Online exams in universities: The dilemmas and challenges

The year 2020 will be a memorable part of our life in different terms.  This year has given the challenges and so many opportunities and setbacks in our life.  This also applies to those who are seeking and providing formal education through various institutions.  Due to COVID19 and lockdowns, life came to a standstill, including the teaching and learning activities.  Except for very few institutions/colleges/Universities were prepared to accept the challenge of moving immediately towards the online or virtual learning approaches. Neither the IT department nor management or teachers were skilled and mentally prepared to shift to digital learning immediately.  I am witnessing several academics who are still not well versed with computer technologies and use them confidently.  Thus training was arranged, and teachers were prepared to conduct lectures, tutorials, and even virtual field trips. It worked out nicely for some, but each day one would hear the faculty’s complaints blaming either the power failure, poor internet or pressing the wrong key or getting stuck somewhere. In that context, probably the students were at an advantage, as they were the passive audience and least bothered about the attendance or sitting on a desk/table and be dressed or not.   Of course, there was a lot of cheating by just joining the class and disappearing and watching the lectures conveniently. Some teachers also tried the multiple or best choice questions, and the students who could not pass or even attempted came up with a novel excuse of having problems with the internet.

This learning process has been going on throughout the year with varied problems but managed quite nicely in many places. Now comes the time of final examinations. The Higher Education Commission (HEC) of Pakistan announced that the various universities could organize the exams according to their choices, i.e., online/virtual or physically attending the exam hall. That appeared to be an easy process but has turned into an ugly face. The student started the process, including grappling with security people and demanding online exams as the classes were conducted online.

Conducting online exams appears to be a valid argument by the students, especially when HEC has also allowed it.  So why are the universities not conducting those online exams?  Is it the stereo-typing that students will be cheating, especially on the pretext that even in the physically appearing exams, they have been resorting to cheating.  The online approach is much easier!!   There are many innovative ways that students can cheat, though there are solutions to address this.  A study conducted by McAfee, an online security software manufacturer, found out that one in three students in the USA used mobile phones or other connected devices such as smartwatches to cheat in exams.

Rather than seeking solutions, the Universities are becoming part of the problem.  The Universities are also not prepared or willing to take up that challenge to get themselves at par with international standards for digital technologies.  In a country where most of the Universities are still using (rather abusing) the papers by distributing notices, memos, invitations, and so many other purposes, it will be a prudent  decision to move towards “paperless” approach supporting the climate challenges.  In many of the discipline computer knowledge and hands-on experience is not part of the learning process for both the students as well as teachers.  This is further compounded by the fact that we ( I am talking about highly paid professionals, such as Medics, Engineers, Chartered Accountants and so on) are never taught about both written and verbal communication skills and how to be absorptive to the new technologies, especially working digitally.  The argument of students being morally corrupt is partially valid. But we need to be mindful of the fact that the teachers and management of universities must be equally blamed.  Have we ever tried to share moral knowledge with our students?? How many have taken any concrete steps to stop the cheating?? And above all are we ready to shift to the online approaches as and when needed.  This pandemic is a wake-up call for all of us.  Mind it. This may be the beginning of so many other pandemics and emerging infectious diseases according to epidemiological transition  Getting into digital technology is the need of the time, disregard of the field of profession or practice.  Perhaps, it is also high time that the educators/educationists also discuss the alternative to rote learning and just conducting the exams, which usually assesses the memory and maybe some other skills.  In a time where equality and the standard of education are moving towards a downward spiral in Pakistan, these challenges have to be addressed.


It has been a long time that I have not written a blog. Each day, I think of something and something comes up. Or may be its a simple procrastination. I hope InshAllah I will be sharing some of the experience about the COVID19 and getting locked down.

However, to day is something exceptional that I read and could not resist myself to share my thoughts.

Some of us may not know what it means by the idiom, “Tail wagging the dog,” should read this. Our Pakistani society seems to be dragged into this consciously (or maybe unconscious).  The case over here is regarding admission in medical colleges, especially in Sindh.  Today, while enjoying my tea-coffee combination and reading the newspaper, I came across this exciting news.

There is now a discussion that all the illnesses of flawed government health care system is actually “non-availability of the doctors.  This will be more so this year as the PMC  It appears that several aspirants (or to be precise) the applicants for the MBBS have failed in the entry test called MDCAT.  Many explanations are being given, and justifications have been offered as to why so many failed and why the girls have excelled.  Above all, if all the girls get admission, then many may not practice after their graduation.  So the ultimate blame is that MDCAT test.

The most surprising part is that it comes from the medical fraternity who should be safeguarding and improving the quality of “products”  from the medical colleges, especially the ‘private medical colleges’.   Back in 1973, I do distinctly remember when I was getting admission to medical college.  There was a big protest for increasing the number of seats from 150 to almost something like 350-400 in the public sector medical college.  Though it was raised due to different reasons, the then health minister had predicted that in the future, the doctors will be selling their skills on a cart!!.  This was meant about the quantity that would be produced and, of course, the quality going down.  I had once asked about the quality of young graduates from my mentor Prof Ghaffar Billoo. I can not forget his reply.   The number of good qualified graduates is still the same, and if one plots them on the graphs, previously, it was a normal bell-shaped graph, now it is a graph which is skewed towards left, with proportionately few having the high quality.

Can we as a society claim to afford this approach of getting high-quality doctors?  Perhaps some of us, who can afford to seek services from the “highly qualified” doctors, but the majority may be the victims of the lot having compromised quality.  I understand that some of the readers may not like or agree to my comments, but let us all leave in reality.  We all are not only corrupt in financial terms, but also in moral terms. It’s high time that we wake up and call our house in order.

Writing a book: Dilemmas and procrastination

Writing a book:  Dilemmas and procrastination

Staying at home (during the COVID19 pandemic) for a so-called workaholic seems to be an excellent opportunity to slow down and try to do something which one has been delaying because of the busy schedule.  Nowadays, you seem to be free from your routine work-schedule and think that it’s a great time to do the long-wished plans.  However, things are not so easy as one would plan.  You are bombarded, or actually, you unnecessarily expose yourself to so many social media outlets, including the compulsion to check your emails.  In a way, you pretend to be busy but with no real productive output.  And, each day, before going to bed, you remind yourself that I will be doing ‘this’ as the priority.

Well, this may not be true for many, but it seems to apply to me.  I had among my many “wishlist” one crucial project for writing a book. It is not originally my idea, but I have been suggested/told that based on my knowledge and experience, I should be writing a book.  Many of the undergraduate students (whom I am teaching now-a-day) had also prompted me to write my book, as on various occasions, I have been discouraging them not to read a particular book.  I always had doubts in their (apparently honest) suggestions, as I suspected that then it would become more accessible for students to learn from a book and be prepared to take exams and oral/practical exams by the teacher who has written the book.  I still suspect that it will reduce their learning habit and having better conceptual understanding.  Recently, I was impressed by one of my colleagues (from the clinical side) who has managed to write a couple of good books, and recently his latest book also got published.  So, I was a bit motivated and sought his guidance; he also motivated me to go ahead and promised to help me when needed.

Since then, I had been pondering on this idea; even came up with the titles and many other plans.  However, at the back of my mind, I have been going through various arguments and the dilemmas that may be associated with writing a textbook.  These were: So what? What difference will it make?  Do you want to re-invent a new wheel? Who will publish? What will my professional think of it?? etc. etc.  Besides, I always thought that I should be sharing my experiences of my field, how it has evolved over four decades, especially when I have been a witness to this process. Also, during my professional life, I have seen so many paradoxes in the development field that I always wanted to share “the other side of the story”.  This is a different approach than what is needed for a textbook and, ultimately, its publications.  Working digitally and virtually at home and surfing around have convinced me that you can still “publish’, but not necessarily through some publisher producing hard copies.  You need not write the whole script for the book, and you do it at your pace and mood. You write blogs based on your thinking process and keep on adding it till you feel that its time to compile them.  The idea is to enjoy what you are doing and make it more of experiential learning; this, of course, is from a special lens and mind-set.  You may even invite comments and suggestions as to how to go about it??  So, while trying to overcome my procrastination as well as dilemmas, I have proposed to name the book as “Concepts & applications of Public Health approaches in Pakistan”.  The title, as well as my sincere intention, is to make it a combination of some facts combined with theory.  This also includes the reflections and experiences (which are not usually written or shared).  Well, since I had to make a beginning from somewhere, so this is the first blog (or my so-called preface) to begin with.  I intend to keep the format of each of the chapter or section of the chapters as

Theory (background, introduction, concept clarification etc)

The status in Pakistan (including some historical evolution, if needed, some facts and figures and any achievements and the process evolved by public or private (including not-for-profit) sectors

Reflections & discussions (this will be based on personal or shared experiences).

Continue reading → Writing a book: Dilemmas and procrastination

PWA-the inside story

The PWA–Patients Welfare Association, MashAllah is completing its 40th year of services, mainly by the students of the then Dow Medical College and now Dow University of Health Sciences.  The PWA is one of the success stories and thus everyone talks, praises and wishes to contribute.  However, it’s always interesting to learn what happened in 1979 which led to the establishment of this activity by the three students.  Of course, all three of us have been friends and have our own versions according to what the internal, as well as external factors, influenced us.  Abdul Rahman, Mohammad Iqbal and I Inayat Thaver, then were class-mates & worked together. So the inside story below is entirely my version and perspective and by no means refuting others.  Last not but the least, you may find many similarities in my story, but let us not forget that it is only Allah (SWT), Who bestowed some of us to do some good deeds; without His guidance, no one can do any good deed.

One my uncle’s (a big businessman) had been giving me the charity money of PKR 250/month to be given to poor patients in Civil Hospital Karachi and would ask for the details each month; I have been doing it regularly.  The second factor that played a major role in making PWA a reality was that in 1979, there were language riots and all the students’ unions and activities were banned; in fact the college was closed for an indefinite period; so we were spending most of the time in hospital wards and learning, running around and supporting our seniors.  The third and the most important factor in my life though was a small incidence but was a turning point. Abdul Rahman’s niece was admitted in Children’s word and the attending lady doctor one day told us that baby needs to be given 100cc of blood and asked us to arrange for it.  We, as usual, went to the blood bank and requested for blood which was supposed to be bought by “regular blood-sellers” (mostly poor and many of them addicts).  However, to our surprise, we were told that they are on strike and asking for a raise for one pint of blood from PKR. 100-125. So, we went looking for them at nearby places and an adjacent hospital. We met few of them, requested them, did a lot of bargains, but none of them was willing to sell the blood.  Ultimately, dejected we went to the lady doctor and told her the whole story.  She was not only very upset but also shouted at us that “its only 100cc; we bleed more than that each month and nothing happens, why don’ you give it yourself”.  Well, well that was very stunning & challenging to us.  We looked at each other and of course, realized the condition of the baby and agreed that I will be the volunteer to give blood. so that was my first experience and thought “well that’s not bad and the voluntary blood may be given by my other colleagues in college”.  So we slowly started that process also.  In the meantime I mentioned this to my uncle; he suggested why don’t we organize it in a formal way; I replied him jokingly that ” I wish to pass my final year MBBS in the first attempt and not get involved in this time-consuming activities”.  However, The discussion and planning process commenced among us; the name, logo, and motto were proposed and agreed.  The biggest hurdle was to open an account in Bank and it had to be mainly authorized by the Principal of the college.  As expected, she refused saying that “you students have ways of making money, I will not sign it”.  So here comes another help (as I said Allah is always there to guide!!), we went to Dr. Camer Villani; he was a “guru” to us by his style and approach; we were running after him at midnight to see “filaria” (hahah).  We told him the whole story, he, as usual, mumbled and nodded to go ahead for signing the Bank Account and also to be our first ‘patron’.  That was a big breakthrough and thus we opened the account, we printed the letter-heads, we developed a system for giving medicines and we also went to heads of some of the major departments needing blood about the availability of volunteered blood, mainly by the students.  One would not believe that our quota was only 6-8 bags of blood per month; so sometimes the Professors were upset also, especially Prof. Mushtaq who at that time had started ‘doing liver transplant surgery’ and asked for many pints of blood; he was also our second patron, just before Prof. Zakiuddin Oonwala.

Last but not the last twist in the story (remember Allah is orchestrating it all the way) was when our final exams. dates were announced and we could not then spend a lot of time distributing medicines and convincing our colleagues to donate blood.  Then we got hold of Dr. Yousuf Jan Muhammad, Dr. Hanif and some more.  Though they were a bit reluctant but agreed to work under our support/supervision.  Then, we realized that it may be very difficult to work even after graduation and since we called it as students’ activity, we decided for PWA to be a students’ run organization and the graduates would play the role of supporters and advisers. Initially, it was a selection process, but later when we had many memebers we moved on to a semi-selection-election process and by and large it worked very smoothly.

Moral of the story is many; it begins with a good intention, commitment & persistence to do it, ignoring the criticisms, working in a team, and above all not ‘owning’ something that has been initiated. And the outcome is a lifelong ‘sadqae-jaaria’, supporting so many families, ones own grooming and nurturing for leadership and team approach skills.  However, just keep in mind that many among us, may have all the ingredients described above, but if there is no guidance and ‘taufeeq’ by Allah, nothing can happen.  In this journey of PWA, let us not forget our generous supporters and other well-wishers also.  PWA is a story of teamwork initiated by students but having so many external supports; Alhamdulillah.  May Allah grant us to continue all the good deeds, selflessly and without having expectations of getting any reward.


lactation blues
The great decision

The breast-feeding practices in Pakistan, over the years have either been stagnant or showing a decline. Various, social, cultural, health services and nutritional interventions have been suggested and implemented. However, there seems to be not a significant change; the blame is always put on the media and its abuse by artificial milk producing companies. This in a way may be justified.  But, perhaps we need to step back and reflect on the basic physiology, the ‘lactation reflex’ and factors influencing interruption of this process.  This blog is an attempt to draw some attention, on how the mothers’ mental health problems may be an important factor in decline of breast feeding trends varying from its early initiation, exclusive breast milk and then continuing it for at least 6 months.

The dilemma of breast feeding management commences initially due to the artificial divide between the ‘birth attendants’ (of any level of expertise) and the care-giver of newborn/infant (varying from LHW, doctor) later.  Both disciplines have their varying compartmentalized approaches as well as messages; above all both focus separately & exclusively on mothers and newborn/infant respectively. The dilemma gets further compounded when we tend to underestimate the basic lactation reflex and look for quick fixes based on various pre-determined but mainly medicalized and sometime socio-cultural factors.

Pakistan ranks highest among the prevalence of Post-Partum Depression (PPD); figures vary from 28% to 63% have been quoted among various studies.  Interestingly studies demonstrate that breastfeeding can protect depression, however, this association may be in the other direction, i.e PPD may lead or be associated with poor lactation and breast-feeding decline. The causality in either direction is still not clear but in terms of logical thinking the PPD has pre-disposing factors and keeping in mind the lactation reflex and arc, one can imagine that a mentally disturbed mother would experience interferences in the stimulus for lactation. This get furthers complicated when various ‘advisors’ at home and care providers load her with different messages and remedies. The baby gets more irritated and hungry all leading to the declaration that “mother is just simply not producing milk” and an easier decision by all to move on to bottle feeding and related alternatives.

We always cherish in conducting research and big seminars on breast feeding issues and its remedies, but have we ever thought of addressing the issue of PPD, which I believe is easy to screen and detect, and hopefully mange, also. Unfortunately, in our society, seeking an advice for mental health and its related experts is akin to declaring oneself as “mad” or mentally sick. Alternatively, the elders and husband label this situation (PPD) as being normal.  Its high time that we think out of the box and also look into this important dimension, rather than prescribing and promoting recopies for breast feeding, with apparently no significant changes.

Thinking out of box – Malnutrition fiasco

Public Health Professionals

“Insanity is doing the same thing, over and over again, but expecting different results.”

We, in Pakistan, are at least doing same things consistently with ‘malnutrition’; we do the survey, cry over the high rates, bully the government and come with same interventions (but with newer names). And then after few years, we repeat the cycle. In my lifetime, I have been quoting the famous 1976-77 survey and then so on; the latest is being undertaken or may be completed. We, all do the academic luxury by presenting it in 4-5 star hotels, presenting and writing the papers and beefing our CV, in addition to monetary benefits.

I don’t have any hesitation to admit that the only exam I failed was for my Diploma in Child Health (DCH) and the examiner was actually the teacher of my teacher (Prof.  Billoo) and just because I could’nt satisfy the examiner about management of malnutrition in a child; her exact words were “you can’t do a Pediatric practice without proper understanding & management of malnutrition”.  This is also true on a larger scale for Public Health practitioners for managing the malnutrition at a community/district/provincial levels.

Perhaps we all need to appreciate many dimensions related to malnutrition and its management.

  1. There can be a whole spectrum or pathway to malnutrition, starting from normal to at risk, getting into developing obvious signs of complications.
  2. There is a biological dimension & illness-malnutrition nexus.
  3. The social norms, taboos, maldistribution within family/society.
  4. A number of influencing &/or contributing factors other than just food insecurity and poverty.
  5. What intervention, how, by whom and how the malnutrition is being managed
  6. What percentage of time is being contributed to managing malnutrition by mothers, workers, doctors, nurse, hospitals?
  7. Are we doing enough with whatever resources we have got? How many success stories do we have on a small scale and how many have many have been scaled up.
  8. Is there a strong political will and commitment or is it just restricted to policies, strategies, big reports and a big push by the bi-laterals or multi-laterals (donors).
  9. Above all what are we focusing; on promoting good nutrition, preventing malnutrition or managing malnutrition.

As a “hopeful-pessimist” (or sarcastic), I don’t expect large and longer-term investment by respective provincial and even federal governments, except for knee-jerk responses or project-oriented (max for 5 years) by donors and lenders. Unfortunately, it appears that we act too late when the malnutrition (wasting or stunting has developed); the worst part is both are difficult to manage and need higher-cost.  Even disturbing ritual related to malnutrition is mis-interpretation & abuse of “growth chart” when it is used to pick up malnutrition and send the data at a higher level to be fed (in computer) and reported; neither instant action is taken by community health worker nor the manager except to put it in the report and present as needed. As big “nutrition advocates” we join the bandwagon of ‘multi-sectoral’ approach without appreciating the fact that at the end the malnutrition has to be managed by a health worker working at some level—from a community to hospital.

So do we keep on doing the same…… Let us think out of the box!!. Let us go back to basic of Public Health.

  • Why can’t we put our efforts on “positive-deviant” approach and understanding why in the same community some children are still healthy.
  • Why not put our efforts on maintaining the good nutrition of a child (and for that matter her mother’s).
  • Why not pick a child when the growth on “growth-chart” starts faltering rather than wait to let him/her slip into malnutrition? It is much easier and less costly to adopt this approach for promoting good nutrition.
  • Why can’t mother herself and mothers in a community be taught to handle nutritional status of their children by using social media and digital technology?
  • Why not address adolescent girls before their marriage rather than giving iron and nutrients at the time of pregnancy.
  • Above all, whatever we keep on doing, if we don’t address rapidly expanding the population, we will just keep on adding more malnourished children in our community.

Well, one can say, these all are being done!  However, I would contest that based on my observations, discussion and some actual work. For those having some academic flavour, please refer to my few papers (through the web) related to risk approach, P in GMP, undernutrition in squatter areas, intermittent growth monitoring, on rickets etc.  Even if all or something has been done, it must be a time-bound, projectized and small-scale approach.  Of course, more inputs are needed for discussions and actions.



Measles and miseries: A gift or curse

Measles was described by Muhammad ibn Zakariya ar-Razi (860-932) or Rhazes – a Persian philosopher and physician, in the 10th century A.D. as a disease that is “more dreaded than smallpox”. Razes published a book entitled “The Book of Smallpox and Measles” (in Arabic: Kitab fi al-jadari wa-al-hasbah)[1]. Interestingly a lot of myths and misconception had been carried with Measles, especially calling it as “Sheetla Mata” (the gift of Goddess)[2] and/or “ouri Maata”. Interestingly while working in one of the Hindu communities in an urban squatter of Karachi, I had observed that the child who had developed Measles was put in a separate room and it was pretty cleaned with some ‘Naeem’ branches. In fact I had heard from my parents and some elder relatives that it is much better to allow the disease to come out rather than suppress it. I thought that these must be related to a particular ethnic group or religious group, however, while discussing just yesterday with one of the colleagues, I was told that in Sindh in Muslim families, this myth still persists.  However the children are managed differently. They are not give bath, the room is not cleaned, rather closed and to add to miseries, other children are also put in that room, so that they also “benefit” from this gift!!!

Almost 4 decades back, as a student and then as House Officer, I had seen not only the early signs but also all types of complications ranging from, Koplik’s spot, Maggots in mouth (because of unhygienic conditions and Pneumonia and meningitis.  Unfortunately, we are still having Measles complications being manifested as Pneumonia, ultimately leading to death.

The recent WHO estimates about the status of Measles in Pakistan are very disturbing to all of us. We are still grappling with communicable diseases, without realizing that quite a population has now also contracted non-communicable diseases and last but not the least, MNCH/RH issues and rapidly aging population.  Of course not to forget the rapidly increasing population which is adding more and more and children.

The government alognwith bilateral and multilateral partners have been coming up with lot of projects/interventions including the so called “surveillance system, the vaccination campaigns and yearly MNCH days etc etc. I really what had happened to all these efforts and suddenly WHO comes with the news that 65% of Measles cases in South East Asia are from Pakistan. It seems that our vaccination efforts has not made a difference due to ineffective surveillance system which has not been able to pick due to faulty data; ineffective vaccination; lack of awareness and willingness to vaccinate their children and above all no advocacy by our leaders to make a difference.

Considering a health systems approach, availability of vaccines by GAVI may be just one component, converting it into success will require the need to put attention on other components. We have yet to get rid of Polio, but if take that “single-targeted” approach for controlling the immunizable diseases, we may not achieve our targets in the so many future targets.  Let us do something out of box; there are examples of success stories from different parts of the world, it is high time that rather than inventing a new wheel, we try to adapt the wheel already prepared by someone



Political will or ill-will: The case for “Population” in Pakistan

The rapidly growing population in Pakistan, and its horrible consequences have been known & articulated by all the stakeholders including especially the Government and donors, besides the civil society.  A quick look at historical evolution to address this issue reveals that at the end of the day, it’s the political will or otherwise which makes a difference.

Modest but impressive beginning

In ’60s, FP (Family Planning was initiated by an NGO, which made a big difference to capture the attention of Government and later within some decades we had a formal Ministry of Population Welfare and a famous program of Village Based FP Workers along with mobile clinics etc.  Interestingly this was even before the existing Lady Health Worker Program

Good intentions but bad consequences

The Government appeared to have good intentions in having two ministries i.e. The Ministries of Health,  and Population Welfare at Federal level and similarly at the Provincial level.  Perhaps the rationale may be to have focus and desired emphasis on population issues.  However, this artificial divide resulted in compartmentalized approach by putting all the health related issues to Ministry of Health, except for FP; though some lip-service was still maintained.  This issue has further worsened by the devolution in Pakistan and each province is addressing this issue separately; some not paying attention because ‘their’ population is already very low and thus federal distribution of money is also less!!

Playing with Population data

The population have been produced but there had always been issues related to projections and of course fudging of the data at health services delivery levels because of stringent requirements and consequent punitive punishments.  Thus, usually, with few exceptions, the news was that all is well and we are slowly progressing in increasing our contraceptive use rates and the consequent indicators. It was untill when PDHS 2007 and later on 2012 revealed that all is not well.  I remember that the Ministry of Population Welfare held back the results for more than 6 months.  In the meantime several surveys and consultancies (Technical Assistance) work had been conducted to identify the reasons and suggest the solutions. Of course each time we came up with the ‘old wine in a new bottle’.

FP agenda further widened & its consequences

The ICPD agenda and further declarations coined the word for ‘Reproductive Health’ (RH) and then even Sexual and Reproductive Health and we joined the bandwagon as part of political will and international signatory.  I have all the fears that it further diluted the FP focus but opened up the doors for new interventions. This followed the advocacy for Adolescent Health, Abortion Rights, Women sexual and Reproductive Health and lot of talks on population bulge, the demographic dividends etc etc.

Failed efforts for integrating Health & Population

There had always been growing realization that population is part of health and why not the two Ministries be at Federal (before devolution) and Provincial levels be merged. There have been lot of efforts by the UN agencies to make it a reality and I know that even there was all the willingness to do it by the head of state, but just because of one of minister it was postponed and in a way cancelled.  There are some services provided by both the Departments’ outlets and outreach workers but still each one respectively reports to their parent department.  In addition, though some efforts had been made by the other sectors such as education, it has not made a big difference.

Should we keep on using the old wine in a new glass? The way forward

“We cannot solve our problems with the same thinking we used when we created them”, Albert Einstein.

One might be shocked when you start calculating the amount of money put by the Government as well donor agencies and international NGOs to address the issue of FP. Interestingly, most of the NGOs and implementing partners have always showed that they have made a difference in their 1-5 years project. Unfortunately, when money and inputs finishes, all goes to ground zero and no replication, what to talk about scaling up.  Perhaps, all the stakeholders and champions have to make some ‘hard’ and ‘bad’ decisions. It appears the existing government and may be the coming government will not have FP in their political agenda, as they have so many other ‘pressing issues’ to tackle.  But, the question is, has any bilateral, multilateral and Bank has to courage to make these steps; or should we leave it to civil society or at the last to people themselves.  Maybe, let us leave it to Allah, as now we have major populist Islamic dominance who are also not in favour of addressing FP issues.

Educational & Intellectual corruption: The case for Medical & Public Health fields


What is it ? 

Corruption is the abuse of entrusted power for private gain. It can be classified as grand, petty and political, depending on the amounts of  lost and the sector where it occurs. We in Pakistan, have been discussing, especially in cable networks & social media about the “corruption” in context of money, especially after PANAMA leaks and very recently the Paradise leaks. However, another big evil in our society has been the “educational corruption”; it usually follows or sometime exclusively exhibits as “intellectual corruption”. I was surprised to see by searching in Google, About 7,960,000 results (0.51 seconds).  Like other fields, corruptions in medical and Public Health is not an exception.

Story of Medical education & practise

The story begins with admission in a “private” medical college, where special seats, foreigner seats or donation-based admissions are highly promoted. I am witness to a parent (landlord) who wished to get her daughter admitted and I suggested him to actually use the money (quite a lot at that time) to give it to her as a dowry. He in fact said that she is becoming a doctor to get some good name and a proposal matching to their standards.  This follows by the “tuition” system, whereby there is a longer & shorter duration contract along with the guarantee to pass the student; of course all manged by the respective faculty member.  Well, leaking paper is of course no exception and even ignoring cheating being widely practised. More interesting is the fact that when an “honest” teacher (usually a Head of Department) sends the results without maneuvering, the respective University staff sends it back mentioning that there is something wrong as 10-15 students have failed in that subject.  Thus, the Principal calls him and argues by mentioning that since the parents are paying handsome money, they expect their children to pass each year.  The story keeps on for internship whereby cronys are entertained and even the post-graduate exams. in which there are some ‘favourite’ candidates.

The Public Health saga

The Public Health education is even much worse than medical education.  Here there is a bigger motive and incentive for owners/managers of the institution to earn money at any cost.  This would mean admission criteria will be wavered off, entry exam will be easy, and any candidate having completed 14-16 years of education will be legible to admission. Then, there will be half-a-day, evening , weekend and even no classes and of course exams and results may also be manipulated. The external examiners for thesis will be the ones who are ‘well-wishers’ of that institution.  Above all the faculty is told that as long you are able to get the admission of X number of candidates, your job will continue.  So the poor faculty, has to do their best to get enough students and have a “good” reputation, so that the cycle keeps repeating.

All the above results, inevitably, into the products who are out there in various institutions and hospitals and serving people and various other stakeholders. There is another dimension to intellectual corruption which is observed in health related institutions, whereby the employees (of any level tend to keep on neglecting the truth & denying the facts, just because that’s not their organization’s ‘punchline’ or more so because they don’t want to get labelled as ‘bad’ guy at the cost of losing their jobs.

The consultancy gimmick

The other intellectual corruption, is practised in awards of contracts, whereby networking, under-table deals or already decided party is unduly favoured. The reports prepared are ‘modified’ to suit all the audiences and only those points are highlighted in big ‘dissemination’ seminars which suits to bot donors and the ones who gets the money; sometimes even for the government department. Highly talented experts sitting in government institutions either keep quite to promote/advocate what the big ‘bosses’ wish to project; they even don’t argue in those high level meetings.

Is this reflecting our society??

Well, one can say that is an echo of a frustrated person, however I can bet that most of us may have encountered, observed or heard stories shared above.  How long can we keep on acting like a hypocrite in spite of the fact the truth is something else.  We are not only producing but also setting the role models as to who can be successful in the medical and public health career.  Can some of us, stand up and play the role of  “whistle-blower” and point out the evil-doers. Perhaps we, including myself are afraid to do this.  However, I fear that I will, like others may be made accountable for not doing anything against this “zulm”. MY only satisfaction could be that I am trying to show just the tip of iceberg and really fear of the consequences.  May be its the reflection of our society which has deteriorated to that extent.

TAKE OUT “GUNJAISH” گنجائش نکالیں

In Urdu, like for any other language there are so many unique words which may not have the exact translation or meaning as it may have otherwise. In addition, some words (just as Arabic), in Urdu have so many meanings and could be attributed to a particular situation.

So what would be probable meaning of Gunjaish?? Let me try some of them:

  1. If you are shopping and trying to bargain then you can use it for suggesting discount !!
  2. To be considerate or accommodative
  3. To forgo and forget
  4. Let it go

So how all this started; this can be a usual situation; you are supposed to be in a meeting or attending a workshop or attending any party at a described time and place. You out of good etiquette reach on time (may be with many others) and the ‘Facilitator’ of meeting or workshop is also there but there are few (or even half of them) who have not turned up.  Everyone is waiting and/or started looking at their mobile and started surfing around or busy with FB.  Someone like me is anxious to get that meeting done and sort of requests the facilitator to commence it.  And, you get an interesting answer “Dr. Sahib Zara Gunjaish Nikaley”.  And then the debate starts.

We as human beings have not only lost patience but also have forgotten that our behavior are not only reflections of the situation but how we respond, react and attribute to a situation. In that context, we many of the times fall into “stereotyping” and respond, “why should the early birds or those on time suffer for those who are late, may be because they are used to it; or its their habit or do not bother about others. However, there may be some alternate issues which would have delayed the presence in meeting, such as emergency at home; missing the alarm; traffic jams due to VIP moments etc. Thus, then the Gunjaish can have even a wider meaning of “let it go” or be empathic to others. Perhaps, we in this materialistic world have become more of self-centered and wish to see the whole world in our own way.

So giving “gunjaish” is one sided or two-sided.  If the act of delayed reaching at a meeting is deliberate or due to negligence or ill-planning, then why can’t we be more considerate so that others are also do not suffer.  Nevertheless, understanding and practicing of “Gunjaish” has made a big difference to me… so do you?