Mr Edhi is gone and the prime minister (PM) is back. Along with the PM load shedding has comeback with a vengeance. And yes, the monsoons are here, and every time it rains more than a couple of millimetres, most major streets in Lahore turn into open sewers. I am still waiting to see the PM on national TV thanking us the ordinary folk for our prayers and, more importantly, assuring us that he is well enough to be in charge and to run the government. But that has not happened as yet. Might happen by the time these words end up on the printed page. As far as Mr Edhi is concerned, he was very sick and was getting along in years, and the inevitable eventually happened. The outpouring of sorrow at his demise was a genuine sadness many Pakistanis felt at the loss of an icon. Though some complained that his funeral was hijacked by the high and mighty, but then that is what happens whenever somebody this important passes on. However, with all the time available because of the long holidays I had a chance to think about things that have bothered me about Pakistan. An often-heard ament is that “institutions” are not built, and if present, not allowed to progress. And Edhi sahib leaving us made me wonder about what was going to happen to the institution he had built over a lifetime. This question became even more pertinent as I thought about the institution he spent his last days in, the Sindh Institute of Urology and Transplantation (SIUT). For those who are not familiar with it, SIUT is a major centre for kidney transplantation as well as treatment for other kidney problems, where, most remarkably, all services are provided free of cost to all patients. Edhi sahib was at SIUT because of the kidney failure. And almost like the Edhi Foundation, SIUT is also a product of the vision and the hard work of a single individual, Dr Adib Rizvi. Also, the Shaukat Khanum Memorial Cancer Hospital (SKMCH) in Lahore, and the other ones being built are all a product of Imran Khan’s vision and dedication. It is indeed true that these three institutions are run successfully by hundreds of different individuals. Yet the one thing common among them is that is that there are three men behind them who were able to create these institutions, and then chose the right sort of people to delegate responsibility. People gave money to Edhi sahib, and people give money to Dr Adib Rizvi and to Imran Khan because of the trust these people have built up over the years. Without Edhi sahib, the foundation he has left behind will have great difficulty in generating the same level of donations, and will possibly dwindle away in time. As far as SIUT and SKMCH are concerned they might also suffer a similar fate. No, they will not disappear but they will definitely become much less effective. The holidays themselves make one wonder how an entire country can essentially close down for almost 10 days and still expect to exist as a functioning entity. This is made more obvious when one realises that the chief executive of the country, the PM, was out of the country for more than a month during which time he was obviously too unwell to manage the affairs of the state. These two realities immediately expose the fact that whoever is in charge of running this country is clearly not too serious about efficiency or direct personal responsibility. Personally, I believe that it is the bureaucracy that really runs Pakistan. During the years that I worked in the public health care sector I had a reasonable experience of the bureaucratic mindset. No, I don’t think that it is just Pakistani bureaucrats that behave like that or think like that. But there are certain “qualities” that are most marked in the Pakistani environment. First, of course, is the total obeisance of the Pakistani bureaucracy to their political masters with a complete disregard for the ordinary people that they are supposed to serve. This is perhaps the most important thing Pakistani bureaucrat learns in the “academy” as a leftover from the training mandated by the former British masters. The second important aspect is that a bureaucracy rarely wants to make things better. The reason why most bureaucrats do not want to make things better is that once things get better, and then they will have to be maintained at that level, and that is hard work. And if things don’t get better they tend to get worse. The reason for this worsening of things is the nexus between the bureaucracy and their political masters. The bureaucrat wants to keep things as they are, and the politicians depend on the bureaucrats and so lets them work at their own pace. On that depends the politician’s ability to get a few things done that make the politician look good. Instinctively, ordinary people understand this “noxious” relationship between the politicians and the bureaucrats, and wish to end it by bringing in a military government. But eventually every military dictator takes on the role of the politicians and develops the same symbiotic relationship with the bureaucracy. And the bureaucrats are smart enough to never allow institutions to develop and become established that can challenge their “supremacy” at least in the public sector. Of the three successful entities that I mentioned above, two are entirely in the private sector, and the third, SIUT, is funded to a great degree from private donations. And that is why those that lead them are so important. Ordinary Pakistanis might not be enthralled when it comes time to pay taxes but they are quite generous when giving money to worthy causes. Such contributions depend almost entirely on the perceived trustworthiness of the person behind the charitable institution. And that is why I am worried about the future of these institutions. The author is a former editor of the Journal of Association of Pakistani descent Physicians of North America (APPNA)