Friday, 4 January 2013

Of Protocols and Parchi System

Published on 04 January, 2012 in The Friday Times

"Kindly admit our patient, Doctor Sahab. We have talked to the Medical Superintendant and your Head of Department. They have sent us here."

I was sitting in the ward, making discharge slips for patients when someone got my attention by uttering these words. I checked the papers and found that the man was right. He had been sent to our hospital by a top office-bearer of the ruling political party in the province. I was reluctant to oblige such commands as I don't personally think political workers are any more deserving of a doctor's attention than the downtrodden people who fill government hospitals. By sheer luck, there was no vacant bed available in the ward. I explained the situation politely to the man and the hospital employee sent by the "Protocol Office" (designated to oblige influential people, their relatives and lackeys). They tried to reason with me by pointing out that the M.S. had talked to our professor twice and he had written on a slip that these people should be accommodated. I asked my immediate superior about this, and he was also of the view that we have no spare beds and can't accommodate someone just because they have better connections. He talked to my interlocutor himself and in the end the party left without the bed. This was one of those rare times when we resisted the protocol patients, as we have come to call them. Most of the time, however, anyone designated as a protocol case gets preference over ordinary patients.
At the public hospital where I work, there are special VIP and VVIP wards specified for senior bureaucrats, political figures, judges and their families. In spite of that, countless patients are referred by political figures to the hospital with small slips on their letter pads. This is true for almost every public hospital in Pakistan. As we are based in Lahore, we get most of our "slips" from party affiliates or government officials employed by the ruling party of Punjab. In other provinces, only the names change and the "slip system" remains the same. Underlying this whole culture is the belief that unless you are influential enough, you won't get good treatment from public service providers, be they doctors or engineers or policemen. This understanding breeds a more-than-bearable nepotism for any society.

The worst abusers of public service systems are public servants themselves. Senior bureaucrats consider government property as their personal fiefdom. To ensure that every whim of the politicians and bureaucrats is fulfilled, most appointments on the post of Medical Superintendents are politically motivated. Subservience and acquiescence are the requisite qualities desired by the higher-ups for the highest posts in public hospital administration. 

Doctors themselves are no less culpable. It is usually said that doctors make the worse patients. I would like to add to this axiom that they not only are the worst patients, they usually are the worst attendants as well. I distinctly remember one time when a classmate of mine at medical school brought her grandmother over to our ward for admission. We provided her with the best care that we could. After two days, she passed away. Since then my classmate has not talked to me, as if it was my fault. She herself is a doctor. 

I have worked in the Intensive Care Unit (ICU) and a lot of times we've had undeserving patients brought in by other doctors. The ICU is supposed to be for patients whose lives can be saved by intensive care and who are on the brink of death. This is true unless you happen to know a doctor; then rules and regulations can be thrown out of the window. The tragedy of public hospitals in Pakistan is that unless you know someone working there, you are not awarded any extra care. As a doctor, I always try to provide equal care to my patients, irrespective of their status. I am not alone in behaving like this. We feel ashamed when resources are diverted for the sake of "sifarshis". We are sick of tending to the favored ones. We believe that our healthcare system is already neglected and needs no further roadblocks than the ones it already confronts. My request and plea to the people at the top: kindly stop pulling your rank to make us care for your cronies. Thank You.