A healthcare Emergency Medicine consultant perspective.
Abdus Salam Khan, MD FACP Nov 2019
We had the chance to visit Kalam, a tourist destination in northern Pakistan which had the busiest season in the summer of 2019.
It was a joint collaboration of Pakistan Society of Emergency Medicine, Shifa international hospitals and SDG 3. It was ventured to help the local hospital in its bid to provide the care to the local community. Initiated by Madam Sadaf Khalid who is the SDG’s Sustainable Development Goals National Project Coordinator for Pakistan. The idea was to teach and train the staff on emergency management and BLS and also to have a workable plan to improve the care delivery for the locals as well as the tourists visiting this beautiful destination.
Kalam (Urdu: کالام) is a valley located at distance of 99 kilometers (62 mi) from Mingora in the northern upper reaches of Swat valley along the bank of Swat River in Khyber Pakhtunkhwa province of Pakistan. It is a spacious sub-valley of Swat, at an elevation of about 2,000 meters (6,600 feet) above sea level, and providing rooms for a small but fertile plateau above the river for farming.
The mountain peaks are from 12000 feet upto 22000 feet. The valley is quite sizable and the journey is pleasurable although a bit tough due to broken roads which get continuous repair and ongoing damage and need for further repair.
The hospital was nicely constructed yet neglected. Talking to local healthcare representatives and journalist it was clear that due to difficult living circumstances it is tough to retain a doctor or a good nursing staff year around. We taught the staff lessons about first aid and also gave them training on the basic life support. The sick patients have to travel about 4 hours to cover a distance of about 100 km to reach to the bigger city and get the care they require. The goal of SDG3 was to make this hospital functional to care for the local community and the tourists visiting from all over Pakistan.
Coming back from this trip and after so many similar visits across Pakistan I have this firm belief that the key to better healthcare lies in strengthening small community places of healthcare delivery. A real impact can be created by first strengthening the emergency services and care delivery and then the ability to transfer a sick patient to continue care by a secondary care hospital from these local communities. A well-equipped emergency room and then adequately trained emergency doctor and the nurse can have a better impact than any other intervention. After the emergencies are dealt with and the patient is stabilized then an adequate transferring modality in terms of functioning ambulance and competent paramedic will ensure best effort to save life and decrease morbidity and mortality from these communities. The third significant part is effective and better communication between the transferring hospital and accepting institution for the seamless care of the sick.
These steps will ensure that the patient get help with least time wasted and was sent with adequate intervention to provide best outcome to a more specialized and better resource place. It will also decrease the burden on referred hospital as they will be receiving better managed patients and also decrease number of self-referred patients due to trust in the local hospital for care.
Rather than investing in extravagant infrastructure or getting cutting edge technology, we should invest in people. Our people hold the key to improving our own healthcare. Local and small communities would benefit from competent emergency services and managing these services would result in immediate improvement in the suffering of the common person. Local and central healthcare institutions have to ensure that staff and facility is maintained and the communication channel with the referred hospital is well established. Doing frequent audit and improvement cycles will get us the result that we want.
It is my hope that the plight of the small rural community is addressed by the local and federal healthcare authorities to improve the trust level of communities on the healthcare facilities.