Contrasting to the usual story where Pakistani doctors come abroad and stay abroad, Dr. Bakthiar Ishtiaq took a different direction where he chose to go back to his homeland after working and studying in the U.S. It was our privilege to interview such an individual and discover his reasons for moving back and the experiences he has dealt with while doing so.

PIC

By way of introduction, what would you like to tell us about your education, professional training, specialization, and work experience?

All of my schooling was completed in Pakistan. From Cadet College at Hasan Abdal to King Edward Medical College, Lahore, the formative years of my life were spent in Pakistan. I completed a pediatrics residency at Georgetown University in D.C. and a residency in Emergency Medicine at Mount Sinai SOM in NYC. Since 1997, other than a 2 yr stint in a small town in KY for my visa waiver, all my work was at Westchester Medical Center and NY Medical College in Westchester County, NY.

What would you say are your biggest professional accomplishments or achievements?

Frankly, not many achievements other than the somewhat usual slew of scholarships in school, college and medical college. I received a few best employee awards during residency; however, my most cherished possessions and memories are the patient appreciation notes/letters that I have received over the years. That really makes it worth the ‘hassle’ of being a physician.

You are currently practicing at the Fatima Memorial Hospital as well as the Defense National Hospital. What is the difference between the two hospitals in terms of patient care, amenities, special services, etc.? Is one better for some purposes than the other?

I returned to Pakistan after staying in the U.S. for 18 years. Without going into the details of that transition, here in Lahore I took up a position as the Director of the Emergency Department at Fatima Memorial Hospital, a 500 bed teaching hospital for the FM College of medicine. It’s a charity trust hospital in the center of Lahore. The patient population is a mixed bag of very poor to affluent Lahoris whose doctors practice at FMH. Interestingly, while FMH is a trust hospital, it has the maximum number of U.S. trained faculty of any teaching hospital in the city. National Hospital in Defense, Lahore is a medium sized private community hospital in a privileged setting and caters to an affluent population. I spend a few hours there everyday in my pediatric practice.

Medical care and practice in Lahore is very different than what I was trained for. For the most part, money in your pocket dictates what you get in healthcare. I don’t want to talk about the poor but even for the wealthy, there is no guarantee of the standards of care. The medical community has for the most part absolved itself of the responsibility of ensuring that the patient gets appropriate and timely medical care. As a patient, it is your responsibility to find the right doctor, the right lab, the right pharmacy and so on to make sure you follow through on the doctor’s advice on the long road to recovery! National hospital boasts of a good neurosurgery program while FMH has the best trained pediatric emergency department staff. (That last bit was a little self-serving!)

Are there any common health issues that you see among your little patients that can be prevented or treated with better nutrition or food/personal hygiene, e.g. anemia, stomach problems, etc.?

Sure. Better nutrition will definitely lower the prevalence of such nutrition related illnesses as iron deficiency, anemia and rickets. The same goes for hygiene- gastroenteritis, typhoid and hepatitis A, which are prime examples of whose incidence can be markedly with better public health measures and improved sanitation.

For parents traveling to Pakistan with infants and small children, is there any way to protect kids from unnecessary exposure to viral or bacterial infections?


I suppose the usual precautions about good and frequent hand washing, drinking bottled water and avoiding all but the most reliable of food/entertainment establishments are a good start. Make sure the kids are vaccinated against typhoid and hepatitis A. My family lives on peptobismol, an essential item in your baggage! It will save you from many of those crampy stomach pain situations. Top it off with mosquito repellants and know a good doctor in town!

You trained and worked in the U.S. and then returned to Pakistan – a decision that many people ponder for years but only a few have the guts to make. What inspired the move on your part and how do you feel about it in retrospect?

I wouldn’t go so far as ‘guts’ but ponder I did for all of those 18 years. Simply because that was the original plan and I had to get it out of my system. You can call it my mid-life crisis. My wife Saira supported me in this and for that I am very grateful to her. She has been with me on this and contributes in her professional capacity as a practicing child and adolescent psychiatrist. Whether I will have her and the kids continued support is a different matter. As in any situation, there are pros and cons; and in our case the jury is still out. It has been about two years now; and as the Zen master (from Charlie Wilson’s War) said, ‘we’ll see’.

What are the biggest strengths about living and working in Pakistan as a professional?


My most satisfying experience in Pakistan has been the 6 months I spent in the earthquake relief operations soon after I first landed in Pakistan back in September of 2005. What I saw and treated, and how everyone in the world came together in those fateful days, will stay with me forever. The enormity of the devastation and the resilience of the victims was awe inspiring. In fact, I can say without an iota of doubt that, that was our finest hour. I worked with the Army relief effort initially as part of a contingent of Fatima Memorial Hospital and then a short stint with MSF and later with my friends from NY in an NGO called NYC Medics. Amazingly, 2 years out and I still get a word or call of thanks out of the blue-they remember! It makes those long days and the terrifying nights with aftershock worthwhile.

Professionally, Pakistan is a happening place. While foreign trained professionals have a tremendous opportunity and capacity to contribute to the body of knowledge and clinical experience, the system unfortunately is not geared towards taking advantage of them in a mutually beneficial manner. There seems to be some reservation towards US trained ex-pat physicians. With the exception of Agha Khan University, and perhaps Shaukat Khanum Hospital, most places while exposing one to a wide variety of medically exciting pathologies, remain frustrating to actually work and deliver. Nevertheless, there are now a lot of US trained physicians in town. Many of them in public institutions and they are definitely adding to the overall improvement in the availability of trained manpower. This will definitely lift the overall healthcare standards over time.

Do you find the healthcare infrastructure, e.g. the lab facilities, hospitals, etc. in Pakistan adequate for providing high quality healthcare to your patients? What kind of improvements do you consider necessary?


Like I said before, if one has the resources then one can find a very high quality of care right here in town. While one can make new hospitals and better labs etc., I feel what is needed here are better and more stringent liability laws, healthcare regulatory bodies and the enforcement of those policies which will improve the standards in the long run.

As a professional living and working in today’s Pakistan, how would you characterize the country for people who don’t have first-hand knowledge about day-to-day life in Pakistan?


Well, given the national situation over the last 12 months and the publicity in the international media surrounding Pakistan, it’s difficult for me to spin a rosy picture, but the Pakistan I knew and hope to see again is a worthwhile place of friendly people and laid back attitudes (unless you are driving…). As a physician, one can expect a lifestyle without much liability, an inordinate amount of respect from patients and families alike and sometimes (it depends but nonetheless) a very professionally satisfying experience.

Anything else you would like to add for people reading this interview?


Remember, we Pakistanis are an emotional lot. My advice to prospective emigrants is that you should have a very good reason for moving back in the first place. The lack of one will haunt you every time it’s a load shedding, water main break or the neighbor’s servant throwing garbage right smack in front of your gate. And, don’t expect or wait for it to get better. It’s not. This is the way it’s going to trot along for some time, at least. One will have to learn to ride the waves to feel comfortable here.