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There is some hidden force which keeps me pushing to do something-Surgeon M. Rehman.

Byline: Shaukat Ali Jawaid

It was perhaps in 1975 that I went to see Prof. Dr.A. Ghaffar Jatoi the cardiac surgeon at NCVD in connection with the supplement on Mideast Medical Center (the private hospital which he was building at Clifton Karachi) which we were planning. He was in the Operation Theater and called me there. I could see another doctor sitting in the tea room. When Dr. Ghaffar Jatoi finished the operation and came over, he introduced me to the young doctor sitting there saying "Meet Surgeon M. Rehman. As you know I am building a private hospital hence to ensure that there is no conflict of interest, I have resigned and Surgeon M.Rehman will be the new cardiac surgeon at NICVD." This was my first meeting with Surgeon Rehman. After a few more meetings, we became friends and the rest is history. I learnt a lot from him and he showed me valvular surgery, Coronary Artery Bypass Graft Surgery, Valve replacements etc., which helped me a lot in accurate reporting about cardiac surgery.

Incidentally both Dr. Ghaffar Jatoi and Mideast Medical Center are no more there. Dr. Ghaffar Jatoi died a few years ago, he also served as a Senator of PPP and Mideast Medical Center was demolished and has been replaced with a shopping plaza.

After retirement Surgeon Rehman, the pride of Pakistan whose contributions to promote cardiac surgery in Pakistan are commendable has gone back to Peshawar and established a State of the Art healthcare facility Rehman Medical Institute with numerous other institutions. I have often thought of talking to him and reporting about his professional journey from Peshawar to UK, then to Karachi and eventually returning back to Peshawar but every time he would laugh at it and avoid it with the result that it did not materialize all these years.

I was in Peshawar in March 2017 in connection with some Workshops on Medical Writing at various medical institutions in Peshawar and I also went to see him. We met at MRI; Dr. Shahkar another noted cardiac surgeon also joined us at tea. However, I could not accomplish my objective of talking to him in detail firstly because I had no prior appointment and secondly he was also a bit busy. I went to Peshawar again on May 18 th and went to see him in his clinic at MRI. Dr. Sher Mohammad Khan the noted Nuclear Medicine specialist another dear friend who also practices at MRI was with me. I told Surgeon M. Rehman that he can finish with the patients and I was waiting outside. Once you are free, I would like to talk to you and this time no excuse was acceptable. Let it be an emergency and the surgeon should be prepared for any emergency at any time. He realized that this time I meant business and eventually agreed.

After he had seen the last patient, we went to his office and sat there for about two hours and had a detailed sitting. Here are the excerpts from the conversation:

"After matriculation my parents were initially not interested that I should continue my studies further but later, my father and grandfather agreed and I got admission in Islamia College Peshawar. I took Pre-Medial subjects and after doing FSc got admission on merit in Khyber Medical College, Peshawar. I did MBBS from University of Peshawar in 1967 and then did house job at Lady Reading Hospital in 1968. In 1969 I went to UK. It was freezing and everything had turned white something I had never seen before. I got a job in Kent, did house job in Orthopaedics and Emergency Medicine which were mandatory in those days. I earned Fellowship of Royal College of Surgeons Glasgow in 1973. I came back to Pakistan for a month on vacation and went to see Prof. Feroze Shah, Prof. M.Kabir, Rahim Gul the well known surgeons in those days to consult them for my future career. I asked Prof.Feroze Shah that cardiac surgery was an important emerging specialty.

Similarly paediatric surgery was another emerging specialty, what should I do? Prof. Feroze Shah said that forget about cardiac surgery or paediatric surgery. Do General Surgery, come back and do Hernias and Appendices etc. I went back to UK. There was a job in Great Ormond Street Children Hospital. Prof.Kabir had introduced me to Prof. Robert Kenderic who was a noted General Surgeon and Vascular Surgeon. I told him that there is a job at Great Ormond Street Children Hospital and I am planning to do paediatric surgery. He said it is very difficult to enter that hospital. However, I was lucky and I got a job at GORS Children Hospital. I worked there for one year, it gave me a boost and it also became a reference for me. I did general surgery with Robert Kenderic for a year.

In 1974 I noted that cardiac surgery was becoming very popular and it was all the time in the news. I had experience of working in general surgery and paediatric surgery. In those days Brampton Hospital was Makkah for heart surgery. I was told that it was not possible to get there and I might have to plan for a lateral entry from somewhere. In those days London Chest Hospital, National Heart Hospital and Royal Brampton Hospital were the leading hospitals. I managed to enter London Chest Hospital. Dr. John Wright a cardiac surgeon from USA was doing coronary bypass surgery in those days. I worked with him for nine months. My next job in rotation was with Dr. Jack Belcher one of the pioneer surgeons. Both had been working at London Chest Hospital and they recommended me to Brampton Hospital to Prof. Christopher Lincon and M. Panet. I got rotation job doing cardiac surgery. In those days two paediatric patients came from Karachi and they had surgery for ASD and VSD.

After surgery they were admitted in ICU and their parents were very much worried and used to ask me frequently how the children were progressing. They also asked me why don't I come to Karachi and join a Heart Hospital which has been established by President General Ayub Khan. I told them that I have just one and a half years experience so far and I wanted to get some more experience. I told about this to Dr.Christopher Lincon who said that you have got this God sent opportunity in life, go ahead and join there. I told him that he had not given me even the simplest case which I could operate at my own independently, how I can take the risk of operating independently in a new set up? Dr.Christopher Lincon said that he had full faith in me and if ever needed, he will be there to help me. You go there and whenever you will need my help, I will come over.

I rang up Prof.Shaukat Ali Syed Director of NICVD and said I want to come and see you. He said you are most welcome. When I came to Pakistan, I went to see Prof. Shaukat Ali Syed who told me that Cardiac Surgeon Dr. Abdul Ghaffar Jatoi is leaving as he is building his own private hospital and they wanted some cardiac surgeon at NICVD as his replacement. You can stay with us and do some simple cases like ASD etc. He further asked me that if we offer you a job, how soon I can join NICVD? I said give me some time and I can join by September 1 st 1975. Hence, I joined NICVD in 1975. I worked there till 2002 and then took leave. Eventually I retired in 2004.

It was a privilege to work at NICVD and it was also the biggest challenge for me in my life. I wanted to assist and learn from Dr.Ghaffar Jatoi as long as he was there. Though he was very kind and affectionate, some other members of the team were not happy. Dr. Ghaffar Jatoi asked me to find my own cases and operate independently but I said I wish to assist him and learn from him. In those days they had very high mortality. They used to give patients too much fluid an they would die due to overload of water because of acute water intoxication. Soon Dr. Ghaffar Jatoi went on leave and with him went the entire cardiac surgery team as they wanted to start operating at Mideast Medical Center. Dr. Haque left and the perfusionist also left. I got hold of a technician who knew a little bit about perfusion, asked him if he can put in the tubes. He replied in affirmative. I said let us do this case.

Unfortunately Dr.Ghaffar Jatoi and his team did the first case at Mideast Medical Center which died but we did a case which survived. They did the second case and the patient died while our second patient also survived. Operating at a new set up is always very risky and challenging. Dr. Ghaffar Jatoi was very much depressed and he stopped cardiac surgery for a few days to get things settled.

From 1975-1980 was the period of training the nurses, technicians and cardiac surgery at NICVD was being developed. We were just doing valvular surgery and congenital. I did the first coronary bypass surgery at NICVD in April 1977. Dr.Mehkeri a social scientist and a well known writer was also admitted in the ward as he had a pace maker implanted. He saw me coming again and again to see the patient admitted on the nearby bed and asked me why I was taking so keen interest in that patient? I told him that this was the first bypass operation at NICVD and if he survives, it will make history. The patient survived. Dr.Mehkeri wrote a lengthy feature on this in Daily News, an evening newspaper of the Jang Group. We continued to do lot of work at NICVD but it was never highlighted. From 1980-1990 was the era of establishing cardiac surgery at NICVD quantitatively and qualitatively.

I had my clinic at Medicare Hospital and I started doing bypass surgery at OMI in April 1985. Late Surgeon Rahim was very kind. He provided all the help and facilities to ensure that cardiac surgery was started at OMI. We had the best technicians, employed some very good well trained nurses from Philippines. The hospital already had a very neat and clean environment and state of the art diagnostic facilities which made the job easy. When bypass surgery started at OMI, it came in the news and everybody knew about it. One day I was going to my clinic at Medicare Hospital, on the stairs, late Prof. Zaki Hassan stopped me and congratulated me on successful bypass surgery. He was really very happy and delighted and said now the public will know.

We were doing bypass operations at OMI routinely but cardiac surgery teams used to come from Cromwell Hospital London and used to operate upon private patients at NICVD and some patients were asked to come to UK for surgery. Their visit used to be highlighted by the print as well as electronic media which gave a very bad impression as if our own cardiac surgeons were not capable of doing cardiac surgery. I myself remember that once when Lt. Gen.M.Afzal Najeeb was the Director of NICVD, Dr. Bashart Jazbi was the Health Advisor to President General Mr.Ziaul Haque. They organized a press conference at NICVD to highlight the surgeries performed by the British team. During the press conference I asked Dr. Basharat Jazbi to name the cases which the British Cardiac Surgery Team had done at NICVD which our own surgeons cannot do? It generated lot of heated discussion and numerous other journalists present on the occasion also started firing questions at Dr.Basharat Jazbi and the British team.

The message was conveyed and perhaps that was the last time the British Cardiac Surgery team came to operate upon private patients from PIA and other corporate institutions in Paksitan at the NICVD.

One day Surgeon M.Rehman said Air Martial Dauoodpota chief of PIA came to OMI to see some patient. He was impressed with the cleanliness and facilities available. He enquired about the patients admitted and was surprised to note that there were quite a few patients who were recovering after successful coronary bypass surgery. We incur lot of expenditures on sending patients and their attendants to London for cardiac surgery every year he remarked. He was so much impressed that he issued an order that from now onward no patient from PIA will go abroad for cardiac surgery unless he or she is recommended by Prof. Surgeon M.Rehman that they cannot be operated in Paksitan. This gave lot of boost to cardiac surgery in Pakistan. We started getting lot of VIP patients from PIA, State Bank of Pakistan, Habib Bank Limited and cardiac surgery got well established.

We were just four cardiac surgeons in Pakistan myself, Col. Cheema and Jawad Sajid in Lahore while Keyani was in Rawalpindi at AFIC. Dr. Shahkar Ahmad Shah also came in those days. I told them that we will have to do something. We approached CPSP and prepared the syllabus. I was appointed Dean Faculty of Cardiac Surgery. NICVD was approved as training center for FCPS in Cardiac Surgery. Earlier CPSP had honoured me with Honorary FCPS in Cardiac Surgery. We had six postgraduate in the first year and then six PGs after every three years once the first batch had qualified. So in three batches I trained eighteen cardiac surgeons, two postgraduates Dr. Arifur Rehman and Dr. Nadeem did MS in Cardiac surgery. Hence from 1990 to 2000, twenty cardiac surgeons were trained by me in ten years. I also got the Perfusionist course recognized by University of Karachi.

After the death of my first wife and son I was very much depressed. Life in Karachi was also very stressful. Law and order situation was getting from bad to worse. I had two attempts on my life in Karachi, once at the NICVD and the second when six armed men came and fired at my residence early in the morning at 2.00 AM. That was the time I decided that I should go back to Peshawar. I came to Peshawar and met Prof.Tariq Nishtar who was the provincial health secretary. I asked him if I decide to come back and set up a small healthcare facility here, will it be worthwhile. He encouraged me and asked me to buy a plot in Hayatabad and build the facility. I bought a plot of land measuring twenty four kanals at commercial rate. It was in 1990 when it was planned, the construction was started and the Rehman Medical Institute was formally commissioned in 2002 as the construction was completed in twelve years.

It took so long because whatever I earned from OMI, I invested here. I must admit that RMI was built by OMI and in fact staff from OMI has helped establish cardiac surgery at Aga Khan University Hospital, South City Hospital and many other healthcare facilities.

We had the first open heart surgery at RMI within a week. Dr.Haque, Dr.Akhtar, Dr.Faiz all came from Karachi. In those days Governor of NWFP Lt. Gen. Iftikhar Hussain Shah had banned private practice, introduced institutional practice which was not accepted by many senior professors. They all resigned and came to RMI and started their practice here. Hence it became a very busy place immediately. I took long leave from NICVD and shifted to Peshawar. We had maximum number of patients in KPK and over 60% of patients came from Afghanistan as well as from Iran. But then we had this Tora Bora in Afghanistan, with Americans bombing Afghanistan, the number of patients coming from Afghanistan reduced. The situation eased a bit but then again due to the tense and strained relations at the border, patients flow from Afghanistan has reduced drastically to such an extent that even maintaining services became difficult. However, the Sehat Card scheme has come to our rescue to some extent.

Though the charges they pay are highly subsidized but it helps us to maintain the service and it also helps the most poor in the society who get specialized care. Now we are doing eight to ten cardiac surgeries a day which is perhaps the second highest number after NICVD. We are quite busy which is evident from the fact that at present we have a one month's waiting list.

When I asked him will he like to share some of the hurdles and difficulties he had to face while establishing RMI, Surgeon Rehman took a pause and then said, " If you are a Pushtoon and you are on the other side of the Attock Bridge, everybody in KPK is your friend and well wisher. But the moment you cross the Attock Bridge on the side of KPK, there is a dramatic change in the relationship. Perhaps some people do not want to see others flourish or there is some professional jealousy. Having said that, I must add that there is no dearth of people who are sincere friends and wish to help you". We had to start from scratch. We prepared the SOPs for all the departments, had the infrastructure, and started with Director Finance, Director Planning, Director Administration, Director Medical Services, Information Technology Department, and Director Human Resource and so on. We built the whole system starting from the junior level to the highest level in all the departments.

When we started, everybody was sympathetic but then we became the target. We had to train our nurses, technicians. They all got highly professional training but the moment they were trained, they all got jobs and we had to start the training afresh including Operation Theater Technicians, Cath Lab staff, Finance etc. Now it has become a routine, we take people, train them but then they get jobs somewhere else and we have to start training people again. This problem continues till today. Most of the staff that we trained, the nurses, technicians, IT people, administration, finance, pharmacy has joined Lady Reading Hospital, Khyber Teaching Hospital. The human resource heads of all the three big hospitals in Peshawar were trained by us.

All other hospitals are following our pattern, they are copying our forms. I am glad that we have transferred state of the art technology to the public hospitals. They do not have to work much as they get well trained people who have excelled in their respective skills.

When we established RMI, it was the only healthcare facility in this area. Now we have North West General Hospital, Peshawar Institute of Medical Sciences, Shaukat Khanum Memorial Cancer Hospital and yet another big hospital is now under construction. Khyber Medical University has also established the Cardiac Institute here in this area hence all these hospitals have put lot of pressure on limited facilities and services available including sanitation, drainage, water supply, parking problems, traffic problems.

Once, Prof.Tariq Nishtar visited RMI. He said we should buy the open plot in front of RMI otherwise if some other party purchased it and set up some business it may spoil the surroundings of our institution. We may need it in future if we ever had a plan to build a Medical College. I said, the price was too much and we do not have the money. Anyhow I accepted his suggestion and went to see the Chief Minister Sardar Mehtab Ahmad Khan Abbasi. He is a very kind hearted gentleman. I told him that the commercial rate for this plot in front of RMI was too much but we also wanted to buy that land for the proposed medical college which we intend to establish later. We will be glad if he would help us and permit payment in installments. He was very kind and allowed us to make payment in installments in four years though we bought this plot measuring thirty two Kanals on commercial rates.

We have established state of the art diagnostic center, laboratory on three floors, Research Center, Nursing School, Dental College, Medial College, Paramedics School and a General Hospital across the road. We had an adjacent facility by a dental surgeon. It was not running properly. We purchased that too. We have planned a 12-storey building there with two basements. Basements and Ground Floor is ready but the construction work is now held up due to lack of finances. We hope the situation will ease in the next few months; we have lot of bills for Sehat Card pending. Once we start getting payment in routine, it will ease the situation. Then Dental College construction will start.

Surgeon Rehman also disclosed that now they are all set to establish the Medical University. The entire paper work has been completed and the file is lying with some government officials. HEC and PMandDC have all inspected the premises and facilities. Hopefully the file will be forwarded to the concerned quarters soon and we will be able to pursue the case of our university. There are some "friends" who do not wish us to become a university. However, we are determined to establish the university for certain reasons. Firstly the normal MBBS course in KPK is completed in six years instead of five. Sometime the exam is held up, sometimes the result is declared late and so on. We wish to complete the MBBS course in five years so that students do not have to waste their one year. Secondly we wish to introduce integrated system of learning from the very beginning like Aga Khan University. We are already practicing this.

We wish the students to explore the patients from the first year but KMU is following the old system. Numerous top positions in Khyber Medial University are bagged by students from Rehman Medical College every year which is the reflection of high standards maintained by Rehman Medical College. We have been successful in providing quality health services and we now intend to improve the quality of medical education further so that our graduates can compete at the national and international level. We wish to maintain high standards. Many institutions are trying to adopt our system.

At present we have total bed strength of over six hundred beds. I am glad that we have also provided jobs to two thousand five hundred people. There is some hidden force which keeps me pushing to do more. I wish I could do more for my country. Sometimes I think if I was the Prime Minister or the Chief of Army Staff, I would have done many other things which I cannot do now. I had the 12 th position in the Board in the province in Matric examination. I never thought I will become a cardiac surgeon. Thanks to the voucher system in UK when we used to get jobs while here. I got a job in NICVD while I had very little experience. Late Surgeon Rahim of OMI gave the biggest boost to cardiac surgery in Paksitan. At OMI he had skilled nurses, well trained doctors. They were all well paid and they worked round the clock. He acquired the services of six Philippine nurses before we stated cardiac surgery at OMI.

I trained six doctors from OMI at NICVD besides OT technician and other staff so that they were well trained to handle emergencies before we started cardiac surgery at OMI. There is no exaggeration when I say that OMI has contributed a great deal in providing skilled people including nurses, technicians, and doctors for cardiac surgery in various hospitals in Karachi. I have tried to serve to the best of my ability and I cannot tolerate any one talking against Paksitan. Government was kind to honour me with Sitar-e-Imtiaz in recognition of my services. My own colleagues have been very kind too and I was elected as President of Pakistan Society of Cardiovascualr and Thoracic Surgeons. Rehman Medical Institute is now developing as a multidimensional corporate entity with numerous institutions in the healthcare field.

As regards children, my elder daughter did MBA and she is interested in Finance. She got married. My son Shafiqur Rehman has done BBA from UK and then he did Hospital Management Course from Germany. My second daughter has done MSc in Psychology. The third and the youngest daughter has done MBBS, and then did MRCS from UK. She has done FCPS-I and also cleared the Intermediate Module and is getting training for FCPS-II in Cardiac Surgery. She is already doing cardiac surgery and wish to follow my footsteps. I remember once I invited Dr. Walton Lilihae to cardiology conference in Karachi. He visited my surgical ward at NICVD. Addressing the conference participants, he said that he was glad to see that his grandson was dong a commendable job in cardiac surgery in Pakistan. Everyone was stunned at this and wanted to know who his grandson was? He soon clarified that he had trained Dr. Panet who was his trainee and Dr. Panet has trained Surgeon M.Rehman hence he was my grandson.

I don't have words to thank God Almighty for what he has given me Surgeon M.Rehman concluded.
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Publication:Pulse International
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Geographic Code:9PAKI
Date:Jun 15, 2017
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