Your can tell whether a hospital is failing or succeeding by looking at the way the public transport lines up, even before you enter the premises. You can test this theory of mine by comparing any hospital in Lahore with Shaukat Khanum Cancer Hospital and Research Centre (SKCHRC). You can see scenes of chaos, disorder and aggravation in front of all hospital entrances, and that applies to ambulances as well as other traffic. Not so at the SKCHRC.
As soon as you enter the complex, you notice the large number of people and the total lack of noise. Things hum along with a cool, purposeful and quiet efficiency. The central air conditioning has a calming effect against the enervating heat of Lahore. You take a token and wait for your name to be called out by an automated queue management system. There is no jostling or anxiety at the counters.
The doctor will see you at the appointed time. All appointments are through prior booking, except in the walk-in centre. All records are electronic and online, accessed from a central database. You can have the test done in Peshawar and it will end up in your record, so that the doctor can retrieve it in Lahore. You can actually access your own test on line. There is very little in the way of paper records. All the functionalities are integrated into one computer system, including the clinical notes, lab results, X-Ray images, endoscopy, pharmacy, laundry, kitchen, and inventory.
This is jaw dropping for any one visiting from the UK, as I am. There, the National Health Service had to scrap the National Programme for IT and write off a large part of the 12 BILLION pounds budget. AND the SKCHRC system was developed for a pittance by a team of young, in-house professionals and has been operational since 2005.
The Accidental CEO
How does a first world facility pop up in a third world country? Is it through accident or design? I asked Faisal Sultan, my friend from the KE days. Faisal was always very bright but I don’t think he ever took himself too seriously. He was a top class physician and a researcher and had to step in during the early years of Shaukat Khanum when there was a leadership crisis. Faisal says that there is a policy of no compromise on the quality of care and the absolute commitment to the equality of access for the non paying cancer patients.
The Key Factor
Imran is the key factor. He was and remains an icon for millions of people. His political fortunes have seen ups and down. His policies have received their fair share of criticism. He has ardent followers and fierce opponents. But his financial integrity and passion to help cancer patients, have always been beyond doubt. This means that he still remains the bedrock of fundraising campaigns. Shaukat Khanum has an annual budget of eight billion rupees, half of which is generated by the provision of services, mainly by the labs. The other half is raised from donations.
This is serious business and is performed to the highest professional standards, by a team which has grown with the hospital and gained experience over the years. Apart from a short duration in 1997, when Imran had to sell his property to pay the salaries, there has never been a short fall.
Shaukat Khanum pays well and employs the best. This is good policy, as the money spent on quality is money well spent. They are able to employ highly qualified physicians from all over the world. Having said that, I think that the doctors who work here do not come for the pay alone, as they can make much more in western countries, where most of them have trained, or indeed in Lahore. There is a sense of achievement in succeeding against odds and making something work in an environment where nothing works. I think it is this feeling that keeps many people going.
Aasim Yusuf, the Chief Medical Officer, is my classmate from King Edward and, like me, a gastroenterologist. He was trained in England and gave up a consultant post in the UK when he came to join the Shaukat Khanum just before it opened, in 1994. He is a pragmatist, with a lot of personal discipline and common sense and has a very clear view of the future of the organisation and its core mission. He is responsible for all clinical activity, and for maintaining clinical excellence at both the Lahore hospital and at the new Shaukat Khanum in Peshawar, which is progressing nicely. Hopefully, he will also be setting up the Karachi Hospital in the not-too-distant future. I attended a few endoscopy lists with him. About one third of the patients were from Afghanistan. I did not see anyone who was paying. About 75 percent of the cancer patients are treated free and to exactly the same standards as the paying patients.
Take a trip around the hospital. Have a seat on one of the wooden benches next to the duck pond and look at the fountain playing, the serene water and the lovely red brick building in the background. Kids, both patients and visitors, love feeding the ducks. One forgets the troubles of the world for a delicious moment. Or hang around the glass-fronted inner courtyard, to watch the peacocks, I have always seen little kids watching the birds with fascination. Step into the gift shop which has a tastefully done interior and a few children and their mums watching the Disney cartoon, dubbed in Urdu. You can’t help feeling a lump in your throat.
Visit the clinical areas. There are two patients to a room, with the provision for a relative to stay. The rooms are quiet, private and dignified, all with a toilet and a shower. The ITU is probably the best in Lahore, both in terms of design and functionality.
Aasim tells me that all departments operate to the highest professional standards, and many are affiliated with international quality standards organisations. The pathology laboratories, for instance, participate in quality control programmes run by the College of American Pathologists. Even the food service is certified for Hazard Analysis Critical Control Point (HACCP) from an international food standards organisation. This is no small achievement.
All the patients are given their meals from the hospital, in individual trays, with a caloric value printout. They have a menu to choose from. The pharmacy will dispense drugs, with the instructions printed on the packs. The chemotherapy day unit is comfortable, dignified, not crowded and unhurried. The hospital as a whole has been prepared for some years to be audited by a leading international hospital quality certification organisation, whose inspectors have been unable to travel to Pakistan owing to a travel advisory issued by the US State Department.
All these things are taken for granted in the developed world but they are a tremendous leap forward for medical care in Pakistan, perhaps even a miracle.
Aamir Ali, affectionately known as ‘the Pole’ from his days at King Edward, because of his great height, is the associate director of surgery. He has been at Shaukat Khanum since 1996. He is the technical maestro who has done all sorts of surgery over the years in the way of the old school general surgeons. He is currently doing mostly gastrointestinal surgery. He regularly puts in 12 hour days, six days a week and remains a happy man.
I have wondered, like many people, whether the hospital and the larger organisation will outlast Imran Khan. With the kind of people I have seen working here and the systems in place, I am sure it will. In fact, I think the management and IT systems are scalable, meet the local needs, are to international standards, and have immense commercial as well as public welfare potential. They are beginning to be used in other public and private hospitals.
Go, see the hospital, it is world class, made in Pakistan.
The author is a gastroenterologist, currently working in the UK. For more information on Shaukat Khanum go to www.shaukatkhanum.org.pk
Published in The Express Tribune, July 3rd, 2016.