Healthcare in Pakistan: No one cares because they're not taught to

By Arif Mahmood

No civilization would ever have been possible without a framework of stability, to provide the wherein for the flux of change. Foremost among the stabilising factors, more enduring than customs, manners and traditions are the legal systems that regulate our life in the world and our daily affairs with each other. — Hannah Arendt.

Grey slacks, blue button-down oxford shirts: this was the daily attire at St Marks School of Texas, where rules — of which there were many — were pervasively enforced. At my all-boys' prep school, life could not have been anymore regimented.

Uniforms established equality, while a core curriculum rounded out carefully manicured courses of study and training. It wasn't until many years later, as an adult, that I fully appreciated the formative powers of such structure, regulation, and order.

From the carefully constructed storyline of my cloistered childhood, descent into Islamabad constituted pure culture shock delivered by sensory overload.

Stepping out of the airport, chaotic traffic, colourful buses, and a barrage of beggars competed for my attention from all sides. The meaning and profundity of the experience flew over my head, but it definitely struck a nerve. I had come here to study medicine at a school established by American-trained physicians, but it immediately was clear that the most important lessons in medical practice would be those taught by the people of Pakistan.

A foreigner or driving in Pakistan: If I can drive in Pakistan...

An excited relative shepherded me through the dense swamp of people to a car, where a driver who had been patiently awaiting us tucked away my baggage and authoritatively drove us to our destination.

"Arif, you see, a driver is a buffer. You see, the road here is sort of like a jungle. If there's an altercation; it's the driver’s responsibility to resolve it," my uncle explained to me.

Indeed, the rule of the road seemed to be anarchy: cars ploughed through red lights, lane markers were egregiously disregarded, and disorder was rampant.

And the disorder didn't end at the medians and sidewalks: structure, regulation, order were often nowhere to be found.

The scene stirred in me an awareness of the disparities around me, and I applied the lessons in order and discipline of my schooling towards a goal of contributing towards the propagation of equality and justice through health care in the city around me.

Every Friday, I would venture into the open-air bazaar to seek out the anxious beggars who were otherwise entirely overlooked in the bustling market, offering attention, care, and charity of my means. It was here that I learned how compassion and empathy play vital roles in the process of healing.

One ageing woman I met there had been suffering from osteoarthritis for at least 10 years, unaware of the existence of analgesics; imagine the change in her quality of life when medical intervention came. Following diagnosis by X-ray, prescription of anti-inflammatory drugs and a simple aerobic exercise schedule; she was ecstatic.

There were many like her – for whom dramatic relief was a greeting and a brief consultation away. My most memorable experience, however, was of a pariah whose compulsive outbursts of obscenities left him shunned by the public; hoping to help, I established a rapport.

Suspecting a Tourette's diagnosis (neurological disorder), I arranged for a psychiatric evaluation to confirm. His diagnosis changed his self-concept.

With heartbreaking gratitude, he would continuously tell me that no one had ever really acknowledged him before. I remember feeling completely overwhelmed when he called me his saviour.

During a dermatology rotation, I was greeted by an extremely coy and impoverished 12-year-old girl. After an in-depth history and physical examination, it was determined that she had primary syphilis.

Coming from a family of 10 living in a single room, she regularly witnessed her parents fornicating. She became intrigued one day and engaged in sexual activity while her parents were at work.

We were unable to involve her parents, knowing they would react harshly. I remember she was terrified of seeing a doctor initially, but she also trusted me. We treated her with Penicillin G and counselled her about safe sexual practices.

Delving deep into the chasm of these individuals' personal lives and health made me realise how fortunate I was to grow up in a country where you can actually see legal rights and equality in action. No one really cared for any of these people because they were never taught to.

As a society where legal violations were disregarded and dealt with monetarily, it's no surprise Pakistan has lost track of its most valuable asset: its people.

Medical school taught me the importance of maintaining a high regard for humanity and equality. The value of human life, regardless of geographical location, socio-economic status, or education should always remain high and level. Our biggest asset is our people, but that is yet to be learnt.