0:13
A Seth Beshear, who is one of the three presenters today, is a diplomat of the American Board of Neurosurgery and now Professor and Chair of Neurosurgery and the Executive Director and Dean of the
0:27
Punjab Institute of Neurosciences in Lahore, Pakistan,
0:34
an institute he and his family have founded He was formerly a professor at the JFK Neurosciences Institute in New Jersey and the reconstructive and spine neurosurgery section, neurosurgeon and the
0:48
JFK Neurosciences Institute in New Jersey. His email is listed below his picture.
0:58
Okay, so just to give you, so I'll give you a few over because I was just invited to speak as one of the honoured guests at the Apla meeting two months ago in Dallas. And this was addressing almost
1:13
4, 000 physicians of US, Pakistani descent in the US. So I gave them what we are doing and where we moving forward. And what these last seven, seven and a half years of my journey have been,
1:28
which has been shorter than Karsems. But fortunately, I was at the platform, which for neurosurgery, people knew what it was all about, thanks to our father, as well as so currently, I'm
1:40
heading the dean of Pakistan's neurosurgery. I'm also the president-elect for the Pakistan Society of Neurosurgery, which was my leg as well as Jim Osman and Professor Bashid and all of them founded
1:52
in 1980s.
1:54
My job, I take it as after this point, leading this institution, which is the institution in the world as I take it, is I call myself a facilitator in chief. I don't call myself, I like to
2:08
ensure that anybody who wants to do something, guess to do it. And
2:16
let's see moving forward with me from here. Okay, so thoughts of a surgeon who probably has learned a lot, but like I always say, there's always much to learn. Physicians as leaders, we've
2:31
developed a lot of leaders here also. It started with 1964 with a father, Professor Bishiramal, who came back to Pakistan, and then he started in Nister, and then this is where he started from.
2:43
Nister, Moltan, King Edward in 1966, which in fact, at that time, like Dr. Malik mentioned, he would not even be offered an honorary job. So I finally had to go to Moltan, and he started
2:58
there and moved, and now this is what is the horror journal hospital has been converted into a
3:06
autonomous, this is a history of Pakistan neurosurgery. started with Professor Juma, Dr. Khazi, Professor Bashir Ahmed, Iftakar Ali Raja from the 1960s, when he came back Dr. IHBati, who was
3:20
still living, many to follow after that. Park Sun Society of Neurosurgery was set up first meeting in at King Edward in 1987. Professor Bashir was the first president, first WFNS interim meeting
3:36
where all of you were there, Jim Osman as well as Waspalik, just to give you a recap after almost, I would say 40 years and recognized membership in
3:49
Barcelona. And I'm very, very fortunate that in a month's time, I will be the president of the same society. I'm the president and like currently, you know, I show this picture to every forum,
4:03
by the way. And it turns out it's
4:09
Jim Osman, Professor Beshear and Waspalik in the good old days and I think Armando Basso and
4:16
in the center at one of the WFNS meetings. This is where from 1985 to 2018, this is a 500-bit plus facility, which is out of that 450 are neurosurgery beds. This is one of the largest, if not the
4:34
largest, neurosurgical neurology neuroscience institute in the world. I think there's one in Beijing, which is bigger, a little bit about me. I don't need to go into the details, but started
4:50
with you at UIC in 1997, and it's been no looking back, trained at Syracuse, moving forward, came back in 2017 to date. One of my favorite slides, I think Pakistan needs this at every level,
5:06
starting from the
5:09
but everybody has a big ego here, less knowledge. And it's a 10-story building. It houses neurosurgery, neurology, neuro-radiology. We run 10 11 operating rooms now, including with the cat lab,
5:23
which Kasem is running. And then over, close to 10, 000 cases are done. Almost 9, 000 elective and emergency procedures. Over 9, 000. We have a three-test LAMRI. This is a public facility
5:37
Everything is done free of charge. We have 45 neurosurgeons. In fact, it's over 15 now, 173 residents out of that 70-plus neurosurgery residents. It's home to everything we get to do in US,
5:52
except a few things which we do in the private sector.
5:60
The human resource is over 1, 300 people who work there that does not count. some of the security personnel and all that, which are there, and the budget, as we were trying to move the stroke and
6:15
neuroendovascular program, we had to increase the budget to
6:21
33 billion, which is about
6:26
over about12 million roughly.
6:30
This is what we get to spend in a public sector facility We have a board of management, and this is one of the only facilities in the public sector, which is recognized as a job health care facility,
6:44
which has passed the test with 94. This is how we operate. Can I have you go back to two slides where you were just slide before this one, yeah? That's right, okay Because I think that you
6:59
mentioned the private sector and this is the public sector. So I talked about the private sector at the end. And I know this was a, this is true all over the world. This was a very complicated
7:11
road to maneuver. And now what you've done is, you said before, your father couldn't even get an honorary position in a public sector hospital. I mean, that's how far you've come. And so now you
7:27
have this public sector, this is public sector neuroscience.
7:33
Do you guys run this? Yes, so fortunately for the last few years, so I joined here as the professor, a lot of resistance at that time, but I became the dean and the executive director of this
7:50
almost three years ago. And that's when we brought Kasim, we put in the cath lab in 2023. And with me being in charge, we just facilitated everything which needs to be done the right way. It's
8:05
all about begging the government. And I'll give you my resolution at the end because in this public sector, both Qasem and myself, you know what we get paid till about 3 pm, 2 to 3 pm. in the
8:17
afternoon. I started in 2017 when the dollar to be careful was 100 to one.
8:27
It was about1, 000 salary a month. Now it's gone down to 750 bucks a month So if we look at that, that's something which you cannot look at to even surviving. So in the afternoon, we found in was
8:42
pins, Pajamas to This two things.
8:46
neurosciences, which came up about a year before I moved. So I was able to become the director of that. And I stayed in there, otherwise these things would not have carried out. But there's
8:56
always a time to exit also. Like you say, you always want to exit at the top What we founded in 2020. a BNI, which is like a baro neurological institute. That's the private sector. They are two
9:09
tiers in this country. One for the private, one for the public. Public is totally free. Every implant, custom does, every pipeline that it does, every instrumentation we use. By the way, I've
9:22
made a couple of trips to China during this time. And if you have a medical screw, it's 1, 200 bucks in US. We get it for 30 bucks, because the same company is making in China, Kanhui And we
9:32
have direct account tenders with them through the government. We should do the same thing in the private sector. But after 2 pm, we go private. And that's at BI, which we are now looking to build
9:45
into a real large-scale hospital network also.
9:49
Moving forward, this is the same scopes which we use in US. This is how we teach. Like today, it was an operating day for Thursday Every day, six days a week. eight elective rooms are running.
10:06
And this is exactly the way we have all facilities, all microscopes, we have six microscopes, we have endoscopes, we have, but it is a constant struggle. Like what the
10:21
funscasting talked about, I had to, for that endovascular stuff, I, you know, with a personal connections, this is all, I don't think this is possible without what we do in the private sector,
10:31
because all these people, starting from an average person to the
10:40
prime minister, we treat all of them in the private sector. They don't want, they don't come to the public sector. And this is the difference between 50 years ago and now. And this is based on a
10:50
similar, goal is to treat the needy and poor, same as the,
10:55
as the people who can afford. And we've been very fortunate to be able to develop the system.
11:03
from on the model of barrows and some of the slides that I got from Dr. Spessler also many years ago when I was looking to move back. So Neuroscience Institute which is already made private and
11:15
public, all these things philanthropy like Barbara Lisa Gassen had mentioned a couple of times. We're doing all these things, you know philanthropy, sub-specialization, education and Dr. Aspen
11:28
you'll be surprised to know that we have residents now rotating from US University of Missouri in fact October 20th when you when we had invited you also when we're doing the Congress. You know we
11:42
have Mayo Clinic, we have Duke, in fact Faridish Arbelisk coming himself also, David Hassan from Duke. We have Charlie,
11:55
Charlie from Big Four. Charlie Blanche. Charlie? Yes No, no, not Charlie Hives.
12:09
Charlie Branch. Charlie Branch is the North American president and he's been instrumental doing a lot of work in Africa and all that, so we are going to, in fact, this morning I called up Dr.
12:22
Malek and I said, You have to be here because we are also inaugurating Professor Bishirama's book. And Dr. Asman, we still have time. We talked to you about how we can get you on a flight to get
12:33
here at a short notice. So we founded a foundation also.
12:40
You know, this is the same model where we have a, we are the US. Medicaid charity care hospital, right? We're all, but the government pays for it. We are not allowed. Nobody's allowed to even
12:54
charge a hundred rupees to a patient. Everything is done free at
13:00
this facility. But funding comes from the back and then we have to struggling for two years. What we did was, you know, I was able to get at the funding for customs program, added to our budget
13:14
so that we don't have to beg for it every year for the stroke program because we have to buy all these spoils and implants and stents and all that. So that has been now added into the pins budget for
13:25
2025, 26. This is the only way We just founded the editorial office, we donated it as a family. It's named Almas Bashir, editorial office after my mother. The auditorium at pins, LGH is named
13:41
after a father, Professor Bashir Ahmed auditorium, which is almost a 500-seated state-of-the-art facility. We're doing all these things at the facility similar to this. We have our own journal
13:54
coming up We are
13:57
in the local journal and now I think close to a hundred publications have come up in this,
14:04
and for this coming World Federation meeting at Dubai, as well as the one in South Africa two years ago, pains was the highest number of stand-up talks from anywhere in the world. In fact, this
14:15
time it's 73 presentations at World Federation meeting. So this is the difference which is happening academically in that. So
14:25
every resident has to come up with at least one of the publications, we have modified the training program also. And now Cosm is now changing the -
14:36
this is the Catlab, which was put up. This is Siemens biplane Catlab, which Cosm is
14:43
the director of this, and this started in '23 as I became the director for this. And now we have a listing. This is a weekly since 2018 when I came in presenting MM was a no-no. Getting a
14:60
post-operative CTE before my predecessors was a no-no. Nobody could get a post-operative CTE also. Every patient, after every surgery, gets post-operative imaging within a few hours now. It's at
15:11
the government expense, but this is the only way you can learn. We have a Wasting Prof program. Dr. Malik has been a Wasting Prof. We have professors and all these coming from all over the world.
15:21
We had a Vasto conference yesterday, all the cases for endovast, combined endovasto, just like you had Ford and UIC. There's a tumor board, there's a journal club with Aga Khan University.
15:33
Arthur Anam and I, we have worked very closely. And somehow, Arthur says that you were able to achieve in three years what took me 15 years to do. And I think one of the things was that I tried to
15:47
stay within the system and work on the politics and not just speak against them, but try to convince them to come on board and let us get into that but always keep.
15:58
your hand on the top leadership in the country also because you know you can get things done by just benevolence. You know some of our visiting profs over here.
16:09
This is a weekly thing. You know we've had the Suheel Mirza was the chair of Dartmouth. He's an orthopedic surgeon. He talked was fine. Hassan is coming again for this. He's the chief of
16:20
pediatric surgery at
16:24
Washington DC. This is the Bishir Ahmed auditorium. So Dr. Asman you must be very pleased to see. This is you see all the pictures of previous shares including if the Carmelik and this is where we
16:37
do all our meetings now. Leadership you know I talk about this all the time. Muhammad Ali I met as a student later as a physician also but these are the things we try to impart. Muhammad Ali Jinnah
16:50
our leader Abustal Ili you know he's
16:54
the biggest philanthropy person in the country who has to be. couple of years back, and of course, you know, we get a lot of support from our army also. You have to, we basically covered the
17:05
army hospital also in the hall in humility, and this was the first DBS we did in 2018, which was also at a private setup when I came in, but now we've done close to a hundred of these cases. A
17:20
couple of fellowships which we started, patient quality measures are, we have an EMR, a spine fellowship, neuro endovascular fellowship, as I mentioned, pediatric neurosurgery fellowship. And
17:32
another train which I've now done is anybody who's done a local fellowship, I encourage them to take USMLEs instead of going for training for residency because they start to get in, we are sending
17:42
them for one or two year fellowships. One is going for a functional fellowship at Kentucky, then one of my former fellows is currently with Paul Clemo at St. Jude's this week. we're trying to get
17:58
them and all of them need to come back also. This is this is a deed which we have them. You know, Scenic Society, Vosmalek was instrumental and
18:07
now I'm also probably the only outsider to be part of the Scenic Society and we we are we are rotating residents from them. All of these people have come in and visited us and
18:22
some of our Kendall Lee who I trained with Fred Meyer, you know, well Ross Mopman, Dr. King, Charlie Hodge, of course, this is my graduation and this is the baking who I saw operating in '93
18:37
when I was looking for a job in Houston by the way. So coaching, this is what we're doing.
18:44
You know, I was going to be Wimbledon play by the way before I became according to this. So we've we've cultivated our our friendship with some of the German neurosurgeons. We've done a lot of
18:55
robotic. is what I'm looking into and
19:01
I don't want to get into politics, but where US stands today, I think they already lost the game because most of this technology is coming out of China now, other than the electric vehicles and all
19:11
that, we are getting a lot of stuff from. So the centers of excellence in neurosurgery, we have, by the way, we do two to three aneurysm clippings. By the way, we are publishing a paper which
19:22
is going to be an eye opener We are doing all interior circulation, aneurysm clipping, ruptured, eyebrow now, all of them. This is a couple of hundred cases. Like yesterday, we did three
19:36
eyebrow clippings. And the teaching was that you stay away from - you know, minimally invasive. But we have crossed this border as long as we approximate control this is what I teach. And we've
19:47
been able to do that. Functional, stereotactic, neuroendocrine, All of them get post-operative, Andrew Graham and CTH. spine center has been started. We have a 247. A patient comes in for the
20:00
last few months now, any trauma which is shipped to because we are the center for the country, not just for Punjab, because this is the only neuroscience institute in the country. And
20:12
neuroendovascular calcium is leading it pediatric neurosurgery, the separate departments and the three neurosurgery professors with us. And similarly for neurology also, all these are specialized
20:23
now. Neurorehabitation
20:27
neurovascular, general neurology, epilepsy, so specializing into all of these. Education,
20:36
I want to take you to, you know, a lot of clinical research, a lot of publications, whatever we do, we're trying to publish now, all are required to do in a journal, even if it could be
20:48
Pakistani, but it has to be a PubMed index, and I think we are coming up with the Supplement with Search for Neurology also. Our team is working with your team, Dr. Osman. This is the first
21:00
Congress which we are starting, which is going to be on 19th to 21st October. And all these specialties will be participating. And with this, we are also inaugurating this book, which Dr. Osman,
21:15
you've already reviewed and you've given your comments. Dr. Malik has been instrumental in recollecting and giving comments from a partition from India where he moved as a 12, 13 year old child to
21:28
becoming a pioneer. And of course, the offspring, which has us, have taken it to the next level. But above all, I feel after doing all of this,
21:43
All the patients who treat in a private sector, all the networking, all of them, is done through the private sector. And in order to get these things, we use our first two favors from the
21:55
government to do this.
21:58
This is not a solution to this. And I'm very convinced, like India has done, we have to go into a private sector network. Because that's the only way you can pay the bills, and you can do
22:09
everything under one roof You don't allow private practice at this institution. Even if you did, you can mix a county hospital, unfortunately, with a private state-of-the-art facility. So now we
22:22
are proposing this BNI Health, which is almost a 200-bed facility. The first one, just like Apollo, came up in India in
22:33
1980s. And we started the small one. This is the BNI currently and we are coming up with a large travel with funding, we are tapping into IFC, DFC, OPIC, and in fact, Dr. Asman, I would need
22:46
your help. We would need your help also to guiding us because we're trying to fill in the gap with the funding.
22:53
Just this week, we have a vascular surgeon who has moved from New Jersey. We have most US. trained physicians in neurology, neurosurgery, vascular, internal medicine, all
23:10
of them joining as being part of it and some of them are investing also. So our vision, I think this is the only way you can transform and we just filed for the first private neurosurgery training
23:23
program on the BNI and the PhD, which is the hospital, which we do because currently we cannot select our residents. We cannot fire a resident. I cannot hire a resident You just pick the residents
23:35
which are given to you from the government and then you just work on them and maybe. So unless you train people, you cannot have a
23:45
legacy to move forward for the next generation. And this is the first move at vantage. This is what we are doing. I presented it in Dallas also. And there's been tremendous interest from so many
23:57
physicians who want to move, and especially with the conditions in the US. They all are looking for a backup option or more productivity or freedom to work This is the plan, future medical
24:11
university, educational research hub. It'll be a sustainable growth engine. This is going to be, I go to Dubai. I go to Middle East. I'm going to be in South here at the end of the month. Again,
24:23
Riyadh, Pakistan, Saudi Arabia has signed very close relationships now. Currently, US and Pakistan are at very good terms also, which may or may not stay long-term but you have to come up with a
24:37
chain of certain, this way, alone do it. It has to be all specialty under one rule, spine orthopedics. The top orthopedic setup is also a BI. Stroke and Devastra are customers, the top person
24:49
in the country, oncology, cardiac, radio surgery, gamma knife, all these being put up under. And then this is the real frontier I work on, minimally invasive surgery, which we have crafted to
25:02
a level which not in the US can even compete now because of the sheer volumes. If somebody does two cases a day in a program, you know, we do five cases a day here, because of the sheer volumes,
25:14
where else would they go? And all these, we need to have digital health patient management. Today we were at the meeting with the US company, also started by a Pakistani entrepreneur in Florida.
25:26
And we
25:28
decided that that is the way forward. We cannot afford Epic or Surna here. So I think we are developing these things here locally. And we have to be the leaders on that. So this is what we're
25:41
looking forward to, and we welcome
25:46
you to all the either attended in-person, which we would really, really appreciate. But otherwise, maybe remotely also. Thank you.
25:58
Excellent presentation. Let me ask a couple of very simple questions because the viewer needs to understand the structure when you guys finished your training in the US, you went back to Pakistan,
26:16
correct me if I'm wrong.
26:18
You couldn't work in the public hospital. It wouldn't pay you. You couldn't live off that. So you worked in the private sector.
26:27
Okay. Custom, you should go ahead, customer lens, of course, you can go. Yeah, so I joined, yeah, I joined kind of a semi-public, but run by the military hospital. but then in the evenings,
26:38
I would be doing private factors because that's the only way you can make a living. Well, it's true in a lot of countries around the world. People work for the government, say up to two o'clock in
26:51
the afternoon and then the rest of the day there's in the private sector. The point I'm trying to make is, is that what you did is you continue to do that, but we're still dedicated to developing
27:05
and enlarging what was happening in the public sector, correct? Correct, right. In order to do that, you had to, you're at a first of all, I'll assume you did this, you started your programs,
27:17
and one thing you said stuck with me. And that is, and I'm sure I get the message of gospel to this and that is pick the patients correctly, so that they come out to be successful. Otherwise, if
27:32
it's not, you're finished
27:37
And so you have to start out with successes. And once you start out with successes, and it's true in the business world, once you start out with successes, then people are willing to invest more
27:50
in more successes. And so I'm sure as you started with your interventional treatments and your treatment of stroke, people saw the results. They invested some more money But now you're getting
28:04
money from both the public sector and the private sector into what it has pins, right? Yes. So, okay, I'm developing this for a reason. And so as people try to adopt this, you don't go back and
28:23
walk into the head of the public sector hospital and say, I just come here, I was educated at Super Duper U, give me the
28:35
money. It doesn't mark that way. It's what you're what happened to your father, it's you've got to wait, even though you were educated in the UK, and you've got to work your way up and it takes
28:44
patience and time. And eventually what you did is you had a long-range plan. That's the next thing. It wasn't a two-year plan. It was a long-range plan, right? Your whole education, your whole
28:57
development was a long-range plan that gouged your father and I and you guys had worked on And as to, I think you were in the hospital, you were in the United States getting educated for 10 years
29:10
before you went back. But you went back. Yeah, I think by the time I have 50, 16 years. Yeah, and
29:16
so it was a long investment, but it was a long-term plan and that was the goal. And so you got there, you got into the system, it's very political, same as in our countries And
29:31
in order to navigate that, this is politically frustrating. You finally wind up getting to have some leadership, which they accept after your success in the public sector, which allows you to
29:46
determine what you want to do, but you're keeping the private sector going, correct?
29:52
That's correct. As I see it, now you're
29:57
getting generous funds from the public sector, which has got to be an amazing accomplishment in a developing country I mean, the demands they have for that money are have to be excessive. And
30:10
you've got to make a case that this is very important and you're going to get a big return on your investment. I mean, you're going to come in and I'm going to treat you with a stroke and most of
30:22
these people would be wind up paralyzed and devastated and you're showing them you can get them back to work. Well, my God, that's an enormous accomplishment. And you keep building on that. And
30:37
so they give you some more money and you expand it and you develop it as you're doing it. Is that the correct scenario? That's what you asked me correct. And I feel like you know, for me, when I
30:50
think I'm done, the difference between the private and the public sector in special reference to the stroke is that I came to a point of view and I still hold that is that the stroke care is
31:04
extremely expensive even for someone to come into the private sector. And the reason is that we still need a lot of RD in the stroke area because unlike the acute conry where even if they open up a
31:18
vessel, the worst, what can the worst thing happen is that you can have a low ejection fraction and you can live with a congestive heart failure with medication, but in the stroke, if you open up
31:28
a vessel, and the people's expectations are that our patient is going to start running after six hours or 24 hours. That
31:37
depends on patient to patient. And if you keep that patient in the private sector for five or seven days, that keeps adding up the bill. And so I would say that majority of the stroke patient
31:48
population by far lands in the public sector. And that's where the majority of the strokes are also happening in that category of patients So that's why for me, it was very important that the stroke
32:02
development comes in the public sector because otherwise they cannot afford from victim devices, connective plays and those things. And also the post-hyperticue therapy stays in the hospital because
32:16
in the public sector, the hospital stays not even calculated in the budget. So you can stay even for a month and no one will even question you about it but the main cost is the cost
32:27
only disposable.
32:31
and the medication. So that's one big difference that I have from the private sector that stroke, in my opinion, needs a lot of public stroke programs because majority of patients cannot afford it
32:41
here. Let me ask you another question 'cause I'm coming to a key issue here. Asif, you guys alluded to this. You alluded to this that, as if you said you cannot hire a resident, you've got to
32:54
take what you get Yeah, I know you're not satisfied with that. And so you also said that you can't get people into programs in the United States, so you get them fellowships. Very interesting
33:08
development. The point I'm
33:12
trying to drive at it because I'm going to tell you something in the end that's going to shock you about American healthcare.
33:21
But it looks like if you guys were not in charge, And I'm saying this, you're not saying this. And Gus, you can answer this. If you guys were not in charge of what you're doing, this wouldn't
33:35
work. Is that right? Yes, that's right. There's no second thought about it. If I wasn't there, I can assure you the customer may have started giving TP and all that, but intervention would not
33:48
have been able to survive. And if, you know, this is coming from our personal context. So Dr. Aspen, I didn't mention about it The customer just mentioned, but when I came back, they, after I
33:60
joined, just as a professor, not even as the director and all that, even though I was offered to be the director at that time, because of the certain context which we had, that cheapness at that
34:09
time. They took me to course. We didn't even know who was swinging, right? I'd never been sued in US. They took me to course only that the training, the certification is fake. He's got a fake
34:21
degree, you know, things like that And I was looking to resign anyways. But when that happened, I said, OK, I'm going to resign after one week, then maybe after one month. But after six weeks,
34:32
when they sued me, I said, I'm not going to resign now. I'm going to fight it. So that's where I think I really survived. And I think it is my survival is directly related to
34:44
Carson's survival. And his survival is related to mine. We coexist each other. But once I got into being the in charge, now we decide what needs to be done As regards to residents, all the
34:57
residents are selected through a central induction system of the government. So the government gives you this. They have to do under service area and all that. And by the way, coming back to that,
35:09
you know, we fought them in the court. We got it verified from US again that I was a full professor in US and the Supreme Court and the court threw it away. This is how it happened. And those
35:18
people were, they said, you know, when I asked him who the guy was suing me, I said, who's behind you? Professors who are retired and you're stepping on the private practices, right? That was
35:29
the reality. So I said, I'm not even stepping on anybody's private practice. We are trying to teach these kids how to operate. They were, you know, the youngsters were not allowed during
35:39
residency or they were just doing stunt work. So now, after their residency, I required them to spend three years as senior registrar. That is when they rotate every four months through, we don't
35:51
use ENT. We do our all endoscopic skull-based thing You know, they do six months of vascular, they do function, they do all of their rotate. And by the time after these three years, that's
36:02
altogether seven years, seven, eight years, that becomes comparable to the US training now. But once we have trained 40 plus of that, I think you've already done your job, right? Because these
36:15
are compliment people, which are outside, you know, our trainees are now sitting in Kabul, other than Peshawar and all that I I was able to use a place, leverage it, and use all those people to
36:29
allow them to get trained. I didn't hand train them, but I facilitated their training. So they get to do things which, you know, that the endoscope was not allowed by even an assistant professor.
36:40
They could not touch it. Only the professor could use the microscope or the endoscope. This is how these
36:46
were being used that, you know, don't use it, it'll get broken. They were not using drills. We bought them six drills They were using jiggly saws, even in this time, you know, how can you have,
36:56
so there's a lot of things which we did, but how could I have delivered if I was not the boss, right? Let me give you a story. When I went to, I was asked to come to Henry Ford, and Henry Ford
37:10
built Henry Ford, the real Henry Ford.
37:15
I'm going to just, I'm just going to grab the charger also. I'm listening to you My fear is dying. So you keep on speaking I'm listening, yeah. Henry Ford had a son, and he wanted him treated at
37:28
the University of Michigan, but for some reason he had difficulty. We got so angry that he said, I'm gonna develop my own hospital. Correct me if I'm wrong, right, gosh. And he went ahead and
37:40
he developed his own hospital where he hired his own doctors, and it was basically socialized medicine. They were all salary. And it was, it did well initially, but it didn't, it wasn't going
37:54
the right direction. People were incentivized. They didn't work like ghost did. They came, they put in their time and left and so forth. And so when they came, I was Dan Nelson who came and he
38:07
said, we want to establish capitalism at Henry Ford Hospital. We want you to do it. And so we came, and remember that house, we got together, we said, if we're gonna do this, we're gonna have
38:20
to have our own incentive program.
38:24
We'll take, you can give us 50 of what we make on us up. But we're gonna make the rest of whatever it is we make, we make, and we built the program on that basis. The reason I bring this up is
38:40
because what that system allowed was entrepreneurial spirit, private enterprise, and private development. Medical care in the United States has gone the reverse. We have returned to
38:56
government-dominated, socialized medicine. Is that correct, Gus? That's correct. And so the reason I asked you guys, and the reason I asked you, and the same for us if, is would this work,
39:11
and I asked you this, Gus, because I can see it coming. I hear you guys have established this with tremendous patience, and that's a Gus characteristic. And tremendous, let's go and be patient,
39:28
we'll get through this. Now you're in charge, you're in control, you built this basically with some government support, but you've built it with an entrepreneurial spirit. And if they came and
39:42
said, You can't do it anymore, you're gone. You're right. And so the problem is that they don't understand that And they certainly don't understand that in the United States. And so what's
39:56
happening in here, we have a health system that's basically a disaster from everybody. Very true. You, disaster. And so you
40:09
said before, Kasim, that you're getting instruments from China, you're getting instruments from elsewhere, and which is fine. There's nothing wrong with that. What it's called is competition
40:20
breeds excellence.
40:23
And that's what you're trying to do.
40:27
If we have central control, that becomes mediocrity. And that means mediocrity isn't excellence.
40:39
So that's why I'm going full circle until you guys came back. You worked through tremendous difficulty. You worked yourself in from the private sector, into
40:52
the public sector, a tremendous sacrifice because you didn't get a paid lot for that. But your motivation was there. You didn't go into this to make money. You had that on your slide. You went in
41:03
this to help people, and that's never ending. And so that's the spirit they have. That's what's going on. If you kill that spirit, it's dead. The program's dead. And that's what's dying in this
41:17
country
41:21
So, one of the. You go ahead. One of the critical factor there, and over the years I have had the opportunity to talk to some of the government officials kind of
41:39
privately, there has to be same
41:46
solution that you managed to initiate at Henry IV. There has to be some degree of privatization of work within those public hospitals. That is the only way those institutions can grow, people can
41:56
stay there, they can
42:10
academically be active, they can train people because if they can be paid for all of their private work and the institution the funding also are taking care of those people who are going into small
42:29
private hospitals, that would grow the academic institutions. And so I think one of the, you know, the solution that RFS is very legitimate considering the local circumstances. But at the same
42:46
time, if you got the years of the hierarchy, I think having a change in public institutions, academic institutions is also very, very critical because private enterprise is not going to be able to
43:06
solve the problem of that population.
43:11
Okay, I agree with that. Let me just ask a couple of questions and we got to wind it up. It's been, I hope you guys have found this worthwhile because it's going to help. help a lot of people
43:22
around the world to see that it can be done
43:28
against incredible odds, starting decades ago and being patient. So let me see what I had here. So you
43:40
really went and you established this program, you had you had
43:46
a key point in your slide, it's time is brain. You're constantly working against time is brain. So where somebody had a stroke and they were in an outline community, you would get them treated
43:58
there, which means you had to educate them there, which means you I think at the ambulances to take them there. And the nurses to triage them, they had to understand what the difference is between
44:09
a cardiology problem and a neurology problem. That's not a small thing to do. That's difficult. Okay. And then they have to triage it if it becomes more to the major center. And that's where you
44:23
guys take care of them down in the major center. So there's a whole bunch of parts that go together here that are all dedicated to time is brain. You had too much triage time between when they hit
44:36
the emergency room in the cath lab and you found very creative ways to overcome that. You cut the time in half. Time is brain. It's like keeping you up at night It's constantly driving you to do
44:51
that because time is brain and that is stroke and that is functional recovery. And let me see what else I had down here. So I think people get that. I think one of the things I encourage you to
45:04
think of all you, Bill, you probably have done that. I think people will see this video. I think if you need to go and you went to Dallas, but you both have stories to tell a different take on
45:17
the same story coming from two different directions. you need to go out and use this video or whatever it is, and they broadcast your experience around the world, particularly to the
45:30
low-to-middle-income countries. We're working with Africa, and as I told you, there are 50 countries, there are a billion people. That's five times what you've got in Pakistan. And they're
45:45
extremely creative, and so you've got to let them have some freedom And you've got to let them have some time to create. We've come up with very creative solutions. They had a solution there. We
45:56
had it two weeks ago, which will revolutionize surgery and neurosurgery. It's like an exoscope, but it isn't. It's all done through an endoscope, and it's indirect. It'll revolutionize surgery.
46:11
We had a presentation about, how can you tell if they've got raised in Ukrainian pressure from some intensive care and there's a simple. product you can use, you can put it on the patient's eye,
46:23
and you can, again, with computer help tell if there's a raised intracranial pressure. So if somebody comes in and they're, we're observing them, we're using, and there's nothing wrong with that,
46:35
we did it pretty well for years, and they're deteriorating. This gives you some help in quantifying it. So that means that people all over the world, something we talked about many times goes
46:48
They're bright people all over the world. They just are just not in Europe or the United States. It just doesn't make sense. And we got to open it up so we get all those creative ideas. You guys
47:01
have had a ton of them here. So I think you got to reach out and educate people some more,
47:08
and let me see what else.
47:12
Yeah. And that's what you're saying. Well. Let's do it.
47:18
I'm talking about the state I'm in now, which is Nevada. You can see that on the screen.
47:25
And Nevada has three million people. And like all states throughout the United States, they're losing money in healthcare and over fist. If you look at what the people think about healthcare in the
47:40
country, they're totally dissatisfied. You can get figures anywhere from 60 to 90, including doctors. Nobody knows what to do about it. Everybody's giving up their hands about it. They're trying
47:53
to put bans aids on the system. They use this graph here, which is a graph you've seen before, which is life expectancy in the United States
48:03
is about, is here in the red. And here we spend 10, 000 dollars on a person. And the rest of the world spends half that amount and has longer expectancy There's a problem with the statistics. but
48:17
that's basically what's going on. And so here the answer is, these people say, this is basically we make up 5 of the world's population consume 55 of the medication and it's not increasing our
48:32
lifespan. So there are major problems. And so I put together something to help them. I'm not sure they're gonna listen. Gouse, we've been through that many times And this
48:46
is just a little slide to show how doctors started out. This is your father. Your father started out with the doctor-patient relationship. That was it.
48:58
And they had a contract between your father and the patient about this is what I'm gonna do for you. And there was excuse for not spending whatever he could to make sure that patient was better.
49:11
That was what it was And now what we have is a system. And these are all the people involved in health care, doctors, hospitals, government, lawyers, workmen's compensation, insurance,
49:23
biomedical and pharmaceutical companies, corporations, paramedical people, local and state money, state government. We want to start out with a pot of gold here, which is money to be spent on
49:34
health care. And we wind up with nothing left over for the patient. The patient now comes last I show that to you because beware, beware. This is most of the socialized health systems throughout
49:51
the world. It's UK, it's Europe, the United States, where they like to admit it or not. It is in socialized medicine. You're trying to establish something that's individual and entrepreneurial
50:05
in a place that's desperate for help, and you're spending the money appropriately When I went to Peru, I asked the head of the health system there. I said, and he happened to be a cardiac surgeon.
50:19
I said, if I gave you a billion dollars, what would you do with it?
50:24
I was thinking to me, I know what he's going to tell me. I was wrong. So he thought for about an amenio. And he said, I'd spend a billion dollars on sanitation.
50:37
And he said, because I'm going to help the most people with those dollars, you're making a case that if you give me some of your money, which is short supply, because every country in this world
50:51
is in debt. Every country, including ours, major problem in the future. Especially ours, especially US. Yeah. Unless the highest debt in any country holds. More of a40 trillion. You got it.
51:07
It's a trillion every 100 days. So you're going to go to them and ask them for money. Are you kidding me? and to have achieved what you've achieved. is remarkable because you've shown a return,
51:19
this is a business principle, a return on investment. If I put meaning in you, I get it back. Most people in the socialized medicine world in the socialized world said, give me the money and I'm
51:34
not sure I'm gonna tell you what the return on investment is.
51:40
And that doesn't fly, but that's what they're selling So anyway, that's it. And I have a whole plan here to go through to tell them how they can get over this. And maybe sometime I'll show it to
51:55
you. But the answer turns out to be the answer is to return the health system to the doctor-patient relationship and get rid of the socialism, get rid of the government.
52:11
And the reason for that is the government can't run anything, But you two guys. have shown the government how it can be run, which is why I asked you the question 10 minutes ago, if you're not
52:22
there, what's gonna happen? And Gao says it fails. That's exactly right. So the question is, how do you ensure that from the future? Because you're fighting a worldwide trend for government
52:36
support of everything and everybody. And there isn't enough money in the world to do it. And what you have to do is a slide I just showed you before. In the end, you have to make the patients
52:49
responsible for their own healthcare. Nobody does that. They give them a credit card. They take it to the hospital and somebody, everybody uses a credit card. And we don't know what they use it
52:59
for. But it's a patient out there establishing a great health behavior. It's a patient trying to control his blood pressure. Is he checking up on it? Is he eating the right diet? Those are all
53:10
challenges in the end you have to come to. You're not there yet You're just working on the cute face.
53:17
That's how people are going to have to look at it here. So I don't want to take you into it, but it's what I'm telling you is what you're telling me you're doing in a part of the world that most
53:27
people want to ignore. While the rest of the world, it's going to pot right in front of everybody and they've given up knowing what to do. Because what they've abandoned is the fundamental
53:42
principle that we establish when we went to before or that you have to establish in life, you have to give people a chance to do things on their own, the government can't do it. It's not smart
53:57
enough and there won't be enough range to do that. I don't know if you agree with it, but that's what that's where I'm coming from. You know, I totally agree with you, Dr. Aspen, also because
54:09
there's a little difference in how we are doing it government doesn't want to do it. Do you think they're It's in their favor. They have to do it because they need us. If something, whatever, so
54:22
all these, all these physicians I'm talking about, we have a control on their health care in the private sector. I'll give you an example today. You know, the health minister of our province, or
54:36
XYZ, whatever, you know, on a Saturday, they have to look for us for anything related to neurology. They look for Kasim or anything related So if they are in our hands, then we say, okay, why
54:47
don't you get this done for us, also in the public sector. You know, why don't you, you know, this is the funds we need. Give us another billion for the equipment and all that. So this is, we
54:58
are doing it as a personal, but
55:02
I'll tell you what I think of the US system. I think that growth is going to happen in this part of the world where we are now, because you mentioned a billion people Pakistan is almost 300 million
55:13
people, China. India, Bangladesh, that's two thirds of the world,
55:21
right? So all the growth is going to be happening in this part of the world. How sanity prevails in the Middle East, I think that's important. But I was offered to come back to US a couple of
55:33
years back to lead the entire network. Like Henry Ford, we have 19 hospitals. I politely convinced one of my senior partners to take the job because for a couple of million, that impact does not
55:47
translate to what the impact we are making here. Correct. All right. It reminds me a short story. The hospital where the PNI is right now was in the outskirts of Lahore. And in order to get down
56:05
there, it would take significant amount of time. They had to pass over a railway line And the guess would be.
56:15
closed, so it might take sometimes 15, 20 minutes if there was rain, there were floods. So there was a patient that Professor Bashir had at the hospital, who was related to the governor. And so
56:32
he invited the governor, he raised a question, he says, Yeah, yes, sure, you can come and visit and we'll be glad to help you And he got stuck at the railway line. And so when he got to the
56:47
hospital, he says, This is very terrible, you know, I will stop there for 20 minutes or 30 minutes. And first, when she told him, You know, I have to make these rounds two or three times a day,
57:00
sometimes in the middle of the night. And the next thing was that we got a bridge, an overpass over the railway line, which helped the rest of the public too, not only the hospital. So Asif is
57:16
right, I think being at the right point and taking advantage of those relationships is very, very important. Yeah, remember one thing. 85 of the diseases occur in the low to middle-income
57:33
countries. And
57:36
that's where the action is. And people in the high-income countries don't get it. That's where the action is So you're right, doesn't mean what is at, what place does that mean for a place like
57:49
the United States or Europe, Europe is as gone. The United States are losing its way. They've got to maintain, be creative. They've got to be innovative. They've got to find out ways to help and
58:04
become involved with this 85 of the world that has 85 of the population and 85 of the disease.
58:13
And that's what you're in the center. So you're at the right place. I agree with Gao, said the right time doing the right things. So anyway, thank you. Gao, do you want to say anything at the
58:24
end? No, I think we did a great job in representing what is being done. And as I said before, I have all along and encourage them to stay in there and keep on working In a little improvement has a
58:44
tremendous benefit as costume has shown
58:49
and show to the people, things can be done. I
58:56
totally agree. One last thing I want to add, this is an observation and a reality which is happening in the health system in the US. So where you're right, Dr. Asmin, you've always nailed the
59:10
way it was done supposed to be. The hint? system and US. is collapsing. And you know, this is, I say this, when I went to the APNA meeting, I said, you know, your time is over,
59:20
unfortunately. You guys have to look at the outside world, because our insurance company in US, because both of customers and I still maintain privileges, we still operate there, I said,
59:31
UnitedHealthcare, I know patients who are being shipped outside US, or instead of a 200, 000 procedure, they can get it done in 20, 000 in India or Bangkok Why should it not be Pakistan? Because
59:45
if the same physicians who are licensed to practice in US. are doing your surgery, if they are available, and they are better trained now because they have touched 10 times the volume which a
59:57
resident in training in US. would not get to clip more than 10, 15 aneurysms. Here, they do 50 plus in two months, so we wish to the
1:00:06
senior society and they are seriously thinking how to make it possible for them to come and spend a month. We just had a student, MD program from University of Arizona. In fact, he lives in - he's
1:00:18
from LA. He spent a month here, James. And the type of stuff he did in a month, he probably would spend in two years in US. So I think this is where the sheer volumes, as well as the economic
1:00:33
direction is also going to dictate down the road to stay competitive for the US physicians The reimbursements are going down, in our bill next year, the big beautiful bill, I call it the breakup of
1:00:47
the blood brain barrier, the way it is described. By next year, before the Medicaid is going to go away, Medicare reimbursements are going to go down. If they go down, the private insurance will
1:01:00
go down. This will hurt the physicians and the hospitals. It may not hurt the hospitals, but the physicians will definitely be at loss. So look outside.
1:01:13
I think that's a reasonable, we talked to some young people in Glasgow who are not getting enough patience, experience in England. And they were looking for places to go. And so I'll tell them
1:01:26
about Pakistan. It's the same, Africa offers the same opportunity. It's not at your level yet. But you can still learn a great deal from a lot of pathology. So you guys have done a phenomenal job.
1:01:38
I congratulate you and everybody who's worked with you I know your achievements. And I wish you to have many, many more and
1:01:51
keep looking forward. So when are you coming to visit us? You have to make one trip again. This is a golden opportunity. I call Dr. Malik this morning also. His celebrating is 15th anniversary
1:02:05
of Andrew Ford. I think 110th or 105th. So I said, this is going to be even a bigger milestone attend this first spring's Congress and dedication to the book, which you have both contributed.
1:02:20
Well, we appreciate it. We'll keep thinking about it. I just had a little setback about three weeks ago, and well, we'll keep thinking about it. Okay. Thank you, sir. Thank you. Thank you.
1:02:32
Okay, now thanks for coming,
1:02:36
and
1:02:38
I'm just a phenomenal job. And, Sif, you need to come to work and and wear a super protection.
1:02:49
I'm sure everybody's aiming at you. So
1:02:55
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