A curing system that heals by name, but disseminates malice silent.
This does not mean failure, but a trend.
The country experienced one of the worst public health crises in Taunsa Sharif and Ratodera. Parents took them to get regularly treated, because of fever, because of weakness, because of the common ailment. And most went away with something much worse. The condition of HIV which was later diagnosed in hundreds of children was life altering as they did not choose the condition, nor did they understand it. Enquiries were made into dangerous injection, re-imbursement syringes, and a set of clinics which had lost the lowest possible standards of care. The anger was extreme, but it was short-lived. Promises were made. Committees were formed. Then was there a restoration to what always was.
The trend reoccurred several years later. In Taunsa, a state hospital that was intended to take care of the impoverished was the focus of another scandal. An investigation by BBC uncovered the truth behind the hospital walls. Hidden cameras showed the reusing of syringes, neglect of hygiene, and treating patients like numbers, rather than a life. The effects were catastrophic. Hundreds of children became HIV infected beyond 2024-2025. The hospital even denied it when evidence of this malpractice emerged. This rejection was no big surprise. It was its expression of a system that has learned not to change its core in order to absorb scandal.
This is not a crisis of a single hospital, or a single district. It is based on a healthcare culture of overuse of injections and their seldom questioning. The unnecessary therapeutic injections are high in Pakistan; Pakistan ranks among the highest globally. Patients expect them. Providers encourage them. Every injection is practiced as is commonplace, without due caution. However, the basic infection control routine is hazardous. One used syringe is capable of transmitting disease to multiple patients. Multiplication of risk is silent and unannounced in such a system.
That culture is based on a deeper structural failure. A lot of clinics are run without much regulation. Unskilled assistants carry out activities which need expertise and training. Sterilization is ignored. There is poor record keeping. Safety becomes optional. Unsafe syringes and poor injection control have long been warned against in Pakistan, reports by World Health Organization and UNAIDS have indicated that there is danger in Pakistan due to injection safety and inadequate infection control. The knowledge exists. The guidelines exist. Enforcement is lacking.
The politics, bureaucracy, and an informal economy that feeds off on suffering of the population perpetuate the crisis. The issue in the provinces such as that of Maryam Nawaz and that of Murad Ali Shah is never the lack of policy but the lack of political goodwill to implement it. Systemic reform is a disadvantage in political priorities due to the interest in visible projects. Another new building, a hospital building, catches the eye. An effective sterilization procedure does not. This causes the more profound failures to be left unchanged, even when the same crises perpetuate.
Then, the red tape weight comes in. The procurement systems are inflexible, stratified, and prone to manipulations. Depending on the paperwork that goes through bureaucracy, hospitals fail to attain promptness in delivery of the basic supplies. Unsafe practices grip in this vacuum. Workers are shaving off ends to make ends meet. A single use syringe is re-used. It is not necessarily a sacrificed safety that was purposely done, but rather because of a system where doing right would be hard, and doing wrong would be easy.
In this busted chain, a parallel economy flourishes. The diversion involves medicines and supplies that should be consumed in the public hospitals to end up in private markets. This cannot be classified as petty theft. It is powered in a network. They steal it and push into the market by the insiders, sell it over the counter by the middlemen, and people, the very group of which was to get it free of charge, buy it back again in the local pharmacies. The patients will be compelled to purchase medicines that are already paid by the state. The good intentions to provide free healthcare fail at delivery. What was to have been a right, turns out to be a transaction.
This unofficial system is sustained by the poor accountability. Inspections are inconsistent. Documents are manipulable. Grievances do not go beyond documentation. In case of exposure, one can only respond to suspensions or transfers. The building has not been demolished. Bonuses do not change. Provincial governments are in charge of healthcare under the 18th Amendment of Pakistan. It involves control, manpower, purchasing and policing. Unsafe injections that transmit disease when supplies run out at hospitals are not lone errors but failures of governance.
These forces are brought together on day-to-day risk at the ground level. When a hospital is in need of supplies but delayed by procurement it resorts to reuse. Untrained staff are employed in a clinic that does not bother with regulations. A patient that is unable to avail free medicine is led into the private markets. Failure breeds failure. The outcome is to have a system in which unsafe activities are not an exception. They are routine.
Physicians usually give the reasons as pressure, poor pay, and congestive wards. These are significant issues. Yet there is no reason to neglect the general safeguard. They fail to explain how the untrained assistants are allowed to carry out the medical procedures and why infection control can be considered as an option. Once a system condones carelessness, people tend to do so as well. With time the boundary between constraint and complicity starts to blur.
In Ratodero to Taunsa, the trend is evident. Unsafe injections. Infected children. Official denial. Public outrage. Then silence. There are more victims with each outbreak and the answers to the questions are fewer. The rec-occurrence is no coincidence. It embodies a systemic arrangement, in which abuse is tolerated.
This is not mere mismanagement. It is a social health mishap that continues to be ignored due to lack of reprimand. Basic necessities include clean, disposable needles; trained employees; and close supervision. There is obvious corruption behind the lack of providing basic, safe healthcare. The system cannot fail since it is ignorant. It does not work, as it is not accountable.
The promise of healthcare is simple. It must be good, not evil. In Pakistan, there are too many broken promises. Until enforcement becomes the norm rather than the rhetoric and accountability is enforced to replace denial, the needle will be, not a symbol of care, but of danger.