It indeed had been quite a long time that I have not been writing a blog; perhaps my un-wanted engagements or to be more precise distractions to the social media especially FB, which I definitely find more enjoying but time-consuming. Nevertheless though I will sharing my “Journey from Thar to Islamabad” which indeed is very near to my heart but may pushing myself to write the third Episode of that journey had deterred me to share some of my random thoughts.
I am not sure how many of you know about David Werner, but he has been well known working with Hesperian Foundation. And some of my colleagues and friends would bear me out, I had the opportunity to work with him when he visited the Aga Khan University back in 90s. To cut short, he is the author of “Where there is no doctor“, one of the few famous books translated in many languages and a good resource for grass root level workers. Among other works, he has challenged the status qua by ‘questioning the solution’. Its high time that we in Pakistan also start “questioning the solutions”.
The Public Health practices and its focus on improving the health of the people has undergone so many changes/improvements and of course improvement in health status in Pakistan. However, we have also come up as well as recommended a number of solutions which though apparently seem to be working but we are not raising the questions whether its the right solution or not?? Back in 80s David had challenged about the role of village health workers which in our new terminology can be equated with more or less similar workers; to a name a few, are the CHWs and CMWs. When both of these programmes were launched the idea should have been to help the community for ensuring access to basic health services and and in that process make the community/beneficiary to take care of their health by themselves. However, with the recent move for getting more political gains, the services of CHWs have been regularized or recognized by government with some salary. Similarly, the CMWs against what it stands for i.e. the community based and patient-centered care is incentivized for establishing some static facility and push the community for having that care as opposed to old age home deliveries. I am, by no means, asking the planners to move towards deliveries without basic skilled birth attendance, but to just not ask the community to change their whole old-age behavior (see my earlier blog on how my brothers were born) of having their births at home.. by CMWs. Similarly now we are hearing about the so called readily prepared high caloric food being promoted by bilaterals and government (at provincial levels) are ordering it from international markets at a reasonably high cost. Though fact of the matter is that an indigenously prepared high density diet has already been prepared and successfully test by one of my teachers, Dr. DS Akram. Why this diet has been taken by our worthy planners is another long story.
Questioning the solutions has always been fraught with oppositions and repercussions as you are challenging the status qua. Perhaps we all the Public Health Practitioners would have to at least generate the debate on pros and cons especially the economics of this approach; then and then we reach to some better solutions. InshAllah I will be putting more thoughts on these issues; I do not have anything to lose and I can not be part of that “zulm” as I may also be questioned about this on the basis of the knowledge and wisdom Allah has given me.