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Doctors on strike

A cat and mouse game is raging on between young doctors and the government of Punjab. There is a set pattern being followed by both sides, based on earlier skirmishes in the last two years. The primer is usually an untoward incident involving young doctors. The result is outrage on the part of the young doctors, while the government announces some form of committee to sort out the problem.

Nothing discernable happens for the next few weeks or months. Doctors come out on the streets and Out Patient Departments (OPD) are shut down. A few individuals are dismissed from service by the government and a few people are arrested. As a last resort, doctors announce withdrawal of emergency services, crippling the already overloaded public health system.

Within a few days, some makeshift solution is cobbled up and things go back to normal. This process has now been followed for the last two years. If things remain as they are, this routine can, in all probability, be repeated this time as well.

Young doctors have been branded assassins and mercenaries, devoid of all humanity, sacrificing all moral values to bargain for their demands. The services of hundreds of doctors have been terminated over the last two years, and dozens have been jailed.

A vicious propaganda campaign was designed last year to malign doctors, costing the public exchequer more than 400 million rupees. There is little understanding of the issue plaguing doctors in this country and they are seen with derision and contempt because they have the temerity to demand their rights.

The most prevalent misunderstanding about the doctors’ protests is the belief that they are demanding a pay raise. While this was true two years ago, the issue of salaries was resolved. Let me clarify that it is not mentioned anywhere in the Hippocratic, or any other medical, oath that doctors ‘have’ to provide medical care regardless of the conditions. The morality of the strikes and protests by young doctors are explained by fellow doctor, Awais Aftab as thus:

“A doctor enters into a contract with the society only by virtue of his contract with the government. Therefore, if the government refuses to honour its obligation of providing adequate facilities and working conditions for the doctors, then the doctors’ obligation to work for the government becomes questionable. This includes the issue of pay and service structure.

If the amount of work and the circumstances in which they are expected to perform deviate significantly from the pay and facilities they are receiving, the government is violating its obligations. This can be augmented by a utilitarian justification.

If the short-term harm brought about by the strike is balanced by a long-term benefit to the society in the form of an improvement in health-care, virtue of the fact that doctors can work more efficiently in better working conditions, then a strike is justified. But this utilitarian argument can only be an augmentation, not the crux, because we all know that human lives cannot be added and subtracted.”

The primary demand of doctors is provision of a better service structure. The current structure is completely dependent on the whims of the baabus at the Civil Secretariat who consider doctors as inferior people. There is no uniform system of promotion of doctors.

I have documented cases of different doctors who graduated in the same year, from the same college, with similar qualifications, where one of the two was promoted as a professor while the other is still a grade 18 doctor. Hundreds of ‘relics of the past’ are occupying (senior) positions in major cities while young doctors are transferred to far-flung areas.

Professors of respective wards are kept busy in administrative affairs, which affects their teaching schedules. The induction of doctors on ‘medical officer’ posts is done via the Federal Public Service Commission (FPSC). There have been no inductions on regular seats in the last two decades, with contract employment being favoured instead.

Young doctors in most major hospitals live in dilapidated hostels and single rooms shared by up to three people. There are more doctors doing house jobs without being paid any salary than those who get paid. These issues are important when you are doing more than 60 hours work per week without any reward.

In November 2012, an agreement was reached between the (young) doctors and the Punjab government with the understanding that a new service structure would be implemented. Two months after that agreement, there was still no sign of implementation.

The dispute over non-renewal of contracts and housing allowance was simmering in District Head Quarters (DHQ) Hospital Gujranwala as a direct consequence of the non-implementation of doctors’ demands. A team of interlocutors from Lahore was there on January 2, 2013 when the whole scene got ugly, resulting in physical violence by both doctors and hospital administration. It was broadcast on live television across the nation with some spiced up subtitles.

As a result, more than a dozen doctors were arrested and are still in jail. OPDs are shut down throughout the province in protest and a major ‘dharna’ has been planned for February 7, 2013.

Personally, I do not endorse the physical violence unleashed by young doctors in Gujranwala and would happily demand an impartial inquiry into the matter. Apart from that, I stand by the doctors’ community in the struggle for the proposed (and agreed-upon) service structure.

The government of Punjab has tried all sorts of delaying tactics including court delays, inviting 200 army doctors to work in place of the YDA doctors, allowing substandard doctors to work in place of better doctors during the strikes and using the police to threaten and even torture YDA doctors. As a doctor and on a humane level, I hope the issue is resolved completely this time – if not, both sides are set to lose again.

The writer is a doctor based in Lahore and tweets @abdulmajeedabid

Abdul Majeed Abid, "Doctors on strike," The News. 2013-01-31.
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