Dr Yasmin Rashid of Pakistan: the minister extraordinaire

I remember meeting Dr Yasmin Rashid, Punjab Minister of Primary and Secondary Healthcare in March 2020 at the office of Chief Minister Usman Buzdar in Lahore. A big smile on her face, she was talking to different groups of journalists as she walked through the room before the commencement of the Chief Minister-headed meeting on the coronavirus-related SOPs and the lockdown in Punjab. Answering a question, Dr Rashid cheerfully remarked how young people should not complain of being overworked as she at the age of 71 was working impossibly long hours every day.

And that is what the workaholic Dr Rashid has been doing for the last one year before the first COVID-19 case appeared in Punjab, and after being afflicted by cancer in December 2020. Neither coronavirus nor cancer has been a deterrence for the remarkable woman, doctor, and minister to take a break. A long-time PTI senior leader and a politician known for her principled stances, straight-shooting approach to her politics and work, and no-nonsense yet well-behaved attitude with the opposition and the media, Dr Rashid is an inspiration for all those who wish to make a mark for themselves in the complex, demanding, and occasionally, cruel world of politics.

I asked Punjab’s Minister of Primary and Secondary Healthcare Dr Yasmin Rashid a few questions:

As a first-time health minister, what was the biggest challenge you faced when cases of coronavirus began to spread in March 2020?

Dr Yasmin Rashid: The biggest challenge was it was the first time we were facing a pandemic. Being the first-time health minister, I had to be involved in everything to keep abreast of the major issues that we would or could face with the onset of the pandemic.

The first major challenge was the paucity of infrastructure. Another challenge was to ensure that we had proper protocols of treatment once patients infected with coronavirus began to reach hospitals. One other challenge was to guarantee that our medical personnel who would have to handle patients received proper training, learning from the limited experience that was coming out of China.

But we faced all these challenges by organising ourselves much before the cases reached Pakistan. A team of experts was formed as soon as we heard about the spread of a new disease in China. That happened as early as end-January or the first week of February 2020. We began the work on the formation of different protocols that would be helpful to fight the disease.

Infrastructural and bureaucratic–individually and collectively, how have your ministry dealt with or is dealing with obstacles, if any, in your ongoing fight against the coronavirus?

DYR: We have come a long way in the last one year since the first case was detected in Punjab. One important thing that we did was to develop the infrastructure, ensuring that there was an ample number of beds, high-dependency units, intensive care units, ventilators, and BiPap machines. Money was invested in the required equipment. More than 50 billion rupees were utilised in the first year to improve the infrastructure of various hospitals. Wards with central oxygen supply were increased in number.

It was all teamwork on a large scale, and I had an excellent response from all the bureaucrats working with me. No hurdle at all. My team worked very hard to ensure that all the requirements were taken care of.

A medical emergency was declared to ease up various rules and regulations wherever any procurement was required. Alhamdulillah, there has been a massive expansion in the infrastructure because of the meticulous teamwork. When the pandemic started, we had only one VSL lab that could do all forms of PCR tests; now we have 22 labs in Punjab. Initially, we could only do 500 tests in one day, and now more than 22-23,000 tests. We are expanding our testing capability with the addition of four labs. A huge field hospital with 1000 beds was developed to ensure that, if need be, we were prepared to deal with an overflow from hospitals.

Because of the massive investment in infrastructure, we are in a much better position now when we are dealing with the third wave. If we had not developed the infrastructure, it might have been extremely difficult to deal with so many new cases.https://6eb6f8005a5d9cae3fcebb97e49ff288.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

Pakistan suffered a great deal with the loss of human lives, and the damage to an already fragile economy. Pakistan also seemed to bounce back quicker than the expectations based on its financial and infrastructural limitations. What, in your opinion as a doctor and the health minister of Pakistan’s largest province, is the principal factor behind the success of Pakistan’s 2020 strategy that greatly slowed down the destruction of the coronavirus?

The most important thing was the formation of the National Command and Operation Center (NCOC). All the data regarding COVID-19 cases was and is recorded in the NCOC. The decisions taken with the input of the experts of various fields were very beneficial.

When we look at 2020 in retrospect, the first six weeks of the national lockdown were necessary to make improvements in our infrastructure and to ensure betterment of the situation. Later, we switched to smart lockdowns for those areas where the number of cases was large and continued to increase. Those lockdowns were beneficial to the economy as more than 40 percent of Pakistanis work on daily wages.

Daily wage earners were the ones who would suffer [and did suffer] the most in a complete lockdown. The prime minister’s vision was that we could not have a prolonged complete lockdown that would damage the economy in an irrevocable way. Keeping that in mind the steps that were taken were quite beneficial. The smart lockdowns resulted in slowing the virus. People were permitted to work, various industries started operating again, and daily wage earners resumed working.

Indeed, we were very fortunate. The number of lives that we lost is immensely tragic. But if we look at our neighbouring countries, I think Pakistan’s fatality rate has been comparatively low. One probable reason is our large younger population that has managed to deal with the COVID-19 infection more vigorously as compared to the older population. Most of our fatalities were of the patients in older age brackets. The sizeable young population managed to resist the infection or fight the infection in a much stronger fashion.

The two important reasons–a large young population, and the decisions that were taken closely following the available data on a regular basis–greatly helped us [in fighting the ravages of the pandemic.] Whenever or wherever we felt the situation was worsening a lockdown was imposed. The economy continued to function. One of the most positive things was the robust revival of the textile industry. We did not have sufficient technical equipment at the onset of the pandemic, but in a few months, Pakistan began to export protective equipment to many countries.

What is the main reason for the delay in vaccination supply and slowness of vaccination to Pakistan? Were the orders for required amounts made on time? And how would the possibility of any short-term restriction on international travel affect the speed of vaccination in Pakistan?

There was no purposeful delay in the placement of orders for vaccine. The World Health Organisation in COVAX gave us the commitment of providing vaccine for 20 percent of our population initially. Unfortunately, that did not happen. It was difficult for me to understand why WHO backed out of the commitment. I’d say backed out of the commitment because we haven’t received any vaccine at all from COVAX. As a developing country, we were very hopeful for that assistance. And once that did not materialise the initial procurement was delayed.

Fortunately, we have an excellent, long-time friend–China. Initially, China sent us the gift of one million vials for our frontline workers, now China is committed to giving us 30 million more vaccines.

The vaccination process has been initiated and is continuing quite smoothly in Punjab. On May 1, our target was to vaccinate 80,000 people in one day. Alhamdulillah, we managed to vaccinate more than 78,000 people.

The vaccination programme in Punjab is appreciated by everyone visiting our vaccine centres. People find the entire process easy, simple. One initiative in Punjab is the ambulance service provided to people who are incapacitated in some way and are unable to come to a vaccination centre. They call on the helpline 1033, and our staff vaccinate them at their homes.

We are doing our level best to increase the rate of vaccination. We started with the oldest age group, and then moved to the other age brackets. The recent development of walk-in vaccination has increased the number of people coming in [for vaccination].

We might have started late but inshaAllah, in the next couple of months I’m quite sure that we would have vaccinated a very large number of people in Punjab.

How are the cases of COVID-19 in 2021 different from those in 2020?

The cases that we have in this wave are different because of the very high infectivity ratio. The cases that we had initially were of the Wuhan variety but currently, almost 90 percent of the cases in Punjab are of the UK strain. The infectivity rate of the UK strain is much more than that of the Wuhan strain. That is why the number of patients in the third wave are more than the ones in the first and the second waves, making the situation extremely difficult. However, the variants of the virus are the same, and therefore the treatment being given is also the same.

Is the government of Punjab successful in the implementation of SOPs and ensuring genuine adoption of the precautions against COVOD-19?

The NCOC has recently reiterated the instruction to fully implement the SOPs. I’m glad to see that in Lahore there has been a very strict implementation of SOPs in the last few days. On weekends there is a complete closedown of all markets. That seems to have resulted in reducing the infectivity rate of Lahore from 23 to 18 percent. I’m very hopeful that if the SOPs are continued to be followed with the same enthusiasm, we might be able to control the infection to quite an extent.

Regarding other districts, they have been instructed to follow the same model. Our government is quite hopeful looking at the evidence that with the strict implementation of the SOPs–wearing a mask, maintaining social distancing–we can manage to control the disease.

Now new instructions have been issued for religious gatherings. Aitekaf is being disallowed in mosques where the infectivity rate is above eight percent. We are ensuring strict closedowns between iftar and sehr. We are also ensuring that Eid should be observed with simplicity as it is extremely important to control the spread of the virus.

We are hopeful that the strict steps being taken will ensure a reduction in the cases of COVID-19. If God forbid the infectivity rate increases, we may, as the prime minister said, have to go for a complete lockdown.

When do you expect the vaccination in Punjab to be complete for its entire vulnerable-to-disease population?

This is a difficult question to answer. We have a huge population in Punjab, 110 million, but the largest number of our people belong to a younger age group. Registrations that we recently had were for ages above 50 and 60. That is about eight million people. We are quite hopeful that in the next couple of months these eight million people would be vaccinated. The age bracket between 60 to 80 has already been vaccinated. We are also planning to vaccinate the 40-age group next, registration for which has already started.

I think the entire vaccination process would take about six months as long as a good supply of vaccine continues to reach us. We are very hopeful as we have increased the number of vaccinations every day. If we plan to give 80,000 vaccines per day, I’m quite hopeful that in another six months we’ll be in a good position; at least a little more than the 20 percent of our most vulnerable population would have been vaccinated. That would be a step in the right direction.

Your constant hard work is exemplary in the governmental and ministerial circles of not just Punjab but all of Pakistan. What is the secret behind your tireless commitment to your work, and your 24/7 dedication to the noble idea of serving the people of Punjab?

I’m a doctor by profession. And not only a doctor I used to be a health activist. I was the president of the Pakistan Medical Association for quite a long time. I understood the problems of the healthcare system. One of my biggest wishes was that if I ever got an opportunity to improve the healthcare system in Pakistan, I would give it my full commitment. I’m very lucky that God granted me my wish, and I was given the responsibility of the healthcare system of Punjab, the largest province of Pakistan.

For the last two and a half years I feel that even if I might not have made a large difference, a discernible change has been made in the healthcare sector with the introduction of the Sehat Sahulat Card, and improvements in the infrastructure by increasing the human resource that was needed in government-run hospitals.

We have done record employment; more than 32,000 people have been recruited through a proper merit-based and a transparent system. Almost 50 percent of the positions were vacant in some major hospitals; 100 percent of work was done by half the staff. We have managed to now reduce the difference to about 20 percent vacancies.

We are planning to give the Sehat Sahulat Card to every Punjab ID card holder, irrespective of the class they belong to. This is the facility to aim for universal health coverage.

The number of mother and child hospitals that we are constructing is one important area that had been hitherto ignored. The scarcity of such hospitals is the major reason for the high maternal and infant mortality ratio. One advantage of being a gynaecologist is my understanding of these problems; my last assignment as a doctor was as a professor at the King Edward Medical University, Lahore. I’m certain that if we are to improve our sustainable development goals, we must improve the healthcare facilities for mother and child. Seven mother and child hospitals are being constructed in various districts, only one of which is in Lahore.

I love being a doctor. I love my medical profession. And I believe that this opportunity [being the health minister of Punjab] that God has given me I should not squander it in the least. I’ll keep doing my best to bring about more and more improvements in the public healthcare system.

Pakistan is united in its prayers for your good health as you go through chemotherapy. You have set an incredible example of not letting your personal fight with cancer affect your awe-inspiring work ethic even for a day. How have you managed to sustain your gruelling professional life while suffering from a disease like cancer? How is your health presently?

Alhamdulillah, I was diagnosed at an early stage in December 2020. I had breast cancer, and I had my surgery in December. I was prescribed four courses of adjuvant chemotherapy, planned over a period of four months. I have already had eleven chemotherapy sessions [until May 2].

It is my passion and my love for my profession and my dedication to improve the healthcare situation in Pakistan that keeps me going. It is the prayers of my family, friends, supporters, and well-wishers that keep me strong.

I have always believed that it is mind over body. I hope I can inspire other people who are fighting cancer that doing productive work that benefits people is greatly helpful in your fight against your own disease.

I think I find it helpful that I have such a great deal of work to do and so many responsibilities. That keeps me going.

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