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Postgraduate MPhil training programme started ( PIMS ) news report

Islamabad The Pakistan Institute of Medical Sciences (PIMS), which was the first public sector hospital in Pakistan to have started postgraduate MPhil training programme in transfusion medicine, is facing lack of adequate number of haematologists to run the precious programme.

Despite the retirement of two senior pathologists, PIMS has not hired a single haematologist to successfully run the training programme in transfusion medicine, which now appears to be in jeopardy. As usual, there is opposition to good work, with administrative hurdles and red tape further complicating any endeavour intended for public benefit.

The significance of training in transfusion medicine can be understood in the context of the recent Dengue outbreak in Pakistan. The outbreak has exposed the acute deficiency in knowledge and training of doctors in requesting proper blood components and ensuring their effective utilisation.

Sheer ignorance led to a panic situation, where blood components, which were not required and which could prove harmful, were strongly demanded and wasted at the expense of those who actually needed them. Usually, there is no need to transfuse platelets unless the count is below 20,000, but people have been seen demanding and getting platelets for patients whose count was in the range of 60,000.

There are many aspects that necessitate proper education and training of doctors-not merely with respect to platelets but also in relation to proper procurement of blood and its products in blood diseases such as Thalassaemia and Haemophilia, as well as various other diseases requiring transfusion of blood products.

All developed countries have blood banking, which is now called transfusion medicine, as a separate specialty requiring intensive and extensive training. In Pakistan, on the contrary, the situation is extremely worrisome, largely because of the absence of a programme for postgraduate training in transfusion medicine.

A majority of the blood banksin Pakistan is not managed by adequately trained blood bankspecialists, and are often left to the mercy of corrupt technicians who sell blood components for money. Some of these technicians have amassed enough wealth to afford lavish houses in Islamabad. In a country whereinfected syringes are sold worth only a few rupees,infected and rejected blood which can often fetch handsome amount of money, is sold to unwary public and thus contributes to the spread of diseases such as hepatitis. Even the blood bank at PIMS, a prestigious tertiary care hospital, is presently being ‘supervised’ by a non-haematologist with no solid and substantial training in transfusion medicine.

There have been numerous instances of top positions in blood-related organizations being doled out either to political appointees who have no idea about the basics of transfusion medicine or to research degree holders such as PhDs with no clinical training. The culture of nepotism and cronyism has not spared this important branch of medicine either.

“There is a need to strengthen transfusion medicine training in Pakistan so that bloodbanks are properly supervised by qualified and trained physicians. The first step that needs to be taken in this direction is to initiate a postgraduate training programme in the specialty,” said former head of the department of pathology at PIMS Dr. Anwar-ul-Haq, who has a Double Board American Certification and who has played a vital role in strengthening the PIMS blood bank along with eminent haematologist Dr. Lubna Naseem.

The retirement of Professor Anwar-ul-Haque and the transfer of Dr. Lubna to exclusively look after haematology have created a serious vacuum in the PIMS blood bank, which is at the mercy of untrained people. “The slightest of mistake can result in a big tragedy; inquiry committees will then be set up to deceive public,” Dr. Anwar-ul-Haq pointed out. Indeed, PIMS must hire adequately trained haematologists with interest in blood banking or transfusion medicine to continue the programme. This way, it will be in a position to not only provide adequately trained specialists for various hospitals throughout Pakistan but also emerge as a role model for other institutions.

Commenting on the scenario, PIMS Executive Director Professor Dr. Mehmood Jamal clarified that Dr. Lubna has not been transferred and that the spectrum of her duties and responsibilities has been expanded to include management of haematology in all other components of the PIMS set-up as well, including the MCH Centre, the Burn Unit, etc. “Hers is a senior position and we could not have her looking solely after the blood bank,” he said.

Dr. Jamal conceded that a huge tertiary care hospital of the ilk of PIMS should ideally have four separate departments under pathology. “We need to have separate departments for haematology, microbiology, histopathology and chemical pathology, and each of these departments should have dedicated posts for professors and assistant professors,” he said. Responding to a query, the ED said plans are afoot to reorganize the entire set-up. “It will take a few months for everything to be streamlined,” headded. The Pakistan Medical and Dental Council and other administrative bodies also need to provide support in this neglected domain so that blood transfusion can be adequate, quick and free of risk. This is also a subject that merits the attention of the country’s political leadership. Special posts for transfusion medicine specialists must also be created in due time in all big medical centres across the country. This will go a long way to improve the standard of blood banking, quality management of Dengue fever, Haemophilia, and Thalassaemia and other surgical disorders.The news.

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