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How Pakistan’s healthcare is failing its female doctors

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A career break isn’t always a choice for women; instead, it is necessary because the system has failed them completely

It is essential to rephrase the narrative regarding non-practicing female doctors in Pakistan and reconsider how we observe doctors’ employability issues in the region. Loopholes in the healthcare system in Pakistan prevent female doctors from practicing medicine despite the many laws in the Constitution protecting women’s right to employment and equal opportunity.

Like India and Bangladesh, Pakistan is a country where healthcare has a higher ratio of female graduates in the medical and dental fields. It is worrisome, however, that 70% of these graduates cannot practice what they learn in medical schools. Six out of 10 female post-graduates are unemployed in Pakistan, and according to a survey by the Labour Force, “compared to 64% males, only 18% females are employed”. While most people express disappointment when referring to non-practicing women in the healthcare system, it is pertinent to remember that it is not a choice made willingly.

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The cultural norms and socioeconomic conditions in Pakistan make it hard for women to access and maintain their education, especially the expensive enrolment process that precedes medical universities. Once enrolled, they must overcome barriers such as conveyance, buying expensive medical supplies such as books, examination equipment, and in my experience, dental materials, to graduate smoothly. Students receive little help and facilitation from parent institutes, especially in the public sector, due to the underfunded healthcare system in Pakistan.

A recent graduate, Dr Nada Ahmed, voiced her concerns, stating,

“I graduated in 2019, and after my house job, I worked in a private clinic where I did an unpaid internship for months. Eventually, they hired me on a meagre wage, but I still had to pay 150 rupees to and from the clinic out of my pocket for conveyance, leaving me with barely anything to spare.”

Unpaid hiring is a real and prevalent problem in the healthcare community, so it is not rare to see doctors protesting in front of press clubs and government institutes.

Government officials and employers often dismiss these protests as a nuisance. They are a familiar but largely ineffective part of every doctor’s career. Dr Wajiha M Ali is a graduate of DOW University and has served at Agha Khan University Hospital (AKUH) as Chief of Residents. It is one of the few hospitals that offer a daycare centre for employees to accommodate working mothers, and they are working at total capacity often with the help of waiting lists. Dr Wajiha says that the child care facility was “one of the main things that attracted her to AKUH”. As a doctor with over 13 years of experience, she has identified an “absence of child care facilities, low wages, and lack of work-life balance as major distress factors amongst working female doctors”.

Medical careers require doctors to continue their studies after completing a bachelor’s degree, which can be very expensive and even impossible for women in Pakistan who wish to marry and start a family.

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“Post-graduation programs are costly and often a non-negotiable requirement to secure a promotion. Women who don’t have the privilege of a support system or struggle financially can either excel in their career or raise kids due to lack of an inclusive work environment,” she added.

The human resource department and management is an organisational factor that is entirely missing in Pakistan’s healthcare sector. Dr Wajiha believes that “there is little to no attention to mental health screenings for doctors, and there is an absolute absence of family-friendly human resource policies”. Women might feel more overworked than men in healthcare because house chores and family responsibilities are still gender-based in Pakistan.

“Women have to work long hours with little to no paid leaves or family time in healthcare; financial constraints cause them to avoid marrying, and a poor work-life balance can often result in broken marriages,” added Dr Wajiha.

A narrative review titled Doctor Brides, published in the Journal of Pakistan Medical Association, highlighted that female trainees believed having children would be a barrier to their career progression due to time constraints. “Female doctors also thought that having children would also mean that other people may develop negative perceptions about them,” confirms the paper.

Officials often pinpoint early marriage as the cause behind a decline in working female doctors. In actuality, the reason is much more complex. According to Dr Zeerak Nadeem, a recent graduate with a bachelor’s degree in dental surgery from Karachi Medical and Dental College:

“Career counselling, salaried hiring, childcare facilities, flexible working hours, and supportive mentors are critical to increasing the number of practicing female doctors. We must stop blaming female graduates, who are victims of a severely neglected healthcare system in Pakistan. A career break isn’t always a choice for women; instead, it is necessary because the system has failed them completely.”



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The systematic persecution of minorities for political mileage

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We are now making it impossible for Ahmadis, who are as much as Pakistanis as all of us, to live in this country.

A few days ago, I wrote a blog on a shameful incident in Faisalabad involving the arrest of three Ahmadi individuals for practicing the Islamic ritual of animal sacrifice, otherwise known as “Qurbani” in Urdu. The incident shocked me for two reasons. First was the sheer inhumanity of arresting someone for an act which is performed by millions in Pakistan. Second, because the said individuals were performing the ritual within the confinement of their own homes, which means technically, they were not violating Section 298-C of the Pakistan Penal Code, which prohibits any person of the Ahmadi sect from calling himself a Muslim or preaching or propagating his faith. Notwithstanding the draconian nature of the said law, the arrested Ahmadis were not violating it any ways.

Condemning the incident, I wrote,

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“From policing their behaviour in public, we have now started to breach the privacy of their homes and in doing so are forcefully stripping them of their human dignity and respect completely.”

At that point, I thought we had reached the lowest possible level of our moral bankruptcy. Little did I know that when it comes to Ahmadis, both our state and the society have an amazing capacity to constantly outdo all our previous misdeeds.

Since then, two similar incidents have come to surface, which again have left me completely stunned. First, the government of Chaudary Pervaiz Elahi, immediately after taking over Punjab, decided to amend the nikkah nama form by including the clause about belief in finality of Prophethood. Second, in another and even more troubling development, Pakistan Muslim League-Quaid (PML-Q) leader Malik Ilyas Awan submitted a letter to the deputy commissioner of Khushab, requesting him to take away security from the Ahmadi residents of the region, while also calling for their eviction from Khushab.

While the Eid incident demonstrated bigotry and hatred at the general population level, what makes these two latest developments particularly shocking is involvement of the government. When such steps are taken by the government, then it means that it has abandoned its basic responsibility of provision of safety and protection to all its citizens and has become completely partisan against a minority and in the process increasingly showing traits of a quasi-fascist state.

The updating of nikkah nama is the continuation of the long trend of including such clauses in various government documents. This step was not needed as such since this requirement is already present in many identification documents. Moreover, the Muslim Family Law is not a provincial subject and yet the Punjab government decided to take this step. In my opinion, it does not serve any purpose except to further promote and institutionalise discrimination against Ahmadis for the purpose of extracting political mileage. This was first proposed in March 2022, before the no-confidence motion and even at that time there was criticism from the liberal quarters that the sole purpose of this was nothing but petty political gains.

Now, after “retaking” Punjab, the PTI and PML-Q coalition immediately enacted the bill they had proposed in March. One reason as to why they have done so is that in recent by-elections, which they won convincingly, they played on a religious wicket in order to outflank the Tehreek-e-Labbaik Pakistan (TLP). They were so effective in their campaign of whipping up religion, including the finality of Prophethood issue, that TLP witnessed its share plung to merely 5%. Since the issue of finality of Prophethood is intrinsically linked with Ahmadis, therefore, whenever it is raised for the sake of extracting political mileage, they end up getting victimised.

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Since the coalition had already charged up its base by using this tactic, it has now tried to demonstrate that those had not been just “empty slogans” after taking over. In other words, the coalition has tried to prove its “commitment” to the issue.

Due to recent sloganeering, the issue has gained strength and as a result, the second development, i.e. request from PLM-Q to expel Ahmadis and removal of their security can also be understood in the same context. It is a continuation of the trend in which religion, particularly the issue of finality of Prophethood, is raised, followed by some measure against the already marginalised Ahmadi community.

As I mentioned in my old blog, although all minorities in Pakistan suffer from discrimination, the treatment meted out to Ahmadis is by far the worst. There is what I call “Ahmadi exceptionalism” in Pakistan. And the way things are going, I really don’t see an end to this pattern. I genuinely fear that the tactics used by PTI will now be adopted by other parties such as Pakistan Muslim League-Nawaz (PML-N) and TLP with even greater vigor in the future.

Two years ago, in a piece about the politicisation of the Ahmadi issue, I wrote:

“Academic Sadia Saeed has identified three state responses, each one harsher than the previous, over the Ahmadi issue. First was accommodation, when in 1953 the state curbed anti-Ahmadi agitation; second was exclusion, when the state declared them non-Muslims in 1974; and the third was criminalisation under the Ziaul Haq regime, where anti-Ahmadi ordinances were introduced. The way we are regressing, I am afraid that a fourth one is not far away: ethnic cleansing or forced displacement of Ahmadis from Pakistan.”

I think with these recent developments, the fourth stage has started. We are now creating circumstances where it is impossible for Ahmadis, who are as much as Pakistanis as all of us, to live in this country. In doing so, we are depriving them of even basic human dignity and right to live while we are ourselves are morphing into a bigoted, hate-filled and cruel society.

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May God help and show us the right path which is of kindness and empathy.



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Will Pakistan be able to evade a fate like Sri Lanka’s?

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Poor policies by the ruling party put Sri Lanka in debt default. Pakistan could follow if it doesn’t course-correct.

Sri Lanka is facing serious political, social and economic crises and now the island country is being termed as a ‘state in crises’. Certain factors are responsible for pushing the country into the abyss, but mismanagement on the part of the government tops the list of potential catalysts. It is being speculated that the political instability in Pakistan along with international crises is likely to make the country meet the fate of Sri Lanka.

Taking a look back at Sri Lanka’s growth trajectory reveals that the current scenario did not really emerge out of an unprecedented milieu. In July 2019, the country achieved the status of upper-middle income nations, from the World Bank, but its economy faced serious blows with the spread of the Covid pandemic since the country’s economy is highly dependent on the tourism sector and the pandemic negatively impacted this sector. Then, in the August 2020 elections, the Rajapaksa dynasty took hold of important government offices, including those of the president and the prime minister. The Rajapaksas signed contracts for mega infrastructure projects and spent the country’s reserves this way. The Russia-Ukraine crisis further deteriorated the condition as it led to inflation at an international level and the island nation was not prepared to face this chaos.

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In 2020, the country was downgraded to lower-middle income nations. This happened because the government did not take into account the looming crises and resorted to populist moves to increase the vote bank. Lack of sound economic policies, such as cutting taxes without reducing spending led to fiscal deficit, a condition when government’s expenditure surpasses its revenues in a year. The government also banned the import of chemical fertilizers – an ethnonationalist move – and this caused a serious decline in agricultural production. This poor management by the ruling party got Sri Lanka into debt default which gravely affected the situation of the country with no significant help from international community or other organisations because of economic uncertainty. And Pakistan seems to be facing a similar fate if it doesn’t course-correct.

Turning towards Pakistan, Bloomberg’s Sovereign Debt Vulnerability Ranking, ranked Pakistan fourth on its list of countries with the highest default risk in 2022. The inflation rate in Pakistan is 24.9% while the debt accounts for 71.3% of the total GDP, according to the statistics released by the Pakistan Bureau of Statistics (PBS). These figures are quite close to those of Sri Lanka.

Pakistan has a semi-industrial, agro-based economy with about half of employed labour force, and contributes to 24% of the total GDP, according to PBS. Despite this much dependence on the agriculture sector, Pakistan imports wheat, which is the country’s staple food. The recent Russia-Ukraine crisis as well as the climate change debacle caused spike in the prices of certain commodities, including wheat, which caused problems for Pakistani economy. In addition to this, certain populist moves also exacerbated the situation. For instance, when the whole world was facing inflation issues, the government of Pakistan decreased oil prices to give subsidy to citizens in order to win the support of masses, but Pakistan’s economy was not in a position to bear the brunt of this decision.

Pakistan’s economy is dependent upon foreign loans and imports, instead of on locally produced items. This factor often leads to rupee devaluation against the dollar, as country’s imports surpass its exports and cause a hike in the dollar price. The Bloomberg report revealed that severe shortage of US dollar in Pakistan can make the country descend into economic crisis. Also, Pakistan’s foreign exchange reserves and the foreign currency reserves held by the central bank can only be helpful for two months of imports. During this state of affairs, the only way out for Pakistan is linked with the International Monetary Fund (IMF) disbursement of $7 billion that is to be released in August after the international organisation’s final approval. This will help Pakistan meet its ‘foreign financing needs’, according to Murtaza Syed, Acting Governor of State Bank of Pakistan.

The IMF bailout can provide ephemeral relief to the crippling economy of the country, but proper policy-making is required for long-term sustenance. In the case of Pakistan, the outcome of policy-making seldom meets the needs of the time because of severe political failures. In order to help Pakistan ease its its worsening condition, it is important to pay attention to its policies. Moreover, the scourge of dynastic politics is inflicting the country for decades, and awareness of this plight among masses is necessary to root it out. Furthermore, Pakistan’s youth bulge and women’s participation in the labour force can help improve the country’s economy to a great extent. However, flawed policies and socio-cultural fabric hinder this process which can enhance the human capital of the country. If Pakistan focuses on local production of commodities and works on its human resource, then it is unlikely for the country to become a victim of debt trap.

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The power of literary fiction

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Fiction can help us escape into our own fantasies and also ensures an interaction with those realities we overlook

“But wishes are only granted in fairy tales.”

Simone Elkeles in Perfect chemistry comes up with this perfectly brewed notion, which decidedly can be felt but is unfortunately restricted to what we call ‘fiction’ – that distinctive world we all would’ve imagined back in our childhood. A world populated by the talking crockery in Beauty and the Beast, the wizarding world of Harry Potter, or any of the sublime imaginative creations which exist either in the form of a book or movie. Fiction always plays a vital role in filling one’s mental capacity with diverse characters, subjects and their essence.

The alchemisation of our thought process is a direct consequence of fiction, so we may label it as something which has majestic transformative powers. How? The answer lies within its very structure, the base upon which it stands firm. Let us begin with characters and their characteristics as stated before.

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Though it might seem like a piece of cake to construct characters in a story, for a writer, building strong characters is far more pivotal than the story itself. Their demeanour and the treatment of their abilities requires massive constructive work and contemplation so that they may be able to create empathy among readers. Here lies the crux. This is why I have been stressing over characters being the overriding component of fiction.

When a reader develops cognitive empathy, it makes them able to sneak through lives of fictional figures with astonishingly realistic feelings, allowing a personality refinement of ourselves. This is the very theory nowadays being emphasised by mainstream psychologists to understand the virtues of fiction. I must say, at this point, story acts in quite familiar way in terms of its influence upon us. Writers are one of us, influenced by varying ideologies, cultures and the atmosphere of this world. One would definitely pen down what one sees and scrutinise it.

With different minds having different thought processes, different lives, different perspectives and, above all, distinctive philosophies, this allows them to fill fiction with a fantasy of their own. As a result, we witness angles of reality from their eyes and juxtapose their conclusions with our life philosophy, making us able to identify flaws in a way which makes us constructively criticise ourselves rather than heeding to the scathing remarks people around us propagate.

Fictional worlds have a way of showing situations which may seem different from our world. However, their true essence remains in the social philosophy and rudimentary ethics present in this world. Breaking it down to a simpler definition, fiction, especially the fantasy genre, depicts right and wrong in a quite pleasing way. When curiosity is ignited, people start to think and relate those lessons with real life. For example, the Harry Potter series still shows such basic fundamentals of human life when holistically analysed. Putting aside its fictional elements, a person with such an odd life, without his parents, attaining fame, battling insecurities, but still managing to get through every problem because he is resilient, consistent and brave. Harry has not at all been represented as a protagonist without any flaws or failures. Instead, he has some extremely extraordinary but pragmatic qualities to ensure his success despite his vulnerabilities.

How this representation impacts our mentality is not hard to determine. Living in a world full of problems and failures, this type of escapism containing such life lessons could easily benfit us. Another distinction which has been represented in fiction is the difference between right and wrong. A story specifically wrought out to show the victory of truth is a real treat, making us believe that truth always triumphs.

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Jane Austen delineating the power of love in each of her fictional works, or Fyodor Dostoyevsky propagating the dilemma of right and wrong in his distinctive literary works would have a certain impact on our mind. Thus, fiction successfully works as a remedy to our mind, encompassing our thoughts, and giving us a sense of relief and refinement. From children to adults, all of us can experience this if we indulge ourselves in these worlds. Fiction can not only help us escape into our own fantasies but also ensures an interaction with those realities of life we often overlook due to fear and doubt.



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