What does an average day in your professional life look like?
In Pakistan, I live the traditional ER Consultant life: 4-5 shifts a week involving supervision of my department's doctors, managing throughput, teaching medical students and attending departmental meetings. With MSF, a lot of the same but with some key differences. There is a lot more focus on capacity building. Because of the security context, it is not always possible to have an ED consultant on the ground. The heavy lifting has to be done by the local general physicians (also because the expatriate doctor may not speak the local language). Therefore they need to function as experts to the maximum extent possible. Therefore, I provide my team with a lot of technical support. This includes maximizing the services our ER can provide through training. It also includes traveling to other parts of the country to conduct similar training for government health facilities, e.g. Mass Casualty Preparedness, burn care, ACLS etc.
It also involves a lot more learning. For example, as the places I have worked in Pakistan would refer burns patients to specialized burns centres, I never really need to upskill my burns management. Since I don't have that luxury here, I had to teach myself inpatient burns management, burn dressing and even physiotherapy!
How do you see the role of alumni in strengthening collaborations and academic partnerships between institutions like AKU and Médecins Sans Frontières (MSF)?
Collaborations between alumni and their current organizations is essentially enriching one's organization by taking advantage of a diverse buffet of experiences. MSF and AKU are 2 organizations that have similar visions and work in overlapping contexts. Alumni-led partnerships increase efficiency by reducing the risk of reinventing the wheel and expose the involved organizations to learning their unknown unknowns, i.e. gaps in their knowledge they had no idea even existed.
In your vast experience, what are some similarities in the pressing healthcare needs of the people of Yemen and Pakistan? Where are we, as a healthcare community, doing well and where do we need more effort and investment?
What struck me when I arrived the most is how strikingly similar both Yemen and Pakistan are. Other than the different languages, I am hard pressed to find differences between the two countries. The culture, the types of diseases, the health systems, the poverty, the infrastructure, sometimes I feel like I haven't left Pakistan. However, I feel Pakistan has a lot more resources and skilled manpower to support its health system as compared to Yemen. I think we just need to direct it in the right direction. A strong primary healthcare system is the only way forward for a low-middle income country. Working with MSF, I have seen this strategy to be successful in the organization's projects. An obsession with systems strengthening has compensated for the lack of manpower in rural areas and warzones. NO ONE is bigger than the system, including me. If I disagree with the system, there is a mechanism in place to change it. But till the system approves the change, I have to tow the line. While that bothered me initially (keep in mind, in Pakistan, the consultant is king), I quickly learnt that I stand on the shoulders of giants who have enacted these rules for a reason.
Could you highlight some of your key research interests and any impactful projects you have worked on?
While I love reading academic papers, I don't have the discipline for publishing. I'm more of an ops guy. Within this framework, I love conducting audits of new things I try. As chief resident at AKU's ER, we tested a backup system to ensure our department has enough manpower to support operations when there are last minute sick leaves. I am proud to say that system is still in place. When I worked in an ER in Interior Sindh, we noticed that the number of patients visiting the ER on the EMR was double what we were actually seeing on the ground. This was leading to a lot of understandable questions by our donors. To sniff out the problem, we followed tracer patients through the system from entry to ER to their exit. We discovered that the Unit Receptionists were both triaging and registering patients. By shifting the responsibility of registration to the doctor actually physically seeing the patient, we learnt that this excess of patients were actually those leaving without being seen, allowing us to lobby for hiring more staff. Sometimes it is as simple as updating people with the latest literature. In MSF in Yemen, were able to reduce our consumption of Anti-Rabies Immunoglobulin, an expensive drug by informing the medical staff that the latest guidelines now recommend using smaller amounts.
From your time at AKU, do you have a favorite moment, anecdote or incident that is etched in your memory? How would you describe that journey?
Having done both medical school and residency from AKU (a whopping 10 years total), I have so many good memories. AKU has always been my happy place, no matter how much I cribbed while going through my training. My wife has a joke that whenever I would return to Karachi from Interior Sindh each week, I would perform a mandatory pilgrimage to AKU before coming home. It helped that AKU was on the bus route home, of course.
If I had to choose one memory, it would be our weekly night football games on the pitch (now the Jumaa building parking lot). Nothing like playing under the floodlights on a cool Karachi night with your buddies.
If you had a time machine, which period of your journey as a healthcare professional would you like to revisit, and why? Would you change anything about that time?
To be honest I am very happy with my journey so far, so I don't think I would want to change anything. Yes, I do sometimes witfully wonder about what could have been if I had matched to an EM programme in the US in terms of my career growth but I then remind my self that I probably wouldn't have had the unique experiences I have had at JPMC, in Badin and in Yemen. It has been a wild ride. So if I had a time machine, I'd probably just use it to relive these experiences. Oh, and rent it out to make a quick buck and mess with the space-time continuum.
Past Alumni Spotlight
1. Dr Philomena Drago
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
