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EverypublicsectorinstitutioninPakistanisafailure,changehastocomeeverywhereandSocietyitselfhastochangeDr.NadeemulHaque

AEME2013ConferenceconcludesatapositiveoutlookforChangeinhealthcare

EverypublicsectorinstitutioninPakistanis
afailure,changehastocomeeverywhereand
SocietyitselfhastochangeDr.NadeemulHaque
Wespend0.5%ofGDPonHealthwhileloseover
2%ofGDPonenergysystem
Educationalinstitutionsmustaddresstheneed
forHealthPromotioninthesocietytheyserve
KARACHI: The three day AEME (Association for Excellence in Medical Education) conference held in
conjunction with 16th AKU Symposium concluded here on January 27th with a positive outlook for change in
healthcare in Pakistan. Theme of the conference which was attended by a large number of medical
educationists from all over Pakistan and many distinguished invited guest speakers from abroad was
Education for Service and Patient Safety. It did stimulate people and those affiliated with medical education
andhealthcarehavestarteddoinginternalthinkingforchangeandhowtointroducethesechangestoimprove
notonlymedicaleducationbutpatientcareaswell.
Dr. Nadeemul Haque, Deputy Chairman of the Planning Commission, Government of Pakistan who was the
chiefguestintheconcludingsessioninhisaddresswhilewelcomingthisthinkingforachangealsoreferredto
the forces that resist such changes. Increasing healthcare cost, he stated, is an important issue in United
States as well as in Europe and it is the healthcare professionals who increase the healthcare cost. He also
disclosed that Pakistan spends about 0.5% of its GDP on health which is very negligible but somehow the
healthcare facilities do manage to work. However, management is a big problem for us. A visit to any tertiary
healthcare facility will reveal that some of the units are not functioning and equipment may be rusting. People
do not want to pay taxes hence we cannot allocate more funds for health. While we allocate jus 0.5% for
health, we lose about 2% of our GDP on energy system. But sill we have not been able to overcome load
shedding.InKarachiitisnotamajorproblembutinPunjabthereisloadsheddingalmosteverytwohoursandit
hasruinedtheeconomybesidesmakingthelifeofpeoplemiserable.Wehavetofigureoutthistheft,stealing
andcheatingintheenergysystem.Arewegoingtotolerateitfortoolong,heasked?
ContinuingDr.NadeemulHaqueremarkedthateverypublicsectorinstitutioninPakistanisafailure.Changehas
tocomeeverywhereandthesocietyitselfhastochange,heremarked.Wehavenomoneyforresearchbutwe
are spending lot of money on development. Guiding principles of management has changed. We do not use
informationtechnologybutusethesameoldfilesysteminmostofthegovernmentdepartments.Hewondered
why the young doctors go on strike every other day. They want time scale promotion. Lady Health Workers
which are accepted as the backbone of primary healthcare are being funded by us. We have to address our
marketing,evenmedicalmarketingastowhysomegovernmentdoctorsareseenengagedinprivatepracticein
the morning. We still continue to follow the Close System but we have to adopt the open system and go for
openness, compete and compete if we wish to make any progress. It was no one else but the medical
profession itself which did not allow an eminent neurosurgeon like Prof.Ayub Ommaya to join King Edward
MedicalCollege.AgainwhoforcedProf.AbdusSalamtoleavethecountryisverywellknown.Ourbureaucratic
systemhobblestheprofessionalswhoareafraidofopencompetition.
Wecannotprovidethesamehealthcareinurbanandruralareas.Wemustgetdeeperinthecommunity.There
are thousands of kids who are not going to schools. We must educate these children. We build Gold Courses
and not libraries and then say we are serving the community, which community, he asked? India has a few
thousand Think Tanks but what have we got, he asked? Our problem is not resources but we need fresh
thinking to solve our problems. We must have a task force which should look at the healthcare set up much
deeper.Whenpeoplestartthinking,itisachangeinitself,heremarked.
Earlier during the panel discussion the importance of faculty development was highlighted. It was pointed out
that once we get stimulated, get the reflections what we need to achieve. Changes are complex and
complicated. We need to understand the problem, go for elaboration and then go for implementation. The
speakers also highlighted the fact that we need to look into our own countrys environment, culture and
resources, have meaningful discussion and then go for any implementation. Every report including the Lancet
Report needs to be examined carefully and see what works in which country. It was also pointed out that the
LancetReportdidnotdiscusstheactualtransferofknowledgeandresourcesfromtheWesttothedeveloping
countries.ProvidingFreeOnlinecoursescouldbeextremelyhelpful.Whilenursingprofessionisconsideredas
abackboneofthehealthservices,theydonotgettheduerespect.LeadershipinNursingprofessionwasalso
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EverypublicsectorinstitutioninPakistanisafailure,changehastocomeeverywhereandSocietyitselfhastochangeDr.NadeemulHaque

lackingwiththeresultthatitcouldnotgetduerecognitioninPakistanshealthservices.
Moderating the concluding session Prof.Ara Tekian from university of Illinois at Chicago said that between
understanding,elaborationandimplementationthereisanotherstagewhichisadaptingtolocalcircumstances
in context. Prof. Z.A.Bhutta opined that ripples of change were already being felt in medical schools where
medical students now use iPads and other devices to access information during the lectures. India is
contemplating to reform their health sector to meet their Nations needs, Thailand has also set in the process
and we need to do the same, he stated. Prof. Rukhsana Zuberi referred to the ever increasing number of
medical colleges, our lack of recognition of the needs of the community and offer solution which are
inappropriate. Prof. Stephen Lindgren President of World Federation for Medical Education pointed out that in
the revised standards for basic medical education WFME has paid special attention to aspects on the social
accountabilityofmedicaleducation.Thestandardsreflectwhethertheeducationalinstitutionswereaddressing
the need for health promotion in the society they serve. This includes needs for knowledge development and
researchaswell.

InauguralSession
Prof. Syed Sibtul Husnain President of Pakistan Medical and Dental Council who was the chief guest in the
inauguralsessioninhisspeechremarkedthatwemustaimatprovidingmedicalcareatinternationalleveland
work for that. Role of leadership is vital and selection of people was extremely important to efficiently run any
institutionororganization.Itensuresefficiencyintheinstitutioneverywherenotonlyinthepatientcare.During
the last six years, a large number of new medical colleges have been established both in public and private
sector.Butwemustproducegooddoctorsandeveryonehasarighttoprimaryhealthcare.Toensurethatwe
mustprovidegoodeducationandtrainingtothedoctors.Publicshouldalsobeeducatedonhowtoidentifygood
doctors and how public should be protected when doctors fail to perform their responsibilities. That is why
licensing,certificationanddisciplinaryactionagainstthoseviolatorsofmedicalethicswasimportant.Itcanbe
done but it is the public, government and the profession itself which plays an important role in its
implementation.Nowpublicexpectsgoodmedicalcare,henceweasdoctorsmustlistentothemtobeableto
solve their problems. Profession gets respect from the public and it can take it back as well. Governance of
medicineisalsoimportantastohowthemedicalprofessionisheldaccountable.Selfregulationworksnomore
andwehavetoachieveproperregulationofthehealthcareprofessionals,headded.
Dr. Farhat Abbas Dean AKU Medical College spoke about areas of common interest and highlighted the need
for further collaboration. Prof. Ara Tekian pointed out that AEME was founded in 2011 and first we had an
international medical education conference in 2009. We made it an independent body to help both public and
private medical institutions. Our mission is promotion of health professionals education and research besides
providingencouragementforsupport.Educationwasformallyrecognizedasadisciplinein2009conference,he
added.
Dr. Greg Moran Provost of Aga Khan University in his speech said that there are three important areas i.e.
Research,educationandservices.Weneedresearchinallareas.Wedeliverqualitycareatbothouruniversity
hospitals, we are committed to education and support our medical, nursing faculty as we have sincere
commitment to quality. Acknowledging that we are working at a university hospital, we must be aware of new
developments in curriculum and must learn new developments in curriculum. We have responsibility that what
weareteachinganddoingiscurrentandneedsofthestudentsarefulfilled.Secondimportantissueisevidence
based in our practice. It applies to class rooms. We apply our expertise in evaluating what we are doing, we
havenotdoneenoughandwemustdomore.Thirdlywemustdisseminateknowledgewhichweget.Itismore
difficulttoexamineeducationandweallmustsupportit,heremarked.
PresidentofAgaKhanUniversityMr.FirozRasulinhisaddressstressedtheimportanceoffollowingprinciples
in improving quality of medical education. We must learn from each other and continue to maintain quality.
University has to work with various national and international agencies to maintain standards and quality of
service to ensure that students receive quality education. PM&DC as well as HEC has played a vital role in
improving standards of medical and dental education. It is important that people who are part of these
institutionsupholdstandards,protecttheinterestofteachersagainstforceswhoareopposedtoit.
Prof. Umar Ali Khan ProVice Chancellor of Isra University speaking on the occasion remarked that we must
produce service oriented doctors and monitor patient safety. We should not look at who did it but how it
happened.Wemustensuremedicalsurgicalproceduressafetyandcurriculumdevelopment.Wemustalsosee
howwecanapplypatientsafetyatalllevelstoensuresafehealthcaredelivery.Oneofthewaysistolookat
the hospital agenda and see if patient safety has figured in it during the last six months and what was its
priority.Patientsafetymustalwaysgetpreference,headded.
Prof. Ghulam Qadir Kazi Vice Chancellor of Isra University said that he always thought that good teacher is
GodgiftedbutnowIhavelearntthatapartfrombeingGodgifted,itisanartandsciencewhichonehastolearn
as well. Hence we decided to have a national conference. Medical education will flourish in Pakistan if we are
committedtodoit.Wenowplantohavethisannualconference,nextwillbeinLahoreandthenwewillmoveto
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EverypublicsectorinstitutioninPakistanisafailure,changehastocomeeverywhereandSocietyitselfhastochangeDr.NadeemulHaque

alltheprovincialcapitals,headded.
On second day of the conference various speakers highlighted several methods of improving patient safety in
practiceaswellasinthemedicalcurriculum.Thespeakersemphasisedonstartingwithsimplestepssuchas
instillingpatientsafetyintotheinstitutionaleducationalaswellasprofessionalculture,attheundergraduate
and postgraduate education levels and in practice. Creating such a culture would in turn help in honest
disclosureandacceptanceofmistakesinordertorectifythemforthefuture.
Patientsafety,itwasstated,hasreachedasignificantandvisiblelevelofimportanceinmedicalpractice.For
years medical professionals worldwide have been testing various approaches to improve the standard and
qualityofpatientcareandsafety.However,thedebateonwhethertheabilitytograspandapplypatientsafety
ismoretheoreticalorpracticalstillgoeson.
Professor Janet Grant in her presentation stated that in teaching students about patient safety one must
recognise the limits of their influence She was of the view that teaching patient safety in theory is not a
substitute for practical role models. There is no accurate way to assess the understanding medical students
haveofpatientsafetytillyoudontassesstheiractionsoncetheybeginpractice.Still,itiscriticaltocreatea
cultureofpatientsafetyandcareinmedicalprofessionalsfromtheonsetoftheireducationintothefield,she
added.
ProfessorValerieWass,HeadoftheSchoolofMedicineatKeeleUniversityintheUnitedKingdom,focusedher
presentation on a greater need for social accountability. Her presentation touched on several key factors
including the importance of institutions to define professionalism in providing quality education for quality
service. Continuing, she said that we need a common set of values around social accountability. Institutions
must start by defining their local definition of professionalism which must be culturally acceptable and shares
across all areas of patient care. The framework on which professionalism rests is laid by a foundation
comprising clinical competence, communication skills and ethical and legal understanding. The pillars include
excellenceinthefield,humanism,accountabilityandaltruism,sheremarked.
Professor Ara Tekian said that loss of life and limb are among the most severe consequences of a lack of
patientsafety.Deathduetoanoverdoseduringchemotherapy,havingthewronglegamputatedandadrugmix
upduringaminorsurgeryhaveallmadeheadlinesandcausedgraveconcerninUnitedStates.Identifyingrole
models who promote zero tolerance for medical errors is one method to improve patient safety he stated. In
identifyingrolemodelsotherscanlearnfrompracticeratherthanjusttheory.ProfessorTekianalsosuggested
allowingstudentsaccesstospeakwithfamilieswhoarewillingtosharetheirtragicexperiences.Thiswillhelp
studentstofullycomprehendtheconsequencesoftheiractions.
While Prof. Umar Ali Khan the Pro Vie Chancellor of Isra University from Islamabad was the moving spirit
behindtheAEMEinitiative,itwasProf.RukhsanaZuberiandDr.SyedaKausarfromAgaKhanUniversitywho
along with members of the organizing committee put in lot of efforts to organize this three day academic
activity. However, there were too many workshops and too many concurrent sessions apart from the plenary
sessionswiththeresultthatattendanceinsomeoftheworkshopswasverylittlewhilesomeoftheworkshops
also had to be abandoned. Registration Fee for the conference and the workshops was also considered quite
high. Prof. Naeem Jafary an eminent medical educationist at present Advisor to Ziauddin University was also
presentedtheLifeTimeAchievementAwardbytheorganizersintheconcludingsession.Somemorereportsto
follow.

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