Springtime in Belgium



Dr Wajid in Media Mark Brussels

 Belgium is small but a nice place for visitors during sumer time. Belgium is an inpartant country in EU because its capital of EU so you can see here representative of all countries. Th e climate of belgium is very intresting and i enjoy alot. I will never forgot these days which i spent in belgium. i like and Love belgiul climate. belgium Governament also give alot of facilities to visitors, I am very satisfy from belgium govenament that they give facility to all, not only own citizens but to all.  There are many historic and very famouse places in belgium, which i visited and like laot. I also go to see side and i become surprise to see that how organized evry one here.

Hepatitis B virus (HBV) infection is a major global health problem , especially in Asia, Africa, southern Europe and Latin America. About 2 billion people are infected with HBV worldwide, and 400 million among them are suffering from chronic HBV infection. Pakistan is highly endemic with HBV with nine million people infected with HBV and its infection rate is on a steady rise. The reason may be the lack of proper health facilities, poor economical status and less public awareness about the transmission of major communicable diseases including HBV, HCV and HIV.
  The clinical course and sequel of chronic hepatitis vary among individuals. Infection with HBV leads to a wide spectrum of clinical presentations, ranging from asymptomatic carrier state to acute self-limiting infection or fulminant hepatic failure, chronic hepatitis with progression to cirrhosis, and hepatocellular carcinoma (HCC). Studies are too limited to give a clear picture of the prevalence of HBV at the National level, especially among otherwise healthy individuals. Most previous studies targeted different small groups of individuals with some clinical indications therefore; these do not accurately reflect the overall prevalence in Pakistan. The present article briefly presents the prevalence, risk factors associated with HBV transmission, awareness status and HBV genotypes prevalent in Pakistani population. 

Risk factors associated with HBV infection

History of dialysis for more than 2 years is a risk factor for dialysis patients. Major risk factors for mother to infant transmission include increasing maternal age, number of pregnancies, repeated injections and addiction major risk factors in surgical patients include re-use of contaminated syringes, contaminated surgical instruments and blood products risk factors in pregnant women (antenatal) include ear and nose prick, history of jaundice among them or with their partner, history of blood transfusions, history of injections

HEPATITIS IS A SILENT KILLER IN PAKISTAN.



HEPATITIC LIVER



A person may have hepatitis virus while not being aware of it as sometimes in the case of HBV infection, the primary cause of the disease, has no symptoms at all. The newborns are at particular risk as they can get HBV at birth. The failure of the government to include hepatitis B in the immunization programme and the absence of creating the public awareness that the situation demands, is putting millions of new born at high risk. This is more fearful as Pakistan already has a high infant mortality rate of 88 per 1000 and under-five mortality rate of even higher as 123 per 1000. While children are at particular risk, the huge majority of adult population is also at the risk due to lack of public awareness in Pakistan. Even the medical profession, which should have played its due role to create the public awareness, has failed to fulfil its obligations to a great extent. For instance, a fairly educated father of a new born baby was given a vaccination card by the doctor at the clinic where his son was delivered. While the card listed six fatal diseases— poliomyelitis, neo-natal tetanus, pertussis, diphtheria, tuberculosis and measles, included on the Extended Programme of Immunization (EPI) of the government, it only mentioned hepatitis B vaccination as optional. This is also the case with the majority of the maternity hospitals as the government has not officially included the hepatitis B vaccination in the EPI. The majority of population, not only the vast number of illiterates but also many in the fairly educated group, are thus unaware that hepatitis B vaccination is no more optional but a must. The mass unawareness and the lack of concern on the part of the government are putting the lives of the majority of newborns at grave risks. Sources in the medical profession, who chose to remain anonymous, blamed the indifference of the government to include hepatitis B in the national immunization programme on account of non-allocation of funds. As is, the health sector has been allocated a meagre Rs 2.7 billion in the Budget 1999-2000 which translates into just 2.3 per cent of the funds allocated for the development expenditure only a part of which will go the existing EPI. Sources blamed the reluctance on the part of the government to officially include the hepatitis B in the national immunization programme as it would mean making provisions for funds. As hepatitis B vaccination is fairly expensive the inclusion would mean an allocation of Rs 3.25 billion to vaccinate about 5 million babies every year. However, the economic justification is medically and morally unacceptable as it put the lives of babies at great mortal risk. The cost of hepatitis B vaccination, which is administered in three doses over two months, is high for a poor country like Pakistan where many find it unaffordable. Unlike developed countries where hepatitis vaccines cost no more than buying a bottle of mineral water in a restaurant, the cost of the vaccination in Pakistan, which is totally dependent on imported vaccine, is highly expensive. Hepatitis B vaccination in Pakistan costs Rs 645 for children and almost Rs 1,100 for adults for all three doses. While the government has chosen not to play a role in the vaccination of hepatitis B, the Pakistan Medical Association (PMA) has been trying to create public awareness on the issue for the last two years. However, it was only recently that the PMA initiated a media campaign to set up hepatitis B vaccination centres in the country.

The PMA has established 12 centres in Karachi offering hepatitis B vaccination for both, adults and children, at a ‘discounted rate’. PAGE visited one of the twelve centres, at PMA House, on two consecutive days and found not a single administration of the vaccination. The attendant, however, claimed that the campaign, started two weeks ago (to end on August 15), vaccinated some 30-35 persons per day initially and some 65 persons a day in its finishing phase. Half of those administered vaccination were children, he added.

The multinational pharmaceutical company, SmithKline Beecham, is providing the hepatitis B vaccine, imported from its parent company in Belgium, at a discounted rate for the PMA campaign. Beecham is providing the two dosages of the Vaccine— 10 mcg for person’s up to 19 years of age and 20 mcg for all those above— at four per cent discount. While the vaccine is available for Rs 205 and Rs 340 at the designated vaccination centres as compared to Rs 214 and Rs 354 in the open market, the centres does not charge for disposable syringes and the fee, a saving of about Rs 30. Sources told PAGE that while the PMA awareness drive, over the last two years, has been able to create a greater awareness about the hepatitis B, much remains to be done as not even one per cent population of Pakistan is vaccinated against the deadly disease. Though the awareness has grown somewhat in the urban centres, the bulk of population still remains oblivious to the risk that hepatitis B poses to their health. The situation in the rural areas, which houses the majority of Pakistan’s population, is worse.

Even in the urban centres, such as Karachi, the campaign has elicited diametrically opposite response from basically two segments of the populace, those who can afford it and those who cannot. Sources told PAGE that the lower income group has shown much greater interest in the campaign as compared to those who could easily afford it. However, despite the overwhelming response the former are finding it difficult to afford. On the other hand only a small portion of those who can afford it, has chosen to get vaccinated, PAGE was informed.

HEPATITIS CAN BE PREVENTE AND CONTROL IF…

1. Government should established Screening / diagnosis centres for hepatitis at Teaching & DHQ level Hospitals free of cost, that every one 
2. Government and NGOs provide Counselling and treatment facilities of chronic liver diseases at Provincial, District and Tehsil level hospitals in a phased manner.
3. Establishment of Reference water quality control laboratories at National institute of health (NIH) and at Provincial level.
4. Improvement of health care provider’s knowledge for prevention of Hepatitis through focus on injection safety.
5. Safe blood transfusion practices.
6. Hospital Waste Management System.
7. Introduction of lab based surveillance system for evidence based policy decisions and creating opportunity for epidemiological research studies mainly community based and establishment of provincial satellite offices of the Provincial Coordinator.
8. Advocacy and Behaviour Change Communication (BCC) Strategy development and execution on persistent basis for prevention of Hepatitis by creating awareness among general masses for adoption of healthy practices.
9. Strengthening of routine immunization services of Hepatitis B vaccine for infants through provision of immunization against Hepatitis B in children below one year of age by using Expanded Program of immunization infrastructure.
10. Reduction of vulnerability to Hepatitis in medical staff of public sector and other High Risk Group.

In addition to receiving vaccinations against hepatitis A and B, here's how to protect yourself against hepatitis virus infection:

Ø  Don't have unprotected sex.

Ø  Avoid intravenous drug use and sharing of drug paraphernalia.

Ø  Wash your hands before handling food and after using the bathroom.

Ø  Be sure tattoo or piercing shops sterilize needles and other equipment properly.

Ø  Don't share toothbrushes or razors. Hepatitis can be transmitted through sores or cuts.

Ø  Avoid eating raw shellfish (such as clams or oysters). You could put yourself at risk for hepatitis A if the shellfish was harvested from contaminated water.

Ø  Hepatitis infection can be serious, but knowing what puts you at risk can help protect you.

Hepatitis is big challenge in Pakistan.

 Hepatitis C virus (HCV) is well known etiological agent for causing chronic hepatitis, liver cirrhosis and hepatocellular carcinoma in developing as well as developed countries. An estimated 170 million people are chronically infected with HCV and 3–4 million people are newly infected each year. The World Health Organization estimates that approximately 3% of the world population has been infected with HCV.

HCV infections are serious public health concern in Pakistan. The first description of HCV in Pakistan was in 1992 and since then there is no proper review. With approximately 6% of the population being affected by it (approximately 10 million), it is becoming a Herculean challenge. With the current disease burden, Pakistan has Left behind all the major developed countries like Japan, USA and Europe. The annual incidence of HCV in the industrialized nations has fallen in recent years, primarily because of effective blood screening efforts and increased education on the dangers of needle sharing. Contrary to that the burden of HCV related chronic liver disease (CLD) in Pakistan has increased. Studies from the past showed that of all patients presenting with CLD, 16.6% were anti-HCV antibody positive but more recent data shows nearly 60–70% patients with CLD tend to be positive. Medical literature had also reported that nearly 50% patients with hepatocellular carcinoma (HCC) in Pakistan are anti- HCV antibody positive. Past medical literature reports a highly variable seroprevalence of HCV from different studies in different population and the trend continues within the same province. The reason is primarily attributed to HCV being a blood-borne infection, spreads rather sporadically or in micro epidemics. The most predominant HCV genotype is genotype 3 (75-90%), followed by genotypes 1, 2, and 5. In Pakistan, several population groups have been described as being at increased risk of HCV infection. In several published studies, the proportion of patients with HCV infection who received injections is in the range of 16% to 100%. High prevalence of HCV has been recorded among middle-aged (40-50 years) people[6]. Haemodialysis patients were also noted to be at high risk of HCV infection. High HCV prevalence (23.7% to 68.0%) has been noted in this group of patients, and particularly those on long-term haemodialysis. There are about 1.5 million units of blood products transfused each year in Pakistan. Data on the safety of this transfusion process is rare which may be due to the lack of system of reporting infectious or non-infectious adverse events. The risk of HCV transmission through blood transfusion in Pakistan is still unknown but is considered to be high due to a lack of appropriate screening of blood. Also, number of studies have shown the relationship between therapeutic injections using non-sterile needles and the transmission of HCV. There is an enormous dependence on parenteral therapy for treatment, both in the form of injections and infusion of drips, driven by cultural beliefs in the power of parenteral therapy. The general population of Pakistan typically prefers to be treated by injection rather than oral medication. Thus, patient demands and financial incentives for doctors favor the use of injectable treatment in patient care. Another significant risk factor of HCV transmission which had previously been reported from different regions of Pakistan is daily face and armpit shaving at community barber shops. The delicate skin of the face and armpit are susceptible to micro trauma, Hepatitis C in Pakistan- A neglected challenge leading to possible exposure to HCV through a contaminated traditional long-handled razor. Additional risk factors that may be important modes of transmission include ear piercing and non-sterile surgical and dental practices of unqualified health care workers. The HCV epidemic in Pakistan continues to rise due to lack of education and awareness of the disease, shortage of medically qualified and scientifically trained health care workers and lack of health infrastructure. The government of Pakistan had taken some steps in this area in the past, by announcing a national blood policy in 2003. In 2001–2002 Pakistan received a grant from the Global Alliance for Vaccines and Immunization (GAVI) that has enabled the introduction of Hepatitis B vaccination in routine Expanded Program on Immunization (EPI). Vaccination for HBV as part of EPI was launched in a nationwide vaccination campaign in 2004. Unfortunately, HCV infection is not a notifiable disease in Pakistan and there is no national data collection system for evaluation of routine risk factors. In March 2009, government officials reported the Senate that around 8,800,000 people in Pakistan are suffering from deadly hepatitis C while another 5,600,000 are affected by hepatitis B and that availability of diagnostic facilities and awareness campaigns have un-earthed the hidden burden of the disease. The Prime Minister Programme for Prevention and Control of Hepatitis was launched in August 2005 with a total cost of Rs 2.594 billion for a period of five years. The number of patients with the disease since then has increased significantly as the government started to provide free treatment, though on a limited scale. When the programme was launched in 2005-06 the number of patients, most of them poor, who were registered and treated at government hospitals were 10,815 and 1,000 for hepatitis C and B respectively. For the year 2008-09 the figure is 84,773 and 7,204 respectively for the two categories of the disease. If we critically analyze the figures with the present disease burden, we confront with the harsh fact that the gap between people getting affected each year and getting treatment is too wide and only a small population is seeking care with yet uninvestigated numbers of actually getting rid of the disease. The picture gets even gloomier if we realize that this what government is reporting and the ground reality may be even worse. The increasing HCV epidemic is likely to progress to a considerable increase in disease burden over the coming years. The pillars of HCV infection control are blood safety, the prevention of needle sharing among Intravenous Drug Users (IVD), the strict implementation of standardized preventive measures in healthcare settings, screening of at risk groups and treatment of chronic hepatitis with multiple drug therapy (pegylated interferon and ribavirin). Despite its public health importance, however, how surveillance systems for hepatitis C should be designed is still a matter of debate. Cross sectional surveys on at risk population or groups are essential to estimate the burden of HCV infection and to describe affected persons who will need to be targeted for screening and treatment. However, they reflect past transmission routes, provide no information on the current dynamics of HCV transmission and no data on people currently getting infected. Although the world is now hearing about Hepatitis awareness specially after commencement of the Hepatitis awareness day On May 19th every year from 2008, numerous efforts are required to prevent this day from becoming an event of seminars, lectures and conferences and the rest of the year , we forget about the disease. We are living unfortunately without HCV vaccine, because of the virus high mutation rate and substantial heterogeneity of the genome of HCV. Still it is largely treatable and HCV infection can be cured by the existing antiviral drugs in more than 50% of the patients. So efforts should be made to save the waste of at least 50% of these needless lives. Hepatitis preventing measures should include a situational analysis and a realistic assessment of the blood requirement in the area, followed by recruitment and maintenance of voluntary, non-remunerated blood donors and standardization and regulation of appropriate blood screening procedures. IDUs are numerous in Pakistani society and though they have a disproportionately high burden of health problems, they have been inadequately studied. Disseminating adequate information about all aspects of HCV is essential in developing patient understanding of the disease. It appears such information can only be effectively and reliably disseminated through effective awareness strategies. We also propose that for health promotion action, programmed should be made to increase awareness and use of specially prepared video clips for the prevention of disease. Media is one of the instrumentalities which facilitates and gives a directional Thrust to the efforts to cure the disease if not to treat it. If medicine can treat Hepatitis, media is capable to prevent it with an ultimate goal to cure it through its capabilities to impart education through entertainment.

Hepatitis vaccination center in Nowshera



Sajid Iqbal Daudzai Advocate Nazim ( Mayor ) Union council
Azakhel Bala Noshera Pukhtoon khwa.



Nowshera District (Khyber pukhtoon khwa, Pakistan) is known for its various types of industries located on the bank of river Kabul. It has borders with Peshawar on the west and Punjab province on the east. Most of the population is Pushto speaking. The district has about 200 villages.Viral Hepatitis is a cause of great concerns the world over and more so in the developing countries especially in Pakistan. Its incidence has already increased to alarming proportions and is likely to increase further in the near future. Among the hepato-celluler viruses, B and C tend to be more severe and lead to chronic conditions, co-morbidity and high case fatality rates. In Pakistan, the following factors are responsible for the spread of these viruses,

1.    Invasive surgical practices,

2.    Infected syringes

3.    Unsafe blood transfusion,

4.    Unhygienic instruments used by barbers and vertical transmission from mother to child during pregnancy.

More than one cause was reported to be risk factor for transmission of the disease by our study group. However the most common causes reported were repeated use of disposable syringes, dental apparatus, nail cutting, and sexual contact amongst many others.

Local studies shows that carrier rate of Hepatitis B Virus (HBV) is 4-10%. It is estimated that 7% of all blood donors, 3.5% of all children and 13% of all cases requiring hemodialysis are Hepatitis B surface Antigen (HBsAg) positive. HBV infection has been reported to cause 31% of acute viral hepatitis cases, 60% of patients with chronic liver disease and 51% of cases of hepato-cellular carcinoma. Whereas, the sero-prevalence of Hepatitis C Virus (HCV) is 6.7% in women and 1.3% in children in Pakistan.3 In Italy about 4,00,000 new cases occur each year. About 200,000-300,000 new cases of Hepatitis B occur annually in the USA Hepatitis C accounts for approximately 20% of cases of acute hepatitis, 70% of chronic hepatitis and 30% of end stage liver disease in the USA. This study was undertaken to assess then knowledge of rural communities in regard to HBV and HCV in 10 villages of District Nowshera, Kyber Pukhtoon khwa, Pakistan. Nazim Sajid Iqbal Daudzai Advocate Nazim (Mayor) union council azakhel bala request from NIH ( National institute of health) to make hepatitis vaccination center in DHQ Hospital Nowshera. Now NIH has vaccination center in DHQ hospital Nowshera. Peoples of nowshera now no need to go NIH or PIMS islamabad for vaccination.

Prof S.M. Awais ( Sitara-e-Imtiaz )

Prof S.M. Awais ( Sitara-e-Imtiaz )

Prof S.M. Awais ( Sitara-e-Imtiaz )
Syed Muhammad Awais was born on 10th December, 1955 at Sialkot, Pakistan. His father Syed Mushtaq Hussain was a Government Servant. Awais completed his primary education at Karachi, Higher Secondary School Education at Gujranwala (1972). Graduate Medical Education from Nishtar Medical College, Multan (1979), and Post Graduate Education in Surgery from College of Physician and Surgeons of Pakistan 1982, Masters in Orthopedic Surgery from Punjab University, Lahore (1985), M.Sc. Bio-Engineering from Dundee University, U.K. (1987). Dr. Syed Muhammad Awais started house Job on 16-11-1978. He joined Government Service as Demonstrator Anatomy, Rawalpindi Medical College on   09-03-1980. He became Registrar, Orthopedic Surgery at Mayo Hospital, Lahore on 24-07-1980, Senior Registrar, Mayo Hospital on 18-04-1983, Assistant Professor, Orthopedic Surgery at King Edward Medical College on 20-04-1986, Associate Professor at King Edward Medical College on 12-04-1989 and became Professor of Orthopedic Surgery on 12-01-1995 (on regular basis). He has worked as Prof. at Postgraduate Medical Institute, Allama Iqbal medical College and is now working at KEMC, Lahore
As a Researcher; He has to his credit development of new devices and techniques in Pakistan Bone Lengthening Device used in the country and abroad as Naseer Awais Fixato (NA-Fixator). This device has been published in Principles and Practice of Surgery by Baily & Love published from U.K. (The largest selling book on surgery in the world) (2) Modular Ankle Foot Orthosis for cerebral palsy children, (3) Custom-Made Total Hip, Total Knee and Shoulder Prosthesis, (4) Wooden L-Board used for Gait Training of Paraplegics, (5) Indigenous Halo Pelvic Distraction Apparatus for Difficult Spinal Problems, (6) Solid Nail for Tibia Fractures and (7) Technique and Apparatus for elongation of Peripheral Nerve Defect. All devices were designed and manufactured in Pakistan. He supervised and co-supervised more than 40 research projects leading to Dissertations of CPSP and Master of Surgery (M.S.) Thesis of Punjab University. He has contributed more than 45 research papers and other publications to different Medical Journals and Books. He has five Longitudinal Research Projects in Epidemiology, Experimental and Clinical Research.
In 2004 he has been selected by WHO , Geneva as resource person for two projects; (i) development of Patient Management and tracking program for Orthopaedic patients and (ii) improvement of surgical care through e-learning for which Pakistan has been elected as a pilot country.
As an Educator He has been regularly involved in education courses of Diploma in Physiotherapy and Diploma in Orthopedic Technology of Orthopedic Technicians, MBBS for medical students, FCPS (Ortho) and MS (Ortho) Courses. He is author of Training Program for Orthopedic Surgeons in Pakistan (approved and practiced by CPSP – 1990 and University of Punjab - 2001)
He has experience of coordinating curriculum committees of the University of Punjab for uplifting and modernizing 43 postgraduate courses of MD/MS/MDS/M.Phil in different subjects.  He is author of common guidelines of B.Sc. honors programs (2004) of medical technologists at University of Punjab.
Prof. M. Awais was member of National Task Force on Nursing Education established by the Higher Education Commission of Pakistan (2004). He is representative of University of Punjab for collaboration project on postgraduate education program with university of Brussels, Belgium.
Prof. Syed M. Awais has the honor of working as member of the Chancellor’s Consultative Group for Reforming Education in Public Universities of the Punjab. He is assisting the Governor Punjab in bringing.     

Higher Education Reforms in Punjab.
Prof. Syed M. Awais has played important role in organizing six National Seminars on postgraduate Medical Education during 2001 to 2003 in different Universities of Pakistan and developed National Consensus recommendations on the Guide Lines to revise Curriculum for Postgraduate Medical Education.
He has given Post Graduate Training as Supervisor/Co-Supervisor to more than 40 doctors for FCPS and MS courses in Orthopaedic Surgery. He was trained in (i) curriculum planning and development (ii) Effective Teaching and (iii) Assessments in Medical Education in University of Dundee in 1987.
He has organized 30 National/International Conferences/Workshops/Seminars/Courses. He has extensively traveled abroad (for more than 40 times) as invited speaker/visiting Fellow/visiting Professor and as a participant in Scientific Conferences/Seminars. (Never sponsored by any pharmaceutical or businessgroup)
As a Clinician He has National and International recognition in his major areas of interest i.e. Spine, Pelvis, Limb Salvage in Bone Tumors, Limb Lengthening/Bone Segment Transport, Rehabilitation Surgery, Orthotics and Prosthetics and Biomechanics.
He runs a Bone Tumor Management Services where Limb Salvage is carried out. The mega prosthesis in this service are designed and developed in Pakistan and are provided free to the patients.
As Editor, other than being a member of various editorial boards he was editor of KEMC Bulletin and was Chief Editor, Journal of Pakistan Orthopaedic Association (1998-2001) and 92003-2004) and is member Editorial Board (2004-2007). He is Assistant Editor of International Orthopaedics published six (6) times a year from Belgium (2000- to date), which is an official Journal of International Society of Orthopaedic Surgery and Traumatology. In 2000 he was elected as Editor-in-Chief of Punjab University Journal of Medical Sciences. He is Chairman of Journals Committee of PMDC. He is Principal author of the document PMDC Guide Lines for Editors of Medical and dental Journals and member of the Council of Science Editors, USA. He has written extensively on different topics of Orthopaedic Surgery, Undergraduate and Postgraduate Medical Education, Reforms and Restructuring of the Health Care Systems in Pakistan, the early experience of Autonomy in Medical Teaching Institutions. He is member/fellow of eleven (11) National and eight (8) International Associations/Societies dedicated to research and Education and service in medical field.
As Social Worker;
He is actively contributing in areas of Rehabilitation of Physically and Mentally Disabled, Accident & Injury Prevention, Health Care Education, Management of Orthopaedic Problems and has contributed in improving hospital services. In all Public Hospitals where he has worked, enormous restorations and uplifting were carried out through private donors. He has so far arranged private donations of more than Rs. Twenty (20) Millions for uplifting of the Govt. hospitals and to provide treatment facilities to poor patients.  For poor patients from outside Lahore he conducts Free Camps.
He is Technical Advisor to (i) Okara welfare Trust Hospital Okara since 1993. This charity hospital has grown into a full-fledged facility for modern Orthopaedic treatment services. (ii) Alrae Trust Hospital, Gujranwala. He conducts 4-6 Free Camps per year at out reach areas with other voluntary doctors.
He has also contributed in accomplishing followings through private donations;
1.New Operation Theatres at Services hospital Lahore. 1998 (approx four millions).
2.Internet Library at PGMI 1998   (1.5 Lacs)
3.Free food for all poor patients of the Orthopaedic wards at Jinnah hospital and Mayo hospital Lahore, 1999 to 2003.
4.Free medicines and Implants to poor patients at Mayo hospital, Services hospital, Jinnah Hospital and Mayo hospital (1995 to date) during tenures of his postings.
5.Uplifting of Operation Theatres at Jinnah Hospital.
6.Uplifting of Emergency OT Mayo Hospital, Lahore 2001 (one million).
7.Uplifting of Orthopaedics OPD Services at Mayo Hospital 2001 (3.5 Lacs)
8.Uplifting of Orthopaedic Ward, (2 millions)
9.Uplifting of Orthopaedic Operation Theatres (5 millions)
10.Establishment of New Education Center with 21st century educational and computer with internet facilities at Department of Orth. Surgery KEMU/MHL(3 million Rs.)
11.Strengthening of Medicines and Implants services to poor patients of ward patients (5 million per year)
12.Developed one floor of new building of Pediatric Medicine at cost of Rs. 4.0 Millions.
13.Earthquake; Established Orthopaedic Operation Theaters and Intensive Care Units at DHQ, Mansehra, and AIMS Muzafarabad. (cost 25 millions).
14.Under Construction Limb Fitting Center and Physitherapy Center at AIMS, Muzafarabad, (Rs 10 Millions)
15.Under construction Education Centers at DHQ Mansehra & AIMS Muzafarabad. (cost Rs 3 Millions).
16.Installation of Automatic Sterilizers at Ortho OT Mayo Hospital, Lahore, (Rs one Million ).(March-1006)
(He has developed a successful model of Private – Public Cooperation)
As Manager He has training and experience in Curriculum Planning and Management, Systems/Process Management, Working Group Coordination and Quality Control Standards.
He is producing every year Annual Policy Manual for the educational and clinical procedures of his department since 1998. He has arranged his own international performance audits in 1999 and 2000 through support of International Society of Orthopaedics and Traumatology and Canadian Orthopaedic association. At present he is preparing his department for ISO standardization with the help of Pakistan Institute of Quality Control and an Echo West (a private concern). The project will be completed in October 2004 at the cost of Rs. One million by the private donors.
He was appointed as Member of Management Committee of Gujranwala Sub-Campus of University of The Punjab 2005-06
Hobbies
Being Student      
Cricket, Hockey, Volley Ball, Weight Lifting and Riding.
Being Professional
Reading, Writing, Research, Traveling and Voluntary Social Work.
Marital Status; Married with four (4) Children born in 1987, 1989, 1991 & 1995.
                                QUALIFICATIONS AND EXPERIENCE.


ACADEMIC QUALIFICATIONS

1.1970 Matric, Lahore Board – St. Joseph’s English High School, Gujranwala – First Class
2.1972 F.Sc., Lahore Board – Govt. College, Gujranwala – First Class
3.1973 - 1978 M.B.B.S. Nishtar Medical College, Multan / Punjab University – All Professional Exams First Attempt, First Class
4.Oct. 1982 M.C.P.S. (Surgery), College of Physicians & Surgeons of Pakistan – First Attempt
5.April, 1985 M.S. (Orthopaedics) (Master of Surgery in Orthopaedic Surgery)¸ Punjab University – First Attempt.
6.October, 1987 M.Sc. (Bio-Engineering) Dundee, U.K. – First Attemp
The Chancellor / Governor Punjab;
Member, Governor’s Consultative Group for Higher Education Reforms, since 2003 as member of this group has participated in,
(1) Uplifting of Curriculum in all Universities of Punjab,
(2) Development of Policy for Faculty Development,
(3) Launching Quality Assurance of Academic Programs,
(4) Harmonization of Admission and Academic Calendar of Universities.
(5) Review of Administration of Public Universities of Punjab.
(6) Principle Author of Guidelines for developing Curriculum of Higher Education Programs approved by the Vice Chancellors Committee of Public Universities of Punjab under Chairman ship of Governor Punjab, in 2003.
(7) Participated in Punjab Vice Chancellors Committee meetings 2004 & 2006 at Governor House Lahore.
(8) Accompanied Governor Punjab to attend;
national conference on Semesterization held at Baha-ud-Din Zikria University Multan on 24th January 2006.

University of the Punjab;
1. Being Associate Dean Postgraduate Medical Education since 2001 contributed in  revision of Statutes and Regulations of Postgraduate Medical and Dental Courses at the University of Punjab in 2001, and development of modern curriculum of forty eight (48) courses of MD/MS/M.Phil/MDS.
2. Member Board of Studies in Medicine,
3. Member Advanced Studies and Research Board;
4. Member Doctoral Program Coordination Committee has contributed in:
4.1 Launching of Ph.D. Program in the Faculty of Medicine and Dentistry (2001). Conducted entry tests during 2001,2002,2003,2004,2005, and organized PhD Research Synopsis evaluation of more than fifty (50) PhD candidates.
4.2, Principal Author and Launching of New M.Phil leading to PhD, Programmes (2006) for Basic Medical/Dental/ Nursing and Allied Health Sciences.
5. Member MD/MS/MDS/M.Phil Research Synopsis Review Committee on behalf of VC Punjab.
6. Punjab University Gujranwala Campus; Member Punjab University Gujranwala Campus Management Committee, Chairman Curriculum Reforms Committee to revamp curriculum of all Programs, Member Quality review with visiting US Prof. Rodger Randle.
7. Member Qualification Equivalence Committee.
8. Principal Author of Frame work of Curriculum for B.Sc. (Hons.) Professional Courses in 16 Allied Health Science Subjects.
9. Collaborated in organizing Faculty Development Courses at Human Resource Development Center.
10. President, Punjab University Medical Postgraduate Alumni Association PUMPAA. Since 1999.

As Professor Orthopaedic Surgery;
Other than regular teaching, training and research,
1. 1995 at Postgraduate Medical Institute, member of Library Committee, Postgraduate Curriculum Reform Committee, and Chairman Store/ Purchase Committee.
2. 1996 at Allama Iqbal Medical College; Store Purchase Officer,
3. 1997, King Edward medical College, Deputy Chairman Research, Member Library Committee, Secretary KE Alumni Symposium, Chairman Boxing Club, Member Curriculum Committee, Member Institutional Autonomy Committee,
4. 1998 Postgraduate Medical Institute, Member Library Committee, Curriculum Committee,
5. 1999-2000 Allama Iqbal Medical College, Chairman Institutional Private Practice Committee (Author of Private Practice Policy), Chairman Hospital Purchase Committee, Chairman Library Committee, Chairman research Committee.
6. 2001- to date Chairman Library Committee, Member Medical Education Committee, Director Postgraduate Education of Punjab University. President Shooting Club, Examiner B.Sc Physiotherapy and M.S Orth Examinations. Education Committee, Pakistan Orthopaedic Association (2004-06)
7. Principal author of The Policy Document of Strengthening of Emergency Medical Services (2004) by Punjab Government.
8. Principal Author, Training Courses for Nurses and Paramedics.
9. Principal Author, MBBS. Orthopaedics Surgery Curriculum, HEC, PMDC. 2005.
10. Author of Standards and Procedures Book for standardizing the departments of Orthopaedic surgery and Traumatology.
11. Author of the Accident and Emergency Manual for Emergency department of Mayo Hospital, Lahore.
12. Author of first Postgraduate Training Program for orthopaedic surgery in Pakistan (1990).for FCPS.
13. Author M.S.(Orth) Curriculum, 2001, Punjab University.
Pakistan Medical & Dental Council, (PMDC).
1. Member since 2000 to 2005
2. Executive Member 2000-2004.
3. Chairman Journals Committee.
4. Member Curriculum Committee, Continuous Professional Development Committee, Ethics Committee. Qualifications Schedules Committee.
5. Principal Author of the Code of Ethics for Medical and Dental Practitioners.
6. Principal Author of the Guide Lines for Authors, Reviewers and Editors of Biomedical Journals.
Federal Ministry of Health
1. Member Drug Appellate Board 2004-2005.
2. Member Education Reform Committee, 2005-06
3. Member Ethical Committee for Pharmaceutical Businesses.(2006)
Higher Education Commission of Pakistan.
MBBS Curriculum committee, 2002-2004),
Task Force on Nursing Education,  (2005)
Punjab Health Department.
Member Orthopaedic PVMS Committee.1996-99
Co-Chairman Punjab Govt. Prequalification Inspection Committee. (1997-2000),
Secretary/member Medical Education Committee headed by Minister Health with  Secretaries of Health and Education and Principals of Punjab as member  1997-2000; Member Health reform Unit, 1996-1999.;
Member Emergency Medical Services Committee (Principal Author of Punjab Emergency Services Guide Lines);
Chairman Ortho- PVMS Committee (2001- to date).
Member Institutional Private Practice Committee.
Pakistan Orthopaedic Association;
1. Life Member since 1989.
2. Vice President 1990-92.
3 President Elect- 2003-04
4 President  2004-05
5. Immediate Past President 2005-06
6. Chairman Education Committee, (2004-2006).
Pakistan Medical Association. PMA
Member, Executive Body PMA Punjab.
Member, Executive Council, PMA Center
Member Education Committee.
Member Legal Committee. (2002-2004)
Orthopaedic Association of SAARC.(OASC)
1. Member.
2. Vice President 1997-2000
3. Executive Member 2004-2006
4. Chairman Education Committee.(2005-2007)
5. Publication Secretary & Editor of The Journal of OASC) since 2005.
Civil Services Academy, Lahore.
05-10-04, Gave Lecture on Analysis of Autonomy in Teaching Institutions in Punjab.
05.Gave Lecture on Transformation of Government Servants into Public Servants in Pakistan.
02-06; Discussion on Private Public Partnership.
International Society of Orthopaedics and Traumatology; SICOT.
Member, International Education Committee SICOT. Since 1997 National Delegate for Pakistan and member International Committee .
Member, International Board of Examiners, for awarding International SICOT Diploma to Orthopaedic Surgeons of all Countries of the world.
Pakistan Cricket Board Being Medical Advisor, and member of Medical Commission, (12-02-2005 to date) is looking after fitness and technical care of sports injuries of members of Pakistan Cricket Team and members of Cricket teams of India and England while in Lahore.
King Edward Medical University Being its Pro Vice Chancellor, and Chairman of several committees, has served to compile technical docu

HIV/AID in Pakistan



Dr Abdul Wajid khan Daudzai ( Belgium)



HIV is not currently a dominant epidemic in Pakistan. However, the number of cases is growing. Moderately high drug use and lack of acceptance that non-marital sex is common in the society have allowed the AIDS epidemic to take hold in Pakistan, mainly among injection drug users, some male sex workers and repatriated migrant workers. AIDS may yet become a major health issue.

The National AIDS Programme,s latest figures show that over 4,000 HIV cases have so far been reported since 1986, but UN and government estimates put the number of HIV/AIDS cases around 97,000 ranging from lowest estimate 46,000 to highest estimate-210,000. More realistic estimates that are based on actual surveillance figures, however, suggest that this number may be closer to 40,000 - 45,000. The overall prevalence of HIV infection in adults aged 15 to 49 is 0.1%. (0.05% if one accepts the lower estimates). Officials say that the majority of cases go unreported due to social taboos about sex and victims’ fears of discrimination. On the other hand, more detailed and recent data suggest that this may be an overestimate.

HIV epidemic evolves in three phases. First phase is low prevalence, when prevalence of the disease is less than 5% in any high risk group of the country. Second phase is concentrated epidemic when proportion of infected people in any high risk group rises more than 5%. Third and last phase of epidemic is generalized epidemic when prevalence of HIV infection rises over 1% among blood donor or pregnant women. Current data suggest that Pakistan has a concentrated epidemic among injection drug users in most cities and among male sex workers in a few cities.

Pakistan enjoyed a low prevalence phase of epidemic from 1987 to 2003. This may have been due to lack of formal surveillance systems, although no study found significant HIV in any group until 2002. In 2003, an outbreak of HIV among injection drug users in one city heralded the onset of HIV epidemic in the country. Since then different studies and the national HIV surveillance (which started in 2004) have confirmed an escalating epidemic among IDUs and more recently among male and transgender sex workers. Currently the national average prevalence of HIV among IDUs is nearly 20%. Several cities also show concentrated epidemic among MSWs/ TSWs as well.

A number of factors may have contributed to keeping the overall transmission of HIV within the general population. One, Pakistan is a predominantly Muslim country with near universal circumcision. Secondly, taboos on sex may have led to a higher proportion of the need for non-marital sex to be met via sex between men, much from a smaller group of men within each person's acquaintance. Some of this is suggested by the fact that about 45% of all sex acts sold are by either male or transgender sex workers (HIV/AIDS Surveillance Project 2007). These factors may have led to a high rate of HIV transmission among MSM/MSW networks but may (temporarily) slow down the transmission of HIV to the rest of the population.

A major factor that must be accounted for in the overall HIV transmission scenario is the rampant use of therapeutic injections, often with non-sterile injection equipment. There are an estimated 800 million therapeutic injections given annually in Pakistan or approximately 4.5 per capita. This is among the highest in the World. A small but significant proportion of these are reused. This has led to the prevalence of Hepatitis C infection (which is nearly exclusively transmitted via blood exposures) to become >5% nationwide, although this seems to have stabilized at a national level. Conservatively this suggests around 150,000 new HCV infections annually, leading to the conclusion that HIV can also potentially spread via this route as well. Indeed recent community based outbreaks in Punjab suggest that the process may have already started.

Pakistan’s response to HIV/AIDS began in 1987 with the establishment of a Federal Committee on AIDS by the Ministry of Health. The national AIDS control Program was then established. Its objectives are the prevention of HIV transmission among specific population sub-groups, safe blood transfusions, reduced STI transmission, establishment of surveillance, training of health staff, research and behavioral studies, and development of program management.

The prevention efforts received a major boost since 2004 when a World Bank loan/ grant allowed the Ministry of Health (and the provincial Departments of Health) to start a program which seeks to provide HIV prevention services to IDUs, sex workers and truckers; perform advocacy and communication for the general public and covers significant proportion of the national blood supply for HIV, HBV and HCV screening. This "Enhanced HIV/AIDS Control Program" has been able to establish these services using NGOs to perform the interventions in most large cities although the quality of the services as well as the completeness of their "coverage" remains low. Overall the IDU programs in Punjab are performing the best with over 70% coverage of target populations with services in 4 cities. Programs for sex workers lag some what but are bolstered by the fact that the metropolises have higher levels of knowledge and safer behaviors. However, the overall levels of coverage of services remain low at around 16% for IDUs and <10% for sex workers nationwide. The communication project has performed probably the least with only 44% of Pakistani women reporting ever hearing of the word "AIDS" in 2007. Finally HIV treatment was started in 2005. Currently over 900 individuals receive free HIV medicines and tests from 9 public and 3 private sector facilities.

Going forward the Government of Pakistan has approved a new ambitious 5 year plan that will be worth almost PKR 8 billion. However, a number of challenges will have to be met during this phase. The most immediate perhaps will be developing the methodology of measuring the impact of program interventions. A National M&E Framework has been developed but implementation on it has yet to start. Lack of the ability to measure the outcomes or impact of interventions in real time (so that this knowledge can inform program direction) was likely the most important factor in the low performance of the first Enhanced Program. Other challenges that must be overcome include establishment of a transparent financial management and a smooth logistical and procurement system. Much of the Enhanced Program services are contracted out and delays in procurement of these services meant that many of the cities went without services for months to years. More complex (and longer term) challenges will include determining how to integrate many of HIV activities within other health activities, improves planning to anticipate future direction of the epidemic and its response and to enhance efficiency and effectiveness of the interventions. For these researches must become part of the interventions to guide their implementation using local context and to involve epidemiological tools such as routine analysis of available data and even mathematical modeling to guide program planning.