Pakistan Has a Health Care Solution Worth Exploring

Patients in a waiting room at the Sindh Institute of Urology and Transplantation in Pakistan. (SIUT)

 

By Zubeida Mustafa

In a Third World country, “health for all” cannot be taken for granted, given the iniquitous provision of welfare and health care, combined with rampant poverty. So it comes as a surprise to me, a citizen of Pakistan, that health care should be the subject of such a fierce debate in the United States, where many of the problems faced by Pakistanis do not exist. This world power, after all, has the resources to provide the best health care for its people, if it wants to.

Yet Truthdig’s search engine brought up 708 results for the last few months when I keyed in the words “health care.” It was eye-opening. It is clear that, despite the heated argument surrounding the Affordable Care Act, or “Obamacare,” that marked the advent of the Trump administration and the president’s failed efforts to repeal it, the controversy has not been laid to rest.

Michael Winship’s article titled “One Nation in Sickness and in Health” very cogently sums up America’s health care problem. “It’s a given that our health care system, one-sixth of our nation’s economy, is a nightmare,” he writes. Winship attributes this “nightmare” to the “stinkers out there so quick to abuse the system and make a quick big fast buck, especially in the pharmaceutical and health insurance industries.” Winship argues that reforms are necessary to attain the ultimate goal of making “universal health care a right for every one of us.”

Ironically, we in Pakistan face somewhat similar problems to the U.S.—albeit on a humongous scale: The factors that have led to a flawed health care system in Pakistan are different. They are mainly scarce resources, an expensive private sector for a handful of elites, no feasible medical insurance and a government that lacks political will and sensitivity to upgrade the existing ramshackle health care system

Health reforms in Pakistan have met equally formidable resistance as in the U.S., where reforms in the health sector have always triggered major political battles. We in Pakistan have done slightly better at creating health care reforms from time to time, some of which were perfect on paper. But alas, these reforms were never implemented, even decades later.

So our quest for a health utopia continues. In an ocean of despondency, ill health and morbidity, we Pakistanis, however, have a few islands of excellence. One institution in particular has the greatest potential when it comes to offering health solutions in universally challenging circumstances: the Sindh Institute of Urology and Transplantation (SIUT). The SIUT, a tertiary care hospital based in Pakistan’s most populous city, Karachi, has been sustained for more than four decades, during which it has grown incrementally in size and reach. The principles that underpin the SIUT’s model of health care could be adapted, adjusted and modified by any country to suit its own circumstances.

As a starter, one needs full commitment to the precept spelled out by the World Health Organization: “Health for all.” Many Americans fight to uphold this concept as a universal right. And health care should be seen as a fundamental right of all human beings and be the ultimate goal of all states. Dr. Adibul Hasan Rizvi, founder and director of the SIUT, labels it the “birthright of every person.” This translates into his institute’s motto: “We will not allow anyone to die because he cannot afford to live.”

Rizvi adds, “We offer health care free with dignity to every one irrespective of colour, creed, caste or religious beliefs.”

Dr. Adibul Hasan Rizvi, founder and director of the SIUT. (SIUT)

And he means it. This is proved by the presence of mammoth crowds that throng the SIUT’s premises in search of succour. All treatment is free, despite the state-of-the-art technology involved, which is expensive. As might be expected, the overwhelming majority of the patients are poor, coming from the 39 percent of Pakistan’s population classified as suffering from multidimensional poverty, who have traditionally been denied adequate health care. At the SIUT, even the most costly laboratory tests or surgical procedures are provided for free, and the ailing are treated with compassion and dignity. “This approach hastens the healing process,” a bladder cancer survivor confided in me after he was pulled out of the jaws of death in this hospital. The SIUT’s Hanifa Suleman Dawood Oncology Centre offers cutting-edge technology for cancer treatment, and last year treated 34,420 patients free of charge.

In 2016, the last year for which consolidated figures are available, 1.1 million people received treatment at the SIUT. Services provided included 8.8 million laboratory tests, 367 renal transplantations and 302,037 dialysis sessions. These can be frightfully expensive, especially transplantation and post-transplant medications, which have to be taken for life. By making its services available and free of charge, the SIUT, with its high success rate, has saved hundreds of thousands of lives. By adopting this approach it has also intervened in the illegal organ trade in Pakistan. The southern province of Sindh, where the SIUT is located, has never experienced the ignominy of hosting an organ bazaar.

How has the SIUT’s miracle worked? The institute is a partnership between the government and the common man. The government facilitates the working of the institute, an autonomous body in the public sector, by partially funding it through budgetary allocations, physical infrastructure where available and project grants. The community’s role is crucial. While the affluent members of the public donate generously, the poor also drop a five-rupee coin in the collection box—such boxes are scattered all over the city. Businesspeople and industrialists have donated buildings and medical equipment worth millions. This combined effort makes it possible for the SIUT to expand—it now has 12 premises under its wings, with three outside Karachi. Donations enable the SIUT to provide free treatment to the community, which reciprocates by showing a sense of ownership toward it.

To instill this confidence in the public, the institution must be seen as delivering on its promises. Any health care system that benefits the underprivileged inspires confidence in the donors and becomes sustainable in due course of time.

People gathered outside the outpatients department of the Sindh Institute of Urology and Transplantation in Pakistan. (SIUT)

No donor wants to feel cheated, which is why wastefulness and profiteering are the biggest enemies of such a relationship. To sustain confidence, expansion at the SIUT is incremental and strictly need-based. It has grown from its initial six beds to 900 beds today. Other health care facilities have tried to emulate the SIUT, but after many adjustments, Rizvi says the viability of the SIUT model is successful because it has been sustained for 42 years, expanding even while the national economy has shrunk. In 1975 the Pakistani rupee was worth almost 10 to a dollar. Today, it is 110.

It is, however a young woman—Aymen Khan, 19—who is the best ambassador for the SIUT. Born with bladder exstrophy, a rare and dangerous bladder condition, Aymen commented, when I first interviewed her five years ago, “To God I owe my birth and to SIUT I owe my health.” Had it not been for the SIUT, Aymen would not have the normal life she leads today as a university student and sports enthusiast. Her family could never have paid her medical bills at a private health care facility.

Source: Truthdig

Failure of women

Continue reading “Failure of women”

It wasn’t English

President Mamnoon Hussain in a Group Photo during the Inaugural Session of Conference on South Asia arranged Pakistan Institute of International Affair at PC Hotel Karachi on 15-11-2017

By Zubeida Mustafa

AT the inaugural session of its 70th anniversary conference, the Pakistan Institute of International Affairs, Karachi, did us proud when the proceedings were conducted in Urdu. It was a pleasure to hear chaste Urdu perfectly articulated at an occasion not dominated by our Urdu litterateurs.

I was told that this was at the suggestion of President Mamnoon Hussain who was the chief guest. Masuma Hasan, the chairperson of the institute, confirmed it, adding that it was her idea as well. Urdu is Pakistan’s national language, so no one should challenge Masuma’s decision. However, the smooth sailing at the PIIA function made me wonder why the demand for other provincial languages being given the same constitutional status cannot be considered favourably. Continue reading “It wasn’t English”

Playing with hellfire

TLYRA dharna

By Rifaat Hamid Ghani

MUCH significance is being attached to the rise of the TLYRA (Tehreek-e- Labaik Ya Rasool Allah) and its political face TLP (Tehreek-e-Labaik Pakistan) ; and the MWM (Majlis Wahdat-e-Muslimeen). There must be finer points of differentiation in party postures but the new bodies seem a Maulana TQ’s PAT derivative in terms of political leverage (intent is a matter of speculative personal opinion). But the future may be fraught with menacing linkages.

In 2012 Maulana TQ baulked from venturing to show how his national electoral vote-bank matched the heft of his staunch foot soldiers in road-camps. Awesomely righteous he remains; but a comparatively familiar game changer does not occasion the anxiety the undefined goals of these fresh but by-electorally promising moral stalwarts do – or, perhaps even more pertinently, could be projected as embodying. They are not waving the Daesh flag (anyone can chalk walls or paste posters of any sort) but they have made their debut  customized to the current international perception of militant Muslim obscurantism. Their apparent success and the government’s apparently craven surrender enables international global-jihadism terrorist-risk-perception tanked up thinkers to move Pakistan a notch higher on the flashpoint watch-list of alarmingly unstable, no matter how wistfully democratic, extremism prone Muslim countries. Continue reading “Playing with hellfire”

Misuse of faith

By Zubeida Mustafa

A RECENTLY launched collection of Hamza Alavi’s papers and speeches should be a timely reminder to us about the role that faith has come to play in Pakistan’s politics. Translated into Urdu by Dr Riaz Ahmad Shaikh (dean of Social Sciences, Szabist), Tashkeel-i-Pakistan: Mazhab aur Secularism leaves no one in doubt about the misuse of religion by our leaders to gain advantages in public life at the expense of the people’s well-being and the national interest.

Hamza Alavi, who was a Marxist scholar recognised in world academia, firmly believed that the founder of this country never sought to set up a theocratic state. Yet that is the direction in which Pakistan appears to be heading. Continue reading “Misuse of faith”

Storytelling

If the storyteller is good, children listen with rapt attention

By Zubeida Mustafa

READING is an essential element of education, and textbooks are an integral part of the curricula of formal education that can’t shrugged off. But reading books other than course texts helps children enrich their minds and makes them superior to their ‘non-reading’ peers.

Yet the general impression is that our children are not into the reading culture. This is surprising because in the last few years children’s books have flooded the market and some of them are really good. They have all the qualities a book should have to grip the readers’ interest — a lively style, strong storylines and characters with which our children can connect. Continue reading “Storytelling”

New American Strategy in South Asia Targets Pakistan

By Zubeida Mustafa

Secretary of State Rex Tillerson’s return to Washington after a hectic week in South Asia and the Middle East leaves us speculating on the purpose and result of his mission.

World attention was focused on his exercise in diplomacy for no other reason than that his trip was a follow-up on President Donald Trump’s announcement in August of a new South Asia strategy. Continue reading “New American Strategy in South Asia Targets Pakistan”

The legendary Ahmad Ali Khan

LAUNCHING THE ISLAMABAD EDITION OF DAWN: (R-L) Ahmad Ali Khan, Saleem Asmi and M.Ziauddin (2001)

By Zubeida Mustafa

DAWN of Karachi is 70 this year. Over the decades, scores of people have joined hands to help the paper sustain its standing and standards. But there is one man whose contribution was singular. Without the direction he provided, Dawn could not have risen to the heights to which it has, notwithstanding the numerous crises it has had to weather in its eventful life. Continue reading “The legendary Ahmad Ali Khan”

Fragility

Sabeen Mahmud was killed for her liberal views

By Rifaat Hamid Ghani

JUST a few weeks ago there was an example of the inter-related fragility of our political-religious equilibrium. The wording of the oath for elected representatives was altered. The drift of reaction was that the reworded version insulated avowal of the finality of prophet-hood.

The previous wording was rapidly restored before cries of heresy and the like gained violent momentum. But the matter gave clerical-conglomerate cause for a rally; and the fact of the cancelled alteration is there to be referred to by those who choose to find Islamic intent deficient in the way persons or parties of their naming practice politics. Continue reading “Fragility”

Sorry, Dr Zulfiqar

Demonstrating against the death penalty in Islamabad

By Zubeida Mustafa

OBITUARIES should not be set aside for another day. But I am writing one after two years when I have summoned up the courage to write about a man who was hanged on May 6, 2015.

There was a time I wrote frequently about Dr Zulfiqar Ali Khan when he was living. I wanted to save his life. He remained in prison for 17 years — seven years on death row — before the hangman got him. The night before his hanging I had received a desperate message from Justice Project Pakistan if I could help get him clemency. I, a retired newspaperwoman, have no clout. The next morning, JPP informed me that Zulfiqar was no more and I felt I had let down his two young, motherless girls. I had also failed the cause of education in Pakistan. Continue reading “Sorry, Dr Zulfiqar”