Doctors’ Exodus Impedes Economic Progress
By Dr Syed Ehtisham

I came across a report that spotlighted an alarming fact: Pakistan was losing 1700 doctors every year to foreign countries! Some individuals, for reasons best known to them, have called it a worthwhile export and compared it to the departure of US and European doctors for the Middle East. It is unfair to make such a comparison.
Pakistan doctors’ exodus is more of an economic necessity of the immigrants and is truly a great loss of national assets. Remember that a considerable amount of money is spent on the education and training of a doctor (and other skilled personnel), be it in the state or private sector. The USA and the UK save the equivalent of a million US dollars per doctor they accept.
Western doctors working in Mid-East are a part of neo-colonial package. On top of that they make a lot of tax-free money.
Pakistan is still under served in terms of the doctor-population ratio. High-tech, state-of-the-art medical schools and private hospitals serve only a tiny percentage of the population. They cater to the class which would otherwise go to the West for treatment. They thus save money for those who do not need to save.
Pakistan is one of the lowest spenders of funds on social welfare - education, health, creation of jobs and construction of infrastructure even among the under-developed countries. It is groaning under a tremendous load of foreign loan which instead of developing the economy is channeled back to donors for overhead. It has hard time servicing the debt (read interest). IT has started mortgaging and selling natural resources as South American countries have done. It is fast approaching the situation that obtained in pre-Castro Cuba.
The country has retained the feudal and tribal system which has the lowest productivity of all the economic systems. The system requires protection from the wrath of the people. It has co-opted the army as the strong arm. It has patronized the mullahs who provide "religious" justification for all illegal and immoral acts and economic dissipation. Bureaucrats trained and indoctrinated by the relics of the Raj act as civilian enforcers.
I have just finished reading ‘Guns, Germs, And Steel-the fates of Human societies’ by Jared Diamond and am quoting the following: 'At best centralized societies provide expensive services impossible to contract on an individual basis, at worst they become kleptocracies transferring net worth to upper (ruler-ruling classes". Diamond gave the example of Mobutu. We have had several Mobutus - both of civilian and military kind, in addition to the relics of colonial rule.
75% of the national budget is spent on "defense" and interest payments. Mullahs vociferous about banks giving interest bearing loans have never raised even a whimper about "loan servicing". I am paraphrasing "religion is too important a business to be left to mullahs".
Leaving aside the class character of GOP (feudal-comprador bourgeoisie) and GOI (government of India-proto-capitalist), Army expenditure is the single most important factor of sickeningly slow development of Pakistan's economy. Half the budget is spent on it. All they are good for is suppression of the people-and Kargil like adventures as an excuse for over throwing a lawful government. Bhutto had a good idea. He was developing the Federal Security Force. You do not need a regular army for gunning unarmed civilians down. A few atomic bombs are sufficient deterrence to an invader.
Pakistan has only one possible military foe - India. Essentially Kashmir is the only grave dispute between the two sides. Pakistan should have realized after the 1965 war that under no conceivable circumstances would it be able to wrest control of the territory from India. Why not accept the ground facts? India, assured of non-interference from Pakistan, will loosen its stranglehold on Kashmiris and the latter would have a better life. Canada has far smaller armed forces. The USA has no plans to take it over. They share the same economic system. Pakistan could develop its economy along the lines of India. Sounds like good logic, except that the army will lose the reason for its bloated existence, feudals will lose their strong arm, mullahs will lose their clout and bureaucrats will have to become civil servants.
Pakistan (West) started off with a population of 35 million in 1947. East Pakistan had 45 million. India had 320 million. Current (estimated) census is 160 million (more than 450% inflation), 145 million (300% inflation) and 1100 million (340% inflation Indian reactionaries claim with spurious justification that greater increase in population is due to the vast increase in the number of Muslims).
Pakistan does not need reforms, progressive legislation and advocacy groups. Even if all the radical reforms residing in the wildest dreams of arm chair socialists were to be enacted, who would enforce them. To expect the present dispensation to do it would be akin to my favorite story of the Russian peasant in the jaws of the wolf and a social worker appealing to the better nature of the beast to let it go.
Pakistan requires restructuring of its economic base. It is an impractical idea. South American countries like Venezuela and Bolivia have launched a restructuring program without the benefit of a communist revolution. Their people are not better educated or more developed than Pakistanis.
Pakistan needs a vibrant working class collaborating with peasants and serfs. The intelligentsia needs to get out of their ivory towers and lead them in the field.
Free and fair elections are an essential first step. Elections by themselves are a great learning process. They can, in timeform a government which will take rational decisions. Nawaz Sharif, despite all his faults, was taking correct though admittedly clumsy steps to control the monster that the army has developed into. He was promoting trade with India.
To borrow another phrase winds of change are blowing again. South America is waking up out of its supine slumber. It is Asia's turn.


Editor: Akhtar M. Faruqui
2004 . All Rights Reserved.