From Rochdale to Karachi in 7 Days

Last Tuesday I attended a celebration dinner to mark the 71^st Pakistan Independence Day. It was a fantastic night. The colour green was everywhere (yes the green clogs came out), the music was foot-tappingly good, and the smiles and happiness were infectious. Iron-Bru, Coke and water were the only drinks to be had, but the wonderful food more than made up for there not being any alcohol! There was a serious side to the celebration too. Prayers were said, and beautifully sung, and although I couldn’t understand Urdu, my table companions told me the prayers centred on peace and continued security for the country. Gaining freedom and independence from the British Raj (the British run system of governance in what was called British India) was remembered. The British Raj had lasted from 1858 – 1947.  

These days of course, that region is now divided into the sovereign states of Pakistan, India and Bangladesh. Pakistan got its name from the Urdu words ‘Paak’ which means ‘pure’ and ‘stan’ meaning ‘land’ or ‘place’. I have only been to Pakistan once, and that was to Karachi. With a population of 21 million people, it’s the most populous city in Pakistan, and the sixth most populous city in the world. I got a sense of this when I arrived at the airport. The queues to get through passport control ran into literally thousands of people – it was a completely mesmerising sight. Fortunately, I was met by colleagues of my host, Professor Adibul Hasan Rizvi. They seemed to know the officials at the airport and before I knew it, I was on my way out and into the city.

The city streets teem with people. Some of the city’s infrastructure is very poor. For example since 2015, when the city’s sewerage system failed, Karachi residents have been discharging 100% of their raw sewage into the nearest coastal waters. It is also not one of the safest places in the world. Everywhere I was driven during my stay was in a locked car, with a guard armed with a Kalashnikov in his hand. Every time we returned to the hotel, the car was searched for bombs, before it was allowed through the hotel’s formidable defences. However, like the Independence Day Celebrations, the food was absolutely fantastic, and especially so for vegetarians! 

I was in Karachi to visit the Sindh Institute of Urology and Transplant (SIUT). This fantastic institute is run by Professor Rizvi. He has been the director of SIUT for some 40 years. Over this time he has slowly built this organisation into one of Pakistan’s largest public health organisations. Pakistan’s health system suffers from corruption, mismanagement and a lack of resources. Many people in Pakistan simply cannot gain access to or afford even basic health care, let alone the specialist health care provided at SIUT. The SIUTs mission is to provide ‘free public health with dignity’. If this mission statement sounds a little familiar, it may well be because Professor Rizvi came to Britain after he finished his medical education and training in Karachi. He undertook a surgical fellowship and remained in Britain for the next 10 years.

An interesting connection for me was that he undertook the surgical fellowship at Salford Royal Hospital and worked in many of the Greater Manchester hospitals. The work of the SIUT is both pioneering and carefully based on contemporary research. Education and training form a big part of the way in which SIUT undertakes its work. Doctors come from all over the world to learn and share knowledge. However, other professions, such as nurses, do not have the same skill level or autonomy as nurses in the UK. SIUT carried out the first Pakistan cadaver kidney transplant in 1995. They quickly established a reputation for making cadaver organ transplantation a reality. They have become the ninth Islamic country after Saudi Arabia, Turkey, Iran, Egypt, Kuwait and others to carry out cadaver organ transplants. These are all countries often known for other more undesirable reasons.

My trip to SIUT was an extraordinary experience. If I compared some of the things I saw there with what we expect in the UK, I probably would have been horrified. Patients were nursed in corridors, there was often little privacy other than a thin curtain and the rest of the ward, the medical records system and storage was reminiscent of what I imagine the tower of Babel to be like. Yet out of all this confusion and apparent chaos, goodness came about. There was no doubting the high esteem many of the patients and their families had for the staff who cared for them. There were many elements of the Independence Day Celebrations last week that reminded me of this visit. A catalyst for this was an appeal for donations for a cancer charity made at the event. Whilst I am undoubtedly sure that many donations will be made, and vital equipment and drugs will be purchased, what they really need is a skilled, knowledgeable and experienced health care workforce. 

If we think that in the NHS we have a workforce shortage, it’s nothing compared to what is being experienced in Pakistan. I am not sure what the answer might be to solving the workforce issues in either the UK or Pakistan, but unless we do, sooner or later the quality and availability of what we have come to expect from our health services will become impossible to provide. Perhaps the implementation of the ambitious Health Education England (HEE) ‘earn, learn, and return’ scheme for overseas nurses could be accelerated. Now that really would be worth the reported increase of HEE boss Professor Ian Cumming’s salary (now somewhere between £200,000 – 205,000) and the reported increase in his bonus pay range to (now up to £10,000 - £15,000). Just saying…