How the government fails the nation’s nurse
As harsh as it may sound it is a fact that a large number of nurses in Pakistan are, by and large, neither skilled nor trained. Only a small number of nursing students receive proper education and structured training in their schools and training hospitals. Very few of the 162 nursing schools in Pakistan have a properly trained faculty to teach theory in classes, or clinical teachers to train nursing students in the outpatient department (OPD), and wards and other important areas of the hospital.
A majority of nursing schools are facing shortage of human resources because of unavailability of funds and lack of interest by authorities at the federal and provincial levels. Many nursing schools are established in rented buildings and are not attached to any hospital and students are awarded a diploma in nursing after completing their so-called ‘course work’. The nurses also often face sexual harassment and are exploited by doctors, male paramedics, hospital administrators and owners, patients and their attendants. It is sad that in majority of the cases it is the nurses who are blamed for the acts of omissions and commission by others in the system.
In 1935, before Partition, a training programme for nurses was started at Civil Hospital Karachi, which was followed by similar programmes at Lady Reading Hospital Peshawar and Mayo Hospital Lahore. The Pakistan Nursing Council (PNC) was established in 1948 and the Nursing Council Act was passed in 1952, which was amended in 1973 after East Pakistan became Bangladesh and the four provinces of West Pakistan were restored.
The PNC was supposed to be an autonomous and independent body regulating nursing education and training in Pakistan by helping provincial nursing examination boards and the armed forces nursing services. Because of lack of interest shown by different federal and provincial governments amid powerful interest groups, the PNC has not been able to function independently. In spite of this, the PNC is trying to do its best to improve the state of nursing and midwifery in the country. But it is very difficult for an organisation to work as per its mandate without the support of government and other key stakeholders.
An interesting phenomenon that can be seen in Pakistan is that doctors have also served as members of national and provincial assemblies — of which some became ministers, while some held higher offices such as that of speaker, chief minister and governor. In electronic media — which is arguably as powerful as politics — we have doctors working as anchors and hosts on national television.
Despite this, it can be as said that neither the legislators nor public opinion-makers have contributed anything substantive for the betterment of medical education and training in Pakistan. In fact, the National Assembly and the Senate passed the 18th Amendment Bill in haste and without necessary deliberations. This resulted in making the federal level institutions such as the Pakistan Medical and Dental Council and the Pakistan Nursing Council ineffective. They did not understand that without adequate proper planning capacity at the provincial level it is not possible to design and deliver quality healthcare for the poor people of Pakistan.
Nurses are the backbone of a healthcare system. But in Pakistan, they are poorly trained, underpaid and not valued as professionals
According to the latest official statistics there are 40,879 nurses and 12,488 doctors in Sri Lanka; 154,309 nurses and 66,880 doctors in Iran; while in the USA there are 3.3 million nurses and 730,811 doctors. But in Pakistan it is the other way around: 94,766 nurses and 184,711 doctors. And the irony, as mentioned earlier, is that the majority of these nurses are not well-trained which renders our healthcare system weak. This doctor-nurse ratio also shows how serious our policymakers are about the health of the nation. Our parliament hardly knows about these alarming statistics and the anchors on various TV channels do not even understand the significance of this shortfall.
The Pakistan Medical Association has been demanding that we need an army of paramedics including general nurses, midwives and specialised nurses to run our basic heath units, rural health centres, taluka and district general hospitals to provide primary healthcare to all citizens. A country cannot provide healthcare to its people without competent healthcare workers, of which skilled nurses play an integral role.
In countries like China, Iran and Indonesia, a dedicated cadre of community nurses help in providing preventive medicine to eradicate polio, malaria and waterborne diseases. It is so depressing to see that the chief minister of the biggest province of the country with unlimited resources has to sit with health officials every year to announce his war against dengue fever. I wish he had invested that amount to strengthen the nursing profession in his province, which would have helped in the long term.