Excerpts from Silent Musings by Dr. Alaf Khan

My Medial Unit-A served as a Labour Room where
sub-specialties were born

Enter the New Age. My Medical Unit in LRH was a kind of medical Labour Room and Nursery where hemodialysis, ultrasound scanning, medical oncology and fiberoptic G.I. endoscopy were born and nurtured for the first time in the North West Frontier Province now known as KPK.

Dr. Alaf Khan

1. Hemodialysis.  Special diet, a few drugs and peritoneal dialysis had been our only options for treating kidney failure.  Several liters of special dialysis fluid were run through a tube into the space between the tummy wall and the bowels. After several hours, the fluid was then allowed to drain out through the same tube, taking with it the harmful substances it had picked up from the circulating blood. This procedure was not always effective nor invariably safe. The so-called artificial kidney machines had not yet appeared in our province.  Our Administrator, the late Prof. Jamil Ahmad, told me he had purchased five new American kidney machines (hemodialyzers) some two years earlier.  They must be lying in the medical stores or in the urology unit, he added. They were indeed lying in the urology department in their sealed original COBE’scartons. The urologist had neither the space for the machines nor a trained technician to operate them.

 We prevailed upon the supplier of the machines, Fazal Din & Sons of Lahore, to pay the return airfare to USA for my Registrar, Dr. Abdullah Shah, for training in hemodialysis. In the meantime I had, through Fax messages, requested a nephrologist friend in the USA if he would train a young doctor for me in all aspects of hemodialysis.  Your man,  he told me, can be accommodated officially only as anobserver,  but I will give him plenty of hands-on-job training.   Dr.  Abdullah Shah was a solid man holding FCPS in medicine. He came back with excellent skill in hemodialysis, plus structural drawings for constructing the high-pressure overhead water tank and deionization system. The large colonial era veranda of my Male Medical ward was glazed and converted into a hemodialysis suite. The machines were operational within six weeks of Abdullah Shah’s return. One of the five machines dialyzed hepatitis-positive patients while the other four served hepatitis-negative persons.  Miss Maqsooda was a quiet, intelligent and dedicated Staff Nurse in my ward.  She was deputed to Abdullah Shah who trained her so well that soon she would run the systems unsupervised.  There was no music, no aerial firing and no cake-cutting at the birth of this first born.

Aninterestingepisode relates to hemodialysis and Miss Maqsooda.  Yunis Khan, perhaps the most upright bureaucrats who ever served as Provincial Health Secretary, had  invited me to attend a meeting in his office for selecting deserving individuals for the awards of Presidential Medals that year.  I agreed to attend on the condition that none of those attending the meeting shall be considered for the Awards.  I had been with Yunis Khan for about 20 minutes in his office when the other participants streamed in one by one.  Soon we had the Principal of Khyber Medical College, Principal of Khyber College of Dentistry, one senior District Health Officer, a senior official of the Health Directorate and a serving Professor of Khyber Medical College who had once been Health Secretary himself.  Yunis Khan winked and smiled at me as he opened the folder that contained the list of names proposed by these participants. Every one of them had nominated himself. It wasn’t a tasty situation.  Yunis Khan bailed me out by telling an innocent lie.  Alaf Khan Sahib, you told me you had a commitment. You can leave after finishing your tea if you wish.

I sought Yunis Khan’s permission to mention our dialysis Staff Nurse, Miss Maqsooda, and requested the selectors to consider her for an Award.  Who is Maqsooda?  What is she doing?,  they asked almost in a chorus. We will know who she is and what she does if someone we care for happens to need hemodialysis. None of us is a pioneer in our field; Maqsooda is in her’s. The deafening silence was reason enough for me to beg leave of  Yunis Khan and the other hopefuls.  None of them got the Medal, anyway. As for Maqsooda, every life that she saved was a Medal that no worldly decoration could match.  And she earned those medals by the dozens.  I had deliberately avoided naming Abdullah Shah, the real pioneer in nephrology, as he happened to be my Registrar. The participants, I thought, would deem it a kind of nepotism.

2.  G. I. Endoscopy.   Dr. Sadiq Shah had practiced gastroenterology and G.I. endoscopy in Ireland and, later, in a Federal health facility in Islamabad before joining us as Assistant Professor in general medicine. I let him continue his endoscopic work on the ordinary ward beds behind screens.  Bureaucrats and politicians soon began to stream in for ˜passing down the pipe.  Demand for the pipe became a craze among the affluent and the neurotics. Bloating and psychogenic belching were attributed to possible cancer rather than gluttony or the nervous habit of swallowing air. So many of our homebound female patients asked for drugs to cure their neurotic habit of swallowing air (aerophagia) and the consequent explosive belching.  It is all this gais (gas), doctor sahib, they swore.  Does it bother you when you are asleep at night’ you ask them. No, but it is there just as bad the moment my eyes open in the morning.  Most of our obese patients swear by the Holy Book that they hardly eat a thing. Even a chickeneats more than I do  was a frequent fable  firmly believe in.

The NWFP government created, and the Public Service Commission advertised, the post of Associate Professor of gastroenterology.  Sadiq Shah’s application was rejected for want of a formal Registerable Diploma in the subject. The certificates and testimonials by his Irish trainers had no value with the Commission, nor would the Commission accept the fact that there was no formal diploma in the subject in Ireland in those days. The Commission’s letter to Sadiq Shah came to me through the Administrator for observations. My comments ran something like this:-

Sadiq Shah has been performing endoscopic procedures on patients in my Medical ward since he joined the unit.  It seems that, in the Commission’s judgment, he has been performing procedures for which he is not legally qualified. I request that no punitive action is taken against him for his past illegal deeds. As from today, he will not be allowed to endoscope anyone in this Medical unit regardless of the patient’s social status or physical condition.  

After Sadiq Shah had refused to scope a few high ups, the Public Service Commission asked him to resubmit his application. He did, and gastroenterology was officially launched in the NWFP.  We had our second baby after a threatened abortion.

3.  Ultrasound.  This amazing diagnostic tool had not yet reached our province.  I stressed to the Administrator the need for this essential facility.But we  purchased an ultrasound machine long ago,  Jamil Ahmad told me.  It seems no one knows how to use it,  he added. The brand new Japanese machine was, like the dialyzers, still in its original carton lying in our Medical Stores. The radiologist had neither the space, nor a trained person to operate the machine and interpret the images.  

Al Morlang was an experienced radiologist and ultrasonologist from  Oregon, USA.  He was a close friend of my erstwhile student (and now the famous) Dr Nasim Ashraf.  Together they planned that Al Morlang would donate his services to LRH for a few months. We lodged Al Morlang in the Shahi Mehmankhana next door to Peshawar Museum.  I surrendered my air-conditioned office in my ward and shifted to the common staff room with my junior colleagues. Dr. Murad Ali was a gifted young man employed as my Registrar. He was seconded to Al Morlang full time for extensive training. Together they sat by the gadget from 8 a.m. till 8 p.m. Patients were wheeled in from all the clinical units for scans all day long for about three months. Murad was groomed so well that, for the next few years, he and ultrasound became synonymous in the province.  We had our third baby in Medical-A. Again no feasting and no aerial gunfire. A quiet revolution.

4.  Medical Oncology.  The Institute of Radiotherapy and Nuclear Medicine (IRNUM) provided a good range of diagnostic and therapeutic services to the province in the field of cancer and endocrinology.  No government hospital in the province had a cancer specialist of its own.  Dr Abid Jamil, the talented younger son of the charismatic Dr. Durri Kamil, returned from London with a PhD in medical oncology.  There was no post of medical oncologist in the province. He was posted to my unit at my request as a General Duty Medical Officer (GDMO). With the knowhow for lab work that I had imbibed from J. H. Hutchinson in Scotland, I had developed a well-equipped side room laboratory.  It had a binocular microscope, a multipurpose colorimeter and a range of stains and reagents for examining blood, bone marrow, urine, stools and other body fluids. Attached to the lab was a small room for procedures.  All this was placed at Abid Jamil’s disposal.  Abid made significant contribution in diagnostic and therapeutic oncology.  This fourth sapling soon grew into a sizable tree in the backyard of Medical-A.  Abid Jamil ultimately got the Chair of medical oncology in Khyber Teaching Hospital.  

That’s the way Medical-A thus became a hotchpotch of general medicine, gastroenterology, ultrasonic scanning, hemodialysis and medical oncology. The family diversified and grew larger, but continued to work harmoniously as a team.