chapter 25

Chapter 25

Pakistan 1983-1991


Early Days
We left for Pakistan in November 1983. It had been 20 degrees below freezing in Bath. Karachi was 80 degrees above. We went around in short sleeve shirts and switched on ceiling fans. People made fun of us, some thought that we were putting on airs. It was chilly for them. Black and brown outs were frequent. Phone service was run on the same lines. The difference between the two was that phone service had improved for a short while. Pakistan shares the concept of lack of planning with other under developed countries. From being the less developed part of the subcontinent, which itself had been kept back by the colonial power, it was thrust abruptly into “modern times”, but did not have the where with all-will, resources and technology, to cope with demands of the time. It was unable to control population explosion either which consequent greater demand on public services.
When lights went out Sarah would get frightened. We bought an electricity generator. It was noisy. We lived in a congested area and neighbors complained. Water supply was also capricious. We decided to have a tube well installed. Water from the well was contaminated with sewerage. We took to driving to my uncle’s home; fortunately only ten minutes drive away. He lived in an older colony and the area seldom lost electric supply. They for some reason had uninterrupted supply of municipal water as well.
The first priority, after we had more or less settled, was to find a school for Sarah, now three and a half. Public schools in Pakistan, like every other service, had declined in standard of education, social and cultural values and basic safety as well. Teachers on a meager salary, and less respect, have to coerce students to seek private tuition. The more affluent ones pay enough to make it worthwhile for the teachers to coach their progeny in their own homes. Other parents send their children to the homes of teachers. Parents take two jobs each and make do without comforts of life in the hope that their offspring would have a better life. It is a forlorn prospect. During my visits to Pakistan I regularly come across university graduates, a few even with professional degrees, who drove cabs, not to support themselves in higher studies, but because they could not find an appropriate job .
Private schools vary enormously in standards; the best ones are academically better than the vaunted missionary schools. Worst ones are a waste of time and money. With the arrogance of a returning expatriate and that from USA, we went to the premier Christian missionary institute of the town. The head mistress refused to be impressed. She was used to feudal families, the high and mighty of the land, and income tax officers .
Schools run by Christian missionaries have a high snob value. They are still run as they were in colonial times. Their students are taught western manners and code of behavior. That includes looking down upon fellow natives. About the only positive point is that the pupils can speak English fluently and have self-confidence . The latter attribute has less to do with the milieu they are exposed to, but more a measure of opulence at home. Besides fluency in spoken English they have little to recommend them. In India I went to a private non-missionary school. We used to look down upon the students of our local St Francis School. We had better English Grammar and Composition, far better mathematics and other subjects. Having studied in India till 9th grade, when I got to college in 11th year, I was far better than my missionary school classmates, in all subjects.
When leaving the head mistress’s office, I felt heaviness in the chest, difficulty breathing and profuse sweating. Whether it was the cumulative effect of the stress of starting anew in Pakistan or the outrage at not being received like royalty, I did not know but I felt very weak and asked my driver to take me to the nearby office of a close friend Dr Aziz. While waiting for the elevator in his building, I had to sit down on stair steps. I told my friend that I had chest pain and probably the beginning of a heart attack. He asked me not to be funny. I went and laid my self down on the examination table. That took care of his complacency. He examined me, checked my blood pressure, listened to my chest and accompanied me in my car straight to the National Institute of Cardio-vascular diseases-NICVD-the only heart hospital in a city of over ten million souls and for that matter the only one in a country of a hundred million humans.
Every one in the hospital knew Aziz. He was a pillar of the Pakistan Medical Association. I was a senior physician and by virtue of years of activism as a student was well known too. The staff attended to me immediately and gave me an intravenous injection, which made me feel entirely better. I wanted to go home, but they wouldn’t let me. They had let a doctor do so a few weeks ago, in similar circumstances. On reaching home, he had died on them. The director of the institute, no less, supervised my treatment. He was my former teacher who had, incidentally, looked after me when I was admitted under his care in 1961, while I was a state guest. He was leaving on an overseas trip, and apologized that he couldn’t cancel it, but reassured me and assigned another British trained cardiologist Dr Aslam of “the old” school, for my care. This gentleman, with a long face- literally and expression wise- and a serious demeanor, did not inspire friendliness, but did command respect and confidence. He seldom smiled and during his visits he would inform me that all my tests had been normal so far. During the later part of my stay, in an effort to cheer him up, I asked him if an abnormal result would please him more, I could make a special request of the laboratory. In response I was rewarded with a flicker of his lips .
I was kept in ICU for forty-eight hours. I do not have a clear recollection of my time in the unit, as I was kept sedated all the time, but do remember that I was on complete bed rest and a zealous staff catered to all my bodily needs. I am not sure if it was part of the routine or the good care I was being given was due to my connections. I suspect it was the latter. My physician saw me twice a day. Visitors were not allowed except for half an hour twice a day, but like every where else in the world Doctors on the staff could not be stopped from visiting any hospital facility including the ICU and the Operating rooms. And all my friends were senior physicians and I had a constant stream of solicitous visitors all day. They even let my mother and wife peek in more frequently than was permissible.
I was transferred to a private room on the third day. My physician continued his visits, once a day now. Visitors were now officially allowed. They came in great numbers. Practically all my friends and acquaintances among the doctors in Karachi, including the majority of medical specialists came to see me at least once. My only complaint was the terrible headaches I got from the Vaso-dilators . I asked my doctor about them. He said I would get used to them. I never did.
I was discharged home after a stay of five days. The hospital bills, including that for two days of intensive care, came out to be about $200.00. At the time in the USA it would be a minimum of $10,000.00. I was advised complete bed rest, no stairs, and no excitement for six weeks. Follow up tests and cardiograms turned out to be normal too. I gradually resumed normal life.
Our first quest was again a school for Sarah. A friend recommended a kinder Garten (KG) pre-school. It was run by well educated and well turned out lady. She was happy to take Sarah.
We were very happy with the school. Sarah seemed to take it well and got straight A’s.
In due course Sarah graduated from the KG. It was time for to look for a school where she would stay till tenth grade or O levels . Admission in “good” schools was at a premium. All credible ones took a pre-admission test. We were confident that Sarah would do well, and chose Mama Parsi School; a venerable old institution patronized by the solid middle class people, but in the good old sub-continental fashion looked for connections to make sure that she will be accepted. I asked around among my friends if any one knew some one important in Mama Parsi. You can imagine my elation when one of my closest friends Saleh Memon told me that the founder’s physician granddaughter
Dr Mama had her office next door to his and offered to put in a good word.
Sarah took the test and we happily anticipated a letter of acceptance.
The brief note that we got a few weeks later that the school would not be able to take her floored me. But I reassured myself that it must be some kind of mistake. I called Saleh and must have sounded so distressed that he left his busy office to talk to Dr Mama and called me back in about half an hour that the latter would like me to call on her. I left immediately. The lady received me courteously and apologized that she had not been able to help. She had called the principal while I was on my way and was told that Sarah had done very poorly on the test. She had insisted that the score sheet be sent to her and presented the sheet to me. My daughter had not scored higher than ten out of a hundred in any subject. I was acutely embarrassed and flabbergasted, thanked the lady left her office. Though determined to get to the bottom of the mystery, I was very depressed.
After a lot of research, which included calling on other parents who had sent their children to the school and interviewing a few members of the staff, I discovered that the school left the pupils pretty much to their own devices. They had to depend on parents and private tuition to learn any thing. In order to please the parents all students were routinely given. “A” grades. I decided to confront the principal. I was fuming and must have used intemperate language. She mumbled about my lack of consideration for her sex and status, but did not offer a word of explanation.
I also discovered that the practice of lavishing "A" grades was not uncommon. The government, unwilling and unable to cope with the needs of the burgeoning population, had abdicated their responsibility. Private schools-and hospitals had mushroomed. The official school boards charged with the responsibility of regulating and supervising the system did little more than issue the requisite licenses on payment of a “facilitation fee”; a euphemism for bribe. Competition for pupils was terrible, the number of trained and capable teachers limited; schools had to hire barely literate tutors and resort to base tactics to attract and retain more students to make enough money meet the ever bigger demands for bribes, school expenses and a handsome return on the investment of owners.
My second project after recovery from my “heart’ trouble was getting the baggage out of the clutches of Customs and finding a piece of land to build a hospital on. Baggage clearance was not too much of a hassle, though with my ignorance of the “red tape” and cupidity of government functionaries, it seemed an onerous task at the time. My contacts came in handy. An old friend was a clearance agent, and an older brother of another friend was a high customs official. I am an impatient person and did manage to lose my temper a few times. I did end up paying a small bribe as doing otherwise would adversely affect the future dealings of my clearing agent or as he put it “yeh aap ko bad dua dein ge”. Roughly they will make adverse prayers for you.

Hill Park Hospital -Construction

The story of what I went through in the quest of building a hospital would merit a book in its own right. But I will restrain myself and cut it down to bare bones. The saga begins with a visit to Pakistan a year before. A relation by marriage of one of our partners had had heard of our project, and had persuaded the partner that the deal he could offer was the best we could get. He was building a block of apartments in a suburb of Karachi and would remodel the structure to suit our requirements. I consulted with other shareholders and all agreed that I should visit the site and report back.
In anticipation of my visit the man had hung a sign “NY Polyclinic of Karachi” on top of the building. I told him of our requirements. He agreed readily-too readily I thought. I further advised him that the building would have to be transferred in the name of the partnership, which will name a board of directors to manage the venture, and he would not necessarily be in the driving seat. That made him think a bit. He promised to get in touch with his financiers and get back to me.
He called back the next day that he had discussed the matter with his own partners, they all agreed with my demands and he had taken the liberty of making an appointment with an attorney who would draw up the legal papers to my satisfaction. I was again struck with the pace at which things were happening. I had been out of the country for a good many years but could not persuade myself that my countrymen had changed so drastically and become so efficient. But I did want to give the man the benefit of the doubt.
We went to the attorney’s office at the appointed time. He turned out to be a person I had known quite well in my Karachi university days. After a few minutes of polite chitchat on how we happy were to meet again and exchanging news of mutual acquaintances, he offered a draft contract for my consideration and waited expectantly for my approval. I thanked him and told him that I would have to go over it at my leisure. He seemed to prick up his ears and I am certain exchanged a glance with my prospective partner. It was a confidential document and he would rather it did not leave his office. I told him that surely he did not expect me to agree to any thing with out legal advice from my own attorney. That rubbed him the wrong way. Did I not trust him, he rejoined, and what did I need another attorney for. I said I was sure he was a man of high integrity, but I was acting for a partnership, and a person I was planning to enter into a business relationship with had engaged him; it could be construed as conflict of interest. He vehemently disagreed; using the same legal adviser was a common practice in Pakistan. Besides the convenience one saved a lot in legal fees.
On that note of disagreement we parted company. But my prospective partner kept on pestering me that I should transfer money to him; the project would suffer great loss otherwise, and offered to sign all kinds of promissory notes. Though I had lived out side the country for eighteen years I retained enough cultural memory that legal documents not backed by high-level contacts and/or brute force were not worth the paper they were written on. The best I could hope for in case of breach of faith was a lengthy and costly law suit-with uncertain out come. He finally took the hint and complained to my friend who was put out that I was so skeptical of his relative by marriage.
With that experience under my belt I proceeded to contact real estate agents. This is another harrowing story. I, for the first time, faced the full spectrum of South Asian guile, lies, gall, subterfuge and chicanery. I used to tell the agents that I was interested in a commercial plot, not in a house, which could be converted into a hospital or an amenity, plot .The agents from “reputable” firms continued to take me to this beautiful home and that amenity plot going cheap. I had to carry them around in my car with no perceptible progress week after interminable week. Once I got so annoyed that I told an agent to get out of my car in remote area and make his way to his office from on his own steam. And that was the end of my dealing with realtors.
The wife of a partner in the project had introduced me to a fairly well known architect. He offered to assist me in my search for land, if I would give him the architectural and construction work . I gave him the same spiel about a commercial plot and made a conditional agreement with him. He turned out to be no better than the real estate agents and kept on offering homes on sale. I was of necessity more patient with him, finally got fed up. If he did not have what I needed up his sleeve, we should part company. He then started escorting me to vacant plots but would not introduce me to sellers. On enquiry, it turned out that many owners didn’t want to sell; some even had been out of the country for years. One owner took pity on me, and told me that it was the usual practice of agents, middlemen, and realtors to string you along and dissuade you from seeking other help. I said this man was an architect, why would he stoop to trickery. Simple the man said, he wants your architectural as well as construction work.
. I was at a dead end and ready to pack my bags. But fates finally smiled on me. An acquaintance told me of a commercial plot in a posh area. At the recommendation of my friend Dr Aziz I got a retired manager of a nationalized oil industry (Aziz was the chief medical officer of the plant) to negotiate and finally bought the land and appointed the man project manager. The architect had, I do not know how, kept abreast of my progress and started pestering me. I had no intention of hiring the bamboozling architect. He appealed to his kin, my partner’s wife who had introduced him to me. He had also, some how, learnt of another partner visiting the town, inveigled an invitation to see him and begged the latter to intercede for him. He moaned that I had exploited him, and used him for finding a plot of land. It wasn’t his fault that he couldn’t find one. He had a reputable architectural firm etc. I told the visiting partner of the man’s shenanigans. The architect called and apologized and promised to mend his ways. The contract he offered was at a much lower rate than the norm. I consulted the project manager who advised me to accept it as such contracts were more honored in the breach than in compliance and I would at least be starting from a lower base. I allowed my partners prevailed upon me to engage the firm and award it a contract to design and build the hospital. The architect produced blue prints, which were discussed (perfunctorily) by partners and agreed to.
The partnership did not have sufficient funds to finish the whole project. I started looking for investors and found quite a few, but the most invaluable was Dr Aslam, my cardiologist. He not only agreed to join the partnership, but also offered to facilitate the loan process. He was on the staff of the only heart hospital in town, and counted the high and mighty among his patients. I had pursued many banks and finance houses for a loan, to no avail. The heart doctor took me straight to the chairman of the National Development Finance Corporation (NDFC). The dignitary promptly approved the loan subject to submission of a feasibility report. His staff was sore, as we had gone over their heads and they had been deprived of the customary kick back. I was ruefully to learn later that they had many tricks up their sleeves.
The architect, as was usual with him, offered help in obtaining a feasibility report as well and introduced me to an “expert”. The expert promised a report within ten days. Two weeks, and then three passed. I got excuses , his children were sick, he had to go out of town on some “secret” mission; everything except that his mother in law had run away with the milkman. I served notice. If I did not have the report in my hands within forty-eight hours, I will find someone else. The bluff worked. By this time all my acquaintances had become cognizant of my strange ways and temper tantrums.
A week after I had submitted the feasibility report, I got a call from an irate senior vice president of NDFC. Did I know what was in the feasibility report? I confessed ignorance, but submitted that an expert had written it. He demanded that I go to see him immediately. It was my sacred naptime, but the man insisted. When I arrived there, he spluttered that the report was a copy of a confidential document submitted a year ago for another hospital and my expert had not even bothered to erase or excise NDFC remarks that the report had been approved. I had had enough. I shot back. In that case NDFC were guilty under official secrets act for not keeping the report secure. It was also possible that someone had willfully given it away to agencies unknown for a consideration, and why shouldn’t I report the incident to the chairman. At that he deflated visibly. I let him stew in his juices and left. I was inundated with solicitous calls from other NDFC big wigs. I was not used to local ways. It would be a sin to get someone punished for what was routine here. He may even be suspended .
Officials in Pakistan are very conscious of the milieu. An executive VP, who had been all smiles when we visited the Chairman, cut me during an official NDFC dinner! In a later meeting with the chairman, I commiserated with the executive. He must have been rather under par during the late dinner, because I had always found him effusive during our meetings with the chairman. He has enough sense to blush. The Chairman took the hint and asked the minion to expedite our work. Dr Aslam who always accompanied me to the house of finance remarked dryly, as was his wont, at my brinkmanship and warned me that even a snake under the heel could turn to strike at the first opportunity. He was right. Though constrained by Dr Aslam’s relations with the chief, the man tried to undermine our work.
Loan was finalized, signed and sealed. It was to be released in installments after defined stages of construction. My architect advised me that I should pay three percent as kick back to the SVP in charge; otherwise I would have to face interminable delays. I angrily refused. It was immoral, unethical and illegal and I was not there to promote bribery. In any event how was I to explain the gap in funds to my partners? He warned me. The project would suffer and it did in a big way. Funds were not released to buy the Air conditioning equipment then duty free for hospitals. By the time I got the check, the government had imposed 400% tariff. We were never able to buy the AC unit. My partners, wiser in the ways of their native land, did not thank me for my scruples.
The stage was now for construction. I asked the man who had negotiated the land deal to continue as project manager. I needed all kinds of permits from Karachi Building Authority (KDA) and other civic agencies and did not have a clue as to how to go about it. The architect got KDA to approve plans, presented a contractor to me for formal approval and construction started.
A rough and ready tin and mud hut built over night served as our “corporate HQ.
Much to my surprise construction work proceeded at a fast pace. Then it came to a grinding halt. I asked the architect. He was evasive. I asked the contractor. He looked around as though watching for eavesdroppers. Finally he let out that the architect had offered me too low an estimate and had difficulty managing his bills. I buttonholed the man. After a lot of hemming and hedging he confessed. The rate was too low. I asked him why. He confessed that he had been scared that I would find another firm and requested revision of the contract. I knew that the rates were on the lower side but would still give him adequate margin of profit. Acceding to his request would lead to ever escalating demands. Work stoppage was a regular subterfuge and pressure tactics to raise the rates; the underlying idea was that owners would not be able to accept losses inherent in delay. It was a test of nerves. I threatened a lawsuit, but what worked was the intervention of a newly found friend who knew high ups in KDA who could make life difficult for any architect in town. Work resumed, but the man would try the tactics several times.
The project manager, sensing my inexperience, started acting up. He complained that the hut was stifling; there was place to have a cup of tea in peace. I reminded him that if I enfeebled by years abroad could put up with it, so could he. He thought otherwise and demanded more money and amenities. I refused. He threatened to resign.
I was in a fix. I could not handle the work without assistance and guidance. I sought the advice of my uncle. He had recently retired from the railways maintenance department and was savvy in ways of the government and contractors. We were very close and he was the only worldly-wise member of the family. I had wanted him to work on the project, but forbore to ask him for fear of an accusation of nepotism. I was now in no position to abide by scruples and broached the idea to him. He was agreeable. His compensation was a delicate issue. He solved it by naming a reasonable salary.
I took him along to the construction site the next day. He asked the project manager some searching questions. The man took umbrage. He was not used to being questioned as though he was a junior subordinate. In that case, I told him he could leave. He wanted notice. I informed him that he just had it.
My uncle was a track engineer, knew all about iron and steel, but was not fully conversant with concrete and foundation work and invited a retired colleague who was a construction engineer to assist us, at a nominal consultation fee. Between the two of them, they saved me a lot of heartburn and expense. The friend, a man of few words and dour expression, checked concrete mix and quantity/quality of iron and would say a simple no if the material did not meet his standards. He won’t budge regardless. He even turned down haughtily, a large consideration offered for his favor, threatening to have the contractor and the architect sacked. Nepotism has its uses.
Some months later the accountant, who was a distant family connection, also decided to act grumble. Out of family consideration he had accepted a fee much smaller than he was entitled to and if I could see my way to increasing it-substantially. My uncle could not help me in this field. He was constrained by the relationship too. The man was his second or third cousin . I asked my CPA to find a replacement. He was reluctant too. The man I was trying to get rid of was a shrewd operator. He had taken care to refer a few accounts to the CPA. Then I got a lucky break. I met an accounts clerk in a wedding party, and asked him to visit me in the hospital the next day. He had low-level experience in the field. I hired him, and fired the distant relative. The new man was not very bright, but with the help of our accounting firm, he managed quite well.
In 1986, my malpractice insurance carrier asked me to visit NY for a court appearance. We agreed to a date. I took the opportunity to visit and talk to my USA based partners. We had made an informal agreement, that I would go to Pakistan first, and another partner would replace me after three years. I reminded them that my rotation was up. I knew that it would be difficult to persuade them to move to Pakistan, but I was not ready for the rude awakening. No one was willing to return . They made all kinds of excuses; their children were in school, their wives did not want to come back, they could not find a replacement and wished me luck I told them that I could ditch the whole thing and return. I was losing a lot of money. They offered to pay me and took a sigh of relief when I agreed. I also told them that I would have to co-opt partners from Pakistan. They promptly agreed to both that too.
On my return to Pakistan I started broaching the idea of partnership to Doctors I had got to know and liked The first person I talked to was an anesthiologist, Dr Akhtar Aziz Khan. He had trained in Chicago. To my surprise he agreed instantly. I had to tell him that I would have to get the approval from my partners. After a while I told him that my partners were agreeable. He turned out to be a good choice. He helped and assisted me sincerely and effectively for a long time. Among several others, I was successful in bringing at least one Doctor in every specialty on board.
Two years later, in 1987, a partner, and close friend, and former fellow member of NSF, Dr Ali Ahmad arrived from the USA. He was a great help while he lasted and was good at negotiating with contractors, vendors and officials. He suggested the name Hill Park General. He started private practice, but was not very successful and had “wife’ problems too; was not making enough money to keep her in the style she had got used to. After six months, he told me that he had to return to the USA to wind up his affairs. Two weeks later I got a call. He was sorry, but he had changed his mind and would rather stay on in America.
None of my local partners, except for the Akhtar Aziz and Syed Aslam helped in any work. I once asked the architect to meet me and other partners for a briefing. A few turned up half an hour to one hour after appointed time. They did pass a resolution in a Board of Directors meeting, that I was the chairman of the Board as well as managing director. Akhtar was made director administration and finance (DA&F).
It would be tedious to go into details of wheeling and dealing with various government agencies and private enterprises. Suffice it to say that after I had lived in Pakistan for three years I would look askance at an offer of help with out any strings attached and would instinctively seek a recommendation in the least little thing. I was proved right time and again .
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Professional work and life in Pakistan.

With the influx of expatriate money from Pakistani workers in Mid-East and Africa demand for private health care had grown exponentially and many private hospitals with varying levels of mismanagements had opened their doors for business. It was in a way a step forward as in the olden days if you did were not on a government hospital staff, you could not survive and appointment as an unpaid honorary member was also at a premium. I had to devote a lot of time to the hospital project. That left little time to develop private practice but I was actually not too badly situated. My practice had got off to a flying start. Even before I had formally opened an office, I started getting calls to visit patients at home. The rich and the powerful deem it beneath their station in life to visit Doctor’s offices. They could have their way as in the past specialists used to return from the UK with little savings. All one could hope to bring back was a car and a few hundred pounds and they had to cater to the whims of bureaucrats and the establishment for a job and private work. In the kind of rigid class based society they lived in, even professors of medical colleges had to visit patients at home. If they did not all the facilities they enjoyed-virtual exemption from paying tax, license to import motor cars, foreign travel, allotment of choice plots of land to build houses on, ease in obtaining building and other permits and supplies, preferential treatment in government offices, slots for their progeny in schools, colleges, foreign scholarship and in public service jobs would evaporate instantly. They may even lose their own jobs.
After working for nine and a half years in the USA and living with little ostentation I had saved enough money to live on comfortably for several years. I also had financial backing to build a high standard hospital and did not feel I had to fawn on any one.
I had not had any exposure to officialdom and was unaware of ground rules as well. My exposure to progressive thought had had also made me impervious to privilege and temptation. I was, in my own estimation, a person of high ideals, socially aware and had political insight. I could not stoop to take advantage of the system and had promised myself that I would endeavor to help the poor and the destitute. I had arrogance born of long years abroad in the relatively free milieu in the UK and the USA. Like all self-made persons I was brimming with self-confidence too.
But I had reckoned with out the tenacity of our upper class. A repatriate Ear, Nose and Throat Surgeon Dr Iftikhar Salahuddin whose acquaintance I had made in the USA gave my name to one of his friends. This man’s employer was the owner of a large Tobacco firm, and had developed backache. The employee called me with a request to see his boss at the latter’s residence. I told him that I had not even started work yet, I did not make house calls, and I could not do much at a patient’s home any way. He insisted. His chief was the owner of the biggest cigarette manufacturing company in the country; it will help me to develop contacts. I told him that I had quit smoking. The man persevered. His job depended on it. He finally asked me if I would agree to look at the X-Rays of the great man. I invited him to join me at a restaurant the next evening where I was scheduled to meet some one in connection with the hospital project.
The man turned up clutching a huge bunch of X-Ray films. I asked the restaurant manager if he would mind that I was converting part of his place into a medical office for a while. He was all for it, and all over me. In the short time I took looking at X-Ray films I had gathered an audience from the patrons and employees of the business. Some even ventured to ask for my advice .
The restaurant I had met the factotum in, was a fashionable one. I was to get quite a few referrals in the future because of that public consultation. The place has since been converted into an electronic shop. Once I asked a Taxi Driver to take me to the electronic market. He shot back, the whole city was an electronic market, which specific part did I want to go to. The taxi driver turned out to be a University graduate! I was taken aback. I blurted out “why are you driving a Taxi”. He smiled. Would you rather I robbed a bank. He was lamenting the transformation of Karachi from an emerging center of culture into a smugglers paradise and an intellectual wasteland. (Please see note 2 below).
The Tobacco baron had consulted all the leading specialists of Karachi. He appeared to be suffering from a herniated disc . In my opinion the problem in his management was too much advice and the resultant confusion. I could only add to the chaos. I fore bore from conveying my impression to the emissary, as he would only think that I was treating him disdainfully and confined my remarks to reassurances that his boss was being treated correctly.
That nonchalant remark, if any thing, whetted the tobacco chief’s desire even more to have me visit him at his home. He prevailed upon the ENT surgeon to call me. It could not do any harm, my friend told me. It could be a useful contact. I reluctantly agreed. The assistant came to my house to drive me to his boss’s home. The house, located in the most exclusive and expensive area of the city, was palatial. Mercedes Benzes were strewn about in the courtyard as chicken are in Indian/Pakistani villages. It was beautifully landscaped. Many households’ servants lined up to receive me, in a veritable guard of honor.
But I had also noticed a huge and rotting garbage dump right out side the gates!!
I was ushered into the presence. The big man was lying in a large, and ornate bed in a huge room. It was tastefully decorated with paintings; fine specimens of handicraft and others works of art. About a score of solicitous well-wishers were sitting in a semi-circle around the bed. They all rose to greet me. The man apologized. He could not get up; it hurt too much. The place looked more like an old time Durbar of a fair sized princely state than a sick room. I could visualize myself as a visiting plenipotentiary from another state rather than a Doctor come to minister to a patient.
I asked if I could examine him in private . This turned out to be an expected and unusual request. The man asked his guests to step out side, in a tone, which indicated that he was doing it only to humor me. The crowd left with obvious reluctance, as though being unfairly deprived of a great spectacle.
I debated with myself if I should tell him that the advice he already has had was correct, and he had to decide which Doctor to trust and follow his treatment. The other alternative was to skirt around the issue. I, certainly, did not want to tell him that the other Doctors had not given him good advice. That besides being dishonest would have been foolish. He was too intelligent to be taken in by that. So I decided to tell him that all Doctors have different techniques of management. He had to decide if he was going to follow my advice. By going Doctor shopping, he was only going to delay treatment and suffer for longer than necessary. If after I had examined him, he liked my advice, he should follow it. If he did not like my advice, he was to tell me frankly. I would not mind. I would not even charge him for the visit, which I was making only to oblige a friend and not to make money. This seemed to impress him. He had not been spoken to in this blunt manner for a very long time.
After I had examined the Tobacco chief, I told him that he should be in a hospital. He could not be properly taken care of at home. He needed physical and mental rest and visitors were not giving him any peace. It would be very impolite to turn the visitors away; he would really get sick in a Hospital. I had only to name it and he would get all that a Hospital could provide and very reluctantly agreed to restrict the visiting period to six hour a day. I gave his assistant a list of equipment we would need to convert his bedroom into a Hospital room. With his resources, contacts and money, we had all the supplies, a Hospital bed and a traction kit with in forty-eight hours. Bed was available locally, but the kit had to be imported from Hong Kong.
He got better in due course. He was not a pretentious man and had not forgotten his roots and told me with out a hint of embarrassment that he had only a small Bidi (a tiny version of a cigar, very popular among the poor in India) factory in India. He migrated to Pakistan, and had started a Bidi factory, but the Indian Government stopped the supply of tobacco leaf. Pakistan did not produce any tobacco. The Government came to the rescue, and gave him a license to make cigarettes. He never looked back. During my last visit he asked for my permission to go to India where his mother lived on the coast. He would walk on the beach, his mother would minister to him, and he would get better. He did.
A few years later I got another call from him. His wife had bad knees. He wanted to know, if she needed knee replacement. His son came to fetch me from my hospital, which was under construction, and where I spent most of my time. The huge garbage dump was still there right out side his home. I asked the son if it was the same garbage I had seen some years ago. He was acutely embarrassed. Uncle , you are making fun of us. I told him that his family had all the money in the World. Why did they not have the garbage taken care of? His response was that it was the job of the Municipal Corporation. I rejoined that the Mayor did not live there. His family did. He did not respond to that, but did not seem to appreciate my remarks.
Soon after we arrived in Pakistan Sarah fell sick. She was diagnosed typhoid fever. It was endemic in the country. Few Doctors in Europe or North America even know how to diagnose the disease, or Malarial fever for that matter. In the west typhoid patients are quarantined and subjected to barrier nursing. Any one entering the patient’s room has to wear gloves and wash their hands before and after handling the patient. In Karachi, it was routine; nobody took any precautions. My wife was very upset and wanted us to return to the USA soon after our arrival in Pakistan. But she is not a feminist and generally accedes to my requests. She, though, contrives to get her way most of the time. But I was stuck. I had invested my partner’s money in addition to my own, and felt honor bound to stay put.
We had other problems too. Traffic in Pakistan is very difficult to understand and to cope with unless you have learnt to drive there. There are definite rules of the road but they are very different from the one you would get used to in the west. The larger vehicle has precedence. You give way or risk being run over. Drivers have an uncanny faculty of judging if the other driver will stop. Coming out of a side road you have to nose your car into the main road; no body will give way or let you enter the traffic. Nerve is very important. I once rode on the back seat of a scooter behind a cousin in Rawalpindi. He would drive fearlessly, I thought recklessly, in front of a rushing truck. Truck drivers would swear but stop at a safe distance. On a round about (traffic circle in the USA), there was no right of the way, you just drove in, and the other driver will stop. Once I witnessed an unskilled driver like me block the traffic for twenty minutes during the rush hour, till the driver behind him got out of his car, and drove him across the roundabout.
I could never manage to drive except on a Friday, the weekly holiday in Pakistan at the time. Of all the imaginable people Bhutto, whisky swilling, womanizing autocrat had changed the weekly day off from Sunday to Friday. In his declining days he had done so to curry favor with the fundamentalist lobby. He also passed a legislation to declare Qadianis, a deviant sect of Muslims, non-Muslims. That did not help either. The clerics finally got him. I had engaged a full time driver. Wages were very low, and one was quite affordable.
My wife learnt driving in Karachi and was able to, after a while, drive like a native. She used to drive us around, the children to school across town and me to the Hospital halfway there, and when we went out. Very rarely one would come across a person wearing a seat belt. Not many cars had them. The subcontinent boasts the oldest cars in the world. It was not unusual to see one made in late forties. Labor and maintenance were cheap. Workmen had not lost skills. They would repair a vehicle an auto shop in the USA would not allow on its premises. A car, which would be a write off in the USA, would give many useful years of service. New cars were expensive. A fairly affluent family would keep a car for a minimum of fifteen years. During early days, I would fasten the belt as soon as I got into the car. Neighborhood children, once they got to know me, took to asking me, half sarcastically, half jokingly, if I was planning to fly a plane. They thought it was quaint behavior. I gradually adopted native ways and stopped using the belt. Some people I knew had the system taken out of their cars! When I asked my driver to use the seat belt, he said that if he had an accident, by the time he could undo it, the other driver would have had time to punch him several times. Fist fights between drivers after an accident were quite common.
Given the total lack of discipline and contempt of rules, accidents should have been very common. I had long been intrigued by the fact that they were not. I discovered that there was a system to the madness. If you hesitated the other driver would barge in front of you. If you went boldly forward, the other driver would give way. If there were a grievous injury, the offending driver would speed away. If both drivers stopped, a street argument would inevitably ensue. An impromptu court comprising of the passers by will be held. Soon a small crowd would gather and serve as members of the jury. A more vocal person would take it upon himself to prosecute the case; another one would play the defense attorney. After half an hour of arguments going back and forth, one side would concede and pay for repairs on the spot. No body called the police .
As our children grew older we had put them successively into “better” schools, but the commute got longer and longer. We lived in my parent’s house, which was in an unfashionable area, and had few facilities for children’s sports and entertainment. I felt bad about their lack of outdoor facilities. But I was too scared to let them play on the street, as other children did. Relatives and friends alike constantly pestered us that the area was beneath our status. If the reader was not aware that out in the East your business is every one’s business, he/she should do so by now. People get annoyed if you do not meddle in their affairs. I was often, in the beginning, accused of turning into a snob and an unfeeling creature. Soon after arriving in Karachi I was asked to talk to a couple who were having serious marital problems. I was taken aback. Would not they ask me to mind my own business? I would be snubbed. Not at all was the refrain. I still hesitated. For my scruples I was cold shouldered; have it your own way.
Not long after, the lady in the question who had been my class mate at the medical school and a dear friend too, asked me if I was really as callous and self centered a person, as friends had told her, I had turned into. I was stunned. I plaintively asked her “why do you say that”. She shot back, if that was not so why had I not talked to her or to her husband. I told her that that I was scared they might snub me. She, in a matter of fact tone, stated that if she did not know me any better, she would call me a fraud and worse. With great trepidation I called on the husband. He was quite receptive to my inquiry and reassured me that things would settle down soon. He promised to call on me the next Friday and explain. We had a long and a pleasant session.
We eventually bought an under construction apartment in an expensive area and my wife managed to build a house in a posh area on a piece of land which my eldest daughter, on one of her visits to Karachi, had forced me to buy. She lived with her mother in an upscale area in Lahore and would stare down her nose on our neighborhood. My wife spent more time on the site and the housing society offices than the architect or the contractor did. But we never lived a day in the apartment or the house. By the time they were ready for occupation, I had already returned to the U.S.A. My wife and children followed after the school year was over. I had spent all my time and energy building the hospital. I have often regretted that and felt that I should have spent my time on building a house before getting too involved with the hospital. But my children console me that if I had done that I would still be in Pakistan.
My younger son (and the youngest child) Hasan was born in Karachi in a hospital owned and operated by a medical school classmate Dr Farzana Mahboob. She is an OBGYN Doctor and her husband is a pediatrician. My wife had already had two babies by C-Section, so she had to have another one for the fourth baby. Farzana chose May first for the procedure. The day is, of course celebrated in most of the world as the international Labor Day. She had a radical past too, her husband Mahboob, mentioned in the chapters on student movement, had been a leading light of the “left” .She not only did not change for surgery, but also made the anesthesiologist return the fee I had given her. Hospital stay was free too; she even sent food for my wife and all visitors.
My son had breathing problems. Mahboob, who had been a few years senior to me in Medical College and also had been one of my political gurus, advised transfer to another hospital with a Pediatric ICU. I asked him if they would be able to manage better than he would. He said no, but if any thing untoward were to happen, you might blame me. Needless to say my son stayed put and his doctors visited him several times a day and at night too, till he was out of danger. My son used to complain that I had not brought him over to be born in USA, so he was ineligible to become the president. But he has not complained since George W assumed office.
Though the children never got very sick after the first year, all but one-Sarah who thrived there, looked like scarecrows. The photographs taken while they were living in Pakistan are proof positive. They immediately gained weight on return to the American soil, and have been healthy since. They even tended to be slightly obese, till they went to college where they missed moms cooking and shed pounds. The children had done well at school in Pakistan and continued to do so here. They have retained the Pakistani habits of mixing with adults easily and have acquired the aggressiveness and self-assurance of American children. Whether they live here or in South Asia, our children tend to be loyal, respectful and well behaved. Drinks and drugs do not easily tempt them.
We tried to provide as many leisure activities as we could, taking them out to dinner at least once a week, visiting amusement parks, beaches and a well known lake about an hours drive away from Karachi. There was a very good park behind the hospital I had built which unscrupulous builders and corrupt civil servants had not been able to encroach upon. We spent many pleasant hours there. There was a decent restaurant in the park, where we would snack on fried chicken, Kebabs, Samosas and Ice cream.
Social life was going to wedding dinners and music parties. Dinners started and ended late. The hours took some getting used to. There were fairly frequent ”male only” drinking parties, though younger persons in affluent neighborhoods had mixed gatherings too. New year and Christmas used to be festive occasions for all, till fanatics took charge of public behavior and morals. . Public parties were discontinued after obscurantist hooligans mobbed them. Restaurants, clubs and out door facilities in the western mode, would actually close early on the New Years Eve lest the self styled guardians of public morals on the lunatic fringe demolish the place for the greater glory of Islam! They would stone any such place if they sighted a light on the premises.
In fifties and sixties Karachi used to be a city of coffee and teahouses. Students, young teachers, poets, writers, aspiring politicians and intellectuals would sit there till midnight or after, then take a bus or walk home. It was perfectly safe. One cup of coffee would last hours. The waiters would, once in a while, gently remind us to order again, but didn’t harass the regulars. It would seem owners were not really in the business to make money. They have all but disappeared because the city had grown so big, and it has become difficult and unsafe to commute in the middle of the night. Mullahs had taken to stoning coffee houses as well.

Work At HPGH- Visits To Quetta

I quit all other hospitals and started working full time at HPGH. I would arrive in my office at about 8.am, incidentally an un-earthly time for the doctors in Karachi. If I had scheduled surgery, I would proceed straight to the operating room-OR in the USA, operation theatre-OT in Pakistan and the UK. Besides Agha Khan University Hospital our Hospital was the only one, which started surgery at 8.00am. I scheduled the cases on Tuesdays and Thursdays. On other days I would head for my office, and spend morning in entertaining people- friends, union officials, physicians and acquaintances. The hospital administrative officials would drop in for advice/direction. It was open house. I reveled in it and it was good for business too. I would make administrative rounds every other day.
Lunch was at 1.30 pm and naptime was 2.00 to 4.00pm. Office hours were from 4.30 PM onwards. I got home by 8:30 to 9:00 pm and did manage half an hour with children. All the family, my mother, wife, children and sister would have dinner together.
Then it was bedtime, and get up at 6:30 AM, hasty breakfast, drop children at school by 7:30pm, and go through another day. School closed at 1.30 pm. My wife would bring the children to the hospital for us to have a few minutes together. I worked half day on Thursday, and would return home with children, Friday was off, barring emergencies. Life was regimented, with little time for relaxation. I did to take a week or so off during school vacation and we would drive to Quetta. If I could call any city home in Pakistan, it was Quetta. Though I lived in Karachi for much longer, yet it is difficult to call a collection of settlements home. We would leave for Quetta between 7.30 and 8.00 am. It was about eleven-hour drive through hot dry hills and desert for the first eight hours. It would then cool off, and turn chilly as we approached Quetta. One year we stayed with my uncle who was the director of education of the province. In subsequent years, my TV executive friend would arrange for us to stay in the Provincial assembly hostel.
I would start making rounds of my favorite city haunts the next morning. Quetta boasts of some of the finest fresh fruits in the world. Besides apples, grapes and apricots we have a local variety of melons called “Sarda” roughly translated “of the cold”. I am sure nectar would not taste better. I have never enjoyed any thing more than the plump dark blue, almost black cherries of Quetta. At the risk of being accused of male chauvinism, I would compare them to the dusky beauties of South India. Natives made an especially delicious roast goat leg called “sajji” and Chapli Kebab are out of the world.
Afghan refugees had nearly overwhelmed the population. I have yet to see a more affluent group of shelter seekers . But none of these groups had reduced the indigenous population to such straits). They controlled nearly all transport business and poached upon the profitable smuggled goods, the lifeblood of local bourgeoisie. They sold American and Russian guns too. Vast tent markets had mushroomed in which you could buy blankets, army uniform from many countries, electric appliances, generators, shoes, tinned food and drugs. They had opened many restaurants. The food was different and quite good. The refugees were insufferably arrogant and misbehaved with the indigenous population, like Chiang Kai Shek’s cohorts did with Taiwanese Islanders. About the only positive aspect of the influx of Afghanis were the many restaurants they opened. Food was delicious).
We would make a day trip to a local tourist site, the Hanna Lake. Together with a natural spring known as Huruk, they were called Hanna-Huruk. We paid calls to friends and family.
Quetta also boasts of the second largest smugglers market in the country . Before the advent of Russians in Afghanistan and the subsequent “Jihad” which gave Klashnikov assault rifle and the drug heroin to the country, the economy of the area was based on goods smuggled across the border. When you left the town, Octroi and customs agents would try to extract bribes from you for carrying contraband. If you handed over the goods to agents you would get them hassle free in other towns, just as you bought them. That was one of the rare instances of honest business practices I experienced in the country. My wife would naturally make a beeline for the market. The wives of our friends and relatives would drop everything, discount their husband’s protests and accompany her shopping.
The other distinguishing feature of the city is the huge cantonment adjacent to the town. I do not mean to endorse it. It is just that it made a larger part of the city than army towns usually do. It did support the city economy, but the people resented it as a tool of neocolonialism. But for their huge presence, and ease of deployment, Baluchistan would have been much more successful in its struggle to get the evil Quad hegemons off its back Houses in military jurisdiction did offer more security, but the army had not yet got into real state business in a big way yet, so the scope of civilians living in the cantonment was limited.
After a few days in Quetta, we would drive to Ziarat, a hill station eighty miles away. Ziarat owes its name to a fable. The word means pilgrimage. The story goes that a daughter of a king of Afghanistan fell in love with saintly young man. The saint as their type was wont to do in those long forgotten days, did not welcome her advances. Incensed, she complained to her father that the man had made indecent suggestions to her. The king sent his soldiers to take him into custody. He tool shelter in a forest. The trees closed their ranks around the pious youth. Soldiers tried to smoke him out by putting the trees to fire. The earth split and they were sent to well deserved perdition.
The king when made aware of the incident called his errant daughter. She under the threat of royal spanking broke down and confessed her love. The king sent an emissary with a message that he would give his daughter’s hand to the young man and begged him to come to the palace. It was not exactly a remorseful move. He would earn public approbation and get rid of a trouble some female as well. But the trees with their precious refugee had moved away. The saint chose the middle of a bleak and desolate region for his final destination. That Ziarat is the only lush green area with hundreds of miles of parched desert around, lends credence to the story.
I had first visited Ziarat in 1958, before the depredations of deforestation. The town was full of trees of all kinds. One was believed to be five thousand years old. Right in the middle of the settlement was a thicket a few miles in circumference. Every house, tenement, hotel and building was hidden behind a curtain of nearly impenetrable profusion of trees.
At the time to was very difficult to get to the town. The track from Quetta, it was not even a mud road, forced the buses to stop several times to unload passengers as a full bus would not be able to pass over ditches and depressions. We came across a few mudslides as well. A distance of under sixty miles took aver six hours. But we arrived at the destination exhilarated though exhausted. Every thing was incredibly cheap Hotel “room” was if I remember correctly, five rupees a day (fifty cents at the then exchange rate). But for my financial situation, even that was too much. I shared the room with a friend.
We spent a few idyllic days, roaming around all day, hardly getting tired, eating at hotels housed in mud huts, drinking innumerable cups of green tea and gorging our selves with fruits of all kinds. Water was ice cold and very refreshing. A glass would rejuvenate as a beaker of blushful Hippocrene with out the intoxicating effect of the latter. It was quite chilly even in June. In the evening we would gather around coal fired heaters. The hotel would have huge samovars of tea, which you could help yourself from. But it was difficult to keep warm at night.
In 1984 the dirt track from Quetta had been replaced by a two lane macadamized road and it barely took two hours to get there. But all else had deteriorated. The area shared the general population explosion. Development had not kept pace with it. Ziarat used to get completely cut off during winter snowstorms. The inhabitants had to fell trees for fuel. Sui, with its huge gas deposits is only thirty miles away, but the terrain is hilly. That is the official reason Ziarat did not get a gas pipeline. I suspect the real reason was that the number of customers was small. The huge thicket had disappeared and had given way to ugly tin roofed hovels. Except for fruit orchards, the settlement was practically bare of trees.
The actual shrine is in a deep valley, which is very difficult of access. The drive was over a single track and hairy dirt road with acute bends, which hid the opposing traffic till it was upon you. It had high mountains on one side and a drop of a thousand feet on the other. You could walk down steep paths too. The paths to the shrine had mercifully been spared. Natives believed that the curse of the saint would visit them, if they cut the trees, which had walked hundreds of miles with the man of God. I hope they do not get enlightened.
We used to spend a few days in the hill station. We stayed in the government rest house, courtesy of the same TV news chief in Quetta. One year though we found our rooms occupied by army officers. My friend asked the district officer how could the officers take over the rooms booked for us. His laconic response was “the same way they have occupied the rest of the country". It was Zia’s martial law time. The all too brief holidays over, we would drive back to Karachi and the routine of life.
I was unable to drive in Karachi except in my immediate neighborhood and on holidays and Fridays when the traffic was thin. My wife who was locally trained would not hesitate getting in front of a speeding truck. The larger vehicle would invariably stop just short of our car, or I would not be writing this narrative!
.
.Inauguration of the Hospital and Aftermath

At the end of January 1989, the hospital, by common consent named Hill Park General Hospital, (HPGH) was ready for operation. We debated if we should have a formal opening ceremony or an open house and finally opted for the latter. The argument that won the day was that with freedom to come and go as they please, doctors, potential patients, Chief Medical officers of nationalized industries and neighbors would visit in larger numbers. Our hunch proved true. We had a stream of visitors through a full day. Late breakfast, lunch, afternoon tea and dinner were offered. And we had advertised the invitation by word of mouth alone.
We started looking for contracts from nationalized industries. I had treated many influential persons and they came in handy. Dr Aslam was as usual an invaluable help. Other partners chipped in with links, especially the Gynecologist Saeeda Rahman had close relations with Pakistan international Airlines. Akhtar Aziz exhibited rare facility in these negotiations. Over all we were fairly successful .
A contractor approached Akhtar and offered to provide nursing, sanitary, janitorial, security and “lower” staff. Our DA&F, a thoroughly nice person but not very shrewd, was enticed into making a deal with the street-smart crook. One morning I found the hospital abounding with men and women wielding all kinds of brooms and buckets. At the time only two patients constituted the entire in patient census of the hospital. I told the contractors that we did not need thirty sweepers for two inmates. Fawning, he assured me that Allah will look kindly on us, that hospital will be brimming with patients soon and I would need all the personnel. I told him I would wait for Allah’s benevolence to work through and to leave four persons. We will call them as necessary; in the meanwhile he was to send all but four away and forgot all about it. A few months down the line, the man presented me with a bill for half a million. I was flabbergasted. I demanded a proof of work done and a contract authorizing it. He produced a document with forged signature of the DA&F. I threw him out of my office.
A few days later the manager of the night shift called me that the contractor and his strong-arm men were harassing the staff. It was late in the evening. I went to the hospital and found a “law and order” situation and I called Akhtar. Another partner Saeeda Rahman happened to be on the premises. She called a senior naval officer friend. . He advised her to leave the hospital right away and he would send help. None arrived. Akhtar did shortly afterwards. We tried calling the police. They were all busy as BB was addressing a public meeting. In desperation, I called a friend of NSF days who was now head of the national airline union. He brought about two dozen enforcers, beat up the contractor and his men, and threw out their office furniture.
A few days later, I had a call from the local police station. The inspector was sending a jeep for us and wanted to discuss the situation. Saeeda Rahman and I went there. The police officer implied that very high police officers were friends with the contractor. The man somehow managed courtesy with menace. If we knew what was good for us we would pay up. He had good reason to believe that we did owe the money. He was not only doing his duty but was doing us a favor. We told him that we would get back to him. On return she called naval HQ. I do not know what transpired but she was very depressed. My guess is that the navy officer told her of his inability to do any thing.
The inspector took to calling us everyday. We were very nervous. Police are nasty in Pakistan, much more than in the west (even after 9/11), where there are some checks on their behavior. I recalled that a friend in Lahore, the very same Dr Rizvi of “dead student walks in.” fame, was very thick with police officers. His father had been a police Superintendent. The high and mighty in the department had been his family minions. I called him. He promised to contact his friends in Karachi police, called back with in the hour, and asked me to go to police headquarters the next day and see the Deputy inspector general- an eminence indeed.
It was my first visit to the imposing colonial building. It is constructed around a huge courtyard and is a walk up two-storied rectangular structure. I duly presented myself at the man’s office at the appointed time. As soon as he learned of my identity the man’s secretary greeted me effusively in Punjabi “Saheb thwada intizar karde pai nain”, the big chief is waiting for you and escorted me to the inner sanctum with the remark "Sir Ji Eai Dr Rizvi de yaar ain ". I was at a loss. If I spoke Urdu, the man might take it amiss. “Historic”* memory saved me.
The chief was equally ebullient. He greeted me with reassuring words. “Eai kera inspector ai je thwanu tang karda pya ai” . I replied. “ His name is so and so in charge of the station in our area. My English, which had a hint of British and a lot of American accent, worked as magic. I presume he had taken me for a member of his linguistic group. I knew the language, but disdained to speak it. Such is the level of inferiority complex even among the mighty in south Asia that my facility and preference for English pleased him no end. He said “we can’t have that’ rang the bell and asked his receptionist to get Superintendent (SP) so and so. He ordered tea for me too .
The SP arrived in a minute and the DIG pointing towards me told him, “aei sadde Rizvi de yaar nein. Eai kera inspector inuon tang karda pya ai”. The superintendent said “Sir Ji tusi fikar na karo, main unu vekh lende nai”. To me he said “tusi mere naal aao” I went with his “naal”, continuing to converse in English now with a more atrocious accent. In his office I found a collection of holy men in colorful sheets, all laden with beads of all kinds. I suppose the SP was cognizant of more intensive need of intercession with the Almighty.
In any event the SP called the inspector and swore at him in three languages.
When I arrived back at the hospital the inspector was waiting for me. He tearfully fell on my feet, pleading with me to take pity on his young children, wife and widowed mother. I had never been appealed to in this way before, but knew of the custom and haughtily told him that I did not even know that he was married, I had nothing against him and it was not necessary to wet my boots with his tears. He got up timidly, confessed that the contractor had gotten a DIG (traffic) to get him to be rude to us and was highly ashamed of the behavior. But I had gotten to a much more potent DIG, the one in charge of headquarter. His fate was in my hands. There was a vast difference in the authority of DIG traffic and the one I had approached. The traffic DIG was, moreover, an Urdu speaker. He could hurt only a traffic inspector, but not those in charge of police stations. DIG (HQ) on the other hand was a Punjabi and on the ascendant- he was soon promoted to IG rank- but even as DIG, he could transfer a station chief to a desk at the head office . He could even be dismissed in which event all the criminals he had apprehended would tear him from limb to limb.
It was getting to be like a scene from a B class Bollywood movie and a few onlookers had gathered around us. Their senses were titillated by the spectacle of a police inspector bowing and scraping in front of an ordinary mortal. I took him to my office where he apologized again.
The incident raised my stock to great heights. I only had to mention the man’s name to have policemen fawning on me. He also took to bringing all family and friends to me for treatment. To put a stamp of good will, as it were, he got his mother transferred from another hospital for me to operate on her fractured hip.
The contractor saga does not end here. I got a visit from an MQM don with a few gangsters in tow. His demeanor was deferential, but he insisted that I give the contractor half a million. I pointed out that the contract document was fraudulent. One of the thugs took offence at this statement stood up and expostulated “Doctor Sahib, if I snatch your glasses and smash them what would you do”? I said I could do nothing; only lament the low level the political party, which claimed to represent my interest, had stooped to, that they would allow a young man to threaten a venerable immigrant born into the language. That took the wind out of his sails. The don begged my pardon but continued to insist that I would be well advised to pay up.
A few days later, I got a very respectful letter from a member of the Sindh assembly. It was couched in very stylish, courtly and respectful language requesting me to honor his office with a visit the next day. The office was in a very unsavory area. I took the DA &F and another doctor with MQM connections with me. The assemblyman was holding court and pompously announced that the party stood for justice and fair play. He was arrogant and would not listen to us. We had to pay half a million, he told us. I told him that the contactor had brought thirty menials when the hospital had only four patients. That is as may be, the assemblyman responded, but a contract was a contract and ordered the contractor to present the “legal” papers. We told him that the signature of DA&F had been forged. He would not agree and with utmost courtesy reminded me of my obligations. His patience was wearing thin; rich no longer had the right to exploit the poor in Karachi We left promising to get back to him.
We left the “court” and held discussions with partners. They were all apprehensive.
We started getting threatening calls at home. MQM were known to be tough customers. Rumors of their torture cells were rife. Some children had been abducted too. We were very nervous. A brother of the number two man in the hierarchy-Azim Tariq-used to insist that I be woken up from my nap and would relate his dreams to me. They were bizarre. In one the prophet of Islam had received him. I am sure he was a psychiatric case, but that knowledge was not much help. DA&F got calls too. Our wives were very nervous. We were too.
Fortunately for us the doctor with MQM connection had operated upon the number two man in MQM hierarchy, Azim Tariq’s wife. He called his patient. The effect was dramatic. The assemblyman called me, apologized, and begged me to visit his office again and kick the B.., the adjective he now used for the contractor. We visited the office. The assemblyman cursed the contractor profusely. He should be hung upside down, and given eighty lashes . We forbore any comment and agreed to pay fifty thousand.
I must say the contractor was irrepressible. He filed a suit in a lower court. The judge was an ethnic Sindhi. One of my closest friends, an eye doctor Dr Saleh Memon was a very influential Sindhi. I called him. By now I was adept at the native way, and never took a step with out discovering connections. He sent word after a while that I had treated the high court registrar, a very powerful personage indeed in the ranks of the Judiciary. The registrar would visit me in the evening, and discuss the problem. The man assured me that he would take care of it. The lower court judge called me the next day. “ Bara (big) Sain called me. Sain, he went on, you write the judgment. I will sign it (
That was the curtains for the contractor.






Al-Shifa- Dewa Sharif Association -IPPNW
Pakistan Orthopedic Association

I have always been keen on organizations. I founded my Indian village (Dewa Sharif) association, and co-founded the Pakistan chapter of international physicians for prevention of nuclear war ( PPPNW). I also did volunteer work for a handicapped children’s association called Al-Shifa, funded by the national airlines I also served as Secretary general of Pakistan orthopedic association, wrote its byelaws (the original had been lost), and arranged regular monthly meetings.

Al-Shifa

Soon after arrival in Karachi, a friend told me of an organization called Al-Shifa, which had clinics for looking after handicapped children. It was sponsored by Pakistan Airlines. He had watched Zia preside over the inauguration of one of the facilities in a TV program . I called Al-Shifa. The president of the trust, wife of a senior retired Air Force officer who managed the organization, on hearing that I had recently returned after eighteen years in the UK, Canada and USA, welcomed me with open arms. I started consultation clinics there. With in a few weeks I realized that the advice I gave for corrective surgery was not available to the patients. They could not afford private care, and state hospitals were swamped with acute injuries. I proposed to the President that I would perform surgery pro bono, if the trust picked up hospital charges. She pleaded lack of funds.
This facility had air conditioned and well appointed offices, lavish lunches and dinners, chauffeured transport for officers, well paid and under worked physical therapists, but little money for patients in whose name they all had a good time. I was incensed. But unusually for me I did not adopt a path of confrontation. I wrote to the wife of the chairman of the trust, a lady who had trained as a nurse. She also had the good sense to marry an army officer who had risen to the rank of a major general. The man was at the time serving as the defense secretary and by virtue of the office, the boss of the national airlines as well. She asked to come to the next trust meeting and promised to see what she could do.
The President was rather taken aback to find me among those present, and looked at me askance. The General’s wife quelled her with a glance, and a word that she had invited me to present my case. I laid it on. We all liked the good life, but living it up in the name of the wretched of the earth was illegitimate. Advising the patients a treatment with full knowledge that they would never get it was unconscionable. The lady, as though she had only been waiting for my speech, glared at the President. The latter was rendered speechless. My host ordered her to finance surgical procedures and requested me to try to persuade the hospital owners to give discounted rates. She also withdrew the luxurious transport facilities the employees of the trust were enjoying.
That did not make me very popular. But they dare not flout the wife of the chairman. I did successfully appeal to the better nature of several hospital owners to admit the patients on nominal cost price charges and managed to carry the program for two years. Then the general retired from his job. An Air Marshal replaced him whose wife took over as the “working head” of Al-Shifa. She was not terribly interested in handicapped children, and was led by the nose by the officers of the charity. The Air marshal, in one of his rare appearances, did pay lip service to the work I had done. The program was discontinued soon afterwards.
In 1986, Al-Shifa offered to send me and the senior physical therapist , Mrs Pirzada a lady who was the wife of a one-time foreign minister of Pakistan, to Bombay to observe the facilities for treatment of handicapped children there. We visited a federal government facility first. The director of the facility was a typical bureaucrat. He had a lavish office, entertained us royally but lost interest as soon we asked him to show us around. He called an underling, who I am sure had instructions to get rid of us as soon he could with out appearing too uncivil. He made a perfunctory tour of the facility with us. Like all government run services elsewhere in south Asia, this place had more show than substance. I felt let down.
But the next day we visited a facility managed by a charitable organization supported only by public contributions. They did not have any government or semi-government funding and ran a fifty-bed hospital performing, on the average, thirty surgical procedures a week. It supported a fully functioning and well-equipped physical therapy department manned by dedicated technicians. An orthopedic workshop with facilities for making all kinds of aids to locomotion from simple splints to artificial limbs was on the premises was. It was an eye opener. On the average thirty quite complicated reconstructive surgical procedures a week were performed on the premises. An attached workshop fabricated all kinds of prosthesis, artificial limbs, wheelchairs, crutches and walkers etc. The administrative office was unpretentious. It had a few straight-backed chairs, two typewriters on sturdy tables made, I suspected, on the premises. The only concession to decoration was a desolate vase with some flowers picked from the patch of lawn in front.
The head of clinical service was a retired orthopedic surgeon, who had been the Professor and head of the orthopedic department of a famous Medical college. The lady was internationally known for her work on cerebral palsy, an affliction caused by deficient blood supply to the brain before or during birth . During the visit a gentleman rode into the facility on a bicycle .I thought he must be some kind of messenger. I was taken aback when he started participating in our discussions. He turned out to be a fully trained orthopedic surgeon. I couldn’t help contrasting what I saw there with conditions in Karachi. An orthopedic surgeon riding a bicycle to work would be laughed out of the town in Pakistan.
On the third day, we visited another non-government facility. This was housed in a six-storey building. Every floor had several cottage industries, printing, knitting, and carpentry, dress making, bookbinding, and electric equipment repair etc. You name it and it would be there. All workers were handicapped. One was even triplegic, that is paralyzed in three of the four limbs. The office in this facility was even more unassuming. The armrest of one of its chairs was broken. Tables looked even shabbier, and it did not even boast of a flower vase. The staff was simply dressed and out visit appeared to fluster them. My lady companion was very expensively and fashionably attired.
At the end of the visit I asked the charitable hospital management if they would be willing to train our Physical Therapists. They readily agreed, offered training at no charge and free lodging with cooking amenities as well. All we would have to do be to get them an airline ticket and money for food. On return to Karachi I broached the subject of training with the President of the trust. She demurred. We will need permission of higher ups. The federal minister of health at the time was a personal friend and an old NSF colleague. He visited Al-Shifa soon afterwards. I was sure he would tell the President to go ahead. But he apologized. He could send trainees to The UK or USA but India was off bounds. BB would have a fit. Her detractors had already accused of pro-India bias. I could go on a government financed training course. I reminded him of the cost difference He knew but shrugged his shoulders in a gesture of helplessness.
The contrast between Pakistani group and the Indian one couldn’t be greater.
Mrs. Pirzada was very well connected. She arranged a visit to a “film shoot” in which the delectable Rekha was acting. I was thrilled. Movies did not do her justice. She was more beautiful than she looked on the screen. She (my companion not Rekha, I wish it was her) took me shopping too. Fabric and handicraft was much cheaper than it was in Karachi. Food was less expensive too except in Chinese restaurants. Another aspect of Bombay I was struck by was the traffic. People, pedestrian and in vehicles, followed the traffic rules. Even the buses stopped behind each other. One time about mid night, my taxi driver sped through a red light. I asked him if he was from Karachi. He grinned and said “Saab , I had looked both ways”.
In 1988, Al-Shifa sponsored a visit for me, another Doctor and a few physical therapists to Bangkok. The occasion was an international conference on the management of handicapped children. But we were taken to only to a few token lectures and workshops and spent most of our time in dinners, boat trips, and at tourist sites. We were also treated to formal banquet and a stage show. This function was presided over by the younger daughter of the king, a girl about in her early twenties. For two hours she sat haughtily, with not even the hint of a smile on her face. All native persons presented to her, including our host of the evening the minister of health, would bow low to her and walk backwards! It was weird.
We made a day trip to the famous Patayya beach and ate lot of shrimp and lobster and guzzled Singha beer. It was delicious. Fortunately I did not know at the time that lobsters had high cholesterol content. Prostitution male and female was overt. They knocked at hotel doors. We were wary. HIV was quite common there even then. We were able to have a few meals on our own. Food and beer were incredibly cheep. A huge chicken rice dish was about two dollars. Shopping was oriental style. You haggled. One of my colleagues who had been to the city before, offered thirty Bhat (local currency, then less in value than Pakistani rupee.) for a shirt marked for two hundred. I was nervous, and reminded him that we were strangers in town and could get into trouble. He told me to keep quiet, and allow no expressions on my face; shopkeepers are adept at reading them. He and the shopkeeper both laughed good naturedly, and a deal was finally made for forty Bhat. Thai silk is famous; it was selling for two hundred Bhat a yard in a swank shop. I bought identical material a few shops down the road in a less opulent house for eighty Bhat a yard. Gold and silver plated cutlery and precious stones, rubies and emeralds were very cheap too.
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Pakistan Orthopedic Association

Among my other activities in Pakistan, I had become an active member of Pakistan Orthopedic Association. The body was moribund. Except for an annual event which was spent in dinners and politicking, they hardly had any meetings. They had even lost the constitution. I was elected Vice President, drafted a new constitution and had it passed in an annual meeting. The following year I was elected General Secretary and re instituted regular monthly meetings of the executive committee. I also managed to bring out a glossy but well written Magazine. The entrenched interests in POA felt threatened by this burst of activity. They tried to sabotage the work. At every meeting agents of the Professors, themselves Assistant Professors, tried to corner me. I told them to go lick the boots of their bosses, of course not in so many words
The professors, except for those in Karachi who were used to the belligerence of juniors, behaved like hegemons. They had inherited the supercilious manners of their British counter parts, with out the saving grace of academic and professional excellence of the latter. They spent little time on teaching, less on patient care and negligible on research . The crop of professors I came across in the eighties spent most of their time in private work. The academic sinecure was only to attract more patients. Confrontation was looming large. I had arranged to dismantle the opposition. They were saved by the bell. I left for the good old USA to practice in Bath NY, before the critical meeting I had arranged. My successor did manage to hold the fort for a while, but was handicapped by lack of political grounding and a busy practice

Dewa Sharif Association

The village organization was a pleasant affair. Soon after arrival in Karachi I had contacted all relatives, acquaintances and friends. We felt an acute need to with preserve at least some vestiges of our culture, modes and customs. I was surprised to find surprising resonance of the longing among my cousins who born in Pakistan had never seen Dewa. Rizwan Zaheer, a cousin I got very close to and I started contacting people who claimed a common heritage from our ancestral Qasbah. Nearly all reciprocated our sentiments.
I called a meeting over a weekend. It was held under a colorful Shamiana (described in the chapter on my earliest memories) in a park behind the house of one of the elders of the group. We had potluck dinner. I introduced the idea and concept behind the proposed venture. After a lively discussion, which included a good deal of nostalgia, we decided to found the association. I was elected the President and Rizwan became the General Secretary.
I contacted my lawyer and had byelaws drafted and approved and the association registered as a non-profit organization. We had biweekly lunches and an annual function.
We even attempted to develop a housing society where as many Dewa “Walahs” as we could persuade would live together in close proximity.
I moved back to the USA. Rizwan carried on till he immigrated to Canada. The Dewa association faded away.

I.P.P.N.W-Dehli Moot

In 1987 a delegation of International Physicians For Prevention Of Nuclear War (IPPNW), a Boston, USA based organization of which the Soviet Minister of health and an American physician were the Co-Presidents, visited Pakistan. Pakistan Medical Association gave them a formal welcome. We decided to form a chapter of the organization in Pakistan. Mahboob Ali was elected the President. I was elected the General Secretary. We held regular chapter meetings. IPPNW used to hold international meetings in various world Capitals. We sent delegations to Tokyo and Montreal, Canada meetings in successive years .I could not go to these moots, as I was very busy with construction and management of the hospital and my private practice.
I was, however, able to attend the Indian Chapter meeting in Dehli in 1990. Among our delegates was a lady physician. She was as is customary, laden with gold jewellery. The custom officer at Dehli airport was fascinated by all the gold. He weighed, and wrote a description of each item on a ledger and took a long time admiring them. When we finally we got out, I had missed the flight to Lucknow I had booked to visit my ancestral village. I hope they are better organized now, and behave less like innocents abroad. On my return journey, I came across the same customs officers. He recognized me and was very effusive. I cleared you when you came in. I said you took so long over the jewellery of one of my companions, that I missed my connecting flight. But, Sir she was carrying so much gold. Do you think so, I asked him? In Pakistan, we think a woman must be hard up to have only so little. He was not amused. I was being churlish, but I was very annoyed. I had not been back to my village since 1951.
A young Physician and his wife received us at the Airport. They took us to a restaurant for dinner. On the way to the restaurant and while there too, the young man kept on praising Muslim food, culture, customs and language etc. I thought he was lauding everything Muslim to please us. Eventually I felt he was rather overdoing it and told him that we were not that religious. With a twinkle in his eye he said that he was a great admirer of Muslims. His wife blushed deeply. It turned out that she was a Muslim.
We passed through practically deserted Dehli streets. The city was in the grip of upper-lower caste agitation instigated by right wing groups. The Government under PM V.P. Singh had decided to implement the affirmative action in favor of lower castes, ordained by a government committee several years ago. The “untouchable” castes had remained wretched in spite of being called “Hari Jans”-progeny of gods- by Gandhi Ji.
The situation calmed down the next day, and we were able to visit the red fort and Chandni chowk etc. The traffic was chaotic, but we used to the ways of Karachi, took it in our stride. People were very friendly. As soon they learnt that we were from Pakistan, they welcomed us even more. I took the opportunity of visiting a few surgical supply shops. You could buy instruments, screws and plates to fix broken bones, artificial hips and knees and other equipment at a fraction of the cost of what we had to pay in Pakistan. GOP would not allow direct import from India. The very same equipment came to Pakistan via Dubai, and the intermediaries duly added their profit.
Our Indian counterparts welcomed us hospitably. We had sessions and lunch in the parliament house. Just before the formal session started, a man in his thirties, with a cloth shopping bag in his hand, walked in. He proceeded to the dais, ascended the steps and approached the head table. I thought he must be a messenger. To my utter surprise he was placed in the seat of honor. He turned out to be the union Minister of Education. Pakistani rulers could take a lesson or two from Indian leaders. But the Pakistani big wigs, most of them political carpetbaggers or general/usurpers, try to gain a measure of legitimacy through ostentatious western outerwear. We heard the then PM V.P Singh of India and a former Sikh president of India, Zail Singh. The latter clad in a Shervani and Chooridar Pajama spoke eloquently on the need for peace, in chaste Urdu of the purest diction I have heard, lauded the prophet of Islam in glowing terms, and if one closed ones eyes, one could easily mistake him for a Muslim scholar. I was asked to co-chair a session. I made a highly critical, and under the circumstances, rather rash speech against Zia of Pakistan. I was apprehensive that I would get into trouble on return to Pakistan, and took care to ask my wife to call the US consulate. Fortunately no body took any notice. GOP was by then quite used to open and frank condemnation.
During a trip I started talking to a rickshaw driver. He turned out to be a Muslim. I asked him about the condition of his coreligionists in India. It was not so good, he replied but this after a pause, certainly better than of the immigrants who lived in Karachi!
One of our delegates had a childhood friend when both lived in Burma. This man was a member of an extremist Muslim hating group. But friendship is only a little less potent than a love affair, and certainly longer lasting in most cases. He took us around. We even visited the hunger strike camp of his leader. The leader received us very graciously, even posed for photographs with us, but visibly shrank back when we told him that we were from Pakistan. He must have regretted our pictures with him. I hope the papers published them with suitable captions.

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Stockholm

In 1991 I went to Stockholm for IPPNW annual meeting. Members of the host committee had very kindly arranged our stay in private houses. We were heartily welcomed by our hosts. My hosts were a university professor of music and his physical therapist wife. Both spoke good English. I was a little surprised by the facility of the general populace in the language till I learnt that English was taught as a second language in schools and literacy was 99%. A delegate from Philippines was staying with me. Our hosts gave us breakfast and dinner unless we were invited out. The professor even dropped us to the bus stop for the conference hall.
The weather was gloomy though. It was winter and quite cold. Sun rose, I think, at 11.00 am and set at 1.30 pm. People generally drank heavily. Their tolerance to alcohol was impressive, matched in my experience, only by the Scottish people. I did not come across any one losing control. We were routinely offered hard liquor at lunchtime! On the final day we were treated to a cultural evening with songs, dances, skits and general revelry. Alcohol flowed in abundance, but it was evening time.
The conference was well organized and the attendance was impressive. I met delegates from all over. General sessions were attended by several hundred delegates from practically all countries of the world and were treated to high oratory in different languages. I was designated Chair of the Israeli-Palestinian session. Israeli participants were all liberal left leaning people openly sympathetic to the Palestinian cause. Palestinians spoke of being Red-Indianised. With their numbers drastically dwindled they had been reduced to living in reservation. Israelis tried to put the best face on the situation. There was a lot of bitterness between the Palestinians and even the liberal Israelis.
Smaller caucuses followed. The American co chair met our delegation in an informal session. He tended to be rather condescending, an attitude I have encountered and resented among many liberal-progressives of the west. He spoke to us about the dangers of atomic warfare, how we could all be annihilitated and it was our bounden duty to assist the people in the west in their campaign to have the weapons outlawed. I was very annoyed and so were many of our companions. We told him that the problem of atomic weapons could not be taken or tackled in isolation. It was inextricably linked with colonialism and its new incarnation capital-imperialism. The term globalization was not in vogue yet. People in the west had to demolish their economic system before the governments would look after the general population. He retorted that a soviet minister was the o-chairman and he certainly was not a capitalist. We shot back that his was only a nominal presence; Americans who did nothing to change the lot of the poor in their own country controlled IPPNW. It was an unpleasant and acrimonious argument.
From Stockholm I flew on to Philadelphia to visit my eldest daughter Eram who was a student at the University of Pennsylvania. At the Stockholm airport though, the US security personnel gave me a hard time. Why did I attend an anti nuclear conference? Remember, it was long before 9/11, and the concept of civil rights and privacy had not been thrown over board. I told him that it was none of his business. That annoyed him visibly. He asked me if I had packed my bags myself. I said I had forgotten to bring my valet along. He advised me that he would be flying with me on the same plane to the USA. I invited him to come along with me when I paid a call to my congressman and complained about his officious behavior. That deflated him immediately. I did not come across the security man on the flight to Philadelphia. Mention of my congressman’s name had put the fear of god in him .
During the visit I availed of the opportunity to renew contacts with friends and acquaintances. I called my old Hospital in Bath NY. The CEO was out of town, but his secretary told me that my successor had left and would I like to come back. I did. She booked a flight for me for the following day. It felt like coming back home. I met most of the old crowd. The CEO offered the old practice back to me on enticing terms. I agreed to return. I was very unhappy in Pakistan and frightened out of my wits too, most of the time. A few well-known doctors had been kidnapped for ransom, and worse, one had his child abducted. Before the trip I had discussed the situation with a partner who was weighing anchor to go back to the USA. I told him that I had spent all my savings on the hospital. Who would want to kidnap me? He, more worldly wise, told me that kidnappers would not know that. They will look at the hospital, come to the very reasonable conclusion that you were loaded. It would be worse. You would not have the wherewithal to meet their expectations. That convinced me all right.
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