The doctor who built Pakistan's largest free hospital

A blood bank run by second-year students

The episode opens with Muzamil asking Dr. Abdul Bari Khan to trace the journey from school to the work that has defined his life. What emerges is not a straight line but a series of crises that each demanded a response.

Dr. Khan studied at Springfield School, then Adamjee Science College, then Dow Medical College — the standard path for a high-achieving student in Karachi at the time. “Hamara bhi itna insaniyat khismat karenge,” he says with a laugh, explaining that in his generation there were really only two choices: medicine if your maths was weak, engineering if it was strong. He had already decided he wanted to be a cardiac surgeon.

What he found at Dow, attached to Civil Hospital, was a public tertiary care system under enormous strain. Patients arrived from across Sindh and beyond, having sold livestock or property to make the journey. Mothers and fathers, he recalls, would sometimes say in front of him that they would rather let a child die than continue spending money they did not have.

In 1980, as a first-year student, Dr. Khan joined a small patient welfare organisation that supplied medicines and blood to two or three patients per ward. The blood supply at the time came entirely from professional donors — drug addicts who sold their blood twice a week, whose samples carried hepatitis, HIV, malaria, and syphilis, and whose haemoglobin was so depleted the transfusions were barely useful. In 1981, those donors went on strike for higher pay. The crisis, Dr. Khan says, turned out to be a blessing. “We said, we can’t be hostage to these people. Let’s make our own blood bank.”

He was made project director of that blood bank in 1982, while still a second-year medical student. By 1984 he had travelled to Germany, brought back a cryofuge machine for component separation, and trained doctors in its use. The blood bank that started with one voluntary donation on a good day — “jis din do aate the, hum party karte the” — now processes 275 to 280 units per day, with professional donors eliminated entirely.

The 1986 bomb blast and a dream spoken aloud

When Dr. Khan graduated, Karachi experienced its first terrorist attack: a bomb blast in Bori Bazaar. Hundreds were killed, thousands injured. He was doing his house job and helped pull the wounded from the rubble at Civil Hospital’s casualty department, which was overwhelmed and under-equipped.

Two things struck him that day. The first was the sight of people standing in mile-long queues outside the casualty ward, waiting to donate blood — the same public that had previously refused. The second was the sight of ordinary citizens standing with trays of cash, asking which medicines were needed. “Woh hausla diya aapko,” he says.

The response was to raise funds for a new, hundred-bed state-of-the-art emergency department. The budget was 36 lakh rupees. To raise it, Dr. Khan and his colleagues went into schools with carousel slide presentations of the blast — dead bodies, fire, chaos — and gave children collection boxes. Twenty-four of the thirty-six lakh rupees came from those children, three lakh of it in coins.

The night before the inauguration, standing outside with friends as the board was being put up, Dr. Khan made a promise. “Maine apne doston ko kaha: Allah ne mauka diya to inshallah, ek aisa hospital banayenge jo quality care karega, free of cost karega, aur koi birakrati nahi hogi.” The dream, he says, was spoken in 1987. It would take another twenty years to realise.

Cardiac surgery at Civil Hospital, funded by one man

After graduating, Dr. Khan trained in cardiac surgery at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, where the waiting list was three years long and he knew that more than half the patients on it would not survive to their appointment. Within months, he had raised three to six crore rupees from personal contacts to add two operating theatres and double the ICU. The waiting list fell to six months.

He turned down an offer to join Aga Khan Hospital — where a colleague had moved and was building a cardiac surgery programme — because he had made a commitment to start cardiac surgery at Civil Hospital, in the public sector, free of cost. “Chance to lunga,” he told the colleague who warned him it would be difficult. He kept that commitment. Today, he says, more than nine lakh operations have been performed there.

The fundraising in those years was entirely personal. There was no organisation, no social media, no infrastructure. One critical donor — a jewellery manufacturer — came close to backing out, arguing that his children might not continue the work after his death. Dr. Khan’s response was characteristically direct: he told the man his children had exactly three options. They would either honour his legacy, or Allah would give them a hundred times more and they would give a hundred times more, or Allah would take back what he had given and find someone else to carry the work forward. “Koi bhi option ho, kaam chalega.” The man wrote a cheque for ten crore rupees in twenty minutes.

Building Indus Hospital from a half-finished structure in Korangi

In 2004, Dr. Khan gathered his friends — all now post-graduates — after Fajr prayers and told them the time had come to realise the 1987 dream. A foundation was registered under the name Rafaida Foundation. They found a site in Korangi: twenty acres that had been acquired in the late 1980s by a Pakistani doctor based in Abu Dhabi who had wanted to build an Islamic Mission Hospital. The structure was at ground-floor level, complete but unfinished. The doctor had left after firing on his house in 1992 as Karachi’s security situation deteriorated. It took a year to convince him to hand the project over.

Work began in 2005. A contractor was hired and told to start demolition and send bills immediately, so that Dr. Khan would have something concrete to show donors. When an earthquake struck in October 2005, the entire team relocated to the affected areas for a year, running a field hospital in containers. They returned in October 2006. Indus Hospital opened in Karachi with 150 beds in 2007.

“99.99% logon ne yahi kaha tha: yeh chal nahi sakega. Aap ko paise lene padenge.” Some gave it a month. Some gave it six months. Some gave it a year. Muzamil notes the significance: “Aaj hum pandrahwe saal mein dakhil ho chuke hain. Kisi ek mareez ko paise na hone ki wajah se wapas nahi bheja gaya.”

Fourteen hospitals, 34 billion rupees, and no cash counter

Later in the discussion, Dr. Khan lays out the scale of what has been built. From one hospital with 150 beds and a ten-crore-rupee budget, Indus Hospital and Health Network now runs 14 hospitals across Pakistan — in Karachi, Badin, Muzaffargarh, five locations in Lahore, Multan, and others — plus four rehabilitation centres, four blood centres, and public health programmes in 51 districts covering TB, malaria, community health, mobile clinics, and a boat clinic on the Indus River in Southern Punjab, where, Dr. Khan says, communities had not seen a doctor in seventy years. “Pehli dafaa satttar saal mein unhon ne doctor ki shakl dekhi hai.”

The network employs more than ten thousand people and serves 4.5 to 5 lakh patients every month. The annual operating budget is 34 billion rupees. “Yeh main sirf opex ki baat kar raha hoon. Capex alag hai, expansion alag hai.”

There is no cash counter anywhere in the network. Government hospitals in the network are funded by the respective provincial governments; everything else runs on donations, zakat, and international charitable registrations in the UK, US, Australia, Canada, UAE, Switzerland, and soon Germany. When Muzamil asks about the source of that funding, Dr. Khan’s answer is pointed: “Is budget ka 90% Pakistan se raise hota hai aur 10% aap se hota hai” — addressed to diaspora audiences. “Kam se kam yeh to kar lo ke fifty-fifty ki baat kar lo yaar.”

The hospital is also entirely paperless, running on a hospital management information system built in-house. Dr. Khan’s first hires were software engineers, whom he locked in a room with doctors and told them to build exactly what the clinicians needed. “Doctor-friendly hai, woh khud chalate hain.”

Why Pakistan’s healthcare is among the worst in the world

Muzamil asks directly: given that some of the world’s best doctors come from Pakistan, why has the country failed to build a healthcare system that improves year on year?

Dr. Khan’s answer is blunt. “Ek priority nahi rakhi humne health ko.” Pakistan allocates between 0.6% and 1.2% of GDP to health — among the lowest in the world. The infrastructure exists on paper: lady health workers, basic health units, rural health centres, district headquarters hospitals, teaching hospitals. But the pyramid is not functioning. A patient who should be seen at a BHU ends up at a tertiary care hospital because the lower tiers are not resourced or accountable.

The deeper problem, he argues, is that the people who make decisions stopped using public services. “Agar hamare arbab ek taraf apne bachon ka ilaaj aur apne bachon ki taleem public sector mein galat the, to aaj yeh haal nahi hota.” When elites withdrew, the incentive to maintain quality withdrew with them.

He draws a contrast with Sweden: when the Mughal emperor Shah Jahan’s wife died in childbirth, he built the Taj Mahal. When the Swedish king’s wife died in childbirth at the same time, he built a free school of midwifery. Sweden’s maternal mortality today is near zero per 100,000. Pakistan’s is 250 to 400. “Ek aadmi ka visionary faisla poore nation ko badal deta hai.”

The fix, Dr. Khan says, requires paying doctors enough to live decently — he calculated in 2007 that a consultant needed roughly two lakh rupees a month to afford a house, a car, and school fees — and moving to hospital-based hiring rather than centralised transfers. “Health secretary koi strategy kaam hi nahi kar sakta. Woh posting transfer hi kar raha hota hai.” As long as a politician can call and move a doctor from one city to another, accountability is impossible.

The inverted pyramid: prevention as the real return on investment

By the end of the conversation, Dr. Khan has arrived at what he considers the most important structural insight from fifteen years of running Indus Hospital. Data from the network’s research centre showed that 70% of patients arriving at the hospital needed primary care, not tertiary intervention. “Why should he come to hospital? Hum free to kar rahe hain lekin woh jahan se uthkar aa raha hai utna paisa to uske mohalle ke doctor se kara leta wahan ho jaata uska.”

The data also revealed specific, preventable patterns. In Badin, 95% of snake bites occur on the foot, because farmworkers walk barefoot. A snake bite that goes untreated leads to kidney failure, dialysis dependency, and eventually transplant — a multi-million-rupee chain of costs. “Agar main usko long boot par na doon, jab woh kheton mein jaaye, woh pehen ke jaaye to katega nahi.” The cost of a rubber boot against the cost of a lifetime of dialysis is not a difficult calculation.

“It’s basically ROI on dollar is much more than in a tertiary care hospital,” Dr. Khan says. “Inverted pyramid hai. Base par jo primary care hai usme agar ek dollar lagaaunga to zyada logon ko faida hoga. Tertiary care par ek dollar lagaoon to ek mareez ko bhi nahi lagega.”

He is cautiously supportive of the Sehat Insaf Card — the universal health coverage scheme piloted in KP and expanded to Punjab — but argues it needs to extend to primary care, not just inpatient treatment, and that it will only reach its potential when public hospitals are capable of billing against it so the government stops double-dipping: paying both the facility grant and the insurance premium.

Pakistan in 2050

Muzamil closes by asking Dr. Khan — who has lived through Karachi’s worst decades of violence, watched the city go from the Paris of the East to something far darker, and spent his career building in the face of institutional failure — how he sees Pakistan in 2050.

“Main bahut optimistic aadmi hoon,” Dr. Khan says. “Main positive soch rakhta hoon. Aur main samajhta hoon 2050 mein Pakistan ek sehatmand aur khushhaal Pakistan hoga.”

His argument is not sentimental. He points to the not-for-profit sector as evidence of a living nation: Indus, SIUT, Shaukat Khanum, LRBT, Edhi, TCF. “Yeh log indifferent nahi rahe hain.” When the state failed, civil society filled the gap — and the state eventually came back to ask for help. “Within a year, do saal mein hamare paas government kehna shuru kar diya: aap hamare hospital le lein.” The government is now beginning to understand, he says, that its job is policy, legislation, and monitoring — not running hospitals. “Government business nahi karti. Government factoriyan nahi chalati.”

He ends with a comparison that is both humbling and pointed. New York lost power for five or six hours in the twentieth century and descended into looting. “Mere mohalle mein paanch ghante bijli aati hai, yeh nahi hota.” America is seven or eight hundred years old as a functioning state. Pakistan is seventy-five. “Humko bhi century poori karne dein. Hum bhi aapko dikhayenge.”