Pakistan: a long road ahead

Islamabad

Faisal Masjid Islamabad (Syed Bilal Javaid, Unsplash)

This article was exclusively written for The European Sting by Ms. Yameena Nadeem, a medical student at Allam Iqbal Medical College, Pakistan. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


In Pakistan -A country marred with political instability, financial upheaval, precarious security situations, does the government ever focus their energies on planning to improve healthcare especially for the marginalized communities.

Though in accordance with the law and culture homosexuality is illegal in Pakistan, The Transgenders Persons act passed in March 2018, provide the citizens the right to self- identify as male, female, neither or a blend of both as well as protect their rights. So has this ensured safe access to healthcare for the third gender?

I cannot say this with utmost certainty but as far as I have realized unfortunately no.

Being a third-year medical student in a 5-year MBBs program at a reputable institution I should surely have an idea on how to best provide for these patients. But never once have I specifically been told how to deal with such patients.

Our curriculum remains silent on the subject. It fails to sensitize these future medical doctors to the growing demands of the society. We do not even have the slightest idea as to how to even address them without offending them or sounding derogatory. However, a bright spot in all of this is that we are willing to learn, willing to bring up such conversations, willing to play our part.

we have a long road ahead of us. we need to try and identify the hurdles blocking us. One of the major issues we face is the lack of sensitization in the medical community as well as the general public. In order to overcome this, we need to train our students to remain unprejudiced. Help them realize transgenders are as human as anyone else and deserve our attention care and kindness.

, teaching them skills to help make such patients comfortable will ensure that in the long run the transgender community will not only not be refused treatment anymore just because of their gender but also feel safe in accessing medical services in any part of the country.

Years of stigma prevalent in the society has cost us many innocent lives. However, we are ready to fight this demon. we want to deliver dignified and non-discriminatory healthcare and we have taken the first right step but we have an extensive journey ahead of us. Hope we succeed in reaching our goal.

About the author

Yameena Nadeem is a medical student at Allam Iqbal Medical College, Pakistan. She is an avid reader with a love for travelling. She has previously been an active member of the literary society as well as worked for the magazine at her school. She has always loved writing. And with opportunities like these, writing about issues facing healthcare ,would help further the discussion and continue trying to play her part.

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Comments

  1. samir sardana says:

    Pakistan has 3 problems – corruption,power sector and the trade deficit.W/o solving these 3 problems – there is no chance of investments, in the health infrastructure of Pakistan,

    Solution to Pakistan Imports/Trade deficit

    The burgeoning Pakistani import kills the PKR (due to deficit and FX timing of flows in the spot cash and IBR market) and is a drain of FX earnings

    But the solution is simple – just 5 steps.dindooohindoo

    Step 1 – Ban all luxury imports

    Ban all luxury imports,like the destruction of wine and alcohol cedars by Babar,in his conquest of Hindoosthan – as a moral proxy for the jehad in Kashmir,and the character required,to support the Kashmiri freedom struggle against Hindoo oppression.Within that,Liquor,Tobacco,Intoxicants and Cosmetics are easy for a Muslim and would appeal to the common Pakistani (as a sacrifice made by the Rich Pakistanis – in terms of abstinence)

    Next are pristine luxuries – watches, cell phones,jewellery,cars and expensive bikes etc – which are really not required at this juncture.,Imports of Liquor etc can be allowed only for Diplomats and Foreign tourists in quotas renewed each year – and imported by CANALISED IMPORTS by Pakistan PSU only.(Embassies,in any case,can import free of restrictions under UN conventions)

    Lastly, are autos.There is no need for people for import cars/bikes,if they already have 2 vehicles. So A TBT can be imposed that a certificate is sought on number of vehicles by actual user – at the time of remittance.Some people will use drivers names to import autos – so better to ban them outright.

    At a later stage, sole manufacturing and assembly rights can be given to a few licensees to make these items in Pakistan so that the cost of power,labour and some materials are in PKR and the profits are retained for some time,so that some FX is saved,and the rest is postponed.

    Most Asian nations are sitting on unused capacities and so low capital goods imports is not an issue,in any case

    Step 2 – Restructure Imports paid by Inter bank route

    For all imports paid by “inter bank route on CAD or DA” – shift it to LC mode on usance mode (from the Pakistani importer bank).The problem is that some importers may be making small imports and so the cut off limit by value, of imports by amount,can be set.The objective is to roll over the LC payments,as far as possible – so that the date of USD outflow is deferred,for the Pakistan banking system.

    If cost of LC usance (on life cycle mode) is high – the importers can use SB LCs to secure the suppliers (who will discount the drafts on Day 1) and the rollover financiers.

    As a result,the Pakistani importer will have surplus cash in that period and some importers will divert it – so that cash has to be blocked/liened by the bank on the date of the 1st date of rollover.During the tenor of the LC rollover,the FX position has to be hedged as a mandatory rule and the cash invested in safe T- Bills or Short dated GSecs,to finance the cost of the FX covers.

    The importer wil earn a treasury profit,and will have time to fine tune the date of crystallisation of the FX rates on the date of remittances – vs using the IBR TTSR,as of today.In the alternate – Blue chip entities (in terms of ethics) can use the cash surplus of the LC,to discount supplier bills (whose deemed cost of capital is 25-30% per annum) with significant margin improvements for the importer and the suppliers

    There is no dearth of banks who will roll over Pakistani LCs of 1st class banks (In Dubai/London/EU/New York. .For Non 1st class banks – some Pakistani Top rated bank or Foreign bank in Pakistan can add confirmation of the LC.LCs can by creative tools be rolled over – forever – till Jesus returns to earth.Some Hedge Funds also might also do it,as it is safe bet with a yield ,way over the USPR.

    This will avoid squeeze of USD in the IB markets – data about which is known to bankers,and so is also known to speculators and then the grey market.It affords flexibility in pushing out USD payments at various points of time – and can be restricted at any time by the SBOP.The Uncertainty in the SBOP policy on rollovers will ensure that the market is unaware of the CRYSTALLISED FX Liability on ANY DATE for the banking system (as there will never be a CERTAIN CRYSTALLISED DATE)

    So no punter will be able to speculate in the FX market,as the SBOP can change the crystallised liability on any date (unless the SBOP leaks the data) and the date of CRYSTALLISATION CAN BE CHOSEN IN SOME CASES, WHEN THE PKR HAS APPRECIATED

    For large importers in Pakistan importing on 90 – 120 days clean credit for many years on a regular basis – factoring and forfaiting limits can be set up in Dubai/London etc., to make the suppliers draw bills of exchange (drafts) for the rollover period of say 180 days or 270 days,which are accepted by the Pakistani importers.The drafts can be factored or forfaited by overseas financiers,with recourse to the importers (at say LIBOR + X points) and with recourse to suppliers (at a lower rate). The Risk is that the Pakistani importer signs the draft and disappears with the money (for the companies with doubtful ethics).In such cases,the importers bank can co-accept the drafts (and block or lien the importer funds)

    In the alternate,if the supplier cost of capital is lower, the supplier can “extend longer credit based on SB LC” issued by Pakistani importer (banker) and then “keep rolling it over” – based on “effective rates and arbitrage”

    Step 3 – Grey Market Imports

    This is the market where “no import duty is paid” and the USD is bought in cash “in advance” in Karachi or HK or Guangzhou. None of the imported items are necessities – denial of which will lead to death of the user.Some portion of the imports are made by baggage imports by air – which is an evil,which can be overlooked.

    Speculators take advantage of the squeeze in the interbank and the DEMAND of these grey market imports,to play havoc in the spot market – which hits the headline on the newswire.

    The solution is to identify say “500 high value imports by Tariff codes” and BAN Them – and direct only imports vide canalised imports from Pakistan PSUs (called,say SOPSU) with liaison offices in Dubai,HK/Singapore/Guangzhou/Shanghai.The Pakistani importers can identify their supplier and cargo – the chinese supplier will raise the bill on the SOPSU, who will stamp it as accepted – after the Pakistani importer has accepted it – on a back to back basis.The SOPSU will accept it after the Pakistani importer has deposited the PKR in Pakistan,with the SOPSU.

    The Chinese importer will take the SOPSU accepted bill to any Chinese bank and get the money. Of course, now the money is “on recprd and liable to Chinese Tax”.However,in Foshan,Chengdu,Dalian,Shanghai,GZOU there are many Chinese financiers,who can discount a draft endorsed by a chinese and PAY IN CASH (with no questions) so long as the drawer has no restriction/objections.

    Surely,some Chinese and Pakistanis will start “printing SOPSU acceptances” – SO THE SOLUTION IS TO DIGITISE ALL LIVE ACCEPTANCES and UPLOAD THE SAME,for all discounters to be aware of it (and this is to be printed on the acceptance)

    The SOPSU will pay the Chinese banks on deferred payments (after 6/12/18 months) at the pegged rate,on date of acceptance plus interest.

    This will take out all the Spot cash USD-PKR demand,in Karachi/HK/Dubai.

    Next,it is the Pakistani importers turn to take delivery from the Chinese after receipt from the Chinese banker – and clear it from Pakistani customs the way he wants (as he is doing today).It is easy to know that the chinese exports recorded from chinese ports do not reach (on paper) the stated ports of import in Africa,West Asia,East Asia and South Asia – so the Pakistani trader can operate the way he wants.

    The other way is that the SOPSU can canalise all the logistics in BULK by booking containers with Shipping lines and get much lower freight rates.Some Chinese and other flag carriers with Old Ships and Containers can be used to cut down the freight – where the containers are on the last voyage to the Karachi scrapyard etc. In such cases,the imports will be on record – so the importer will pay only the DEEMED DUTY (bribes) which he is paying currently + freight saved.Since the State has wiped out the hawala and FX punters and launderers, the duty can be lowered to the level of the DEEMED DUTY + freight saved ,as the corruption in Customs is wiped out,FX is controlled and all FX racketeering is wiped out.

    Most importantly, since the Pakistani importer has paid the import amount in PKR to the SOPSU on Day 1, the SOPSU will earn interest in PKR,for say 36 months at 20% per annum – which is 30%,and might close out the import financing on a date,wherein the PKR has appreciated (w.r.t the date on Day 1 – as the SOPSU would know the intervention plans of SBOP).For exporter nations,where there is no currency peg w.r.t the USD, the SOPSU will need to hedge the exposures (but the cost will be far below the Treasury gains)

    Step 4 – Making Exporters pay for Pakistan Import Duties and FX mismatch (defacto basis)

    W.r.t the “indusrial raw materials” legally imported by entities in Pakistan – the imports are “scattered and in small lots” based on “JIT concepts” – and the suppliers are loading “country,price (exchange traded) and credit risk” in the price

    These imports should be canalised by a SOPSU whose sovereign status will ensure that there is no country and credit risk in the price.In addition ,since purchases can be be aggregated on a BULK shipment,and ALSO for a LONG TENOR, THE BENEFITS OF STRATEGIC SOURCING WILL ACCRUE. For LME/CBOT/NYMEX/DALIAN/SME products,price formulas and hedges will TAKE OUT THE price risk BUILT INTO THE PRICE – and could reduce the price sharply, in some cases.

    If required,the SOPSU can issue a SB LC or a comfort letter,for purchases for 12 months and identify bankers in London,who will provide pre-shipment credit to the exporter of the industrial material (w/o recourse to the SOPSU)

    Long term contracts will reduce costs of affreightment.

    Then the SOPSU can find bankers to roll over the financing of the purchases,for 12-18 months,with the supplier getting payment on BL SOB.

    This will save 15- 25 % in purchase costs and the SOPSU would have deferred the FX outflow with treasury gains,and the BL can be endorsed
    to the pakistani user on High seas,or the SOPSU can clear the cargo and sell it to the user

    In essence,the cost of the supply chain to Pakistan,is lowered by 20%,and the FX out flow is pushed out by 18 months,and there are treasury gains.The Pakistani user can pay the SOPSU, the way he is paying in the existing mode.

    W.r.t the industrial raw materials illegally imported (w/o duty or misdeclaration) by entities in Pakistan – the imports are scattered and in small lots based on JIT concepts – and the suppliers are loading country and credit risk in the price and THE PAKISTANI IMPORTER IS PAYING ON CASH DOWN MODE (in USD) AS THESE CARGOS ARE MIS-DECLARED – AND SO,THE CARGO IS INSURED AS X WHEN IT IS Y,AND WITH A VALUE OF A WHEN THE VALUE IS C .

    These imports should be canalised by a SOPSU,AS ABOVE, AND THE SAVINGS CAN BE OFFERED TO THE IMPORTER AND HE CAN ASKED TO PAY THE SAME AS IMPORT DUTY.THIS WIPES OUT CUSTOMS CORRUPTION AND ALL HAWALA IN THIS TRADE and ACCRUES REVENUE TO THE STATE. THE IMPORTER WILL PAY THE ENTIRE AMOUNT ON DAY 1 (AS HE IS PAYING TODAY) AND THE SOPSU HAS A ROLL OVER PERIOD OF 18 months,with huge treasury gains and possibility of closing out the trade at an appreciated PKR

    Step 5 – Crypto

    Pakistani IT experts can tie up with some Chinese engineers to “start a Crypto” for Arabs,Bangladeshis,Lankans and Pakistanis working overseas for their remittances and student fees.This Crypto can be used by DIE HARD PAKISTAN smugglers for payments to suppliers – so that the PKR:USD is not pressured AT ALL FOR GREY MARKET IMPORTS.

    The Crypto Algo can be altered,to delete forensic trail,after a certain layer.

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