IN a society as morally perverse and corrupt as ours, does a centre of ethics have any relevance? A cynic’s answer would be a resounding ‘none whatsoever’. The idealist/reformer would say, ‘all the more’. That is a dilemma that faces all activists in this country seeking to light the spark of change.
In this context, the SIUT’s Centre for Biomedical Ethics and Culture (CBEC) faces a daunting challenge. It has been struggling for the last 13 years to introduce an ethical perspective not just in healthcare but also in the non-medical sector. Its endeavours became meaningful and received international recognition when last week WHO declared the CBEC a Collaborating Centre for Bioethics — one of the eight to receive that prestigious status worldwide. Continue reading “Right vs wrong”
Why is the SIUT a success story when other health institutions in the public sector in Pakistan have failed? This question is frequently asked by people who are wonderstruck by the SIUT’s performance. Few can believe that this immaculate hospital that sprawls before them is in the public sector. It has taken it 40 years to reach its present greatness. And it is still growing.
The only feature that betrays its ownership is the over-crowding you see there. Being in the public sector, this tertiary healthcare institution attracts all and sundry. Moreover it is a hospital that is affordable and actually works, where people are treated and recover from their illness. Continue reading “The secret of success”
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”
The pronounced lack of interest in the public health system in Pakistan is not difficult to explain. Public opinion in a country as stratified and uninformed as ours, is created and moulded by the so-called privileged classes, comprising those members of society who have the means to pay for private health care. Hence they are not affected by the abysmal state of health care in the public sector on which the poor depend.
The general attitude is: what is the role of the poor in our society? They are useful only for domestic labour in the homes of the rich or for menial work in public places and factories. And, of course, to vote at election time. A higher birth rate among the impoverished ensures there is never any shortage in the labour force. If they fall sick, they are easily replaced. With limited skills and training, none are really indispensable. Continue reading “A Global Conglomerate of Oppression”
THIS 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”
I DISCOVERED the SIUT in the 1980’s when the private sector had begun to invade the healthcare system in Pakistan in a big way.
My quest was for an institution that could meet the health need of the masses at a time when the government was stepping back from its basic responsibility of providing citizens their fundamental right to health.
Of course the SIUT was not known by this name then. It was the Urology Department of the Civil Hospital – a public sector health institution. But even then it was so distinct from its parent body in its working and approach to issues of health and disease that one could not fail to take note. Be it its impeccable hygiene or the atmosphere of kindliness radiated by those who took care of the patients, this institution stood out for its uniqueness. Continue reading “SIUT’s philosophy: a rare creed”
The Sindh Institute of Urology and Transplantation (SIUT) is well-known for the healthcare it provides free of charge to the marginalised. Not so well known, however, is the egalitarian philosophy that its founder, Dr Adibul Hasan Rizvi, has instilled in the Institute’s working guidelines. This means providing equal opportunities to all in other walks of life as well. Take the case of Muhammad Imran, 53, who is the head of the operation theatres at SIUT.
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.
KHALID, who lives in Shikarpur, suffers from end-stage kidney failure. His ailment was diagnosed at the Sindh Institute of Urology and Transplantation, Karachi. I met Khalid at SIUT, Sukkur, where he was on dialysis. He is fortunate to have a donor — his younger brother. But Khalid has to wait for a few months more till his sibling comes of age.
Until SIUT, Sukkur, became operational in 2012, patients like Khalid had to visit Karachi for dialysis, and camp out on the streets. Today, the travel time has been cut immensely saving patients a lot of hassle. This is what the director of SIUT, Dr Adib Rizvi, terms “taking medical facilities to the people’s doorstep”. Had it not been for the SIUT’s presence in Sukkur, Khalid would have become a victim of homelessness as well.
Establishing SIUT, Sukkur, was an innovative response to the need of the people of Sindh. Since SIUT holds human life valuable and healthcare as the people’s birthright, the Khalids of society “are not allowed to die because they cannot afford to live”. Dr Rizvi anticipates the needs of his patients and responds accordingly.
To make dialysis accessible, he conceptualised a network of satellite centres in various localities of Karachi to save patients the trouble of commuting from far-flung places for this procedure twice a week. When records showed that 60pc of the patients were travelling from outside the city, mostly from Sindh, in the absence of similar facilities closer to home, the quest for a solution was launched.
This took the SIUT team to Sukkur where the Chablani Maternity Home was discovered in a decrepit state. The Sindh government was approached and much planning, renovation and reconstruction transformed this medical facility into a modern hospital that is a miniature version of SIUT, Karachi, with similar facilities and commitment to service.
This was in line with the SIUT’s need-driven approach and its philosophy of not turning back any patient who comes in search of relief from pain. With the patient-load growing as the incidence of disease in Pakistan escalates, SIUT, Sukkur, has proved to be a welcome addition to Sindh’s healthcare system.
When I visited it recently, I found it to be an oasis of modernity with state-of-the-art equipment in a sea of squalor and neglect. You enter the gate, which is barely visible in the flood of encroachments outside, and you are in another world of peace and horticultural beauty.
Many of the facilities that SIUT, Karachi, boasts of are also present in SIUT, Sukkur, which is a full-fledged 36-bed hospital that reported 1,256 indoor admissions in 2012. That year 33,918 patients went to the thrice-a-week outpatient clinic, 16,403 dialysis sessions were performed, 2,400 patients received lithotripsy, the laboratory carried out 111,913 tests and 4,254 surgeries were performed supported by diagnostic radiology services
The only conspicuous omission is transplantation. Dr Iqbal Daudpota, who volunteered to move to Sukkur as the coordinator, assures me that transplantation surgery can be started any time it is needed. As is the case in SIUT, Karachi, all services are provided free of charge with dignity.
Since a key feature of the SIUT model is the professionalism, dedication and compassion of the staff, the postings are controlled by Karachi. The staff is posted in Sukkur by rotation from Karachi. Dr Adib Rizvi, who leads by example, travels by train to Sukkur every Wednesday night for his OPD on Thursday, to return to Karachi the next day. Some of the surgeons in his team stay on to return home a week later. Thus the rota goes on.
SIUT, Sukkur, has reinforced the belief that the government-community partnership model that Dr Rizvi has been advocating is possible. The SIUT’s ethos has impressed the community in Sukkur which has responded generously with donations.
Two donors, Zahid Iqbal Choudhri and Munawwar Khan, have never let the institute down in times of crisis which are common occurrences in Pakistan. As for the patients who have never experienced such compassion and care from the medical profession ever before in their life, the SIUT is a blessing. What is important for many of these downtrodden people is that the SIUT’s philosophy facilitates excellent services without imposing any charges on them.
The SIUT model is doable if health professionals imbibe the ethos needed to provide the best services for no charge and with compassion and dignity. This calls for adopting cost-cutting strategies and shunning ostentation that make an institution self-sufficient. This is how the SIUT has won the confidence of the community in Pakistan which is reputed internationally for its generosity in philanthropy.
The writer is the author of The SIUT Story: Making the ‘Impossible’ Possible
THE health sector in Pakistan is in a crisis. Various reports and surveys paint a bleak picture which is not surprising given the breakdown in the healthcare infrastructure.
If the country has a high infant mortality rate, if polio cases have taken an upwards turn and the state of health is abysmal, prompting observers to warn that the Millennium Development Goals are unachievable, the root causes are obvious. Continue reading “In a diseased state”