In Pakistan, awareness of various neurological diseases is minimal. This is causing more harm than we realize
NEUROLOGY is the scientific study of nerves and their diseases. The nervous system of a human body chiefly constitutes of the spinal cord, brain, nerves and muscles. The field of neurology is so extensive that it is no longer considered a sub-speciality of medicine.
It would be harrowing to note that between 10 and 15 per cent people living in our world get affected by illnesses related to the brain. According to some reports, millions of people suffer from one neurological disease or another at some point in the world. There are many neurological diseases which may not bother people forever in the developed countries; but as far as Pakistan goes, they are likely to assume epidemic proportions pretty soon.
Let’s analyze which of the neurological diseases have been affecting our society and how they can be prevented.
In this regard, polio is a disabling illness which can be prevented through oral vaccination. Despite availability of vaccines, thousands of children still get affected by polio in our country.
Similarly, rabies is a fatal disease caused by rabid dogs. It has been eradicated from the United States and many European countries by simply getting rid of stray dogs, vaccinating pets and through post-exposure vaccination. In Pakistan, the exact figure of victims of rabies is not known, but thousands get bitten by stray dogs and hundreds die because of the non-availability of proper vaccines. The so-called vaccine, available at government hospitals, used for treating such patients, is nothing more than plain water. It has become obsolete in the developed world, but is still being used at our local hospitals.
Tetanus is another infection related to the nervous system. Its organism is found in soil and infects the human body after a minor trauma. Despite the availability of its vaccine, thousands in Pakistan get affected by tetanus and hundreds die. Public awareness, free vaccination and laws to mandate vaccination for students, employees, and inmates are key steps that must be taken if such infections are to be eradicated. Other infections leading to high morbidity and mortality include meningitis, tuberculosis and cerebral malaria.
Strokes mostly cause disability and the third leading cause of death, worldwide. It is believed that there are more than 20,000 stroke patients only in Karachi. The exact rate of incidence is probably higher than these numbers due to a very high prevalence of stroke-risk factors. According to a national health survey, almost one-third of our population (people who are 45 years of age or older) is suffering from hypertension. There are 2.7 million diabetics in Pakistan and 20 per cent adult men and women eat betel nut or consume tobacco. About 25 per cent of these stroke patients die and 30-40 per cent become disabled. A large number of these strokes could be prevented and disability could be minimized.
The prevalence of epilepsy is estimated to be 10 per 1,000 individuals (1.4 million patients). Epilepsy is a treatable illness and a large number of patients could be completely cured through timely and effective treatment. If not treated properly, epileptics are unable to continue education or employment and become non-functional component of society. Sadly, most of these patients do not have access to neurologists.
Headaches and backaches are the most common neurological symptoms across the world. Lifetime prevalence of migraine ranges between 3.5 and 7 per cent. A large number of these patients become incapacitated or disabled due to non-availability of state-of-the-art facilities for treating such patients. These two problems are highly prevalent in Pakistan.
Dementia is a degenerative disease of the brain, leading to a loss of memory and of functional capacity. It is highly prevalent among the elderly population. In our country, these symptoms are labelled symptoms of aging. A large number of these patients improve with timely and correct diagnosis and treatment.
Other common neurological problems include depression, Parkinson’s disease, neuropathy, multiple sclerosis and neurogenetic diseases. These diseases are under-diagnosed and largely remain untreated in our country.
The most essential component of neurological care in any part of the world is availability of neurologists. For example, in the United States there are 10,000 neurologists for a 240-million population. India has more than 4,000 trained neurologists for one billion people and Iran has more than 500 neurologists. In Pakistan, there are only 70 trained neurologists for a 140-million population (one neurologist for two million people). These 70 neurologists are concentrated in seven big cities. Adding to the misery is the fact that only a few medical colleges have neurology departments and very few hospitals have a neurology faculty. For example, the Liaquat Medical University, the Chandka Medical College, the Khyber Medical College and many more have no neurology department or even a neurology faculty. There are only a few neurology training programmes in the country, producing 4-5 neurologists per year. Neurological care cannot be provided without opening such positions in every district hospital. Neurology is a compulsory part of curriculum in all medical schools worldwide. It has to be made compulsory for all medical students in Pakistan as well. Also, a number of neurology residency programmes must be in place to train at least 50 neurologists each year. There are more than 400 well-trained Pakistani neurologists in the United States. Many of them would be willing to return to their homeland if the infrastructure is properly developed.
Technological advancement, for example CT scans and the MRIs, have brought about revolutionary changes in diagnosing and managing neurological problems. There is no MRI in any government or public health facility in the entire Sindh province. Many a patient cannot afford a test like MRI or even CT scan.
A well-equipped national institute for neurological diseases should also be established by the government with the support of the private sector. This institute will serve as a place for neurological research, specialized training and quality care. All neurology care hospitals and centres then must be linked to this institute.
To increase public awareness about neurological diseases and what role neurologists play in treating such diseases is vital to improving the quality of treatment and care at hospitals in our country. This could be done with the help of the media. Neurological societies must play a role in this regard. By increasing mass awareness and using proper vaccination, polio, tetanus and rabies can be eliminated from Pakistan. Patient support groups and disease-specific organizations can also do their bit. Likewise, time should be allocated on TV and radio stations for health awareness.
The cost of care for neurological diseases is high due to expensive, imported medications. Immunoglobulins, interferons, triptans and TPA are a few examples of such medicines. A large number of patients are unable to afford these medications. The cost of these drugs could be reduced by making them locally or through regulatory modifications.
If this happens, our country would be a safer place to live in.
In Pakistan, awareness of various neurological diseases is minimal. This is causing more harm than we realize 
