July 2017 News Updates

by Dr. Sajad Ahmad

It has been a while since I have written about any progress or new updates, a lot has been going on for the past six to eight months. We had an amazing July this year, more about that later.

At the end of last year, some of us started to engage with Khyber Medical University on how we could be of help in promoting Family Medicine. The interest had been mutual, a discussion of those few months saw the foundation of a separate panel on family medicine flourish at Khyber Medical University’s 8th Annual Health and Research Conference held on the 25th of April 2017. Family Medicine was discussed in detail by the secretary of health and options and discussion surrounding its promotion, trailing health centers, as well as the training of future family physicians, was discussed in detail.

Many insights were discussed in the panel dedicated specifically to Family Medicine by our Dr. Asma Kazmi representing APHCP.

The momentum from this did carry on, slow and steady, but this resulted in the formation of a focus group. Participation was encouraged from all over Pakistan with Ayub Medical College (Abottabad), Shifa (Islamabad), Fatima Memorial, University of Health Sciences (Lahore), Agha Khan University (Karachi) as well as the unflinching support of the World Health Organisation EMRO has been a key to the progress so far. It has been a great honor and privilege for APHCP to be a part of this team and help shape the future of Family Medicine in Pakistan.

The discussions from the initial focus group and after exchanging ideas and discussion in hundreds of emails in countless chains and telephone calls we flew to Pakistan in early July to participate in a two-day consultatory workshop held by Khyber Medical University under the auspices of World Health Organisation. The two-day event was attended by participants from all the four provinces including representatives from Kashmir and Gilgit Baltistan.  The attendance of Health department has been the key in taking the proposals forward. Presented by Family Medicine academics, senior examiners, PMDC, Family Physicians from both within Pakistan and the United Kingdom had the opportunity to suggest a way forward for the future. The two-day consultation concluded with the formulation of a concept note, a list proposals for the health department to carry out.

It has been an enormous privilege to be part of the team to help in laying the foundation of this wonderful speciality in Pakistan. Although some elements of Family Medicine are present in scattered forms in other provinces, Khyber Pakhtunkhwa, Balochistan and Gilgit Baltistan in particular lacks a setup to towards training generalists doctors. This in-spite of the facts that Four Medical Training Institutes of the province are recognised for Membership of the  College of Physicians and Surgeons of Pakistan in Family Medicine.

I believe more can be achieved in Khyber Pakhtunkhwa,  I believe there is a lot of potential for change towards better primary health care while keeping the costs of providing service down, I believe we can train our doctors working in the basic health units and provide them with the skills of family medicine. I believe we, working together can create a structure of primary health care that will complement the subspecialties of medical care already in existence. To do this, we need ownership, for, without it, we would be lost.





A collapse and 1122

By Sajad Ahmad.

So I am standing in “The book shop”, a newly launched bookstore, welcomed and awaited good news after the last shut its doors to customers a few months ago in Peshawar, Pakistan.

I am trying to find books when I hear a loud thud, an elderly woman had collapsed on the floor hitting her head and back on the table behind her, her daughter panicking, (this is in Peshawar) they tried to sit her up, my adrenaline surge pushes me forward, I shout, “leave her laying down! I am a doctor” and then a thought comes to my mind, I am unsure of the services available here, I try to speak to the elderly lady, she is unresponsive with a vacant look. Next, I check her breathing, there is a very slow effort, suddenly she starts to gasp and lets her breath out. Panic sets in, her pulse barely palpable. I keep my hand on her pulse and suddenly I feel it stopping, “lay her flat”, I shout, while at the same time saying she needs CPR, I attempt and after a few compressions, I feel her responding moving her eyes, again.

She starts to breath better, her pulse becomes stronger.

The next moment I shout out, call for an ambulance, call 1122, it’s the equivalent of 999 we have come to know in U.K. I am unsure if this will work in Peshawar! I explain, now that the lady is more stable, I am a doctor, but don’t work in Pakistan and am here on a holiday. I am unsure of the services here.
We gradually help the lady to a chair, two guys from the shop are waving books to fan the lady. She feels somewhat better.

Next, I start taking a detailed history and ask for a paper and pen to write it for the family, I think the doctors in the hospital would need it.

I don’t recognise the names of the medications, they are trade names, and I am used to the UK system of generic drug names, here is a learning outcome for me!
The next thing I see, is the efficient paramedic from the 1122 service, arrived, taking no longer than 10 minutes in Peshawar traffic!

I hand over to him with details, giving the written sheet, and my phone number to the family.

I hope she recovers, I have hope that Peshawar is on the way to reforms. Well done 1122!