Article authored by three generations: International lifetime commitment to child health

Three continents (Africa, Asia and Europe) are represented in the current issue of the Sudanese Journal of Paediatrics (SJP) which has focused attention, since launched in 1977, on the major health problems facing Sudanese children, as well as other children of resource-limited countries. The articles include communicable diseases with infectious aetiology: malaria, rheumatic heart disease and acute bronchiolitis. They also cover neonatology, nephrology (nephrotic syndrome and haemolytic uremic syndrome), as well as other diseases which are currently gaining more visibility (diabetes mellitus, Kawasaki disease, and rheumatoid arthritis). Also included is a reflection, from the Czech Republic, on a recently published article [1] highlighting the use of a new investigational drug, burosumab (KRN23) in the management of X-linked hypophosphatemic rickets.

However, the most notable is an article on the relationship between birth weight and congenital heart disease, authored by three generations! The first author of this article is Hafiz Osama Hafiz Elshazali, Sixth Year Medical student, Faculty of Medicine, University of Khartoum, Sudan [2]. The article represents the findings of a research project which he completed in his fifth year of medical training as part of the course in Community Medicine. Fifth Year research projects have been adopted by the Faculty of Medicine, University of Khartoum (U of K) for decades to provide medical students with the experience of designing, conducting, analysing, and publishing biomedical research. Also, the Students Medical Association (SMA), Faculty of Medicine, U of K used to organize yearly seminars on various medical issues in which the medical students, supervised by Faculty Staff, present their research findings. These were then published as proceedings in the SMA journal “Al Hakeem” [3,4]. Established in the late 1950’s, Al Hakeem (meaning wise person or doctor in Arabic) continued to publish original articles authored by medical students, and remained pioneering in its field worldwide [5]. The second author of the article is the father of Hafiz, Dr Osama Hafiz Elshazali (Consultant Paediatric Cardiologist, Department of Paediatrics and Child Health, Faculty of Medicine, U of K) who supervised the project together with Professor Hafiz Elshazali, the grandfather!

Professor Hafiz Elshazali is an icon of Sudanese paediatricians who vividly portray lifetime commitment to child health. As Fellow Professor of Paediatrics, Faculty of Medicine, U of K, he attended in April 2016 the signature of the Memorandum of Understanding between the Royal College of Paediatrics and Child Health (RCPCH), United Kingdom (UK) and the Faculty of Medicine, U of K to host the first MRCPCH Clinical Examination in Sudan in March, 2017 [6]. This lifetime commitment gaudily shines throughout his medical career, following his graduation in 1960 from the Faculty of Medicine, U of K. As Medical Officer in the Ministry of Health (1961–1964), he worked in different provinces of the Sudan: Khartoum, Kurdufan (El-Obeid, Umm Rawaba), and the South (Wau). This provided him with remarkable experience and direct contact with the different health problems in the different parts of the country. He joined the Department of Paediatrics and Child Health (DPCH), U of K in 1964 as Research Assistant, and was involved in teaching of undergraduate students. He had his postgraduate training in UK, obtaining the MRCP (London) certificate in 1967 and the Diploma in Child Health (DCH, England) in 1968. Returning from UK, he joined the DPCH, U of K as Assistant Professor and worked with distinguished WHO visiting professors, Professor Neal, Professor Brimbilecombe and Professor Webb, who established the DPCH in U of K, gaining a lot from their supervision and experience [7]. In 1969 he became the first Sudanese Chairman of the DPCH and continued in this post till 1972. He introduced the concept of Community Paediatrics, with actual teaching of the students in the community to engrave comprehensive and holistic approach in the management of a sick child. During 1971–1972 he attended the WHO/UNICEF Senior Teachers Training Course, organized by The Institute of Child Health (ICH) at University of London [7]. Moving to Wad Medani Teaching Hospital in 1972, he became Senior Paediatrician for the Blue Nile Province (1972–1978) and then The Senior Paediatrician, Ministry of Health, Sudan (1978–1979). During this period he started the Karaiba Project: a pioneering rural community oriented program working for the community and involving the community as an active stakeholder [8]. Child morbidity and mortality dropped. This, of course, is due to multiple factors. By control of infectious diseases through immunization and improvement of nutritional status Karaiba Project clearly demonstrated a drop in child morbidity and mortality [8]. The improvement of nutritional status was primarily due to nutrition using food ingredients available at all Sudanese homes and cooked in the traditional manner. He also published seminal work on diarrheal diseases, the vital importance of breastfeeding; and childhood malnutrition [9] and its relation to weaning [10]. He also devised recipes for home-made weaning foods [10]. This seminal experience was compiled in his authored book “Children-Feeding and Health”. The book was published by Khartoum University Press in 1973, in simple Arabic to suit even those with primary education, and is now in its fourth edition. The impact of this seminal work was later revealed in studies on breastfeeding and feeding during infancy [11,12].

During 1979–1983 he acted as Professor and Chairman, Department of Paediatrics and Child Health, Faculty of Medicine, University of Gezira, Sudan [13], and was involved with six colleagues in the planning, setting of the objectives, and designing the innovative problem-based learning (PBL) curriculum for the Gezira Faculty of Medicine.

Professor Hafiz Elshazali had memorable inputs in guiding child health in local, regional and international arenas. He was Member, Expert Panel on Maternal and Child Health, WHO, Geneva (1972–1982); Member, Expert Panel on Nutrition, WHO, Geneva (1974–1978); Member, Committee on Medical Education, United Nations University, Japan (since 1976).

He was also President of the Sudan Association of Paediatricians (SAP, 1977–1983), President of Arab Paediatric Association (1978–1980), and President of the Union of Middle Eastern and Mediterranean Paediatric Societies (1978–1980). He convened the first international conference for paediatrics in Sudan. This was the XII Congress of the Union of Middle Eastern and Mediterranean Paediatric Societies (UMEMPS), held jointly with the 6th Conference of SAP in Khartoum (15–18 December 1979) [14]. The Opening Ceremony was addressed by Professor Hafiz Elshazai, President of UMEMPS and the Late Professor Ihsan Dogramaci, the renowned paediatrician, entrepreneur, and educationalist [15] who held the posts of chairman of the UNICEF executive board, and president of International Pediatric Association (Figure 1).

Figure 1.

The Opening Ceremony of the XII Congress of the Union of Middle Eastern and Mediterranean Paediatric Societies (UMEMPS), held jointly with the 6th Conference of the Sudan Association of Paediatricians (SAP) in Khartoum (15–18 December 1979). Sitting on the platform are the President of UMEMPS, Professor Hafiz Elshazali (second from left), H.E. Khalid Hassan Abbas, Sudan Minister of Health (middle), Professor Ihsan Dogramaci (second from right) [15]; and Professor Mohamed Ibrahim A Omer (first from right), Ex-President SAP, Ex-Head, Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum; and former Editor-in-Chief of Sudanese Journal of Paediatrics [16].

Both Editors of SJP (MOS and MAMS) attended this conference as postgraduate students enrolled in the U of K Master in Paediatrics and Child Health (MPCH, which was later renamed Clinical MD in Paediatrics and Child Health). The organizers of UMEMPS gracefully encouraged the postgraduate students to contribute to the scientific meetings. One of us (MAMS) had the privilege of presenting the findings of his MPCH thesis on a “New type of muscular dystrophy”, supervised by Professor Mohamed Ibrahim A Omer (Figure 2) [17]. This paved the way for the development of an MD thesis, registered at the University of Khartoum, and to get training in Newcastle, UK [7] in paediatric neurology with Dr David Gardner-Medwin [18] and neuromuscular disorders with Lord Walton [19].

Figure 2.

During the XII Congress of the Union of Middle Eastern and Mediterranean Paediatric Societies in Khartoum (15–18 December 1979), the International Editor of the Sudanese Journal of Paediatrics (MAMS) had the privilege of presenting the findings of his thesis for the Master in Paediatrics and Child Health (MPCH, which was later renamed Clinical MD in Paediatrics and Child Health) on a “New type of muscular dystrophy”. The thesis was supervised by Professor Mohamed Ibrahim A Omer [19].

During 1983–1985, Professor Hafiz Elshazali was seconded by University of Gezira, Sudan [13], to devise and implement a programme for training of physicians in comprehensive primary care, run by Saudi Defence Force and linked to the King Faisal University Family and Community Medicine Fellowship Programme [20]. Thereafter he moved to Bahrain, where he was appointed Professor and Chairman of Paediatrics, Division of Human Behaviour, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University ((1985–1987) [21]. He became Dean of CMMS (1987–1993) and during his tenure, the College managed to finalise writing and implementing the innovative problem-based learning (PBL) curriculum. For the following 10 years, he acted as Vice Dean for Academic Affairs and Undergraduate Programme, CMMS, Arabian Gulf University.

Professor Hafiz Elshazali maintained his commitment to child health after returning to Sudan. He was Chairman Board of Trustees, Gaafar Ibnauf Children’s Hospital, Khartoum (2005–2010) [22]; Chairman Curriculum Committee, Sudan Medical Specialization Board (Paediatrics and Child Health); Professor of Paediatrics, Faculty of Medicine, Ahfad University for Women; and Fellow Professor of Paediatrics, Faculty of Medicine, U of K.

The article of Elshazali dynasty, authored by three generations in the current issue of SJP, is truly inspirational. It vividly highlights a role model for us, and teaches how international lifetime commitment to child health should be!