off record
Shaukat Ali Jawaid



Pakistan needs more
institutions like PKLI


It was in 1968 that Dow Medical College organized a seminar on Tuberculosis at Hotel Intercontinental (later Pearl Continental) which was chaired by Prof. A.Waheed Principal of DMC. Making a presentation on this occasion Consultant Cardiothoracic Surgeon Shirazee from Ojha Sanatorium (later renamed as Ojha Institute of Chest diseases) said that they need a new Operation Theatre which will cost Rs. Five lacs but if it is built by the PWD, it will cost Rs. Twenty lacs. Innocent and naïve as I was at that time, I could not understand why this huge difference which was later explained to me by another noted surgeon Prof. Iftikhar Rathore that it is how the work is done in Government Departments. In my later professional life of now almost fifty years, I have seen this every day. It is in this context that one would like to thank Prof. Saeed Akhtar and former Chief Minister of Punjab Mian Shahbaz Sharif for the valuable gift of Pakistan Kidney, Liver Institute and Research Centre established in the Education city at Lahore at a cost of Rs. Twenty billion in a record time. We need more institutions like PKLI to be established in other parts of Pakistan.

At present a large number of Pakistanis are going to India for Liver Transplant which is not only an embarrassment for the country but expensive, wastage of precious foreign exchange and lot of inconvenience for the patients and their attendants. During a flight returning from New Delhi after attending the WAME Conference, I had a chance to talk to six Pakistanis who were travelling in the same flight after getting liver transplant in India and came to have firsthand information of their hardships and difficulties. If such facilities are made available within the country, it will be much better as not everyone can afford to go abroad. Planning, construction, completion and commissioning of the PKLI in a record time has un-nerved many political opponents of Mian Shahbaz Sharif and professional colleagues of Prof. Saeed Akhtar as well and we see a malicious campaign against PKLI.

Late President General Ziaul Haque was the first Head of the State who made a passionate appeal to the Pakistani doctors settled in United States and Europe to come back to serve their own country. Addressing the first conference of Association of Pakistani Physicians of North America (APPNA), held in Karachi in 1979, the main theme of his speech was his request to these Pakistani doctors to either come back and serve their own country or help equip, strengthen their own Alma Matters. He used to preside the APPNA annual conference in Pakistan every year and his repeated pleas to them had a tremendous effect. APPNA and various Alumni’s representing different medical colleges started helping their alma maters, teachers and students through cash donations, donation of instruments, equipment, books, providing training facilities to young Pakistani doctors in United States, sponsoring short visit of faculty to USA and this continues till today in different forms.

I met Dr. Zaheer a pharmacist by profession at APPNA meeting in Chicago in early 80s where he told me that after successful meetings with the President Gen. Ziaul Haque and responding to his request and suggestion, they are going to establish a State of the Art Hospital in Islamabad. Hence, Shifa International Hospital at Islamabad became a reality after few years of which late Dr. Zaheer was the first Project Director. Now it also houses a medical college as well as a medical university. All the investments came from Pakistani doctors settled in USA. It has not only provided a state of the art healthcare facility in the country but also attracted talented physicians and surgeons from all over the world and specially North America and Europe to serve their own country. Some of the facilities available at this center are not available at any other public sector hospital. It also has a successful Liver Transplant Programme with which Prof. Saeed Akhtar of PKLI was associated for many years. Later Pakistani doctors established another state of the art healthcare facility at Lahore by the Name of Doctors Hospital which is perhaps Pakistan’s busiest center providing cardiac surgery. The healthcare professionals working in these hospitals are doing a commendable job. Their services need to be appreciated and commended. Every Pakistani must respect these doctors who have committed the sin of coming back to Pakistan after years of training to serve their country men instead of them being defamed and humiliated.

I also remember the historic speech delivered by Prof. Iftikhar Ahmad the former Principal of King Edward Medical College who also served as Punjab Health Secretary for some time during the Zia regime. He invited President Gen. Ziaul Haque to the KEMC convocation which was also attended by all the high ranking officials, top bureaucrats from Federal and Provincial Governments. In his welcome address Prof. Iftikhar Ahmad recalled that it is the cream of the society which gets admission to the medical colleges after the FSc result and then they spend five years in medical college, complete house job, postgraduate training, go abroad for further training, spends many years abroad earning highest professional degrees of FRCS, FRCP, FRCOG etc., and then come back to Pakistan to serve their country. What to talk of ordinary medical teachers even the Principal has no powers and often he is termed as helpless, hopeless, and useless to such an extent that he cannot even sanction the leave of his staff. They can maximum go to Grade-20. On the other hand, those who cannot get admission to medical colleges which he termed as “Lassi”, later join other profession and in actual life later “it is the Lassi which then rules over the Cream”. This is the tragedy of Pakistan. A bureaucrat can go up to Grade-22 but this facility is not available to the doctors. How then you expect them to work with dedication and devotion, he asked.

Gen. Ziaul Haque listened to Prof. Iftikhar speech patiently and when his turn came to address, he said, he has decided not to read the speech which was prepared for him for this occasion. Instead he would like to speak from his heart. He also warned Prof. Iftikhar that after this speech bureaucracy will never forgive him and he must be careful. Then he said, I fully agree with whatever has been said by Prof. Iftikhar Ahmad. Gen. Zia then addressing Mr. Fazlur Rehman the then Federal Health Secretary who was present among the audience and then hastened to add that by Mr. Fazlur Rehamn he also means the entire bureaucracy of Pakistan. “You must respect Prof. Iftikhar and all other physicians. They should have the same privileges which are enjoyed by the top bureaucrats. The Government should immediately work out a plan whereby the senior most physicians should also get Grade-22. Principals should be given powers and his office must be strengthened so that they can dispose of routine work. Not only that, Principal must be consulted in all decisions being taken about their institution and their input must be taken while preparing development plans. During Gen.Zia’s Government doctors in general and medical, dental teaching institutions in particular got lot of funding and enhanced powers as well as authority. He also encouraged everyone to respect the doctors.

Let us not discourage those doctors who are thinking of coming back to Pakistan and do not humiliate and defame those who have already committed the crime of coming back and are serving the country. It is heartening to note that PMA(C) and PIMA have also taken notice of derogatory, insulting remarks against Prof. Saeed Akhtar of PKLI. Ideally, major medical institutions should have two cadres, one full time non-practicing who should be only allowed institutional practice and others should be called part time who should be named consultants. The existing faculty members can be given option, while all new selections should be based on these lines if we wish to improve the functioning of the public hospitals. PTI Government in Khyber Pk has also introduced the concept of institutional practice, it has been initiated at NICVD at Karachi by Prof. Nadeem Qamar and is also being practiced at some other public hospitals as well. Till such time that we are able to change the culture of public hospitals where we see strikes quite frequently, junior doctors misbehaving with seniors, patients, closing OPD and Theatres, law and order situation is created too frequently, promotion of the concept of Private-Public Partnership to establish, run and mange healthcare facilities should be adopted. Let the government provide land, other incentives, facilities and initial funding to run these institutions for two to three years and later let them run on self-help basis. These institutions like PKLI should have their own Board of Directors which should lay down the policy, charge from those who can afford, take care of those who cannot pay, oversee their functioning and arrange funding and there should be no government interference in their affairs. SIUT at Karachi is yet another shining example of Public-Private partnership which is doing a commendable job with the participation of the community under the leadership of Prof. Adeebul Hassan Rizvi. Otherwise we see the performance of government institutions, PIA and the Steel Mills at Karachi are most prominent examples. There are some corrupt elements within the bureaucracy and politicians who will ruin every institution. One hopes that the message gets across to all those concerned.

Tail Piece: Learn to respect others if you wish to earn respect.

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