Dec 10, 2009

A prescription for accountability

By Kamila Hyat

From billboards across Lahore, the face of a small girl looks down at all of us. The caption blames doctors at the five-star Doctor’s Hospital for her tragic death.

The brave actions taken by the parents of three-year-old Imanae Malik have meant her story is now widely known and has been splashed across the media; an inquiry commission has been set up and following its findings of negligence doctors arrested. Members of the top management at Doctor’s Hospital have reportedly fled the country. The child died after being taken to hospital to treat a minor scald on her hand. As the hospital has said in an unforgivably glib posting on its website, accidents happen everywhere. They are absolutely right. What is unforgivable is the incompetence that led to a powerful anaesthetic injection being administered to the child – who experts say was unlikely to have needed anything more than some cold water over her hand, a topical painkiller and some reassurance – and the callousness displayed by the administration following the incident. This was no accident. Indeed the lack of remorse has continued with attempts apparently made to cover up the actual happenings through a hasty internal inquiry, efforts to influence the outcome of the investigation ordered by the Punjab chief minister and the beating up of a team of TV reporters covering the sealing of the hospital pharmacy on government orders.

The swift action we have seen in the case is unusual. As a society we are accustomed to an almost complete lack of accountability in every sphere. Politicians snatch millions of rupees from the exchequer and walk away scot-free; laws are enacted to protect them; allegations of massive military corruption have never been investigated; schools think nothing of charging exorbitant fees for minimal services; medical malpractice is said to be rampant with the WHO stating 80 per cent of health care in Pakistan is unregulated. We of course hear of only a tiny percentage of the tragedies that take place. Each year dozens of cases, many from government hospitals, are briefly reported in the media. Others of course never make any kind of news. Most victims are too poor and too powerless to even bring their plight to our notice. Even those who are not attribute the death to fate or the act of a merciless God.

The proactive efforts of Imanae’s traumatised parents suggest how much could be achieved if more acted in the same way. It is true of course that child will never return, but perhaps others can be saved. The case followed one that is no less sad. Huma Akram’s death in October this year has been blamed by a medical inquiry team constituted by the federal government on the failure of doctors at two top hospitals to make a correct diagnosis and also on the inadequacies of their laboratory services. Others suggest there may have been some lack of ethics involved – with profit taking precedence over good practice.

All of us know of other cases. What binds them together is not negligence or incompetence, although that may have played some part in some cases, but the absence of accountability. There is every reason to believe that it is the threat of this which leads to more responsible behaviour from practitioners in the developed world. A greater sense of ethics may play some part. The failure of the Pakistan Medical and Dental Council, the statutory authority for the regulation of medical education and practice in the country, is of course a factor in this. It remains a body which lacks teeth in the form of sufficiently tough laws – and perhaps the will – to make any real difference. Indeed, most involved in medical education report that standards have slipped steadily. At one prestigious college in Lahore students were reported some years ago to be ‘hiring’ members of the lower staff to perform autopsies – and thus avoid the messy business themselves. Curriculums in many places are outdated, and students say attempts to point this out to the administration bring no results. Efforts have continued for years to put in place legislation to regulate private hospitals and private medical colleges — some of which run out of nothing more than several cramped rooms – but these have been blocked by the influential people who run many of the hugely lucrative medical businesses.

We obviously need an initiative at both the legislative and regulatory levels. Reports state that even medical practitioners who are appalled by the happenings in hospitals are reluctant to take on administrations for fear that their own careers will suffer. Those who have tried to revamp government hospitals have rarely survived. Politics plays a role. Even now there are whispers that the affiliations of senior management at Doctor’s Hospital may have motivated the action against it and the recommendation that it be closed down till flaws in its running can be amended. We must hope that the decisions taken stem from a genuine desire to improve the system and prevent other tragedies, rather than political victimisation. If this is indeed the case, the initiative should be expanded and the set-up at other leading private centres also examined. Many do not deliver what they promise and some lack basic equipment. International practices under which patients are informed of their rights, including that to make a complaint, are rarely in place. Doctors at some clinics prescribe medicines stocked only by their own pharmacies. In other places there are doubts over the quality of medicines stocked and supplied. More details could emerge once the LHC begins its hearing into the case in a few days time.

The problem is of course one that is immense. Aside from the problems at private hospitals, we have all kinds of centres in all major cities – and presumably smaller towns as well – offering ‘miracle’ cures of all kinds. Huge sums of money are extorted from the desperate. Fabricated ‘research’ papers are used to promote such ‘clinics’, some staffed by persons with no medical background at all, equipped with falsified degrees and certificates. At others those who possess genuine degrees but no morality cheat people, in some cases putting lives at risk. The Internet has helped perpetuate such fraud. Despite laws that restrict them, advertisements of all kinds aim to sell a variety of dubious products to consumers, offering instant solutions to obesity, raised blood pressure, diabetes and much more. Some cause more harm than good. ‘Sugar’ pills have been offered as a ‘cure’ to diabetics.

The issue ties in to a lack of concern for human life. But the increased readiness on the part of affected citizens to take a stand could change this and bring in the greater accountability in medical practice that we so urgently need.

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