A Moment of Shame for a Pakistani Doctor

This article was published in The Friday Times on March 7, 2023. Should you choose to read it at the newspaper website, please click here.

“A good doctor has to wear three hats. That of a clinician, a researcher, and that of a teacher.” I remember being instructed by the Program Director on the first day of my residency training. I always enjoyed the teaching aspect of medicine and am fortunate to work at an institution where I have the opportunity to teach students of all levels. These range from trainees early in their careers such as medical and nursing students, residents, physician assistants, and nurse practitioners all the way up to fellows undergoing high-level specialty training.

While teaching, to make any topic interesting, one tip is to dig into the history of what is being taught. The history of medicine is a subject on its own and it is simply fascinating to learn how doctors used to treat patients since the beginning of times. It is interesting to read about the then-prevailing theories and understanding, or the lack thereof, of human physiological and pathological mechanisms and how many advancements have been made in the last couple of centuries. Antibiotics and vaccines that are responsible for saving millions of lives on a daily basis are relatively recent discoveries for mankind. The discovery that the heart is a pump responsible for the circulation of blood was made only a few hundred years ago. The prevailing theory for centuries was that the human body is made up of four liquids (humors); green, red, yellow, and black, and bodily functions are dependent on their harmonious balance. These are just a few examples of how fascinating the history of medicine is.

During rounds, it is not uncommon for me to check Wikipedia’s history section to look up the story behind certain clinical syndromes, where their names are derived from and other interesting historical pieces of information about the topic under discussion.

This particular morning, I was teaching the residents that there is only one device that has ever been invented in the history of medicine that is used to deliver chemotherapy into the area called the intrathecal or intraventricular space that carries the cerebrospinal fluid surrounding the brain and the spinal cord. This is to either treat or prevent the spread of cancer into this area where drugs injected into the veins cannot enter because of the so-called “blood-brain barrier.” The name of this device, which is used all around the world, is “Ommaya Reservoir.”

Flanked by about half a dozen students, I turned around and pulled up the computer screen and typed in “history of Ommaya Reservoir” in Wikipedia. To my absolute surprise, I came to find out that the device was named after its inventor Dr. Ayub Khan Ommaya. This name sounded like a very familiar Pakistani name to me. When I read more about him, I came to find out that he was actually a Pakistani neurosurgeon who graduated from King Edward Medical College in Lahore and had an illustrious career at George Washington University in Washington, DC.

Suddenly, a feeling of profound shame hit me. Here I was, a Pakistani-American medical oncologist having gone through medical school in Pakistan followed by years of training in medicine and then oncology at various institutions in the United States. I had used the Ommaya Reservoir countless times not knowing the origin of the device. I was finding out by a random internet search that this device, a widely used instrument across the globe, was invented by a doctor who had walked in the same footsteps as I did. I felt betrayed by my Pakistani medical education system for not highlighting this piece of information in our curriculum.

I read more about him. Born in Mian Channu, Punjab in 1930 to a Pakistani Muslim father and a French Catholic mother, Dr. Ayub Khan Ommaya became a Rhodes Scholar and was accepted to study at the Oxford University. He later progressed on to work at the prestigious National Institute of Health in Bethesda, Maryland and became a professor of Neurosurgery at the George Washington University.  Not only did he invent the Ommaya Reservoir, but he was also an expert in the field of traumatic brain injuries and his work had special importance in the establishment of the National Center for Injury Prevention and Control at the Centers for Disease Control (CDC.) He was an interesting character in that he was also an opera singer and used to sing for his patients after finishing surgeries, earning him the nickname of the “singing neurosurgeon.” In his younger years, he won the National Swimming Championship in Pakistan and was also in the rowing team at Balliol College in Oxford. In his later years, he developed Alzheimer’s disease and moved back to Pakistan. He eventually died in Islamabad.

If you look at the history of medicine, for the last couple of centuries, most of the diseases and syndromes were named after either the doctor who discovered them for the first time or occasionally named after the patients. Surgical operations were also routinely named after pioneering surgeons. These eponymous practices have now been mostly discontinued in the favor of giving more technically accurate names to newly discovered diseases and procedures. In today’s world, it has become quite unique to have a medical device named after a person.

There are a number of such devices and catheters that are used to gain access to the arteries and veins and other organs of the body but to date, the Ommaya Reservoir remains to be the only device that can be used to gain access to inject chemotherapy or antibiotics into the cerebrospinal fluid.

Having mixed emotions – of pride on one hand but the shame of ignorance on the other, I started asking around. I went to multiple other Pakistani-origin doctors and asked them if they knew who Dr. Ayub Khan Ommaya was. All I encountered were blank faces and they were equally surprised as I was to find out about the origins of this device. I called up a couple of friends who were graduates of King Edwardes Medical College and asked them if they knew about Dr. Ommaya. Since he was a graduate of the same medical school, I thought that they may have a higher chance of knowing about him but unfortunately, no one knew of him. I thought that maybe this was very specific to Oncology or Neurosurgery and other fields of medicine might not know much about him, but none of my colleagues from those specialties knew about him.

I still do not have an answer as to why Dr. Ayub Khan Ommaya is relatively obscure in the Pakistani medical community. In the current times, most of the cutting-edge research and new advancements in medicine are happening in the United States, followed by Europe. In this climate, for a Pakistani doctor to invent a device that is used across the world and for it to be the only device used for this indication is a pretty big deal.

Why is his name not included in our medical curriculum? Why isn’t there a chapter about him in our medical books? Why aren’t there lecture halls or auditoriums named after him? Why aren’t grants and scholarships named after him? Why is he an anonymous figure for the doctors of the whole country?

A quote attributed to Abraham Lincoln goes, “A nation that does not honor its heroes, will not long endure.” The anonymity of Dr. Ommaya’s name amongst the medical fraternity of Pakistan is nothing less than a matter of neglect and shame for us.

I hereby make a petition to the College of Physicians and Surgeons of Pakistan to include a mandatory chapter in the medical curriculum of Pakistan. How else do we expect to produce and present more Ommayas to the world?

March 12, 2023

Please click here to read other pieces on my blog.

Title Image:

Ommaya diving into the water as a swimmer during medical school in 1952.He won the Pakistani national championship in swimming in 1953 (Courtesy of Alexander Ommaya, Ayub Ommaya’s son). Dossani et al Neurosurgery 80:324–330, 2017