Medicine and Social Services in the East and the West

Medicine and social services in the East and the West
Practice and Politics
I can vividly recall the years 1945-51, I spent in a mid sized town, called Gonda, in the eastern United Provinces (UP, since renamed Uttar Pradesh, the only state to retain its pre-independence abbreviation).
For most of the ailments, we used to a (Unani-Greek, the system was so called, recalling its Greek origin. The other system was called Ayurvedic indicating its origin from Vedic times of ancient India. The practitioners were called Veds), Hakeem (oriental medicine physician), who was my Nana’s friend. Once I developed Beri Beri (due to deficiency of vitamin B)
The Hakim sahib gave me a majoon (a sweetish gel like compound of indigenous medications-it is supposed to be very potent). *(A folklore runs thus. Nadir Shah, after sacking Delhi during the reign of one of the last Moghal emperors, Muhammad Shah Rangeela (dilettante), developed stomach upset. The royal Hakim prescribed a 'majoon’ with instructions to take one teaspoonful every four hours. Such was the terror of Nadir shah that the messenger dare not convey the instructions. He liked the taste and ate it all in one go saying that “this Halwa (dessert) is very tasty, bring some more”. The moral of the story is that what would kill the effete Moghal, would not harm the hardy Afghans at all).
I did not get better, so my mother insisted that I be taken to the Civil Hospital (every district had a government run hospital. The chief physician was called Civil surgeon, usually a physician of British origin, though in later years of the Raj a few Indians were appointed too. This hospital had 15-20 beds). A saw an *assistant surgeon (LMP), who duly prescribed vitamin B pills. I started getting better, but Hakim Sahib got the credit. ( I can’t recall if there were any private family practitioners in the town. The other place I lived in India was Jhansi, whose claim to fame is the legendary Jhansi ki Rani, who killed herself rather than surrender to the British when Indians lost the 1857 war of independence, a much larger cantonment town, where I was told a Bengali family practitioner had ‘saved’ my life when I was afflicted with typhoid fever at the age of 2-3).
The capital city Lucknow had a medical college offering a five year MBBS degree course. Agra and Allahabad, the other university towns, offered a three years LMP (licensed medical practitioner course
The popularity of the practitioners of indigenous medicine was attributable to long time practice and tradition, the scant number of practitioners of Western allopathic medicine, the conspicuously rare onset of side effects and tasty compounds that Hakims and Veds offered, in sharp contrast to the bitter allopathic mixtures and pills, especially Quinine for malaria.
Patients would have recourse to ‘Jarrah’ barbers, if they had an abscess, and to bone setters, in case of broken bones.
Allopathic hospitals had earned a bad name, and only very serious surgical cases were taken there, because anesthesia was very primitive, and antibiotics were still in the future (penicillin was discovered in 1941, Streptomycin in 1948. the only anti-bacterial medications were sulphonamides, which had a high allergic reaction rate). Blood and other intra-venous transfusions were virtually unknown, and if a patient survived surgery and anesthesia, the chances of succumbing to bio-chemical imbalance and infection were very high. People preferred to die at home, surrounded by near and dear ones.
Pakistan
This kind of situation obtained in Quetta, a cantonment town in the Baluchistan province of Pakistan too, which we migrated to in 1951, though the town boasted of several family practitioners. The hospital had some 50-60 beds.
I went to join the University of Karachi in 1954. Karachi, which had been a sleepy little city of less than a hundred thousand souls before WW II, had attained a degree of importance as a transit point for the British military and a small cantonment, a naval port and air force base had been built. It had a military hospital, in addition to the usual civil hospital. A medical school had been launched in 1945. It was not too long ago that Sindh had been separated from Bombay and accorded the status of a province, with Karachi as the capital city.
The city was divided into an upper class (British and a few homes of major landowners like Benazir Bhutto’s grandfather) seaside locality called Clifton, a Hindu Amil colony, a Parsi colony, a commercial area called Saddar, and a Bunder (port) Road which boasted of offices of commercial houses. Muslims, including Jinnah’s family lived in outskirts of the town in ramshackle buildings, surrounded by slums.
With the advent of independence and partition, non-Muslims left for India, taking 48 out of 50 medical students and all the staff. Muslims immigrants from India had to fill the vacuum, not just in the medical school, but all the offices, schools, colleges, businesses and services.
The city was overwhelmed by refugees and by the year 1954, the population had grown to over two million. People lived several families to a two bed-room apartment. These were the lucky ones. An estimated 50% of the population lived in mud huts. All public services-sanitary, water supply, health and housing broke down.
Vast majority of the population had no recourse, but to visit Hakims for minor as well as major illnesses.
India had inherited a more or less intact infra-structure, with skilled staff, academics, functioning universities, a well developed business class, finance houses, an industrial sector which had already started competing at the international level, and a vibrant political parties, with dynamic leadership supported and funded by the commercial and industrial class.

Pakistan, in stark contrast, was devoid of industry, business, finance, and skilled workers. As though that was not enough of a handicap, it was soon embroiled in an armed conflict with India.
The Indian government withheld Pakistan’s share of the assets, on the grounds that they will be used to finance the war in Kashmir. Pakistan was on the verge of collapse, and collapse it would have, but for a huge loan from the Nizam (ruler) of Hyderabad, the largest princely state in India, in area actually larger than France.
About the only source of foreign exchange Pakistan had was *Jute that East Bengal produced (Mills which processed raw Jute into fiber for making bags were located in Indian West Bengal. West Pakistan did produce high quality cotton, but all the mills had been owned by non-Muslims, and were dysfunctional. The Western wing also rich in wheat and rice, sufficient to feed twice as many people as lived in both wings at the time. But border with India was porous, and most of the grain was smuggled into India.
But the structural defect Pakistan suffered from was that the leadership of the Pakistan movement, barring Jinnah and a few of his expatriate followers consisted of the landowners of West Pakistan. True East Pakistan had a middle class, but the entire bureaucracy, higher judiciary, the officers of the military came from just two sources-the Punjab and the immigrants from what was India now (Pakistan inherited 83 senior civil servant, only was from Bengal, none from Sind, NWFP or Baluchistan. The same ratio held in judicial ranks. Among the senior army, Navy and air force officers, there was none from Bengal, Sind or Baluchistan, and only Ayub khan from the NWFP).
Jinnah combined the role of Marx, Lenin and Stalin for the country. He had excluded all but yes men from the government.
Jinnah had actually wanted entrenched guarantees for the rights of Muslims of India, and had endorsed the British offered plan for a con-federal India, with the center only holding control over foreign affairs, defense, currency and communications. Indian National congress had also accepted the plan, but there was so much bad blood between Jinnah and the congress leadership, that Nehru sabotaged the plan (India wins Freedom Maulana Azad). They were also apprehensive that Jinnah’s Muslim League would allow the feudal system to thrive in the region governed by them, thus making land reforms a near impossibility.
Jinnah, though he had allowed his lieutenants to invoke the name of religion in the campaign for creation of the country, wanted to separate religion from the government, and declared so in his presiding address to the first session of the constituent assembly of the country on august 11, 1947, three days before actual independence, (the Muslim clergy almost to a man had opposed creation of Pakistan).
One could find excuses for the country not being able to pay much attention to education, health, welfare and job creation.
But Jinnah died in September 1948, just over a year after the birth of the country, and the helm passed to his heir apparent Liaquat Ali Khan a British trained barrister and an Oxford educated scion of a feudal house. Apparently the schooling in England had not rubbed much on him, neither had the secular views of his supreme leader.
Another complication, existential as it would turn out not in too distant a future, was that the Eastern wing’s population was 45 million to the Western wing’s 35. Any constitution based on universal adult franchise would give a commanding majority to the non-feudal middle class led Eastern wing. This the leadership of the Western wing were not prepared to countenance at any cost. They were frightened out of their wits that a truly representative government would introduce comprehensive land reforms, cut back on military expenditure, reform civil services so the British trained bureaucrats would serve the public and not lord it over in the interest of the colonial rulers.
Short on experience politicians, the country was in the form grip of bureaucrats. They, champions of the status quo, were natural allies of the feudal system.
Religion had traditionally supported the establishment, so the clergy, only wielding marginal influence yet, were nevertheless on the side of keeping the anachronistic feudal system.
Liaquat, even if he had wanted to, could not have a democratic constitution passed by the constituent assembly. He was content with getting an Objectives Resolution (Qarar Dad e Maqasid) passed which, though paying lip service to the rights and privileges of the minority, nevertheless put paid to the dream of Jinnah for a secular government of Pakistan, by declaring that Islam would be the state religion, and only a Muslim adult male could be the head of the state. Liaquat was assassinated while addressing a public meeting by a reportedly demented soldier who was disgusted by his lukewarm support of the ‘jihad’ for Kashmir, or so the official security apparatus would have one believe.
Now the bureaucrats came into their own. Their god father, one Ghulam Muhammad was chosen as the governor general (not having adopted a constitution, Pakistan was still governed by the 1935 India act for self governance, and the Crown of England appointed the governor general, on the recommendation of the Prime minister of the Dominion. India, in contrast had passed a constitution, declared itself a republic and elected a president all by 1950.
The bureaucrats wanted to destabilize the government, and launched a bloody murder and mayhem campaign against a minority ‘heretical’ sect of Islam, called Qadianis after the birth place of their *‘prophet’. Several thousands were killed, and Martial law had to be imposed in parts of Punjab, thus giving the army an early taste of governing civilians.
Ghulam Muhammad lost little time in sacking the prime minister, and followed up the act with dissolution of the assembly in 1954. the supreme court upheld the decision, (thus laying the ground work of all the later take over by Ayub, Yahya, Zia and Musharraf).
Liaquat, though fully aware of the utterly futile expectation that the military would ever be able to wrest control of Kashmir from India, nevertheless kept on pampering the armed services. In the early days of his tenure, he had turned down the invitation of the Soviet Union to visit the country, this notwithstanding the fact that Stalin had ordered the communist party of India, much against its instincts and ignoring the religious tinge of the movement, to support the creation of Pakistan, on the basis of his much discredited theory of autonomy for minorities. In stead he went to visit ‘Christian’ USA.
The bureaucrats brought in the army chief Ayub Khan into a cabinet post, while he kept his army one, thus setting a precedent that he and future usurpers followed.
The bureaucratic-feudal-army regime now started the collaboration with the imperialistic block and joined *‘mutual defense’ pacts with the USA, Britain and pre de Gaulle France, aimed at deterring the expansion of the influence of the Soviet Union.
Arab monarchies led by Saudi Arabia had been nurturing the radical Islamist Wahabist Muslim Brotherhood, in whose birth Imperial Britain had played a great part. They used it against the rising tide of Arab nationalism, and also helped its tentacles over the rest of the Muslim world through a network of ‘charities’ and Saudi funded seminaries and ideologically bonded parties such as the Jamaat e Islami of Pakistan led by an ideological heir of the early Brotherhood leadership, Maulana Maududi.
Through these years, expenditure on ‘defense’ kept on increasing, with little left for social services.
East Pakistani politicians had been coerced to accept parity with the Western wing on the issue of the number of seats in the constituent assembly, and enshrined in the 1956 constitution. As a sop the four provinces of West Pakistan had been merged into ‘One Unit’, which served to consolidate the power further into the hands of the bureaucrats and the landowners, as for every little decision, people had to travel to Lahore, not an insignificant expense for the poor.
The stage was now set for general elections which were announced for January 1959. Suhrawardy, the most credible leader after Jinnah, had attracted a large following in his native Bengal, and was making headway in the army-feudal heartland of the Punjab. Other progressive elements of the society had tapped the latent national sentiments in the smaller provinces-Sind, NWFP and Baluchistan. An election could conceivably offer sufficient number of seats to Suharwardy for him to adopt egalitarian policies.
The establishment could not countenance that. In October 1958, Iskander Mirza, an old time colonial bureaucrat, who had inherited the job of governor general from that archetypal mandarin Ghulam Muhammad, and had been elected President under the 1956 constitution , declared martial law, dissolved the national assembly, sacked the government and appointed Ayub Khan the chief martial law administrator, while retaining the office of the president.
After three weeks Ayub dispatched him into an ignominious exile.
Ayub was very popular. He could do no wrong. He appointed a close associate as governor of East Pakistan. The man Lt General Azam Khan was a born populist. He opened the governors house to the public to visit and have tea and biscuits any time and publicly upbraided bureaucrats for not taking their three piece suits off and physically help during a flood. The public took to him like they would a savior.
Ayub promptly replaced him.
Smugglers, politicians, journalists, hoarders and people he had personal grudge against were arrested (Ayub Khurro, as defense minister had kept him waiting for 45 minutes. He had to suffer solitary confinement, in the desert heat of Sind, with out even an electric fan). He also took the opportunity of dismissing 301 senior bureaucrats, all but one of whom were * (the term ‘son of the soil’ was coined meaning persons whose fathers were born in what became Pakistan. In practice the group included immigrants from the Indian Punjab as well, and excluded Sindhis, Baluchis, while Pathans were kept at the fringe) immigrants from India. He set the precedent of extra-legal acts, which all the subsequent military and civil dictators followed.
Ayub was no revolutionary. He announced, with great fanfare, land reforms and only redistributed the land among the close kin of landowners. He declared that the country was going to be industrialized in no time, but only arranged to concentrate wealth in fewer hands
He pledged to excise corruption from body politic, but looked the other way when criminals and administrators got out of jail after offering hefty bribes to army officers.
He raved and ranted against nepotism, but his son Gohar, hitherto a captain in the army, and his father in law a Lt general became the owner of a huge industrial complex, overnight.
He proclaimed institution of pure democracy as his life’s mission, but only offered indirect elections through an electoral college, whose members were elected by a few by a few hundred voters who could be coerced and manipulated, and were, to vote for government approved candidates.
What was perhaps worse was that he got the country deeper into Western alliances.
There was little development of infra-structure, or advancement of social services. People remained unemployed and could only visit Hakims and worse quacks for illness. Government hospitals continued to cater to high officials and the affluent.
JFK had stopped him from walking into Indian held Kashmir, while India was down and out after its humiliating defeat at the hands of the Chinese. He had got him a pledge from Nehru to arrange a plebiscite in the state.
But JFK was assassinated and Nehru died. Ayub was widely and openly derided for losing a golden opportunity for a victorious Jihad.