The day I listened to a dying patient and found my career direction in disease prevention
A Career Moment with Yasar Yousafzai
Everyone’s career matters. From those in the early stages, to those with a longer story.
We all have a tale to tell, and often there are moments that just have some special meaning or consequence.
In this series we ask people about a career moment and how this influenced, even in small ways, their career or learning. It’s not about a life story or a documentary — it’s a moment.
Using a moment allows early career as well as those with established careers to contribute. Indeed, hearing about moments from early career folk is highly informative in understanding the thinking of those just starting out — it helps us see the world through the lens of youth.
This series makes no assumptions about stage or when a ‘career’ started or career breaks/changes. It makes no assumptions about success.
The moment can be anything. An opportunity or an act of kindness or support; an activity or project; hearing a talk or reading a book; seeing someone from afar yet sensing a role model…
…and now a Career Moment with Yasar Yousafzai
Yasar lives and works in Pakistan as a clinical academic. Yasar is the Director of Khyber Pakhtunkhwa’s Public Health Reference Laboratory (PHRL), and associate professor at Khyber Medical University. Yasar recently received the British Council Global Award for Science and Sustainability.
His work is split between teaching, research, and diagnostics of various diseases of blood.
Based in Pakistan’s Khyber Pakhtunkhwa province, Yasar led his region’s laboratory response to the COViD-19 pandemic (Public Health Reference Laboratory — PHRL). The PHRL has become one of the largest infectious diseases labs in the country. His team became central in guiding public health policy across the whole country and Yasar was honoured with the Tamgha-e-Imtiaz Medal of Honour, one of the highest civilian awards given to Pakistani citizens. Since then, his team and institute, have continued to invest in genomic surveillance programmes and established a laboratory that specializes in diagnostic tests which are not available elsewhere in the province of 35 million people.
His dream includes establishing a much-needed centre for blood diseases and haematopoietic stem cell transplants.
Hello Yasar, thank you for agreeing to share your career moment and for being so open. I wonder if you could briefly share your chosen moment.
When I think about a career moment, I keep returning to one of the most profound experiences of my life.
It was during my medical training, and I was 24 years old. I was on nightshift in the hospital when I heard a heard a young boy in distress. He had thalassemia (a genetic disease affecting the blood), but with many complications, and with little chance of survival.
We talked, and he told me his story, his life, his realities. I remember the conversation like it was yesterday. All the decisions in my professional life are influenced by that moment. It’s the reason I work in public health, and disease prevention.
That is a very emotional moment. What led to this situation for this young patient?
After my graduation, I began working in paediatrics unit for my house job — a mandatory work experience required to be registered as a medical doctor. It wasn’t by choice. Just that it was the only option available at that time. The work was demanding, with too many patients, too few doctors, and long hours. Patients would deteriorate, new emergencies would come in, and you could call the on-call resident just so often. Sleep deprived and short of support, you could only pray that the night passes peacefully.
One night, I heard someone sobbing. I went to the bed and it was an adolescent boy in misery. Between the groans, he said that he was in pain. I took the medical history and found out that he was suffering from thalassaemia — a genetic disease characterized by severe anaemia. Such patients if not treated properly, do not survive beyond the second decade of life. This boy had complications from his treatment. His abdomen was swollen with fluid, heart struggling to beat, and liver and kidneys failing. I prescribed him a painkiller tablet whereas he wanted a painkiller injection. Injectable pain medicines are more efficient in relieving pain, but may cause complications. As I explained the situation to him, I could sense a little agitation in his demeanour.
It was a relatively peaceful night otherwise. Most of the other patients were stable and there were no new admissions. So, I decided to sit at the bedside till the pain went away. And that’s when we began talking.
The boy came from a large, low-income family and had lost a sibling to thalassaemia. Since early childhood, he had learned about taking care of himself and his medications. Since thalassaemic children require frequent blood transfusions, and getting these in Pakistan is not easy, he often went to college and university cafeteria by himself asking for blood donations. He had become used to rejection, stigma, and pain.
In his later childhood years, he started developing complications of the repeated blood transfusions. He contracted hepatitis C infection, and developed iron overload in his body. His growth stopped and his bone became fragile. He stopped going out with his friends and he dropped out of school. Despite his young age, all the hardships had made him wise beyond his years.
We had spoken for about half an hour and the medicine seemed to have eased his pain. I thought it was time for him to rest, so I thought of getting up. Then, unexpectedly, he asked me something that was deeply shocking. He said, ‘ Doctor, when will I die?’. I was surprised and taken aback, and he rephrased, ‘Will it be tonight? I wanna die tonight’. I just had stood up from the bedside, but I couldn’t hold myself up; my knees felt weak. I held onto the bed side and sat back down. I didn’t know how to respond. Trying to put up a smile, I said, ‘why are you thinking this way, you’ll be alright. All you need is a little rest, and you’ll feel better in the morning’. The boys returned a sad smile, and said, ‘Doctor, I know how it will end’. I had never seen this type of hopelessness in anyone, let alone in a 13-years old boy. I had nothing better to say to him. He closed his eyes, and I went back to the doctors’ chamber.
Why was this so important to you — what did you learn from this experience?
The life within the paediatrics ward was a continuous cycle of responding to one medical crisis after the other, keeping me busy with one patient after the other. But that chat always remained with me.
I came to believe that the purpose of medicine is to enhance life experiences, which extend beyond disease management or a medical intervention. A doctor’s job is not just to manage the disease, but to treat a complex psycho-social organism.
There is enormous burden of disease, and a ward’s doctor can only help so much. Meaningful progress would come from larger, more systematic approach disease prevention. My focus shifted from perusing clinical medicine to working in public health, and disease prevention. I started following the developments of thalassaemia prevention program in Pakistan, and proposed a revision to thalassaemia prevention program that would better address thalassaemia prevention.
This was also a moment where I acknowledged the importance of having a conversation with the patient, rather than talking to them for just medical history taking.
All the great textbooks of medicine describe the pathological features and treatment options, none talk about patients’ emotional experience and physicians’ healing touch. It has been shown that ‘patients-as-teachers programs’ have far more engagement and satisfaction amongst medical students and trainee doctors. I encourage all my students to talk to their patients, and develop an empathetic relationship. Not only does it make their jobs more rewarding, it was also been proven that doctors with higher levels of empathy have a much greater success rate in improving patient conditions such as diabetes and hypertension.
I also believe that the purpose of medicine should not be only to alleviate the disease from the body, it should be to do so with causing minimal harm and greatest care. Oncologists frequently discuss the quality of life, acknowledging instances where cancer treatments may exacerbate suffering and marginally improve lifespan. Recent guidelines on some slow growing cancers do not recommend giving potentially toxic chemotherapy right away after diagnosis.
I believe doctors should consider themselves only a part of team that includes nurses, counsellors, the family members, and most importantly the patient.
I believe landmark changes in the health systems are needed universally, especially in countries like Pakistan. The focus of health must move from individual to public health, from hospitals to community, and from treatment to holistic care. Advocacy is required to maintain the balance between medicine as a science and as an art. Consultation with patient groups should be mandatory before devising any health policy.
What has changed in your approach to patient-centred research and care as a result of this experience?
From that chat with the patient, and the following life experiences, I have learnt that individual efforts can only bring about limited change in the world. Genuine transformation requires collective effort and sense of community.
During Covid-19 pandemic, when I volunteered as a first responder, I witnessed the world uniting as a global community, sharing data, PPEs, medicine and vaccines. The resolve of the world community resulted in swift development of diagnostic tests, and vaccine rollouts.
This spirit needs to continue for prevention of other diseases. At an individual level, I learnt that developing collaborations with scientific and non-scientific community helps getting things done faster and more efficiently. I also learnt that one should not limit themselves to a niche field, rather one can utilize valuable skills (PCR in my case) for other purposes.
Acting upon ‘what needs to be done’ rather than asking whether it is your field or not, creates greater impact.
Do you have one piece of career advice for others?
Career is not like a fixed bench in a park where you can sit and work, but it is rather like sailing in the ocean. Where you navigate your life through crests and troughs, learning new skills, changing directions, and moving ahead. As long as you enjoy the ride, you don’t mind little bumps on the way. In this journey, you would hopefully understand meaning of the ocean of life itself.
Do you have one piece advice for organisations around supporting and enabling careers?
I believe every person has a purpose in this world. One has to identify their calling. We often see people in well-paying jobs, yet unsatisfied with their work. We may have lost so many brilliant minds to fields they are not destined to find greatness in. There could be a potential Marie Curie or a Louis Pasteur working in a completely unrelated field.
We should engage students in career development at an early stage. In developing countries like Pakistan, people chose well-paying jobs to escape poverty and to support their family. Few years ago, I initiated a career counselling program for high school students. In this program, young and enthusiastic students were exposed to medical scientists working in different labs. A number of students told me that they were highly excited by research and would love to do research later in their life.
The COVID-19 pandemic served as a stark reminder that even the seemingly mundane jobs play a vital role in upholding our societal functions. We need to make job structures more equitable so that fields of work like social sciences, nursing care, and research better job satisfaction for the value they bring as part of the partnership with clinicians, physicians and surgeons.
Do you have one piece advice for health care organisations around supporting patients?
I believe healthcare organizations can bring remarkable change in promoting health through community engagement.
Healthcare organizations should integrate with the society through primary healthcare, focus more on prevention and health promotion, and not lose the healing touch of care and empathy that is the hallmark of medicine.
We should also invest on providing care with dignity, particularly patients with chronic severe illnesses. Sometimes, a patient doesn’t just need a pill, they also need someone to talk to, during the night, when they’re feeling low.
And finally, we have three quick-fire questions for you.
What do you value — these are something you aim for and hopefully bring to any role.
Empathy, readiness, sustainability, integrity
Emerging skills. Which emerging skill sets for working and living would you prioritise.
Cross-cultural competency; New-media literacy; Adaptability; Contextual problem-solving
What gives you energy?
New challenges give me the energy and stimulus for innovative thinking, problem solving, connecting with people, and learning new skills
You can find out more about Yasar here:
LinkedIn https://www.linkedin.com/in/yasar-mehmood-yousafzai-1b048632/
Our lab www.phrl.pk is always looking for support from international community in building our capacity for disease early detection and prevention. We are also looking for collaborating with organizations which can help us with our ambitious plan to build a bone marrow transplant centre by 2028. I can be reached at the following addresses:
https://twitter.com/Yasaryousafzai
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