The News on Sunday (TNS): How many people in Pakistan were affected by the Covid-19 pandemic?

Dr Sulaiman Shahabuddin (SS): I think it’s safe to say that every Pakistani was affected in one way or another; the healthcare system was overwhelmed, students could not attend school, the economy suffered and many people lost their livelihoods.

Of course, the poorest and the most vulnerable parts of the population were disproportionately affected: those with limited resources and savings; those lacking access to clean water, sanitation, or health care (including access to vaccines when they were available); women and girls; the elderly.

TNS: How many people in Pakistan are condemned to live below the poverty line after the pandemic?

SS: The World Bank estimates that globally some 120 million people fell below the poverty line due to the pandemic, with low and lower-middle income countries—like Pakistan—being especially vulnerable. But without trivialising the challenge, let me say that we should not consider people to be permanently “condemned” to live in poverty. We need to look for innovative solutions and new approaches to address the various causes of poverty. No one institution or sector can do this alone: it will take concerted efforts by the government, the private sector and the civil society working together.

I certainly believe that there is a role here for the AKU. With regard to health, we have been working successfully for many years, in partnership with the governments, to improve maternal and child health in rural areas and low-income communities. With regard to education, we have been especially active in working to improve the quality of education in public and private schools across the provinces of Pakistan, especially in most marginalised areas of Gilgit-Baltistan, Khyber Pakhtunkhwa, Balochistan and Sindh. Last year, we provided more than Rs 4,332 million for patient welfare in Pakistan to make AKU health care accessible to patients. We also provide significant financial assistance to help students access an AKU education.

TNS: How did the Aga Khan University cope with the sudden outbreak of Covid-19 in the country? What was the first line of response?

SS: The arrival of Covid-19 was an extraordinary challenge, probably the biggest in AKU’s history. I’m very, very proud of the way our staff responded – they were the “first line” and their work was heroic. AKU’s response took several forms. There was the direct care we provided: treating thousands of the seriously ill, testing hundreds of thousands for the virus and then administering over 100,000 vaccine doses to date. There was the support we provided to the government: advising officials, training thousands of health professionals in caring for Covid-19 patients, and setting up a Tele-ICU hotline where doctors from other hospitals could consult our experts. Then there was the Covid-19 research we conducted to assess vaccine safety and other issues. Our examination board also supported policymakers in developing an evidence-based policy for promoting students after exams were cancelled across the country. Finally, there was the huge effort that went into making sure our own students at AKU were able to continue learning. In short, I think we have made a very wide-ranging contribution to the fight against the pandemic.

TNS: What are the focus areas that need attention for improving public health in Pakistan? How can we reduce the gap between health education and healthcare needs in the country?

Infectious diseases, childhood illnesses and reproductive health remain major challenges. In addition, roughly half of Pakistan’s burden of disease is non-communicable diseases. Nor can we overlook injuries and mental health.

SS: This is a huge and complex question. Infectious diseases, childhood illnesses and reproductive health remain major challenges. In addition, roughly half of Pakistan’s burden of disease is non-communicable diseases. Nor can we overlook injuries or mental health. As for how we deal with these problems, there are issues of access to care, quality of care and staffing, among others.

Regarding access, we’ve seen important progress towards universal health coverage with the introduction of the Sehat Sahulat health insurance programme. Regarding staffing, the AKU and many others are working to educate the health care professionals the country needs. If you look at the AKU, we are now educating twice as many doctors and nurses as we were two decades ago. We’ve also added a number of new graduate programmes and dozens of residency and fellowship programmes. Many factors go into achieving quality care, but one of them is the quality of the training people receive. I believe that our graduates are helping to raise quality standards in the country.

TNS: How does the AKU envision uplifting the quality of life in Pakistan?

SS: We are very grateful for the vision of our chancellor, His Highness the Aga Khan, for the Aga Khan University to be at the global knowledge creation table, to develop women and men of our Ummah to the highest education standards to serve the developing world and Muslim societies. The AKU is generating knowledge to provide solutions to problems that people face every day in innovative and enduring ways. That is what universities are for. We do that by educating future leaders – people who have the ability to apply knowledge to the task of improving health care and the quality of education. We do so through our research and innovation, which addresses questions such as: how can we increase vaccination rates and thereby save lives? We do so by working with governments, sharing our expertise in an effort to help improve the quality of services for the public.

This year, we are launching a new academic programme – the Faculty of Arts and Sciences. Students will be able to major in human and environmental biology; philosophy, politics and economics; social development studies; or Asian and Middle Eastern studies. FAS graduates will be prepared for success in a wide range of fields: business, entrepreneurship, the non-profit sector, creative fields, academia, etc. It’s a new phase in AKU’s development and we’re very excited about it.

TNS: Due to an acute shortage of doctors, health professionals tend to suffer from extreme burnout. Being a progressive healthcare organisation, how is the AKU working to combat this?

SS: Let me first point out that there is not just a shortage of physicians but also of nurses. In fact, Pakistan still has far more doctors than nurses and midwives, which is the opposite of the situation in most countries. For both doctors and nurses, burnout is an issue that we need to be sensitive to, particularly post-pandemic.

At the AKU, we have health and wellness programmes and counselling for our staff, faculty, students and healthcare professionals. We have a well-equipped gymnasium and sporting facilities. The Sports Centre often organises sports tournaments and family events for employees and their families.

The architecture of our campus is focused on providing a calm and uplifting experience. This happens through its water bodies, gardens, and courtyards among many other features. The New York Times has described it as “a breathtakingly beautiful place… an oasis in a hectic city.”

TNS: Do you think public sector hospitals in Pakistan are performing better than private sector hospitals?

SS: Rather than set public and private-sector hospitals in opposition to one another, I view them both as vital components of the health system. I also think private-sector institutions can help strengthen their counterparts in the public sector. The AKU does that, for example, as a source of healthcare professionals, a provider of education and training opportunities and through its influence on other institutions that produce healthcare professionals.

During the pandemic, we collaborated with the government of Sindh and the Ministry of Health to develop frameworks for health-systems strengthening. Our doctors visited ICUs across Pakistan to assess the quality and scope of facilities, staff, equipment and systems. To bridge this gap, we set up Tele-ICU hotlines, where healthcare professionals consulted with AKU specialists to ensure that the best quality of healthcare was provided to ICU patients. During the recent floods, we were called upon by local governments to set up health relief camps in flood-affected areas in many districts of Sindh, Balochistan, Khyber Pakhtunkhwa and the Punjab.

TNS: How can the impoverished segment of Pakistan maintain a healthy diet?

SS: This is an important question. It’s especially important for mothers and young children because poor diet from conception to 24 months can have lifelong negative consequences for a child and lead to poor health in adult life. We, therefore, need to ensure that people get enough of the right things to eat at the right time – it shapes the health and capacities of the workforce and the citizenry. To ensure the consumption of a healthy diet by the impoverished, we need to look at the problem holistically: starting from production, availability, affordability, marketing of food to improved nutrition awareness and more. Nutrition has been a major focus for the AKU. For example, we partnered with the government and the UNICEF to carry out the National Nutritional Survey, which generated data on the nutritional status of 115,000 households across the country. That’s a key resource for anyone who wants to try to improve nutrition in Pakistan.

TNS: What steps need to be adopted to contain the onslaught of climate change and global warming?

SS: Clearly, the world needs to reduce its carbon emissions, which are the source of climate change. At the same time, climate change is already here, so countries and institutions need to take steps to adapt to a warmer world. That means every sector, every organisation – not just governments – needs to be looking ahead and addressing its contributions to climate change, as well as its vulnerabilities. I think it’s important for people to realise that this is a problem that we can all help address. As part of the Aga Khan Development Network, the University has committed to achieving net-zero carbon emissions. So we have analysed our emissions very carefully and we’re looking at dozens of ways to reduce them. On our Stadium Road campus, we’ve already installed more than 1,000 solar panels. That’s just the beginning.

TNS: Does news create fear among people in terms of the social, economic and environmental situation?

SS: The media can and should play a vital role in society, helping inform citizens and promote responsive and responsible institutions. I think most people – journalists included – would agree that there is a line that separates informing the public in an unbiased way about problems that exist and focusing on problems to such an extent that “good news” is overlooked. There is a debate about where exactly that line is, and people will have different perspectives. That’s true everywhere, not just Pakistan. Hopefully the discussion stays constructive and helps thoughtful practice by journalists, as well as informed news consumption by the public.

The interviewer is a  journalist and peace activist. He writes on health, heritage and environmental issues. He can be reached at shahidhusain01@gmail.com