Karachi’s Medical Tower at JPMC

A 14 storey medical tower is being inaugurated at JPMC, which will house fully-equipped operation theatres, surgical and general wards, with 2000 beds, and complete diagnostic facilities under one roof.

Over the years, extensive usage has diminished the strenght and quality of the medical facilities at JPMC and there is a dire need of new infrastructure there. However, not everyone is jubilant about this project. (As people in pakistan are expected to be no doubt).

This part i find really interesting, enough to be annoying actually. A group of ‘medical experts’ from Pakistan Medical Assocaition, object to the building of the new tower on the basis of “health sector in Pakistan [being] completely devoid of any preventive strategies”. How does preventive medicine relate to clinical medicine, i do not know, maybe some of the readers can enlighten us on the subject. All i can think of is they’re opposing because they did not get kickbacks?

What remains to be seen is, will the new tower function within the same cost structure and subsidies by the govt, and not turn treatment here into a expensive proposition.

17 Comments so far

  1. MB (unregistered) on February 23rd, 2007 @ 1:00 pm

    Three cheers to all the responsible ones. well done, keep it up. PMA should come up with technical objections, if any.


  2. Ramla A. (unregistered) on February 23rd, 2007 @ 2:26 pm

    Mansoor, I wanted to congratulate you and KMB for the recent eclectic flavor of the blogs – but I am interrupted by this post.

    I don’t understand: if everyone has a right to opinion, why is that right not awarded to reasonable, sound criticism? It’s rather manipulative to call any criticism “criticism for criticism’s sake.”

    Mansoor, how could you not know about an issue and allege someone of wanting kickbacks? Do you work with the medical sector? Do you know about the issue of preventive health-care? Why should a person who spends their life in this profession, expressing a concern which actually happens to be quite valid, be not only brushed aside by their medical fraternity as nit-pickers BUT be accused of wanting bribery by the uninformed public? In the same breath, the accusation also implied that someone IS getting kickbacks from the medical complex, i.e. the ones who favor it.

    First, this is NOT responsible journalism on a well-read blog.

    Second, please research an issue you are writing about. Preventive medicine is not hogwash. Preventive medicine is a de facto way of thinking about health-care that is taking such strong roots worldwide, it’s threatened the Big Pharma.

    Open recent economic and other magazines. They are all taking about a shift in health-care management which is actually being resisted by the powers-that-be. You may refer to Tom Peters’ blog feed on health-care to learn about contemporary thinking on health-care management (HCm).

    The critical professionals haven’t presented a great solution either- they ought to realize practical HCM steps have to be taken… they aren’t presenting a work-able solution. But they are saying something important, valid, and critical. Perhaps they could generate a solution if given a chance. Bottom-line: this voice has to be heard.

    In this case, the building ought to be redesigned if it’s collapsing, but the economic situation of the patients and the design of HCM services has to be factored in.

    Ask any architect, that’s the basic of constructing a building: what will it be used for? Who will use it? How will it be used?

    It’s too big an issue to be written about in such off-handed manner both by the paper and the blog.


  3. Ramla A. (unregistered) on February 23rd, 2007 @ 2:29 pm

    Preventive medicine is cheaper. And there is something very rotten about the way people are designed to think about disease, illness, and cure.

    Guess what the contemporary thinking is? Western-styled HCM is OUT! Eastern-styled low-cost HCM, preventive medicine, and basic healthy, responsible living is in.

    We can’t afford the pro-disease mentality and the lifestyle of the heart- and stomach-disease ridden!

    These critics are saying something that matters; yet they ought to be challenged to design a workable solution rather than look up to the unwilling to do it.


  4. Ramla A. (unregistered) on February 23rd, 2007 @ 2:40 pm

    Having said that – you have written some very interesting and entertaining stuff recently. I love posts by you and Jam.

    I really like the lyrical subjects you use – the one about Phantom of the Mortuary was really cool. Spring is upon the blog! Very lively of late.

    Just don’t get into this “I gotta do good by calling society bad” generalist writing; it’s not been getting a great response by readers. Generalized judgments are typical, boring, and uninformed. Sorry!

    Your strong point are humorous twists and thoughtful pieces on urban issues. We love it when you simply the scary police for us and make things human. Your humanity is puffy-puff adorable. That’s it; that’s your strength.


  5. Ramla A. (unregistered) on February 23rd, 2007 @ 2:43 pm

    *simplify the scary police

    –excuse the bandwidth hogging. I am off to American Idol’s results of the week. You can tell Simon Cowell was on my mind. :)


  6. Behan hay chutia (unregistered) on February 23rd, 2007 @ 3:18 pm

    How much money should you borrow?

    MONEY TALK

    Andrew Montlake

    Partner, Cobalt Capital

    When you apply for a mortgage or remortgage, many lenders will calculate the size of loan they offer you by multiplying your income by a set amount.

    Andrew Montlake

    These days you can borrow more, says Andrew Montlake

    If you’re applying for a mortgage on your own, for instance, they will usually lend around 3 to 3.5 times your gross annual income – hence the ‘multiple’ bit.

    If, on the other hand, you’re applying for a mortgage with someone else, they’ll typically lend either 2.5 times your joint income, or 3 times the larger income plus 1 times the second income.

    So, by way of example, if you earn ¬£50,000 a year and your partner takes home ¬£30,000 annually, and you’re applying for a mortgage on a joint basis, many lenders will offer you in the region of either ¬£200,000 (2.5 times ¬£80,000) or ¬£180,000 (3 times ¬£50,000 + ¬£30,000).

    Basic earnings

    It’s worth pointing out that gross annual income is generally deemed to be your basic salary plus any guaranteed bonuses.

    For many people, this is perfectly acceptable as they earn a basic salary only and have no bonuses or commission to take into account.

    However some people earn a low basic salary but actually earn double or triple that amount via commission that is not guaranteed (let’s say you’re an estate agent, recruitment consultant, or work in advertising sales).

    Income multiples clearly work against them, as lenders will often only look at the guaranteed chunk of their income.

    Higher and higher

    In recent years there has been a clear trend towards higher multiples, in some cases as much as 7.5 times annual salary (although 4 to 5 times salary is more common).

    Lenders are currently offering larger multiples

    This is mainly because interest rates, since the late nineties, have been consistently low and much less volatile.

    In short, lenders feel the threat of borrowers being overstretched by sudden interest rate rises is significantly lower these days.

    So they are happy to lend more than they would have done 10-15 years ago when interest rates were higher and the climate less stable.

    Of course, low interest rates also mean mortgages are cheaper to repay, meaning there is less chance of borrowers defaulting, even on bigger loans.

    The availability of longer fixed rate periods, from five to sometimes 25 years, is another reason why lenders are currently offering larger multiples, as there can be no ugly surprises for borrowers in the form of sharp increases in their repayments.

    What sort of job?

    In some cases, the type of employment you are in can also result in a bigger loan offer.

    For example, if the lender feels the borrower has strong future earnings potential or will not struggle with the repayments because they are in very secure employment, they will tend to be more ‘generous’ with their multiples.

    Doctors, accountants and solicitors fall into this category.

    Lenders may also offer a higher multiple if the borrower puts down a bigger deposit, as they are seen as less of a risk.

    However, consumer bodies stress that borrowers should always be extremely cautious when considering higher multiples because the repayments, relative to net monthly income, can be sizeable.

    And if interest rates rise, the repayments will too if you’ve opted for a variable rate mortgage.

    Thing of the past

    Over the past few years, some of the big lenders have started to turn their backs on income multiples, which they see as crude and simplistic.

    Income multiples will soon be a “thing of the past”

    Instead, they are using a new criterion called ‘affordability’.

    This is considered to be a far more sophisticated and responsible approach to mortgage lending.

    One high street lender even went so far recently as to announce that income multiples will soon be a “thing of the past”.

    Rather than apply a multiple to the applicant’s gross annual salary, it sets out to determine the disposable income the applicant will have after all the other essential monthly spends and outgoings.

    For example, as well as loan commitments, the lender will look at other areas of essential spending such as:

    * travel and transport costs.

    * food budgets.

    * council tax.

    * insurance premiums.

    * monthly credit card bills.

    * whether you have children living with you (with all the associated costs!).

    * the different types of household bills you are liable to pay.

    With this knowledge, the lender gets a far clearer picture of what applicants can realistically afford to spend on repayments each month.

    Overtime and bonuses

    More positively, lenders may also take into account any regular overtime and commissions, even if not ‘guaranteed’ (a collective sigh of relief from all advertising sales executives).

    What if someone has a gross annual salary of £30,000, but has, say, £5,000 in credit card debts, spends £250 a month on loan repayments and £100 a month on travel costs?

    That person would be offered a smaller mortgage than an applicant with the same salary but no debts and travel costs.

    In this sense, it’s clear that people without debt will benefit most from the affordability-based approach, particularly if they are single with no dependants.

    In many cases, they will be able to secure a mortgage far bigger than they would have using the income multiples system, allowing them to buy homes previously beyond their price range.

    Of course, other people, for example, a derivatives trader with a hefty basic salary but equally hefty outgoings (think Ferraris, Chateau Petrus and Bachelor pads) would be better off with the traditional income multiple approach.

    To each his own!

    The opinions expressed are those of the author and are not held by the BBC unless specifically stated. The material is for general information only and does not constitute investment, tax, legal or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.


  7. Faisal (unregistered) on February 23rd, 2007 @ 3:38 pm

    Whats going on ??? Is this blog no longer monitored ?


  8. mansoor (unregistered) on February 23rd, 2007 @ 5:04 pm

    ramla: thankyou for your opinions/comment(s). This is excatly what i wanted to know about. The importance of preventive medicine. However.. there are still scores of people who are sick and who need access to better medical facilities. My reason for thinking the senior members of PMA was not their wanting preventive medicine, but the fact that they wanted it in PLACE of clinical one.

    Preventive medicine is a way of life.. but not a replacement for clinical one. People *will* get sick, that is a reality of life, no matter how careful they are or how safe they try to be.

    Plus, everyone’s been screaming we need better medical facilities here anyway.. and when they get it, instead of accepting it they would rather look it in the mouth?

    faisal: those three had slipped through. Dont worry.. they’ve been caught and junked appropriately.


  9. Nouman Alvi (unregistered) on February 24th, 2007 @ 4:13 pm

    Having a mother who spent her life time working at Jinnah ( JPMC), having lived in the doctors’ colony and offocurse having worked at JPMC……my two cents worth is as follows:

    I think this mighty mother of all towers or whatever utopian title being granted to these monostries, is going to be THE joke of the next decade.

    I kid you not , but JPMC has perhaps the highest patient’s mortality rates in the region.Health care is NOT provided by building, there is much more to it….(time and place not suitable for that discussion)

    Its going to be another exercise where contractors and directors will make their millions and offer their ritual umrahs and hajjs on haraam kee kamai.

    Imagine somebody planning to build the corporate headquarter of CitiBank in Orangi Town , then the same chap puts all his eggs in one basket and opens a starbucks outlet in the midst of essa nagri …..take a quantifiable measure of his craziness, multiply that exponentially………thats how stupid is the plan to build these medical towers at JPMC.


  10. Ramla A. (unregistered) on February 24th, 2007 @ 9:47 pm

    Mansoor:

    The issue is that these are things that require STRATEGIC thinking. One can’t come to a turn on the road and realize, Oh we’ve been on the wrong road all along.

    In the case of our country, we are too feudal in our thinking. A single school of thought takes a decision completely ignoring the other voices. Usually, this reigning school also happens to be one that takes no real stock of the situation – influenced rather by imported or fanciful ideas. You know what I mean.

    This was just one piece of news at a point in time. I am sure the dissident pros have been thinking on their lines since a long time, and probably not given importance. If my opinion were to be heard, I’d challenge the DISSIDENTS to take action by working out a plan of how THEIR idea would work.

    After all, history has always been created by those challenged the norm AND created their own path. Pretty much how the Indian HCM sector has done: they are simply making Indian medicine (based on theories of yoga and natural health-care) understandable, accessible, and well-marketed.


  11. omar r. quraishi (unregistered) on February 25th, 2007 @ 2:39 pm

    well said ramla


  12. mansoor (unregistered) on February 25th, 2007 @ 2:58 pm

    ramla: quite right.. u’ve just made the argument i’ve made myself on quite a few occasions, but after a few hundred times.. you come across one fact.

    When you challenge people here on telling you ‘how would you make it better?’, their response usually lies in the realms of “i dont know, only this is just wrong” or “i cant do it, its the govt’s job” or my personal favourite.. “its not my responsiblity!”

    what then can you expect of people?


  13. Ramla A. (unregistered) on February 25th, 2007 @ 5:34 pm

    Omar: Thanks :)

    Mansoor: Well, we are all tired with the status quo. So my private solution is this: VALIDATE the “other” voice by listening to it. Create an unusual conversation. Sometimes, people can do wonders if faith is invested in them. We all need that.

    The trouble with good souls in this world is that they are not getting support from amongst themselves.

    So this is what I attempt to do: I withdraw my faith and support from where I think it doesn’t belong, and I give it to those who need it most. [:)] Can’t change the world, but hope to only invest my energy where it’s right! Who knows what difference one little seed sown makes!?


  14. Ramla A. (unregistered) on February 25th, 2007 @ 5:40 pm

    On a more practical note, what I’d do is to approach the dissidents, and explore their thoughts in detail.

    Omar, does the idea interest you? There may be a story here.


  15. Nouman Alvi (unregistered) on February 26th, 2007 @ 5:07 pm

    I think , its being suggested here that people like myself dont offer any positive alternative when asked for? I may be wrong but if indeed thats being insinuated? ….I will tell you what I did…….I SURVIVED , jumped the sinking rather stinking boat and left the system to its inevitable and equally natural pathetic abysmal evantuality .

    We live in a fish bowl of ludicrous contrasts.We have been churning medical graduates from the commmercial medical degree sweat shops like there is no tomorrow. Instead of having an army of nurses, para medics, physiotherapists, speech therapist,nutritionists, mid wives, dispensers ………we have focussed on mass production of medical graduates. Not surpringly people with the aid of either quota system and political might have entered the field who probably were not fit enough to be mortuary attendants.

    The market forces and higher powers that be ( offocurse of single digit intelligence quotient) have got no planning acumen let alone ability to lead.

    In government where you would not even find oxygen ,palstic gloves, dustbins or clean sheets…the talk of a ‘ elite 15 floor medical tower’ is lierally a major stage for making us the laughing stock of any scrutiny.

    But again , I am not surprised, any starving nation which gifts her semi-literate cricket players a million rupee grants for some sport……deserves the kind of health establishment which see today.


  16. Ramla A. (unregistered) on February 26th, 2007 @ 7:14 pm

    Nouman,

    Ready agreement with your statement about the ridiculous gifts to cricketers… I was upset when Muhammad Yousuf was given I dunno how many millions of bucks. Rich or poor – what kind of nation just give out taxpayers’ money to sports-people like that? Very true you are.

    Also you have a strong point about the lack of strategic planning and the completely idiotic policies. I only went into a medical school once or twice and decided that I am *not* going to buy any services from the kind of people I saw there – no offense, but people who don’t have basic courtesy and manners have no RIGHT to be a doctor.

    Now the question remains: now what?

    It’s easy to have intellectual disagreement, it’s another thing to WORK OUT A SOLUTION. Theoretically everybody knows the solution. That’s not the point; one’s got to work it out.


  17. atif abdul rahman (unregistered) on March 1st, 2007 @ 3:10 am

    karachi kay senators, mayors aur activists aaj kal building-building khail rahay hain.
    chalo acha hai, kuch to kar rahay hain.



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