See More on Facebook

Culture and society, Opinion

Pakistan’s healthcare system is not ready for coming epidemics

Naseem Salahuddin, an infectious disease specialist, looks at the bigger picture in Pakistan.


Written by

Updated: June 11, 2019

THE Larkana HIV outbreak has opened up a can of worms throughout the length and breadth of Pakistan, exposing our feeble healthcare system — of which infectious diseases (IDs) comes into sharp focus. I do not recommend the following exposé be read by the faint-hearted, nor by those in positions of decision-making who have only observed health inequities from the comfort of their offices. It might hurt their sensibilities.

A snapshot of a day in the ID department of the Indus Hospital, Karachi, will give the reader stomach-churning insights into the lives of the poor and sick.

In the TB clinic, over 200 patients are waiting to be diagnosed or receive their free medicines, a third of whom have drug-resistant TB. One is a woman with both lungs destroyed by the most drug-resistant form of TB, pregnant for the ninth time, sharing a two-room shanty with 35 others, six of whom have had TB.

Another, a garment factory worker with syphilis, brings his two wives for checkups, boasting of his 20 children. The mother of 13 of his children has acquired his syphilis, while the mother of his seven children mercifully tests negative. A 53-year-old man is wheeled into the emergency room, vomiting blood due to liver cirrhosis from chronic hepatitis.

A phone call from JPMC informs me of their fifth case of rabies in three months brought from interior Sindh, where no vaccine or rabies immunoglobulin (RIG) is available — the child’s death is inevitable. Our rabies prevention clinic informs me of 15 people bitten by a single rabid dog that has inflicted wounds on the face, neck, trunk and limbs. We can expect an onslaught of infectious disease outbreaks.

In the ward are patients with life-threatening AIDS, drug-resistant typhoid, fragile young women with bellies full of tuberculous fluid. A microbiologist messages from her phone, deriding a private laboratory that habitually reports misleading results which cost the patient precious money and weeks of futile medicines. Another colleague from Swabi shares his caseload of Congo hemorrhagic fever.

The Indus Hospital is but a microcosm of the larger picture: vastly overcrowded government hospitals where young doctors work fast and furiously to alleviate the sufferings of the wretched. The sick arrive in droves from distant villages, parking themselves from the early hours on broken sidewalks, hoping to be attended to.

Supplies of anti-rabies biologicals are rapidly depleting, as are other useful vaccines. We dread the day we see upsurges in deaths from the world’s most horrific diseases. Tongues will click and hands will be wrung, as more deaths hit the headlines. Cases of drug-resistant typhoid originating from sewage-contaminated water pipes escalate daily. Come summer, mosquito-borne malaria, dengue and chikungunya will fill outpatients and hospital wards, rendering absenteeism in schools and workplaces. We are desperately hoping that the Zika virus never enters our skies, which, given our high fertility rate, will cause tens of thousands of malformed newborns.

Having placed this brief but sordid reality sketch before the reader, it is evident that most IDs are a result of poor governance.

Sewage-contaminated water is replete with bacteria and viruses that cause diseases like hepatitis A and E, cholera, typhoid and dysenteries. When a carrier’s infection-laden excrement mixes with the city’s water supply, the consumer inherits these infections. It is not practicable for a large household to boil cauldrons of water daily, and neither can they purchase expensive bottled water. Water supply to citizens should be properly chlorinated at source, and rusted and broken pipes replaced and separated from sewage pipelines.

The mounds of garbage attract flies and mosquitoes, while cats, rats and dogs feed off trash. Every household, community and municipality must vociferously promote and publicise personal and environmental hygiene. Organised trash collection and disposal is the only solution. More than half of public health diseases will disappear by improving sanitation.

The PMDC must make it mandatory to teach holistic healthcare. Practitioners with medical degrees from more than 150 dubious colleges are not necessarily proficient in healthcare management. Many are responsible for perpetuating IDs through syringes and bad prescriptions. The subjects of diagnosis, treatment and prevention of common IDs in Pakistan, as well as medical ethics, are woefully absent from the curriculum, and should be introduced at basic levels.

Finally, no amount of health regulating will succeed if the population continues to proliferate at the present annual rate of 2.5 per cent. Overcrowding and sharing of scarce resources negate attempts to create a healthy population. Population control must be placed highest on the list of the country’s priorities.

It is never too late. Proactivity from those in power can still prevent massive ID calamities. If ignored, we will be doomed.



Enjoyed this story? Share it.


Dawn
About the Author: Dawn is Pakistan's oldest and most widely read English-language newspaper.

Eastern Briefings

All you need to know about Asia


Our Eastern Briefings Newsletter presents curated stories from 22 Asian newspapers from South, Southeast and Northeast Asia.

Sign up and stay updated with the latest news.



By providing us with your email address, you agree to our Privacy Policy and Terms of Service.

View Today's Newsletter Here

Culture and society, Opinion

No safe spaces for women in Pakistan

Rafia Zakaria writes for Dawn. THAT crime lurks in the streets and corners of Karachi is not news for anyone. Precariousness and predation are the mainstay in this southern corner of the land of the pure; if you have something you are hunted and if you have nothing, you hunt. Destiny damns both, the hunters and the hunted, enacting a dystopian version of The Walking Dead, every day and every night. Karachi is, after all, judged as one of the world’s cities that are least liveable. The scars of it all are visible everywhere, on the bodies and faces of its people, on the hospitals that do not care, and the police that do not protect. This time, the dark forces that breed within the city came for a young girl. According to news reports, 20-year-old Dua Nisar Mangi was ‘committing the crime’ of walking down a city street. This was over the weekend past, and with her was a friend named Haris. It was not suppo


By Dawn
December 5, 2019

Culture and society, Opinion

Relentless against child marriage

Farida Yesmin wins an award for her work to prevent child marriage. It was a rainy day in July 2018. As the evening fell, someone called Farida Yesmin, upazila nirbahi officer of Netrakona’s Barhatta, over her phone and informed her that a child marriage was about to take place in Kawrashi, a remote village in the upazila near the Bangladesh-India border. Farida immediately called the police and left for the village in the dark of the night amid rain and thunderstorms. The road was so bad that at one point, the UNO and her team had to leave their vehicles. They walked about two kilometres to find the girl’s home. “As we reached the spot, a local leader tried to stop us. But despite all these hurdles, we were able to prevent the marriage,” Farida said while recalling how she and her team stopped a staggering 59 child marriages after she joined as the Barhatta UNO on May 9, 2017. She


By Daily Star
December 2, 2019

Culture and society, Opinion

Rental car accidents involving foreign drivers increasing

The number correlates to the increasing number of tourists. As the number of foreign tourists to Japan has increased in recent years, so also has the number of traffic accidents involving rental vehicles with foreign drivers. According to the Institute for Traffic Accident Research and Data Analysis, 330 such accidents resulting in injury or death occurred from 2014 to 2018, with the accident rate about 5.5 times higher than that for rental vehicles driven by Japanese. Differences in road traffic rules followed in Japan and overseas mainly explain this, and with only about eight months remaining until the start of the 2020 Tokyo Olympics and Paralympics, the government is scrambling to install road signs written in English, including ones to warn drivers approaching dangerous spots. To drive in Japan, a visitor must possess documents including an international dri


By The Japan News
November 29, 2019

Culture and society, Opinion

American killer

Staying away from an American policy that does not value brown and black people. CHIEF Special Warfare Operator Edward ‘Eddie’ Gallagher is a man of many sins. According to military prosecutors in the United States, Gallagher is responsible for brutally stabbing and murdering a teenage so-called Islamic State (IS) fighter, using his sniper rifle on ordinary Iraqi citizens, and boasting about racking up his ‘kills’ to others. To top it all off, Gallagher is also guilty of taking a triumphant photo of himself with the young IS fighter that he killed. Gallagher was tried and convicted by a military court earlier this year, and was to be deprived of his rank and booted out of the US Navy SEALs. President Donald Trump could not tolerate this. Despite having been told by top military and defence officials that he should leave the issue alone and allow the navy to handle what happened to Gallagher, he


By Dawn
November 28, 2019

Culture and society, Opinion

Xi stresses cultivation of military personnel

President Xi Jinping called for enhanced efforts to train more military professionals. Xi, also general secretary of the Communist Party of China Central Committee and chairman of the Central Military Commission, said in Beijing on Wednesday that a strong pool of talented professionals is the foundation of a powerful military. He urged the armed forces to uphold the military education strategies of the new era, prioritize personnel training, further deepen military school reforms and boost innovation so they can make new generations of professionals having both integrity and capability. Xi was speaking at the opening ceremony of a training session for heads of military academies and schools at the National Defense University of the People’s Liberation Army. He was accompanied by all members of the Central Military Commission. The president said that the core mission of mili


By China Daily
November 28, 2019

Culture and society, Opinion

Women in rural Nepal still ashamed of reproductive health issues

Most of these women are suffering from diseases related to uterus and many of them have physical injuries from domestic abuse meted out to them. Sushila Pariyar suffered from uterine prolapse when she gave birth to her first child at the age of 22. Pariyar, who is now 66, didn’t tell her family about the incident until she was 63. Despite her condition, she gave birth to five more children. It was only recently that she underwent surgery after she found out about the dangers of uterine prolapse on a radio show. Bhawani Chaudhary, of Naya Basti in Ghorahi, shares a similar story. Chaudhary, 80, had been suffering from piles for a long time but never sought treatment out of shame. She only recently went for a check-up. The disease has now taken root and needs extensive medication and surgery, but her family doesn’t have enough money to seek treatment. Many women like Pariyar and Chaudhary keep their d


By The Kathmandu Post
November 27, 2019