Alumni Corner

I love coffee, it puts me in the right mood, it helps me deal with my morning blues, and helps me get more done throughout the day. I could not get over the fact that I finally found a place that had great coffee and I could have a cup whenever I wanted.

I carried my brimming cup of black brew over to the table and sipped away quietly as everyone else slowly made their way into the room. It was the first day of the PGD course at

CBEC. At 8.00 am, we were introduced to Dr. Wahab Suri, Professor of Philosophy at University of Karachi. He was going to set the stage for the next couple of weeks. He was the opening act, the beginning of bioethics – Philosophy and Bioethics. I examined Dr Suri and watched him as he moved around the room introducing the class to philosophy. Suddenly he stopped in front of me, paused and looked straight at me. “What do you think will happen to you when you die?” Philosophical questions are an effective tool to stimulate and develop critical thought. However, I was not prepared for this question. I had never really allowed myself to think about it. It was something that I was afraid of. I wanted to say I didn’t know, but I was afraid of being judged by a room full of medics whom I had just met. Should I tell the truth, or should I make up an answer? I was silent, he read the fear on my face and the fumbling of my soul through my eyes. He carried on with his lesson. I will never forget my first day at CBEC.

We often do not have the time to delve too deep into ourselves; life’s practicalities and challenges do not allow it, so we adopt thoughts and ideas because it is easier. For the last 17 years, CBEC has been my Wonderland, Oz, and Narnia. I have been ‘Dorothy’ looking for my way home, I have been ‘Alice’ excited and amazed constantly chasing white rabbits, and I have been ‘Lucy’ realizing that I too can be brave and change things. At CBEC I found shade when it was too hot and shelter when it rained, a cup of coffee ready for me whenever I needed it.

At CBEC, you won’t just receive an education; you’ll become part of a nurturing community where you can find intellectual nourishment, support, and a sense of belonging. From exploring humanities to navigating the challenges of pandemics, CBEC offers a space where individuals can reflect, grow, and engage with difficult questions. I have my answer now to Dr Suri’s question, I am no longer afraid to think about difficult questions nor afraid to speak up. All I need is my cup of coffee.

I did my postgraduate diploma in Biomedical Ethics from CBEC in 2010. At that time, I was working as an Assistant Professor at the Department of Dermatology, Ziauddin University (ZU), Karachi. It was an amazing experience.

Being a science student all my life, my brain had been programmed to look for facts, realities and theories which meant that I always got clear answers to my queries. But the most shocking part for me as I pursued the PGD was the realization that there can be no one, clear-cut answer in any case of ethical dilemmas and moral quandaries. The purpose of class discussions was to make us “think.” It took me weeks to adjust and realize that I was the one asking odd questions in my search for the right answer in every session.

Before I learnt anything at CBEC, I had to follow the process of “unlearning.” I had to unlearn a belief that “I am always right” and that “everyone will accept my perspective.” CBEC created a feeling of unease, which is necessary to reflect upon the decisions we make whether in a clinical setting or while conducting research.

CBEC Faculty including Dr. Moazam and Dr. Aamir created this alternative world for people like me which changed us from the core. I found that your mentors can be your guides, friends and advisors all at the same time. I received guidance from faculty as I embarked upon the task to develop procedures and refine the working of the Ethical Review Committee (ERC) at ZU.

Over the past twenty years, CBEC has done a commendable job in educating healthcare-related professionals. One cannot ‘undo’ what I learnt there. While I am no longer in Pakistan, what I learnt at CBEC guides me while doing my clinical practice in Dubai, whenever I face dilemmas related to patients presenting with sexually transmitted diseases, or when I’m dealing with pharma companies. Thank you for creating this alternative world and for helping us to bring positive changes in clinical and research settings in Pakistan.

It was a hot summer day when a senior colleague from my medical school suggested that I consider enrolling for a course on Biomedical Ethics at CBEC in Karachi. With little prior knowledge of the content and nature of the course, I appeared for the interview knowing little that this small event was about to change my life forever. I had never been part of such a focused and meaningful interview with questions that targeted areas of the medical profession that had always perplexed me. The interview struck a chord in my heart. I was instantly hooked.

What transpired during my PGD year was a journey to learn, unlearn and explore. People hold onto their beliefs dearly and stubbornly, but if provided a safe and stimulating environment, it’s not uncommon for people to open their minds and expand their hearts to ideas contrary to their long-held notions.

Adult learning in general and medical education in particular have seen remarkable changes during the last three decades and it was refreshing to witness how faculty at CBEC merged traditional styles of teaching with contemporary methods of learning. Our modes of learning ranged from student-led teaching to facilitated group discussions. Using videos as teaching tools was significantly effective in stirring interesting debates around ethical issues. A broad-based curriculum was backed by a diverse faculty instrumental in delivering the course in its true spirit and meaning. It was mentally and emotionally challenging to cover topics across the spectrum swinging from philosophy and law to children and women rights. An important aspect of the course was how the historical background of biomedical ethics was connected with modern debates around organ donation and artificial support technologies. It was fascinating to define “life” and “death” from both philosophical and scientific paradigms. As a learner, I was intrigued by formal and informal feedback I was provided through length and breadth of the course. It provided an insightful perspective on my strengths and shortcomings both as a student and as a teacher.

Learning extended beyond classrooms through informal interactions with colleagues and faculty over tea and meals providing ample opportunity to clarify concepts. It also brought to the fore a much more relatable human interaction based on mutual respect and trust. Visits to the historical sights like Makli graveyard and Shah Jahan Mosque helped in “switching off” from rigours of dense coursework and building camaraderie among classmates.

Beginning of the PGD course was unsettling as it opened doors to uncertainty and unpredictability. But as the year drew to a close, initial confusions were replaced by a reassurance that in real life, it’s important to shun conviction and embrace complexities. Human lives are not simple and our interaction with medical science provides more questions than answers. As a healthcare provider, it’s paramount to stay humble and curious.

In 2023, when I decided to enroll for the PGD in Biomedical Ethics at the Centre of Biomedical Ethics and Culture, I wasn’t sure what to expect. I certainly did not realize that I would spend a significant amount of time studying and nor did I imagine the profound impact the year would have on me. Throughout the year, we confronted new challenges brought about by advances in science and technology as well as diverse and shifting societal values. I came to understand Heraclitus’s adage that “change is the only constant.”

The year breezed by quickly and before I knew it, we were appearing for the final exam. By this time, I had a clearer idea of what I wanted to do with the new knowledge that I had acquired. I decided to not only incorporate this into my daily clinical practice but also make my colleagues within my pediatric nephrology clinical unit aware of basic knowledge in bioethics so that we could become better, ethical physicians.

My PGD journey has taught me that while empirical evidence may not always provide clear-cut answers to ethical dilemmas, it can serve as the foundation for constructing well-reasoned arguments. Equally important, the PGD has developed in me the capacity to listen to a person sitting across from me, to understand her point of view and not just respond.

For me ultimately, bioethics should be a life-long commitment to personal growth that contributes to the betterment of society.

Bioethics is about value judgements that we make in life. My awakening to this fact goes back to my early service as an army physician in the mountains of Kashmir and deep inside Baluchistan, where I increasingly found myself thinking about the “why” and the “how” of distributive justice in local communities where “most in need are found with the least” especially in health.

This aroused my curiosity and led me to search for a robust understanding of issues of fairness and justice. In 2014, I discovered an online course “Introduction to Bioethics” from Georgetown University in the USA. Instead of quenching my curiosity, this course increased it further, and I started searching for formal bioethics programs in Pakistan. My search led me to the Centre of Biomedical Ethics and Culture (CBEC) located in Karachi. I followed it with full zeal and was admitted to its PGD program in 2016.

CBEC’s existence in Pakistan turned out to be a blessing. One year spent in CBEC and the level of education there truly enlightened me “On what matters,” to borrow the title of Derek Parafit’s book.

I consider 2016 an important year of my life which transformed the way I look at human interactions, rights, values, perspectives, and contexts. I learned that intellectual flexibility and humility are the greatest of virtues.

Seven years on, post-PGD, my life is different and interesting. The knowledge gained in 2016 has helped me to further my learning by teaching a few modules on bioethics to newly inducted physicians-in-service. I have conducted and co-facilitated a few workshops and guest lectures for different specialties  in  various  hospitals.  PGD has also honed my writing skills. Since 2016,1 have published articles in scientific and popular science journals on subjects focusing on the ethics of healthcare in military settings and, those pertaining to artificial intelligence.

My journey continues. I yearn for a day when I can return to CBEC as a student of the Master’s program, an opportunity I missed in 2018 due to work commitments. I would like to not only further my knowledge in the field of bioethics but to engage with more fundamental questions related to human existence in the world.

As a Kenyan human rights lawyer with an interest in research ethics, my decision to embark on the PGD in Biomedical Ethics from Centre of Biomedical Ethics and Culture in January 2020 marked a significant departure from the conventional academic trajectory. This choice catalyzed not only my academic journey but also shaped the profound intellectual and professional expedition I would experience that would lead me to scrutinize assumptions previously held dear from a legal standpoint.

From grappling with foundational concepts to dissecting intricate case studies, each module of the program prompted  me  to  critically  reassess  real-world  medical dilemmas through a novel perspective. I discovered the inherent limitations of the law in navigating decisions within medical practice. Despite initial hesitation about transitioning to virtual learning following the first on-campusmodule due to the COVID-19 pandemic, this shift did not dilute the rich discourse integral to CBEC’s bioethics pedagogy.

Throughout the intensive year-long program, I gained invaluable insights into the pragmatic aspects of ethical decision-making. While the world grappled with the COVID-19 crisis, I found myself captivated by the allure of bioethics. Whether reviewing research protocols for ethics review committees, teaching in CBEC-KEMRI Bioethics Training Initiative (CK-BTI) certificate courses, shaping policy and legislative frameworks in my human rights endeavors in Kenya, or advocating for ethical standards in everyday interactions, ethical values permeated my approach.

I came to recognize that the influence of the PGD program transcends the boundaries of mere coursework. It inspired me to spearhead initiatives aimed at fortifying research ethics and championing the rights of marginalized communities in research and healthcare settings in my country, thus expanding my engagement with bioethics beyond the confines of my legal expertise.

This transformative journey culminated in the conceptualization of my first solo manuscript, grounded in my PGD project—an achievement that will (once published) not only validate my academic journey but also underscore the pertinence of bioethics in shaping my voice and contribution to contemporary discourse. Presently enrolled in a Master’s program in Bioethics at Amref International University Nairobi, I am positioned to actively contribute to teaching, research and the advancement of bioethics in Kenya and the wider African region.

I am humbled by the depth of bioethics knowledge acquired and the network of like-minded individuals forged along the way. Armed with the ethos of the PGD program and the ethical principles espoused, I embark on future endeavors in both my professional and personal spheres.

With two surgical fellowships and an interest in medical education, I thought I was destined to become an academic surgeon. While involved in teaching ethics to my surgical residents, I felt the need to learn more about bioethics. Hence, in 2008,1 joined the PGD in Biomedical Ethics at the Center of Biomedical Ethics and Culture (CBEC), which broadened my understanding of the intricate dilemmas in healthcare practice and research. Through engaging discussions and real-world case studies, I gained a deep appreciation of the ethical values and principles that underpin every aspect of medical practice. Little did I know then that this transformative journey into the world of bioethics would eventually shape my professional trajectory.

As I explored the field of bioethics further, I became increasingly fascinated by the intersection of bioethics and medical education. I realised that ethical competence among healthcare professionals is not merely a desirable trait but a fundamental component of high-quality patient care. This realisation inspired a profound shift in my career from a surgeon to an educationist, with a focus on integrating bioethics education into healthcare curricula and training programs.

The lessons I learned through my affiliation with CBEC during and after the PGD also enhanced my understanding of the application of educational theories. The opportunity to learn alongside individuals from diverse backgrounds, including philosophy, law and sociology, enriched my learning experience. Additionally, it provided me with a holistic perspective on the interconnectedness of social, cultural and ethical factors in healthcare education.

My experience at CBEC served as a catalyst for my doctoral research on ethics in medical education and in exploring innovative pedagogies and strategies for introducing bioethics to medical students and healthcare professionals. I am grateful to CBEC for an experience that laid the foundation of my commitment to promoting bioethics in healthcare.

Anaesthetists are the energetic souls of operating theaters, rushing around, chattering and muttering, with the constant beeping of monitors and assorted equipment. They change the environment of the OT from barren fields to combat zones where the single aim is to achieve patient care and safety.

It was May 2017. I was told arrogantly by a surgeon colleague to anaesthetize a female patient without taking her consent. I knew from the core of my heart that this was wrong even though I did not possess formal education in bioethics. We are not taught ethics during medical college and there was no one at my institute whom I could turn to for information or support. I resisted and recorded the event in my notes.

This episode led me to join the PGD in Biomedical Ethics program of CBEC-SIUT, where I was to learn that the field of ethics extends beyond informed consent. During the year I spent at CBEC, my perspectives of ethical issues and dilemmas related to research and clinical practice were completely transformed.

After completing my PGD project of introducing the fundamental principles of bioethics to postgraduate trainees of Anaesthesiology, I realized I could still do even more in sensitizing my colleagues including trainees and faculty members from other medical disciplines. Since then, I have continued ethics education cycles every year. My quest continues although it’s not easy to make cracks in rigid dogmas and firm beliefs that people hold. I believe however, that my journey will bring change in the system if not today then tomorrow.

I first heard the word “Biomedical Ethics” from a friend who suggested that I should pursue a diploma in this subject from the Centre of Biomedical Ethics and Culture in SIUT. I was confused. I remembered that during high school and college, only non-Muslim students were required to take ethics as a subject whereas Islamic Studies courses were mandatory for Muslim students. However once I obtained the necessary details, I was convinced that I needed to apply and learn about ethics.

During my interview with Dr. Moazam and Dr. Aamir Jafarey, I recall mentioning the recent theft of a car from my 15-year-old son. Dr. Moazam asked me, “Isn’t it illegal to drive before 18 years?” I felt ashamed but at the same time, I thought to myself, “Acha to yeh doctoron ko sudharte hain [So they work to improve the moral conduct of physicians].”

My experience while doing the PGD was wholesome with wonderful faculty who left me wondering, “Aisay log Pakistan me hote hain? [Do people like these still exist in Pakistan?]” Throughout my education, I had only experienced  traditional  methods  of  teaching  involving didactic lectures. At CBEC, I was exposed to interactive sessions, role-plays and learning through videos. Philosophical and religious discussions made everything more interesting. I have fond memories of my time there and I still miss those days.

I was fortunate to have a colleague who had already begun efforts to introduce ethics at my university Liaquat University of Medical and Health Sciences (LUMHS) in Jamshoro. Following my graduation from the PGD, I began to work on the foundation laid there by my colleague. A couple of years later, LUMHS became the first public medical university in Pakistan to incorporate bioethics formally in medical education curriculum for medical students.

Initially the response of students and faculty was mixed with a few dismissive of the importance of ethics. For example, when we taught informed consent, some voiced that as doctors they know the best since they know about the patient’s disease. They would ask questions like, “Why should we tell patients everything and let them decide?” However, gradually these discussions gained acceptance among faculty and students alike.

My colleague and I also established an Ethics Review Committee at my university with the support of CBEC faculty. Human subject research, mandatory for major degree programs, was being conducted without ethics approval. The administration considered ERC a hurdle for students instead of realizing its importance for the protection of human participants. However, over time, the ERC became well established in the institution although running it still has its share of problems.

All is well that ends well. At present, bioethics education remains an integral part of the undergraduate curriculum at LUMHS, and the ERC continues to work well. In the future, we have plans to establish a Centre of Bioethics and Professionalism in our institution and have already received approval from our Academic Council.

The Diploma in Biomedical Ethics from Centre of Biomedical Ethics and Culture in 2014 has opened new horizons for me. In 2021, European Society of Medical Microbiology and Infectious Diseases (ESCMID) had a position in their Ethics Advisory Committee for a representative from low-middle- income country (LMIC). The CBEC faculty encouraged me to apply for it, provided reference letters and I was selected.

My involvement with ESCMID has grown over the years with a special focus on engaging with ethical issues within infectious diseases. During the annual congress of ECCMID held in Portugal in 2022, I chaired a session on “Ethical issues in Infectious Diseases (ID).” I also involved Dr. Natasha Anwar (CBEC MBE Alumnus) and Rehan Khan (ID pharmacist from Lahore) in the conference who highlighted the inequities in COVID-19 vaccine distribution and access to antibiotics from an LMIC perspective.

In the following year, ECCMID was held in Denmark and I presented a study about the low LMIC representation in ID scientific journals, highlighting barriers such as language, colonial mindset and lack of mentors for research. In the most recent Congress, CBEC had a prominent presence. I chaired a session on “Clinical practice guidelines on ID: present and future” in which I stressed upon the lack of experts from LMICs in development of guidelines, cost considerations and access to diagnostics and treatments particularly newer antibiotics. An ID colleague as well as a CBEC PGD alumnus, Dr. Amjad Mahboob gave a talk, highlighting language barriers as one of the factors for the lack of research on neglected tropical diseases.

While doing my diploma, I had not imagined that ethics could contribute in such significant ways to my field, and that the PGD would prepare me to present Pakistan at an international level.

My journey continues. From next year, the Ethics Advisory Committee plans to initiate an online course on biomedical ethics on a regular basis targeting ID doctors and microbiologists. Our hope is to help them understand that the specialty of ID poses unique ethical and social challenges.

As a rookie house officer in a hospital in Karachi, one of the consultants asked what I would do in a case being discussed during a grand round centering on allocating resources between two children. One was a child whose parents had sold everything to keep him alive for a few more months versus a child who had a greater chance of living a longer life. I remember my righteousness, the consultant playing the ‘devil’s advocate’ and the conversation ending with my feeling furious.

My formal introduction to the subject of ethics came in 2016 when I joined CBEC for the Postgraduate Diploma in Biomedical Ethics. Like many physicians, I thought most issues are clearly defined but I learned otherwise during thought provoking sessions at CBEC. Following graduation, I served on the research ethics committee of my university and also helped in establishing a clinical ethics committee. My colleagues and I introduced bioethics in the university’s curriculum and conducted sessions with undergraduate and postgraduate students.

After 12 years, I moved to the UK to widen my surgical horizons. When asked to give an introductory presentation during the grand round as a new consultant in London I chose to talk about ‘“empathy.” The attendees included paramedic  staff,  medical  students,  house  officers  and consultants from different specialties. Noticeably, not a single surgeon was present. Many attendees approached me during the tea break to continue the discussion, inquiring about the situation of bioethics in Pakistan.

The healthcare system in the UK has defined policies but there is room for improvement. During COVID-19, I was the lead of emergency surgery in London. I remember junior doctors and nurses approaching me, scared and near tears, worried about themselves and their families. They were concerned that the Matron had asked them to not wear masks as this would frighten patients and spread panic.

Following my discussion with the Matron that patient care would be affected if the medical staff felt unsafe, she changed her stance and the Infectious Disease consultants sent out an official email to the Trust making mask-wearing mandatory in clinical spaces.

I attend webinars on ethics to keep myself updated, and participate in regular multi-disciplinary team meetings to address ethical issues. And I find myself always going back to what I learnt during my year at CBEC.