The recent scandal concerning a Pakistani company issuing false academic diplomas and degrees for money has upset a lot of people. Many have claimed that all this has brought a bad name to Pakistan. Even our interior minister has taken on this scandal almost as a personal affront. All the law enforcement arms of the government are on this job amain. But for most of us this entire activity looks strange and entirely peculiar.

The government is going nuts about a company handing out false degrees and diplomas to foreigners but cares little for the sorry state of education within the country and least of all about thousands of men and women that are practicing medicine without any diploma or training of any sort. If we exclude diseases due to poverty and unsanitary living conditions, the major healthcare crisis in Pakistan is the hepatitis epidemic that kills thousands of people every month. And most cases of this deadly disease are spread by unqualified medical and dental practitioners often referred to as quacks and by improperly supervised blood banking services.

Almost every Pakistani from the poorest to the richest has a relative or a close acquaintance suffering from Hepatitis B or C. Fortunately, newer treatments for these once fatal diseases have been discovered but for the poor in Pakistan that can barely afford a full meal every day, such medicines are like a pie in the sky. Also, in spite of all the claims by the Punjab government, neither the problem of quacks, nor of substandard blood banks has been taken care of. And affordable, appropriate, and accessible medical care is not available to a vast majority people.

What, however, is even more discouraging for me as a physician and a former teacher of medicine is the fact that our present system of medical education is rapidly deteriorating. We are approaching the point where even the official diplomas awarded by many of our state run medical colleges and ‘universities’ as well as most of our private ‘for profit’ medical colleges will not even be worth the paper they are printed on. Exceptions in this case prove the rule.

Fortunately, we still have intelligent and hard working young men and women that go through these medical education environments (no I won’t call them colleges) and essentially teach themselves. Considering post graduate training, here again these self-motivated new graduates learn enough to go on and actually practice medicine that is safe and of good quality. Many of the best students coming out of our so called medical educational system try to go abroad for further training. Sadly those that leave rarely come back and the few that come back are forced out of the medical colleges and universities to pursue private practice.

During the middle and the later part of the last century, many of the best and the most ambitious of the young physicians graduating from our medical colleges went abroad for further training. Most of my teachers in King Edward Medical College (KE) had received advanced training in the United Kingdom. Of my generation of medical graduates, many went to the United States for advanced training and few came back. During my years on the faculty of KE, a majority of the professors in most disciplines had been trained in the UK and a few like me in the US.

Today most of the teaching staff in KE is locally qualified and the last time I checked, there were no foreign qualified PhDs teaching the undergraduate students. During my time as a student in KE almost every basic science professor and assistant professor was so qualified. As a consequence our medical graduates are rarely taught about the latest advances in medicine that are related to basic sciences. This creates an interesting problem particularly for those graduates that want to proceed to the US for further training. Certain examinations have to be passed before our graduates can apply for training positions in the US.

Most of the stuff asked in US-based examinations is not even taught in most of our medical colleges. I found this out when I was on the faculty at KE. Even though I ran a specialised department of cardiac surgery, I would get many of the top qualifying students applying for house job positions in my department in Mayo Hospital. I could never figure out why so many top graduates wanted to learn about cardiac surgery. There were two reasons as I found out about my department’s popularity.

First, since we had no emergency room coverage so my house surgeons had few night calls and therefore a lot of time to ‘study’. Study what I asked them and the answer was for the US exams. Evidently they were never taught what they needed to know to take those exams. The other reason was that being US trained myself, my recommendations for them when they applied for training positions in the US would have some heft.

However, at the same time I learned how bad the medical education in some of our state medical colleges had become. As the chairman of the department of cardiac surgery, I was forced to accept applicants for the position of Master of Surgery (MS) in Cardiac Surgery. One of the applicants was a graduate from a well known state medical college. On medical rounds I asked him what an ‘ovum’ was. He had no idea what that was and when I asked him what Obstetrics was, he was equally clueless. Of course his ‘diploma’ stated that he was authorised to practice Obstetrics.

What then is the point of this discussion? Dear reader the physicians coming out of our medical education system might be quite competent to treat your diarrhoea, but don’t ask them whether you (if you are a woman) need a preventive removal of your breasts because you might have the BRCA1 gene that Angelina Jolie, the actress, has. I am sure that many if not all the Pakistani trained doctors will look at you when you ask that question as if you are an alien from the Planet Ork. And yes, the quack treating your diarrhoea is equally competent in that respect.

That then is my question to our interior minister, Chaudhry Khan. Sir you and your family can afford the best medical care that is available in Pakistan and that is pretty good, but what have you done for the poor and the disadvantaged that are being treated by persons without any medical diploma or training? I realise that Axact excites you. But what about all the supposed medical colleges (including the non-Allopathic) that are awarding ‘sham’ degrees to Pakistanis and as a consequence cause major death and deprivation to ordinary Pakistanis?

I realise that health is a ‘provincial’ subject but so is education. But then, Axact is about education so then why is the federal government so intimately involved in this situation when the bad state of education in the entire country is of no consequence? And if the Axact situation is not about education then what else is it about, terrorism?