A letter from Young Doctor

The right to strike and a background of Young Doctors Association in Pakistan

 

Sad to read!

Dr Yusra Hanif, wrote this heart-wrenching letter that would become the heart of the movement last year. The most individual act of politics starts in the workplace, the doctors are being blamed for system that is inherently rotten. This was also published in viewpoint and looks to give a fresh and alternative perspective on the issue. -Comrade Sher Ali Khan

My dearest Ama and Aba,

 Please forgive me.

I chose to be a doctor.

 I did not mean it to end this way, really. This reality is so deviant from the fantasy that I just stand here, shocked and dumbfounded.

Do you remember Ama, when you would tell me stories in the night and as I’d gently transcend into sleep, you’d kiss my forehead and pray to God for me to become a doctor. You would laugh when I’d play “doctor doctor” with my little sister and pretend to magically heal all her mock ailments. Your eyes would gleam, tenderly.

Do you remember, Aba, when I’d come back from school with my result card, you’d proudly show it to anyone who’d come visit us? You had dreams for me. I did everything I could to fulfill them.

Remember when I passed my intermediate with an above 80 percent aggregate and got into the medical college? How you both almost danced with joy. How you distributed laddo and how Aba told all his friends that even though he was a factory worker yet his son will become the best doctor in the town. Aba you thought you would retire quietly once I had started my job.

For a middle class family, it promised so much. Aba gave all of what he had been saving from his meager income for my tuition fee so merrily, it made me cry. I resolved to live up to his hopes.

 I was your trophy. Your dreams became mine. And egged on by the hopes of being noteworthy, famous, selfless and I admit, financially stable someday, I worked harder and harder.

Little did I knew, the destination is long and the road arduous.

I gave up friends and every social activity just so I could study for my professional exam. I stopped playing outdoors just so I could manage to cram the colossal burden of my syllabus. I did not even realize when I turned from 18 to 24. I hardly did anything youth in my age would otherwise often do.All I thought was that one day I’d make you both proud.

 I remember the day I graduated; you called up all our relatives. Swollen with pride, you would tell them that your son was now a doctor. Teary eyed. Gleeful.

And me? I couldn’t wait to start experiencing what it really is to be a doctor. To begin my clinical experience. As a government hospital House Officer. There were so many like me that day, House Officers and Post Graduate Trainees, eager to finally start the new life. The practical side.

And then, the “practical-side” materialized:

 We, the junior doctors, worked days and nights, at a stretch for 24 to 36 hours and we got no recognition. We worked without electricity, without fans and without furniture. We worked in conditions so inhuman, it is impossible to describe. With the filth lying around and the cats roaming around in the wards, without even a proper sewage system let alone a proper equipment.

 We daily risked our lives when we treated patients with TB coughing on our faces, cleaned fungus-filled abscesses. We pushed gurneys with patients to other departments for radiology or to get expert opinion. We chipped in to buy medications for our patients.

 We were the first to come and the last ones to leave. We settled family disputes. We cleaned their bed sores, gave them medications, changed their cannulas and drips , recorded their vitals and charted their urine outputs€¦(although these duties are primarily what a nurse is supposed to do in developed countries)€¦We ran codes and defibrillated… we declared deaths. We saved lives. We had to break bad news to the family members all by ourselves because this is Pakistan and we can’t afford to have social services and grief counselors. We volunteered when the floods hit. We rushed to the hospitals at nights whenever emergency was declared owing to a bomb-blast. Amidst smell of freshly burnt flesh and relatives screaming, we tried to focus on getting the job done. On saving lives!

You know Ama, these people who mock us, sitting in their air-conditioned rooms having decent office hours and proper lunch and tea timings haven’t come and seen us once. The media hadn’t come and seen us once in all these years, Aba.

The news was just not spicy enough, you see. Telling people about us young doctors country-wide who fight the battle on the front-lines everyday doesn’t bring you enough TRP. What brings TRP is masala news.

Remember when you saw the news of a patient’s death and a local news channel claiming that it was due to our negligence? At first the news strip read “mubayyana ghaflat” (alleged neglect) and then within seconds “mubayyana” (alleged) was excluded with the reporter shouting at the top of his lungs calling us killers and death devils. He was so sure that he did not bother to ascertain if a neutral qualified panel of physicians had made an inquiry and figured out if it indeed was negligence. It did not, even for a second, go through his head that perhaps the patient was so debilitated, so terminal on arrival that all attempts to save him were futile?

He captured all the scenes of the relatives crying in the corridors and protesting but he did not bother asking from the house officer the other side of the picture. That patient had metastatic terminal colon cancer Ama. It was so advanced that even in the first world countries; the survival rate is very low. You know Ama we could have placed him on a ventilator but I work in the biggest government€“run hospital of the city and we have only 5 ventilators, 2 of which are out of order. We have written several times to the provincial government for fund allocation and we were finally told that the budget is tight. It is not possible. Do you know, Aba, that a single ventilator costs less than 1/10th of the price of a bullet proof car? Sadly, we now have to be very cautious in deciding who is worth being put on a ventilator and whose life is no longer productive enough. Am I to be blamed? But the reporter did not care. All he wanted was audience. Nothing else.

Where was he when a cardiac patient crashed because the entire floor had just one defibrillator and it cannot be used simultaneously on two patients? I can understand the government not understanding this because our leaders rush to the elite London hospitals on feeling the mildest of chest discomfort [which has a more political than medical differential diagnosis]. But I expected the media to at least understand and help us voice our concerns.

I am not saying that we are angels who can never be wrong. In fact, we are so over-worked, under-slept and burnt-out that we are bound to err. But not always. And never intentionally. Maybe someday my country will understand this.

 And remember the day when I came home all bandaged up? It was because I preferred admitting a sicker patient over someone who was influential but had non-urgent ailment. And his family members and friends beat me and my senior with sticks and canes and threatened to kill me. They swore at my female colleagues. You know, Ama, there was no security. Not even a single bodyguard. No one came to our rescue that day. We were all alone. But who am I to complain? Right? There are incidents of even consultants and professors being beaten up, physically and verbally abused and shot dead.

I know it hurts you, Ama when you hear that all my old friends who chose to be bankers, accountants, engineers and even taxi drivers are now earning better than me. You may not say that to me but I can feel it. Oh, you should be glad Ama that at least I am being paid. Many of my co-workers are working without any stipend at all. You see, Ama and Aba, our government is very poor. So poor that it can only afford to pay a fraction of house officers and postgraduate trainees. The rest go unpaid. Yes we do get an experience certificate at the end but really a certificate cannot feed someone. I couldn’t buy you a jora or Aba his hypertension medications with it. Could I?

 

Although I was one of the lucky ones who did get stipend but I thanked my stars that Aba is not yet retired or crippled or dead. For if he was, how could have I paid the house rent? How would I pay for the grocery, our electricity and gas bills and still manage to save some for my sister’s marriage? I joined in grade-17 Ama and unlike other professions, even after 25 years of service, will stay in the same grade without any periodic promotion. People tell me that the money will eventually come but when Ama? When you both will have died without me being able to support you? When I’ll be in my mid-forties? And even then, like many others, I’d be doing long hours of private practice on weekdays and weekends to afford a comfortable life. My oh-so-great leaders have enough money to promise to award cricketers with acres of irrigated lands on winning a single match but not enough to announce a decent pay package for us. They could spend double the amount of money on buying laptops for the students but not on formulating a sensible service structure for the young doctors.

So here I am, like many other young doctors, with no security or help or guidance or financial stability or hygienic meals or paid leaves or a job guarantee.

 

Should I at least have the right to protest? I am not responsible for the dismal condition of our health system. The government is. So why are these people pointing at me?

 

All I did was to withdraw my services from outdoor wards. I promised myself that enough is enough. That I will not surrender until I am given my due credit and a proper service structure and until the health conditions improve. The government did not listen. Deaths were nothing but figures to them. Despite knowing that out patient wards do not cater for emergency cases, media kept shouting, `the death toll is rising’, misleading the general public. We were painted as ruthless murderers. We were arrested, beaten, crushed.

 

And then we were pushed so much on the edge that we withdrew from the emergency services. The point is that, Ama, we did not stop the services. They were continued by our seniors. We just withdrew OUR services. The figures they quote regarding people dying due to our protests are also misleading. They comfortably include all deaths, regardless of the cause, nature and severity of the disease. And no Aba, I am not justifying the decision. In fact we soon realized that the innocent people were suffering so we resumed our services for blast victims and in cardiac centers. All I am asking for is justice. This is just not about raising my pay. This is about giving me respect. This is about providing me with security. This is about raising the standards of our health-care system to at-least a universally accepted threshold. Is any of my demand unreasonable? Many will criticise my way of demanding but they do not know that we were silently protesting for two years. Nothing happened. It is sad that in this country, silent, harmless protests go unnoticed.

 

I may have made many mistakes in my ways of protesting but please do realize that I am just 26 years old. I am a son of this land. I decided to stay back and serve. Was that my crime?

 

I am sorry, Ama and Aba; I couldn’t fulfil a single dream of yours.

 

I know your hearts ache when you see me, day after day, protesting. Out on roads asking for my due rights like a beggar. But they just won’t listen.

 

My heart aches too. For my community. For this country.

Please forgive me for not being a better son.

Please forgive me for choosing to be a doctor.

Much love,

Hanif

Dr Yusra Hanif

A young Pakistani doctor