Living and dying in Pakistan

Years ago, in the scorching heat of a June afternoon, I found myself tasked with the discomfiting social obligation of visiting a very ill cousin in Rawalpindi’s Central Hospital. Discomfiting, because that’s what hospital visits in Pakistan generally are: in the run of the mill public hospital – and a fair number of the private ones are no different – your experience is sure to comprise a smorgasbord of noise, disarray, fetid odours, visible grime, dysfunctional equipment, the red tape of incompetent and indifferent health care professionals, and – packaged in it all, albeit invisible to the human eye – hordes of bacteria and viruses, that are the product of criminally poor standards of hygiene, and that you will gratuitously inhale for the duration of your presence within a hospital’s confines.
I stifled my urge to flee what was sure to be an unpleasant experience, however, as the relative in question was a loner and perhaps nearing an unremarkable, painful and tragic end. Navigating through the labyrinthine bowels of the Central Hospital (now renamed the Benazir Bhutto Shaheed Hospital), I found my cousin on the last of a long row of beds in a ward that had no ventilation, no air-conditioning, and just enough light to make out the faces on the supine, diseased forms of the bedridden.
The duty nurse could not remember his diagnosis, the medical file only had a list of tests and the doctor was away on call with his mobile turned off. And there was no one to shoo away the cat that seemed to have made the ward its home, and who the bored attendants of the dozen odd patients had taken to occasionally engage in games with, to while away the time. All around was an atmosphere of wretchedness, despair, the presage of death. My cousin had suffered a stroke and muttered incoherently in delirium pointing now and then with a frail hand to what he desired – a biscuit, a sip of water. An apparently fatigued nurse with a desultory attitude informed us of the medication required, which we found was not in stock in the hospital’s pharmacy and so required a journey outside to a nearby chemist.
Expectedly we were charged double the price, as the chemist claimed that he too was a victim of a mass shortage. We requested fresh linen, for the bed sheets were stained with pus, blood the residue of medicinal ointments and were damp with the humidity of closed quarters. We received irritated and steely responses in return till visiting time ended, cutting short our travails in the hospital. I left with a sense of an overwhelming dread, borne out of a gnawing certainty that my cousin would not make it.
A week later it was an emergency call that brought us to the District Headquarters Hospital where my cousin had been transferred for neurosurgical care, and which the Benazir Bhutto Hospital had finally admitted it was incapable of providing. I found my cousin dumped on a stretcher in an alleyway outside a ward, semi-conscious, with an arm dangling off the stretcher and dripping blood from a dislodged cannula. We ranted and raved and after an hour long altercation managed to find him a bed cramped in yet another poorly lit and ill kept ward.
The electricity situation was terrible in those days and unscheduled loadshedding would continue for hours, sometimes lasting half the night. There were no back-up generators, except perhaps in the intensive care units, and if there were any generators they were out of order or out of gas; plunged into a pitch blackness, electrical diagnostic equipment switched off, the hospital would turn into a mausoleum whose eerie silence would intermittently be broken only with the moaning and wailing of the sick and the wounded.
Despite this, the nursing staff, to my surprise, remained steadfast in their duty, doing their rounds aided by the light from their cellular phones, or the occasional torch or candle that the families of patients would offer in assistance – Florence Nightingale in Scutari would have been proud and relieved to have received such assistance!
Again we encountered the medicine and supplies shortages, the absent doctors, the filth, the poor sanitation, the disrepair of furniture and equipment; and amidst it all hundreds of patients from all parts of the country – men, women and children, squatting, lying, standing or praying silently – their faces, masks of anguish and a crushing helplessness, borne in part out of the indigence of their backgrounds, and also the experience of purgatory that was the hospital system. I wondered then if this was indeed a way station to hell, that my cousin like innumerable others, had been sentenced to as punishment, in his case for leading a life characterised by iniquity, vice and indolence.
I recall this French art cinema film, where the protagonist, a salesman in his early fifties, divorced, burdened with debt and in the midst of an existential crisis owing in part to the callous indifference of an estranged daughter, is diagnosed with a possible terminal disease and admitted to a hospital. There is a striking moment when our hero, upon being informed of his medical crisis, expresses immense relief and with a smile accepts the verdict of hospitalisation. For him the hospital admission signals an end to the frightful, dreary, crushing burden of existence, as his life and its principal decisions are handed over to a team of doctors.
He imagines himself as being placed on a conveyor belt, with no cause but to be conveyed from one medical examination to another, stripped of compulsions and of any necessity of purpose. Medical solutions, diagnoses and cures are what hospitals are meant to accomplish, and which they do by and large achieve, in the advanced countries of the west. It is no surprise then that our protagonist is eventually cured and ironically thrown back into the very life he has chosen to abjure.
In Pakistan of course, it is precisely the structural abnegation of any concept of justice and the preservation of human life that appears to drive the management policy and administrative machinery of much of our state and privately run medical health facilities. With less than five percent of GDP being allocated to the health sector in the national budget, with the focus being primarily towards tertiary (specialised) medical care and with a third of the population living below the poverty line, it is no surprise that state run medical facilities suffer from a systemic incapacity to provide quality and wide reaching health care.
The spectrum of medical malpractice ranges from criminal neglect borne out of incompetence, insufficient funding for equipment and training and education to that inspired by the obligations of profit accumulation. In the case of my cousin, therefore, it was with no relief I’m sure that he took the news of being admitted to the hospital system of the city of Rawalpindi. On the first day I visited him I knew that he had realised that his curtain call was nigh. I knew that if his disease did not kill him the hospitals surely would. We buried him on another sweltering June afternoon quietly. Many said they saw the faintest smile of relief on his dead face.
The writer is a freelance columnist.
Email: kmushir@hotmail.com
Twitter: @kmushir