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PAKISTAN is a developing country of some 199 million. A majority of its population lives below the poverty line. Access to even the most basic healthcare is limited. The attitude of the majority towards disease, despite living in the 21st century, remains antiquated. There is a huge information void. On the one hand, the public is unaware about disease severity. The lack of a system to keep track of patients, on the other, adversely affects the maintenance of healthcare records. Research into types and patterns of disease is, therefore, practically nonexistent.
According to the World Health Organisation and the Harvard School of Public Health, non-communicable diseases, particularly neurological disorders, contribute significantly to the healthcare burden worldwide. The figures are measured in disability-adjusted life years (DALYs) ie lost years of healthy life due to earlier-than-expected death. The most notable contributors are strokes and Alzheimer’s disease. These result in tremendous loss of human capital. Unsurprisingly, statistics for neurological disorders are unavailable in Pakistan.
That Pakistan remains largely a consumer nation, as far as healthcare information is concerned, is also not surprising. A quick search through Pubmed comes up with no studies that report the prevalence of neurological disorders. Research into the cellular and molecular mechanisms and genetics of these disorders appears nonexistent. The lack of trained faculty members to supervise, and the scarcity of institutions where such basic science research can be conducted further underscores the impediments to knowledge generation.
Pursuing scientific research should be a part of medical training.
The training of medical professionals and delivery of healthcare is also highly variable. This disparity creates a multi-tiered system. A standardised model of healthcare is absent. Only a handful of institutions emphasise scientific inquiry alongside medical training. Yet, there are others that create wholesale professionals. Ironically, about half of the graduates don’t even get to practise. The only overseeing body, the Pakistan Medical and Dental Council, does little to ensure standardised care for everyone. The result is that most suffer whereas those few who can afford the hefty costs have the best care available.
The role of information technology in healthcare management can’t be stressed enough. That IT helps in the proper dissemination of information, assessing outcomes and improving efficiency is an understatement. Despite an official drive to upgrade educational institutions in IT, the vast majority remains compartmentalised.
Communication, even within the various departments of the same institution is negligible. Clinicians work in isolation, without any input to or from the basic sciences faculty. Whatever little research is being conducted, thereby, lacks focus. IT can, indeed, help improve that inter- and intra-institutional cross talk.
Most healthcare schools in Pakistan don’t have operational websites. Hence reaching out to faculty members, if and when particular questions arise, is impossible. The access to such information as faculty members, their research interests and means of contact would indeed be very useful.
Additionally, it is public institutions that handle heavy patient load. That untapped information, if proper medical records are maintained, would lead to large-scale multi-institutional studies. The answers to such questions as prevalence, risk factors, etiology, disease severity, and prognoses would begin to emerge. This would improve the quality of care across institutions.
In developed countries, news media are excellent sources of information propagation. Many major newspapers have sections on various health problems. They are also the first ones to report major scientific breakthroughs.
TV and print media remain underutilised in Pakistan for health-related information. Following the international example, our media outlets should launch health and science sections to disseminate knowledge and redress misconceptions about disease. This will bridge the gap that exists between public understanding of the disease and that of healthcare professionals.
It is said that a problem identified is a problem solved. It is high time we acknowledged that there is a dire need for research both at clinical and basic sciences level. Pakistan is said to produce some 14,000 doctors each year. Their training, however, lacks emphasis on scientific investigation.
Pursuing scientific research shouldn’t be optional; instead, it should be obligatory as part of medical training. Only then can we tackle the major scientific questions that clinicians face today. Through research we will be able to identify areas where resources must be allocated, equitably. After all Pakistan remains poor in resources; research therefore is not a privilege, it is a necessity.
Kashif Majeed is an Aga Khan University alumnus who is primarily interested in the study of the brain.
H.R. Ahmad is a professor of physiology at The Aga Khan University.
Published in Dawn, October 19th , 2015
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