Hemophilia Care of Pakistan

Pakistan 3: “82 patients, 82 stories.”

Laurie Kelley greeted with flowers
On Wednesday,
December 6, 2017, day 11 of my 14 day trip, we met with Imran Zia. With me were Masood Fareed Malik, president
of the Lahore Chapter of the Pakistan Hemophilia Patient Welfare Society
(PHPWS) and Raul Ahmed, who has hemophilia and is our main liaison for Save One
Life in Lahore. The day was sunny and cool, perfect for visiting. Rauf and
Masood picked me up at the hotel and after only a 20-minute drive we arrived. We wiggled the
car down a narrow street that was decorated with dangling shimmering streamers celebrating
the Prophet’s birthday.
Imran Zia and Laurie Kelley
Imran is president and founder of Hemophilia Care of Pakistan, a charitable
organization that helps people with hemophilia. Why does this exist when there
is the Lahore Chapter just 20 minutes away? Good question. The World Federation
of Hemophilia does not recognize two organizations in one country, which means
HCP is not eligible for any of their resources.
I was
excited because it had been 19 years since I’ve seen Imran! I first met him in 1999, when he was just a 24-year-old with hemophilia. He was very quiet, under the tutelage of Dr. Shahla, who founded the chapter. I still have
an image in my mind of him sitting quietly behind her, as she presented
the chapter and all their work. I asked the boys around her to identify
themselves so I could know them. Who would ever have guessed that a few years
later this quiet 24-year-old with a degree in IT would start his own hemophilia
nonprofit and help so many patients?

See complete Pakistan Trip gallery here.

Mother clutching vial of factor
Imran stood
on the street corner, dressed in modest grey garb, flecks of gray streaking his
hair. He was and is serious, focused and professional. He extended his hand in
greeting. I hope I greeted him warmly, because I was truly happy to see him. I
learned that he and Rauf knew one another as little children at Fatimid, where they
used to go for FFP infusions! We stepped into the narrow hallway, where some families
waited patiently for us on a bench. A six year old in a warm knit cap extended
flowers to me and I knelt down to take them and smile at him.
Imran infusing girl with VWD
Care of Pakistan exists in a one room office, attached to the Zia family home.
In it is a desk, two benches, a coffee table, fridge for factor, and shelves
which held all sorts of documents and reading material, including very detailed
infusion logs, certified by the hematologist; I was impressed. Imran has
existed really on his own for the past 15 years, assisting families who live in
Lahore, but also those who live very far away. He has made trips to visit them
in their homes up in the mountains, something I truly admire and would like to
do myself.
Was there
any chance he would merge his organization into the Lahore Chapter? Imran, I
learned very quickly, would never join PHPWS. He likes working independently,
has funds from somewhere as he volunteers full time, while having a family to
care for. And he clearly has a model that works.
One by one,
Imran introduced the patients and families to us. “We have 82 patients,” he
told us, “and 82 stories.”
We met Ayesha first, who was wearing a red dress and a very mischevious smile. She is very thin, age 11. She has VWD
type 1 but has joint damage. Her brother Muhamma, was not present, and needs a
circumcision for cultural reasons. Circumcisions are the norm in the Muslim
faith, as in the Jewish faith, and here, not to have one means you are like a
social outcast. It will also worsen your chances of being married, as arranged
marriages are also still the norm. I felt the mother’s concern and knew it
wouldn’t use much factor. Just this small operation could change the boy’s
self-esteem and improve his lot in life. Strange but true! We pledged to help
get the factor for him somehow.
Then came
the boys. Shumail Nadim, wearing a maroon jacket– a handsome son-of-a-gun with a
ready smile, hemophilia A. His brother Usama, age 15, wearing beige jacket,
also handsome with a wide and easy smile. Saleem, hemophilia B, age 11, a
confident, charming kid. His brother Amir, age 6, the one who gave me flowers.
And Awair,
so handsome, with a face like a child movie star—we dubbed him “Tom Cruise” for
his fair complexion and jet black hair. Age 11, he speaks a little English. He
had Volkman’s contracture once, and a right calf contracture. Imran showed us
the before and after photos. He has two brothers without hemophilia. His father
is a bicycle tube repairman, who earns about $150 a month, which is very poor.
Imran said
that 70% of Pakistanis live below the poverty line and all his patients were
very poor.
Two things
make his organization a stand out: 1) Imran provides very personalized care. He
visits with patients in their homes, oversees their infusions and rehabs. He visits
them in the hospital even. He feels that he does this better than anyone. 2) He
provides factor to patients for them to keep at home, and has taught them home
This is revolutionary. I’m in favor of home treatment in developing countries, especially for
those who live long distances from the HTC. On Facebook, everyone knows a few
select people from Pakistan who keep pleading for factor. Factor is available
thanks to the Bioverativ/WFH donation, but only in the major cities. If you live three-six hours away,
you are expected to travel all that distance, even with a bleed, to come and
get it. Impossible! Imran has found a solution by sourcing his own factor
(Project SHARE has helped in the past) and shipping to families who live in
remote areas. Kudos to him! This is where being independent has helped patients.
Laurie Kelley with Amir
But his patients
may miss out on other things when not registered with the Lahore Chapter:
meetings, educational symposia, access to more medical experts. Imran has a
medical team that works with him, and they seem to work well together, and they
have expertise in hemophilia.
Abid and his father: worried about their future
Finally we
met the saddest case of all: Abid Anwar, age 28. Thin, quiet, with hemophilia A
severe. Imran only met him a year ago. He’s had seven surgeries. Imran claims
that the doctors didn’t follow up and the wound suppurated, and is still
oozing. The father, present, sold his ancestral agricultural land for $25,000,
an absolute fortune here—all the
money he and his family ever owned and would ever own– so they could pay off
the hospital debts. They are now desperately poor. They have 4 sisters and
another brother. They live hours from Lahore.
This case
really disturbed me. This is exactly what we don’t want to have happen; patients threatening their entire family
system just to pay for factor that is readily available and medical services!
My heart broke. The look on the father’s face… worry, fear, hollow eyes that look to the future with no certainty. What can be done to
help? If we get him $25,000 he can get his land back, and the entire family
(in-laws, parents, children, even children yet to be born) will survive.
One solution
was to enroll Imran’s members into Save One Life which will help ease some of
their poverty. While we questioned whether we could do this, because the Lahore
Chapter is already enrolled, I was delighted when I returned home to learn that we could
do this! Soon, we will have more Pakistani children as part of the Save One
Life family.
We finished our
visit with a delicious lunch of roti (bread), rice and meat. I met with Imran’s
family, his mother, sister and sister-in-law. All educated, English-speaking,
and wonderful hosts. The Pakistani culture is incredible: every visitor is
treated like family, but honored like royalty. The world could learn a lot in
civility from a visit to a Pakistani home, rich or poor.

Laurie with Imran’s mother
While they
treated me so well, I hope to return the favor by bringing more factor and funds,
no matter which organization we worked with. We said good bye to Imran: six
hours had flown by. I know it won’t be 19 years till we meet again—I don’t have
that much time here on earth. I vowed to return next year, and to see the faces
today as beneficiaries of Save One Life.

Visit gallery of Pakistan photos here.

Imran and the HCP families
Blood brothers: Imran, Masood and Rauf
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