In this episode, Sujani sits down with Tahani Waqar, a physician and community health researcher at Aga Khan University Hospital in Pakistan. They discuss what public health or community medicine is like in Pakistan and how Tahani’s love and passion for public health came to be.
What You’ll Learn from this Episode:
- Tahani’s journey from clinical medicine to community health and research work
- What projects and research work Tahani has done and what areas of community health she is interested in
- What a day in the life of Tahani’s school and work is like
- How the community medicine residency program is structured at Aga Khan University
- The biggest challenges that Tahani has faced in her professional journey so far and how she has overcome them
- Advice from Tahani for others interested in public health and early career public health professionals
- What the public health system in Pakistan is like and what unique challenges it brings to public health professionals working in Pakistan
My name is Tahani. I hold a bachelor’s degree in medicine (MBBS), graduated in 2017. I am currently enrolled in the community medicine residency program, a synonym for public health in Pakistan, in one of the most prestigious institutions in Pakistan, Aga Khan University Hospital. My first work experience in public health was in the National Committee of Maternal and Child Health. I am extensively trained in providing Family Planning Contraceptive Methods. Since then I have been very much interested in the Sexual and Reproductive Health and improving S&R health status in Pakistan.
Featured on the Show:
- Learn more about Aga Khan University
- The previous episode with Sophiya Garasia
- Tahani’s tribute to Imtiaz Kamal
- Share ideas for the podcast: Fill out this form
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Just been brought out that extrovert in me and you know, networking and socializing side a very good experience. And I think I will not give up anything to just not have this efficient.
Welcome to PH SPOTlight, a community for you to build your public health career with. Join Us Weekly, right here. And I’ll be here too, your host Sujani Siva, from PH SPOT.
Hi Tahani, and welcome to the PH SPOT podcast. And thank you so much for coming on to share your career story with us. And I just found out that it is 1am for you in Karachi, Pakistan, and I did not know. So I’m sorry about booking the set this time and just feeling very grateful and honored that you were able to join us.
Thank you, Sujani. Thank you so much for having me on your podcast. And I feel so honored to be here. Like I really feel so honored.
Oh, that’s amazing. And yeah, I’m excited to dive into your kind of journey into public health and the work that you’re doing and, and I’m sure our listeners and our community, they’re going to find some great value in what you’re going to share with us. So Tahani, maybe we can start kind of all the way at the beginning. And just thinking back to when you first discovered this area of public health and that you wanted to dedicate your career or your life and work towards public health. Can you maybe take us back to that moment?
I was a final year medical student. So I had my bachelor in medicine MBBS. So I was a final year medical student and I was rotating in Guinee and ops department. You know, during that time in my life, I realized that there’s so much that needs to be done for, you know, the underprivileged women in Pakistan. And I got to know that Pakistan’s maternal mortality rate is already so high, and you know, in the South Asians region, and even in the world, but then in Pakistan, you know, coming from a country like Pakistan, we have this monotony of clinicians, like people do not really look upon to someone or look forward for someone to go for research to public health area over clinical sites. So for me, it was like, I always wanted to do something like that. But then after graduating and then getting my house job done, I realized that I’m done with clinicals. And I just want to focus on this area of my career. Yeah. Then, fortunately, I got a job in one of the leading NGOs of Pakistan National Committee of material and unit and health, and they had this project running off where you know, woman centric, post abortion care, and postpartum family planning. So that’s how my journey started. And then I worked there for like two years, and I realized that this is what I wanted to do, because there’s so much that can be done. And you know, there’s a lot of need of work to be done in this area, even though we have been working in and doing POCs. On there has been a lot of work that has been done. That’s how it all started.
Yeah. Was it just as you were training for your MBBS? There were kind of stats and just research that you were discovering, or was there kind of an experience that you had personally that kind of pushed you towards this path of focusing on like child and maternal health?
Oh, you know, there was this girl and she was 18 years old, and she was full time pregnant, like nine months into pregnancy.
She was one of your patients?
She was one of my patients. She came and you know, they did not had her registered in any hospital. And the main tertiary care hospital where they could go the public hospital was very far away from where they were coming from. So our hospital in which I was practicing, so that was in the middle of the way so they just came along, like I don’t know how many kilometers they traveled just to get to that hospital in which I was working. And she needed care in tertiary hospital. She was an 18 year old girl and she had eclampsia. And she was having fits and what we could only do it in our hospital was just to give her first aid, subside symptoms and just the initial management. And then you know, she was referred but later came on to us that she died because the way was so much and the traveling costed them and they couldn’t reach the hospital, which they were supposed to go to, in the time, that was the safe period for her, or they could save her. So that is when I realized that, you know, it’s not just giving treatment to a patient that will cure them, it just trying to, you know, improve the system, the overall system, which makes health accessible to everyone. So that is when it struck me so hard that I said, okay, this is not what I’m going to do. This is- this is what I’m going to do. And this is how I’m going to, you know, live my life.
Yeah no, no, that’s a such a powerful story and experience to kind of shift your career a little bit. Yeah, I’m always curious for those people who were clinicians previously, and then kind of step into a research role, whether you miss clinical work, because I guess there’s like this special moment when you get to interact with patients and hear stories firsthand. Do you ever miss that?
I kind of miss the thrill of clinicals, like, you know, the calls, the thrill, treating patients, and then they going home and you kind of like, relieved. But even at that stage, I did not want to be a part of the system. I wanted to change the system. So at this stage, I’m very satisfied. But yeah, sometimes I go like a life would have been a lot more easier if I would have been a clinician rather than a researcher.
But I really don’t like- I don’t have that FOMO Fear Of Missing Out kind of feeling for clinical. So I’m pretty much all that.
Yeah, yeah. No, that’s, that’s good perspective. And I suppose, you know, my other question is, had you wish that you, you know, hadn’t done a medical degree and stepped into research much earlier. But, you know, I kind of am assuming that that’s what kind of gave you the experience you do have now, is that safe to assume?
When I, you know, I started if I compare myself to other people, I started very late in research. So all my peers, you know, just after graduation, they knew that they had to go into public health, and yet they have to go into a research field. For me, I was just like, I wanted to test the waters. First, I got a job in public health at first, you know, in an NGO, and then I had that experience, I got that experience. And then I decided that I wanted to do this for the rest of my life. If I compare myself to other people, I think I’m a bit behind. And I kind of started late, but when I look back at my experience, so that sets me apart from them that I have some kind of experience and as some kind of, you know, goal in my mind and clarity that in which field of public health I’ll progress.
That’s good. So I think our listeners are probably wondering what it is that you do now, because, you know, you’ve been talking about about research that you’re working on. So I’ve seen kind of on your LinkedIn profile that you’re at the Aga Khan University Hospital doing research there. So could you tell us a bit about the research and the work that you do?
Right now, I am a resident in training and Aga Khan for public health, commonly known in Pakistan as community medicine or community health sciences.
So I’m a year one resident and training and basically my interest is to work for sexual and reproductive health in Pakistan, and maternal health is, you know, a part of it. So it just comes along with it. But main focus is to work on sexual and reproductive health in Pakistan. And other than that, you know, the whole residency training program includes us to conduct researchers in different fields of public health, like environment or health policy and systems, epidemiology and biostatistics or rural health program. And there is an urban health programs and population reproductive health. So we have these sections, you know, in our training program, and we have to rotate in them, and we have to conduct researches or be a part of any project that is running on it there in that particular department. So right now, I’m working on a research that we did with one of my supervisors, Dr. Imran. And we conducted a third party evaluation of contracting out of health services to a private entity. So we did health facility assessments and they were like, I guess 13, secondary and tertiary care hospitals that we assist. And second is I’m working on qualitative study and we try to explore the barriers that are faced by private practitioners, private general physicians in rural sin. So these two projects that I’m working on for now.
Yeah, it sounds like there’s certainly kind of different skills that you had to pick up from your clinical, since your clinical work, so is that is that type of training, then something that you were able to kind of access during your work? Or that things that you just learned on the job? Or did you have to go back and get some training?
So it’s basically a training program that I enrolled into area. You know, in Pakistan, this specialized program of community medicine that is just a synonym for public health. So it’s basically like you give your exam and you get conducted into that program, right? A lot of people don’t know about this. But in other countries like America, or Canada, you guys have a master’s in public health, masters in epidemiology. And by that, we have Aga Khan in Pakistan as well. But in addition to this, we have this specialized degree that is just only for the people who belongs to an MBBS background and that FCPS fellowship, you know, FCPS, and Community Medicine, it’s a basically by College of Physicians and Surgeons.
So that’s a four year program that only people with, you know, MBBS background can do, they have to give an exam that goes by the name of FSCPs part one, so then they get inducted into any program, and then you know, like, they get their training done. And after having their training, then they have to give an exam again, and then get the license or the certificate to, you know, practice. So it’s a four year training program. Yeah.
Did many of your peers then who had, you know, gone to medical school go down this path? Or is it just a small cohort of individuals that pursue I guess, this public health route?
So I am, I guess, one of the very few people of my batch or the whole university that have gone down this path.
You know, people literally made fun of me, because as a student, we have this subject in, you know, in our MBBS years, we have the subject mean, this community medicine, it was just public health.
I mean, never took it seriously, it was just an additional subject for additional marks just for fun and used to do it and, you know, get done with it. Like if it was just like in a subject, which was just a requirement to just get done with it.
So we were like that, and you know, how tables have turned now. I was made final by of my peers, also, like people always used to tell me that it’s not something that you should be doing, because as before I told you that, you know, there’s one artery for clinicians, there’s, people don’t really like when you go for research and bucks on, they look down upon you.
Why is that?
It’s really confusing to understand is that why is that, but it is what it is? Like? I don’t know, I haven’t even, you know, like, grab the reason behind it. Why is it that’s why people are not going for different parts, maybe because we don’t have that exposure. You know, when we were students, nobody told us that there’s going to be a field out of, you know, community medicine. And now, after COVID happened, and the pandemic happened, and people now realize that there is a field that goes by the name of public health students, or they want to now be a part of it. So at first, they didn’t know that. So it is more about the exposure, because when we are medical students, or we are a bachelor, so we just told to just take to, you know, clinicals, and you have to have a very specialized field of yours. And if you don’t, then you’re not a good clinician, and everyone’s sensitize towards being a clinician. So that’s just that.
Yeah, there’s some similar conversations that, you know, I’ve heard as well, I recorded a podcast episode a few years ago with an individual, her name was Sophiya Garasia, and I can share that episode with you as well. And we talked about public health, at least in Canada, it was a fairly new degree. So it’s not something that many people knew, like they know now because of COVID. And the pandemic, so when she would tell her family and friends that she was going to be pursuing public health, but she would get asked, Is it because you didn’t get into medical school? Is that the reason that you’re going to go to public health? So yeah, I now that you, you’re kind of telling me the reasons why you’ve heard these kinds of comments and reflecting back on that conversation I had, and I guess, yeah, it is the awareness and education for the field of public health that’s missing. And I think often people don’t know how big of a role that it plays in society.
Yes. I mean, people used to ask me, which field are you specializing in and what kind of doctor I was, I would always tell them that I’ll be a public health professional. I’ll be a public health consultant or I’ll be specializing in public and they would be like okay, so are you going to do clinicals, will you be opening your clinic?I’ll be like, No, that is not me.
We would be very confused just to make sense what I’m saying and you know, I’m like, okay, fine. Let them judge.
Yeah, yeah, exactly. So do you know any, I guess not from your specific cohort. But I’m sure you must have come across other individuals who have gone through this fellowship and are specializing in public health.
Not from the people I know. But when I got into our science, so then I came to know a lot of people who have taken the same route, like my supervisors, and people who are working under Doctor, so they went through the same path, and they were enough, and they did their FCPS or fellowship and are fine, and then went on to do their PhDs or whatever it is they wanted to do.
That’s not how I got to know. But then you see your seniors and you know, like, you see that the path that can be taken. But before that, I was still working with public health people, because I was in an NGO. So I was working with very big names, I was working with who was the first midwife- Qualified midwife of Pakistan, and she was a lawyer. And then she left everything, and then came to Pakistan and got trained as a midwife, and then educated people and got her degree in mph. At that time, we’ll be talking about 1950s or 60s, she got her Master’s and PhD, and then she went on to revolutionize the public health, in terms of maternal health, and sexual and reproductive health. And basically, she worked a lot on family planning. So I kind of had those ideas. And they were a lot of feel like my program manager was one very much talented person who had been in this field for 16 years. And we are talking about these people who graduated in 90s. And you know, it is way before even I was born, they were working in that field. So they kind of changed my perspective. And even though I was reassured that I wanted to take a public health, but then there was also the self doubt that maybe this field might not be for me, or I might not be the one gifted enough to go further into this field. But these people made up my mind, and these people, you know, made it possible for me to think of a career in this.
Yeah, it’s really nice to have individuals like that to look up to and find inspiration from and I saw that tribute that you wrote about such a beautiful kind of story that you shared on your LinkedIn. So I might link that up for listeners to also go and visit and I’m very curious to read up on her life and the work that she’s done. So that’s something I’m going to add to my to do list. So thank you for yeah, introducing me to such a huge person. I’m kind of curious about kind of what a day in the life of your, I guess work looks like? So you shared two different projects that you’re focused on and maybe you can tell us a bit about, yeah, when you walk into work, what your day sort of looks like and how you split your time between those two projects? And, you know, is it all just work at your desk? Or do you get to go out into the community and collaborate with members there.
Basically what happens that it’s a very normal ECDN, right? So what happens is, you know, it’s not always desk work. So both of the projects that I was involved in the first one, the facility assessment, and the second one that was in qualitative study about private practitioner, so it required for me to travel to interior sense and conduct these interviews or conduct these health facility assessment. So it’s not just always desk work, it’s also going into the field and that is the main aim of our program, you know, the residency in community medicine, the main aim of this program is to let us have the exposure of the field and community as well as just go out there and explore it. And other than that, because it’s a training program, so it includes classes. So we have to take classes, for example, right now we have a core module of health systems and policies. So we have to take classes for that as well. It happens on Tuesday, then we have our general clubs also which we are you know, we do this critically appraise an article. And then we have you know, other activities like we have to teach undergraduate students as well. Yeah. So there is a module of research and public health for undergraduate students of ours and university so we have to teach them and then we are taking this pile sets in epidemiology course we don’t get free time. First, I never used to work late night but now I havlate work late at night also because you know, I think time between 8:30 to 5:30 is not enough to get done.
Yeah, that’s such a- Yeah, it’s such a great way to spend your day, it’s not all the same. And it’s nice that you get to do kind of a little bit of teaching and a little bit of learning with a research now that- that’s, that’s really great. We talked a little bit about this in the beginning. But looking back, would you have chosen to get to where you are today? Like, would you have chosen a different path? Or do you feel like the path that you took was the right one, and you if you were to do it, again, you’d kind of go through the same path.
As we’ll go through the same path, I’ll always choose Public Health over anything, but the way I did it would, you know, I would make it different, because I think is always you know, your, when you look at your peers, and you know, their article, your level, where they are just, you know, their city, and you’re just starting out. So you kind of compare yourself and you go into that kind of depression. I’m left behind. But I’m very much contented with the experience that I had, coming to this point, working in an NGO, working with people, and networking, going out, like this job and this field, and it was out of my comfort zone, I was an introvert, I did not talk to people, I never socialize. I was just into myself. And then this spiel, brought out that extrovert in me, and you know, networking and socializing, I had a very good experience. And I think I will not give up anything to just not have it sufficient.
It was everything to have it again,
That’s such a good point. I’ve heard that from others as well, where you, you look around and your peers have gone a little bit faster than you and you start to question the path that you’re taking. And it’s always good to remind yourself why you took the path that you took.
Yeah. And I would have taken another path that would involve me, you know, going for mph or a master’s in epidemiology, biostatistics or master’s in health policy management. But I took this longer two to four years, because the exposure and the training skills that I’ll get through, you know, this path is incomparable to others, you know, we have this class is combined classes, master students, as well. And I could already see that there is some kind of gap between the knowledge gap and because of exposure that we have, like, regularly, we are- Have journalists absolutely critically appraising the articles, and we’re learning new things. And on the other hand, just studying, so I’m getting it hands on experiences where that is why, you know, I took a very long span of four years now, and I’m 28 years old, I’ll be 32 when I graduate, probably have a kid or something.
I think I heard you correctly. But you said some of the classes is with other kind of masters and undergraduate students, is that what you’re saying?
Basically, like I told you, these three programs running in parallel. One is FCPS, and Community Medicine that I’m a part of. And then there are two master programs as well, masters and bio sets and epidemiology and Masters in Health Policy and Management. So you have these three programs running in parallel. So sometimes, you know, we have to take these courses like beginners courses with these master students as well.
So that’s what it is like, sometimes it’s a combined cohort, and sometimes just the community medicine residence.
I asked that question, because one of the other questions I was going to ask you is based on what you experienced so far, and for some of our early career professionals, or public health students, you know, individuals who are kind of thinking about stepping into the field of public health, what sort of advice and tips and reflections would you be able to share with them. And I was curious to also know whether when you sit in the classroom, with maybe undergraduate students or master’s students, whether they also kind of come to you for that sort of mentorship and advice.
The advice that I would like to give everyone as you know, we’re someone who’s very much interested in public health is, this is a labor of love. If you love it, then you’re going to do it very well. You’re not going to love it, they might become a little boring for you or a little bit stressful for you. Because a lot of times you’re not seeing the results that you want to see and conducting your research and then you’re facing problems and that research and statistical analysis or even conducting a simple research, changing your research question, doing the literature search, and then advocating for that to become a policy so that might make you feel burned out at that point, but you need to love it. That’s what I want to say and for the people who are in public health who are currently training in public health or masters, you need to work on your skills. So you need to get as many skills as you can. Because more you skills you will have, the more chances that for you would be to, you know, progress in this industry, because I think it’s all about skills. And it’s all about how knowledgeable you are about the kind of thing that you’re doing or the kinds of interests that you have, like, for example, if someone is intersection, and you practice how so you need to know the local context, as well as the global context of sexual and reproductive and and what is going on in the world and what is going on in your own country. For people who are from developing world like for myself, I’m from Pakistan, Pakistan is one of the developing countries, just not a developed nation. And we will have you faced many challenges that you really want to come into public health,
What are some of the top skills like if you could pick one or two that you would encourage, you know, anyone interested in, we can get specific to like research in reproductive health, for example, what sort of skills would you recommend that early professionals kind of really work on?
First and foremost, I think Sujani, they should have an understanding of reproductive health, they should know what’s going on in the world, what’s going on in their own country, or internationally, as a researcher, they should have the ability to critically appraise a research like, you know, that should have the skills to know that whether a certain study design is, you know, you want to do something and how you’re going to do it. Right, like epidemiology and biostats, on some of the skills or some of the areas that they need to be an expert. And that is research. And when you come down to as a public health professional, like whether you are interested in reproductive health, or you’re interested in environment, or you’re interested in health policies, you need to be an excellent communicator and a person who can go out there and network with people. Because if you fail at it, then you- you know, you will not be up for collaboration, you will not be afford, you know, meeting new people and exchanging ideas. So this is the very main, you know, component of being a public health professional that you need to go out there and network with people.
Yeah, I’m glad you said that. I was thinking if I had been asked this question, what are some of the top skills I would recommend people and I think communication and networking are two of my top recommendations as well, regardless of what field that you’re specializing in, within public health. I think those two really help you shape your career and yeah, pursue kind of your your dreams in your career. Shifting gears a little bit Tahani, I’m personally kind of curious, you know, we talked a little bit about your career in public health. And you once in a while, were able to give us a bit of background on public health in Pakistan. And I was wondering if we could take a little bit of time, and if you could share with us any reflections you have so far, just working in public health within like the context of Pakistan, and you could share that with our listeners, a lot of our listeners are from North America. But something that I am hoping that this podcast will do is bring to light public health and how it’s done and everywhere around the world. And hopefully, the- This also acts as a platform to perhaps allow for collaboration, I mean, someone somewhere else in the world could listen to this episode and hear about the work that you’re doing and perhaps reach out to you. And the two of you could do some great work, whether it’s in reproductive health or sexual health. So yeah, I really want to use this platform as a way to also encourage collaboration. So with that, maybe you could tell us a little bit about you know, just as a quick, I know, we can do it in this episode, but a bit of an education for those who kind of don’t know, anything or just know very little about just how Pakistan approaches public health.
In Pakistan, working as a public health professionals is a challenging area, like it drains us because you’re doing work as a public health professional or researcher, you’re producing research, you’re finding, you’re coming up with suggestions and recommendations to change policy or to formulate one, and you’re giving policymakers the data, the evidence to change some things, but if- If a policy maker is not in the favor of that, you know, policy, then it just fizzles out. So being a public health professional in Pakistan is just not something that makes you very happy. It just frustrates you. Other than that in Pakistan, we have these institutions that offer master’s in public health. So this apna Institute, this Health Services Academy in Islamabad, and then there’s Aslan University Hospital in Karachi. You know, there are other teaching institutes are teaching hospitals and all over Pakistan who offers residency and Community Medicine, but they are not that developed. So the leading institutes in Pakistan are Health Services Academy, apna institute in Karachi, and often University Hospital in Karachi. And the most elaborate Public Health Training that happens in Pakistan happens in often University Hospitals, we’re not only offering a four year residency program for doctors, we’re also have impacts on us and you’re also offering masters and inshallah next year, we’ll be starting mph master’s in public health. So that is also another word and rest and that we have like every other country, we have this ministry of health and you know, that ministry work, and there’s, you know, national health secretary. And so in Pakistan, federal is very much different from, you know, we have four provinces and parks and so every province has their own provincial health ministry. Same 18th amendment. So there was this 18th amendment that happened in 2010. And that devolves the decision making and legislative powers to provinces. And the federal was only left with, you know, some certain vertical programs and decisions like policymaking or national health policymaking and grants and funds that were, you know, the donors. So Central was left with these responsibilities, the other responsibilities, which goes to provinces, every province has their own health ministry, and they have their own autonomy over their own decisions. So in such time, you will see a disparity because if one province is doing something, and you know, the Federal wants them implemented in all of the provinces, so that’s the problem over there, because some of the provinces will not be in favor of that policy. For example, you must heard of this social insurance program that was being implemented in Pakistan, that was by the name of. So it was for the purpose of universal health coverage. And it was a social insurance program totally funded by government for, you know, deserving people. But then it was implemented in three provinces and one province did not go for it. Because, you know, the province is not very much fan of the federal government task, political instability and political favors. Those are the bottlenecks that we have to fight or face and say this one of the provinces in Pakistan that needs something like universal health coverage, because the government of sense does not want it, the people are not getting it. So that’s why it happened. And that’s why it’s always a problem because one province is doing good and another province is not doing good. So that’s how it is for us. It we know this is good for the people of this province, but we cannot do it because-
Yeah, Canada, we also have provinces and territories and health is very much yeah, provincially and territorial kind of mandate. And then obviously, public health is so intertwined into politics. Yeah, I can, I guess, attest to those frustrations that are there when you know that it’s good for the people, but how do you actually get decision makers to buy in and and listen to kind of the recommendations that you have? Thank you for that, Tahani. And I guess another question I kind of have is when I built PH SPOT, one of the goals and the goal that we continue to work on is helping individuals build their dream public health careers. And I’m curious when you think about the phrase dream public health career, what comes to mind for you, and what would you say is your dream public health career?
My dream public health career would be to, you know, in a leading position in any one of the big organizations working for sexual reproductive health of box, and that would be a dream career for me. So.
Best wishes on that from me and the PH SPOT community and I really hope I can bring you back on the podcast to hear how your- How your training has gone and where you land at the end of the four year training. And I just want to say thank you so much for joining me today.
Thank you for having me, Sujani. Really honored. I think I have done a good job.
It was- it was a great conversation. Thank you.
Hey, so I hope you enjoyed that episode. And as always, if you want to get the links and information mentioned in today’s episode, head over to pHspot.org/podcast and we’ll have everything there for you. And before you go, I want to tell you about our hands on intensive training program that empowers early public health professionals, recent graduates and students with the mindset skills and tools required to land a public health job, advancing your career and become future public health leaders. So if you’ve been feeling overwhelmed and uncertain about building your dream public health career, then we can help you through this program. And right now, you can join the waitlist at pHspot.org/program. And we’ll notify you when the next cohort opens up. And so until next time, thank you so much for tuning into PH SPOTlight, and for the invaluable work that you do for this world.