A Conversation with Dr. Ali Hussain Rajput by U. Khan and A. Khan

A mischievous little boy from Chukk Number 30, District Sanghar, Pakistan, recounts his journey from the plains of Sindh to the top echelon of Neurological Sciences.

Introduction
In April 1997, Dr. Ali Hussain Rajput, already a renowned Pakistani-Canadian Neuro-pathologist, was anointed Officer of the Canadian Order (the Canadian equivalent of the British Baron-hood, an honor above a Knighthood). In doing so he became the first Muslim and the first Pakistani to earn the recognition and capped an illustrious career as a scientist and humanitarian.

Born in 1934 in a village named “Chukk No. 30” in district Sanghar, Sindh, Dr. Rajput showed outstanding scholastic promise at his Sindhi-medium primary school and later at the secondary school in Nawabshah. After topping his class he proceeded to Intermediate College in Hyderabad and then to Liaqat Medical School. After establishing a lucrative practice near his home village, Dr. Rajput suddenly left off the profit and prestige for specialization in Neurology at the University of Michigan. After the Ministry of Health in Pakistan informed him that they did not have any need of his services back home, whimsical turns of events brought him to his current home and work place of 30 years, the University of Saskatchewan, in Saskatoon, Canada. Here, first as a researcher/lecturer, then as a professor and finally as head of the department of Neurology, he conducted extensive research in neuropathology which lead to over 200 publications (books, papers, articles), including several ground-breaking papers on Parkinson’s Disease, and numerous accolades.

As founder and trustee of the Saskatchewan Parkinson Disease Foundation, at the helm of neurology research at the University of Saskatchewan, doing collaborative research with Nobel Prize nominees, Dr. Rajput now enjoys such honors as a state visit to Pakistan and India in the company of the Canadian Governor General. These gratifying achievements and accolades came after an incredible journey that underscores family ventures, innovating against all odds, simplicity, patience, and high-yield human investments.

Early days in Sindh

I was number 7 in a line of 9 siblings. And as one of the youngest sons, was quite spoilt. So mischievous was I that my mother determined that I be sent to school years earlier than required just to get me off her hands. I was so young that I could not walk the entire distance to the school – I was carried there by my brother. The work benches in the classroom were so big that when I tried to sit on them I fell over and cut myself on the chin. I was still a handful at school, would frequently play truant, even more regularly get into mischief (of a largely benign variety). I suppose I would have much rather play at home than work at school. Now my father was a very wise man – far wiser than I ever will be. He told me that the choice for me was between a lifetime of farm work and a few years of schoolwork. He told me to get away from the farm. I certainly hated the thought of eternal farm work. So I did.

Once I finished grade 4, my parents, impressed with the promise of their 8 year old son, decided that I must go to the main English medium school in Sinjhoro to continue my education. So it came that I learnt Punjabi (my mother tongue), Sindhi and English, but very little Urdu.

The school in Sinjhoro was beyond daily commute. Yet it offered no boarding facility. Hence, we launched an innovative family venture. We (our family and other folks in our community) rented a small house near the school which we converted into a boarding house. The boarders consisted of my cousins and family friends and other boys from our locale. My parents helped set up our makeshift boarding house. All of us shared the chores. Being the youngest at 8, I did not have much acumen in husbandry and did the only task I found manageable: kneading the dough for the daily rotis.

Going to grade 7 meant another school change – primarily because I wanted to try for a scholarship (available to seventh graders) to try and ease the expenses of my education. Sinjhoro did not have the facility to prepare me for that district-wide exam so I determined to go to Nawabshah. There I would prepare for the test – if I passed I would have the much-needed money. My class teacher at Nawabshah, a nice enough fellow called Jeevat Ram, was incredulous to hear of my wish to win the scholarship. He told me that only 3 or 4 of the thirty boys would be picked to appear for the exam in the first place and as a newcomer I was unlikely to be chosen. To prove myself I tackled all class exams well enough to be among the highest scorers in all, till he was finally convinced that I deserved a shot at the scholarship. In the exam I got the second highest marks in the entire district.

With the scholarship won, I completed the remainder of my high schooling in Nawabshah. The one teacher I remember best from my high school days is Mr. Haji Khan Khoja. He was very fond of me – to the point that the other kids would be jealous. I would get his daily newspaper to read (Dawn) and he ordered that I get a glass of milk every morning on his personal expense. I could not afford such luxuries myself, being on a scholarship that just barely met my needs. He became a father figure – a model for me of what dedication and hard work should be – and a catalyst to my desire for higher education.
Education and Career in Pakistan

When I entered college in Hyderabad, I fell very ill my first year there. So much so that in my second year I was faced with the task of completing a two year curriculum in one. Again my family helped make this daunting task a family venture. The scene during my vacations at home would be of my brothers hopping about the local ponds trying to catch frogs which I would dissect and study while at home, trying to make up for the lost year. Fortunately, buoyed by their help and prayers I passed my intermediate exam and got into medicine.

After finishing my MBBS at Liaquat Medical College, Hyderabad – top of the class – I started my housejob at Liaquat Hospital. I worked hard for nearly a year at the government job for Rs. 450/month. But then the job I had set my sights on, that of Registrar, was given to a foreign-qualified Canada-return doctor. This left me fairly disillusioned with the prospects of working on in government service. And then there was the reality that I could not afford to support my siblings on this stipend – my younger brother would be going to medical college soon. I therefore decided to leave the hospital and set up my own practice.

So in 1959, I returned home and set up a private practice in Sanghar. This again was a family venture. My eldest brother made the chairs and tables and my family helped me pick and populate a clinic.

The natives did not take to me immediately. Basically they thought I was crazy to acknowledge that I did not have the expertise to treat an ailment, that either there was no cure or that I was not the person to effect it. Amid the placebo-pushers and charlatans, an honest physician was an abnormality of nature to be mistrusted and mocked. But not for long. In less than 3 months the people, who had wondered whether this man was an imbecile or an exceptional talent, had analyzed all the diagnoses/treatments and made their judgment. My practice flourished from that point onwards. In less than a year I was earning Rs. 9,000 per month – that in 1959 and with about 20% of my practice being free (for friends, family and the needy). I remember I used to be so busy that just to get an undisturbed night’s sleep I would sometime hide out at night at my sister’s place.

About that time, Dr. Karim Abbas, a friend of mine doing specialty training in the US, contacted me and asked me to consider specialization. He felt that a private practice was a waste of my potential. I thought it over and found myself agreeing with his view. So following his guidance, I decided to take the US college entrance exams in Karachi. I remember being very nervous before the exam: The little town boy suddenly in the big leagues. But then I heard a few students from Karachi discussing certain topics that would be tested on the exam, and I said to myself, if one of them passes, I will pass. So I passed.
Onwards to North America

I was always very close to my father. He had always supported me during my education. He had owned some beautiful horses which he had sold to get me through school. My mother sold much of her jewelry (I did not know about this at the time). They had invested a lot in me and I faced a bitter dilemma in deciding to go abroad. Once I received admission in the University of Chicago, I apportioned my savings such that my younger siblings were provided for – the elder ones were married or had steady income. Still, I did not realize the impact my decision to leave home would have on my father. He gave me his blessings but years later my sister would tell me that my father cried every day for two weeks after I left. It is still very traumatic for me to think of him and the effect my departure – completely unexpected as it must have seemed to him – had on him.

Many people did not even know I had left. My compounder, Ghulam Rasool was about the same built as I was. Sharp chap that he was, he continued running the clinic under my name (for a long time he left my board outside), and people thought it was me! He had a very successful practice.

I remember leaving Pakistan with my fare paid and $20 in my pocket. By the time I arrived at the hospital, I had less than five dollars. I remember having to borrow money to buy a pen. Anyway, that was my start in the US.

Now I could not afford to go back very often. While I was doing my residency in Neurology, I was also enrolled in the graduate school to do my Masters in Neurology, a degree I had to pay for in full myself. In fact the fees were so high that my stipend would not cover them. So my chief of department requested that the graduate school deem me an “in-state” student. That was how I afforded the degree program.

The first trip back home came nearly six years later in 1965. At that time I was in Ann Arbor, Michigan and was preparing to take the Canadian exams because the American exam was not recognized in Pakistan: I was tailoring all my education such that I could go back I had a very good friend there, a Jewish fellow by the name of John Malkov. He knew that whenever I got a letter from my parents I was essentially dead for at least two weeks. So John said that if I were to have any chance of doing well in the exams, I had first to go home, meet my family, and reassure them I would come back. I listened to his advice and went home.

After I came back, I passed the exam, and went over to Canada – this was in July 1966. There I was to complete my education, pass the LMCC (Licensed Medical Council of Canada) and return home. At that point after 6 years in the US, I had an old Volkswagens beetle (valued at $972) and just under $100 in cash. I remember that very vividly because a friend of mine from England had asked me for $100 and I did not have it. So I had to go borrow money from the local bank. Here I am, just arrived in Kingston, Ontario, and I go to the bank for a loan. The manager looks at me and says: “You don’t have an account here; you don’t do any business with our bank; you don’t have any collateral. And you want to borrow money?”. I said yes. The manager decided that I looked and sounded so simple that I was not going to run away with his money. So he loaned me $100.

I had come to Canada for further training in neuropathology. At the time Ontario had a law that no Pakistani or Indian doctor could get license to practice in Ontario. While doing residency in Kingston Ontario, I passed all written and oral qualifiers in neurology, but I could not get a license in Ontario. Since I did not have plans to practice in Canada, I did not mind this fact. However I did need a special permission to appear in the final qualifying exam for the LMCC (Licensed Medical Council of Canada). Ontario would not give me this permission. I finally got permission to appear in the exam from the province of British Columbia.

Once I had passed the LMCC, I wrote to the Minister of Health in Pakistan of my intention to come back to a post suited to my background. Their initial response was very encouraging. So I wrote to my parents that I would soon be back. I was not concerned over the salary amount. I wanted a position utilizing my years of training in neurology – ideally I would have liked to have gone back to a medical school and established a neurology department there. Eventually, however, the ministry told me that they had nothing for me and I was to look in the Pakistan public service bulletin and apply for a job whenever I saw a vacancy. Now where was I going to get the Pakistan PSB in Canada?

So then I had to look for a place in Canada where I could get a license. I found out of a neurologist in Montreal, Dr. Baxter, whose advice I sought. He advised me to go west: Vancouver, Calgary, Saskatoon. Saskatoon?? A small town in Saskatchewan – not at all what I had in mind for a place where I would become a neurology consultant. He told me that he had himself spent time at Saskatoon, had left for the big city university and regretted not having continued there.

On the beckoning of Dr. Baxter I decided to write to the department head at the University of Saskatchewan, and after some correspondence and phone calls was convinced to visit the town of Saskatoon, Saskatchewan at least once. I liked the town – it was beautiful country. The one thing I remember was how like Sindh the landscape of Saskatchewan seemed to me – expanses of flat, dry lands; huge open spaces undisturbed by mountains. After a bit of soul-searching, I decided to spend a year there.
The Man from Saskatchewan

Meanwhile the medical practice laws changed in Ontario and I was one of the first to get a license to practise there. So I told the department head, Mr. Bailey that since I had a commitment till June 1968 I would stay till then but after that I would leave for Ontario. Dr. Bailey told me not to make any commitments to anyone just yet, that he was leaving town for a meeting and wanted to have a serious chat with me upon his return. Dr. Bailey never returned from the trip – he died while still away. After a suitable wait I approached the newly appointed head and told him I will be leaving soon. The poor man literally started crying: “One neurologist is dead, another one wants to leave; and I didn’t even want to be the head…” So I committed to be there for one more year. But then in 1968 I met my wife. And I have been in Saskatchewan ever since.

One thing I decided early on: if I want to be in academics, I want to in the same row as the Harvard or Stanford professors. This was my personal, private resolution. The odds were all against me. Saskatoon was not the Harvard of everyone’s knowing. There was no money. There was no one leading the way before me. I had to trail-blaze on my own.

I could not compete with the Big Boys head on in everyday research because their money, resources, prestige would always win. I had to innovate to find things to do that they could do in their big city, big university setting.

For example, what I could do that they would/could not do was to attack something they thought would be too esoteric or too mundane. Perhaps I could look at the disease [Parkinson’s] in a unique way.

Now I was the only expert in the entire province of Saskatchewan. I could call on the patients as often as I wanted to. I could follow the patient history longitudinally. So I asked the question, admittedly esoteric at that time: What is the natural history of this disease [Parkinson’s] over a patient’s life. Nobody knew because nobody could follow it through an entire life. But I could.

The other advantage was that in my clinic I am the only one seeing all the patients. There are no assistants, internists consulting doctors as are present in the bigger establishment. That gives my research and findings extra credibility – I can say with surety that these patients are mine, that all records and statistics are completely consistent.

A fringe benefit of this fact was that I could attract scientists with the integrity and credibility of my data. So for instance I am collaborating with a Nobel Prize nominated neuro-pathologist, Dr. Hornykiewicz of the University of Vienna, whose main reason for partnering with me and my clinic was the integrity of my records.

The people of Saskatchewan are nice, straightforward people: like Sindhis – they reminded me a lot of Sindhis. They were appreciative of my care and in return they were cooperative in my research efforts. I told them of the importance of studying brains of patients who died of the disease and a large number of them agreed that I could use their brain to further my research, in addition to agreeing to be tracked during their life. My human investment was later on to return high yields.

Decades later I can make the claim that I have studied the largest number of brains among any active neurologist in the world. There are patients that I have followed throughout their lives and then I received their brain for research. No other neurologist can claim this. Part of the research coming from these longitudinal studies came out 17 years after the starting point in a major paper in 1984 on the Epidemiology of Parkinson’s Disease.

The second thing I did which is considered a salient achievement was in disproving a popular theory about Parkinson’s Disease (a theory which originated at Harvard). The theory at the time was that Parkinson’s Disease originated due to exposure to a certain virus in the time period 1914 to the 1930’s and would therefore gradually be eradicated as that generation of exposed people passes away. Now I had spent a lifetime studying this disease. I would be happy for mankind if it would naturally go extinct but I needed to know for sure for myself. I approached several people to take on this project but no one would. So I took a year off and took a sabbatical during which I investigated this hypothesis in collaboration with the Mayo Clinic in Rochester, Minnesota, the largest private clinic in the world. My stay and research were funded by my own money – I had no grants. At the end of the year I disproved the theory: Parkinson’s Disease is not going to go away with the passing of the older generation.

I learnt a lot from my experience with the Mayo Clinic. Their computerized records archives dating back to the 1930’s gave me the idea that I must start my own database. And that initiative has made it possible for me to truly exploit the data that I have collected since 1968 and led to several original findings and publications.

How has all my research been funded? Well, when I started at Saskatoon, there were no funds for clinical research. At the time I wanted to initiate a study of the effects of Levadopa on Parkinson’s Disease. To fund it I had to setup a Provincial Foundation, the Saskatchewan Parkinson’s Disease Foundation, was a the first signatory and deposited the first cheque in it. The Foundation has grown primarily with the aid of rich patients who appreciated our commitment and left generous amounts to the foundation in their will. This foundation has since supported the Research Clinic I set up and have headed since.

Dr. Rajput’s contributions to Neurological Sciences and subsequent accolades are staggering in sheer numbers:

Over 350 publications (papers, articles, books, etc.)
Authored/co-authored 18 books
Member/Associate of over 80 organizations/committees
Frequently interviewed on Radio/TV
Approximately 10 – 15 public lectures, television, radio and newspaper interviews every year
State Visit to India & Pakistan with Governor General of Canada (1998)
Received Order of Canada Award (1997)
Tony Dagnone Spirit of Royal University Hospital Award (1996)
Saskatchewan Order of Merit (1993)
Ciba-Geigy Award for best original article (1991)
Rotary Golden Wheel Award for Excellence in Science and Technology(1991)
American Academy of Neurology: Excellent and Frequent Reviewer
Nominee for Izaak Walton Killam Memorial Prize (eminent Canadian scholar)
Founder, Saskatchewan Parkinson Disease Foundation

The Many Little Secrets of Success

I succeeded against all odds. This friend of mine was saying the other day to me: You are not in a big name institute, you are a foreigner: You were never meant to succeed. You had no business succeeding.

Why and how did I succeed? Well one has to have ability. You can’t do much without that. You need the breaks – a lot of luck. But usually ability and diligence earn you the luck.

And you have to have the willingness to work. I always say North America is a beautiful place to work. 98% of the people here will get exactly what they work for. About 1% will get more than they deserve, and 1% will get less. Look at me for example. I was a foreigner, an unknown quantity when I started here. No body wanted me. My own country did not want me back – at least the government didn’t. I simply worked hard and had some very good luck along the way. And that was enough.

I also think one must always play to one’s strengths. Innovate in the way you utilize what’s available to you. Innovate against the odds. And you must have patience. I had several publications in the 70’s but my first major paper came in 1984, 16 years after I started my research. Work hard and eventually you will get what you deserve.

Always remember how much family support matters. When we got married I told my wife, Karla, that I am going to make $12000/year in academics but I can make $40000 to $60000 in private practice. She asked me what I wanted to do and she has since always supported my wish to be in academics. So the credit to a considerable extent of me staying in academics goes to my wife. I am certain that if my family life was suffering because of this decision, I would have switched. If I am not happy at home, I can’t function. And I feel that I have succeeded in having a good relationship with my son Alex and daughter Rachel. An open, understanding relationship. And my rigorous work schedule did not compromise unduly the time I had for them. I hope they think so too.

Feel at harmony with your community. My wife once said to me: “You know, you have adopted well to the west but you have not lost the qualities of the East” And really why should I have to compromise on my values and identity? My praying 5 times a day does not take away from my work or my family or my role in the community. I am part of my community in every sense. But I have achieved this integration without compromising any of my religious beliefs (I am incidentally, the founder of the Islamic Association of Saskatchewan.)

And finally, one thing that I have always seen happen: be generous and kind to an individual, or do something without expecting returns and invariably you get something back. Whenever I have initiated something simply to help someone out a bit, the gesture has turned out to be the best investment I could have made. For example a friend approached me a few years back to see if I could give his son, who had not qualified for medical school, an internship while the boy tried again. Just to accommodate the friend and his son, I said all right. It turned out that the young man was extremely hard working and smart and within a year had become the backbone of the operations of my research clinic. Even after getting into medical school, he remains strongly affiliated with our work.
Final Thought

Despite our look back at the life and work of Dr. Rajput, so many details, questions, anecdotes, events, people remain untouched: the fact that he dances a mean tango; that he once seriously took up biking to prepare for competitive cycling; how his children perceive Pakistan; why he wrote a letter to Nawaz Sharif letting him know he and other expatriates would always be receptive to positive, progressive initiatives; how he feels when he returns home after all these years; how he and his wife have managed to avoid a single fight in 30 years of marriage.

One last thought will have to suffice.

My ancestral home is in India from where my forefathers migrated to Punjab in 1900. I am by birth Sindhi. So I am an amalgam of all three – Mohajir, Punjabi, Sindhi. The divisiveness within Pakistan is a deeply sad reality. But it is not a new phenomenon. I remember that in my college days my Punjabi friends considered me Sindhi because I lived in Sindh and spoke Sindhi, even though my mother tongue was Punjabi. And my Sindhi friends considered me Punjabi because my mother tongue was Punjabi, even though I was born and raised in Sindh and spoke Sindhi just as fluently as they did. Somehow people always use their heritage to exclude everyone else….. unless you do something marvellous and then everyone wants to include you on their side.