up to date with the most recent developments in medicine. For anyone interested the complete list can be found at www.pakmedinet.com/journal.php .

[thumb=H]225742_6654374.JPG[/thumb]

Where do we stand now?

It would be unfair to compare Pakistan with the modern western countries when it comes to health care development. Better would be to look at countries that, half a century ago, were in the same situation: Countries neighbouring Pakistan and also other Muslim countries. One cannot but admit that the first comparison be made with India. Although the economic and technological advances made by India cannot be negated, when it comes to health care issues both countries have made the same amount of progress and still face the same problems: the huge contradiction between the big cities and rural areas.
The recent collaborations and contact, e.g. in sports, econimics and politics, should be extrapolated to health care issues as well, because diseases don't restrict themselves to borders. A good example can be taken from the coast areas where the see-police of both countries collaborated to clean and clear the mess made by oil leakage down the coast of Karachi. Further projects should be started since there is a lot of potential in this teamwork.

Moving on to how Pakistan relates to other Muslim countries, we see that Pakistan has a top position when it comes to health care provision and health care education. Pakistan universities on a regular basis have students coming to study from other Muslim countries, like Iran, UAE, Malaysia etc. This indicates at least that the Pakistani universities have something to offer to those students which they can't get in their own country.

So whereto from here?

All in all one can justifiably say that the ingredients are present to ensure Pakistan a healthy future. The fundamental building blocks, namely medical schools, hospitals, trained faculty, public support, financing, students, international backing, are all present. The only missing link is quite literally ‘the missing link’. I reckon, a central -politically independent! - institution should be formed that will act as organizer and coordinator between the medical colleges and hospitals of various activities related to the education and practice. From admissions to giving grants and scholarships for (international) research such an institution could also be easier accessible for international organizations that are interested in collaboration. Once such an agency can be realized and the points mentioned above can be tackled I do not see what else could interfere with a prosperous future of the Pakistani medical system. A day such as August 14th is the ideal opportunity to reflect back, not only on the apparent negative points, but equally importantly to cherish the positive points and to build on them. These positive points are slowly evolving and it will take time before we reach our goal, but once the right path is taken, the goal is eventually always reached.

Have a Happy and Healthy Independence Day everyone!

3

:k:
Did u write this urself Ness?

4

:smooth:

5

very informative and I was kind of looking for something like this. Thanx!

Initially, i thought its a copy paste but now I also wanna ask if you have written it or just pasted it?

good job though :k:

6

:k:

great stuff nes

i wana point out something

u know, sometimes when organisations like WHO help us, the local ppl take advtg and dont let the help reach the common man

lemi give u an example

like, u know how in pak infants dont have enough drinking milk avlbl..

in the past an international relief organisation provided these big bags of free milk powder to be distributed among the poor, which were for FREE DISTRIBUTION, NOT FOR SALE

and what happenned?

the locals got all the milk packets in hoards, and started selling them in shops, and the milk wasnt distributed for free

a lot of the times the help we get from international orgs, though well meaning they r, doesnt reach till the grassroots level coz of greedy and dishonest ppl in our own society, the govt and the relief agencies shud look into this

7

GTG: are, don’t u expect something like this to come from me?? :hoonh:
I’ve written it all by myself, without any copy-pasting :smiley:

irem: exactly, this is still a stumbling block, and time and again precious help is lost this way. Furthermore, this doesn’t encourage organizations to invest effort in future

8

nescio, thanks for the article..

i am wondering about something..don’t you think that other people might have suggested a politically independent institution before? and if they did..what was the outcome? do you know anything in that regard perhaps? its a good idea though :k:

9

Good effort Nes.

I thought there was a central board that governed medical schools in Pakistan and issued degrees. I think it is based in Islamabad.

Also, I noticed you mentioned European exchanges in helping out medical needs but did not mention any American aid (talk about a political-free article :D) . Also, did you omit Imran Khan's state of the art cancer research center and Abrar-ul-Haq's modern hospital in rural Punjab? I think those two were the biggest individual acheivements after Abdus Sattar Eidhi's social work. I know it is hard to cover it all in an essay but we must acknowledge the not for profit orgs when it comes to medical field.

10

Qrius and fg: thnx for the additions. About the central organization. I'm sure there is something in name present...I'm just concerned about the practical influence it has. Cuz -although having been to a Pakistani school myself- I get the feeling all medical schools are totally independent-working.

The European help I mentioned: hehehehe, yes of course America helps a lot too

The two hospitals u mention are indeed great individual achievements. Here, I want to add something, cuz just like the universities the hospitals too are uncoordinated. Every street corner one cud open a hospital if s/he wish. I'd like to see a bit more organization: if there is already an orthopedic centre somewhere, the government shudn't give licenses to open up many in the neighboorhood. Instead it shud encourage other clinics like dermatology just to mention one. Also, I'd like to see such hospitals cooperate: like in other countries, one big hospital functions as the major referral centre and trauma centre. The others are satellite hospital all with different specializations

11

A well written peice Nes :k:

If we could rearrange our priorities, the results would be beneficial.

Instead of our mbbs grads dying to go abroad for further studying, if the gov’t invests money in research projects/institutions within the country, there could be room for expansion for the nation as a whole.

The girls to boys ratio in med schools is of great significance because it totally limits the extent of our national progress. On merit basis, three-fourths of the seats are usually granted to the female population of which a good percentage ceases to practice medicine after grad b/c of various reasons. There is a good amount of investment that goes into med students and the results arent quite satisfactory. I’ve heard this year the seats allotted will be based on a pre-calculated quota for males adn females (but then again, I heard this last year and the year before that too).

Public awareness has had a lot of emphasis put on it lately. Ranging from TV ads to door-to-door polio schemes, they are working on letting the public know about everything from the cause of disease to preventing measures.

And yes, the increasing rise in privatization of health services clearly shows the lack of support from the govt in health specialists. Almost 9 out of every 10 doctors work their dayshift at a gov’t hospital (mostly just showing up to sign their attendance) and from evening onwards, they’re found at thier pvt clinics, offering the best of their insight and knowledge. Why are they doing this? It’s their need to survive! What good is a mere 5 grand rupees check going to do for not only the doc himself but his family as well? He’ll need a lot more than that to raise a family adn that ‘lots more’ comes from his pvt clinic.

Corruption cannot be eradicated at once but like you said Nes, evolution is on its way – let’s pray for the best.

12

nicely done nessie :D
I m surprized this is comming from you :p
( I guess we both know what I mean :D )

annyway, your right about everything, but the problem is the pakistani system and corruption. :D yes I know Im bringing in another topic, but I feel its in its place over here :)
pakistani peeple are on average corrupt and do everything for money (no am not generalizing )
thats the only heavy obstackle i c and as long as there are MANY such peeple in one place, there s no progress.

13

Very informative! I'm planing to go to Pakistan next year to do medical research myself. I haven't had the time to do research on the healthcare system yet, so you've been a great help. And thanx for the list of journals! I think I'll be making much use of it later!

14

Pra: u made me thinking here for a while....but then i remembered :biggthumb as they say: ere we ere toekomt

X-Com and Miss A: thnx for ur comments :)

X_Com: indeed, there are more girls than boys in med school, but the problem is also that boys tend to study less than girls. Hence the best suited students for medical studies are girls. It's a pity that they in the end don't practice. We then get a strange situation where the boys in general are too lazy and dumb to study, whereas the girls stop practicing after study

15

^ that is my concern too.. i know several female doctors who have topped in FJ or are doing extremely well thru private medical schools, except they are not willing to practice.. too afraid of the label society will give them..

if there was only a way in which females could be encouraged to practice, and for their parents to also support them.. i think Pakistan could definately say it has the best docs..

p.s I hear PIMS is an awesome hospital too and some of the best doctors are there :k:

16

[quote]
Second point worth mentioning is the high percentage of girls in medical schools. Although this is a big step towards full emancipation of women in the Pakistani society, fact remains that an overwhelming majority of these girls eventually do not become practicing doctors; thus priceless and irreplaceable knowledge is not used for the sake of society.
[/quote]

so true. I was actually thinking about this yesterday. And this is not only true for medical schools but for almost every other school as well. Degrees dont do you or your nation any good if you're gonna sit at home and do nothing.

Also, I agree with x-commi on the low paychecks of docs at gov't hospitals. My uncle actually had the same problem and he left that job and opened a private practice.

17

Good Info Nescio....
Except that King Edward Medical College is not affiliated to the University of the Punjab now...It is a seperate University called King Edward Medical University.

18

[QUOTE]
*Originally posted by funguy: *
Good effort Nes.

I thought there was a central board that governed medical schools in Pakistan and issued degrees. I think it is based in Islamabad.

[/QUOTE]

That is not a central board...It is a center that registers all the Doctors & Dentists in Pakistan Called PMDC(Pakistan Medical & Dental Council)....It is the Universities in Pakistan that issues the Degrees..

19

Second point worth mentioning is the high percentage of girls in medical schools. Although this is a big step towards full emancipation of women in the Pakistani society, fact remains that an overwhelming majority of these girls eventually do not become practicing doctors; thus priceless and irreplaceable knowledge is not used for the sake of society. <<<

I don't think it's a complete waste because even if these women don't practice, they still use that education in their own home and people do come to them so society does benefit. Just like people on this board ask you stuff Nes.

20

^by now, I even have to keep dossiers of various guppies :hehe: