“Deposit Rs500,000 and we will let you know when there is a bed available,” said the man at the admissions desk at a ritzy private hospital in Clifton, Karachi. With her 76-year-old mother sick with Covid-19 and struggling to breathe in a wheel-chair outside, her daughter, FA, hesitated.

“What happens if my mother’s condition worsens and I have to rush her to some other hospital before we get a bed here? I won’t have funds for her treatment,” she said. The man shrugged and answered nonchalantly: “We will give you a refund.”

Cases of hospital asking astronomical amounts to treat Covid-19 patients is just one example of the rampant disaster capitalism that has taken hold of the country along with the pandemic.

Overcharging

A young nurse earning Rs29,000 a month at another elite hospital in Clifton spoke in hushed tones of the scandalous increase in rates. The difference in charges for a single day in the general ward and intensive-care units where he did his shifts was significantly more than his monthly salary.

A five-dose Remdesivir course was costing FA’s family Rs175,000. On the black market, it would have cost twice as much

And it is not that the overcharging is trickling down to the staff working in the upscale hospitals. “About 100-150 members of the staff have been terminated because the administration argues that the flow is less… fewer non–Covid-19 patients are visiting hospitals,” said a technician of a private hospital. “No additional allowance has been extended to the staff despite the surge in prices,” he lamented while admitting that their hours have not increased either.

Medicine black market

Talking about the notoriety of the swanky private hospital in Clifton, GM who is from the pharmaceutical sector spoke of its practice of inflating bills. “For example, a local company will offer a dose of medicine for Rs10 whereas the same medicine by a multinational will cost Rs200. The hospital will bill the more expensive medicine while using the local one,” he said.

In the early days of the first wave, before Remdesivir, Roche’s Actemra was all the rage. An expensive injection costing roughly Rs80,000-85,000, it could not be bought by the individuals directly and had to be sold to hospitals.

While his cousin was admitted there, GM had arranged for Actemra to be hand-delivered to the hospital. It took the medicine and then refused to administer the injection on the grounds they did not have it in stock. It took the threat of media after a video was made and calls to high-ups at the hospital for the pharmacists to accept that they indeed had the medicine in stock.

Despite all efforts, the person expired, leaving behind a bill of roughly Rs5 million that the family scrambled to pay off by taking loans from relatives and friends.

One may argue that the injection could have been administered to another patient. However, FA’s experience during the second Covid-19 wave indicates more nefarious designs.

“Earlier, before my mom became so critical she needed to be hospitalised, we had gone to the hospital for a Remdesivir injection. While the medicine was not in stock, the lab technician indicated that he knew someone who would come to her house and administer it. The catch: the market value of a single injection was Rs35,000 but we would have to buy it for Rs70,000.”

A five-dose Remdesivir course was costing FA’s family Rs175,000. On the black market, it would have cost twice as much.

Cases abound of the life-saving medicine being sold at many times the price. A father in Faisalabad narrates how he had to buy Actemra injections for Rs2m. The man who he was buying from refused to sell the number required and insisted that the entire stock be bought or he would sell none of them.

Underground plasma economy

“I received 10-12 calls a day,” recalls Salman Zafar. A Toronto-based individual who had been visiting Faisalabad. “My blood type is the fairly common B+ and my antibody count was over eight, which is a requirement for plasma donation.”

His cousin had let a small non-governmental organisation know about the desirability of Mr Zafar as a candidate for donation, after which it appeared his number had been passed around many times.

“The lab technician who drew my blood for plasma offered me Rs500,000 for it,” said a bemused Mr Zafar who had donated out of charity.

Another man narrates how he received a random call offering plasma for Rs500,000 though he is not sure how anyone got the information that he had tested positive and was wealthy enough to afford it. Ironically, once he had tested negative, he got another call. This time requesting him to donate plasma fi sabillilah.

It’s a business model any capitalist would be proud of: purchase at zero cost and sell for half a million.

Testing scam

“The bags were packed, the extended family had gathered to say goodbye, and my cousin was waiting to drive my wife from Faisalabad to Lahore’s international airport,” narrates AA. His wife, visiting from Toronto, had gotten stuck during the pandemic lockdown. When the flights opened, they had a narrow window to get her and the toddler back home.

After the flight was booked, AA’s wife took the Covid-19 test from Chugtai lab and was tested positive. Since she had no symptoms, she took another test from Shaukat Khanum. The second test came negative, a few hours too late for them to catch the flight.

“Back then, the airlines were not as accommodating as they are right now. Plus, there were limited flights. By the next booking, my son had turned two. Between the rescheduling and his ticket, it cost me about Rs100,000.”

It sounds like a minor inconvenience but during the time of frantic calls and chaotic coordination, it had been a trying time. Since then, Chugtai Labs has gotten a bad reputation with media reports indicating many airlines do not accept its test results.

“I talked to someone at a lab and requested them to give me a negative result. They showed willingness to do it but by that time the test results had been posted and sent ahead. If I had been able to contact them earlier, I could have gotten the test result I needed,” says ZA while talking about how easily test results can be manipulated if you have a person on the inside.

The good guys

While stories abound of bad guys, there are also those who continue business-as-usual without exploitation. From the free care provided by the Indus Hospital to the diligence of Aman ambulances (now Sindh Rescue and Medical Services) to the funeral transportation of the Edhi Foundation, FA talks about her favourable experiences when her parents, siblings, sister-in-law, nieces and husband had contracted Covid-19 together.

“The boy who lugged the heavy cylinder tanks at all times of the day and night was one of those few who was willing to enter a house that had so many ailing and contagious. The safety deposit of each cylinder was Rs20,000 and at the peak of the crisis we had four tanks in the house. He waived off the deposit for the other three tanks.”

“With rent, filling and transportation charges, each tank cost us Rs2,500 per day. But at that time, when there were no beds available all over the city, we would have paid many times over and he knew it. We don’t begrudge him running his business and charging a fair amount.”

Eventually, FA did not gamble on the posh Clifton hospital that looked more like a hotel than a hospital. The risk of her mother suffering complications while waiting for a bed that would never be available for too high. But she still thinks of the agonising time, right after her father’s death, when her mother’s passing seemed imminent as well.

Capitalism has its natural place in every economy. It is only when it morphs into disaster capitalism, making the most money out of the misery and helplessness of others, that it becomes truly reprehensible.

Published in Dawn, The Business and Finance Weekly, February 1st, 2021