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Lie 1: Patients are dying owing to the strike Truth: Every argument against the doctors strike invariably

takes refuge under the false notion of innocent deaths, but as far as the strike goes, there is no possible way that it could have killed the patients. Emergency departments in all the hospitals remained fully functional during the strike, and that is where all the critical patients are brought to. All doctors did was to close the OPDs. And the media might not have told you this, but closing down OPDs doesnt kill anybody. Yes, patients died; but only when the doctors themselves had to run and desert the emergency departments. Here I consider it fitting to share a sweet secret with you: when the policeforce is unleashed upon you irrationally, you do run for life dearest. I would. You must be kidding if you say you wont. Lie 2: Doctors went on strike at once, creating havoc Truth: I shall agree, but only after you convince me that a time span of about a whole year can be reduced to a scrap like that. You might not have noticed, but its been quite some while since the doctors have been sporting black bands and protesting peacefully. For those who listen loud, youve got to shout! No one lent any ear to what the doctors were saying before loss seemed imminent. Why on Earth didnt the Punjab government come up with the idea of telecasting their version of the story before this? If you keep on playing the ostrich while others want you to respond, things definitely will get messy. Sorry, mate, but thats how it goes! Lie 3: Its just about the money Truth: Only partly. You might believe the doctors to be a heap of greedy filth, but youve got to be in place to realize the drudgery they do in the name of work. That said, it isnt all about money. The strike hovers around the demand for improvement in the service structure of medical professionals. And this demand includes various aspects of the health sector of Pakistan. And believe me when I say this: if implemented, these changes will not only be good for the doctors, but the patients will also get way better treatment than what they are getting now. Lie 4: The media is telling you the truth. Truth: Precisely. And Constantinople was a sheep. The medias reporting in this entire scenario hasnt just been myopic; it is brazenly one-sided. It has, very conveniently, chosen to echo the powerful voices and hasnt paid much heed on knowing the truth before making a fuss. Petty coverage, if any, has been given to the doctors. Thriving on sensationalism, it has influenced the masses so much so that everyone is now coming up with all sorts of fancy expletives for the doctors, or presenting them with gems of wisdom such as, These monsters should go abroad Thank you, thats kind! Lie 5: The strike doesnt suit the doctors; they are the servants of humanity Truth: Perhaps bringing this concept of morality and ethics into all this is the strongest and the weakest point against the doctors. I beg your pardon, but the last time I checked, the doctors werent angels. Nor was anybody else. And since, I suppose, the doctors arent being blessed with any Man-o-Salwa from the skies, it is as much their right to strive for their betterment as is of any other professional. If you compare the pays and perks of doctors with other professions, they might as well end up in the minus. So before you

point your finger at doctors again, make sure youre either Mother Teresa or have a heart of pure gold. The doctors are not refusing to treat, but they arent sheep either! Lie 5: The doctors are completely right; all their demands are justified Truth: And hence we shift to the other extreme of the story. The doctors are not claiming to be all good (if anything, it was the masses calling them saviours and messiahs). And ironically it is this point to which all this episode should have started with, and should have remained at. The demands might not be all justified, some might even be impractical. But thats the debatable part. Ideally, the Punjab government shouldnt have treated doctors like animals; arresting and torturing them. Ideally, doctors shouldnt have gone on strike. Ideally, some official should have lent some sympathetic observation to the doctors demands long ago. But thats too much for idealism. In the real world, we now have about ten deaths due to this fiasco. I dont know whose hands their blood is on; but Im just pretty sure its not the doctors.

Punjabs problems are not only escalating (vertically),but also very visibly expanding (horizontally). The unscheduled load shedding,EnergyCrisis,and the Doctors strike. The perceived culprits in Punjabs suffering vary from the federal government,the provincial,or corruption and the jealous peripheries,influenced for the most part by prior political leaning. During the past few weeks we have witnessed deep conflict between the Punjab government and the Young Doctors Association,little was spoken about the health structure proposed by each party. The morality of doctors,who gave up their duties and put lives at stake,has been questioned. The Punjab government has aired a campaign against the YDA strike worth Rs 40 million,and used army doctors to pressurize the young lot going astray. Only on Friday,Punjab government also replaced the Principals of Allama Iqbal Medical College (Dr. Javed Akram) and Quaid-e-Azam Medical College. Was this the fallout for failure to curb the young doctors? Or worse,was it punishment for supporting the rebels,as the Parliament and Intelligence Agencies have suggested? Frankly,the Punjab governments decision to remove the few influential,senior doctors,who should have been used as an asset to bridge the ever-increasing gap between them and the doctors,seems premature. Of the few of this profession who

chose to side with the state must have been interrogated and removed only if after interrogation any signs of disloyalty surfaced. When well respected senior doctors,both inside and outside of their profession become the collateral damage,levels of suspicion escalates. While Punjab Governments latest decision to slash some of the doctors off its team might aggravate the problem,solely holding one side responsible for the matter under question would be unreasonable. With the bone of contention,what started the problem,the proposed health structures by both parties,easily brushed away,a lack of education about the matter seems prevalent. The perception of political field as subject to a zero sum game by the Central and Provincial,or in the Doctors case,between the Provincial government and the YDA has resulted in a dearth of facts. Neither the YDA,nor the Punjab Health Department,have made their proposed health structures public. To make the service structure public is by no means a criterion,but in a dysfunctional setup where doctors and government cant seem to agree at this point,it becomes the right of the masses whose lives even in some cases have been compromised. Firstly,my aim is not to justify the strike,but perhaps to gauge a better understanding of the technical problems that the young doctors are suffering from. The basic issues of political influence and corruption are not unique to the medical profession. But drawing a comparison with the much more successful Army setup,helps understand a few areas that the Punjab government can work on to improve the working conditions of doctors in general. Secondly,it is crucial to educate those at the brunt of this healthcare malfunction to at least understand the service structure of the Civilian Doctor,in light of the Army Doctor,who heroically came to the rescue of the people. The answer is simple:the Pakistan Army Medical Corps,in contrast to the Civilian Doctor,inherited an excellent service structure from the Royal Indian Medical Corps. There are two categories of appointments:short commission and regular commission. The former is administrative in nature whereas the latter is specialist. Whereas initially only administrative officers could rise to the highest rank,now even the specialists enjoy this privilege. Pakistan Army as an institution posts these doctors based on merit and takes responsibility for their further education and training. While the career of an Army Doctor is merit based and decision making is undertaken by a board making it transparent,in contrast Pakistans Civilian health sector is influenced by the whims of politicians,ministers and the bureaucracy. Young Doctors bear up to 80% of the workload in all major hospitals. Their further education is not the responsibility of the institution that hires them,rather comes at a high opportunity and material cost. As dumb-witted politicians,with little acumen to administrate handed over technical matters,it is convenient to misuse the overflowing services of under experienced doctors,still partially in training,for the free checkups,while keeping the specialists reserved for elite clientele or those with access to the right strings. This leads to,as mentioned earlier,more strenuous working hours,and compromised healthcare. Here is where the Army Structure,with administrative matters in the hands of technical people,really wins the edge. What young doctors therefore need is a service structure that makes their future less dependent on an ill-equipped administrative unit,where further education and training is based not on personal means or an influential family member,but on merit. As far as fixing the administrative unit is concerned,ideally the Army Structure where doctors

handle the management of hospitals should be practiced. It is high time that the Civilian Government use the Armys Structure as a template to improve the working conditions for Government Employees. The Health Service needs to understand that hospital administration is a full time job,which must be undertaken by medical doctors,further trained and qualified to fit the job requirement. When laymen make decisions that neglect the fragile needs of a running hospital,and instead order billions of rupees worth of split air conditioners (as CM Shahbaz Shareef did),the already low health budget fails to deliver the little that it can. Technical staff handling these matters will be more beneficial if there is more accountability of course. Even a trained and aware individual may choose to make the wrong decisions for personal gain. But corruption in the government sector is a matter that is relevant to all service sectors;therefore it becomes futile to comment on that. Another major concern,the journey from Grade 17 to Grade 22,is based on available vacancies,and becomes relative. Therefore a doctor could be brilliant and well qualified on an absolute scale more than worthy of promotion to the next Grade;however this promotion depends on availability of slots. Little can be done about promotion except make it entirely merit based,to assuage the pain of the wait. Once the government can ensure solely merit based progress,and politicians cease to treat their areas as personal kingdoms,where the quota of even generic drugs can be influenced by the political elite,even the best service structure might fail to deliver. The problem of the young doctors is only a microcosm of what Pakistans civil service sector is facing. With stronger structures in all sectors,there will be lesser loopholes to maneuver through.


There is something about the protest of the Young Doctors Association that I really liked this time for a change. They must have been at it before, but I did not notice that. They have been setting up medical camps outside government hospitals where they are deputed. I think this is a brilliant way to protest because it does not in any way cause inconvenience to the public. Like many in Punjab, I found their OPD strikes rather inappropriate with all the problems that it created for patients. Despite the fact that I acknowledge that it is the responsibility of the Punjab government. And yes I do recall news, true or false, ofpatients dying due to the absence of medical staff. When that happens, I dont care if its the governments fault or the doctors fault. I say fuck them both. First, the protests were about the payroll of doctors and later about providing better medical facilities, if I am not wrong. All perfectly legitimate and justified demands. But whether you support it or not, one thing is for sure. It pretty much failed to garner public support. This is where I guess the Young Doctors Association seems to have learned something, as evident by their medical camp protests. Given the importance of the cause of better healthcare facilities, I think these doctors fully require public support to make it effective. This is why the way they protest, rally and get their voices heard is of utmost importance. I believe their cause of pursuing better healthcare in Punjab is phenomenal and probably the most important of all the issues I can think of. However, in my humble and flawed opinion, they lose their strength and credibility, not to mention sabotage their own efforts, by choosing protest methods that disturb the already troubled patients in government hospitals. This is why I like the medical camp idea. Apparently, the Young Doctors Association is pretty proactive when it comes to communication with the media, which proves that they want their campaign to be recognized publicly. This further enhances the importance of the methods of protests they choose. Because every time they do that, they are making a PR statement. The medical camp idea is brilliant since their work is their greatest asset. It is also the medium through which they interact with the public and they can use their professional skills as the greatest form of protest. I know protests are impulsive and emotional things, but this is something the hot-headed leadership of the association needs to think about with a cool mind. Not saying if there is anything wrong with sit-in protests and rallies. The Punjab government had been trumpeting a lot of propaganda against them and it worked because the general public found little reason to support their cause at the time. The government even used pretty brutal measures against the doctors but very few people objected to that from outside the doctors own group. At least in Punjab. As a matter of fact, the earlier protests of the Young Doctors Association, when they were at their severest, created a triple conflict of Doctors v Punjab Government v the People. All three were working against each other and probably the greatest advantage of that went to the Punjab government which apparently had no issues with fighting either of the opponents, given their seriousness towards healthcare issues.

There is another reason why there are not enough protests in Punjab, and even anywhere in Pakistan, because healthcare is not an issue of priority for the people. People simply do not assign enough importance to it. I hardly remember anyone staging a serious protest due to the lack of healthcare facilities in my lifetime at least. Our political parties spend billions of rupees on reconstructing roads and fly-over bridges to satisfy voters, when they should actually be spending a good amount of that money on hospitals and better facilities. Furthermore, there is really no one to lead the people to the cause of better healthcare, probably because it does not involve any special benefits. Another positive about the latest protest campaigns is that its objective is better health facilities in general hospitals, offering the public an incentive to back it. Because I believe the objective should be to turn the equation from Doctors v People v Punjab Government to Doctors and People v Punjab Government. That should be the aim of any such campaigns. People are selfish, you see. They are more concerned about their own convenience than any doctors salary. Since the public generally consider doctors profiteers any way. I am not implying that it is a fact, but thats how the poor public sees just about any business they deal with. Imagine what can be accomplished if the people stand with the doctors for demanding better healthcare facilities. It will certainly force the government to take some action. But its how you do it that matters.

The struggle of the young doctors in public hospitals in the Punjab province reveals the real picture of the poor health system in Pakistan. It also makes clear how much or better how little the capitalist class care about the working class and poor people. Demands Young doctors went on strike on 18th June. The strike is led by the Young Doctors Association (YDA). The young doctors suffer from low wages and demand a substantial increase. According to the YDA they earn only 24.000 rupees per month (Note from the Editor: this is about 211 Euro) which is only a portion of the income of a stenographer of high court (65.000 rupees). They also demand the introduction of a regular services structure for doctors, nurses and paramedical staff. At the moment young doctors stay in one and the same salary schema for many years. In addition they call for a substantial increase of the health budget which at the moment stands by a pathetic share of 0.3% of the GDP. Finally they protest against plans for the privatization of the health services. Police brutality and media slander However the Punjabi government led by Shahbaz Sharif ignored the young doctors demands and finally sent police forces to brutally attack them. As a result more than 450 doctors were arrested and many are seriously injured. The capitalist media, the politicians and the Punjab government have started a wave of slander against the doctors. They state that the young doctors have no right to go on strike. They also spread the lie that because of the strike, patients have died. These filthy rich and middle class people, who all earn

much more than the young doctors, lecture them that being a doctor is a noble profession and such a person would not call for pay increases. And so they claim the government does not have the money and doctors already get already sufficiently high salaries and any further increase is not possible. The media are portraying the young doctors as criminals and supported the brutal police attack. Of course they dont give the doctors space in the media to argue their case. Steadfast doctors So it appeared that the young doctors were isolated. Even this bourgeois opposition parties sided with the government on this issue. But the young doctors bravely stand for their demand. Unfortunately the young doctors get no support from the labor movement. However there are some symbolic solidarity activities from some left groups. Also when the doctors faced the brutal police attack, they got support from the young doctors from other provinces. Representatives from the paramedical staff and nurses said that they will go on strike if the government does not release the imprisoned doctors and talk with the strike leaders. The strike has sparked a political crisis. The government ordered army doctors to replace the young doctors and undermine the strike. However this could not solve the conflict and in the end the judiciary intervened and asked the government to accept the demands and the doctors to end their strike and resume their duties. However the government strongly opposes to accept the demand of the doctor since it fears that in such a case protest could spread to other public sectors. This could create a mighty mass movement. Solidarity! Now the young doctors have started again protests with demonstrations all around the country to mobilize for their struggle. The Revolutionary Workers Organization (RWO) stands in full solidarity with the demands of the young doctors. RWO members joined them on the picket line for common activities. Together with radical medical students we call to build rank and file committees in all public hospitals which integrate the young doctors, nurses and paramedical staff and lead the strike. * Victory to the young doctors struggle! * For wage rises! For a regular services structure for young doctors, nurses and paramedical staff! * For a massive increase of the health budget! * No to plans for the privatization of health services! * For solidarity actions of the workers movement and student organization! For a joint protest movement to fight against the austerity policy, unemployment and for a public employment programme which massively creates jobs and improves the health and social services. Such a public employment programme must be financed by taxes of the rich and the multinational corporations!

While I was working on the Haitian project, I received urgent messages again from Pakistan. Our team was ambushed and fired upon by extreme Muslims who came out with 8 automatic rifles (Kalashnikovs). By a miracle, nobody was injured and our ancient little white van came through the ambush. Pastor Viktor described it as follows:

In cooperation with Voice of the Martyrs (the only Organization with which we can work together there), we brought blankets, literature and other supplies to a specific region. We wanted to show Gods compassion in the actions we do. Afterwards we had a wonderful prayer meeting in which the Gospel was explained. The enemy was clearly not happy with this action. When we were back on the way home we were suddenly ambushed and shot at by at least 6 radical fundamentalists. They shot at us with automatic weapons. I could look in their eyes and saw nothing but hate. But God may be praised because we did not only come safely through the ambush, there was not even one bullet that had hit us!
Two weeks ago, some fundamentalists kidnapped two Pakistani pastors. Our young team (that knows no danger because of their strong faith) followed the kidnappers trail but lost their tracks in a densely wooded area when it became night. Also, a 12-year-old Christian girl fell in a 7-foot well while on her way home from school. She died instantly. Our team visited her poor family and brought gifts (food, clothing) to comfort them.

Doctors striking outside Services Hospital. PHOTO: ABID NAWAZ/EXPRESS


Several doctors fainted and had to be taken to emergency care on the second day of the Young Doctors Association (YDA) Punjab hunger-strike camp established outside Services Hospital Jail Road on Tuesday.

YDA Punjab spokesman Nasir Bokhari and members Ahmad Badar, Zahid, Ahsan, Usman Dar, Ayaz, Abdul Hanan, Sajid and Zulqernain fainted and were injected fluids to maintain their blood sugar levels. The YDA is protesting for the rights of patients and doctors. We have decided to sacrifice our lives for this cause. We will run this camp for as long as we can. Those who are shifted to emergency are in high spirits and plan to come back as soon as their condition improves. The number of protesting doctors will increase with every passing day and we are determined to stay here until our demands our met, said YDA senior member Dr Amir Bandesha. The strikers played national songs and kept asking about the condition of their colleagues. Many lay in blankets and brandished victory signs. Those whose sugar level drops to 60 are kept under observation and if their sugar level dips below 50 they are administered fluid or taken to emergency. Several young doctors have had to be shifted to Services Hospital Emergency in ambulance as they were unable to walk, said a YDA member present at the camp.

YDA President Dr Javid Aheer said young doctors were making history by standing up for the rights of poor patients. He said young doctors from other cities were also determined in their support for the YDA cause and some would come and join the camp in Lahore. Special Assistant to Chief Minister on Health Khawja Salman Rafique said the government was concerned about the hunger strike. He said the government had been in contact with the young doctors since the Gujranwala incident. He said the government is still ready to negotiate with the young doctors but they should accept their mistakes in Gujranwala. Commenting on the claim that the young doctors were fighting for the rights of poor patients, Rafique said that when doctors went on a strike for 37 days, some of the patients died from the lack of treatment. He said that doctors who occupied the Gujranwala medical superintendents office and had misbehaved with their seniors should remember that the publics tax monies paid their salaries. Published in The Express Tribune, February 6th, 2013.