Many countries across the globe have settled the question of the healthcare system. The affluent have opted for science-based modern medicine; the poor, unable to afford this premium model, stick with ancient methods, touted as a natural medicine to make it more palatable to the dying patient and drowning families. But, then, there is a third group of nations, where both systems coexist and are acceptable—and these nations get the worst of both. Pakistan belongs to this group.
Before we go any further, let me explain the types of healthcare systems in Pakistan. While our streets and markets teem with exotic new treatment methods, there are only two main healthcare systems, practically speaking.
One is our modern medical body—clinics and hospitals—run by physicians and nurses trained in the medical colleges approved by the state medical authorities. The other group consists of a slew of questionable practices that lack substantial scientific backing and, in most cases, state approval.
I lump all practices of the second group into one category because they all believe in the miraculous powers of the healer rather than a logical treatment, fail to explain the sickness or cure through science, and lack any coherent management plan. In their world, there is a disease and a cure, without the logical sequence of cause and effect. There exists no definition or gradation of disease, no measures to manage emergencies when, let's say, a patient finds it hard to breathe. No means to provide critical care. And, lastly, no tools for surgery. Once a patient's miseries have piled up to an unmanageably high, they transfer this mess to biomedical healthcare, which in and of itself is far from good.
But before I jar your senses with the jagged surface of our biomedical system, let me first describe how the non-medical gang ruins patients' health. Until now, you have learned that the toxic compounds of Hakims, cute-looking pills of homeopathy, and weird ways of treatment by many more constitute the criminal web that does the primary damage. But that is not the whole story. This group doesn't cause so much real damage with their treatments as they do with their social existence. How?
We all know that most of these dubious doctors use potent chemicals, now even biomedical drugs, in their prescription, and yet it is hard to believe that such concoction taken once or twice a year should cause significant damage, even though this can be a possibility with the use of heavy metals like lead in heavy doses. What actually causes damage to the patient's health is the delay in diagnosis. This is because while some patients get better, probably from the placebo effect, others show no improvement. Unfortunately, the latter group suffers the most. Since these practitioners don't refer their patients for an expert opinion, they receive repeated doses of harmful chemicals. But what is worst, the proper diagnosis is put off, smoldering in the darkness of false hopes, ready to declare itself sooner or later. When the diagnosis is reached, it has already been too late. This story is played in the clinics and hospitals day in and day out like a news alert on the TV screen.
But what makes our biomedical healthcare so bad? Clearly, there cannot be a single factor responsible for this bad reputation. On the one hand, several deviations and impurities dilute its healing powers. On the other hand, exaggerations and hesitations lead to lethal effects.
One powerful factor is our love for the past, so much so that we find every novelty suspicious, and rather than being intrigued by the new, we try to avoid it at all possible costs. You must have known a grandparent who dismisses all your poking to use a smartphone, saying, “I am too old for this.” Somewhat similar elderly in our healthcare system, who constitute the majority of our primary care physicians and almost all the academic leadership, fear adopting new methods, new medicines, and new guidelines. While hesitation on the part of a loving grandparent may look cute, the attitude of grandfathers in the halls of medicine brings grave consequences for the field as well as patients. That’s why you would still see drugs in a Pakistani prescription that the rest of the world has already shelved. On the other end, any new surgical procedure lands in our hospitals decades later, only because the elderly didn’t approve of it for a long time. If you drag your imagination, you can connect this behaviour to what our ancestors did with the clock, the printing press, the loud speaker. Our grand-grand professionals are simply an anachronism.
Another equally powerful influence is the market forces, the biggest being pharmaceutical companies. I don't mean here to say in any sense that pharmaceuticals and doctors are in league to make profits. If you have this image of healthcare in your mind, scratch it. Travel packages, hidden deals, and under-the-table kick-offs—these are practices of the past. In the real world, things have gone pretty far off. Just like the military-industrial complex in the United States, ours is a pharmaceutical-healthcare complex, a powerful alliance that can easily sway the doctors' prescription away from patients' interests.
Then, our physicians have to work under the weight of culture. Dealing with patients who have still not been able to shake off the two millennia of Ayurvedic theory of hot and cold, our physicians often undermedicate their patients, giving in to the complaints that medicines are too hot. What do you expect to happen when one gets less than the desired dose of a drug?
On the other hand, the concept of drugs being hot is not complete nonsense, either. Though most of the hot and cold feeling is a theory that lies in the head, we cannot wholly dismiss the reaction. Consider this. Most of these drugs have been experimented on the white population, particularly white men, whose metabolisms vary widely from an average person of Pakistani or Indian origin. This difference in the metabolic process might account for the more pronounced drug effect, even at smaller doses. Consider statins, the most common medication to lower cholesterols. While most Americans easily handle the maximum dose, the body of a Pakistani patient starts to ache at only half.
Despite all its shortcomings, our healthcare, abdominal as it may be, is not wholly responsible for our poor national health outcomes. I doubt it has ever provided any service to many of its critics and complainers. Mainly, its bad reputation has multiplied more by word of mouth than its poor performance. Its hideousness haunts more minds than its operations damage lives. This brings us to our next puzzle. Which system is then to blame for our condition?
This question remains to be answered, for we don’t have research-based numbers, and we can rely on only conjecture backed by common sense. You might have noticed I haven’t used the word “main,” “primary,” or “major” for either healthcare system because there isn’t one. So let me lay out the facts and leave it to you to decide which one is our main healthcare system—the certified state-run system or the non-certified quack-run system.
Most of our medical graduates stay in big cities, which house only a minority of our population. As a result, most of our medical workforce is stationed in cities, leaving the peripheries, home to the majority population, to the mercy of non-certified healers. So, if a system serves the whole population of the village and small cities while forming first-line service in the cities, doesn’t it qualify as the primary healthcare system of Pakistan?
Why do we need to get this stat straight anyways? Because depends on this information the strategy to improve our healthcare system. For example, if only a minority chases behind the miracle cures, we have to eliminate this unlawful healing business. On the other hand, if this love for traditional healing has deeper roots and psychological links, the logical choice should be integration, just as China did for Traditional Chinese Medicine; India, for Ayurvedic.
As long as this dichotomy in our healthcare persists, it is hard to imagine any improvement in our health outcomes, even after we make remarkable improvements in biomedical healthcare. A large part of our population would continue to be served still by a system that is uncontrolled and harmful.