Medical Education in Pakistan has become a business-Prof. Shabbir Lehri


 Int. Med. Conference at Ziauddin University

Medical Education in Pakistan has
become a business-Prof. Shabbir Lehri

Doctors should be ashamed that their cases are being settled in courts

By Mubarak Ali

KARACHI: Situation of medical education in Pakistan has been deteriorated due to corruption and lack of qualified faculty in some of the medical and Dental Colleges which has been established in rented buildings and Banglows. Even Sugar and Ghee Mills owners have entered in this business. This was stated by Prof. Shabbir Ahmed Lehri, President Pakistan Medical & Dental Council while speaking at the inaugural session of the International Conference on Bridging the Gap in primary Health Care Innovations, Translation and Beyond, organised by of Ziauddin University at Karachi from February 3-5, 2017.

 Continuing Prof. Lehri said that we have decided to take appropriate measures against these colleges and will not support anybody. Regarding admission to the medical and dental colleges, Prof. Lehri stated that some of the private medical colleges collect donations from students which vary from percentage and those with 60% marks are preferred as they can collect more money as donation for admission. He asked the people in this business to stop unethical practices and come to the PM&DC we will help and guide them to solve their hunger and greed problem. PMDC is a sole body and its credibility was damaged by the vested groups. After taking over the responsibility within three months we have resolved twenty thousand pending cases and a Curriculum Committee has been appointed which is doing the job round the clock. He asked his opponents that you had almost destroyed this institution and now let it work by the properly elected body of the PM&DC. Doctors should be ashamed that their cases are being settled in courts, he added. He further said that things are changing due to modern teaching skills and these type of conference are the best way to attain the knowledge and expertise from the dignitaries attending the conference from abroad and within the country.

Sitting on the dais during Ziauddin University Conference from (L to R) are Prof Abbas Zafar, Prof. A.G. Billoo, 
Prof. Shabbir Ahmed Lehri, President PM&DC (Chief Guest), Prof. Dr. Pirzada Qasim Raza Siddiqui 
and Prof. Ejaz Ahmed Vohra.

Prof. Ejaz Ahmed Vohra, Chairman organising committee speaking at the occasion said that Primary Healthcare with lack of basic health facilities has been the most neglected sector because it does not provide the facility for engraving name in stone of rulers. Only 22% of the populations have access to Government sector according to National Health Survey 1994. The situation is still unworthy of a welfare state. WHO Health indices 2015 paint an unsatisfactory picture of heath. Almost 45% of the children suffer from malnutrition leading to stunting of brain development. Mortality of neonates and children under the age of 5 years is alarmingly high and so is for maternal mortality.

Continuing Prof. Vohra said that our progress on Millennium Development Goals (MDGs) is highly unsatisfactory. This conference is designed to bridge this gap in primary health care. Recent efforts for “universal health coverage of low income group” have been taken but needs adequate planning for preventive health care and management of non-communicable chronic diseases. There is need for registration of families with primary healthcare physicians or designated health centres. Our system of education is disease oriented and we have to change its direction towards population healthcare along with individual patient care. Inclusion of family medicine in curriculum is a praiseworthy step in emphasizing and redirecting medical education, he added. Prof. Ejaz Vohra also lauded the efforts of Dr. Jawaid Usman and his team for their efforts to organise the conference.

Earlier Prof. Dr. Pirzada Qasim Raza Siddiqui, Vice Chancellor Ziauddin University in his welcome address said that Ziauddin University is a renowned institution established in the memory of Sir Ziauddin a great educationist and philosopher of Sub continent. Theme of the conference “Bridging the Gap in Primary Healthcare Innovations, Translation Beyond” is very important and provides opportunity to interact, learn and share ideas with dignitaries. Besides opportunities to start joint ventures. Ziauddin University was the first one to start problem based learning which was conceived by Late Prof. N.A Jafary. In Pakistan public private sector are very important but not much is available for poor people because only one precent GDP is allocated to health, but still we are doing our best to provide best professionals in the country, he added.

Dr. Maud Nauta from UK delivered Dr. Ziauddin memorial lecture, human factors: How and why we make mistakes. Human factor threats are silent killer in primary care. Over confidence and lack of knowledge, She stated, are the major factors of human errors. The Changes can only happen within, it is us who have to change ourselves. Its reflections are painful and the process is slow. Regulators, organization, individuals have to work to design system with locally adopted material, training and observed behavior.

Prof. A.G. Billoo, Professor of Pediatrics at AKU and Founder of HANDS delivered Prof. N.A. Jafary memorial lecture on Community Empowerment. Community Empowerment, he stated refers to process of enabling community to increase control over their lives. Main purpose of Community Based Organizations (CBO) is to empower the community from the very beginning to ensure the sustainability of the programme. If we do not have CBO no one will get the responsibility. It is very important to involve as many people in different committees, discuss their basic problems, give them powers and responsibilities and provide material in different languages according to their needs. Regular monthly meetings of CBO, community capacity building package training, resource mobilization plays an important role for success of a project.

Prof. Billoo also showed a video about Health and Nutrition Development Society (HANDS) which was founded by Prof. A.G. Billoo in 1979. HANDS have evolved in 34 years as one of the largest Non-Profit Organization of the country with integrated development model. HANDS have a network of 30 offices across the country and have access to more than 16.2 million population nearly 20,274 villages/ settlement in 34 districts of Pakistan.

Plenary Session

Prof. Riaz Qureshi from Aga Khan University delivered a talk on “Is Trained Family Physician The Jack of all Trade and Master of None?” The importance of trained and qualified family physician in the healthcare system, he said, is increasing and we have made progress in this regard. Six to seven colleges in Pakistan has now established family medicine departments. According to WHO major barriers to equitable health care consist of unequal access to disease prevention care, rising cost of healthcare , inefficient healthcare system and lack of emphasis on family physicians training. Desirable qualities of a trained family physician should be that he is caring, clinically competent, provide cost effective care, continuity of care, comprehensive care with holistic approach, have common problems management expertise, besides communication skill with confidentiality.

 We have to earn respect, self-respect and self-confidence in giving cost effective quality care to your patients which will make you feel good. You will have the better job opportunities nationally as well as internationally. Competent Family Physicians may become faculty member in one of the medical college. The principle and competencies required for the practice of family medicine are universal. They are applicable to all cultures and all social groups, from the poorest to the richest in the community. A trained family physician is master of 90% of the health problems presenting in a community and he or she can also guide the other 10% to the appropriate sources of help, he concluded.

Dr. Zarrin S Siddiqui from Australia talked about Professionalism: a charter for Pakistan. Framework for Professionalism includes dealing with self, dealing with work and dealing with others. The health of my patient, she stated, should be my first consideration. Doctors are committed to the individual patient and protecting the doctor-patient relationship. This relationship is a partnership based on mutual respect, trust and collaboration, where both doctor and patient have rights as well as responsibilities. What Patients/Carers do not like is posing as Khudaa, unwelcoming attitude, use of mobile phone, late to clinic, attending to friends, Inappropriate jokes, Sexist remarks, bad mouthing about other health professionals, using patients, colleagues and student’s photographs on social media and confidentiality breaches.

We never saw the doctors on duty or the nurses never wash their hands before examining, No one from the hospital talked to me. It is unthinkable to ignore a person who is praying for a loved one’s life for days standing in a corridor. When passing by, it is customary to exchange a word or two, just a common courtesy, some of the medical ‘elite’ think they can do whatever they want. They think what they say is the be-all and end-all. Hotshots tend to have that kind of egotism. We should remember,no matter how much any medical education program advances, the key is simple love and compassion for the patients or else, you might as well build castles out of sand. On another front we have In Pakistan Fake Doctors, “like Dr. M. Khalid Butta, ARTHU PEDIC SARJAN” if he is a doctor, we should close our medical colleges, She added. Incompetent Doctors, majority of these teachers have zero knowledge of how education and communication work specially with college adults and Showbiz doctors doing head message on females in morning TV Shows without mentioning their speciality. A health professional charter for Professionalism in Pakistan should have Leadership qualities, Compassion, Ethical, Empathy, Lifelong learner and Love for Nation, she concluded.

Prof. Nighat Huda from Liaquat National Hospital talking about Inter-Professional Education and Collaborative Practices said that IPE improves the health of population, improves patients safety, care efficiency, promotes team based learning and help to reduce the patients anxiety besides reduction in cost of care. It is now well established that inter professional education enables effective collaborative practice which in turn optimizes health services. WHO have endorsed IPE and calls on nations to reform education in view of IPE effectiveness. Inter professional education centre has been established in India but we do not have any. Pakistan faces several challenges in health and health professional education can ease health system challenges through enhanced responsiveness to the health system needs by preparing competent health professional trained to work collaboratively. We have never learnt to respect each other which is a big issue, we have to work as team, she added.

Continuing Prof. Nighat said that Inter-Professional Education can be achieved by small group activities, clinical placement for chronic illness, anxiety disorders and depression, case based discussion, acute hospital training centre, community health centres, inter-professional training wards, blended learning besides simulations. Faculty development to transform the culture of health education, Create a collaborative culture is way forward. Reform in the education of health professionals should be well aligned with health system reform. Initiate with the existing programme, adopt core IPE curricular competencies, develop faculty to teach in innovative technological IPE learning environments. Investment of time, energy and resources is essential for implementing IPE and innovative teaching and learning strategies. She concluded her presentation saying “The equitable partnership in education and practice does not happen overnight. It takes time, patience and perservance to build inter professional collaboration”.

Prof. Rukhsana Zuberi from Aga Khan talking about Simulation based education said that it is very important, we do not wants to let our dear ones die by the untrained third and final year students. We do lot of errors because we are not trained enough. In medical World Simulation help to ensure procedural competency, patient safety cultural sensitivity and ethical practices.

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