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?
It is to be the hub of the SIUT’s new thrust towards the broadening of its healthcare horizons. For over four decades, the SIUT, a tertiary centre of excellence in Karachi, has provided services in urology to the underprivileged. Its beginnings were, however, humble.
As a specialised urology facility it has expanded horizontally. Given commitment, an institution will grow, more so if a philosophy guides its growth.
Believing that healthcare is the birthright of a person, the founder of the SIUT, Dr Adibul Hasan Rizvi, was resolute about not charging his patients irrespective of their capacity to pay. His approach combines medicine with equity, dignity and compassion. This philosophy has been imbibed by the staff and the SIUT has among the best technology and human expertise.
The approach to medicine must combine equity, dignity and compassion.
Who pays for these facilities and services? Part of the cost is borne by the government which has admittedly failed to keep pace with the growing health needs of the country. The community has stepped in to fill the shortfall. By economising — not on quality but on overheads — the SIUT manages to survive and expand.
Dr Rizvi illustrates his philosophy by drawing a triangle at the centre of which is the patient. The three sides of the triangle symbolise the government, the community and the doctor.
How is the expansion determined within these parameters? It is always incremental and needs-driven. Accessibility is another key feature as many patients travel long distances in the quest of relief. Every department, equipment or service that has been added has been in response to their needs. The approach is holistic so that all facilities are available in one place.
Beginning with urology it has added to its services dialysis, nephrology, diabetes, paediatrics, diagnostic technologies, a high-tech laboratory, lithotripters, infectious diseases, oncology and the list goes on. Satellite dialysis centres have been dispersed all over the city. Sukkur has a hospital with services in urology.
In this scheme of things, Mehrunnisa Hospital’s role should set another pattern which would need to be observed closely and emulated. As Drs Altaf Hashmi, Manzoor Husain and Naqi Zafar, all specialists in their fields, showed me round, I could see that the expansion is to be a move from the tertiary towards the basics — primary and secondary healthcare.
After Mehrunnisa Hospital was donated to the urology centre, it set up within two months a 20-bed dialysis unit running 60 sessions a day. Other departments have followed and today healthcare is available for the most vulnerable section of our population, namely children. Six paediatric OPDs are held every week, while adults can go to OPDs in medicine, urology and nephrology. An operation theatre has been equipped for minor surgeries. The hospital is expected to have its own laboratory, X-ray unit, ultrasound services, MRI, PET CT and lithotripter shortly.
Mehrunnisa spells the formalisation of what Dr Rizvi terms the SIUT Healthcare System. At a time when health sectors worldwide are in crisis in the states which traditionally provided strong social security nets to their citizens, the challenges faced by the developing countries are enormous. Under neoliberal pressure, governments are disengaging themselves from their social responsibilities, leaving the underprivileged to the mercy of sharks in the private sector.
In this context, the SIUT model offers hope. Mehrunnisa hospital is gathering strength incrementally. It is funded by the SIUT which also provides it staff on rota duty.
Thus the SIUT philosophy should trickle down to the primary healthcare level — the most neglected in Pakistan. This neglect accounts for the growing load of patients for the tertiary level because primary healthcare serves as the first line of defence against serious illnesses. A way is thus being shown to apply the government-community-doctor triangle model equally effectively to primary healthcare. That is the need of the people from which one cannot be isolated.