Health services in public sector hospitals in Punjab have recently been disrupted by young doctors’ strikes, called by Young Doctors’ Association (YDA), which has emerged as a representative body of mostly postgraduate trainee doctors. The deliberate health service suspension is aimed to force the government to raise their salaries and approve a job structure. It has allegedly resulted in quite a bit of suffering for the patients. It has given rise to a heated debate in the media and social networks about the fairness of these demands and the actual method of getting them fulfilled. Critics have raised the point that though the doctors’ ‘cause’ is fair and their right to protest cannot be denied, yet it is in no way superior to the harm that can be inflicted to a sick person who is not given adequate and in time medical attention. Medical graduates have shared their part of the story that is unfortunately a matter of great neglect on the part of the state towards health sector.
The health sector has been deprived of financial assistance that it deserves since long. The number of hospitals has not grown in response to great increase in population, which has resulted in overburden on the pre-existing health facilities. Outdoor patients departments of government hospitals are crowded with an overwhelming number of patients waiting to be attended. An average doctor on a daily basis has to examine much more patients than what is internationally recommended. Not only the doctor is unable to spare adequate time to interview, examine and diagnose every patient, he is also prone to stress, fatigue and professional dissatisfaction resulting from overwork. Same is the case with indoor patients. Admissions and discharges sometimes happen without reaching a final diagnosis, only to accommodate new ones. More recently, the increased incidence of violence against duty doctors has added a sense of insecurity to young graduates working particularly in casualty departments. A common visitor of a hospital emergency finds it difficult to attribute lack of services to the percentage of GDP spent on health. In lieu of that, he blames the duty doctors for not working efficiently that quite frequently results in manhandling of physicians and surgeons exposed to public in ER. Although promised a free health service provision in constitution and political slogans, what they get is a mockery of services actually.
Until recently, every such incident used to be followed by a report in the newspaper, an FIR in the neighboring police station against unknown people for disrupting the hospital’s supposedly smooth working environment, an internal inquiry by the department involved, a token protest by colleagues of manhandled staff demanding better security, a warning, a suspension, a penalty and an eventual reinstatement. The latest is the trend where such incidents are not forgotten easily. Every time it happens, it is shared on social networks and strikes are called which bring us to our initial point, the frequently happening discontinuation of health services provision to the public.
No one has denied the urgent need to reform health sector. As a recapitulative of the current situation, let me tell you that doctors inducted in public sector hospitals (grade 17) work many times (literally thrice or even more than that) more than other government servants working in same grades, with no less possibility of national or religious holidays. When compared to neighboring or any other country anywhere in the world, they are low paid. There is virtually no job structure available to them whatsoever. Doctors inducted in grade 17 have to continue in the same grade sometimes 15 years after their inductions whereas people in other departments get promotions regularly. Even worse is the fact that in presence of postgraduate trainees, government stopped inducting fresh doctors a longtime ago and many public sector hospitals are virtually running on the internees. The internees live on stipend and work day and night to make their both ends meet. Their plight can be imagined from the fact that they donot have health insurance not even a proper system of vaccination during outbreaks of contagious diseases. While all this has been happening since many years, what might have led to the recent trend in medical fraternity (strikes and refusal to work) needs to be understood carefully.
The prime factor that led these young medics to creation of YDA was the absence of an efficient platform to voice their demands. Although Pakistan Medical Association has existed as a unanimous body to represent health professionals in the country, it failed to make room for trainee doctors and their needs. Postgraduate trainees need to work as well as to study so that they can prepare for their exams. Yet their educational establishment as well as their representative bodies failed to protect them from the overwork forced unto them. Regular Medical officer posts remain vacant and FCPS trainees are made to fill the gap, at the cost of their studies and of course proper health delivery to the public. This ‘abuse’ of potentially vulnerable young graduates and postgraduate students has led to a feeling of being disowned in the said group. Like elsewhere in the world, the improved communication and social networking amongst younger generation has resulted in what I would term as doctors’ spring, where the anger and dissatisfaction have caused blunting and refusal to continue their job at the existing terms. The grilling at the hands of television anchors about their morality as well as false promises by the government has made them feel insecure.
Moral questions aside, let us discuss how can we resolve this crisis, and create a win-win situation for doctors as well as patients. From the government’s side, what young doctors need is a sense of security, for their young representatives, for the promises made to them as well as physical security at their workplaces. For a successful and sensible dialogue with the authorities, what needed from young doctors are more realistic demands with an even more moral and ethical retaliation in case of a deadlock. I seriously doubt that they can be tamed by calling names or given threats to transfer and disperse them. The only ray of hope that I see lies with the more sober PMA representative body to mediate between the two. Deadlocks are encountered where institutions fail to respond. And if institutions fail to respond now, jerk responses from the insecure segment of doctors will continue to come. It is responsibility of the PMA to absorb the young blood in their organization and to make room for their just demands. Blaming one another will only result in more loss of lives as well as suffering. This is the time to act.