A win for the pa­tient

The Pak Banker - - EDITORIAL - Shah­baz Sharif

Can you imag­ine scores of pa­tients suf­fer­ing for months due to the ab­sence of a com­monly used medicine called Flagyl, with de­mand fall­ing on deaf ears and money ly­ing in the bank, unutilised?

I couldn't, at least not till a few days back when I made a sur­prise visit to Sheikhupura District Head­quar­ter Hos­pi­tal. Pa­tients were sub­jected to need­less agony be­cause the rel­e­vant District Co­or­di­na­tion Of­fi­cer did not deem it a pri­or­ity de­spite the wail­ings of the hos­pi­tal med­i­cal su­per­in­ten­dent. Stand­ing there in the suf­fo­cat­ing heat, I re­al­ized that the pa­tients' whim­pers had been muf­fled by bu­reau­cratic din. And that, with­out wast­ing a sin­gle day, we had to re­fo­cus our health sys­tem on one sin­gle fo­cal point: pa­tient care. Health­care is not about what a politi­cian may de­sire, or bu­reau­cracy may feel com­fort­able with, or for that mat­ter what doc­tors may find con­ve­nient to prac­tice. It is only about a sin­gle ob­jec­tive: pa­tient care. For me pa­tient care is not a catchy slo­gan but an un­wa­ver­ing com­mit­ment. Re­al­is­ing that it can­not hap­pen with­out all stake­hold­ers tak­ing full own­er­ship of this in­ter­ven­tion, I con­vened a Doc­tors Con­ven­tion on July 4. The con­ven­tion was at­tended by top doc­tors, vice chan­cel­lors and prin­ci­pals of uni­ver­si­ties and teach­ing hos­pi­tals, pro­fes­sion­als of the health depart­ment, health sec­tor NGOs, and rep­re­sen­ta­tives of para­medic and nurs­ing staff as­so­ci­a­tions. I could not have asked for a better pro­fes­sional con­stel­la­tion. In our ex­haus­tive four-hours long, no-holds barred in­ter­ac­tive ses­sion we touched ev­ery op­er­a­tional and con­cep­tual as­pect of the health­care sys­tem, rang­ing from fix­ing bro­ken power gen­er­a­tors to mend­ing the ca­reer paths of doc­tors. From em­pow­er­ing the hos­pi­tal MS to em­pow­er­ing the needy pa­tient, we dis­cussed it all. Many im­por­tant de­ci­sions were taken right there and many more are com­ing. To cite a few here, pa­tients' care al­lowance of Rs10,000 was an­nounced for doc­tors and den­tists of grade 17 and 18, whereas doc­tors of grade 19 and 20 will get Rs5000 per month. Un­der this head, the Pun­jab gov­ern­ment will bear an ad­di­tional ex­pen­di­ture of Rs3 bil­lion per an­num. In a sharp de­par­ture from the past, now the hos­pi­tal MS, not the DCO, will get funds di­rectly along with dis­ci­plinary pow­ers to al­low for op­er­a­tional and fi­nan­cial au­ton­omy. It was de­cided to es­tab­lish the Pun­jab Health­care Coun­cil, which will con­sist of doc­tors, pro­fes­sors and ex­perts. To en­cour­age better pa­tient care, mer­it­based monthly awards, cer­tifi­cates and cash prizes will be given to med­i­cal su­per­in­ten­dents, doc­tors, nurses and paramedics for out­stand­ing per­for­mance. The pres­i­dent of Pak­istan will give Pride of Per­for­mance awards to top per­form­ers among the med­i­cal fra­ter­nity.

Al­ready the health bud­get for this year stands at a his­toric Rs207 bil­lion, a whop­ping 62 per­cent in­crease over last fis­cal year. Rs30 bil­lion will be spent this year on pro­vi­sion of clean drink­ing wa­ter while another Rs16.6 bil­lion has been kept for free medicines for needy pa­tients. Rs1.5 bil­lion is there for health in­sur­ance and bil­lions more will be spent on up­grad­ing DHQs, THQs and other health fa­cil­i­ties. And the list of ini­tia­tives reads on.If you were to ask for my sin­gle line take of learned coun­sel from that con­clave, I would say com­mit­ment, or in many in­stances the lack of it. It was clear that the health­care sys­tem nei­ther suf­fered from lack of re­sources nor a se­ri­ous de­fi­ciency of in­fras­truc­ture and that the big­gest con­trib­u­tor to the un­der­serv­ing of suf­fer­ing masses was the apa­thy of the peo­ple and the sys­tem re­spon­si­ble for pro­vid­ing re­lief.

To change health­care, those at­tached to the sys­tem will have to change their at­ti­tudes and lev­els of com­mit­ment. Doc­tors are not nor­mal peo­ple with nor­mal lives, for theirs are ded­i­cated to pa­tient care and al­le­vi­at­ing hu­man suf­fer­ing.

But sadly, some amongst our doc­tors have also for­got­ten their sa­cred oath. Un­for­tu­nately, visit upon visit to BHUs, THQs and DHQs, I ob­served the is­sues that pa­tients face, is­sues that could be taken care of in no time if some of our doc­tors re­mem­ber their sa­cred oath. It is for this rea­son that we need to talk about the fo­cus of both the doc­tors and the gov­ern­ment. Sadly, the story of ab­sen­teeism is true. The saga of se­nior doc­tors not spend­ing full-al­lo­cated time holds wa­ter. There are pro­fes­sors and as­sis­tant pro­fes­sors who don't do the req­ui­site num­ber of op­er­a­tions or don'' take their OPD du­ties ded­i­cat­edly. There are new doc­tors that qual­ify more as rab­ble-rous­ing union lead­ers than mes­si­ahs. But to be fair, doc­tors alone are not to be blamed. The depart­ment func­tionar­ies have not been great ei­ther, for if they had been good, they would not have let this slip so low. If they had done their du­ties, the sad state of af­fairs of hos­pi­tal in­fras­truc­ture and mal­prac­tices around the sys­tem would have been nipped in the bud. It takes two to tango. To­day, the fo­cus is to re­store this ur­gently. The pa­tient has to win. In the com­ing days, I will be con­sult­ing with doc­tors and other front­line care-givers like our nurses, hos­pi­tal man­age­ment and med­i­cal schools.

I will be talk­ing to the depart­ment and other ex­perts and we will then in­voke a med­i­cal emer­gency of sorts. This much is clear - more of the same will not work. We need a sys­tem that works. This bro­ken sys­tem can­not de­liver. Thank­fully, the over­whelm­ing ma­jor­ity of our ded­i­cated doc­tors share my con­cern and from amongst such no­ble doc­tors, we will find the lead­er­ship of will­ing tango part­ners. The depart­ment has a huge bud­get. Money is not the real is­sue here; ded­i­ca­tion, lack of clar­ity and lack of a co­he­sive ap­proach are. I in­tend to get these mal­adies re­moved, to en­sure that a par­a­digm shift takes place. When doc­tors en­sure self­less pa­tient care, they be­come our na­tional trea­sure. No one gar­ners more re­spect and love than doc­tors. And I will stand by our doc­tors as long as they stand by the pa­tient. I will stand by the depart­ment for as long as the depart­ment stands by the pa­tient. For Pun­jab to pros­per, its peo­ple must be healthy and for that to hap­pen, the pa­tient must win. It is as sim­ple as that. -

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