Wednesday December 06, 2023

Critical tasks

March 25, 2020

Last year, I was invited to attend the First Military Health Security Summit held in Sydney, Australia. It was jointly organized by the US and Australian armies and focused on the role the military has to play in case of a massive outbreak in any country in the Asia Pacific region.

During the course of the summit, we did some infectious disease modelling to figure out that, if there is an epidemic in the Asia Pacific region, how it would spread in terms of geographies, and the different best- and worst-case scenarios associated with it.

We discussed how health systems can differentiate between a natural epidemic and biological warfare. There were detailed deliberations on how health systems should respond, when would be the right time for militaries to move in and join hands with the civilian governments, and what that cooperation would look like.

Having worked in Pakistan’s health systems from Sajawal to Khyber Pass and from Ghotki to Rawalpindi, I believe that the government already delayed the deployment of the army. At this point, it is imperative to assign the army four critically strategic tasks to get ahead of this race against time.

The frontline soldiers in this fight are public health trained nurses, epidemiologists and environmental health officers. However, thanks to our colonial system of governance, we don’t have these cadres and we are left with the sole institution that can be relied upon in such a situation: the Pakistan Army.

The PAS-led bureaucracy and physician-dominated health system has effectively destroyed systems to such an extent that the common man will have to pay the price unless the army takes charge of four critical factors in this Covid-19 equation.

The first of these factors is the most critical part of disease surveillance and response that Pakistan’s health system missed: contact tracing. When the first coronavirus-positive case emerged in the health region in Canada where I work, we deployed a military intelligence styled tracing of contacts. Carried out by a well-trained cadre of public health trained nurses and environmental health officers, this is yielding results. How many public health trained nurses in Pakistan are there? Practically none.

It is imperative now that the government assigns the contact-tracing part to a military-led joint tracking team. This is the single most effective measure that needs to be taken. The right approach would be to reach out to every identified case and ask for any possible contacts even if it entails geofencing of the suspected contacts. Do this one thing right and you have already won half of the war.

Second, I cannot overemphasize the fact that we need to protect our frontline healthcare staff, particularly nurses, on a war footing. If they fall, we fall. Next, it is imperative to get some C130s in the air and make sure that we have an adequate supply of personal protective equipment (PPE) specially the N95 respirator masks. Data so far supports supplying N95 masks to frontline health workers. By giving them only surgical masks, we are sending them in harm’s way.

Third, it is imperative to immediately train at least 500 troops on infection control measures including the PPE and disinfecting the health care environments. Once they are trained, batches need to be dispatched to the priority districts and train every possible nurse, doctor and paramedic. Staff need to be trained in the required infection control measures. It sends shivers down my spine even thinking that 70 percent of the health sector is private in Pakistan, and we have dysfunctional healthcare commissions in all our provinces.

Lastly, these steps have to be augmented by setting up field hospitals in every district with at least five cases of Covid-19.

This is the time to overreact because we have already lost the strategic edge in this war against time. Once this is over the PM can take out his surgical knives and fire a whole group because many of us have been warning about this situation for at least a decade now.

The writer is a senior policy analyst with the public health department of the Fraser Health Authority, Canada.