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Interview: Prof. Khalida Tareen
WHO has recommended that Child Psychiatry should
be given more importance than adult psychiatry?
Authorities should ensure adequate replacements before people retire in
different departments to ensure continuity of service

LAHORE: Prof. Khalida Tareen is a well known child psychiatrist who joined and established the only department of child psychiatry in Pakistan at King Edward Medical College now King Edward Medical University/Mayo Hospital Lahore in 1976.  Her husband Prof. I. A. K. Tareen also joined KEMC department of psychiatry in early 70s. Both of them played their innings successfully and eventually retired. Before retiring in 1996, Prof. Khalida Tareen had done a commendable job in the field of child psychiatry. The department was strengthened to such an extent that it enjoyed international recognition. In an exclusive interview with Pulse International recently, Prof. Khalida Tareen spoke about the establishment of this department, the present position of the sub-specialty of child psychiatry in Pakistan and the common mental disorders seen in children. Given below are the excerpts from the conversation:

You have been a pioneer in the field of child psychiatry. You established a proper department of child psychiatry at KEMC/Mayo Hospital and later retired. What is the situation of child psychiatry today in Pakistan and what can be done to improve the current state of affairs?

It took twenty five to thirty years to establish a department of child psychiatry. This was the first department of child psychiatry in Pakistan at KEMC/Mayo Hospital, Lahore. It was strengthened to such an extent that it got recognition from world bodies like WHO, World Psychiatric Association and the UNICEF. It was declared as a resource centre in this discipline. It takes lot of time and struggle to establish new departments but the system should be such that once the occupant retires, there should be trained, and experienced people to replace them to ensure continuity of service. It is the responsibility of the rulers in general and the provincial health departments, institution heads in particular to see that such replacements are available in time. This department was providing service to children with mental disorders.  After my retirement, this department has practically vanished. Patients go there, at times they find some doctor and sometime there is no one. Some qualified and experienced staff has joined the department in honorary capacity but unless the proper posts are created and people are formally selected, one cannot expect proper care for the patients. Medical officers who are not trained in child psychiatry cannot handle children suffering from mental disorders efficiently since they themselves had no exposure to this discipline.

What can be done to make this department of child psychiatry functional once again and just one department in the whole country will not be good enough either.

Our health planners must realize that general psychiatrists cannot handle the entire world load of patients i.e. adult psychiatry, adolescent psychiatry, geriatric and forensic psychiatry as well as child psychiatry. These are all specialized disciplines in their own right and are recognized sub-specialties all over the world. It is important that those at the helm of affairs realize the importance of mental health. If children suffering from mental disorders are not looked after in time, they won’t enjoy good mental health when they grow up, hence their mental faculties will be impaired. Their emotional health and psychological developments will be seriously affected. The general gossip is that children do not need any specialized psychiatric care. People tend to forget that mental and physical development of children is as important as of adults to have a complete personality. Even before retirement I had started writing to the health department and all others concerned and even as Prof. Emeritus I have written dozens of letters to the authorities including Health Secretary, Principal of the medical college as well as the Medical Supdt.   of the hospital to appoint some one so that this department of child psychiatry does not disappear. The answer one always gets is that no one is available. However, they forget the fact that if competent, qualified and experienced people come but fail to get a job, for how long they are going to stay in the country. They will definitely fly overseas whenever they get a chance. The authorities must appoint House Officers, Medical Officers, Registrars and Assistant Professors to begin with. Once there is a proper department, other qualified people will get attracted. However, if qualified people see that there is no department and no posts, who will come back. Many people did come back from overseas but failed to get absorbed since there were either no jobs or selection process became so lengthy, that they got frustrated and went back. WHO has recommended that child psychiatry deserve to be given more importance than adult psychiatry. However, unfortunately till today except King Edward Medical University/Mayo Hospital, there is no other separate department of child psychiatry in the country. The Children Hospital at Lahore has a department of child psychiatry but it does not have the requisite experienced and trained staff.

What are the common mental disorders you see in children in Pakistan?

Depression and anxiety are quite common. We also see psychosis. Generally people think that mental retardation is the only mental illness affecting the children which is not true. The fact is that we do not have experienced people to diagnose these diseases in children. Unless the doctors are trained, how can they diagnose the children suffering from depression and anxiety?  I am talking of grown up children eight to ten years of age not infants. When a child refuses to go to school, wakes up and weeps at night, is afraid and does not wish to leave the mother, it is said that these children were not brought up properly or he/she is reluctant to go to school.  The children also complain of constant headache and abdominal pain. Usually all sort of investigations including gastroscopy, endoscopy is done but no body bothers to find out if they suffer from any mental illness. Eventually the treating physicians tell the parents that there is nothing wrong with the child and we cannot do much. Such a child may be depressed or may be suffering from anxiety. The causative factor may be disturbed relations among the parents. These things can only be diagnosed if they are recognized.

Medications, it is said, has very little role to play in child psychiatry. On the contrary it requires psychotherapy and talking to the patients, parents which naturally requires lot of time. Do you think doctors in Pakistan have so much time to spend with these patients?

It is true that doctors usually do not give enough time while examining patients and particularly so in case of pediatric patients. I personally feel that the problem does not lie with the doctors alone but it is linked with our system of education. We do not tell our medical students that they should treat a patient or a child as a person. Our doctors are trained to look at symptoms and examine various body organs. If the patient is having cough, the doctor will order Chest X-ray, if the patient complains of abdominal pain, they are given something to relieve spasm. They just talk about the system as they are not trained to look at the patient as a person.  It is true that we use very little medications in child psychiatry but if the parents are aware, they take care of the children, come and talk, discuss their problems with the doctor, most of these disorders are relieved within very little time if recognized early. The route cause of the problems is identified and if it is supplemented with little bit of counseling of parents, it will yield much better results. In Pakistan we do not teach the parents how to bring up children in a healthy environment. They should be taught about parenting and how to handle the children.

Do you think the school children have some role in early detection of children suffering from some mental disorders?

Teachers have a very important role. I think they can be the first line of defense and apart from parents, first person to identify if the children have some problem. However it is also important that the teachers should be aware of these issues. At present they are not taught anything about child psychology. There is no such concept although some children suffer from school related anxieties. If a teacher talks in a harsh tone to a girl student in front of twenty children in the class, she will be frightened and afraid of going to school. Her school anxieties will go on increasing. Hence, if the teachers are aware of such things, such situations can be avoided. Teachers need to be taught how to talk to the children, how to handle them?  Little training of teachers may not solve all the problems but at least it will help identify these issues. I am happy to state that in Lahore there are a few schools and institutions which are aware of these issues. I get so many children referred from schools. When I ask them how they came to me, parents say they were advised by the school teacher who felt there was something wrong with the children and we need to consult some child psychiatrist. Awareness is certainly increasing but still it is not as much as one would like to be.

What responsibilities you have as Professor Emeritus of Child Psychiatry at King Edward Medical University/Mayo Hospital Lahore?

I go to the department once a week. Some patients, who come to know that I will be coming, do come for consultation. Sometimes doctors in the department keep some patients for me which they cannot manage successfully and seek my advice. I examine those children and also teach the doctors present so that they start taking interest in child psychiatry. However, unless these doctors have the basic knowledge, they cannot be expected to take interest in this field.