Lessons from a Symposium

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.