Four days a week, Deneize Asim Puri, MSc, makes her way through the streets of Karachi to the city's east side Indus hospital. She is one of two practitioners who make up the hospital’s department of nutrition and dietetics—responsible for ensuring meals meet nutritional and halal requirements, ordering supplements and formula and documenting outpatient biometrics.
In addition to rounds in the hospital’s malnutrition clinics and pulmonary tuberculosis center, Puri’s clinical duties may range from providing guidance to people with diabetes to planning micronutrient regimens for parenteral nutrition.
"Most patients are poor here," says Puri, whose dietary plans are cost-effective for home-based, nutrient-dense meals. "Some are willing to follow our advice, while others have no money to give two meals to their children."
Although many of its services are free, Indus Hospital continues to grow through private donations and sponsorships (future plans include adding another 550 beds). So far, budgetary constraints prevent hiring more dietitians, but practitioners hope this will change as their roles gain recognition.
In 2010, a small group of dietitians established the Program for Accreditation of Nutrition Activities in Pakistan to standardize training for nutrition careers. While there is no credential or license, clinical dietitians must have at least a master’s degree as well as advanced training, and “nutritionists” must hold a PhD in nutrition and dietetics.
Currently, three universities in Pakistan (in Karachi, Lahore and Peshawar) offer educational programs recognized by PNDS, and Puri hopes that educational opportunities abroad become more accessible. "We are still in our infancy," she says, "so some training, like three months in a clinical nutrition department abroad, would do wonders for the profession of dietetics in Pakistan."
Rubina Hakeem, PhD, past-president of the Pakistan Nutrition and Dietetic Society and member of the American Overseas Dietetic Association, agrees—also noting the usefulness of expertise in nutrition and health in regulatory issues such as food safety and labeling laws. "In spite of being a small community facing several challenges, Pakistani dietitians are making a significant contribution to health care in Pakistan and giving credibility and visibility to this profession out of their own efforts and teamwork," Hakeem says.
At Indus Hospital, Puri works closely with physicians to support patient care, in addition to offering nutrition education classes to nursing students and hosting weekly lectures on nutrition for medical and surgical residents. "I think now has come a time," Puri says, "when doctors have realized the importance of the dietitian in Pakistan."