off record
Shaukat Ali Jawaid

Diabetes Care
in Pakistan


Prof. M. Ibrahim was Prof. of Medicine and also Director of Jinnah Postgraduate Medical Center Karachi in late 60s who established the First Diabetic Clinic by Diabetic Association of Pakistan in Karachi on Shahrah-e-Faisal. I had the pleasure of meeting and interviewing Prof. Ibrahim in 1969. After the 1971 tragedy and separation of East Pakistan, he opted to go to Bangladesh and laid the foundation of BIRDEM which has now emerged as a Medical University, having medical colleges and numerous other postgraduate institutions. He with his colleagues also laid the foundation of Diabetic Association of Bangladesh. During his life time, Prof. Ibrahim ensured that not only BIRDEM which is the world’s biggest diabetes hospital flourishes and earns international recognition but the Diabetic Association of Bangladesh is also established on sound footings. It now has its branches in every District of Bangladesh and has played a vital role in managing patients with diabetes in Bangladesh. Diabetic Association of Bangladesh has a very democratic set up, holds regular elections and has its branches all over the country which are all affiliated with the central body but are also self-supporting, somewhat autonomous at the same time. Patients with diabetes are registered with the local diabetic association at the district level. These branches get guidance, help and assistance from the central body. Prof. Hajera Mehtab daughter of late Prof. M. Ibrahim, herself a distinguished diabetologist whom I have now known for over three decades  and Prof. Azad Khan are important members of the team which now runs and manages the BIRDEM Complex, its affiliated university and the medical colleges, postgraduate medical institutes in various disciplines of medicine. In recognition of his dedicated and devoted services, Late Prof. M. Ibrahim was honoured by the Government of Bangladesh and he was named a National Professor. He also earned a lot many other Honours and Awards at home and abroad.

While in Dhaka last year, attending the South Asian Federation of Endocrine Societies (SAFES) conference, Prof. Hajera Mehtab asked me “Pakistan has many eminent distinguished diabetologist but even then why Pakistan has not made much progress in looking after its patients with diabetes”? I thought for a while and then replied that “Pakistan could not produce a physician like late Prof.M. Ibrahim who had devoted and dedicated his life to the cause of patients with diabetes”. Unfortunately, we have some people with their own vested interests and no sincere effort has ever been made to establish Diabetic Association of Pakistan on sound footings, making it a representative body with a democratic set up. There is no denying the fact that now we have a large number of eminent diabetologist and endocrinologists in the country.  We also have many islands of excellence providing diabetes care to the patients who can afford at different public and private healthcare facilities. There are too many associations, societies, groups working in this field including various NGOs and all of them survive through the financial support of the pharmaceutical industry marketing Insulin and diabetic medications, Glucometers and Insulin Pens etc. Since diabetes is a very faithful disease, there is a big market for these and in order to increase their share, various companies in this filed are all the time willing to support and sponsor meetings organized by these associations and societies or institutions. But unfortunately, there is no cohesion, unity in their ranks and no single platform on which they all can sit together and work for the betterment of the patients with diabetes.

We have Diabetic Association of Pakistan which has most of its activities confined to Karachi, Pakistan Endocrine Society, Association of Primary Diabetes Care Physicians, centers of excellence located at Aga Khan University,  diabetes unit at Sir Syed Medical College and DUHS at Ojha Campus,  various medical institutions in Lahore at SIMS, SKMT, Allama Iqbal Medical College/Jinnah Hospital and Shalamar Hospital, at  PIMS in  Islamabad and in Peshawar at Hayatabad Medical Complex and Postgraduate Medical Institute at Lady Reading Hospital, Peshawar in Khyber PK. However, Baqai Institute of Diabetes and Endocrinology (BIDE) affiliated with Baqai Medical University at Karachi is perhaps the only institution in Pakistan which provides most comprehensive diabetes care to the patients. It also has facilities of diabetes education, Diabetes Foot Care, cost effective Foot Wear for patients with diabetes. Not only that it has established over 115 Diabetic Foot Care clinics all over the country training General Practitioners, Family Physicians, trained 417 doctors having Diploma in Diabetes, Trained 199 Diabetic Foot Care Teams, 178 doctors have completed advance course in Diabetic Foot Care, Trained  103 Diabetic Foot Care Assistants with six weeks course approved by International Working Group of Diabetic Foot, trained Diabetes Educators, and other healthcare professionals in diabetes care.  Diabetes care in Pakistan can certainly be divided into pre-BIDE and Post-BIDE era as this institution under the dynamic leadership of Prof. Abdul Basit has played a vital role in diabetes care in Pakistan. What is much more important is the fact that he is a mentor who  believes in team work, provides opportunities to all those who are interested to work, get training and improve their professional career sending them overseas for training at centers of excellence offering diabetes care. A keen researcher, his team has also published numerous studies done in Pakistan thus successfully putting Pakistan on the World Map of Diabetes Care where now BIDE enjoys international recognition and has been able to get numerous research grants from international funding agencies including International Diabetes Federation.

Some other diabetologist in their own institutions are also running various programmes. Prof. Naeem ul Haque and his team at Aga Khan University has trained many people in diabetes but there is no cohesion among all the diabetologist and endocrinologists in Pakistan.This issue was also discussed at an informal get together at lunch time among Pakistani diabetologist and endocrinologists at the SAFES meeting in Dhaka last year but so far not much headway could be made. Many of them are good “Individuals” but since we the Pakistanis are known to have a typical mentality that we cannot work as a Team which is highly disappointing. One can only wish and hope that better sense will prevail on every one and the day will come when they will decide to work as a team helping, benefitting, sharing their knowledge and experience, facilities for the common cause of improving the care of patients with diabetes. Let us also hope that one day we will have a representative Diabetic Association of Pakistan with a democratic set up, have its branches all over the country at the District and even Tehsil level. All the patients with diabetes will be registered with these local branches and we will know the exact number of people with diabetes in the country. Diabetes has already become an epidemic and its prevalence is increasing fast particularly in Asia. If the healthcare professionals looking after the patients with diabetes join hands, it will also save lot of resources of the pharmaceutical trade and industry which are wasted sponsoring too many meetings organized by different groups, institutions which they of course pass it on to the patients in the shape of higher cost of Insulin, medications and other devices. Instead we can have a national programme, avoiding duplication of efforts, save the resources of the Pharma Trade and Industry and the same can be used for the improvement of the care of patients with diabetes by establishing Insulin Bank, Free Drug Banks for those who cannot afford these medications all over the country. It only calls for giving up personal egos by few and willingness to work as a team by helping each other supplementing the efforts everyone is making at present. We can learn a lot from Bangladesh in various fields including how to establish an effective, representative Diabetic Association of Pakistan having a democratic set up and improve care for people with Diabetes.

Tail Piece: Leadership is not about popularity. It is about integrity. It is not about power, it is about purpose. It is not about title but rather Talent. Leadership is not about managing things but about developing people.

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