A Paediatric Legend

Dr. Abdul Ghaffar Billoo is truly a big name in the field of paediatrics in Pakistan. He did his MBBS from Dow Medical College (Now Dow University of Health Sciences) in 1959. Then he went to Edinburgh for further studies where he completed his MCP. After coming to Pakistan, Dr. Ghaffar served Dow Medical College as Professor and Head of the Department of Paediatrics. He also served as the Dean, Faculty of Medicine, University of Karachi from 1994 to 1997. He is also the member of many esteemed national and international organizations. Currently he is working as Professor and Chairman, Department of Paediatrics, Aga Khan University Hospital. He is also the founder member of a non governmental organization that works for the welfare of rural and urban people of Pakistan. The praiseworthy philanthropist has also been honoured with the most prestigious civilian award, Sitara-i-Imtiaz. Recently MAG got an opportunity to meet the dynamic Dr. Abdul Ghaffar Billoo. Excerpts:

WJ: Why did you decide to become a paediatrician?
GB: When I was a child I dreamt of becoming a teacher as for me it was the most noble profession. But I opted for medicine as all of my close friends wanted to become doctors and they also wanted me to be with them. After completing my MBBS in 1959, I aimed to become a surgeon but again it was my close friend Zaki who convinced me to go for residency in paediatrics. At that time well known paediatrician Prof. Hamid Ali was the in-charge of the Department of Paediatrics at Jinnah Hospital. The residency at children's ward made me think of life from an entirely different angle. I would always get disturbed when I saw weeping mothers holding their ill children. I therefore decided to pursue a career in paediatrics and devote my life for the well being of little angels.
What are the most common paediatric diseases in Pakistan?
Diarrhoea is one of the most commonly found diseases among children in our country. In 1970s and 80s the disease claimed the lives of around 5 million children. However at present, conditions have improved and mortality rate due to diarrhoea has decreased from 25 per cent to 15 per cent. The second most common disease is pneumonia. It's affecting the lives of around 18 per cent children every year. Typhoid, dysentery, measles, tuberculosis, malnutrition, hepatitis A and E are some other commonly found paediatric diseases. There are also some day to day ailments found among children, which could be treated with simple home remedies or general medicines such as fever, whooping cough and flu.
What is your take on these desi totkas where a child with jaundice is advised to expose to sun instead of consultation by a doctor?
In my clinical practice I highly encourage mothers to go for these desi totkas. Around 70 to 80 per cent cases can easily be treated with the help of these home remedies. For cough it is better to give a bowl of vegetable or chicken soup with a pinch of crushed ginger and black pepper added in it. For a slight soar throat, a glass of warm water with honey added in it can do the magic instead of any antibiotic medicine.For diarrhoea mothers can prepare ORS at home by adding sugar in water with a pinch of salt and they can enhance its flavour by adding orange or lemon juice in it.
Almost 38 per cent Pakistani children of age less than five are malnourished and it highly affects their growth. What can we do to address this problem?
Malnutrition is a very dangerous condition. It can be lethal when a child gets attacked with infectious diseases such as pneumonia, malaria, measles and diarrhoea – the major killer diseases. The situation needs to be properly addressed. The good health of mother is the first requirement. Only a healthy mother can give birth to a healthy child. For this purpose we have to educate girls about their diet. In Pakistan around 25 per cent children are underweight at the time of their birth. Pregnant women should give extra importance to their diet. Other than regular intake of food they should add 400 calories more in their diet plan. They should also take calcium, iron and folic acid supplements to overcome the deficiency of micronutrients in their body. After birth, a mother should start breastfeeding her child within 30 minutes and extensive breastfeeding should continuefor six months for the good health of her child.
What is autism in children?
Autism is a disease where the child completely dissociates himself from the social contact. He starts living in his own world. He faces problems in socialising and has impaired verbal and nonverbal communication. Sometimes a pattern of repetitive behaviour with narrow, restricted interests has also been observed. They clap, flap and wave automatically in a repetitive manner. The first sign that parents usually observe in a child with autism is delayed speech and such children also avoid eye contact with other persons. When someone calls them, they don't react to it giving an impression that they are not listening to them, which is untrue. It is really a frightening scenario for parents as most of them are unaware that their child is a patient of autism. Number of children with autism is increasing day by day. Earlier, I hardly got a case of an autistic child in a year and now 2 to 3 children with autism approach me for consultation every month. The treatment of autism is possible with behavioural modification therapy in which efforts are made to increase the social interaction of such children. It is also important to praise such a child to make him feel more comfortable. Families have been advised to increase communication with the child and make efforts to bring him back into the socialfolder.
It has been observed that with the passage of time the number of children with attention deficit hyperactivity disorder (ADHD) has increased. What could be the possible reasons behind this raise?
Yes, it is true that number of children with ADHD has increased. It is a psychological disorder in which a child is totally unaware about his destructive behaviour. It also creates problems in following social norms since parents find it difficult to take their ADHD child with them to social gatherings. Inattention, hyperactivity, and impulsivity are the key behaviours of ADHD. It is severe than autism and more difficult to treat. Behavioural modification therapy is the only treatment available for ADHD. It takes years to change the behaviour of ADHD affected child and a lot of patience from parents, family members and teachers is needed. First thing in the treatment of ADHD child is the observation of the child's behaviour where he is using his energy. The main purpose of the treatment is to channelise the energy on the positive side otherwise ADHD child can be very destructive to the society. He can use his intelligence for negative purposes. Fortunately we have several outlets available in our city where the energy of a hyperactive child can be turned to positive directions such as early learning centres. There are also some children's games available that could be used in the treatment. Mothers often complaint that they are fed up of their child, I simply tell them that I can't treat them without their cooperation. I have several cases on my credit where I have treated several ADHD children successfully but it is all possible with the help of parents and teachers of a child.
As a paediatrician what are your concerns related to children following current economic situation?
Because of the current economic situation the buying power of an individual has gone down. People can't afford even the basic food items that leave a bad impact on their health. Especially if a pregnant woman doesn't have access to healthy food, she can't give birth to a healthy child. I have told you this before that malnutrition is lethal when it gets combined with infectious diseases. It is difficult to strive for better future with a malnourished society. I strongly believe that this issue needs serious attention of people sitting in the power corridors. But unfortunately they are not doing anything for the welfare of the people of Pakistan.
What steps should be taken by parents to develop healthy eating habits in a child?
It is necessary to develop the habit of eating healthy and home cooked food in children at an early age. In the first six months feed him khichdi, mashed banana and potatoes along with mother's feed. Sweet foods are the biggest weakness of every child. One can feed soft sweet dishes to their child such as suji ka halwa. Don't experiment with too many food items. Repeat the food items frequently to make the child familiar with the taste. One can also feed protein rich food to their child such as chicken and fish in the seventh month. For breakfast, cereals and suji ka halwa are best choices as they are very nutritious.
Why is it important to vaccinate children? Could you please tell us about the vaccination program of children?
It is said that the best investment any nation can make in the health of its people is to improve the water and sanitation conditions and immunisation of the children. Mother's feed serves as a first vaccine for a child as it has key antigens that provide protection against several diseases. Expanded Programme on Immunisation (EPI) Pakistan provides vaccination against childhood tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, haemophilus influenza type B and measles. We are struggling really hard and hopefully we'll include a few more vaccines against different diseases in EPI program in coming years that will be helpful in preventing children from many other fatal diseases.
How does personal hygiene play an important role in children's health?
It is important that children are introduced to healthy personal hygiene habits from an early age. First of all keep the body clean by bathing and develop the habit of washing hands. Objects such as furry toys are full of diseases and are a major source of infections and allergies. Give them toys that are washable. Keep their nails clean and cut. One can prevent their children from many chronic diseases just by introducing hand-washing habits in them.
What were your feelings when you were honoured with the prestigious Sitara-i-Imtiaz?
Obviously I was really happy but to be really honest I have several other stars that shine and make me happier than the sparkle of Sitara-i-Imtiaz and they are my brilliant students who are taking my legacy forward.
Could you tell us about the proudest moment of your life?
There are several proud moments in my life and getting Sitara-i-Imtiaz is surely one of them. I felt on top of the world whenever I see my ex-students making true progress. The vice chancellor of Dow University is my ex-student; when I saw him grow as a person and earn so much respect it made me really proud. One of my ex-student is Aziza T. Shad who is the chief of division of Pediatric Hematology/Oncology, Blood, and Bone Marrow Transplantation in Washington DC. It is the blessing of Almighty Allah who has given me a lot of success in life and I want to give it back to the society that is why I have built up an NGO to uplift the lives of downtrodden people and I am sure that it will keep working for the welfare of people.
It has been observed that rural kids have stronger immune systems than urban kids, why is it so?
It is actually a misconception that almost all of us believe very strongly, but in reality the picture is totally different. Rural kids live in extremely unhygienic conditions and they are malnourished. Poor water and sanitation makes them more disease-prone. Out of every 1000 children in villages, nearly 100 to 150 die of several diseases such as typhoid, diarrhoea, dysentery and pneumonia. The main reason behind rising child mortality rate in Pakistan is lack of child healthcare facilities in rural areas, where majority of our population lives. Low state spending on healthcare, abject poverty, low literacy, lack of skilled birth attendants, widespread communicable diseases, insufficient emergency child health services in government run district and rural hospitals are amongst other major reasons behind child deaths. Sri Lanka has more or less similar geographical and economical condition as Pakistan but there the child mortality rate is only 20 per year. Serious steps should be taken by the government to improve the living standard of rural population.
You have been associated with an NGO. Briefly tell us about it?
I am the founding member and Chairman of a non-governmental organisation. During my clinical practice a lot of distressed women from rural areas of Sindh came to me for consultation for their sick children. One day I went to a small village near Malir in my car along with a resident medical officer. On reaching there we found out that there wasn't any doctor and medical facility wasn't available in that area. Since then I made a practice to visit that area once a week. Local people were very happy with my arrival, and told other villagers about it. Soon I started getting requests from some other villages also. When UNICEF came to know about my efforts they contacted me. Then another organisation showed willingness to work with us. The main purpose of my NGO is to provide basic health services, primary education, income generation opportunities and development of institutions to empower the underprivileged communities. We work in coordination with the local community to give them a sense of participation. Currently our network has spread up to 20 districts.