NationalVolume 14 Issue # 19

After Nishwa’s death

The Hippocratic Oath requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. These include the principles of medical confidentiality and non-maleficence.


“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm”. A statement, which certainly encompasses the rights of a patient in critical condition fighting for his or her life.


Minor girl Nishwa, who was administered a wrong injection at Karachi’s Darul Sehat Hospital, passed away and the hospital was fined Rs500,000 only.


Accused Sobia had filled the injections which had no labeling and gave it to male nurse Agha Moeez. On April 14, a nine-month-old girl had paralysed allegedly after being administered “wrong injection” by “untrained nursing staff” at Darul Sehat Hospital situated in Karachi’s Gulistan-e-Jauhar area. Nishwa’s father Qaiser Ali told the media that police had threatened him to back out.


The provincial government and the state could even plan to send Nishwa abroad for treatment but nothing was done.


Ali said that he would approach every forum to seek justice for his daughter, so that others did not fall prey to such practices.


There is no working regulatory framework that governs the health sector in Pakistan, where markets are incomplete (no doctors for the old) and have large information asymmetries (where it is not clear if what is being prescribed is in the patient’s best interest), regulation becomes very important. Otherwise, the temptation to take patients for a ride becomes too much. Even if some doctors and hospitals do not indulge in unethical or illegal practices, it becomes impossible to differentiate between these and the less scrupulous ones. The Word of mouth is not enough to make clear distinctions.


But there is more to it than that. When each specialist is visited, they order a panel of tests to be done before they will even start talking of treatment.


Hospitalisation is sometimes the only option left if you want a team of doctors to examine the patient holistically. But even that is not easy. Getting admitted into a private hospital is costly and even there you are placed under the care of a particular doctor. It may not be easy to get other specialists to come and visit.


More importantly, even if they do, they still diagnose and prescribe in isolation. There is no primary doctor who coordinates with other specialists or looks at issues of medicinal interactions, the effects of one treatment on another, and so on. It comes down to the patient himself/herself or to the family of the patient to coordinate between doctors. But they have no way of knowing medicinal or treatment interactions.


There are too many cases in Pakistan that one hears of where mistakes have been made by doctors and care providers like more about the lack of an effective regulatory structure that should have been created for the sector.


Our judicial institutions must also be quick to dispense justice which will allow for a remedy against malpractice. Usually, hospitals have strong internal peer group-based quality audit systems.


The Medical profession also has membership requirements, standards, checks and balances, can vary across societies. Nonetheless, almost all checks and regulatory structures are in place in most societies. In some places, we even have insurance companies and other intermediaries coming in on behalf of the patients. We have none of these in Pakistan. It is no wonder medical markets are lucrative in Pakistan but provide, on the whole, a terrible service to the people.


A medical research study in the US has shown that 30% of all deaths in the US happen because of a medical mistake or negligence somewhere during patients lives. The most important thing is not the doctor. It is to have a very well-funded, well-organized and very centralized form of healthcare. Oath does not improve healthcare. It is the system that does (eg. see Scandinavian health models). In Pakistan, a junior doctor in the public sector works like a donkey. Realize condition of hospitals, no better than doctors themselves, being under equipped and understaffed in addition to being overburdened.


Being a developing country, Pakistan has always struggled with health issues. This also makes us stand at 122nd position out of 190 countries in a report by World Health Organization (WHO). There is need to increase the health budget. In such circumstances, the current number of government hospitals and doctors are not enough to cater the large population while the private hospitals are out of reach for lower or middle class patients.


Pakistan is ranked 149th out of 179 countries in 2015 on the Maternal Mortality Ratio Index. The healthcare blueprint needs increased funding and efficient cross-sector linkages.

According to UNICEF, despite significant improvements over the past two decades, Pakistan ranks AT the bottom among other countries when it comes to infant and neonatal mortality.


There is a need to keep democratic institutions strong. The three-tier approach should be switched with a four-tier approach, with the 4th pillar being preventive healthcare. This is a very wide branch but if launched, could do wonders in our healthcare system. Furthermore, there should be strict penalties for wrongdoings. A procedure for proper investigation for such cases should be set and punishment should be applied accordingly. Moreover, every person of medical field must have defined duties whether they are a doctor, pharmacist or any other paramedical staff. The PMDC and DRAP must awake from slumber. SOPs must be followed so that cases, like Nishwa, can be prevented.