Preparing for future health catastrophes

Issues which if addressed timely, would give birth to a prepared and strengthened healthcare system in our country

As the Covid-19 cry grows fainter and fainter to much of our relief, let’s start addressing issues which would enable our health sector to tackle future health crises in a prepared and disciplined manner. Earlier this month, the 54th convocation of the College of Physicians and Surgeons Pakistan (CPSP) was held in Lahore. When doctors, professors, health officials and political personalities come together under one roof, new opportunities and policies are made which benefit the health structure far and wide.

Some important health issues were highlighted by CPSP regional (Islamabad) head, Dr Shoaib Shafi, three of which I have talked about below which if addressed timely would give birth to a prepared and strengthened healthcare system in our country.

First, there are only 7,685 postgraduate trainees currently working in public hospitals of Punjab. The doctor to patient ratio is markedly disproportionate and is the root cause of our troubled healthcare. Less number of doctors means more work and more burn-out which leads to neglect in treatment which overtime has given rise to growing public intolerance towards doctors. This results in formulation of unwise health policies which are against the interest of health professionals leaving doctors with two options: (1) work abroad (2) dream of working abroad.

Dr Shafi shook the hall with a staggering revelation that more than 14,000 postgraduate training slots are empty while doctors eligible for these seats (those who have passed FCPS part 1 examination) remain at home unemployed. Why are training slots empty? Why is the workforce not being reinforced? Why is this even a question? We are on a suicide mission. This dearth of doctors will once again exhaust our hospitals when we come face to face with future pandemics.

Second, our hospitals do not need fancy entrances and administration blocks at the moment. Instead, focusing on uplifting emergency medicine can put us on the road to revolutionise our health sector. A strong national emergency medicine setup is the first and most effective line of defence in any health catastrophe such as Covid19. Unfortunately, only 13 institutes across Pakistan have an emergency medicine department.

Third, critical care medicine in Pakistan is critically ill itself. There are only 20 institutes in the whole of Pakistan and only 5 in Punjab which have a recognised critical care unit, all in Lahore and most of them without supervisors. Now, let me take you on a virtual round of an average critical care unit or an intensive care unit (ICU) of Pakistan. On an average, one in every ten patients visiting the emergency department needs to be taken care of in an ICU. A hospital’s most critical patients can be found in ICUs battling between life and death and the state of these limited facilities is a tale of endless sorrow and grief.

Intensivists or critical care specialists are the physicians taking care of the critically ill in ICUs. These come from a pool of anesthesiologists, pulmonologists and specialists in internal medicine. Trained intensivists in our country can be counted on fingers and are almost like a figment of imagination.

A single black cloud hangs over our critical care medicine in the form of unqualified nursing staff and insufficient beds in ICUs because of which every day we have to refuse multiple patients ICU care.

Our to-do list has two urgent tasks: (1) increasing the number of postgraduate seats so that a good pool of healthcare professionals is available in the hour of need (2) uplifting emergency medicine and critical care medicine in Pakistan. The ball is now in the health ministry’s court.