Online exams in universities: The dilemmas and challenges

The year 2020 will be a memorable part of our life in different terms.  This year has given the challenges and so many opportunities and setbacks in our life.  This also applies to those who are seeking and providing formal education through various institutions.  Due to COVID19 and lockdowns, life came to a standstill, including the teaching and learning activities.  Except for very few institutions/colleges/Universities were prepared to accept the challenge of moving immediately towards the online or virtual learning approaches. Neither the IT department nor management or teachers were skilled and mentally prepared to shift to digital learning immediately.  I am witnessing several academics who are still not well versed with computer technologies and use them confidently.  Thus training was arranged, and teachers were prepared to conduct lectures, tutorials, and even virtual field trips. It worked out nicely for some, but each day one would hear the faculty’s complaints blaming either the power failure, poor internet or pressing the wrong key or getting stuck somewhere. In that context, probably the students were at an advantage, as they were the passive audience and least bothered about the attendance or sitting on a desk/table and be dressed or not.   Of course, there was a lot of cheating by just joining the class and disappearing and watching the lectures conveniently. Some teachers also tried the multiple or best choice questions, and the students who could not pass or even attempted came up with a novel excuse of having problems with the internet.

This learning process has been going on throughout the year with varied problems but managed quite nicely in many places. Now comes the time of final examinations. The Higher Education Commission (HEC) of Pakistan announced that the various universities could organize the exams according to their choices, i.e., online/virtual or physically attending the exam hall. That appeared to be an easy process but has turned into an ugly face. The student started the process, including grappling with security people and demanding online exams as the classes were conducted online.

Conducting online exams appears to be a valid argument by the students, especially when HEC has also allowed it.  So why are the universities not conducting those online exams?  Is it the stereo-typing that students will be cheating, especially on the pretext that even in the physically appearing exams, they have been resorting to cheating.  The online approach is much easier!!   There are many innovative ways that students can cheat, though there are solutions to address this.  A study conducted by McAfee, an online security software manufacturer, found out that one in three students in the USA used mobile phones or other connected devices such as smartwatches to cheat in exams.

Rather than seeking solutions, the Universities are becoming part of the problem.  The Universities are also not prepared or willing to take up that challenge to get themselves at par with international standards for digital technologies.  In a country where most of the Universities are still using (rather abusing) the papers by distributing notices, memos, invitations, and so many other purposes, it will be a prudent  decision to move towards “paperless” approach supporting the climate challenges.  In many of the discipline computer knowledge and hands-on experience is not part of the learning process for both the students as well as teachers.  This is further compounded by the fact that we ( I am talking about highly paid professionals, such as Medics, Engineers, Chartered Accountants and so on) are never taught about both written and verbal communication skills and how to be absorptive to the new technologies, especially working digitally.  The argument of students being morally corrupt is partially valid. But we need to be mindful of the fact that the teachers and management of universities must be equally blamed.  Have we ever tried to share moral knowledge with our students?? How many have taken any concrete steps to stop the cheating?? And above all are we ready to shift to the online approaches as and when needed.  This pandemic is a wake-up call for all of us.  Mind it. This may be the beginning of so many other pandemics and emerging infectious diseases according to epidemiological transition  Getting into digital technology is the need of the time, disregard of the field of profession or practice.  Perhaps, it is also high time that the educators/educationists also discuss the alternative to rote learning and just conducting the exams, which usually assesses the memory and maybe some other skills.  In a time where equality and the standard of education are moving towards a downward spiral in Pakistan, these challenges have to be addressed.


It has been a long time that I have not written a blog. Each day, I think of something and something comes up. Or may be its a simple procrastination. I hope InshAllah I will be sharing some of the experience about the COVID19 and getting locked down.

However, to day is something exceptional that I read and could not resist myself to share my thoughts.

Some of us may not know what it means by the idiom, “Tail wagging the dog,” should read this. Our Pakistani society seems to be dragged into this consciously (or maybe unconscious).  The case over here is regarding admission in medical colleges, especially in Sindh.  Today, while enjoying my tea-coffee combination and reading the newspaper, I came across this exciting news.

There is now a discussion that all the illnesses of flawed government health care system is actually “non-availability of the doctors.  This will be more so this year as the PMC  It appears that several aspirants (or to be precise) the applicants for the MBBS have failed in the entry test called MDCAT.  Many explanations are being given, and justifications have been offered as to why so many failed and why the girls have excelled.  Above all, if all the girls get admission, then many may not practice after their graduation.  So the ultimate blame is that MDCAT test.

The most surprising part is that it comes from the medical fraternity who should be safeguarding and improving the quality of “products”  from the medical colleges, especially the ‘private medical colleges’.   Back in 1973, I do distinctly remember when I was getting admission to medical college.  There was a big protest for increasing the number of seats from 150 to almost something like 350-400 in the public sector medical college.  Though it was raised due to different reasons, the then health minister had predicted that in the future, the doctors will be selling their skills on a cart!!.  This was meant about the quantity that would be produced and, of course, the quality going down.  I had once asked about the quality of young graduates from my mentor Prof Ghaffar Billoo. I can not forget his reply.   The number of good qualified graduates is still the same, and if one plots them on the graphs, previously, it was a normal bell-shaped graph, now it is a graph which is skewed towards left, with proportionately few having the high quality.

Can we as a society claim to afford this approach of getting high-quality doctors?  Perhaps some of us, who can afford to seek services from the “highly qualified” doctors, but the majority may be the victims of the lot having compromised quality.  I understand that some of the readers may not like or agree to my comments, but let us all leave in reality.  We all are not only corrupt in financial terms, but also in moral terms. It’s high time that we wake up and call our house in order.

Writing a book: Dilemmas and procrastination

Writing a book:  Dilemmas and procrastination

Staying at home (during the COVID19 pandemic) for a so-called workaholic seems to be an excellent opportunity to slow down and try to do something which one has been delaying because of the busy schedule.  Nowadays, you seem to be free from your routine work-schedule and think that it’s a great time to do the long-wished plans.  However, things are not so easy as one would plan.  You are bombarded, or actually, you unnecessarily expose yourself to so many social media outlets, including the compulsion to check your emails.  In a way, you pretend to be busy but with no real productive output.  And, each day, before going to bed, you remind yourself that I will be doing ‘this’ as the priority.

Well, this may not be true for many, but it seems to apply to me.  I had among my many “wishlist” one crucial project for writing a book. It is not originally my idea, but I have been suggested/told that based on my knowledge and experience, I should be writing a book.  Many of the undergraduate students (whom I am teaching now-a-day) had also prompted me to write my book, as on various occasions, I have been discouraging them not to read a particular book.  I always had doubts in their (apparently honest) suggestions, as I suspected that then it would become more accessible for students to learn from a book and be prepared to take exams and oral/practical exams by the teacher who has written the book.  I still suspect that it will reduce their learning habit and having better conceptual understanding.  Recently, I was impressed by one of my colleagues (from the clinical side) who has managed to write a couple of good books, and recently his latest book also got published.  So, I was a bit motivated and sought his guidance; he also motivated me to go ahead and promised to help me when needed.

Since then, I had been pondering on this idea; even came up with the titles and many other plans.  However, at the back of my mind, I have been going through various arguments and the dilemmas that may be associated with writing a textbook.  These were: So what? What difference will it make?  Do you want to re-invent a new wheel? Who will publish? What will my professional think of it?? etc. etc.  Besides, I always thought that I should be sharing my experiences of my field, how it has evolved over four decades, especially when I have been a witness to this process. Also, during my professional life, I have seen so many paradoxes in the development field that I always wanted to share “the other side of the story”.  This is a different approach than what is needed for a textbook and, ultimately, its publications.  Working digitally and virtually at home and surfing around have convinced me that you can still “publish’, but not necessarily through some publisher producing hard copies.  You need not write the whole script for the book, and you do it at your pace and mood. You write blogs based on your thinking process and keep on adding it till you feel that its time to compile them.  The idea is to enjoy what you are doing and make it more of experiential learning; this, of course, is from a special lens and mind-set.  You may even invite comments and suggestions as to how to go about it??  So, while trying to overcome my procrastination as well as dilemmas, I have proposed to name the book as “Concepts & applications of Public Health approaches in Pakistan”.  The title, as well as my sincere intention, is to make it a combination of some facts combined with theory.  This also includes the reflections and experiences (which are not usually written or shared).  Well, since I had to make a beginning from somewhere, so this is the first blog (or my so-called preface) to begin with.  I intend to keep the format of each of the chapter or section of the chapters as

Theory (background, introduction, concept clarification etc)

The status in Pakistan (including some historical evolution, if needed, some facts and figures and any achievements and the process evolved by public or private (including not-for-profit) sectors

Reflections & discussions (this will be based on personal or shared experiences).

Continue reading → Writing a book: Dilemmas and procrastination

Educational & Intellectual corruption: The case for Medical & Public Health fields


What is it ? 

Corruption is the abuse of entrusted power for private gain. It can be classified as grand, petty and political, depending on the amounts of  lost and the sector where it occurs. We in Pakistan, have been discussing, especially in cable networks & social media about the “corruption” in context of money, especially after PANAMA leaks and very recently the Paradise leaks. However, another big evil in our society has been the “educational corruption”; it usually follows or sometime exclusively exhibits as “intellectual corruption”. I was surprised to see by searching in Google, About 7,960,000 results (0.51 seconds).  Like other fields, corruptions in medical and Public Health is not an exception.

Story of Medical education & practise

The story begins with admission in a “private” medical college, where special seats, foreigner seats or donation-based admissions are highly promoted. I am witness to a parent (landlord) who wished to get her daughter admitted and I suggested him to actually use the money (quite a lot at that time) to give it to her as a dowry. He in fact said that she is becoming a doctor to get some good name and a proposal matching to their standards.  This follows by the “tuition” system, whereby there is a longer & shorter duration contract along with the guarantee to pass the student; of course all manged by the respective faculty member.  Well, leaking paper is of course no exception and even ignoring cheating being widely practised. More interesting is the fact that when an “honest” teacher (usually a Head of Department) sends the results without maneuvering, the respective University staff sends it back mentioning that there is something wrong as 10-15 students have failed in that subject.  Thus, the Principal calls him and argues by mentioning that since the parents are paying handsome money, they expect their children to pass each year.  The story keeps on for internship whereby cronys are entertained and even the post-graduate exams. in which there are some ‘favourite’ candidates.

The Public Health saga

The Public Health education is even much worse than medical education.  Here there is a bigger motive and incentive for owners/managers of the institution to earn money at any cost.  This would mean admission criteria will be wavered off, entry exam will be easy, and any candidate having completed 14-16 years of education will be legible to admission. Then, there will be half-a-day, evening , weekend and even no classes and of course exams and results may also be manipulated. The external examiners for thesis will be the ones who are ‘well-wishers’ of that institution.  Above all the faculty is told that as long you are able to get the admission of X number of candidates, your job will continue.  So the poor faculty, has to do their best to get enough students and have a “good” reputation, so that the cycle keeps repeating.

All the above results, inevitably, into the products who are out there in various institutions and hospitals and serving people and various other stakeholders. There is another dimension to intellectual corruption which is observed in health related institutions, whereby the employees (of any level tend to keep on neglecting the truth & denying the facts, just because that’s not their organization’s ‘punchline’ or more so because they don’t want to get labelled as ‘bad’ guy at the cost of losing their jobs.

The consultancy gimmick

The other intellectual corruption, is practised in awards of contracts, whereby networking, under-table deals or already decided party is unduly favoured. The reports prepared are ‘modified’ to suit all the audiences and only those points are highlighted in big ‘dissemination’ seminars which suits to bot donors and the ones who gets the money; sometimes even for the government department. Highly talented experts sitting in government institutions either keep quite to promote/advocate what the big ‘bosses’ wish to project; they even don’t argue in those high level meetings.

Is this reflecting our society??

Well, one can say that is an echo of a frustrated person, however I can bet that most of us may have encountered, observed or heard stories shared above.  How long can we keep on acting like a hypocrite in spite of the fact the truth is something else.  We are not only producing but also setting the role models as to who can be successful in the medical and public health career.  Can some of us, stand up and play the role of  “whistle-blower” and point out the evil-doers. Perhaps we, including myself are afraid to do this.  However, I fear that I will, like others may be made accountable for not doing anything against this “zulm”. MY only satisfaction could be that I am trying to show just the tip of iceberg and really fear of the consequences.  May be its the reflection of our society which has deteriorated to that extent.

Higher education programmes: Planning, Challenges and outcome

Pakistan is faced with major task of increasing its basic primary as well higher education; leave alone how and in what fields the products will be utilized.  Today, I will be focusing on higher level education illustrating a comparison between two programmes; one is BSc and other is MSc.

Last days as part of my consultancy work I have been working on evaluating the BSC-Midwifery programme.  This is is one of the pioneer initiative supported by a UN agency and being implemented by School of Nursing and Midwife of a prestigious university. I was surprised and rather embarrassed by the fact that it has been scientifically and strategically designed alongwith international and national consultations and with full support of Pakistan Nursing Council (PNC) and Midwifery Association of Pakistan (MAP). In addition to that there are other groups who are either running the similar programme or in fact have also developed a draft “Midwifery vision 2025”.

so what was embarrassing to me??  Well after spending almost three, decades wherein a bunch of seven “preceptors” working in Community Health Sciences Department ( from 1985) who had then be practicing as well advocating for the role models, and later on joined by so many Public Health experts including the PhDs, we have not been able to achieve the following:

a) A strategic planning for the syllabus and curriculum;

b) no functional and active association (have been having off & on) and

c) no regulatory authority to ensure quality of products (PMDC has its own challenges and rules of business).

I can even add, in this list a dedicated and highly esteemed “Journal focusing on Public Health” issues; we have produced many papers, mainly to beef up our CV.

So where the things have gone wrong.  One can come up with lot of semantics and rhetoric, but as a ‘hopeful pessimist’ I feel that our (Public Health graduates) education/training, job opportunities and the contribution which should have been made to address health challenges –all are showing a downward trend. I am proposing that the academia, teaching institutions as well the young graduates should have to address these issues. My long time observation is that we are not ready and even willing to challenge the status quo, simply because we wish to save our job, consultancy opportunities or just least bothered. We attend big workshops and conferences with luxurious lunches, talk all the good things which everyone wishes to hear, make resolutions and then forget all.  How many of us, including myself is wiling to challenge that building more hospitals are not the solution, that supplying ready to use foods can be replaced by simple home made techniques, and that institutions are not putting lot of efforts to produce high quality graduates.

All is not well !!

RANDOM THOUGHTS: questioning the solutions

It indeed had been quite a long time that I have not been writing a blog; perhaps my un-wanted engagements or to be more precise distractions to the social media especially FB, which I definitely find more enjoying but time-consuming. Nevertheless though I will sharing my “Journey from Thar to Islamabad” which indeed is very near to my heart but may pushing myself to write the third Episode of that journey had deterred me to share some of my random thoughts.

I am not sure how many of you know about David Werner, but he has been well known working with Hesperian Foundation.  And some of my colleagues and friends would bear me out, I had the opportunity to work with him when he visited the Aga Khan University back in 90s.  To cut short, he is the author of “Where there is no doctor“, one of the few famous books translated in many languages and a good resource for grass root level workers.  Among other works, he has challenged the status qua by ‘questioning the solution’.  Its high time that we in Pakistan also start “questioning the solutions”.

The Public Health practices and its focus on improving the health of the people has undergone so many changes/improvements and of course improvement in health status in Pakistan.  However, we have also come up as well as recommended a number of solutions which though apparently seem to be working but we are not raising the questions whether its the right solution or not?? Back in 80s David had challenged  about the role of village health workers which in our new terminology can be equated with more or less similar workers; to a name a few, are the CHWs and CMWs. When both of these programmes were launched the idea should have been to help the community for ensuring access to basic health services and and in that process make the community/beneficiary to take care of their health by themselves.  However, with the recent move for getting more political gains, the services of CHWs have been regularized or recognized by government with some salary.  Similarly, the CMWs against what it stands for i.e. the community based and patient-centered care is incentivized for establishing some static facility and push the community for having that care as opposed to old age home deliveries.  I am, by no means, asking the planners to move towards deliveries without basic skilled birth attendance, but to just not ask the community to change their whole old-age behavior (see my earlier blog on how my brothers were born) of having their births at home.. by CMWs. Similarly now we are hearing about the so called readily prepared high caloric food being promoted by bilaterals and government (at provincial levels) are ordering it from international markets at a reasonably high cost.  Though fact of the matter is that an indigenously prepared high density diet has already been prepared and successfully test by one of my teachers, Dr. DS Akram. Why this diet has been taken by our worthy planners is another long story.

Questioning the solutions has always been fraught with oppositions and repercussions as you are challenging the status qua. Perhaps we all the Public Health Practitioners would have to at least generate the debate on  pros and cons especially the economics of this approach; then and then  we reach to some better solutions. InshAllah I will be putting more thoughts on these issues; I do not have anything to lose and I can not be part of that “zulm” as I may also be questioned about this on the basis of the knowledge and wisdom Allah has given me.

Village life, values, culture and practices- birthing by Dais


As a Public Health Practitioner, among many other issues, MMR, IMR and NMR (neonatal mortality rate) are being focused; now with the induction of CMWs, lot of emphasis is being given on institutional based deliveries by giving the targets to be achieved for various health facilities. We are also guilty of prescribing recipes to mothers for breast feeding, giving the right diet, when to and not to get pregnant, where to go for check ups, where to deliver and so on…  The over-riding assumption for us is that since these are really nice “magic bullets” or interventions and since the mothers/women do not know or even care about it, we should tell them. While doing it we use our “medicalized model” and even undermine the common wisdom.

In that wishful thinking, we even wish to change the centuries old practices and experiences, on which the village life has thrived. Before I come to birthing by dais, let me remind the rich culture and values in village life. Well, the media may have played a role in bringing the ‘development’ of villages, but I believe many practices will be more or less same. The village is something like a large family, everyone knows each other and care for whenever it is needed. The respect for elders is equal disregard of social status; the only source of information as to what is happening in various houses, for ladies is the “bishti” the leather-bag water carrier.  If you lost your parrot, it can be easily located; if you are stung by a scorpion, the local moulvi will do the ‘dam’ and you will be alright.  While going to main market you don’t say that you are going to the ‘bazar’ or for that matter a mall, but you say, ” I am going to the city”.  Swimming in river, playing ‘guli-danda, pittoho, Dhoronaro-white river

and visiting railway station of Dhoronaro (my village name) are the common pass-time activities. These are some of the memories of childhood. And talking about health care, you will be given ‘churan’ which works as a laxative so that you get rid of worms, if you are vomiting, then local herb and lemon is the best. Of course, for delivering the babies the “dai’ or my family called it as “maim saheb”

The importance of “maim shaeb” was realized by me, after quite a number of years, when in fact she visited our family residing in Kaharadar, Karachi, to deliver  my youngest brother. She came with a big suit case and we were told that she has brought for us our younger brother (we were already 5 MashAllah); but she will show us later on.  AND, of course we were shown the baby and she stayed with us for at least a month. When I grew a bit older, then I started finding out from my grand-mamma/daadi as to who was delivered where. And she had some interesting revelations for me. The eldest brother (I am the second one!!) was delivered by a private doctor and in a supposedly expensive hospital/maternity home, as the first baby is always a precious one. I, being the 2nd was given relatively lesser attention, so I got delivered in a charitable hospital of our community. But, then rest of all i.e. the 3 next brothers got delivered at home in the village and the youngest in a flat in Karachi.

so what wisdom or barriers were influencing these practices, which in a way were/are norms for a middle class person residing in a village. Going to hospital for maternity care can easily be explained by us, but we fail to understand why my family did what they should not have done, especially for the last delivery. We in fact tend to understand that getting delivered at home environment is much more practical and congenial to an expectant mother, rather than to go to hospitals. In addition, its the trust and confidence in the maim saheb which encourages these decisions.

The community midwife is by far a good idea, but why on earth we are forcing the mothers to come to health facilities to get themselves delivered, until and unless there is a need to do it or it is by option. I am not totally against the skilled birth attendance, but I am not convinced, the way it is being promoted, inspite of the name CMWs–community midwives. It is os interesting that when in many developed countries, mothers are being encouraged to deliver at home, we are pushing it very hard to break the old age milieu and culture if the intended harms/risks are addressed.

From Thar to Islamabad –E-2- Major phases of life

Thanks to all the viewers who shared their interest.  Please do not take it as just a story; reflect on it and try to deduct some lessons.

In all of our lives, we tend to take decisions, sometimes, we get a favorable response and outcome. Alternatively we get frustrated or disappointed as to what we get in future. Perhaps, we human beings are hasty in taking some decisions or we either think that this is the best solution; some people leave it to destiny. Allah, has made all of us independent in living our lives and taking decisions, but in the guidance of HIS teachings. However, our independence seems to be quite restricted, as very well said by someone when asked about the power of freedom and independence. He said the person to raise on foot while standing, so he did; however when asked to raise the other foot also, he showed his was relied, .. that’s what is your power.  The results we get by our decisions if guided by Allah, may not be understandable at that moment, but we do realize it later on. My life has been full of those incidences, wherein apparently I did not achieve the results at the time that I wished; in addition, so may co-incidences (apparently un-explainable) have happened with me, which guided my future course of action.

Keeping that in mind, I thought of sharing some of those incidences in life and decisions either taken by my parents or me, which had resulted what I am today. following could be those phases

A. Village life, values, culture and practices- birthing by Dais

B. Moving to Karachi and living in Kharadar, Karachi –by the way, Kharadar is a birth place of Quaid-e-Azam and it is claimed that he was from a Gujrati (the Indian one) family– no co-incidences !!

C. Schooling in a charitable school with classes in a big empty warehouse

D. The joys of Burns Road in DJ Science College-not to forget Lassi and tram

E. The golden period in Dow Medical College and birth of PWA

F. Beginning of Public Health with HANDS and joys of working with Billloo Sahib

G. Grooming in CHS-AKU- traing in London

H. Training for MPH in Baqai University and joys of working Ilyas Sahib

I. Working with donors and development world

J. Working of Health Services Academy; ups and downs

K. Birth of Mustashaar and revelations about consultancy world– both the client as well as vendor

L. Public Health getting in Pakistan’s arena; but are we getting the right products

M. Frustrations with post-graduate education- business in teaching/training

N. Period of reflections in past

so in next episode we will see the village life and how the beliefs and practices passed on in city life.


From Thar to Islamabad –Episode 1

The story of Tharparkar, the desert situated in south of Sindh got in the news when babies were reported dying in hospitals and having severe malnutrition.  Of course there were lot of debates held all over the country including in Islamabad, where the so called specialists including the donors gathered in 5 star hotels and talked, sympathized and then criticized the government followed by a sumptuous lunch and went back home or to their work.. so the story reached from Thar to Islamabad.

BUT, this a different story of a person who had lived over there and has passed through different phases of life and profession and has landed up in Islamabad. This is a story of frustrations, progress, sacrifice and a continuous struggle to achieve and contribute something to make a difference in his life and lives of so many people. This however, is not meant to praise someone or even sympathize with him, but to learn and pick up some of the lessons.

It all started when his parents migrated after partition of India in 1948, when his family came to settle in a place called “Dhoronaro”, a sindhi word meaning white river and it was so true.  A small village connected by road as well as railway line to the bigger city such as MirpurKhas, Hyderabad and Karachi; having a coal engine. The father was working in a cotton ginning factory supposed to be marking the cotton-bails with numbers. His father has to do this as his grandfather died at a very early age and since he could not get the education, he could only write English numericals and some alphabets. But, his father had other qualities, including the entrepreneurship, building business relations; he was made the manger of that factory within few years. The factory had the generator for running the machines and the only source of light for the factory workers who were living in that premises. However, his father was given a separate residence just few meters away from the factory, where there was no electricity and the family have to rely on the old method of ‘laltain’ or ‘petromax’–colloquially called “gola batti” and kerosine oil operated pedestal fans. He always used to think that though his father is supposed to be the “seth” colloquially used for the ‘boss’ or a relatively rich person, why we are not having the facility of electricity.  Here is what his house looked like; the lane is occupied by so many encroachments and in a way it is closed… so this is the beginning of a long journey…. join me if you are interested.

!my home