Pakistan: Threat to close outpatient departments

CAUGHT between an uncaring state and an intractable set of problems, it is always the people — overwhelmingly, the poor — that must pay. Many iterations of this can be seen in Pakistan, but the example in the news yesterday is particularly arresting.

On Sunday, according to the president of the Sindh Paramedical Staff Welfare Association, “representatives of all the bodies of paramedics met at the National Institute of Child Health in Karachi in which we have decided to lock the outpatient departments of all the large and small hospitals across Sindh”.

This statement is particularly jarring coming from an association tasked with providing healthcare. The country’s healthcare sector in general, with Sindh far from being an exception, is already in a shambles and utterly inadequate for the needs of the population.

Given these stark realities, government hospitals are accessed mainly by those who cannot afford far more expensive but of generally better quality private healthcare. What this means is that any shutdown of OPDs would primarily affect large swathes of the already marginalised.

Such an extreme step on the part of health workers is not an aberration; there have been several instances, from Karachi to Lahore, where medical staff have forced the shutdown of facilities and departments, or impeded patients’ access to them, as a method of protest.

To be sure, like all other sections of the citizenry, health workers have the inalienable right to air grievances. In the current case, the paramedics are protesting the provincial government’s alleged plans to privatise health facilities and hand them over to NGOs.

More light needs to be shed on this, for doing so may well prove to be an unwise idea, especially given the profile, as outlined above, of the bulk of patients accessing government hospitals.

Providing affordable and regulated healthcare is a primary duty of the state, and Pakistan is regrettably already doing little in the field. That said, the principles of medical ethics, no less the Hippocratic Oath, demand that patients’ suffering be mitigated in every way possible and their access to healthcare not be disrupted.

For this very reason, certain professionals are viewed as belonging to the ‘essential services’, such as policemen and healthcare workers, who have less leeway than most to stop work.

Better sense should prevail: the government urgently needs to pay attention to the complaints of paramedics out of fairness to the latter and to avoid actions by them that could deprive patients of healthcare.