By:
Dr Saqba Alam
PGR -Oral and Maxillofacial Surgery (Abbasi Shaheed Hospital)
Graduated in the year 2011 as a dentist from a renowned institution from Karachi, I was lucky to be accepted as a post graduate FCPS resident at a public sector hospital in the field of Oral and Maxillofacial Surgery very soon after clearing my first specialization exam. Oral and Maxillofacial surgeons are trained to do just about any surgery or cosmetic procedure to correct any kind of problem with the mouth, jaws, facial structures and neck. We do everything from correcting cleft palates to reconstructing jaws, cheeks, noses, eye sockets and foreheads damaged in accidents. We remove complex cysts and tumors as well as impacted and non-recoverable wisdom teeth, along with several other complex dental extractions.
To restore jaws, we use several techniques of bone grafting to replace the missing skeletal support and implants to replace the missing teeth. Using the same implant technology, we place retentive supports for prosthetic ears, nose and even eye balls and eyebrows. Much of our work involves cosmetics.
With the advent of Orthognathic Surgery we change facial profiles of people with skeletal and dental jaw irregularities and attempt to straighten and realign jaws in their correct position after precisely calculating and measuring deformities with the use of scientific cephalometric analysis. Using Botox and fillers, we aim to correct facial asymmetry and age related sagging of face.
Head and Neck Oncology has become our major domain since the past twenty years. Almost one third of Oral Cancer cases of the world arise chiefly in Pakistan and India and has almost become endemic. There has been a great rise in the number of maxillofacial surgeons operating oral cancers with hemi mandibulectomy and selective neck dissection as a routine now in Karachi and Punjab. Thousands of patients suffering from Oral Fibrosis and malignancy are treated every month by only Maxillofacial surgeons in Pakistan even then unfortunately no advance training for the post graduate residents have been setup in oncology other than the 4 year general residency program nor any mandatory yearly program of their training abroad has been ensured uptil now to help us treat our patients in accordance with the international standards.
As with any surgical specialist program in UK or Canada, Pakistan accesses its dental graduates after a 4 year schooling system and a 1 year clinical rotational training period called House Job in which the candidates learn General Dentistry and practice basic medical and surgical knowledge.
Having acquired a dental degree, the candidates aiming for specialization in Pakistan, after clearing a mandatory part.
- FCPS exam move towards one of the four sub specialties of General Dentistry which are1.Restorative Dentistry,
- Prosthetic Dentistry,
- Orthodontics
- Oral and Maxillofacial Surgery for hospital based residency programs.
During the 4 year residency program, it is essential for the hospital to train us alongside Anesthesiologists, General Surgeons, ENT surgeons, Neurosurgeons and Plastic surgeons for a whole 1 year as per the criteria laid down by The College of Physicians and Surgeons Pakistan (CPSP).
Upon completion of the minimum four years dental school and four years hospital training an Oral and Maxillofacial Surgeon becomes a full member of the health care team and is accepted worldwide. Some complete an extra two years of training in an integrated OMS/MD program to obtain a medical degree.
Unfortunately Pakistan lacks building up a 1 or 2 year program for its trained Oral and Maxillofacial residents following which they can attain an MBBS degree alongside the dental degree. It is requested to the Ministry of Health to pay heed to this issue because without attaining a medical degree an Oral and Maxillofacial Surgeon cannot practice maxillofacial surgery in the West. Formulation of a syllabus specifically designed to give exemption to these trainees is much needed and luckily was already formed by the combined efforts of many honorable professors working hand in hand for the cause.. A lot of the effort was put forward by many professors in OMFS including Dr Riaz Warraich Dean of Oral and Maxillofacial Surgery Mayo Hospital Lahore to make the steps easier in requiring foreign recognition for a fresh post graduate trainee in the field of Maxillofacial surgery but due to the political control in the healthcare systems of Punjab, the issue was neglected and was soon left in the dust.
Dentists and physicians alike refer patients to Oral and Maxillofacial surgeon for diagnosis and treatment of oral and maxillofacial problems and a trained Oral and Maxillofacial Surgeon shares call with medical and surgical colleagues in trauma centers and local hospitals.
It is an established fact that every year the country loses almost half of its medical and dental graduates. The products fly abroad and seek jobs there after being brain drained by the country itself. Thousands like me with the spirit of patriotism still burning, work day and night to instill in public the faith and trust required to keep the Health Care system going.
Last year in October, The Hammad Medical Centre organized an International Internal Medicine conference where well-known Pakistani Health Care professionals were especially invited and taken good care off. All the expenses were carried out by Doha, Qatar and a state of art conference was concluded in which the Qatari Residents were given exemption to continue their fellowship in Pakistan without passing any evaluation tests or license examination. This was accepted by our own health professionals and presidents PMDC and CPSP.
Surprisingly, up to date no such positive steps for continued training of Pakistani residents for the better were ever taken by the Pakistani Ministry of Health during any health care seminars throughout the world.
The constant lack of interest towards the country’s own skilled health professionals by the government itself and Ministry of Health Pakistan makes the world see us as inferior in talent and knowledge. This is just one example out of many which causes brain drain among doctors all over Pakistan. The political affiliations is used as an essential “instrument” to maintain the survival of the system be it either education or health. Secondly the code of medical ethics of the Pakistan Medical and Dental Council does not mention anything about violence and torture hence the doctors who take part in the process of torturing fellow colleagues by verbal or physical means or threats do not face any disciplinary action by PMDC.
For a brighter tomorrow of skilled health care workers including the budding maxillofacial surgeons in Pakistan, I request the Health Council to pay heed on this critical issue as it’s the right of every national to acquire knowledge for the better. The College of Physicians and Surgeons should ensure at least a one year training of the residents abroad upon completion of the residency programs. Moreover PMDC is requested to make the steps easier for its maxillofacial residents to aquire an additional MBBS degree so our degrees and standards are known and accepted internationally.
