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Sickening healthcare

The present mess in the healthcare system is due to the fact that public sector is being run by politicians, sycophantic bureaucrats and their often inappropriately promoted lackeys

Sickening healthcare

Recently I asked a friend and a former colleague who knows the working of the Punjab Health Department about the sudden need to ‘privatise’ public healthcare. His response was a slightly derisive chuckle followed by the recitation of a famous verse by the Urdu poet, Qamar Jalalvi. The verse is: “Jab kishty doobnay lagti hai to bojh utara kartai hain” (When boats start sinking, you throw things off to lessen the weight). His answer is self explanatory.

Mian Shahbaz Sharif, the Chief Minister of the Punjab, has often been described as a very busy man who is always doing something that he feels is good for the province. The only problem with him is that his priorities are a little mixed up. Mian Sahib has run this province for seven years, two things are clear to me as a physician. Our great public hospitals and our world famous medical colleges are deteriorating rapidly. Whatever one might say about the previous administration of the Punjab, at least they had a healthy sense to try and improve the quality of medical care and medical education in the province. And the most important difference with the present government is that they depended on advice from physicians and not their pet bureaucrats.

I was part of the faculty of King Edward Medical College (KEMC) when it was elevated to the level of King Edward Medical University (KEMU) by the administration of Chaudhry Pervaiz Elahi. I was on principle opposed to this change. How things went bad for KE after it became a university is a story for another day. When Mian Sahib took over as CM, he immediately fired the first Vice Chancellor (VC) of KE. Here again I must admit that even though the VC had his faults, his successors till the present VC was recruited were people of dubious calibre.

Two things became obvious as far as KE was concerned. First, Mian Sahib wanted to revert KE to a medical college, in essence to undo what his predecessor had done. The other thing was that Mian Sahib had no interest in completing the ‘pink elephant’ better known as the ‘surgical tower’ standing as a shell in front of Mayo Hospital. This monstrosity was the brainchild of medical bureaucrats running Mayo Hospital and demonstrated the weakness most politicians have for large buildings with their name on it. Here again I was opposed to the entire concept but once large amount of money had already been spent, the surgical tower deserves to be finished or else pulled down.

As far as converting KEMU back to a medical college is concerned, the KE faculty opposed that measure and KE stayed a university. At this point it seems as if out of pure vindictiveness Mian Sahib brought in his favourite bureaucrat to run the Health Ministry. Here it is important to point out that Mian Sahib has held the portfolio of health minister of the Punjab for the last seven years. The purpose of that bureaucrat being brought in was to destroy the Young Doctor’s Association (YDA) and put the KE faculty in its place for defying Mian Sahib. This bureaucrat in my humble opinion was an enforcer and not an administrator. The YDA won out but the medical faculty of KE was completely demoralised.

Arbitrary transfers, unmerited appointments, suspensions and early terminations of contracts were just some of the methods used to intimidate senior faculty. The ultimate insult for the entire senior faculty of KE was the appointment of a junior professor as acting VC for many years. This violated all norms of seniority and merit and if I may say so, decency. The aforementioned bureaucrat has now moved on to bigger and better things but his legacy is still with us.

Arbitrary transfers, unmerited appointments, suspensions and early terminations of contracts were just some of the methods used to intimidate senior faculty. The ultimate insult for the entire senior faculty of KE was the appointment of a junior professor as acting VC for many years.

Recently it seems that something unusual happened at a new public medical college in Lahore named after a senior professor of surgery who not only taught my father in the forties but was also one of my teachers in KE during the sixties, albeit with emeritus status. Junior members of the faculty were interviewed for the position of principal while senior faculty was ignored. Evidently the matter is in the courts but even so it seems entirely peculiar. A strange way to honour the name of somebody who is referred to in the Punjabi medical community as the ‘baba’ (grand old man) of surgery.

Continuing in the same tradition it seems that recently the senior most member of the medical faculty at the ‘premier’ heart institute in the Punjab was arbitrarily removed from his position as the head of the institution and replaced with a junior member. It is quite possible that this physician was not good at what he was expected to do. Fine, but then a proper enquiry should be held and if this physician was proved to be incompetent, he should have been fired. Clearly something fishy is going on and a Karachi-based newspaper that broke the story a few weeks before it happened made a mention of VIP patients not being given the proper protocol and attention. (Dawn “PIC head’s removal on the cards” 6-15-2015, 12 AM) It would seem that in the days of Mian Sahib, sycophancy rules supreme.

Sycophancy needs a way to approach the top. That reminds me of the verse from Mirza Ghalib: “Bana hai Shah ka musahib, phiray hay itrata” (He is now a courtier of the king so he is full of airs). But even to get to the king you need an intermediary and that is the bad thing done by this administration. That is to put politicians as the heads of ‘boards’ that run many medical institutions. When I served as a member of the faculty at KEMC, the college was supervised by a board of management (BOM). The BOM was chaired not by a politician but by a senior, retired professor of KE.

Once you put politicians in charge of medical institutions you are opening decisions to charges of sycophancy and political expediency. The present tragedy is that medicine in the public sector is being run by politicians, sycophantic bureaucrats and their often inappropriately promoted lackeys in medical institutions. Merit or seniority is not the basic criterion of appointment or promotion but the willingness to cede to all bureaucratic and political demands is what counts.

What has happened is that the faculties of our public medical colleges, medical universities and the teaching hospitals are totally demoralised. As an example, KE is short of faculty at all levels. Well qualified physicians that were once proud to be a part of KE now much prefer to join private hospitals where at least they can thrive based on their medical abilities and not their sycophantic capabilities.

That our CM goes off to London every time he feels under the weather does not augur well for the future of medicine in the Punjab under his administration. You spend money to build things you think are needed. Like good roads that can quickly get you to the airport if you need to go abroad to get an emergency Flu Injection.

Syed Mansoor Hussain

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The author has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University.

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