Sharing space

I have done an experiment multiple times - each time with essentially the same result. It goes something like this: I go to a pharmacy somewhere near a major public hospital (think PIMS in Islamabad, JPMC in Karachi, etc), and ask them about some drug that is commonly prescribed (could be an antibiotic, or something else for another ailment). The answer is always the same. The pharmacy worker offers a few options, with varying prices. The price range can be substantial, sometimes spanning five or ten-fold. I inquire why there is a difference, and the answer is about trust and quality. The pharmacy worker has no qualms about telling me that one (the expensive one) is better than the other. One is reliable and the other one is not!

My experiment, when I have shared with colleagues, both who are in public health and those who are not, is not particularly surprising for them. "Not sure what your point is?" they say. They see this every day in pretty much everything - fans, solar panels, batteries, shoes. You pay for quality - simple as that. While this has become the norm, this should bother us. Drugs are not just anything. We are talking about potentially life and death here. Why should someone be given a risky drug just because they are poor? This question, of course, is rhetorical.

But maybe my colleagues do have a point. They do not need my little toy experiment. The real experiment plays out everyday anyway. In 2023, according to one report, at least 68 people died because of open manholes in Karachi alone. We know that the rich don't walk in streets, and certainly not on the streets that do not have covers for the manholes. There is no surprise in guessing which socioeconomic group the deceased were from.

The examples are endless - fire, building collapse, hospital mismanagement, domestic or school abuse. Somehow on the receiving end is always the poor person, sometimes without a name, sometimes with just the first name. The tragedy is that none of these are unsolvable problem.

Blaming it on the umbrella term "corruption" is an easy, and perhaps a lazy, explanation. I am not sure it is even a useful notion anymore. I believe that many of those who are well-connected and well-resourced actually live in a different country or have created a different country for themselves. Increasingly they occupy different places from the rest: private schools, private hospitals, members only clubs, different malls, different housing communities. Even their seminars for poverty eradication happen in luxury five-star hotels. There is, of course, interaction between the residents of the two countries but both sides know where each belongs.

The deep inequity has bothered people over the years. Our researchers and scholars have proposed thoughtful ideas with better models for economic empowerment, better functioning of the judiciary, effective regulatory frameworks and other areas in this realm. Many of these models provide important ideas and are based on strong research. But I worry that these ideas may never get the full support of those in high offices because many in high offices actually do not consider the poor as citizens of the country that they live in. Their kids do not play in the same grounds, take the same public transportation or share the classroom with others who do not enjoy the same privilege. This early exclusion breeds suspicion, doubts and apathy. Multiplied over decades, we end up with a society where people who may look exactly the same and yet are unrecognizable to each other.

A lot needs to be done in strengthening laws and ensuring accountability, in developing better policies and ensuring that they are carried through - but all this would remain weak until we have empathy for each other. That empathy does not develop in a vacuum; it thrives and flourishes when we spend time to get to know each other, and in doing so perhaps learn a simple lesson in chance and randomness. Any one of us could have been born anywhere, including in that other country in our midst.