The collapse

Mohsin Naqvi may have said it. PIMS proved it. Fourteen young lives were burnt to ashes in a jiffy. Born and gone because of a fire in the newborns' Nursery that no one knew how to report or manage. The five people on duty at night had a choice – save themselves or the children. They chose self over duty. The desperate parents of the newborns could do nothing because the door to the Nursery was locked from the inside by the staff. It was an incinerator waiting for a light, which came from a reported spark in an air conditioning unit that some said was unfunctional for some time. The first responders, the firefighters, could not find their way into the Capital's most popular and most frequented teaching hospital because the entry and exit gates for the vehicles in such emergencies were locked. Those who were meant to be at their stations chose to sleep through their duty time. The Nursery in the Mother-and-Child Wing, meant to save the lives of those needing special care at birth, burned to ashes. This is how a collapse looks.

Just a month back, I walked into the Emergency of PIMS to assist someone with the process to help his son get the attention he was seeking. I passed by a stinking corpse of a decayed human body, thankfully in a bag but just lying unattended at the gate of the medical unit. The only way was to close the nostrils and go around it at a distance, as everyone else was doing. My first thought was about the stretcher on which it had been placed and the next patient who would be wheeled on it. Would someone clean and sanitise it for the next use, or in desperation just place the next one on it to run into where hundreds seemed to teem into small attending rooms. There was no order or a sense of sequence. Our society, and hence the medical practitioners, are not trained for order. This was the outer Emergency. What they call the Main Emergency is a little further ahead. The first building is meant to exercise what they term medical triage. I don't think there was a chance in hell that the concept has moved out of the pages where it is first read. Contacts, influence, status, position and money short-circuit all teaching.

PIMS is a people's hospital. Only the common man visits there. Of which there are just too many from areas around, as indeed the ones who may be living in Islamabad but are clearly out of place. The rest, entitled, walk directly into the Consultant's office because they are bigwigs of the government or society, as are indeed the attending Physicians who are meant to be tops in a top governmental facility of the capital. For some reason, my thoughts wander to Delhi's All India Institute of Medical Sciences (AIIMS). PIMS too is Pakistan Institute of Medical Sciences, but God alone knows when and if we will ever be able to touch the gold standard that AIIMS in India has become. I guess it has a lot to do with how the society at large is coming up. In the normal run of things, though, the common man is dealt with by the duty doctors in the wards and the Emergency. That too, if he is lucky, has walked in with a reference, or knows someone in there who can navigate him through to the doctor's desk. I, over the next three days, endeavouring to help someone, did not get to see a consultant. The collapse is complete.

If this be so, and it is so – hail to Mohsin Naqvi for calling it out – we should be doing something about it. The collapse is all around, in every sphere of our national and societal journey, save a few. But what is of the government, by the government, and with the government is already at its bottommost. Let's save those few that are not and recover those that can be. I wrote last week about the need to change attitude and the approach. It will only come slowly, if at all. Can structures change behaviours? That is my next inquiry. When we talk of reforms, we talk of changing structures where such human frivolity has less agency. Maybe it is worth a try.

Since the politicos cannot put pen to paper nor have the mind to wield the pen, they must then fall back on the bureaucracy to help devise the way out of their predicament as people's representatives. Except, why would a bureaucrat burn his own boat and suggest that the system needs complete replacement with another kind? It becomes a zero-sum circle of no joy. The government will do well to build a spine, collect some experts, read some models, and take the leap of faith in building anew.

Here is a recipe to consider. And it addresses those who are concerned, hold the power to get things done, and can make it happen; hybrid or otherwise: Over the next year, review and reconsider the path that has been imposed on this nation while facing the inevitability of the corner it found itself in. Turns out, those steps have only dug the hole deeper. So I would review all that I undertook as an immediacy to the issues at hand. And this includes the incremental mutilation of the Constitution and the judicial system. The entire gamut needs to be reconstituted to obviate self-serving deviations. The judiciary must be independent and seen to be independent. Then only can the people repose their trust in the 'system'.

Reforms through restructuring should run in parallel, led by experts in the field. This applies to all governmental functions that have required bureaucratic intervention. These functions need to be made bureaucrat-proof. Instead, a citizen's body should exercise control over the labyrinth of the process, and ensure the predictability of a function. It can always induct a specialist to advise when needed. For too long, the politicians have outsourced their thought, mind and intellect to the bureaucrats who have, over time, turned into guns for hire.

A model to remedy the dysfunctionality of the state already exists. The 18th Amendment Committee took nine months to modify the Constitution in favour of the ruling dynasties and elites; a similar arrangement can be made to undo the damage and institute reform over the remaining period of this government. Reform, restructuring and improved governance should bring greater efficiency, transparency, effectiveness and responsiveness. It can be done. If not today, then never. This one isn't working. Let's try another. If that too is doomed, we are doomed anyway. How far worse can it get? We are now burning newborns.

PS: The young man of eighteen years I was trying to assist was handed back to us dead on Day 6. He had walked in with a perfect Blood Pressure, remained unattended despite 'suspected Hydrocephalus' till his kidneys began to fail on him. A nephrologist could never make it to the ward he was in.