By Dr. Zeeshan Qasim
Allah Dita’s trouble began, as these things so often do in the villages of the Daaman, with a stomach ache and a great deal of unearned confidence. The local quack, a man whose medical qualifications consisted chiefly of a steady hand and a very large box of colored tablets, diagnosed gas, prescribed gas medicine, and sent him home with instructions to eat less spice. When the ache did not improve, the quack revised his diagnosis to worms, then to what he called weakness in the liver, each revision accompanied by a fresh injection administered with the same unhurried confidence, until Allah Dita, three days and four injections later, could no longer stand up straight and had to be carried out to the Main Road on a charpoy hoisted onto the back of a Hilux pickup.
On the very morning a nearby university hosted a very important, beautifully catered seminar, where slides were read aloud with great conviction, on how artificial intelligence would transform the health sciences and save humanity, Allah Dita arrived at the District Headquarters Hospital in Dera Ismail Khan the way most villagers arrive at their first proper hospital, completely unprepared for the experience of a queue with a number on it. He was handed a hand written parchi with a number scrawled in blue ballpoint, told to sit, and watched with growing bewilderment as an entire morning passed while he clutched that scrap of paper, number sixty-two, wondering aloud whether the hospital was, in fact, running some sort of lottery. Above the reception desk, slightly crooked, hung a laminated notice promising treatment to all citizens without discrimination, first come first served. Allah Dita believed it completely, the way a man who has never been told otherwise tends to believe anything printed in bold type. He did not yet know what the rest of the room already understood, that the sign was true for him and negotiable for someone else, and that the difference would reveal itself the moment the right phone rang.
It was around then, on a hard bench past hour three of his wait, watching a man breeze past the queue on the strength of a single sentence into his phone, that the scene began to remind me, oddly, of a novel I had studied years earlier in the first semester of my first university degree. George Orwell never set foot in a District Headquarters Hospital in Dera Ismail Khan, more’s the pity, because he would have recognized the place at once. Animal Farm’s barn wall carried its own laminated notice, painted rather than printed, insisting with the same quiet, self-assured tone that all animals were equal. It enjoyed roughly the same relationship with reality as the one above Allah Dita’s head. Somewhere between the sixth commandment and the seventh, without anyone formally amending anything, the pigs discovered that equality, like a hospital queue, has a way of reorganizing itself around whoever happens to be holding the right sifarish at the right moment.
What the laminated notice never mentions is where the money behind it actually goes, and Dera Ismail Khan’s own health department has recently documented that in uncomfortable detail. An internal audit forwarded to the Anti-Corruption Establishment found that this very DHQ hospital had lost four hundred and forty-one million rupees, funds meant for patient care, to theft, illegal appointments and irregular contracts. Over two hundred million rupees was traced to a pharmacist and the hospital’s own acting director, accused of siphoning off medicines worth a hundred and thirty million rupees for resale on the open market, on top of a further sixty million rupees in stock that simply disappeared, some of it donated medicine meant for the poorest patients in the first place. A contract for CT scan services was quietly handed to a private lab in Peshawar rather than run through the hospital meant to own the machine. These are the health department’s own written findings, not rumors passed over tea, and they explain rather plainly why a man clutching a hand written parchi might wait three hours while the medicine meant for him is somewhere else entirely, being sold.
Nor is Dera Ismail Khan unusual in this respect. The Auditor General of Pakistan’s own report on the province’s flagship Sehat Card health insurance scheme found financial irregularities exceeding twenty-eight billion rupees over a five-year period, private hospitals folded into the panel improperly, facilities paid despite never registering with the health care commission, oversight so weak that nobody appears to have noticed the sum until an audit went looking for it. A province struggling to account for twenty-eight billion rupees in health spending has no shortage of laws requiring equal treatment. The laws simply behave in Khyber Pakhtunkhwa the way Animal Farm’s seventh commandment behaved on the barn wall, printed, quoted, and quietly rewritten in practice by whoever has the standing to rewrite it.
None of this would matter half as much if the stakes were only inconvenience. There is Allah Dita himself, weeks later, back on his feet but now chasing a disability certificate through the same DHQ hospital, told each visit to come back next week, while a man with the right surname walks in and out with his certificate signed inside twenty minutes. There is the mother two benches along, holding a prescription for medicine the pharmacy insists it does not stock, medicine that turns up, curiously, at a private shop across the road at triple the price. People have stopped calling any of this unusual. It has become the ordinary weather of a health system in which two hundred million rupees can vanish from a single hospital before anyone outside an audit team notice.
Orwell’s animals eventually looked through the farmhouse window and could no longer tell the pigs from the men, because both had learned to negotiate for themselves at the expense of everyone else. Pakistan’s health system has not reached that particular ending, and nothing says it has to. But the province would do well to look more closely at its own laminated notice, at the promise insisting all patients are equal, and ask honestly how four hundred and forty-one million rupees came to vanish beneath it. Because somewhere on a hard bench right now, another Allah Dita is watching the queue rearrange itself around a stranger’s phone call, still clutching his parchi, still waiting to find out what his turn, and his share of the medicine meant for him, was actually worth.
