History

History of Physical Medicine and Rehabilitation in Pakistan

The origins of Physical Medicine and Rehabilitation (PMR) in Pakistan can be traced back to the pioneering efforts of Dr. Syed Rafi Uddin Ahmad Kirmani. In 1961, Dr. Kirmani went to Europe for a World Health Organization (WHO) sponsored training program in rehabilitation medicine. On his return, he laid the foundation of contemporary rehabilitation in the country. In 1964, Dr. Krmani upgraded the Physical Therapy section at Jinnah Post Graduate Medical Center (JPMC) to Bachelor of Science Program (BSc). The next landmark was the establishment of School of Occupational therapy in 1973. He was also the first in Pakistan to introduce Electrodiagnostics at JPMC. Dr. Kirmani was assisted in his endeavors by Dr. Abdul Moeed Kazi from Karachi. With a background in Internal Medicine and a long standing academic affiliation at major teaching institutes of Karachi, Dr. Kazi's efforts led to the recognition of rehabilitation medicine regionally. Over the years, their sedulous attempts led to development of allied health sciences, acceptance of PMR in medical community and acknowledgment of the specialty at national level.

In early 1980s, a physician from Lahore, Dr. Khalid Jamil Akhtar went to U.K for advance training in Neurology and did a diploma in rehabilitation medicine from the Royal College of Physicians (RCP) London. On his return, he established the first department of PMR in Punjab at the Mayo hospital Lahore. This was among the first three centers to be recognized for residency training in the discipline of PMR. Dr. Khalid Jamil Akhtar continued to promote the specialty through his philosophy of social empowerment with main emphasis on awareness and disability rights. He is a well-recognized personality in media and has become a public figure aka Big Brother. Dr. Khalid was awarded Sitara-e-imtiaz in recognition of his efforts. It is is one of the premier national awards granted for the highest degree of service to the state. He was later honored as Professor Emeritus at the first national conference of PMR.

Rehabilitation services under Pakistan armed forces provide the most advanced and comprehensive disability care in the country. The sequence of events which led to the foundation of PMR in Pakistan military dates back to 1981 when a directive was issued by then president of Pakistan, General Muhammad Zia-ul-Haq to establish two centres of excellence in Rehabilitation Medicine in the country. It is believed that the inspiration behind this was his daughter who had special needs. Two physicians were sponsored by Pakistan military for foreign training in Rehabilitation Medicine. Dr. Muhammad Afzal Kiyani underwent advanced training in Spinal Cord Injury Medicine while Dr. Pervaiz Hassan Khan Niazi specialized in Electrodiagnostics. On their return, both teamed up and pioneered the establishment of PMR in the Pakistan Army. The foundation stone for Armed Force Institute of Rehabilitation Medicine (AFIRM) was laid in 1991. Later, the Department of Rehabilitation Medicine at Combined Military Hospital (CMH) expanded to merge with AFIRM. The outpatient setup was started in 2001, while the inpatient department was opened in 2005. Dr. Pervaiz Hassan Khan Niazi was awarded Sitara-e-Imtiaz (military) in recognition of his services for promotion of rehabilitation and disability care in the country.

In 2005, a massive earthquake in northern Pakistan led to 70,000 casualties and left 120,000 injured. This mandated the need for the rehabilitation of thousands of patients who sustained traumatic injuries resulting in disability. The rehabilitation services provided by physiatrists led to the recognition of PMR at the national and international levels. Not only were the contributions of PMR acknowledged by the local health sector, but also this laid the foundation of international collaboration between Pakistani physiatrists and foreign medical organizations providing disaster relief in earthquake affected areas. The impact of this tragedy was immense and the individuals with disabilities continued to require rehabilitation services for many years. The need for rehabilitation grew stronger and rehabilitation services led by rehabilitation physicians resulted in further institutional and academic development of PMR. Moreover, since 9/11, thousands of Pakistani military and civilians from the north and northwestern regions of Pakistan have been affected. The estimated death toll currently exceeds 49,000 Pakistanis. Between 2008 and 2013, 5,678 Pakistanis were injured in bomb blasts and suicide attacks. A rise in traumatic brain injuries, spinal cord injuries, polytrauma and amputations was subsequently observed even though there are no comprehensive statistics available regarding disability among civilians and the Pakistan army populations. A need was felt to train more PMR physicians in Pakistan from the platform of the College of Physicians and Surgeons of Pakistan (CPSP). With special interest of the then President of CPSP and efforts led by leading rehabilitation physicians across the country, PMR was recognized as one of the specialties for post graduate training by CPSP. The pioneers who helped to materialize this were Dr. S R Kirmani, Dr. Abdul Moeed Kazi, Dr. Khalid Jamil Akhtar, Dr. Muhammad Afzal Kiyani, Dr. Pervez Hassan Khan Niazi and Dr. Mumtaz Jabeen Babar. Three departments were recognized initially for training in PMR, including JPMC Karachi, Mayo Hospital Lahore and AFIRM. On her return from the United States, Dr. Mumtaz took lead in developing rehabilitation services at Sheikh Zayed Hospital Lahore, followed by establishment of department of rehabilitation medicine at Children's Hospital and Institute of Child Health Lahore. Dr. Aamir Waheed Butt and Dr. Amjad Hussain were the first trainees who successfully qualified the FCPS part II exam in PMR in 2001. Dr. Nabila Soomro became the first female PMR physician of the country and also the first one to bag the gold medal in the discipline of PMR. Later, she took the lead in the development of institute of Physical Medicine and Rehabilitation (IPM&R) at Dow University of Health Sciences, which is providing state of the art rehabilitation services regionally and running multiple graduate and postgraduate training programs. In 2009, CPSP introduced a collaborative residency program in PMR between King Fahad Medical Saudi Arabia and CPSP. 5 out of 6 residents completed their FCPS training under this program up till 2016.

In 2005, a massive earthquake in northern Pakistan led to 70,000 casualties and left 120,000 injured. This mandated the need for the rehabilitation of thousands of patients who sustained traumatic injuries resulting in disability. The rehabilitation services provided by physiatrists led to the recognition of PMR at the national and international levels. Not only were the contributions of PMR acknowledged by the local health sector, but also this laid the foundation of international collaboration between Pakistani physiatrists and foreign medical organizations providing disaster relief in earthquake affected areas. The impact of this tragedy was immense and the individuals with disabilities continued to require rehabilitation services for many years. The need for rehabilitation grew stronger and rehabilitation services led by rehabilitation physicians resulted in further institutional and academic development of PMR. Moreover, since 9/11, thousands of Pakistani military and civilians from the north and northwestern regions of Pakistan have been affected. The estimated death toll currently exceeds 49,000 Pakistanis. Between 2008 and 2013, 5,678 Pakistanis were injured in bomb blasts and suicide attacks. A rise in traumatic brain injuries, spinal cord injuries, polytrauma and amputations was subsequently observed even though there are no comprehensive statistics available regarding disability among civilians and the Pakistan army populations. A need was felt to train more PMR physicians in Pakistan from the platform of the College of Physicians and Surgeons of Pakistan (CPSP). With special interest of the then President of CPSP and efforts led by leading rehabilitation physicians across the country, PMR was recognized as one of the specialties for post graduate training by CPSP. The pioneers who helped to materialize this were Dr. S R Kirmani, Dr. Abdul Moeed Kazi, Dr. Khalid Jamil Akhtar, Dr. Muhammad Afzal Kiyani, Dr. Pervez Hassan Khan Niazi and Dr. Mumtaz Jabeen Babar. Three departments were recognized initially for training in PMR, including JPMC Karachi, Mayo Hospital Lahore and AFIRM. On her return from the United States, Dr. Mumtaz took lead in developing rehabilitation services at Sheikh Zayed Hospital Lahore, followed by establishment of department of rehabilitation medicine at Children's Hospital and Institute of Child Health Lahore. Dr. Aamir Waheed Butt and Dr. Amjad Hussain were the first trainees who successfully qualified the FCPS part II exam in PMR in 2001. Dr. Nabila Soomro became the first female PMR physician of the country and also the first one to bag the gold medal in the discipline of PMR. Later, she took the lead in the development of institute of Physical Medicine and Rehabilitation (IPM&R) at Dow University of Health Sciences, which is providing state of the art rehabilitation services regionally and running multiple graduate and postgraduate training programs. In 2009, CPSP introduced a collaborative residency program in PMR between King Fahad Medical Saudi Arabia and CPSP. 5 out of 6 residents completed their FCPS training under this program up till 2016.

Today, rehab medicine is progressing by leaps and bounds with many young aspiring physicians undergoing training at Lahore, Rawalpindi, Karachi, Peshawar, Muzaffarabad and in Saudi Arabia. Nobody can fathom its humble beginnings and past diminutive status. Each and every single achievement and advancement in this field is in fact a testament to the untiring efforts of our esteemed pioneers who had the foresight to predict and the guide to shape a bright future for this unique specialty of medicine.

Acknowledgments: Dr. S R Kirmani, Dr. Farooq A Rathore, Dr. Omer J Khan, Dr. Ahmad Z Qureshi
For further interest in the history and origin of the specialty of Physical Medicine and Rehabilitation, the following links are excellent resources. Some of these narrations are by the pioneers of modern day rehabilitation.