ON November 19 2005, a report in the national press under the headline ‘President may intervene in ministry’s row with PMDC’ told us that “credible sources confirmed that even the presidency was watching the war between the Senate, health ministry and the Pakistan Medical and Dental Council with ‘concern’ . . .”. This concern related to “an unusual communication” to the General Medical Council (GMC), London.

On April 1 last year, Professor Sir Graeme Catto, the president of the GMC received a six-page letter on the subject of “Junior doctors trained in Pakistan — Issues regarding fitness to practise” from a gentleman who requested anonymity “considering the fact Pakistan has a dictatorial rule, unfortunately freedom of speech is not a privilege and the exposition of truth in particular is considered to be a threat to the relevant authorities.” (One must disagree with this statement as the freedom we have today we have not enjoyed in the past.)

The writer of the letter, who has “worked in Pakistan for many years in various capacities, finally opting for an early retirement [for] personal and professional reasons,” stated that he is a “witness to the decline in the standard of medical education and health services over the years and in particular to the extremely rapid deterioration which has taken place over the last 10-15 years ...” Copies of his letter were endorsed to the presidents of the Royal Medical Colleges, England, the Royal College of Surgeons and Physicians, Edinburgh, the Royal College of Surgeons, Glasgow and the Royal College of Surgeons, Ireland.

The letter was widely circulated by its recipients to many other relevant institutions within the United Kingdom and Ireland.

The serious issues raised was the steep increase in fraudulent measures adopted by junior doctors trained in Pakistan in order to gain employment in the UK, including concocted CVs, false titles and tenures of jobs, fabricated testimonials, publications and presentations and other numerous acts involving plagiarism — all encouraged by certain senior doctors of Pakistan.

The letter gave details of how Pakistan’s medical colleges and teaching hospitals function (or rather malfunction), and how doctors obtain house jobs certificates without spending a single day in their wards. It described Karachi’s Civil Hospital as a “complete shambles” and “a den of corruption,” it blamed the PMDC, “a puppet of the federal ministry”, for letting medical education fall to the despicable standards it has reached today, it accused the College of Physicians and Surgeons of Pakistan (CPSP) of being out of control of the PMDC as the president of this institution runs it “on a commercial basis collecting exorbitant fees and has been in the chair for more than 20 years.”

Giving credit where credit is due, the writer did say that “there are still a few institutions such as the Aga Khan University, SUIT, etc, that have managed to maintain their professional standards.”

Suggestions were made as to how the British authorities should control the registration of doctors coming from Pakistan so as to ensure that fraudsters and unqualified people are not let loose to do their worst for the health and welfare of the citizens of the UK.

In May last year, the head of registration of the British Medical Council requested permission from the writer of the letter to forward a copy to the PMDC in order to seek its members’ views. Permission was granted by the writer, on condition of anonymity, and he forwarded to the head of registration a dozen copies of cuttings from our national press (this newspaper included) of news items and columns written on the shenanigans and shortcomings of the PMDC and the Pakistan medical scenario.

Una O’Rourke, the senior executive officer, registration, on August 5, 2005, addressed a ‘strictly private and confidential’ letter to Dr Nadeem Akbar, deputy secretary, Pakistan Medical & Dental Council, Islamabad : “I am writing to you regarding the enclosed letter with attachments which has been anonymized and the writer’s name withheld on request. The registration committee has considered the documentation and would appreciate receiving the observations and comments of the PMDC regarding this correspondence at an early date.”

On November 9, the same officer sent a reminder, again attaching a copy of the original correspondence, to Dr Nadeem Akbar requesting a response to her earlier letter, which in typical Pakistani bureaucratic manner had been ignored. She also sent an e-mail on the same date to Dr Akbar asking him to respond. There the matter rests. How can Dr Akbar, or for that matter anyone concerned here in Pakistan, respond? It would be futile for them to deny the charges levelled as the truth is no secret to us here in Pakistan or to those abroad who have a problem to deal with.

It is no wonder that the state of medical education and medical practice in Pakistan leaves much to be desired. This is the case in each and every aspect of education ; the systems are falling apart. Not only are those who run many of our educational and professional institutions unqualified to do so, but they are by and large expert practitioners of graft, nepotism and fraud.

The writer of the letter to the GMC, who wishes to remain anonymous, has cited the example of the president of the CPSP who has sat in the same chair for some 20 years and supervized the on-going degradation of the institution. This gentleman, whose medical academic record does not even glimmer, also wields enormous influence over the PMDC, of which he is a member, and he has a free hand to meddle in all matters, including, inter alia, appointments and recognitions of private medical colleges.

Last year, another council member addressed a letter to the chairperson of the standing committee on health of the honourable and august Senate of Pakistan, which at that time was in the ostensible process of reviewing the alleged malfeasance in the PMDC.

He related, inter alia, how the affairs of the Council were actually run by the secretary under directions from the president. As he put it, “during the years I have served on the Council, the tail has been wagging the dog and the servant of the Council is its de facto master.”

He also, inter alia, related how the secretary, instructed by his master, “pursued a narrow course of serving the interests of an influential group of medical politicians,” and how he has “been a witness to the regular manipulations of minutes of the Council and selective implementation of decisions.”

Now, one would have thought that the Senate committee, had it any commitment to its cause, would have taken some sort of action to rectify matters. It obviously did not. Last November, the Upper House was still wrangling acrimoniously over the subject of the PMDC and the health ministry’s rotten relationship. This is when it was mooted that the President of Pakistan, General Pervez Musharraf, may be called to intervene.

He should, particularly in view of the fact that the matter of doctors trained in Pakistan not being qualified or fit for employment in the UK has now been taken up by the British General Medical Council and various other medical bodies in the UK and Ireland. All power flows from the presidency and from GHQ — from nowhere else. Health is not a joke, neither are quack doctors. The general needs to wield his stick — and swiftly before more damage is done.