Negative attitude of institution heads and senior clinicians has always been a major barrier in the development and progress of sub-specialties


Negative attitude of institution heads and senior clinicians
has always been a major barrier in the development
and progress of sub-specialties

Medical Universities and other Postgraduate medical institutions must
play their role in promoting neglected sub-specialties like Emergency
Medicine, Paediatric Cardiology, Paediatric Cardiac Surgery, Paediatric
dermatology, Child Psychiatry and other important subjects

By Shaukat Ali Jawaid

KARACHI: Negative attitude of institution heads and senior clinicians who always desire to monopolize things has been a major barrier in the development and progress of sub-specialties. Those who took up this challenge had to face innumerable hurdles, hardship and wrath of their seniors but it was their determination, faith in their cause, hard work and sincerity that eventually earned them an important place in their respective disciplines.
When Prof. Hamid Ali Khan returned from UK after completing his postgraduate training in Paediatrics, he was appointed as Assistant Professor of Medicine the post which he refused to take. He insisted that he has been trained in paediatrics and would like to establish the department of paediatrics but he had to face lot of opposition from senior Professors of Medicine as well as the institution heads. However, he insisted and got himself appointed as Assistant Professor of Paediatrics. During the almost same period Prof.S.M.K.Wasti succeeded in establishing the paediatric clinic at Mayo Hospital Lahore and that was the beginning of the story of paediatrics. Once this initial step was taken, there was no looking back and now the discipline of paediatrics is fully developed and almost each and every medical institution starting from small Tehsil Hospitals to undergraduate and postgraduate medical institutions have well developed department of paediatrics. Not only that we also see the department of Neonatology in major healthcare facilities.
Prof. A. Rahim was the first qualified orthopaedic surgeon in Pakistan. When he returned after completing his postgraduate training in orthopedics from UK, he was offered the post of Assistant Professor of Surgery at Khyber Medical College Peshawar. He refused to accept that and insisted that he had been trained in orthopedics hence he should be given the job of Assistant Professor of Orthopaedic Surgery. The senior surgeons at that time were not willing to accept it and with the patronage of the institution heads blocked this initiative. Frustrated, Prof.Rahim came to Karachi and using his contacts managed to get a job at Dow Medical College and Civil Hospital Karachi. He not only established a model department of orthopaedics at CHK but also established artificial limbs, rehabilitation center at Civil Hospital Karachi. He was also given the additional charge of Medical Superintendent of CHK and he built the Arag Auditorium. He was a strict disciplinarian and Civil Hospital Karachi in those days presented a very neat and clean environment. It is another story when the Peoples Party Government came; he was removed from service through intrigues and professional jealousy. Though he was reinstated in his job but he came to CHK for few minutes, took charge and then resigned from his post never to return to Civil Hospital Karachi again. Many orthopaedic surgeons and eminent medical personalities tried their best to persuade him to reconsider his decision but he told me that he will never visit Civil Hospital Karachi again but will build his Clinic into a state of the art tertiary healthcare facility. He lived upto his promise, never stepped into CHK and built Orthopaedic and Medical Institute (OMI) at Karachi. It was the decision taken by people like Prof.Abdul Rahim that the discipline of orthopaedics got recognition and now it is also a very well developed specialty.
Prof. O.V. Jooma was the only qualified Neurosurgeon in this part of the world who often used to be called to manage patients in different countries in this region. When Prof. Najib Khan, the well known Diabetologist and medical educationist of the country who was working as Principal of Nishtar Medical College Multan, invited Prof. Bashir Ahmad a noted neurosurgeon working in UK to come and join the faculty of Nishtar Medical College, Multan, Prof. Bashir accepted this invitation with gratitude. He was delighted at the invitation which he had received from Principal of NMC and hoped that this will provide him an opportunity not only to serve his country men but also train other doctors. He had absolutely no idea about the hostile attitude of other faculty members at the institution. He was allotted a few beds in one of the Wards but the Professor in charge of the ward had instructed his staff never to allow him enter the ward. He tried a number of times but every time he wanted to enter the ward, found the door closed. He went to Prof.Najib Khan and complained about this and also briefed him about the state of affairs. Principal, Prof. Najib Khan told him that he has been allotted some beds in that ward and now it was upto him to take charge. Go and snatch what is your right. The message was clear. Prof. Bashir Ahmad made up his mind and next day went to the Ward. When he saw the door was being closed as per instructions of the Professor in charge of the Ward, he is reported to have forced his entry into the ward. This sent the necessary message to the Professor in charge of the Ward and his staff. From that day onward, he started admitting patients and taking rounds regularly. That was the beginning of the story of development of neurosurgery in Pakistan. He trained a large number of neurosurgeons. Later he was transferred to Lahore General Hospital affiliated with King Edward Medical College and he developed this specialty further. In the meantime many other trained neurosurgeons came back from UK after completing their postgraduate training, joined various institutions and discipline of neurosurgery got established on sound footings.
Prof. Syed Ghulam Shabbir was a qualified dermatologist posted at King Edward Medical College/Mayo Hospital Lahore. There were a few trained Graded skin specialists in the Army as well while Dr. Nusrat Ali Sheikh was an eminent skin specialist working as Director of Institute of Hygiene and Skin diseases at Karachi. He was also visiting dermatologist at PNS Shifa. However, the discipline of dermatology was never given any recognition which it deserved nor it was allowed to develop and progress further. It was only when Dr. Tahir Saeed Haroon came back from UK who was invited by Prof.Naseer B.Sheikh the DG Health in the then Z.A.Bhutto lead PPP Government that this important neglected specialty found someone who was determined to develop this specialty further. He had also done house job under Prof. Ghulam Shabbir at Mayo Hospital. When he was invited to come back to Pakistan he was working as Consultant Dermatologist in UK which is a very rare phenomena and distinction that an Asian had been appointed as consultant in this discipline of medicine in UK.
Prof. Tahir Saeed Haroon collected a team consisting of Prof.Ghulam Shabbir, Brig.Jaffer and Dr. Asfhaq who later became Major General and Prof .of Dermatology at Army Medical College, prepared a curriculum and convinced the CPSP to start MCPS as well as FCPS in dermatology. He also played a pivotal role in organizing the Pakistan Association of Dermatologist and those who helped him a lot in this task included late Dr. Aleem Saeed Qureshi, Dr. Khurshid H. Alvi and Cdr Rashid at PNS Shifa Karachi. PAD started holding its regular monthly clinical meetings where senior clinicians from other disciplines used to be invited to deliver talks related to dermatology. He starting training postgraduates at JPMC and soon we had many doctors who did their MCPS and FCPS in dermatology. At present we have professor of Dermatology as well as consultant dermatologists in almost all the major medical institutions, healthcare facilities. Credit for all this goes to Prof. Tahir Saeed Haroon and his team of dedicated colleagues that dermatology got recognition and a respectable place among other disciplines of medicine in Pakistan. In the meantime, he got no help and support to develop his own department at JPMC nor he was promoted. Frustrated, when he got a chance, he appeared in the interview and got selected as Professor of Dermatology at King Edward Medical College his own Alma matter which is again a rare honour and distinction. Prof. Tahir Saeed Haron utilized all his energies, contacts and established one of the most modern, well equipped and staffed Department of Dermatology in the country with its own departmental library. He retired from this position a happy satisfied man who had accomplished a lot and had achieved his objective of establishing the discipline of dermatology on sound footings.
It was Prof. Khalida Tareen who played a pioneering role and established the Department of Child Psychiatry at Mayo Hospital Lahore. Like all others, she too had to face lot of hurdles and hardships but she had the advantage that later her husband Prof. I.A.K. Tareen a well known psychiatrist was working as Professor of Psychiatry in the same institution. The couple (Tareens) has contributed a great deal to promote this discipline and it was their hard work that the Department of Child Psychiatry, the only such department was established. They worked hard and eventually it became a professorial unit. Prof. Khalida Tareen was promoted as Prof. of Child Psychiatry, the department of child psychiatry got its own identity as a separate Department. However, despite her efforts and persuasion, the department of health did not create any posts in the department of child psychiatry with the result that the department was closed on her retirement. All the efforts made to promote this neglected discipline of child psychiatry in Pakistan had gone in vain.
A couple of years ago, Dr. Nazish Imran returned from UK after completing her postgraduate education and training in Child Psychiatry. She had to work in an honorary capacity for quite some time before she was formally appointed as Assistant Professor of Child Psychiatry and later she was promoted as Associate Professor. With the help of philanthropists and her professional colleagues she has established an indoor facility at Mayo Hospital Lahore which till today is the only such facility in Pakistan. Rawalpindi General Hospital now renamed as Benazir Bhutto Hospital has some facilities for child psychiatry but not a proper department. Similarly no other medical university, postgraduate medical institution in the country has established the department of Child Psychiatry simply because of the negative attitude of the institution heads and professors of psychiatry.
Prof. Kh. Zaki Hassan was a world renowned neuro-physician. When he was working at JPMC, we did not have many qualified and trained psychiatrists, only few with minor diplomas were working as Medical Superintendents of various mental hospitals in Pakistan. So Prof. Zaki Hassan named it as Neuropsychiatry unit. Prof. Munawar Hayat was another qualified neurologist working at King Edward Medical College/Mayo Hospital Lahore. Prof. S.S.Naeemul Hameed was also a qualified neurologist but he got himself appointed as Prof. of Medicine. As such this discipline of neurology could not develop. After the retirement of Prof. Kh.Zaki Hassan, Prof. Hassan Aziz an eminent neurologist who was working at the Neuropsychiatry department got a separate dept. of neurology established and separated it from the psychiatry department with its own boundary. He also started a Certificate Course in Neurology besides training a large number of MCPS and FCPS in neurology along with his other neurologist colleagues. Thus the specialty of neurology got established and it is now on road to progress. When Prof. Malik H. Mubbashar a well known psychiatrist became the Vice Chancellor of University of Health Sciences at Lahore, he made behavioral sciences as a compulsory examination subject at undergraduate medical colleges. This move has given the discipline of psychiatry or behavioral sciences a great impetus atleast in the province of Punjab.
Prof. M. Rehman, an eminent cardiac surgeon and Prof.of Cardiac Surgery at NICVD for the first time invited the perfusionists to participate and make presentations at the annual conference of Pakistan Society of Cardiothoracic Surgeons. They were not only given due respect but their important role was also recognized by the cardiac surgeons. Now the discipline of perfusionists is well developed and Pakistan Society of Clinical Perfusionists has been formed which is doing a commendable job in training and certification of clinical perfusionists. Prof. Surgeon Rehman was paid rich tributes and the perfusions speakers at the recently held annual conference of PSCTS at Aga Khan University remembered him and offered them their gratitude.
One can go on and on to narrate such stories but this brief historical background should be enough to throw light how difficult it has been to establish any new sub-specialty and get it recognized. However, little do these institution heads and senior clinicians realize that nobody can stop the change and it does come, sooner or later? The only difference is that sometimes it comes smoothly while at other times change comes through revolution. Those who block the way, create hurdles and indulge in intrigues to stop the progress and development of the sub-specialties are also remembered while those who are cooperative and help support in the development of these important disciplines of medicine known as sub-specialties are also remembered with good words. Now it is upto the institution heads and senior clinicians in various specialties to decide as to how they wish to be remembered.
The world is progressing at a fast pace. In order to keep ourselves update and continue our journey of progress in the field of medicine, let the institution heads, Vice Chancellors of Medical Universities, Deans of Postgraduate Medical Institutes and Principals of Medical Colleges along with senior clinicians play their positive role in promoting and establishing these sub-specialties. It will go a long way in not only providing specialized care to the patients in these areas but also create job opportunities for those who take up these sub-specialties as their professional career. If God Almighty has given these institution heads some honour, they should utilize this opportunity to earn respect of their professional colleagues, uphold merit and leave their foot prints in developing some of these disciplines and sub-specialties rather than being arrogant, harsh with dictatorial attitude. The path they select for themselves will determine how they are going to be remembered in the days to come.

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