Inspiring Change: A Journey in Pakistan’s Healthcare System
Photo: View of the City from the Hostel taken by author
By Anum Qaiser (BHSc Candidate, Western University)
When I first arrived in Pakistan in February 2023 to begin my journey as a medical student, I was filled with hope and determination. As a Canadian student, I saw this as an opportunity to immerse myself in a different healthcare system, gain valuable experience, and contribute towards global health equity.
The Hostel: A Difficult Start
The hostel (my university residence), which was supposed to be a safe and comfortable space, became a source of constant stress. Eleven girls were crammed into a small two-bedroom apartment. Private space was nonexistent, and the lack of space created an environment of constant tension.
The two washrooms were insufficient for so many students. Mornings were a race against time, with some of us resorting to using the kitchen sink to get ready. The absence of hot water made basic hygiene a challenge, and the unsanitary conditions including stray cats roaming freely, ants on the countertops, and muddy footprints across the floors, posed serious health risks.
The hostel’s location, a 45-minute drive from campus, added to the difficulties. The daily commute often meant long rides in overcrowded buses without proper handrails or enough seating. Students had to stand closely packed in the aisle, struggling to maintain balance as the bus moved through traffic. It was physically exhausting and at times felt precarious, particularly during sudden stops or turns. The lack of a meal plan forced us to rely on unhygienic local eateries, where I contracted a severe case of food poisoning, leaving me weak and unable to focus on my studies. While some local eateries were affordable and offered home-style meals, the inconsistency in nearby local hygiene standards made it difficult for us to rely on them regularly. My experience of food poisoning reflected these gaps, though I recognize that other students, especially locals, often managed to navigate these options more successfully.
The College: A Reflection of Systemic Challenges and Strengths
My experience at the college highlighted both limitations and potential. As a public medical college, the resources and infrastructure available to us differed markedly from those of private institutions, where tuition fees often sustain higher levels of investment. This distinction is critical in understanding the systemic disparities across Pakistan’s medical education landscape. The infrastructure showed signs of strain, classrooms showed signs of wear, and the physical space wasn't always able to accommodate the strained student concentration. Much of the teaching relied on lecture-based approaches, with limited opportunities for problem-based or interactive learning.
My impressions align with recent research. A comparative study of medical colleges in Sialkot reported challenges such as under-resourced laboratories, traditional curricula, and restrictions in student–teacher engagement and clinical training, common across both public and private institutions (Zaheer et al., 2024). Additionally, an analysis by Khan and Strivens emphasized reliance on theoretical teaching, uneven resource allocation, and a lack of uniform admission standards, identifying clear areas where reform is needed (Khan & Strivens, 2021).
Still, Pakistan’s medical education landscape also encompasses significant strengths. The Pakistan Medical and Dental Council (PMDC) recognizes over 185 medical and dental colleges, many of which train professionals who go on to contribute to healthcare both locally and internationally. Leading institutions like Aga Khan University Hospital remain a beacon in the region, known for excellence in medical care, research, and graduate training internationally. Its graduates and faculty contribute to global health initiatives, with many taking leadership roles in international healthcare systems and research collaborations, which reinforces its reputation beyond Pakistan. (The Aga Khan University, n.d.).
Another example is the Nuclear Medicine, Oncology, and Radiotherapy Institute (NORI) in Islamabad. NORI is one of Pakistan’s major public-sector cancer centers, serving thousands of patients annually (Junaidi, 2024). Importantly, a large proportion of its diagnostic and therapeutic services are either free or heavily subsidized, particularly for patients from low-income backgrounds (Cancer Hospitals, n.d.). In a country where the socioeconomic gradient strongly influences health outcomes, NORI’s model helps reduce barriers to specialized oncology care (Cancer Hospitals, n.d.). By offering treatment irrespective of financial capacity, NORI demonstrates how equitable access to care can be achieved within resource-constrained environments. This not only improves survival for marginalized patients but also illustrates the role of public institutions in narrowing health inequities.
Such examples remind us that Pakistan’s healthcare system, though strained, is not defined solely by its challenges. It has institutions that embody resilience, innovation, and a strong commitment to equity. Recognizing this dual reality, systemic constraints alongside centers of excellence provides a more balanced understanding of the medical education and healthcare landscape.
The Viral Email: A Catalyst for Change
In April 2023, I wrote an email to the Dean of the medical college and the provincial health minister, detailing the challenges students were facing in their living conditions and day-to-day experiences. The message was never intended to become a national headline. It began as a carefully worded letter, drafted on behalf of my peers who had long endured circumstances linked to hostel overcrowding, limited sanitation, and the exhausting daily commute, conditions that had come to be accepted as “normal”. I remember sitting in that dimly lit hostel room, crafting each sentence with the hope that it would spark constructive dialogue rather than defensiveness.
At the time, I had already decided to return to Canada, and I felt an acute sense of loss that all my efforts to study medicine in Pakistan were coming to an early end after multiple health challenges in a short span. I did not want to leave silently, fading into the background as just another statistic to report regarding student enrollment. Writing the email was my way of ensuring that our concerns were at least acknowledged, even if I had no expectation that the message would gain traction. My primary audience was the faculty and administrators who had the authority to improve conditions, but what happened next was beyond anything I could have imagined.
Within days, the email spread widely. Somehow it found its way to social media, where it was shared across Facebook and Instagram, circulated in WhatsApp groups, and then picked up by national news outlets. What had started as an internal communication became a public conversation about student welfare, accountability, and the responsibility of institutions to safeguard learners’ health and dignity.
On June 2, 2023, DAWN News, Pakistan’s leading national newspaper, published an article highlighting the concerns I had raised (Chaudhry, 2023). The response was overwhelming. Many students from across the country reached out to share similar experiences, while educators and policymakers began openly discussing the need for reforms. Although it was validating to see the story resonate with so many people, it also revealed how deeply entrenched these issues were.
The administration did not remain passive in the wake of the coverage. According to the DAWN article, the principal publicly acknowledged the issues and established a committee of senior medics to investigate and address the problems highlighted in my email (Chaudhry, 2023). Among the most significant changes was the decision to relocate students to a new hostel closer to campus, which eased the strain of long commutes and offered safer, healthier living conditions. Additionally, long-term plans were put forward for a new campus spanning 2,800 kanals (350 acres), which would include modern facilities, a dedicated hostel, and a 500-bed hospital. At the same time, I remained cautious. In public policy, ambitious infrastructure plans are often announced with optimism but take years to materialize, if at all. The promise of a new campus symbolized progress, but without sustained accountability, such commitments risk fading into aspirational rhetoric rather than concrete reform.
Contrastingly, the immediate aftermath brought tangible changes. Within two months, the administration relocated students to a more suitable building, recognizing that the conditions we had been living under needed to be changed. For many of us, this move was a moment of relief, but also a powerful reminder that collective frustration, when voiced effectively, could lead to change.
Currently, in 2025, the new residence building allocated to students two years back, remains in use today. Its continued existence serves as evidence that even imperfect advocacy can create ripples of lasting reform. Yet, reflecting on this moment, I cannot ignore the role privilege played in shaping its outcome. Would the same email have gone viral if it had been written by another Pakistani student, one without the “Canadian” identity attached to their name? The uncomfortable answer is likely no. My words carried weight not only because of their content but also because of how I was perceived: as both an insider and outsider.
This raises an unsettling truth. Many of my peers had raised similar concerns before, only to be overlooked. My voice broke through not because it was more compelling, but because it was interpreted differently. This inequity illustrates how systemic change is often influenced less by the merit of the message than by the identity of the messenger. It is important to emphasize that my peers lived through the same conditions with equal, perhaps more resilience and determination. Their struggles and advocacy were no less valid than mine. My email did not carry more truth, only more amplification because of how it was perceived. Recognizing this dynamic reminds me that change must elevate all voices, not just those that are seen as more ‘listenable.’ This experience forced me to ask an unsettling question: would the outcome have been the same had the complaint come solely from a local student without international ties? Acknowledging this privilege is uncomfortable but necessary to understand how unevenly voices are valued in reform efforts.
The viral email taught me that advocacy, even when unplanned, can serve as a powerful tool for change. But it also underscored that true reform requires more than a single voice amplified by circumstance. The challenge moving forward is to ensure that every student, regardless of background or privilege, has the ability to speak, be heard, and influence the future of education and healthcare.
Pakistan’s Hospitality and Cultural Richness
Beyond the hardships I encountered during my short-lived stay, Pakistan has a deep sense of community and cultural vibrancy. Despite its struggles, there is an undeniable warmth in the people. One of the most memorable aspects of my experience was the unwavering support of my fellow medical students. In moments of exhaustion and frustration, they were the ones who reminded me why I had chosen this path. Whether it was exploring the city together, helping me learn local customs to fit in, being the support available when I had become severely ill, or simply listening when the stress became overwhelming; their kindness and camaraderie were invaluable. Despite the challenges we faced, there was a shared determination to push through, and that sense of solidarity was truly inspiring.
The country’s rich heritage is also reflected in its breathtaking architecture, from historical monuments to the awe-inspiring landscapes of the northern regions. Food culture is another defining element, bold spices, traditional flavors, and dishes that tell stories of history and regional diversity. The resilience of the people, their ability to find joy in the smallest things, and their unwavering generosity left a deep impression on me.
A Call for Constructive Dialogue
My journey was marked by challenges, but it also revealed the potential for positive change. By sharing my story, I hope to foster constructive dialogue about improving medical education globally, while also celebrating the resilience and potential of its people and institutions.
At the same time, I recognize that many of these reforms are already being driven by Pakistani educators, policymakers, and students themselves. My reflections are meant to contribute to, not replace, those ongoing efforts. Sustainable change must be grounded in local leadership, with global dialogue serving as a source of solidarity and shared learning.
As I returned to Canada, I carried with me not just the disappointment of an unfulfilled dream, but also a renewed determination to advocate for reform. The viral email showed me that speaking out can spark conversations, but for change to endure, advocacy must move beyond one student’s experience. It requires structural solutions, collective effort, and sustained accountability.
So how do we begin? Reforms in medical education within lower- and middle-income countries (LMICs) who face similar challenges must be grounded in both feasibility and equity. First, there needs to be greater investment in student housing and infrastructure, not only to provide safe and healthy environments but also to support academic success. Partnerships between governments, universities, and international organizations could help mobilize resources to achieve this.
Second, reform should focus on listening to students and including them in decision-making. Student councils, anonymous feedback mechanisms, and peer representation in governance can help ensure that concerns are addressed before they escalate into crises. Importantly, all students, not just those with privileged identities or international ties, must feel empowered to speak up without fear of retaliation or being left unheard.
Third, faculty support and curriculum development are also key areas of growth. Many countries, including Pakistan, are already engaged in efforts to update medical education through curriculum reform and faculty development initiatives. Strengthening these ongoing efforts by supporting professional development, fostering collaborations across institutions, and sharing best practices globally, can help ensure that students are equipped with both clinical knowledge and the skills needed to meet evolving healthcare challenges. E-learning, when implemented thoughtfully, can also complement traditional teaching methods and expand access to resources, especially in contexts where faculty shortages and large class sizes pose challenges.
Finally, reforms must be supported by policy frameworks at the national level. Ministries of Health and Education, alongside regulatory councils, play a critical role in setting standards for medical colleges. By aligning institutional reforms with national health workforce strategies, countries can ensure that changes are not isolated but part of a broader push to strengthen healthcare systems.
These steps are neither simple nor quick, but they are possible. The new hostel allocated to students in 2023 stands as proof that advocacy can translate into action. Yet, real progress lies in ensuring that reforms are institutionalized, not reactionary, so that future generations of medical students inherit systems that nurture rather than hinder them.
My story is just one of many, and while it carried weight because of my position as a Canadian student studying in Pakistan, I hope the lesson it leaves behind is larger than me. The goal should be to create systems where all voices matter, where students do not need privilege to be heard, and where reforms are driven not by crisis but by a commitment to equity and excellence in education.
Works Cited:
Cancer hospitals. (n.d.). https://paec.gov.pk/medical/
Chaudhry, A. (2023, June 2). Disheartened Canadian quits MBBS at public medical college in Lahore. DAWN.COM. https://www.dawn.com/news/1757356
Khan, J. S., & Strivens, J. (2021). Medical Education in Pakistan: Challenges & Way Forward. South-East Asian Journal of Medical Education, 15(2), 10–15. https://doi.org/10.4038/seajme.v15i2.285
Junaidi, I. (2024, December 19). Relief for cancer patients as NORI brings ‘cyclotron’ technology to capital. DAWN.COM. https://www.dawn.com/news/1879610
Pakistan Medical and Dental Council - Institutions & qualifications. (n.d.). https://pmdc.pk/colleges
The Aga Khan University. (n.d.). The Aga Khan University. https://www.aku.edu/Pages/home.aspx
Zaheer, S., Qurat-Ul-Ain, N., Malik, U., Usman, F., Dawood, A., & Sidra, N. (2024). CHALLENGES OF MEDICAL EDUCATION IN SIALKOT: A COMPARATIVE STUDY OF PUBLIC AND PRIVATE MEDICAL COLLEGES. Pakistan Journal of Physiology., 20(3), 77–80. https://doi.org/10.69656/pjp.v20i3.1653
Photo credit: Anum Qaiser
