You do solemnly swear, each by whatever he or she holds most sacred
That you will be loyal to the Profession of Medicine and just and generous to its members
That you will lead your lives and practice your art in uprightness and honor
That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice
That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it
That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret
These things do you swear. Let each bow the head in sign of acquiescence
And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.
For those who are not acquainted with the aforementioned words, it is a revised and modernized version of the Hippocratic oath taken by physicians entering the medical practice in many contemporary medical schools of many countries of the world. It is a doctor’s promise to uphold medical standards to seek to preserve life. But the health industry does not solely comprise of doctors. It incorporates all medical personnel including the nurses, medical students, volunteers, paramedic staff, medical institutes, pharmaceutical companies, laboratories and the law enforcing parties at the government level. The objective of each one of these entities is to observe ethical standards of their profession in order to save lives, restore well being, elevate health and prevent sickness.
In the 21st century the meaning of health and medicine seems to be taking a new meaning. Medicine has taken a holistic approach towards serving mankind now. Decades ago when war veterans were handed crutches on losing a leg these days if an American soldier loses a limb the health care system looks into the matter. Whether the man can afford an artificial limb or if his house would need to undergo renovation is a concern for the health department. But let us not fret over how the West is modifying its health system and health industry. Looking at our own country one becomes despondent, for it is a sad fact that what used to be a service to the ailing humanity has now become a money gearing trade of today. It is one the largest and fastest growing industries in Pakistan like in the rest of the world. However, we look at our country and we see a health care system almost entirely dedicated to money making. The concept of serving humanity for the sake of serving humanity seems to be becoming a myth day by day. But why is that so? Is the idea of serving humanity that out dated? Is the economic instability of the state eating away our conscience? Is the pressure to progress turning us into money churning robots completely bare of morals?
So lets break it down. Our government, which rests at the top of the medical food chain, makes policies with respect to administering certain health care plans. For instance shortly after the advent of the millennium, the government started screening and treatment for hepatitis B and C patients. Hepatitis poses a major health problem in Pakistan and if left untreated invariably progresses to hepatocellular carcinoma after a couple of years. Interferon which are the cure for the disease were administered but after the first course of the dose given to the patients the program was aborted due to the large cost of the program which the government could not cover. it should be mentioned here that a single injection of interferon costs 15,000 Rs. One would think if the government could have figured the expense of the program earlier maybe they would not have had to waste the bulk of money they wasted on the dose of the interferon they did give. As a result the whole project was a complete forfeit.
Moving on to another level, namely the pharmaceutical companies, we have several foreign and many local brands of companies providing medicines and medical equipment, all of which claim to be the oldest and the best in the market yet we still face issues of cartel, black marketing and counterfeit medicines. Being a part of the medical profession and having close encounters with the health industry every day one tends come across some very disturbing experiences. My views used to be harsh towards the health industry but they turned sordid when I was standing in the operation theatre and the anesthesia administered to the old man lying on the operation table refused to show affect. A heated argument began between the nursing staff and the surgeons. The anesthetic agent given to the patient was a counterfeit and the whole thing resulted in delaying the operation for 2 hours. Such are the numerous instances medical professionals come across every day. An issue that rampaged in the near past and is still persistent in the health industry is the spread of HIV infection through contaminated syringes. One cannot help but raise an eyebrow at least at what provoked such a scandal. Was there any truth to the matter at all or was it an attempt to make the companies suffer losses for some perverted reason by even more perverted entity, who knows.
As medical students we are taught about the need for social hygiene, upgrading the level of cleanliness and sanitation at hospitals yet the capital city of Islamabad can only gloat over having one incinerator in the entire city. How the infectious and hazardous waste of human septicemic organs, infected fluids, amputated limbs, is disposed off is very questionable. I myself have witnessed small but hefty felines eating off the umbilical cords of recently delivered babies!
Having implied the incapacity of the pharmaceutical companies to provide with genuine medicines we also need to take a look at what many doctors are doing. Many of us have heard of caesarian sections carried out by incompetent obstetricians and many more unnecessary surgeries carried out by renowned surgeons of our country. All this makes us wonder if the health industry is at all dedicated to delivering relief to the sick and the suffering. Having said that, one should add, all doctors, working in our community, are not inept. We live in a developing country comprising of under privileged people served by under-paid doctors working in an under-financed medical sector of an intensely flawed government.
Take for example the government’s initiative to revamp the methodology of treatment of patients. Under the five year plan (2005-10) a holistic approach had been adopted to achieve the objective. This approach has been adopted in the west and it merely describes therapies that attempt to treat the patient as a whole person. i.e. instead of considering an illness or treating an illness as in orthodox allopathy, holistic medicine looks at the individual’s overall well being before recommending treatment. But unfortunately there is no record of a follow up of this plan. While the west deals with issues concerning the inclusion of children in medical trials we are yet to overcome dilemmas of maternal mortality, tetanus infections, bottlenecks in the Extended Program of Immunization, eradication of poliomyelitis and family planning.
But we have yet to ponder upon one of the appendages of the health care industry which we have not mentioned, the consumer. Apparently health and well being is a commodity only to be owned by the rich while the poverty stricken ailing is left to succumb to death. This is in itself in contradiction to the very philosophy of health care. Equity is mistaken for bias and therefore we read about epidemics of controllable epidemics in the newspaper. The medicines that the government does offer for free are either fake or ill fated to perish against the present taboos in our society.
So to sum it all we have patients who cannot afford treatment. We have pharmaceutical companies charging them with absurd prices they cannot bear the expenses of. We have dedicated doctors who are paid peanuts compared to the services they are required to offer. We also have inept incompetent doctors that have dedicated their services to minting money. We have a government that makes policies without bothering to consult the concerned section of the literate society. And at the end of it all we have a persistent maternal mortality rate of 500/100000 compared to 30/100000 in the developed countries, an infant mortality rate of 80/100000 compared to 4 in the developed states, a life expectancy of 65 compared to 85 in Japan.
As helpless as we are in comparing ourselves to the western society and their comprehensive health projects we are even more helpless and hapless in elevating our health sector and the execution of its under financed and under sponsored health projects according to the needs of the concerned. The probability of our health industry turning into anything more than a life sucking money making ogre is highly almost non-existent.
The underlying problem is that health care industry has become a profit-driven industry; not only are health care providers (profit and non-profit) focused increasingly on profitability, but the majority of the medical knowledge that guides even the best informed doctors is produced and disseminated by commercial sources whose primary responsibility is to maximize profits, not health. This is the source of our unnecessarily high costs and poor health status. Unless and until we excavate the original problem causing all the above mentioned alarming consequences, we will not be able to extirpate the present day predicaments concerning the health industry. Nevertheless it must be borne in mind that these endeavors will be fruitful with economic stability to authenticate such efforts. Maybe that time has a long way to come.
“It is the potential for economic growth that provides the basis for the development of countries, for bringing to people essential goods and services, such as water to drink and facilities for healthcare.”
Lee R. Raymond
- Sarah Khalid Khan
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