Nation on the verge of a nervous breakdown

The floods destroying Pakistan’s infrastructure are against a backdrop of corruption, impunity at th

This is the month of Pakistan's birth, the month that a generation once claimed for freedom and liberty. But on 14 August, its 63rd birthday, Pakistan was submerged. There was no fanfare as on previous anniversaries - no noisy street festivals marked by flag-waving and family outings, no young men on motorcycles paying homage to national monuments and shouting slogans into the open air, little celebratory music on state television. Instead, there were vigils, quiet remembrances and a solemn accounting of what has been one of Pakistan's most turbulent years since its proud but bloody inception.

According to the UN, the flooding has affected more than 14 million people, making it Pakistan's worst ever natural disaster. The government claims 20 million people - roughly 12 per cent of the population - have been affected. As I write, six million people are in desperate need of food aid, more than three million children are at risk of contracting fatal waterborne diseases, and millions more are displaced. Over two million acres of agricultural land have been ravaged. With the monsoon season still upon us, Pakistan's food belt, Punjab and Sindh Provinces, has been hit especially hard.

As the country suffered, the entire top echelon of the Pakistani state - led by the rapacious president, Asif Ali Zardari - embarked on a tour of Europe. First up was a visit to France: a handshake with the Sarkozys and then a jaunt to the president's private chateau. London was next, and the itinerary barely unchanged - handshake, swanning around, photo opportunities at stately houses. When asked by the BBC why he had abandoned his country as floods raged from the northernmost province to the southern tip of Pakistan, Zardari cleared his throat and replied that parliament was in session and that he, as a munificent democrat, had empowered others to deal with the dis­aster; the prime minister, Yousuf Raza Gilani, was on duty.

But even the city of Birmingham was not far enough away from Pakistan to protect Zardari from outrage at his feckless rule, as an old man, a supporter of his own party, lobbed two shoes at the president while he was addressing a crowd of British Pakistanis. Zardari's machine was quick to block reports of the attack appearing on Pakistani television channels and to restrict access to websites that carried accounts of how the shoe went flying towards the ducking president.

Back home in Pakistan, a scandal grew over parliamentarians who had fudged paperwork to claim that they possessed academic degrees - once a condition of participation in provincial or national politics. So far, of the 47 MPs shown to have bogus degrees, the largest number of offenders came from the president's Pakistan Peoples Party. One of its coalition partners, the Pakistan Muslim League (Nawaz), had almost as many.

In the southern city of Karachi, meanwhile, human rights groups estimate that roughly 300 politicians and political activists have been murdered this year. In the first week of August, Raza Haider, a Sindh assembly member for the Muttahida Qaumi Movement (another coalition partner), was gunned down at a mosque. Since then, more than 50 people have been killed and another hundred-plus wounded in ethnic and partisan attacks. The response of the state, through the unelected minister of the interior, Rehman Malik, was to empower Karachi's elite Rangers squad with "shoot on sight" orders. More blood to quell the bloodletting.

The disasters pile up

There is worse. This year alone, Barack Obama's White House has sanctioned 70 Predator drone attacks on the north of the country, with one suspected attack ordered while the floods raged, killing 12 people. The Pakistani state, eager to be as willing an ally as possible without adding 49 stars to the national flag, has allowed the US to kill and maim from on high, resulting in the deaths of more than 200 unnamed, unindicted and unconvicted Pakistani citizens.

In the past month, Pakistan has also suffered its deadliest civil aviation disaster. A commercial airliner crashed in the Margalla Hills north of the capital, Islamabad, killing all 152 passengers on board. Families were distraught when the interior minister appeared on television to announce the surprise discovery of five female survivors of the crash only to return and admit that he had made a mistake.

As the disasters pile up, Lieutenant General Nadeem Ahmed, chairman of the National Disaster Management Authority, has estimated it will cost as much as £38m to fix the damage from the floods to highway infrastructure. Half that amount would be required for dam repair and maintenance. But the nation's coffers are empty. The hobgoblins at the helm of Pakistan's teetering state fail to remember the words of our founder, Muhammad Ali Jinnah, to those who would build Pakistan from nothing, raising a new nation out of centuries of colonial rule and violence: "I may tell you that unless you get this into your blood, unless you are prepared to take off your coats and are willing to sacrifice all that you can and work selflessly, earnestly and sincerely for your people, you will never realise your aim."

These floods are the cost of Pakistan's endemic corruption and political malfeasance. The vast numbers of people affected by the disaster multiply every day. They join the millions of other forgotten Pakistanis living in fear, hunger and homelessness.

This year, we marked our birth in silence.

This article first appeared in the 23 August 2010 issue of the New Statesman, Pakistan

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The proposed cuts to junior doctors’ pay will make medicine a profession for the privileged

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged.

The emblem of the British Medical Association (BMA), the trade union for doctors in the UK, symbolises Asclepius, who was believed to be the founder of western medicine. Asclepius was killed by Zeus with a thunderbolt for resurrecting the dead. In the same way, the proposed government-led contracts to be imposed on doctors from August 2016 may well be the thunderbolt that kills British medical recruitment for a generation and that kills any chance of resurrecting an over-burdened National Health Service.

The BMA voted to ballot their junior doctor members for industrial action for the first time in 40 years against these contracts. What this government has achieved is no small feat. They have managed, in the last few weeks, to instil within a normally passive profession a kindled spirit of self-awareness and political mobilisation.

Jeremy Hunt is an intelligent man with a first-class education. This makes his ill-fated proposed contract appear even more callous rather than ill-judged. Attacking the medical profession has come to define his tenure as health secretary, including the misinformed reprisals on hospital consultants which were met not only with ridicule but initiated a breakdown in respect between government and the medical profession that may take years to reconcile. The government did not learn from this mistake and resighted their guns on the medical profession’s junior members.

“Junior doctor” can be a misleading term, as we are a spectrum of qualified doctors training to become hospital consultants or General Practioners. To become a consultant cardiac surgeon or consultant gastroenterologist does not happen overnight after graduating from medical school: such postgraduate training can take anywhere between 10 to 15 years. This spectrum of highly skilled professionals, therefore, forms the backbone of the medical service within the hospital and is at the forefront of delivering patient care from admission to discharge.

Central to the opposition to the current proposed contract outlined in the Review Body on Doctors' and Dentists' Remuneration is the removal of safeguards to prevent trusts physically overworking and financially exploiting these junior doctors. We believe that this is detrimental not only to our human rights in a civilised society but also detrimental to the care we provide to our patients in the short term and long-term.

David Cameron recently stated that “I think the right thing to do is to be paid the rate for the job”. This is an astute observation. While contract proponents are adamant that the new contract is “pay neutral”, it is anything but as they have tactfully redefined “sociable hours” as between 7am and 10pm Mondays to Saturdays resulting in hardest working speciality doctors seeing their already falling inflation-adjusted pay slashed by up to further 30 per cent while facing potentially unprotected longer working hours.

We acknowledge that we did not enter medicine for the pay perks. If we wanted to do that, we would have become bankers or MPs. Medicine is a vocation and we are prepared to sacrifice many aspects of our lives to provide the duty of care to our patients that they deserve. The joy we experience from saving a person’s life or improving the quality of their life and the sadness, frustration, and anger we feel when a patient dies is what drives us on, more than any pay cheque could.

However, overworked and unprotected doctors are, in the short-term, unsafe to patients. This is why the presidents of eleven of the Royal Colleges responsible for medical training and safeguarding standards of practice in patient care have publically stated their opposition to the contracts. It is, therefore, a mystery as to who exactly from the senior medical profession was directly involved the formation of the current proposals, raising serious questions with regard to its legitimacy. More damaging for the government’s defence are the latest revelations by a former Tory minister and doctor involved in the first negotiations between the BMA and government, Dan Poulter, implying that the original proposals with regard to safeguarding against unsafe hours were rejected by Mr Hunt.  

The long-term effects of the contract are equally disheartening. Already, hundreds of doctors have applied to the General Medical Council to work abroad where the market price for a highly trained medical profession is still dictated by reason. With medical school debts as great as £70,000, this new contract makes it difficult for intelligent youngsters from low-income backgrounds to pay back such debts on the modest starting salary (£11-12 per hour) and proposed cuts. Is medicine therefore reserved only for students from privileged backgrounds rather than the brightest? Furthermore, the contracts discourage women from taking time out to start a family. Female doctors form the majority of undergraduate medical students – we should be encouraging talented women to achieve their full potential to improve healthcare, not making them choose unfairly between work and family at such an early and critical stage of their career.

Postgraduate recruitment will therefore become an embarrassing problem, with many trusts already spending millions on hiring locum doctors. Most hospitals are not ready for Hunt’s radical reforms as the infrastructure to supply seven-day working weeks is simply not available. With a long-term recruitment problem, this would also be a toxic asset for potential private investors, should the health secretary venture down that path.

Jeremy Hunt has an opportunity to re-enter negotiations with the BMA to achieve a common goal of improving the efficiency and recruitment to the health service while protecting patient care. Although the decision for industrial action should never be taken lightly, as future leaders of clinical care in the UK, we will do everything in our power to defend against such thunderbolt attacks, by men playing god, the integrity and dignity of our profession and on the quality of care it delivers to our patients.