Organ donation

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By Zubeida Mustafa

ABDUL Sattar Edhi, the iconic humanitarian, who passed on recently, has been highly eulogised all over Pakistan and beyond. He has also received accolades for something more. He donated his corneas after death which bestowed the gift of sight on two visually impaired people.

Edhi’s donation was of immense importance. Coming from a person held in such admiration by all, his example has inspired many. That is what we need today — heroes who lead by example and not words alone. As it is, Edhi was a man of few words. Continue reading “Organ donation”

A 40-year journey

By Zubeida Mustafa

siut9THIS week the Sindh Institute of Urology and Transplantation (SIUT) is holding an international symposium to celebrate 40 years of its existence.

The logo designed for the occasion sums up its philosophy: “Every human being has the right to access healthcare irrespective of caste, colour or religious belief, free with dignity.” At SIUT you actually see this happening.

For long, it was the dream of its founder, Dr Adibul Hasan Rizvi, to create a nucleus that would evolve into an equitable and inclusive healthcare system that would be accessible to all. Continue reading “A 40-year journey”

A new venture

By Zubeida Mustafa

AWAY from the bustle of downtown Karachi in a remote area of Korangi bordering Ibrahim Hyderi, where our fishermen eke out a hazardous living, an experiment in social engineering is taking place. It is expected to be a milestone in the history of healthcare in Pakistan.

This new venture — the Mehrunnisa Hospital — is seemingly a modern hospital for the poor like any other, waiting to open its doors fully to patients. They are bound to visit it in droves once the bus routes are adjusted to make it accessible by public transport.

Built by a philanthropist — businessman Haroon Abdul Karim — it was donated by him to the Sindh Institute of Urology and Transplantation in January 2013. Abdul Karim’s obsession was that patients be provided services absolutely free of charge. He visited hospitals incognito and felt that the SIUT alone met his criteria.

What makes Mehrunnisa so different that it is expected to be a model? Continue reading “A new venture”

Pakistan’s healthcare history: a unique chapter

When devotion overtakes every other consideration what one ends up doing is setting an example that inspires others to follow suit with even greater zeal. The story of Sindh Institute of Urology & Transplant (SIUT), very ably and comprehensively narrated by renowned journalist Zubeida Mustafa in her book entitled “The SIUT story”, too is about the admirable devotion and commitment of those who run the SIUT.

What is particularly commendable about the book is its coverage of every aspect of SIUT with relevant details. Besides, the book is a ‘must read’ for all physicians, surgeons and hospital attendants because it gives them important message – humanity must be served without any distinction, and the most deserving are the poverty-stricken; serving them is the route to salvation and Professor Adibul Hassan Rizvi is a living example thereof.

guest-contributorBy A.B. Shahid

June 15, 2013
When devotion overtakes every other consideration what one ends up doing is setting an example that inspires others to follow suit with even greater zeal. The story of Sindh Institute of Urology & Transplant (SIUT), very ably and comprehensively narrated by renowned journalist Zubeida Mustafa in her book entitled “The SIUT story”, too is about the admirable devotion and commitment of those who run the SIUT.

What is particularly commendable about the book is its coverage of every aspect of SIUT with relevant details. Besides, the book is a ‘must read’ for all physicians, surgeons and hospital attendants because it gives them important message – humanity must be served without any distinction, and the most deserving are the poverty-stricken; serving them is the route to salvation and Professor Adibul Hassan Rizvi is a living example thereof.

How in 1972, an eight-bed unit of the Civil Hospital, Karachi was transformed into SIUT – an internationally recognised medical centre – is the story of a remarkable struggle that succeeded because of the commitment of Dr Rizvi and his team, to serving humanity, especially the down-trodden, and at the same time steadily raising the standards of care in many fields besides the delicate area of kidney-related illnesses.

The book highlights in detail the success of SIUT, given a historic background wherein healthcare never got the importance it deserved in a country like Pakistan that has the reputation of having one of the world’s highest rates of population growth. The book begins, and very rightly so, by summarising this sad track record to show how inspite thereof SIUT made the ‘impossible’ possible.

The author sums up the philosophy of SIUT very well when she says “The idea is to be as self-sufficient as much as possible and provide the institution with state-of-the-art technology without any ostentation.” That’s why there are no private wards in the SIUT, nor do its senior doctors have private offices. This profile has been hugely helpful in SIUT benefiting from the world’s top-ranking medical institutions, physicians, and surgeons.

Organ donation is imperative for transplant, which can be exploited as an irreligious act by those who place saving lives – the prime human obligation – at a low priority. SIUT was able to pre-empt such a disastrous move back in 1998 by obtaining legal and religious support for it when the father of a diseased young man set a great tradition by deciding to donate the organs of his son to give the ‘gift of life’ to those who needed them.

This great act and many thereafter, provided the beginning for SIUT’s transplant service in which it made great strides and has now become a world renowned institution. This initiative convinced institutions abroad about the sincerity, commitment and futuristic approach of the team at SIUT in reaching new heights in medicare and making it a truly humane service.

The support SIUT receives from global medical experts has been dealt with extensively by the author giving both the details of the experts from the US to Australia helping SIUT, and their very encouraging assessment of the services the SIUT offers, as well as its achievements in this context. Some of the messages coming from top-notch medical specialists assure you that not everything is wrong with Pakistan’s medical services.

Encouraged up by global support and the commitment of its physicians, surgeons and paramedical staff, SIUT now offers a variety of treatments and therapies including dialysis, endoscopy, oncology, nephrology, ultrasound, haematology, renal failure, lithotripsy, prostrate surgery, organ transplant, and more and has elaborate diagnostic expertise and requisite technologies therefor.

The ability to offer a variety of therapies is rooted in a knowledge sharing base – teachers, laboratories and libraries – building which has been an ongoing task. Besides setting up teaching facilities, a library with over 5,000 books and subscribing to 125 medical journals, a landmark was the setup of Zainul Abideen Institute of Medical Technology. In 2009, HEC too recognised SIUT as a degree awarding education institution.

In spite of all the negatives that Pakistan has been suffering from, SIUT has earned global recognition as a forum for global conferences. In 1994, SIUT organised the first International Symposium on Urology, Nephrology and Transplant. Since then SIUT has been hosting international conferences that are attended and addressed by renowned foreign medical experts, and add to the knowledge-base of SIUT’s team.

Besides medical treatment, SIUT has set up the Centre for Biomedical Ethics and Culture (CBEC) – a forum of physicians and sociologists devoted to designing the core values of the profession. Until CEBC’s setup, in Pakistan the need for institutionalising a forum to define and impose ethical practices in the medical profession was not realised. CEBC now holds regular sessions for physicians as well as for visiting students.

Education programmes and publications of the CBEC forum led to global recognition of this centre, and Dr Farhat Moazam and Dr Aamir Jafery of the CBEC were elected to global forums on biomedical ethics. More importantly, CBEC also helped the WHO Task Force on this subject in upgrading its global guidelines on organ transplantation – no small achievement for a Pakistani institution.

The author has allocated a chapter to the role played by donors, both big and small, without whose help SIUT could not become what it is, given the consistent inadequate funding of the health services by the state. Among institutional donors, the first to begin contributing back in 1980 was the Bank of Credit & Commerce Int’l Foundation (now called the Infaq Foundation), under the leadership of the late Agha Hassan Abedi.

Besides many reputed contributors special reference is made to Suleman Dawood, the Haroon family, the Cowasjee Foundation, and to Dewan Farooq who financed the setting up of Zainul Abideen Institute of Medical Technology. Then there are thousands of donors in Pakistan and abroad who regularly donate sums to the SIUT besides helping in acquisition of medical equipment.

This wide scale of public support is the manifestation of the peoples’ confidence in the way SIUT is run by Dr Rizvi and his team. To institutionalise the recording, accounting and appropriate use of donor funds, back in 1986, SIUT had established the Society for the Welfare of Patients of Urology and Transplant, which is overseen by an independent Board of Governors.

The book concludes with comprehensive indices about virtually every aspect of SIUT services, expert opinions thereon, SIUT’s connections and affiliations and, very rightly, also includes a roll of honour listing the many national and international awards bestowed upon Dr Rizvi and his team of able physicians, surgeons and paramedical staff who performed with unmatched commitment and devotion to serve humanity.

Source: Business Reorder

Hope for the Children

Philip Ransley (L) and Jeeta Dhillon
By Zubeida Mustafa

A boy — seemingly healthy — is born to a young couple and there is much rejoicing in the family. But little do the parents know at the time that tragic news awaits them. The infant has urethral valve obstruction at birth and if he is not treated in time he will head for kidney failure.Today there is hope for the infant, thanks to the Sindh Institute of Urology and Transplantation (SIUT), Karachi, which is the only medical facility in Pakistan that has a unit for paediatric urology. Dr Philip Ransley, a paediatric urologist from the UK, who helped in the establishment of a paediatric urology unit in SIUT, finds it ‘crazy’ that there is no other unit of its kind in a country of 180 million where 45 per cent of the population is under 15.

The parents of the children — 20,000 of them who visit SIUT’s biweekly paediatric clinic every year — have much to be thankful for. They are provided the best state-of-the-art treatment free of charge by specialists trained by world renowned urologists in an environment that is child friendly. Bladder extrophy, spina bifida, and traumas caused by accidents that could become the cause of much anguish to children and their parents no longer lead to despair. There is hope.

The silver lining in Pakistan’s dark cloud of the public health sector is the SIUT which is the creation of the iconic Dr Adibul Hasan Rizvi who recently received a standing ovation in the National Assembly where every political party head lauded his efforts.

It was his vision — he always speaks of having a dream and then goes after it like a driven man — that saw the birth of the paediatric urology unit in 2002. The significance of this was driven home to me by Mr Philip Ransley who was in Karachi last week to conduct the Second International Paediatric Urology workshop. Mr Ransley retired a few years ago from London’s Great Ormond Street Hospital where he had trained under Sir David Innis, the legendary father of paediatric urology in Britain. He has made it his life mission to help the children of Pakistan and says, “Like many other areas of medicine, urology is a discipline that requires specialists trained for children. A urologist who operates on adults cannot really treat children’s urological problems with the expertise needed for it.”

“When I first started coming to Pakistan (he has been here dozens of times) my idea was to do surgery to rescue children from problems which no one could do here. Then following the dictum ‘give a man a fish and he feeds himself for a day but give him a fishing rod and he feeds himself for life’ I decided to pass on my expertise to the surgeons in Pakistan. The essence of our success is that SIUT’s paediatric urologists now take care of the vast majority of cases themselves — they have been quick on the uptake. They are even doing bladder reconstruction surgery which they had never done before,” Philip Ransley comments.

That explains the importance of the four day workshop held at the SIUT last week. The idea was to transfer knowledge of the new techniques that are continuously emerging in the world of medicine. Along with Philip Ransley and his colleague from London, Jeeta Dhillon, a perinatal urologist, the workshop was conducted by a guest faculty of four from France, the US, Germany and Italy.

Run with “amazing organisation of a military nature” (in Ransley’s words), the workshop was found “mind-blowing” by Jeeta Dhillon. There were three operation theatres running simultaneously throughout the workshop — unheard of in any surgical workshop anywhere in the world — ensuring continuity and intensive interaction. It also allowed the faculty to introduce the participants (about 150 of them from all over Pakistan) to different techniques. Laproscopic surgery, the latest entry in the field of paediatric urology and practised the world over, topped the agenda. Another area of interest was reconstruction of the bladder — a complex and time-consuming procedure.

What made the workshop so successful was not just the minute-to-minute scheduling done by Jeeta, the wonder woman of the exercise, but also the care and time taken in the selection of the 17 children operated upon — a nine-month process undertaken by Dr Sajid Sultan and the paediatric unit of the SIUT he heads. Jeeta pointed out that urologists don’t get to see so many cases in any workshop — and all free.

It was therefore a pity that the delegates from abroad — excepting the Turks — didn’t turn up. It is the image of Pakistan being an unsafe place that put them off. But the faculty who came were so pleased with their experience in Karachi that, as Philip Ransley hopes, they will talk about it and more people will visit.

Not surprisingly, WHO has decided to select SIUT as its collaborating centre for organ transplantation in the eastern Mediterranean.

Source: Dawn

Continue reading “Hope for the Children”

SIUT on life-saving mission

94-20-01-1996a                                                                                                                                     KARACHI: The light at the end of the tunnel for Karim Dad is growing dim-. He is a 36-year-old farm worker from Tando Jan Mohammad and has lived on dialysis for the last five years. A patient of end-stage kidney failure, Karim Dad could not have survived had he not been visiting the Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, twice a week to be hooked on to the dialysis machine which removes impurities from his blood. (This function is normally performed by the kidneys in a healthy person.)

SIUT has spent Rs 400,000 on Karim Dad so far and not charged him a penny. In the private sector, Karim Dad would have had to pay Rs 1,000,000 for dialysis to stay alive — something beyond his means.

Nizamuddin, a 30-year vegetable vendor from Orangi Town, is in the same boat. A patient of kidney failure, he has been coming for free dialysis to SIUT since July 1990. Continue reading “SIUT on life-saving mission”

At SIUT the dead help the living

Shehnaz: A gift of life from the Netherlands
Shehnaz: A gift of life from the Netherlands

By Zubeida Mustafa

The story begins five thousand miles away in the Dutch city of Maastricht. In mid-January a 14-year old girl slips into a coma and dies due to a ruptured cerebral aneurysm. Her grief-stricken parents decide to gift her organs to the dying. Thus they would have the satisfaction of knowing that a part of their child has not died.

That is how the central registry of the Eurotransplant Foundation in Lieden gets an AB+ blood group donor.

It is noon in Karachi. At the Sindh Institute of Urology and Transplantation (SIUT) in the Civil Hospital there is a call for the director, Dr Adibul Hasan Rizvi, from Dr Ganke Kootstra of the University of Maastricht. There is a cadaveric kidney available. Does Karachi have an endstage renal failure patient who needs the organ and has the matching tissue type?

Thus begins the miracle for Shehnaz, a young woman of 24 and a resident of New Karachi. She has been haunted by the spectre of death for the last four months since her kidneys stopped working. She has survived with the help of dialysis — a procedure in which the function of cleansing the impurities in the blood is performed by a machine to which the patient’s artery is hooked. But life has been robbed of all joy. Since October Shehnaz has had to come to the Institute thrice a week for a four-hour dialysis session. Then too, she feels fit for only a day, after which the nausea returns. She also gets breathless. Continue reading “At SIUT the dead help the living”

Why not organs from cadavers?

By Zubeida Mustafa

75-18-06-1993.AOrgan transplantation technology was introduced in the West in 1904 when the first corneal graft operation was performed in a New York hospital. The first kidney was transplanted in Boston in 1954. Today, surgeons in the Third World have adopted the technology with a growing measure of confidence and success. Nearly 40,000 transplantations are being performed every year all over the world and this technology has come to stay.

As happens in the case of any scientific breakthrough, many related issues, especially of an ethical nature, are now being debated. The 1 Institute of Urology and Transplantation, Civil Hospital Karachi, which has kept up a constant exchange of views and expertise with transplantation surgeons in Western centres, recently played host to two eminent gentlemen from the Royal Free Hospital, London. Dr Oswald Fernando, a surgeon from Sri Lanka, and Dr Zac Verghese, a basic scientist from India, have worked in Britain since 1963. They are therefore well placed to understand the challenges transplantation technology faces in the socio-economic conditions of the Third World. Continue reading “Why not organs from cadavers?”

Gift of Life

By Zubeida Mustafa

69-27-11-1992Two hundred children in Britain who faced certain death from liver failure are alive today and leading a normal, healthy life. They owe their recovery to the miracle of transplantation: the technology that allows surgeons to graft wholesome organs from one person to another.

Behind every milestone in medical science there is invariably a human story of sustained commitment and caring effort. In the case of these 200 British children the man who has made liver transplantation possible is Sir Roy Calne, a pioneer in the field of transplantology. A professor of surgery in the Cambridge University and president of the. International Transplantation Society, Dr Calne has contributed to the science of transplantation by his research on the immuno-suppressive drugs, without which no organ graft can be successful.

The defence mechanism of the human body normally ensures that it rejects foreign objects, which include organs taken from another person. Hence the use of drugs to suppress the immune reactions but in such measured doses that infections do not kill the patient. Continue reading “Gift of Life”

Organ transplantation has come to stay -Dr Adib Rizvi

By Zubeida Mustafa

68-04-08-1992a
Dr Adib Rizvi

In the early 1970s a magistrate from the interior of Sindh died of kidney failure in Civil Hospital, Karachi. This should normally not have merited a mention, especially twenty years later. Nearly 10,000 people in Pakistan come down with kidney failure every year.

But Mr Shaikh’s death, that was the magistrate’s name, proved to be an event of far-reaching consequences. In those days there were no facilities in Karachi for dialysis (let alone transplantation) — the only process by which the life of a patient of end-stage renal failure can be sustained. Mr Shaikh was sent to London where he was dialysed for a few weeks until his budget was exhausted. He was sent home with the false assurance that he was cured. He returned to Pakistan very pleased with himself looking forward to a new life. He brought as a token of his gratitude a small gift of handkerchiefs for the urologist who had attended to him in Karachi. Continue reading “Organ transplantation has come to stay -Dr Adib Rizvi”