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Pakistans doctors protest at killing of 13 colleagues this year


Zarar Khan Karachi
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More than 50 prominent Karachi physicians staged a six hour hunger strike last Saturday in protest at the targeted killing of fellow physicians in Karachi and elsewhere in Pakistan. Also, the Pakistan Medical Association, angered by the governments apparently uncaring attitude towards the killings, has now called for a countrywide strike on 8 April. Doctors here have been calling for adequate security for some time now. This year alone, 13 doctors, most of them belonging to the Shiite sect of Islam, were killed in Karachi, while 270 have been killed countrywide since 1997. Most victims have been based in Karachi. The hunger strike was the second attempt by Karachi doctors to gain the authorities attention. A strike throughout the province was observed on 22 March. However, it had proved ineffective, even though all government hospitalsexcept for their emergency unitsremained shut. Police and doctors believe that the recent spate of attacks on doctors is part of a campaign being waged by religious extremists, mostly belonging to the

mainstream Sunni sect, to wreak revenge on Pakistans president, Pervez Musharraf, for his recent attempts to crack down on militant Muslim groups. Doctors are an easy prey as just about anyone can walk into a clinic posing as a patient, said dermatologist Dr Tabassum Jaffery. Moreover, killing a doctor appears to create a lot more fear among the population. Professor Tipu Sultan, a prominent anaesthetist and a central figure of the Pakistan Medical Association, points out that in one week, 11 doctors have left the country and gone overseas. They are unable to concentrate on their work, said Professor Sultan. But health officials say that the doctors are protesting to preempt a government law restricting the private practice of doctors employed by the public sector. The Pakistan Medical Associations secretary general, Dr Syed Shershah, denied this: Our protest has one aimto guarantee security for all citizens, he said. Doctors as citizens are more vulnerable to terrorist attacks. He added: We are not politicising the issue. We are just drawing the

Pakistani children protest at the killing of doctors 16807

governments attention to its primary duty. It should protect the lives of the citizens. The governor of Sindh province, Muhammadmian Somroo, has promised to step up security for doctors, but the doctors have yet to see any change. Karachi police chief Asad Jehangir suspects that the banned Sunni group, the Sipah-e-Sahaba,

is behind most of the killings. We have arrested many activists of the group. Efforts are on to nab some more, he said. The Sipah-e-Sahaba is among five extremist groups banned by Mr Musharraf. Police have arrested six members of the Sipah-e-Sahaba in connection with the attacks on the medical community.

Staff shortages threaten public health in London


Alex Vass BMJ
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Staff shortages threaten to limit the effectiveness of Londons new primary care trusts, a Kings Fund study has warned. The report says that although there is a wealth of public health experience in London, shortages of some staff could hamper the efforts of the 30 London trusts to deliver public health. For example, the rate of health visitor vacancies is almost five

times the national average. Also, the report says that primary care trusts have had little opportunity to work out in detail how they will organise public health locally under the new structures. Managers, specialists, and practitioners, the report concludes, have broadly welcomed the devolution of public health responsibilities to the trusts. But some of the people interviewed

feared individual professionals specialties might be lost as they take on generic functions, as larger teams were broken down among smaller trusts. Maintaining public health standards in London is an urgent matter, said David Woodhead, public health fellow at the Kings Fund. The report says that tuberculosis rates in some parts of London have reached a significant level, and rates of infection of sexually transmitted diseases continue to rise across the capital. Huge inequalities in wealth mean that poor health is much more common among the eco-

nomically disadvantaged, and life expectancy and infant mortality show wide variation between inner London and outer London boroughs, it says. q More than 300 primary care trusts took over responsibility from health authorities from 1 April. Although the NHS Alliance fully supports the formation of primary care trusts to devolve power to front line staff, it is concerned that debts of around 500m ($712m; 816m) will hamper their ability to deliver services.
Public Health in the Balance is available at www.kingsfund.org.uk

BMJ VOLUME 324 6 APRIL 2002 bmj.com

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AP PHOTO/ZIA MAZHAR