Finding a Path in Medicine: An Interview with Dr. Mirza About the Experience of Establishing a Pakistani Clinic
A NextGen Original Article by Janoo Naqvi
Modern medicine is becoming increasingly diverse with more specialties and ways to practice. Physicians can work in large insitutions as researching academics, or spend the majority of their time in a traditional clinic setting. Programs, such as Doctors Without Borders, also provide physicians with an opportunity to practice medicine while donating their time to impoverished communities. The Next Generation caught up with Dr. Mohammed Mirza, who decided to combine a these pursuits and open a clinic in Pakistan. Dr. Mirza shares his experiences helping impoverished patients in his native community and the decisions that ultimately led to this unique career path.
Dr. Mirza grew up and completed his secondary education in Pakistan. After earning his MD from the University of Maryland School of Medicine, he received lucrative offers to work in hospitals throughout the country. Dr. Mirza thought deeply about what he wanted and which path would suit him best. The domestic offers would have provided him with enriching opportunities to further his career. However, he remembered the poverty and lack of doctors in the neighborhoods of Pakistan. He wanted to help improve the situation and ultimately decided that his dream was to return to his homeland and open a clinic that would treat these patients with everything from cuts to chronic diseases. "I believe in what my mother always taught me: You can never forget those who are less fortunate and you should always remember to repay what you have received by helping others. My roots in my native country and my upbringing brought me back."
Before opening his clinic, Dr. Mirza started his career by working in local Pakistani hospitals. Though long shifts and grueling rotations are expected by any physician, Dr. Mirza had to deal with the additional stress of inexperienced staff and power failures that plagued the hospital. However, this provided him with a reasonable salary, which he used to purchase supplies and save up for the establishment of his clinic. His tenure at the hospital also allowed him to establish vital connections with other physicians, to whom he could direct his patients for specialized care. After working for six years in the hospital, he accumulated enough resources to open his clinic in Karachi, Pakistan. He continued doing hospital rounds in the morning and tended to the clinic in at night, until his clinic provided enough revenue to take care of itself. This financial independence was especially difficult to obtain, as Dr. Mirza promised himself that he would never charge anyone more than 100 Pakistani Rupees (the equivalent of $1.25). He likewise committed to an honor system that provided free treatment to those who said they could not afford the fee. This commitment, he said, came about because of a specific patient that he met almost 20 years ago. "One day as I was seeing patients, a middle aged man came to me with a child in hand. The boy had a respiratory infection and needed antibiotics. After I wrote the man a prescription, he told me that he couldn't afford to pay me. I gave him some antibiotics out of my stock and told him to go home. He was the first patient that told me of his troubles. I have tried to help others like him ever since.”
In response to the possibility that some may take advantage of his generosity, Dr. Mirza says, “There will always be people who try to take advantage of you. They will be there no matter what you do. I just cannot find myself in a position where I stop helping others because of a few bad apples. God has provided me with enough to offset those who try to cheat the honor system."
Dr. Mirza’s clinic has been so successful, in fact, that has been able to expand expand his establishment and provide specialized care for those who have chronic illnesses, such as diabetes. As a diabetic himself, Dr. Mirza decided to establish a specialty clinic on Sundays that focuses on treating patients with diabetes. About six years after founding his clinic, he gave a home to diabetics who were otherwise lost. Dr. Mirza has found that some of the major health problems in his community stem from a lack of education, especially about diabetes. Many of his patients come to his clinic complaining of symptoms, such as pain and blurred vision, but they don’t even know what diabetes is. Dr. Mirza says, "I grew up in this country and I know there are those who advertise cures for illnesses such as diabetes. I believe that the best way to move people away from these potentially harmful medicine men is to expand education about diseases such as diabetes. I know how difficult it is to manage my diabetes and I don't want people to hurt themselves or their family members because of a lack of knowledge."
His clinic, therefore, offers tutorials on how to monitor diet, test their blood sugar, and administer insulin shots, among other important tools. Because of the respect that Dr. Mirza earned in the community, he was further able to work with local pharmacies to provide insulin and other medication to his poverty-stricken patients at a reduced cost. Without the help of Dr. Mirza's clinic, these patients would be forced to resort to ineffective, and potentially dangerous, home remedies.
While Dr. Mirza feels confident that he is helping the community, he realizes that there are larger bureaucratic problems that still need to be resolved. In addition to the general lack of education, citizens suffer from limited rights and poor labor laws that result in increased competition for grueling, low-paying jobs. Communities are over-run by unemployment and minimal wage positions, which hardly provide enough income for basic medical needs. While Dr. Mirza can help people medically, he finds it especially frustrating that these socio-political issues are often beyond the realm of what he can control. In some cases, Dr. Mirza even feels that the political system is taking advantage of his services. The government, for example, uses clinics that help the poor as an excuse to forego universal healthcare. In his opinion, there are not nearly enough clinics like his for this to be a reasonable solution to the lack of health care – as the sheer number of patients waiting outside his clinic every evening attests. While Dr. Mirza agrees that there needs to be action at a higher level, he believes that change must start from the ground up. In his opinion, it would be helpful for officials and fellow physicians to spend some time in a clinic like his so they can witness the issues first-hand. "I don't think that this problem can be solved by people with only superficial knowledge. The lack of medical care is not only a Pakistani or American issue. It is a global issue. Politicians and even my colleagues in medicine need to get into the trenches to fully understand the problem. It is only then that we can find bigger and better solutions to this global issue." The bureaucracy cannot improve these conditions until the fundamental problems are legitimately acknowledged.
Dr. Mirza says that if he had to start over again, he might have tried to do more from a public health standpoint, perhaps getting a masters in public health or working for the department of Health and Human Services. In fact, he believes that every medical student should have some background in public health, so they understand how socio-political issues, such as those in Pakistan, affect health care on a local and national level. "Medicine cannot be a treat the patient and you're done job anymore. There was a time when the physician could end his job there. Modern medicine requires a multi-faceted approach. We have to be able to understand the socio-economic conditions of patients, the problems associated with the health care systems of our respective nations, and be able to find solutions to these problems by working with others. I would love to be able to work at that type of level, but I would still choose to do what I am doing because I love every moment of my job."
Though it may have taken longer to achieve, Dr. Mirza believes that even if he had pursued these alternative goals, he would still have ultimately fulfilled his dream of opening the clinic in Pakistan. Dr. Mirza believes the choice between these paths is analogous to the choice between research and practicing medicine. He says that when they are asked, many researchers regret their lack of interaction with patients, but are nonetheless confident that they would have still chosen to do research if they had to start over. While choosing a path may be difficult, it is reassuring to know that many doctors, such as Dr. Mirza, ultimately find comfort in their decision, whatever it may be.
Dr. Mirza also recommends that medical students volunteer as much as possible in clinics like his in order to gain a deeper understanding of global medicine. In his opinion, traveling outside of the United States and observing global health problems is just as important as research. As Dr. Mirza says, “the heart of medicine is still caring for others.” Though his path may not have always been easy, Dr. Mirza’s story is an inspiring example of the way a career in medicine can allow one to make a genuine difference in the community.
Janoo Naqvi is a writer for the Next Generation and a member of the Duke class of 2010.