It all started when the administration of Liaquat Medical College (LMC) Jamshoro was planning events related to their Golden Jubilee celebrations to be held in 2001. Some “pragmatic” professors came up with the idea of establishing the first medical university in the public sector in Pakistan. Unfortunately, the LMC did not have a great reputation as a good medical college because of student politics at the campus and the total lack of interest of government as far as accountability, merit and performance was concerned. Like other medical colleges in Pakistan, this college was also facing acute shortage of faculty, facilities and lack of structured training programme for undergraduate and postgraduate medical students. The faculty seemed disinterested in improving the standard of medical education or training.

The idea was opposed by many serious and sincere doctors in the province, while concerned citizens wrote letters to editors of newspapers like Dawn. The government was approached by Pakistan Medical Association (PMA) with the argument that there was a need to improve the LMC as a medical college and its hospital as a teaching hospital instead of declaring it as a medical university by an executive order. A debate started with heated arguments for and against the formation of first public sector medical university in Pakistan. It was argued that students and patients will not benefit by just converting a part-time medical college into a medical university. Such a conversion would result in the formation of a part-time university with a half-baked teaching hospital. A counter argument was given that the university would be an autonomous body with its own funding mechanism and would be able to carry out research which was not done in our medical colleges.

When the argument regarding funding mechanisms was unpacked, it became evident that this was to be done mainly by increasing the number of seats and through introduction of self-financed admissions ignoring merit. It was mentioned that there was a need to improve our medical colleges and to make them autonomous academic bodies with proper funding to improve medical education and to turn them into full-time medical colleges like Aga Khan Medical College in which even the faculty members of public-sector medical colleges want to send their children for education.


Plans to set up a new medical university, raises the question of improving poor standards in the existing ones


Unfortunately during the government of General Pervez Musharraf, a retired army general became the health minister of Sindh who happened to be a graduate of the LMC. The vested interest group at the LMC was able to convince him to declare the medical college a university on the occasion of its golden jubilee celebrations. Against the advice of the technical committee at health department (which was headed by an honest bureaucrat at that time), the health minister declared LMC as a university.

This was the start of a rat-race for establishment of medical universities in public and private sector. This was also a development for which students and patients paid great price as far as their education and management was concerned. In Punjab, General Musharraf appointed one of his surgeon friends as the health minister, who immediately decided that if Sindh could have a medical university then Punjab should also have a medical university on emergency basis. By another executive order, the University of Health Sciences (UHS) was established at Lahore.

In the meantime, a vested interest group convinced a powerful political party in Karachi that a medical university in Hyderabad was politically not acceptable without a medical university in Karachi. On the initiative of this group Dow Medical College (DMC) was upgraded to Dow University of Health Sciences (DUHS). With this development in Sindh, some ambitious professors at King Edward Medical College came with the idea that if Sindh could have two medical universities in the public sector then why Punjab, which is a bigger province, could not have two medical universities. The idea was bought immediately and the King Edward Medical University was established to satisfy these professors amidst the demands of some senior professors at Nishtar Medical College Multan who wanted a university, too.

Some professors at Khyber Pakhtunkhwa and Balochistan were watching these developments and they also demanded establishment of medical universities and got a medical university in Peshawar. Later the Sindh government converted Chandka Medical College and Peoples Medical College Nawabshah into medical universities.

In Balochistan, the government established a postgraduate medical centre with a provision to develop Bolan medical university very soon. A few months ago the chief minister of Balochistan told me that although he did not agree with the idea of converting Bolan Medical College into a medical university, he was under immense pressure from the professors of the medical college and a medical university would be established in Quetta and Khuzdar.

In the meantime, the chief minister of Punjab announced a new medical university at Fatima Jinnah Medical College (FJMC). A couple of months back the senate passed a bill to open a new medical university in Islamabad. It was also announced that all medical colleges belonging to the armed forces would be affiliated with this new university.

 As expected, none of these medical universities appointed their first vice chancellors on merit. Instead of creating a system to run a university, the newly appointed vice chancellors created an environment that was not conducive for faculty members who were competent, capable and sincere to medical education. Soon many faculty members left these universities because they witnessed violation of merit, lack of vision and non-academic atmosphere in these institutions. Many competent doctors left the country or joined private educational institutions in Pakistan.


It was argued that students and patients will not benefit by just converting a part-time medical college into a medical university. Such a conversion would result in the formation of a part-time university with a half-baked teaching hospital.


 All vice chancellors became very active in construction of new buildings, purchasing new, expensive instruments, as well as in acquisition of heavy vehicles for themselves and the pro vice chancellors. Instead of investing on faculty, students and patients, they were more interested in establishment of new departments that were often without adequate and qualified faculty or resource persons. They did not even try to learn from the Aga Khan University to develop a rule-based system for the appointment of faculty members. Incompetent faculty members were promoted and foreign scholarships were given to them. By this mechanism a new generation of faculty members were nurtured who were not able to take ethical decisions in the day-to-day running of medical universities.

 As it turned out, the university leadership was not interested in converting the part-time medical schools into full time institutes. They did not appoint the required faculty members in basic medical sciences as per requirement of the Pakistan Medical and Dental Council (PMDC). They neither endeavoured to develop a structured training programme for their postgraduate medical students neither were they interested in the problems of patients whose care did not improve because of misguided priorities. A host of new academic programmes offering MS, MD and PhD degrees were started without proper planning and often without adequate and qualified faculty members. This resulted in production of new crop of extremely incompetent and dangerous specialists in the medical profession.

 The role played by the PMDC and the Higher Education Commission was, to say the least, very dubious in the mushroom growth of medical universities in Pakistan. They were least bothered about the performance of these institutions and were not able to act against the violation of their own rules and regulation. Because of this relaxed and negligent attitude of regulating bodies, the part-time medical universities flourished in the country and at the same time every provincial government was able to open new medical colleges without fulfilling the PMDC criteria and affiliating them to existing medical universities. The retired professors in collaboration of investors also became very active and many medical and dental colleges were opened in the private sector just to make money. I can say with confidence that with the exception of the Aga Khan Medical College and Armed Forces Medical College, none of the medical colleges in Pakistan is fulfilling the criteria laid down by the PMDC.

Uncle Tom

In 1904, the American Medical Association (AMA) noticed that the US had 155 medical schools which at the time was far more than the total number of medical colleges in other countries. They also noticed that majority of these colleges were there to make money and produce dangerous doctors. The AMA established the Council of Medical Education (CME) which, with the help of the Carnegie Foundation, appointed Abraham Flexner in 1908 to prepare a report about the state of medical education in the USA.

Reforms

The Flexner report, published in 1910, changed the practice of medicine in the US. He described some of the medical schools as a “disgrace”, “indescribably foul” and “plague spot of the nation”. He recommended reducing the number of medical schools from 155 to 31. The report is now remembered because it succeeded in creating a single model of medical education. It changed the whole philosophy of medical education and training system in America. As a consequence of this report, the USA was able to establish great medical colleges and hospitals — not medical universities — and produced some very great physicians of our time.


As expected, none of these medical universities appointed their first vice chancellors on merit. Instead of creating a system to run a university, the newly appointed vice chancellors created an environment that was not conducive for faculty members who were competent, capable and sincere to medical education.


Lessons

It is high time that the federal government formed a high powered two- or three-person committee (in the United States only one person was able to write a great report) to address key issues related to medical education and training system in Pakistan. The committee should find out how many doctors are needed in the country every year, what kind of medical education and what type of doctors are required, how many doctors should we produce for overseas jobs, why do we have so many medical colleges and medical universities, what is their performance, how our medical education system can improve patients’ care in our country. The committee should give its findings in the greater interest of our country, and its recommendation should be applied as soon as possible for the greater benefit of medical students, doctors and patients.

It is also about time that all ‘good’ doctors examined their consciousness, health planners did some soul-searching and people in power decided that a nation with atomic power, submarines, F16s and so many filthy rich people deserved a health care system where poor people — men, women and children — should not die because of negligence and unavailability of proper medical care.   The writer is Ex-Secretary General of Pakistan Medical Association (Centre)

Published in Dawn, Sunday Magazine, December 6th, 2015