Since I was born and raised abroad and after having lived there most of my adult life, I’ve come to expect a certain amount of quality when it comes to the most basic amenities in life.  Protection from police forces, drivable roads, clean water, and quality health care – all examples of the basics millions of us around the world take for granted.  All these topics are separate blogs in and of themselves but for now, my main gripe is the quality (or lack-thereof) of medical and dental care in this country – and the corresponding accountability that one would assume exists in such professions.  I’m not saying that high quality is not available here – I’m just raising the point ‘how is one to discern quality from mediocrity in this case?’  In a place where there is little to no regulation, no standardization and a blind faith general acceptance, without question, of whatever is being relayed by medical professionals – how is the average person to know when to do a figure eight and leave before the damage is done?  I once had to have dental work done and after a careful examination it was determined I would require two teeth extractions and one filling, each in subsequent sessions.  Later when I went in to have the procedures done, I was sitting in the dentist’s chair, fully comfortable with the doctor’s abilities, only to discover that the filling had been performed on a tooth that was to be extracted a week later!  If I hadn’t been conscientious enough or proactive in the business of my own healthcare, it would have just slipped by, I would have had to pay for it and then assume the mental and physical damage of having yet another filling done, in vain.  The sad part is that this took place in a well-renowned, ISO-certified facility. 

I feel that though it is a major hospital in Karachi which, despite bearing the internationally recognized ISO logo all over it, there is a major lacking in many of the typically anticipated aspects that one would expect of a city’s best medical care facility.  Ample amount of clean beds with linens that are not several decades old; an ER with the accommodation to privately hold those waiting for emergency care, rather than in the midst of all the others while vulnerably lying in a stretcher clothed merely in a hospital gown ; Proper grief counseling and the availability of such when needed, rather than only during office hours; twenty-four hour availability of anesthesiologists awaiting duty that may call as per the birth of a child, again rather than just during office hours.  Is this too much to ask?  Another question I’ve found myself asking since the first time I required medical care after moving here, is “why aren’t I treated as an equal in this patient/doctor relationship?”  In fact, as I see it, I am hiring them for their services and should have the rights of any other consumer for goods/services.

All I am asking for in my doctor(s) is accessibility, credibility, reasonable hygiene in the treatment environment, progressive practices (as opposed to rigid and old-school attitudes) and basic respect. 

Where is the concept of doctor/patient relationships?  Rather than the relationship being a lopsided one of authority versus submission, I rank being able to relate to my doctor and vice versa, very high on my list of priorities.  Rarely have I witnessed a doctor in this society, who is open to questions, comments and, dare I say, criticism.  As a patient who is very proactive and used to an open-door policy of communication, I am appalled at the sheer demigod mentality of many, if not most doctors here.  With the amount of research one is able to accomplish these days, it should be of no wonder to doctors when we want to discuss in detail what our options are, when we openly desire a second opinion (without the need to hide it from doctor #1), or when we would like to opt out of one or the other prescribed method of treatment.  SO WHAT if the patient is taking an active and proactive role in their health and that of their close family?

Unfortunately, here it is considered defiance or hard-headedness when one questions any aspect of their healthcare. Case in point: As a first-time pregnant woman a few years ago, I had a natural propensity to read up on anything and everything I could find on the subject and so I had lots of questions.  Is green tea ok to drink during pregnancy?  How much DHA should I take and for how long during each trimester?  How much is too much fish for fear of mercury poisoning?  Do I need to get rid of my cat or just keep him at arm’s distance to prevent toxoplasmosis?  The first inkling I had of the situation of doctors vs. patients and the utter blind faith with which many people carry on according to their doctor’s suggestions, came during my first pregnancy in Karachi when I dared ask these questions.  To make matters worse, I ‘interviewed’ my short-listed choice of doctors, to see which one shared the same basic [medical] philosophy I believe in.  It was a painstaking and disheartening experience when I learned that this exchange of philosophies was about as unwelcome as a power outage in the dead of summer.  In sharp, sharp contrast – my doctor abroad (for my next pregnancy) asked me herself whether we were on the same page.  She read through all six pages of my birth plan and made every attempt (successfully) to accommodate most of my requests.  SO, SO different from the experience a good friend had with her pregnancy here in Karachi, during about the same time I was abroad.  Despite her repeated requests to be given a local anesthetic during a (fairly routine) Caesarian section, it seems very likely that since she tried to take an active role in this discussion and decision, she was forced to undergo the surgery under general anesthesia, something which resulted in a major complication, bringing her dangerously close to death and causing considerable collateral damage to her trust in the system.  Her doctor at the time is considered one of the best in the field, having studied abroad and is even certified with an accredited international association, yet after repeated one-sided ‘discussions’, in the end it was the doctor’s stubbornness that prevailed.

Most recently (and the main reason I began writing on this blog), I suffered near to sure irreversible damage to a tooth, after a local dentist whose thriving practice resides on the main and bustling main street of Karachi handled and re-handled my tooth, resulting in a botched-up root canal that was otherwise a routine procedure on a fairly simple tooth.  The dentist never told me of the damage that was done to my tooth.  Instead, I was left to discover the problem after months of pain and suffering.  Never mind the eight visits and countless injections and the doctor’s numerous attempts at completing this simple procedure.  The fact that I had to discover the truth on my own accord really makes it hard to trust the system again.  Why can’t there be an organization such as the Better Business Bureau (USA) – where companies and institutions who have received numerous complaints, are cited and advertised, their shortcomings investigated and their administrations penalized?

Adding insult to injury to all my experiences, there is no regulatory body looking out for mishandling, ill-placed medical advice and (worst of all) medical malpractice.  The medical profession can practically get away with anything.  I am asking what are we to do if the healthcare industry is not held accountable. How can we overcome this problem, and promote progression rather than regression?