Quacks like a doc
Too many medics in Pakistan are fake
MOHAMMAD ZAHID sat sullenly in the office where minutes earlier he had been doling out advice, pills and injections to a long line of patients. His customers had melted away at the sudden arrival of Saeed Asghar and his police escort. Dr Asghar, deputy director of the Anti-Quackery Department of the Pakistani province of Punjab, spends his days hunting for people practising medicine without the proper qualifications. Mr Zahid briefly tried to claim he was a proper doctor, before admitting he was not when his paperwork was checked. In fact, he had been trained only to help a pharmacist dispense medicine. His set of rooms in the backstreets of Rawalpindi were full of medicines he was not qualified to prescribe and syringes he was not trained to use, said Dr Asghar. “I haven’t been doing this for long,”Mr Zahid said, by way of an excuse. Beneath his desk was a plastic tub stuffed with banknotes.
A HEALTH-CARE census earlier this decade found Punjab, Pakistan’s most populous province with 110m inhabitants, had between 70,000 and 80,000 totally unqualified practitioners. Many more, like Mr Zahid, had a medical qualification of some sort, but were doing work that far exceeded their training. Pharmacists, homeopaths and herbalists often pose asGPs.
THE FRAUDULENT doctors and dentists are not only charging handsomely for ineffective and often dangerous treatment. They are also threatening public health, according to Punjab’s health-care commission, which enforces health-care standards. Reuse of unsterilised syringes and other implements is spreading blood-borne diseases such as hepatitis C. This scourge is especially alarming because many backstreet clinics specialise in pick-me-up steroid injections for almost any ailment. Lax prescription of antibiotics is helping to breed bacterial resistance to them. Quacks do not keep records and are not able to spot, much less report, outbreaks of infectious diseases.YET WHEN Dr Asghar and his team catch charlatans and seal their premises, the crowds that gather to watch are not grateful for their deliverance. “Local people say: ‘He’s our only doctor, please bring us another one before sealing this,’”Dr Asghar says. Quacks thrive because public health care is so poor and private health care so poorly regulated. Government spending per person on health is barely three-fifths that of neighbouring India, in part because so much of the budget goes on defence, squeezing out other items. As a result, Pakistanis end up paying for two-thirds of their health care themselves. The poor naturally resort to the cheapest option, even if they know the care is substandard.
THE QUACKS are also canny. Within minutes of a raid, other sham clinics in the same neighbourhood will abruptly shut, having received tip-offs via WhatsApp. The fake doctors often operate with the connivance of real ones, who lend them authentic credentials in exchange for a share of the profits. Professional bodies rarely take action against members caught doing that sort of thing.
THE HEALTH-CARE commission acknowledges that unless decent treatment becomes more readily available, the quacks will continue to thrive, no matter how much energy is put into enforcement. As Dr Asghar bursts into a clinic lined with vials of veterinary steroids ready to be injected into human patients, it becomes clear his team has visited before. The Anti-Quackery division had sealed the shop next door, but an enterprising fraudster has simply rented the adjacent premises and knocked a hole through the wall…
(The London Economist, March 30th, 2019)