APPNA, NCHD et al. Review
Post-Disaster Health Care Systems
A view of the conference
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Rawalpindi, Pakistan: The Association
of Pakistan Physicians of North America (APPNA), in collaboration
with the Rawalpindi Medical College, the National Commission
for Human Development (NCHD), and the Aga Khan University
took an important step in defining the long-term strategy
of disaster management in Pakistan. The premier association
of doctors held a two-day conference in Rawalpindi on December
22-23 to deliberate on the important subject.
While APPNA members and people of Pakistani continue to work
and focus on the immediate and intermediate needs of the October
8 earthquake disaster, it is critical to look at the strength
and weaknesses of the current health care system response
toward a disaster of this nature and magnititude. Dr. Saud
Anwar, cair of the Scientific Committee of the conference,
described the concourse as the first organized step towards
enhancing the current health care system to be better equipped
for the later phases of the current challenge and future disasters.
The conference title was “Post Disaster Health Care
Systems in Pakistan: A National And International Challenge.”
The conference attracted a wide variety of experts with experience
and knowledge of disaster preparedness and building of health
care systems. The various organizations, institutions, disaster
groups, and stakeholders represented in the conference along
with APPNA included representatives of the Government of Pakistan,
Rawalpindi Medical College, National Commission for Human
Development, Aga Khan University, Higher Education Commission,
Pakistan Society of Emergency Medicine, Pakistan Medical and
Dental Council, Pakistan Medical Association, Pakistan Islamic
Medical Association, Ayub Medical College, Punjab Emergency
and Ambulance Services, Rescue 1122, and the Pakistan Army
to name just a few.
Besides there were a good number of foreign participants affiliated
with prestigious institutions like the Johns Hopkins University,
Harvard Medical School, USAID, Save the Children, Rush University
Medical Center, University of Connecticut, Arizona Department
of Health Services, American College of Surgeons, WHO Collaborating
Centre, Center for Public Health Preparedness and Disaster
Response, American Medical Association, Ephesus Emergency
Medicine Training and Research Center Izmir, Turkey.
The conference discussed four broad topics, namely:
a) Focus and plans for rebuilding acute health care system
post disaster (including an effective and efficient national
emergency medical system)
b) Developing health care personnel proficient in disaster
management (including improved education of nurses, emergency
medical technicians, and doctors to have improved knowledge
and preparedness of disaster management along with making
emergency and disaster management as a separate training faculty
and specialty in Pakistan)
c) Increasing knowledge and understanding of psychiatric and
rehabilitative dimensions of disaster along with the health
care of internally displaced people and women and children
issues resulting from disasters.
d) Enhancing the existing district development system including
a need based health care system for providing disaster support.
The conference included main sessions and presentations by
various experts followed by four strategic planning sessions
(as mentioned above). The expert spent time in discussing
ways of inducting changes to enhance the current systems.
Dr. James James, Director of American Medical Association
Center for Public Health Preparedness and Disaster Response,
mentioned how impressed he was with the level of organization
and commitment of the organizers. He commented on the excellent
quality of presentations and focus of different presenters.
Dr. James Fowler, who has extensive experience in setting
up disaster management systems in Turkey, evaluated plans
for higher education in Emergency Medicine with Dr. Junaid
Razzak of the Aga Khan University and mentioned that the current
planned curriculum for Emergency Medicine residency appears
better than the one in Turkey. He however mentioned that the
success of the disaster and health care systems depended on
the commitment of the government and its ability to collaborate
and communicate with the civil society and concerned institutes.
Dr. Mussadik, Principal of RMC, mentioned that it was time
to change the curriculum of the medical schools to start focusing
on disaster-related education and training. Dr. Rashid Joom,
representing the PMDC, joined in the stimulating deliberations
wholeheartedly.
Dr. Stephanie Rosborough from Harvard Medical School and Harvard
Humanitarian Initiative agreed with the proposals and suggestions
and added that strengthened primary health care systems act
as a very important buffer to help sustain any disaster management.
She spoke on the health care issues of the internally displaced
populations.
The disaster conference will lead to set of general and specific
recommendations which will serve as guidelines for a future
disaster plan. The conference will serve as a guide for the
stakeholders to work with, and to be better prepared to deal
with disaster.
Dr. Saud Anwar summarized the discussion and views of the
conference participants which emphasized the principles of
commitment, communication, collaboration, coordination, continued
planning and capacity building. He stated that this initiative
should mark the beginning of an era of preventive approach
and safety and preparedness culture. Need for a multi-prong,
top-down and bottom-up approach was stressed with focus on
hazard risk and hazard mapping plans along with improvement
in the pre-hospital level of care with specific focus on a
volunteer based national movement, and strengthening of the
primary health care model as a backbone followed by a nationwide
trained and appropriately equipped EMS services. The two models
of EMS services were discussed with focus on each model’s
strength and weaknesses.
An increase in both horizontal and vertical growth of the
system was stressed. Dr. Anwar further stated the need to
strengthen the hospital emergency level of care, with a focus
on re-evaluating medical and nursing education. An important
and critical need for paramedic and EMT (emergency medical
technicians) was stressed. Special focus on the vulnerable
populations, internally displaced people, and understanding
and appropriate implementation for the psychiatric and rehabilitative
dimensions of disaster were also reviewed. A group discussion
was held between multiple groups currently involved in the
physical and mental rehabilitative activities following the
current disaster.
The recommendations and the disaster conference declaration
were read by APPNA's President-elect, Dr. Abdul Piracha on
behalf of Dr. Hussain Malik. Dr. Raza Bokhari, the conference
chair thanked all the collaborators and participants and especially
Dr. Muhammed Umar, Professor of Medicine at RMC and Dr. Saud
Anwar for their role in organizing the conference.
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