
Parivish Kanwar
I am an American high school student from Houston, Texas, and this summer I had the rare
opportunity to complete medical internships at several hospitals in Pakistan (thanks, Mama).
Upon my arrival, I was quite eager to see how Pakistan would differ socially, politically, and
culturally. What I had not fully anticipated was how deeply social realities and attitudes influence
aspects of Pakistani healthcare negatively, from infrastructure and hygiene to the way hospitals
view patients.
In the United States, my concept of a hospital was shaped by spotless hallways, enforced
sanitation protocols, appointment-based scheduling, and a privileged assumption of privacy. My
first internship in Pakistan, at Fatima Memorial Hospital (FMH), challenged those assumptions
almost immediately. Patients were treated in large, shared spaces with little to no privacy, a
huge shock to me as someone used to separate rooms and strict HIPAA regulations. Something
that surprised me most was the inconsistency in infection-control measures: staff members
required visitors to wear shoe covers but never wore gloves themselves. What has a higher risk
of contacting the patient, a doctor’s foot or hand? Why cover one’s feet but not one’s hand? I
really did not understand this. Additionally, FMH was quite small in size and resources which left
me wondering if in the case that lots of patients were admitted to the hospital, would they have
enough beds to take care of everyone? Finally, I noticed that in some areas of the hospital, it
smelled bad or looked unclean, especially the bathrooms, but that is how most public bathrooms
in Pakistan are. The lecture rooms were spotless, though, and a majority of the hospital was in
reasonable condition in terms of cleanliness.
My second internship at Indus Hospital provided a striking contrast. Entirely funded through
donations and sponsorships, Indus offers all services free of charge. This was truly impressive
to me as I had never seen a charity hospital in America–and incredibly well managed at that. Its
infrastructure was modern, its facilities clean, and patient privacy was maintained with bed
curtains. Additionally, the hospital had an impressive amount of rooms, beds and maintenance.
The hospital’s adherence to international standards was maintained and obvious considering its
organization and hygiene protocols. However, one of its biggest challenges was the long wait
times, reflecting both the hospital’s popularity and the overwhelming demand for accessible
healthcare in a country where many cannot afford private treatment. One issue I noted is that,
while given the task to survey patients, one of the patients recalled having been denied the use
of the restroom because a staff member said she was “too dirty”, while she simply seemed to be
low-income. While this does not represent the hospital as a whole, I do think it highlights the
need for professionalism and empathy in Pakistan’s healthcare space, especially in the next
hospital I will be speaking about.
My third internship was at Chaudhry Muhammad Akram Teaching and Research Hospital. This
hospital faced several issues: infrastructure was deteriorated, sanitation was inconsistent, and
the smell of cigarettes occasionally lingered while passing by several rooms, an environment
that not only compromised patient safety but also undermined the hospital’s credibility as a
qualified place of healing. Almost every doctor I saw worked without gloves again! One middleaged patient had a contractive disease and I saw the nurse take her vitals with no gloves on!
Similar to FMH, patient privacy was minimal unless a patient could afford one of the more
expensive private rooms, creating a sense of elitism in my eyes. I will say, the hospital had a lot
of noble work being done outside of just providing healthcare, though. During my internship,
they presented me with extra work which was an absolute pleasure to complete: surveying and
educating new mothers about Post-Partum depression; educating nearby schools about basic
life support and preventative healthcare while distributing health kits; patient caregiver mental
health awareness and support; heart attack and stroke awareness education; and projects
working to improve patient understanding of Post-Operative instructions for families with lower
education levels. These were several of the welfare projects I had a privilege to plan and
participate in, and I truly believe that CMA–despite some weaknesses– is doing some really
great work regarding the social healing aspect of healthcare.
Additionally, I did a healthcare journalism internship with Neo News where we visited several
hospitals including Services and Jinnah hospital. There, I was told an alarming piece of
information: Jinnah plus Pharmacy was selling expired sedative injections for months, causing
the death of a woman following her usage of said injections. Above all else, this seemed to be
the biggest indicator of a need for massive change in Pakistan’s health field, primarily in the
aspect of professionalism and supervision.
Across all three hospitals I interned at, I noticed several common themes. Patient privacy was
rarely prioritized, preventive healthcare received little attention, and there was often a cultural
tendency to seek treatment only when conditions became severe. Many patients relied first on
home remedies, only turning to hospitals in emergencies. I witnessed a woman seeking care
after a domestic violence incident whose treatment consisted of pain medication rather than any
deeper medical or psychological intervention. The reliance on symptomatic relief rather than
root-cause treatment reflected the need for a change in attitude towards preventive healthcare
across Pakistani society as a whole.
Reflections
A recurring sentiment I heard from both patients and observers was that “private clinics just
want your money.” On three separate occasions, different individuals expressed these exact
same words. This perception highlights the lack of trust in healthcare providers within Pakistani
society, most likely rooted in recurring experiences of ineffective treatment or prescription, and
minimal follow-up care. Without consistent regulation or oversight, private facilities are free to
prioritize revenue over patient well-being. The absence of structural accountability not only costs
lives but also diminishes public trust in facilities that are otherwise meant to be places of morale.
I will say though, many of the shortcomings I observed are the product of decades of
underfunding, political instability, and overwhelming patient demand. Even the most dedicated
doctors and nurses are working within a strained system, with too many patients and not
enough resources. While these hospitals are working under this strained system, many attempt
to maintain and monitor several divisions in the hospital to improve efficiency. For example,
CMA hospital had a Quality Improvement (QI) team actively trying to raise standards and
implement better practices through daily accuracy and professionalism checks on the staff and
doctors. The QI team at CMA was even willing to implement several of my suggestions into their
hospital, demonstrating their intense desire to improve their facility and strive for excellence in
the face of a lack of resources/funding.
My Thoughts
Perhaps the most shocking thing about Pakistan’s reality was the way patients viewed
healthcare itself. In Pakistan, for many, seeking medical care is a gamble rather than an
expectation. People do not necessarily anticipate privacy, modern equipment, or even timely
treatment; they are grateful simply to be seen and attended to. On the other hand, in the United
States, patient privacy, strict professionalism, preventative healthcare, and cleanliness are
foundational, something I used to overlook. This contrast forced me to consider how privilege
shapes perception: what I view as a baseline necessity may be seen elsewhere as an
unattainable luxury.
This experience left me with two lasting impressions. First, healthcare is not just about
medicine. It is about dignity, respect, and the trust between patients and providers. Second,
while large-scale reforms would undoubtedly help, meaningful change does not always require
billions in funding. Sometimes, it starts with smaller commitments: enforcing basic hygiene
standards, offering patient privacy whenever possible, and cultivating a culture of empathy
rather than one that prioritizes money. These improvements do not erase the need for systemic
reform, but they do create immediate, tangible benefits.
If anything, my time in Pakistan has strengthened my desire to be part of that change, whether
through advocacy, policy work, or direct patient care. The lessons I learned in these hospitals
will shape the way I think about medicine, privilege, and service for the rest of my life.