There are many things on Dr Rehman Rasheed’s mind when he walks into his small, unassuming clinic tucked away in the north of Karachi, but the overriding concern of coming across a novel coronavirus patient has taken a backseat.
After drawing comparisons with Brazil, which is now seeing an average of 50,000 new cases daily, Pakistan has dramatically reversed course and brought its number of daily new coronavirus cases from a high of 6,850 on June 13, to less than a thousand reported cases on July 26. This was also the first time in almost three months, since May 2, when Pakistan’s daily new cases were in the three figures.
“When the pandemic started, and when there was a surge in cases, there were a lot of Covid-19 patients,” says the 58-year-old general practitioner who has been working in the sprawling locality of New Karachi for the last three decades.
“But now, since the surge has been curtailed, the number of Covid-19 positive patients has drastically gone down,” says Dr Rehman.
According to the latest census, the primarily low-income area of New Karachi is home to nearly 900,000 of Karachi’s population of around 20 million, with poor levels of education and income.
Dr Rehman says one reason for continuing his clinic was that the people of the area have limited access to healthcare due to the abysmal state of government hospitals and the presence of a large number of quacks in the area. But his greatest motivation stems from the Hippocrates Oath that is historically taken by physicians. “It gives me peace that I am of some use to the people of this area. Secondly, I love being a doctor.”
This is the reason that despite his age, he is at his clinic seven days a week, working at least six hours a day and seeing a patient every five minutes.
“On average, I see 100-150 patients daily,” says Dr Rehman. But he doesn’t let this compromise on his thoroughness when checking the patients, comprising primarily of daily-wage earners.
Because of the (New Karachi) area, he does not charge a lot. “I charge Rs120 per patient,” he says, which is less than a dollar.
“The charges are close to non-existent,” says Mrs Asif, who has been bringing her ten-year-old son to the clinic since he was six months old. “Dr Rehman is basically doing welfare as he charges a token amount.”
With the high number of walk-ins, the threat of a Covid-19 patient infecting him or other patients was always high on his mind. This problem is compounded in neighbourhoods with densely populated residential pockets and informal settlements that have poor ventilation, with residents’ miseries compounded by poor system of hygiene and sanitation as is the case in this area.
The doctor says he takes all the necessary precautions like keeping the air-conditioner off and doors open while ensuring ventilation. “I have placed a pedestal fan in front (to disperse the viral load).”
He took off the N-95 mask on our request but wears it at all other times along with his face shield, gown and gloves. This means that the situation could become sweltering, particularly for the doctor wearing multiple layers.
He also urges all his patients to wear masks at least when coming to the clinic. “Some wear masks, others don’t.”
Dr Rehman’s three decade long association with the area started by chance. He took over the already operational clinic in New Karachi a few years after his graduation from the city’s DowMedical College in 1986.
Back then, his family lived nearby. However, he later shifted to the central part of the city, almost 20 kms from the clinic, but continued with it as he had already developed a clientele.
Since then, it has blossomed into a love affair, with the doctor at his clinic come rain or shine. “I am very satisfied working over here, and I make enough from my practice to have a good life.”
His wife Sadia, who works at a children’s school, agrees. “We live comfortably enough and have been able to provide quality education for our three daughters,” she says, with the eldest also a doctor.
“I expose myself to the virus more than Rehman, who covers himself completely when venturing out,” she chides herself. “There is always the nagging concern that if one person gets infected, they will give it to everyone else. That is the scary part but we take all the precautions we can.”
Healthcare professionals are at a higher risk of contracting the virus due to their proximity with potential patients, and at least 60 medical doctors have lost their lives to the virus, says Dr Atif Hafeez Siddiqui of the Pakistan Islamic Medical Association, who also heads the ENT department at the Civil Hospital Karachi.
“Those who lost their lives died of a ‘blind bullet’,” he says, explaining that a doctor sitting in his clinic won’t know which patient is carrying the virus.
He blames the poor healthcare structure and the inadequate response from the government, including unavailability of personal protective equipment. The shortage became acute initially and particularly during the time of a spike in cases, making doctors more vulnerable.
But both doctors agree that the numbers are declining and the curve flattened and on a downward trajectory, which was corroborated by their personal experiences with patients, though Dr Atif noted that the numbers of tests had also decreased.
“Previously, every third patient seemed Covid-19 positive, which isn’t the case anymore,” says Dr Rehman.
But they warned against complacency while calling for strict enforcement of standard operating procedures (SOPs).
“The number of positive cases rose to 60,000 by the end of Ramazan (May). Then, there was a peak in June, with around 135,000 infected in that month only,” says Dr Atif, adding that the burden (on healthcare) isn’t as severe as it was a month or so ago, when ICU beds weren’t available.
“Previously, the positivity rate was 25%, but that has gone down to 5%, as per late July statistics,” he added.
LIVING WITH THE DISEASE
The case incidence might decline in Pakistan and globally but until there is a vaccine, the virus will not be eradicated, says Dr Rehman.
“Most probably, the vaccine won’t be available before February next year,” he says, adding that people must learn to live with the virus and take all the precautions till that time.
Dr Atif is worried about another potential surge, similar to the one in June when there was a spike post Eid. “We have another Eid, the festival of sacrifice, coming up. We had a peak post Eidul Fitr, which has since been curtailed. If we don’t follow necessary precautions, there can be an upsurge in cases.”
This concern about a potential spike was also voiced by Sindh Health Minister Dr Azra Pechuho. She said congregations during the Islamic months of Muharram and Rabiul Awwal could result in a second wave. “Moreover, the virus impacts lungs, so a peak is possible in winters as well.”
Calling the government’s response inadequate, he called the pandemic another wake up call for those holding the reins of power.
“If the government did its job, we wouldn’t have had to step in,” he said, saying that his organization distributed personal protective equipment (PPEs) worth Rs125 million across the country.
Dr Rehman, who dealt with the local administration, had a similar story of lip-service. “Once, the district’s deputy commissioner came to my clinic, who offered to provide essentials and get the clinic sanitized. However, I never heard from him again.”
Dr Rehman credited pharmaceutical companies for support while Dr Atif said that philanthropists and organizations stepped in to plug the gaping hole left due to the inadequate healthcare system.
“There have been a lot of announcements regarding additional salary, risk allowance, etc. But all these things are on paper only,” added Dr Atif about the Sindh government, while calling for compensation to be provided for doctors and healthcare professionals who have either died or gotten infected with the virus.
While expressing hope that the government would be ready for the second wave, Dr Rehman urged people to be responsible. “If something happens to us, it will only be a statistic for the government. But for us, it impacts our life and family.”
Producer: Muhammad Hussain & Adil Jawad
Shoot: Noman Ali
Edit: Noman Ali & Manaf Siddique