August 25, 2005

The rate of diabetes is rising in our country. Over the last decade the total number of diabetics in Pakistan has increased from 4.3 million to over 8.5 million. It is anticipated that at this rate, there will be 14.5 million diabetics in the country by 2025. Not only are these people at a high risk for acquiring chronic complications, they cause a big financial burden on the family and also on the government, explains Dr Fatema Jawad to Rumana Husain

Arranging a date and time for this interview wasn’t an easy task, as Dr Fatema Jawad, a renowned diabetologist, keeps a long and busy daily schedule. However, meeting this soft-spoken, devoted doctor who excels in her field in more ways than one revived my pride for such a people.

Dr Jawad says that her specialization in diabetes is incidental, as the Diabetic Association of Pakistan, where she regularly took her mother-in-law for treatment, was located close to her house.

“In those days, the Association was headed by Prof. Ibrahim, who was from the fomer East Pakistan, and who also headed the medical department at the Jinnah Hospital. He encouraged me to join the Diabetic Association. “Don’t waste your time, come and work here, we need doctors,” he urged. This offer came at a time when Dr Jawad had done a lot of important things in her life. She had graduated from the Dow Medical College, Karachi (in 1959), completed her house job, got married to her first cousin, and had her daughter.

“The Diabetic Association then was a modest place. People from all over Karachi used to visit it; they were charged Rs2.00 only,” Dr Jawad narrates her journey towards becoming a specialist.

Dr Jawad was fond of learning languages, and after two years of working at the Diabetic Association, she enrolled for a German language course at the Goethe Institut. She topped in her class in the first year and went on to complete two more levels. She then decided to apply for a post-graduate degree in diabetes in Germany.

“Prof. Sauer from Bad Oeynhausen, located near Hannover which is known for its hot springs, wrote back saying that Germany had a shortage of doctors at the time and that my German was ‘very good.’ He wanted me to come straight away and arranged for my visa and other related matters. My mother-in-law agreed to look after my daughter and I left for Germany.” Dr Jawad feels it was at Bad Oeynhausen where she got her initial grounding in diabetes treatment. “The Germans are thorough professionals!” she declares admiringly.

Since she had no domestic responsibilities there, she could devote her entire time to her professional training. These were the early seventies, and the doctor not only came across adults but also children and pregnant women with diabetes, thus widening her exposure. After completing two years there, and despite Prof. Sauer’s insistence that she continue, she decided to return to Pakistan, “to treat her own people.”

After coming back to Karachi, Dr Jawad did her MCPS from the College of Physicians and Surgeons in 1976.

I request Dr Jawad for detailed statistics pertaining to her field. She readily divulges the information, saying it is important for people to know, as diabetes involves all ages and the entire body. It is a life-long disorder; there is no absolute cure for the condition, but the sugar level, weight and blood pressure can be controlled by regular treatment and a healthy lifestyle.

“Unfortunately, the incidence of diabetes in Pakistan is rising. This is an alarming situation which calls for immediate action.” The diabetologist attributes this trend to the following major factors:

a)Rich food leading to obesity. Whether rich or poor, Pakistanis’ intake of calorie-dense food such as parathas, and the generally excessive use of oil in cooking are major contributing factors, as the relationship between diabetes and obesity is well established.

b)Lack of exercise: any sustained activity, such as a brisk walk (for at least 30 minutes each day), can reduce the risk.

c)Genetic factor: marriages between cousins as well as marriages within the same community tend to perpetuate the problem.

Dr Jawad laments that although awareness regarding diet and exercise is slowly increasing, overcoming cultural barriers with regard to inter-family marriages is difficult, and may take a long time.

“The Government has not played its part in encouraging the use of the electronic media for imparting knowledge and understanding regarding diabetes. Advertisements and public service messages must be placed on television so that people develop an understanding of the risks involved. For example, men and women with excess abdominal fat are at a high risk for diabetes. This is due to growing insulin resistance and eventually glucose intolerance,” she explains.

The expert further elaborates that there are two types of diabetes: Type 1 involves insulin dependence, in which the pancreas stops producing it, so the patient has to depend on external insulin. A larger number of people suffer from Type 2 diabetes, which involves relative deficiency or insulin resistance.

In 1994 the Diabetic Association started a nation-wide survey which continued until 1998. According to its findings, 12 per cent of our population above the age of 25 years has Type 2 diabetes, whereas another 10 per cent has Impaired Glucose tolerance (IGT). Overall, urban Sindh has the highest incidence of diabetes (16.50 per cent), whereas urban Punjab has the highest IGT (11.54 per cent).


I want to know if Pakistan has access to the research and drugs available to combat the problem. Dr Jawad informs that on August 15 last year, the first TZD drug (Insulin resistance breakers which sensitize the body insulin to work more efficiently) was launched in our country.

Dr Jawad has been working for the past fourteen years in an honorary capacity for the Sindh Institute of Urology and Transplantation (SIUT), Karachi where she treats diabetic kidney patients.

“Diabetics develop kidney problems which may result in serious consequences. To date, forty-seven diabetics have undergone kidney transplantation,” says the doctor who continues to visit the Diabetic Association of Pakistan, where she is now a Senior Research Fellow.

“We conduct modest research there. I love writing and I write for various newspapers and publications. We bring out a monthly –– the Diabetes Digest –– for patients and junior doctors, and I am also the Editor-in-chief of the Journal of the Pakistan Medical Association, which is the first journal in the country to be indexed with the Index Medicus. I have been associated with it since 1975.”

Dr Jawad clarifies that her bread and butter is her private clinic which she runs twice a week. At another location, again twice a week, in the evenings, she treats patients from low-income areas. Nearly fifty per cent of these patients get free treatment.

“I am never in a hurry when seeing my patients. As a diabetologist, I am not just talking about diabetes. Some of my patients come from the remote rural areas of the country and sometimes they want to discuss their family problems. I am grateful to God that He has endowed me with the patience required to deal with them.”

“According to WHO, Pakistan is at number eight level globally, but if we don’t curb the rise of diabetes, we may go up to number four. An alarming situation indeed,” says Dr Jawad

Towards the end of our meeting, Dr Jawad mentions that she has been a Fellow of the Royal College of Physicians (FRCP), Edinburgh, since 2004. “It was a touching ceremony. You don’t sit for an exam, but you have to be nominated for your achievements by a Fellow of the College. One must then get at least nine out of ten votes to qualify for an FRCP. I feel honoured to have got all ten,” she says.

Not surprising, as her family including three sisters and a brother, are all high achievers. “I am the eldest. My father was an engineer who worked for the Pakistan Railways. He retired as the Director General of Pakistan Railways. After that he was appointed a member of the Public Service Commission.”

As we move towards the gate of her house, Dr Jawad reflects humbly that all her accomplishments, and indeed those of her siblings, have only been possible due to their parents’ upbringing and prayers.

The rate of diabetes is rising in our country. In the last decade the total number of diabetics in Pakistan has increased from 4.3 million to over 8.5 million. It is anticipated that with this increase, there will be 14.5 million diabetics in the country by 2025. Not only is the person having this condition at a high risk for acquiring chronic complications, he or she causes a big financial burden on the family and also on the government.

Dr Jawad, therefore, feels strongly that if we wish to stop the growing rate of diabetes, then interventions have to be made urgently. Although now there is relatively more awareness among diabetics and also among those who treat them, a lot more needs to be done.

Dr Jawad has been sharing the findings of the research carried out at the Diabetic Association of Pakistan with her colleagues and junior doctors. She also passes on the latest research material that is sent to her by the Royal College of Physicians, Edinburgh.

Dedicated professionals like her do have an impact. However, unless there is the political will to spread awareness on a mass scale, the health of our people is threatened by ignorance and poor or inadequate medical practice.

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