Safety & Security Today (S&ST): Being proclaimed as one of the most renowned cardiologists and an immense contributor to the field, please tell us how did it all start?
Professor Nadeem Qamar (NQ): I graduated from Liaquat Medical College, Jamshoro (LUMHS) in 1984 and then subsequently I went to United States of America (USA) for further training. I interned at Detroit and then went to Baltimore where I did my Internal Medicine residency. I did my cardiology fellowship from McGill University in Montreal and Intermission Cardiology fellowship from Ottawa Heart Institute. After gaining ample experience I returned to Pakistan with the aim to serve my country and joined National Institute of Cardiovascular Diseases (NICVD) in September of 1995. I have been working for this institution for more than 26 years and with hard work and dedication became Executive Director of NICVD in February 2015.
S&ST: Keeping in view, your experience in United States and Canada, what are the key factors/points that you think should be improved in Pakistan’s medical education?
NQ: To answer this question more thoroughly, allow me to construct a narrative with some observations from the past and where we are heading towards. When I was in medical college, the male-female students’ ratio (Gender Ratio) was 80:20 and what I see now is that with the progress in societal norms the gender parity in medical colleges has significantly improved and actually reversed. The female students have shown tremendous improvement in securing seats on merit. The problem lies when these young women doctors do not pursue their career in the medical profession due to various cultural and social reasons. Statistically speaking, 77% of women doctors after completing their MBBS do not progress further and/or entirely quit the profession altogether. As for the young male doctors, majority of them seek jobs abroad for better pays. Due to this fact, our country may face acute doctors’ deficit in future.
To avoid going that route, the Government needs to rethink and re-evaluate some of their policies. Foremost, we must bridge the gap of dedicated medical colleges for men just like we have all women medical colleges, to name a few, Peoples Medical College in Nawabshah, Sindh and FJ College in Lahore, Punjab. By taking this step, even if 20-30% of the male doctors explore and avail opportunities abroad the rest of the 70-80% will stay back and serve the noble cause of being the healing hands for the people of Pakistan.
As for the quality of education, we must understand that there is a contrast between the quality of education being provided in a private medical college when compared to a public sector medical college. For instance, the number of students in a public university classroom is high and hence the professors cannot provide required attention to students. Some medical colleges produce really good quality medical professionals, for example, Aga Khan University Medical College (AKUH) a private sector college, Dow University of Health Sciences (DUHS), a public sector university etc. but at the end of the day, it is the individual’s efforts that sets them apart from others. In my early formative years as a medical student, somehow, I understood the fact that it is very difficult to find someone who could actually teach you and the key to counter that analogy is to self-study.
To better understand the issue, I think the solution lies in 1) change of curriculum especially for public sector colleges/universities and 2) dedicated male medical colleges.
The whole system of medical education in this country needs to be reformed. I am hopeful that the Government is keeping a keen eye on the subject matter and a positive change will come about.
S&ST: Do you think cardiovascular diseases are given due attention in Pakistan? Also, what improvements can be made to reduce such diseases?
NQ: That’s a very good question, my entire focus at this stage now is how to prevent cardiovascular diseases. In Pakistan, cardiovascular diseases are neither given due attention nor do people take preventive measures. What we have observed is that in recent times young patients, their ages ranging from mid 30’s to early 40’s, are coming in with Myocardial Infarction (MI) or most commonly known as heart attack. What really affects me is that these young men are the sole earning hands of their families and unfortunately if anything happens to them, imagine how difficult it becomes for those families to fend for themselves.
The cardiology community in Pakistan for the last 70 years, frequently and repeatedly, has tried to raise awareness regarding best practices to improve cardiac health such as exercising and eating healthy. But I believe we all need to approach the issue and prioritize coherently that the best way is to be proactive rather than reactive. We all know the side effects of smoking and eating unhealthy oily food but regrettably ignoring such facts will only result in severe health crisis and dire consequences on quality of life. The US has reduced mortality from cardiovascular diseases by 17% by taking preventive measures like healthy diet and exercising.
We have to change this mindset, for which we have now decided to involve the Government, media and pharmaceutical industry. Unless all of these parties join hands together with cardiologists to raise awareness – no effort put alone would be effective. Cardiologists alone can never be able to achieve the desired outcome. The media has to be a major partner, the Government has to fund these prevention is better than cure projects and the pharma industry has to contribute. Only this way we can effectively reduce the mortalities from cardiovascular diseases.
S&ST: NICVD has been a pioneer when it comes to critical and unique issues just like the issue of paralysis stroke, what is the motivation behind this out of the box approach?
NQ: The biggest motivation is serving the population which is suffering. I could have stayed back in the US and made more money but it is the passion which brought me back. I believe in paying back to the society and that leads to the belief that all lives matter. Providing the best health care for those who are suffering and also ensuring that the quality of treatment is the same for all patients across the board, i.e, is to give the underpriviledged same treatment that a priviledged would be able to avail. This is my field and I try my level best to change lives of the poor population. Just short of a heart transplant, we have tried to bring in every kind of treatment to NICVD and its satellite centers that is available to the developed world. We are very lucky to have support from the Government of Sindh that we are able to provide these services free of cost which actually costs millions of dollars. We are the world’s largest center for heart attack angioplasties in terms of volume.
My out of the box approach, as you may call it, is because I myself belong to an agrarian background. I have seen the sufferings of poor people first hand and I knew what exactly was needed to facilitate the people in need and I am thankful to Allah Subhanahu Wa-Ta’ala that I was able to resolve many of those problems.
Earlier, it was very difficult for the masses to travel from interior Sindh to Karachi for healthcare services but now with nine satellites of NICVD across Sindh cardiovascular disease treatment in Sindh is more accessible.
To ensure that every patient gets the best treatment, we only use FDA approved equipment. Our cardiologists are well qualified and trained as per the international standards.
S&ST: Talking of NICVD, how has this great institution evolved under your leadership since 2015?
NQ: When I became the Executive Director, the treatment of heart attack had changed worldwide but in Pakistan, we were still using the method of giving Thrombolysis or Streptokinase.
At that time in the Western world,, when anyone had a heart attack, they would immediately be taken to a Catheterization lab where the affected arteries would be opened through angioplasty without wasting any time. So, the first thing we did was start a primary angioplasty program.
Another thing I noticed was that, the pediatric patients were coming to NICVD from all over the province and they were all very poor. Just coming to Karachi for tests and treatment was too expensive for the parents and the children were also greatly suffering. So, we decided to go to setup NICVD satellites.
Today, NICVD has 9 satellite centers and they are all proper hospitals – Karachi is the 10th. At these centers, we also provide primary angioplasty treatment, which has to be done within 3-4 hours after heart attack happens. If someone has a heart attack in Sukkur, the patient would never be able to make it to Karachi in time because the artery has to be opened within 4 to 6 hours of the attack, if not then the patient would die. Hence with these satellites, we ensure that all heart patients get the treatment in time. We developed Karachi center as the mother center. Here we implement all best procedures that are being practiced in the world and then further improve our expertise in all satellites of NICVD.
To combat the timely treatment of heart attacks in Karachi, where reaching hospital is a hassle due to heavy traffic, we have developed chest pain units. These are first aid centers where anyone who has chest pain can be seen by a cardiologist and get their ECG done. In case they have a heart attack they can be rushed to NICVD hospital.
S&ST: How many patients has NICVD (including 9 satellites) treated in the past year?
NQ: In 2019, 2.9 million patients were treated in the entire NICVD and in 2021, 1.9 million patients were treated.
S&ST: In these crucial times of COVID, how do you think it has affected cardiovascular domain?
NQ: We had to treat patients who suffered from both Covid-19 and heart attack. Since, Covid-19 causes the thickness of blood so the number of heart attacks have increased subsequently.
Every person in the country has gone through a psychological/mental change in the past two years. The only good thing was that we were able to develop a very good covid unit and we have a critical care program. The death toll of patients due to Covid-19 who were admitted at NICVD was remarkably low – which in itself is a huge achievement.