a young pakistani doctor blogs...
Saturday, December 02, 2006
  The O'level Dilemma
On Monday or Tuesday, I will be going to Peshawar. I need to go in order to finally get around to getting my PMDC registration done, something which, until now hasn’t been a priority with me. To explain why I need to do the registration now, I have to explain Shakir’s story.

Shakir did his O’levels outside Pakistan and his A-levels in Pakistan. He did very well in both and was admitted to Aga Khan, where he completed his MBBS last year. Since then he’s gone on to score a 99 in Step 1 and a 92 in Step 2. He’s currently in the US on the interview trail along with the rest of my friends, Uzer, Hussain, Moiz, Usman and Aya. After his MBBS exam, Shakir when to get his PMDC registration done. As it turns out the PMDC required his Matric and F.Sc scores. Shakir had done O’levels and A’levels instead, so it was a simple matter of getting these scores converted, which was a routine affair.

When he went to get this equivalence certificate from the relevant office, he was told that from 2005, a rule was passed that made it mandatory for any Pakistani in the O and A levels system to have done Urdu, Islamiyat and Pak Studies, otherwise an equivalence certificate would not be issued. Shakir had done his O and A levels in long before this rule was introduced, but apparently, they were applying it retrospectively as well. This meant that Shakir, who had not done these subjects because he did his O’levels in a foreign country, was now required to pass O’level Urdu, Islamiyat and Pak Studies before he could be given his equivalence certificate. Shakir went to everyone he could, including the big guns at AKU, asking for help to be exempted from this rule. He tried very hard and ran everywhere, but the rule would not be changed for him. He had to do these three O’level subjects in order to get his equivalence certification which he needed to get his PMDC registration, which he needed to get a residency in the US.

After finding this out, he put the matter side and studied for his Step 1 and Step 2 exams. He scored very very well on both exams, and right after he passed the Step 2 exam, he moped for a while, then finally got the O’level books for Urdu, Islamiyat and Pak Studies and started studying for the October/November O’level exams.

So here was Shakir, a doctor, from Aga Khan, who scored 99/92 on his Steps, studying for his O’level exams. As a result of this experience, the Aga Khan Medical University has reportedly changed it’s prospectus to warn incoming applicants of this problem.

Now while this sounds funny and completely insane at the same time, it had another level of relevance to me. I, like Shakir, also did my O’levels from outside Pakistan and A’levels within Pakistan, and I, like Shakir had not done Urdu, Islamiyat or Pak studies. I actually cannot even read Urdu, let alone pass the O’levels in it.

The crux of the matter was/is the equivalence certificate. Therein lies a crucial difference b/w me and Shakir. Aga Khan recognizes O’levels/A’levels as is, they don’t need an equivalence certificate in its stead. However all government colleges in Pakistan, including the one I went to, required an equivalence certificate, and so when I applied to my college, I had to have one made. At that time, there was no rule that required Urdu/Islamiyat/Pak studies to be done, so I never had that problem. So I had made my equivalence certificate before entering college, whereas Shakir had not.

However the problem has been bugging me because things can still go wrong for me. All of my original equivalence documents are still with the college. What if they’ve lost them and I need to get new ones? That’s not impossible considering the gross incompetence of our Student Affairs Section. What if the PMDC requires new equivalence certificates and won’t accept the ones I made in 1999?

When Shakir told me his story a couple of months ago, I brushed my own concerns away because I had already made equivalence certificates before. I decided I’d embark on the bureaucratic adventure of my PMDC registration after my Step 2 exam was over in March.

However, since then I’ve made a firm commitment to be in the US to give my Step 2 CS exam by mid-April (I applied for the exam they other day). My father then reminded me that if I’m going to be in the US by mid-April, then if the PMDC gives me any trouble, I might not be at hand to try to fix the problem. Hence I have decided to get this headache over with now.

I called the PMDC registration a bureaucratic adventure. Here is what I need to do in order to get my PMDC registration done:

First I must get my medical transcript from my college. But they won’t just give it to me if I show up, no, no, no! That would be far too easy and simple. In order to get my transcript I have to prove that I have no outstanding dues from any department associated with the college. This means I have to get a signed release form (clearances) from the people in charge of those departments. The departments in question are:

The transport department (to make sure I don’t have outstanding bus dues).
The library (to make sure I don’t have any books left with me)
The accounts section (to make sure my fees are all paid up)
The sports department (don’t ask me why)
The boy’s hostel number one,
The boys hostel number two,
The boy’s hostel numbers three. (Even if you have never lived in any of the hostels)
I also have to get an unemployment certificate. I have no idea why, but the fun part is that it must be done from some mysterious office miles away from the college.

I’m pretty sure there are a couple more departments I have forgotten that will make their presence felt when I go there. To add more fun to this trekking adventure, most of these departments are located far apart from each other. The hostels, for one thing are a 15 minute walk from the college and from each other. To make things even more fun, it is wholly possible that the people in charge of any one department might be on vacation or at home sick from naswar poisoning, and if that happens, I absolutely have to wait until they are back before I can complete my clearances. If even one person is away on extended leave, I am stuck until he comes back. The guy in the transport department is particularly notorious for being difficult to find. To make my life even more exciting, all these people have to sign the same piece of paper (the clearance sheet). I’m literally going around collecting signatures that attest to the fact that all my dues are paid up. If one person is missing and I decide to come back later, I have to take this paper with me, so I can’t even leave anything with him to sign in case I am not there when he decides to return to work.

When all this is done, I will receive my medical transcript and all other original documents (including my equivalence certificates) from the student affairs section.

After that is done, I have to have the detailed marks certificates (DMCs) of all my years in college (1st, 2nd, 3rd, 4th, and 5th) and get them, as well as my photographs, my equivalence certificates (let’s hope I don’t have a problem there!!) attested. This can be done by only 3 professors in our college, so I had better pray they are there. When this is done, I have to lay these documents down humbly at the feet of our local PMDC office (assuming the man in charge is there) and beg them to have them processed.

After these simple steps are done, I will receive my PMDC certification in a month’s time.

Unless of course, my equivalence certificates are lost, or the PMDC decides they will not accept them. In which case, I will have to learn how to read and write Urdu, cancel my plans to go to the US and sit for my O’levels.  

And you thought Frodo had it hard?
Sunday, November 26, 2006

My convocation is in a few days. The time when they give us our degrees for all the pain and suffering we subjected ourselves to for 6 years. I will not be going, even though my fiancé (and class fellow) has repeatedly asked me to come. When I left Peshawar after the last viva more than a year ago now, I turned my back on the place for good. It would be nice to meet some people again, but there really isn’t anyone whom I’d be looking forward to seeing again.

Why is it that after 6 years of living in a place, I have no real friends to call my own in Peshawar. Does it say something about me? Or the place that is Peshawar? A part of me is bitter and angry that I seemed to have spent so many years in that place riddled with self-loathing and - yeah, let’s just say it – in hate for the entire city. I hated the mentality of the people there, who seemed light-years behind the rest of the world. The biggest enemy the pathans have are themselves, not Some Great Big Evil Western Devil, but the devil in themselves. I am reading “The Crisis of Islam” by Bernard Lewis these days and along with the many interesting things he has to say, he points out something that struck a chord. He talks about the influence western imperialism had in the 19th century over the countries it conquered:

“The contrasts can be seen very clearly by comparing the countries that suffered under the imperial yoke, like Egypt and Algeria, with those that never lost their independence, like Arabia and Afghanistan. In Saudi Arabia universities were late and few. At present, for an estimated population of 21 million, there are eight universities – one more than the seven institutions of higher education established by the Palestinians since the Israeli occupation of the territories in 1967. Slavery was not abolished by law in Saudi Arabia until 1962, and the subjugation of women remains in full effect.”

Peshawar, which borders Afghanistan, has also evolved from the fortune or misfortune of not having been influenced by the more positive aspects of Western “imperialism”. To this day, Punjab, the province that had the heaviest British presence prior to independence is the most culturally and economically advanced part of the country. It’s certainly an interesting thesis: to suppose that Western imperialism of the last century had some positive imprint on the lands that it ruled.

In the last couple of months, I’ve been fortunate enough to meet a group of friends from AKU, 3 of whom live here in Islamabad (Uzer, Shakir and Hussain). The other two are fellow bloggers Usman and Moiz. They are a very close knit group and meeting them made me realize what I had missed out on in Peshawar. I thought Peshawar was an extremely insular and backward place. Hussain and I would argue when he was still here in Islamabad over which city was the asshole of Pakistan. He insisted it was Karachi, while I said it was definitely Peshawar. While physically, the two places might look the same, Hussain and his friends had each other, and a world-class university that brought the best minds in Pakistan together under one roof. The year that I joined my college, there was an enormous and violent fight between the Jamaat-i-islami students and the outgoing final year students over the right of the latter to celebrate their passing out by playing music in the college and dancing (after the classes were over of course). In the ensuing battle, several people were sent to hospital, some with serious injuries and gun-toting jamati-i-islami students fired indiscriminately, although miraculously, no one was hit. The worst of it was that after the dust settled, the principle of the college was thought to be involved in organizing the mess, siding with the jamaat in order to teach the outgoing final year students “a lesson.”

These things just don’t happen in a civilized place. The exam system was horribly flawed, there was widespread corruption in the administration, professors more interested in flirting with the girls than teaching, unethical practices by the doctors, and a student population who had never talked to a member of the opposite sex until they entered the college.

I don’t mean to say of course that all this is the case because the NWFP of Pakistan was not as soundly colonized by the British as the rest of Pakistan. Of course not - but it’s just interesting how the above passage in the book leapt out at me. I was born in Saudi Arabia and lived there till I was 17. Then I lived in Islamabad for 2 years before going to Peshawar for another 6 years. It’s strange how I seem to have lived in those two parts of the Muslim world which are the most retrogressive in the world (barring some war-striven countries in Africa). I never fit in in Peshawar, and I would never want to live as an adult in Saudi Arabia (growing up there was great though).

A friend of mine who has lived in the US for the last 10 years, having been born and raised in Jeddah like me, told me once that he “was a westerner” before he arrived there. I know what he means and in a sense I think I am one too. I used to think I want to come back after my residency and work in Pakistan, to “serve my country” so to speak. Now I don’t know. I don’t know where I belong. Having spent my teens in one country, my 20s in another country, and making plans to spend at least 6 years of my 30s in a third country, I don’t know where I belong. I don’t want to spend another 6 years like I did in Peshawar, not fitting in, not making close friends, not being comfortable with where I live.

I guess the convocation and my total lack of interest in it unleashed a big can of worms. Sorry for the rant folks.

Monday, November 20, 2006
  The Last Big One

When I was in final year of medical college, and I started to appreciate more of the medicine that I saw in the hospital, I started enjoying it a lot more. During this time, I would practically live in the hospital, staying on late, although we were not required to. I loved interacting with patients, learning from doing and being in that general environment where very smart people working together towards a common goal. I learnt a lot faster by doing and observing than I did from reading the same stuff from books. Now, after the interminably long Step 1 prep is over, and I’m well into my Step 2 prep, I I’ve reached a stage when I’m heartily sick of reading stuff directly from books and learning stuff that way. I can’t wait to go to the hospital again and learn in the context of brutal 12 hour days. I can’t wait to be done with these exams.

Inshallah, this Step 2 will be the last exam in my life where I will have to lock myself up with the books for several months at a time. After this, my learning will come from patients, seniors and consultation with the books on matters I am unclear about. The learning process will move from theory to practice. Besides the fundamental paradigm in the method of learning will be the new company I’ll keep. I’ll be actually working with real life people, and not staring at dead paper all day long, in a room by myself.

Studying for hours and hours, month after month from books is no longer working for me. I’m just pushing myself the last mile for the Step 2 exam. After this, I’ll never have to go through this torture again for as long as I live. I will use books, of course, but not as intensely as I am doing so now. Not ever again, thank God.

Saturday, November 18, 2006
  On Guilt
I’m reading Karen Armstrong’s The Spiral Staircase these days. It details her transition after she abandoned her life as a nun. The following passage really made me think and put a whole new perspective on guilt and repentance:

“One of the good things I had leaned from my superiors was that guilt could be pure self-indulgence, a wallowing in the ego. Guilt, I was told, usually sprang from misplaced pride; it might simply be chagrin that you were not as wonderful as you hoped.”
Friday, November 17, 2006
  Al Jazeera International: First Impressions.

Al Jazeera has come out with a 24 hour English language news service. I remember reading about Al Jazeera planning to roll out such a service a couple of years ago, but was disappointed to hear nothing more on the subject in the year that followed. As it turned out, the English version of the station had hit quite a few technical snags along the way. I guess they were overly optimistic in predicting the channel would roll out in 2005.

I had a very suspicious view of Al Jazeera a few years ago, and like most, associated it as Bin Laden’s mouthpiece. That, coupled with the fact that if came out of some small country in the Arab peninsula suggested it was nothing more than government sponsored anti-American drivel. The channel properly came into my attention when I heard about Bush’s “joke” about bombing Al-Jazeera a couple of years ago. I read up on it, and then found a blog of an Al Jazeera staffer and learnt to my surprise that it seemed like a very progressive effort, with particular attention being paid to eliminate as much bias as is humanly possible from their stories. I also read up on Hamad bin Khalifa Al-Thani, the Emir of Qatar and patron-founder of Al-Jazeera. I saw he was a genuine modernizer and founded Al Jazeera with a vision of an unhindered, unbiased Arab news source. Gradually Al Jazeera seemed to turn into the “good guys” in my mind.

So I was very curious to see the kind of fare they would offer in the English version of their service. I had read that Al Jazeera offered a people-centric approach to the news. Rather than going to diplomats and government spokesmen for their news, they went directly to the people on the ground. I didn’t really get this concept until I saw their broadcast today. There were two in-depth stories of life in Darfur - one of a UNICEF aid worker in the region, and another of a bright 13 year old girl whose had not seen her parents for months, but still studied in the rudimentary school at the refugee camp and wanted to grow up and be a doctor. Then there was a program called Witness hosted by Ragieh Omar, who visited the town of Dewsbury in England where one of the suicide bombers of the 7/11 attacks in London came from. He interviews many residents of the town, comparing the perceptions that the media has assumed about the place to ground realities and presented a convincing thesis that in the town, where a third of the population are Muslims, there are no religious or ethnic tensions between the Muslims and the non-Muslim population, and that far and away their biggest problem is rampant unemployment (40%), and drug addiction. The local population expressed their frustration that politicians choose to use the town to score political points and sound bites while their economic troubles were completely ignored.

There was also a long interview on a group called Combatants for Peace, a group headed by a former Israeli military pilot, and a former Palestinian Fatah activist (who spent 10 years in jail) who were promoting a non-violent approach to the resolution of the Palestinian crisis. Then Harold Pinter came on, much to my delight, and voiced the strongest condemnation of American policies that I have ever heard on a news service. I had my mouth open in surprise over how strenuous he was. Throughout the day I noticed there were no ‘bubble-gum’ news stories to ‘lighten’ things up. No news on Britney Spears’ divorce or the new James Bond film, thank you very much.

I had a positive first impression from what I saw but it will be months before the channel forges a definitive identity for itself and the final verdict comes in as to whether this turns out to be a truly unbiased, honest news service, or just the Arabian answer to CNN.

Thursday, November 16, 2006
  The Hudood Law Amended
The Hudood Law pertaining to rape has finally been amended at long last. Previously, if a woman was raped in Pakistan, and sought to seek justice from the police, she needed to provide 4 male witnesses to the act to prove the charge. If she failed to do so, she would be charged with adultery and locked up in jail. This is such an obviously perverted misinterpretation of Quranic law, I cannot imagine how it was ever introduced by sane people in the first place. As Musharraf rightly said in his speech to the nation last night, it is something to be deeply ashamed of.

We Muslims have allowed our under-educated, ignorant religious leaders to romp over us for too long. As expected, the bearded ingrates of the MMA are strongly protesting the amendments, claiming that they will turn Pakistan into a “free-sex” society. They believe the Hudood laws on rape should have stayed the way they were. I shake my head in anger, shame, and bewilderment that people like this should ever have found their way to parliament.

I think it’s important for mainstream, practicing Muslims to come out and say that more often then not, the ostenable “religious leaders” of the Muslims do not represent the sentiment of the masses. Whenever Muslims bash the mullahs, they seem to be the ‘liberal extremists’, who are usually Muslim only in name, having rejected the religion for all practical purposes. I think it’s time that Muslims who do pray regularly, and who do hold their religion to be an integral part of their identity to come out and say loud and clear that most of the time, the mullahs are not speaking for them at all. We should acknowledge that the mullahs do not hold an absolute grip on our sentiments. We are not obliged to follow their lead. We should acknowledge that the religious education they receive just like other parts of the education infrastructure of Pakistan, is simply not good enough to warrant the degree of power they assume for themselves when they are done with their studies. People like the MMA, who oppose the amendment to this bill, who claim it is done on the behest of the US, who claim it will increase promiscuousness, are either shockingly displaced from reality, or are outright hypocrites, beating the war drums just to gain some political leverage.

There is no excuse for their position. I don’t just disagree with these people; I hate them and everything they stand for. May Allah punish these corrupt Mullah bastards for all the damage they have done to our society. Amen.
Saturday, October 28, 2006
My Step 1 result came back a few weeks back. The score was lower than I was hoping for. I got an 85, when I was hoping for something more than a 95. I was disappointed but didn’t stay down and out about it for very long. To be honest, I was just glad it was over and I didn’t have to study all that useless junk again. Step 2 and everything after is more clinically oriented and hence a lot more interesting.

The story of my result deserved a few entries here, but I had just fallen out of the habit
writing anything down here. My result seemed to have been displaced by the USPS, and I had to wait an excruciating 5-6 days before it finally turned up. It was an incredibly tense time for me and one that I wouldn’t wish on anyone. The result finally arrived about a month after I gave the exam. I hadn’t started studying anything till then, despite previous lofty goals (and Aya’s incessant urging) of starting on the 15th of September. I was impossible to concentrate, with the result pending. I certainly didn’t “relax” much during this time, I was just freaking out all the time, wondering what would happen. After the result came out, I spent a lot more time trying to truly relax. I watched all 5 seasons of 24 back to back. It was quite an experience and took up some 2 weeks. I loved the show and was totally addicted to it. Ramadan was here and as we all know it’s tough to study much during Ramadan, although I did give it a go and got something done. Now that it’s over, I’ve finally gotten into the groove of studying, but I feel kind of weird. For step 1, I had a great deal of impetus and drive. So far for Step 2, I feel like I’m going through the motions only. That worries me, because I need to score well on Step 2 in order to help compensate, in as much as that is possible, for my Step 1 score. I plan to give the exam in the 3rd week of February. Thereafter, I’ll be going to the US to give the Step 2 CS exam, the third and final exam needed to get my ECFMG registration. That will be in March, and the plan is to get externships after march all the way upto October in order to get the much coveted US Clinical Experience to put down in my CV. I’m hoping a good Step 2 result, certification before applying to the programs, applying early, and USCE will make my application strong enough to see my through.

Will write more later.
Recent med school graduate from Peshawar, Pakistan. Started blogging when in throes of final year exams. Currently studying for USMLE Step 1. Aiming for the 2008 Match. I blog about my studies, my worries, and my thoughts on life. I live in Islamabad.

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