Fourteen infant lives later

Will anything meaningful change?

The answer is no secret. The tragedy at Pakistan Institute of Medical Sciences PIMS in Islamabad this week was waiting to happen. The rot – deep stinking rot – within this institution provided a readymade recipe for it. But what this tragedy has exposed is far worse than most feared.

To call it a tragedy, in fact, is a tragedy unto itself. Fourteen infants were murdered. It is as simple as that. They were murdered by a system that is stitched together with criminal neglect, undiluted incompetence and institutionalised apathy. We should not be sad. We should be furious.

Multiply all this by a million times and that's the sum total of the rot permeating through the entire length and breadth of the Pakistani governance structure. The system is well and truly broken. It is easier to dismantle it than to reform it.

But that is exactly what is not going to happen. The system as it exists today is built to survive threats to itself. It shapeshifts as per need to absorb shocks and minimise damage. It has ways to do it. We will witness these ways in motion in coming days. In fact, the play is already in motion. The composition of the enquiry committee tasked with investigating the PIMS manslaughter is a dead giveaway. Infested with former and serving bureaucrats, the committee will produce a report such committees infested with such bureaucrats have always produced. It will be strong in language and weak in resolve; harsh in censure and soft in change; unsparing in blame and forgiving in institutional restructuring. That's how the system works. That's how it protects itself. Change is measured less through outcomes and more through process.

Muscle memory kicks in. People in big office call other people in big offices and quietly advise against upsetting the delicate apple cart. Blows have to be softened. Time has to be bought. Networks gun into life. Connections are found. There are batchmates, coursemates and classmates whose bonds trump requirements of merit, truth and professionalism; and layered above and below these bonds are further social, political, ethnic, linguistic bonds that protect and preserve precious people at times of peril. The system survives and regenerates at the same time.

When Interior Minister Mohsin Naqvi says the system has collapsed, he is right in his observation, but perhaps less right in what he means by the system. The system of governance that he may have referred to is as good or bad as the people and institutions that lord over it. PIMS is but one manifestation of this. Removing the Executive Director and his team may be the preferred outcome of the enquiry. But this act in itself is an indictment of the system – and of its inherent deficiencies.

No one will question how the largest public hospital under the nose of the federal government was allowed to be so atrociously managed without anyone noticing, or doing anything about it. No one will bother to dig deeper to figure out who was responsible for appointing such criminally incompetent people, and why. No one will have the professional or moral courage to investigate who made rules and regulations that block the most qualified and competent professionals to be appointed in leadership positions instead of cronies with contacts.

The fact is that the pathetic story of PIMS is the story of nearly every government department, institution, organisation and ministry in Pakistan. They are all staffed by people who are mostly unqualified, incompetent, demoralised, or probably all three. These people are slaves of a system that outlived its utility at least three decades ago. It is incapable of reforming itself because those people and institutions that have the power and authority to reform it are direct beneficiaries of the unreformed version. Someone will need to take a hammer to the system and hack away from the outside.

The hammer may need to travel outside the federal territories. If in doubt, see the reactions of the provinces after the PIMS disaster. All of a sudden, the provincial governments realised they should also check the fire safety standards of their hospitals. It had to take the deaths of fourteen infants for the chief ministers, chief secretaries, health ministers and health secretaries to wake up and do what they are paid to do. The system is as rotten in the provinces as it is in the Centre. As long as you live in a palatial residence in GOR, all is well.

Except, all is rotten to the core. The same types of people who are responsible for the pathetic state of affairs at PIMS are the ones who will protect the people who are responsible for the pathetic state of affairs in Polyclinic hospital or CDA hospital or all other government hospitals. It is the same type of people who fight to protect their turf, their authority, their power, and their privileges at the expense of those they are meant to serve. The world looks very different when seen from the inside of the Red Zone, or the GOR.

Nothing will change in PIMS. Nothing will change in Islamabad. Nothing will change in Pakistan. Not unless the system as it exists today is dismantled and built anew. Evolution is clearly not evolving. Governance is afflicted with a terminal disease. Reform is a curse word.

Perhaps things have to get worse before they get better. Perhaps that's the last hope of a people condemned to survive in system plagued with institutional diseases like PIMS. Perhaps Pakistan will always be like this, run by people like this, in a system that will forever remain like this.

Unless, someone says: enough is enough.