PKLI: A journey towards a thriving centre

Pakistan Kidney and Liver Institute has been made fully functional and it is fast scaling up services.

Notwithstanding the ruckus over the performance of the institute, it has made great strides forward in surgeries as well as diagnostic and treatment services at the facility. Last week, Alhamdulillah, the PKLI performed 73rd kidney transplant, 7th of this year.

After much deliberation by legal and technical experts, we have rendered the PKLI the much needed transparency. There were sections of “omission and commission” aplenty in the hastily-prepared Pakistan Kidney and Liver Institute Act in 2014. Having fixed those, finally the PKLI is now a thriving institute with the transparency it hitherto lacked.

One moot point here is that for all the hyperbole the last government put into the PKLI media build-up, the project turned out to be a damp squib so far as functionality and transparency was concerned. Everything was pulled off in such haste that legal, financial and administrative complexities ended up in numerous audit paras. Further, although the hi-tech equipment was procured, yet no mechanism for supplies was developed, resulting into wastage of resources.

By the time we took over, the Institute was already in a legal and administrative chaos necessitating immediate government intervention, ownership and direction. The Supreme Court had intervened and ordered necessary revisions in the Act. It may be pertinent to mention that the Supreme Court had ordered a Forensic Audit (Digital Forensic Research & Services) that revealed discrepancies in funds allocations and spending. On the court order, then Board of Governors was replaced with an ad-hoc Committee on 13th September, 2018.

Put in retrospect, we would have chosen to utilise these resources on other initiatives, with greater focus on prevention of liver and kidney complications and modernising the existing facilities. But since a lot of resources had already been put into the project, wisdom was in making it better than originally conceived. Public offices are accountable to people; they are custodians of tax-payers’ money, there must not be a waste.

The Pakistan Kidney and Liver Institute and Research Centre Bill 2014 was approved in December 2014. It was a one fell swoop emanating from the fantasy world of our former chief minister. For a project worth a staggering Rs17 billion, there was no PC-1, let alone approvals from the ECNEC, the apex forum for approvals of mega projects. And this amount was handed over to a body with little government control. Even worse, the government could not interfere into the administrative affairs of the institute. Our legal team worked on the draft of the new PKLI Act and it was finally passed on 13th March, 2019.

The new legal arrangements bring it under government control and ensure financial and administrative transparency. A new Board of Governors has been appointed on 11th May, 2019, with renowned and respected names from the respective fields. All bits have been put into place and to this day 73 kidney transplants have been performed, 7 only in the month of January 2020. Administratively, one big issue was loose government control thereby compromising the transparency. Besides ensuring compliance with existing laws, the system has been made transparent and accountability strengthened. The new Board of Governors brings together experts from a diverse range of backgrounds, from finance, law, administration and other relevant fields. Similarly, proper representation of the hospital management has been ensured. The new Board of Governors will hopefully bring major improvement in performance. In order to ensure transparency in hiring and human resource, the recruitment of the management positions (Dean, Hospital Director, Medical Director, Nursing Director & Finance Director) have been placed with a Selection Board that will select the staff on merit. Previously, it was the sole discretion of the BOG. In the new PKLI ACT, the land shall remain the property of the Punjab government, which was earlier handed over to the Institute. Since we took over, a 34-bed Dialysis Unit had been added in October 2019 and with this new Dialysis Unit the total number of dialysis beds had been increased from 20 to 54. The number of total dialysis machines had reached 63 and we are in the process of adding more facilities. Only in the year 2019, a number of new services have been started which are: MRI, Liver Transplant, Lithotripsy, SPECT Scan, PET Scan, Lab Histopathology, Dialysis Unit-II and Inpatient beds.

Much has been said and written about PKLI, mostly without evidence. In view of rumours being spread about the PKLI, I would like to share the number of patients utilising services at the PKLI which are self-explanatory. So far, we have performed a total of 73 kidney transplants; in the year 2019, there were 45 transplants and in 2018, 21 transplants were performed. The number of out-patients visits recorded a steady rise. In the year 2019, 74,119 patients benefited from the services as compared to 61,183 patients in 2018. The IPD admissions in 2019 were 2,493 against 1,508 in 2018. There were 26,073 radiology procedures in 2019 as compared to 18,280 in 2018. The nuclear medicines facility was started in 2019 benefitting 613 patients so far. In 2019, 12,974 patients underwent dialysis as compared to 6,140 in 2018. Emergency Department Census was at 1,159 in 2019 against mere 106 in 2018. The urology and gastro procedures were 2,559 in year 2019 against 1,646 in the year 2018. The Institute performed 175,514 Pathology tests against 122,413 tests in the year 2018.

I will reiterate that immense resources have been put into the institute. These resources must be used judiciously and wisely; therefore, we are trying to make the most of every penny spent on it. Inevitably, it belongs to the people of Pakistan. Lastly and importantly, we envisage that PKLI will be a Centre of Excellence emerging as one of the leading institutions for research and professional development.