KARACHI: Youth's death underlines need for transplants
By Nizamuddin Siddiqui
KARACHI, Jan 10: Noman Sami, a young man of 27 years, died of respiratory failure on Monday at the Liaquat National Hospital.
Over the last few weeks the capacity of his lungs had been declining rapidly and he was put on a ventilator in the middle of last week.
The 27-year-old man's death spotlights a rather neglected area in the Pakistani health sector, which pertains to the transplantation of organs. It is not that Pakistan has not made any headway in this area. With at least 1,700 kidney and liver transplants, the country surely has but much more needs to be done.
Noman was suffering from bilateral cystic bronchiectasis, the definitive treatment of which was lung transplantation. But, since no hospital in the country had the facilities and expertise to undertake such operations, he needed money to go to a country where such surgeries are common.
Had he been a rich man, Noman would have had at least two options before him. Option number one was either the United States or the United Kingdom - developed countries that are rather expensive.
Option number two was Singapore, which is cheaper than the two but still very expensive for a common Pakistani. (The workup for lung transplant, for instance, is 50,000 Singaporean dollars, which comes to about Rs1.8 million.)
A question, which must be raised here, is: Why and how is it that ailing Pakistanis have to go abroad to get proper treatment for a number of health problems. Surely, there is no dearth of competent doctors here in Pakistan. And there is no shortage either of multi-storeyed buildings that house the hospitals which are staffed and managed by these professionals.
The government, on its part, spends billions of rupees on healthcare each year. Admittedly, at just under 1 per cent of the GDP, the authorities should invest more in the health sector. But, the question still remains: Are we as a nation getting an adequate return on the billions that are spent every year on health? Put differently, are the billions spent on healthcare each year properly utilized?
Prof Adibul Hasan Rizvi of the Sindh Institute of Urology and Transplantation reminded this reporter that Noman was not the first Pakistani who had died because his family could not afford treatment in a foreign country. Neither is he going to be the last.
"Incidents like this will keep on happening because we lack indigenous capabilities in several areas of healthcare, especially transplantation," he remarked. "Let me add here that, as a modality, transplantation has come to stay.
"And transplantation, as a discipline, is no longer experimental in nature. In the West, developments in this discipline are occurring at a very rapid pace." For transplantation, including that of the lungs, to take firm roots in the country, its legislators should adopt a brain death law under which organ donation was legalized, said Prof Rizvi.
One cadaver could provide organs for as many as 17 ailing people, thereby improving the life of each recipient. "It is time that people from all relevant areas get together on this issue - the medical community, clergy, philosophers, philanthropists, journalists and other civil society activists."
Asked why healthcare was comparatively cheaper in India than Pakistan, Prof Rizvi said improvements and developments had been taking place in Pakistan over the years, but in an unorganized fashion.
"And as opposed to India, where there is considerable competition among hospitals, there is little or no competition among the Pakistani ones. This is why the charges are on the higher side in Pakistan."
He, however, added that in India, much like Pakistan, only the rich could afford to take benefit from the healthcare system. Asked whether transplantation was a luxury, especially when Pakistan had still not eradicated polio and when even common diseases such as diarrhoea and tuberculosis posed big challenges, Prof Rizvi said: "Look, for the last 50 years we have been trying to control common diseases through prevention.
"And we have largely wasted five decades in trying to do so. I think that instead of wasting the next 50 years, or rather 55, on prevention initiatives we should run the high-tech and basic programmes side by side."
He said the technological gap between Pakistan and the rest of the world, including India, was already quite wide. "This gap will widen if we do not launch programmes soon that seek to touch the frontiers of science and technology, if not extend them.
"So it is imperative that we understand fully the importance of prevention efforts as well as the need for opening some high-tech programmes, which will include transplantation initiatives."
When the same question was put to Dr Shershah Syed, the secretary-general of the Pakistan Medical Association differed with what Prof Rizvi had said. "No doubt, transplantation is an important area but the cost is prohibitively high.
"So, in the cost that one person undergoes a transplant surgery, hundreds and possibly thousands of patients may be treated for tuberculosis or diarrhoea," he said.
"Look, at SIUT thousands of kidney transplants have been carried out. But the fact remains that thousands more will require kidney transplants in the future as well because the authorities are failing to provide clean water to them."
He was of the opinion that the authorities should first try and control the prevalence of stone-formation in people, which is caused by consumption of unclean water, before investing in transplantation and other high-tech programmes.
Dr Syed pointed out that transplant operations were being performed in Pakistan, albeit in a disorganized manner. "We already have the SIUT, where thousands of renal transplants have been done.
Bone marrow transplant is also being done. But, the effort largely remains uncoordinated." He added that the Pakistan Medical Association had formulated an alternative health policy, which will be unveiled shortly.
