Sunday, February 12, 2017

Why I Became Passionate About Prevention

Nauman Mufti, MD, MPH. 
Medical Director Allies Medical Group and Better Medicine Company.

After spending years in a medical college, dissecting cadavers, learning about human body...its anatomy, physiology, and pathology. Seeing patients under the supervision of senior clinical faculty, I became a freshly minted physician. Similar to the medical education elsewhere in the world, the next step was to receive residency training which in Pakistan was called a 'house job'. My very first clinical rotation was in Cardiac Surgery ward, commonly known in Mayo Hospital, Lahore as the 'thundi ward'. It was so named because it was the only ward which was air-conditioned. This was a huge attraction at least for me as my training started in July...the middle of a brutal summer with outside temperatures exceeded 110 degrees Fahrenheit.  In this ward most admitted patients had lesions in their heart valves. The average age of these patients was between 18 and 20 years of age. Compared to their Western counterparts, these patients were rather young (lesions of heart values in the US and other European patients are commonly seen in patients of 50 years and older.
It was very hard to see these young teenagers struggling to breathe and turning blue and breathless at the minimal of physical exertion.
By this point, you might wonder why had they developed these life-threatening ailments at such a tender age.
You see, most of these patients were here from the remote areas of Punjab and Khyber Pukhtunkhwa (close to the Afghan border)Province.

These people lack the most basic health care. There were no trained doctors in those areas in early to mid-1980s. Medical history of most of these young patients was the same. They had a sore throat

as a child. They never saw a doctor. Most went to local quacks who treated them with the cheapest of the analgesics. They were never diagnosed nor treated for Strep Throat. They never received any antibiotics what so ever. Now Strep throat if left untreated can cause lesions in the heart valves and or glomerulonephritis (a severe kidney disease). Most common valve disease that we saw were either Mitral Stenosis ( a valve of the heart becomes misshaped and narrow thereby leading to lungs not getting oxygen).
As the physicians in training, we became rather close to these young patients. One of them, I remember to this day was named Sajid. He was 16 years old and came from a small village near Mingora, a small town in Swat district of Pakistan's Frontier Province. He was nearly always smiling, regardless of how grim his physical ailments. He had Mitral Stenosis. Slightest of exertion would turn his lips and fingers the purple color of an eggplant and make him severely short of breath. His smile and his will to fight his illness made him stick out among his cohort of very brave young people.
Since the treatment at the hospital was primarily free (the boarding and lodging and cost of surgery and the imported heart-valve was borne by the Government of Punjab) however, their parents were still expected to pay for some medicine needed during the surgical procedure) Sometimes rich local citizens did visit our ward and pay these extra expenses when patients were extremely poor or very lucky. 
Soon it was time for Sajid to undergo the surgery to correct the defect in his Mitral value. I had managed to secure the needed additional medicine through a generous donation from the mother of my college friend. She was a white lady of German descent married to a prominent Justice of Pakistan. The last hurdle was to collect enough blood for the needed surgical procedure. For this, we made a request Lahore studio of Radio Pakistan (the only radio station that served the about 7 million residents of Lahore). The job of getting Sajid ready for surgery was squarely on my shoulders. In response to our request on the radio for blood donation, enthusiastic Lahorites came in droves to donate blood. For my part, I bought chilled fruit juices for all the donors in appreciation of their donation in sweltering heat. 
When Sajid was rolled into surgery, he had a big smile on his face. He was confident that this surgery would treat his disease and he will be able to go back to his village to play soccer (called football locally).
Alas, that was not to be.  Although surgery went well, he developed post-surgical complications and passed away. 
His young death was particularly very devastating to me since he and I had developed a sweet friendship. After his death, I did a soul search trying to make sense of this tragedy. Then it dawned on me, Sajid died because his sore throat was not treated with antibiotics when developed a Strep throat at the age of five. A few doses of the cheapest of antibiotic such was amoxicillin would have PREVENTED this tragic end. Soon after finishing this rotation I decided to focus on Preventing the disease rather than a futile effort to save a life later.
With this goal in mind, I came to the United States and became Diplomate of American College of Preventive