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.