Ifran Masih's family and community members staged a sit-along with his body on the inter-district road connecting Umerkot. PHOTO: TWITTER

Refusing to treat sweepers in Ramazan only highlights our doctors’ unethical unprofessionalism

The doctor claimed that touching the body of the sweeper covered in effluent would make him impure and break his fast.

Asad I Mian June 06, 2017
“Primum non nocere” is Latin for “first, do no harm”. Although not overtly found in the text of the original Hippocratic Oath, the message in that Latin phrase holds firm for students making the transition from medical apprenticeship to medical practice.

Scholars have widely attributed the oath to Hippocrates, the father of western medicine. As their rite of passage, young doctors graduating from medical schools the world over take some modern version or another of the oath, several in their own languages.

Medical schools in Pakistan follow suit in terms of the oath being taken by students prior to practicing as independent doctors, with valid medical licenses issued by the Pakistan Medical and Dental Council (PMDC).

How many of those individuals actually understand and practice the oath in letter, let alone spirit, is another story.

Today, I was reminded of the oath when I came across the Pakistani headline, “Sewer cleaner dies as ‘fasting’ doctor refuses to touch patient”.

 A sweeper had stepped into a blocked gutter with the intention to open the sewage line, and while inside, he apparently came across a pocket of poisonous gases (likely hydrogen sulphide and methane) that he inhaled and succumbed to. He was rushed by his family to the nearby hospital where a doctor on duty refused to treat the critically ill sweeper covered in sewage water. The doctor claimed that while fasting, touching the body of the sweeper covered in effluent would make him impure and thus break his fast.

I was more saddened than shocked upon reading the news item – similar episodes had occurred in Pakistan in the past, and continued to do so into the 21st century.

It’s as if I would refuse to treat a smelly baby just because it peed or pooped in the diaper”, was the first thought that crossed my mind.

I then recalled scores of times when my colleagues or I had been coughed, sneezed, spat, vomited, urinated or defecated on, and the countless number of soiled clothes of ours because of presumptively infected, nasty bodily secretions or fluids received from our patients. None of those incidents had deterred us from catering to our patients’ medical needs.

On further introspection, I realised that it was simply ‘the cost of doing (medical) business’. Irrespective of bodily filth that us doctors and nurses were exposed to, I couldn’t recall a single health care professional within my circles who had refused to treat a patient simply because he or she was covered in filth of any sort.

As physicians and nurses, we were beholden to the premise, and promise, to treat all, regardless of age, gender, religion, filth on the body, or lack thereof. By not treating the person in extremis, by not doing what was expected of me as a medic, I was doing grievous harm. By not acting within my capacity as a physician to save a life, any life, became a sin of omission. By creating distinctions in my head about whom to treat or not, based on religion, caste, socio-economic status, my fasting status, or else, was in complete disregard with the essence of being a healer. And it went without saying that by doing so, I was placing myself on a slippery slope, ethically and morally, potentially medico-legally too.

It’s a well-known fact that the vast majority of our sweepers in Pakistan, our fellow citizens, are from a few minority religions. Shouldn’t the holiest of months be a reason enough for us to be doubly thankful to those who ensure our gutters are functioning adequately – don’t we owe it to them? Why take them for granted? I am not in a position to judge anyone, let alone the doctor who refused to treat a patient in distress. However, there is something absurdly wrong with the stance taken by a fasting doctor who refuses to treat a sweeper covered in refuse.

I suppose the medico-legal process shall take its due course where this incident is concerned, but this Ramazan, I take it as an opportunity to reflect on my role as a healer, and perhaps others in this still noble profession might do so too. The responsibility upon us healthcare professionals to save lives, regardless of our or our patients’ religio-politico-social views, is a serious one. Only by holding ourselves up to the highest ethical and moral codes of conduct that both the medical fraternity and the public demands of us, shall we be able to do full justice to “primum non nocere”.
Asad I Mian The writer is a pediatrician, ER physician, and researcher by profession, at the Aga Khan University, but his proclivity for writing is his means of creative exploration and expression. His articles on health, education, children, humour and popular culture have appeared in newspapers in the US and in Pakistan. Other than the Biloongra series of bilingual books for children, he has authored 'An Itinerant Observer' a book of brief narratives first published in the US in 2014 which will be reprinted by Bookgroup in Pakistan in June 2020. He can be reached on Twitter @amian74 and he blogs at anitinerantobserver.blogspot.com.
The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.

Facebook Conversations


sterry | 3 years ago | Reply | Recommend I would think that treating a sick person, sweeper or not would earn someone higher praise than fasting in the month of Ramadan. After all Allah sees all and understands all. He would understand that no fast is broken by touching dirt or effluent. I wouldn't be surprised that this sweeper business breaking a fast is some cast off tradition from India where Shudrs are untouchables and challenge caste status. A lot of people in Karachi come from India so I am sure that this is part of the Indian culture that has been imported there. In Islam, there is no castism although naative Pakistani people are proud of their clan and ethnicity it is not the Indian type of castism where shudrs do sewage work, brahmins do high class work etc. Look at all the Muslims in the West who do labour and low class work despite whatever their families did back home. Hard to believe that in 2017 Pakistan, anyone can be refused treatment on this basis. Even if a patient is dirty like in NYC when street people are brought in to the ER, staff put on gowns, masks and gloves while they treat the most deprived of society. I find it hard to believe that such apparel was not found at the Karachi hospital where the patient was brought in. If this story is true, the attending physician should be disciplined.
Ahmar | 3 years ago | Reply | Recommend This is a disgrace if the doctor really did refuse to treat him for that reason. Even moreso because a large number of people from minority religions work in the medical profession in our country.
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