The first law of medicine
is “doing no harm.”
People who spend years in medical colleges, followed by equally strenuous training, to become responsible medical practitioners inherit the commandment. However, in developing and underdeveloped countries, we find doctors giving little or no respect to this law and the oath they have taken. The question is why is this law not followed through in letter and spirit? There were times when doctors were remembered as ‘messiahs’. Since the lapse of those good days, especially in the context of Pakistan, doctors are mostly referred to as peddlers in the exploitative social environment that the country has acquired. Probably the Messiah of the yesteryear, donning the white coat, would read the first law of medicine with a self-imposed second law: “Do what you can to relieve the suffering that is in front of you”. This law might not be part of the medical statute, but was ingrained much deeper in the conscience.
Fast forward to 2018 and we find a case for a health sector in our country where the element of ‘care’ is missing. What to talk of the could-be-second-law of medicine, when the first law is not adhered to selflessly.
Academically speaking, three reasons are given for the absence of care in Pakistan’s health sector. One group argues that there is a shortage of doctors and infrastructure. Another group posits that doctors do not perform responsibly and are often absent from hospitals. A third group contends that we lack a sense of quality, leading to deterioration in the delivery of healthcare services. There is yet another group that postulates that when quality becomes a non-issue and is taken for granted; it affects the overall sense of responsibility. The question is, why does quality take the back seat, especially in a sector like health, upon which depends the quality of human resource, skill development and economic enrichment of a country?
Developing countries spend much less on health and education than developed countries. Their list of priorities may end with health sector improvement, but it never begins with any such intention. The patients in a developing country suffer in multiple ways, because of this governmental negligence. One, the private doctors-cum business men fill the gap left by the public sector and fleece people through exorbitant fees. Two, the private sector healthcare sector gets infested with imposters, called quacks in the medical parlance. Three, people are over-diagnosed, because that serves the purpose of both doctors and those associated with delivering health services. The worst hit, though, comes through quacks, who unfortunately usually work as the agents of the private doctors and medical stores.
A quack has his ways of proving his worth. A quack uses his so-called satisfied patients as testimonials to garner support. He also makes extravagant claim about patient care for almost every disease, and last but not the least, he dispenses relatively cheaper treatment. A quack, since he is not qualified, skilled and trained to prescribe medicine does multiple damages. He can complicate people’s diseases, often resulting in permanent disability. He can make the poor poorer by extracting whatever they have accumulated in the name of savings. But the worst he can do is to let a patient lose their life, because of wrong treatment or diagnosis. When governments show negligence towards healthcare, they do not only shy away from their constitutional responsibility, they even become accomplices in the crimes that quacks and exploitative medical practitioners commit in the name of healthcare.
As a developing country, Pakistan has faced it all: the deteriorating public health sector; the abnormal rise of the private healthcare delivery system, and the growth of quackery in both the rural and urban areas. Human rights activists consider it a crime to drive poor patients towards private health services for primary healthcare.
When the Punjab Healthcare Commission took over the reign of regulating the health sector, it had two clear targets: One to standardise, according to its mandate, the healthcare delivery services; two, to remove the scourge of quackery from the health system. Both were tough calls because of years of tolerance the private and the public health sectors had shown towards legal irregularities. Section 4(2) (q) of Punjab Healthcare Commission Act 2010, gives power to the commission to ban quackery in all its forms and manifestations. The Act defines a quack as somebody who pretends as a healthcare provider without either being registered with Pakistan Medical and Dental Council, the National Council for Tibb, the National Council for Homeopathy or the Pakistan Nursing Council. The Commission went so far as to conduct a laborious census of the healthcare establishments rendering services of varying natures and disciplines across Punjab, which led to the identification of quackery outlets. The monitoring and inspection department works in cohesion with the Anti-Quackery team to make the effort more meaningful and productive. Since 2015, the PHC has closed down 14,700 quackery outlets in Punjab. Earlier this year, the Supreme Court of Pakistan took suo motu notice of the rising quackery in Punjab, appointing the Commission as a lead agency against quackery.
Just as the society learns to relive the moments of truth, to at least begin practicing the first law of medicine: “Doing no harm,” the struggle of the PHC to eliminate quackery and sensitising the government to fulfil its duty of providing safe, accessible and free primary health services may as well rekindle the implicit second law of medicine: “Do what you can to relieve the suffering that is in front of you.”
The writer is a freelance journalist based in Lahore.