For me at least, the difference between a visit to the hospital in Pakistan and a similar visit in, say, Western Europe, has one crucial qualitative difference. In the Pakistani hospitals, my first impression has always been one of suspicion as a patient - given the state of hygiene and the generally run-down conditions. In my mind’s eye, I cannot see much of a difference between hospital corridors in Pakistan and the average government department - the levels of cleaning being kept to a bare minimum as if it were a matter of principle, paan stains lining corners, patients and those accompanying them sitting on floors with all the helplessness of refugees in a conflict zone. By contrast, the experience of a public hospital in the (decaying but still strong) social democracies of the West is one of immediate relief: as a patient, I always found the atmosphere around me immediately comforting. One can, with justification, believe that given the stratospheric standards of cleanliness, order and advanced medical equipment, that one is in safe hands and that any medical situation is but a problem to be easily addressed by well-equipped professionals.
I am not a believer in the idea that the populations of poor countries should settle for less in these matters - the idea that your worth as a human being ought to be determined by the GDP per capita of your country ought to be utterly repugnant. I am told, of course, that this is pointless idealism, and that the mathematics just doesn’t add up.
On a visit to Lahore’s Punjab Institute of Cardiology’s recently constructed new facilities, however, I saw a sliver of hope that international standards of humanity are still applicable to Pakistanis, even if our daily lived experience often suggests the opposite.
Dr. Nadeem Hayat Mallick
Dr. Nadeem Hayat Mallick, Chief Executive of the institution, was most generous in showing me around the newly constructed facilities, and explaining to me the concept behind it. The idea is fairly simple: he is among those healthcare professionals who believe that international standards of care for patients are not merely slogans for politicians – they are in fact practical goals which can be achieved through the correct confluence of institutional interest, support from the state and, of course, some philanthropy to get the wheels turning.
The state-of-the-art new facilities at the PIC boast of some 200 beds now, and a level of medical equipment and expertise rare in public healthcare.
Dr. Mallick tells me of a time when heart disease was not prevalent in Pakistan. Just two to three decades ago, it was not quite the killer that it is today in Pakistan. For Dr. Mallick, the breakneck process of urbanisation has introduced the majority of our population to deadly new health risks which were previously marginal. From being a problem of the developed world, heart ailments became a predominantly “Third World” menace. Dr. Mallick cites one estimate that up to 80 percent of all heart-related deaths might be from the Indian Subcontinent and South East Asia. For him as a healthcare professional, the most alarming aspect is the risk to young people from heart disease - something unheard-of just a few generations ago.
“Obviously, there has been no major genetic shift in our population, so the rise in heart disease, especially among young people, has to be linked to radically different, sedentary lifestyle choices,” he explains. “Smoking, obviously, is doing a lot of damage. And the diet, especially the increased prevalence of fried foods, has changed as rapidly as the cities have swelled.”
I find myself mentally kicking myself over the hearty dinner of paratha and tawwa chicken I’d had just a day ago.
Dr. Mallick takes me around the newly constructed facilities. You need not be a healthcare professional to realise that this is miles above the usual level of medical facilities in the country. The corridors are quiet and clean. The wards appear well-staffed and well-equipped. Arrays of HD screens display real-time data on the condition of various patients.
The labs are bustling with activity, as various tests are carried out. Dr. Mallick tells me that in case of a heart attack, there is approximately a 90-minute window in which action has to be taken. In the past, the facilities at cardiology-related institutions in Punjab did not allow for immediate angioplasty or other such measures. Now, he explains, the emergency service at the PIC can take instant action.
For Dr. Mallick, heart-related medical facilities are a logical first choice for such revamping. He notes: “Lung diseases, cancers, etc. - these are killers, but cannot really compare to the swift, deadly effects of heart problems.”
As we pass by a wall mentioning the names of various donors, it is clear from the names that the Who’s Who of industry are represented among the donors, who raised some Rs. 55 crore to kick-start this immense project.
Dr. Mallick points to the various additions he personally added to the facility - garden spaces, fountains, even a gym to help patients get used to physical activity as they prepare to be discharged. “They used to dump trash here before,” Dr. Mallick points to a decorated fountain surrounded by glass walls.
I speak to Mr. Aamir Fayyaz Sheikh, CEO of Kohinoor Mills Ltd., who happens to be one of the moving spirits behind this initiative. When he went to the PIC for a heart-related procedure, he saw an emergency department with around sixteen to twenty beds for hundreds of patients. He wanted to get involved, and very soon had gathered a committee, the ‘Friends of the PIC’.
Previously, he explains, facilities at the PIC meant that some degree of lasting damage to a sufferer from a heart attack was inevitable. Now, with primary angioplasty possible within the first (‘golden’) hour of a heart attack, the possibility exists to protect the heart from most damage.
The ‘Friends of the PIC’ included Mr. Sohail Kabir of Fazal Din & Sons, Mr. Jawed Iqbal of Mayfair Textile Mills, Mr. Akbar Sheikh and Mr. Ali Ahsan of Ashiana Textile Mills. These captains of industry, having decided to help, asked the management at the PIC to list out what was necessary to turn the institution into a healthcare facility that fully conforms to international standards in its field.
“The Chief Minister of the Punjab, Shahbaz Sharif, gave the PIC management and ourselves a free hand to make this possible,” says Amir Fayyaz. “We used to meet every Friday and within some 16 months, our team was able to construct and equip this new facility.”
The operational costs, of course, are down to the Punjab government. Dr. Mallick estimates that the state might be spending some Rs. 100,000 per day on each patient in the emergency ward.
As some of the kind staff of the facility usher me out, we pass by a procession pushing a stretcher. On it is a human form with a white sheet stretched across it from head to toe.
Nothing could bring home the need for this sort of expenditure more than such a stark reminder of the deadliness of heart disease and our own tenuous grip on life.
