After graduating from AKU with an MBBS degree in 2012, Dr Mohsin Ali Mustafa chose to opt out of specialising in clinical medicine. He thought that pursuing a hospital-based position would be a “distraction” as he was interested in broader questions about Pakistan’s healthcare system and how well it was serving those in need.
Throughout his studies and subsequently his work at the not-for-profit The Aman Foundation, Mohsin came across a recurring gap in the way healthcare services are structured.
AKU faculty members Dr Asim Beg and Dr Naila Kayani meet the team at Clinic5.
While the very wealthy and the very poor were ‘serviced’, a very large population of low-and middle-income families has no access to quality yet affordable healthcare.
As he worked to understand the needs of this sizable segment of Pakistan’s population, he was also hearing about their specific needs. Besides criticism of long waiting times and the poor hygiene of low-cost community clinics, he noted that the majority of patients were worried mothers who lacked information about how to care for their child when s/he was sick. They wanted guidance from their doctor but often left the clinic disappointed by the information provided during brief appointments and unsure about what to do on returning home.
As he heard more and more stories around how healthcare services were falling short of expectations, Mohsin began to think about setting up a different kind of low-cost primary facility, an enterprise that could provide quality healthcare at a price any family could afford, in a location close to them.
Clinic5 was born and joined by fellow entrepreneur Dr. Naseeruddin Mahmood, Class of 1988, they have taken on the challenge of providing quality services at an affordable cost, carrying forward AKU’s principle of access and quality to a larger number of people.
In this interview, Mohsin speaks about his ambitions for Clinic5 and his commitment to public health initiatives.
Why a career in public health?
An incident in my final year at medical school was really a turning point for me. I used to love spending time in the ER and it was during one of these volunteer shifts that I got to know Ashok, a child with thalassemia who had been rushed to AKU suffering from respiratory distress.
Ashok told me his story: he and his parents had travelled 12 hours in a makeshift ambulance all the way from Thatta district – in the interior of Sindh – to AKUH. They had no choice as there were no healthcare facilities near his home that could help him.
So we stabilised him when he got to the ER and I thought he was out of danger – but I was wrong. A few hours later Ashok collapsed and there I was, doing CPR on him in tears. The tears weren’t just tears of sorrow but also tears of anger and frustration. I had just realized that the system had failed Ashok.
That night I went home and thought of all the ways we had failed him: this child shouldn’t have had to travel in a makeshift ambulance; he should have had proper emergency transport. He shouldn’t have had to travel in the first place, there should have been a facility close to his hometown where he should have been given care.
I could do one of three things: forget this incident ever happened; remember it as a nightmare; or accept this failing as a challenge to be fixed. I have chosen the latter and decided to dedicate my life to fixing problems in the healthcare system around me.
Tell us more about your work at Aman Foundation.
Soon after graduation, I got in touch with Professor Junaid Razzak, AKU class of 1994, who was heading the not-for-profit Aman Foundation’s Healthcare Services at the time. At Aman, he led the introduction of their pioneering ambulance services before going on to spearhead many initiatives to improve first-aid and emergency response services.
He encouraged me to apply and I joined the organisation in April 2013. My first initiative was to form a team of professionally-trained paramedics who could provide essential CPR services. It took us 6 months to meet our target of imparting first-aid training to 10,000 people and some of our trainees went on to became master-trainers who are now sharing these essential life-saving skills with others.
Later on, I worked with colleagues to expand the organisation’s ambulance network, making it easier for critically-ill patients to promptly reach hospitals. We were always working to improve the efficiency of the 24-hour ambulance operations, but our overall goal was even more ambitious. We wanted to scale up our ambulance services, from Karachi to all 21 districts of the province. This involved my acting as a liaison with the Sindh government to set up ambulance services in Thatta and Sajawal that could then be scaled to the rest of the province over the next 5 years. The irony of this isn’t lost on me. Thatta is the same district Ashok hailed from and makes me believe that God works in wonderful ways.
We partnered with the government to launch a 25-vehicle ambulance service and in 2015 they agreed to extend our services across the province. It was very satisfying to work on boosting the organisation’s fleet from 60 ambulances to, eventually, over 200 vehicles and to make sure that these life-saving vehicles are always available for patients, no matter where they live in Sindh.
How did you develop the idea for Clinic5?
During my three years at Aman Foundation, I worked on a range of initiatives that showed me how the healthcare needs of large segments of Pakistan’s population weren’t being met. As I looked into secondary healthcare facilities, I noticed that mothers were taking their children to general physicians in their neighbourhood, for diagnosis as they wanted to access healthcare close to their own home. Another issue that I found is that GPs mostly practice in the evenings even though mothers prefer to take their children to the doctor during the day.
I realised that the needs of these families weren’t being met by neighbourhood facilities and so I started working on developing an affordable network of quality clinics that would be open during the day in areas that could be easily accessed by large segments of the urban population.
In order to develop a system that could meet this need, I consulted another AKU alumni, Dr Naseeruddin Mehmood, Class of ’88, who is a renowned paediatrician. I am fortunate to call him my co-founder in this venture. Mentored by senior doctors associated with AKU has given me the courage to take the path that I am now on.
As we discussed this idea we agreed that there was a huge unmet need and so we partnered to set up a clinic in Karachi in 2015 that would operate on the principles of preventive care, health education, compassionate service, quality healthcare and affordability.
Our goal is to establish 5 clinics in Karachi by December 2017 and, in the future, we hope to find another partner who can help us expand our services to cover mothers. Mother and child health are key indicators of the health of a population and we’re confident that we can make an impact on public health by bring healthcare to underserved communities.
At present, my focus is on making Clinic5 a self-sustaining entity. Once I achieve that I hope to deepen my understanding of social entrepreneurship through a master’s degree. I’ve already been accepted to Oxford University’s Said Business School for an MBA but I’m deferring the degree until I’m sure that Clinic5 is sustainable.
How did you find your studies at AKU?
AKU is like an oasis within a desert and I was fortunate to have mentors who exposed me to the importance of compassion in medicine. We learnt the importance of evidence-based practice and patient counselling right at the start of the degree and it’s something that I use in my work every day. My class fellows came from different backgrounds from all over the country and this gave me a variety of perspectives about the world.
In many ways I’m still connected to the University as my co-founder and staff at my clinic are from AKU as well! I’ve also been a participant and a mentor at the University’s hackathons and my ex-professors often visit my clinic to share their advice. The mentorship I received from senior doctors associated with AKU gave me the courage to take the path that I am now on and I hope that people at the institution continue to guide young doctors on how to make a difference to society.