Category Archives: SIUT

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

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Syed Adibul Hasan Rizvi: Book Review

By Zeenat Hisam

THE reading habit needs to start being cultivated in early childhood through stories of fantasy, fairy tales and folk sagas as these ignite the imagination and the curiosity of children. Every culture and every language has its own heritage of such stories. And so does Urdu. However, what was missing was biographies of renowned people written for younger readers in Urdu.

The Oxford University Press is now filling in this gap by bringing out a few series devoted to the genre. Under the series Azeem Pakistani and Tasveeri Kahani Silsila, biographies of notable figures highlighting their contributions to the country have been published. Roshni kay Meenar is the third series focusing on biographies of prominent personalities of Sindh who have made valuable contributions either before Partition or since. The three biographies published earlier under this series presented the lives and works of Mirza Qaleech Baig, Hasan Ali Effendi and Ruth Pfau. Continue reading Syed Adibul Hasan Rizvi: Book Review

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Right vs wrong

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

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The secret of success

By Zubeida Mustafa

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

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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

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A Global Conglomerate of Oppression

Noor Zaheer

By

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

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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

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SIUT’s philosophy: a rare creed

By Zubeida Mustafa

imagessiutI 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

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Extraordinay People: An ‘inspirer’ who empowers

By Zubeida Mustafa
Imran-1-300x199The 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.

Continue reading Extraordinay People: An ‘inspirer’ who empowers

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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

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