With the coronavirus pandemic still reigning supreme in the region, the conditions of healthcare facilities in the country have been under scrutiny for some time now. However, what remains to be common practice in Pakistan is that many people still choose to opt for alternative medical treatments (with some in more impoverished areas even resorting to quacks) instead of seeking healthcare options available at mainstream hospitals.
In many cases, patients will in fact only resort to going to a hospital after exhausting all other options such as use of home-remedies, self-prescription of medicines and visiting quacks for medication.
There are many options available for patients in Pakistan other than going to a doctor and that is the main reason the medical health facility is in shambles. “The basic criteria that doctors work on is that you first go vist a general physician, who then, depending on your condition, refers you to the surgeon and then afterwards, there’s the post-care,” shared Dr Muhammad Ubaid, who is a consultant and an assistant professor of medicine at Dow University of Health Sciences. However, not going to a doctor and seeking a cure in alternative treatments in Pakistan is economically helpful for the patients which is why different aspects of treatments are more common. “Home-remedies, homeopathy, hakimi, pharmacies, spirituality and many other options are available for free or the amount of the fee is very low while consulting any MBBS doctor can cost as low as Rs 200 and the medicine can take it up to Rs 600 so people instead try to save their money and time,” he explained.
Pharmacies in Pakistan are the hub of self-medication and pharmacists not only provide medicines but also help in prescribing by just listening to the complaints of the patients, “Anyone can go the nearest medical store and tell the person behind the counter, who is not even a pharmacist, what their symptoms are and he will easily prescribe him the medicine which is saving him from a doctor's fee, the travel expense to and from the hospital, and also save his time,” said Dr Ubaid, adding that people opt for easy access of medicines and treatments since hospitals seem like a lengthy, long-drawn put process to them.
Another major factor why patients don’t go to hospitals at their earliest is the investigations or tests which are needed for diagnosis of their treatment and instead to avoid that, the patient either compares their symptoms with any relative or opts for self-medication. “Minimum consultation fee for any doctor is Rs 200 while normally it can go up to Rs 1000. Then a common habit to diagnosis among doctors is to get few lab tests done. Then many of the doctors tend to give unnecessary medicines in the first visit be it multivitamins or anything, so the bill for the patients can reach upto Rs 2,500 for a day’s visit while he can get a medicine from his nearby medical store for Rs50 to Rs100 for a week. So why would he come to a doctor?” he said.
The difference between other treatments and allopathic medicine is that all other treatments are not as recognised. Allopathic treatment is often considered a last resort in terms of treatment for any disease. “If to be explained then homeopathy medicine is symptom-based treatment and not to cure the actual disease, which is why it is prolonged. Other than that, Hikmet is still considered as it is a 2,000 years old medical treatment and also treats from different herbs and natural extracts,” he shared, adding that one of the reasons of alternate options is the education that people need to have to make themselves medically safe. “People in Pakistan believe in advice coming from the right and left and even neighbors but people need to learn that to keep themselves safe they should go to the right person to get treated and not to quacks.”
A common understanding of treating Covid-19 in the world is to do preventive treatments and develop preventive drugs. “Even the Chinese vaccines are of preventive drugs idea and the only way to be safe from Covid-19 is following the SOPs and not taking any medicines,” said Dr Ubaid explained.
According to the Pharmacy Act of 1967, every pharmacy must have a pharmacist at the store and no medicine will be sold without a prescription other than a few over-the-counter drugs. “There are laws regarding pharmacies. One is to have a pharmacist for prescription, while second law is to have generic medicines. Just as all over the world, the doctor doesn’t provide the name of the medicine but the formula and the pharmacist will provide him with the cheapest medicine of the formula so that the prices will go down by 80 per cent,” said Dr Ubaid shared explaining that over-the-counter medicines, which include anti-allergy, paracetamol and other such medicines are to be sold without prescription.
The most common alternative treatment other than hospitals and self-medication is homeopathic treatment in Pakistan on which a majority of the patients rely even in times of a pandemic. The major difference between both treatments is the medication idea. “Unlike allopathy, homeopathic medicine digests fast and easily while allopathic takes time because the dynamic of the medications is different,” said Syeda Arooba Hasni who is a practicing homeopathic.
Homeopathic treatment is said to be slower which is a common understanding about the treatment but the basic idea is that the medication does not suppress the pain and numb the body area, unlike allopathic medicines. “Our medication works through the nerves and prevent the disease through stopping the symptoms, the medicine does not numb or suppress the pain but eases it through the tablets, tincture and drops that we provide,” she said who has completed her four-year diploma from Pakistan Central Homeopathic Medical College. She also pointed out that in allopathic the disease remains there and it only cures the recurring pain while homeopathy works symptomatically.
The difference between medicines and the way of cure is also varied in both the fields as in allopathy there are similar medicines for different pains or similar for coughs but it is not same with homeopathy. “In homeopathy, the medicines vary from how the body reacts, we even have different medicines for a patient who feels a cough while sitting and different for the one who feels like coughing while standing or walking,” said Hasni on how there is no easy way out in any medical treatment but as homeopathy is not an emergency treatment this is why it is not promoted equally to allopathy. Sharing more differences, she said that homeopathy is based on symptoms so they do not have investigations or tests but now as diseases are more lethargic than they also opt for few lab tests in some cases.
A vast number of people in Pakistan believe to be taking homeopathic medicines to prevent themselves from getting infected with Covid-19. “There is no medicine to cure Covid-19 in homeopathy but yes we have been providing and even taking medicines ourselves which we used to cure influenza, as all the symptoms are the same,” she said, who herself along with her family, has been taking preventative homeopathic medicines for Covid-19 ever since February 2020.
“We have been taking this medicine for a year and a half now and we have all remained safe until now, and I do believe this works,” shared D*, who along with her family has been taking homeopathic medicine as a precaution to Covid-19. While talking to The Express Tribune, D* also said that they got the medicines from Durrani Shifa Kahan near Peshawar University where her relatives reside.
Other than allopathy and homeopathy, the recent most garnered treatment to have grabbed people’s attention has been cupping. “Hijama has been developing in Pakistan for last 20 to 25 years and now it has grabbed the attention of a lot of people. The main reason of patients believing in cupping is a religious connection to it as it is Sunnah of our Prophet,” said Hakeem Muhammad Usman Ghani, who runs a Hijama clinic. The history of cupping goes back to 3,000 years ago but in Pakistan, it was started by Dr Amjad Ahsan in Liaqat National Hospital, however, at the time, many doctors didn’t accept it as a cure to for diseases. “We have a trend to follow the West in everything and how could we accept this when we already have modern medical science so it was not accepted widely back then but now when we keep seeing pictures of Olympic swimmers flaunting cupping marks, which we then in turn even promote on our mainstream media,” he shared.
The treatment, which is used as a cure to treat every disease from diabetes to cholesterol and from hormonal issues to thyroid, is said to have no side effects or have no oral or injecting medications involved. “The best part of this treatment is that it does not have any side effects, we are not giving any medication to be taken orally or we are not injecting anything but we rather we are sucking out something harmful from our body,” said Ghani, adding that the blood which is taken out is the toxins which are extracellular fluids and the trick is that it does not suck the blood from venal artillery but instead it vacuums it from the upper layer of the skin. Also, the treatment does not include any bandages or deep cuts which are not even painful for the patients but patients do relax and get addicted to the treatment after a few times.
“From many Islamic references it has been proven that the points for cupping between shoulder blades can prevent over 70 diseases. Similarly cupping in fasting is even more effective as after fasting, the blood circulates throughout the body,” he said, adding that there are 10 to 11 pressure points in the body while there is a total of 150+ points, which are used to cure several diseases.
The treatment varies from patient to patient and cupping points vary as well. “The main shoulder blades points is for everyone who wants to have hijama which is more effective on the Islamic calendar 17,19 and 21 of every month while for specific diseases patients there cupping is done after consultations and points keep changing depending on their recovery,” Ghani explained.
The time frame to get cured through cupping varies from disease to disease. Ghani, sharing an example, said that a diabetic patient’s diabetes will drop down by at least 50 to 60 points with 3 to 4 sessions and after 2 to 3 months their body will start making insulin and they do not have to rely on insulin in their life.
Sharing another example he said that even with blood pressure, cupping helps and just after one session the patients’ blood pressure level will go down on an average of 30 points. “Hijama works on a strategy of making the organ active while allopathy and any other medicine work as a substitute of that organ,” he said, adding that there are different kinds of cupping methods which include dry, wet and herbal but Sunnah is the one in which the upper layer is cut to vacuum the blood out.
To regulate and get a license to perform Hijama, one has to get registered and learn the practice through the Hikmat Council. The Hikmat council is not obliged to regulate the fee of any clinic charges for cupping, they only regulate registration and certification. “Hikmat council in their studies teach how to do hijama in their first and second-year courses, which is why they allow their students to perform and they also regulate the clinics as well,” he informed adding that only Hakeems can perform it and anyone who is doing it on their own can be penalised as more than 80 percent of the people who are performing cupping in the city are not certified to perform it. Hamdard University is also teaching cupping in their courses in their degrees of Bachelors of Eastern Medicine and Surgery (BEMS) and Fazil Tibb wal Jarahat (FTJ).
Negligence of doctors
Medical science and MBBS doctors have many cases in which patients have had to suffer dire consequences even if they have gone to the hospital immediately. “A few years ago, I had to go through a surgery in which my appendix was removed while my appendix was never a problem,” shared Muhammad Ahsan who was later diagnosed with colonic polys increased. Ahsan who was immediately taken to Aga Khan Hospital the morning he started feeling pain in his stomach was sent back after initial treatment and pain killers, and told the pain is gastric. After a few weeks he was given similar treatment at the Liaqat National Hospital and six months passed with the same pain killer injections when he was taken to Baqai hospital where Dr Baqai himself diagnosed him with appendicitis and operated him but even then his pain persisted. Only ater a family doctor from the USA asked him to get a CT scan of his stomach, he was diagnosed with colonic polys which was then cured by medicines only.
“We lost our two sisters due to the negligence doctors do [here],” said Noreen Khan while reminiscing her sisters who both died due to negligence of doctors during delivery at Jinnah Postgraduate Medical Centre. “Both of my sisters died similarly. They both contracted an infection after stillbirth of their children as the doctors didn’t clean them properly, which is why the infection spread fast and they died,” she shared adding that despite filing complaints, nothing could be done as she had already lost her sisters.