Lulua
25-08-2002, 08:57
BMJ 2002;324:1045 ( 27 April )
Reviews
Personal views
A new hazard of medicine
In a tragedy of mounting proportions, doctors in Karachi are facing a grave
risk
on account of their professional identity. In the past three years, more
than 80
doctors have been killed in Pakistan's largest city, ambushed during their
daily
commutes by motorcyclists who deliver automatic gunfire from point blank
range.
Karachi has had a reputation for being something of a powder keg, but no
one had
anticipated it would come to this.
I, too, am a doctor in Karachi. These are not easy times for any of us, but
to
belong to a profession whose members are being senselessly killed is an
experience bordering on torture. Panic has rippled through my city's
normally
thriving medical community. I know colleagues who have fled the country and
left
behind flourishing practices and distinguished teaching positions. Some
have
confined themselves indoors. The rest of us are varying our daily routines,
sleeping over at the houses of friends and neighbours, and exchanging cars
so we
don't get marked by what we drive.
My colleagues are either getting killed or are running away. Our dreams are
shattered, riddled with bullets
Who or what is behind these killings remains a mystery. Someone obviously
thinks
killing doctors is an effective means of spreading terror, but no one
claims
responsibility. The only real clue comes from the religious affiliation of
the
overwhelming majority of victims: all but three of them were members of
Islam's
Shia sect, a minority group in Pakistan.
The stories are heart-wrenching. One recent case was that of a 40 year old
nephrologist who had relocated to Karachi after years of training and
practice
in the United States. He was shot and killed by two motorcyclists while his
car
was waiting at a traffic intersection; he had been on his way to dialysis
rounds. The gunmen disappeared without a trace. In another case, an ear,
nose,
and throat surgeon was gunned down as he headed home following an afternoon
clinic. Both men left behind young children, as did many of the other
victims.
This may be a targeted attack on the medical profession unprecedented in
history. It is a new hazard of practising medicine, because it is our
profession
that is making doctors newsworthy victims in Karachi.
Life goes on, but it goes on in fear. One day recently, after we had woken
up to
yet another newspaper headline about a slain doctor, staff physicians
gathered
together for a meeting at the private university hospital where I work. We
searched for answers, but could go little beyond our grief and rage. People
exchanged notes about bodyguards and bullet proof vests.
The Pakistan Medical Association, the largest professional body of doctors
in
Pakistan, began leading a wave of protest strikes last month in which
doctors
suspend outpatient activities for a day and wear black armbands. The
delivery of
medical care in the city has suffered. On the day of a strike, normally
packed
clinics are deserted and operating lists are pruned down to the most
essential
cases. It goes against the ethic of our profession, but we are desperate
and
scrambling. We hope this will put pressure on the police and other law
authorities, who have yet to produce a major lead.
The goals of the killers are unspecified, though theories abound. Because a
particular religious sect has been targeted, the origins of the attacks may
well
be in religious extremism. The attacks have increased in frequency
following the
events of September 11, possibly fallout from the complex local and
regional
situation that Pakistan currently finds itself in.
My colleagues and I have confronted these attacks with anger and
bewilderment.
After that has come fear, for ourselves and for those we will leave behind.
But
the most depressing reality in this morbid calculus is the unequal value of
lives. When an American journalist was kidnapped in Karachi recently, the
entire
state machinery in Pakistan sprung into immediate action. The killing of
local
doctorseach one a Pakistani citizenhas yet to be noticed with the same
urgency.
Like many others in my position, I have also thought about running away.
But
when I recently learnt that one of my close colleagues had actually done
so, it
jolted me. I am part of a cohort that spent several years overseas in
postgraduate training after finishing medical school in Pakistan. In our
time
abroad, thoughts about returning home sustained us. When we finally
relocated to
Karachi and found the jobs of our choice, we felt we had found happiness.
Now my
colleagues are either getting killed or are running away. Our dreams are
shattered, riddled with bullets and littered with the dead bodies of
doctors who
had committed no crime other than to take an oath to heal.
Footnotes
If you would like to submit a personal view please send no more than 850
words
to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR or e-mail
editor@bmj.com
Saad Shafqat, assistant professor of neurology.
Aga Khan University, Karachi, Pakistan
Reviews
Personal views
A new hazard of medicine
In a tragedy of mounting proportions, doctors in Karachi are facing a grave
risk
on account of their professional identity. In the past three years, more
than 80
doctors have been killed in Pakistan's largest city, ambushed during their
daily
commutes by motorcyclists who deliver automatic gunfire from point blank
range.
Karachi has had a reputation for being something of a powder keg, but no
one had
anticipated it would come to this.
I, too, am a doctor in Karachi. These are not easy times for any of us, but
to
belong to a profession whose members are being senselessly killed is an
experience bordering on torture. Panic has rippled through my city's
normally
thriving medical community. I know colleagues who have fled the country and
left
behind flourishing practices and distinguished teaching positions. Some
have
confined themselves indoors. The rest of us are varying our daily routines,
sleeping over at the houses of friends and neighbours, and exchanging cars
so we
don't get marked by what we drive.
My colleagues are either getting killed or are running away. Our dreams are
shattered, riddled with bullets
Who or what is behind these killings remains a mystery. Someone obviously
thinks
killing doctors is an effective means of spreading terror, but no one
claims
responsibility. The only real clue comes from the religious affiliation of
the
overwhelming majority of victims: all but three of them were members of
Islam's
Shia sect, a minority group in Pakistan.
The stories are heart-wrenching. One recent case was that of a 40 year old
nephrologist who had relocated to Karachi after years of training and
practice
in the United States. He was shot and killed by two motorcyclists while his
car
was waiting at a traffic intersection; he had been on his way to dialysis
rounds. The gunmen disappeared without a trace. In another case, an ear,
nose,
and throat surgeon was gunned down as he headed home following an afternoon
clinic. Both men left behind young children, as did many of the other
victims.
This may be a targeted attack on the medical profession unprecedented in
history. It is a new hazard of practising medicine, because it is our
profession
that is making doctors newsworthy victims in Karachi.
Life goes on, but it goes on in fear. One day recently, after we had woken
up to
yet another newspaper headline about a slain doctor, staff physicians
gathered
together for a meeting at the private university hospital where I work. We
searched for answers, but could go little beyond our grief and rage. People
exchanged notes about bodyguards and bullet proof vests.
The Pakistan Medical Association, the largest professional body of doctors
in
Pakistan, began leading a wave of protest strikes last month in which
doctors
suspend outpatient activities for a day and wear black armbands. The
delivery of
medical care in the city has suffered. On the day of a strike, normally
packed
clinics are deserted and operating lists are pruned down to the most
essential
cases. It goes against the ethic of our profession, but we are desperate
and
scrambling. We hope this will put pressure on the police and other law
authorities, who have yet to produce a major lead.
The goals of the killers are unspecified, though theories abound. Because a
particular religious sect has been targeted, the origins of the attacks may
well
be in religious extremism. The attacks have increased in frequency
following the
events of September 11, possibly fallout from the complex local and
regional
situation that Pakistan currently finds itself in.
My colleagues and I have confronted these attacks with anger and
bewilderment.
After that has come fear, for ourselves and for those we will leave behind.
But
the most depressing reality in this morbid calculus is the unequal value of
lives. When an American journalist was kidnapped in Karachi recently, the
entire
state machinery in Pakistan sprung into immediate action. The killing of
local
doctorseach one a Pakistani citizenhas yet to be noticed with the same
urgency.
Like many others in my position, I have also thought about running away.
But
when I recently learnt that one of my close colleagues had actually done
so, it
jolted me. I am part of a cohort that spent several years overseas in
postgraduate training after finishing medical school in Pakistan. In our
time
abroad, thoughts about returning home sustained us. When we finally
relocated to
Karachi and found the jobs of our choice, we felt we had found happiness.
Now my
colleagues are either getting killed or are running away. Our dreams are
shattered, riddled with bullets and littered with the dead bodies of
doctors who
had committed no crime other than to take an oath to heal.
Footnotes
If you would like to submit a personal view please send no more than 850
words
to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR or e-mail
editor@bmj.com
Saad Shafqat, assistant professor of neurology.
Aga Khan University, Karachi, Pakistan