KARACHI:,,, Pakistan Medical Association (PMA) said in a report on Thursday that considers 2020 as unfortunate year not only for Pakistan but also for the whole world due to pandemic of Covid-19. Pakistan went through so many political and economic problems along with increasing number of health issues which have raised the burden of diseases more.
Although, PMA has always offered recommendations and places a charter of demands for the government to implement to improve the healthcare system in Pakistan. Unfortunately state of affairs shows that, the voice of PMA always falls on deaf ears. Nothing has been changed in health sector during the year 2020. Instead of any improvement things have gone from bad to worse.
Since the end of 2019 Pakistan and the whole world has been facing the pandemic, COVID – 19. A novel coronavirus outbreak was first observed in Wuhan, Hubei Province, China in December 2019. The pandemic reached Pakistan in February 2020 and the first case of Covid-19 was detected on 26th February 2020.
Now along with many other countries of the world we have been facing the second wave of Covid–19. Presently the Coronavirus has mutated into the 3rd Variety which was initially detected in South Africa and has reached fifteen counties of the world. The 3rd Variety is 60% more contagious and 70% more transmissible. Now till today the tally of the total confirmed cases in Pakistan has reached to 479,715 and the death toll is 10,105.
PMA was the first to sniff out the difficulties Pakistan is going to face due to the spread of pandemic in coming days. From the very first day when Coronavirus erupted in China and the number of death tool then just rose to six, PMA through a press release on 22-01-2020 came out with the suggestion for the government to take up some urgent steps to avoid spread of coronavirus in Pakistan. We also suggested installing scanners at all air ports, sea ports and at all border entries to check the suspected cases of Coronavirus.
The PMA also issued preventive measures for public. Unfortunately when we asked people to use mask and sanitizer the prices of these items were increased and similarly when few medicines, oxygen cylinders and other medical devices were discussed in media for treatment their prices also reached many times higher. Then there was no proper guideline for public to reach hospitals. Many people died on their way to reach the Corona Designated hospitals. Even doctors died in the same way.
Unfortunately despite our regular warnings regarding Coronavirus nobody acted upon our advice. Even the public has never followed the preventive measures seriously and the government also seems to be failed in implementing SOPs. Now the 2nd wave is proving to be more lethal and deadlier as the virus has mutated itself and has become more transmissible and more infectious. It has been observed that people are not getting fully recovered even after being declared negative.
The increasing burden of disease of the second wave in the community is proving to be more fatal for doctors. Till now 154 doctors have lost their lives due to COVID –19 in Pakistan. During this second wave which started from November, 45 doctors have lost their lives (Punjab-16, Sindh-14, KPK-13, AJK-02).
The situation is very alarming. The government seems to be very careless about the welfare of the families of the deceased doctors. They announced Shuhda Package for these families but never implemented it.
The Polio infection remains endemic despite over 100 rounds of vaccination being carried out in the past decade. Our Polio program has deteriorated; in 2018 polio program seemed to be on the brink of eradicating wild poliovirus transmission but unfortunately during the year 2019 as many as 117 cases were reported and in 2020 the tally of polio cases reached 83.
15 million people are affected with hepatitis B and C in Pakistan. Thousands of new patients are added every year due to lack of prevention, testing and treatment resources as well as poorly screened blood transfusion, improperly sterilized invasive medical devices and unsafe injections. Hepatitis B and C are several times more lethal viral diseases than the coronavirus infection and resulting in around 300 to 325 deaths daily in Pakistan, while COVID-19 is causing far fewer casualties than viral hepatitis.
It is neither terrorism nor natural disasters but the unavailability of safe drinking water which leads to the highest number of deaths in Pakistan. The release of untreated industrial waste, unsafe sewage system, agriculture run-off and unplanned urbanization, has downgraded water quality over the years, especially in the big cities, depriving almost two-thirds of over 200 million Pakistanis of potable water.
It is estimated that, in Pakistan, 30% of all diseases and 40% of all deaths are due to poor water quality. Diarrhea, a waterborne disease, is reported as the leading cause of death in infants and children in Pakistan while every fifth citizen suffers from illness and disease caused by the polluted water. The outbreak of XDR-Typhoid cases in Karachi and interior Sind reached in thousands.
The number of HIV/AIDS patients in Pakistan currently stands at 1, 83,000. The ratio of spread of HIV/AIDS cases in Pakistan is at 57 percent, similar to Philippines, which is very alarming. Out of big number of estimated positive cases only 25,000 cases are registered. This shows our poor performance. There is dire need to increase testing capacity to check HIV/AIDS patients.
Different researches have revealed that most of the cancer cases in Pakistan (around 60pc) were diagnosed in women as compared to men. The most common cancer among women is breast cancer, followed by oral and then esophageal cancer, while in men it is oral cancer. Research indicates that cancer, often a hereditary malady, is also linked to environmental factors and poor dietary habits, as in the case of oral cancer that affects those who regularly consume tobacco products, paan and betel nut and naswar . The increasing incidence of cancer in Pakistan has made it the second leading cause of death, every year, around 148,000 new cancer cases are reported in Pakistan.
Pakistan ranks first in Asia for most deaths caused by traffic accidents. According to the latest WHO data published in 2018 Road Traffic Accidents Deaths in Pakistan reached 30,046 or 2.42% of total deaths.
The World Bank estimates that Pakistan’s annual burden of disease due to outdoor air pollution accounts for 22 000 premature adult deaths and 163 432 DALYS lost, while that for indoor pollution accounts for 40 million cases of acute respiratory infections and 28 000 deaths/year. This is the worst situation due to the air pollution but again no significant change has been observed.
PMA has been very vocal on the increasing tendency of aerial firing in our society during wedding or other celebrations. This practice is an open violation of law, which often kills innocent people. Unfortunately this bloody practice has never been stopped and these horrifying incidents take place regularly.
The year 2020 will also be remembered as critical for medical education because instead of opposition of all the stakeholders Federal Government established Pakistan Medical Commission (PMC). The stakeholders never accepted it as due to its grave defect they consider it to be disastrous for medical education and health delivery system in Pakistan.
Now PMC seems to be at mess and under bad governance. Instead of improving, the situation is continuously deteriorating and doctors and medical students are facing huge problems. Both the medical education and health delivery system is worsening.
We have been raising our voice for years for the security of doctors and paramedics but our rulers never heard us. So many incidents of violence against healthcare workers took place in 2020 also.
PMA has been advocating for investing more on prevention of the diseases rather than curative side but nothing has been done and as a result the burden of diseases is increasing day by day. By just providing clean water to all the citizens of Pakistan we can prevent 60% diseases. If we eliminate mosquitoes we can prevent all mosquito borne diseases which are 40% of our total burden.
According to W.H.O recommendations, the health budget of any country should at least be 6% of the national GDP. In our case, the health budget, despite repeated PMA pleas and reminders to the government, has remained less than 1%.
PMA believes that proper planning; political will, honesty, increase of health budget and its proper allocation and above all the consolidated preventive measure can improve the health delivery system in 2021.