Aga Khan University Pakistan
Link between Addenbrooke’s Hospital and Aga Khan Hospital Karachi.
Professsor AML Lever
Professor of Infectious Diseases and founding member of Addenbrooke’s Abroad
"In 1999 I was invited to lecture at the annual Medical Symposium of the Aga Khan University in Karachi, my first visit to this bustling and vibrant city.
"The Aga Khan University (AKU) is one of several health care and educational institutions founded by the Aga Khan and is one of the most prestigious hospitals in Pakistan. It is a medical school which attracts some of the best and brightest applicants in the country. At that time one of the junior doctors Dr Bushra Jamil was in the middle of her Infectious Diseases/Microbiology training and was looking for a chance to broaden her experience overseas.
"Through an application to the Association of Physicians overseas links scheme we were able to secure funds to begin what turned out to be a long standing commitment to AKU/Cambridge interaction.
"Bushra came for 6 months in 2000 (weeks after she had just married!) and has flourished since her return being promoted to Consultant and being awarded the FRCP in recognition of the huge innovations in service practice and teaching that she introduced at AKU.
"Last year to improve her knowledge of Infection Control practices she returned again funded by a grant from the Association of Physicians and spent another 8 weeks in Cambridge first attending an ICT course in London and then coming to see the ICT practices in Addenbrooke’s’."
Bushra's account of what she gained from the recent visit is as follows:
"After spending 6 fruitful weeks at Cambridge, I have been able to propose and/or implement many new strategies at the Aga Khan University Hospital (AKUH), Karachi Pakistan. At AKUH, we are faced with unique problems, which are a consequence of availability of tertiary level care in a third world setting.
"My discussions with infection control personnel and Professor Lever’s continuing guidance has helped me in proposing solutions to our own specific problems, which are many and varied.
"The changes I have been able to bring about in the working of hospital infection control after my visit to Addenbrooke’s hospital are listed below:
- High impact interventions to prevent central venous catheter related blood stream infections, ventilator associated pneumonia and catheter-related urinary tract infections have been implemented in the ICU and the medical ward
- The prevalence of Clostridium difficile associated diarrhoea in hospitalized patients remains unknown in our part of the world. The laboratory tests which are available are suboptimal. To tackle this issue, our infection control team has submitted two research proposals to look at C difficile in our patients and to compare the efficacy of different laboratory tests. In the meantime, we have started collecting data on hospital associated diarrhoea in different parts of the hospital
- Prospective surveillance on surgical site infections has been initiated
- Visitor control has been implemented in high dependency areas of the hospital
- The idea of a CVC team based on Addenbrooke’s model has been proposed
- Antimicrobial stewardship program is being prepared
- A TB control program has been prepared and proposed for implementation
- Hospital infection control policies are being updated
- As a consequence of our reminders, the hospital is finally in the process of creating an occupational health unit, with input from infection control
- Interactive sessions and work shops are arranged for physicians, nurses and other staff on a regular basis. Sessions were also held last year at other government and private institutions on hospital infection control and surveillance. We would continue such educational activities both at AKU and in other hospitals in 2009
- We are hoping to launch an intranet based infection control module (which is designed on the NHS on line course) for faculty and staff at AKUH
- We have introduced hand hygiene station in years 2, 3 and 5 OSCEs. Other aspects of infection control are also being addressed in years 2, 3 and 5
"The hospital is aiming for reaccreditation by JCIA this year. The performance of hospital infection control has improved significantly and this will count towards reaccreditation."
Professor Lever continues: "Between Bushra’s first and last visit our funds have stretched to provide support for a visit for a medical student summer elective each year. The students are in their late preclinical/early clinical years and come to work in the research laboratory. They get a project and are supervised by one of the helpful scientists in my research group. Where possible we take them to the wards and meetings to get some clinical exposure to UK medicine. They have been uniformly excellent, charming, intelligent and hard working and several have ended up with publications from their time with us. This scheme which attracted five or so applicants in the first year is now hugely oversubscribed and requests for attachments usually start arriving the moment the previous student has returned to Pakistan. Fortunately Bushra is able to advise me on suitable candidates and the first of these to apply gets the post. We pay for their travel and their subsistence while they are here but the have to find their own accommodation which to date has not been a problem since many have contacts in the UK. It has been a rewarding experience for me and for the people in my lab to meet these bright, self confident and delightful students. They give us a picture of people and life in Pakistan which is very different from that to which we are treated in the media and altogether a more reassuring and optimistic view."
Photos of some of the students and their comments are below.
Sana Syed
Summer Research Student June-July 2004
"I graduated from medical school at the AKU in 2007 and am currently applying to the USA for paediatrics training. I have spent the past year working as a research assistant for the neonatal infections section of a WHO external epidemiology unit, the CHERG (Child Hood Epidemiology Reference Group). I came to work with Dr. Andrew Lever in the summer of 2004 as a summer research student. I worked with Doug, a PhD student, on an offshoot of his thesis work on oligonucleotide lentiviral vectors – our work was later published. Additionally, I attended weekly clinical rounds, lectures and workshops.
"It was the first time I had worked independently as a bench work basic scientist and it was my first exposure to research of international repute. It was also an opportunity to work in an exceptionally academic environment with co-workers from basic science, medical and non medical backgrounds; an environment that helped me think outside the box about how I wanted to develop my medical career. More importantly, I gained wonderful mentors with whom I have since been in regular communication. Andrew and Doug have been wonderful in supporting me, whether about queries of basic science work or career advice. From my two months at Cambridge, I feel I gained an exposure to academics and more significantly, great friends and mentors."
Ayesha Ejaz
Summer Research Student June-July 2007
"I am currently in fourth year (class of 2010) and about to start a 2 month rotation in obstetrics and gynaecology, just got done with paediatrics. I've done some research here with one of our ophthalmologists Dr.Azam Ali. I loved my stay in Cambridge, I got some hands on laboratory experience and the ward rounds weren't just academically useful but they were also very interesting. I remember there was one about a patient's wish to experience zero gravity which was done with the JFK space shuttle service. That was a really good presentation. Plus, the people I worked with in your lab (especially Harriet) were very amicable and cooperative. Overall, the best part besides the fact that Cambridge is a lovely place was the atmosphere at work. It wasn't a stuffy, serious environment but more of a relaxed, interactive professional learning experience."
Sannia Javed
Summer Research Student June-July 2005
"‘I had a great time working under your supervision and I make sure I tell all my juniors what a wonderful opportunity it was for me to work with you in the summer. I graduated this November. It feels good being a doctor! Currently I am taking some time off, studying for the USMLE Step 1 exam which is in June this year. I plan and hope to be US board certified by the end of this year. Do wish me luck! I plan to start my Internal Medicine internship right after Step 1 of USMLE, here in Islamabad."
Awais Ashfaq
Summer Research Student June-July 2008
"‘The thought of going to University of Cambridge, in itself, made me excited when I was invited by Prof Andrew. At the same time, I was a little worried as well as I was not sure what was expected of me. But that was taken care of. Working with him and his colleagues was one of the most enjoyable experiences for me, not only from learning standpoint but also the friendly and easy-going nature of people working at his lab. I was fortunate enough to perform such detailed techniques and use sophisticated equipments which I would not have been able to carry out in Pakistan. One thing that I cannot forget! The confocal microscope!
"Throughout the time spent in his lab, there was not even a single moment where I felt that I was under any obligation to do anything. Work came to me as fun, running experiments, staying late in the evenings, coming on Sundays on my own initiative, discussions with Dr. Ulrich every now and then, reading his LONG list of recommended articles and impressing him by my computer skills. However, I also happened to be on the other side of the see-saw when my viral cultures got contaminated and that too when my project was about to finish!
