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    Acute shortage of Neurosurgeons

    I recently read in news that Pakistan has a little over one hundred neurosurgeons and one or two facilities in each of the big cities are equipped with MRIs for diagnosing brain related trauma and treatment.

    When you take 140 million population into an account, it's as bad has having virtually no facilities where professional and sophisticated techniques are available for patients who are in urgent need of treatment. The case is even worst for the people living in rural areas, who make up for the sixty percent of total population.

    I don't think Pakistan has made adequate progress towards training post graduates in medical profession. Pakistan does have some of the elite medical schools, but many graduates either opt to leave the country or blend in the workforce as physians and surgeons due to the lack of government funded programmes solely geared towards higher training of medical professional. With the boom in IT sector, and government pouring millions to attract and retain talent, I am just afraid that once again we are neglecting our basic duties of provding basic medical care for our citizens.



    [This message has been edited by Abdullah k (edited November 26, 2001).]

    #2
    Good point Abdullah K. Additionally, it is very unlikely that anyone coming out of Madrassah background of education will make a neurosurgeon. The Government needs to allocate grand resources towards education, and cutting back on our Military expenditure will help, but alone will not be enough.

    Comment


      #3
      so expatriate physicians are one group that can return and benefit the country. Good example.

      Maybe the govt needs to set up programs where ppl are sent abroad for education but have to go back and provide services there for sometime.

      It would have the chance of abuse as anything else but it could work. same for educational assisatnce and scholarships to med students in Pakistan
      The greatest trick the devil ever pulled was convincing the world he did not exist. And like that... he is gone.

      Comment


        #4
        Fraudz, you need resource allocation for any program to work. By asking ex-pats to return to the country for fe-sabil-illha only looks good on paper. I am sure a lot of professional class would like to return (like it is happening in India) when the country is stabilized and political and religious bickering comes to an end. Personally I believe that we need more elemantry school teachers than neurosurgeons.

        Comment


          #5
          NYA, political differences aside, I know many top physians and surgeons who are hafez-e-quran and their basic education started from madrassahs. So your logic does not hold any weight. A surgeon is a surgeon whether his basic education was done at a madrassah or some convent school, it doesn't make any difference.

          Although, I agree with both of you, that the government should take proactive measures conducive to luring talent in medical profession just like it has done so in the IT sector. We must be able to seperate and distinct sectors which will be the engine of our economic growth in the future and the ones which improve the basic quality of life, and then allocate equal resources, perhaps more so on poverty alleviation and health care.

          Comment


            #6
            NY we do need to overhaul the educational system, but we suffer a similar issue as faced even in the US. people dont want to become teachers in general because it does not carry the importance as well as financial benefits as it should. Now multiply that several times over in Pakistan.
            So that is a problem faced by many, we need to have more and better schools with properly trained people.

            As Far as doctors going back to Pakistan. There are several I know personally or whose kids I know who have gone back if not to settle back to spend 2 months out of the year working there. Eye surgeries in Karachi, Heart Surgeons going to Islamabad. It takes place, we should encourage that until we can have a better system in place.
            The greatest trick the devil ever pulled was convincing the world he did not exist. And like that... he is gone.

            Comment


              #7
              How much is a life worth in Paskistan/India


              it cost America only less than 750 millions $$to buy 140 million through Musharaff the present broker of Pakistan

              Not only thousand have died (pakistani) & many stil trapped in Afghanistan.


              Its very simple to imagine what politician think of a murder or accidents in which death occured .it may be 1 -2 lakhRs compensation.So you try the resource of lakh rupees to train lure & retain an American neuro surgeon ,the most coveted here in America ,it doesnt add up.

              Same about thoracic surgeon.

              heck there are NO doc ,outside the city limits anywhere ,you are talking about sub specialization.Moreover Pak -India hospital & medical school is patterened after U.K. Mrcp or Frcs are more suitable for work those system than from here.

              In some way investment in I.T. is a better investment given the choice between the two.In America medical industry is more servitude to economic health of the country than physical health of American.Prolongation of life expectancy ,in Pakistan,still is in the area of epidemiology ,infectious disease & public health of clean water ,air ,food environment & personal hygienes.Simple stuff .No need to be worrying for brain surgery or heart transplant although it may seem heartless for those who are patients of these ailments.Rich do take care by coming to u.k. or u.s. but then poor dont get housing food shelter job,entertainment among the many things routine for ppl. here .

              ------------------
              Mausam Ke Tarah Tum Bhi Tou Badal To Najao Ge

              Comment


                #8
                does every damn post have to go on pakistan/afghanistan/US angle sheesh.

                anyhow...there are surgeons who go to Pakistan to perform surgeries, not due to compensation but as their act of service.

                We can try to encourage that and facilitate that.

                As far as no doctors being in rural areas. I think that the stipulation should exist that if you are getting in a med school due to a rural domicile quots, then you must go back and serve that area where you are domiciled for atleast 5 years.

                The greatest trick the devil ever pulled was convincing the world he did not exist. And like that... he is gone.

                Comment


                  #9
                  I understand that there is some sort of policy in Canada whereby if you are immigrating on a professional visa then you are required to work in specific areas of the country where there is a dire need for related services.

                  I know of a doctor that did this and was stationed out in the boonies for two or three years before he was able to make his way back to the city.

                  Why can't we implement this type of structure in Pak, but make it mandatory for local grads?

                  Comment


                    #10
                    Fraudz, I think expatriates have a major role to play revamping the health sector in Pakistan. Moblie clinics, the ones you mentioned, is one way of addressing the health care needs. However, neuro trauma requires a more immediate response from skilled surgeons who are available at that very moment in the vicinity. I know that nine years ago there used to be only one neuro surgeon for the whole Multan division; population about 3 million, and few months out of the year, he used to be out of the country. The situations hasn't really improved ever since. Same is true for other medical related fields.

                    I think the long term solution lies in attracting more expatriates to come and live permanently not only through higher salaries, but also by spending more money in upgradation of medical colleges so they are well equipped to do research and facilitate post-graduate studies.

                    Most important of all, as you have mentioned, the doctors who have gotten admission on reserved seats must be held accountable for going back and serving in their respective areas. Muzna, brings up a good point, that making it mandatory for every new grad to serve certain amount of hours or days in underserved areas could eventually lead to provision of better health care for all citizens. Even though, you will always have some bad apples who would find a way to circumvent their duty, but there will be more who would happily serve the underprivilaged.

                    Comment


                      #11
                      The med schools in Pakistan are very inexpensive, heavily subsidised and all. I mean Baqai and Aga Khan may be diff but even they are not too expensive.

                      If there were more med schools, with higher tuitions, and government scholarships to those who need it, and grants etc, with the condition that as a result of them getting the grant, scholarship, they must service a certain area, it may work..if it is enforced.

                      As far as people getting into med schools on quota seats for rural domiciles, I believe the idea was so people from those areas will be able to get the education as well as serve their communities. No one goes back to Bhai pheroo after finishing DMC or chandka, they all go for big cities or try to go abroad.
                      The greatest trick the devil ever pulled was convincing the world he did not exist. And like that... he is gone.

                      Comment


                        #12
                        This forcing people to do jobs is a very scary proposition. Thatís one of the fundamental reasons of brain drain to begin with. You canít tell people where to go and serve. Volunteerism canít be dictated or institutionalized. In rural Pakistan, people need clean drinking water and access to schooling and not neurosurgeons. Even a trained med assistant in a village of a few hundred can take care of basic health needs of the community. There are more trained midwives in my village and the infant mortality rate is extremely low (in line with urban figures). What we need in Pakistan is a basic infrastructure that promotes education and freedom to make a decent living. Until the equality of economic opportunities is attained (e.g., an Army Office with an IQ of a table lives in an air-conditioned villa and is supplied with 4 servants, and a highly trained physician makes only 4000 rupees a month in a Public Hospital (it is not a joke, ask any doctor working in a Public Hospital). It is no wonder that every one wants to immigrate.

                        You may say Army and Public Health are two different debates. They are not. Pakistan needs an integrated approach to economic development. Unfortunately, those responsible for making decisions happen also to have in IQ of a table.

                        Comment


                          #13
                          Originally posted by NYAhmadi:
                          This forcing people to do jobs is a very scary proposition. Thatís one of the fundamental reasons of brain drain to begin with. You canít tell people where to go and serve. Volunteerism canít be dictated or institutionalized. In rural Pakistan, people need clean drinking water and access to schooling and not neurosurgeons. Even a trained med assistant in a village of a few hundred can take care of basic health needs of the community. There are more trained midwives in my village and the infant mortality rate is extremely low (in line with urban figures). What we need in Pakistan is a basic infrastructure that promotes education and freedom to make a decent living. Until the equality of economic opportunities is attained (e.g., an Army Office with an IQ of a table lives in an air-conditioned villa and is supplied with 4 servants, and a highly trained physician makes only 4000 rupees a month in a Public Hospital (it is not a joke, ask any doctor working in a Public Hospital). It is no wonder that every one wants to immigrate.

                          You may say Army and Public Health are two different debates. They are not. Pakistan needs an integrated approach to economic development. Unfortunately, those responsible for making decisions happen also to have in IQ of a table.
                          I don't think making it mandatory for the new grads to volunteer in rural areads would directly result in brain drain. With added incentives such as bonus marks, I am sure most wouldn't mind. Brain drain is happening as a result of lack of opportunities. How different is it from the idea where in some countries every citizen spends time in the boot-camp at a certain age/time. Although, your next point perhaps addresses the crux of societal decay taking place over the year: rampant unequality and bureaucracy, which needs to end.

                          Comment


                            #14
                            Ny I was suggesting that those who qualify based on rural domicile should be expected to go back and serve their locality for some predetermined amount of time.

                            Its a question of representation these days and not of service.

                            A better qualified student from karachi can not get into DMC because of the quota someone from interior sindh with lower grades who would not have made it on the merit list gets in. Fine this allows representation of those areas and providing them with opportunities.

                            Next step is that the person graduates and decides to work in an urban area. this is a lose lose situation for everyone but this guy and maybe his family.

                            Lose-lose #1- we now have a docotor who would not have made it if it were not for the quota system. The better candidates did not get in.

                            Lose-lose #2- his rural area still does not have a doctor.

                            if we have a licesing system similar to US, and believe me we need it, we have too many "doctors" from chandka etc who got in due to connections and sailed trhu due to JSSF etc and now are such quacks that if you ever put them in a room with a real doctor they look like chimps. so if we have licensing requirements and for that people would have to compete for seats and then go serve in underserved areas it will be better for the general population.
                            The greatest trick the devil ever pulled was convincing the world he did not exist. And like that... he is gone.

                            Comment


                              #15
                              Quote:
                              I recently read in news that Pakistan has a little over one hundred neurosurgeons and one or two facilities in each of the big cities are equipped with MRIs for diagnosing brain related trauma and treatment.
                              ------------------------------------------------------------------------------------------
                              Hi Friends
                              I think the situation is same even in India, for basic rural health services but India has some top class neurosurgeons in the country. Luckily the migration of doctors has slowed down and majority of the top class surgeons stay back in India.
                              I agree with NYA that in villages, just basic medical care can solve many of the problems and can act as a first aid centre. They also can advise patients for further treatment in case of complications.
                              In Chennai & Hyderabad, I had come across many patients from pakistan who had come for treatment. Especially there was one cute young girl from Karachi who had a congenital heart disease and was being operated in Madras Medical Mission hospital. When I talked to the parents, they were telling that there was not even a single hospital where cardiac ablation could be carried out. (this was in 1995). I hope things would have improved by now.
                              __________________________________________________ ________________________________________

                              Quote: Pir Sahib
                              As far as no doctors being in rural areas. I think that the stipulation should exist that if you are getting in a med school due to a rural domicile quots, then you must go back and serve that area where you are domiciled for atleast 5 years.
                              ------------------------------------------------------------------------------------------
                              In some of the states of INdia it was made compulsory to serve for few years in rural areas, and it did produce mixed results. I have some of my friends who as soon as they graduated out, used to go once in a week to sign the register and get back to the city for the rest of the week. On the other side atleast 10% continue to serve regularly in the villages.

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