The 1998 Ramon Magsaysay Award for Government Service

BIOGRAPHY of Syed Adibul Hasan Rizvi

Rubina was only in her teens when she faced a serious problem. She was suffering from chronic kidney failure and her doctors told her she had only two choices: to undergo dialysis treatment for the rest of her life or to undergo a kidney transplant. The dialysis treatment would have cost Rubina's father 160,000 rupees a year. The transplant would have cost him 300,000 rupees. Either way, he could never have hoped to raise that much money.

Then, Rubina's family heard of the Sindh Institute of Urology and Transplantation, better known as SIUT, at Civil Hospital, Dow Medical College, in Karachi. Civil Hospital itself is a typical government hospital-dingy, maze-like, and crowded. One journalist describes it as "one of the dirtiest in Karachi." Patients' relatives who have no place to stay in Karachi sleep on the ground floor of the hospital, while their loved ones undergo treatment.

But SIUT, which began as a ward at Civil Hospital, is an entirely different story. A recent visitor notes how the third floor of Civil Hospital, where the kidney unit is located, stands in stark contrast to the rest of the building: the unit is "spanking clean," the marble floors gleam, the walls seem to have just had a fresh coat of paint, and everything is efficiently organized. In the dialysis room, visitors have to change from their shoes or sandals to specially provided slippers. The institute director, the visitor is told, demands cleanliness at all times.

What impresses the visitor most about the unit, however, is the fact that it houses, under one roof, some of Pakistan's most skilled and experienced doctors and medical staff for the treatment of urological diseases. It also has state-of-the-art equipment. The country needs such specialists and facilities because twenty million of its 130-million population-a good many of them in the province of Sindh-suffer from diseases that affect the kidneys and other parts of the urinary system. These diseases are brought about by diarrhea, dehydration, improper diet, or infection and include urinary tract infections, stones, and prostate problems. Few of those who suffer these diseases, however, can afford professional help because they affect mainly poor people who have unsanitary sources of water. Only half of Pakistan's population has access to safe drinking water and only a third has adequate sanitation.

Most of SIUT's patients-from 60 to 70 percent of them-are from rural Sindh, from 17 to 23 percent from urban Sindh, and the rest from other parts of the country. Most of SIUT's patients come from Sindh because of a greater awareness of kidney disease in the province and the availability of free treatment at the institute. Often the institute attracts more patients than it can handle.

SIUT has over five hundred staff members, sixty-five medical residents, and sixteen consultants who serve more than seventy-five thousand patients every year, providing them outpatient services, specialized diagnostic investigations (including ultrasound scanning, uroflometry, and renal angiography), percutaneous renal surgery, and specialized high technology services such as dialysis, lithotripsy (nonsurgical removal of stones in the urinary system by pulverizing them with shock waves, using a lithotripter), specialized tissue-typing tests, and kidney transplantation.

The institute's new premises, the Dewan Farooq Medical Center, is a six-story complex that contains a 350-bed hospital, operation theaters, a pathology laboratory, three intensive care units, four clinical laboratories, rehabilitation facilities, a drug store, an auditorium for four hundred people, three conference rooms, a helipad for emergencies, a training center, nursing and technological schools, various wards for different categories of dialysis patients, and a children's clinic.

There is something else that a visitor to SIUT notices: patients smile at doctors and do not hesitate to ask questions.

Rubina's parents brought her to SIUT. There, she received dialysis treatment until she could have a transplant with a kidney donated by her father. After she became well enough to return home, she kept coming back to SIUT for checkups and her post-transplant medication, which she will take for the rest of her life. In the first six months after transplantation alone, these drugs would have cost Rubina's father as much as 10,000 rupees a month.

But everything that Rubina received from SIUT-the dialysis treatment, the transplant, the post-transplant checkups, and medication-did not cost Rubina's father anything. Everything was, and still is, being provided to her for free.

The man who made all of this possible is Dr. Syed Adibul Hasan Rizvi, a urological surgeon whose philosophy as a healer is expressed in SIUT's stated mission: to provide comprehensive and modern medical facilities free of cost to all patients. Rizvi believes that health care is the birthright of every man, woman, and child, irrespective of cost. Treatment should not be denied to a person because he is poor and cannot afford the cost of medicine. He also believes that health providers should be free of ethnic bias and must provide equal treatment to everyone, whatever the patient's background, caste, creed, religion, or gender. He further believes that health providers must attend to a patient holistically, providing not only free treatment and medication, but also social and health counseling so that the patient and the patient's family can cope with the emotional stress caused by illness.

Who is Dr. Rizvi, and what led him to found a most unusual public health institution in Pakistan?

Syed Adibul Hasan Rizvi was born on September 11, 1938, to a close-knit, middle-class, landowning Muslim family in Kalanpur, a small village about ten kilometers from the city of Jaunpur in Uttar Pradesh, British India. He was the youngest of nine children-six boys and three girls. His father, Syed Mohammad Hussain Rizvi, was an only son who was orphaned early in life. Rizvi's father spoke Urdu and Persian but, out of need, learned English on his own as well. He was brought up by a great-grandmother and, while still in his teens, joined an engineering company set up by the government to build roads and bridges. He began as an apprentice, qualified as a civil engineer through self-study, and worked his way up to become chief engineer in Jaunpur.

Like all the other Muslim families in Kalanpur, the Rizvis lived in the central part of the village. Around them were Hindu peasants who worked the Muslim families' land. Despite differences in socioeconomic status, the Muslim landlords and the Hindu peasantry who made up the majority of the village population remained cordial to each other because practically everyone in Kalanpur was educated. In fact, the village became famous not only in Uttar Pradesh but throughout India because of the many scholars and educated people that the village produced. It helped that the educated people were keen to see those around them educated as well. "They were famous for opening schools, colleges and universities," Rizvi says.

Rizvi's father built the family house on ancestral land and named the house Rahat Manzil-the place of peace. It was a large house with a barn at the back, where animals were kept. On the farmland, which was of considerable size, the family grew wheat, barley, sugarcane, and potatoes. The farm produced just enough to meet the needs of the family, as well as those of relatives and guests.

The families of the Hindu peasants who worked the Rizvi land shared the Rizvi family house. Because Rizvi's father laid down a rule that the children of the servants should not be discriminated against, Rizvi says it was "very difficult to differentiate between us (the Rizvi children) and the children of the servants."

Rizvi's father was a devout Muslim, but he also respected other people's religious beliefs. "My father saw to it that anything which was kept for the Hindus should be kept just the way their religion dictated. He never wanted anything to be tampered with." Rizvi's mother, Jinnatun Nisan, was a housewife whom he describes as "a lady of great character." Her cultivated manner of speech belied the fact that she could neither read nor write. Rizvi says she was devoted to her husband and family. While still a child, Rizvi fancied that he would become an engineer because that was the career assigned to him by his family. An elder brother whom he describes as "a wonderful person, with a lovely personality, very soft-spoken, very jovial" was supposed to be the doctor but drowned while swimming. "So, for the sake of my mother, I opted to become a doctor," Rizvi says. "When I chose to become a doctor, the closest I could get to engineering was surgery. So, from the word go, I had no doubt that I was going to become a surgeon."

Rizvi recalls that, as a child, he did not want to go to school. "I never liked to study," he explains. "I was always happy when I was with the sons and daughters of the field labourers. I wanted to be one of them." His parents provided him with tutors, but they were of no help. "They were very strict disciplinarians," Rizvi says. "They wanted me to stay up late and memorize everything. I simply hated rote learning."

Rizvi walked to school every day. Most of the villagers were poor, so the school did not require its students to wear a uniform. Rizvi wore a shirt and Bermuda shorts to class, but most of the other boys came in loincloths. In the classroom, everyone sat on the ground. "Poverty, even in those days, was everywhere," Rizvi recalls. "The only difference was that we weren't as conscious of it." Like other children, Rizvi thought it normal that he wore shoes or sandals while others walked barefoot.

Rizvi's aversion to school changed after his father brought home a man named Sajjad Husain to stay with the family for a year or two. Rizvi was only six then. Unknown to Rizvi, Sajjad Husain, who was about sixty, was a teacher-in fact, he was the principal of the local teacher's training college. During Sajjad Husain's stay, Rizvi provided him company. "I didn't know that it was a trap for me," he recalls. "He was very nice. He used to play with me, talk to me."

Then, Sajjad Husain began teaching Rizvi. "I realized that I avoided school because the teacher would ask me questions that I didn't know the answers to," he confesses. But when he learned these things from Sajjad Husain, he suddenly felt like going to school "just to show off that I knew these things." Rizvi describes Sajjad Husain's method of teaching: "He would pace back and forth as if he was addressing a classroom. That used to fascinate me, so I would stay close to him, just to see what was happening, what he was doing."

After meeting Sajjad Husain, Rizvi became a different student in school. Where he used to settle for second or third place, he now moved to first. This required more effort on his part-"auto-stimulation," he calls it. At times it was difficult, but he was glad because "no one had to say anything to me."

After completing elementary school, Rizvi went to Jai Narayan High School in Benares, which is about seventy kilometers away from his village. The school was run by British and local Methodist missionaries. His parents sent him there because they believed, like other Muslim parents, that Christian schools were progressive and did not force their religion on their students. He studied there for two years, living in one of the hostels on campus. English was the medium of instruction and the teachers were, according to Rizvi, "very conversant" in the language. This helped him a lot, he says. One teacher in the school, an elderly Hindu who converted to Christianity, had a strong influence on him. Mr. Singh had trained in the United Kingdom and taught English. Rizvi describes him as "kind and soft-spoken" but "very lonely." He used to live in the hostel and would "sit and talk and talk and talk." Among the things he talked about were communal sentiments and how destructive they were. Rizvi recalls Mr. Singh was "the only person who used to talk about these issues because other people were too scared to discuss anything."

Rizvi was in Jai Narayan when the Indian independence movement was launched by Mahatma Gandhi. Except for Rizvi's father and a few other family members, everyone in Kalanpur was pro-independence and pro-Gandhi. Although his father was not pro-Gandhi, he was not pro-Mohammed Ali Jinnah either. Instead, he wanted a separate and permanent place for the Muslims of the subcontinent and believed that the British should continue to rule India until people were educated enough to look after their own affairs. He was afraid that if the British left the country, chaos and anarchy would ensue. This belief made him unpopular with those who wanted freedom.

Rizvi says that although he was too young then to understand what was going on, he was sure of one thing: his family was worried about their safety. For a while they were afraid immigrant outsiders would attack Kalanpur, because the village was known to be a place of people with means. But in the school itself, the atmosphere was "very good" because Hindu, Christian, and Muslim students studied there in equal numbers. Outside school, however, the atmosphere was, in Rizvi's words, "a little aggressive."

When Partition took place, Rizvi's father did not want to leave India, so the family stayed on. But Rizvi's mother was so frightened by the communal riots in the country (even if none broke out in Kalanpur) that she decided to move Rizvi and a brother to Pakistan. She reasoned that Rizvi, being the youngest in the family, would not be able to defend himself and that his education was in jeopardy because several schools had been attacked in the riots. Rizvi says that, at first, he did not want to leave because all of his friends were in India. Later he realized that he and his brother had no choice. So, in 1951, when he was thirteen, he and his brother moved to Pakistan, along with a few other relatives.

In Pakistan, Rizvi entered Diaram Jetha Mal Science College, more popularly known as DJ College. He says "it was the only school at the time in the city of Karachi," and so he had no other choice. Students went to DJ for pre-medical and pre-engineering studies.

Although Rizvi came from India and was a newcomer in Pakistan, he says he did not experience any animosity or prejudice against him. Instead, he integrated with the other students very quickly, especially with the group of students from East Pakistan (now Bangladesh) who were staying in the same hostel as he was. Rizvi spoke Urdu but in Karachi he had to learn Sindhi as well.

What Rizvi liked best during his days at DJ was that students there could be "proud of their poverty." He says they believed it was not wrong or not a crime to be poor-to be unable to afford certain luxuries such as going to the movies or having tea in a hotel. Rizvi says those same years at DJ were the most turbulent in his life. When he entered the school, he found that he and all the other students were required to pay their fees for the whole year in advance. They rebelled against this, saying it was not possible for every student to collect that much money. Because of this rule, many students were unable to continue their studies at DJ.

Rizvi joined student organizations and became so involved in student politics and activism that, as he put it, he was "made to contest" the elections for the student union presidency at DJ. Despite being the youngest and most junior candidate for the post, he won. He was only seventeen then. "That," he now recalls, "was the real problem. I didn't know how to run it." Because of their protests over school fees, he and many other students were arrested by the police, charged with sedition, and jailed for eight or nine months. The police were wary of communists and suspected that the students were socialist in leaning because they protested about fees. When the case against the students was brought to court, Rizvi says it was "just laughed off." All of them were released. Lawyers had volunteered to take up their case "and everything was free."

Rizvi says being in jail at the time was not terrible at all. Even while behind bars, he and the other boys had access to their school books, could continue their studies, and take examinations. "That was the period when we had some of the best people in the country and a lot of opportunity to study," he says. The experience, he says, did not affect his studies. His father, however, was angry at him for what had happened. Rizvi says it was difficult for him to explain that what he had done in school was not for himself and that, as president of the student union, he had to look after the interests of the other students. Rizvi recounts that after his father thought his son had "recovered from this hiccup," he was "happy and satisfied."

While at DJ, Rizvi was greatly influenced by A. L. Shaikh, the school principal, and Mr. Baig, his teacher in zoology. As president of the student union, Rizvi had to deal frequently with Dr. Shaikh. "We never had any problems," he recalls. Dr. Shaikh was always sympathetic, understanding, and supportive. As for Mr. Baig, Rizvi will always remember his advice: "We must see what is coming and what is new. You may not know what is new, you may not understand it, but you must try to know what is new."

After three years at DJ, Rizvi moved on to Liaqat Medical College in Hyderabad, Pakistan. His admission to that college pleased both him and his parents, but for different reasons. For Rizvi, Hyderabad meant a change from his very hectic life in Karachi. For his parents, it meant that he would be away from his friends and political associates. Indeed, at Liaqat Medical College, where Rizvi studied anatomy and physiology, he applied himself more to his studies and came out at the top of his class. "My parents were very happy," he recalls. "They thought I was redeemed after that."

For Rizvi, however, studying hard and having a good time were not always mutually exclusive activities. At Liaqat, every student, in order to really learn anatomy, had to dissect a whole human body. However, since the college had more students than cadavers available for dissection, as many as four students were allotted the same part. Sometimes the part assigned to a group was not good. When Rizvi was faced with this problem, he found a way around it. As it happened, a new building was being constructed in the college, so the anatomy class was conducted in a makeshift building where 150 cadavers were kept in two huge air-conditioned sheds that were surrounded by barren hills. The setting scared people from going to these sheds at night; in any case, they were off limits after 5:00 p.m.

Rizvi recounts that, during the day, he and the members of his group would just loaf around. When night came, they would slip back into the area and, with a key borrowed from a keeper, open the door, enter, and have all the cadavers at their disposal. The keeper, whom they had befriended and whose palms they "just kept on greasing," was too scared to join them himself. This went on for quite some time.

"We learned a lot from this," Rizvi relates. "That's why I wanted to do surgery. With surgery I had to do anatomy. I had to know everything about anatomy. . . . We used to sit up all night and dissect and study." He and his group thought nothing of the devil, spirits, or stories that other people told-of a cadaver getting up while being dissected, of another cadaver slapping a girl while she was dissecting it, or of a skull dancing. The group would dissect a whole body and then close it up afterwards.

In the morning, there would be a hue and cry because the body was already dissected. Once, when asked about this, Rizvi replied, "They must be dissecting each other-I don't know." At another time, his fellow classmates opened an abdomen, took out the liver, and dissected it. Afterwards, one of them mistakenly placed the liver in the wrong cadaver. The next day, other students found two livers in the cadaver they were dissecting.

After studying at Liaqat for five years, Rizvi returned to Karachi to continue his medical studies at Dow Medical College, Pakistan's premier school of medicine. There he did his pharmacology, pathology, and general surgery. After he completed all of these subjects in 1961, he received his MBBS-Bachelor of Medicine and Bachelor of Surgery, landing among the top four in his class. This honor entitled him to choose his line of specialization and the unit that he wanted to work with.

Before he received his MBBS, however, Rizvi had written to his father to say that he was planning to return home to India after his MBBS and go into private practice. He thought his father could use some help back home. But his father replied, "There are hundreds and thousands of MBBSs. Another MBBS will not make any difference. So why not try to go to England for postgraduate studies? We can look after ourselves."

Rizvi knew his father meant this and decided to follow his suggestion. Moreover, he felt he had enough confidence in himself to do what his father wanted. He also had the backing of all his friends, whom he says never let him down. "My friends come from all denominations, all religions-Jewish, Christians, Hindus, Muslims."

Rizvi decided to pursue surgery at the Jinnah Postgraduate Medical Center, which he considered the best surgical unit at the time. There he began as a junior house surgeon. "Junior house surgeon" actually meant doing clerical work, collecting patients, and assisting anyone in a senior position. "You're a doctor because others will call you Doctor. The sisters (nurses) will call you by your name. But that's the formative year, and that's the time when every doctor is keen and willing to learn a lot from senior sisters, from senior doctors, from the technologists-they all teach you. You can't say no to anything. Everybody will boss you around. But there's learning." Later Rizvi advanced to senior house surgeon.

Thereafter he went to Dow Medical College as registrar in surgery, which meant that he did not merely assist in operations but actually performed them, although under a surgery supervisor. This lasted eight or nine months and prepared him for his fellowship in England. During this period, he and other doctors who were aiming for fellowships abroad did whatever surgery they could because, after a year, they were expected to be informed about virtually every aspect of general surgery.

Although they concentrated on general surgery-including abdominal, chest, trauma, and vascular surgery-Rizvi and his friends entered every operating theater they could, including neurosurgery, to see what was going on and, if possible, to assist. "We used to work around the clock in order not to miss any opportunity," Rizvi says. "We knew that once we went to England . . . we might not have access to other departments. And in the examination we were supposed to have a working knowledge of everything as a surgeon. That's why we used to work a little extra. Reading up on procedures and even witnessing them was one thing," Rizvi says. "But to be a part of the team when somebody was operating was an entirely different situation. In surgery, that's what matters."

Rizvi says he and the other young surgeons at Dow Medical College were very lucky because they had very good teachers and a very good team. "My bosses were all trained in England and they had a reputation for being people who were always updating their knowledge," he says. "They were never out of touch with current literature and surgical practices." They were also ex-Army men and, he says, "very brilliant people."

After making Rizvi and his fellow doctors work the whole day, the teachers at Dow would give each of them one or two articles to summarize by morning. This meant that, even after having to do work till late at night, he and his classmates would have to stay up the rest of the night, going through these articles and preparing summaries of them. By seven in the morning, they were supposed to be ready for duty-clean, properly shaved, and properly dressed. "I'm sure that was just part of our training," Rizvi says.

Of these teachers, Rizvi idolized two: Colonel Said Ahmad and Professor S. A. Hamid. Each of these doctors, he says, had an open mind, was an avid reader, liked to engage colleagues in discussion, and was open to being corrected. "This is something very rare," Rizvi says. Moreover, each was hardworking and made himself available when needed, even if that meant getting up in the middle of the night to consult with a fellow doctor or to rush to the hospital. And each one readily made himself available to patients. Rizvi remembers the friendly mentoring of these teachers but says that, where the welfare of patients was concerned, they were uncompromising. Colonel Said "will give you his chair and . . . a cup of coffee," he says. "But if anything goes wrong with a patient, he will be a different man. He will kill you."

Rizvi has tried to emulate the qualities of Dr. Said and Dr. Hamid. He always encourages colleagues and juniors to let him know if there is any way he can help them. "I always try to keep the telephone lines open," he adds. He says his teachers trained him so thoroughly that he "never thought that any job was too much for me."

In late 1962, Rizvi left Pakistan with a merit scholarship to the Royal College of Surgeons in London. When he got to London, however, an officer at the Pakistan Embassy told him that no slots were available for Pakistanis in London and that he should enroll instead at Sheffield. But Rizvi happened to know that Pakistan's quota provided vacancies for eight Pakistani doctors and that one of these vacancies was at the Royal College. He proceeded to enroll on his own, bypassing the embassy placement officer. The aggrieved officer retaliated by writing to the British government to say that Rizvi had violated procedures and should lose his scholarship. Rizvi did, in fact, lose his scholarship.

But this was a blessing in disguise. It freed Rizvi to look for a job. He got one at Salford Royal Hospital in Manchester, where Dr. D. S. Poole-Wilson, a famous urologist, introduced him to his specialty and became his mentor.

Rizvi remembers well his interview with Dr. Poole-Wilson. "What have you come here for?" Dr. Poole-Wilson asked. "I have come to do my fellowship in surgery." "What will you do after that?" asked the doctor. "I will go back." "Why do you want to go back?" asked the doctor. "Sir, I am needed there." "Are you sure you will go back?" "Yes." "But suppose there are a lot of opportunities here," said the doctor. "There will be other people to fill the vacancies here," replied Rizvi. At this, says Rizvi, Dr. Poole-Wilson "developed a liking for me." In those days, most Pakistani doctors who went to England stayed on in England, so his reply "was something."

Rizvi found Poole-Wilson to be "a real human being, a thorough gentleman, and a superb surgeon." He was also tireless and very strict. "I liked that bit of him," Rizvi says. "It was [with him] that I learned what medical work is."

Both men worked tirelessly for six months, so much so that Rizvi had no time to get a haircut. One day, Dr. Poole-Wilson said, "Right, let's bring a pair of scissors. You clip my hair and I will clip yours." Poole-Wilson was well known for not remembering the names of the many doctors who worked for him. He would refer to doctors as "that little man," etc. But with Rizvi, things were different: "He remembered my name and that was a great honor for me."

Later, when Poole-Wilson found out what had happened to Rizvi's scholarship, he helped him go for his primary training in England-a six-month course on the basic subjects (anatomy, physiology and pharmacology)-and thereafter, his general surgical training. He also told Rizvi that if he wanted to move from one teaching hospital to another anywhere in England, he would vouch for him.

Although Rizvi had covered all of the basic subjects for his MBBS in Pakistan, he had to go through all of them again for his "primary" in England. This time, however, it was "with an elevated standard." Back home he had learned these subjects more-or-less by rote, he says. "There was no applied physiology and anatomy."

After completing the introductory course at Salford, Rizvi went to Crumpsall Hospital, also in Manchester, for part one of his restored fellowship. In this teaching hospital, he was the senior house surgeon in urology. Thereafter he practiced emergency medicine at Ancoats Hospital for a year, and then rotated for cancer surgery and plastic surgery at Christie Hospital, also in Manchester. From there he went to Hope Hospital, a postgraduate facility of Salford University, to train in general surgery and urology. While he was still in training at Hope, he was hired as resident surgical officer there, a post normally reserved for doctors who had completed their fellowships. This occurred on the recommendation of Dr. Poole-Wilson, who telephoned the hospital chief personally on Rizvi's behalf. Being chosen ahead of other applicants who had already completed their fellowships put great pressure on Rizvi to excel in everything he did.

As resident surgical officer at Hope Hospital, Rizvi had to be on call at all times. He had to be prepared "for anything and everything," he says, from routine surgery to emergency surgery. He will always remember that, during his three years at Hope, there was not a single Christmas when he was not on duty and not operating. In 1967, Rizvi took the examinations for his fellowship.

In 1969, while still at Hope Hospital, Rizvi returned home to Pakistan to marry Hajira Iqbal Shahmalak, a former schoolmate from Liaqat Medical College in Hyderabad. They had been committed to each other ever since their college days but had come to an understanding that they would marry only when Rizvi had completed his fellowship. After completing her MBBS at Liaqat, Hajira had returned home to practice medicine. She and Rizvi kept in touch through letters.

After their wedding, Rizvi returned to England alone to answer a job offer as a senior registrar. Taking the job implied staying in England more or less permanently. But what Rizvi really wanted to do was to return to Pakistan and test his mettle there. He thought it would be unfair to accept the offer because, if he did so, he would be blocking someone else's opportunity. So he told his bosses at Hope, who had been most kind to him and who were keen to keep him, that he had decided to just carry on as resident surgical officer.

In 1971, Rizvi finally cut his ties to England and returned to Karachi. He had the choice of doing general surgery at Jinnah Hospital or urology at Dow Medical College. He chose general surgery at Jinnah because he saw that there were no instruments and facilities for urology at Dow. In his ninth month at Jinnah, however, he was pressured to transfer to Dow or get blacklisted from government service. His old teachers told him not to be stupid and to go ahead and shift to the medical college. So he did, becoming assistant professor at Dow Medical College and, at the same time, practicing surgery at Civil Hospital, the school's teaching hospital.

At Dow and Civil Hospital, Rizvi taught and trained medical students and operated on patients. And, though he was only an assistant professor, he was also made to run the hospital's urology ward because there was no professor above him in that department. Dow permitted him to engage in a potentially more lucrative private practice after 2:00 p.m., but during his initial years there he chose not to do so. He disliked it when doctors in the public hospital told their patients, "I can't do justice to your problem here. You had better come in as a private patient." So, for five years Rizvi went without a car, taking only a public bus to and from work. By this time, he and Hajira had a child and, as Rizvi himself puts it, they "lived hand-to-mouth." But they were happy.

When Rizvi set up the urology ward, all that was given to him was a small, eight-bed room in Civil Hospital's burns ward. He had seen this ward before, when he was only an intern and, later, as a junior house surgeon. It was fully air-conditioned then and well-organized. When he saw it again after his return from England, it had deteriorated. He tried to make the best of the situation, urging friends to buy new bedsheets and to give him their old ones for the ward. At other times, he says, to get what he needed, he had "to beg, borrow, or steal"!

For example, he made a trip to England. "I had some money there," he explains, "and I had a car." He also had good contacts in several hospitals. Rizvi was aware that quite a lot of used medical equipment was available for sale in England. He pawned his car and mobilized his friends in the medical community to buy all the useful equipment they could find. Then, he says, "I collected all of that and I shipped a container full of things from England. I just filled up my ward with all of those things."

Rizvi says that he had to do this to convince his colleagues that there were better and more modern methods of managing urological cases: "We were very much used to cutting for every operation. Endo-urology or other [less invasive] specializations had not seen the light of day. My problem was, when I said that a problem could be solved without cutting, they didn't believe me . . . especially the senior teachers. So I had to show them." To do this, and to instruct younger doctors, he needed the proper instruments.

When Rizvi formed his team in the urology ward, he broke at least four conventions. First, he did not sit alone in a room, separate from the junior doctors; he sat among them. Second, he did not see only cases selected for him by junior doctors; he saw every case. Third, he did not limit the number of cases he and his team handled to those that could be accommodated in one or two hours of consultation; he attended to every case. ("I didn't have the necessary experience and wanted to learn," he reasoned. "I wanted to see how many patients were coming in." This brought him closer to the patients and enabled him get a better idea of their problems. "If I had a patient and I had no bed," he says, "I had to look for the bed.") Fourth, Rizvi broke the rule that senior doctors should not fraternize with junior doctors. When a certain senior doctor told him that senior doctors should never let junior doctors sit with them, Rizvi said, "I'm sorry, but I cannot have tea without my doctors." After this exchange, he and Rizvi did not have tea together again for fifteen years.

These practices had two benefits: first, they enabled Rizvi to know his team well and become close to them; and second, they allowed Rizvi to know his patients well-or at least as well as his junior doctors did.

To improve the training of doctors and nurses at Civil Hospital and at Dow Medical College and to educate the hospital's administrators by making more demands on them, Rizvi initiated the subspecialty of urology. He began by setting up a stricture clinic for people with difficulty in urinating. This condition, which results from the narrowing of the urinary passage due to trauma or venereal disease, is relieved through dilation. Conventional wisdom had it that 90 percent of stricture cases were traceable to venereal disease, or VD. As a result, stricture patients were regarded as morally reprehensible; they were treated last and hurriedly by the most junior doctor around. "That was awful," Rizvi says. He had his staff in the stricture clinic do research on exactly how many of the cases were caused by VD. To their surprise, they found that 90 percent of all cases were caused by trauma or some other infection, not by VD.

Stricture cases often required x-rays and medicines. When the hospital administration told Rizvi that neither x-ray machines nor the medicines were available, he had two choices: to leave Civil Hospital or to do something. He chose the latter and found a secondhand, portable x-ray machine for his ward. Rizvi also questioned the high cost of acquiring instruments, suggesting that this was taking place due to "other considerations." When his inquiry into the purchasing of instruments and its findings became known, he and his team won the support of the public for being aboveboard and conscientious.

Rizvi also insisted that end users have a say in the purchase of instruments. Once, while he was in England, the hospital administration bought a kidney machine for his ward; the machine was in Singapore and half of it arrived in Karachi but the other half did not. Naturally the machine did not work, so Rizvi suffered "great frustration." Fortunately, at about the time that this happened, he and his team operated on a well-known businessman. This businessman later had another operation, which Rizvi performed alone in a private hospital. The businessman wanted to pay Rizvi but Rizvi told him to give his team a kidney machine instead. Grateful, the businessman obliged. After that, Rizvi showed representatives of the government the machine that he was able to purchase and told them he needed more. They gave him one and, this time, the machine worked. As a result, the number of patients in the ward grew, and his nurses, doctors, and technicians began training. After a time, he had about twenty machines running in his unit.

Then something happened that changed the way Rizvi managed dialysis cases. One of his brothers, who was in the police force in India, developed kidney stones and, subsequently, suffered renal failure. Rizvi took a two-month leave to keep this brother company as he underwent dialysis in New Delhi. Rizvi says of that leave, "I learned more there, sitting by the side of my brother, than [when] . . . I was dialyzing my patients." Rizvi would ask him what was happening, he says, and he came to understand it "as if it was happening to me." For example, Rizvi's brother told him, "I get the shivers sometimes." The shivering was awful. "You can't hold yourself still; your body keeps on shaking." Taking careful notes about everything he learned, Rizvi noted the connection between "shivering, fever, nausea, and vomiting."

He also learned about depression. Whenever his brother had fever and was wrecked with pain and nausea he would say, "Life is not worth living. I feel like taking out my [gun] and shooting myself." Rizvi says he sometimes used to ask himself (about a patient undergoing dialysis): "I have done the maximum. Why is this patient complaining?" Now he knew better. Sadly, before his brother could have a kidney transplant, he developed liver disease and died.

The episode strengthened Rizvi's determination. He saw the financial burden that his brother and his brother's family had had to bear. And he saw how the whole family became involved and gave its support. Rizvi asked himself, what if the same thing had happened to someone who did not have a family? After he returned to Karachi, he began to spend months and months sitting with his patients. "I used to get mad if any patient was running a temperature," he recalls. "Why should he run a temperature?" He would imagine it was his own brother lying in bed. This traumatic experience helped him sensitize his colleagues. "I told them this is what happens. I know because this came from my own brother. When he was dying, he used to tell me these things."

Rizvi says this "created some sort of understanding" between him and his fellow doctors and technicians and nurses. After discussing why patients experienced shivering, for example, his unit instituted many improvements in patient care and medication. Even the water supply is now ten times better. "Now, you will rarely see anybody in my unit who shivers," Rizvi says. "If any patient shivers, members of the staff are very attentive."

People began to notice that doctors and staff members in Rizvi's unit would sit and look after a single patient through the whole day and night. "It was from this that we got support," Rizvi notes. "It was not only monetary support; it was more moral support. That helped us." Rizvi's doctors go to such lengths because they have come to believe, as Rizvi does, in "reading" a patient. This means discussing the patient's problem with the patient at length: "You must discuss him as a whole-his whole background, his socioeconomic status, his liabilities." Rizvi explains, "Unless you find out these things from a patient, I don't think any doctor can do justice to his or her treatment. And, in so doing, you get involved."

"We are taught not to get involved with patients," Rizvi says, "but we get involved with patients. For example, somebody has come and he needs to be dialyzed. You know the person hasn't got money and his relations are not conversant with what dialysis is. They are skeptical. You cannot say, 'Well, let them discuss it and make the decision themselves.' That's not fair. They don't know what to do. So, you have to sit with them and talk to them and, by doing so, get involved. You come to know more and more about the patient. As a doctor, I cannot leave patients to make their own arrangements for medical treatment that is beyond their means. Either we should leave the profession or we should become their advocates."

After two years at Dow, Rizvi did establish a "very select" private practice. He explains what this means: "Any patient who comes to Civil Hospital may not come to my private practice. And any patient who comes to my private practice may not go to the hospital, unless he wants to. [If he does want to go to Civil Hospital], my secretary will refund the money he spent on private treatment." Rizvi's private practice is largely limited to consultations. He never does renal transplants or dialysis and rarely performs lithotripsies privately. Instead, he does all of these procedures at the public Civil Hospital.

Again, he explains that public institutions have been so degraded and so demeaned in Pakistan that, these days, it gives him pleasure to see people knit their eyebrows when he asks them, "Could you come to Civil Hospital?" They reply, "Oh, Civil Hospital," as if to say, "that godforsaken place. . . ." Rizvi once thought the same thing when he was a student and he heard his teachers say, "Such and such a person needs an operation but the instruments are not available at Civil Hospital." Now he gets immense pleasure when wealthy businessmen ask, "Well, can't you do it privately?" and Rizvi replies, "Oh, no, I'm sorry," explaining that the best medical team as well as the best instruments and facilities are available only at the public hospital. When the patient goes there, everything is provided free. "But although it is free, there is so much moral pressure on [well-off beneficiaries] that they voluntarily pay more than I would charge them," Rizvi says.

For several years, Rizvi and his colleagues delayed performing kidney transplants at Civil Hospital. For one thing, there were no facilities for tissue typing. For another, people were skeptical, fearing that patients who had the procedure would die. But in 1985 a teacher named Rashid became the institute's first transplant patient. Rashid received his new kidney from a brother. This matching was done at Royal Free Hospital, London. Rizvi says he and his team were "so possessive" of Rashid that, for three months after the transplant, his food was cooked by Rizvi's wife herself; they would not trust food prepared by anyone else. Rizvi feared that if the transplant failed, it would mean a great setback not only for his department but, given popular beliefs, also for the idea of transplantation itself. Rashid's transplant succeeded and Rizvi and his team began doing the procedure regularly.

After Rashid, the team carried out transplants on ninety other patients, with funding provided by Pakistan's Bank of Credit and Commerce International (BCCI) Foundation. BCCI donated about 2.5 million rupees for every transplant patient that it supported. This was the same amount that it had previously spent for each patient sent to England for a transplant. Dr. Rizvi and his team did the BCCI-funded transplants for free and used the BCCI money only for medications. With the savings, they bought instruments for tissue typing and equipped the urology ward with a state-of-the-art laboratory.

Five years after joining Dow Medical College, Rizvi was offered a full professorship there but he turned it down. He cared less for the promotion and title and more for the needs of patients that were not being met at Civil Hospital. This decision annoyed the health minister at the time. "You are insulting the government by turning down this offer," he told Rizvi. To which Rizvi replied, "Becoming professor is not going to add anything to me or my patients. My patients don't need a board on my door showing that I am a professor. Patients need beds; they need diagnostic facilities; they need medicine; they need operating rooms; they need instruments. So why become a professor?" The two later became great friends.

Although Rizvi had the support of the government for what he was doing, he could not depend on it for funds. He had to look for these elsewhere. Indeed, from the time he set up the urology ward, most of the support that he received and continues to receive has been from private donors.

In 1986, upon the advice of lawyers and helpful officials, Rizvi organized a society for the welfare of patients through which such donations could be channeled. Known as the Society for the Welfare of Patients of Urology and Transplantation, Civil Hospital, it is made up of representatives of the academe, the press, the chamber of commerce, doctors, social workers, lawyers and the beneficiaries of the work that Dr. Rizvi and his team do. The Society raises funds for equipment and dialysis costs, lithotripsy, transplant operations and post-transplantation care and drugs.

By 1991, the urology ward had become a department and had been declared a Center of Excellence. That same year, it was also granted the status of an autonomous institute-the Sindh Institute of Urology and Transplantation, or SIUT-by an Act of the Sindh government.

Rizvi maintains, however, that the urology ward was already independent even before such autonomy was granted. He admits that this comes from what he describes as "a rebellious attitude." He explains, "We were becoming, to some extent, an embarrassment for government officials. Why is this ward different from the other wards? They had no explanation. We had already made everything independent: we had our own electricity, we had our own lift, we had our own cleaners, everything." The unit even had its own water supply and water treatment plant.

In the years that have followed, the pressure for the institute to raise funds has been great because its patients have grown in number astronomically, word having gotten around that it provides its services for free. The government can cover only 30 percent of SIUT's expenses. And though the rich who avail of the institute's services do donate, they do so voluntarily because they feel a moral obligation to support SIUT.

Rizvi's staff say the institute needs from US$19 million to US$20 million for an endowment, but it has only US$6 million so far-"very little money," according to Rizvi. At the moment, he says, the whole philosophy of the institute is that people should feel responsible for the less privileged-"whether less privileged in health, in finances, in understanding, in vision. . . . That's what Christ said: more profit, more mercy."

Rizvi says that before he and his team do a kidney transplant, they talk to the patient about "ten times." Afterwards, they monitor the results carefully because a person can have only one kidney transplant in his or her lifetime. For two weeks after patients are released, SIUT monitors conditions in their homes and provides advice about boiling water properly and keeping the surroundings clean. Patients are also given the doctors' telephone numbers to call at any time if needed. To enable patients to live a healthy life, SIUT also provides doctors for follow-up visits, laboratories for tests, and any drug they need-free. If patients do not come for a follow-up, the doctors and a social worker go to them and administer the medications. To be able to trace patients, SIUT needs a good record and contacting system. Since most patients are extremely poor and live in small, far-flung villages, Rizvi's team must also record the phone numbers of the village chief, a doctor in the area, and the police station.

Kidney transplantation in Pakistan faces many problems. For one, there is no system in the country for organ donations from cadavers, which is common elsewhere in the world; only intra-family donations are allowed. This means a patient has to depend on a relative who is willing to donate a kidney and whose tissue type matches his or her own. This is not easy. Not every patient can find a donor. And even if a patient can find one, the tissues do not always match. Moreover, sometimes it is medically inappropriate for the patient to be transplanted with an organ from a live donor.

Rizvi says more than twenty-five thousand people die in Pakistan every year from organ failure because no organs are available for transplantation. These include ten thousand who die from kidney failure, eight thousand from liver failure, and six thousand from heart failure.

Organ donations are potentially possible but the Pakistani government must first enact a law that defines brain death. SIUT is lobbying for the Organ Donation and Transplantation Bill, which states that the organs of a person who is declared to be brain-dead can be legally removed. Ulema (Muslim religious teachers) already accept the validity of cadaveric donation under Shariah law. Even if this bill is passed, however, people must be educated and motivated to bequeath their organs after death.

In 1995, Rizvi forged ahead and performed Pakistan's first cadaveric renal transplant using a kidney donated by the Eurotransplant Foundation, the largest center for coordinating transplant activities in Europe. The kidney was successfully transplanted into a young female patient.

Rizvi and his team now do three transplantation cases a week. Their success rate is good: about 94 percent of their patients survive for more than a year. A majority of their cases are persons under thirty, because the team gives priority to those who still have a full life ahead of them. By 1997, SIUT had completed five hundred successful renal transplants. To celebrate this achievement, it organized a unique event. This consisted of various track and field games where all the athletes, numbering over a hundred men and women, were either recipients of kidney transplants or kidney donors. Known as the First Transplant Games, the event included distance races, relays, javelin throwing, and shot put contests. The games are remembered for the emotional bond and affection that recipients and donors alike showed SIUT.

At SIUT, Rizvi and his team fought for the right to decide who they would hire as doctors, nurses, and technicians in the unit-and how much these people should be paid. SIUT's pay scale is far better than the bureaucracy's but slightly lower than the private sector's. Employees have security of tenure. Rizvi asserts: "If you pay peanuts, you will get monkeys."

Rizvi says that, whether rightly or wrongly, he and his team make SIUT staff feel they are different from the rest of the hospital staff. When his staff members are teased by others, "Oh, you are working like a slave twenty-four hours a day." They answer, "Well, we are different from you." Institute staff are free to bring up their problems. "Even the cleaner . . . can come and catch ahold of me," Rizvi says. This ensures that everyone performs their job with peace of mind. "Whether it is their health, their job, or their children's problems, we're used to looking after them." A common canteen encourages fellowship between doctors and staff.

The doctors working with Rizvi have been sent for training to the Institute of Urology in London, which reserves three or four slots for them each year. All who went there have returned home. And, except for Rizvi, none of them has a private practice; all work full-time and are "very devoted," he says. They all have a cordial and easy relationship with him.

Rizvi himself returns to England every year for six weeks or so to take refresher courses. He explains that such courses are necessary because "things change so rapidly"; one has to stay in touch. He adds: "Because I was fully registered (in England) and had worked there, I always made it a point to go." He wants his doctors to do the same, on condition that they rotate.

Staff, particularly technicians and technologists, are also sent for further education and training to England, France, or Germany. Although attracted by the higher pay in these countries, 99 percent of them return to the institute. The SIUT board is ever on the lookout for training opportunities for its staff and new machines to upgrade the institute's services.

By 1992, the institute had grown tremendously. Not only did it have a large board of directors, it also had a lot of space because Rizvi expanded his unit wherever there was extra room in the hospital. Wherever they expanded-whether on the rooftop, a vacant room, or an adjacent building-Rizvi and his staff made something out of it. For example, he set up an area exclusively for dialysis; here, twenty-five dialysis machines run round the clock, following the unit's motto of "No to nobody," unless, Rizvi adds, there is "a definite indication."

Rizvi also established what he himself describes as a huge outpatient department. Whereas other units in the hospital closed their outpatient services by 12:00 noon or 12:30 p.m., Rizvi's stayed open until 5:00 or 6:00 p.m. This did not sit well with other units. "They wanted us to be separate from them," Rizvi says, "because we were a bad example." Rizvi was happy to comply. "So we had an outpatient department that was independent; we had a whole lab that was independent; we had our own x-ray machines and ultrasounds. Then we had a dialysis unit and a transplant unit. But most importantly, we had an operation theater that ran twenty-four hours a day."

Because of this, some people resented Rizvi. Others "hated me," he says. But Rizvi points out that he does not take any perks for himself. He has no office, does not have anyone in particular to look after him, and he pays for all his meetings out of what he earns from his private practice. "We don't take a penny from multinational pharmaceuticals for our international meetings abroad," he says. The reason for this long-standing policy is that, if they did, "We cannot bargain with them. When they put you in a very posh hotel and drown you in champagne, you cannot argue with them when you are negotiating."

The institute has many admirers. These include members of the younger generation from Pakistan's national colleges, from England, the Middle East, and Bangladesh, whom the institute welcomes for exposure or training. SIUT offers a degree program for doctors who want to specialize in urology. Doctors who join the program are expected to finish it in five years. Within that period, they do their academic work, participate in on-the-job training, and write a thesis on a subject related to the specialty. Apart from local specialists, the training staff includes doctors from Sweden, the United Kingdom, the United States, India, and the United Arab Emirates who come for three days to lecture.

SIUT also has the support of the Karachi community and the press. "We have always had a very strong press that guided us, guarded us, and supported us," Rizvi says. "We were always an open unit. People could come and look over our accounts, criticize us, and guide us. There was two-way communication and that helped a lot."

Some critics said that Rizvi was not discriminating enough about his donors and patients. He replies that he can defend what he is doing in any court of law-or in a court of divinity. To his critics' annoyance, he once said, "Let there be a panel comprising David, Jesus Christ, and Mohammad, all of them, and I will plead my case." Rizvi says he deliberately gave this statement "a touch of internationalism, of humanity" to make clear the ecumenical nature of SIUT's team. "I've got Christians, I've got Parsis, I've got Hindus, I've got Muslims. They are free in the way they want to practice [their religion]."

The institute also receives contributions from zakat, the Muslim charity fund that is collected by the government and then distributed by a special government agency. But some people prefer to give zakat directly to SIUT because they have reservations about the way the government dispenses it. This, according to Rizvi, is "a great source of funds for the Institute."

In fact, the institute urges people through an advertising campaign to dedicate part of their zakat to SIUT. In the beginning, the government frowned upon this because it felt the institute was running a parallel government. The ensuing controversy drew quite a bit of attention and criticism. Some people took it upon themselves to investigate how the institute was using its zakat. "That was a great blessing in disguise because, when they came, they were convinced," Rizvi says. All that the donors wanted was an assurance that their contributions were not being misused. The institute keeps a separate account for the zakat that it receives. Rizvi says he has nothing to do with expenditure; that is the job of a committee.

The institute's single biggest donor so far is Dewan Mohammad Umer Farooq, an industrialist who was a friend and a patient of Rizvi's. How he came to be the largest benefactor of SIUT is a story in itself. When Rizvi treated Dewan, Dewan wanted to pay Rizvi but Rizvi refused to take anything. Then Dewan asked if he could do something, so Rizvi said the institute could use an operation theater where he and his team could start transplantation work. One evening, over a cup of tea, Dewan promised Rizvi that he would build such a theater at a cost of 2.5 million rupees. Work on the project would start the very next day, he said.

The following morning, Dewan told Rizvi that he had changed his mind. This shocked Rizvi because Dewan's family was known for keeping its word. Rizvi later found out that some doctors had advised Dewan not to build the theater because, they said, it would be a waste of money as transplants would never succeed in Pakistan. "Why should I lie to Dewan?" Rizvi asked. When Dewan asked if he could do anything else, Rizvi answered no. "And that's where we parted," Rizvi recounts.

Then another industrialist came to see Rizvi. The man's mother was operated on in a hospital in England but unfortunately developed a fistula; her urine was leaking from her abdomen. She refused further treatment in England, so she was brought to Pakistan. Her son asked Rizvi to operate on her in a posh private hospital in Karachi. Rizvi said no, this was something he could not do in a private hospital; the man's mother would have to come to Civil Hospital. The man did not take him seriously; he got his mother admitted to the posh hospital and had the hospital tell Rizvi that she had been admitted. When Rizvi still refused to treat her there, her son said, "You can charge as much as you want." "That's not the question," Rizvi replied. "I cannot operate on her there because she will be better off with minimally invasive surgery." The man finally agreed and brought his mother to the urology ward at Civil Hospital. There he asked if his mother could bring her own bed. Rizvi refused again. He and his team performed the procedure and the mother recovered. When the son asked what he could do in return, Rizvi spoke of the operation theater. The man built it for him.

Soon after the theater went up, Rizvi met Dewan again. Dewan had once again taken ill and had come to see Rizvi at home. Dewan's doctors wanted to operate on him for something, but Rizvi told them Dewan did not need the operation; he would be all right. Dewan did recover and one of his younger brothers quietly told Rizvi that his family was very sorry that Dewan had not been fair with him, that they were ashamed of themselves and that they wanted to make it up to Rizvi. "Forget it," he answered, "we all make mistakes." But since Dewan's brother insisted, he said, "Right. Visit the ward and then we'll discuss it."

Unfortunately, this brother died within a week of his discussion with Rizvi. But yet another of the brothers came forward and said, "Why don't you ask for something?" By this time, the ward needed its own lithotripter. At the time, Pakistan only had one such instrument, at the Aga Khan Hospital, where each patient paid about 50,000 rupees for its use. "A poor patient couldn't afford the treatment," Rizvi says. "And because we had a huge clinic, every patient used to come and ask, 'Why don't you get a lithotripter for us?'"

This was in 1988 when the cost of the instrument was 30 million rupees. The government had promised to give 10 million rupees but withdrew its offer when it heard that Rizvi's ward would accept it. Since that much money could not be raised from the public quickly, Rizvi asked Dewan's brother, "Can you contribute something for our lithotripter?" He immediately said, "Right, 8 million rupees." After getting another contribution of 6 million rupees from BCCI, and after some bargaining with the German supplier, the ward got the machine. It was named after Dewan's brother. Thereafter, relations between Rizvi and Dewan became even closer.

Then another friend, this time a high official in the government, asked Rizvi if he wanted anything else. Rizvi answered that he could use a big plot of land for a new building. He got 1.5 acres of government land, just a stone's throw away from Civil Hospital.

When the institute's society met to discuss raising funds for its building, among those who came was Dewan, who was a member of the society. One night, at around 10:00 p.m., while Rizvi and Prof. S. Ali Anwar Naqvi, Rizvi's deputy at the institute, were in their car, they received a call from Dewan. He told them, "I have been considering this new project. I think I would like to finance this alone in the name of my father. My father gave me everything I have." But Dewan set one condition: "You must pick up this memorandum of understanding tomorrow morning, first thing, because I'm signing this paper now."

"Why," Rizvi asked jokingly, "are you leaving the country? Have you taken another wife?" Dewan laughed, then answered, "No, no, not at all. You see, I've made this contract between myself and my God. And any contract I make between myself and my God, I want finalized as soon as possible. So please get this piece of paper from my office or send somebody because I won't be here. I'm going to Islamabad."

Because Rizvi was going to do a transplant the next day, he requested Prof. Anwar Naqvi to pick up the paper from Dewan and take it to the ward. At 3:00 p.m. that day, they received the news that Dewan Farooq had died in Islamabad. The paper that Prof. Anwar Naqvi picked up was the last he had signed.

Dewan's sons honored their father's commitment. But because of inflation, the cost of the building and facilities went up to 250 million rupees-nearly twice the original estimate. These facilities included a new lithotripter, a gamma camera, the only electron microscope in Pakistan, a CT scanner, a magnetic resonance imaging machine, and a helipad. Why a helipad? Rizvi and Prof. Anwar Naqvi decided that their building should have one because in twenty-five or thirty years Karachi will be so crowded that a patient will probably die before he or she can reach the institute by road.

Aware that the institute could not meet the needs of the entire country, Rizvi and his team developed their specialty in their own province of Sindh by encouraging the establishment of satellite centers. Six such centers patterned after the institute have been set up. The institute directly supervises three, all of them based in medical schools in the interior of Sindh-in Larkana, Nawabshah, and Hyderabad. With support from the local communities, these centers can do lithotripsies and dialysis but not transplants. The institute trains the staff from these centers, guides them in buying new and secondhand equipment, provides backup services if their machines break down, and looks after patients referred to it by the centers. In turn, the centers help the institute by following up on its patients. SIUT helps these centers by educating the public on the prevention of disease through its sixteen radio programs. On this score, much has yet to be done. Many people do not know that kidney failure can be cured following a successful transplant; instead, they still believe that people with renal failure are doomed to die. And, in remote villages, it is believed that people who stop urinating are cursed or have angered God.

Other regions or provinces in the country-Baluchistan, Punjab, and the Northwest Frontier-have also sought the help of the institute in choosing and buying machines. Rizvi says, "They will ring us up to ask which machines to buy and how much we would pay because we are known to be very hard taskmasters and good bargainers."

One prime minister was so impressed with the institute that he decided to open twelve such centers in the country. The trouble was, he thought the buildings themselves were all that mattered. Dr. Rizvi says he and his team are most careful that, one, they do not concentrate on buildings but on the training of specialists and, two, that they should stay away from, or remain above, politics. For them, their patients are paramount. This is why, even when there are strikes all over the country, the institute is never closed. People do not mind because they know that the doctors and staff there are working; that patients who go there will be looked after.

Apart from his team as a whole, Rizvi considers Prof. Anwar Naqvi as the most important person at the institute, describing him as "a great planner." The two first met when they both volunteered their services during the big flood in Sindh in 1973. Together for a month in the jungle, they operated a twenty-bed camp hospital at a place called Chuhar Jamali. Conditions were awful: snakes were rampant; malaria and infection were rife. But the army was with them and it had a big generator and rescue equipment. There were also malaria eradication and infection control workers. Rizvi and Naqvi got everyone under one roof and organized them to work together-spraying the jungle with pesticides to get rid of the snakes, setting up a laboratory, and building the camp. All this gave Rizvi a taste of teamwork, which, he said, "laid the foundation for a lot of things we are doing now." The experience also made him see the misery as well as the goodness of the poor and to discern "what was real and what was a façade." Ministers and officials, for example, came to the site but stayed only long enough to have their pictures taken. Rizvi refused to join them. Greatly annoyed, they asked, "What the hell are you doing?" "I'm doing a real job," he replied.

By the time Rizvi and Naqvi were ready to leave Chuhar Jamali, they had accumulated enough beds, equipment, and instruments to establish a local hospital. They convinced the local government to provide a place for such a hospital and today, run by a government doctor, the hospital is still operating.

Rizvi is confident that, when he retires, Anwar Naqvi and the team will be able to carry on because they have worked together for a long time and because they respect one another. They are also constantly cultivating new people who are carefully chosen by Rizvi.

What drives Rizvi? Is it religion? He himself says that he is not a religious person and that he rarely prays. He is a teetotaler but he would not consider himself a moralist. He eats only halal food but this, for him, is "a little thing-it is not going to harm anybody and there is no problem with the family." He prefers to be described as a humanitarian because he believes that religion, in the end, is all about humanitarianism.

"To be a member of any religion, one has to be a human being first. I was born into a Muslim family and I'm proud of my heritage. But at the same time I would be proud if I were practicing the basic norms of humanity which are part of any religion. I don't think I should discriminate from man to man because of his color, cause, or religious belief." If one discriminates, he says, one is not carrying out one's obligation as a Muslim, a Hindu, a Jew, or a Christian.

In fact, Rizvi carries a bigger obligation. He is a Syed, meaning he is a member of a clan that claims to descend from the Prophet Muhammad. Rizvi says this is very special: "We are supposed to do everything right," he says. "I wish we could do that."

In the case of Dr. Rizvi, the grateful people of Sindh are the best judge of that.

Vicente G. Tirol

REFERENCES

"A Message of Hope for Those with Renal Failure." SIUT Newsletter, January 1998, p. 5.

"A Message of Hope to Seven Million People across the Nation." Dawn, February 2, 1996, p. 2.

Editorial, "Hope for Renal Patients." Dawn, January 4, 1992.

Editorial, "Institute of Urology." Dawn, n.d.

"Game Plan." Review, May 22-28, 1997.

"Governor Stresses Benefits of Medical Research for Poor." Dawn, March 9, 1995.

Mustafa, Zubeida. "A Gift of Life." Review, May 22-28, 1997.

Prof. S. Adibul Hasan Rizvi and the Sindh Institute of Urology and Transplantation. Information brochure, n.d.

Sindh Institute of Urology and Transplantation. Information brochure, n.d.

"Succor for the Critically Ill." Review, May 22-26, 1997.

Syed Adibul Hasan Rizvi. Interview by James R. Rush. Tape Recording. Ramon Magsaysay Award Foundation, Manila, September 2, 1998.

______. "Providing Quality Medical Care for the Poor: Can It Be Done?" Paper presented at the Awardee's Forum, Ramon Magsaysay Award Foundation, Manila, September 1, 1998.

Various interviews and correspondence with individual familiar with Syed Adibul Hasan Rizvi and his work; other primary documents.