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Pakistan: Victory for Young Doctors' Association strike

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After two weeks of determined strike action, the Punjab Government has conceded the demands of the Young Doctors' Association. This victory shows that working class action can defy the brutal attacks of the ruling class if it is united and prepared to make sacrifices in the struggle. It also shows the real power that workers can wield because it is their work in both the production and service sectors that allows society to function at all.

On August 1, the doctors organised a march in Lahore from the Services hospital to the Secretariat of the Chief Minister of Punjab at the Government Officers' Residence. When they reached their destination, the police attacked them with water cannon and tear gas. Many doctors were arrested but in response their Association declared a strike in all hospitals. From the next day, young doctors established an emergency-only hospital service in which they decided what treatments and procedures would be allowed, on a humanitarian basis.The government's first reaction was a massive clamp down on the doctors with threats, arrest, torture and sackings.

Demands
The demands of the doctors include the appointment of a specialist health secretary, an end to the central induction policy, which is frequently misused, an increase in the number of burns units, the establishment of new hospitals, an insurance system for doctors, a reformed career structure, completion of health projects, and permanent contracts for the many doctors on temporary contracts. In the face of government threats they also demanded an end to all victimisation.

Instead of considering these demands, the government dismissed and tortured the striking doctors across Punjab. The situation was given a new twist when the ex-prime minster and main leader of the national government, Nawaz Sharif, protested against his disqualification by the Supreme Court. His rally, from Islamabad to Lahore, was given full protection by the government, underlining the differences within the ruling class.

It also showed the different standards applied to workers and government; the protests by the ruling class are televised, even though the media itself is divided on the issues splitting the ruling class. By contrast, all the media were united against the young doctors but, despite this, their struggles and the strike spread across Punjab. This was the best possible answer to the provincial government's slandering, arrest and dismissal of young doctors.

Media
The media spread stories that the doctors were responsible for several deaths. Dunya TV was typical, it said that young doctors were going on strike over every issue, causing loss of human lives which went unpunished. They said the strike was just for salary increases and that the young doctors were not fulfilling their commitment to this noble profession. No one presented the case that deaths were not because of the doctors' strike but because of the government's lack of interest in the health sector and its preference for building roads, metros and railways. One of the main demands of the doctors' strike was actually for an increase in the general health budget.

In a modern health system, although doctors are of course important, treatment requires other resources as well; well-equipped operating theatres, medicines, nurses and paramedical staff, without them, the doctor can be little more than an advisor. The ruling class has no interest in the health of the working class and poor and this is very obvious from the fact that government spending on health is only120 rupees (approximately 90 UK pence, -Ed) per person per year. That shows how much government cares for the pain and suffering of the ordinary people.

Hospitals are insufficiently resourced either with equipment or beds and this means that managers and doctors have to make life and death decisions over who to admit. With a doctor to patient ratio of 1:1400, such decisions inevitably create tensions and frictions between doctors and patients and their families. This ratio is far below world standards and also means that doctors can give little individual attention to patients. Instead of recognising the legitimacy of the young doctors' demands, the government is trying to avoid them. This makes it clear who is the real culprit, responsible for the suffering and avoidable deaths of patients.

Providing free and effective medical facilities for citizens is the government's responsibility, but it has no interest in it and similarly does not recognise the needs of young doctors or of the paramedical and nursing staff who are also essential. That is why there has been a recent upsurge in struggles by all these medical staff.

In this situation, it is the working class and poor people who are most affected because they cannot afford expensive treatments in private hospitals. The government's lack of concern forces them to rely on unscientific treatments while the government officials and capitalists class go out of country for routine check-ups and treatments.

The majority of young doctors do not have a private practise and have only their wages to survive on. During training, they are forced to work without wages and the majority who are qualified and earning are on temporary or agency contracts, often having to be on duty for as much as 36 hours. If they protest against such working conditions and for better working conditions and wages, they are absolutely right.

The Punjab government is being presented and praised in the media as a new development model. In fact, it is the same discredited neo-Liberal model, in which development means the growth of capital and opening new arenas for its expansion. Instead of investing in the public hospitals, the Punjab Government is issuing health cards with which the poorest can pay for treatment in private hospitals. This is presented as a progressive measure but is actually just a state subsidy to the private hospitals.

The young doctors' strike stands in contradiction to this model, which also argues for the privatisation of the hospitals and wants to make healthcare a commodity. That is why we are seeing protests, sit-ins, and strikes becoming the norm in the health sector. We are in favour of a united struggle of young doctors, nurses, paramedical and other staff in future and call for other unions to stand with them in their important struggle for health sector reforms that would be in the interests of the whole of the working class and the poor.