Much needs to be done for better emergency services in Pakistan

Karachi
For reliable round-the-clock services, it is essential for all healthcare centres to constantly keep improving on their emergency services, said Dr Junaid Razzak, professor of emergency medicine at the Johns Hopkins University USA, and pioneer of Pakistan’s first emergency medicine residency programme.
He was speaking at the fourth Annual Emergency Medicine Conference (AEMC) held at the Aga Khan University Hospital (AKUH), organised in collaboration with the JHU National Institute of Health and the Fogarty JHU-Pak International Collaborative Trauma and Injury Research Training Programme. The conference was organised with a focus on integrating clinical care and public health in emergency medicine.
“Pakistan needs 15,000–30,000 trained emergency physicians today. But with only two education programmes for the field in the country, we are able to produce only 6–10 emergency physicians annually,” Dr Razzak revealed.
He stressed on the need to fill in the massive vacuum through initiating more emergency services training programmes comprising of a shorter curricula.
Dr Adnan Hyder, professor of international health and director International Injury Research Unit Johns Hopkins Bloomberg School of Public Health, while addressing the conference, emphasised on the need to integrate public health approaches in accordance with the global paradigm shift in emergency medicine.
He urged medical practitioners to set up a national taskforce to develop an innovative road map to maximise the impact of emergency care in Pakistan. Perhaps the strongest indicator for the need to revamp emergency medicine system and move towards a holistic, integrated approach was the heat wave crisis which had hit Karachi this year in June, Dr Hyder added.
“The number of patients affected by the heat wave was unprecedented, and the current emergency care set-up was not adequately equipped to deal with a crisis of such intensity,” stated Dr Munawar Khursheed, assistant professor department of emergency medicine AKUH, during a panel discussion held to review experiences gained during the heat wave.
“On June 21, we triaged more than 300 patients whereas on subsequent days the hospital was filled up to 94 percent of its occupancy. Not a single bed was available in the ICU or the SICU,” he added.
The situation was not specific to AKUH but all emergency centres in the city were facing a similar situation, Dr Khursheed said. A session, featuring Dr Marcus Ong, visiting clinician scientist at the department of emergency medicine at General Hospital Singapore, focused on the scientist’s experience of developing emergency medical services in Singapore.

Physical violence and emergency care
The medical conference, had as its sub-theme, focused on violence against women and children in the society as well as their workplace, including the ethical values surrounding the issue.
“We have dealt with women in depressive stupors to those beaten beyond recognition. Even though the injuries are strikingly visible, the women deny being physically abused. They rarely admit to what had happened,” said Dr Khushro Shamim, an instructor at the AKUH Department of Emergency Medicine. He said that as a part of the healthcare system, the emergency department had a role in identifying, reporting and managing cases of violence against women. AKUH Department of Psychiatry Professor Dr Murad Moosa Khan, in a session on bioethics and emergency medicine stated that, “Work in emergency care systems posed unique ethical challenges which varied from dealing with patients who may or may not be in a position to give an informed consent to the need to maintain privacy and confidentiality.”
Invited as a guest speaker at the conference, director of the Islamabad-based Centre of Gender and Policy Studies Dr Yasmin Zaidi, stressed on the need to establish standardised indicators for conducting research on gender based violence.
She shared initiatives undertaken by the National Commission on the Status of Women to develop Pakistan-specific indicators on violence against women. Dr Asad I Mian, key organiser of the conference and AKUH associate professor and director of paediatric emergency medicine, gave an overview of the paediatric emergency medicine.
UK Salisbury District Hospital Dr Nick Brown, AKUH Syed Faisal Mahmood, AKUH Dr Shehla Zaidi, AKUH Dr Madiha Hashmi, Advocate Zia Ahmed Awan, JPMC Director Dr Seemi Jamali, lawyer and political activist Mohammad Jibran Nasir, AKUH Johannes Hans Theodorus Kedzierski, AKUH Dr Zafar Fatmi, Netherlands Medical Centre Dr Christien van der Linden, JHU School of Public Health Dr Amber Mehmood also spoke at the conference.