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ACP Global Perspectives: Bangladesh

Quazi Tarikul Islam, MBBS, FACP
Interim Governor, ACP Bangladesh Chapter
President, Bangladesh Society of Medicine (BSM)

Established in 1971, Bangladesh, officially the People’s Republic of Bangladesh, is a country in South Asia, bordered by India and Myanmar. It is the world’s eighth populous country, with a population of almost 169 million. It is one of the most densely populated nations in the world. *

The Bangladesh Society of Medicine (BSM) was formed in 1999. It is an organization of Medicine specialists in Bangladesh. It was established to ensure the rights and benefits of Medicine Specialists, and provide comprehensive healthcare services to the people of Bangladesh.

*Source – Wikipedia

What inspired you to become a physician?

I think everyone is driven by their dreams. In Bangladesh, we are very motivated by the dreams of our parents. In 1969, as a young boy I accompanied my mother to see my grandpapa in the hospital. He was suffering from breathlessness. There were no modern facilities or medical specialists available to him. I didn’t know the disease he was suffering from, but he died. I cried a lot about this and dreamt that one day I would be a physician. Becoming a doctor is the best way to serve and cure ailing people. My dream merged with the dreams of my parents. 

What do you enjoy about being an internist?

First of all, I really enjoy being an internist because of its intellectual challenges and diversity.  I feel like Detective Sherlock Holmes. In Bangladesh, there are a variety of patients and I have worked in both rural and urban areas for many years. Being an internist, patients approach me first with their problems and I treat people from head to toe. I correlate, counsel and give them comprehensive healthcare, which is what I enjoy most about my profession. 

Can you describe the role of the Bangladesh Society of Medicine (BSM)? What are the missions and goals of the organization?

The Bangladesh Society of Medicine (BSM) is a platform for all postgraduate internal medicine doctors. From the birth of the society, the BSM has focused on academic and professional development of physicians. After completion of a postgraduate degree the BSM helps the internist to develop as a physician in the 21st century. The BSM helps to establish academic communication with international bodies like ACP and the International Society of Internal Medicine (ISIM). Besides organizing national and international seminars, the BSM helps develop professional leaders and provides grants for research activities.

The mission and goals of the BSM include:

  • To ensure comprehensive patient care.
  • Academic and professional development of Internists.
  • Encouragement of research oriented activities.
  • Development of young leadership.
  • Responding timely to the national crisis in developing curriculum for undergraduate and postgraduate health policy and national guidelines for different diseases when required.
  • Clinical skills development program organized for postgraduate students.
  • To disseminate updated and recent news of advancement of the medical sciences among internists. BSM organizes regular seminars and symposiums and publishes newsletter and journals.
  • Constant liaison with ACP and ISIM to upgrade events in global perspective.
  • Public awareness programs on different, burning healthcare issues.

What motivated you to become involved in the BSM and to take on the role of President?

First of all, I am proud to be an internist. I wanted to stay under the umbrella where all internists gather. The BSM inspires its members to contribute efficiently for different activities at national and international levels so that internal medicine can remain as it was. Globally at this moment, because of subspecialties and sub-subspecialties, internal medicine seems smaller. I disagree with this view. In my opinion, only an internist can treat patients comprehensively and completely, and not on an organ by organ basis. This effort will remain as long as the sun rises in the morning.

I am always proud to be a BSM member, not just the President. I was elected in a democratic system, but of course, I was motivated and I had a dream to do something for BSM. I had a vision to integrate BSM more with other international bodies and make sure our internists gain access to international arenas. My mission is to see our internists achieve the international standard.

What have you accomplished as BSM President? What do you hope to accomplish at BSM in the future?

My best achievement is that I have established communication with all internists. Though internet connection is available everywhere in Bangladesh, everyone doesn’t check e-mail on a regular basis. We started sending text messages via cell phone regularly for any new medical events. This has made a tremendous difference. We now communicate better with each other and share our visions and problems. We can also gather more participants for national and international seminars that have been arranged in different medical colleges. In my tenure, with my fellow members, we worked hard to form the ACP Bangladesh Chapter.

One of our best plans for the future is to establish an Internal Medicine Research Institute. We have already started working on this. Also, I hope at least two brilliant, young internists from Bangladesh will receive a fellowship award in the ACP International Fellowship Exchange Program. We are also in the process of making a formal agreement with Malaysia for a fellowship exchange program, in collaboration with the Bangladesh College of Physicians and Surgeons.

What is the role of the internist in Bangladesh? What are the education and training requirements needed to practice internal medicine or one of the subspecialties of internal medicine?

In Bangladesh, the role of the Internist is great because they have to be able to deal with whatever problem a patient brings, no matter how common or rare, or how simple or complex. Internists are specially trained to solve puzzling diagnostic problems and can handle severe chronic illness, as well as situations where several different illnesses may strike at the same time.

In Bangladesh, after earning a 5 year Bachelor of Medicine and Bachelor of Surgery (MBBS), one has to complete a one year internship. Then they can sit for the postgraduate Step 1 examination. After passing Step 1 they have to complete 4-5 years of supervised training with submission of a dissertation/thesis research paper. After receiving clearance of the research paper by the appropriate body they can sit for the competitive exit examination. Lastly, after passing the examination, the postgraduate degree must be accredited by the Bangladesh Medical and Dental Council (BMDC), before practicing as an internist.

What are some of the most significant challenges that physicians in Bangladesh face? What are your thoughts on the best way to meet those challenges?

Physicians in Bangladesh most significantly face the challenges of overcoming disparities between resources and demands. Our country is classified as a low-middle income group by the World Bank Economic Indicators and providing proper healthcare with limited resources has been a great challenge for us. In many situations patients report to physicians late, when the disease has become complicated and often developed into an acute emergency. Quick transportation during emergencies is another problem that we frequently face. Also, sometimes the cost of research imposes a threat on determining a diagnosis.

But our physicians have always tried to mitigate these to the best of their efforts, knowledge, empathy and sincerity. The best way to overcome these will involve economic measures, as well as political and social commitment.

What can other countries learn from your health system?

In our country, the greatest success of the healthcare system is preventive medicine. Our country has been declared polio free and vaccination is almost 100%. Bangladesh has significantly improved in establishing birth control, maternal mortality and child mortality reduction in comparison to neighboring countries. We have already started adult vaccinations nationwide. Government and NGO’s are using mass media to alert people. By appropriate training of healthcare professionals we have significantly reduced the death rate associated with Malaria, Kala Azar, Tuberculosis, Dengue fever and diarrheal disorder. Additionally, oral rehydration saline (ORS) was discovered in Bangladesh, which saves many lives and has been widely adopted by many countries around the world.

We have proven to be an exemplary country in disaster management within our resources. Bangladesh is on the verge of achieving the Millennium Development Goals by the World Health Organization, focused on child health, education, and women’s rights. Also, Bangladesh received the South-South award for healthcare achievements in the country.

What have you found to be the most rewarding part of leadership? The most challenging?

As President of the BSM and Interim Governor of the ACP Bangladesh Chapter, I want to give credit to my fellow members and colleagues. The most rewarding part of my leadership is that I have brought internists under the common platform of the BSM, with the intimate relationship to grow and obtain the international standard. I always listen to the voice of our internists and the conglomerate that acts in the best interest of our nation. 

Yet challenges always remain in any leadership. I want to establish a system of academic credit for all internists; CME credit and publication for promotion; and revalidation of postgraduates every five years. 

You are currently the Interim Governor of the ACP Bangladesh Chapter, ACP’s newest international Chapter, established January 1, 2016. Describe your involvement in establishing the ACP Chapter in Bangladesh.

Since 2003, I have been involved with ACP and its programs. I became a fellow of ACP in 2004. The years following, I attended the ACP Internal Medicine Meetings with my colleagues, the BSM would send 20 to 60 members to the meeting each year. Over the last decade we have developed a good bond with ACP for academic development. Robert M. Centor, MD, FACP, Past Chair, Board of Regents, inspired us to be more involved in ACP activities and form an ACP Chapter in Bangladesh. I am especially thankful to him and all the leaders at ACP.

Why do you think it is important to have an ACP Chapter in your country?

We were following the British system of Curriculum in the healthcare sector. A few years ago the UK decided that the Membership of the Royal Colleges of Physicians of the UK (MRCP) examination would be an entry examination for postgraduate medicine, whereas before it was just an exit examination. In the U.S. hands-on training with formative assessment is the main tool for becoming a postgraduate doctor, which I feel is the best way for producing postgraduate faculties.

I think it is important to have an ACP chapter in our country, so that we can share our knowledge and experiences with the U.S. and the rest of the world through the various conferences and CME programs. Students and junior doctors can have access to updated information and have good guidance during the course of their training, and make themselves fit for the global community of Internal Medicine. To the best of my knowledge, ACP is the largest professional organization and platform for internists in the world.

Please share a memorable ACP international experience.

There are plenty of memorable experiences, with ACP that give me a lot of pleasure. We worked hard to form the ACP Chapter in Bangladesh. I cherish the moment I handed over the official proposal for opening the ACP Bangladesh Chapter and I was elated when the proposal was accepted. It was the most memorable moment for me, as the BSM President, and also in my professional career.

 

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