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October, 2017 >>

The minimal role of the medical professionals in preventive medicine in Pakistan

Zubeida Mustafa  ( Senior Journalist, Karachi, Pakistan. )


A recent report issued by the British Heart Foundation said, "More than 20 million people in the UK are physically inactive. Inactivity increases the risk of heart disease and costs the NHS around £1.2bn each year."1

Seventeen years ago in 2005, the British Medical Association and the Irish Medical Organisation had warned in a public statement that a million British children accounted for a third of the cases of obesity seen in children in the European Union countries. The BMA called for strong action by member governments and the EU health commissioner to stem the rising epidemic of obesity in under-16s.2

This was followed by a report in July 2015 in which the BMA  called on the government to impose a tax of 20 per cent on sugar sweetened drinks to pay for subsidies on fruits and vegetables in an effort to slow down  the "obesity epidemic".3

The BMA also demanded a clamp down on the marketing of unhealthy food and drinks to children and even a ban on clusters of fast food outlets.

This persistent campaign by the BMA has produced results. It has created enough public pressure and the British parliament is now set to adopt the Sugar in Food and Drinks (Targets, Labelling and Advertising) Bill 2016-17.4

Can we ever expect the medical profession to take  a stand on similar issues  in Pakistan and then sustain the pressure to produce results?

The fact is that the health professionals in this country focus too heavily on curative medicine. They are inclined to treat the person who falls ill with the aim of curing him rather than pre-empt his illness by preventive means. Doctors are trained to perceive their responsibility to ease an ill person's pain and provide him relief while regarding it the civic authorities' responsibility to work for preventive medicine.

Physicians and surgeons have launched campaigns on some issues that have serious implications for public health. For instance it was the collective efforts of the SIUT and the Transplantation Society that the Transplantation of Human Organs and Tissues Ordinance5 was promulgated and the illegal organ trade was brought into the limelight. While this proved beyond doubt that our professionals have the capacity and skill to launch public campaigns, this was not what one would call a preventive health issue. It was a public evil, a heinous crime that also had to be curbed.

It is not that Pakistan never had a programme of preventive health. True it was the municipality that undertook this function but the health professionals were also concerned about its success.

What would qualify as measures of preventive health? In a nutshell it would be anything that prevented the outbreak of a disease and ensured that people generally remained healthy.

Preventive health would include immunisation programmes, sanitation, anti-TB measures, eradication of malaria by destroying the breeding grounds of mosquitos, nutrition projects, screening and monitoring drives and the supply of potable water.

True the main work will have to be undertaken by civic authorities but the medical professionals' bodies could always pitch in to put pressure on the government to undertake the above listed measures that prevent disease and ensure the well-being of people. That is the role the BMA has played.

Health professionals have yet another function to perform. They have to act as the advocates of the health rights of the people. If doctors were to demand vocally clean drinking water for the people it would have a powerful impact. Besides they are in a better position to make a convincing case supported by facts and figures.

The PMA at times makes demands of this nature. A few months ago it had invited a sanitation expert for a talk and called on the authorities to lift the garbage from Karachi's streets. But this was a call from the blue and not a campaign. 

Unfortunately we do not have a strong tradition of health education. With such a weak education sector, it has not been possible to create health awareness in the public through schools and textbooks. Even in a limited way most physicians and surgeons have failed to teach individually their patients the basic principles of remaining healthy. With most doctors giving only a few minutes to their patients, they tend to skip out the preventive side. With the doctors' waiting rooms chock-a-block it is a pity that the professionals do not avail of this opportunity to pass on the message of the good practices of preventive health. Many doctors have televisions fitted in their waiting halls to keep patients entertained.

One can understand that given the heavy load of work, it is not physically possible for the doctor to play the teacher's role as well.  But it is not clear why doctors cannot with a bit of effort get social workers and health workers trained to talk to the patients in waiting rooms and tell them about basic health principles. There are measures individuals can adopt and reduce illness in the family such as boil drinking water, use mosquito nets and so on. This effort on the part of health professionals would certainly help in reducing the burden of disease. This apathy on their part is unforgivable.

The government's indifference to preventive medicine is underlined by the health plans. I looked up the section on Dengue Fever in the Pakistan Economic Survey of 2011-2012.6 Titled Dengue Epidemic and Control Programme, it lists 13 measures ranging from sending delegations abroad, research, setting up task forces and cells to online surveillance of cases. There are only two points which can be considered as truly preventive measures. One is called environmental measure which includes proper disposal of waste water, desilting operations, timely repair of leaks in plumbing and cleanliness drive in eateries. The second point speaks of vector control without elucidating it. We do not know how much was actually spent on each item. We do know that Dengue Fever is now a common disease -- perhaps as common as malaria.

This is certain that preventive medicine incurs less expenditure than curative medicine which is very expensive. And its impact is greater.

References

1. More than 20 million Britons 'physically inactive'. BBC Health News. Cited on 9 April 2017. Available from URL: http://www.bbc.com/news/health-39457993.

2. Lorraine Heller. More than 20 million Britons 'physically inactive. Newsletter Food Navigator. Cited on 9 April 2017. Available from URL: http://www.foodnavigator.com/Policy/Doctors-call-for-EU-wide-approach-to-obesity.

3. James Gallagher. Tax sugary drinks by 20%, say doctors". BBC News, 13th July, 2015. Cited on 9 April 2017. Available from URL:   http://www.bbc.com/news/health-33479118.

4. BMA. Doctors leaders welcome sugar tax. BMA news, March 2017. Cited on 9 April 2017. Available from URL: www.services.parliament.uk/bills/2016-17/sugarinfoodanddrinkstargetslabellingandadvertising.html/.

5. The transplant of human Organs and Tissues, Pakistan, March 2010. Cited on 9th April, 2017. Available from URL: https://academic.oup.com/ckj/article/1/2/128/565238/Organ-transplantation-law-in-Pakistan-to-curb.

6. Health and nutrition- Ministry of Finance, Chapter 12,  Pakistan Economic Survey 2011-2012. Cited on 9 April 2017. Available from URL: https://www.google.com/search?q=Pakistan+ economic+surver+1995-1996+health+chapter&ie=utf-8&oe=utf-8.


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