Pay Versus Care, Ambition Versus Conscience



Pakistan is a country of ironies. We epitomize a paradoxical lifestyle; donating money to schools while employing underage children to work in our households – for many genuine reasons, assuredly. We make international headlines for ever-increasing national debt and abject poverty while also getting featured for alarmingly expensive weddings and parties. We collect donations for poor patients and pump that money into establishments with policies that make illness and low income the equivalent of a crime. Hypocrisy and contradictions seem to run in our blood, engraved so deeply into our system that even an attempt at addressing the ugly truth is met with derision and cynicism.

As medical students, the responsibilities on our shoulders weigh us down considerably more than our contemporaries. The expectations we face exceed most other professions. Throughout school and clinical training, we are constantly reminded that even a miniscule error is unacceptable. Everyone does not just want but needs for us to be perfect.

As time passes by, the pressure keeps mounting and merely hitting the books is not enough. Clinical hours, social connections and the research publication race go hand in hand. Being good at your job will never be as simple as having a satisfied patient. Our job encompasses a gruelling checklist of qualities that will require our entire lives to fulfil. Add to it the pressure of achieving financial prosperity and we seem to be racing towards suicidal ideation. It is no wonder that the JCPSP recently published an article on the ‘Alarming Rise of Suicide in Medical Professions in Pakistan’.
It seems natural then for our excitement and passion to gradually fade into a certain hardening and disillusionment. Is it inevitable to develop a selfish attitude? At what point, would you stop prioritizing the patient and start prioritizing yourself?
As you think of your answer, allow me to tell you a story.

Jawad is a 30-year-old father of two, supporting his family with a Rs. 10,000 salary. Jawad was unlike most people I had ever met, mostly for one reason – he spends every other day of his week running around one of the largest government hospitals in the city with only one agenda: to get patients what they need. He explained how a major problem that patients in government hospitals face is not just lack of funds, but being able to get to the right person at the appropriate time.

A 13-year-old cancer patient spent a month being solely treated with Panadol in the medicine ward. Jawad found him and pushed for a shift to Oncology. Unfortunately for this child, Jawad’s help came too late. He stood with the patient’s grandfather, who only spoke Sindhi, despairingly watching his grandson take his last breaths. The harassed doctor in charge was singlehandedly managing fifty patients while scrounging around for donations, working in surroundings that make you want to shower three times a day. Over worked, underpaid – would you start letting things go too?

A 16-year-old girl fell from the roof of her house sustaining a pelvic fracture. A condition that is considered a medical emergency, was wait listed for a week. Jawad aggressively pursued the reason for this delay. He could not ignore the tears of a single mother, helplessly watching her daughter drowning in an abyss of pain. Unfortunately, such a complicated case can only be operated by the Head of Orthopedics. As a staff member pointed to the name on the wall, he explained “Barey Dr. Sahib jab aayenge tab hi list aagey barhey gi”. Jawad looked around, wondering why a ward full of seriously injured patients were only allotted two half days in the OT per week. The attendant on the next bed explained the reason; the Dr. Sahib spent the rest of his time at his private hospital.

There are countless such examples among the thousands of preventable deaths occurring in this city. We have dug a hole so deep that the people at the bottom are no longer visible. We hear their screams from a distance, an echo that reverberates briefly around us as we shake our heads and move on with life. This article does not intend to discredit the responsible physicians that work themselves into the ground. Neither do I condemn the culture of private practice. At the end of the day we are all cogs in that wheel. Our own healthcare depends on it.

What then, of those at the bottom of the pit? As I sat and listened to the desperation in Jawad’s voice I realized that our desensitization does not stem from watching constant suffering but from the understanding that we will have to use our knowledge and skills selectively. We cannot save everyone.
He asked me why they put their name on the wall if they don’t actually want to be there? His hatred for this culture runs deep. He doesn’t understand how these doctors sleep at night. A large group of our population has to live with the fact that they come second, their lives are not priorities, that they will have to fight every minute. We are the criminals in their lives, the people they grudgingly respect out of desperation and a lack of choices. Do we acknowledge it? Do we discuss it? Did anyone ever teach us about the healthcare system in school? I wonder why.

We stay silent, make our own plans and become another voice in this debate of private versus government, pay versus care and ambition versus conscience. The reality is that we have distanced ourselves from the real problems and victims. I understand the temptation of covering mirrors that reflect a divide so great that one individual cannot possibly bridge it. But as I sit and speak to Jawad at the end of every month, I can’t help cringing. Does that still happen to you too?

About the author: A young doctor devoted to deconstructing walls. 


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