Lifestyle Profiles - Paediatrics

Javed Iqbal
Consultant Paediatrician
Edith Watson Unit
Burnley General Hospital

I am currently employed by the East Lancashire Hospitals NHS Trust as a Consultant Paediatrician based at Burnley General Hospital. I am also a PRHO Tutor and Clinical Director.  My special interest within the clinical practice of paediatrics is nephrology.  I remain an honorary Consultant Paediatrician with Central Manchester and Manchester Children’s Hospital NHS Trust.

My training as a Paediatrician has been largely received within the hospitals in the north west of England including a number of years spent at the Royal Manchester Children’s Hospital both as Registrar and then Senior Registrar.  Before taking up the Registrar post at Royal Manchester Children’s Hospital I spent more than a year as Registrar at Our Lady’s Children’s Hospital at Dublin.  This post had followed the Senior House Officer posts at Burnley and Bolton.

Having graduated from King Edward Medical College and Punjab University at Lahore in Pakistan and completing my internship in paediatrics and general surgery, I commenced my training in United Kingdom.  At the time of graduation I was equally attracted by paediatrics and psychiatry which in the first instance may strike rather odd but has a major element of psychosocial medicine in common with each other. 

My first substantive posting in United Kingdom was in adult psychiatry which I found tremendously educating and that one year spent there has served me very well in my clinical practice as a paediatrician.  This is through better recognition of psychosocial aspects of disease and dynamics of human and family behaviour.  Having toyed with the idea of continuing in psychiatry as a future career I decided to return to paediatrics for a number of reasons

Paediatrics is a tough but very attractive speciality.  It is a very broad based field of medicine and as a Consultant Paediatrician you may find yourself practicing simultaneously the opposite ends of the spectrum.  As a district Paediatrician you are involved with neo natal intensive care and at the same time you may be dealing with interesting dynamics causing a somatic illness presented to you in an outpatient setting. 

In today’s Britain knowledge and understanding of transcultural matters is vitally important.  Having worked in a number of specialties during my training, I have found Paediatrics having its own culture.  Perhaps partly as a result of that as well as the fact that certain type of person would be more attracted to the practice of Paediatrics, most of the Paediatricians would have a number of traits in common with each other.  One result of such a culture is the keen interest most of the senior Paediatricians seem to take and show in the training and general welfare of their junior colleagues.

As a junior trainee I have always been impressed by the degree of interest shown by my seniors and the support that they provided through positive feedback and constant encouragement.

Paediatrics as a specialty has had a number of hallmarks of its practice which are being increasingly recognised as good practices and being actively promoted by a variety of agencies.  One of these hallmarks has been concept of team working.  Whereas in most of other specialties the team has been mostly vertical in its constitution headed by a Consultant and PRHO or an SHO providing the workhorse role.  Paediatrics has always had horizontal as well as vertical team working practices.  Consultants have always supported each other and worked together including joint ward rounds.  In our department, like most others, junior doctors are not attached to a single Consultant but work with most if not all the Consultants simultaneously.  This gives them tremendous advantage in getting to know different styles of practices based on experiences of individual Consultants.  This also provides experience in a wide variety of paediatric work as most of the Consultants will have special interests.

At the time of choosing to come to Britain for further training I considered United States as an alternative.  Because most of my teachers in the medical school had been trained in United Kingdom and partly due to that the practices in medicine were very akin to the ones in United Kingdom with a strong emphasis on clinical skills, it seemed natural to choose United Kingdom.  Since the intention has always been to return to practice in Pakistan nearer to my family, I did so after completion of my training.  I worked as a Consultant Paediatrician and an Assistant Professor of Paediatrics at the Children’s Hospital in Islamabad, which is within the larger Pakistan Institute of Medical Sciences and Quaid-e-Azam Post Graduate Medical College.  I worked there for 5 years in total before returning to take up my current post at Burnley.  This period proved to be perhaps one of the most important in my development.  In a strange way this was simultaneously exciting, gratifying, educating and frustrating period. 

The Children’s Hospital in Islamabad catered the 2 very extremes of Pakistani society.  On the same day you could be dealing with a heart breaking situation of a moribund child that you are desperately trying to help to survive and the parents are begging you to stop treatment and discharge because it is cheaper to carry a dying child rather than a dead child back home which may be hundreds of miles away or a child/grandchild of the most powerful politician or a bureaucrat.  You were constantly faced with diagnostic problems which exercised your mind.  The training opportunities for juniors were limitless, as on any single day you could choose to present in your educational meetings a wide variety of cases of a single rare condition.  The Children’s Hospital had been newly commissioned and was in its very early stages.  I helped to develop the neo natal intensive care and subsequently paediatric intensive care as well as paediatric nephrology section.  I learnt to appreciate the limitations of resources and respect them.  I learnt a lot more and different medicine.  I learnt one’s own limitation.  I learnt that rationalisation of resources may be a necessary evil.  You could help to save hundreds of lives by prevention and appropriate management of simple and common conditions like diarrhoeal disease and acute respiratory infections with the same degree of resource that you need to sustain a single life with ultimately lethal condition.  I learnt to respect a natural resource like breast milk and its huge value in preventing disease.  I learnt how people behaved in challenging situations.  I learnt how people behaved with each other in a workplace.  I learnt the value of working in a happy and mutually co-operating and respecting atmosphere because medicine is a tough line to be in and you have no time to worry about trivia.  Slowly but surely it seemed increasingly evident to myself that I was naturally more suited to and perhaps had become quite used to a working life culture of British paediatrics and decided to return to United Kingdom.

I was warmly welcomed back in Burnley when I expressed my interest in wanting to return and I had such fond memories of my stay at Burnley and the respect that unit enjoyed within paediatric circles particularly within north west that it seemed natural for me to choose Burnley in preference to some other options that might have been considered preferable by many other people.  Burnley paediatrics has gone from strength to strength and in recent years has enjoyed national accolades.  Generations of trainees have left the unit with fond memories and continue to do so.  We are constantly thinking of and introducing innovative developments and now that the trusts have merged we are looking forward to working together for the good of children and families across East Lancashire.