Pakistan has been in news alot, unfortunately due to Osama Bin Laden and some of her own follies.  The nation has lagged far behind in development driven by false idealogies as well as socio-political system. The nation has fought several wars and is now fighting the biggest of all with the internal enemies.

Aid provided to Pakistan has been mismanaged, used for more weapons than for development of vibrant economy.

In spite of all these, nation is working to catch up to development.  With so much debate going on in the USA on healthcare, It is worth while to understand what is going on around the world.  Here is an excerpt from an Article from Middle Journl for Family Medicine by Dr. Manzoor Butt about the categories of healthcare providers in Pakistan.

The Doctors

Medical Doctors. 

These are selected through rigorous processes.  After high school, a candidate with good result should take entrance exam.  Subsequently they are in a 5 year program .  After the 5 year program they have to pass 4 professional examinations conducted by various organizations.

The residency period is for one year before the doctors are free to practice independently or take up an employment.  Family Physicians play the largest part in the delivery of primary care. They are the first contact of people who not only seek their help for primary care but also in acute emergencies and accidents. There is no organized Family Medicine in Pakistan.

They do not provide evidence based care to people. Many Family Physicians are involved in taking kick backs from pharmaceutical companies, pathological laboratories and private hospitals. They do not write proper prescriptions and use multiple medicines and injectables in a very irrational way. There is no definite system of referral and follow up; patients are usually referred when they become critically ill.

The Alternate Medical Services

In addition to going to Registered Family Physicians, people do go to Registered Hakims (traditional healers), Registered Homeopaths and quacks in vast numbers. There is a situation of rivalry between various types of primary care providers. The Hakims (traditional healers) and Registered Homeopaths are free to make/manufacture any medicine because drug policy does not cover them.  They are legal and even elected leaders go to them.  People have a strong belief that these two types of treatment are quite harmless and more effective than our scientific medicines.

To become Hakim, there is no need of any basic general education but the famous Hakims are usually Graduates or Master degree holders in non-medical education.  To become a Homeopathic doctor, the candidate must full fill the following criteria;

• At least ten years of study in school
• Four years course called “DHMS” from any out of hundreds of private colleges scattered throughout the country.

   These people use ultra-sound machines themselves and avail pathology labs and all available diagnostics including CT-scan and MRI. They buy time on famous private TV channels and popular FM radios to project themselves and their work. Every such doctor claims himself to be a new inventor and researcher.

Traditional Quacks

They are endemic in the society. There have been many half-hearted efforts to eliminate them but they are on the rise.

Religious Quacks

Traditional Quacks have been a major threat to the health system for quite long but now a new category of quacks is emerging that consists of so called religious persons who not only give blessings but also dispense their own made medicines. They are very famous for treatment of Hepatitis A, B, & C.

The Paramedics

A) Female Paramedics :

The following categories which are included under this term “Nurse” in Pakistan ;

1) Classified Nurse: The female must have passed high school examination in science to get admission into this course. She takes a four years’ course in Nursing during which she has to reside in hospital. She does not pay anything for it rather she is given an attractive monthly help throughout the course. Despite all these facilities, only girls from poor background enter these courses. Such nurses are only present in big city governmental hospitals and very expensive private hospitals. Due to proper education and training, they work ethically and are aware of the importance of working within their own limits.

2) Lady Health Visitor (LHV): The female must have passed high school examination in science to get admission into this course. She takes a short course of about two years and she is basically trained in womens’ health and midwifery. They are meant for villages and towns but are rarely found there. They usually practice in cities as lady doctors. Most of them exceed their limits and are involved in criminal abortion.

3) Locally Trained Nurses: This is the most available variety. Some of them are high school pass but most of them are usually middle passed or less. They are neither adequately educated nor properly trained. They are absolutely not aware of their limits. They work in clinics and most of the private hospitals. Seniors among this category work as lady doctors and are involved in criminal abortion.

4) Lady Health Worker (LHW): This type was produced by the government to induce health education and create awareness about womens’ health. Females should be only middle pass and a local resident. Unfortunately, they also forget their limits and start acting as lady doctors.

5) Midwives or Traditional Birth Attendants (TBA): In Pakistan, TBAs are absolutely uneducated and non-trained. They not only are unaware of their limits but also do not understand the importance of the referral network. They are a major cause of maternal mortality and morbidity. They cause damage to mothers and newborns due to lack of knowledge and skills. They do not understand the importance of sterilization and use dirty hands on women and on newborns. They cut umbilical cords with non-sterilized knives and tie it with dirty pieces of cloth or thread. They insert harmful weeds and their own made medicines in the vagina and freely inject Oxytocin I/M as a tonic or power injection before delivery.

 B) Male Paramedics

25 % of this group are qualified but 75% are just locally trained in clinics and pathology labs. Pakistan does not have life saving paramedics except in the army.

C) Highly Trained Mobile Paramedics

This is a very recent addition to the system. At the moment, these are only found in Lahore. These are fully qualified .