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PDA could not leave a mark, new council will not start from January 1st; Dr Mahmood Shah

by Dr Hira M. Khan

Dr Syed Mahmood Shah became president of the Pakistan Dental Association in 2017 but has been working with the association for over a decade. Dental News spoke to him about his contribution to the dental profession and community, in Pakistan, from his position of power.

Dr Mahmood Shah was also elected as Chairman of Oral Diseases Commission, Asia Pacific Dental Federation (APDF) at APDF Elections held during 40th APDC. He told Dental News about his efforts toward positive representation of Pakistan on global dental platforms.

After completing BDS and residency at Liaquat National Hospital, President Pakistan Dental Association Dr Syed Mahmood Shah moved to Ireland for his Diploma in Dental Health from Trinity College, University of Dublin. On returning, he joined Sindh Government Service. Later, he got admission in University of California, Los Angeles, in an Orthodontics program. On completion of his foreign degree, he resigned from government service and devoted himself to fulltime practice. For over 20 years, Dr Shah practiced at private dental hospitals before he finally established his own dental clinic.

The excerpts of the interview are as under:-

Dental News: Please tell us about yourself, why you chose to become a dentist and an orthodontist?

Dr Syed Mahmood Shah: Dentistry was not my first choice. After I did my intermediate in pre-medical from St. Patrick’s College, I went on to pursue admission in MBBS program at Dow Medical College. I could not get in at that time and decided to opt for dentistry. Back in the days, Liaquat Medical College was the only institute offering dental program in Karachi. To date, I am unable to fully express enough gratitude for this turn of event. Dentistry has given me the status and prominence that could not have been possible in the medical field.

About how I stepped into the Orthondontic specialty: I spent many years in government service after graduation; during that time the practice was mainly about minor oral surgery. Most of the cases were of RTA or extractions, which led to the exhaustion of my interest in oral surgery. I applied for admission in endodontics and orthodontics programs in a foreign university and got accepted for both. However, I had begun finding Orthodontics as a very exciting field, and I still think it is an extremely interesting specialty. I feel that maxillofacial surgery and orthodontics are the only two main specialties in dentistry, because other procedures, including RCT, restorations etc., are very commonly performed by general dentists as well. But orthodontics is a specialist’s field and, therefore, I chose it.

DN: Introduce PDA, its vision, its objectives, and the role played by its office bearers.

MS: Pakistan Dental Association (PDA) was formed in 1960 and has been representing the entire Pakistani dental community ever since. We have a Central Office, which represents the entire country; I am currently the President of that. Then we have 5 further divisions, each for the 4 provinces and the federal capital. These are called zones. These zones are further subdivided into branches established in all major cities.

The PDA network functions to safeguard the interest of the dentist, to promote oral and dental health, and to advise the relevant bodies on what should be the policy institutions and policy matter as PDA sees it. PDA’s major role is also to represent Pakistan in the global dental community. I am proud to state that Pakistan is a very active member of the World Dental Federation (FDI), which has representation from around 200 countries worldwide. The FDI President on a couple of occasions has asked for an invitation to Pakistan. They want to visit our country. Similarly, we have represented Pakistan well at the Asia Pacific Dental Federation. I am currently the Chairman Oral Disease Commission of APDF.

DN: What achievements do you count as PDA’s greatest? Please specify the achievements under your specific tenures.

MS: Unfortunately, I cannot name an achievement of PDA that brought a significant paradigm shift in dentistry in Pakistan, and there are reasons for that. But to highlight a few achievements let’s start with the Asia Pacific Dental Conference, which was held in Karachi in 2006. 28 countries took part in the conference, for which I was the patron. In 2012 and 2015, again, international conferences were organized in Pakistan. I was the patron of these as well.

During my current tenure as the President PDA (Center), my most notable achievement is the revival of the branches. Despite challenges, I managed this uphill task, by conducting elections in 19 cities of the country where PDA branches were either inactive or absent. I am of the viewpoint, the task of organizing conferences and symposiums should now be handled by these branches, now that we have activated them. The Central Council of PDA mainly participates in presenting policy matters.

DN: In your view, what are the main problems that agitate the dental profession?

MS: The problems are varied because the field of dentistry itself is. We have academicians, private practitioners, and young dentists. Then there is another category of postgraduate students and another of undergraduate students. All these groups are facing different problems. What I see as the leading problem in dental field is the overproduction of dentists in Pakistan, especially in the urban areas, which is giving rise to unemployment; whereas, the rural areas are not producing enough dentists. This mismatch will amount to a significantly problematic situation if government does not intervene with effective policies. 

DN: Your contribution to dentistry in Pakistan as chairman of oral disease commission APDF and other similar positions held in the past?

MS: Yes, I have held a similar position in the past as well; I was the Vice-President of APDF. The protocols and responsibilities change with ranks. As APDF officers, we have to carry out tasks aligned with the targets assigned to us by APDF. For example, we are currently working on a report on the prevalence of dental caries in the Asia Pacific region, which will also include data from Pakistan. The report will have recommendations on how to fight and limit the prevalence and incidence of dental caries in this region.

APDF is not like FDI where you are given grants, but you might be allotted conferences via which revenue is generated, especially by the hosting country. Pakistan last hosted APDC in 2006. We have made all possible efforts to bring the Conference back, but remain unable due to the order situation in the country.

But now, APDF has tentatively allotted Pakistan the APDC in 2022, which will be an immense achievement if we can execute it. 

DN: Why is it that female dentists are hardly represented in PDA, while they outnumber male dentists?

MS: About females in Dentistry, I am of the opinion that the reason that dentistry is still thriving in Pakistan is because of the female dentists. It is kind of a paradox. Let me explain: 80% of the admitted candidates in dental colleges are females, out of which 80% of the graduating females never practice, or leave practice after spending a year or two in it. (This is a guesstimate.) The practicing dentists left behind are few and mainly male. Despite that the unemployment rate for dentists is high. Imagine if 100% of the graduating lot was to enter the workforce, we would have a crisis.

Due to lesser working women in the field we see lesser female representation in associations like ours.

DN: What are your comments on PMDC, its role, and the new ongoing changes?

MS: Aha! PMDC is my favourite subject to speak on. Over the years, PMDC has derailed from its regulatory responsibilities and has turned into “Private Medical and Dental Colleges Recognition Council”. And so instead of promoting general and oral health, PMDC has become more interested in raiding colleges. PMDC used to be an effective body when its roles were well-defined. It would take notice of significant matters like quackery and different epidemics. Due to the underperformance of PMDC, Pakistan has become one of the unfortunate countries where we do not have proper data on disease prevalence; we are clueless in terms of numbers about our dental caries prevalence, periodontal index, and oral cancer spread. We do not even have a plan to limit these conditions. When you do not have the diagnosis, how will you draft a treatment plan? This is one of my main questions for PMDC.

Currently, PMDC is running on Ad hoc- and individual-based policies. A new candidate would come into power and, instead of working on inherent issues, would start doing things their way. There are no concrete, long-term policies, which leads to the Council’s faltering time and again, whereas the real healthcare issues remain unresolved and are left to multiply. Despite having around 50 dental colleges in the country, the trend of oral diseases in still on the rise, which does not make sense. Something somewhere is very wrong.

After discussion with my council I drafted a letter and shared it with President Dr Arif Alvi. In the letter I pointed out the flaws in PMDC; the Council runs on revenue collected from doctors and dentists, yet the new ordinance promoted a selected council instead of one produced after fair elections between representatives of the same field.

The solution is simple; there is no need to reinvent the wheel. The PDA has suggested it and would consider it their most impactful delivery to the dental field if a separate Pakistan dental council was made. There are separate councils for Nurses, Homeopaths as well as Tib, then the forced unification of medical and dental council makes no sense. There are over 30,000 dentists and around 50 dental colleges in the country, yet the dental council is attached to the PMDC like an appendix. The need for separation is based on the fact that the woes and challenges, and, therefore, the solutions, of dentistry in Pakistan, are different.

Secondly, I want to request the President of Pakistan to form a steering committee with MNAs from PTI, PML-N, PPPP, and representation from PMA, PDA, and PAMI. These are the 6 major stakeholders of the future of medicine and dentistry in Pakistan. A PMDC draft that is unanimously agreed upon by this committee should be passed in the National Assembly. This should be a smooth process considering all parties were involved in the decision-making. If need be an expert health planner should be involved since PMDC should be a healthcare-specific council. I believe that the subsequent bill will win without opposition. Short-cut ordinances that are reinvented and introduced after every few months carry no promise but the promise to relapse.

Secondly, there also needs to be a Dental Act, which will specify standards for dental practice. Mandatory specifications of dental units, radiology units, etc.; creating a system for an organized dental structure and addressing tier-based problems, all come under Dental Act.

PDA has been striving for the introduction of, both, Dental Council and Dental Act and will continue to do so.

DN: According to the updated PDA constitution, the new president will assume office on January 1st, 2020. Is that right? What are your comments?

MS: When constitutions are formed, tentative dates are added. January 1st is mentioned as the first calendar year, but the current PDA office did not assume charge on that date. Our elections were held in August, so you can well imagine that if the tenure did not start on January 1st, it will not end on it. There are other dates mentioned for important events as well, but they are tentative and are not always met. PDA is at liberty to make alterations in dates if the need arises and the change is not in violation of the constitution.

Having said that let me assure you that the next elections for PDA center will be held in 2020. And it will be a year of change in PDA.

DN: What are your comments on Dental News’s contribution to the dental profession?

MS: I have had a longstanding and close-knit relation with Dental News ever since it came into being in 1995. I believe that I was one of the first dentists to be interviewed by the magazine, and here we are again! It is a matter of pride to consider how Dental News has flourished over the years; the publication is now among the most prestigious and reliable, and is the leading dental periodical in Pakistan. Their journalism is objective and unbiased, and aligned with their editorial policies.

Dental News in its impactful ways has contributed lots to the evolution of the dental profession and professionals in the country. It has remained at the forefront of the movement to develop organized dentistry and continuing dental education. PDA has many times collaborated with Dental News for such conferences and wishes to do so in the future as well.

October 19, 2019

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