The French author Antoine de Saint-Expury wrote in his memoir that “a rock pile ceases to be a rock pile the moment a single man contemplates it, bearing within him the image of a cathedral”.
The kind of man this brings to mind is one with the imagination and the will to create something magnificent where nothing stood before.
Such a man we meet in Rawalpindi, the third-largest city in the Pakistani province of Punjab, where Dr Husnain Hashim is consultant neurologist and stroke specialist and head of the neurology department at Fauji Foundation Hospital.
When Dr Hashim first arrived here in 2018, he left behind a good life and a thriving career in Dubai. Had it not been for the needs of his elderly parents, that was where he would have stayed. In contrast with the expansive neurology department at Dubai’s eminent Rashid Hospital, what passed for the neurology department at Fauji Foundation Hospital in Rawalpindi at the time consisted of one junior neurologist, a single technician and a tiny room.
Shrugging off disappointment, Dr Hashim saw in his mind’s eye a stroke centre where in future stroke patients would receive the highest standard of care. What he didn’t realize was just how many rocks he would have to move by himself to give substance to this vision.
Dr Hashim became what he describes as a “one-man army” bound to an exhausting routine of hospital rounds, attending to outpatients and conducting neurophysiology testing. To grow his army, he needed to attract doctors and not, as happened on successive occasions, lose them to opportunities abroad. His rather audacious solution was to turn his neurology department into a residency training centre, an arduous process that would take a year to conclude.
In June 2020 the historical moment arrived when the College of Physicians and Surgeons of Pakistan authorised Dr Hashim’s five-year neurology residency programme. But turning points are just that – they’re moments that lead to new and different directions, while the journey still lies ahead. A familiar problem now presented itself. The city of Rawalpindi already had four well established neurology departments. Attracting residents to Dr Hashim’s brand-new programme would prove to be a challenge.
In January 2021 the first postgraduate resident broke the ice. Then another one came, and others followed. By late 2024, the programme will have produced three neurologists and enrolled 15 more, making it one of the biggest programmes in the region.
But this was far from the only change that was taking place at Fauji Foundation Hospital.
In Dubai Dr Hashim worked in what was then the only round-the-clock stroke service provider and the only dedicated stroke unit in that city. Although the thrombolytic drug r-tPA would not be registered in Pakistan for another few years, he knew he could reduce stroke mortality and morbidity by providing evidence-based acute care and avoiding complications. In 2022, with the unstinting support of the hospital administration, he carved out a small stroke unit in the high-dependency department, implemented an acute stroke pathway and formed an alliance with other specialities including emergency, internal medicine, medical ICU, radiology, cardiology and rehabilitation.
Dr Hashim was no longer a one-man army. With Dr Saeed Arif having joined his department, the pace of change was picking up and 2023 would turn out to be a stellar year for several reasons: In January of that year Dr Hashim’s department treated its first stroke patient with thrombolysis; reinforcements arrived when Dr Saima Shafait joined the department; Dr Hashim became vice president of the Pakistan Stroke Society and arranged an international stroke congress, and Fauji Foundation Hospital became the first hospital in Pakistan to win a WSO Angels Award.
When you ask what motivated him to turn the rock pile into a cathedral, Dr Hashim effectively tells you it was because he could. There was a dearth of stroke services for Pakistan’s 200 million people and the situation in respect of mortality and morbidity was “miserable”, he says. “I had the skill, I had the space, so I had to do it.
“I had seen and worked in one of the best neurology departments and stroke centres in Dubai and I had a lot of experience of establishing neurology and stroke services. After coming back and seeing the very limited resources for neurology and stroke care in Pakistan, it motivated me to work with the same enthusiasm and commitment to establish the same services here.
“Very little had been done in the field of stroke and neurology so there was a lot of space and many opportunities. Working for the community gave me the strength and motivation to go ahead even in difficult situations.”
Besides his own enthusiasm and commitment, two things helped Dr Hashim create one of most progressive stroke services in the country. One was the good leadership he had witnessed and experienced in Dubai – particularly in the person of Prof Dr Suhail Abdullah Alrukn who is also the president of the Middle East and North African Stroke Organization, MENASO. “He’s a role model for me,” Dr Hashim says. “He played a major part in teaching me how to make a team and lead a team.”
The other was a team that had been worth waiting for. “I was lucky, I found good people,” Dr Hashim says, eager to pass on the credit to both his own team of neurologists and residents and to the many outstanding specialists at Fauji Foundation Hospital who are the reason the programme has grown.
His responsibilities have grown too. Dr Hashim says, “As vice president of the Pakistan Stroke Society it is my duty to establish stroke services not only in my hospital but all over Pakistan.” This duty as he sees it includes offering training and guidance to other hospitals in the region, and, in his capacity as Pakistan’s national coordinator for the international stroke registry SITS since 2021, encouraging other centres to join the registry and win awards.
Dr Hashim certainly has his eye on more WSO Angels Awards and not only at his own hospital where in the first two quarters of 2024 they added two platinum awards to their tally. There are now more than 15 Pakistani hospitals in the SITS registry and Dr Hashim has filmed a video with guidance on how to participate in the Angels awards programme.
Fauji Foundation Hospital remains for the moment the only hospital in Pakistan among the honours, but Dr Hashim predicts that within the next quarter or two there will be three or four more and that his hospital will realize another of his dreams – to win Pakistan’s first diamond award.
