Dr Ather Enam: Exploring the Mysteries of the Brain

Dr Ather Enam repatriated to Pakistan a year and a half ago after spending 16 years in USA. He left a successful career in USA to join AKU as Associate Professor and Head of Neurosurgery.

His education in Pakistan was at esteemed institutions like Cadet College Hasanabdal and Dow Medical College (DMC). After graduating from DMC in 1987, Dr Enam decided to pursue PhD studies in Neurosciences at North-western University. It was his conviction that an in-depth understanding of neurological disease process should precede his embarking on the practical application of the knowledge so acquired. He spent a year at State University of New York at Buffalo for preliminary training in General Surgery before proceeding to the Neurosurgery training programme at Henry Ford Hospital, where he was later appointed vice-chairman of the hospital's Department of Neurosurgery, one of the largest in the USA.

Dr Enam is the only American Board certified Neurosurgeon in Pakistan. He has a Fellowship of the Royal College of Physicians and Surgeons of Canada, a Fellowship of the Royal College of Surgeons of Ireland and a Fellowship of the American College of Surgeons. He holds the outstanding resident award from Henry Ford Hospital, Physician of the year Medallion award from St. Joseph's Mercy Hospital, and Award of Excellence from the Pakistan Society of Neurosurgery. He is a member of Sigma Xi, a scientific honour society that includes several Nobel laureates as its members. He has published several scientific papers and book chapters on basic science topics and loves to talk about the brain and basic science research.

He disclosed that he returned to Pakistan to be with his parents and relatives. He enjoys spending time with his family more than anything else. His hobbies include reading and listening to music. The extensive collection of books in his library and the assortment of all the music albums he has reflect his love of these pastimes. He enjoys painting; his medium is oil on canvas and prefers impressionists' style.

What prompted you to pursue a career in Neurosurgery?

I am passionate about the brain and I simply followed my passion. Nothing excites me more than talking about the brain. It was this obsession that made me get a PhD in Neurosciences and the same fascination led me to Neurosurgery. I am lucky that I earn my living by doing what I love. Neurosurgery or cardiac surgery can impress any impressionable mind. But what really made the difference for me was a book on the brain, published by the Scientific American magazine in 1979, that my father gave me. The first sentence of that book was, "Can brain ever understand brain?" The mystery and complexity that surround the brain makes it so captivating that understanding the brain becomes an ultimate challenge.

What inspired you to come to AKU?

When the buildings of AKU were being erected and the newspapers were full of articles on this institution, I was already in the middle of my medical school years at DMC. Like everyone else, the quality and the potential of this institution were obvious to me. The desire to join this place never left me when I was pursuing my studies and training abroad. I had visited Pakistan a few times before my final move to explore the prospects and work environments for a neurosurgeon here. In all my travels from Karachi to Islamabad and visits to many institutions, I found nothing that came close to AKU. A culture of set standards, self-evaluation, transparency, and peer review similar to AKU is hard to find in any other institution. Finally a position opened up at AKU and I applied for it. To be working here and being a part of this Institution is like a dream come true

What are the accomplishments of the Section of Neurosurgery?

The main accomplishment of this section is that we provide quality neurosurgery not only to Karachi but to the whole of Pakistan. In fact, we have had patients fly over from Middle East and Africa seeking neurosurgical care at AKU. I am fortunate to be a part of a group of neurosurgeons that are some of the best in the country. Most of them are highly experienced and renowned at international level.

The residency programme in our section has once again been recognized by the CPSP with the addition of new full-time faculty members. With an emphasis on didactic and hands-on clinical experience, and with the opportunity of every resident to interact equally with all the six neurosurgeons in our section, the residency programme is the best in the country now. Two residents trained in our residency programme are already practising successfully - one in Pakistan and the other in Saudi Arabia. For two empty slots last year we had 15 applicants from all over the country. I feel very proud of the quality of residents we have with us and with the right training, I have no doubt that we can produce neurosurgeons of the same excellence as anywhere else in the world.

Our section has also been very active in research. We are involved in both the clinical and basic science research with research grant supports. An ongoing effort to acquire new grants, start multidisciplinary research, and get everyone in the section involved in research activity will bear fruits soon. T h e growth in the clinical practice in our section has also been phenomenal. Last year, we demonstrated a growth of 30 per cent in surgical cases, surpassing the goals for 2008 by 6 per cent. We see continued growth this year as well. The credit for this growth goes to an increase in the number of neurosurgeons with independent privileges and "full" involvement of our non full- time faculty in the section.

Research is an integral part of the University's focus. What research projects has your team undertaken?

I fully appreciate the University's focus. Clinical practice without research is sterile and degenerates over time. We are focusing both on the clinical and laboratory research with a vision to move into translational research. Among the clinical areas our interests include neuro-oncology, CNS tuberculosis and other infections, and head injuries. In neuro-oncology we are joining hands with several other investigators at AKU, as well as some outside AKU, to prepare a multi-centre database and set up a national brain tumour bio repository. We are collaborating with the Emergency Medicine physicians to gather similar data on head injury. In the wet lab, our ongoing projects include neural stem cell transplantation. Research grant application to study the brain tumour stem cells has also been submitted and techniques are being considered to harvest stem cells from adult brain.

What are the future plans of your section?

This section needs to expand further and bring in sub-specialisation with faculty members devoted to their areas of interest. With adequate support from the University for each Faculty Member to grow in their clinical and research areas, we will be able to put AKU Neurosurgery Section on the map, at least as far as Asia is concerned. Eventually, we have to move towards an Institute of Neuroscience. I was involved in the Institutes of Neuroscience as they were developed at North-western University and then at Henry Ford Hospital. I also visited world-class neuroscience institutes, such as Montreal Neurological Institute, to study how they were initiated and what made them so successful. A successful model of the Institute for Neuroscience has three main pillars: Neurology, Neurosurgery, and Research, with Neuroradiology and Psychiatry being major contributors to the three. A second tier support comes from rehabilitation, and other services such as ophthalmology and ENT.

There is a void in this arena in Pakistan and we need to develop an institute of Neuroscience here that has a regional reputation in South-East Asia and can serve the patient population in the Middle East as well. This was one of the few reasons that brought me back to Pakistan.