• Ex-PM hasn’t undergone any procedure since 2020
• Yasmin says ‘Nawaz is fine’ if he can go two years without surgery

LAHORE: The Pakistan Tehreek-i-Insaf (PTI) government’s fresh efforts to secure an update on the condition of former prime minister Nawaz Sharif by ramping up legal pressure against his brother Shehbaz may not prove to be as fruitful as hoped.

Conversations with Pakistan Muslim League-Nawaz insiders and sources close to the Sharif family indicate that the kind of detailed medical reports the government has sought may not be available, since the former prime minister has yet to undergo any of the procedures that have been recommended to him by doctors.

Sources say the former prime minister has been advised to undergo a fresh cardiac procedure that is not without its risks. Compounding the problem is the Covid-19 pandemic, which has led to most — if not all — non-urgent surgeries in the UK being postponed.

But in Dr Yasmin Rashid’s view, Mr Sharif has had ample time for treatment — Covid or no Covid — and “if he has survived for two years on medication alone, he is stable” enough to travel back to Pakistan.

The Punjab health minister has been a key part of the process that saw Nawaz leave for treatment and has subsequently been keeping tabs on his condition in the hope that he would be able to return to face the charges against him in Pakistani courts. She points out that while cardiac catheterisation — the procedure that the former premier was scheduled to undergo when he proceeded abroad — could also have been carried out in Pakistan, Mr Sharif had insisted he would prefer to undergo the procedure in the UK, where he had already been operated upon twice.

Nawaz has been in the UK since Nov 2019, when he was undergoing medical tests. In January 2020, doctors evaluated whether he would need a heart operation, bypass, or a stent. Due to his haematological issues, family sources had said that at the time, they had considered travel to the US to address his complications.

Then the pandemic set in, leaving many hospitals in the UK battling staff shortages due to high infection rates.

However, the UK only went into national lockdown in March 2020 as cases rose and hospitals declared emergencies, and it is unclear why the former premier did not have the surgery between January and March 2020.

Complex health issues

Conversations with PML-N insiders reveal that Mr Sharif has “multi-pronged” cardiac and haematological issues.

The former PM has had two major cardiac interventions in the past (2010 and 2016) and experienced thrombocytopenia in 2019, when he was granted permission by the Pakistan Tehreek-i-Insaf (PTI) government to travel abroad for treatment.

Without the third cardiac surgery he has been advised to undergo, it appears unlikely that the former PM will return to Pakistan.

Sources in the Sharif family said that since the procedure requires experienced surgeons – especially in view of the complications Nawaz has experienced in previous interventions – it is unlikely that the family would let him be treated in Pakistan.

Then there is the problem of his now-expired passport, which will make travel outside the UK tricky, to say the least.

‘Incomplete’ reports

The Punjab government recently constituted a nine-member special medical board (SMB) to examine the documents submitted as medical reports of the former premier by his UK physician, Dr David Lawrence, and give its expert medical opinion regarding the patient’s physical condition and his ability to travel back to Pakistan.

However, the board members claimed that they could not give a structured opinion on Nawaz’s condition or ability to travel without details of his current clinical evaluation, blood reports, imaging results and procedures.

In Aug 2021, Dr Lawrence wrote a three-page report which said: “In Nov 2019, he was referred for treatment because of unavailability of specific expertise, technologies and techniques to treat his diseases along with co-morbidities and associated complications.”

It added: “Great care needs to be exercised in dealing with each of the diseases and comorbidities he is suffering from to maintain the right balance. In London, [Nawaz] Sharif underwent extensive medical investigations and scans, including periodic laboratory assays – Rubidium-82 Cardiac Perfusion PET-CT scan (Rest & Stress), echocardiogram and 24-hour Holter analysis.”

“The reports just define the medical process and procedures required [in London]. They are not political, so they don’t include an analysis or state risks. If you have him examined by three doctors, for instance, they will have three completely different approaches to treatment,” a party source told Dawn.

At best, Dr Adnan Khan, the Sharif family’s physician in Pakistan who has accompanied Nawaz on health visits, will write a letter detailing Nawaz’s health status and share it with the board.

But according to Dr Yasmin Rashid, this would not be sufficient for the SMB.

She said that on Dec 24, 2019, Dr Adnan had sent ‘not-so-complete’ medical reports soon after he travelled to the UK. “I myself called him in Jan 2020 for the complete reports, but they never came.”

The Punjab health minister recalled that Mr Sharif’s procedure was scheduled for Feb 2020, but he had refused to undergo the treatment, demanding that his daughter, Maryam Nawaz Sharif, be allowed to travel to the UK to accompany him.

However, the government had denied her permission to travel, and Mr Sharif has not yet had that procedure done.

When asked whether she buys the rationale that it was the pandemic that was keeping Mr Sharif from getting the requisite procedure, Ms Rashid said that we were now in the fifth wave of Covid-19, but the former PM had not managed to find time for his treatment.

“Covid or no Covid, emergency and life-saving procedures are being conducted the world over,” she said, adding that the UK’s healthcare system was more organised than Pakistan’s in this regard.

Additional reporting by Atika Rehman in London

Published in Dawn, February 1st, 2022