Sunday, 27 June 2010

How My Liver Rested in the Confusion of Karachi

I arrived at Karachi airport at 05.30am last Friday morning. The place was chaotic and reminiscent of Bedlam. The noise was incredible and un-relenting. The queues to get through customs and collect one luggage were the biggest I have ever seen in a life time of travelling. Thankfully I was rescued and fast tracked through all the processes –this meant it took two hours rather than a life time.

I was allowed to rest at the hotel for four hours before being picked up and accompanied to the main offices of SIUT (Sinda Institute of Urology and Transplantation). I was there as part of a delegation from our Faculty and partners from practice. Together with these colleagues I then spent the next six hours being shown around the SIUT facilities.

It was the Director of SIUT, Professor Adib Rizvi, who welcomed us with warmth and sincerity. He spoke of the unremitting challenges in trying to provide healthcare to a large and predominantly poor population of the country. The aim of SIUT is to provide healthcare in the field of Urology, Nephrology and Transplantation to all, entirely free of cost and with dignity. Pakistan has a high burden of urological diseases.

Basic health care is not widely available in Pakistan. Only 1% of the GDP of Pakistan is allocated to the health sector. Private hospitals can be afforded by no more than 2-4% of the population. As with other developing countries, 20% of the population utilise 80% of Pakistan’s resources. Likewise, Pakistan faces a constant struggle over the injustices of illegal child labour, oppression of women and an increasing disparity between the rich and poor. SIUT was there to help those who are poor. Indeed their mission is ‘we don’t let them die because they cannot afford to live’. Starting out as a 8 bedded unit in a local hospital in the 1980’s it has grown to a become a 500 bedded Institute sited on two sites in Karachi, with satellite clinics in the neighbouring areas.

Our visit started in the old facilities. These were, on first impression, a throw back to the dark ages. Wards and clinical areas with beds in corridors and aisles, little privacy and the activity and noise was constant. But a huge number of patients were being seen each day. In 2009, nearly 700,000 patients were seen, 544 renal transplants undertaken, 144,107 patients received dialysis, and 4246 Lithotripsy interventions performed. Additionally, nearly 200,000 outpatient appointments were provided. There is a new 300 bedded unit now that also provides state of the art oncology services. Everything that is provided is provided free to the patients, including long term follow up medication. SIUT receives some 40% of its running costs from the State, the rest comes from voluntary donations.

It was humbling to watch, for a while, this activity being carried out with commitment, dignity, dedication and real skill. In the UK with all our shiny new health care toys, it can sometimes be difficult to discern such high levels of service being provided to a other. Magdi Yaqoob, the internationally renowned transplant surgeon noted that SIUT provides medical care to patients that is as good as that of any premier institute in the western world.

The SIUT wants to agree a partnership with our University and School of Nursing aimed at bring their pre and post reg nurse education and training up to the standards found in the UK. They have run a School of Nursing since 2006 and this has provided  basic three year general nursing programmes. This year has seen the initiation of a specialist BSc in Renal Nursing.

I am sure we will be able to agree such a partnership, despite the desperate political and other related security issues. Somewhat ironically, I think that such a partnership would actually provide more possibilities to extend the role of the nurse than perhaps some of the opportunities we have in our own context.

And the saving of my Liver. Well, for religious reasons, Pakistan really is a dry state. Alcohol can not be purchased anywhere, not in the hotel or even the magnificent Sind Club, an exclusive ex colonial establishment where we provided with a fabulous meal one night by our hosts. Everyone we met was fantastic. We were never left unaccompanied and people were most generous with their conversation, smiles and friendship. However, being driven through the streets of Karachi along with what were millions, yes millions of other road users was made more difficult knowing their would not be a nice G+T to sooth ones shattered nerves at the other end.

I shall be returning to the UK on Tuesday evening, ready to Chair what I think is going to be an exciting day on Wednesday. This is what I hope will be the first in many joint Humanities/Mental Health Seminar Workshop Days. This first workshop day  is entitled: A Novel Opportunity: Reading, writing, and performing to aid the explication of Mental Health and Well-Being – and we have some cracking examples of peoples work to enjoy and learn from.