Notes from a collapsed system

In the final days of the PTI government, a medical doctor-turned-bureaucrat turned-anchor, the then leading light of another think tank (both close to the incumbents), and I were invited to give a talk at a think tank. I forget the topic but remember those were tumultuous days. My talk was nothing to write home about. But during the Q&A session, I had a lot of fun.

I was asked to comment on the morose picture painted by my co-panellists. I told the audience that most Pakistanis exist outside the bubble of privilege and face difficulty every day. But for a long time, a privileged subset of the middle class existed in proximity to power circles. They could get away with virtually anything. But because of changing political winds, this class, for the first time, was exposed to the realities faced by an average citizen. So, they thought the sky was falling.

Fast forward to the present day horror story coming out of the Pakistan Institute of Medical Sciences (PIMS): 14 newborns were either burnt to death or asphyxiated by thick black smoke billowing from a mysterious fire. If you use social media you must have come across a number of ways people expressed their shock, horror and grief. Some wanted justice, accountability and solutions. Since the federal health minister is such a controversial live wire, some wanted his head on a platter. Another group used this incident as incontrovertible proof of systemic collapse. Yet another was using this incident to prove that Imran Khan was taken to the wrong hospital for his court-mandated check-up. I hope we can find justice for those innocent souls, their families and, contrary to past practices, the story is not crowded out by some other controversy.

The system collapse argument took me back to my own ordeal in the same hospital some four and a half years ago. Fair warning. This anecdote is not offered for sympathy or attention harvesting but for a deeper argument. If you find it disturbing please skip ahead and make nothing of it.

It happened when the tug of war between the PTI government and the then establishment was at its peak. It was a very stressful time for me for personal reasons. Delayed contracts, salaries, inexplicable and repeated gag orders were doing a number on my system. Until it all snapped and my family took me to PIMS with severe chest pains.

Navigating PIMS' sprawling structure is no mean feat for a novice. I had to go through two other emergencies before I got to the right one. In hindsight it is a hilarious story that I will keep for another day. It must have been around 7.30pm when I walked into the emergency room of the cardiac centre with an ECG report showing discernible changes. My blood was drawn, an ultrasound examination was conducted and painkillers were administered. While all indicators pointed to an episode, I sat there for hours writhing in pain while the young doctor in charge refused to diagnose me, and without a diagnosis, no meaningful treatment was possible. Why? The blood sample was sent to a lab there. The lab in charge received the sample, closed the lab and left to run some personal errand. Until 2am he had not returned. Routine there.

Do you know what saved my life that day? A silly colleague had put out a tweet claiming I had a cardiac arrest without sharing whether I was dead or alive. Thinking that my wife might not be able to handle condolences, I tweeted to correct the record stating I had an episode, was at PIMS and was being taken care of. Our very own Fahd Husain and Sherry Rehman with their massive online following were among the first to express support and wish me health. That tweet blew up and eventually somebody at PIMS web desk published it as a testimonial. And that changed the tone of the staff. At 2.30am, my family was allowed to fetch a Trop T test kit from outside PIMS. I was tested; data confirmed that I was going through an episode called "widow-maker" and was promptly admitted at three. I don't think either of them is aware to this day that they might have saved my life or how grateful I am.

The next day was different. I was treated by an army of senior doctors. However, despite all that I rarely saw any nursing staff when no doctor was around. In short, systemic collapse might be news to some in power, but for most of us it is just a state of being.

For the privileged, PIMS is an oasis, so no incarcerated politician needs to worry about this shoddiness affecting their experience. For the underprivileged, it is a different story.

The minister overseeing my field called five days after my discharge to inquire about my well-being. The then managing director of my channel took even longer to ask me if he could be of any help. I asked for ten-day retrospective leave and on the eleventh day I was back at work.

Our post-colonial governance system was never a match for the challenges faced by our growing population. This is not unique to Pakistan. All of South Asia and many other post-colonial states have the exact same lived experience. Remember this governance system was primarily created for extractive purposes. You can change the label, but not the nature or character. Abandoned by this structure everyone is forced to fend for themselves. Some turn to petty corruption, others rough it out by dint of sheer bloody-mindedness. And sadly there is no quick fix. Most of us expect things to improve eventually. Every system that is allowed to run uninterruptedly for a long enough period does. Ask America, ask China, ask a whole host of nations that got better. Only we do not expect this during our lifetimes.

But here is a mystery for you. Why do people at the heart of privilege suddenly realise this systemic failure? Because power has its own dynamics and demands. As a student of power, I get it. I do not nitpick. You gotta do what you gotta do. But as an ordinary citizen I have no interest in becoming an exhibit, a monkey in somebody else's circus or wood in a fire which I cannot ascertain will burn for as long as it claims to burn.

This realisation goes back to the days when terrorism was rife in the country. It must not have escaped your attention that even huge terror attacks could not deter the resumption of daily life in a few short hours after the fact. This is not resilience. It is the existential awareness that while life cannot be taken for granted, your bills or your boss will not accept such excuses.

For a reform to be credible the first test is of its ubiquity. If reform does not reinforce the causal link between actions and their consequences and visible exceptions remain to the rule it is hardly anything more than a fairytale you entertain your progeny with. And without a two-way conversation it always lacks popular ownership.