News from the Palatucci Advocacy Leadership Forum
Mughis Sherrani, MD
Neurology from the Front Lines of Afghanistan
ARTICLE IN BRIEF
Dr. Mughis Sheerani discusses his plans to create a neurology training program in Afghanistan.
Mughis Sheerani, MD, was in his third year of medical school in Pakistan in 1983 when his cousin suffered a head injury, fell into a coma, and then into a persistent vegetative state. He helped care for him, and during those agonizing months he saw firsthand how the doctors at the hospital had nothing to offer his cousin.
With a population of approximately 190 million there were only handful of neurologists in the country. His experience with his cousin lit a fire — with few neurology residency programs in Pakistan, he headed to the United States for training in the residency program at the University of Utah in Salt Lake City.
He went on for further training at the Medical College of South Carolina and then worked for a practice in Texas before heading back to Pakistan.
Throughout his training in the US, the seedling of a larger goal emerged — he would bring his training to bear in the region to lay the foundation for the creation of neurology programs in Pakistan and other developing countries. And that is precisely what he has done since returning to Pakistan in 2002.
He has set his sights on a larger landscape, heading to war-torn Afghanistan to train local doctors to care for war-related injuries and epilepsy.
With the teachings that he learned as a fellow in the Palatucci Advocacy Leadership Forum, Dr. Sheerani hopes to inspire doctors to take up his mission and become leaders and trainers for future generations of neurologists.
Today, Dr. Sheerani works at the same facility, Aga Khan University, where his cousin lived in a vegetative state for seven months until his death in 1983. At that time, there were only five to 10 neurologists in the whole country. When he returned to Pakistan nine years later, the conditions were much better, and he set out on his mission to create homegrown neurologists.
In the US, he had trained in epilepsy and once he was back on his home turf, he decided to start an epilepsy surgery service. He brought in surgeons from the US and Canada to train local surgeons, and now they do a few epilepsy surgeries every year. The program is now a decade old. He and his colleagues follow a few thousand epilepsy patients a year.
As director of the residency program at the Aga Khan University — which is part of a network comprising programs and hospitals in more than 30 countries in Asia, Africa and the Middle East — Dr. Sheerani launched training programs for future neurologists. Today, the country has more than 200 neurologists, and the numbers are growing. There are too few of the neurologists to have a subspecialty, but he hopes that even this will change someday.
Now in his fifth year as associate dean for post-graduate education, he oversees 60 programs with 400 residents and 40 fellows; 10 doctors are being trained in neurology at Aga Khan University.
Recently, with neurology finally coming of age in Pakistan, Dr. Sheerani decided to set his sights for new training programs in Afghanistan, a country that has been war-torn with political strife for 30 years. He soon realized, however, that carrying out his plan would have its challenges. He knew that he would have to bring in ministries and institutes in the two countries, whose relationship has been strained by the activities waged by the Taliban.
In 2014, he was invited to be part of the AAN Palatucci Advocacy Leadership Forum, and proposed a training program for Afghan residents in neurology. Up until then, there were no neurologists in Afghanistan.
At the forum, he learned how to shape his message and direct it to government authorities, lawmakers, and media. He developed an advocacy plan.
“The war and political instability has fractured the health care system in this country,” he told Neurology Today. A decade ago, Aga Khan University took over a local hospital in Kabul and began training programs in nursing, midwifery, pediatric medicine, and pediatric surgery. Dr. Sheerani was interested in the French Medical Institute for Children in Kabul (FMIC), which was also a part of the Aga Khan network. FMIC offered residency programs in a few specialties, but there were no neurologists to cater to this huge population. Thanks to what he learned in the Palatucci program, he helped start seven training programs there.
To date, one Afghan physician, Esmatullah Hamed, MD, has completed his neurology residency training in Pakistan and has returned to Afghanistan to practice neurology. Another Afghan doctor is now in residency training in Pakistan. A partnership between the AAN, the Afghan Research and Education Fund, and Aga Khan Development Network supports this training program.
The training programs have been collaborative in scope. Dr. Sheerani worked closely with other neurologists, including Mohammad Wasay, MD, and Sarwar Jameel Siddiqui, MD, a fellow of the Royal College of Physicians and director of the neurology residency program at Aga Khan University in Karachi Pakistan, as well Pervez Nayani, MD, head of Aga Khan academic programs in Afghanistan. They also receive support from the FMIC in Afghanistan and Pakistan Medical & Dental Council.
“We are developing the resources there so we can create a residency program in Afghanistan,” said Dr. Sheerani. “There is a great need for neurologists in this country.” It won't just be a matter of training neurologists but keeping them there, he added. “Our hope is to train more neurologists to work in the country and help them become leaders so that they will go on to train others.”
Things haven't been easy for the neurologist, who continues his general practice of neurology in Karachi, Pakistan. “Every year, we go and train there but it is challenging. Pakistan and Afghanistan do not have good relationships with the Taliban. There are a lot of hurdles and a lot of paperwork.”
Neurologists will be critically important in an area that is rife with war-related head injuries, he said. The incidence of epilepsy has increased. There is also a need to diagnose and treat brain infections and post-traumatic stress disorders. In 2014, Dr. Sheerani and his colleagues developed a five-day neurology course in Afghanistan to provide basic information on how to care for patients with neurological issues.
Dr. Sheerani understood from the beginning that this dream would have its risks. He must sometimes use bulletproof cars when traveling in Kabul. “It looks like a friendly city, but any time there could be a bomb blast,” he said. “A few of our colleagues from Aga Khan Development Network were killed in a hotel near the hospital. There are many stories of near misses. We must always be mindful that we are training people in a war zone.”