The following is an excerpt from the book Game Changer: The story of Yasmin Amarsi & the Profession of Nursing in Pakistan. The author is a senior journalist with over 26 years of experience and former editor of The Express Tribune. He previously served as Director of the Centre for Excellence in Journalism at IBA, and has also been associated with The News, Dawn and AAJ News.
According to the State of the World’s Nursing Report 2020, Pakistan faces a shortfall of one million health workers, including nurses. It was to address this shortfall that the government launched the Nursing Now Movement for which then President Arif Alvi, himself from the medical profession, invited over 200 nurses for a meeting in 2018. It was decided to discontinue diploma programs for nurses and focus instead on degree programs to help raise the standard of the profession as well as to be at par with international benchmarking. In the same year, the government launched its National Human Resources for Health Vision for 2030 aimed at developing the skills of the health workforce, particularly of nursing staff. The year 2019 was declared as the Year of Nursing in Pakistan. Big promises were made, including a proposal to set up a nursing university to provide training to 25,000 students every year. However, the promised nursing university is yet to materialize due to a lack of funds and interest from the relevant quarters.
Given her prolonged career and her liaison with government agencies, Dr. Amarsi feels one of the reasons the nursing profession is neglected is because, historically, there has been a lack of representation of nurses on committees at the government level. It was only a few years ago that a task force, formed to look into the health sector, included three senior nurses.
There is some optimism from the fact that even if the government’s efforts have been lukewarm, other stakeholders in the profession are working on improving standards. The Pakistan Nurses Federation, an organization that focuses on the welfare of nurses in Pakistan, helped train several leaders in nursing, which in turn improved membership within the federation. The Federation is considered a prestigious body because the founding leaders of the country, such as Begum Ra’ana Liaquat Ali Khan, took an active interest in it. Similarly, the Pakistan Nursing Council, the regulatory body of the profession in Pakistan, helps standardize nursing education in the country, such as establishing three nursing cadres: Registered Nurse, Registered Midwife and Lady Health Visitor. It also develops the nursing curriculum, conducts examinations, and registers nurses. Most importantly, it licenses nurses to practice professionally.
After many years of being led by non-nursing staff, the Pakistan Nursing Council succeeded in having a nurse become its president. Coincidentally, or perhaps not, she was a graduate of AKU-SON. Though a remarkable achievement, the Council still faces criticism for having non-professionals in key decision-making roles.
The unfortunate reality is that the medical profession in Pakistan has more doctors than nurses. It has one of the poorest ratios of doctors to nurses and midwives – there is only one nurse for every two doctors. Compare this to the global trend, which requires four nurses for every doctor, and it becomes clear that Pakistan desperately needs more nurses entering the profession. Yet, it is the number of doctors that continues to rise. Between 1980 and 2017, the average increase in the number of male and female doctors per year had nearly doubled and quintupled, from 2,810 male and 976 female doctors to 5,313 and 5,008, respectively.
Most families push their children – both sons and daughters -- to become doctors, instead of nurses. There is a widespread belief that doctors earn higher salaries and are more respected as compared to nurses. This is why, until very recently, the nursing profession was reserved for those students who could not meet the entry requirements for medical school or those who could not afford the tuition fees.
But Dr. Amarsi finds hope in how the situation is changing. Not only are more women enrolling in nursing, but men are also enrolling in nursing schools. This is significant given that it was not until 1967 that men were allowed into the nursing profession. Initially, men could only work as nurses in the operation theatres but, over the years, they have been allowed into different wards. According to one estimate, the number of male nurses is almost the same as female nurses in Pakistan today.
One reason why Dr. Amarsi believes that nursing is becoming an attractive choice for students is because of the high demand for these professionals abroad. Immigration and job prospects are brighter for nurses as compared to many other professions and easier than for doctors. As a result, there has been an increase in nursing schools in Pakistan.
While she is happy that the public image of nurses has come a long way, she warns that, although nursing schools are mushrooming, the standard of the educational institution imparting education and teaching on offer is questionable. Her efforts for nursing may continue as she now feels the need is to ensure the profession not only remains acceptable but also credible.
It would be apt here to quote how much of a powerhouse Dr. Yasmin Amarsi is seen as by her colleagues. As put by Director for Health at the Aga Khan Development Network (AKDN) Dr. Gijs Walraven: "Dr. Amarsi is the most powerful advocate for the profession of nursing I have ever met. And she does this in her own humbling and charming manner, grounded in her decades of experience as a nursing professional, based on evidence and informed by her learning as a senior academic in different settings and environments.”
It is in teaching and interacting with students that Dr. Yasmin Amarsi finds her true sense of fulfillment. Despite no longer holding an official position, she has requested to be included in a few teaching sessions, even if her name does not appear on the official roster. This stems from her deep satisfaction in sharing knowledge, guiding students, and witnessing their growth.
Dr. Amarsi, whose dream was to become a doctor but opted for nursing as a career due to the closure of colleges and political strikes in 1968-69, has no regrets whatsoever and never once looked back. On the contrary in an interview she gave after joining AKU-SON, she stated “I am proud to be a nurse.” To date, after fifty years, she maintains the same views.
The motivation and the driving force behind all the achievements and milestones Dr. Amarsi derived from was her sincere desire to help people and elevate the image of the nursing profession in Pakistan.
As Dr. Amarsi’s story comes to a close, her legacy as an exceptional educator and compassionate mentor will continue to inspire generations of students and future educators, leaving an indelible mark on the world of nursing education.