As part of my internship experience, I had the chance to visit both a private and a public hospital. I do not lie nor do I exaggerate when I say that there is a world of difference between these two health sectors. I was in a state of shock as I received a tour of one of Karachi’s most populated public hospitals. There were stains from beetle leafs (paan) and tobacco in every corner of the hospital. Fresh blood on the ground as people stepped over it with their sandals without a second thought. There was only one garbage bin for miles around, which too was overfilled. It was difficult to find at least one wash basin, even around the nursing wards. Patients received health care out in the open without any curtains to protect their privacy and dignity. The hospital was undergoing construction while patients were receiving care, thus being exposed to harmful chemicals and dust. What shocked me the most was the hygiene, or lack thereof, practiced by one of the critical care doctors. I observed him as he obtained an alcohol swab to perform phlebotomy on a child. He then started to talk to a fellow colleague all the while rolling that alcohol swab in his hand. They talked for a bit, after which he used that same swab to perform the procedure. We do not know if he had already washed his hands or not. Regardless, the alcohol swab must have become dry in his hands and its effective agents lost. To make it worse, he was not wearing gloves.

Upon leaving that hospital, I concluded that I would rather die then be admitted to this hospital. The sad part is that MANY individuals living in Pakistan and other developing countries do not have the option of choosing which health care facility they would like to receive care in. They have only two options: 1) receive health care in an institution where you may come out sicker than when you came in or 2) become sicker and not seek health care of any sort. These individuals do not have the money or the resources to seek care at well-recognized institutions that provide quality care. However, some health care is better than no health care, right? Private hospitals in Karachi charge an arm and a leg, literally, before providing acceptable health care. If health care is a universal right, then why is there not equal access for such? So the rich not only get richer but they also get healthier while the poor become poorer and sicker. Why such disparity? One of the major causes of this disparity, in my opinion, is governance. Good governance dictates that the people elected to run parliament (ethically or not) of a specific country are directly responsible for the health status of its people. It is a known fact that changes in health spending of a country, significantly affects the health status of its people. Developing countries, where 78 % of the world population lives, spend only 10% of the total world health expenditure. In 1991, developing countries spent only 4.7% of their GNP on health, whereas the ratio was 9.2% for established market economies (EME). In 2006, Pakistan’s total health expenditure was 2.1% of GDP, of which 80% was private expenditure and 20% public. Out-of-pocket expenditure accounts for 98% of private health expenditure. About 2.3% of households are estimated to experience financial catastrophe due to health care costs. Pakistan spends more money on its defense system than health care or education. Military spending in Pakistan accounts for 3.5% of GDP. In 2005, it was close to 4.90%! Additionally, of the 11 billion dollars given to Pakistan as aid money from America in 2008, 8 billion dollars was spent in strengthening the military. However, America’s involvement with Pakistan and its army is a whole different issue that one can write a book about it! Regardless, changes in health expenditure eventually affects the people who rely on government services for their well-being. When government services are not up to par or lacking, then the people left to seek the services of private enterprise whose quality of services may be excellent but nothing comes without a price. In this case, the price can be quite hefty and can even claim a life.

I would like you to reflect on these two stories which were in a local Pakistani newspaper:
1) “My wife suffers diabetes. Her feet are now swollen and she often feels tired. Apart from medicines, the doctors have suggested a special diet - but how can we afford to give her fruit and meat when I earn only Rs 8,000 [about $106] a month and must educate my children as well,” said ______, 35, a father of two. ______ suffers from a shortage of breath, but says: “If I go to a doctor they will prescribe expensive tests and medicines and I cannot afford them. Therefore I simply do not go”.

2) “I suffer from hepatitis C. Please help me live by giving your charity to help me buy medicine. I have five children who depend on me.” Thus reads a placard next to ________, who has taken to begging on the streets of Lahore in her spare time in a bid to afford the medicines, which could save her life. As a cleaner she earns about US$40 a month. On this income and about $53 handed over each year by her brother, she must support her children - the eldest of whom is 15. Her husband, a drug addict, abandoned the family two years ago. “I don’t know how I contracted hepatitis C. It could have been when my youngest daughter was born about 18 months ago. A dai [traditional, untrained midwife] delivered her. But now doctors say I need injections that cost at least Rs 50,000 [$666] for a six-month treatment plan if I am to live,” she said. “I beg, even though I hate doing it, because somehow, for my children, I must live,” she said.