Rawalpindi: The label should have made it clear that the medicine was not for people. With pictures of camels, horse and cows as well as the words “veterinary use only”, there could be little doubt about the type of patient meant to receive the vial of steroids.
Yet as far as the poor and often illiterate patients being given injections at Mohammad Kashif’s backstreet clinic in Rawalpindi knew, they were receiving the best of care.
His lucrative business was halted one evening earlier this month by the abrupt arrival of Dr Saeed Ashgar, deputy director of Punjab’s Anti-Quackery Department.
As Dr Ashgar burst in through the clinic door accompanied by an armed policeman, the bogus doctor appeared ready to bolt until the health official took his arm and his defiance wilted.
“Many times a quack shows violence and sometimes their nearby relatives come and join in,” Dr Ashgar later explained to The Sunday Telegraph.
Dr Ashgar and his anti-quackery cell are at the forefront of a crackdown on unregistered doctors in Pakistan who officials say are a public health menace. They are normally either totally unqualified, or are operating beyond their remit.
A census of health care providers earlier this decade estimated there were 70,000 “quackery outlets” in the province of Punjab alone — far more than real doctors.
Sloppy hygiene and lax sterilisation, particularly from unqualified street dentists, is blamed for an epidemic in blood-borne diseases such as hepatitis C. Slapdash prescribing of antibiotics is also thought to contribute to a dangerous wave of microbial resistance. Infectious diseases are not spotted and not recorded.
The fake doctors are a symptom of a struggling health care system where too few people have access to a genuine doctor and legitimate medics have a reputation for aloofness and disdain.
“Treatment by quacks is a health care nightmare,” said Dr Mohammad Ajmal Khan, chief operating officer of the Punjab Healthcare Commission.
Faced with a barrage of questions by Dr Ashgar, Kashif at first tried to claim he was a qualified medical doctor, but later admitted his only qualification was in homeopathy.
His backstreet clinic was full of drugs he was not allowed to prescribe, while the bins were full of used syringes. His desk drawer was stuffed with cash and his back room contained shelves of veterinary steroids.
The steroids are one of the most popular treatments given by quacks. The powerful drugs temporarily mask a patient’s symptoms, while providing no long-term cure for their ailment.
Dr Ashgar’s team have the legal authority to lock up premises and to impose fines of up to half a million rupees (Dh26,260).
But quackery is a profitable business and with that comes corruption and collusion. Many quacks operate with the blessing of real doctors, paying them a “rent” in return for using their name and qualifications as cover.
The Punjab Healthcare Commission is trying to enforce professional standards in a province of 110 million people where treatment has until recently been a free-for-all. Of 70,000 unregistered health care providers found in the census, the commission has visited 41,000 and closed down 18,400. Another 9,700 have abandoned their practice. Without addressing the shortage of legitimate health care, however, the battle against fakes will never be won, Dr Khan says.
“Unavailability, non-availability or partial availability of health care facilities are a great incentive for quacks,” he said.
“Because quackery is so prevalent, so rampant ... there comes a point where people have started accepting it as an OK thing and we have to fight this mindset. People think, ‘At least I am getting some service’.”
The unregistered doctors are often well-known and well-liked members of the community. In one case last year, Dr Ashgar was temporarily taken hostage after closing a popular clinic.
The Commission is adamant that the unregistered doctors do more harm than good, however. Dr Ashgar, a former hospital administrator, said his hospitals had to clear up the mess left behind, including amputating the limbs of patients treated for fractures by backstreet bonesetters.
Another problem is infertility caused by infections caught at unregistered maternity hospitals.
The Telegraph witnessed one raid on an apparently well-equipped maternity hospital. The woman in charge claimed she was a qualified doctor, but when her certificates did not stand up to scrutiny, she admitted she only had midwife qualifications.
“I’m shocked because we have been coming here for three months,” said Mohammad Imran who was waiting with his heavily pregnant wife. “We thought she was a doctor.”
Dr Khan said his campaign against quacks was a war, rather than a single battle that could be easily won. “Unless we resolve this issue of access, it will be like trying to fill a bottomless bucket with water,” he said.