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After Nishwa’s Death – Govt focusing on medical ethics?

By Dr. Zeeshan Khan

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 sounds 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 and hospital is fined five lac only. Accused Sobia had filled the injections which had no labelling 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 (Nishwa’s father) 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 be quick to dispense justice which will allow for a remedy 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 patient 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.

The writer of this article is a medical doctor at CMH by profession ,a content writer, freelance writer, certified trainer and Poet. He can be reached at

Email: dr.zeeshan.alias.ghazikhan@gmail.com

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