In April 2007, Prof. Muhammad Umar, President of Pakistan Society of Gastroenterology, attended WGO’s seventh Train-the-Trainers (TTT) workshop in Portugal—accompanied by his wife, Prof. Hamama-tul-Bushra, a practicing gastroenterologist who was also a participant. Dr. Umar talked with WGN about how the workshop has affected their clinical practice and about health care in Pakistan.
WGN: Prof. Umar, what are the biggest health-care challenges facing Pakistan today?
MU: In the field of gastroenterology, the most important issues are shortages of training institutes and trained faculty. Clinically, the top health issues in gastroenterology are acute and chronic gastrointestinal infections due to poor sanitation, and gastrointestinal bleeding as a complication of portal hypertension caused by hepatitis B and C. Nutritional deficiencies are also a major concern.
WGN: What provisions does the government make for public health care?
MU: The government spends less than 1% of GDP on the health sector. A public health-care system has been in place since 1947. It covers about 70% of the population and offers free health care, including medication. A private health-care system has also developed during the last 10 years, although only 20–30% of the population can afford to visit a private hospital. Government medical schools provide medical education at much lower cost than private medical schools.
WGN: Why is there such a lack of trained faculty and training institutes in Pakistan?
MU: As Pakistan is a developing country, there is a major lackof institutes that offer specialized training. Additionally, fewer doctors are returning home to practice after studying abroad, due to low salaries and few job opportunities. Recently, however, we have seen some very positive developments, and in terms of specialty training we are beginning to catch up with international standards.
WGN: As head of the gastroenterology and hepatology department at Rawalpindi Medical College, you train junior doctors on a daily basis and develop the curriculum—so you have a great deal of experience in medical education. Why did you attend the TTT workshop?
MU: Attending TTT was part of my continuous professional development, and I strongly believe that interaction with international colleagues deeply improves our understanding of teaching and training methodology and research. I also wanted to make connections with international faculty to improve my awareness of international standards. I found the TTT workshop fulfilled all of these goals.
WGN: What did you “take home” from TTT and how did you put this into practice?
MU: The TTT adult education and “hands-on” modules were particularly interesting for me, as I noted a need in my college to improve the teaching of procedural skills, and the methods we learned in the TTT workshop were ideal. The TTT workshops are ideally suited to improving training in the developing world, where medical training is in need of support. When I returned to Rawalpindi, Dr. Hamama-tul-Bushra and I organized the first course in “Basic Skills in GI Endoscopy,” based on material from the TTT workshop. Twenty-five medical professionals from all over Pakistan attended the course, as well as several professors from other teaching hospitals, who returned to their home institutions to teach the same skills to their medical students and junior doctors. More information about activities at the Rawalpindi Research Center is available on its web site (http://www.rawalianresearch.org).
History of the Pakistan Society of Gastroenterology
The Pakistan Society of Gastroenterology and Gastrointestinal Endoscopy (PSG) was established in 1985–86 by a group of gastroenterologists, gastrointestinal surgeons, and pathologists. The Society has five provincial chapters, each of which held 3-day meetings every 5 years until 2006, when a Pakistan Society of Gastroenterology Week (PSGW) replaced the provincial meetings. The one-week meeting includes a formal core program and symposia, as well as postgraduate courses and specialized workshops. Gastroenterologists, hepatologists, gastroenterology fellows, and general practitioners from all over Pakistan attend PSGW. The Society’s official journal, the Pakistan Journal of Gastroenterology, is published twice a year and is accredited and indexed by the Pakistan Medical and Dental Council.
Training in gastroenterology in Pakistan
There are two types of training program in gastroenterology in Pakistan. The first is the Fellowship in Gastroenterology run by the College of Physicians and Surgeons of Pakistan, which is a 5-year program. The other course is a master’s degree in gastroenterology, which is a university program involving 5 years’ training in gastroenterology. Both programs are well structured and standardized. There are also two types of gastroenterology training center in Pakistan—public and private. In both sectors, the facilities are well equipped and the curriculum is standardized, but the courses do not currently meet the country’s needs and require improvement and international assistance. The PSG is currently lobbying the government to establish new training and research centers for gastroenterology and liver disease. This is especially important now, with the increasing numbers of cases of acute and chronic infections, gastrointestinal malignancies, and complications of hepatitis B and C.