When Doctors Strike

Over 15 children have died at our hospital alone as a direct result of the strikes, and the number continues to increase.  The blackened cinders of the tyres burned by the doctors lay as epitaphs on the road outside the entrance to the hospital.  Hundreds of doctors across the Punjab and Islamabad have violated the governments 24 hour warning to return to work, continuing with demonstrations.  The newspaper today gave a comprehensive list of 80 plus doctors who have been struck off.  The television shows pictures of weeping mothers and sick children.  I can’t help but feel the media is demonising the doctors.  The government have offered to increase wages by a mere £20 per month and so the strikes go on. 

I came home today to debate the issue with my Pakistani cousins.  “Doctors shouldn’t be allowed to strike.  If they want money they should have gone into a different profession.  They take an oath to protect life and that’s what they should be doing.”  I defended the doctors who clearly don’t get paid well but couldn’t help but wonder what I would do in such a situation.  Does it really have to take increasing numbers of dead for the voices of the doctors to be heard?  What other avenues can doctors here use beyond those tried already? Discussions and debates with government made by the Young Doctors Association have fallen on deaf ears.  It is clear that here, if you don’t take the opportunity, you are left in the gutter like all the others who either have no voice or couldn’t say it loud enough.

 “They should just go into private practice to make up the difference” my cousin states but later admits he would never pay money to be treated by a trainee.  “Well, the poor village people don’t mind paying to be seen by trainees” he says.  Those poor village people can barely afford to live let alone pay for private consultations.  And there arises another of the major problems here.  As with many developing settings, the rich only want to get richer and rarely look over their shoulders at those left behind.  They can’t quite grasp that the steepening social gradient will only make things more difficult for them.  An interview with the teenage boy who blew himself up near Islamabad yesterday killing a young girl but surviving himself showed him explaining how the Taliban had promised him heaven.  Poverty can push people do anything.

David Cameron will be visiting here tomorrow. I would like to be able to say with confidence that his presence will make a positive difference but the large army planes that fly over head in the direction of Afghanistan only remind me of the UK’s contribution to the development of this country.

The price of life.

Every life is priceless, and yet here it seems necessary to put a price on life.  How much is a family able to pay to keep a sick child alive? 

For the past few days we have been caring for an 11 year old child.  6 months ago he was a normal child.  Then he developed severe bone pain.  Local doctors prescribed course after course of antibiotics to no avail.  On admission to us his blood counts showed he had leukaemia.  Each morning on the ward round he would sit up in his bed, his pain eased by the opiates we had prescribed.  This morning however he lay writhing in his bed and the consultant called for him to be moved to the treatment room where very sick children are observed.  The ward round continued and on arrival in the treatment room it was clear he was peri-arrest.  He started vomiting and lost consciousness.  To my horror doctors went on with their daily business.   When I started shouting for help, the doctor beside me made a feeble attempt at chest compressions (with his thumbs!) while I tried working through my ‘ABC’ protocol for resuscitation.  Oxygen and suction had to be borrowed from the baby in the next bed and no one had heard of an arrest trolley.  As I walked away from the boys body I felt in shock at the complete lack of effort to at least give him a chance.  “This is how it is”, a fellow medical officer stated bluntly, “he was sick and his family couldn’t have paid for treatment anyway”.  If this is the best care the population, many of whom travel from Kashmir and beyond, can expect I wonder at the care provided elsewhere.  

It doesnt surprise me that every 11th child here dies before their 1st birthday.  To be blunt, the system sucks.

Accidental injury and poisoning are also common.  3 children in 3 days were admitted with kerosine poisoning which people think clever to keep in Coke bottles.  One 2 year old child with near drowning had fallen into the family water tank that had been left uncovered in the garden.  He was submerged for over 7 minutes and arrived unconscious.  I was delighted to find him sitting up in bed today.  

The sadness felt by Pakistanis after yesterday’s loss against India was tangible in the atmosphere.  “We don’t even have this much”, my cousin said pointing to the tip of his little finger.

Hospital Strikes

As I type this looking toward the Margala hills from the patio window, the air is rolling with the sound of thunder. 

Today was my first day at the local government hospital.  On my arrival a patient asked if I was a nurse because all the doctors were on holiday.  I can’t believe that I thought.  I looked around and had to agree that there was an absence of people in white lab coats and stethoscopes.  “You have come at just the right time” the consultant paediatrician explained.  All the doctors in the Punjab and capital are on strike.  The average salary of a medical officer (MO) is around £180/month and many of the first year house officers get paid nothing.  I can’t imagine having to do my FY1 (junior house officer year) voluntarily.  It would have made being called “the ward monkey”, which was a term often used back home to describe junior doctors, all the more unfavourable.  For the past 5 days they have been protesting outside the hospital demanding pay of at least £800/month.  It was nice to see all members of staff in support of the juniors though there was understandable concern over patient care.

I attended the ward round with an excellent female paediatric consultant whose scarf draped delicately over her head and gentle, wise old eyes gave her a beatific air.  We made our way past row upon row of beds holding two children and their mothers and occasionally granny or aunty too.  Many were told off for eating their curries on their children’s beds and staining them.  Most children were very sick.  Pneumonia, meningitis, convulsions, osteomyelitis, renal failure, congenital heart defects, more pneumonia.  Livers, spleens, heart murmers far bigger/louder than any of those in patients I’ve examined back home.   With limited resources the doctors make clever use of what they have including adapting syringes into sterile containers by attaching a bent needle to the end and using the plunger as a lid.   The transition from sanitised well resourced NHS care to this will involve a steep learning curve.

At the weekend we visited the magnificent Rohtas Fort built by the Afghan King Sher Shah Suri to challenge the Mughal Emperor Humayun in 1541. Sadly, it is falling to ruin with large sections of the magnificent 4km wall lying as rubble.   With few tourists about and natures green fingers slowly taking possession there was a magical air about the forlorn fort.

Pakistan Day

Wednesday the 23rd of March saw people here celebrate Pakistan day which is a national holiday that commemorates the Lahore Resolution which later cemented the formation of Pakistan. It saw the winning of Pakistan vs West Indies at cricket and the birth of my cousins baby girl. People were out on the streets celebrating. Men in Shalwar kameez dancing on the top of cars. It was also a reminder to Pakistanis of the problems they face and the meaning of Pakistan and its birth to them.

Back in the UK, a demonstration was held in Glasgow organised by the group Youth for Justice in Pakistan: “We believe (the release of Raymond Davis) brings disdain upon the common Pakistani civilian in that we know for certain that our governments will do nothing to bring justice to the lives of innocent civilians who are killed mercilessly.”

Speaking to a friend here, the continued US drone attacks at the border with Afghanistan are also creating friction. There is much narrative surrounding the issue of Raymond Davis. According to many, he shot two Pakistani civilians in supposed self defense and was also found to be carrying many weapons in his car. Initially the US government claimed that he was a diplomat and demanded immunity. It was later discovered that he was a CIA Agent and numerous like him roam the streets of Pakistan with weapons. Senator Kerry even visited Pakistan demanding his release but the government was under immense pressure from the Pakistani population who threatened that if the government released him they could expect a massive uprising like that in the Middle East. Two days ago, Davis was acquitted. He’s flown back to America now. Blood money was offered in the name of Shariah Law at an amount of 200 mn rupees (1.1 million pounds). A victim’s wife committed suicide after demanding “blood for blood”. On the day Davis left a drone attack killed 40 civilians in Pakistan.

Despite the politics which are impossible to avoid here, people know how to enjoy themselves. My family invited some local musicians to their home and we enjoyed an evening of singing Urdu, Punjabi, Pashto and Bollywood songs without a mention of Zardari who will require a blog post of his own.

Here I am, back in the land of mangos and cricket.

The weather is still cool enough to use blankets at night.  During the

These things drive me crazy in the morning!

day the birds sing to the hum of city traffic with incessant chirps that start soon after the morning call to prayer that reverberates from mosques on every street corner through each and every home.  I no longer need my alarm to wake me for Fajr.

We have been introduced by my now grown up cousins to the hip and cool scenes across the city of Islamabad.  The sense of hightened security is undeniable.  We regularly pass through concrete block protected check points.  Character profiling such as men with beards or cars full of men are stopped and questioned.  The Marriott, where many parties occur, has been bombed 4 times leading to several deaths and now requires you to pass through 4 checkpoints before entering.  Despite this people keep going back.

I can now say have watched and enjoyed an entire cricket match, and to a certain extent, understood it. 

Pakistan beating Australia in the quarter finals, putting them top of their group, was a huge boost for the Pakistani’s.  I was saddened to hear my cousin’s comment earlier today, on

The fashion currently is long baggy kaftan like tops with baggy trousers. Superb ventiation.

watching the foreign support for Australia over Pakistan visible on screen during play, that “everyone else in the world supports every team other than Pakistan”.  The youth here are clearly disheartened and ashamed of their global reputation not helped by their corrupt politicians and celebrities including musicians such as Rahat Fateh Ali Khan who has been jailed for Tax evasion and the infamous Pakistani cricketers banned for match fixing.  The elation of the supporters at the cafe where we watched the match on a large projector screen outdoors amongst shisha’s and coke’s was heartening.

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