THE CHALLENGE TO STATUS QUO:
The current shape of emergency medicine started forming in early 21st century when College of Physicians and Surgeons approved it as specialty for the training. It was a long struggle that became a success in 2010. when we look at the concept of emergency department t and the work done over there it is obvious that emergency care was been delivered throughout the history of Pakistan. Whether we called it casualty, A&E or emergency, we always had this designated area in all hospitals where anyone who gets sick and needs care was seen 24 hours a day and 7 days a week. This designated area was managed by all specialties and a few casualty medical officers or CMO’s. Different doctors would work on different shifts and different days and would manage the patients of their own specialty. This is the way we have always delivered the emergency care and we have seen it as the status quo despite acknowledging that there are problems in the system but no one was willing to change it.
The first challenge to the status quo came from Aga Khan Hospital when they started their emergency department with dedicated emergency staff to run the emergency care. It was first time in Pakistan that dedicated emergency doctors provided the emergency care to all the patients coming to the emergency department. The system created the awareness among the doctors in a very limited way. But what was amazing that they started publishing some research on the need to enhance the emergency care as well as portraying the understanding of the people who were working in the emergency department.
The efforts of these very few physicians failed to change the status quo but it was able to attract some valuable physicians. Aga khan hospital started a non-accredited training in emergency medicine which was 4 years program. It was a structured program but was not backed by CPSP or Aga Khan as any degree or training program.
At the same time two other institutes thought about starting the training in emergency medicine. Pakistan Institute of Medical Sciences and Ziauddin Hospital started MD in Emergency Medicine. Both were accredited by their own respective universities. The MD program of Ziauddin Hospital started around 2005 and is running successfully. The program of PIMS was one man’s sole effort and although it is still going on but not a well run program.
Aga Khan hospital’s program produced quite a few doctors through their 4 years program and then it was replaced by the CPSP recognized 5 years structured training program. The residents who completed the 4 year training program were not recognized by the College of Physicians and Surgeons, and they faced quite a struggle settling in Pakistan. They left for the UK and are settled over there.
College of Physicians and Surgeons was approached in early 2000’s by physicians from Aga Khan Hospital to start the training program in Emergency Medicine. The College was not convinced about the need for the training, and later on would not agree to start the program based upon the assumption that it would be a wasted effort. A second private institute joined hands with AKUH. It was the efforts of these two private institutions, Shifa International from north and AKUH from south of Pakistan that convinced the College to give a go ahead to the training of Emergency Medicine. The history of CPSP and Emergency Medicine can be read here. CPSP.
A NEW BEGINNING:
It lead to the start of another chapter for the Emergency Medicine in Pakistan. Now the struggle was multipronged:
- Establish a good residency program to convince the CPSP that the trainees coming out of the program will be capable of handling all the emergencies.
- Convincing other hospitals to start the training in their institutions, especially the public sector hospitals.
- To create an environment of dialogue thus convincing the people working in the emergency department in the old system to come and start the work with the newer and better concept.
- Help in the creation of a service structure and pave the way for the people working in the emergency departments so they can see it as a career rather than a transition.
THE FORMATION OF SOCIETY:
The above concepts were the building thought for the formation of the Society of Emergency Physicians Pakistan (SEPP). SEPP was created in 2009 and the founding President was Dr. Junaid Abdur Razzak. The Society faced very stiff challenges and the environment of the country was also quite turbulent politically and for the working of emergency Physicians. Still the SEPP managed to join people together and was slowly becoming a single voice for the emergency medicine in Pakistan. Due to the situation of the country a few key people left the country and SEPP could not stay active for technical reasons.
A second organization called PSEM (Pakistan Society of Emergency Medicine) was created by the same group of physicians in the year 2017. It is more of a continuation of SEPP rather than competition. This time the efforts were more coordinated due to past experiences of SEPP. It is now the only voice for the Emergency Medicine in Pakistan.
PSEM held its election and Dr. Abdus Salam Khan was its first President in 2018. Him and his cabinet faced the same challenges as the SEPP, but this time things were more favorable. It was because of the fact that firstly, there were more Emergency Physicians in Pakistan. Secondly, training had started through CPSP and there were a few training institutions in Pakistan.
TRAINING PROGRAMS IN PAKISTAN:
Through a combined effort the following programs were initiated and each deserves to be commended.
- Aga Khan University Hospital. Karachi.
- Shifa International Hospital. Islamabad.
- POF Hospital Wah Cantt.
- Lady Reading Hospital Peshawar.
- Indus Hospital, Karachi.
- Jinnah Post Graduate Medical Center.
- Combined Military Hospital Rawal Pindi.
- Mayo Hospital Lahore.
- Liaqat National Hospital, Karachi.
We expect that the number of training institutions will slowly increase in future and number of trainees increase steadily. As a result of that the trained physicians will increase in number in Pakistan and thus the emergency care will be positively affected.
RESEARCH AND PUBLICATION:
Another development that has happened is the initiation of the journal of Emergency Medicine. SAJEM (South Asian Journal of Emergency Medicine) started its publication in 2018 by EMAG(Emergency Medicine Advisory Group). This is the first Journal of Emergency Medicine in Pakistan and is the best vehicle for the documentation of the scientific development in Emergency Medicine in Pakistan.
The history never stops and so will our journey. We will be updating the history from time to time so that people will know the struggle that we all went through when the emergency medicine was budding in Pakistan.