Pakistan Kidney & Liver Institute – the real story

It had been a particularly long night. Some battles had been won and some, despite heroic efforts, had been lost. As I trudged, through the now silent corridors, in the wee hours of the morning, the exhilaration and the dejection, the hope and the anticipation of what would come next, ached through my tired body. Ah! The life of a physician who specializes in the care of the acutely ill. I would never ask for another profession. Why would anyone! I entered the physicians lounge and eagerly walked towards the coffee machine, a much-needed fuel before I started my day all over, rounding on numerous patients. As the aroma of fresh brewed coffee rejuvenated my soul, I heard someone speaking in Urdu over the phone. Looked like he was trying to book an airline ticket. This must be a country-fellow, I thought as I walked over to introduce myself. This was my first encounter with Dr Saeed Akhtar, the future President and CEO of Pakistan Kidney and Liver Institute and Research Center (PKLI).

Recently I had been very excited at the prospect of moving back to Pakistan with my family. After years in the USA the ache to go back to the motherland had taken root deep inside my heart. I would go back and teach each and everything I knew to any medical student or resident I could get my hands on. I would see patients free. I would sit in the Emergency Room and Outdoor, round on the Inpatients and if needed, come back to the hospital even in the middle of the night. I would do it the way it hadn’t been done for ages and the way it should’ve always been done. The plan to move back to Pakistan had me resign from my regular job and move into a “locums mode”. Locums was something that worked wonderfully in a well-oiled system. I would pick up empty shifts in hospitals across the country from as far east as Pennsylvania to as far west as California to as central as Illinois and North Dakota and then go back to Pakistan, only to return again if the bank dried up. Dr Saeed was also doing locums here when destiny would have me run into him.

We were a couple of country fellows in a city with few brown men. While I had started locums in anticipation of moving back to Pakistan this year, I found out that Dr Saeed was here for a very different reason. Long discussions on everything would take place between us. The occasional movie at the theatres was also on the cards. The highlight would be getting together in his hotel, or mine, and cooking our own desi food while congratulating ourselves on our excellent culinary skills. He told me that he had moved back to Pakistan a while ago and was heading his Urology department in Islamabad. He was trying to create excellence in services where none existed. He wanted to help the poor and was always in need of funds. He would come to the USA a couple of times every year to do locums. The locums would pay for his expenses as after that he flew his plane (he’s a pilot) from one city to the next, meeting Pakistani physicians in various communities across the USA to raise funds for his Pakistan Kidney Institute (PKI). PKI treated patients free of cost providing the exact same care to the poor as to the rich.

My return to Pakistan was full of anticipation. I eagerly applied to my alma mater as well as all large government medical schools across Lahore. Seats were open, the need for someone like me seemed to be clearly there also. The next couple of years brought me down to Earth and into reality. Influential friends offered help getting me in but, a stubborn pathan as I was, I would always clearly refuse. If I was to get into a teaching hospital where I could fulfill my dreams for imparting care and education to my own, especially the needy, it could not start on the wrong foot. Reliance on locums in the USA increased as I continued to seek opportunities for teaching in Pakistan. Reality sank in late but it finally did. Maybe practicing in a private hospital half of the week, to generate running expenses for me, and work for free at my own clinic the rest of the week is what the future held for me in Pakistan. It wasn’t the perfect dream but it would be an acceptable compromise.

I would often meet Dr Saeed on my locums’ trips. Soon we would try to tie up so we ended up for locums at the same time. We developed a deep friendship based on mutual respect. What bound us together was the clarity that one day we would go back to the Creator and He would ask what we did with the skills that He had blessed us with? I would vent with him on what had been going on with me in Pakistan. He always told me to come to Islamabad and work with him. “Lahore Lahore Ey” was always my answer. He passionately explained how he didn’t think his miniscule service for PKI was enough and that he wanted to create a center of excellence which could provide the best services to thousands of patients regardless of their ability to pay. He had been knocking on one influential door after another, trying to get 50 acres of land in Islamabad on which he would build his dream hospital. Like me, he too was getting dejected.

Back in Pakistan I soon realized that even private hospitals had their politics. Private medical care had become a huge business industry in Lahore as government services were too shabby and couldn’t cater for those who could pay. The “big boys” in the government sector could hardly make a living in their day jobs as salaries were so poor, many ignored their primary responsibilities in teaching hospitals and setup shop in evenings at private hospitals charging exorbitant sums from patients desperate for care. Over the decades this had become a deeply entrenched system and had resulted in a monopolized and highly politicized healthcare culture in Lahore. To enter into a private system was as difficult as entering into the government system as both were inextricably linked. One got fame sitting on teaching chairs of large government hospitals and that fame ensured busy private practices in the evenings. Completely dejected I totally gave up the idea of practicing in Pakistan. I would do locums trips to the USA and the time in between, I would pursue my hobbies. The next five years I pursued reading, pro-photography, carpentry, rare gardening, pedigree British Shorthair cats breeding, tinkered with every high-end electronic under the sun from building computers to home theatres to extreme car audio. It was the extreme hiking across the mountains and deserts of the world where I thought I had found my next calling. This is where God could be felt everywhere. An outwardly wonderful life did not reflect the deep void inside as I still hadn’t been able to give back to my country and people and for no fault of mine.

Dr Saeed made a trip to Lahore as he had a breakthrough with the Chief Minister Punjab in getting land for his hospital. As I sat with him for the first time at my home in Lahore, he was excited as he informed me that he was going to get land in Lahore to build the hospital we had been discussing for years. The only conditions laid were to move the project to Lahore and add liver services. The government would not only pay for building it but also operational costs would be covered completely for three years. He said I should now work at Pakistan Kidney and Liver Institute and Research Center (PKLI&RC) as his dream would be materializing in Lahore. He quickly judged my confusion (or was it hesitation), looked me in the eyes and said “Amer I have also put two conditions. No political interference and no bureaucratic interference. I will not have it any other way. It will be an independently run organization by a Trust. Chief Minister completely agrees”. Had it been anyone other than Dr Saeed Akhtar, the bitterness and optimism-changed-pessimism deep seated inside me over ten years of dejection and failure, would have laughed it off. How many like me had their skills lying wasted in this beautiful land? How many had never been optimistic enough to return to the motherland? How many hundreds came back only to return totally disappointed?

From day one the struggle started in clarifying the concept of PKLI. This is a mission. This is the future Harvard of Pakistan. We have to create disease awareness for prevention as disease burden is so high, several PKLIs would not fulfil the need. I shudder to think at the cost to the economy treating rampant diseases which are totally preventable at pennies to the dollar. Excellence means treating everyone similarly to the highest international standards and giving your patients time, that too with a smile. Where have the smiling faces of my country gone? We have to create training programs for doctors, nurses and allied health staff so we can quench the thirst for expertise across our beloved land and eliminate reliance on overseas human resource.

A PKLI university will lay the foundation of cutting edge research, both clinical and basic, including stem-cell which will put us on the world map and drive prices down due to research guided homemade strategies for treatment and invention of vaccines, lasers and medications. How can we attract our people, who have exposure in world renowned organizations where time tested systems are in place, back home so they can help us build the future? PKLI will need infrastructure and machinery to match international standards. Why should our destiny be filthy dilapidated hospitals where no one wants to work? We will need to give good salaries so, despite a heavy cuts compared to their outside salaries, people could at least have a decent living. So many Pakistanis are eager to give up the luxury and prestige overseas but at least for a middle-class life in Pakistan where they can provide for their family respectably. PKLI human resource will not be allowed to work outside as one cannot achieve excellence when ones’ heart is elsewhere.

PKLI is not just a building; we see it as the start of a fundamental change in healthcare across the country. We know we cannot copy paste from the West. We need to take the best from there and the best from here and make our own recipe which will Inshaa Allah bloom and thrive. The Pakistani Harvard of tomorrow would likely not be realized in our lifetime but we have a real opportunity to lay its foundation right.

Today hepatitis prevention clinics working under PKLI, across twenty districts of Punjab, have catered to almost one hundred thousand patients in less than a year. PKLI has structured a Punjab-wide hepatitis survey for the government. We have been instrumental in formulating and getting the Hepatitis Ordinance passed. We have participated in breathing life into the Human Organ Transplant Authority (HOTA). Seventy Pakistani doctors are returning home to play their part in giving back to the motherland! This is the biggest reverse brain migration in our history. The hospital itself is only partially constructed but clinical services, even though very basic right now, have been started and some four hundred patients are being catered to daily. Our hepatitis prevention and treatment clinic in Lahore is seeing up to six hundred patients a day and combining all district level clinics, almost three thousand patients per day. Dialysis has been initiated and candidates for kidney and liver transplant are being screened. Soon our Emergency room will start as well as our formal Inpatient Department, Operation Theatres, Intensive Care Units and Laboratory services.

My back had been bothering me for years. This started when I was lifting boxes full of my books from the basement, loading for my return to Pakistan. It was a few years back during Hajj, when I was in particular distress and quite literally incapacitated, that I knelt down in Arafat and beseeched Allah to help me with my back pain and give me the opportunity to do something, anything, worthwhile for my country. The back pain resolved the same day. The second part shaped into reality as I joined PKLI over a year ago. I am in the process of putting my brick in the foundations of this national institution so I can thank God for the opportunity He gave me to serve His ailing family and then ask for His forgiveness on the Day of Judgement. My brick alone will not do the job; neither will Dr Saeed Akhtar’s. Thousands of bricks will need to be placed by thousands of people. (The writer is the Medical Director and acting Chief Operating Officer of PKLI&RC)