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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

Blogging again

I was quite motivated to read one of the blogs by a seasoned blogger as how it is so important for the academics to use the social media and what are the joys of blogging and tweets. That landed me to WordPress and here I am. I have so many things to share, but of course i have to take time out to write it.

well I will try to be regular. This is a challenge to myself and I tend to accept it. .