Drenched in corruption and shrouded in incompetence, district headquarter hospitals (DHQs) are supposed to provide advanced medical care to rural communities. However, they lack both the equipment and human resources to serve their purpose. Earlier this year, after a roadside accident, Zafar Iqbal Jhagra, a prominent leader of the Pakistan Muslim League Nawaz (PML-N), had to receive initial treatment at a DHQ. He had sustained a head injury. Being a powerful person, he was transferred to Islamabad after the initial checkup and from there to London to obtain specialised care (as expected). Since the available information sheds little light, I am not sure about the quality of care he received in the DHQ. However, without a specialised team of neurosurgeons, latest CT scanners, dedicated operation theatres and trained ancillary staff, it is not hard to figure out especially if he had required an urgent craniotomy (brain surgery). Just imagine his progress had he not been moved to the UK. Nevertheless, we pray for his uneventful recovery hoping to welcome him back into active politics as the secretary general of PML-N. No doubt, he is a well-groomed and polite person, a dedicated democrat and an asset to his party. Maybe after his experience he will take personal interest in improving the conditions of these facilities. As sad as it is, lack of resources represents only one part of the story. What is more disappointing is when you believe you deserve better quality of care in a private university hospital and you end up receiving suboptimal treatment. This holds true despite the size of one’s medical bills that may run into the hundreds of thousands of rupees and the number of consultations obtained for expert opinions. Muhammad Raheel, a 33-year-old private contractor, squirmed back to life after going through a similar experience. He was admitted in Agha Khan Hospital a few months ago with acute renal (kidney) failure, a life threatening condition that may lead to long-term requirement for dialysis. Yes, I am referring to the most reputable institution in Pakistan, the leading medical centre that will charge you your life’s savings if you are admitted there for only a few days. Before he got sick, Raheel promised himself that he would lose weight. Determined to melt the extra fat, he followed an intense plan with more than 90 minutes of exercise every day. On top of that, he self-prescribed some over-the-counter protein supplements, a common practice among youngsters. Notwithstanding their claims as being safe, we know these ‘nutrients’ may still inflict damage to the kidneys even when they are authentic and not counterfeited by a local manufacturer. Under pressure from his workout in the simmering heat of Karachi or as a side effect of the medicines, his muscles broke down, releasing toxic chemicals into the blood. These enzymes, when spilled in a small amount, are excreted with no problem through the kidneys and out of the body. However, if their number crosses a certain threshold, the filtering tubules get clogged up and stop working. This condition in medical terms is called Rhabdomyolysis, which can lead to abrupt shutdown of the kidneys, requiring dialysis. However, the patient receives aggressive treatment and dialysis can be avoided. All one has to do is to provide vigorous and urgent intravenous hydration to the patient. Some authorities recommend up to two to three liters of saline pushed through a drip every hour in the initial period. Raheel, however, was not fortunate enough. Can you imagine: instead of getting five to 10 bags in the first 12 hours, he just received one liter after being treated in the emergency room for hours and being evaluated by a medical specialist in the hospital? I talked to the resident (trainee) physician myself to convince him about the urgency of the matter. But nothing I could say would persuade him to change the management. That too was not surprising as we realise in Pakistan that physicians do not pay heed to the family’s requests. In response to a question from the patient, they get defensive, rude or personal, as if their authority has been challenged. Not only that, they do not share pertinent medical information with the patients either, brushing off the family’s concerns by embarrassing them: “Well, we know, and we do not expect you to understand how the body works.” His kidney functions deteriorated without appropriate care. Over the next 24 hours, he just received one more liter of saline instead of multiple infusions and had to go for dialysis the following morning. Once discharged, his bill for not getting the treatment in 48 hours was a resounding six figure sum, an enormous amount that only few people can afford for a short stay in the hospital. Lady luck being on his side, Raheel was young with no other co-morbidities. As a result, after a few sessions of hemodialysis he did not require any more. The absence of any pre-existing health condition also enabled him to go back to work in a few weeks. We do not know how much damage to his kidneys is reversible and how much will be permanent. We also do not know whether 10 years down the road at the age of 45 if he will require permanent dialysis. Only time will tell. I know I have picked up a simple case with s positive outcome. My point is not to malign a hospital but rather to indicate far bigger problems overlooked by society. First, even when we go to advanced medical centres and get the opinion of renowned specialists, the system does not ensure internationally recognised standard of care. Second, the certifying agency does not hold practitioners responsible at all. Like any other department, accountability does not exist in medicine too, even when doctors show criminal negligence. And, third, hospitals do not guarantee the right of the patients to voice their concerns. The medical profession just shuts them up. The writer is a US-based freelance columnist. He tweets at @KaamranHashmi and can be reached at skamranhashmi@gmail.com