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→
ONE major flaw in the education sector in Pakistan that hardly ever figures in popular discourse is the deeply rooted inequity which denies underprivileged children access to academic excellence. This is not a one-time phenomenon. It is a self-perpetuating one.
The offspring of middle-class parents face a formidable challenge when they seek admission to a public-sector medical university, let alone the elite private institutions which charge a forbidding fee. Even government institutions now impose heavy tuition charges that are unaffordable for the majority of the people. Denied education of good quality, can these children ever hope for upward mobility which comes with a good job? Continue reading Opportunities for all→
HAS the illicit organ trade that gave Pakistan such a bad name in the world of medicine made a comeback? We do know that for about a year after the Transplantation of Human Organs and Tissues Act was adopted in 2010 there was a lull and we were celebrating the end of this crime against humanity in our country. But one cannot be sure about that now.
Today reports trickle in that the clandestine sale of human organs is thriving. The scale of the operation is not known but the exploitation of the poor remains unabated.
With such a reputation, it was not really surprising when five days after the bombing of the All Saints Church in Peshawar last month, a website, Agenzia Fides, that has been described as the news agency of the Vatican, carried a shocking report linking the incident with the problem of organ trafficking. Continue reading Give the gift of life→
THE SIUT’s Centre for Biomedical Ethics and Culture (CBEC) holds interesting forums periodically where renowned scholars are invited to address the members. Since ethics is a wide-ranging subject the thought-provoking speeches on a variety of subjects delivered there provide the audience some issues to chew upon.
In July, Dr Arifa Syeda Zahra, who teaches history in a Lahore college, was a guest of the CBEC and the point she drove home very forcefully and convincingly was that those who destroy history do it with the purpose of erasing the collective memory of a people. The idea behind this act of vandalism is to pre-empt change, which Dr Arifa Zahra describes as the most difficult process in individuals and societies. Continue reading Fabricating history→
Glowing and touching tributes were heaped on the Sindh Institute of Urology and Transplantation (SIUT) Director, Dr Adeebul Hassan Rizvi, and international award winning journalist Zubeida Mustafa, the former for having rendered yeoman’s service to the sick, the needy and the underprivileged across the length and breadth of the country, and the latter for having brought these achievements on record through her book, “The SIUT story: making the ‘impossible’ possible”.
The occasion was the launch of Mustafa’s above-noted book at the Mohatta Palace Friday evening.
Ghazi Salahuddin, noted journalist and columnist, recalled the time when Dr Adeebul Hassan Rizvi was a student leader and paid him tribute for not having let his idealism wane and for remaining true to his ideals for the betterment of society.
“There’s lots of talk in our society about human dignity but in actual practice, there is none. We are a terribly class-riddled society, utterly apathetic to the travails and needs of our fellowmen. Dr Rizvi’s devotion to human dignity is so very evident in his institution. The SIUT’s stress on human dignity is not based on charity. Rather it is based on the natural rights of all human beings”, said Ghazi Salahuddin.
Having been her colleague for a long time, he praised Zubeida Mustafa and said that Zubeida had introduced a totally new research-oriented approach to journalism, something that hitherto had not been there. This, he said, made all the information so very profound and authentic.
Former Commissioner, Karachi Divisions, Shafiqur Rehman Piracha, in his very touching and emotional tribute to Dr Rizvi, talked about the “divine madness” of Dr Rizvi that had made the inception of an institution as altruistic as the SIUT possible where human beings were accorded their natural right to things that could make life a pleasurable experience for them. He said that everyone was treated with dignity at the SIUT without having to pay for it.
In a tribute to Rizvi’s altruistic simplicity, Piracha narrated how there was a concerted effort by the country’s most powerful segment of the bureaucracy to induce Rizvi to accept the post of federal health minister and what a hard time Rizvi had warding them off till they gave it up. He narrated how even these days, Rizvi travelled by train once a fortnight to Sukkur and its environs along with his medical team to perform surgeries and transplants absolutely free of cost.
He lauded Mrs Mustafa for having authored such a book on a subject as vital as healthcare and set the record straight for posterity.
Dr Adeeb Rizvi, acknowledging the accolades, and in his tribute to Zubeida Mustafa, recalled his first encounter with her and narrated how she was constantly grilling him with the questions: “How will you render such advanced medical care for free?” “How will you carry out dialysis for free?” and said that he was always hard put for a ready answer. “Ultimately, we made up and Zubeida joined us in our tissue transplantation campaign”, he said.
Zubeida Mustafa, acknowledging all the tributes, thanked the Support Trust (one of the sponsors of the book launch) for their cooperation in her painstaking venture.
“I wanted everyone to know that there are as many good people in our society and good works being done and that our society is not just bloodshed and killing”, she said.
The SIUT, she said, was not a charity organization but one where all humans got their rights with dignity. “That’s what I wanted to convey”, she said. She went on to state that all citizens had a right to education and healthcare and even though today’s liberal economics had turned things upside down, the SIUT still abided by its noble philosophy.
Kishwar Zehra, a thriving businessperson and a committed social worker who devotes of her time for voluntary work in the institute, lauded the most selfless service to society by Dr Rizvi and praised Zubeida Mustafa’s journalistic acumen in putting the story together for posterity.
Nusrat Ali Khan and Hassan Jameel, trustees of the Support Trust, outlined the aims and objectives of the Trust which, in a nutshell, could be summed up as publicizing all the work being done on a voluntary basis in various walks of life in the country and augmenting the mission of altruistic organizations. Nusrat Ali Khan proposed that copies of Mustafa’s book be sent to all diplomatic missions in the country and to all Pakistani diplomatic missions overseas to disseminate knowledge about the reservoir of selfless and noble individuals in our society.
Noted TV journalist compered the function and lauded Zubeida’s press crusade against the deficiencies in our healthcare and social systems.
KARACHI, June 14: “I was only following my emotions but she had the backing of research and proper data before asking me to explain how exactly I intended to offer free treatment to my patients. I was at a loss,” recalled Dr Adibul Hasan Rizvi at the launch of The SIUT Story — Making the ‘Impossible’ Possible while referring to its author Zubeida Mustafa at the Mohatta Palace Museum here on Friday.
“When we started our free dialysis work, she was back on the request of her editor at Dawn newspaper, Ahmad Ali Khan sahib, firing more questions that I didn’t have the answers to,” he shared.
“Our first kidney transplant was done quietly. We kept it from the media and when she found out, she was mad at us for being so secretive,” he laughed, adding that then it was Mrs Mustafa herself who also helped guide them on ethical things and how to tackle the issue of tissue transplantation, etc.
“Thank you for writing this book, which immortalises our philosophy that every human being has the right to healthcare and dignity,” Dr Rizvi said.
Senior journalist Ghazi Salahuddin said that he knows Dr Rizvi from the time when he was a young student at DJ Science College actively involved in students’ union. “He still believes in the dreams he had back then,” he said.
Praising the author of the book, he said that Mrs Mustafa came to Dawn from an academic background. “Not just this book but all her well thought out writings over the years are the product of extensive research and data collection,” he said.
“It is great that she could do this for SIUT now. The book is like a revolution in a society where there is no value of life leave alone the concept of human dignity,” he added.
Former Karachi commissioner Shafiq Paracha called Dr Rizvi’s passion to help people gain health regardless of their being rich or poor or belonging to any religion or belief “Divine Madness”.
He narrated an incident from former President Pervez Musharraf’s time when Dr Rizvi’s name came up for health minister and the doctor was determined to make the government officials drop the idea. “He took us on a round of the hospital trying to explain how much he was needed there only until one of us understood that it wouldn’t be wise to spoil one kind of good to start another,” said Mr Paracha.
“Dr Rizvi is that island of hope which balances our society,” he added.
About the author, he said that he was grateful to her for introducing us to the people who make the “impossible possible”.
Finally, Mrs Mustafa said that in Karachi where losing lives had become a common occurrence there was the Sindh Institute of Urology and Transplantation that is dedicated to saving lives. “It gives us hope. It had to be celebrated,” she commented.
She said, “I am glad that I wrote this book now after doing so much research on this place. The research I did over the years has helped settle all my doubts about its running. It is not just any charity hospital. It is a model hospital and the philosophy behind it can help build other such institutions.
“Being part of the public sector, there is also no element of commercialism attached to it. The treatment offered at the SIUT boasts foreign standards. The technology brought here from the West is also adjusted to local needs. It is laudable that they started from eight beds and have become what they are today through need-based extensions.
“The experts at the SIUT were just normal people who received proper training before putting it to good use. Foreign experts come here as well to train the doctors here. They also treat the patients at the hospital. It is compassion of the people working here that has raised the value of humanity at SIUT. But this team works so well because it has a great leader,” she said gesturing towards Dr Rizvi.
Meanwhile, it was suggested that an Urdu edition of the book also be brought out so that it can reach a bigger readership. Mrs Mustafa said that she would consider the suggestion.