Brain drain: a harsh reality, international migration of Pakistani medical graduates

To explore final year students and fresh graduates' intentions to train abroad, identify the influencing factors for this decision and understand their attitudes towards conditions in Pakistan and abroad. Following informed consent, respondents were asked to complete a self administered structured questionnaire to collect demographic and educational information, their plans for post graduation training abroad, factors influencing decision to migrate abroad or stay in Pakistan as well as attitudes towards prospects in Pakistan and abroad. Data was entered and analyzed by SPSS 17.0. Among the 275 respondents, 176 [60.4%] intended to go abroad for postgraduate training. Professional excellence [25.5%], easier career settlement [10.2%] and financial prosperity [7.6%] were some of the goals respondents wish to achieve through training abroad while required process of certifications i.e exams and tests [37.5%], expenses [24.4%] and visa problems [21.5%] were identified as barriers for migration abroad. Agreement among various groups [general public, patients, healthcare institutions, academic community] considering doctors trained abroad as more qualified than doctors trained in society and government attitude towards doctors as well as living standards in Pakistan. Positive attitudes were identified towards doctors' status, living standards, and ability to cope with working conditions, political and social circumstances abroad. A significant percentage of medical graduates intend to migrate abroad for post graduate training. Apart from better economic prospects, unhelpful view towards conditions in Pakistan also contribute for increasing trend of migration among physicians from our homeland

Children's mental health: pattern of referral, distribution of disorders and service use in child psychiatry outpatient setting

To determine the pattern of referrals, socio-demographic factors, frequency of psychiatric diagnosis, and help offered to children presenting in Child Psychiatry Department outpatient clinic of a tertiary care hospital in Lahore. A cross sectional study of children attending child psychiatry outdoor in a tertiary care hospital in Lahore was conducted. Following informed consent from the parent/ legal guardian, 1000 consecutive new referral to the department were assessed by interviewing the parent and the child. A Structured proforma was used for data collection. ICD-10 criteria were used for the diagnosis of psychiatric illness. Record was made of the interventions offered to the child and family.Total sample size was 1000 children with predominant male gender [65%] and mean age of 8.46 [S.D 4.51].More than half [54.5%] of the children in our sample were not enrolled in school and 19% had family history of psychiatric illness. Among the various sources of referral, self-referral was the highest [84.7%] followed by referral from Pediatrics [8.4%]. Psychiatric diagnosis observed were Speech Related Difficulties [including speech delay, articulation problems and specific developmental delays of speech and language [46.5%], Learning Disability [43.3%], Behavior Problems [26.3], Epilepsy [12.6%], Dissociative Disorders [10.1%], Attention Deficit Hyperactivity Disorder [4.5%], Autism [3.2%], Depression[2.4%], Anxiety[1.7%], Psychosis [1%] and Tics [1%]. Co-morbidities were found in 44.7 percent of the children. The various interventions offered included medications, referral to psychologist [for family therapy and individual work], play therapist and speech therapist. Majority of children presenting to the child psychiatry clinic have multiple and complex needs due to high frequency of learning disabilities and co morbidities. The findings illustrate the importance of multidisciplinary approach and to assess the different dimensions of psychopathology in children for future service planning

Unhappy doctors in Pakistan: what are the causes and what can be done?

To determine if the general perception of doctors being unhappy is true as well as to explore the underlying causes for this phenomena. This is a cross sectional study that was conducted over a six months period in two tertiary care hospitals in Lahore. Data was collected by using a structured questionnaire. Demographic information and data assessing perception of overall physicians being unhappy in Pakistan, and their own personal level of satisfaction in life was collected. Possible reasons for unhappiness among doctors from a list of factors was also explored. Finally the respondents were asked about their intentions for near future of remaining/ leaving Pakistan. The data was analyzed by using the statistical package for the social sciences [SPSS version 17]. Six hundred and one [49% males] with the mean age of 28 years [s.d 5.95] participated in a self-reported survey. Majority of the participants [393; 65%] were junior doctors. Fifty nine percent of respondents believe that overall Physicians in Pakistan are unhappy. When asked directly about their own level of unhappiness, respondents gave almost equivocal reply [43% dissatisfied vs 42% satisfied]. Low pay [87%], increase workload [73%], no positive feedback [70%], job insecurity [64%] and poor mutual support [47%] being the most significant causes responsible for this unhappiness. High proportion of doctors [55%] would prefer to be in any other country than Pakistan. This study demonstrated that unhappy doctors are a worldwide phenomenon, Pakistani Doctors being no exception. High proportion of doctors intending to leave Pakistan is a source of concern for the health services. We need to accept the causes and take steps to address the issues identified

Psychological problems in children of parents with mental illness: a comparative study from Lahore, Pakistan

Mental illness in parents and its link with adverse outcomes for children has been well reported in western literature, but there is a paucity of published studies from Pakistan on this issue. The aim of our study was to determine the prevalence of psychological problems in children of parents having mental illness and to compare it with children of parents without any diagnosed psychiatric problems in urban area of a developing country. A case control study was conducted from January to April 2008 in Lahore. Following informed consent, cases were recruited through interviewing psychiatric patients. Controls were children of parents with no diagnosed psychiatric illness and were recruited through a school. A structured questionnaire for demographic information, and Strengths and Difficulties Questionnaire [SDQ] were filled in by parents. Seventy- six parents were recruited to get a sample of 200 children. [100 cases, 100 controls]. The mean age of children was 9.7 years and 111[55.5%] were boys. Children of parents with psychiatric problems had almost two times higher rate of mental health problems compared to controls [55% versus 28%; P value <0.001]. Emotional difficulties [P=0.028] and conduct problems [P=0.025] were found to be statistically significant. Boys were more likely to be hyperactive and have conduct and social difficulties. Girls had higher rates of emotional problems. Children of parents with mental illness are at much higher risk of childhood psychiatric problems. Risk was higher for males than females. Majority of parents had not sought any help for their children difficulties