No matter how much we talk about the importance of modern primary health care, a concept of family medicine, it is nothing but a drop in the ocean. Many of us know that Family Medicine as a concept still needs to be nurtured in Pakistan. It was in the middle of the year we started planning our talk at Ayub Medical College at Abbottabad. A city named after Major James Abbott (1), It grew from a small district in January 1853 to the second largest city in Khyber Pukhtunkhwa Province of Pakistan. With a current population of above one million souls (2) many have come to this beautiful site, an existence in the foothills of Himalayas, doctors have often struggled to provide health care.
Primary health care like anywhere else in Pakistan is provided by multiple sources. Ranging from private providers to specialists often treating multiple specialties in their private clinics. However, it was the earthquake of 2005 that saw a major burden on the already over-stretched health care system in Abbottabad. Many volunteered from the west, Orthopedic specialists, General Surgeons, and even Physicians, but of great pride is the involvement of Family Physicians in a disaster situation (3).
Pakistan as a country desperately needs a better system of primary health care, it needs the concept of trained family physicians, generalists specializing in the generality of medicine. That, we believe should be the way forward.
It was natural for us to plan one of our talks in the second largest city in Khyber Pakhtunkhwa province after our talks in Peshawar earlier, this time, the venue was Ayub Medical College at Abbottabad, the city of pines as its lovingly known. The planning for the talk was the culmination of discussions with the Dean and Associate Dean of Ayub Medical College. The Associate Dean, Dr. Umer Farooq arranged and hosted the event.
On 21st September 2016 We arrived at Ayub Medical College, the venue of our talk. Presented by two of our core committee members Dr. Abdul Jalil Khan coming back to his alma mater and Dr. Moeen Ashraf.
We were very warmly welcomed by the team of Community Medicine Department.
“It was very emotional to meet my great teachers Professor Huma Jadoon (head of department), Professor Saleem Wazir, Dr Umer Farooq (Associate Dean, AMC), Professor Dilawar, Professor Nisar Sb and Professor Aziz-un-Nisa (Dean, AMC).” ~ Dr A Jalil Khan
The talk was attended by final year MBBS Students, House officers, Trainee Medical Officers and the faculty Members. It has been a source of great pride, as Dr. Jalil stated, “I was really pleased to see my class fellows and other fellow students now sitting in the faculty seats especially Dr. Aftab Khan, Dr. Owais Khan, Dr. Zeeshan and Dr. Inaam. I am really thankful to Dr. Yousaf Aziz (pediatric Surgeon in Kuwait) who also attended our talk”.
Our aims and objectives of these talks have always been to promote family medicine as a specialty. The discussion we have had so far with the health professionals in Pakistan has concluded that a comprehensive primary care may be one of the better solutions to improve the health care system in Pakistan. For primary health care to be promoted in any capacity would require funding, training of general practitioners is the core foundation of any modern primary health care system and is directly related to the funding it receives. We have seen first hand how the inequality in the health care budget and lack of prioritization have led to the sprawling of specialists hospitals. But the lack of investment in primary health care still burdens the same hospitals (4) which ironically were set up to cope with the disease burden in the first place.
The talk at Ayub.
It all began with a brainstorming session, a scenario we placed to the medical students, asking them to come up with ideas how to improve the health care system. The purpose for this was to let the audience think differently, by challenging the common perceptions , the ideas we already have ingrained in our subconscious. and then began the talk, delivered by Dr. Abdul Jalil Khan and Dr. Moeen Ashraf.
The first part of the talk, “The Story” was meant to share an experience of being transformed from a student at Ayub Medical College into a career GP and Family Physician in U.K. The life of a GP in United Kingdom’s National Health Service (NHS), the variety, the challenges and most importantly the trust of community in this speciality.
The second presentation which was the main theme of the talk “Family Medicine as specialty and it’s Future” was delivered by Dr. Moeen Ashraf. Here came the advice to the students on current models of training that is offered across the developed world especially U.S.A, U.K, and Australia. Dr. Ashraf also discussed what is currently available in Pakistan in regards to the availability of training.
The last part of the talk “Why Family Medicine” was delivered again by Dr. A Jalil Khan. It was concentrated on the importance of a comprehensive primary care and how we might adopt it in Pakistan.
The talk was concluded by the closing remarks from the Dean, Professor Aziz-un-Nisa who acknowledged the importance of a comprehensive primary care. She mentioned how the specialist outpatient clinics are overcrowded by patients presenting with primary care problems. She agreed that developing a family Medicine specialty will not only train future Family physicians but will also run the filter clinics and improve the triage system in tertiary Hospitals.
1. Wikipedia. James Abbott (Indian Army officer): Wikipedia; 2016 [cited 2016 14th October]. Available from: https://en.wikipedia.org/wiki/James_Abbott_(Indian_Army_officer).
2. Wikipedia. Abbottabad Web: Wikipedia 2016 [cited 2016 17th October]. Available from: https://en.wikipedia.org/wiki/Abbottabad.
3. Newmark J. A month as a GP in the earthquake area of Pakistan. British Journal of General Practice. 2006;56(524):224-5.
4. Ahmad S. Letter to the editor (How to extend GP training and improve urgently and emergency primary care). Br J Gen Pract. 2016.