Three years ago I had written a guest editorial (Training Neurologists in Pakistan - Meeting needs of the country. Pakistan journal of Neurology. Volume 6, number 2 January -June and July - December 2000:1-2) since then, I am happy to note 12 more neurologists have joined the elite work force in the country, That's a 50% increase in the total strength of neurologists. Of these twelve, 10 are local FCPS and 2 have returned from abroad. It is hoped this new trend will continue.
As of October Ist 2003, there are 7 Neurology training programs in the country. (3 in Punjab, 3 in Sindh and 1 in NWFP) Currently there are 22 trainees (8 in Punjab, 14 in Sindh). The 1st FCPS in Neurology was obtained in 1995. Since then 30 more candidates have passed the FCPS Examination in Neurology. There are now more than 40 Neurologists in the country (24 in Karachi, 7 in Lahore, 7 in Rawalpindi/ Islamabad, 2 in Peshawar, I each in Quetta,It seems if this trend continues we may eventually meet the needs of the country. The training program supervisors and trainers as yell as CPSP need to be commended for w orkin- towards this goal, The quality of trainers/ supervisors s also improving. The new FOPS Neurologists are also being inducted into the training programs which is also increasing the total strength of trainers / supersvisors.
An area where more work is needed is Clinical Neurophysiology. It has been observed that barring one or two program in the country, most of the trainees Iack adequate opportunities to learn Electro Diagnostic Neurophysiology. This may be due to inadequate services or supervisor's lack of interest / training in Neurophysiology. Perhaps one option to consider is to have Neurology Residents in various programs spend time in hospitals where Neurophysiology training opportunities are better available. The residents can rotate for 3 or 6 months at a time. For further training, Neurophysiology fellowships can be organized. Currently only one hospital is offering this. we need more fellows to be trained that will mean more fellowships at various hospitals.
Since Neurology has become a vast subject, sub¬specialty training should now be emphasized. Fellowships in stroke, epilepsy, movement disorder, neuromuscular disorder, rehabilitation and pediatric Neurology should be organized. Pediatric Neurology in particular should receive its due importance as there are many pediatric Neurology patients in the country and they are either cared for by pediatricians or adult Neurologists. There are many degenerative / metabolic disorders that affects pediatric population and appropriate investigations as well as genetic counseling are lacking.
The jobs of Neurology trainees / supervisor should not end upon completion of the individual's training. The supervisor should also help the individual in proper placement and continue mentorship / relationship.
The Neurologists can help the medical community by bringing about continuing medical education on topics that are poorly understood (epilepsy, stroke, CNS infection etc). Neurologists are one of the most respected specialists in the country. It is crucial that the trainees / supervisors impart this attitude to their trainees. In order to maintain this respect, they must practice Neurology in an ethical manner. The temptations to become commercial are high but they have to do what is right as their patients will have chronic and complicated diseases that will require a lot of empathy besides the cost effective management approach. Cross consultation with other Neurologists needs to be encouraged. Each Neurologist has some thing to offer. He / She may have a sub-specialty interest or better diagnosis and management techniques. I would even go as far as suggesting formation of a Neurology Board that would ensure that the/ standard practice parameters are followed by the Neurologists in the country. Practice guide-line that meet the needs of the Pakistani Neurologist and his / her patients can also be standardized. Perhaps the Pakistan Neurological. Society can play a role in this important step.
Public awareness is as important as physician education. There are many diseases in Neurology that carry taboos amongst local people with appropriate teaching, which can be removed. A patient or family that is aware of the diagnosis and its implication is more compliant with management and also does not get into the doctor shopping loop. Again the Pakistan Neurological Society or other similar organizations (such as Pakistan Stroke Society, Epilepsy Society etc) can take the lead. They are already involved in such work but perhaps at a local level only. A National level involvement is needed. Health Ministries, both Federal and Provincial should be approached there are many International Organizations such WHO that are always I coking for private / NGO's that are willing to invest their time and effort.
Overseas Pakistani Neurologists could be a great resource. They are always keen and generous for helping their countrymen. They can assist academically as well as financially Scholarship Programs, endowments, library subscription, attendance at conferences, workshops / courses can all be sponsored with their help.
I am indebted to Dr. (Col.) Shahida Nagi of CPSP for her kind assistance.