Neglected, still

Paramedics are exposed to dangerous diseases while working in hazardous conditions

By Tahir Ali

Paramedics play an important role in therapeutic, preventive, and rehabilitative fields in medical care in the country but they have been neglected by successive governments. They are still waiting for a uniform service structure that has been given to doctors and nurses but denied to them.

Sharafatullah Yousafzai, Senior Vice President of All Pakistan Paramedical Staff Federation (APPSF) says, "While there is Pakistan Medical and Dental Council for doctors, Pakistan Nursing Council for Nurses, and Pakistan Tib Council for hakims, etc, there should be one for paramedics. The draft for paramedics' council was proposed and discussed initially in 1988 but it has not been presented to the parliament as yet."

Yousafzai points out that "after a long delay, the government now wants to establish allied health professional council, and not paramedics' council, so that doctors and nursing staff could be accommodated on administrative/decision-making posts, which is a great injustice to us."

For lack of uniformed pay structure, paramedics work in different pay scales in different parts of the country. "For example, sanitary inspectors are working in BPS-6, BPS-12, and BPS-16 in different hospitals having the same qualification. "Paramedics are being unjustly treated. For example, in the 1960s paramedics and nurses were recruited in BS-5. Nurses are working in BS-16 and can go up to BPS-20. But paramedics still work in BPS-9 with the same or even higher qualification. While a separate directorate, council and board have been established for nurses, we have been denied all these. We are not against their benefits but wish that we are also treated at par with them," adds Yousafzai.

"Paramedics appointed as dispensers, radiographers, operation theatre technicians, lab-technicians, dental technicians and paramedical tutors used to retire in the same pay scale till the recent past. Their service structures have been approved in the four provinces except in federal institutions, but these have not been implemented fully. The Khyber Pakhtunkhwa government has implemented the service structure but only partially. We demand that the structure is implemented in its entirety so as to provide opportunities of promotion to paramedics upto the scale of 20," he says.

"The female medical technicians and LHVs and male dispensers/technicians are practically running the government dispensaries in dangerous and far away rural settings," says Yousafzai. "There are at present around 110,000 class three paramedics in the country. The strength is insufficient and it should be tripled."

Shahid Jan Khatak, General Secretary APPSF, says the absence of council has led to a mushroom growth of substandard private paramedical institutes, irregularity in duration of courses, and absence of standardisation in curricula and examinations. "Today, when a democratic government is there, it is hoped that the council would be established by the government sooner rather than later," hopes Khatak.

Paramedics at the federal level, however, still wait for the approval of their service structure. "The national commission for service structure of health professionals at the federal level was constituted in 2005. While its recommendations were implemented in case of doctors and nurses, those about paramedics still await implementation," complains Khatak.

Sirajuddin Burki, Central President APPSF, says the importance of paramedical staff has tremendously increased and it is essential for them now to acquire modern education, "The paramedical staff should be provided opportunities of higher education, leading to PhD, in and outside the country so that they could improve on their performance," says Burki.

"Khyber Pakhtunkhwa is leading in that it has four colleges for all categories, though their standard is also on the decline for some time now. In other provinces, however, there is no such structure. The training colleges, both in public and private sector in federal area and provinces, have no uniform syllabus and have different duration of training, while those in the private sector are mostly without hospital attachment, proper teaching staff, and registration," Burki adds. According to him, paramedics have been neglected in the projects and training meant for capacity building of health professionals while doctors and nurses benefited.

"A few years ago, around $300m were provided by the Japanese government for providing training to health professionals. At that time too, paramedics were simply ignored. The money lapsed without having been utilised," says Burki.

Paramedics are exposed to Hepatitis B and C, cancer, tuberculosis, jaundice and other dangerous viral and infectious diseases while working in hazardous conditions in X-ray laboratories, operation theatre, emergency and wards, etc. "Doctors sign the reports prepared by the paramedics. But paramedics have been denied allowances though these are available to the nursing staff," he adds. Akbar Ali Khoso, General Secretary APPSF Sindh, and Abdus Samad Raisani, President APPSF Balochistan, say they would continue their peaceful struggle for paramedics' council, risk allowance, and higher education for paramedics.

The spokesman of the health ministry, Qazi Abdus Saboor, says a lot of work has been done on the issue of paramedics' council and the service structure for federal government's health institutions. "A summary has been prepared for it and it may be approved any time soon. All the important demands of the paramedics have been incorporated in it," he claims.

On the issue of demanding higher education for paramedics, he says there are many such institutes working in the country that are providing education to them. But he adds that "the number is insufficient and there should be at least one paramedical institute and nursing school in each district of the country." Saboor says risk allowance is only given to those working in emergencies and was not meant for all. "With the introduction of danger-free machines and standardised operating procedures, health hazards to health technicians have decreased considerably."