During the 25-kilometer commute to the hospital from home, I take the time to prepare spiritually for the challenge of the day, catch up on emails and review the day's calendar. The workday starts with an early morning meeting, usually a committee meeting for heads of departments; a good time to wage minor battles over resources for the pediatric oncology departments in Lahore and Peshawar.

At 9 am a busy clinic starts and runs till 1 pm. The clinic is a roller-coaster of encounters. There is a young child with newly diagnosed blood cancer with anxious parents who are eased into a world of new information about diagnostic tests, chemotherapy appointments and medication schedules. There is a Persian-speaking teenager from Afghanistan who is counseled about life-saving surgery using an interpreter. Then there is a young girl and her mother who are given the bad news about the cancer returning. There are parents to a young child who discuss end-of-life goals of care. Then there is a seventh grader who gifts you a colorful painting of a parrot and tells you how well she is doing at school since being cancer-free for 3 years.

At lunch, I catch up with colleagues from around the hospital over a teeming hot meal (my favorite is chicken pulao with mint raita), followed by some tea. Sometimes there is a lunch-time educational session. In the afternoon, there is a short telehealth clinic. The rest of the afternoon is spent catching up on research, planning for our annual research symposium, and dealing with administrative tasks such as assessing physician competencies, analyzing department performance indicators, and addressing quality improvements needs. 

The ride home is a time to unravel the compartmentalized emotions that are a side-effect of pediatric oncology, practice gratitude for the privilege of pressure, and catch up on emails because the day may end but emails never do.

About two to three times a week, I'll have an evening zoom meeting with research collaborators, cancer registrars or oncology working groups. This is the time to escape the cacophony of the hospital, take a bird's eye view of where we are today and how we are going to make the future better for children with cancer. ​

Pakistan has a large population, and we are not likely to have enough specialist clinicians to cater to everyone's needs. That is why we need a system that provides access to the right physicians in the shortest time possible. There are three essential steps to achieve this. 1) A patient with an ailment should have access to a physician (access to healthcare). 2) The physician should be qualified to understand the need for a specialist (quality medical education). 3) The specialist should be accessible through a referral network (nationwide referral network).

For many parts of Pakistan, there is a dismal lack of healthcare infrastructure. Even within Lahore, which is a large, urban center, patients are often left to navigate a complex healthcare system without a formal referral network. A child with cancer may die within the outskirts of Lahore because they did not go to a pediatrician who can recognize cancer and recommend referral to a pediatric oncologist.

On the other hand, there are many exciting and heartening developments in Pakistan's healthcare system. Organizations such as Aga Khan University and non-profit institutes such as Shaukat Khanum continue to expand their local imprint by providing quality medical and nursing education and improving access to healthcare. There is also growing recognition for quality standardization such as through accreditation with Joint Commission International. There is an expansive body of local health investors, philanthropists and humanitarians who are committed to elevating healthcare standards in Pakistan by launching innovations such as AI-powered healthcare tools, telehealth networks and digital health applications.

Pakistan's healthcare climate is ripe for seismic change and growth. We are approaching a critical mass of bold healthcare leaders and innovators, a market that appears open to healthcare investment, and a population with pressing healthcare needs. 

My clinical expertise is in pediatric bone and soft tissue sarcomas. These are a group of rare pediatric cancers whose survival outcomes are inferior to the more common childhood cancers such as leukemias. It is a challenging group of cancers with multidisciplinary needs involving surgeons and radiation therapists. Over the past 4 years at Shaukat Khanum, I've had the privilege to work on the diverse aspects of care for these children, ranging from community advocacy for their early diagnosis and referral, specialized biopsy techniques, provision of wheelchairs for patients with disabilities, elevation of treatment regimens to global standards, and training of professionals across Pakistan. ​

I'm a board member for the Pakistan Society of Pediatric Oncology (PSPO), a society founded several decades ago by a group of pediatric oncologists, many of whom were AKU alumni. PSPO is a vibrant oncology working group with members from across institutions in Pakistan. We have many projects aimed at improving survival for childhood cancer. One of these initiatives is the National Pediatric Cancer Registration Program (NPCRP) for which I am the Chair and work closely with my long-term mentor from AKU and co-lead for the project, Dr Asim Belgaumi. This year we secured a capacity building grant to pilot the NPCRP and train data managers for cancer registration. Cancer registration is essential to have a meaningful understanding of our cancer burden and to plan resource allocation so we hope that this project will change the future of childhood cancer in Pakistan.  

As a person who is always drawn to the needs of the most vulnerable populations, a work that is close to my heart is advocating for Afghan refugee children with cancer. It has been an immensely rewarding journey to witness the resilience of the Afghan people who have continued to seek care for their children against insurmountable barriers. Their stories inspired me to join the CHH-Lancet commission on health, conflict and forced displacement as a scholar to learn about the challenges and opportunities for providing healthcare in humanitarian settings.

AKU has a wonderful legacy of producing leading pediatric healthcare visionaries. There are many cooperative groups and professional societies such as PSPO where alumni are engaged in efforts to standardize care for childhood cancer and study national survival outcomes. Many alumni across institutions in Pakistan are collaborating on research projects. In addition, they are routinely seeking expert clinical advice from each other for their patients. The relationship also extends to organizing local educational workshops and participating in research conferences. Frequently, there are medical students at AKU who reach out to alumni for clinical elective experiences and research collaborations, which they are quite willing to entertain in the spirit of paying it forward.

Although I would like to see more alumni returning home, there are many initiatives that are started on alumni community platforms in USA and come to fruition in Pakistan. Alumni are also a vital source of philanthropy towards local healthcare and humanitarian projects as well as fierce advocates for engagement with Pakistani researchers on a global stage. 

The pediatric medicine rotation at AKU was a foundational experience for me. I recall sitting in a group discussion with Dr. Abdul Ghaffar Billoo, Sitar-e-Imtiaz, learning how to identify a child who is grunting with respiratory distress. Later, I met with Dr. Babar Hasan who had recently returned to Pakistan from Harvard medical school as a pediatric cardiologist. We partnered on a project on cardiomyopathy in Thalassemia patients and collaborated with Dr Zehra Fadoo, founding member of Pakistan Society of Pediatric Oncology (PSPO) and department chair of pediatric hematology oncology. My interactions with the famous Dr. Anita Zaidi were brief but impactful and she connected me with my now long-time mentor, Dr. Asim Belgaumi, who graciously helped me secure a clinical elective at St Jude Chidlren's Research Hospital in Memphis, USA, which turned out to be the birthplace of my journey in pediatric oncology.

Another experience that stood out for me was writing for the AKU newsletter which helped forge a lifelong friendship with the Alumni Affairs Director, Mr. Abdul Haq Wahedna (Haqqi). Over the years we had many conversations around life, medicine, and service that shaped my career including the decision to return to Pakistan. There were many full-circle moments that happened over the years too. One day in third year of medical school, I'm sitting in the auditorium penning a report for AKU Nama on Dr. Adil Haider's talk with medical students. Many years later Dr. Adil Haider, then dean of medical college, circulated my essay on Afghan refugee children during his weekly newsletter.

My relationship with AKU continues, enriching with each passing year with new and old friends and mentors appearing on the stage, a gift that keeps on giving. 

There are so many moments that one wishes to return to, not to change them, but to linger a while longer in their sweetness. AKU has many of those moments.

I spent two incredible years of my fellowship in the research lab of Dr. Russel Ware at Cincinnati Children's Hospital and Medical Center. Those years were marked by an exponential learning curve where I went from learning how to hold a pipette to performing complex hematological assays. I worked with a kind and encouraging group of scientists who motivated me to routinely step outside my comfort zone. Looking back, I wish I had spent another year at that lab and taken the opportunity to complete my master's in clinical research which I only did for 1 year. The skills I learned at the Ware lab extended beyond science and medicine, infused me with a sense of self-agency and can-do attitude that continues to stay with me. I can only hope to pay it forward to my trainees in some way or form.​

Past Alumni Spotlights

1. Dr Philomena Drag​
2. Dr Bashir Hanif
   
3. Dr Sehreen Khan
   
4. Dr Naila Baig Ansari
   
5. Dr Muhammad Asim Khan
6. Dr Azam Jan
7. Dr Rahat Naz
   
8. Dr Faysal Subhani​​