Among the leading Dental Surgeons and researchers of Dentistry in Pakistan, Dr. Ayyaz Ali Khan is a leading figure, who has spent a long professional career with outstanding achievements in research, while working in Pakistan, as well as numerous other countries. During the IADSR International Conference 2013 in Islamabad, during August, Dental News (DN) had the opportunity to discuss some long standing issues and sustainable solutions for dentistry in Pakistan. Here are some important facts and suggestions from this senior practitioner. DN: As a senior member of the Dental fraternity, do you think that it is time for the promulgation of Dental Act in Pakistan, to check malpractices and eliminate the menace of quackery? Dr. Ayyaz: In all honesty, I very strongly believe that it will take at least one whole generation to eradicate Quackery. I have written a concept papers on this topic. The latest country to have passed and implemented a proper legislation against quackery was Bangladesh, and they too have planned to eradicate quackery from their country over the next 50 years. Historically, when England abolished quackery, it took them a very long time with extensive efforts. You see there are big challenges and issues in quackery. Why do you think the quacks are coming up everywhere and thriving so successfully? The basic cause of quackery is that the quacks are there, where no qualified dentist would like to go. The first surgery in the world was done by a butcher. But the issue is very simple. Your medical professional does not want to go to any remote place where the quack is already available. The doctor will not treat the patient at the price at which a quack would. So even if you have a dental act and if you have legislations, then you can only expect to eliminate the quacks in about 50 to 70 years in future. As a regulatory coordinator, I went one step ahead of the A register and B register. There is an association in Pakistan called; The Dental Practitioners Association, which actually functions and is run by the quacks. I have had a few discussions on this issue with that association. They simply say; “Train us”. The A register, the B register and the C register will also depend on a comprehensive initiative to provide training to these quacks over a period of time. The quacks are willing to engage in such initiatives, to be formally included in the mainstream health-care function. When we were working on a solution to this problem, we actually wrote a book, regarding the basic pharmaceuticals, the basic principals of dental practice, the basic sterilization methods, etc. We started providing Pressure cookers to these quackery clinics. We instructed them to just boil the water under pressure with a little bleach in it. Put all your dental instruments in it. This will give you 95% sterilization. Such initiatives can help, only if we can make the quacks follow the basic procedures and acquire formal training, aimed at protecting the health of their patients. If these procedures are followed for a couple of generations, we can expect a revolution in safe dental practices. Otherwise, the idea of eliminating them is simply wishful thinking and Utopian aims. I spoke to a politician once and he said to me in a very matter-of-fact tone; “If you are leading the qualified dentists, you have only 10,000 votes. But if you engage the quacks in your developmental efforts, you will have more than 750,000 votes for enabling effective reforms in the dental sector. DN: How can we facilitate the provision of effective dentistry in the far-flung, remote areas of the country? Dr. Ayyaz: You see, now you are talking of Utopia to me. These are just academic possibilities. Unless and until the government invests in this sector, there is no way that it can happen. In 1971, the primary healthcare initiative was begun. The dental facility was given at the basic health unit, which at that time, could cater to only 25000 people. Today a Rural Health Center is meant to cover 200,000 people. I did a survey many years ago. We saw that 80% of that equipment does not work. Another problem is that the dental materials purchase is not included in the system. That means the government cannot buy dental materials as a part of the medical and pharmaceutical procurement. So basically, we have to go back to the drawing board and redesign the system and then restructure it. Even the medical outreach of the armed forces is not helpful enough. They only have limited outreach. The CMH are only available in the larger towns. They have a limited number of Mobile Dental Units which will only treat the civilians, if they pay for it. DN: What will be the result of 80% female student dominance in the medical colleges of Pakistan? What about the Brain-Drain that is occurring in Pakistan, as the qualified dentists and young graduates migrate to other countries for greener pastures? Dr. Ayyaz: These are both global phenomenon. Ofcourse, the female students majority will lead us to a crisis, where we will not have enough practicing doctors in the country. The only solution is a district based merit system. A town like Turbat will usually not have as many first division students as Quetta or Karachi. If you expect the large city residents to go and serve in a remote town, most of them would decline the offer. However, if you select the brighter medical students from Turbat, you can make it mandatory for them to go back after graduation and serve in their hometown for a certain number of years. Baluchistan had actually adopted a district based merit system once. I know of people who had 45% marks and they became doctors and dentists. But they had to work for 5 years in their hometown. In my opinion, there is no brain-drain from Pakistan. It costs at least 200,000 dollars a year to specialize in dentistry. So only the rich and the mighty are able to go. The loss is only for the upper middle class, not the lower class. DN: Dr. Ayyaz, it was a pleasure getting your input on such essential challenges in Pakistan’s dentistry. We hope that together we can solve the problems of this important sector of healthcare soon. We really appreciate your efforts in organizing the recent IADSR International Conference 2013 in Pakistan. Such initiatives will surely lead us towards sustainable solutions to ensure quality health care for the patients in Pakistan, as our dental practitioners and students will be more equipped and aware of the most modern trends, technologies and procedures in global dentistry. Thank you very much for your time.
