Postgraduate Medical Education in Pakistan (1947 to 2012)

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 Postgraduate Medical Education
in Pakistan (1947 to 2012)

Prof. Altaf Hussain Rathore FRCS
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At the time of independence 1947, the whole world especially Britain and Europe was coming out from the ravages of W.W.II. Britain was busy in rebuilding its devastated economy and social system. They were busy in planning for housing, health and education of the British island. They had no resources and time to think positively for their colonies. What they did they gave a lollipop of promise of independence to India which kept people of the subcontinent busy in fighting with each other.

Prof. Altaf Hussain Rathore

At the time of partition there was no efficient health system in Pakistan, There were very few qualified doctors in the country what to talk about the specialists. The qualified doctors & specialists were meant for the VIPs and their cronies, army officers, civil servants, missionaries and very rich people. The most of the public was at the mercy of tabibs, dispensers(one year training after matriculation) and quacks. There were only two medical colleges (K.E.M.C, Lahore and Dow Karachi) with few admissions in them and one medical school (awarding three years diploma after matriculation). The specialists were concentrated at these teaching institutions and a few were serving at the big district head quarters (that District used to be equal to almost three present districts) so called civil surgeon with multiple duties in the whole district. These surgeons in the district head quarter and in the medical colleges used to do most of the surgeries. Common operations were done for hernia, hydrocele, piles, stone bladder, appendix, prostate, phrenic, crush, artificial pneumothorax, closed reduction of the fractures and dislocation & POP and drainage of abscesses, Some daring surgeons used to do laparotomes, cholecystectomies, resections and may be gastrectomy. Anesthesia was usually administered by the dispensers in form of open ether inhalation and spinal. There were a few anaesthesia machines in the teaching hospitals, using gas, oxygen and ether or trilene (chloroform was out). Mostly herbal medicines were used and only antibiotics available were streptomycin, penecilline and sulpha drugs, Opiate, chloral hydrate bromide and recently introduced barbiturates were the most commonly used drugs (phenothiazines and antibiotic tetracycline’s were not yet freely available). The physicians usually concentrated upon the nutrition of the patients. Enemas, flatus tube, nasogasutric tubes, ice cold and hot water bottle and local applications were more popular.
No doubt the K.E Medical College Lahore and Punjab University awarded postgraduate qualifications like M.D and MS but due to some reason or other very few people used to get these qualifications. However minor diplomas like DA, DCH DOMS, DMRD, TDD, DTCD, DLO and others were more popular. The most popular post graduate qualifications were MRCP, FRCS or MRCOG from UK. Eventually late Z.A. Bhutto thought of expending our health sector efficiently and opened so many medical collages in 1973. Before that Ayub thought of opening a post graduate medical institution in Pakistan to train our own specialists. The main person who was the instrumental in his idea was his health minister Lt. Gen. W.A. Bruki who himself was an ophthalmic surgeon.
Lt. Gen. Wajid Ali Burki belonged to Jalundar (India) and did his graduation in medicine from ST. Andrews, UK, 1925 and DOMS from London later on, Opening of College of Physicians and Surgeons of Pakistan was his idea which was shared by all the veterans in medical education in Pakistan, So C.P.S.P. was started in 1962.
Like Gen. Bruki most the medical veterans were British qualified so they opted to adopt British model of post graduation education and trainings. Any medical graduate who wanted to do post graduation was allowed to appear in the examination of the CPSP provided he should have passed the examination of the college in basic medical subjects (FCPS I) and had done three years job in that specialty in any teaching hospital. One additional thing required was that he should have written and submitted a dissertation on any medical subject in that specially. FCPS was the main degree in the main clinical subjects i.e. medicine surgery, Gynecology obstetric, ENT, and Eye and other inferior diploma of two years MCPS was also introduced. Qualifications like MS, M. Phil, M.D. and PhD continued to be awarded by the universities In the beginning CPSP was just an examining body to award FCPS and MCPS which continues more or less same status up till now.
General Burki was a visionary, capable, brilliant, friendly yet a strong army officer. He had a force of Ayub’s marshal law on his back and all the resources of Pakistan, at his disposal. He had a good team of all bright veteran medical educators with him. Blue prints of well establish model of post graduate education (British) was already with him. So starting of CPSP was a great success. A grand well planned building was erected on a spacious piece of land in the most beautiful and popular area of Karachi (Defense) allotted by the Govt. of Pakistan. Museum library, offices, symposia rooms auditoriums, rest houses for the examiners and hostel for the students, well maintained lawn and garden were built. Capable and devoted persons like Prof. Siddiqui , Col. Subhan and Col. Azmi were employed.
Gen. Burki could rightly be called the father of C.P.S.P. Being in the power corridor no body dared to oppose him; yet he was polite & respected the Veteran professors. The old professors were encouraged and examiners from abroad were inducted. Rules and regulations were formulated; Most of the medical teachers with post graduate qualification were awarded honorary FCPS. Twenty Councilors were elected to run the college affairs, who also elected from themselves two VPS (North & South) one president and one treasurer. Election was held after every four years. (Secretary, registrar and other posts are not elected), in the beginning the 20 councilors were elected on whole Pakistan basis i.e. those 20 fellows who got the top most votes in the general body. Later on each province was given quota, Punjab 11, Sindh 6, Khyber Pk 2 and Baluchistan 1. Mind it fellows from army were included in Punjab. President should have been a councilor for 8 years and must have been elected as VP once and must be more then 50 years age, The first president was Gen. W.A. Burki who occupied the post till his death i.e. form 1963 to 1989. It was definitely a good take off but not many specialists were passed out as was expected. There were so many reasons:-
1. Most of the young doctors opted for the more prestigious post graduate qualifications abroad if they could afford.
2. There were no structured training programs for the post graduate studies like in the neighboring country
3. The standard of the examination of the examiners (who were mostly veteran professors) was very high so the pass rate was very low.
4. The most important thing perhaps was the scarcity of the medical graduates in the country who could go for the post graduation.
As a young assistant professor so many times I argued and requested our seniors to be a bit more lenient in the FCPS examinations, but they were determined to show to the world that the standard of Pakistan postgraduate degree is highest in the world and at what cost? The doctors who could not pass FCPS used to go abroad and could get through the British qualifications without much effort.
Everything went well till the death of the founder president in 1989, for the remaining term of three years both VP S.M. Rab and Prof. Hayat Zafar became president for half of the periods in turn. For next 6.5 years from 30th June 1992 there was confusion and power politics. Quite a good number of young fellows passed out, they were perhaps fed up of the authoritative period of Gen. Burki and his senior veteran colleagues. They wanted to run college affairs by their own ways. Different presidents came for short period and left due to some reasons or other. Prof. Luqman, A physician from Bahawalpur served for the shortest period of 28 days. Then came Prof. Sultan Farooqi for two years followed by senior physician of Lahore Prof. Khawaja Saadiq Hassan for one year. He was succeeded by Prof. Ijaz Ahsan, a surgeon from Lahore who served for two tenures, one year and three months and second for one year six month interrupted for 6 months when a Physician from Lahore Prof. Haq Nawaz (who has migrated to Canada) took over as president.
Then came again Prof. Sultan Farooqi, from Karachi. He passed MBBS from L.M.C, Hyderabad in 1960 and F.C.P.S. (Medicine) in 1974. He got elected as president from 6th of December, 1998. He was professor of medicine at J.P.M.C and has been a great name in the history of C.P.S.P. Basically he belonged to Patiala (India) and was really a good politician. He was the only councilor elected form Sindh. He took the leadership of the young fellows and was elected as president. He had a vision and did lot of improvements. He took so many drastic steps like increasing the examination fee and taking huge donation from the intending fellows. His 19 councilors were out of Sindh so naturally he had to take the help of the local fellows to run the college affairs. Later though he was very close to higher ups but he started neglecting the youngsters. It gave the wrong impression to the people that running of the C.P.S.P. had become just a Sindh (Karachi) affair and I also published a write up in 2004 (Pulse International. Vol. 5, No. 20, Oct. 1-14, 2004. ) Actually like any body in Pakistan who stays in power for long period becomes authoritarian (Dictator in Strong words) and that is perhaps what happened to him. He used to keep strict discipline and decorum. Juniors were made to give proper respect to seniors. I was told that he sometimes used rude and insulting language to the young fellows (perhaps unknowingly) so he became unpopular with the younger generation. That is why in 2007 college election he could not be elected even as a councilor.
But still I will say Farooqi’s tenure was a golden period of the college due to its achievements.
1. He expanded the college and started regional centers at Hyderabad, Larkana, Bahawalpur, Multan, Faisalabad, Lahore, Rawalpindi, Islamabad, Muzzaffarabad, Peshawar and Quetta.
2. He called the examiners from UK and other countries their stay was arranged in Five Star hotels.
3. He made regional centers abroad in Saudi Arabia and Nepal
4. He got reciprocity with the colleges of UK.
5. The college organized workshops, lectures ad Symposia on regular basis
6. There was increase in the M.C.Q. and T.O.A.C.S. bank
7. More incentives were given to the supervisors and examiners
8. To make the qualifications more glamorous, the examinations and meeting were held mostly in five star hotels.
9. The college was made financially independent to minimize the interference from the Government officials. For the above reasons the exuberant fee from the candidates for which there had been lot of hue and cry. It was a good investment because next president continued the same policy.
Dr. Farooqi got unpopular and the main reason seemed to be;
1. He started putting too much stress on the discipline to the extent to rudeness.
2. All the correspondence and submission of synopsis had to be directed to the head office in Karachi. This caused too much of the delay in reply, approval of synopsis and getting dates for the workshop (conducted at Karachi), causing lot of inconvenience to the candidates from Quetta, Punjab, Kashmir and Khyber PK.
The next president of the college was a retired professor of Surgery from KEMC, Lahore. Basically he belonged to Vehari (Punjab) did his Graduation from Nishtar Medical college, Multan in 1960 and F.R.C.S. from Edinburgh in 1968, He was my contemporary as a senior registrar surgery in K.E.M.C. Lahore. He was a great diplomat with his seniors, colleagues, juniors, students and patients. He has a good vision and a good team. He is a good speaker and has a great convincing power. He cashed all the shortcomings of his predecessor.
1. He has given more responsibility and authority to the regional centers as far as correspondence, submission and approval of synopses and holding of work shops are concerned.
2. Most of the examination are held in the regional centers.
3. A quick response to the students correspondence and early date for workshop is given
4. There is more propaganda of the college abroad. Examination is also held in Riyadh, Jeddah and Khatmandoo. Exchange of fellows is done with K.S.A and Nepal, so our F.C.P.S. is given a great respect abroad specially in middle east
5. More doctors are encouraged to pass F.C.P.S examination which minimizes the frustration in doctors.
6. Government has been pressurized to create more paid jobs for the postgraduates. (It was started by Prof. Farooqi)
The after effects are going to be seen later on, but one thing is clear that Pakistani specialist have good repute abroad specially in Saudi Arabia and Gulf states. They employ Pakistani specialist in bulk to the extent of almost depletion of specialists at home. Though it is objected from some quarters that there are lapse of discipline in C.P.S.P. and juniors don’t respect the seniors as much as they used to do before.
Establishment of C.P.S.P. has been a great achievement for Pakistan and its present form is a great success, though it started a bit late, Its single headquarter controls the standard and awards FCPS in 64 specialties and MCPS in 25 and DCPS in two subjects. It maintains the uniform and strict standard of the qualifications, which has given good name to the college. It is compared to the Indian qualification which is awarded by different centers which could not maintain the uniformity of standard and its reputatrion abroad. So I think a single headquarter at Karachi is serving a great purpose.
All the presidents of C.P.S.P did the commendable job. But the greatest credit should be given to the founder president Gen. Burki and his team of veterans, Prof. Farooqi, and Prof. Zafarullah and his team. So far college has produced 13395 FCPS, 2451 MCPS and 164 DCPS who are rendering a great service to the humanity, not only in Pakistan but also other countries.

* The author is a retired Prof. of Surgery, has 6 books and 110 papers to his credit. At present he is consultant’s surgeons Foundation Hospital Rajana Distt. Toba Tek Singh. Pakistan.

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