Missing factors in health education

By Zubeida Mustafa
Source: Dawn

THE good news from the medical sector is that Dr Azhar Faruqui, the enterprising director of the National Institute of Cardiovascular Diseases, Karachi, has taken the initiative to establish a paediatric cardiology unit at the NICVD.

This will be the first of its kind in Karachi. Lahore already has one such unit. Until now, infants needing cardiac surgery did not have many choices and many of them went abroad for simple corrective surgical procedures if their lives were to be saved.

Some medical professionals resent it that patients are taken to India when similar procedures can be performed here. But the fact is that the facilities here are very limited. Recently, Shabina, who runs the Garage School for children of the katchi abadis in Clifton and also arranges for the healthcare of her students and their families when needed, took Maxwell Happy, aged 14 months, to Chennai for a congenital heart problem that needed corrective surgery. Doctors in Karachi had refused treatment saying they did not have the post-operative care facilities to perform the operation on such a young child.

It is therefore heartening for children like Maxwell that the NICVD will be setting up a unit for paediatric cardiology. Dr Azhar Faruqui told media representatives that he plans hiring the services of foreign surgeons and anaesthesiologists for the paediatric unit.

While initially foreign expertise might be required, one hopes that Dr Faruqui plans to have his own men and women trained in this branch of medicine as soon as possible. Pakistan does not lack surgeons and physicians who excel in their field, although the declining state of medical education in the public sector has badly affected the middle cadre health professionals. But it would be a short-sighted policy to go in for foreign experts on a permanent basis rather than create training facilities to produce our own paediatric cardiologists.

We return to the question posed in these columns a few weeks ago: do we really need foreign expertise? Yes, for paediatric cardiology until NICVD can train its own specialists, which should not take more than a few years. Other health institutions in the country are sending their professionals to foreign medical institutions to provide them training under an arrangement. The Sindh Institute of Urology and Transplantation invites transplant surgeons to perform specialised surgery to train their own staff.

There have been other precedents. Prof John Hadfield, a British surgeon who died recently, rendered yeoman service to this country by paying annual visits to conduct post-graduate courses in surgery free of charge for the fellowship examinations of the Pakistan College of Physicians and Surgeons. He did that for 30 years until advancing age and failing health prevented him from undertaking the arduous journey. It is estimated that over a thousand Pakistani surgeons owe their post-graduate training to Prof Hadfield.

It is time that we explored innovative measures in the health sector. These should be designed to train young health professionals to equip them with expertise in modern technology and knowledge in their respective fields. The idea should be to opt for methods that do not unduly enhance the cost of treatment since ultimately it is the poor man who has to foot the bill for his own treatment. It is therefore more feasible if doctors who plan to stay in Pakistan and serve their own people are trained in their own environment or as close to home as possible.

We have a strange paradox here. The public-sector medical colleges and universities, which at one time produced top-ranking physicians and surgeons in the country, are in a state of rot with a few exceptions. Many new institutions are so appalling in terms of the quality of education they provide that it is actually hazardous to seek treatment from the so-called doctors produced by them.

The private sector medical institutions are vastly superior and also seek to root their education in the local socio-cultural milieu. One would have expected their graduates to form the backbone of the health delivery system. But they failed because they are not motivated enough to stay and serve their own people. They opt for the greener pastures abroad. Hence, the first step should be to revamp and radically upgrade medical education in the public sector, which should also be tailored to indigenous conditions.

If medical professionals are trained scientifically on the basis of the concept of continuing education, their performance would improve since they would understand the local needs and the people better. Some may have to be sent abroad for specialised training. But many would not have to go far. The medical institutions in China seem to produce better graduates and are quite affordable too ($2,475 per annum which includes tuition and hostel). Moreover, the health statistics of the country are living testimony to the commitment of the Chinese to public health.

Four indicators can be taken as the yardsticks to measure the state of health of a nation. One is the life expectancy at birth which is 71.5 years for China and 62.9 years for Pakistan. Infant mortality rate in these countries is 26 and 80 per 1,000 live births. Maternal mortality rate in China is 51 per 100,000 live births and 530 for Pakistan. And above all, the literacy rate is important to determine the capability of the people to contribute to their own health. In China 91 per cent of the people above 15 are literate. In Pakistan, this figure is 50 per cent.

What is missing in our medical colleges and health professionals is the sensitivity to the importance of public health. Very few of our physicians lobby the government on public health issues. How many of the medical bodies have launched serious campaigns demanding clean water, sanitation, better solid waste management?

Significantly, all of these have a direct bearing on the health of the people. It is important that a holistic approach to health be inculcated in health professionals and medical students. Specialists are certainly needed and some foreign training will improve their skills and knowledge. But better public health policies will reduce the need for medical specialists because people would not be falling ill so frequently.