Association of Pakistani descent Physicians of North America (APPNA) is one of the largest Pakistani origin physician’s organisations in the United States with almost 2000 dues paying members. This organisation is more than 30 years old and has over this time evolved from being just a ‘fraternal’ collection of Pakistani origin physicians into a true welfare organisation. Before I proceed, I must in the interest of full disclosure inform my readers that I am a ‘life time’ member of this association and have been a part of it for almost three decades.

Essentially, APPNA has two major goals. First is to provide a platform where Pakistani American physicians in the US can interact and network for professional and social reasons. The second goal is to help develop and improve medical care in Pakistan. Over the years, APPNA has done a great job as far as its first aim is concerned but was never really effective in having any lasting impact on the quality of healthcare in Pakistan.

Most physicians in Pakistan do not realise that APPNA is also the ‘umbrella’ organisation of different US alumni associations of Pakistani medical colleges and universities. As such its component alumni associations have provided direct support for different medical colleges. This support has been responsible for improving care in the attached hospitals of the parent institutions as well as improving medical education.

The King Edward (KE) Alumni in the US, for instance, support a well-established computer network in KE and Mayo Hospital besides providing scholarships to deserving students through five years of medical college. Another example is of the Faisalabad Medical College Alumni that helped set up a neo-natal Intensive Care Unit in the affiliated teaching hospital. Other alumni are and have been doing similar things.

Also, general membership of APPNA supported disaster relief efforts during the devastating earthquake in the northern areas a few years ago. Such support was not only in monetary terms but many APPNA members came to Pakistan and actively participated in the medical relief. However, APPNA by itself never had a lasting presence in the Pakistani medical scene.

With the focus on treatment of ‘active’ disease, most Pakistani hospitals, both in the private and the public sector, have developed the capability to treat even the most advanced medical problems. More importantly from the perspective of APPNA, advanced expertise available in the US can at best only marginally add to the general quality of medical care in Pakistan. As it is, Pakistan already has a wealth of well-trained physicians that are capable of handling most medical problems.

Even so, many Pakistani American physicians travel to Pakistan every year at their own expense to provide free specialised care in local hospitals. This is especially true in the field of cardiac medicine. The US based physicians bring donated ‘supplies’like coronary stents with them and implant them in needy patients free of cost. This has been going on for many years.

However, the education and training of public healthcare workers is still lagging behind training of physicians and ancillary staff responsible for care of established disease. The old adage that ‘prevention is better than cure’ is extremely important for a ‘poor’ country like Pakistan. Prevention is much cheaper than curing established disease. APPNA has recently collaborated with Pakistani medical institutions on the ‘hepatitis epidemic’ in Pakistan and how to prevent it.

In 2013, APPNA for the first time took a major step in the right direction by supporting the creation of a Public Health Institute attached to the Sindh Medical University. This new institute is called the ‘APPNA Public Health Institute’. Clearly, public health and preventive medicine is one area that needs development in Pakistan. And by taking the initiative to help set up this institute, APPNA might finally have taken an important step to leave a ‘permanent and positive footprint’ in the realm of medical education and care in Pakistan.

Dr Javed Suleman, the president of APPNA, took the lead in this initiative in 2013. Dr Suleman is one of the US-based physicians that has visited Pakistan many times over the last few years to perform free cardiac procedures for needy patients and was awarded a Tamgha-e-Imtiaz by the Government of Pakistan for his services. I approached Dr Suleman to enquire about his reasons for taking on this initiative at this time. He had an interesting story to tell that is worth recounting. And I quote:

"As president of APPNA, I was invited to the Iftar dinner at the White House in August, 2013. We were about 250 guests there, and fortunately I was seated right next to President Obama. When I told him that I represented the Pakistani American Physician community through APPNA, he seemed impressed. In the casual chat we had, he stressed that countries like Pakistan should place more of their resources in public health education and prevention of disease. The meeting ended late and I missed the last train back home. I had to rent a car and while driving home I kept thinking about what President Obama had said, and that gave birth to the idea of APPNA Institute of Public Health."

Dr Suleman then brought up the idea among other members of APPNA where there was considerable support for it. He then approached Vice Chancellor (VC) of the Jinnah Sindh Medical University (SMU) about APPNA helping them set up a Public Health Institute as a part of the University. SMU was recently upgraded to university status and before that was Sindh Medical College (SMC). Dr Suleman is an alumnus of SMC and has been involved in its change of status to a university. As such it was natural for him to think of his alma mater to start such an institute.

Professor Tariq Rafi, VC of SMU, took up the suggestion positively and over a short period of time, a feasibility study was prepared. The budgetary requirements for the building and subsequent staffing the institute for a period of three years came to just over three million US dollars. APPNA officially then committed to provide ten per cent of the costs. So far, APPNA members have donated about eighty five thousand dollars towards this venture. APPNA leadership has also approached US AID for financial support and are hopeful that such support will be forthcoming. The institute was officially inaugurated on December 26, 2013. The institute will train physicians and paramedical staff in public health issues.

What the future holds remains to be seen, but it is definitely a good beginning. Public health, especially preventive medical care, is extremely important area for a country like Pakistan where more people die from preventable medical problems than from most other causes. Prevention starts from prenatal care (before birth care for mother) and goes on through things like childhood vaccination, control of communicable and waterborne disease and other important issues like early detection of chronic disease and education about risk factors for serious illnesses.

The important concept to consider is that public health is an independent area of study and not just an adjunct to medical education at the undergraduate level. As a subject it is important enough to require institutions that specialise in education and research in this field.