My dear PM, ‘this platelet thing’ hurts

My dear Prime Minister,

You are a wonderful person. Your mother passed away after battling cancer, and you decided to battle cancer by building the Shaukat Khanum Memorial Cancer Hospital (SKMCH). That means you have that tremendous human capability to feel other’s pain — empathy. You felt the pain of cancer patients and realised what you had visualised for them by putting your feelings and will into action. All so great; but Sir, when you mocked at the suffering of a fellow human being — Nawaz Sharif — who happens to be your arch rival, it gives me an impression that your anger overcame your empathic self. Your anger repeatedly overpowering your empathy has consequences for people and your own self, and that concerns me because you are my prime minister.

Your words in Mianwali address — “now this platelets thing has come up” — hurt me personally, not because I am Nawaz Sharif’s fan or else, but because I have already been through hell of an ordeal in dealing with low platelet count of my wife and I have seen others also struggling with this issue. Indeed, my premier's jibe at the illness is hurtful.

My wife had been struggling for over 13 years with a systemic syndrome that also involved low platelet count. We got almost all her blood work done at the SKMCH so her medical record is there to ascertain the veracity of my contention in this open letter to you. That condition is Autoimmune Pancytopenia, an illness in which all types of blood cells — red, white and platelets — go down.

First having gone through massive blood transfusions and stereotypical drug therapy that only went on to worsen her illness, she was eventually treated by a scholarly professor of medicine in Lahore.

The professor discovered an underlying condition ignored by other doctors. Now she is living a drug-free life, but many like her continue to suffer from this morbid, potentially fatal disease because of inept clinical handling and sparse facilities with huge costs beyond the reach of even a reasonably well-off patient. My own suffering put me into contact with many of those suffering from ITP and other blood disorders.

Prime Minister Sir, your words coupled with the sarcastic tone and tenor made it obvious that you are not comprehending the reality at hand and the scope of what lies beyond it, and that you are missing out on an opportunity to help those who are suffering from scores of illnesses that are akin to what is ailing Nawaz Sharif. Trust me Sir, it’s your arch rival whose illness really offers you an opportunity to once again excel in the field of healthcare the way you did in raising the SKMCH. This time you would be doing that at the state level.

We know a few facts about Nawaz. Before this “platelet thing”, Nawaz Sharif had already been suffering from Metabolic Syndrome (cardiac illness and diabetes) that actually stems from fatty liver — a commonly occurring malaise owing to life style and genetic predisposition. Then we learnt that his platelets are down.

A massive workup by government’s own doctors and a noted haematologist (blood disorders expert) from Karachi revealed that he is suffering from Idiopathic or Immune Thrombocytopenia Purpura (ITP) — an autoimmune condition in which body’s immune (defence) system goes wayward and starts attacking healthy cells instead of staying focussed on body’s defence against infection, inflammation and malignancy. When body’s coagulation or clotting system involving platelets is dysfunctional, the blood thinning medicine (a must for cardiac patients) has to be stopped that makes treating such a patient a nightmare for doctors as such a patient is at risk of internal haemorrhage and stroke.

SKMCH chief also visited Nawaz. The entire medical team concluded that his treatment is not possible in Pakistan.

Prime Minister Sir, when you checked doctors’ report, your empathy kicked in and you allowed Nawaz Sharif to go abroad on humanitarian grounds, but the moment you saw him walking on his own, your anger overtook empathy, and you callously erupted with sarcasm, saying the sight of air ambulance made him fresh.

Well, Sir, you could have only asked the medical team or your trusted SKMCH chief to enlighten you on why Nawaz was not on stretcher. They would then have educated you that an ITP patient needs not be bed-riddled especially when the platelet count is above a safe level — 20,000 or 30,000 etc. Perhaps you were too busy thinking how an illness — “that platelet thing” — came to afflict Nawaz Sharif all of a sudden. Had you given your question a thought, and put the same question to the government-appointed medical team or Dr Faisal of SKMCH, they would have informed you how morbid are autoimmune diseases, and that these disorders are not Nawaz Sharif-specific.

They would have told you that many illnesses, including autoimmune and cancers, do not develop in a day or two. Usually an incident or a random test unmasks the illness that had been brewing up in the body for years.

Those doctors would have told you, Sir, that though the systemic autoimmune illnesses are not common, they do not differentiate between the rich and the poor and their treatment trouble is as enormous as cancer’s. Another frustrating factor is costly laboratory workup that often ends up in false negative tests (results are negative while the disease actually exists) and from there begins another round of misery involving presumptive medication that may or may not work.

They would have informed you that victims of these diseases can be found in every nook and corner of the country, and they have to travel long distances to reach a specialist doctor. Had you consulted with the medical team, only then a new opportunity would have come up before you, Sir — the SKMCH visualiser and builder. They would have told you that there is acute shortage of immunologists, rheumatologists, clinical haematologists and above all experts in internal medicine — the internists — in the country. These experts are concentrated mostly in big cities.

Had you consulted with the medical team, I can then conjure up an image of a Prime Minister who, once aware of the crisis, is fired up with a passion that once powered him to launch an effort in the name of his mother.

Mr Prime Minister! Would that, instead of using your words as spears, you had tried to figure out why Nawaz Sharif’s treatment is not possible in Pakistan. Had you done that, you would have launched a Herculean effort to make up for a monstrous missing in country’s healthcare system at academic as well as clinical level. I think so because I have heard you umpteen times talking about your will power and the kind of person you are in your essence. The SKMCH is a living proof of that.

Let me tell you, Sir, with confidence that the treatment of autoimmune illnesses is quite possible, though rare, in Pakistan of which there are many living examples including my wife and a Karachi girl who completed her engineering degree while suffering from this condition. They both suffered from pancytopenia with different underlying causes of illness and they both came out of crisis owing to the holistic expertise of the professor of medicine. Their ordeal and the consequent research into various ongoing cases makes it amply clear that it is the gradual demise of holistic approach towards systemic illnesses and denigration of the discipline of internal medicine that the management of autoimmune illnesses remains a challenge in Pakistan. Calling a doctor from Karachi to examine Nawaz Sharif proves that Lahore — a seat of medical learning — lacks expertise to treat ITP. The government, however, may contend that they went an extra mile in calling the Karachi doctor because it was the case of an incarcerated former premier. But when it comes to ordinary patients, it is sheer luck that one comes across a good physician, otherwise, there is no end to one’s suffering.

Sir, to overcome this shortcoming in country’s healthcare system, you have no dearth of professionals to advise you on how you can go about reengineering the state’s healthcare mind and machine to benefit all and sundry. Infact you need to set up medical board with you in the chair to treat an ailing healthcare system. In Punjab, you have a minister, a professor-doctor Yasmin Rashid, who appears to be ever so motivated to reform the system, your own trusted SKMCH team and quite a few good old professionals.

So, Prime Minister Sir, kindly forget Nawaz Sharif’s flight, and let your flight of imagination do wonders for people. (The writer is a senior staff member)