In Pakistan history has bore witness to general lack of health facilities and medical malpractices. For one reason or the other, the situation has not been significantly improved, if at all been made better off.
In technical terms medical malpractice means: “A professional negligence by act or omission of a health care provider in which care provided deviates from accepted standards of practice”. Although, usually doctors are held responsible for any medical malpractice in Pakistan’s hospitals, but here I would like to highlight some other factors as well which become the causes of ill treatment of a patient. The causes like the lack of structural infrastructure and basic health facilities, the inefficient role of the hospital administration and the profit motivated pharmaceutical companies run a great deal of risk in exacerbating and damaging a patients already vulnerable condition. However along with these factors, the institutional framework to improve health system of Pakistan has not been given proper thoughtfulness or importance which is deemed necessary.
Pakistan being a third world country does not have enough resources to improve its health care system but that is not enough an excuse to keep a shamefully low amount of budget allocation for health which is just 0.7% of the GDP. Not even 1%! Yet we hear all the time that with the ongoing war on terror and disputes with neighboring countries, Pakistan cannot afford to reallocate its expenditure from defense to any other sector. With the government’s failure to provide better health facilities and increased awareness of health among people; a large gap has been created between the supply and demand of health facilities. To shorten this gap, private sector has stepped in and has been somewhat successful in improving the health facilities in Pakistan.
Private sector has played a huge part in improving health facilities in Pakistan. This has been done by building new hospitals, using latest technology and increasing the doctor’s salaries. Although, efforts have been made in the past decade to improve the overall health position in Pakistan but what underlines this fact is that the number of incidents of medical malpractice has greatly increased, especially in private hospitals. The unfortunate events of medical malpractices (like the case of Immane Malik and similar) can be attributed to a number of reasons. Negligence on the part of hospital administration in handling their staff, duties and responsibility is one main reason other than the obvious doctor’s carelessness. Furthermore, when a pharmaceutical company is motivated by profits, it actually plays with the lives of the patients as recent examples of fraudulent companies and fake medicines have come ashore.
The facilities here in Pakistan are not adequate to treat a patient successfully especially in public hospitals where the demand for medical health care is high. There are not even that many hospitals beds available to accommodate such number of patients. Although private hospitals have come to the rescue but most of the Pakistani population cannot afford it. The charges of private hospitals are very high so people prefer to go to public or civil hospitals where they are forced to stand in long lines and facilities are also not up to proper standards. In public hospitals there is a shortage of doctors, so the ratio of patient to doctor is very high and more often than not the doctors are unable to attend to these patients. There are not enough nurses to see such a large number of patients. Even if there are nurses they are not fully trained and often cause mixing error. Mixing error takes place when the medical staff such as nurses mixes the medication of one patient with the other. This may lead to serious problems and can even lead to death.
Other than this there is no proper documentation in Pakistan’s hospitals. Documentation is essential regarding each and every detail e.g. the number of visits made to the doctor and the dates, the various reports of patients. The absence of any such documentation leads to many errors as a proper follow up is mandatory and if the hospital would not keep record of all this then effective treatment cannot take place. If the patient has been prescribed a certain course of medicine and there is no previous record of that. This can lead the patient to repeat the course which might have serious side effects. So doctors are not responsible for malpractice in Pakistan, it includes hospital administration as well which monitor the facilities provided inside the hospital such as medicine, nurses, ward boy, and finally documentation. Failure in providing any of these to proper international standard results in loss of health.
Other than blaming doctors or hospital administration, pharmaceutical companies are also to be blamed for medical malpractice in Pakistan. It occurs when patient takes some medicine to improve his or health, but the medicine rather than improving the health of the patient further deteriorates and causes other medical problems. And unfortunately recent past has shoved in a number of examples of profit galloping pharmaceutical companies, hungry to make money even on the expense of precious human lives. An example could be the recent Tyno cough syrup incident which took dozens of lives.
Ironically all these factors of structural incompetence or structural malfunctioning are just the tip of an iceberg in relation to the issue of health system in Pakistan. This structural incompetence or malfunctioning actually results from institutional dis-functioning where the main issue lies in planning and implementing better health strategies, and we lack both. With such mockingly low level rates of GDP being spent on health, we can barely hope for a strong stable health system in Pakistan yet we desperately seek one!