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This Week in The Lancet

  • Volume 377 1719 (2011)
  • May 21, 2011

This summer at the Harvard of the East

photo 1

Medicine is one of the few fields where optional is considered compulsory. Electives refer to a period of training in a research or clinical setting outside ones parent institution. Although it is not something new but it has gained enormous popularity in the recent past. Unfortunately electives are undervalued in our region of the world and either there is little awareness or scanty opportunities in this regard.

Holy Prophet Mohammad (Peace be upon Him) said- Seek knowledge even if you have to go as far as china. I always want to do electives because medicine and travelling are my passions. In these summer vacations when I decided to do electives I already knew where to go as Aga Khan Medical College is undoubtly the best medical college, hospital and research center and is the only place in Pakistan to have a world standard elective program.

The aim of this elective was to observe and learn the various modern techniques and lab tests which we study in our medical course books as it is said that seeing is believing. A secondary purpose was to observe the educational system of Aga Khan University Medical College. It follows PBL and module system. I found it very proficient. It is student friendly and according to the needs of modern world. Unfortunately AKU is the only medical institute to follow it; all others are sticking to the annual prof. exam system with more influence on conventional lecture based learning. I think they should also switch to the PBL. I was also a supporter of LBL but after observing the benefits which students get in PBL system, I had to change my views. And not just the view, this exposure has also changed my attitude towards medicine and learning.

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Aga Khan University is a coeducational research university spread over three continents with eleven teaching sides spread over eight countries. Its principal campus is located in the metropolitan city of Karachi, Pakistan.
Equipped with the state of the art facilities and internationally trained health care professionals, the hospital also serves as the principal site for clinical training for the university’s medical college and school of nursing.

I selected Department of Pathology and Microbiology because Pathology and Microbiology are the core subjects in third year M.B.B.S. curriculum in addition to Pharmacology and Forensic Medicine. Importance of laboratory and diagnostic pathology is as much in clinical practice as much of theoretical pathology in medicine.

Aga Khan University is also the first choice for anyone interested in Pathology because it has the biggest network of international standard laboratories with collection centers not only all over the Pakistan but outside Pakistan too.
I will narrate the whole story chronologically to stay simple and for better understanding of others so that they can benefit from it.

The application form and complete instructions are given on the website. One has to apply two months ahead of the proposed elective period. Selection is completely on merit and is especially tough for the Department of Pathology as only one student is selected each month on the basis of academic grades.

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The Department of Pathology and Microbiology is divided into

* Molecular Pathology
* Microbiology
* Histopathology
* Chemical pathology
* Hematology and
* Blood Bank

I had just four weeks for such a huge department and I couldn’t be to the chemical pathology lab due to lack of time. My first rotation was in the molecular pathology lab. It is one of the advanced facilities, equipped with Real time and conventional PCR, ELISA, Gel Electrophoresis and Roche Amplicor. Here the tests for infectious diseases (like hepatitis C, HSV, CMV, MTB, Swine flu and Dengue), neoplastic diseases (like BCR-ABL and 15 17 translocation) and genetic diseases (Thalassemia, Cystic Fibrosis and Spinal Muscular Atrophy) are done. An interesting thing about it was the frequent cleaning of the working desk and changing of gloves after each step in order to minimize contamination, as PCR assays are very sensitive to external inhibitors and the specimens (usually plasma or blood) are highly infectious. One can never forget the principle and mechanism of ELISA and Gel Electrophoresis after having actually seen them.

The next lab was Microbiology to which I was more familiar as microbiology is a subject of third year in our curriculum. But this lab was very different from our academic lab. There are thrice the number of culture media than what I had studied, the organisms are identified at the sub type and serotype levels. Blood cultures are done at the Bactec and there is a separate section for mycology and mycobacteriology. A part or the lab is reserved for Environmental Analysis. This section tests food, water and other similar specimens for bacterial load and contamination and thus coordinates with government, companies and restaurants etc. generally speaking microbiology is comparatively an easier job. All you have to do is to inoculate the organism on the culture plates and read & interpret it the other day. But this is not as easy as it sounds, you have to have the detailed knowledge, experience and up to date information as it is an everyday changing field.

photo 4

Third week brought the best one, yes the Histopathology. It was a huge lab with a lot of things going on which I didn’t even know that they are included in histopathology. The acquainted things were gross examination, fixation, embedding, cutting, staining and microscopy of surgical specimens. I also saw frozen tissue sectioning, semen analysis, FNAC, special histological stains and autoantibody assays. AKUH is the only place in Pakistan to have a fully developed commercial Cytogenetics lab. Karyotyping and FISH are done here. It was a terrific experience to see the chromosomes in real. A similar experience was to see the thousands of motile sperms under microscope, all struggling very hard to find an egg and give rise to life, even the unfortunate abnormal ones. It’s difficult to describe such experiences in words. At one side they strengthen our belief and knowledge of scientific phenomenon and on the other hand they make us think about life and appreciation of nature.

Now was the turn of my fourth and last rotation in the Hematology and Blood Bank. It looked more like a factory than a lab, with a lot of small and large machines feeding on blood. Here I learned peripheral blood films, Automatic Hematology Analyzers, test for G6PD deficiency and RA, HPLC for HB variant analysis, ESR, PTT, aPTT, Bleeding time, Clotting time, Phlebotomy, Blood screening, Plasma and component separation and storage. It ended with a surprise viva exam and with that four weeks had finished like four days and it was time to go back. In last few hours my flight got cancelled and I had enough trouble, thanks to airlines.

Pakistan is a developing country and is progressing in medical field as well. Aga Khan University is a big advancement and a milestone in this regard providing quality medical education, health care and research center.

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Stairs to university’s helipad

Pakistan is also a frontline country in war against terror and is paying its price in the form of terrorism, inflation and hurdles in development. During my electives period too, there were a few incidents of terrorism in the city of Karachi, which adversely affect not just the business, education and everyday life but the health sector as well. Doctors and lab technologists faced problems in coming to the hospital due to which a lot of patients had to suffer as there are some tests which are not done anywhere else in Pakistan except AKUH Labs. But the good thing is that Pakistan is still managing to develop and progress and no one ever gets to disturb the peace of the country.

photo 6

I couldn’t visit much places in Karachi but the beach trip was a unique and captivating experience for me. Hundreds of different restaurants and cafes provide every type of delicious cuisine. University campus itself is a place worth visiting and the city of Karachi is an example of beauty, modernism yet simplicity and cultural diversity.

In conclusion, it was a wonderful, educational trip with lots of fun and pleasant memories. I am sure any one who goes to AKU, will definitely want to go back just like me.

Muhammad Badar Munir
3rd year medical student, CMH Lahore Medical College, Pakistan

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