Healthy New Year

Some of the major healthcare issues that 2019 passes on to 2020

The end of another year approaches. As newspaper columnists we tend to do three things as we write a year-end article. First, of course, we thank Providence for letting us be around for another year. Second, we try and put in one place the happenings that we found most interesting or alarming over the last year or so. Finally, we try to make some predictions or give advice about what to do as another year comes upon us.

To get an idea about what issues I decided to write about this year, I went back and looked at the topics I had addressed. It is a rather eclectic list but a few issues stood out. First was all the conniption surrounding the medical problems confronted by our incarcerated former three-time prime minister.

The second issue that interested me was that of universal healthcare and the attempts by the present government to provide some sort of health insurance for the poorest people in Pakistan. The insurance cards being given out are obviously for the poorest segment of society.

The third issue that was of great significance as well as alarm was the identification of a large number of patients including small children with HIV-AIDS in parts of Sindh. Even though reports suggest a local outbreak, that is clearly wishful thinking.

First then to the health problems of Mian Nawaz Sharif. Information about them came out in dribs and drabs. Most of the information was made available when attempts were made to get him out of jail on health grounds.

We knew that he had undergone open heart surgery and a previous heart operation. About his heart problems we found out that he had multiple heart stents put in (seven?) before he had a quadruple coronary bypass. The bypass operation occurred while he was serving as prime minister and he took a month off for it.

More recently Mian Sahib got out of jail to get his heart problems taken care of and then back he went to jail when he felt better. While out of jail no medical intervention occurred that could not have been done while he was incarcerated and had access to all the hospitals in Pakistan. Yet he did get well enough to go back.

During this time we also found out that Mian Sahib’s kidneys were faltering a bit with even claims made by a family member that he was approaching kidney failure. Fortunately, the failure part turned out to be a false alarm.

Fortunately, both AIDS as well as Hep C can now be treated if diagnosed early. Unfortunately, there already are millions of people with Hep C and many of them have reached a point where medicines are not going to help. I hope we do not reach that point with HIV-AIDS.

The next episode in this saga was the falling platelet count. Mian Sahib being a special person did not get the ‘plebeian’ disease that was making a lot of Pakistanis’ platelets fall, that being dengue fever. Evidently, Mian Sahib had developed an exotic ‘auto-immune’ disease called idiopathic thrombocytopenic purpura/immune thrombocytopenia (ITP) that was making his platelets fall to dangerous levels.

While being treated for his low platelets we also found out that Mian Sahib also had a touch of diabetes or what is also known as ‘sugar’. Suddenly, it now seemed that Mian Sahib had to go abroad because nobody in Pakistan knew how to treat ITP.

Of course there are many well-trained physicians in Pakistan that can treat ITP quite well. But there are no physicians in Pakistan that willingly will treat Mian Sahib for even a slight cold. There are two reasons for this reluctance. First is that Mian Sahib has always been treated abroad so no ‘local’ physician would like to get involved in his medical care when Mian Sahib clearly does not trust the local talent.

The second reason is probably more important. Mian Sahib is a rather unhealthy person. He has multiple heart artery blockages and possible recent heart attacks. He has diabetes and he has borderline kidney function. And now he has ITP. All these things put together make Mian Sahib a ‘high risk’ patient for almost any aggressive form of treatment.

Essentially no physician in Pakistan will willingly take on the treatment of such a sick patient that also happens to be a high profile individual. If anything goes wrong, besides the usual conspiracy theories, the physician will also have to face public charges of incompetence and a rather bad press.

Thirty three years ago Madam Noor Jahan arrived in the US in need of a coronary bypass operation. Her personal physician who was a friend of mine asked me if I would operate on her. I declined saying that even if there is only a small chance that she might not make it after the operation, if she does not, I will go down in Pakistani history as the surgeon that did Madam in.

For these reasons Mian Sahib had to go abroad for treatment of his ITP. It is my sincere hope that Mian Sahib recovers from his ITP and his general health improves enough that he can safely return to his jail cell.

The second issue I mentioned above is about that of universal healthcare. The health cards being issued by the government are only for the poorest segment of the population. I find that unfortunate. In my opinion an infrastructure exists at least in the Punjab that can with some improvement actually provide universal healthcare at a very low cost to the general population.

Between the very poor and the moderately well off there exists a large segment of population that cannot really afford the cost of heart treatment, cancer care or even routine major operations. Rather than subjecting these people to degrading investigations about their ability to pay for medical treatment it would be best to provide subsidised care for all those that seek it.

The point I will make here and I have made it many times before is that healthcare is a right and any government that can provide it for its citizens at a low or no cost should do so. Charity is degrading and does not replace what citizens should get as a right.

The third thing I mentioned above was the discovery of an HIV-AIDS outbreak in a small city in Sindh. Originally, all the blame for the outbreak was put on a single children’s doctor who was being ‘careless’ with sterilisation of his injection needles.

Considering the fact that the people found to be infected included adults as well as small children it is pretty obvious that the infection was from more than one source. We have not heard anything about how the infection spread and that means the usual — a cover up of sorts.

Almost five years earlier in these pages, I had warned of the coming HIV-AIDS epidemic (The coming Epidemic-June 1, 2014). Like Hepatitis C (Hep C), the initial infection is usually mild and can be easily missed. My fear is and has been that like Hep C AIDS will spread unchecked and become apparent only when people start getting sick.

Fortunately, both AIDS as well as Hep C can now be treated if diagnosed early. Unfortunately, there already are millions of people with Hep C and many of them have reached a point where medicines are not going to help. I hope we do not reach that point with HIV-AIDS.

Finally, there is the recent matter of men dressed in black coats and black neckties that attacked Punjab Institute of Cardiology. As is said, the matter is ‘sub-judice’ so it is best not to comment on it. However, I do wonder whether the attackers were hired hooligans masquerading as lawyers.

The writer has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University

Healthy New Year: Some major healthcare issues that 2019 passes on to 2020