Dear Rizwan

First of all I must apologize for being so late. There were few very pressing problems and I was also away for a meeting in Singapore. I have completed the interview over last two Sundays. We have only one day off in a week which too is sometimes busy in doing rounds and meeting people for my Foundation.

Let me first make it clear that I have not yet established the cancer center I have been dreaming for a long time. I am at present looking after two units in Karachi ; Ziauddin and NICH and visiting once a week to Shaukat Khanum Cancer Hospital, Lahore. I have established Children Cancer Foundation (NGO) with a mission to help children suffering with cancer and to establish a children cancer center in Karachi. I am working hard on it and I hope very soon I may give you some good news about it. Please read the whole write up and you will get answer of most of your questions. If you need any further information please do not hesitate to contact me.

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Q. Tell us first about yourself. What have you done in terms of training since your graduation?
After graduation I did my house job in medicine and surgery in Civil Hospital, Karachi followed by third house job in Paediatrics at National Institute of Child Health (NICH) Karachi. I then cleared FCPS part 1 and worked as Registrar in Paediatric department of Civil Hospital, Karachi from January 1987. I passed my MCPS (College of Physician and Surgeon Pakistan) in 1987 and D.C.H (Karachi Univrsity) in 1988. I completed fellowship in Paediatrics (FCPS) in October 1989.

In September 1990 I proceeded to Ireland and worked in General Paediatrics for 18 months during which time I also passed MRCP in Paediatrics. I then entered into the training program for Paediatric oncology. From July 1992 to June 1993 I worked as Registrar in oncology at Our Lady`s Hospital for Sick Children, Dublin and then moved to U.K and joined Pediatric Oncology department of Sir James Institute of Child Health, University of Newcastle upon Tyne for a year from July 93 to June 94. From July 94 to September 1995 I was in Alder Hey Children Hospital, Liverpool as a senior registrar in Paediatric Oncology. During this 3 year period of intensive clinical training I was not only involved in management of sick children with cancer but also participated in research projects and published 4 papers in international journals. I also regularly attended and presented papers in local and international meetings. I am a full member of Society of International Paediatric oncology (SIOP) and corresponding member of United Kingdom Children Cancer Study Group (UKCCSG).

By this time I realized that I had enough training to go back to Pakistan and provide my services to the people in my own country. In October 1995, I therefore, joined Shaukat Khanum Cancer Hospital, Lahore as a Paediatric Oncologist. In March 1997 I had to move to Karachi due to some personal reasons.

When I moved to Karachi I joined Ziauddin Cancer Hospital and gradually established a unit for children. However, very soon I realized that most of the children need financial support for the treatment of cancer as we all know how expensive cancer treatment is ?. I collected some funds from relatives and friends and started support for needy children. However Ziauddin being a private hospital has its own commercial perspectives and I did not get the support I looked from hospital administration. I was looking for a place where I can treat more patients with the limited resources. Child Aid Association with the efforts of Professor Nizamul Hasan established an oncology unit in National Institute of Child Health(NICH) Karachi.I therefore joined this unit as part time and at present I am looking after both units in Karachi. In the mean time I kept collecting money from the people for support of needy cancer children and finally in last Ramazan I decided to estabilsh a Children Cancer Foundation which is now a registered non-governmental organization (NGO).

Q. When did you get the idea of establishing the Cancer Center and what is the driving force behind your project?
Since I have been in oncology training I have been dreaming for a children cancer unit where treatment can be offered not only to those who can afford but also to children who need partial or full support. The quality of care should be excellent and such a center should be actively involved in research and training. With my almost five year experience in this specialty in Pakistan I have realized that such a unit is not possible in Government hospital because this is not their priority and rightly so. It can not be done in private hospitals as well as they have their own commercial perspectives.

At present only the oncology unit at National Institute of Child Health, Karachi is providing treatment to poor children suffering from cancer from whole of Sindh and Balochistan. One center can not look after more than a certain number of patients and also most of the people who can partially pay do not want to go to government hospitals. Children from whole of Sindh and Balochistan are referred to Karachi for treatment of cancer. A Children Cancer Hospital where quality treatment can be offered to those who can pay and those who need financial assisstance can be supported by donations and zakat funds is badly needed In short we need a Shaukat khanum for children in Karachi.  The centre will not only provide quality treatment but will also train doctors and nurses in this specialty who can go back and serve locally. It is also essential to study the epidemiology of childhood cancer in this part of the world and such a centre would be an excellent place for research. In the initial phase we may not start with a very huge investment but with gradual hard work we can progress as Dr Adib ul Hasan Rizvi did with SIUT.

Q. Do we have any facts and figures regarding the magnitude of cancer problem in Pakistan?
In Pakistan we do not have a national cancer registry hence we do not know the exact incidence of childhood cancer. However with the limited data available from hospitals and Karachi South Children Cancer Registry it appears that incidence is no different from international data.  With this background it is estimated that approximately 6000 children get cancer every year in Pakistan. With the improvement in the health care and better diagnostic services a substantial proportion of these are diagnosed and referred for treatment. However it is also a fact that a good number die even before reaching to a diagnosis of malignancy.

Q. What would you like to say about the cancer management in Pakistan?
The facilities for treatment of childhood cancer in Pakistan is far from satisfactory. At present most of these children are referred either to government hospitals or private institutions. Very few government hospitals have adequate funding and expertise to treat these diseases and only a minority of parents can afford private hospitals. As a result most of these children die even before getting adequate treatment. Two major obstacles in the delivery of quality care to children suffering from cancer are lack of specialized unit and financial constraint.

Q. How would you campare the treatment of childhood cancer in Pakistan with the treatment of similar cancers in other countries?
The quality in centres where treatment is given under care of qualified Paediatric oncologists is not too bad but unfortunately this is possible for only minority of children as at present in Pakistan there are only three trained Paediatric Oncologists; myself, one in AKU and one in CMH Rawalpindi. At other places it is far from satisfactory. We have all the drugs and most of the diagnostic facilities but we are very short of funding ,trained medical and paramedical staff in oncology.

Oncology in developing country is very different from developed part of the world. The children on one hand present with very advanced disease and on the other hand they are too frail and malnourished to tolerate intensive treatment. The infection rate is alarmingly high due to poor living conditions. The result is high mortality during treatment.

The protocols has to be tailored according to local needs. As far as survival is concerned at present in developed countries 75% children are cured of their cancer . We won`t be able to achieve this  however if can treat them in specialized centres we can achieve 50% survival even with all the limitations.

Q. With your project what do you plan to achieve?
The objectives of my projects are
1. To provide quality treatment to children suffering from cancer irrespective of their financial status
2. To train doctors and nurses in this specialty
3. To do research in the epidemiology of childhood cancer in Pakistan
4. To create awareness about excellent outcome of cancer in children
5. To provide a base for growth of Paediatric oncology in Pakistan
6. Collaboration with other groups at national and international level.

Q. In your opinion what are the major areas of improvement in the health care system in Pakistan?
This is a million dollar question. We do not have a system in any department. Health is no exception. A large population still has no access to safe water, good sanitation, and adequate nutrition. In villages people still do not have access to qualified medical professionals. There is no medical insurance system and facilities for treatment at Government hospitals are dismal. A large majority can not go to private hospitals. The quality of drugs are dubious. Which area does not need improvement?

Q. How can Dow Graduates in US or UK help and support the projects like yours?
As I have mentioned the major obstacle in the delivery of cancer treatment is financial constraint and lack of trained people. The Dow Graduates in US or UK can help us by providing financial support in terms of donations and zakat. They can also help us in a big way if they can arrange training of doctors and nurses in this specialty at their institutions. We also need their advises and moral support.

Q. How many Pediatric Cancer Centers are there in Pakistan?
There are only four centers for childhood cancer in Pakistan.

Q. In your opinion how much is there for Cancer treatment in Pakistan?
There is lot to be done for cancer treatment in Pakistan. The attitude of the population including medical professional need to be changed from pessimism to optimism by cancer awareness program. Delay in diagnosis is another poor prognostic factor which again can be improved by education of general population and medical professionals. Establishment of specialized units is mandatory for providing good care to patients and train people in this specialty. Formation of oncology groups and collaboration at national and international level is important for studying the epidemiology of cancer and improve the survival data.

Q. Give us your vision for the future for your project?
I want to see my center  St Judes Children Research Hospital of Pakistan.

Q. Would you like to say something for the Dow alumni through this WebSite?
Yes! We must communicate with each other and in whatever way you can help the people in Pakistan please do as you owe something to this country and its people.

Q. How can one contact you?
The best way is e.mail   (mailto:shamvil@cyber.net,pk, shamvil@cyber.net,pk )
In Karachi my address and telephone:
B 111 Datari Castle, Gulistan-e-Jauhar
Block 13, Karachi
Home: 8123468
Mobile: 0320-4026510
Fax: 5673052

"Children Cancer Foundation (NGO) with a mission to help children suffering with cancer and to establish a children cancer center in Karachi".

"it is estimated that approximately 6000 children get cancer every year in Pakistan".

"Since I have been in oncology training I have been dreaming for a children cancer unit where treatment can be offered not only to those who can afford but also to children who need partial or full support".

"there are only three trained Paediatric Oncologists; myself, one in AKU and one in CMH Rawalpindi"

"At present only the oncology unit at National Institute of Child Health, Karachi is providing treatment to poor children suffering from cancer from whole of Sindh and Balochistan".

"Two major obstacles in the delivery of quality care to children suffering from cancer are lack of specialized unit and financial constraint".

"We must communicate with each other and in whatever way you can help the people in Pakistan please do as you owe something to this country and its people".