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Around 1969

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Around 1969 Ali Zafar, 2007
 
 
Interview 55 Ali Zafar

General Practitioner and Hospital Practitioner
Born in India in 1945.


Overview: Ali Zafar qualified in India in 1967 and came to England in 1970. He began to specialise in diabetes when he worked as a registrar at East Birmingham hospital (now Heartlands) from 1972 to 1975. He became a GP in an inner-city practice in 1975, but continued to work at the hospital diabetic clinic, first as a clinical assistant and then as a hospital practitioner, until he retired in 2006. Both the hospital and his surgery were in areas with a high percentage of Asian people. He first produced an Asian diet sheet in the early 1970s.

Please note that Overview relates to date of recording 02 March 2007

 Short samples

1 He still continues to work part-time in general practice and is concerned at the high incidence of diabetes among the Asian population, which he attributes partly to cultural attitudes. [ 58 secs ]

2 One of the reasons he retired was because he felt that government reorganisations in recent years had led to his having less time for his patients. [ 56 secs ]

 
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01 Born India. Family of lawyers. Qualified 1967. Came to UK 1970. Reasons for choosing medicine.
At medical school, Bihar State, `63, `64, saw patient started on insulin – big event. Sent blood to lab.
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02 Diabetes not taught well. Other diseases more common. Asian people reluctant to talk re diabetes.
Came to UK for higher education.
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03 Got General Medical Council registration before coming. No initiation to hospital. Locums in East England, mostly paediatric.
Moved to Nottingham `70, `71. SHO in general medicine. Diabetes clinic at General Hospital…
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04 …now University Hospital – huge numbers. Urine testing – blood results came week later. Podiatrist there, but not in subsequent hospitals. Dietitian. Consultants made decisions re calories. Some went by portions…
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05 …dietitian had to produce diet sheet. East Birmingham Hospital (Heartlands) consultants still using portions, early ‘70s – consultant asked me to produce Asian diet sheet.
In Nottingham calories related to patient`s work. Unrealistic target. Mainly Type 2. Type 1…
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06 …portions spread through day.
Nottingham nurses possibly worked harder then - 4 urine samples daily. Patients stayed long time. Insulin in 3 different units.
At Heartlands, mother in hospital throughout pregnancy.
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07 After Nottingham General - Highbury Hospital, Nottingham, then St. Chad`s, Birmingham – emergencies. Then registrar at East Birmingham – chest medicine. Chest consultant also ran diabetic clinic: I got involved in clinic & ward. One Asian man looked sad…
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08 …thought we`d said he couldn`t eat! Another thought he had to eat usual food plus diabetic diet! Many Asians in East Birmingham Heartlands. I wrote Asian diet sheet in different languages – not then done at Birmingham General.
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09 Outpatients in early ‘70s expanding. Urine testing. Dietitian. Chiropody started. Nurse knowledgeable but not specialist. Many complications. Screening.
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10 No special patient education. Gave details of British Diabetic Association.
General ward. Stabilising on insulin, ketoacidosis, complications. Woman who wouldn`t give up chocolate. Pregnant women cooperative. Joint obstetric clinic from mid-‘70s.
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11 Became GP, 1975 – no training. Remained assistant at diabetic clinic – useful for GP. Inner-city practice, 60% Asian.
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12 Diabetes increasing. GPs` involvement minimal. More involved recently – new contract.
Clinical assistant same as registrar without ward work.
Initially overlooked high incidence among Asians. Obvious from 1980…
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13 …One Heartlands clinic expanded to whole department. Clinics full when I worked there until last April. As GP, I fear mass screening would double numbers. Already testing at places of worship. Theories re Asian prevalence…
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14 …not much in India in ‘60s. Lifestyle. Obese boy considered a good labourer. Need mass education rather than mass screening. Few Asian mothers breast-feed.
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15 Main changes at Heartlands 1972-2006: more clinics, physicians, joint clinics with other specialists, chiropody, eye screening…
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16 …specialist nurses – avoid need to admit for insulin stabilisation or for whole pregnancy. Specialist nurses began mid-‘80s. I got on well with them; some GPs felt threatened.
Became hospital practitioner, 1986/7.
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17 General practice unchanged 1975-85. Then more practice nurses. Fund-holding from 1990. Got used to it, then abolished!
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18 Had more money for nurses & dietitian. In last 3/4 years major shift to community-based clinics. At first, I was afraid we didn`t have resources, but have had own clinic for last 5 years.
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19 More specialists in community. Only special cases referred to hospital. More convenient for patients.
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20 Tensions because hospitals losing empires.
I retired partly because too much reorganisation. More administration, less time for patients. Patients demand more.
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21 Involvement of lawyers. Mutual loyalty decreasing.
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22 Diagnosis of diabetes now less devastating. Some keep it secret. Some ignore it. Encouraging example of people who`ve had it for years.
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