Of fake doctors and fake clinics

Rural and much of urban Pakistan hold within it a sad reality: thousands of blatantly functioning quack clinics which prevent Pakistan’s health sector from maturing.

The latest healthcare census found Punjab, Pakistan’s most populous province with 110 million inhabitants, to have between 70,000 and 80,000 totally unqualified medical practitioners. Pharmacists, herbalists and homeopaths often pose as general practitioners and dole out advices they are not supposed to give, medicines they are not qualified to prescribe and syringes they are not trained to use.

Ignorance and poverty have contributed singlehandedly towards the survival of quackery in Pakistan. People of rural and remote localities, due to lack of awareness and limited exposure, are clueless about the definition of a doctor and the functioning of a medical facility.

Specialised hospitals are located only in city centres and are inaccessible to the majority of poor living in villages who prefer going to nearby private set-ups run by fake doctors. Lack of an efficient health regulatory body deepens the wound and allows these pretentious healthcare practitioners to thrive unopposed. To further strengthen their position, a new stratagem has been devised by these quacks: hiring of registered doctors whose on-site ‘presence’ is used as an alibi by the quacks for their illegal backdoor activities.

Quack clinics are family ‘businesses’ with ownership being passed from father to son. Patients by the hundreds, young and old, visit such fake clinics everyday thinking they are being treated by real doctors. Every hour the receptionist hands over a stack of one thousand rupee notes to the quack owner and together this team of planned killers continue to feast in broad daylight. Unfortunately, in rural and remote areas across Pakistan, a quack is often the first point of medical contact. Having inadequate medical prowess in diagnosing and treating diseases, infection control and sterilisation, these quacks unnecessarily medicate patients with antibiotics and steroids leading to further deterioration of the patient’s condition.

Antibiotics are used to kill harmful bacteria and should be prescribed only after the result of certain laboratory investigations. Unwarranted use of antibiotics is the cause of antibiotic resistance and creation of superbugs (organisms resistant to first and second line antibiotics) which has now become a global health crisis. Unhygienic practices such as using a thermometer from one patient’s mouth to the next patient is a common sight in quack clinics. It comes as no surprise that the same syringe is used by these killer quacks on multiple patients which causes potentially lethal diseases such as AIDS, hepatitis etc. Thus, anyone who visits a quack once becomes a life-long patient.

How long will the gang of quacks take advantage of unaware locals by posing as doctors? There is an urgent need to expand and strengthen our primary and secondary healthcare level (comprising governmental medical facilities located in rural areas) with optimal facilities and adequate staff. This will not only save the thousands who succumb to quack clinics but will also filter out patients with minor complaints, who unnecessarily burden outpatient and emergency departments of tertiary care hospitals in big cities.

This new tactics of hiring a doctor ‘puppet’ while the quack secretly indulges in unethical money-oriented practices reflects on the fact that ethics is a weak trait amongst Pakistani doctors. Medical students should be taught how to deal with such ethical issues prevalent in our society so as to not put a scar on their professional integrity.

At the same time medical education and awareness campaigns, with the help of active media, should be launched especially in the rural sector with regard to the quackery menace. On a war footing, structural and functional changes in the anti-quackery department should be made so that we can hunt those living and minting money so mercilessly at the expense of others.

Published in The Express Tribune, April 24^th, 2019.

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