The greatest resource of Pakistan is its people and it is true to say that Pakistan is a treasure house of talent. In all spheres of activity there is not just talent but oodles of it. There is not a thing that we cannot do well. And yet as a nation and even as a Pakistani-American community we are collectively under-whelming.

“No one is indispensable in this world” was the refrain in our home. Perhaps it was prescience and he was to leave us at the young age of 52 that my father harped on it. Despite the passage of 19 years my wound is raw, but at a personal level he was right. I lived on and made it despite his absence.

There is commonality between the microcosm and the plane of the community and the nation. One has a choice to lapse into depressive psychosis and the national malaise that Pakistan is in, or one can brush oneself off, walk, and then run.

From its inception Pakistan’s has been a personality-cult driven culture. Our motto could veritably be “it’s all about me”. Certainly leadership is indispensable but when everyone wants to lead all we have is a shaky conglomerate of egos and one-upmanship.

It is physiologic to romanticize the dead. More so for it is unimaginable that the founding fathers of Pakistan would have fallen prey to this particularly Pakistani plague. The rule of those that followed ended in defamation or death, and it is a sad day that in all of its 57 years the Pakistani nation can only idolize Jinnah and Liaquat Ali Khan. Their tenures were brief and what would have been is obviously speculative. Subsequent to them the sole concentration of all Pakistani leaders was amassing power and perpetuating their personality cult. It is an un-amusing irony that in this process of self-glorification, Pakistan, their raison-d’etre was all but forgotten.

A few months after gaining power Musharraf quoted the Qur’an in which Allah says that He elevates those whom He wills and debases those He wishes to debase (Al-Imran: 26). Perhaps Musharraf needs reminding that it’s not over till it’s over. As tenaciously as he hangs on to power and if history is anything to go by, his rule is bound to end in one of the above-mentioned D words. Perhaps then he will reflect and know what the latter part of the Al-Imran verse feels like, up close and personal.

If you step down from the national to the level of national organizations, the Association of Pakistani Physicians of North America or APPNA behaves as a perfectly logical extension of the personality-cult driven politics of Pakistan. It was founded twenty-seven years ago at a time when the practice of medicine in the United States was not cramped by managed care. Doctors charged what they wanted and were paid what they charged. Pakistani medical graduates at the time had paid the equivalent of $20 or so per year for medical education and were blissfully debt-free as compared to their American counterparts who began residencies in medicine or surgery with about a hundred thousand dollars worth of student loans. Since its inception in 1976, APPNA has many a feather in its cap, the greatest achievement and the only place where it breaks from the Pakistani norm is its democratic tradition. And perhaps the claim that it is the largest democratic Pakistani organization is entirely credible. Its rural healthcare project APPNA Sehat has achieved immunization rates in the targeted villages of Pakistan that compare easily to the West. The Human Development Foundation does charitable work and was formed by APPNA workers in 1996 and now operates independently. There has also been political and social activism by APPNA.

What APPNA became infamous for however was the “jaguars and diamonds” tale. I am of the firm belief that there must be a forum for Muslim-Americans, for Pakistani-Americans, and for Pakistani-American physicians, for the aggregate is always stronger than the solitary. And when I try to recruit doctors to the fold of APPNA I have received a passionate and undeserved tongue-lashing, enumerating Rolls Royces, Bentleys and Jaguars choking hotel driveways and 5-carat diamonds blinding you.

An APPNA officer explained the genesis of all this ostentation very aptly. Those doctors reaped the harvest of the golden age of medicine and it is only natural that they should want recognition of their achievements. She analogized it to the peacock dancing in the jungle, its majesty entirely un-witnessed. The sad part of it all was that APPNA began to be identified with this hedonistic, “halla-gulla” culture and all the naysayers drowned out all of APPNA’s achievements with their contemptuous cacophony.

Not in defense of elitism but only of human nature I will say that if you’ve got it flaunt it. And to those critics: I feel especially happy that my Pakistani colleague has a Jaguar and his wife the awesome diamond, for many catty remarks are the result of a personally unfulfilled life and a void where inner peace should be.

Rolls Royces get old after a while and managed care took care of pushing them to the endangered species list and Lexuses, Mercedes and Jaguars took over. Concurrently the founders of APPNA are retired or nearly so and the younger generation whilst it may sport a Rolex is more interested in using APPNA as a forum to achieve social and political change. In the real sense of the word and not the lip service that Pakistanis are also famous for.

There is a palpable understanding of the potential of APPNA if it is properly channeled. APPNA is made up of constituent medical college alumni, and on the Easter weekend the Dow graduates of North America, with the cute acronym of DOGANA, had a retreat in St. Louis, Missouri. With the attendance of less than a hundred physicians, half a million dollars were raised for EnDow, an endowment fund created to improve conditions at Dow Medical College and Civil Hospital and for various charitable projects.

There was a crisp professionalism in the air. Conferences were held on time, discussions were well moderated and the most exciting thing of all was that here was a group of people that was totally focused on going past personalities and creating processes and building institutions. The current president of DOGANA as well as the chair of the host committee was short on talk and long on action. Man how un-Pakistani can one get!

There is no desire on the part of this set of organizers to use their positions as springboards for APPNA presidency. And perhaps that is why the event was of such a different flavor and achieved the endowment fund as well as concrete plans for mentorships and visiting professorship among a host of other items.

In the discussion there was a refrain that the APPNA leadership would be well served to hear. Dow physicians did not want any interference by the Pakistan government in any APPNA affairs. Their concerns have historical merit. A one-time president of APPNA used his presidency to springboard to becoming the head of the Human Development Foundation in Pakistan, and currently enjoys blue-eyed-boy status with Musharraf. The same physician when asked in New York in 2002 what he felt about the APPNA presidential election results said smugly to me: “So my trip all the way from Pakistan was worth it!”. Floored by his gloating I lost the opportunity to probe.

“The older order changeth yielding place to new and God fulfills Himself in many ways lest one good custom should corrupt the world”. So said Tennyson and so very truly. APPNA must adjust and do so quickly for it runs the risk of becoming irrelevant. We must create processes such that templates are made and the person filling the role becomes irrelevant, what is relevant is that the process has been created. We must leave the legacy of systems and processes and not egos and personalities. It is rumored that APPNA presidential candidates spend thousands of dollars to become presidents for one year. I have still not found a plausible explanation for this insanity. With however a successively younger age group getting seats in the executive council there is hope that the concentration will be on process and not self-advancement, institution building and not personal glorification. It would be a happy day when the mood of the Dow Retreat attendees would permeate APPNA. What a wonderful contagion that would be!

(Mahjabeen Islam is a family practice and addiction medicine physician practicing in Toledo Ohio. Her email is mahjabeenislam@hotmail.com)