The Hippocratic Oath requires a new physician to swear, by a number of healing
gods, to uphold specific ethical standards. These include the principles of
medical confidentiality and non-maleficence.
“I will remember that I remain a member of society, with special obligations to
all my fellow human beings, those sound of mind and body as well as the infirm”.
A statement, which certainly encompasses the rights of a patient in critical
condition fighting for his or her life.
Minor girl Nishwa, who was administered a wrong injection at Karachi’s Darul
Sehat Hospital, has passed away a week ago and hospital is fined five lac only.
Accused Sobia had filled the injections which had no labeling and gave it to
male nurse Agha Moeez.On April 14, a nine-month-old girl had paralysed allegedly
after being administered ‘wrong injection’ by ‘untrained nursing staff’ at Darul
Sehat Hospital situated in Karachi’s Gulistan-e-Jauhar area. Nishwa’s father
Qaiser Ali told media that Police threatened him to back out also.
Provincial government and state could even plan to send Nishwa abroad for
treatment but nothing was done.
Ali said that he would approach every forum to seek justice for his daughter so
that others did not fall prey to such practices.
There is no working regulatory framework that governs the health sector in
Pakistan. Where markets are incomplete (no doctors for the old) and have large
information asymmetries (where it is not clear if what is being prescribed is in
the patient’s best interest), regulation becomes very important. Otherwise, the
temptation to take patients for a ride becomes too much. Even if some doctors
and hospitals do not indulge in unethical or illegal practices, it becomes
impossible to differentiate between these and the less scrupulous ones. Word of
mouth is not enough to make clear distinctions.
But there is more to it than that. When each specialist is visited, they order a
panel of tests to be done before they will even start talking of treatment.
Hospitalisation is sometimes the only option left if you want a team of doctors
to examine the patient holistically. But even that is not easy. Getting admitted
into a private hospital is costly and even there you are placed under the care
of a particular doctor. It may not be easy to get other specialists to come and
visit.
More importantly, even if they do, they still diagnose and prescribe in
isolation. There is no primary doctor who coordinates with other specialists or
looks at issues of medicinal interactions, the effects of one treatment on
another, and so on. It comes down to the patient himself/herself or to the
family of the patient to coordinate between doctors. But they have no way of
knowing medicinal or treatment interactions.
There are too many cases in Pakistan that one hears of where mistakes have been
made by doctors and care providers like more about the lack of an effective
regulatory structure that should have been created for this sector.
Our Judicial institutions must also quick to dispense justice which will allow
for are medy against malpractice. Usually hospitals have strong internal peer
group-based quality audit systems.
The strength of each of the checks including governments, usually local
governments, imposing strong external quality assurance audits on hospitals,
medical practices and doctors, strict licensing requirements as well. Medical
profession also has membership requirements, standards, checks and balances, can
vary across societies. Nonetheless, almost all checks and regulatory structures
are in place in most societies. In some places we even have insurance companies
and other intermediaries coming in on behalf of the patients. We have none of
these in Pakistan. It is no wonder medical markets are lucrative in Pakistan but
provide, on the whole, terrible service to the people.
A medical research study in US has shown that 30% of all deaths in US happen
because of a medical mistake or negligence somewhere during patients lives. The
most important thing is not the doctor. It is to have a very well funded, well
organized and very centralized form of health care. Oath does not improve health
care. It is the system that does (eg. see Scandinavian health models). In
Pakistan a junior doctor in public sector works like a donkey. Realize condition
of hospitals, no better than doctors themselves, being under equipped and under
stuffed in addition to being over burdened.
Being a developing country, Pakistan has always struggled with health issues.
This also makes us stand at 122nd position out of 190 countries in a report by
World Health Organization (WHO). There is need to increase the health budget. In
such circumstances, the current number of government hospitals and doctors are
not enough to cater the large population while the private hospitals are out of
reach for any lower or middle class patient
Pakistan is ranked 149th out of 179 countries in 2015 on the Maternal Mortality
Ratio Index. New healthcare blueprint needs increased funding, efficient
cross-sector linkages.
According to Unicef, despite significant improvements over the past two decades,
Pakistan ranks towards the bottom among other countries when it comes to infant
and neonatal mortality.
There is need to keep democratic institutions strong. The three tier approach
should be switched with a four tier approach, with the 4th pillar being
preventive Healthcare. This is a very wide branch but if launched, could do
wonders in our Healthcare system.Furthermore, there should be strict penalties
for wrong doings. A procedure for proper investigation for such cases should be
set and punishment should be applied accordingly.Moreover, every person of
medical field must have defined duties whether he is a doctor,Pharmacist or any
other paramedical staff.PMDC and Drap must awake from slumber. SOPs must be
followed so that cases like Ismat can also be prevented.