CPSP is gradually losing its independence and autonomy which is a National Tragedy

Print

CPSP is gradually losing its independence
and autonomy which is a National Tragedy
Instead of competing Medical Universities; CPSP must
join hands and complement each other
A committee drawn from CPSP & Medical Universities
must find a solution to the problems currently faced
by the medical profession in medical education
as well as healthcare

By Shaukat Ali Jawaid

Karachi: College of Physicians & Surgeons of Pakistan is the only postgraduate medical institution from Pakistan which enjoys international recognition, credibility and its Fellowship is recognized internationally. It could earn this unique distinction since it was functioning as an independent autonomous institution without any government control. It was also not dependent on government funding either. The founders of this institution, all the founder fellows and the Council Members who later managed this institution have all contributed in one way or the other to help strengthen, develop and improve its teaching, training facilities meeting the country’s requirements of specialists in different disciplines. It also goes to the credit of CPSP that it managed to put in place an excellent Residency training programme and always held its examinations on schedule without fail, which is no less than a miracle in Pakistan.


However, for the past few years, CPSP is gradually losing its independence and autonomy which is not less than a National Tragedy. Hence all the well-wishers of this institution must be worried. It is also a fact that all this has happened due to short sighted policies of the CPSP leadership over the last two three decades. First when they decided to restrict selection of examiners, supervisors to only Fellows of the College, was a major mistake. Anyone who opted to be the examiner for other postgraduate degrees like MS and MD were debarred from being selected as an examiner for FCPS and they were also not considered as Supervisors. This created a rift within the medical profession and two distinct groups emerged.

Since those with MS and MD qualifications were very few in faculty positions, they failed to assert their authority hence they were ignored. However, with many new medical universities coming up all over the country, hence they had to produce some postgraduates, start some new programmes to justify their existence. They started enrolling more and more candidates, introduced various Certificate, Diploma and Degree programmes in various disciplines of medicine which all went a long way in enhancing their importance successfully ending the monopoly of the CPSP in the field of postgraduate medical education in Pakistan. In the past this MS and MD group was led by Prof. Awais Prof. of Orthopedic Surgery at King Edward Medical College and later on various distinguished medical personalities like Prof. Asad Aslam, Prof. Javed Akram at present Vice Chancellor of UHS Lahore came forward to lead this group giving it the much needed credibility. They also encouraged the Royal Colleges of UK to start Paces exam for MRCP. At the same time it was the young doctors who started misbehaving with their senior faculty members forcing them to accept those they recommended for residency in different specialties. When the seniors resisted it created law and order situation. At this the bureaucracy in Punjab got a golden opportunity to take away the whole induction of postgraduates. Taking full benefit of the division within the medical profession and knowing very well that now two different groups have emerged, the demand of MD MS group for 50% induction of postgraduates in residency training programmes was accepted and it proved to be a major blow for the CPSP. Majority of the postgraduates are from Punjab and CPSP’s lifeline of revenue in the shape of workshops and examination fees was effectively checked. So far this practice of 50% induction of postgraduates in MS and MD programme in other provinces has not materialized but it may be on the cards. If this was not enough, ignoring medical personalities like Prof. Majeed Chaudhry, pushing people like Prof. Umar currently Vice Chancellor of Rawalpindi Medical University, Prof. Mahmood Shaukat, Prof. Amir Aziz and others in the opposition camp has not helped the cause of CPSP in any way. Prof. Umar has now come up with an excellent Residency Training programme for MS and MD named as Residency Training Programme which is a mix of CPSP and the residency programme in USA which he presented at a joint meeting of medical universities held at UHS two years ago and plans are underway to have a uniform training and examination for MS and MD in all medical universities to maintain quality of training and high standards of examination.


Failure of the medical profession to efficiently run and manage the affairs of Pakistan Medical & Dental Council resulted in the establishment of Pakistan Medical Commission. Medical Education and Health is being looked after by the Higher Education Commission with no one in executive position with a medical background. CPSP leadership must be ashamed to know that HEC does not know or is not aware of the fact that FCPS is a major degree and more than 80% of our specialists, faculty members hold FCPS qualifications. However, HEC in its recent accreditation application by Health Science Journals has not included the FCPS qualification. When pointed out, they did not bother to add it either and no one from the CPSP had the courage to take up this issue with HEC. What a pity. If no remedial measures are taken in time, in the days to come things may be much different which the CPSP may not find much palatable. If medical education suffers in Pakistan in the days to come, it will be mostly due to the criminal silence of the Vice Chancellors of medical universities who are supposed to point out these issues and force the authorities to take rational decisions.

Despite the fact that CPSP is a premier postgraduate medical institution but it always had some inherited problems. The founder President Lt. Gen. Wajid Ali Burki managed the affairs of this institution in a dictatorial manner. He never tolerated any dissenting voice. He always used to say that “CPSP is a very democratic institution and here whatever I say goes” 1 It is also a fact that initially it was proposed to establish College of Physicians of Pakistan, its constitution was written by Lt. Col. Najib Khan in consultation with Col. SMK Malik with guidance from President of Royal College of Physicians London Lord Rosenheim. However, when Gen. Burki decided to add Surgeons and established a combined college of physicians and surgeons, it created bad blood and Col. Najib Khan turned against Gen. Burki who had the final say who never forgave Col. Najib Khan for this and his name was not included in the list of founder fellows.


It was in 80s that some young fellows by examination who had the support of senior fellows who raised the voice for elections for the Council as so far Gen. Burki used to pick the council members based on his personal likes and dislikes. Hence, once the CPSP got infected with the democratic virus, it also started to face some problems and internal political groupings. After few years two distinct groups emerged, the one at Karachi lead by Prof. S.M. Rab and Prof. Sultan Farooqui and the other group at Lahore and people like Prof. Akhtar Khan being the senior most fellows was asked to shoulder the responsibilities along with some other colleagues like Prof. Kh. Saadiq Hussain, Prof. S. A. R. Gardezi and others. Then efforts were made to divide the Lahore group by facilitating the emergence of another group in Punjab headed by Prof. Hayat Zafar from Nishter Medical College Multan who extended his influence to the entire South Punjab and involved the Fellows from Bahawalpur as well.

When after the elections at Quetta held in 1992 things did not go the way the Karachi group had planned, Prof. Luqman from Bahawalpur was selected as interim President to be replaced within a month which he did not know. Later an agreement was reached in the Council meeting splitting the four years term of President into two years each. As per agreement, Prof. Sultan Farooqui was to serve as President for first two years who was to be succeeded by Prof. Kh. Saadiq Hussain though some council members had expressed the apprehensions that this agreement will not be honoured. That is exactly what happened, two councilors from Punjab were used to start a malicious campaign against Prof. Kh. Saadiq Hussain and when he felt he could not arrest the rot that had taken place in CPSP, could not check intellectual and financial corruption, he preferred to resign. This proved to be a short lived victory for the Karachi group because Prof. Kh. Saadiq Hussain enjoys tremendous respect among Fellows and since majority of them are also from Punjab besides he had friends and well-wishers in other provinces as well with the result that in the next elections the Karachi Group which had complete control of CPSP for many decades was routed, just one out of twenty councilors from this group could get elected.


It is said power corrupts and absolute power corrupts absolutely. It was in this back ground that I had suggested in 90s that no councilor should be eligible for contesting for Council after completing two terms though after a gap of four years, they can contest again. The first reaction to this suggestion came from Prof. Tariq Bhutta from Nishter Medical College Multan who did not agree with me. I had also suggested that no councilor should be appointed as Regional Director or given other coveted posts on which other fellows who are not council members should be accommodated. No one should serve as President for more than two terms. There should be no elections for faculty members. Instead competent experienced people should be nominated by rotation. They were also reminded of a very useful suggestion made at a meeting hosted by CPSP at Karachi which had guest speakers from various Royal Colleges of UK, Australia as well as Canada to establish a Young Fellows Forum. Identify bright young fellows, send them for short visits overseas to attend some conferences and groom them to take up the future responsibilities of the institution. It will widen the support base of the CPSP but somehow these suggestions did not go well with the CPSP administration.

Once I went to the CPSP campus at Karachi and the Council meeting had just concluded and all the councilors was standing outside the council room. I asked them the name of this institution is College of Physicians & Surgeons Pakistan but all the offices in this institution i.e. President, Senior Vice President, Vice President, Secretary and Treasurer as held by the Surgeons, where are the Physicians? It gives the impression of College of Surgeons of Pakistan. Moreover, you have few female councilors as well but no female physician or surgeon has ever been selected to these coveted posts. Prof. Zafarullah Chaudhry President CPSP and all other councilors present were kind enough to listen to all this patiently and then said, it will be soon rectified. I am glad that in the next annual elections they not only elected one of the physician’s councilor as Vice President but a female councilor was also elected as Vice President in the next elections. In the past there was a time that it was the Physicians who continued to occupy all the coveted offices in CPSP Council which once it is learnt, forced Prof. S. A. H. Gardezi to say that there was no input from the Surgeons in running and managing the affairs to CPSP. Some time ago the idea was floated to have College of Physicians of Pakistan and College of Surgeons of Pakistan one having head office at Karachi and the other at Lahore but it did not get much favour of the fellows though it offers some advantages but also had some disadvantages. The idea to recall all this is to emphasize that efforts should always be made to involve everyone, listen to dissenting voices patiently instead of considering them as enemies. They might have a point which is in the best interest of the institution. Any institution, organization which does not allow dissenting voices within, eventually suffers.


The present CPSP administration is very receptive, listens to the problems of the trainees and sincerely tries to resolve them. It has introduced fellowship in many new emerging important sub-specialties thereby meeting the needs of specialists in the country. These are all laudable steps which must be commended. However, despite the fact that Prof. Zafarullah Chaudhry has also done lot of good work for the CPSP just like his other predecessors but since now he is most of the time out of Pakistan, is not keeping good health as well, it has affected the functioning of the CPSP to a great extent. It has come as a God sent opportunity for the bureaucracy to assert its authority and control everywhere and CPSP leadership finds itself in a very difficult situation. CPSP used to induct Residents twice a year but this schedule was disrupted as the bureaucracy had stepped in. Induction was delayed last year and now for the first time it is said, some of the residents will have to work for couple of months without being registered. Such problems may multiply in the days to come. At least the bureaucracy should not meddle in training schedules and make sure that the CPSP can induct postgraduates in Residency Training Programme as per its laid down schedule. A later report says that on a special request form Punjab Health Dept., the CPSP decided to open its Registration portal for trainees just for four days March 22-25th 2021 enabling the selected postgraduates to get themselves registered hoping that in future the Punjab Health Dept. will ensure timely induction of all postgraduates. Those who are in government service cannot dare to take a stand and assert themselves to plead the cause of CPSP, others have no spine either. Hence it is in the interest of CPSP that its leadership should be passed on to those who are not in service and who can speak from a position of strength and once they also get the support of the Vice Chancellors of Medical Universities who are also Fellows or Councilors of CPSP their job would become very easy.

One may not agree with everything for which Prof. Amar Aziz stands for but he has the courage to call the spade a spade, stand up and talk with conviction with the rulers. He is a well-known spinal surgeon and also has a strong spine himself, something which he has demonstrated at quite a few times. CPSP needs people like him if it has to safeguard this institution. Being a well-wisher and great supporter of CPSP it is quite painful at times to describe all this but my objective has always been to strengthen this institution of which Pakistan can be rightly proud of. On its part too, CPSP President Prof. Zafarullah Chaudhry and all the Council Members have been very kind to me when they agreed to host the EMMJ5 Medical Journals Conference (EMMJ5) at CPSP Campus in December 2010 which was attended by thirty four foreign delegates form eighteen countries. Organized in collaboration with WHO, DUHS, Aga Khan University with support of Government of Pakistan, this conference also helped project the image of CPSP a great deal. The CPSP administration even went out of the way to accommodate Pakistan Association of Medical Editors (PAME) to put its entire campus at our disposal including the Guest House, other accommodation, administrative staff including the IT department and audiovisual arrangements which helped us a lot to hold this conference in a befitting manner for which we all members of PAME will remain ever grateful to CPSP.

Again when we had PAME conference at UHS Lahore Prof. Khalid Masood Gondal the Regional Director of CPSP invited our guest speakers from Iran to visit the CPSP, gave them a detailed presentation on the functioning of the CPSP and hosted a dinner in their honour which was also attended by many Councilors and Fellows in Lahore. This gesture won the hearts of our friends from Iran and opened the doors for future collaboration in the field of medical education.

The situation at present is very bleak. Medical Education is being looked after by Higher Education Commission which unfortunately does not have anyone in the executive position with a medical background. Hence they fail to appreciate and take rational decisions. It is for the representatives of the medical profession to come forward and engage with government functionaries and the HEC administration. Their first attempt should be to have a separate section for medical education looked after by an academician who should look after the medical universities, medical education and healthcare with the support staff taking decisions after meaningful, fruitful discussion and consultation with all the stake holders. It might work but if this cannot be accomplished, let some eminent medical personalities like Prof. Kh. Saadiq Hussain, Prof. Mahmood Ali Malik and few others talk to the government, impress upon them to rename the Ministry of Health as Federal Ministry of Medical Education and Health and all related functions should be taken away from the HEC. One does not have to invent the wheel, our neighbouring country Islamic Republic of Iran did this two decades ago. They have accomplished a lot not only in improving the quality and standard of medical education but also promoting research culture and improvement in patient care. The number of medical journals covered by Web of Sciences, Medline, PubMed, PubMed Central, Scopus and other international databases from Iran has increased tremendously simply because they have professionals, medical academicians, distinguished medical editors who are members of Journals Evaluation Committee working in this area helping the medical profession, facilitating rather than creating hurdles which is seen in Pakistan. One cannot allow Train Drivers to fly aero planes because it will never take off, and even if it does, a fatal crash is imminent with serious complications in the long run.

Let there be a joint committee of representatives drawn from the CPSP and the medical universities which should prepare a working paper under the supervision of distinguished medical personalities mentioned above and convince the rulers that Americanization of our health services is not going to help us. We need to find out indigenous cost effective solutions and all this can be accomplished by Ministry of Medical Education and Health if it is headed by a renowned medical educationist who has the required support staff. Medical Teaching Institutions Act needs to be improved after meaningful discussions with all the stake holders. No one can disagree with some of the noble objectives like ensuring punctuality, clinical and academic audit of faculty members, improvement in patient care, starting institutional practice but for all this, we first need to establish and put in place the required basic infrastructure rather than trying to implement it with force which is not going to work. For all this, medical profession will have to say goodbye to the group politics, get united and speak with one voice. Last year Punjab Institute of Cardiology was ransacked by a mob, doctors and patients had to run to save their lives, but nothing happened. CPSP being a premier institution has much greater responsibility to work for unity in the medical profession. Can they do it only time will tell but if they fail, they must get ready to face more humiliation in the days to come.

Reference

  1. Lt. Gen. Wajid Ali Khan Burki. In “Medical History-Written in Haste” by Shaukat Ali Jawaid. Published by Professional Medical Publications 2020. Page 3-25.
© Professional Medical Publications. All rights reserved.