Today, I attended a workshop at my
university (just so we're on the same page, I'm in medical school in
Karachi, Pakistan) entitled “Pediatric Emergency Care in Developing
World: Setting Priorities” and boy, was I inspired alhamdulillah. I
ditched my day off from classes and went to uni to attend and it was
totally worth it. I hope to infect you with the can-do spirit and
excitement for the future I'm feeling right now through this article.
It was organized by the Aman Foundation and Childlife Foundation (the
former is an Ambulance service among other things and the latter a
child health organization) in collaboration with certain doctors at
the Aga Khan University (my institution), including the head of the
Emergency Department, Dr. Junaid Razzak (also involved with Aman) and
Paediatrician Dr. Naseeruddin Mahmood (also involved with Childlife)
among others. Dr. S.V. Mahadevan from Stanford University was also
present and was undoubtedly the star of the show (NOT because he's
from Stanford. But with faculty like him, one can see why Stanford is
among the premier institutions of higher learning in the US).
A little background on why I attended.
I love Emergency Medicine and hope to specialize in it one day.
Mainly because I don't have to do boring clinics, counsel patients
about their lifestyles (most of my patients would present with more
urgent problems such as with convulsions or strokes, so talking about
their inappropriately large consumption of Jack Daniels isn't the
best idea at the time). I don't like Paediatrics so I was there
mainly for the Emergency part.
Also, I attend these conferences to
remind my self of the 'bigger picture', i.e. the lofty goals I set
for myself at the start of medical school; the ideals I had. I would
serve people, improve the health status of our population, do
research etc. But in the myriad of textbooks and all-nighters in
university, one tends to forget these ideals. So these conferences
help keep my morale up and remind me as to why I am in pursuing the
noblest profession (I said noblest, not oldest OKAY?). Though it
really feels weird when you're all pumped up after these symposiums,
only to come home to study some obscure disease of the eye, something
you'll probably never see, especially if you don't plan to go into
eye. But I suppose our academia knows best, right?
Dr. Mahadevan talked about how his
travels across the globe have taught him some interesting things. In
Nepal, till 2009 there were no ambulances. Being a Sherpa nation,
patients in need of urgent care were carted to hospitals on the
Sherpa's backs. In Cambodia, the Khmer Rouge systematically killed
all the intellectuals (doctors included) a few decades ago so the
country went from a nation with a fairly well-developed medical
system to one in the dark ages within a few months. The Cambodians
had to start from scratch. Indeed the situation was so deplorable,
doctors didn't even know how to use a stethoscope to hear the chest.
Stanford helped train these doctors to recognize medical emergencies
via video aids etc. But his crowning achievement (and possibly
failure) is probably India. He helped train paramedics to
international levels here via innovations like computer games (you
are presented with a patient and given options, You choose a wrong
option and your patient's health plummets. Do the opposite and it
goes up). He trained these paramedics to be able to become
instructors themselves. Sadly, after training, many of these
paramedics left the country for greener pastures like Dubai defeating
the purpose of the training (to boost India's Emergency Medical
Services). But that didn't make him lose hope. The lesson he learnt
was that he should place such teaching tools in place (e.g. video
aids etc) that many people can use with minimum facilitation so as to
mass-produce high quality paramedics.
Another thing I noticed about his
program was that it catered to local needs, sensitivities etc.
Instead of copy pasting diagrams from textbooks. They made new
pictures where any humans were ethnically Indian and wrote textbooks
that weren't wordy and hence easy for the paramedics' levels. This
impressed me and got me thinking about how differently the West does
things differently from us. We copy the West. They create. We think
its sufficient to build a 4-walled clinic, staff it with a doctor and
nurse and the country is saved. On the other hand, the West is
professional; they research the area's needs and create programs
tailor-made to suit these needs. Then they monitor the program
they've set in place and change what's not working. The major problem
is that we lack specialists. We don't have pediatric emergency
medicine specialists among a million other things. The ones we have
have crossed the Atlantic. In reference to my earlier example, we
think a 4 walled structure can be a clinic. Slightly larger and it's
a hospital. However, an architect specializing in hospitals would
know the nuances of such a structure and would build it appropriately
and efficiently.
Dr. Mahadevan then talked about how
even his training at Stanford couldn't prepare him for somethings
that he faced in India. In the States, a woman is usually in Hospital
well before she is at the brink of giving birth. In India, they call
the ambulance when the baby is tunneling it's way out of the uterus.
So in the US, paramedics virtually never have to deliver babies. In
India, 1/3rd of ambulance calls are births. In addition to this,
snakebites and organophosphate poisoning is something he never comes
across. Again, these are commonplace in India. This got me worrying.
My life plan is to graduate from AKU, inshaAllah go abroad to
specialize (since the training abroad is superior to ours) and come
back to serve my people. Go ahead cynics, mock me. See if I save your
sorry rear ends when you present to my ER with suicidal depression.
Anyhoo, since I saw that my training abroad would not completely
prepare me for the nature of medical emergencies I'd face in my
country, I am beginning to debate whether going abroad is the best
thing for my country. I talked to a Doctor who went abroad and came
back and is now running a system of clinics in Karachi. He said that
the main reason I should go abroad is to observe the systems in place
in the west and to bring them back here. Any differences in your
medical training will be made up when you come back inshaAllah. He
cited his own example of how tuberculosis is an unknown entity in the
west. So he didn't know how to treat it when he moved back. Over
here, the disease is so common sadly, every general practitioner
knows how to treat it. But he learnt when he came here and now he
faces no problems. His experience in the States has helped him set up
his chain of clinics. Another option for me is do my residency here
and fellowship abroad. I suppose I should discuss this matter some
more with doctors who have gone abroad and come back. And do
istikhara of course.
