DOCTOR S ASSASSINATION: SECTARIAN STRIFE OR AN ATTACK ON CIVILIZATION?

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1 Editor-in-Chief: Tanveer Imam Volume VII Number 2, June 2014 DOCTOR S ASSASSINATION: SECTARIAN STRIFE OR AN ATTACK ON CIVILIZATION? Dr. Mehdi Ali Qamar, an American-Pakistani cardiologist was brutally gunned down on May 26, 2014, by unknown assassins in Rabwah, Pakistan in front of his wife and 3-year old toddler son. Dr. Qamar had gone to Pakistan to volunteer at the Tahir Heart Institute and had arrived in Pakistan just 2 days before his untimely death. The picture of Dr. Qamar s blood soaked body has gone viral on social electronic media causing uproar among Pakistani American community. Over the last few years, religious fanatics have murdered scores of physicians, mostly belonging to religious minorities. The perpetrators and the culprit religious outfits have escaped scot-free. The continued attacks on physicians and other members of Pakistani intelligentsia and the inability and unwillingness of the authorities to bring the culprits to justice, makes one wonder if there is a larger hidden agenda to create discord and anarchy in the country. The Pakistani-American physician organizations have solemnly affirmed to put up a vehement protest against this atrocity. SULEMAN PALLIATIVE CARE CENTER CONSTRUCTION IN FULL SWING GLOBAL GIVING R AISES FUNDS FOR NURSE AIDE PROGR AM A project was launched by Dr. Nabil Zafar via NHF to raise funds via Global Giving for Nurse Aide program. National Health Forum with the help of Global Giving raised approximately $11,000. This project will train indigent young women to become Nurse Aides. This project aims to tackle issues of women empowerment, poverty alleviation, health education and the health workforce crisis in Pakistan. It provides opportunities for education and help build carrier for these women. Suleman Palliative Care Center construction is in full swing and Koohi Goth Hospital Foundation feel that construction will be completed by end of this year and Dr. Zehra Kapadia, Consultant in hematology and Oncology from Houston will help set up the program. This Palliative Care Center will be first of its kind in Pakistan to promote education and training program for Hospice among doctors and para-medical staff. SOCH S WORLD HEALTH DAY PAGE 6 KOOHI GOTH HOSPITAL UPDATE - PAGE 8 ABID RIZVI DONATES LAND IN KAR ACHI With the help of National Health Forum, Mr. Abid Rizvi a local of Karachi living in California, has donated a land to Koohi Goth Hospital to build a hospital and educational center for Para-medical Staff; where Nurses, mid-wives, laboratory technician, operating room technician, anesthesia technician to name the few and other para-medical staff will be trained. The goal is to build a for-profit hospital on half of the property and on other half this educational institution will be established, and all proceeds from hospital will go to education and this will be NON-FOR PROFIT ORGANIZATION.

2 EDITOR-IN-CHIEF Tanveer Imam EDITOR Amin Gadit Masood Moeen PUBLICATION COMMITTEE Iffat Shah-Ibrahim Raheel R. Khan Mujeeb-ur Rehman Muslim Jami Junaid Syed Asif Monuddin Mansoor Abidi Rizwan Jabir Wamique Yusuf Naseem Shekhani ARTICLE SUBMISSION We encourage every reader to send articles throughout the year on healthcare issues in Pakistan and the US. Articles can be ed as text or in MS Word format to The Editor reserves the right to edit content of all articles that are submitted. FOR ADVERTISEMENTS For advertisement rates, submission and schedule please DISCLAIMER Health Beat, the NHF newsletter, is a bi-monthly newsletter and provides health information to its readers. The views expressed are those of authors and do not necessarily represent the official position of either the editor or the editorial board. NATIONAL HEALTH FORUM PO BOX Ballwin, MO JUNE 2014 ISSUE EDITORIAL COST OF CARE FOR END-OF-LIFE TREATMENT T ake me home!! That is what I perceived my father was saying when he tried to whisper those words and motioned with his hands, while hooked up to a ventilator through a tracheostomy. This was his third week in ICU and was being treated for aplastic anemia and its complications. Despite the best of treatment and advanced technology he did not survive the serious illness. His ailment and hospitalization had placed my family under great stress. I tried to remain objective in the face of a sense of an imminent loss of a loved one. My mind oscillated between hopelessness and hopefulness, knowing fully that the odds were heavily stacked against my father. My father, I believe, was aware of the eventuality and wanted to breathe his last in the surroundings of his home and among his loved ones. But like 75% of Americans, he died outside his home. Death is certain for all living things that is the dialectic of life. But the astronomical amount of money we spend to care for terminally ill may come as a surprise to many of us. Medicare spends $55 billion dollars a year to care for the elderly in their last 2 months of their lives. Approximately 30% of this amount makes no meaningful impact on the patient s overall care. This amount is more than what is allocated for Homeland Security or Education. Just a reminder, we have over 47 million non-elderly patients in America who are uninsured, as they cannot afford health care. Approximately 25 to 30 million people are underinsured, which is defined as people spending 10% of their income towards out-of-pocket health payments. The cost of healthcare is out of control and higher than any country in the world. We spend over $8000 per year per person, almost twice that of countries of Western Europe, while U.S.A. fairs poorly on the health care indices chart. These facts cannot be emphasized more! Medicare spending has far exceeded its revenue for some years now. It is estimated that the program may collapse in a few years if major reforms are not undertaken. Despite the high cost of end-of-life care not much debate has occurred to seriously reform it. No party, whether it is the lawmakers, healthcare workers or the public at large, seem to be ready to discuss the issue. The manner in which healthcare delivery is structured in the United States, the primary care physician does not get enough time to spend with a patient to generate end of life discussions or have the freedom to try a treatment and see its response while trying to keep patients out of the hospital. End-of-life treatment is not exclusively reserved for terminally ill cancer patients, but patients with advanced non cancerous pulmonary illnesses, end stage renal and liver diseases, advanced heart failures, neurological diseases such as ALS and chronic infections such as AIDS are included. Most patients and families understand the expected mortality, but dread the possibility of a painful and violent death of their loved ones. With the advancement of technology and innovation in medicine, the society is in a state of denial and somewhat delusional where death of a loved one is concerned. In the midst of dispensing highly advanced medical care, we are perhaps ignoring the fundamentals of medicine DO NO HARM. It will require a wholesome effort on the part of lawmakers, doctors, patients and society at large to save our healthcare system from collapse and bankruptcy. Cost control is the crux to the solution to the problem. The high return to the delivery of healthcare and its attached vested interests is antithesis to cost effective healthcare. In a majority of cases, contrary to patient s desires we make death a slow, gruesome and messy process by prolonging the eventuality. Recognition of the disease process, education and establishment of a comprehensive palliative and hospice program will alleviate anxiety and complete a salubrious life. Tanveer M. Imam, M.D. Editor-in-Chief ABOUT THE AUTHOR: Tanveer Imam Editor-in-Chief, is graduate of Dow Medical College, Karachi, Pakistan, class of Dr. Imam is practicing Gastroenterologist in Allentown, PA and written extensively on health care issues. HEADSUP FOUNDATION CONTRIBUTES TO NHF Heads-up Foundation, founded by Dr. Nasar Qureshi, presented a gift of $3,000 to Serve Our Civil Hospital Welfare Association (SOCH). The gift was given through National Health Forum on the recommendation of Dr. Saeed Qureshi, Medical Superintendant of Civil Hospital Karachi. The money will be used to deep clean surgical wards and to provide sanitizers. SOCH, an NGO pledges to keep maintain sanitization at Civil Hospital Karachi and help educate staff about prevention of disease.

3 PRIMARY CARE PSYCHIATRY IN PAKISTAN - A LONG WAY AHEAD M. Amin Gadit, MD Dealing with mental health is still a huge burden in Pakistan when it comes to its social, economic and management implications. The government s health policies and W.H.O. have strongly recommended/suggested the inclusion of psychiatric services at primary care level. With an alarming situation of less than 300 psychiatrists, growing social disruption and high prevalence of mental disorders augmented by brain drain of psychiatrists, the brunt falls on the general practitioners who are the back bone of health care system in the country. The question arises as how prepared are the general practitioners to share the burden of treating depression/anxiety and some allied neurotic disorders and are able to refer the other cases beyond the scope of their treatment domain. About 20% of the patients seeing primary care physicians have a significant mental disorder1, and only 23% of the patients with depression treated by primary care physicians receive an antidepressant in an insufficient dose.2,3 Family practitioners spend 50% of their time dealing with emotional problems but will refer less than 10% of these cases for psychiatric treatment because of uncertainty experienced by these physicians and difficulty of referring to specialized services.4 They consistently have been found to under recognize or misdiagnose depressive disorders; however, it is unclear whether it is due to lack of skills or attitude towards these disorders.5 A local study also revealed that the knowledge of family doctors about depression was quite low.6 Reasons for failure to detect such disorders include the diagnostic practices taught in medical schools, the inadequacy of psychiatric taxonomy of neurosis and most of the doctors have not been taught how to interview their patients.7 Primary care physicians fear loss of control, stigmatization from psychiatric labels and issues of time and money. These are reasons for limiting psychiatric intervention, this is an important factor which should be known to the psychiatrist who are in close liaison with the general practitioners. 8 The GP variables include their mis-diagnosis by not considering personal and family history and presence of stressful factors whereas in some cases they are likely to over diagnose patients who suffer from the effects of physical illness. There are other factors, which can possibly influence the ability to detect depression. These include patients who describe physical symptoms only as they believe that their doctors only want to hear about physical symptoms. Some patients have a sense of guilt or stigma about feelings such as gloom and sadness while others view such complaints as evidence of weakness. Such patients consult physicians with other symptoms and don t mention their actual psychological symptoms. This can also happen when the patients are not psychological minded, are of low intelligence or belonging to other cultures without appropriate vocabulary or concept of emotional hurt.9 Personal traits and qualities may remain a stronger determinant of general practitioners reaction to patient problems than formal training and qualifications and general practitioner communication skills are also important to enhance depression-specific interventions in bringing about improvements in patient outcomes.10 Amid the ruins of mental care delivery system influenced by inadequate planning, financial support or public consensus, efforts to integrate mental health services with the health services of primary care physicians are considered the best hope to improve access to mental health care.11 In order to change the scenario, it is vitally important to consider training the general doctors and family practitioners in the best possible way. Psychiatric education is initiated early, before attitudes become fixed, to emphasize self-reliance and mental health problem solving skills, to make learning experience longitudinal and to integrate psychiatric training into the rest of the resident s curriculum. Seminars, clinical experience and liaison with mental health team are all utilized in the training program.12 The pharmaceutical companies are making good efforts in arranging CME programs for the GPs but without the credit systems and points for maintenance of certification there would always remain a doubt about its efficacy. The McMaster s model is worth reviewing.4 Moreover, monitoring and evaluation of both knowledge and practice at work place are important. Evaluation through dummy patients and providing appropriate feedback to the GPs, ample use of videos, CD s and hands on training in the respective place of practice along with observation by a psychiatrist can improve the skills and knowledge of these practitioners who may in turn provide maximum benefit to the patients in the primary care settings. A diploma/certification route may also be followed in the subject of mental health geared for primary care practitioners through a university or a postgraduate body by practitioners interested in gaining further knowledge and expertise. There are challenges ahead but in order to improve the existing condition evident of high prevalence of mental disorders, mandatory inclusion of mental health component in the primary care system and continuous surveillance will go a long way in changing the current scenario. ABOUT THE AUTHOR: Dr. Amin Gadit is a professor of psychiatry in Memorial University of Newfoundland, Canada. References : 1. Olfson M, Fireman B, Weissman MM, Leon AC, Sheehan DV, Kathol RG, et al. Mental disorders and disability among patients in a primary care group practice. Am J Psychiatry 1997;154: Wells KB, Katon W, Rogers B, Camp P. Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from Medical Outcomes Study. Am J Psychiatry 1994;151: Simon GE, Von Korff M, Wagner EH, Barlow W. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993;15: Ballester DA, Filippon AP, Braga C, Andereoli SB. The general practitioner and mental health problems - challenges and strategies for medical education. Sao Paulo Med J 2005;123: Berardi D, Menchetti M, Cevenini N, Scaini S, Versari M, De Ronchi D. Increased recognition of depression in primary care. Comparison between primary-care physician and ICD-10 diagnosis of depression. Psychother Psychosom 2005;7494:

4 PITFALL OF PUBLIC HEALTH IN INDIA IN CURRENT TIMES Linkan Subudhi T he deplorable state of publicly provided social services in many developing countries has attracted considerable attention in recent years from academics and policy makers alike (World Bank, 2004). Health and education sectors are plagued by high provider absenteeism, little on-the-job effort from those who do come to work, and overall poor performance. For example, teachers in primary schools and medical staff at primary health centres in India have absence rates of 25 percent and 40 percent, respectively (2006). A 2008 nationwide survey on educational attainment in rural areas found that, even though percent of children aged 6-14 years old are enrolled in school, many do not learn much: by rade 5 in rural India, only 56 percent of children can read a simple story (grade 2 level), and 19 percent cannot read beyond a word (2009). In Uttar Pradesh, the state where we conducted this study, only 43.5 percent of the grade 5 children could read a simple story. During the 2011 budget, when the Indian GDP is estimated to increase by 37% from to , the allocation for the health ministry for the various public health oriented national disease control and prevention programmes has gone down by 14%. The Indian ruling class are only concerned on protecting their vested interests and the interests of the private health care industry. The very notion of Universal healthcare in India is a cruel joke on the vast majority of its people, where the so called free and universal health system is underfunded, understaffed, under supplied with medicines and surgical equipment and does not meet the basic minimum standards. The average spending by ordinary people for procuring medical care in hospitals is already a large percentage of their earnings. The situation is even worse to that poverty stricken and impoverished people in remote areas as there is a general lack of a functioning government healthcare system and the private healthcare provides are obviously located only in urban areas, as there is no money to be made in rural areas. Public health care plays a very important role especially in the circumstances of prevailing health inequalities and inadequate health care provisioning system. Public health care is about prevention and control of disease, increasing quantity and quality of life and promoting health. To frame a public health policy, to create supportive environments like public parks, fitness and sports centres etc., to engage with communities to identify their health priorities subsequently enabling them to fulfil their health needs, to educate individuals to fulfil their health requirements and finally diverting more resources into prevention and disease control; all of these needs heavy investments. A radical budget allocation into public health care is vital. The recent budget allocations for healthcare particularly public healthcare, which is a meagre 1.4% of India s GDP, proves that the government have no serious intentions to change this trend. This only leads to substandard delivery along with increasing inadequacy to meet healthcare demands of a growing population. At the same time, it has given rise to the exploitative private health sector to establish itself. The health care sector in India is already in the radar of global business corporations, that is today worth $40 billion. Apart from Kerala, majority of the regional governments have so far only paid lip service to the Indian constitution that speaks about the importance of public health. This insensitivity on part of the government can only be reversed by mass struggle of the working people and youth for quality public healthcare as part of the overall struggle for universal social security and welfare measures. For eg., in Kerala, organized working people and educated, socially aware young people and also because of raised political consciousness, is the main reasons for the higher human development index and life expectancy there. This government, like all the previous ones, have been consistently considering social spending as an unnecessary burden, but vital tool for electoral politics. The most immediate need of the hour is for the government to increase the allocation of funding according to the health care needs of the people. However, this government which is tool for business interests is incapable of meeting these urgent needs and will forever protect only their vested interests. Therefore to conclude the actual status we can say though the Indian Public Health Service (IPHS) has established many Public Health Centres and PHC team conducts several meetings to meet the services of IPHS. IPHS spend Crores of money every year on Infrastructure, manpower, drugs, transport facilities with assure life linkages, laundry services, dietary facilities for patients, waste management at PHC level and health & hygiene projects like to fight against TB or malaria or Dengue or food poisoning or water poisoning due to unhygienic condition of living standards of all the slums. All these are not streamlined and hence it troubles the IPHS system and leads to the pitfall of the health status as per the standard should be followed by IPHS. Thus, the need is for a political, socio economic alternative and a true working class alternative to the ravages of Capitalism-Landlordism. ABOUT THE AUTHOR: Linkan Subudhi is a social activist and her field of expertise is Health Care and Child marriage issues. CONT D from page 3. References: M. Amin Gadit s article. 6. Gadit AA, Vahidy AA. Knowledge of depression among general practitioners. J Coll Phys Surg Pak 1997;7: Goldberg D, Gask L. Teaching mental health sills to general practitioners and medical officers. Seishin Shinkeigaku Zasshi 2002;104: Blashki G, Selzer R, Judd F, Hodgins G, Ciechomski L. Primary care psychiatry - taking consultation-liaison psychiatry to the community. Australas Psychiatry 2005;13: Casey P. A guide to psychiatry in primary care. UK:Biomedical, 1990, pp Van Os TW, Van den Brink RH, Tiemens BG, Jenner JA, Van der Meer K, Ormel J. Are effects of depression management training for General Practitioners on patient outcomes mediated by improvements in the process of care? J Affect Disord 2004;80: Jones LR, Parlour RR, Badger LW. Mental health services in primary care - yet another area of disillusionment? Med Care 1982;20: Goldberg D. Training general practitioners in mental health skills. Int Rev Psychiatry 1998;10:102-5.

5 I AM MATCHED Najwa Jamal C ongratulations you have matched! Read the , I read and re-read to make sure I wasn t just hallucinating. Never had an brought me more joy than this one. Doubts of hallucination turned into euphoria as I finally registered that it was actually true and I had indeed matched at a residency position for Internal medicine in U.S. Making it to that point was a long uphill journey. There were many obstacles and challenges but the two most valuable resources were planning and perseverance. When I started as a student in Dow Medical College, I only had a vague idea what the next step in my career would be. I wanted to do my post-graduation in the U.S. not only because I had family here but also because this country has an excellent training program. I was not sure about how I should plan for it but luckily Dow Medical College has an extensive alumni fraternity and some of them held a seminar at college when I was in 3rd year of M.B.B.S. It provided guidance and counselling on how to pursue a residency in U.S.A. Thanks to that seminar, the help of seniors that I connected to on the Facebook alumni page, a website called pakmeds.com that provides resources based on past experiences and various other internet forums and books, I developed a clearer picture of how I should plan to attain my goals. The very first step that I took and would suggest needs to be taken by everyone is discussing about it with family. The entire process of studying, taking exams, opting for rotations in the U.S and then travelling back and forth for the interviews is not just long and draining but expensive as well. It was critical that my family understood and was willing to support me through it. Once I had my family s confidence and support it was time to give my dream all I had. I started studying for USMLE just as the 4th year MBBS started. Medical studies in Pakistan are obviously not USMLE oriented so the course material is slightly different but medicine in essence is the same universally. It felt like a Herculean task to manage both curricula at the same time but my USMLE prep was also helping me in my regular college coursework. I made a time-frame and set one deadline after the other so that I could complete all the requirements and paperwork before the application season started. I took my USMLE STEP 1 and 2CK while in 5th year M.B.B.S and Step 2 CS shortly after my final exams so that applying within the year of my graduation was possible. It s a fact that a foreign medical graduate ranks after the local (U.S) medical graduates when it comes to residency applications, knowing this, I needed to make my resume stand out. Good scores, volunteer work, and research experience, are all contributing factors in a good resume. With a rising number of applicants and an ever increasing competition, U.S clinical experience has now also become a very important factor and even a criteria to apply at some programs. I wanted to make sure I had clinical experience here not only to fulfill a criteria but also to utilize it as an opportunity to get letters of recommendation from the physicians I would work with. I subsequently did a month of subinternship and a month of elective rotations. Coming from Pakistan with the only clinical background being that from Civil Hospital Karachi, working at hospitals here was a very different experience. I was in an environment of strict adherence to protocols and cutting edge technology, but I take pride in saying that the knowledge imparted to us by the faculty at CHK was in no way inferior to what is taught here. I was able to get very well written letters of recommendation, and was specifically told by some interviewers later that my impressive recommendations were the reason they called me for an interview. The application season soon started and I was advised by my seniors to apply widely and preferably to programs that have a good track record of accepting foreign graduates, mostly in the Midwest, and East coast. I traveled for the interviews from one city to another, state after state. I met applicants from many different countries, each with an outstanding profile and an amazing resume. It was unnerving to wait for the results knowing that there are thousands other like me but not enough spots. The joy and relief at knowing I matched cannot be expressed in words. I had put in a lot of time and effort into it but it wasn t possible without my alma mater s advice, and help. From conducting seminars, practice sessions on Skype for interviews, and advising on Facebook and , their contribution had a very positive impact on my struggles. My families and friend s prayers and support also deserve credit. All in all, this road to residency has taught me that fulfilling your dreams is never easy but hard-work does bear fruit. ABOUT THE AUTHOR: Dr. Najwa Jamal is a Graduate of Dow Medical College 2013, and very active in social work at Civil Hospital Karachi. Our Lady Of Mercy Academy Raises Funds For Fistula Program Our Lady of Mercy Academy, a high school in Long Island, NY. Student body of high school headed by Sana Mahmood and raised funds for different charities every year and to help Fistula Repair Program at Koohi Goth Hospital, Karachi. $7000 was donated by Student body via National Health Forum. Inc. (NHF).

6 SOCH WORLD HEALTH DAY 2014 By: Naseha Mushtaq (DMC, Batch of 2016); Urooj Bhatti (DMC, Batch of 2019) NHF HELPED S.O.C.H. TO ESTABLISH AN ENDOWMENT Outside the crowded OPD block of Civil Hospital, Karachi, the Serve Our Civil Hospital (SOCH) team celebrated World Health Day on the 10th of April, SOCH, a nongovernmental organization run by the students of Dow Medical College works at Civil Hospital, Karachi, to attain the goals of cleanliness, infection control and awareness. Under its wing of Awareness and infectious disease control, SOCH hosts global events which includes the World Health Day celebrated by the World Health Organization (WHO) every year highlighting a priority area of public health. The theme for this year was Vector Borne Diseases. More than half of the world s population is at risk from diseases such as malaria, dengue, leishmaniasis, Lyme disease, schistosomiasis and yellow fever carried by mosquitoes, flies, ticks, water snails, and other vectors. Over 2.5 billion people around the globe are at risk from dengue and an estimated 1.2 billion are at high risk for malaria. Being the two most common mosquito transmitted diseases in Pakistan, Malaria and Dengue awareness was the main focus of the SOCH team. The preparations for the campaign started at 9.30 a.m. A huge banner displaying the slogan Small bite, big threat was put up. Flyers containing information and descriptive pictures about how to prevent mosquito bites were distributed at CHK along with a brief explanation of the preventive measures. The SOCH team conducted a small survey which included patients who had a history of suffering from malaria or dengue fever to assess the concept of the two diseases among them. Results showed that 75%-85% of the patients were not aware about the causative agent or vector nor did they have adequate knowledge about the treatment of the disease. However, most were well aware of the symptoms of dengue and malaria and mosquito bite prevention. The patients and their attendants displayed a lot of interest in acquiring information about vector borne diseases and were enthusiastic about implicating the methods of prevention of mosquito bite. The campaign was wound up after 3 hours of service at 12:30pm. Cultivate health instead of treating disease George Bernard Shaw s. It is time to take a step forward and make people realize the significance of the simple measures that can help prevent Malaria & Dengue, for e.g. using mosquito repellents, and window shields, proper disposal of garbage and stagnant water. S.O.C.H in this regards has stepped up to bring a revolutionary change which apart from reducing the incidence of Malaria and Dengue, will also decrease the burden on hospitals like Civil (the cause that inspired me to dedicate myself for this organization). Website: soch.chk@gmail.com facebook.com/serveourcivilhospital

7 APPNA FOUNDATION Dr. Asif Rehman, President of Association of Physicians of Pakistani descent of North America (APPNA), after a long discussion with activists for one month, has announced the committee for the formation of APPNA Foundation to establish long term financial viability of APPNA. Dr. Asif Rehman has pointed out that most of the professional organizations have a foundation to carry their charitable work and long term projects. This three member committee will be chaired by Dr. Naseem Shekhani and committee members will be Dr. Nasir Gondal and Dr. Ahsan Rashid. This committee will take recommendations from activists of APPNA and will debate and discuss all the concerns and ideas introduced in the planning meeting of Chicago Illinois. These three individuals have served APPNA with sincerity and selfless work for many years. They have the experience, the talent and the best interest of the organization in mind. Also thanks to Dr. Mubasher Rana, who is President-elect of APPNA 2014 for his continuous effort in making this a reality. A framework will be engineered after looking at previous documents and work done by various past APPNA Presidents. Furthermore, this APPNA Foundation will work closely with APPNA leadership to give the best endowment for years to come. APPNA will carry out its philanthropic work with the help of this endowment and will assist standing committees of APPNA. It will work in a synergistic way along with existing committees and help those committees to take a leadership role. The role of this APPNA Foundation committee will be to educate membership regarding different styles and types of endowments and begin writing guidelines and bylaws for establishing this APPNA Foundation. Dr. Asif Rehman agrees that for the Foundation to succeed, all sides of APPNA leadership has to stand on one platform, making this a reality by keeping the organization first. Furthermore, Dr. Rehman stressed that this committee will be fair and free of any politics. The goal is strengthen the future of APPNA for all. Dr. Asif Rehman, President, APPNA Dr. Mubasher Rana President-Elect, APPNA Vision: To create a sustainable Endowment Fund supporting the philanthropic work of APPNA thus empowering Pakistan, USA and the Pakistani American Community. Mission : To support Charitable and Humanitarian projects, promote Literacy, and Health education through Association of Physicians of Pakistanidescent of North America (APPNA) sponsored programs; and to provide a structured and dedicated organization this is committed to raising funds for a Pakistani American Diaspora. Activities to be Supported by APPNA : Serving American, Pakistanis and Physician Community in the field of Health care. Each project will be evaluated by the Board and approved if compatible with the Mission of the Foundation and meets the IRS requirements. All program sponsored will be approved by Board of Trustees. The activities of the Foundation will be but not limited to the following: Medical Welfare Projects such as Preventive Care, Free Clinics in USA and Pakistan. Support Pakistani-American doctors, young Doctors and Medical Student in clerkships, residency program and early part of their practice. Scholarship and awards, Low interest rate loans, Professional Development. Research grants. Developing department Chairs. All these activities will be passed by Central Council of APPNA and Memorandum of understanding will be signed between APPNA and APPNA FOUNDATION. WOMEN of DOW In recent DOGANA Retreat women of Dow were recognized who have excelled in the field of education, medical, surgical social work and helping the indigent. Women who were celebrated were Drs. Azra Raza, Saeeda Haider, Seema Khan, Farhat Moazam, Shakila Khan, Aziza Shad, Anisa Hasan, Naheed Mumtaz-Sultan, Asma J. Sadiq and Nasreen Jamil Khan(late Killed in Afghanistan by Militants). Saeeda Haider Azra R. Syed Seema A. Khan Shakila P. Khan Nasreen J. Khan Farhat Moazam Aziza Shad Anisa Hasan Naheed Sultan Asma J Sadiq

8 UPDATE KOOHI GOTH WOMEN HOSPITAL home and at different hospitals in Pakistan. We will recruit students from all over Pakistan and with stipend we will provide boarding a and lodging to these students. A task force is working at Houston to raise funds for future day to day running of this center and the scholar ship for the students. The center will provide free treatment to patients admitted in this center. We are also hoping that trained palliative care nurses will be able to train more people in other part of country. SULEMAN palliative care center will act as a resource center for all those who are interested in palliative care. We need help from those individuals who are working in this area for the training of our students development of curriculum according to their schedule and visit to Pakistan. Pakistan is facing serious problem of shortage of human resource in health care system. We are not producing enough nurses, midwives, OT technicians and other paramedics. KOOHI GOTH WOMEN HOSPITAL is not only providing free health care to women but we also want to develop this hospital in to a center where basic human resource should be developed for the country. We are already training midwives, we have nurse midwives tutors training program, OT and laboratory technicians training program. RECENTLY A friend from Houston donated two hundred thousand dollars to build Suleman Palliative Care Center and school of palliative care training. Hopefully the construction will be complete in December 2014 and in the end of December the center will be functional. This center will start 6 months special training diploma course to qualified nurses in palliative care. We are spending one hundred thousand dollars from collected donations in 2013 in extension and construction of new building to increase the beds for patients. One hundred fifty thousand dollars from collected donations in 2013 are deposited in fixed deposit account as endowment fund for hospital. We will like to deposit double of this amount every year for the sustainability of hospital and its academic activities. We are spending the remaining amount of one hundred thousand plus dollars in the care of patients. We have also started a nurse aid training program, which is six month course for those eight class pass individuals with good IQ who can work as nurse aid at clinics and hospital. We are also training 60 boys and girls as basic health workers to work in rural community. This project is funded by a health NGO in Pakistan. Only those candidates will be admitted who will show interest in palliative care as profession. We are hoping that we will be able to give them a reason able stipend during their stay as student. We are developing a special curriculum with the help of friends working in this area. We are hoping that qualified, competent and trained individual from this center will be able to help patients needs palliative care at DONATE GENEROUSLY NATIONAL HEALTH FORUM PO Box St. Louis, MO KID EATING FROM GARBAGE NONPROFIT ORG U.S. POSTAGE PAID ST.LOUIS, MO PERMIT #PI 1694