“I saw the spark in Resham the first time I met her. Her compassion towards the patients and connection with the families was impressive. She was the ideal candidate for paediatric palliative care because of her personality and her work ethic.” - Dr Sadaf Altaf
Dr Sadaf Altaf, Assistant Professor of Paediatric Oncology, handpicked her mentee Dr Shahzadi Resham from the Haematology Oncology Fellowship to champion Paediatric Palliative Care (PPC) within AKU and across Pakistan. Dr Resham’s devotion to AKU for 15+ years and her inspirational journey is truly an example of how one person can make a lasting difference to the lives of others.
“AKU has been more than a second home for me; I still remember vividly when I joined as an intern way back in November 2006 and since then, I’ve had the privilege of completing three PGME graduations. Fast forward twelve years to 2018, I joined the Department of Paediatrics and Child Health as a full-time faculty in General Paediatrics as a Senior Instructor and was specifically hired with the purpose of developing Paediatric Palliative Care (PPC) services.” - Dr Shahzadi Resham
Dr Shahzadi Resham might be a well-known personality across the Stadium Road campus today but 15 years ago, she almost didn’t make it to the AKU community. Unable to join AKU’s MBBS programme, she soldiered on to complete her undergraduate medical training from Sindh Medical College. While Dr Resham’s class fellows were trying to secure further training abroad, she was trying to secure her next training at AKU. She believed, from a young age, that her efforts would be best utilised towards the advancement of healthcare within her own country, Pakistan. Unfortunately, at the time, Dr Resham was put on the waitlist for an internship with AKU and had to begin further training elsewhere.
When opportunity came calling a few weeks later, Dr Resham answered. She recalls the moment, sharing that she got a call from AKU on 30th November 2006; somebody had dropped out from the internship programme and they wanted her to join the following day. Dr Resham replied, “I am coming right away!”. She got the call she had been waiting a long time for, and she seized the opportunity immediately. From that day in 2006 till today, Dr Resham has built a strong and prosperous career at AKU, leading the way in PPC.
Why PPC?
PPC is an intense subspecialty dealing with the treatment of serious and complex illnesses in the paediatric population. 22 million children worldwide are estimated to need palliative care and more than 98% of these children are in LMICs (WHO, 2018). Over 80 million children reside in Pakistan and yet the country’s healthcare systems are completely devoid of any PPC services, leaving a vast paediatric population to suffer from a lack of treatment options. When Dr Altaf chose her mentee to champion PPC, Dr Resham had little experience in the subspecialty, but within a short span of time Dr Resham became the face of PPC for AKU after receiving on-job mentorship by adult palliative care physician, Dr Atif Waqar. She is one of the few people working in palliative care for the nation's paediatric population. Currently, Dr Resham is pursuing the first of its kind full fellowship in PPC from St. Jude Global.
“My life is not for me, it’s for my country. I tell medical students that they should study from a good institution and gain experience from there, but always come back to your country. They must figure out their priorities. Otherwise, we will remain an LMIC, and good doctors and critical knowledge will remain outside. If we don’t come back, our situation won’t improve.” - Dr Resham
How Dr Resham secured this fellowship is a leading example of the power individuals hold in opening doors to create opportunities for themselves. The Chair of the Department of Global Paediatric Medicine at St. Jude’s Children’s Research Hospital, Dr Carlos Rodriguez, paid a short visit to AKU and as Dr Resham caught wind of his visit, she urged fellow faculty members to arrange a brief meeting with him. She used those minutes to her absolute advantage. Recounting the meeting, she explained,
“I shared a few slides discussing my passion for Paediatrics, and specifically integrating PPC in Pakistan’s health systems, and before I could reach my closing slide describing a way forward which included training at St. Jude’s, Dr Carlos himself extended the opportunity to train at his institute. He asked me if I would be willing to do a full fellowship in PPC at St. Jude Global, on the strict condition that I return to Pakistan with a mission to work in PPC.”
Dr Resham was thrilled to hear this as she always intended to return to her country, but there were a few hurdles to overcome for her to make it to the United States of America.
Alongside her clinical and academic duties at AKU, she had to study for and pass not one, but three, United States Medical Licensing Examinations (USMLEs). Having passed two out of the three exams, Dr Resham was ready to take the last examination in person in the US when the Covid-19 pandemic began, and her plans were delayed indefinitely. Undeterred she continued working hard in her field and managed to make the best of a bad situation; she was promoted to Assistant Professor within the Department of Paediatrics and Child Health in April 2020, and less than a year later in February 2021 she also joined the Department of Oncology as an Assistant Professor for PPC.
“Despite many hurdles and obstacles in getting to her fellowship at St Jude Children’s Hospital, she did not give up which is a testament to her commitment. The feedback from St Jude has been phenomenal regarding her experience in palliative care at AKU. She started many projects for palliative care before leaving for her fellowship which will continue to move forward when she returns from her fellowship.” - Dr Sadaf Altaf
Dr Resham has passed all three USMLEs and is thoroughly enjoying the fellowship at St. Jude Global. She has developed a 2030 PPC visionary plan for Pakistan and is working with experts from St. Jude Global to mature it into a national strategic action plan.
“It is challenging to be away from my family and country but my mission will not be achieved on my own. It is not about my climbing to the top of Everest; it is about creating many Reshams so that they all can reach the top of Everest. This is what success is to me; to sit at the base and support others in reaching the peak, which in this case is spreading PPC across Pakistan’s health sector.”
When asked how she feels about dedicating her life to the betterment of others via such an emotionally-taxing field, Dr Resham responded “It makes me feel emotional, sentimental...I believe in this mission. I can’t thank Dr Sadaf Altaf enough for believing in me. I feel proud of myself that I have been chosen as one of the people who can take this challenge forward and can make this effort. And when I feel happy, then I don’t feel tired.” Dr Resham stressed that she would not have made it so far in her mission without the support of her colleagues:
"Dr Salman Kirmani, my ex paediatrics chair, and Dr Sadaf Altaf's dedication towards their patients and families, and unwavering support for me is unmatchable; I truly hold both of them in high regards and they are like my spiritual parents. Thank you to Dr Atif Waqar for providing me with a strong foundation in palliative care; I would be nowhere without his support and supervision. I learn something new from him everyday. I am grateful to Allah for blessing me with parents who are always there for me with their continuous support; I only pray that I will never disappoint them in this PPC journey. I am also very grateful to Dr Asim Belgaumi and of course, my paediatric and oncology department and my hospital."
Fellow colleagues Vardah Bharuchi and Dr Sidra Kaleem from the Paediatrics and Child Health department wrote “The Many Faces of Healers in Child Health”, in which they stress the importance of PPC and the services provided by their department:
"Holding an empathetic attitude towards the pain of children and their parents with some semblance of congruence, leads physicians towards suffering with and partnering with the families. This is where the recognition of PPC and Child Development Rehabilitation Centre (CDRC) comes in. The PPC service is headed by Dr Shahzadi Resham. The compassionate collaborative care that the team provides is not only to help the child in the transitionary period of this life and death but also to provide solace to those who are suffering from chronic conditions.
Similarly, the team in CDRC which is led by Dr Shahnaz Ibrahim and Dr Sidra Kaleem, assists society to see children who are developmentally challenged as individuals and humans who have their own dignity and worth. The services help with physical, emotional and social functioning with the support of a team of developmental paediatricians, paediatric neurologists, psychologists, physiotherapists, occupational and speech therapists. With collaborative care, a realistic hope is maintained. These services offer a way for patients and their families to heal and to be understood.
Healing is not just limited to a cure; reducing the suffering of patients and becoming partners with children and their families during the journey is equally important. This is the doctrine that the Department of Paediatrics and Child Health abides by."
A big thank you to Dr Shahzadi Resham for writing to us and sharing her journey with PPC at AKU. Thank you to Vardah Bharuchi and Dr Sidra Kaleem for writing such a passionate piece about their Department of Paediatrics and Child Health's critical work in health service delivery.