Prof. Jamal Raza urges pediatricians and Paediatric surgeons to work in close collaboration


29th Int. Conf. of APSP at NICH
Prof. Jamal Raza urges pediatricians
and Paediatric surgeons to work
in close collaboration
National Institute of Child Health has produced
many giants of Paediatric surgery

KARACHI: Pediatricians and Paediatric Surgeons should work in close collaboration to improve patient care. This was stated by Prof. Jamal Raza Executive Director of National Institute of Child Health and a noted Paediatric Endocrinologist while speaking in the inaugural session of the 29th Int. Conference of Association of Paediatric Surgeons of Pakistan hosted by NICH from March 20th to March 22nd 2021. He further stated that he was delighted to note that most the arrangement for this conference have been accomplished by the Residents in a record time of just one month which must be appreciated.

Continuing Prof. Jamal Raza said that in the past doing FCPS-I was very difficult. During my professional career I have learnt a lot from my seniors. Paediatric surgery is a work which requires devotion and dedication as it has very little monetary gains. National Institute of Child Health has produced many giants of Paediatric surgery and now Pakistan is reported to have over two hundred trained and well qualified Paediatric surgeons. At the NICH over the years we have tried to improve Paediatric surgery services. He specially mentioned about Prof. Jamshed Akhtar with whom we often keep on fighting but he is an honest and dedicated professional which is an asset for the NICH. He uphold professional ethics and is a very progressive person. We have arranged more specialized area for Paediatric surgery. We have introduced Day Care Surgery and have embarked upon a progressive way forward on this journey.

Prof. Jamal Raza also disclosed that they are planning to have a bigger area for the pediatric surgery complex which will further increase, improve patient care as well as teaching and training facilities in pediatric surgery. It is important that we pediatricians and pediatric surgeons have good cordial working relationship. We should see what each one of us is doing to have compelte clinical picture of the patients. He concluded his address with a few couplets of poet Saleem Kausar hoping that we do not lose any more healthcare professionals due to Covid19 pandemic.

Prof. S.M. Tariq Rafi Vice Chancellor of Jinnah Sindh Medical University in his video message on the occasion said that pediatric surgery has improved a lot and now it stands on strong foundations. I myself, he said, spent couple of months in pediatric surgery during my residency training. NICH is doing a commendable job in providing pediatric care as well as pediatric oncology facilities to the patients.

In his Video message eminent pediatric surgeon Prof. Abdul Hameed highlighted the importance of ethical practice while Prof. Naeem-u-Zafar Khan another distinguished pediatric surgeon who has published a book on pediatric surgery as well as Atlas of Paediatric Surgery said that these days at most of the pediatric surgery units, surgeons are going for highly specialized procedures, minimally invasive surgery using the development and advances in information technology while the patients with routine pediatric surgery problems suffer. We need to focus on development of basic facilities, ensure long term follow up of the patients. We must ensure professional ethics, ensure safe surgery, management of patients with equity. Cost of treatment matters a lot in a developing country like Pakistan. We are wasting the limited resources available while basic facilities are lacking, he remarked.

Prof. Farhat Moazzam another eminent pediatric surgeon currently affiliated with CBEC (Center for Bioethics and Culture) at SIUT in her video message said that pediatric surgery was a specialized field and pediatric patients are not small adults. I had the privilege of starting the pediatric surgery unit at AKU and got it recognized by the CPSP. We have come a long way in pediatric surgery in Pakistan. He also referred to the contributions of late Prof. Nizamul Hassan to pediatric surgery.

Prof. Abdul Aziz who was the chief guest in the conference in his video recorded message called upon all colleagues to follow the SOPs during the current COVID19 pandemic ensuring their own and their colleague’s safety.

Prof. Zeba Batool Attar who was another Guest of Honour at the conference who also has the distinction of being the first MS in pediatric surgery addressing the participants said that she worked with late Prof. Nizamul Hassan from 1984-1988 and she calls herself the first surgical child of Prof. Nizamul Hassan who was always very kind to me. She also stated that her father was an anesthetist and her mother was a gynecologist and both of them asked me not to opt for anesthesia as well obstetrics & gynecology as a professional career. They had their own reservations. Then I thought of going for pediatric surgery and joined Nizamul Hassan as a trainee Later on I also went to Japan for surgical training. Late Prof.Fazal Elahi was my examiner. Everyone at NICH including Dr. Safia and Prof. Jamshed Akhtar have been very kind to me and I enjoyed my stay at this institution.

Prof. Inayat Ur Rehman the outgoing President of the APSP in his address stated that they have tried to strengthen this specialty and the association. We promoted research culture and academics. We tried to have financial independence for the association. We have started publication of Journal of Adolescent and Paediatric Surgery. He urged all colleagues to subscribe the journal and contribute their manuscripts to the journal. We also managed to establish a central Secretariat of the association with full time Secretary at Lahore. We are trying to have a central data bank for pediatric surgery. He suggested that Residents in pediatric surgery should be recognized and registered as Associate Members of the association. We should pool data from all units, all pediatric surgeons should send their data to the central secretariat at Children Hospital Lahore. He also suggested that pediatric surgery should be included in undergraduate curriculum. Paediatric surgery, he opined, was not a super or sub-specialty but an important discipline as we look after 40% population of Pakistan which comprise of children. Sick child will lead to a Sick Nation while a healthy child will result in Healthy Nation. Deans of Medicine are most often reluctant to help promote the discipline of paediatric surgery hence we have to communicate at higher level everywhere to get this specialty proper recognition which it deserves. We should struggle to get posted paediatric surgeons at the district level. We should also start folic acid supplementation programme, he added.

Prof. Ghulam Nabi Paediatric Surgeon from Quetta Baluchistan who took over as the new President of the APSP also briefly addressed the meeting. Earlier rich tribute were paid to late Prof. Nizamul Hassan, Dr.Daulat Khan distinguished paediatric surgeons who are no more in this world. Their contributions to promote this specialty was recalled and recognized. Prof. Nasir Saleem Paediatric Surgeon at NICH in his welcome address pointed out that it was the young trainees who have worked hard to organize this meeting in just few weeks. Such conferences are beneficial not only for the faculty members but trainees as well.

Thematic Lectures

There were two thematic talks in the inaugural session. The first speaker was Prof. Muhammad Saleem from Institute of Child Health from Lahore who talked about their experience from the administrative point of view during the Covid19 Pandemic. He discussed in detail the problems they had to face, encouraging not only the young doctors, nurses, paramedics and faculty members but ensure proper care to all the Covid and non-Covid patients coming to the Children Hospital. There were numerous obstacles which had to be handled. ENT and Dental wards were closed at the hospital. We organized forty workshops and published thirteen Covid related papers eight from the Dept. of surgery and five from the department of medicine.

Prof. Jamshed Akhtar‘s Thematic talk was related to Teaching, Training and Assessment challenges which they had to face during the Covid19 Pandemic. These crisis, he said, also offered us some opportunities for innovation, to move forward and accept the challenges. There were many gloomy days. We ensured appreciation of healthcare workers managing the Covid patients. Workers were at times forced to work so that patient do not suffer. We had to change our plans for Residents. All elective surgeries were stopped but emergency surgery was continued. Our attendance in OPD was reduced to just one third hence patient contact also got reduced. As the emergency cases increased, it provided an opportunity to the residents to see a large variety of paediatric surgery cases and they had rich experience. During the First year the Residents could not see and complete the required number of cases while Final Year Residents did many emergency cases and missed some routine work, hence there remains some gap between the training of First Year and Final Year resident and we need to fill up this gap.

Continuing Prof. Jamshed Akhtar was also critical of the government efforts saying that they did not provide any additional funding and facilities which were provided by the Govt. of Punjab to Children Hospital at Lahore. While we see the patient’s attendants lying outside the hospital on footpaths spreading corona virus but inside the hospitals we have established Corona Wards. Our health planners need to look at this situation as this increases the risk of the patients as well. Some of the staff members needed psychological help. At times two patients had to be accommodated on one bed. Training was continued and the residents got prepared for the examination. Faculty at NICH worked full time. Assessment was also continue after making some special arrangements and innovations without patients. Later on examination with patients was organized. It was due to this extensive training that all the six Residents from NICH passed in their Fellowship examination. We all worked as a team working as a professional and in a leadership role. The residents also worked alongwith us and in fact it was the Residents who worked a lot, he concluded.

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