Infectious Diseases in Pakistan Are Not Being Reported as a Matter of Policy

I have been feeling concerned about the health of the nation for a large part of January. The reason is that I was severely ill during this time and happened to be in Bahawalpur, a remote district of Punjab situated on the fringes of Cholistan (an extension of the famous Rajasthan Desert). Drawing from my personal experience with the quality of health services available in the area and the feedback received from physicians working there, I now believe that the healthcare system, if it exists at all, needs a drastic overhaul.

Bahawalpur seems to be the favourite place for the bureaucrats of the Punjab Health Department solely for the reason that being a remote district of Punjab, it raises least objection to their easy ways due to its nature and constitution. When it comes to competition for this important slot, those having origins in Lahore and adjoining districts of the provincial capital win the race. Bahawalpur is rife with stories how they mint money during their stay in the area.

One of my friends associated with a basic health unit (BHU) of Bahawalpur told me an interesting story. Waving a yellow form reserved for the reporting of infectious diseases, he said that he happened to fill it once and escaped penalization from his superiors when he pleaded that though he knew well the law, but did not know the norm that infectious diseases - count them as malaria, hepatitis A, chicken pox, etc. - can't be registered but with the title of 'PUO', i.e. Pyrexia (diseases) of Unknown Origin.

In theory, there is no presence of the infectious diseases in Bahawalpur region where people drink unsafe water and the sewerage system is simply non-existent in the fast growing towns and villages in the outskirts of the district headquarters. Common infectious diseases are being unscrupulously reported as diseases of unknown origin. The fast sinking ground water, scarcity of rains and diversion of Sutlej and Beas rivers to India has made Bahawalpur region a home to water-borne diseases.

The reckless use of pesticides - southern Punjab consumes 40 percent of the chemicals, most of them spurious, used in the agri-belt of the country - is playing havoc with the environment. The subsoil water is ultimately affected. The health of the people is in real danger.

The Punjab Health Department follows an equal distribution rather than an equitable distribution approach while allocating funds for the health of the people across the province. A BHU has to deal with a population as large as 26,000 per unit, and has a fixed quota of medicines to combat particular diseases, most of which are non-existent in certain areas. The medics have no option but to return these medicines back to the health department at the end of the day.

Respiratory and skin diseases are common, while water-borne diseases are also rising, but there is little supply of medicines to this end. Due to poor reporting of non-registered drugs by the health department to BHUs, many old generation items are still being used in the area.

Public hospitals are no exception in this regard. The nexus between pharmaceutical firms and health officials is certainly a matter of concern of which there seems to be no solution in sight. Poverty is another cause of poor health. Despite being a cotton district and having a remarkable livestock population, the poor are growing in number every year. Cattle theft and robberies are common while Zarai Taraqiati Bank Limited (ZTBL) is offering agricultural loans on high interest rates. The scarcity of canal water is raising the input cost of agriculture, minimizing the profits of small landholders. The only two industrial units of the area, Gulistan Textile and Ashraf Sugar Mills, are lavishly benefiting from the superfluous labour market, denying them standard wages and a social security umbrella.

The self-serving role of patwaris, ZTBL officials and the police is the main reason behind the growing poverty in the region. The absence of checks and balances, particularly the absence of a responsible press, and the remoteness of this district from the provincial capital have allowed these abrasive elements to play havoc with the fate of the people. When people are poor, they aspire little to have better health facilities. It is worth mentioning here that 50 percent of TB patients in Pakistan live in southern Punjab of which Bahawalpur is a part.

Education is another cause of concern as far as the health of the people is concerned. The contents of the curricula set by the provincial government are totally irrelevant to the social needs of society. Though this problem is not confined to Bahawalpur, it assumes added significance given the socio-economic environment of this area. The large educational infrastructure can be definitely utilized to address the social, economic and health problems and needs of the people.

"Health education contains a secret to revive the dying spirit of the people as they need both," says a health expert planning to found a model institute in a village of Bahawalpur district. The people of the area are sinking into hopelessness; the youth are finding refuge in narcotics. Hash and liquor business are flourishing. "Sports should play a leading role in imparting health education," says the physician-turned-philanthropist.

Above all, there is a need to conduct research to assess the health needs of the people. That includes identifying social norms and habits that stand in the way of developing an effective health system for the region. The way the existing system is working should also be the subject of study. The findings of the researchers will definitely help in correctly restructuring health facilities to make them easily accessible to the people.

The phenomenon of unknown origin diseases (PUO) does not make sense in the global age. It only speaks about the lax attitude of the health officials towards their responsibilities. The human index needs to be improved and the health of the nation comes first in this regard.