“As a doctor and former (state-level) health minister, I am more aware than anybody else of the corruption that is eating into the entrails of every aspect of governance, including the health system.”
These remarks by Indian Health Minister Harsh Vardhan (quoted in the British Medical Journal article by an Australian doctor published in June) sounded like he was talking about Pakistan.
Vardhan called bodies overseeing medical education corrupt and the organisation overseeing drugs standards a ‘snake pit of vested interests’. “I have inherited a poisoned chalice. Corrupt practices had been exposed by several government agencies and Indian parliamentary committees in the past so who am I to deny that it is going on,” Vardhan asked.
The Australian doctor wrote the article after working in an Indian hospital and went on to liken healthcare corruption in India to ‘a cancer’ and said kickbacks and bribes oil every part of the country’s healthcare machinery — in a country where “medical college places are being sold to the highest bidder, drug supplies being diverted from intended users and patients forced to bribe hospital personnel to see senior doctors.
Coincidentally, a doctor employed with the Pakistan Institute of Medical Sciences (PIMS), Islamabad, volunteered to inform me what he knew of the corrupt practices of senior doctors and their collusion with pharmaceutical companies. This doctor, who requested anonymity, said manipulations by doctors — of facilities, medicine, and their status — were boundless with practically no accountability.
Almost all physicians and surgeons draw salaries from public hospitals but spend most of their time at private institutions, charging hefty fees for consultations and surgeries. Most of them don’t even spend one-fourth of the required duty hours, and many leave duty the moment they get a call from a private hospital. Another malpractice is whether all leading medical consultants and private hospitals pay taxes?
At private practices of these consultants, more often than not, the fees for consultations and surgeries are not documented at all. Business is conducted in cash. Many noted surgeons and physicians earn between Rs500,000 to a million a day with no trace of tax being deposited into the national treasury.
Another acquaintance, who owned a pharmaceutical company near Islamabad, once bragged about the hefty profits they make. “We make up to 600 per cent profit off the primary drugs we import from abroad.” He was part of the companies that financed more than three dozen doctors for ‘pleasure trips’ to Southeast Asia.
The Indian minister’s confessional statement also reminded one of the mysterious death of four infants at a Karachi private hospital in June. Ironically, the police registered an FIR against two hospital owners, Tariq Shah and Adnan Bashir, yet they arrested the accountant, Ramzan Shah, on a complaint of the father of one of the deceased children under Section 322 (unintentional murder) and 34 (common intention) of the Pakistan Penal Code.
As this controversy raged, we read about how “a majority of the patients die due to simple injuries because of the non-existence of specialised facilities in district headquarters hospitals,” in a national daily which quoted senior medical consultants in Peshawar. “Four teaching hospitals, including the Lady Reading Hospital, Khyber Teaching Hospital and Hayatabad Medical Complex in Peshawar, and Ayub Teaching Hospital, Abbottabad, have tertiary care facilities, but all the patients couldn’t avail of these facilities there easily.”
What is the consequence of an inefficient and ill-supplied public health sector? This provides the private medical sector — both the consultants and the hospitals — an unparalleled opportunity to fleece patients at will, with zero accountability.
Once known as a noble profession ‘meant to serve humanity’, the medical profession and the pharmaceutical industry in our part of the world are hardly different from other corrupt institutions — both in the private and public sectors. They, too, stand out as not different from the ruling elites — callous, indifferent and given to self-interest.
Published in The Express Tribune, August 1st, 2014.
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