Message from Host Committee

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Publication Committee Message
Dear Friends ,
Welcome to Orlando, FL for the celebration of Silver Jubilee SMC Class of 1990 at APPNA Summer meeting. The
host committee has worked very hard for the past 10 months to make this a memorable and fun occasion for
everyone. I take immense pleasure in thanking the host committee for entrusting us with the task of producing
this publication. The Publication Committee has worked hard at fulfilling this obligation to the best of our
abilities and hope that you will like it.
Apart from one’s own efforts, the success of any project depends largely on the encouragement and guidance
of many others. I take this opportunity to express my gratitude to my class fellows who have been instrumental
in the successful completion of this magazine. I felt motivated and encouraged every time I attended host
committee meetings. Without their encouragement and guidance this project would not have materialized.
In this magazine you will find wonderful articles and stories both in English and Urdu, including some great
literary pieces of work and memorable pictures from our own class.
I am highly indebted to Dr. Tariq Khurshid for his guidance and constant supervision as well as for providing
necessary information. Collecting old pictures and rearranging them was a huge task that without his efforts
would have been very difficult.
I would also like to express my heartfelt thanks to Dr. Ilyas Vohra and Dr. Yaseen Abubaker for their kind cooperation and hard work in soliciting the advertisements, editing articles, providing constructive criticism and
friendly advice on a number of issues related to the publication.
My special gratitude to Dr. Sofia Tariq, Dr. Roohi Abubaker, Dr. Syed Hasan Abid, Dr. Perwaiz Rahim, Dr. Faisal
Waseem and Dr. Nayer Jafri for their support and guidance.
On behalf of the Publication Committee I would also like to acknowledge all advertisers, sponsors, especially all
our class fellows for their generous donations and support.
Finally, I would like to express my heartfelt thanks to my wife, Munza, for her cooperation, who as she holds this
magazine in her hands, will finally believe that when I “work at home” I really do work.
I sincerely hope that this reunion will prove to be a memorable one for you.
Great friends are hard to find, difficult to leave, and impossible to forget.
Mansoor Hasan, M.D.
Editor, English Section, Publication Committee
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Message from Host Committee
Roohi Abubakr, M.D.
Message from Project Committee
Syed Hasan Abid, MD, FACP
Hematology & Medical Oncology
Co-Chair, Host Committee
Project committee members: Chair : Syed Hasan Abid , MD, Vice chair: Nayyer Jafri, MD.
Members: Sohail Cheema, MD , Sohail Rafi, MD
I, along with the Host Committee would like to welcome our class fellows to Orlando to celebrate the Silver Jubilee
Committee Advisors: Tariq Khurshid,MD, Yaseen Abubaker,MD
celebration for our class of 1990. Twenty five years is a long time, it’s a quarter of a century, and we all should feel very
proud and elated that we are able to come together and celebrate this milestone.
Dear colleagues,
It was heartwarming to see all the responses from our class fellows who graduated from our prestigious Sind Medical
With great pride and immense gratitude, the project committee, on behalf of the class of 1990, is presenting to our
alma mater, Jinnah Sindh Medical University, a small gift on the occasion of our class’s 25th graduation anniversary;
the 2nd floor renovated lecture hall auditorium.
College which attained the status of a university not too long ago. Twenty five years ago when we graduated we
all had dreams , ambitions, and the motivation to excel in our profession and to serve humanity, and by the grace
of God, each one of us is contributing in big ways to the communities we live in. The Silver Jubilee is also a time to
look back and ponder and thank every person who served us in any way during our college life, whether it was our
professors, instructors, technicians, or cafeteria staff. We truly owe our alma mater whatever success we earn today.
I would like to thank Dr. Tariq Khurshid for working very hard to make this celebration possible. I would also like to
thank the Project Committee, especially Dr. Syed Abid Hasan and Dr. Nayyer Jafri for working tirelessly to collect the
funds to complete the renovation of the lecture hall dedicated our deceased class fellows. I will also like to thank the
Publication Committee, Dr. Ilyas Vohra and Dr. Mansoor Hasan, for coming up with a state-of-the-art souvenir journal.
Also many thanks to Dr. Pervez Rahim for taking care of the audio-visual part, Dr. Sofia Tariq, Dr. Farha Khan, and to
anyone who contributed in any way. Special thanks to Dr. Yaseen Abubaker , the former President of JSMUAANA who
guided and provided us with his expertise and valuable advice every step of the way. Above all, thanks to each and
every one of you who came from all over the United States and the rest of the world to be with us. It is your presence
that will make this Silver Jubilee celebration memorable and I am sure we will all cherish this event for a long time
to come.
We all are very thankful for the financial, logistical, administrative and moral support of our class fellows during
this endeavor. Almost a year ago, when we first started talking about our silver jubilee graduation reunion, it was
unanimously agreed that such a celebration would be incomplete if we do not include a gift for the institute that
made us what we are today.
Since our graduation a lot has changed, the college has been expanded to acquire a status of a university and has
been renamed Jinnah Sindh Medical University. Despite the changes in name and status, the overall condition of the
college in general has remained very much the same. For a myriad of reasons including limited funds and misuse of
resources, the upkeep of the buildings has been suboptimal. Our project will certainly facilitate the progress of JSMU
in becoming an institute for the 21st century. The renovated auditorium will provide current and incoming students
the facility for conductive learning and enhance the prestige of our alma mater.
All the members of the project committee worked diligently and enthusiastically. They invested their personal time
and put in immense effort to make this project a reality and a long-lasting gift to JSMU.
Dr. Nayyer Jafri worked on several aspects of the project. Advice of Dr. Sohail Cheema was invaluable. Dr. Sohail Rafi
spearheaded the efforts in Karachi. He coordinated the project and managed local finances along with Dr. Fasahat
Ullah Hussaini (batch of 87). Dr. Yaseen Abubaker and Dr. Tariq Khurshid’s contribution as advisors was invaluable and
it should be appreciated. Finally, for all those class fellows who contributed monetarily and with their well wishes, we
very much appreciate your contributions, as you are the pride of SMC and the class of 1990.
Friends, one day we all will be gone but our contribution to alma mater as sadaqa-e-jahiriya will remain as the one of
better investments we’ve made in our lives.
At the time of publishing this article the renovation work on the project is ongoing. The committee will keep you
posted on the progress and soon we will share with you the photographs of the completed project.
Warm regards,
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Ahmed
Chair Host Committee
Dr. Tariq Khurshid
I appreciate your friendship and
will never forget you
Tariq Khurshid
Family Medicine, Springfield, VA
Co-Chair Host Committee
Dr. Roohi Abubaker
Chair, Publication Committee
Dr. Mansoor Hasan
Chair, Project Committee
Dr. Syed Abid Hasan
Co-Chair, Project Committee
Dr. Nayyer Jafri
In Charge of Affairs in Pakistan, Project Committee
Dr. Sohail Rafi
Chair, Entertainment Committee
Dr. Perwaiz Rahim
Chair, Outreach Committee
Dr. Sofia Tariq
Co-Chair, Outreach Committee
Dr. Farha Khan
Advisor to Host Committee
Dr. Yaseen Abubaker Host Committee Members
Dr. Sohail Cheema, Dr. Faisal Waseem, Dr. Gauhar Khurshid,
Dr. Naushad Pervez, Dr. Imran Nisar, Dr. Suleman Lalani, Dr. Aziz Imtiaz. 6|
A loyal friend, Ahmed stood by you when you
needed somebody to be there. I think everyone
who knew him very well would agree with
me on this. The quality that gravitated others
towards him was his sense of humor. He was the
kind of person that would make everyone laugh and make them feel instantly at ease. I will
forever be thankful to God for bringing him into my life 35 years ago. The memories that I have
of our time together will forever be cherished by me.
It is incredibly sad that Ahmed’s life ended so soon and I cannot put into words how much I miss
him. Ahmed was a positive person and inspired positivity in others as well.He would not want us
to be sad today, and if he were here he would tell us to cheer up, smile and remember all of the
great memories we all shared. Even though Ahmed may be gone, his memory will live on in all of
us forever. Ahmed I appreciate your friendship and will never forget you.
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Abdul Haleem,
Abdul Kabir
Abdul Qayyum
Aquilla B. Moosani
Arif Pervez
Arif Somjee
Adnan Anwar Khan
Agha Sajjad
Ajmal Shamim
Asad Aziz
Ashar Humayun
Ashfaque Saya
Aliya Sarwat
Altaf Bosan
Amin Delawala
Asif Hasan
Asif Kamal
Atiq Silat
Amin Lakhani
Amjad Saeed
Anita Allana
Azhar Mashood
Aziz Imtiaz
Bhagwan Bhimani
Pediatrics,Yonkers,NY
Karachi, Pakistan
Karachi, Pakistan
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BC, Canada
Internal Medicine, Monroe, MI
Anesthesiology, Karachi, Pakistan
Islamabad, Pakistan
Karachi, Pakistan
Al Madinah, Saudi Arabia
Internal Medicine, Dublin,OH
Karachi, Pakistan
AKUH, Karachi Pakistan
Pediatrics, Austin, TX
Canada
Karachi, Pakistan
Toronto, Ontario
Edmonton, Albaert
Psychiatry, Lincoln Park, MI
Mirpur, Pakistan
Pediatrics, Kissimmee, FL
Internal Medicine, Ashland, MS
Emergency Medicine, Grand Saline, TX
Karachi, Pakistan
Nephrology, Louisville, KY
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Chandi Ram
Karachi, Pakistan
Dur Muhammad
Karachi, Pakistan
Ejaz Qureshi
Lahore Pakistan
Faisal Waseem
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Internal Medicine, New Hyde
Park, NY
Chandur Piryani
Pain Medicine, Mequon, WI
Dureshahwar Fernandez
Pulmnology, Wichita Fall, Texas
Fahim Iqbal
Riyadh, SA
Farah Khan
Endocrinology, Minnetonka, MN
Charmaine Gill
Hamilton, Ontario
Ejaz Nehmat
Internal MedicineJupiter, FL
Faisal Rahman
Halifax, Nova Scotia
Farooq Nadeem Siddiqui
Doha, Qatar
Farrukh Mateen
Farzana Syed
Fauzia Zakariya
Fayyaz Khan
Stephenville, New Foundland
London,UK
Gauhar Khurshid
Ghazala Hamid
Ghazala Hasnat
Ghulam Nabi Jillani
Habib Siddiqui
Hamid Jibran
Islamabad, Pakistan
Edmonton, Canada
Psychiatry, Exton, PA
Karachi,Pakistan
Albany, NY
London, UK
Karachi, Pakistan
Fauzia Majid
Psychiatry, Boonsboro, MD
Fouzia Rizvi
Karachi, Pakistan
Edmonton, AB
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Hari Kirshan Kantiya
Haris Khan
Hassan Zulfiqar
Jaffer Mobeen
Jai Bhimani
Jamil Gulzar
Huma Abbas
Huma Ghazala
Huma Naqvi
Jamil Mughal
Jan Muhammad Sheikh
Jawed ul Haq
Huma Shahab
Humaid Muhammad
Humayun Mustafa
Jawed Warrind
Jumana Ahmed
Junaid Azher
Huzaima Afzal
Imran Nisar
Izhar Shah
Kamal Muzaffar
Kazi Waqar Ahmad
Khalid Aziz
Salalah, Oman
Child Psychiatry, Naperville, IL
Karachi Pakistan
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Toronto, Canada
Muscat, Oman
Ashford, UK
Ras Al Khaimah, UAE
Pulmonology, Elk Grove Village, IL
Gastroenterology, South Daytona, FL
Pain Medicine, New York, NY
Karachi, Pakistan
Karachi, Pakistan
Anesthesiology, DixHills, NY
Abha, KSA
Pulmnology, Karachi, Pakistan
Internal Medicine,Elkhorn, WI
Nephrology, Louisville, KY
Karachi, Pakistan
Raleigh, NC
Psychiatry, Maitland, FL
Karachi, Pakistan
Psychiatry, Florida
Jeddah, Saudi Arabia
London, UK
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Khempar Shehani
Khusro Zia
Lubna Aftab
Mohammad Yaqoob Dal
Mohammad Yaseen Abubaker
Mohiuddin Ahmed
Lubna Riaz
Majida Tufail Hanel
Mansoor Hasan
Muddassir Khan
Muhammad Ilyas Vohra
Muhammad Kamran Qadri
Matloob Rahmen
Mazhar Bari
Mehboob Nazarani
Muhammad Mazhar Hijazi
Mukhi Suresh
Mustafa Shoaib
Mohammad Tahir Majid
Nabeela Naseer
Nadeem Azhar Siddiqui
Nadeem Baloch
Karachi, Pakistan
Karachi, Pakistan
Nephrology, Covington, LA
Mirza Naseer Baig
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Brentwood, UK
Karachi, Pakistan
Karachi, Pakistan
Mohammad Sabahat Siddiqui
Pulmonology, Lufkin,TX
Toronto, Ontario
Pain Medicine, Madison, MS
Psychiatry, Houston,TX
Nephrology, Orlando,FL
Mirpurkhas, Pakistan
New Market, Ontario
Makkah, Saudi Arabia
Anethesiology Karachi, Pakistan
Rheumatology, Marietta, GA
Internal Medicine, Richmond, VA
Karachi, Pakistan
Karachi, Pakistan
Internal Medicine, Sun City, AZ
Chicago, IL
Orthopeadic Surgeon, Karachi Pakistan
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Nadeem Gazdar
Nadeem Hoodboy
Nadeem Mughal
Naveed Masoom Ali
Naveed Muhammad
Nayyer H. Jafri
Naghma Yasmin
Naila Zahid
Nargis Masroor
Nighat Bano
Nisir Nasar Sohtra
Perwaiz Rahim
Nasar Katariwala
Naseer Rajab Ali
Nasim Kamil
Rabab Rizvi
Rashid Ahmed
Rashke Irum
Nasir Khan
Naureen Wajihuddin
Naushad Pervez,
Reena Rizvi
Riaz Qamar
Riffat Shabbir
Melbourne, Australia
Singapore
Neurology, Chesterton, IN
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Family Medicine, Dallas, TX
Family Medicine, Atlanta, GA
Hematology Oncology, Liaquat
Hospital, Karachi , Pakistan
Warwick, NY
Chicago, IL
Ballarat, Victoria
Karachi, Pakistan
Nephrology,Northville,IL.jpg
Karachi, Pakistan
Karachi, Pakistan
Sydney, Australia
Family Medicine, Harrisonburg, VA
Family Medicine, Chicago, IL
Karachi, Pakistan
Karachi, Pakistan
Karachi, Pakistan
Pathology, Columbus, OH
Pulmnology, Tampa, FL
Gynecologist, Karachi , Pakistan
Karachi, Pakistan
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Roohi Abubaker
Psychiatry, Decatur,GA
Saeed Siddiqui
Cardiology, Ozone Park, NY
Salma Qureishi
Yorkshire, England
Satywan Chhabria
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Internal Medicine, Jacksonville, FL
Rubina Chhatriwala
Chicago, Illinois
Sahar Seemee
Karachi, Pakistan
Sameena Isphani
Karachi, Pakistan
Shabana Khan
Karachi, Pakistan
Rubina Hamdani
Lahore, Pakistan
Sajjad Haider
Makkah, Saudi Arabia
Sami Shaikh
London England
Shafiq Javaid
Birmingham, UK
Shah Faisal
Shah Wajihuddin
Shahdev Vankwaniaukot
Shahid Idrees
Shahid Sheikani
Shakil Ahmad
Shankar Lal Vankwani
Shariq Masood
Al Khobar, Saudi Arabia
AKUH, Karachi Pakistan
Shehla Faraz
Shehnaz Yunus
Shehzad Farooqi
Karachi, Pakistan
Pediatrics, Warsaw, NY
Islamkot, Pakistan
Islamabad, Pakistan
Riyadh,Saudi Arabia
Hematology Oncology,Caledonia, IL
Ob-Gyn, Karachi, Pakistan
Pakistan
Neurologist, Karachi, Pakistan
Shazia Babar
Psychiatry, Troy, Michigan
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Sheila Farooqi
Sofia Rizwan
Sohail Aftab
Syed Haider Mehdi
Syed Hasan Abid
Syed Mairajuddin Shah
Sohail Cheema
Sohail Memon
Sohail Rafi
Syed Mumtaz Hussain Zaidi
Syed Tahseen Rab
Syed Waseem Zaidi
Sophia Qureshi
Suleman Lalani
Syed Amir Anwar
Syeda Aisha
Tabassum Navaid
Takdees Iftiqar
Syed Amjad Imam
Syed Azhar Hassan
Syed Baqar Raza
Tariq Jamal
Tariq Khurshid
Tariq Majeed
Karachi, Pakistan
Psychiatry, Westbury, NY
Rotterdam, Neitherlands
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Child Psychiatry, Atlanta, GA
Psychiatry, Springfield, VA
Dubai, UAE
Geriatric Medicine, Sugar Land, TX
Karachi, Pakistan
Anesthesiology, Toledo,OH
Orthopaedic Surgeon, Karachi
Pakistan
Beaumont Hospital, Lucan, Dublin
Peterborough, UK
Urologist SUIT, Karachi, Pakistan
Karachi, Pakistan
Kano, Nigeria
Karachi, Pakistan
Hematology Oncology, St
Petersburg, FL
Nephrology, Hammond, LA
Obstetrician, Abu Dhabi, UAE
Family Medicine, Springfield, VA
Medical Director Out Reach Services,
AKUH, Karachi, Pakistan
Gastroenterology, Shreveport, IL
Islamabad, Pakistan
Karachi, Pakistan
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Tariq Nazir
Tariq Sharaf
Tazeen Fatima Ali
Wali Ahmed Kamali
Waseem Shariff
Yahya Tumbi
Teekam Das Ochani
Tehmina Ansari
Uzma Imran
Zafar Ahmed
Zamir Siddiqui
Zeba Jabeen
Uzma Jafri
Uzma Khan
Uzma Manzar Ali
Zohra Khan
Zubaida Masood
Zulfiqar Muhammad
Vaqar Siddiqui
Versi Mal Aruwani
Wajahat Meer
Humayun Aslam
Waqar Ahmed
Hematology Oncology, Fayetteville North Carolina
Anesthesiology, Dallas, TX
Naperville, IL
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Neurology, Eastpointe, MI
Karachi, Pakistan
Karachi, Pakistan
Karachi, Pakistan
Internal Medicine, Franklin, NC
Karachi, Pakistan
Family Medicine, Hackettstown, NJ
Family Medicine, Ronoake, VA
Tabuk, Saudi Arabia
Colo-rectal Surgeon, New Zealand
Malaysia
Internal Medicine, Detriot, MI
San Antanio,TX
Canada
Rawalakot, Kashmir
Ob.gyn, Abbasi Shaheed Hospital,
Karachi, Pakistan
Karachi.
Karachi, Pakistan
Hematologist, UAE
Internal Medicine, Minneapolis,MN
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Interview: Prof. Tariq Rafi
Founder Vice Chancellor JSMU
Despite hurdles and problems, JSMU
has not
only survived but made
commendable
progress since its inception in
2012
Plans are ready for ISO certification, establishment of
dental college, Clinical Trials Unit while
Diagnostic Lab
will start functioning within six months
SMC Alumni of North America
has made tremendous
financial contributions
to their Alma Matter
KARACHI: Jinnah Sindh Medical University (JSMU) did not have a normal birth. In fact it was after Dow University of
Health Sciences went through a C. Section that it gave birth to two new medical universities i.e. up gradation of Sindh
Medical College to a University and establishment of Benazir Bhutto Medical University at Layari General Hospital.
When former Prime Minister Benazir Bhutto visited United States, she promised to the SMC Alumni of North America
that when their government comes, it will upgrade SMC to a university. Mr. Asif Zardari was also present on that
occasion. Hence, when the time came, President Asif Ali Zardari fulfilled that promise made with the SMC Alumni of
North America. It was his personal interest that despite lot of opposition, he signed the Charter for Sindh Medical
University at a meeting held at Bilawal House and not at the Governor House Karachi.
than SMC, hence to remove their grievances, the name of the university was once again changed to Jinnah Sindh
Medical University. Even otherwise the government had refused to give university status to JPMC saying that if they
wish to become a university, first they have to establish a medical college and only then it can be upgraded to a
university. No hospital can be made a university. A medical college could not be established at JPMC and this issued
continued to linger on. When the SMC was finally given the status of a university, JPMC senior faculty members went
to the court stating that they wished to remain with the federal government. However, after the 18th constitutional
amendment wherein health was given to the provinces, it became further difficult. Hearing in the JPMC faculty case
has completed, both the parties have given their arguments and now the court has to announce its decision which
is expected any moment. However, this litigation has adversely affected the teaching, training and patient care at
the JPMC. After the retirement of numerous professors, since there was no faculty, many departments have been
closed, some are functioning with bare minimum junior staff. Some of the units do not have a Professor or Associate
Professor because neither any new inductions could be made nor any one was promoted. Many people are waiting
for their promotion which is long overdue.
The JSMU was formally established on June 1st 2012 and Prof.Tariq Rafi, Prof. of ENT at JPMC was appointed as its
founder Vice Chancellor who assumed his new responsibilities on June 29th 2012. In an exclusive interview with
Pulse International recently, Prof.Tariq Rafi highlighted the achievements and accomplishments so far and also talked
about the future development plans of Jinnah Sindh Medical University. The current enrollment in Sindh Medical
College, he said, was three hundred fifty and we have inducted forty five new faculty and staff members particularly
in the basic medical sciences. Except Forensic Medicine where we do not have a Professor, all the basic medical
sciences departments are well equipped and adequately staffed, he added. Problems with the clinical faculty remain
and once the court verdict is announced in the JPMC faculty case, we will be able to make fresh appointments. Prof.
Tariq Rafi opined that it was unfortunate that there was some misunderstanding in the senior faculty members of
JPMC. All the professors are members of the Senate of the University. Not only that, Associate, Assistant Professors
and junior faculty also get representation in the Senate. In any case they would have been in overwhelming majority
in the Senate to run and manage the university the way they liked. At present JPMC has a bed strength of 1600
but there are only fifty six Medical Officers. How it is possible to efficiently run such a big tertiary healthcare facility
with such a meager number of Medical Officers when they also have to do night duty and attend emergencies. This
has certainly affected the quality of patient care. Not only that, when there are no trainers, supervisors, how the
postgraduates can be trained, he remarked. Now the provincial assembly has passed a bill making JPMC and National
Institute of Child Health (NICH) as its constituent institutions with the result that the administration of these two
institutions will also come under the administrative control of the JSMU. At present the following medical and dental
institutions are affiliated with Jinnah Sindh Medical University:
1. Sindh Medical College
2. Jinnah Medical and Dental College
4. Altamash Institute of Dental Medicine
3. United Medical & Dental College
5. Fatima Jinnah Dental College
6. Liaquat National Hospital & Medical College 7. Sir Syed College of Medical Sciences for Girls
Prof. Tariq Rafi
Vice Chancellor, JSMU
This university had to face lot of hurdles and problems from the very first day of its inception but despite all that it has
not only survived but managed to make commendable progress over the past three years. First this university was
established through an Ordinance but the bill could not be passed by the Sindh Assembly in time and this ordinance
got lapsed. The JPMC staff was also unhappy because they felt that it was their right to get a university status rather
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8. Liaquat College of Medicine and Dentistry
Plans are afoot to establish the JSMU Dental College. Faculty was selected after detailed interview by a committee
and now we are issuing them offer letters to come and join us. Equipment has also been acquired while some more is
being arranged. Once we are through this process, we will ask the Pakistan Medical & Dental College to send a team
for inspection and then this dental college will be established after getting necessary permission.
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Replying to a question regarding the financial assistance provided by Sindh Medical College Alumni Association of
North America, Prof.Tariq Rafi was full of praise for them. The Alumni with the assistance and collaboration of APPNA
provided us US$ 86,000/- which enabled us to establish APPNA Institute of Public Health currently headed by Prof.
Lubna Baig. They also provided us US$ 80,000/- for the renovation of two lecture halls while the third lecture hall is
now being renovated with a further assistance of US$ 40,000/- This is not all, they also provided us US$ 25.000/- for
purchase of books for the library besides giving us US$ 10,000/- every year for providing scholarships to the needy
students. University itself has earmarked Rupees one Crore for offering scholarships to the students as well. These
scholarships are of two types. First it is on merit and those students who secure First, Second and Third position, their
tuition fee is waived off. Secondly those who cannot afford tuition fee, they are also provided financial assistance
upto Rs. 50,000/- for a year. We have also got some arrangements whereby some philanthropists also help us with
the result that no student who once gets enrolled in the university, is forced to discontinue his/her studies and we try
to help them through different ways.
Replying to another question Prof. Tariq Rafi said that JSMU syndicate has seventeen members while the strength
of University Senate is over forty. All professors and representatives of various categories of teachers have their
representation on the senate. In addition PM&DC, HEC have their representatives in the Senate. Moreover all the
affiliated medical and dental colleges also have a representation in the Senate. At present the total staff of the
university was one hundred seventy including eleven professors. As soon as the court case is decided, the vacant
positions in the clinical faculty will be filled up immediately. So far we could not start any postgraduate programme
in basic sciences despite the fact that we have qualified and experienced staff, because BMSI at JPMC is a well
established unit and we would like to further strengthen and promote that instead of having a parallel basic medical
sciences unit, if the JPMC becomes a constituent institution of the university after the court decision.
Asked about the teaching and training facilities currently available at JSMU Prof.Tariq Rafi said that we have five
lecture halls each having a seating capacity for 350 students. We have two auditoriums. We avail the facility of APPNA
lecture series which is arranged from 8.00 AM to 9.00 AM on first Monday of every month. These are mostly on
clinical subjects and the presentation from an expert in a particular discipline of medicine is followed by interactive
question-answer session. It is extremely helpful to update the knowledge of our clinicians. We are preparing for ISO
Certification; JSMU Dental College will be established soon. A modern state of the art diagnostic service offering all
the investigations besides imaging facilities of CT and MRI will be available within six months. Hopefully we will be
able to generate some funding for the university from this project. Despite the fact that we had to face lot of problems,
we have accomplished a lot during the last three years. Our annual budget is Rs. 450 Million. Sindh Government gives
us Rs. 250 Million and the rest we generate from our own resources. Answering another question Prof.Tariq Rafi
said that so far HEC has not given us any financial assistance. According to their rules, they do not give any financial
assistance during the first three years when the universities have to survive at their own. After three years they give
grant to various universities. We are now hopeful that from the next year we will get some financial grant from the
Higher Education Commission as well, he added. Ever since its inception in 1973, Sindh Medical College has so far
produced 10,500 graduates, he stated
1. APPNA Institute of Public Health
12. Quality Enhancement Cell
2. Institute of Pharmacy
13. Power Lab
3. Institute of Health Business Management
14. Digital Library for continuous assessment and
4. Institute of Medical Technology
online examination
5. Professional Development Center
15. Administration department
6. Department of Medical Education
16. Finance Department
7. Research Department
17. Information Technology Dept.
8. Admission Cell
18. Audit Department
9. Examination Department
19. Planning and Development Dept.
10. MCQ Bank
20. Students Affairs Dept.
11. Clinical coordination cell
21. Human Resource Dept.
22. Legal Cell
Board of Studies, Academic Council and Syndicate of the university has been constituted and they are functioning.
University is recognized by HEC. Institutional Review Board headed by Dr. Asim has been constituted. We are
implementing integrated modular curriculum, we have introduced Learning Management System, established
Endowment Fund and publication of the university journal i.e. Annals of Jinnah Sindh Medical University has started.
We have also signed an MOU with Board of Trustees of the University of Illinois, USA for faculty development,
consultations, exchange of faculty and students, to have joint educational programmes besides preparation of
academic materials. The most important fact which makes JSMU different from other institutions is that we select
people on merit through a high powered selection committee and then give them free hand following modern
scientific principles of management. They enjoy complete academic autonomy to plan and executive various
projects, we give them due respect and autonomy and this encourages them to give their best. There is no unnecessary interference in their working and they enjoy complete freedom, Prof. Tariq Rafi concluded.
link to article: http://pulsepakistan.com/index.php/main-news-june-15-15/1217-despite-hurdles-and-problemsjsmu-has-not-only-survived-but-made-commendable-progress-since-its-inception-in-2012
Responding to yet another question Prof. Tariq Rafi said that so far we have established the following new institutions
and departments:
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Choosing Wisely…
2) Don’t test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the
setting of major transient risk factors (surgery, trauma or prolonged immobility).
An initiative of The American Board
of Internal Medicine Foundation.
Thrombophilia testing is costly and can result in harm to patients if the duration of anticoagulation is inappropriately
prolonged or if patients are incorrectly labeled as thrombophilic. Thrombophilia testing does not change the
management of VTEs occurring in the setting of major transient VTE risk factors. When VTE occurs in the setting of
pregnancy or hormonal therapy, or when there is a strong family history plus a major transient risk factor, the role
of thrombophilia testing is complex and patients and clinicians are advised to seek guidance from an expert in VTE.
Tariq Nazir, MD.
Medical Oncologist / Hematologist.
Health Pavilion North Cancer Center of Cape Fear Valley Health System.
Fayetteville, North Carolina.
The practice of clinical medicine is fraught with multiple challenges for the physicians in almost all the specialties of
medical sciences. There had been a continued influx of novel diagnostic tests, procedures, treatment modalities, and
an armamentarium of ever expanding drugs over the years. The new concepts are evolved on the basis of “ Evidence
based medicine”, and it is difficult for a busy practitioner to keep up with the latest revised recommendations. We,
the physician community, owe it to our patients, and the community at large, to learn and adopt these changes in
our daily practice.
In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding
wasteful or unnecessary medical tests, treatments and procedures.
Choosing Wisely centers around conversations between providers and patients informed by the evidence-based
recommendations of “Things Providers and Patients Should Question.” More than 70 specialty society partners have
released recommendations with the intention of facilitating wise decisions about the most appropriate care based
on a patients’ individual situation.
I am a Medical Oncologist / Hematologist. I would like to share with you some of these recommendations, on most
common clinical issues, that we deal with, in our clinics and hospitals quite commonly.
American Society of Hematology
Ten Things Physicians and Patients Should Question
Released December 4, 2013 (1-5)
and December 3, 2014 (6-10)
1) Don’t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve
symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients).
Transfusion of the smallest effective dose of RBCs is recommended because liberal transfusion strategies do not
improve outcomes when compared to restrictive strategies. Unnecessary transfusion generates costs and exposes
patients to potential adverse effects without any likelihood of benefit. Clinicians are urged to avoid the routine
administration of 2 units of RBCs if 1 unit is sufficient and to use appropriate weight-based dosing of RBCs in children.
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3) Don’t use inferior vena cava (IVC) filters routinely in patients with acute VTE.
IVC filters are costly, can cause harm and do not have a strong evidentiary basis. The main indication for IVC
filters is patients with acute VTE and a contraindication to anticoagulation such as active bleeding or a high risk
of anticoagulant-associated bleeding. Lesser indications that may be reasonable in some cases include patients
experiencing pulmonary embolism (PE) despite appropriate, therapeutic anticoagulation, or patients with massive
PE and poor cardiopulmonary reserve. Retrievable filters are recommended over permanent filters with removal of
the filter when the risk for PE has resolved and/or when anticoagulation can be safely resumed.
4) Don’t administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K
antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery).
Blood products can cause serious harm to patients, are costly and are rarely indicated in the reversal of vitamin
K antagonist in non-emergent situations, elevations in the international normalized ratio are best addressed by
holding the vitamin K antagonist and/or by administering vitamin K.
5) Limit surveillance computed tomography (CT) scans in asymptomatic patients following curative-intent
treatment for aggressive lymphoma.
CT surveillance in asymptomatic patients in remission from aggressive non-Hodgkin lymphoma may be harmful
through a small but cumulative risk of radiation-induced malignancy. It is also costly and has not been demonstrated
to improve survival. Physicians are encouraged to carefully weigh the anticipated benefits of post-treatment CT
scans against the potential harm of radiation exposure. Due to a decreasing probability of relapse with the passage
of time and a lack of proven benefit, CT scans in asymptomatic patients more than 2 years beyond the completion of
treatment are rarely advisable.
6) Don’t treat with an anticoagulant for more than three months in a patient with a first venous
thromboembolism (VTE) occurring in the setting of a major transient risk factor.
Anticoagulation is potentially harmful and costly. Patients with a first VTE triggered by a major, transient risk factor
such as surgery, trauma or an intravascular catheter are at low risk for recurrence once the risk factor has resolved
and an adequate treatment regimen with anticoagulation has been completed. Evidence-based and consensus
guidelines recommend three months of anticoagulation over shorter or longer periods of anticoagulation in patients
with VTE in the setting of a reversible provoking factor. By ensuring a patient receives an appropriate regimen of
anticoagulation, clinicians may avoid unnecessary harm, reduce health care expenses and improve quality of life.
This Choosing Wisely® recommendation is not intended to apply to VTE associated with non-major risk factors (e.g.,
hormonal therapy, pregnancy, travel-associated immobility, etc.), as the risk of recurrent VTE in these groups is either
intermediate or poorly defined.
7) Don’t routinely transfuse patients with sickle cell disease (SCD) for chronic anemia or uncomplicated pain
crisis without an appropriate clinical indication.
Patients with SCD are especially vulnerable to potential harms from unnecessary red blood cell transfusion. In
particular, they experience an increased risk of alloimmunization to minor blood group antigens and a high risk of
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iron overload from repeated transfusions. Patients with the most severe genotypes of SCD with baseline hemoglobin
(Hb) values in the 7-10 g/dl range can usually tolerate further temporary reductions in Hb without developing
symptoms of anemia. Many patients with SCD receive intravenous fluids to improve hydration when hospitalized
for management of pain crisis, which may contribute to a decrease in Hb by 1-2 g/dL. Routine administration of red
cells in this setting should be avoided. Moreover, there is no evidence that transfusion reduces pain due to vasoocclusive crisis. For a discussion of when transfusion is indicated in SCD, readers are referred to recent evidencebased guidelines from the National Heart, Lung, and Blood Institute (NHLBI).
Cancer Awareness & Prevention
8) Don’t perform baseline or routine surveillance computed tomography (CT) scans in patients with
asymptomatic, early-stage chronic lymphocytic leukemia (CLL).
Hematology & Medical Oncology.
In patients with asymptomatic, early-stage CLL, baseline and routine surveillance CT scans do not improve survival
and are not necessary to stage or prognosticate patients. CT scans expose patients to small doses of radiation,
can detect incidental findings that are not clinically relevant but lead to further investigations and are costly. For
asymptomatic patients with early-stage CLL, clinical staging and blood monitoring is recommended over CT scans.
9) Don’t test or treat for suspected heparin-induced thrombocytopenia (HIT) in patients with a low pre-test
probability of HIT.
In patients with suspected HIT, use the “4T’s” score to calculate the pre-test probability of HIT. This scoring system
uses the timing and degree of thrombocytopenia, the presence or absence of thrombosis, and the existence of
other causes of thrombocytopenia to assess the pre-test probability of HIT. HIT can be excluded by a low pre-test
probability score (4T’s score of 0-3) without the need for laboratory investigation. Do not discontinue heparin or start
a non-heparin anticoagulant in these low-risk patients because presumptive treatment often involves an increased
risk of bleeding, and because alternative anticoagulants are costly.
10) Don’t treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a very
low platelet count.
Treatment for ITP should be aimed at treating and preventing bleeding episodes and improving quality of life.
Unnecessary treatment exposes patients to potentially serious treatment side effects and can be costly, with little
expectation of clinical benefit. The decision to treat ITP should be based on an individual patient’s symptoms,
bleeding risk (as determined by prior bleeding episodes and risk factors for bleeding such as use of anticoagulants,
advanced age, high-risk activities, etc.), social factors (distance from the hospital/travel concerns), side effects of
possible treatments, upcoming procedures, and patient preferences. In the pediatric setting, treatment is usually
not indicated in the absence of mucosal bleeding regardless of platelet count. In the adult setting, treatment may
be indicated in the absence of bleeding if the platelet count is very low. However, ITP treatment is rarely indicated in
adult patients with platelet counts greater than 30,000/microL unless they are preparing for surgery or an invasive
procedure, or have a significant additional risk factor for bleeding. In patients preparing for surgery or other invasive
procedures, short-term treatment may be indicated to increase the platelet count prior to the planned intervention
and during the immediate post-operative period.
Syed Hasan Abid, M.D., F.A.C.P
Cancer has been around for as long as life has existed on our planet. Dinosaur bone fossils from 80 million years ago
show possible evidence of cancer. Evidence of cancer has been found in Egyptian mummies from 3000 BC era.
Human body is made up of trillions of living cells. Cancer starts when cells in a part of the body start to grow out of
control because of DNA damage. People can inherit abnormal DNA but most often the DNA damage is caused by
mistakes that happen while the normal cell is reproducing. Risk factors for cancer development are many, like Cigarette smoking, alcohol use, excessive sun exposure, chemical
exposure to industrial & environmental toxins , certain medications,infections and genetics ( Hereditary ).
In 2014 it is estimated that there will be more than 1.7 million cases of cancer in United States with more than
585,000 deaths, second only to heart disease. There are 13.7 million Americans with a history of cancer alive. World
wide in 2012 there were approximately 14 million cases of cancer with 32.5 million people living with cancer. There
world wide numbers are underestimated as in many parts of the world there is no accurate reporting and diagnostics
facilities available.
A substantial portion of cancer’s could be prevented. Appropriate cancer screening, a healthy life style with healthy
eating habits go a long way in preventing cancer from developing in your body. With modern treatments the 5 year
survival for all cancer’s diagnosed between 2003 to 2009 is 68%, up from 49% in 1975 to 1977.
Prevention, early detection and appropriate treatment is key to curing cancer. Some screening tests that are available
for cancer include colonoscopy for colon & rectal cancer, Skin examination for skin cancers, blood PSA test for prostate
cancer, pelvic exam for cervical cancer, Mammogram for breast cancer and CT scan of chest for smokers who are high
risk for Lung cancer.
Treatment of cancer usually include either alone of in combination surgery, radiation and chemotherapy.
Chemotherapy means medications use to kill cancer cells. Now a days there are other medications called biologics,
immune therapy and cancer vaccines also used to treat cancer either alone or in combination with chemotherapy
drugs. There is a common perception and stereotype in society that chemotherapy can kill you. This is totally wrong.
Chemotherapy is suppose to kill cancer and not you. Side effects do and can happen but with modern supportive
care medications most side effects are tolerable and manageable. The goal is to take patient through the treatment
successfully towards a cure and long term remission, as many people will live with cancer for years, just like people
with live other diseases diabetes, high blood pressure, arthritis etc. to name a few.
I hope that this brief introduction to cancer helped raise awareness to this serious illness. If you or your loved one
is suffering from cancer you need to know that there is a lot of help,guidance and resources available. Please talk to
your doctor so that you can get professional advice.
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State of Healthcare Quality and Patient
Safety in Pakistan
Department of Community Health Sciences, Aga Khan University, Karachi
initiate the formulation of primary and secondary healthcare standards in Pakistan in 2006. Capitalizing on the KPK’s
primary and secondary healthcare standards, The Pakistan Standards and Quality Control Authority (PS&QCA) also
recently formulated a set of national accreditation standards for Primary Health Care and Secondary to Tertiary
Care Hospitals (8). The Pakistan National Accreditation Council (PNAC) started voluntary accreditation of clinical
laboratories for ISO 15189 Certification (9). The previous Government took an excellent initiative on introducing the
Prime Minister Quality Award in the sectors of manufacturing, finance, service, health and education, but it did not
materialize. The award framework was based on the USA’s prestigious Malcolm Baldrige National Quality Award (10).
Pakistan’s Healthcare System
Pakistan’s Key Healthcare Challenges
Pakistan’s healthcare infrastructure include 919 hospitals, 5334 basic health units (BHUs) and sub-health centers, 560
rural health centers (RHCs), 4712 dispensaries, 905 maternal and child health (MCH) centers and 288 tuberculosis
centers (1). The utilization of this strong infrastructure has remained low over the years due to inadequate financing,
lack of resources and structural mismanagement. The country only spends 0.5-0.6% of its GDP on health.
As defined in Pakistan’s Health Policy 2000 (11), the following are key challenges in the health sector:
Dr. Syed Mairajuddin Shah and Dr. Shagufta Perveen
i.
Making progress in current health sector programmatic reforms to achieve MDGs and effectively tackling newly emerging and re-emerging health issues including non-communicable diseases and disasters
ii.
Improving access of essential and cost effective health services especially for the poor and vulnerable.
iii.
Emphasizing more on quality of care and services at all levels
iv. Protecting the poor the from catastrophic health expenditures
v. Improving institutional arrangements and management of the health care delivery system
vi. Improving the availability (especially female) and motivation of health workforce
vii. Aligning outputs of the academic institutes in line with the needs of the health system and improving the quality of education and training.
viii.
Effectively engaging private health sector and civil society organizations to improve health outcomes.
ix.
Developing The pharmaceutical sector and ensuring access to quality medicines
Pakistan’s Healthcare Regulations
x.
Making health system more responsive and accountable
Up till recently, except for the Pakistan Medical & Dental Council (PM&DC) and Pakistan Nursing Council (PNC)
regulations, there were no other regulations for the healthcare facilities in Pakistan. During the past three to five
years, the Khyber Pakhtunkhwa (KPK), Punjab and Sindh Healthcare Commission bodies have been formulated. The
Commissions have formulated local Acts known as KPK, Punjab and Sindh Healthcare Commission Acts that have
been approved by the KPK, Punjab and Sindh provincial assemblies and are in the process of implementation. The
Acts contain a defined set of regulations for the healthcare facilities in KPK, Punjab and Sindh (3, 4, 5) . The prime aim
of these Acts is to register all the healthcare facilities in Pakistan followed by licensing and accreditation processes.
For the nuclear imaging facilities, the Pakistan Nuclear Regulatory Authority (PNRA) provides regulations for safe
operations of these facilities in the country and also ensures licensing of these facilities (5). For regulating the use of
blood and blood products, the Health Department of the Ministry of Health initiated a regulatory body with defined
regulations to ensure safe blood and blood products transfusion services across the country (6).
xi. Ensuring effective research and a monitoring & surveillance system to measure results
Pakistan’s Healthcare Management System
Health care management in Pakistan is primarily the responsibility of provincial governments, except in case of
federally administered territories. However, the federal government is responsible for planning and formulating
national health policies. Each provincial government has established a department of health with the mandate to
protect the health of its citizens by providing preventive and curative services. The provincial health departments
are also supposed to regulate private health care providers. Large variations are found in public sector spending
on health care across provinces. The Private sector serves nearly 70 percent of the population. It is primarily a feefor-service system and covers a range of health care provision from trained allopathic physicians to faith healers
operating in the informal private sector (2).
and evidence based decision making at all levels.
Pakistan’s Healthcare Quality and Patient Safety
Healthcare quality is defined as the degree to which health services to individuals and populations increases the
likelihood of desired health outcomes and are consistent with current professional knowledge (12).
Donabedian defined healthcare quality (13) as desired outcomes of healthcare delivery processes using various
process inputs as follows:
National Healthcare Accreditation / Certification Systems
Many countries in the third world have developed their own national accreditation standards and accreditation
systems for regulating and improving healthcare services. India developed its national hospitals accreditation
system in late 2000 (7). To date Pakistan has no established national accreditation system in place but Pakistan’s
Khyber Pakhtunkhwa, Punjab and Sindh Health Care Commissions have formulated a set of Minimal Service Delivery
Standards (MSDS) for the purpose of accreditation of healthcare facilities (4). In fact KPK was the first province to
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Figure 1: Donabedian Model of Health Care Quality
Assessing Pakistan’s healthcare quality by using the above model will help us understand the phenomenon in a
structured way. Let’s begin with the structures:
Professionals in the form of qualified, competent and skilled doctors, nurses, paramedics and allied health
professionals in Pakistan are really becoming scarce. Brain drain to UK, USA, Middle East and Saudi Arabia due to the
difficult law and order situation in Pakistan, high scale compensations, reputable training programs, and quality of
life abroad is becoming a challenge. In order to ensure acquisition of ongoing clinical knowledge among the doctors,
PM&DC recently made a mandatory requirement of certain CME hours for renewal of licensures.
Facilities in terms of physical layout, buildings, clinics, wards, operating theaters, diagnostic facilities etc are always
compromised in several ways. There are no clinic or hospital design and construction codes in Pakistan with results
that we find most of these facilities compromised in terms of life safety, fire safety, utilities safety, medical equipment
safety and hazardous material (HAZMAT) safety.
Technologies in terms of the acquisition and safe use of medical and non-medical equipment are always compromised
due to lack of standardized policies and procedures. Different hospitals in the public and private sector have their
own procedures for purchasing such equipment. There is no concept of supply chain management in most of these
equipment acquisition processes. It’s rare to see qualified biomedical departments or services in the public sector
hospitals that ensures timely Periodic Preventive Maintenance (PPM) and regular calibrations of medical and nonmedical equipment. Similarly materials in terms of medical/surgical supplies pose risks to patients in an environment
where there are no controls on supply-chain management. The scope of these supplies encompasses medications,
vaccines and all implants. Early this year, a federal regulation has been approved to cover this aspect of healthcare
(14).
Organization in terms of the way the responsibilities and authorities are defined in the organogram varies significantly
between the public and private healthcare sectors. Comparing the organograms at a tertiary care level of public and
private sector hospitals shows significant differences in the way the accountabilities, authorities and responsibilities
are defined.
Coming to the Donabedian Model’s leadership, management, communication, diagnostic and therapeutic processes,
there is hardly any concept of “process design” in most of the hospitals across the country. There is a lack of effective
leadership and management processes from top to bottom in the overall national healthcare system. However, these
processes are comparatively much organized in the private sector due to defined responsibilities, accountabilities
and sustainability of the organizations. Gaps in communication between the healthcare providers and between the
providers and patients are among the top root-causes for preventable medical mistakes, (15) and this is no different
in Pakistan. Risky communications, such as taking verbal orders, lack of medical record documentation, care without
documented care plans, lack of surgical notes, no system for panic lab results and no concept of surgical “time-out”,
are a norm in most of the hospitals in the country. Lack of right patient identification, indications, specimen handling,
quality assurance, proficiency testing and calibrations of the diagnostic procedures are common findings in most of
the diagnostic facilities. Lack of evidence based medicine, use of clinical practice guidelines, pathways and protocols
are also common across the healthcare system in the country. This leads to too much variation in the therapeutic
processes and ultimately bad outcomes.
The final components of Donabedian Model are the, clinical, functional and perceptual healthcare outcomes in
terms of clinical, functional and perceptions. The lack of a proper health information management system at the
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national level poses a great challenge in measuring the health outcomes. The medical records management system
has a great degree of variation across the nation at both the public and private sector level. There is no concept of
disease coding based on the international ICD coding system and hence most of the healthcare facilities depend on
manual registration systems despite the fact that IT is transforming information management systems to provide real
time data to its users.
With no national regulations or poor implementation of the existing regulations, there is no registration or licensing
requirements to operationalize a healthcare facility in Pakistan this results in mushroom growth of inappropriate or
unqualified facilities coming into existence. Flourishing of quackery practices in the primary health care scope of
Pakistan is a determinant factor in the bad outcomes of care. Lack of control and regulation on other alternative ways
of medicine such as homeopathy, hikmat and spiritual treatments are also contributing to the outcomes.
Few studies using the SERVQUAL model have proved that the users of healthcare in Pakistan value reliability and
assurance as important determinants to patient satisfaction (16, 17). The SERVQUAL model uses five dimensions
(reliability, responsiveness, assurance, empathy and tangibles) of service quality as determinants of customer gap in
services marketing (17). The reliability and assurance dimensions are important determinants for clinical outcomes
while responsiveness and empathy dimensions are critical for perceived outcomes such as patient satisfaction.
Best Healthcare Quality and Patient Safety Practices in Pakistan
In the absence of a national healthcare accreditation system in Pakistan, few healthcare organizations in the private
and public sector have voluntarily opted for ISO 9001:2008 Quality Management System. The Aga Khan University
Hospital, Karachi, is the only tertiary care academic hospital in Pakistan that is accredited by the Joint Commission
International Accreditation (JCIA). Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore and
Shifa International Hospitals in Islamabad are among few others who are aiming for JCIA in addition to their ISO
9001:2008 certifications. The Hayatabad Medical Complex Peshawar established standardized policies and procedures
and is the first hospital in KPK for implementing World Health Organization’s (WHO) Safe Surgical Checklist (18). In the
public sector, the Sindh Institute of Urology and Transplantation (SIUT), Peoples’ Primary Healthcare Initiative (PPHI)
and National Programme for Family Planning are few examples with some of the best practices.
Challenges
After going through all of the above discussion, here are some of the specific challenges for Pakistan’s healthcare
quality and patient safety initiatives:
•
A Lack of national healthcare accreditation system
•
A Lack of integrated national guidelines, policies and procedures on healthcare quality and patient safety
•
A Lack of national quality care indicators despite the fact that quality of care objectives are defined in the
National Health Policy
•
A Lack of regulatory audits for public and private sector health facilities.
•
A Lack of an organizational culture that holds people accountable
•
A Lack of Pre-service and In-service training for health staff in quality care management and leadership with little contextual research on quality care initiatives poses another challenge in this regard.
35|
Recommendations
http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM Health-
Care-Quality-Initiative.aspx.
•
Upgrade and implement policies and procedures that regulate quality and patient safety issues in healthcare settings across the country.
•
Introduce a national healthcare accreditation program across the nation.
•
Develop networks and consortia between public and private sectors in Pakistan.
•
Build the capacity of health care professionals in the areas of quality and patient safety.
•
Formulate quality improvement teams at national and provincial levels.
14.
Medical device rules 2015: drug regulatory authority of Pakistan. [cited 2015 June 08]; Available from: http://www.dra.gov.pk/gop/index.php?q=aHR0cDovLzE5Mi4xNjguNzAuMTM2L2RyYXAvdXNlcm ZpbGVzMS9maWxlL01EJTIwUnVsZXMsJTIwMjAxNSUyMC1Ob3RpZmllZCUyMDA5LTAzLTIwMTUt LnBkZg%3D%3D.
•
Develop a culture of accountability and ownership.
15.
Joint Commission Online, April 29, 2015, Sentinel Events Statistics 2014; Available from:
http://www.jointcommission.org/assets/1/23/jconline_April_29_15.pdf
16.
Irfan SM, Ijaz A. Comparison of service quality between private and public hospitals: empirical evidences from Pakistan. J Qual Tech Manage. 2011;7(1):1-22.
17.
Shaikh BT, Mobeen N, Azam SI, Rabbani F. Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan. East Mediterr health j. 2008;14(2).
18.
Hayatabad Medical Complex Achievements. [cited 2015 June 08]; Available:
http://www.hmcpeshawar.com.pk/index.php?p=ach1
•
Learn from experiences of other countries and implement quality care tools and locally validated quality indicators.
References
1.
Shaikh S, Naeem I, Nafees A, Zahidie A, Fatmi Z, Kazi A. Experience of devolution in district health system of Pakistan: perspectives regarding needed reforms. J Pak Med Assoc. 2012 Jan;62(1):28-32.
2.
Akbari AH, Rankaduwa W, Kiani AK. Demand for public health care in Pakistan. Pak Dev Rev. 2009;48(2):141-53.
13.
Donabedian A. Evaluating the quality of medical care. 1966. Milbank Q. 2005;83(4):691-729.
3.
Sindh Healthcare Commission Act 2013. [cited 2015 June 08]; Available from: http://www.pas.gov.pk/
uploads/acts/Sindh%20Act%20No.VII%20of%202014.pdf.
4.
Punjab Healthcare Commission Act 2010. [cited 2015 June 08]; Available from:
http://punjablaws.gov.pk/laws/2434.html.
5.
Pakistan Nuclear Regulatory Authority. 2004 [updated 2004; cited 2015 June 08]; Available from:
http://www.pnra.org/legal_basis/RP%20Regulations%20PAK-904.pdf.
6.
The Sindh transfusion of safe blood act, 1997. [cited 2015 June 08]; Available from:
http://www.sbtp.gov.pk/Docs/Legislations/Sindh%20BT%20Act%201997.pdf.
7.
National accreditation board for hospitals and healthcare providers, India. [cited 2015 June 08]; Available from: http://www.nabh.co/.
8.
Pakistan standards and quality control authority. [cited 2015 June 08]; Available from:
http://www.psqca.com.pk/sdc/Hospital%20&%20Healthcare%20Facilities.htm.
9.
Pakistan national accreditation council. [cited 2015 June 08]; Available from:
http://www.pnac.org.pk/index.php?PageId=90.
10.
National productivity organization, Pakistan: Prime minister quality award. [cited 2015 June 08]; Available from: http://www.npo.gov.pk/prime-minister-quality-award/about/.
11.
Pakistan National health policy 2001. Government of Pakistan.
http://www.nacp.gov.pk/introduction/national_health_policy/NationalHealthPolicy-2001.pdf. 12. Crossing the quality chasm: the IOM health care quality initiative. Institute of medicine of the national academics. ; [cited 2015 June 08]; Available from:
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A trip to Uganda with UNICEF
By: Dr. Yaseen Abubaker
US Fund for UNICEF South East Region Board Member
In August 2013 I traveled to Uganda for a week with three other US fund for UNICEF board members. Although I
have traveled extensively in my life, I have never had an experience like this in my life. I was very excited to have
the opportunity to see UNICEF’s work in action. I have been involved with UNICEF in South East USA for the last few
years, and I helped raise funds for the flood relief work and the ongoing polio eradication efforts by UNICEF’s office
in Pakistan. Having read a little about Uganda before the trip, I certainly expected to see the many challenges facing
children throughout the country. What I did not expect was the level of innovation, coordination and commitment
from UNICEF to reach every child who is in need.
Uganda is landlocked state in Eastern Africa, with Kenya to the east, South Sudan to the north, Congo to the west,
and Rwanda and Tanzania
to the south. The great Lake
Victoria, the largest lake in the
world, is in south of Uganda,
and the Nile originates from
Lake Victoria. Uganda has
population of 34.2 million,
with life expectancy (at
birth) of only 54 years. The
majority of the population,
55.3%, is under 18 years
old. Interestingly only 13%
of Ugandans live in urban
areas. Almost a quarter of the
population lives below the
national poverty line of $1.25
day. Birth registration is only
30% for children under 5.
One of our first visits was to the Karugutu Health Center. This Health Center is designated as a Level 4 center, which
means that there was supposed to be a full time doctor, a 20 bed in-patient facility, obstetric facilities, out-patient
service, and a lab. Unfortunately, the hospital – like many in Uganda – lacked proper resources. We were shocked
to find that there was more than one patient on several beds, and patients of all ages crammed into the same large
room. Several of the bed didn’t have mattresses. There was only one nurse (no doctor) in delivery room. This nurse
was attending three women simultaneously in their deliveries.
UNICEF is also in partnership with Ugandan government to improve and increase the birth registration of children
under 5. At present birth registration is only 30%. UNICEF is providing all the training, computers, software, and
printers to health facilities in the country. We saw one such facility, where we helped to register a child. In all of
these visits, the commitment of the staff – and the intelligence and thoughtfulness of the office’s efforts – were very
impressive.
Beyond the work that is directly saving lives, UNICEF’s office in Uganda is on the cutting edge of UNICEF’s global
Innovations work. We saw this in our visit to the UNICEF’s Innovations Lab in city of Kampala. This lab, which is actually
a workshop, provides key innovations for the entire region of East Africa. Here a team of UNICEF engineers works to
develop and implement innovative solutions to keep children alive, safe, and learning. For example, in a groundbreaking
move to keep children safe, UNICEF has developed an innovation in Birth Registration by Mobile Phones. In partnership
with Uganda Telecom, MoblieVRS will be implemented. UNICEF aims to ensure that 80% of children under 5 are
registered at birth by the end of 2014. This is an amazing and inspirational goal. The “Digital Drum” is another unique
example of an innovation by UNICEF. The Digital Drum is a solar-powered kiosk that works as an information access
point aimed at youth and
their
communities.
The same lab was also
developing a digital “School
in a Box”, which has a small
computer with a projector.
The UNICEF team has
recorded, and downloaded
1500 classroom lectures on
these computers, which can
be displayed anywhere –
even in an emergency.
Most interesting of all the
innovations is “U-report”, a
free SMS service designed
to give young Ugandans a
voice on issues they care about. Every U-reporter is given an opportunity to participate in the decisions that affect
them and take an active role in the development of Uganda, leading to transparency and accountability at the
grassroots level. U-report was launched in 2011with the support of UNICEF and now has over 250,000 active users.
This experience was powerful in so many ways. I learned a great deal about the challenges facing Uganda’s children,
and I was inspired by UNICEF’s commitment to meet these challenges. Most importantly, it made me realize just how
blessed we are here in the United States. I am committed to supporting UNICEF’s work, and to inspiring others in my
community and beyond to do the same.
Later, we visited the Buhinga Regional Referral Hospital in Kabarole District. During the tour we saw children with
severe malnutrition. It was heartbreaking, and shameful, but at the same time it was wonderful to see that UNICEF
was providing all of the logistics for the management of malnutrition, including training the staff how to diagnose
it and how to treat it, providing supplements and formula, and so forth. With UNICEF’s efforts, the percentage of
children under-fives stunted has dropped from 38% in 2006, to 33% in 2011.
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Sad but True
“Love is Instinct and Hate is Reaction”
Saeed Siddiqui, M.D.
Nowadays, us Muslims are going through a “reaction” and when instead we should use our instinct, love, more than
ever. I will highlight a few incidents from our Prophet (PBUH)’s life, where he used his instinct again and again instead
of reacting with hate to destroy those who were mocking him and his followers:
1) When Prophet Muhammad (PBUH) went to the city of Taif to convey the message of God and stones were thrown to him
and he was badly injured, the angels asked him that if he wished they can be destroyed. But the Prophet (PBUH) used his
instinct to love and prayed to Allah to give them guidance. A few years later the whole city converted to the fold of Islam.
2) In the battle of Uhud, the Prophet (PBUH) was badly injured, thrown into a ditch, and became unconscious. Once he
regained consciousness, his friends requested that he ask God to destroy the opposition but the Prophet (PBUH) replied,
“they don’t know me or God nor what I am preaching.” He used his instinct of love, not hate, and a few years later the entire
Meccan community converted to Islam.
3) When the Prophet (PBUH) entered Mecca as a conqueror he could have used his hate to react due to atrocities committed by residents of Mecca in the early days of his preaching, but he did not and announced today is the day of forgiveness.
It’s difficult to follow his path of love, but us Muslims at present need to follow this no matter what we believe in and
stay away from reacting with hate which leads to chaos. We look around the world and all we see is destruction and
flames.
The message “all are forgiven” is the real message of the Prophet (PBUH) and God because it leads to mercy. We all
know that Muhammad (PBUH) was send as a mercy to all humanity, Muslim and non-Muslim, (
) and God is
Rab-ul-alameen, not Rab-ul-muslameen. One of the most important messages the Prophet (PBUH) gave us was in his
last sermon: “the best among you who is God fearing. You are responsible for your actions (irrespective of color, sect,
ethnicity and heritage).” But look at us today, we are more divided. The current issue of lack of tolerance has nothing
to do with God and Prophet (PBUH)’s teachings as I discussed above. If we just learn to respect each other and avoid
supporting oppressors for personal and political gain then society will become more tolerant. May Allah guide us in
developing respect for humanity.
Yaddasht : A book Review
By Roohi Abubaker, M.D.
( Yaddasht is an autobiography of Dr. Muhammad Uzair, father of Dr. Roohi Abubaker and father in law of Dr. Yaseen
Abubaker. He is one of the earliest and most eminent economist of Pakistan, currently living in Karachi, Pakistan. Author
of 12 other book which are on his subject Economics and finance, first person to write a book on “ Interest free banking in
1954 and is still considered a pioneer on this subject )
Ever since I was a child , I would be fascinated by biographies, the few that I still remember reading are Irving Stones’
biographical novel “ Agony and Ecstasy ‘ which encompasses the life of Michelangelo, the famous sculptor, painter
, Golda Meir’s’ “ My life”, Zulfiqar Ahmad Bukhari’s “ Sarguzasht” or Qudratullah Shahab’s “ Shahabnama “ so when I
learnt in 1992 that my father, Dr. Muhammad Uzair is writing his biography , I was very happy and thought that very
soon I will be reading it. I got my married in 1992, years started passing by, now and then I kept asking Ammi “ is the
book finished ? “ she said no he is still working on it , my father will be dictating it to a student from karachi University
who will come two days a week and will pen down whatever my father ( whom we call Abbi ) would narrate. In
the next 5-6 years I think he completed the work but kept on adding whatever he felt like adding. On every visit to
Pakistan I will urge him to have it published , in 2014 my dearest mother passed away and at that time he decided
that he cannot write anymore and gave the manuscript to a publisher and finally in January 2015 , the book was
published.
My father Dr. Muhammed Uzair had a very enigmatic life, he lost his mother when he was only 4 years old, he was
the only surviving child of his parents, his father remarried and he was adopted by his maternal aunt and uncle who
had no children of their own and raised him with utmost affection and love. In the earlier sections of the book the
author describes his early life, he describes how Lucknow and Allahabad were in the early twentieth century, there is
a very interesting section in the book about Allahabad University from which he graduated and had the opportunity
to meet teachers like Firaq Gorakhpuri and Dr. Harivansh Rai Bachchan , who is the father of legendary Indian Film
star Amitabh Bachchan and at that time he taught in the English Department at the Allahabad University. Famous
Urdu Poet Mustafa Zaidi was one year junior to him and in the book he describes that when he was doing BA, as a
requirement he had to write reviews on 6 English novel, a devout reader as my father was, he wrote reviews on 40
English novels which was a record at Allahabad University at that time and a year later Mustafa Zaidi wrote review on
41 book to beat his record.
The book has a section about his days in USA when he was sent on a scholarship to Wharton School of Finance ,
University of Pennsylvania and from where he did his MBA and PHD in 1963, it’s an interesting account of America
at that time and he witnessed the racial segregation prevalent at that time, he attended a speech by Malcom X and
Elijah Mohammed as well. He travelled widely and gives a very interesting account of all the countries that he visited,
since he was an Economist he was sent by the newly born nation of Pakistan to study the Economic structure of
other countries. He also gives impressions of the famous personalities that he met, he describes his encounters with
Zulfiqar Ali Bhutto and General Zia ul Haq. He analyzes the political situation leading to emergence of Bangladesh
and he often analyzes other international and national events that happened and impacted the world today.
The book has such a flow that once you start reading it , you keep reading it, I think there cannot be a more befitting
name for this book than Yaddasht because you cannot help but marvel at the memory of the author. I am sure that it
will be a good addition to any library.
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HEALTHY AGING
you love a person you tend to see and appreciate all the good qualities in them and tend to oversight or ignore or
SULEMAN LALANI, M.D., C.M.D.
world looks differently, little bit more pleasant and better. Life is too short to be wasted in hatred.
even try to rationalize things you don’t like about them. Now apply this concept globally and observe how the same
6) PRIMARY PREVENTION: this includes annual exams, preventive screenings and vaccines. We at Sugarland
“If I’d known I was going to live this long, I’d have taken better
care of myself ” Eubie blake on his 100th Birthday.
Geriatrics and Medical Associates can help you get the most out of your health and be as productive and independent
Life expectancy is increasing. It was only 3.1% of people living over the age of 65 in 1900 to 35.5% in 2000 and is
now. Another very important aspect I would like to mention here is Advance care planning, meaning advance
expected to increase to 40.1% in 2010 and 70.2% by year 2030.
directives to physician and living will to make your medical wishes known and spare the loved ones from getting
as possible. Longitivity will bring its wear, and tear, and damage, and if are not prepared now it may be too late later.
Statistics have shown we are going to live long but it’s up to us to live healthy or otherwise! Let’s do Health planning
into the conflict and guilt of not knowing what decisions to make during tough times.
Healthy Aging is not a rocket science but it is also not very simple, it cannot be just wishful thinking. It is a discipline
to create and maintain a balance in our daily life. As we age , the human body will have its fair share of wear and tear
7) SECONDARY PREVENTION: this means try to avoid or delay the complications of the already existing
but to avoid the unnecessary damage we will have to take a few key steps in the right direction which I have created
disease process. For example if you have any chronic illness like diabetes or heart disease etc. how to optimally care
and I would like to call it LALANI’S SEVEN STEPS TO HEALTHY AGING.
for it to prevent from getting worse.
1) POSITIVE ATTITUDE: As the saying goes Don’t worry be happy. A thought is led to actions and those actions
If we take steps now towards healthy aging then we won’t be regretful on our 100th birthday, instead we’ll be
have led to certain outcomes. If we keep positive attitude we will be able to see positive outcomes even in our
singing…
most trying times. It helps us think outside the box and rationalize the things in the positive way. Instead of reading
opportunity is nowhere, we’ll be reading opportunity is now here.
2) PHYSICAL EXERCISE: During this high tech. time when almost everything is available on a touch of a remote
getting physical exercise is a task! Try to dedicate at least 30 minutes 3 times a week and remember simple exercise
like walking helps! You don’t have to be pumping iron all the time. Please consult a physician prior to embarking on
Grow old along with me! , The best is yet to be,
The last of life, for which the first was made…
ROBERT BROWNING.
this step.
3) GOOD NUTRITIONS: It’s a full subject in itself. Remember a balanced diet. Every excess calorie adds up to
your love handle. It’s very easy to put on the weight but losing it is a different story. Your doctor can help create a
balanced diet according to your need and lifestyle.
4) SPIRITUAL CONTENTMENT: It doesn’t matter which religion you belong to as all the genuine religions
ultimately leads to the same destinations. What matters, is you practice your faith regularly, it will provide you with
happiness and energy that’s beyond the words to describe.
5) LOVE: Love is powerful. It helps you focus on things you like and ignore things you don’t prefer. For example if
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We’ll always remember you
So many things have happened
Since they were called away.
So many things to share with them
Had they been left to stay.
And now on this
reunion day,
Memories do come our way.
Though absent, they are ever near,
Still
missed, remembered, always dear.
Dr Majida Tufail Hanel
Dr Mohiuddin Ahmed
Dr Shagufta Rashid
n
o
i
n
U
e
R
rachi
in Ka
Dr Naseer Rajab Ali
Dr Tariq Chaudhary
Lovely times of life will not return back forever...but, lovely
relation & missing memories of friends will stay in the heart forever..
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