Pakistan has dealt with enormous number of catastrophes in its past both natural and unnatural. Loss of human life and property is ongoing since early 1980’s and it does not seem to end here. Our medical response to the catastrophes has been decimal and contributes to the mortality and morbidity associated with these events. Our growing population size requires us to have a robust emergency response system which we are lacking. We are neither well equipped nor well trained to deal with the medical aspects of disasters or major incidences.
The problem is multifold and although it is evident that the lack of proper infrastructure across Pakistan plays a biggest role, lack of better trained individuals on ground and a lack of system of mobilization of resources are the other important aspects of this issue. Our medical community at large is non-cohesive and lacks the understanding and also the will to bring about the change.
My intention is to change all that and start the discussion to see how we can change this scenario and try building the system, infrastructure and develop expertise to stand up and face the calamity and decrease its impact from a medical stand point. Decreasing the mortality and the morbidity burden in itself is enough of the motivation to keep us going.
Calamities and incidences are not unique to Pakistan, and we see the world face them all the time. Large scale as well as small scale incidences are rampant, such as plane crashes, train accidents, floods, building collapses and so on and so forth. Like any other issue prevention and then cohesive systematic response after the occurrence of the incidences is the way people deal with it. Prevention of these catastrophes and incidences is a topic in itself and so will not be discussed today, but the medical response to it is the focus today.
Our response to any major incidence as well as any disaster has to be well thought out and practiced. These two basic prerequisites are to be developed as soon as possible. This requires a changed mindset of the medical community and the people responsible for the provision and setting up of the medical response. When the calamity strikes, there is no time for us to learn and train, as it is the time to act and display what has been practiced and learned before. The second aspect is the provision of tools and infrastructure to deal with the incidence. It could be seen as the bottleneck for a resource poor and mismanaged country like Pakistan, but experience has shown that this can be overcome with innovation and ways that have to be locally developed.
At the national level the disaster management response has long been discussed and probably has been created and sitting eating dust in the form of paperwork. We need to revitalize that and start at the provincial level and link the center Government with it. The provinces need to develop a team for the medical management and they should put out their recommendations based upon their perceived needs as well as their projected resources. Each province may have its different sets of perceived disasters and they should be making plans based upon that. So in Sindh, flooding and traffic accident can be seen as major issues, while in KPK earth quake, flash flood and terrorism may be high in the list.
No matter where we start from, a well thought out plan is going to win us the day. An organized effort is all it takes, with each person of the team taking responsibility. Which means that we have to stop thinking about me and I and start thinking in terms of we and us and ours.
The next step after the creation of the road map is training. When task is enormous, the training efforts have to be designed to create large impact with minimal expense of money and resources. Rather than creating a top notch team we need to aim for gradual but persistent rise in the caliber of each one of us. We should be uniform in our delivery of care no matter where the incidence happens. We should be predictable and trust worthy. The level of expertise will eventually come to where we will aim for.
My team at Shifa is training at the limited scale and we are also aiming to create master trainers so this circle of training can be further expanded. We always look for motivated and energetic people and incorporate them into our team. Any one willing to be our partner is always welcome.
As this is a team based approach and as discussed, is not just the work of medical personals we welcome any and all walks of life people. We have seen time and again that our response to any disaster has been enormous but it fades away quickly and then the expertise are never developed and the system never created to help the victims of the next disaster. The way things are happening, we need to make sure that we create this type of response and create the system that will provide a decent response to our kids and adults and elderly, our men and our women, and of course our strong and our weak.
I can be reached at erdoc@shifa.com.pk