Making the Unproblematic Problematic:
Government machinations and the Doctor’s Struggle
Rasheed Hasan Khan
After an uneasy calm of about a month, the doctors in Lahore are stirring once again. More than a year has gone by but the government has chosen to ignore the issue of framing a Career Structure for Doctors. This is important not only for the health professionals but also for the integrity of the health delivery system as a whole. The doctors had gone on a strike to achieve the framing of a career structure, hardly a month ago, but the attitude of the government reminded everyone of the former colonial oppressors. Instead of a rational and matter of fact approach of resolving issues on their merits, the government turned the whole matter into a political contest with all the attendant mess and damage to the public interest. The public was grossly misled through disinformation which was disseminated by the more unscrupulous elements in the media. A blatant attempt to bring about a confrontation between the public and the health professionals. The struggle however, ended inconclusively after the intervention of the court.
It is instructive to recall that health professionals in England had gone on strike after negotiations with their Government had failed, in the same time frame as the strike in Lahore. Without resort to repression or violence the Government accepted the demands and the whole matter were settled in a week’s time. But perhaps this is the way elected governments behave with those who have elected them when there is no Colonial mind set at work.
Pakistan is not the only country in the world to have a health delivery system or the concomitant problems. But no country in the world treats its skilled and hard working man power the way it is treated in Pakistan. It is obviously a hangover from the colonial past that governments in this country have always treated those who demand change and reform as rebels, to be put down and crushed, rather than as compatriots who are voicing their problems before their own elected government; who deserve to be given a sympathetic hearing and provided relief at the earliest. This is because in Pakistan, the political element in the governments is often inept and ignorant, so the bureaucracy with its colonial mindset but better training in dealing with public issues leads them by the nose. For the common man, it is difficult to understand why a government that could afford to distribute Rs. 13 billion worth of lap top computers free among potential voters as a quid pro quo, found it impossible to give a career structure to the health professionals which by its own statement would have entailed an expenditure of Rs.3-4 billion only. Instead it chose the path of confrontation, which resulted in a strike, the arrest and incarceration of doctors, misery and suffering for the public and general loss of goodwill and image at home and abroad.
This brings us to the most important question, Why is it necessary to have a career structure for doctors? The answer is simple, because they do not have one. With no written criteria for recruitment, terms of service, emolument and promotion, the whole health delivery system becomes the private feudal fief of the ruling political elite and the bureaucracy. To be run not on the basis of some accepted legal guide lines but according to the whims and fancies of those in power, with the attendant corruption in appointments and promotions and relegation of many deserving individuals to the shelf, this style of governance has destroyed so many of our national institutions within the last decade or so.
The reader is bound to think that with such weighty arguments in its favor, why would the government of Punjab avoid the framing of a career structure for doctors? The answer, to paraphrase former President Clinton is “because it could”. Governments which are not responsive to public needs and institutional imperatives seldom if ever see reason unless they are confronted with the might of the public opinion. To confuse the issue with moral and ethical red herrings does no service to the masses. True nobility of a profession lies in its service to humanity by creating institutions free from corruption, maladministration and wastage of public resources and not the observation of some philistine and notional ethical principles.