A strong smell of disinfectants hits your nostrils as you enter the paediatric chemotherapy ward at the Indus Hospital in Karachi’s Korangi area. Each of the 20 beds in the ward is occupied with a child undergoing chemotherapy. At least as many await their turn in the waiting area outside.

Among the children in the waiting area is 12-year-old Khadija Sardar, whose eyes are fixated on the colouring book before her as she examines her latest masterpiece, apparently putting in finishing touches with the coloured pencil in her hand. As she looks up, her face breaks into an infectious smile, making you momentarily forget her frail-looking body and the dark circles beneath her eyes.

“She was diagnosed with blood cancer (leukaemia) last year,” said Sherbano Sardar, Khadija’s mother. The family hails from a small village located at an hour’s drive from Nawabshah.

Around this time last year, Khadija developed a high-grade fever that would simply not break. When several attempts at traditional medication didn’t provide any relief, her parents rushed her to the Indus Hospital in Nawabshah, where after running some tests, the doctors advised them to shift her to Karachi’s Indus Hospital.

Following another round of tests in Karachi, Khadija was diagnosed with leukaemia — a cancer of the white blood cells, which begins in the bone marrow.

Ever since, Khadija and her parents have been living in Karachi, while she undergoes chemotherapy. “We live in a rented place nearby, which costs us Rs10,000 a month. My husband is a daily-wage labourer, so we only eat food on the days he earns,” said Sherbano, her eyes glistening with tears.

“The only thing we don’t worry about is Khadijah’s treatment because it is completely free,” she added. The Sardars don’t pay a penny for the treatment, which costs Rs25,000 per session at the Aga Khan University Hospital in Karachi. Leukaemia patients typically require at least eight sessions, so that puts the total cost at Rs200,000 just for the chemotherapy.

Like the Sardars, almost every parent in the waiting room had a story of helplessness and despair to share. For them, welfare health facilities such as the Indus Hospital provide a lifeline, without which they would be unable to afford treatment for their loves ones.

Filling the void

Sindh’s public healthcare system, while heavily subsidised by the government, simply cannot cope with the sheer volume of patients. In recent years, the provincial government has partnered with private organisations such as the Indus Hospital and the Sindh Institute of Urology and Transplantation (SIUT) to improve access to tertiary healthcare, but the situation is far from ideal.

To fill the void, several welfare healthcare facilities have been established across the province, providing life-saving treatments such as chemotherapy, dialysis and even organ transplants free of cost. Meanwhile, smaller establishments such as the Jamal Noor Hospital and the Kutiyana Memon Hospital have been lending a hand by running medical tests and providing medicines at subsidised rates, making them slightly more affordable for people in need.

“There are no cash counters in the hospital; any patient can come in, find a bed and be attended by a doctor,” said Muhammad Fawad Bin Rashid, the media relations manager at the Indus Hospital in Karachi.

The cost of these treatments runs in the thousands and sometimes, millions of rupees. While the patients are often provided these facilities for free, the welfare hospitals are in turn dependent on donations.

The spirit of giving

Pakistanis pride themselves on philanthropy. After all, Abdul Sattar Edhi made one of the largest charitable organisations in the world from scratch, simply from donations collected from ordinary citizens.

Most charitable organisations, including those providing medical services, collect a substantial sum of money to run their operations in the month of Ramazan, as Muslims tend to donate more at this time of the year due to religious obligations. This year, however, there has been a sharp dip in the donations collected in the form of zakat — one of the pillars of Islam that mandates Muslims to give a portion of their wealth to charity.

In fact, executives at five welfare hospitals in Karachi told Dawn.com that their collections had dropped between 20pc and 30pc, compared to last year. While the recent spike in inflationary trends may be the primary reason, the situation has been growing consistently worse ever since Covid-19 caused disruptions in the global economy. Moreover, the massive floods last year too caused severe economic losses across the country.

“Our usual donors are at a point of exhaustion,” explained Syed Mashood Rizvi, Executive Director-Pakistan at the Indus Hospital’s Communication and Resource Development Department.

He added, however, that while people are still dipping into their pockets to help others, it’s simply not enough because the demand has gone up manifold.

“Demand for patient services has increased by 42pc in the last one year,” said Rizvi, adding that people who held white-collar jobs and would usually pay for simple treatments, were now finding it nearly impossible to afford healthcare and had switched towards welfare hospitals —something that has not been witnessed in Pakistan before in such huge numbers.

“We never asked for donations for the hospital … the donations were always enough to facilitate people who needed financial aid,” said Muhammad Bashir, an account manager at Jamal Noor Hospital, a semi-private and welfare healthcare facility.

“Our zakat and donation collection have been significantly lesser this year,” he continued. “A lot of our regular donors have been pulling back, given the increase in the prices of day-to-day essentials … one can’t blame anyone.”

While overseas Pakistanis have stepped up to the challenge, said Rizvi, given the depreciation of the Pakistani rupee, the situation will only aggravate if the economy doesn’t improve. “Overseas Pakistanis have donated more than they usually do this Ramadan … this will be helpful, but it won’t last very long,” said the Indus Hospital director.

Medical expenses aren’t essential anymore

While many of these charitable organisations focus on providing medical care for life-threatening diseases, the rising cost of healthcare has severely impacted even those patients whose condition may not be life-threatening but still impacts their quality of life.

According to Consumer Price Index data compiled by the Pakistan Bureau of Statistics (PBS), expenditures related to health, including doctor’s visits, hospital bills, medicines and equipment, have risen by 18.46pc.

Despite being offered free treatment, many patients have been missing their appointments. “Most of my patients come from faraway places such as Malir, Lyari and Korangi; the rising fares have made them think twice before coming for the second appointment,” said Dr Shumaila Zia, a dermatology resident at the Dr Ruth Pfau Civil Hospital, Karachi.

Dr Zia added that for patients who have severe ailments and require constant checkups to maintain the treatment’s efficacy, she had started paying their transport costs out of her own pocket.

Meanwhile, patients suffering from mental health disorders are finding it even harder to keep up their treatment regimen.

“The Edhi Mental Asylum has seen a spike in number of patients, some of whom were shifted from private hospitals because the families could no longer afford to pay the bills,” said Faisal Edhi, the chairperson of the Edhi Foundation.

Since mental health disorders are not considered life-threatening, many families deemed it okay to shift their loved ones to charitable hospitals, given the skyrocketing costs of medications and healthcare, Edhi explained.

Zoha Shah, a third-year engineering student, said that she wanted to take therapy sessions but has been unable to afford them.

“They cost at least Rs1,500 a session, that too online, and if you don’t take at least four or five, they don’t help you at all,” said Zoha distractedly. She added that asking her parents for money for therapy felt unnecessary as it was already hard enough to survive in this economy.

Moreover, the steep rise in the prices of prescription drugs has meant that people must now choose between spending on essential day-to-day expenditures or healthcare.

“The prices of prescription drugs have increased by almost 25pc on average in the past year alone,” said Anfal Dadabhai, who runs a wholesale pharmacy business.

Sakina Hamid, who works as a domestic help, never thought she would asking her employer for a loan but she has run out of options. The medicine needed to treat her condition, scleroderma — a skin disease — has become unaffordable.

Hamid monthly salary is Rs10,000 and her medicines cost Rs1,500 — that too from a welfare-based pharmacy that offers heavy subsidies on medicines. Even so, every month she deliberates the need to buy the medicines.

“I have reduced the dosage,” said Hamid. “I even try to skip it, but if the condition wasn’t making it difficult for me to work, I wouldn’t be taking the medicine,” she said.

Several local pharmaceutical companies have shut shop over the last one year, due to import restrictions and the inability to continue doing business in the volatile market. This has further driven up the cost of medicines and surgical equipment.

A cough syrup that used to cost Rs150 is now being retailed at Rs400. Similarly, nebulisers, which would be sold for Rs3,000 last year, now cost Rs6,000.

The spike in inflation has the common man struggling to make ends meet, making medical care seem like a luxury that is increasingly becoming unaffordable. In these times, welfare hospitals are a beacon of hope for people who cannot avoid the expenditure. If these hospitals are unable to operate due to increasing expenses and reduced funding, thousands will die or be otherwise incapacitated due to otherwise treatable illnesses simply because they don’t have enough money.

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