Throughout the course of history, Homo sapiens have faced pandemics such as Black Death, bubonic plague, and Spanish flu. while these disastrous pandemics killed millions and spread fear for ages, humans eventually survived them, proving the theory of “survival of the fittest.” However, the current pandemic, Covid-19, caused by a novel coronavirus, has put a question mark on humans’ ability to beat the microbes and survive.
Ironically, the Covid-19 has wrecked the most considerable havoc in the developed world. The last few months witnessed the collapse of the advanced health systems of developed countries like the US and the UK. Notably, Europe and North America are the worst hit with infections reaching millions and hundreds and thousands of deaths in the United States, Spain, Italy, and the United Kingdom. The pandemic highlighted the weaknesses in the best health systems, which were overburdened and reached the point of collapse.
Pakistan is a developing country and has a fragile healthcare system, which is at the cusp of the disaster. The system marred with corruption, nepotism, and incompetence is at a breaking point as the pandemic unfolds. World health organization (WHO) has warned that Pakistan has emerged as the worst-hit countries with the fastest rate of coronavirus infections in recent weeks. According to algorithms used by Imperial College of London, for predicting disease and death toll, Pakistan could face a sum of 2.29 million dead by the next January if proper lockdown and social distancing protocols are not imposed. In short, Pakistan is fleeting towards a disaster unless it changes its course in the coming days.
It is obvious to expect an increase in health budget considering the weak state of the health system and the upcoming spikes in infections and death, as predicted by the data. But the budget documents of the fiscal budget 2020-21 reveal a slightly different picture, indeed a horrific one. With a total budget outlay of Rs.7,294.9 billion (about US$ 44 billion), only Rs.25 billion has been allocated for health―a meager 0.4% of the GDP.
Although health is a provincial subject after the 18th Amendment of the constitution, a mere look at the numbers sheds light on the state of affairs and the priority given to the health sector amid the pandemic. Punjab, the most crowded province, has allocated Rs.284.2 billion for the health sector―and increase of a mere 1.86% compared to the last year. A ‘special coronavirus allocation’ of Rs.13 billion― 4.57% of the total health budget―has been earmarked. A significant chunk of the health budget (250.7 billion) will be used for running expenditures, and Rs.33 billion has been kept aside for the development schemes.
Amid a shortage of funds, PPE, ventilators, necessary medicines, and equipment, the government is facing another scarcity of human resources. A source in the health department said that “the hospitals are facing an extreme curtailment of specialized staff with dealing with the pandemic and ultimately they had to divert the existing team to Covid-19 wards.
The country is facing a financial deficit in the health sector, with a severe lack of human resources.
The budget documents of Khyber Pakhtunkhwa (KP) reveal Rs.124 billion for the health sector, which includes Rs.24.4 billion for health-related schemes, of which Rs.13.8 billion would be spent in the settled districts and Rs.10.6 billion in the merged districts. The KP government has also earmarked Rs.24 billion emergency fund to tackle the Covid-19.
The Balochistan Government allocated Rs.38 billion for the health sector―a meager 8.6% of the total budget outlay of Rs.465.528 billion. Among all the provincial budgets, the Sindh government budget for the fiscal year 2020-21 has substantially increased the health sector’s allocation to counter the pandemic and other infectious diseases. The health department budget is raised by 16.1% to Rs.139.18 billion, compared to Rs.120 billion in the outgoing fiscal year.
Muteeb Ur Rehman, a scholar of MS economics, commenting on the health budget says that: “according to the WHO, percentage of health spending to GDP must be near about 6% while in Pakistan it is just 0.4% of GDP (Human Right Commission of Pakistan annual report). Pakistan’s health budget is not only insufficient but also poorly managed.”
He said that “the government should give attention to improve emergency medical services, training, and capacity building of staff through experience sharing of medical staff internationally, focus on the availability of essential life-saving medicines, face-masks, Personal Protective Equipment (PPE), medical equipment, and public awareness program.” He also said that there is a dire need to invest in research of vaccines to mitigate this deadly pandemic
The country is facing a financial deficit in the health sector, with a severe lack of human resources. According to the WHO standards, it is an obligation that around two doctors, a dentist, and eight nurses should be taking care of not more than 1,000 people. However, the overall healthcare scenario in Pakistan is very bleak. While the country faces an acute shortage of hospitals, the number of beds, and the number of ventilators available for patients, it is also facing a scarcity of doctors and specialized staff. According to World Bank data, only 0.7 beds, 0.98 physicians, and 0.668 nurses are available per 1000 people.
Pakistan has not witnessed the flattening of the Covid-19 curve yet. Recent protests and resignations by the health staff and doctors fighting the pandemic at the front lines, due to lack of provision of Personal Protective Equipment (PPE) by the authorities should have been an eye-opener for the policymakers and financial planners of the country. Given the warnings and predictions from international organizations regarding the future, the financial policymakers should have increased the health budget; nonetheless, some amendments are made to the low health budgets amid this deadly pandemic. It could be a perfect recipe for a disaster whose human price would have to be paid by ordinary citizens.
COVID-19 arouse as a global medical emergency that stressed the healthcare systems of every country. Till now, it has claimed 5.6 million lives worldwide. The pandemic created a deficiency of medical types of equipment, starting from ventilators to oximeters, PPEs and even hospital beds when the number of patients grew faster. The challenges grew with each day passed, and some countries are still fighting. Situations like these demand research to profoundly understand and tackle the dilemma and formulate a cure that permanently puts the catastrophe and ensures protection in the future. Pakistani scientists and academicians, too, carried out researches of immense importance on the virus. Contrary to expected, medical colleges couldn’t participate as much as non-medical universities and institutions did.
The medical profession demands intelligence, passion, empathy, and self-sacrifice. Staying this idle when medical students could contribute significantly to biomedical research was quite strange, unfair, and entirely unacceptable. A harsh reality is that our medical colleges prefer to produce medical practitioners rather than medical researchers.
The medical students are always told what is clinically significant and what’s not, but they are hardly reminded that medical research is premium to practice. This might happen because of the fact that medical practice yields more financial and career benefits. But without research, the discipline stays stagnant. The practice is only for the time being and not for the long term. In Pakistan, this has been badly exposed by COVID-19.
How do they get away with it?
Tasbeeha Saeed, a science writer in her piece, wrote that the University of Health Sciences Lahore (UHS) succeeded in staying a major medical university of the province. She says that UHS has taken the following four steps to keep its status.
UHS kept its monopoly over all other universities of the province by conducting examinations and admissions.
UHS has secured the most affiliations of medical and dental colleges from all over Punjab.
UHS has sought affiliation with universities around the world.
UHS has placed a strong public relations (PR) department that manages the media in favor of the university.
She claims that these are the four factors that help UHS survive.
However, the state of research education and activities in medical colleges of Pakistan is appalling. A yet-unpublished study carried out in 2017 in four public and private sector medical colleges of Rawalpindi – Islamabad concluded that 78.8% of undergraduate students found a lack of motivation and incentive as the cause of disinterest in research among them. Other factors included curriculum overload (83%) and faculty-forced research (78.1%). (https://www.pafmj.org/index.php/PAFMJ/article/view/2094)
This clearly indicates how much they are pushed to focus on bookish knowledge and discouraged from participating in research.
“A survey conducted to assess the attitudes and practices of postgraduate medical trainees towards research clearly indicated poor research training and insufficient awareness about research as the major reasons for the pitiable state of medical research in Pakistan. Most had an assertive attitude for health sciences research. This shows that most medical graduates recognize the importance of research, but lack of research infrastructure and paucity of medical scientists as mentors are their major concerns that require immediate attention.” – Pakistan Journal of Medical Sciences.
According to a survey, most postgraduate medical trainees showed an assertive attitude for health sciences research.
Students Opinions
A Survey conducted by Scientia Pakistan shows that private medical colleges focus more on research than public sector medical colleges. Taimur Tahir, a student from Peshawar medical college, a private college in KPK, says that he was introduced to research in his first MBBS. He won second prize in an Undergraduate Medical Research (UMR), a national level contest. He has a research paper published to his credit and working on another.
M Usman, a 3rd-year student from Nowshera Medical College, a public sector medical college in KPK, says that he has never been involved or motivated to get involved in any kind of research activity at his college. He says that in the future, they expect some traditional survey type research from the community medicine department only.
We also reached out to the students of Bahria University Medical and dental college Karachi, Bhittai Dental and Medical College, Lahore Medical and Dental College, Quaid-e-Azam Medical College Bahawalpur and Altamash Institute of Dentistry. The students stated that there was no research activity at their institutions that they could call innovative. They weren’t exposed to it ever or let alone being trained for it. Many students raised voice against lack of research culture in their institution and said that the only kind of research they had at their campuses was the traditional questionnaire-filling.
The Few Exceptions
It will be unjust not to mention a few institutions that are playing a vital part in medical research in Pakistan. Among them, Agha Khan University hospital, Dow University of Health Sciences, PIMS, king Edward Medical college, and some other private and public sector medical colleges and universities work tirelessly to provide a sophisticated research environment to their students.
For this, Agha Khan University publishes an annual Research Outlook magazine to document its research activities. AKU is among the seven global institutions that collaborate on a research study on infectious diseases – United world antiviral Research Network (UWARN). This study is mainly focused on research on emerging viral diseases and curbing pandemics in the future. It also hopes to improve understanding of how viruses manipulate the human immune system. Several AKU faculty members will serve as investigators in the study.
The medical students are always told what is clinically significant and what’s not, but they are hardly reminded that medical research is premium to practice.
In late 2019, Agha Khan University introduced a new typhoid vaccine to combat a drug-resistant strain of the potentially fatal disease. This was the first of its kind ever in the world. There are many other innovative pieces of research to the credit of AKU.
Dow University of Health Sciences is also one of the leading medical research institutes in Pakistan. Their most recent notable contribution was the development of intravenous immunoglobulins (IVIG). This is a more safe and low-risk method of COVID-19 treatment. They also have replicated cyclopia – a rare birth defect in newborns – in common houseflies. The most common symptom of this defect has a single eye. This will help us understand the pathology better.
Role of Pakistan Medical and Dental Council (PMDC)
PMDC was supposed to play a vital role in the promotion of medical research in the country. It had the authority to regulate medical institutions. But unfortunately, politicization ruined the body, and it got engaged in endless controversies. It was accused of authorizing private medical college despite inadequate infrastructure. Even its executive council was dissolved by Supreme Court in August 2015. Just recently, PMDC was replaced by Pakistan Medical Council (PMC) via a presidential bill. Cases were fought in courts, and eventually, the decision was revoked.
PMDC should now take stock of the primary science teaching and medical research in various medical colleges. The HEC-sponsored PhDs returning from foreign universities can be utilized as a teaching and research faculty. PMDC should consider appointing and promoting faculty stringently based on their academic research accomplishments. Research support units should be established in medical universities. Institutions should consider issuing research magazines to update students with recent developments in the field and draw them to conduct their own research. Celebrating research days and sessions on its vitality can also help.
Anam was an eleven-year-old girl who had her menstrual periods for only three months, and then they stopped. At first, her parents thought that it was not severe and that she was of minor age, and her periods would naturally start again. After a few months, though, they decided to get medical advice. They went to a Yunani Hakeem, who focused on the fact that the girl’s hair was thinning and graying (which it was). He gave a dozen bottles of murabba and herbal pastes. The girl ate them and developed acne all over her body since the herbs were warm enough. The problem of the periods remained unsolved.
Later, Anam’s parents took her to a homeopath, who listened to the symptoms and assured them that he would ‘fix’ everything, but that it would take time. The poor girl sucked the homeopathic tablets after every meal, and several years passed. Upon each visit, she was given more pills and the reassurance that she would get well, the treatment only needed time.
When Anam reached the age of 20, her symptoms weren’t getting well, and finally, her parents decided to take her to a gynecologist. They had been avoiding allopathy because of the fear of side-effects. The gynecologist was well-known in her field and asked for a proper ultrasound, hormonal blood tests as well as an MRI scan. After looking at the criteria, it was found the Anam had a tumor in the anterior pituitary gland and an imbalance of hormones. There was nothing wrong with her reproductive organs.
Anam referred to an experienced endocrinologist, and after taking prescribed medicine for 14 months, her tumor had shrunk, her hormones were balanced, and finally, her periods started as well. But she still has to consume the medicines to keep the tumor in check as well as the hormones.
Medicine is the science or practice of the diagnosis, prevention, and treatment of disease. Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant and mineral-based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.
What are the main traditional systems in Pakistan?
There are several kinds of traditional medicine practiced throughout different areas of Pakistan. These are also known as folk medicine, since they are based on knowledge about herbs and spices, plants and remedies etc and have been passed on and practiced from generation to generation before the advent of modern medicine.
Usually, anyone who has a slight physical problem runs to the nearest homeopathic practitioner because the medicine is deemed effective with no side effects. In principle, Homeopathic medicine is pseudoscientific. It is compatible with factual science as well as beliefs and traditions to some extent. The founder of this kind of medicine was Samuel Hahnemann, a German physician, who was not satisfied with the medical practices of his time as it caused harm to the patient as well.
The basic principle involves diluting the medicinal substance with water, ethanol or sugar. The belief that a substance that causes symptoms of a disease in healthy people would cure similar symptoms in a sick person is te main doctrine of this type of medicine and is called similia similibus curenter meaning ‘like cures like’.
Herbal medicine
This is also known as phytotherapy, as it revolves around the basic concept of utilizing the medicinal potential of plants. According to botany, a herb is any plant with leaves, seeds, and flowers which does not have a woody stem and dies down to the ground after flowering. Herbs are usually useful for flavoring food, making perfumes and scents as well as medicines. An example of a herbaceous plant is Mint, which is used in soothing an upset stomach.
Archaeological evidence supports the fact that herbal medicine dates back to about 5000 years, with the Sumerians in the Paleolithic age being the first ones to compile data about herbaceous plant species. There are several writings on herbal plants from ancient Egypt as well, followed by Greek work on them and then from the Shang dynasty of China in 1600 BC.
According to the World Health Organization, modern herbal medicines are the basis for present pharmaceuticals, precisely 25 percent of modern drugs in the USA. At least 7000 medical components in the modern pharmacopoeia are plant-based. Common ones include artemisinin, opium, digitalis, and quinine. The most common form of using these herbal medicines is liquid extraction via chromatography and then making herbal teas e.g chamomile, mint, sage, lavender, thyme, rosemary etc. they can be added to foods in their original leafy form as well to add taste as well as to get their benefit.
On 14th December 2019, the first ever TCM entered Pakistan and it was against bronchitis.
Chinese traditional medicine
This is a type of medicine prevalent for thousands of years to prevent, diagnose and treat disease. It is based on the belief that qi( the body’s vital energy) flows along meridians(channels) in the body and keeps a balance between mental, spiritual and physical health. TCM works for restoring the body’s balance and harmony between the natural opposing forces of yin and yang, which can block qi and cause disease. It is also known as oriental medicine.
It originated back in the days of the Shang Dynasty and includes several practices which may sound a bit odd. E.g. acupuncture, cupping, gua sha/scrapping off of skin, tui na/massage, die-da/bone-setting, qigong./exercise and dietary therapy.
On 14th December 2019, the first ever TCM entered Pakistan and it was against bronchitis. The Yinhuang Qingfei Capsule passed a one-year trial at the ICCBS, Karachi University and was declared safe to use against the usual medicine Amoxicillin-Clauvulanate, which is losing its potency due to resistance by the bacteria.
Chiropractic
This is a medicine concerned with treating mechanical and muscoskeletal disoreders and pains. The main concept revolves around manual therapy, with extra stress on the manipulation of the spine, other joints, and soft tissues. It also includes excercises and lifestyle counseling, but chiropractors are not physicians or medical doctors.
D.D. Palmer found it in the 1890s and claimed it to be effective as it was ‘a science of healing without drugs’, although today it is subject to controversy.
Presently there are several registered chiropractors all over cities in Pakistan and they claim ‘full body pain adjustment’ for a reasonable amount of fee.
Naturopathy
What’s the first thing your parents do when you complain of an ache or ailment or an injury? That’s right, search for a home remedy!
This medicine is based on ideas like natural, non-invasive and self-healing concepts. It is based on vitalism and folk medicine rather than evidence based research. It is passed on from generation to generation as ‘wisdom.’ I believe this is the most common type of traditional medicine in Pakistan, as every other person has some ‘totkay’ to share when someone complains of an illness.
There are professional naturopaths as well, who usually focus on lifestyle, emotional care, physical examination and treat with introducing changes in lifestyle. They usually oppose drugs and their usage.
Usual practices include herbalism, homeopathy, natural cures, applied kinesiology, psychotherapy, public health measures and hygiene, reflexology etc.
Yunani Medicine
This is a system that was practiced in the subcontinent during the Mughal reign. It means Perso-arabic traditional medicine, initially introduced by Greek physicians Hippocrates and Galen.
According to Unani practitioners, the failure of the body to maintain its own its own health and equilibrium leads to derangement of the fluids.
It is also practiced by Muslims in Central Asia and has originated from the four basic classical humours of the body; phlegm, blood, yellow bile and black bile. According to Unani practitioners, the failure of the body to maintain its own its own health and equilibrium leads to derangement of the fluids. Each person has a unique mixture of these fluids and they determine the person’s temperament.
After diagnosis, treatments like cupping, aromatherapy and bathing, massaging etc are used for treatment.
Spiritual Medicine
This is a filed of medicine which believes in the well-being of the spirit band mind. The body is linked to the spirit and in order for one to be healthy, the other should be well too. This medicine is based on beliefs and religion.
Since religion is defined as the way of living, this type of medicine explores the power of meditation and calming the mind in order to attain peace. It guides us towards achieving peace through a better lifestyle.
Spiritual healing is also called energy healing and supported by other cultures and countries as well. Surprisingly, scientific research also praises the calming effect that this has in some psychological as well as physical illnesses.
In Pakistan, this is practiced via reading verses of the Quran and prayers in a redundant and specific manner (dam darood), reading the names of Allah and other prayers on a rosary, taweez etc.
Complementary therapies
These can either be used alone, in combination, or paired with any of the above. They include:
Physical activity and exercise
Nutrition
Massage
Acupuncture
Mind and body practices e.g. meditation and yoga
Which system of Traditional Medicine is most prevalent in Pakistan?
According to Sheikh et al., 2009, modern medicine is prevalent over all other forms of TCM, and amongst TCM, Homeopathy is most commonly opted for, with Yunani medicine being second common.
Modern Medicine/Allopathy
This is science-based modern medicine based on medication and surgery against symptoms of the disease. Doctors and pharmacists use drugs, radiation, and surgery to treat symptoms and diseases. Treatment includes antibiotics, vaccines, chemotherapeutics. The word ‘allos’ comes from the Greek language and means ‘opposite’ and ‘pathos’ meaning ‘to suffer.’
TCM v.s. MM
Although modern medicine is fast evolving, scientific-based, precise, and more efficient, it is often expensive and has side-effects as well. The technology involved has not yet reached remote areas like villages etc
Traditional medicine is a thousand years old and practiced more frequently, so many people in Pakistan have strong faith in it. Also, since most ingredients are derived from nature and not chemically synthesized via industrial processes, it is cheaper and thus affordable as well. TCM, like homeopathy, typically has no side-effects. Other TCMs, which include the usage of herbs or minerals or physical processes, may cause unwanted effects and pull of muscles. Often the root cause of the illness is not diagnosed and thus neglected, and the medicines and treatments prescribed may lead to complications of issues and symptoms.
Why do so many different systems exist?
In this colorful and heterogenous wedge of humanity, thought processes, norms, cultures, and beliefs are also as diverse. Every person believes in a different cure and supports and uses that cure. Some people accept more than one health system and some are critical to the rest while only supporting one.
People support the system, which is linked to their areas of residence, their forefathers, their norms, and traditions. Very few venture to understand or practice other approaches. That is why, in Pakistan, the rigid establishment of traditional health systems is stable and steadfast. It doesn’t matter if the cure is practical or influential; if there is a Hakeem in your muhalla and everyone gets their medicine from him, then that is where you are also going.
Is there a possibility for all these systems to combine into one single system?
Wouldn’t it be lovely if all this hullabaloo of choosing a health practitioner and being juggled between different systems was solved and there was only one standard health system practiced throughout the world? It would make life so simple.
As brilliant an idea as it sounds, it is quite impossible due to the opposite beliefs of traditional and modern medicine. Their basic principles have a stark difference. The purpose of each health system is the same; to relieve discomfort and cure disease. Despite that, it is impossible to combine them into one field.
But yes, it is possible to use some systems simultaneously like modern medicine can be paired with any of the complementary therapies e.g., nutrition or yoga, to attain mental peace along with being physically cured. Many Pakistanis, being Muslims, believe in the power of spiritual healing, redundantly reading the name of Allah or a verse of the Quran along with any medicine they use.
One important aspect of this pandemic has been that it made us identify the scarcity or a lack thereof of a ‘science communication’ culture in Pakistan.
Although we did come across some examples of it through news channels and newspapers, unfortunately, those exemplified How Not To Communicate Science. From overselling diagnostics to misinforming the public about therapeutics, our mainstream media has been, even now, at the forefront of bad science communication.
We have come across multiple Facebook groups with hundreds and thousands of individuals to chains of WhatsApp forward messages, during the pandemic we have seen how rapidly community networks have developed and grown based on the information they received from the mainstream media, and in many circumstances, these groups and messages themselves have been the source of information for the mainstream media.
This form of communication which devoid of scientific and journalistic rigor is not only detrimental to health but it also put vulnerable communities at an increased risk.
The media isn’t the only institution to blame here rather it is a failure of multiple institutions that play an important role in 2 sub-areas of Science Communication a) Public awareness of science b) Public understanding of science.
Except for a few private organizations and startups that work on STEM education, there isn’t one in Pakistan (at least as far as we know) which trains scientists to help inform and make the public understand the scientific reasons behind the processes that influence them and the nature around them.
When communicating science, the communicator has to be wary of an individual’s or a community’s personal and cultural values and biases. This is particularly important because while engaging with the general public if we are developing a message which doesn’t consider their literacy and culture, we risk putting the public “against science” instead of “with science.”
When communicating science, the communicator has to be wary of an individual’s or a community’s personal and cultural values and biases.
Healthcare emergencies create panic, because they influence us economically, socially, mentally and personally, and it is difficult to predict when it will be over. In such circumstances individuals and communities look towards their personal beliefs and resources as a source of a reaction to the emergency and this response itself is dynamic, which makes science communication not just a complex but also a sensitive venture.
As a communicator, be that maybe a scientist, the government or a journalist, there is a critical responsibility to inform the public and this process of information dispensation goes through filtration with the following purposes a) not creating a panic b) not overwhelming the public with technical process that they cannot understand c) influencing them to adopt responsible public health measures. Keep in mind that this messaging is different from the one which informs policy.
While developing the message itself it is important that we write it with scientific integrity to ensure that we communicate the information which is accurate and a similar effort should be made to counter the misinformation infodemic.
All these factors make it important for the mainstream media or journalism houses to actively reach out to area experts, and not “arm-chair” ones, to guide them in the process of public awareness and understanding. We also risk making the pandemic a partisan issue by inviting politicians to speak about the scientific aspects of it as it may lead to a decrease in the acceptance of public health guidelines. There is no alternative for expertise during a healthcare pandemic where new information is emerging continuously, at times making journals retract previously published scientific work. It is imperative for these media platforms to develop the will and acknowledge the need for making use of scientific expertise and using it for social wellness.
No doubt that the current reality of the covid crisis is complicated and there are very few tried and tested solutions to ensure. For us to minimize the unintended consequences, it is important that we share scientific information with the public, responsibly, and be cognizant of what kind of information is relevant for effective action.
Authors’ Note: Genes & Machines has been providing a platform for scientific experts to help inform both the public and policy. You can read their recommendations for policy suggestions here and their public awareness session on covid19 here. You can view their continuing efforts for increasing public awareness, understanding and access to science at GenesMachines.io
Hassnain Qasim Bokhari is a science communicator and a synthetic biologist currently affiliated with the iGEM Foundation, USA. He also works with STEM-focused organizations working on community development, education and advocacy. He tweets at @QasimHassnain
Marsad Siddique is the Founder and CEO of Sukoon.ai, and an undergrad biotech student. He also works as part of the After iGEM HS committee in research and analysis as well as Genes & Machines’ core team and absolutely loves to write be it poetry prose or hot takes on @marsadswords on Instagram. Twitter: @marsadist
Three Nations, China, UAE, and the US, are eager to launch their missions to Mars in a few weeks. Each of these missions is a pathfinder in its own right. Mars is well known to space communities as a graveyard to failed rovers or spacecraft. Besides these failures, a few historic missions to Mars proved successful beyond the Scientist’s imagination and helped rewrite the Red Giant’s understandings. These new missions aim to explore two hidden parts of Mars that never have been seen before.
China’s first exploration of Mars
After successfully launching its mission to the moon, China aims to explore the Red Giant with an orbiter; lander and rover are all packed with around 13 with the most advanced instruments for scientific research. The mission named “Tiawen-1” is scheduled to launch in late July (Last week of July) from an island of Southern China. The word Tiawen stands for the quest of heavenly truth about the planet, which is assumed the next possible home of mankind in our solar system. The spacecraft will reach Mars in February 2021 and conduct a survey of the landing site, its internal structure. Also, the equipment’s onboard will research on Mars atmosphere and surface environment, presence of water, and will find other essential signs for life.
The Chinese government has been tight lip in disclosing information about their Mars voyage. Some researchers from the Chinese Academy of Space Technology in Beijing accepted that this mission to Mars is 1000 times longer and harder than the Chinese journey to the moon; the dense rocks and surface gravity make our mission much riskier and highly challenging.
Tianwen-1 undergoing tests in 2019
UAE’s interplanetary hope mission
UAE is set to blast off its orbiter around Mars, named “hope,” which will be the first interplanetary venture of the Arab world. It was scheduled to be launched on 15th July from the Tanegashima Space Centre in Kagoshima, Japan, but due to bad weather and technical concerns, the launch has been halted, and it is supposed to happen in the next two weeks.
The Emirates Mars Mission (EMM) aims to produce the first weather map of the Red Giant. Its huge elliptical orbit will enable the orbiter to observe big chunks of Mars under both day and night timings, covering the entire planet in each 55 hours. Previously, the orbiters around Mars were limited to observe the weather pattern of the planet.
The hope orbiter will reach the Red giant in early 2021, and with the help of three instruments on board, it will study the Mars atmosphere and climate patterns. These observations will give more insights to researchers, from a relatively warm and wet world to a cold, desert planet we know Mars now. That transition was driven by the disposing of Mars’ once-thick atmosphere by the solar wind. The Solar winds are the stream of charged particles flowing from the sun.
NASA aims to launch its six-wheeled rover named perseverance, which will collect the Martian rock samples and bring back to earth for further in-depth analysis. As per official recourses, a three-meter long rover will only extract and store rock samples that a future mission will pick up and bring back to earth. The rover is poise to blast off in the last week of July and reach the Red giant in early 2021. Whereas, the mission will possibly end in 2031 when a 2nd mission launch and researchers would have the first-ever sample of the Martian surface. The purpose will allow the researchers to deeply dive into the Martian surface and find an answer to the long-lived question of every curious mind that whether life is possible on Mars and mankind can build colonies there.
For this, the rover is well equipped with research instruments. Basically, perseverance is a copy of NASA’ Curiosity rover with similar sensors and a chemical analyzer that blasts rocks with a laser to identify the atoms and molecules they are composed of. The rover also has a sharp-eyed camera system that can zoom in on areas of interest to produce stereo and 3D pictures.
NASA’s aimed to save money by using the same design of curiosity rover with some tweaks, like adding a system to store samples and upgrading the wheels.
“How important it is for us to recognize and celebrate our heroes, and she-roses!”- Maya Angelou.
We claim to be advanced in the 21st century, but do we know the basic concept of the term itself? In simplest of words, a society is said to be advanced when the people of the community are morally, spiritually, culturally, and intellectually sophisticated. A state where refining ourselves each day to bring a positive change in our self and the community is a goal. However, do us, as a community runs parallel to the definition of an advanced society. Do we turn a deaf ear to social norms and taboos? Are we fair in promoting and accepting human rights, giving women a fair representation chance in the world? Let’s rethink about it.
The Deputy Secretary-General of United Nation –Amina J.Mohammed quoted “Gender equality is essential to the effectiveness of our work, and we cannot afford to miss out on the contributions of half of the world’s population”. We must provide a fair and balanced field of opportunities to women in our society in all professions. Women can put their best foot forward and achieve goals that any man can. They have potential, ideas, and insight. So why not let them ace in the industrial, financial and medical sector. It’s high time we should appreciate workers on the basis of their passion, hard work and determination and eradicate the existing concept of the male dominant society.
It is as transparent as it can be: Pakistani society is mostly male dominant. Even if a proportion of us claim to provide equal opportunities to women for growth, do we really mean it? Do we allow fair leadership positions to the female healthcare workforce of Pakistan?
Let me give you all an insight into the root causes that eventually lead to a lack of opportunities available for women in leading positions in our healthcare system. A significant number of females clear the entry test, get into private and government colleges and start off their journey with the aim of having the prefix ‘Dr.’ attached to their name. How ironic is it that the people who encourage these women to become a doctor are the ones who don’t let them practice after years of hard work? They are advertised to everyone as ‘Our daughter is a doctor now’, and consulted for free healthcare advice from family, friends, and neighbors but in the end, not allowed to work in hospitals or private practices.
In our society, most female doctors are expected to stop practicing after getting married so that they can focus on the needs of her husband, children, and even her in-laws. Night shifts for female healthcare workers are inappropriate. Families are not willing to compromise on the tight timing schedule or work with the male colleagues that the job demands. Why is the portrayal of the title ‘My wife/daughter is a doctor’ is believed to earn one’s respect in the society, but her working in a public space with male co-workers or patients is considered to splatter the name of the family?
The healthcare profession is divided. We have numerous female nurses, underpaid, overworked, and yet expected to portray the best attitude they possibly can. Let’s be honest, how many of us have witnessed a significant number of male nurses in this profession: close to none. In Pakistan, another sector, gynecology, is the primary healthcare sector that encompasses an excellent fraction of females.
Insecurity at the workplace is another contributing factor to the dearth of women’s leadership. Working in a male-dominated sector, women are more prone to harassment by fellow colleagues, patients, and visitors. Even if the victims raise this issue, our healthcare system is not transparent enough to punish the guilty. It is considered a threat to the victim’s respect in society. Well, that is the power of harassment over job security and laws.
I believe it is our duty as a young generation to acknowledge our heroes who are paving our way, sacrificing a lot for the betterment of our healthcare system and are doing justice with their duty.
Dr. Shobha Luxmi, the head of isolation ward for coronavirus at Dow University of Health Sciences hospital in Karachi, said in one of her interviews, “My life has turned upside down over these past few weeks. I am working round the clock. I sleep too little, and still, I am thinking about the hospital. I have no time for my only daughter or her studies, my family, or my parents. My daughter is complaining now: I didn’t cook for her for over two weeks.” It is like being stuck in a devil and a deep-sea situation. They cannot give up on either of the responsibilities.
Ruth Pfau
Ruth Pfau, Savior of Lepers in Pakistan, a German-born medical missionary, established almost 157 leprosy (a contagious bacterial infection) clinics all over Pakistan that treated around 57000 people. She came to Pakistan with the mission of rescuing patients abandoned by their immediate families. During her visits, she observed patients suffering from leprosy. This contagious infection affects skin and nerves resulting in studded and discolored skin with lumps, and realized that these patients need her attention.”When you receive such a call, you cannot turn it down,” Ruth Pfau said in an interview to Express Tribune.
For this purpose, she set up the Marie Adelaide Leprosy Center in 1963, which treated patients from all over Karachi and neighboring cities. Her efforts to provide medical care to leprosy patients ended up with her being the Federal advisor on leprosy to the Ministry of Health and Social Welfare by the Pakistani government. “We are like a Pakistani marriage. It was an arranged marriage because it was necessary. We always and only fought with each other. But we never went for divorce, because we had too many children,” she said as quoted by the New York Times. Determined women, firm in her beliefs, aimed to provide better healthcare facilities in Pakistan deserve our honest appreciation. One of her colleagues, Chris Schmotzer, said in an interview for Al Jazeera (2017) “She started a program from scratch, and this is a tough job (but) she was always doing things heartedly.”
Although she passed at the age of 88, she left her legacy behind. A devoted woman, whose heart lay in Pakistan, became an inspiration to many and a gem to Pakistan’s healthcare system.
Dr. Sara Saeed Khurram
Dr. Sara Saeed Khurram, the CEO and cofounder Sehat Kahani is the first Pakistani woman to win Rolex award for enterprise as an associate laureate for her company “Sehat Kahani.” This organization provides a platform for qualified female doctors- particularly the ones that couldn’t practice at times due to their cultural responsibilities. She has opened 25 clinics across Pakistan that look after 95000 patients, equipped by 90 nurses and 1500 female doctors. In the field of healthcare, this is a huge milestone and an inspiration to many other women.
In an interview with the editor of millennial.pk, she narrated her personal experience on how women after marriages are discouraged from working, especially once they conceive children. She said, “It was in one of those moments of extreme clarity when I realized that my purpose in life was to find a path to serve the marginalized doctors in a way that empowered me as not only a female but also millions of females out there looking for a helping hand. Thus, I started the journey of Sehat Kahani, which in Urdu means the” story of health.” An organization that encourages women to take a step for what they want they want to be.
Dr. Sania Nishtar
A physician, a cardiologist, an author and an activist who is devoted to bringing a change to the healthcare system of Pakistan and improving medical facilities, Dr. Sania Nishtar, is one of the aspiring women associated with the healthcare system of Pakistan. She is also an active member of the World’s Economic Forum’s Global agenda council for future healthcare.
She played her role as the Federal Minister for Government of Pakistan; she also provided her services in the interim Federal cabinet in 2013 for public health, education and science. Moreover, she was awarded Sitara-i-Imtiaz (Presidential award) for her leading role in different capacities.
She is associated with Benazir Income support program-one of the biggest programs to help the needy. She was also the founding chair of the UN Secretary General‘s Independent Accountability Panel for women’s and children’s health.
She is the founder of “Heart file”, a health financing organization of Pakistan which provides financial assistance for expensive medical treatments to those who cannot afford. This organization is no less than a lifesaver for underprivileged who do not have to beg in front of anyone to get medical treatment. They ensure integrity and respect for those in need.
These women are a true definition of healthy and determined individuals who can change the world according to their perspectives, give back to the community, help those who are often neglected, and provide a ray of hope to those women who claim of not achieving their dreams and goals.
Take a moment to think about this. Women are carving their path in the dominant male society. All they need is encouragement and support. If a female can work day and night to keep her household running while contributing to society, shouldn’t the males up their responsibilities towards the household? This will not only make way for a smooth running of household chores but also help the females in climbing the ladder of success.
Dedicated and absolutely committed healthcare professionals are few and far. Infact, in underdeveloped countries, persuading a doctor, at the cost of lucrative incentives, to prescribe only one brand to all diseased personnel is brutally common. In such a sorry state of affairs, it is quite hard to find a therapist who treats without medicines. Dr. Ali Madeeh Hashmiis one of those rare ones who are crowned as a doctor without medicine. He treats patients with the healing power of listening and counselling, and this makes him an eminent psychiatrist.
Khola: Sir, why did you return to Pakistan after the longest stay of 16 years in the US? Health care system and the patient care model of the US is up to par. What actually attracted you back towards Pakistan?
Dr. Ali: The reason that most people (especially professionals) return to Pakistan from abroad (other than those who lose their jobs and cannot stay or have other problems) is to be close to parents and family. Another reason is to expose our children to our own culture which is important to most people living abroad. These were my reasons also. In addition, I had always wanted to teach and be around students and young people and I am fortunate that I got the chance to come back to Lahore and to teach at my alma mater, King Edward Medical University where I have been on faculty for the last 10 years. It has been a great blessing and I enjoy it every day. I wrote about some of my reasons for coming back in The News’ article that went to air on 11 December, 2016. If readers are interested, may give it a read: https://www.thenews.com.pk/tns/detail/562284-want-back-home
Khola: In comparison to surgery and other medical specialties, psychiatry is not seen as lucrative enough; additionally, there is a real dearth of Psychologists and psychotherapists in Pakistan. What really persuaded you to opt psychology as your life profession?
Dr.Ali: I am actually not a psychologist but a psychiatrist. The difference is that psychiatrists are medical doctors who complete their medical training first and then get additional training (for 4-6 years) in psychiatry. So we are medical doctors first and are thus trained in recognizing and treating mental illnesses from the medical perspective including mental illness that may be because of medical problems.
Psychologists do not go to medical college. They get a Bachelor’s degree in psychology usually followed by a Masters and sometimes a PhD (in which case they also call themselves doctors which can get a little confusing!). But since psychologists are not medical doctors, they cannot prescribe medications or do medical assessments. They are experts in things like psychological testing for example for children who are having problems in school. They also do psychotherapy (sometimes also called ‘counseling’).
Yes, there is a severe shortage of both psychologists and psychiatrists in Pakistan and my main motivation for becoming a psychiatrist was my interest in mental health. Interestingly, my own father is a psychologist so that was probably one reason I was interested in it.
Khola: Health system of Pakistan is not up to the mark, this is what we are all aware of. What are the real lacks, loopholes, and bars that are restraining us from developing an ideal patient care model?
Dr.Ali: The main problem with our healthcare system is lack of funding. We do not spend nearly enough on healthcare for our population.
Pakistan spends less than 1% of its GDP on health while the recommendation of the World Health Organization is that it should be at least 5%. In addition, mental health does not even have a separate budget.
Unless we are willing to spend more on building more hospitals and clinics, hiring and training more healthcare professionals and providing them with appropriate training and supervision, it’s difficult to see how things can change.
Khola:What we can see is that patient care is not a one man game; only physicians are not capable enough to provide effective and sustainable therapy. So, integration of different health professions and professionals is in the dire need. Why are we still unable to develop a sense of cooperation and harmony among different health sectors?
Dr.Ali: I think this question has been partly answered above. Yes, there is a dire need to develop allied medical specialties starting with nursing and other health professions. We also need more trained professionals for example in physical therapy, lab technicians, ultrasound technicians and many other trained people to support doctors and nurses. But all of this has to start with more government investment in health.
Khola: Quacks and their malicious quackery is brutally common in some medical specialties, psychiatry is one of them. How can an innocent (less educated) person distinguish a reliable therapist from an experienced one? Do we have a quick referencing guide/clues for saving patients from pseudo-psych?
Dr.Ali: Sadly, it’s not just therapists but also many doctors and psychiatrists, as you mentioned, who practice unethically. In general, one way you can assess whether a doctor is qualified or not: check and see if they are on faculty at a medical college and university since those institutions usually have strict criteria for who gets hired. In Pakistan, word of mouth is a good way so you can ask around experiences of families or friends. You can certainly email or message a doctor directly to ask what kind of practice they have, and whether what you want help for is something they treat and lastly, you can get an appointment and go see them. If they are professional, pay attention to your complaints, answer your questions and you are satisfied that you have been listened to, you can go back for follow up.
Regarding psychiatrists, if they want to prescribe medicines, always ask lots of questions about why they are giving your medicines, if they are really needed etc.
And if you end up seeing a psychiatrist who gives you five minutes, doesn’t listen to you and writes you lots of medicines, don’t go back there. Find someone else.
According to Dr. Ali, it’s not just therapists but also many doctors and psychiatrists, who practice unethically.
Khola: Sir, considering a psychiatrist for mental health disturbances is a serious phobia among Pakistanis. In fact, people who seek mental health are often ridiculed. In your opinion, what’s a real psyche behind it?
“The idea of psychiatric medicines is so fraught with misconceptions in our society that most people have a visceral negative reaction to the idea.”
We should be more proactive about educating people, especially doctors, about not stigmatizing mental illness. And we need the general public to educate themselves about it as well.
There is nothing like alcohol, caffeine, and heroin in psychiatric medicines. If they are used appropriately, they can be tapered and cut even after a month of therapy.
Khola: Sir, do you think our education system is contributing to the mental illness of our medical students? We are devoid of interactive and integrated modules for our students; not only this, there’s a considerable scarcity of inspiring educators as well. I wonder if we could spot the root cause of it.
Dr.Ali: Yes, I think our memorization based, top-down education system is contributing to poor mental health in many of our students. Our education system needs a complete overhaul. We need a system which puts students in charge of their own learning and creates a love of learning rather than a hatred of it. Since I have been teaching for over 9 years in Pakistan, I can safely say that critical thinking, questioning, and defying the norms are not only disdained but also punished in the culture of our institutions.
“Being a father of three children of various ages going through the school system in Pakistan, I have heard first hand stories from my own children about teachers who berate them for being curious and inquisitive, who insult them for asking questions and God forbid, if they should ever correct their teachers (which my children used to do), they are severely reprimanded.”
Khola: Sir, how did literature inspire you in your academic and then practicing years, and how far can it influence the life of any student?
Dr.Ali: I have a special interest in how literature, poetry and all branches of the Art relate to medical and psychiatric practice. I have written quite a few articles about it. Reading literature and poetry or learning to appreciate painting, music, sculpture, dance and other forms of the fine arts can enrich our lives in so many ways. And it is particularly important for students of all disciplines to become familiar with Arts. It will help you become a better student, a better worker (after you graduate) and a better person. And it’s really fun!
Khola: Finally Sir, what advice would you give to all studentswho are currently reading this worthiest interview?
Dr.Ali: Follow your passion. Find out what you love doing and do it. Don’t let other people tell you how to live your life, what to study, what kind of work to do. It’s your life. Take responsibility for it and follow your dreams. That’s the only kind of life worth living and you will be much happier in the long run. (and if you love what you do, you will never have a problem making money from doing it).
Comets are small, fragile, irregularly shaped bodies composed of a mixture of grains and frozen gases. They have highly elliptical orbits that repeatedly bring them very close to the Sun and then swing them deeply into space. As comets approach the Sun they develop enormous tails of luminous material that extend for millions of kilometers from the head, away from the Sun. When far from the Sun, the nucleus is cold, and its material is frozen solid within the nucleus. When a comet approaches within a few Astronomical Units (1 AU equals approximately 150 million kilometers) of the Sun, the surface of the nucleus begins to warm, and volatile material on the comet evaporates.
Comets are very important to learn because they are great timekeepers of the universe. They may be the oldest, most primitive bodies in the solar system, preserving the earliest record of material from the nebula which formed the Sun and the planets. On their closest approach to our Sun, they shower their particles and even crashed on to some planets and bring volatile light elements to the Earth’s, playing a role in forming oceans and atmospheres. They are the most organic-rich bodies in the solar system providing ready-formed molecules possibly involved in the origin of life on Earth!
However, there is no evidence found yet. The impact of the Earth and other planets at hyper velocities causes significant changes in climate and dramatically affects the ecological balance, possibly including the extinction of the Dinosaurs. It is believed that they are the building blocks of planetary systems around other stars?
A Stunning Image of Comet NEOWISE Credit; Jeremy Perez
What’s unique about the Comet Neowise?
Our new guest in space has traveled for 3000 years to be seen from Earth. The object was discovered by a team using the NEOWISE space telescope on March 27, 2020. It was classified as a comet on March 31 and named after NEOWISE on April 1. On July 13, 2020, a sodium tail was confirmed. The first ones to find out that NEOWISE had a sodium tail were Twitter users who went by the name of GalacticMilk, CometExtra, Octalactic, Parthbh21167752, and HaleBopp2007 on July 12.
Comet Neowise
The comet cruised just inside Mercury’s orbit on July 3. This very close passage by the Sun is cooking the comet’s outermost layers, causing gas and dust to erupt off the icy surface and creating a large tail of debris. And yet the comet has managed to survive this intense roasting and is easily visible and observable in the sky to all-this is what excites the skywatchers.
Last night I scoured Google Earth lining up roads that would matched the bearing of where the comet would rise this morning. Finally found a spot along my favorite road in Wupatki National Monument and narrowed to this crevices bend to work with. Photo Credit; Jeremy Perez
By July 2020, it was bright enough to be visible to the naked eye. It is one of the brightest visible to observers in the northern hemisphere since Comet Hale–Bopp in 1997. Under dark skies, it can be clearly seen with the naked eye and might remain visible to the naked eye throughout most of July 2020. From July 15 onwards, the comet will be seen from the subcontinent in the northwestern direction at 20 degrees latitude.
Mt Shasta & #NEOWISE Northern California Phot Credit: Rome Starch
Observers worldwide are racing to see the natural fireworks display before the comet speeds away into the depths of space. Even the astronauts aboard the International Space Station (ISS) spotted it from their vantage point high above Earth’s atmosphere. It has become a trending topic for discussion in the day to day webinars and forums across the scientific community. People worldwide share the photographs and facts about this comet and celebrate this astronomical event like a festival.
In Pakistan, transparency has not been a hallmark of the Ministry of health in response to COVID19. Public criticism has mounted about the government apathy in recognizing threats of the pandemic, a complete lack of strategy, and an unclear source of research on the ongoing crisis. People who lost their loved ones due to COVID19 do not know the difference between civil and military; they only know the pain. This led to undermining the public’s trust in health experts and science itself.
The Pakistani government is hardly alone in its strategy for deflecting attention from its poor performance, from the US to India, from Trump to Moodi, many rulers have been acting incompetent, disseminating falsehood and fear exploitation for distracting public’s attention from government deficiencies in response to the pandemic. PM Khan’s playbook is downplaying the severity of the threat since March 2020, and he has been disregarding scientific evidence that supports the critical role of social isolation and lockdown measure.
The healthcare system of Pakistan is in a complicated phase due to decentralization. However, to address the devolution of power between the federal government and provinces, the parliament of Pakistan had passed the 18th amendment bill on 20 April 2010. Taking this into account, the provincial Assemblies took active steps and passed their own healthcare bills to ensure promulgation of equity and quality to the healthcare services and improvement in access to safe medical services. After individually passing such highly aimed bills, the health indicators still lag behind in achieving set targets.
In the health financing domain, the federal government is expanding 25 billion PKR that has been doubled from the previous year’s health budget of 12 billion; still, it carries only 0.4% of GDP. The health force indicates insufficient staff; there are approx—1:1300 doctor-patient ratios, which is lower as recommended by WHO. According to the available statistics for the delivery of medical services, there is an entire absence of programs and initiatives for non-communicable diseases at provincial and federal levels. Almost 78% of the general population pays out of their pockets for medical treatment.
Meanwhile, the statistics marked more than 2, 50,000 COVID19 positive cases with around 4500 death toll, the pandemics threw detrimental effects on healthcare. The ongoing situation has highlighted some criticalflaws in our healthcare system that includes but not limited to a scarcity of proper diagnostic facilities in hospitals, an insufficient workforce, and mismanagement of medical education and practices, especially in remote areas.
There lies a strong bonding between the human workforce and the patient’s safety. As we all recently witnessed, the paramedical staff and doctors are fighting this infectious disease on the front line, stepping out of their comfort zones, enduring painful experiences, and risking their lives to do everything to save our lives.
Pakistan has a pretty diverse healthcare system from tertiary care centers down the roads to primary healthcare centers, but unfortunately, they have lost their credibility at the hands of ill-administration. From posh areas of Karachi and Lahore to far-flung districts of Baluchistan, resource constraints are one of the primary barriers to quality medical services. The mal-governance, negligence, unjust, and unaccountability are the deadly poisons that restrict more allocation of local resources and wound existing ones.
According to a recent survey, in Pakistan, there exists a slight imbalance between private and public healthcare setups in terms of the burden of patients. The primary and secondary healthcare centers, especially in pre-urban and rural/remote areas, have been quite famous for the absenteeism of medical staff and doctors with an entire lack of basic medicines and diagnostic equipment. Therefore, the mal-functioning of primary and secondary healthcare centers has ripple effects and people are forced to take their patients to the tertiary centers, which are mostly located in big cities like Karachi, Lahore, Rawalpindi, and Islamabad.
Although Pakistan has given birth to some notable, globally recognized doctors, surgeons, researchers, and physicians, without question, there were and are severe deficiencies in our healthcare systems. The WHO ranked 195 nations on the overall quality of healthcare services, and interestingly Pakistan ranked 154th, stays behind its South Asian counterparts India (145), China (47), Bangladesh (133), and Sri Lanka (71).
It is evident that the system is leaking at seams, yet politicians are immobilized by ideology, fear of being voted out of the office. The government’s poor policies in healthcare resulted in the scarcity of choices regarding effective diagnostic and medical services. Something has to change, and it has to change quickly; otherwise, if another epidemic or virus outbreak hits the country shortly, the overloaded healthcare system will cripple. The Government should have to work for us—our lives depend on it.
Often heralded as the messiahs for those most in need, doctors in Pakistan have held a reverence few could claim. The profession itself has been glorified for decades. While one can argue as to the validity of this status and doctors themselves might feel patronized as a result of it- one thing is for sure, this status of glory is slowly waning away.
Recent times have sparked repeated cases of healthcare professional assault and public hospital property being thrashed by violent attendants. Patients will always blame the physicians and physicians will continue to change the way they practice in return, afraid for their safety. While such incidents can only be condemned in the strongest of languages, it seems as though we’re all unanimous on one thing. Such incidents are a sign of a failing system.
Public healthcare in Pakistan has long been neglected. One only has to visit a tertiary care public hospital to realize the multitude of problems we need to address. Let us, however, divide these problems and the threats they pose in two major categories- issues internal to the infrastructure of the hospitals and those external to it. The debacle isn’t as nuanced as this; however, we shall try to make it as simplistic as possible.
The federal government estimates a considerable percent of the total fiscal year budget to healthcare. Provincial governments further allocate the budget to various healthcare departments. As a struggling economy with a GDP growth rate of 2.6%, the budget allocated to healthcare is inadequate. But how do we truly know that the budget is inadequate and it is not, as one would assume in a country fighting corruption, a case of money being channeled to fill pockets of those in charge? While it is true that each year billions of rupees are allotted to schemes and projects that only exist on paper, the fact is that it’s not our only problem.
Pakistan has an ever-growing population. It is the 5th most populated country and for the state of its economy, this does not bode well. Lack of resources is doubled when the demand for those resources increases. As an intern in one of Pakistan’s busiest tertiary care hospitals, it was not uncommon to see medications run out of stock each day. One would have to write requests to NGOs working on donations and they would waive a portion of the cost. Patients would then be expected to buy these medications. For starters, transparent, accountable investment is key to developing a good healthcare system.
In January 2018, I had the chance to visit Tharparkar and adjoining towns for awareness sessions in collaboration with a relief eye camp. While on our trip, we were shown around the town and then taken to the local Civil Hospital of that town. The plan was to use one of the wards there for our sessions. The sight that awaited us was one I can never forget. The hospital was a ghost town. There were no patients, doctors, infrastructure except a yellow-walled building crumbling before us.
There was a massive pool of sewerage water right beside the entrance, there was a shiny new board in the basement claiming to be a Protection House for Women but by the looks of it was exactly the kind of place any woman would seek protection from. There was one room that had multiple hospital beds. I looked inside and there was a nest of pigeons in one of the mattresses. The gory details of this hospital are many. As an intern in Karachi’s Civil Hospital, I could yet again see from miles away how these hospitals in small towns functioned because patients from far off would come to us braving days of travel with things as urgent and basic as snake bites and dog bites. The structure of healthcare goes like this – you have primary healthcare i.e. your local general physician.
The doctor to patient ratio in Pakistan in appalling. (Image Credits: www.qoura.com)
Then you have secondary healthcare which is a multidisciplinary community setup. And lastly, we have tertiary care hospitals like Civil, Jinnah, Agha Khan Hospital, to name a few. The setup ensures that tertiary care hospitals aren’t overburdened with cases that can be easily handled by a primary care physician. It ensures that a patient can receive initial care and be stabilized before they’re referred to a tertiary care hospital if need be. Lack of proper primary care and secondary care setups places all the burden on our tertiary care hospitals.
There must be regulated, monitored and PMDC certified primary care setups as well as secondary care setups. This is even more important in the case of trauma. Trauma is the leading cause of mortality worldwide and in Pakistan, it is even bigger of a burden as it causes death and disability in the country’s GDP-dependent population. According to Dr. Haris Sheikh, who worked extensively for First Response and Mass Disaster in Karachi, “ a central EMS system with equipped ambulances and trained paramedics, a functional disaster management cell and a Level 1 trauma center is essential when it comes to trauma care. The clock starts ticking the moment trauma occurs.
Keeping in mind the concept of golden hour, necessary steps can be taken even before a casualty reaches the hospital, the most important of which are resuscitation and activating essential services like CT, Cath lab, or even ORs with appropriate teams ready to take care of the casualty upon arrival. Sadly, none of the aforementioned essential services exist in our system resulting in on-site manhandling of casualties and a delay in the in-hospital treatment, which in certain circumstances can prove catastrophic”. This brings us to the second half of our problem- in hospital inadequacies.
Impediments to healthcare within hospitals are multifold and apparent to anyone who has set foot in public hospitals. The plot gets thicker for those who have worked in the healthcare system. Apart from the significant roadblock coming from lack of resources and inadequate systems, the infrastructure of most tertiary care and secondary care hospitals lacks cohesion. For instance, a patient presenting to the ER must undergo triage, be assessed further, admitted if need be, or set up for an appointment at a later date.
There is an evident lack of assignment of duties and protocols and a lot is left up to the decision-making of the doctors on calls. Diagnostic services are often absent and patients have to run back and forth for getting tested. For example, it is not uncommon to find the CT scan machines and MRI machines at Civil Hospital Karachi in non-working condition for months. Patients, even those who have sustained traumatic injuries and need urgent head CTs or have had a stroke and need immediate assessment for life-saving treatment, have to be referred to other places to get a CT scan. Similarly, most tertiary care hospitals do not have 24/7 Cath Lab services for patients reporting with MI or heart attack as it is commonly known and has to be referred to centers like NICVD and Tabba. A lot of this also has to do with a lack of trained personnel, which in itself is a multi-faceted problem.
The doctor to patient ratio in Pakistan in appalling. We need newer training positions for physicians, regular board exams to ensure they are up-to-date, accountability systems, and recruitment of paramedical staff, which is not only limited to nursing but can create space for respiratory therapists, perfusionists, physiotherapists, pharmacists, etc. This allows a more holistic approach to treating the patient. Perhaps most importantly, job satisfaction amongst healthcare providers, be it nurses or doctors is shallow in public hospitals. Their salaries and stipends aren’t regular; their employment offers no perks nor insurance of any kind, working hours are indefinitely laborious, facilities provided at work are subpar and would shock most people at the inhabitable state of on-call rooms and most days, they are also afraid for their safety and security while at work.
Those in power continue to turn a blind eye to these problems and very little importance is given to attempt to change things. In fact, change is almost scorned at. While the rest of the world looks at Artificial Intelligence and 3D printing to facilitate medical diagnostics and therapeutics, hospitals in Pakistan barely have a well-integrated IT system to record patient information and regulate drug prescriptions. The fact that some of the well-run departments in our public hospitals are those being run on charity, donations, and efforts of philanthropic people is a silent but persuasive reminder of the inefficiency of the administration. SIUT, NICVD, PWA are all such brilliant examples.
Healthcare, like education, is currently struggling in Pakistan. While there is so much to be done, we have hope. New doctors are joining the force each day and new organizations are always on the front running blood banks, pediatric emergencies, and sourcing funds for patients. Ever abysmal situation has heroes and so does ours. We just need to know where to start and have the will power to do so.
