In my last blog I commented on plans to recruit emergency medicine trained residence for UK. I was trying to find a happy medium. A right balance to create a win, win situation for emergency medicine in Pakistan.
It is utmost important to collectively think about emergency care in Pakistan and try our best to support and enhance it. Although emergency rooms are present all over Pakistan and staffed by casualty medical officers, the level of training and expertise is not there. These doctors are untrained and for the most part unsupervised. They go there because they don’t find any spot anywhere else or want to learn the fast pace of healthcare delivery. But the results are not good for the patient as the youngest physicians with unsupervised roles brings the stakes to oddly high levels.
Replacing these untrained junior emergency room physician staff with the trained physicians in such high quantity in the emergency rooms across Pakistan is really a challenge. It involves careful planning with immediate term, intermediate term and long term effects to support a sustained improvement in the emergency care delivery in Pakistan.
Looking at the situation in Pakistan, we realize that robust teaching and training programs are a must. It has to be across Pakistan and should involve all segments of healthcare whether, public, private or hybrid structures. This will lead to sustained delivery of trained physicians and will be perpetual. Along with this, taking care of their service structure will let us meet our long term goal.
Before we reach to that level, we need to work on our immediate and intermediate goals. How do we improve our emergency care when we don’t have enough trained physicians? We have thought about this dilemma and have discussed it in our society meetings and with different healthcare entities. We have a solution in the form of a crash program for the people already working in the emergency departments. We would like for them to have a 6 week to 3 month course in emergency medicine and let them continue their work in emergency departments across Pakistan. This will give them a few basic tools to effectively deal with most of the emergencies whether it is a medical or trauma. Although this will require commitment on the part of people working in the emergency departments as well as on the department itself, but there is no solution that is without any cost. We also don’t have places where we can train this large number of physicians, but again this can be accomplished once we have the resolve to train them.
For the intermediate term goals, we have the model of rotating physicians for 6 months to a year in a recognized department as well as sending physicians outside the country in a planned fashion. These physicians can go to either UK or Middle East to work for two years and come back. They should then be sent to emergency departments across country so they can utilize their learned expertise to benefit patients and improve our emergency medical delivery.
How are we going to implement this plan is the question of the hour. Our emergency departments are the most neglected part of the hospital and are not given the due attention. Part of the problem as has been discussed multiple times is the ownership. The specialists and sub-specialists don’t envision an independent emergency department and so don’t help our cause in strengthening the emergency care. Similarly people who work in the emergency departments presently have no idea about the scope of their own field and often serve as either just a gate keeper or extenders of the sub-specialists. This has to change and the true understanding of the emergency medicine as a separate discipline has to take shape before we can expect a nationwide acceptance of the field. The people responsible for the hospitals need to understand the dynamics and be sold to the idea. Similarly government officials and the healthcare ministries at all levels should look into it and support the efforts.
Coming back to the intermediate goals and ways to achieve that, let us see how we can connect ourselves to the world and get a positive spin out of a worldwide demand. As discussed in my last blog, the world has trouble meeting its immediate goal as well as the intermediate goal when it comes to emergency care. They have a system in place but don’t have enough hands to run it with quality. Their patient waiting times and other parameters are showing a shortage of emergency doctors. Their training programs are generating new doctors, yet failing to meet the demand. This has caused them to look outside for the half-baked physicians who can be absorbed in to their system and would run it till their long-term goals are met. This creates a very interesting window of opportunity for us. We can utilize this time period and help them in such a way to turn it into a benefit for us in the longer run. We will both win if we supply them with doctors who spend two or three years and come back and serve Pakistan.
Through combined efforts of the faculty of emergency medicine at college of Physicians and Surgeons, Pakistan and local training centers of emergency medicine as well as public hospitals, we can develop a program where we can send doctors around the world. We will make our emergency departments ready to receive them. This can be a challenge easily met if we act as a team both at governmental and private sector level. Being involved in emergency medicine training and also developing the training system in Pakistan, I can assure you that this can be accomplished.
I am hopeful that we can capture this wave of emergency medicine and benefit from it. I am also thankful to some of my readers that gave me very positive feedback and their best wishes for Pakistan. You can reach me at ERDOC@shifa.com.pk.
Article reviewed by Zain Alvi…. our young reviewer.