Pioneers of Medical Profession in Pakistan Contributions of Armed Forces Doctors

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Pioneers of Medical Profession in Pakistan
Contributions of Armed Forces Doctors

Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General/DGMS/IS
Pakistan Armed Forces
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It is nice to remember the pioneers of medical profession in Pakistan. In the Civil, the Armed Forces personnel are generally not well known, their contributions are missed in the published articles. In this article, the contributions of the Armed Forces doctors as pioneers and their role in developing the medical profession in earlier period of Pakistan are described.


Lt. Gen. Mahmud Ahmad Akhtar

Psychiatry

At independence, Pakistan Armed Forces inherited well developed psychiatric units at major Military Hospitals with both indoor and outdoor facilities. Military Hospital Rawalpindi had a major psychiatric unit which also trained postgraduates. Maj M. Shoaib (later Maj Gen) was the head of the unit. He was trained in psychiatry before the partition and was the first to acquire D.P.M (Lond) from Pakistan (at that time it was the major qualification in psychiatry). CMH Lahore had a well-known psychiatrist Maj Thaker Das. Later Maj General Ishrat Hussain and Brig Fazle-Haq made contributions. In the civil institutions, psychiatric units emerged decades later.

Neurology

In mid-fifties Major M.B. Azmi (later Lt Col) obtained MRCP (Edin) with neurology as special subject and was practicing neurology at Military Hospitals. In 60s Maj Badar-ud-Din also gained MRCP (Edin) with special subject of neurology and practiced neurology. Thus the Armed Forces had a well-established neuro-psychiatric set up at Rawalpindi.

Neuro Surgery

Maj G.D Qazi (later Brig) was trained in Neuro-surgery at UK. In early fifties established a neuro-surgical unit at CMH Rawalpindi. Major Nisar Mohammad Khan (later Maj Gen) established neuro-surgical unit at CMH Lahore.

Chest Surgery and Chest Medicine

In early 50s a chest surgical unit was established at MH Rawalpindi headed by Maj Shaukat Hassan (later Lt Gen). This unit catered for patients not only from Pakistan but also received patients from the Middle Eastern countries. During that period Lt Col M. Ayub Khan (later Lt Gen), a physician with special interest in pulmonology was working at MH Rawalpindi thus making a well-staffed chest unit.

Urology

Maj. Siraj Jinnat (East Pakistan) established a Urology unit at CMH Rawalpindi in 70s. Lt Gen Shaukat Hassan along with Major Mukhtar Shah performed the first kidney transplant operation in Pakistan in 1970s.

General Surgery

Col. M.N Mahmood (later Lt Gen) was the first Head of surgery of the Armed Forces, later followed by Col Saleem Mian (later Lt Gen), Lt Gen Shaukat Hassan and Lt Gen Mahmud-ul-Hassan. They did a lot in establishing units of surgical and allied subjects as well as in their further development.

Major Mahmud-ul-Hassan (later Lt Gen), a renowned surgeon and a brilliant teacher made enormous contributions to surgery. He had obtained MS from the Punjab University, was later trained in UK and was also trained in Plastic surgery in USA. He had a special flair in teaching Clinical Anatomy- was known as Prof. R.J.Last of Pakistan. Col Sabir Malik was a surgical specialist at CMH Lahore and was also Commanding Artificial Limb Centre Unit at Lahore which made significant contributions in helping injured patients during the wars.

Cardiology

Major Nawab Ali a brilliant physician from East Pakistan was trained in cardiology at the London Institute of heart diseases by the legendary cardiologist Prof. Paul Wood. On returning to Pakistan, Major Nawab Ali established a cardiac unit at M.H Rawalpindi which later progressed to AFIC. Major Malik (later Brig) now Head of the Bangladesh cardio-vascular institute, had joined this unit. In late 60s Major Zulfiqar (later Major General) joined cardiac unit which developed to present AFIC/NIHD, a center of excellence. Major Shaukat Ali Syed (later Maj Gen) did clinical cardiology at PNS Shifa Karachi. General Zia-ul-Haq had personal involvement in the development of AFIC. Major Arshad Mirza (later Lt Gen) did research work on blood pressure for the degree of MD Punjab.

It would be pertinent to mention that Dr. G.M.K Baloch KEMC was in fact the first doctor from Pakistan to receive training in cardiology from Prof Paul Wood thus being the first trained cardiologist in Pakistan. He had earlier obtained MD from the Punjab University with cardiology as a special subject and had published research papers before the partition and later too. Moreover, he was well-read, intellectual and well versed with Urdu and Persian literature. However, unfortunately he died in his early forties. It is also worth stating that Dr. Minhas earned MD Punjab with cardiology as a special interest in early 50s, he went to USA and became a well-known cardiologist there. Major General Akram, Col Cheema started cardiac surgery at AFIC. Major Waqar Ahmad (later Major General) developed paediatric cardiology dept.

Hepato-Gastro-Enterology

Viral hepatitis is a very common and wide-spread disease in the Armed Forces. In 1959 while getting training in medicine at AFM College I wrote a dissertation on acute viral hepatitis under the supervision of Brig M. Ayub Khan, D.G Medicine (later Lt Gen) on the epidemiological, clinical and biochemical aspects which was published in the AFM Journal.

In 1960, this study was extended for the M.D thesis of the Punjab University under the supervision of Brig M. Ayub Khan and Col Nur Ahmad Commandant AFIP. 250 needle liver biopsies (including the first liver biopsy ever done in Pakistan) were carried out during different stages of viral hepatitis and histopathological changes were studied and correlated with clinical and biochemical lab studies. This was the first largest study on liver diseases in Pakistan.
Histopathological changes of Pakistani soldiers’ biopsy material were compared with that of American soldiers assigned to Korea, in collaboration with Col Smetana of AFIP Washington DC, USA. This became an international study.

It was found that the histo-pathological changes of Pakistani soldiers were atypical and much more severe. This was thought to be the result of a different strain of hepatitis virus. Thereafter hepatitis E virus was discovered. Needle liver necropsies were also done to clinch liver disease diagnoses. Later in the years Major Manzoor (later Lt Gen) and Major Iftikhar Malik (later Major General) did a lot of studies on epidemiological and serological aspects of viral hepatitis. I obtained M.D Punjab with a special subject gastro-enterology. A lot of articles on hepato-gastroenterology were published by me. In 60s upper G.I fibre-endoscopy and in 1970s lower G.I endoscopy was started. In the civil gastro-enterology departments appeared much later. Lt. Col. Arshad Hussain (later Lt. General) started doing ERCP procedure.

General Medicine/Internal Medicine

Major General I.D. Hassan succeeded Major General M. Ayub Khan as D.G Medicine contributed immensely in the development of medicine in Armed Forces. Lt Col Ata-ul-Haq, Lt Col AR. Khan (later Major General), Brig Baseer, Lt Gen Arshad Mirza, Lt Gen Mehboob Ahmad, Lt General Afzal Najeeb, Major General Zaheer-ud-Din, Major General Tauqir Shah, Major General Nasir-ul-Islam, Col Saeed Awan and Maj Gen Fazle Qadr contributed to General Medicine.

Pathology

At partition there was a central military path lab at Rawalpindi which later developed into the Armed Forces Institute of Pathology. The lab developed advanced biochemical, microbiological and histo-pathological investigations. Post-mortem work was done routinely. At AFIP Col Nur Ahmad histopathologist, Col Bokhari, Bacteriologist, Major Chaudhary Bacteriologist (East Pakistani, later Brig), Maj Karamat (later Lt Gen) Bacteriologist, Maj Iqbal Chaudhary (later Major Gen) Haematologist, Lt Gen M. Saleem, Haematologist, Maj M.I. Burney (later Maj Gen) Virologist were heads of their departments, At that time histopathological reports of AFIP patients seeking treatment at UK were accepted as such (i.e. were not reviewed in UK). Col Bukhari was the first bacteriologist in Pakistan who obtained D Bact qualification, the highest qualification at that time, published many research papers and had a good personal library. He had a profound knowledge of agriculture and animal husbandry sciences. Col Bokhari became the project director of AFIP, NIH, PIMS, Poly Clinic and established these institutions. He went to WHO as an advisor. Ironically his name is not inscribed in any of the federal institutions he built. A lot of publications came out of AFIP in those days like visceral leishmaniasis in Northern areas, prevalence of typhus in Sialkot rural areas diagnosed first time and many others. A new species of sand fly was discovered by Maj General Burny and named “phlebotomus burnyi”. Prof Sughra Ahmad a brilliant histopathologist made immense contributions to AFIP in 70s.

Paediatric Medicine

Armed Forces were quite late in setting a paediatric medicine department. It was established in the 70s by General Zia-ul-Haq and Major CM Anwar (later Major General) who was the first paediatrician in the Armed Forces. Major Shahida Badshah (later Major General) was trained in paediatric oncology- setup paediatric oncology unit at CMH RWP-the first one in Pakistan. She was the first woman AMC specialist, promoted to the rank of Maj General- also the first woman AMC doctor to become the principal of the Army Medical College. She was also an efficient administer.

Community Medicine

Community Medicine has special importance in the Armed Forces. Prevention is not only better than cure. It is in fact the only cure. In the earlier period, prevention and health promotion was given utmost importance. Col Bashir, Col Mumtaz Hassan and Col Ashfaq contributed in its development.

Armed Forces Institute of Nutrition

After partition, nutrition lab was established; Maj Siddique (later Col) contributed a lot in its establishment and development. Later it was transformed into Armed Forces Institute of Nutrition.

Primary Care/Family Medicine/General Practice

Primary and secondary medical care form about 99% of the medical practice while tertiary care is only one percent of it. In the earlier periods, AMC GDMO cadre was well professionalized but lately primary care education has taken back seat. Like rest of the country mono-organistic medical practice is taking a lot of medical/ surgical practice space consuming enormous amounts of scarcely available health budget delivering very little benefits to the ailing patients at the dire cost of primary and secondary care which is very productive and cost- effective.

Dermatology

At partition major military hospitals had dermatology units with both in-door and out-door facilities. MH Rwp had the main unit of this specialty headed by Major Jaffar (later Brigadier) who had training in UK. Dermatology units appeared much later in the civilian institutions. Later Major Ashfaq (later Major General) made considerable contribution in the development of dermatology. Brig Seemi was the first female dermatologist and head of dept at MH Rawalpindi.

Anaesthesiology

Maj. M.A.R Khan (later Maj Gen) developed anaesthesiology to the state of the art level. Major Nazeer Chaudhry (East Pakistani) and Major Hassan (CMH Lahore) made many contributions. Col Saleem developed “Pain Clinic”.

Radiology

Col. Ramzan, Col Amir-ud-Din and Brig Saeed Malik played significant roles in the development of Radiology Department.

Ophthalmology

The first two Heads of Armed Forces Medical Services, Lt Gen Farooqi and Lt Gen Burki were opthamologists. Brig. Alim-ud-Din, Col Naseem (later Major General) and Lt Gen K. M. Akbar had major contributions in its development.

ENT

Col. G.N. Dar had a major role in establishing the dept of ENT. Later Lt General Ayub Khan (ENT surgeon) made contributions.

Gynaecology

Armed Forces did not possess gynae department and was dependent on the civil institutions for obs and gynae treatment of the wives of military personnel. In the Mid fifties the Armed Forces enlisted a Polish gynaecologist, Col Kubacher who established the dept of obs and gynaecology at CMH Rawalpindi. Dr. Saeeda Akhtar was the first doctor enlisted in the AMC as captain, received training in gynae at Rawalpindi, became the first lady Army Medical Offr, first lady gynaecologist and the first lady to attain the high ranks until the rank of Brigadier and the first lady officer to get SI (M) decoration. Major Wajeeha Fatima Hassan succeeded Col Kubacher at CMH Rwp (later Brig). These lady officers and others did not get the rank of Major General due to the policy at that time. Brig Jahan Ara Pal made significant contributions to obs and gynae especially due to misogynistic policy at that time she did not get the rank of Major General, she was an excellent teacher. Col Sughra Fatima joined the AMC as a senior specialist gynaecologist and worked for a few years till she passed away due to malignancy. Col Sami looked after the Gynae-obs Dept of CMH LHR as an honorary Consultant for a number of years after the independence with a lot of dedication and devotion. Prof. Saddiqui at Karachi, Prof Zakia Minhas at Peshawar contributed their services to the obs/gynae dept. Prof Khalida A. K. Akhtar contributed her services to the AFM College (new AFPGMI), CMH and MH RWP as an honorary professor and honorary consultant. Dr Subhani worked as a senior civilian gynaecologist at PNS Shifa for a long period.

Clinical Pharmacology

In early 1970s, a department of clinical pharmacology and clinical therapeutics was established at MH Rawalpindi/AFM College by Lt Gen Ayub Khan and I was made in charge of it, after receiving training. At that time in UK, it was quite common that medical specialists practiced multiple subspecialties.

Armed Forces Postgraduate Institute

Armed Forces were the first to establish Postgraduate Medical Institute called A.F.M College (later Armed Forces Postgraduate Medical Institute). Col Jilani was the first Commandant of the AFM College- did a lot in its establishment and development. Commandant’s English wife Ms’ Dorothy’ established college’s library. It had a distinctive department of experimental research (animal lab) in which anaesthetists and surgeons experimented and learnt various techniques through working on the animals. It had departments of entomology and malariology etc. Major Majid was a malariogist; he discovered a new anopheles mosquito named Anopheles Majidae. Major Majid was popularly known as Major Machar (Mosquito). In 1970s, basic sciences departments were established at the AFM College to conduct courses of basic sciences for the FCPS Part I candidates by Lt Gen M. Ayub Khan. These courses of Basic Sciences served students from the NWFP, AJK and other areas also. I was made in charge of FCPS-I Basic Sciences course and of experimental research department.

Army Medical College

Army Medical College was established in 1977. Brig Haq was the project Director. Lt Gen (Retd) M. Ayub Khan was the first Principal followed by Lt Gen Arshad Mirza and Lt Gen Mehboob Ahmad. I became Principal in 1989. During that period integrated medical teaching had begun and active learning and problem solving were given emphasis. The subject of clinical pharmacology was introduced. Behavioral sciences and teaching of psycho-somatic medicine were high-lighted; examination system was revamped introducing semester exams in addition to the annual exams. On completion of training at clinical units and labs etc, regular assessment tests were done. In the question paper of medicine, separate sections of Paediatircs, Psychiatry and Dermatology were introduced. Also the practical exams in these disciplines were conducted by the respective professors in their subjects. The Army Medical College was the first to bring these reforms in medical education.

Basic sciences departments like Anatomy under Col Zaidi, Physiology under Lt Col Aslam (later Major General) and Pharmacology under Lt Col Najmi (later Brig) progressed well. Basic Sciences departments developed integrated courses for the MBBS classes and produced post graduates, Prof Gulzar (Physiology), Prof Rose Madan (Physiology contributed to the FCPS 2 courses as visiting professors.

Contribution of Other Doctors

Later many doctors made significant contributions but as this article pertains to the early field of development of medical profession in the Armed Forces, therefore later developments are not included.

AFM Journal

Armed Forces Medical Journal started being published in fifties and is continuing to do so since then. In the past the journal was published regularly, contained more quality articles. Now the strength of the Armed Forces medical services has multiplied enormous times but the interest in academic pursuits has declined.

Armed Forces Medical Services Chiefs

All these developments occurred during the period of early heads of Armed Forces Medical Services Lt Gen Farruki, Lt Gen Burki, Lt Gen M.N Mahmud, Lt Gen Mian and Lt Gen M. Ayub Khan. As a matter of fact the College of Physicians and Surgeons of Pakistan (established in 1962) had Lt Gen Burki as its first president who was also the Minister of Health in the President Ayub Khan’s cabinet. It was Lt Gen Ayub Khan who after having started FCPS Part I courses, also started FCPS Part II courses, when he became Armed Forces Medical Services Chief.

Administration

In the administration, Lt Gen H.K Khalil, Lt Gen C.K. Hassan, Lt Gen Faheem Ahmad Khan, Lt General M. Nasir, Major General Mohsin Pal, Col Amin ul Haq (staff officer of General Burki), and Brig Latif made significant contributions. Major General Shahida Malik was the first general duty medical officer of the AMC to be promoted to the rank of Major General. She later became Director-General Health of Pakistan Federal Govt- first woman to hold this position.

Literary Pursuits

Maj. General Shafiq-ur-Rehman contributed to humor literature, while Lt Gen Mahmud-ul-Hassan and Maj General Mohsin Pal contributed to urdu poetry. Major Aziz had a unique collection of antique books. I authored four books and over two hundred and fifty scientific papers, the highest number in the AMC. One of my books “Rational Therapeutics” 1995 edition received National Book Foundation award. Lt Gen Arshad Mirza published a book “Bedside – Medicine” in the year 2000.

Armed Forces Medical Research Council

The research council was established in mid fifties. Research work was done and papers published. In spite of Armed Forces Medical Services having very meager human and material resources, the research output and publication number was much higher as compared to the present times. These days’ doctors’ priorities have shifted to commercial pursuits.

Patronage of Army Chiefs

AMC progressed under all the Army Chiefs except General Musharraf who denuded it of many higher ranks and gave to the fighting arms. In the Fauji Foundation medical setup, medical superintendent jobs have been given to Artillery and other officers (medical supdts). It was General Zia-u-l Haq (leaving aside politics) who gave maximum higher ranks to the AMC, created institutions and also gave higher ranks and facilities to the civil institutions.

Medical Directorate

Before and after the independence Medical Directorate at GHQ had all the administrative powers including postings etc most of which have been taken away by the non-medical depts.

Hospital Environment

In the past military hospitals were greener, having beautiful gardens lush green parks, trees, flowers etc. Now mostly red concrete buildings have replaced greenery loosing all that natural beauty which is scientifically proved to help in quick healing.

Civil and Military Medical Collaboration

It would be pertinent to point out that in the civil, eminent legendary medical personalities like Prof Amir-ud-Din, Prof M.A. Peerzada, Col. Ellahi Bukhsh, Col Sami, Dr. G.M.K Baloch, Col Muhammad Zia-Ullah, Prof M. Akhtar Khan, Prof Shujat Ali, Prof Yar Mohammad, Prof Yousaf, Dr. Rustam Nabi, Prof Juma (Neuro-surgeon), Prof Mushtaq Hassan (physician) and many others at Karachi and Dhaka made enormous contributions to medical profession in Pakistan. Prof Peerzada was a fabulous orator. He won an All India debate (in 1940s) on the topic of doctors verses lawyers.
In the early days of Pakistan, medical manpower was very little and the pioneers of medical professional in Pakistan had to work day and night. Later many doctors trained by them have also made many contributions, like Prof Khawaja Saadiq Hussain, is one name which deserve to be mentioned, who taught and trained generations of under-graduates and post-graduates.

Doctors belong to the same fraternity, specialist from the civil have been providing medical cover to the Armed Forces at peace time and during the wars. Likewise Armed Forces doctors have been helping the civil population during calamities like floods, earthquakes. In 1960s a medical camp was established in Waziristan at Wana to cater for the needs of the civilian population. I worked there for four months as a medical specialist. It attended patients not only from the tribal areas but also from Afghanistan.

We should remember and pay our gratitude to the pioneers of Medical Profession in Pakistan. The alma-mater of medical profession largely is KEMC, the oldest medical institution in Pakistan. Dr. Farid of former NWFP once remarked while addressing the KEMC alumni that all doctors in Pakistan are “Kemcolians” some directly i.e. educated at KEMC and other indirectly being taught by the “Kemcolians”.

Currently in Pakistan like other spheres of life the medical profession is infected with the virus of corruption as remarked by Prof Khawaja Saadiq Hussain in his address to doctors. The profession is in steep decline. In the early years of Pakistan it was hard to pin-point a dishonest professional while these days it needs efforts to find an honest professional. Let us pray for the turn around to the old Pakistan where there was peace and security, teachers were role models- political leaders Quaids lieutenants were self-sacrificing, institutions were functioning well- Unfortunate change for the worse was brought by Mr. Ghulam Mohd, Sikander Mirza, Ayub Khan abetted by Mr. Bhutto to join Western/ American pacts which brought cold war to this region in earning Soviet Union’s enmity and all the problems which we are facing up till now including loss of support for the Kashmir problem.

Limitations

Pakistanis are very poor in keeping records unlike the British who maintain the records and archives meticulously – due to this it is possible that I may have missed contributions of many.

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