Dignity for the living, and the dead

We have witnessed two pieces of news from Multan separated by just a couple of days. One about those with powerful families, the other about those with presumably no families. One about dynasties vying for more power, the other about the powerless being denied a dignified burial. One about expansion of fortunes and privilege, the other about absence of closure to bookend what was most likely a miserable existence.

Only one of these is likely to be discussed in the coming days and weeks.

The presence of dead bodies, left to rot, on the roof of Nishtar Hospital is simultaneously both shocking and increasingly normal. Shocking because this is not how any society should treat anyone. Shocking because even the unnamed have inherent human dignity. Shocking because medical schools, that use cawdavers, have appropriate protocols, none of which seemed to be in place at Nishtar Hospital.

Yet, it is also being discussed as normal, and nothing out of the ordinary, if we are to go by the statements of the hospital authorities. First they said there was nothing illegal or unethical about the entire episode. Then they came up with a series of bizarre excuses. The excuses ranged from it being the fault of the police and the Edhi foundation, to Nishtar hospital being target of a vicious campaign by the media, to the fact that the refrigerators in the mortuary no longer worked, and hence they had to leave the bodies on the roof.

Underlying the excuses is not just a lack of decency and a sense of responsibility, but a deep disdain for the poor. At no point did anyone from the hospital demonstrate a sense of empathy, or respect. At the government level, the response is also a knee jerk reaction to calm the temporary outrage rather than recognising that this is a failure of the entire system. When the staff at Nishtar Hospital say that this is a normal practice across the whole country, they are probably right.

But system reform is unlikely to happen. We are likely to be stuck in the same cycle of bombastic tweets, a toothless inquiry commission, firing of some low key officials, and moving on. There are plenty of examples, from Peshawar to Sahiwal, where public outrage at the tragedy or atrocity was far greater. Many of us are still wondering what happened to those commissions, reports and promised reforms?

The issue of dignity and respect that got attention due to the evil that was going on at Nishtar Hospital is much bigger and deeper. It is not just the dead who are disgraced, plenty of the living live through it for as long as they breathe. In maternity wards and in outpatient departments, on the floors of the hospitals and in the queues that stretch beyond end, the treatment of the poor and the weak is utterly shameful.

While the issue at hand is serious, and demands urgent attention, it begs the broader question of our national standards in bioethics and medical ethics. It also demands us to investigate if basic norms of human dignity and respect are being observed at our hospitals; and if they are not, what are the consequences? And where does the proverbial buck stop?

The fact that the system does not work is no surprise — the harder question is: how does one make it work? The answer lies in viewing the medical system as part of society and its values. What is needed is not just a system where the refrigerators work, and people are held accountable for their actions, or financial incentives for good performance in meeting ethical and governance standards, but also a deeper recognition of human dignity and respect both within and outside the medical system. This is not just a module in medical school curriculum, or a box to check. It is a collective responsibility on how we treat others, especially those who possess a lot less than us.

Published in The Express Tribune, October 18^th, 2022.

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