THE recent focus for Panorama, the BBC’s flagship investigative programme, was the deteriorating quality of surgical tools used by the 180-odd healthcare trusts in the UK.

They tracked the source for the bulk of the surgical tools being used in the UK. The journey took them, to their immense surprise, all the way to the dark and dirty niches of a healthcare industry almost 4,000 miles away in Sialkot, Pakistan.

Punjab’s third largest financial city, Sialkot is essentially the hub for the world’s surgical equipment, catering to two-thirds of the demand for surgical tools used all over the world and producing a whopping 100 million instruments every year. Tools are sent to all corners of the globe, with the United States and Germany being the biggest buyers followed by the UK. Exports of these surgical tools have consistently yielded more than $200m every year for Pakistan for the last couple of years, with the potential for more expansion considering the rising demand in the African and Asian markets.

There are large manufacturing plants in Sialkot which produce top-of-the-line instruments that are properly checked as far as quality-control measures go. At the same time, however, there are also close to almost 3000 ‘outsourcing units’ that are essentially makeshift centres for the manufacture of surgical instruments.

The quality of the instruments produced by these units is compromised to the extreme. Given the huge demand, large plants frequently call upon these smaller units and sell the quality-compromised products under their own brand names, discounting the issue of safety in the process.

The problem with compromised medical instruments is not just that they cause unwanted injuries or cuts during surgical procedures, but they also give rise to a host of other problems. In the case of the UK, they are being blamed as a potential cause for the spread of ‘superbugs’ — drug-resistant bacteria that are almost impossible to treat and which threaten the whole spectrum of rendering antibiotics ineffective, a phenomenon that is deadly to contemplate. Faulty surgical instruments cause microscopic holes in surgical gloves that allow the spread of the superbug.

The surgical instruments made in Sialkot are often stamped as being produced in another country, helping to increase revenue for the producers. The brand name of Pakistan does not carry much weight these days. Meanwhile, the workers in these factories typically earn less than £2 a day.

The situation becomes more dismal when one starts to factor in the child labour prevalent in the industry. Rough estimates put the number of children working in these factories in Sialkot at around close to 5,000, mostly concentrated in the small, makeshift and unregulated units. The underage in the industry help push up profits not only because they are paid even less than adults, but also because they can be made to work for protracted hours without protest from any quarter.

Panorama spent almost two years investigating this murky business, and the matter is not going to rest easily. In the UK, these facts have sparked off vociferous debate which, with the passage of time, is going to gain more momentum. The issue at hand is that quality-control problems with these faulty instruments, coupled with the sub-standard production facilities in Sialkot and child labour produce a toxic mix that can have devastating effects.

If this idea of compromised quality continues to take hold, it may not be long before the US, Germany and other countries also start investigations and potentially cut Sialkot off from their maps — again. We Pakistanis have especially very short memories and worth mentioning here is the fiasco which happened in 1994 when the United States Food and Drug Administration (FDA) imposed a ban on all surgical instruments from Pakistan. The suspension forced the industry to clean up its act and initiate quality-control measures before supplies to the profitable American consumer market could be restarted.

If things spin out of control in the current instance, we could have a repeat of that episode. This will, in essence, deprive Pakistan of foreign exchange and also add to burgeoning unemployment ratios. Even if just the UK, which purchases just one-tenth of the surgical instruments made in Sialkot, imposes a blanket ban, the consequences would be very costly.

Time is of the essence now, and some drastic measures need to be implemented right away. The Chamber of Commerce and Industry in Sialkot needs to come up with a statement clarifying and re-affirming their quality-control measures, emphasising the checks and balances that are in place to stop unscrupulous behaviour. A strict check has to be maintained across the board, right from the big units to the small makeshift factories. Rigorous analysis is essential for every surgical instrument that comes out of Sialkot as this is a matter of life and death for patients the world over, even if not in Pakistan.

The federal government also has a role to play with the establishment of quality-control boards that could help to maintain a system of unbiased and transparent checks and balances. It would even be worthwhile to invest in a taskforce to tackle this challenge head on, as well as draft policy guidelines for the expansion of the industry in the future.

In addition, the menace of child labour has to be abolished completely and a more equitable distribution of profits in this lucrative business needs to be put in place. Storm clouds have started gathering over Sialkot and if protective measures are not undertaken, the fall-out could be very costly.

The writer is a Rhodes Scholar reading for a D.Phil. in Clinical Medicine at the University of Oxford.