The sharp spread of the coronavirus pandemic and a shortage of doctors in Pakistan has led government to call in students of medical universities to work with doctors at hospitals and quarantine centres weeks after universities were shut down and hostels converted into quarantine facilities.

Punjab Healthcare and Medical Education Department has directed vice-chancellors of all medical universities to call back all final-year students from the affiliated medical colleges, who were doing their finals online.

Dr Muhammad Umar, vice-chancellor of Rawalpindi Medical University, told University World News: “Our university and affiliated colleges were closed after government announced lockdown in the country to contain the spread of coronavirus, but we have called back final professional year students, as directed by the government, to work with doctors to fight the coronavirus pandemic in the country and students of other professional years may also be called in if COVID-19 cases continue to rise.”

Ready to fast-track students

Umar said medical universities are ready to fast-track final-year students as hospitals, especially newly established field hospitals for coronavirus patients, require a large number of doctors. He said that medical universities and the majority of medical colleges in the country are imparting online education, especially to the final grade students as they may be needed in the near future.

But there have been concerns about the safety of the medical students in the absence of protection kits, about which doctors in the country are protesting after three doctors treating coronavirus patients died and more than 15 contracted the disease.

Muhammad Saeed Qureshi, vice-chancellor of Karachi’s Dow University of Health Sciences, told University World News: “Many doctors have contracted coronavirus in Pakistan and, therefore, we should be very cautious before deploying young medical students to assist doctors in the fight against the COVID-19 pandemic. Demand for personal protective equipment is very much logical, legal, necessary and is as per WHO [World Health Organization] guidelines.”

The situation of the medical workforce has worsened in the country as doctors are refusing to work in the absence of personal protective equipment. Doctors were beaten by the police in Balochistan province and 50 of them were detained for marching towards the chief minister’s office to protest the lack of personal protective equipment for doctors treating coronavirus patients.

Medical educationists are of the view that many more medical students may be required in the field and fast-tracking the final-year students into full doctors seems imminent as provinces have declared a medical emergency, doctors are short in number and the situation may worsen if the doctors’ strike continues.

With more than 4,206 COVID-19 patients and 61 deaths as of 8 April, hospitals in Pakistan are faced with a shortage of doctors and a fast-tracked recruitment of medical professionals has been initiated across all federating units.

Punjab province is immediately hiring 10,000 doctors and nurses, Sindh province has also initiated the recruitment of 1,500 doctors and 500 paramedical staff, Balochistan is hiring 344 doctors through walk-in interviews and Khyber Pakhtunkhwa province is hiring 1,200 doctors immediately.

Sindh Provincial Health Secretary Zahid Ali Abbasi told University World News: “Cash-strapped Pakistan, with meagre technical resources and inadequate health infrastructure, is not capable of hiring as many doctors as it needs to fight the coronavirus pandemic. We have to depend on medical students who are better positioned than a non-technical volunteer force.”

He said that government would provide safety kits to medical students to work with doctors treating coronavirus patients.

Ishtiaq Ahmed, a final professional year student at Sheikh Zayed Medical College of Lahore’s University of Health Sciences, told University World News: “We have been called to work along with doctors at quarantine centres, but so far no one has assured us of providing safety kits.”

He said: “Doctors are already protesting for provision of safety kits to treat coronavirus patients. Putting medical students in the field without any protection gear would not be acceptable.”

Joining the fight

Ghulam Farid, another final-year student, of King Edward Medical University of Lahore, told University World News: “I have not yet completed my medical degree, but I have been asked to join a quarantine centre at Multan city of Punjab. I have bought some necessary safety gadgets on my own and am going to join the fight against COVID-19.”

Medical education in Pakistan has been in disarray due to a row between federal government and the Pakistan Medical and Dental Council (PMDC), a medical education regulator. In order to reform medical education in the country, Pakistan’s President Arif Alvi promulgated an ordinance in January this year to disband the statutory body and ordered the establishment of the Pakistan Medical Council instead. But this was not accepted by the medical fraternity and the move was challenged in Islamabad High Court.

Due to this legal battle, medical students who had graduated were in mental anguish as they were not able to get the degree certification which PMDC provides and were unable to start practice as a doctor, that is until the coronavirus outbreak hit Pakistan and the future of medical students and medical education was pushed into the limelight.

The Islamabad High Court on 10 February ordered the restoration of the PMDC and declared the presidential order null and void, but the government did not implement the court orders, to the extent that Justice Mohsin Akhtar Kayani remarked: “Government action is equal to slapping the court in the face. Federal government and the health ministry are playing with fire.”

In another case, the Supreme Court also remarked: “What kind of medical emergency is this when the government itself is not serious. They are doing nothing except telling people to wash their hands with soap.”

High Court steps in

The High Court again summoned officials of the Ministry of National Health Services, Regulation and Coordination on 31 March and ordered them to open the offices of the PMDC within an hour or go to jail. The PMDC offices were then opened but again locked and 220 staffers have still not been paid their salaries for the past five months.

The Pakistan Medical Association, a body for medical practitioners, has condemned the “attitude of the government for deteriorating medical education in the country”.

Pakistan Medical Association Secretary General Qaiser Sajjad, at a press conference on 5 April in the eastern city of Lahore, said: “Doctors are frontline soldiers in the fight against coronavirus, we need more and more doctors, and 15,000 fresh medical graduates are waiting for their registration to start their practice as a doctor and join the fight against COVID-19, but the government is not serious as they have again closed the PMDC offices.”

Academics at medical universities and colleges are of the view that calling in medical students to help tackle the COVID-19 pandemic should lead the government to rethink budget allocations for medical education and services in the country and resolve issues in regulating medical education in the country.