Own goals and self-inflicted gunshot wounds - Ayaz Amir - Friday, April 08, 2011

The Punjab government’s handling of the young doctors’ agitation defies understanding. What could have been settled in a trice – provided there was no surfeit of untreated iron (sariya) in stiff necks – has become a quagmire for a provincial setup priding itself on that last of Pakistani myths, good governance. If this is good governance calculated disaster takes on an entirely new meaning.

The Punjab bureaucracy, especially its health department, has come in for a great deal of criticism because of this agitation. But a bureaucrat is a prisoner of his background and training. Throw him into the open sea – a tempting prospect in many cases – and when he emerges from the waters he will still be a babu, adept at misguiding his political superiors and skilled in looking at the best reasons for saying no.

It is up to the political master to keep the babu in his place and not be misguided by him, and use him as he should be used, as an instrument of administration. But when bureaucratic vision replaces political vision, or when there is not much political vision to begin with, things go wrong. The bureaucrat remains supremely unconcerned. His is a tenured post and he has other nesting-places to go to. The price of administrative failure is paid by the elected politician.

Matters on the doctors’ front are still not past the point of no return. They are very much retrievable if, apart from the proviso of untreated iron in bureaucratic necks, the Punjab government recognises the following: (1) young doctors are the backbone of health services across the country; (2) as an overworked and underpaid community, they have genuine grievances and their demands have struck a chord not only in the Punjab health service but in that of other provinces as well; (3) the movement launched haphazardly by the Young Doctors Association (YDA) represents a collective breaking point, doctors simply fed up with their conditions of service and working environment; (4) this movement has now arrived at a point where it cannot be crushed by police methods; and (5) nowhere in the world is there a substitute for trained doctors.

The Punjab provincial health department is purveying dangerous nonsense when it says that it can handle the situation by replacing striking doctors with freshly-inducted recruits from private medical colleges or basic health units. This is the kind of unthinking arrogance which has led to this crisis in the first place. Doctors are not bus drivers or sanitary workers. It takes years of education and training to produce a medical officer from a recognised institution, say, King Edward Medical College or Fatima Jinnah Medical College.

I spent an afternoon in Services Hospital, Lahore, and another in Mayo Hospital, the largest in Pakistan, and one of the largest in Asia. Emergency services and outpatient departments wore a deserted look. The same is true of other hospitals in other cities. It is the public at large which is suffering while the health department is busy issuing handouts saying that the situation is fast returning to normal.

As I write these lines (Thursday morning) there is word that emergency services will be manned for today as a goodwill gesture and as a mark of respect for World Health Day. But barring a counter-gesture from the provincial government will not the strike continue thereafter? How can any government countenance the shutting of hospitals and the discontinuation of emergency services when all it takes to defuse the crisis is a serious attempt at reaching out to the other side?

This should be a cue for Chief Minister Shahbaz Sharif to step in and take matters in hand. His subordinates have not been up to the task, and so it is for him to resolve the situation. If this doesn’t deserve his attention nothing else does.

But a mystery remains. Matters had been settled between the YDA and the CM’s senior adviser Zulfikar Khoso on March 31st, only a formal announcement remaining to be made. It had been agreed that house officers would get a raise of Rs12, 000 a month and other categories of doctors a raise of 20, 000 a month. The CM was supposed to meet YDA reps and in their presence make this announcement. What happened? Who sabotaged this move? Or was untreated iron the problem again?

This amounts to the Punjab government boxing itself into a corner. On the strength of what higher wisdom? As I have already said, the doctors’ movement will not be crushed. Threats and dismissals have already proved futile, if anything stiffening the mood of rebellion. The doctors can go on almost indefinitely. The Punjab government doesn’t have the same luxury. For how long can it sustain the spectre of empty government hospitals? After a few more days this will become politically impossible, with public frustration and anger mounting, and more questions asked about the meaning of good governance.

The federal government has already stolen a march in this matter by arriving at a verbal agreement with striking doctors in Islamabad. This puts additional pressure on Punjab to arrive quickly at some kind of a solution.

Of course, concerned officials in Lahore have a point when they say that there is no money to spare and if doctors’ demands are satisfied, paramedics, teachers and clerks will follow suit. To which the doctors’ answer is that they should not be the only ones to drink from the cup of sacrifice. If police and judicial salaries can be raised, if traffic constables can get nearly as much as house medical officers, and motorway police officers substantially more, and if scarce money can be splurged on costly and far-from-urgent road projects catering to the needs not of the masses but an already pampered motoring elite, why should doctors, the most trained of professionals, be denied their due?

There are 22,500 doctors in the Punjab health service, of which 2,500 are house officers. The March 31st package if agreed upon – Rs12,000 for house officers and Rs20,000 for other categories – would have had a budgetary impact (I have the rough calculations) of roughly 5-6 billion rupees. The police pay rise of two years ago had a budgetary impact of nine billion rupees. The cost of road-building in Lahore alone involves huge sums, many times more than what it would take to satisfy the doctors. No one puts in longer hours than government doctors. And no work is more arduous than theirs.

True, doctors have a bad image problem. Looking at the private practice of senior doctors too many of us think doctors to be no better than butchers and cutthroats. But the generality of doctors, those who keep health services going, is not like this.

There’s also the larger point about the kind of health service we want in this country. Pakistan is suffering a massive brain drain, with some of our best doctors seeking greener pastures abroad. Come to think of it, 4,000 Pakistani doctors went to Saudi Arabia last year; 2,000 more are on the verge of going.

And why is Saudi Arabia looking for Pakistani doctors? Because Indian doctors are returning to India, drawn by the higher salaries that doctors now get there. What do we want to do with our health services? Do we want to improve them, are we interested in keeping our best doctors here, or are we closing our eyes to trends that spell ruin for the future of our health services?

Clearly, more is at stake than wounded pride or hurt feelings. This is a time for leadership, for transcending pettiness of mind and spirit. And if anyone has to show this leadership, it is the CM, the elected head of the province. But there’s no time to lose, for it is the public which is suffering.

Another point which may be kept in mind: Musharraf had his black coats and he lived to rue the day he pushed them on the warpath. The PML-N can do without the province’s white coats up in arms against it.

Email: winlust@yahoo.com

Source : http://thenews.com.pk/TodaysPrintDetail.aspx?ID=40545&Cat=9

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