top of page
  • Instagram
  • TikTok
  • LinkedIn
  • YouTube
  • Facebook
  • Twitter
Search
Daneeya Sheeraz
Jul 20, 20238 min read

Deep Dive Into Healthcare at Pakistan

Updated: Mar 23


Disclaimer: The sole purpose of this blog is to inform people about the condition of health care in Pakistan. This article provides first- and second-person account of all cases and is based on credible sources on the Internet.


✨Outline✨

 

Introduction

Imagine you are taking part in an internship at a hospital. It’s your second day shadowing a surgeon in the outpatient clinic. You have seen a couple of patients and are taking an interest in the inner workings of the medical world. Now imagine the surgeon pulling a gun out. While in the clinic. In front of you, your fellow interns, and the teenage patient. More on this later. For now, let’s look into the healthcare system of Pakistan, and explore some aspects of it.


Source: BBC

Pakistan

Pakistan is a South Asian country that gained independence from the “British Raj”, or British colonial rule, in 1947. It is the thirty-third largest country by area but the fifth largest country by population, making up nearly 3% of the total global population. The population spans 240 million people. As can be imagined, this creates a huge burden on resources. It is also one of the two only nations to still have incidents of polio. The other is Afghanistan, and one reason Pakistan still has this disease is refugees trickling in from Afghanistan, which shares a border with the northwest. However, due to efforts being made for vaccination and eradication of polio, so far, 2023 has seen 1 case as compared to 2022 seeing 20 cases of this disease. It is also worth noting that, according to the World Economic Forum’s 2023 Global Gender Gap Report, Pakistan is in a devastating fifth last position (142 out of 146), only above (in order from lowest to highest) Afghanistan, Chad, Algeria, and Iran.


Child and Maternal Mortality

To first gain a measure of the kind of healthcare we are looking into here, some statistics and facts can offer good insight. For every 1,000 live births in Pakistan, there are 63.3 deaths of children under five, according to UNICEF. Lack of proper nutrition and premature births, diseases, and opposition to vaccination are some causes.

While doing my internship at the above-mentioned hospital, I happened to meet and talk with a couple of medical students. One of these students, a fifth-year (medical school in Pakistan is five years long), has been doing clinical rotations at PIMS, a government/public hospital. This student told me about a case they saw, where a 19-year-old woman came to the hospital with a severely emaciated and malnutrition infant. The mother claimed that the baby had been healthy at birth but now, a couple of months later, was near-skeletal. She went on to tell the doctors that she had been feeding the child cow’s milk.

Cow milk does not have the necessary nutrients for the growth and development of a human infant. As can be seen, a severe lack of education and awareness contributes to this high rate of child mortality. Moreover, so does families forcibly “marry off” young girls (too much older men in most cases), subjecting them to the prevention of completion of their education, abuse, child pregnancy, and marital rape amongst many other things.


Source: Our World in Data

Dr. Halima Yasmeen says in a DAWN article, “Mankind has reached Mars, but women in Pakistan are still dying from childbirth.” In 2022, the maternal mortality rate showed a 32% increase from 2017, landing at 186 deaths per 100,000 live births. Whereas in the United States, in 2021, the maternal mortality rate was 32.9 deaths per 100,000 live births. Some reasons for this high number include:

  • Unavailability of proper healthcare

  • Neglect of pregnant women by healthcare providers or family

  • Hesitation to gain medical care

  • Incompetence in healthcare

  • Lack of education and awareness

  • Inadequate medical supplies

  • Child marriage and pregnancies

  • Malnutrition

Yearly in Pakistan, 14 million girls between 15 and 19 get pregnant and give birth due to child marriage. Mothers below the age of 15 are five times more likely to die during childbirth than women in their twenties. The chance of an infant who has been born to a mother under the age of 18 dying before turning 1 year old is 60 times higher than that of one born to a woman over the age of 19.


The Government and Medical Care

Pakistan is a country with a collapsing economy. According to the government’s finance budget for 2023, Rs.26 billion ($91 million) has been allocated to the health sector. Meanwhile, government hospitals are both severely overburdened and in shambles. There is a huge gap between patient load and facilities available. The rapidly growing population cannot be catered to. According to a medical student I talked to, doctors in PIMS are seeing around 300 patients a day. This creates a lack of proper medical care. Doctors are overburdened and cannot spend long enough with patients to provide adequate care.

A mix of government and private hospitals is providing healthcare in Pakistan. When public hospitals fail to provide proper care, people turn to private hospitals and larger cities. However, in a country saturated with poverty and unemployment, not many people have insurance and are paying for medical care out of their pockets; these private hospitals often prove to be too expensive. Do these patients take loans from other people that they probably will not be able to pay back later? Do they somehow find the money but leech their pockets dry? Or do they turn to the poor medical care provided at government hospitals and hope for the best?


Multiple patients share one bed at a hospital. Source: NetMag Pakistan

Patients waiting at a hospital. Source: The Express Tribune

There are 1201 government hospitals and 700 private hospitals in Pakistan. Furthermore, there are 5518 Basic Health Units, 683 Rural Health Centers, 5802 Dispensaries, 731 Maternity & Child Health Centers and 347 Tuberculosis Centres. A total of 123,394 beds are available in government facilities in a country of 240 million people. Out of the hospitals that are available here, most are in a poor state.

The doctor-to-patient ratio is 1:1300. WHO recommends this ratio should be 1:1000. The doctor-to-nurse ratio is 1:2, and WHO believes this number should be 1:4. Nurse to patient ratio is 1:20. As can be seen, Pakistan is seeing a shortage of doctors.


Cases of Incompetence and Negligence

While many valuable healthcare providers in Pakistan are very good at what they do, many doctors in Pakistan have careers fuelled by money and greed. Numerous healthcare professionals also have improper training. A lack of empathy and care for human life as well as gross incompetence is seen throughout the country. A lack of accountability and consequences lets this behavior run rampant. Here, we will explore some of the countless cases that are examples of this.


Case 1: I can begin with the story I witnessed with my own eyes. As an intern at a private hospital recently, I experienced two things that particularly stood out to me. I had joined a surgeon in the operating room to watch his surgery. My eagerness soon dissolved into horror as I witnessed the doctor’s behavior in the operating room. He was shouting vulgarities at his staff and being completely unprofessional. After a while of this happening, as I was about to leave, the assistant anesthesiologist came up to me and gestured for me to take it “in one ear and out the other”. It was not this surgeon’s first time displaying such behavior. When I joined him in the inpatient and outpatient departments, it soon became evident that this behavior was not reserved for the operating room, where the patient was under anesthesia, but was also displayed when talking to patients and their families. During rounds in the inpatient department, this surgeon would sit on the couch and vape during discussions with the patient and their attendants.

This unethical behavior reached its peak in the outpatient department. A patient had just left this surgeon’s clinic to get an MRI. The patient’s son muttered something ill-mannered about the surgeon to his staff as he left. The doctor, upon hearing this, leaped up and began to scream at the patient’s son. This turned into a full-blown shouting match which ended with the surgeon yelling for security to escort them out. He stomped back into his office, where a new patient, a teenage boy, and his family were waiting. Some other interns and I were also present. The surgeon continued to shout and swear and hauled up his briefcase, clicked it open, and took out a handgun. He said, in Urdu, “I keep this with me for such people.” He went on to say, “In ko nahi pata, me bhi bara badmaash hu.” (They don’t realize I’m a scoundrel too.)

The patient, who was already terrified out of his mind before this because his mother had passed away due to the same condition that he had, was now even more petrified and no doubt distrustful of this doctor.

Case 2: This, too, is a case I saw during my internship. It highlights the lack of consequence and quality training for doctors in Pakistan. A patient arrived in the emergency department, his legs completely paralyzed. He told the doctor that he had come from Afghanistan for spinal surgery. During the operation, the surgeon cut his spinal cord, rendering him paralyzed. Doubtlessly, doctors are humans and can make mistakes. However, the number of such cases of negligence and carelessness that appear in Pakistan due to the absence of proper checks and consequences is unnatural and overwhelming.


Case 3: In June of 2022, a Rural Health Centre performed surgery on a Hindu woman for the removal of her dead breech baby during childbirth. The torso of the baby was delivered but the head was cut off by incompetent medical staff and left inside her. She had to undergo another surgery for its removal. I cannot begin to imagine the horror and psychological trauma this must have caused for that woman.


A lot of urgent work needs to be done for the improvement of the healthcare system in Pakistan. Such work is being done by international and national organizations and the government. Pakistan has managed to lower its polio cases enormously in the last couple of years. Immunization programs like the Expanded Program on Immunization have increased vaccinations in Pakistan from 5% to 84%. As of 2020, 92% of the rural and 100% of the urban population was able to gain access to healthcare.

As awareness and education increase, so will these efforts to better medical care in Pakistan. Currently, 70% of female doctors in Pakistan do not work and many doctors leave the country in favor of better work conditions, higher salaries, lower workloads, better training, and increased opportunities. Therefore, we must improve the system not only for patients but also for healthcare providers so that they can give the best medical care to their abilities. Pakistan has numerous exceptional doctors and nurses, medical schools, and hospitals whose potential can only be tapped by a strong and developed healthcare system. This will also allow for the formation of more such institutions and physicians.


 

Sources



ความคิดเห็น

bottom of page