Abdus Salam Khan, MD FACP, Nov 2012
Moving forward, let us see now what changes needed to be brought into the healthcare System, who are the stakeholders and let us talk about the intended beneficiaries.
A good system requires proper ground work, healthy infrastructure, appropriate guiding principles, good Support Systems and talented operators.
Presently we lack in each and every aspect of making a good System when it comes to emergency care in Pakistan. In order to bring a change in the present system we need to keep in mind our Govt. policy concerns, money constraints and lack of will among the stakeholders.
Our infrastructure and ground work is faulty and does not support a good System. It is inadequate but it should not stop us from bringing a change in the system. We lack in having guiding principles and operating procedures for emergency care. But this obstacle could be easily taken care of. We also lack good support system, and it is hard to bring a change without a good support system. The last requirement for the change and a good system is the talented operators, or in case of emergency care its physicians and nurses. This area of the System requires a change in the mind set of young physicians and nurses, so they may choose emergency medicine as career path. We will talk about this a bit later.
To recap we could see that in order to build a good emergency care system in Pakistan we need to work in following areas.
- Preparing guidelines and SOP.
- Building a good support system.
- Training doctors for the task of better emergency care.
Let’s talk about the above three areas one by one. The first area of the task is relatively easy, as emergency care guidelines are available from renowned institutions around the world. These guidelines have to be tailored according to our present scenario. This is the work of emergency physicians and some work is already in place and the rest of it could be easily taken care of.
As far as building a good Support System is concerned, it is really a daunting task to overcome. People have their habits and they are used to them for a long period of time. Besides educating them there are not very many ways we can achieve this goal. We need to educate people and convince them regarding this important aspect of medical care.
The last part of training doctors for the emergency care is also a laborious and daunting aspect of the change. Young doctors coming to the practiced life don’t see emergency medicine as a viable option when it comes to choosing career path. Although initiation of training in emergency Medicine at Shifa International Hospitals in Islamabad and at Aga Khan university Hospital at Karachi is a good beginning. We have not achieved the task of changing mindset among the young physicians. We need to train enough physicians before a change in mindset will be a reality.
When we are able to achieve this goal of training emergency physicians, they themselves will become the force of change and create the good support System along with their colleagues in other specialties. The enormous task also brings with it enormous risk. The most important of all those risks is the fatigue among the people bringing the change. It is a real threat and requires a continued soul searching for those working for the emergency care. Lack of resources and lack of will among the Stakeholders is also a challenge and the risk.
Having written all that, when I see the intended beneficiaries, my resolve regarding this task becomes stronger. The intended beneficiaries are not just poor, marginalized or far living people who lack access to healthcare. The beneficiaries are each and every citizen of Pakistan from top to bottom. When we see people mismanaged in city as well as in local areas, we know that the reason is not just access to care, but also the capability of the emergency physicians to deal with the sickness and emergency. We have no other way but to improve the care for our own future and for the future of our coming generations.
In the last part of this series about emergency care I will be talking about practical steps that we can take in order to improve the emergency care. The take is hard and struggle is long keeping in mind that we are a resource poor country with misguided priorities. But if we don’t do it, no one else will.
Awaiting your comments, I could be reached at askhan65@yahoo.com.