Dr.
Philomena Drago-Johnson:
Utilising
Minimum Facilities to Maximum Advantage
| Dr. Philomena Drago-Johnson was one of the first
surgical residents to graduate from AKU in 1990, and is
also presently an Honorary Lecturer in Surgery at the
University. Since 1995, she has been the Medical Superintendent
at Kunri Christian Hospital (KCH) in the interior of Sindh,
Pakistan. Dr. Drago-Johnson has faced many challenges
while working in a rural setting over the past five years,
as well as opportunities to initiate change in an area
steeped in folklore and misconceptions about health issues.
She believes that close interaction with the local community
to inculcate awareness through education, especially to
empower women, is the way forward. |
Dr.
Philomena Drago-Johnson with patients.
|
Could you describe some of the challenges you face in a typical
working day.
Misinformation and blatant malpractice stimulated
by economic motivations is the main blockage to health care
in this area, and can be very frustrating. A common problem I often face is treating
a patient with peritonitis, who has already been treated in
another clinic with drips and expensive medicines, and when
he is moribund, he is referred to us. We then struggle to save
the patient's life. Usually, the cause is a perforated appendix
or typhoid perforation, which is curable if caught in time.
Instead, patients end up with two to three litres of pus in
the abdomen, have to undergo multiple procedures and we end
up paying a large portion of the medical bill because they usually
have no money. The original culprit is usually some "kind" of
doctor who was trying to save the patient from an operation!
How do
you feel your work has impacted the health care delivery systems
in the local community?
I feel the biggest impact I have made is with the
community of local doctors. Initially, the air was filled
with confrontational thinking. As we collaborated on common
problems, some of us saw the power and value of working together
to address certain issues, such as the high maternal mortality
in the region. My colleagues began to realise that we don't
need to compete. If we work together, we can complement each
others' strengths, thereby providing better services to our
patients.
As for impacting the community, I feel
that I have not even begun to scratch the surface of centuries
old problems and general lack of awareness about health issues.
It is frustrating to try and convince people they need a certain
treatment or operation, when their local healer has said something
to the contrary.
Why did
you decide to pursue a career in medicine and specialise in
surgery?
Medicine is in my genes. My father was a doctor
and my earliest memories are of watching him in his clinic
and longing for the day when I would help people the way he
did. I don't know where the interest in Surgery developed
as my father was a general practitioner. But at a very early
age, I wanted a "quick cure" and surgery seemed to be the
quickest way to alleviate a lot of problems.
Why did
you decide to take up your current assignment, as opposed
to working elsewhere in less difficult conditions?
Blame it on my husband! He persuaded me to work
at Kunri Christian Hospital. I have grown to enjoy the challenge
of utilising minimum facilities to maximum advantage. ~Difficult
conditions" are relative. Health care in any situation has
its problems. I merely exchanged one set of problems for another!Another
common occurrence which makes me extremely angry is when a
woman comes to us with a ruptured uterus after a dai (traditional
birth attendant) has been trying for days to deliver a huge
baby through a tiny pelvis, with the help of oxytocin injections.
Again, such cases are only sent to us when the baby is long
dead, and the woman is close to dying herself. We have no
option but to operate immediately. This only reinforces this
hospital's reputation as being a place "where they operate
as soon as you enter the door."
Is it
difficult to balance both a family life and a demanding career?
The support of my husband has been crucial in allowing
me to pursue an exacting career while enjoying a family life.
We have a shared parenting system. He looks after our two
young children when I am called on emergencies, listens patiently
as I vent daily frustrations and then cheers me up with good
practical advice and a cup of tea! I could not, manage without
the two wonderful local, tribal women who look after my house
and children during the day.
What
are your short and long term priorities and challenges?
In one word: Education. Short term, I am trying
to set up a School
of Midwifery at KCH. This will enable the young women of this
area who want to acquire some training, but whose families
are unwilling to send them to the nearest large city, Hyderabad,
to do so in their own area. These women will then provide
good ante natal care and early detection of pregnancy related
problems in their villages, thereby decreasing the high level
of obstetric trauma we currently see. Long term, I would like
to train Family Health Physicians and GPs in surgical practices
essential in a rural setting. I have trained several Family
Physicians for the Aga Khan Health Service, Pakistan. It is
very satisfying to hear the good work they are doing in the
Northern Areas of Pakistan. I also hope that there will be
a closer liaison between KCH and AKU. We can provide a working
environment where the doctor must rely on his/her clinical
judgement and skills, as there are limited diagnostic facilities
available. AKU doctors, in turn, keep us up-to-date and bring
a fresh point of view.
What
role can women play in health care development in rural areas?
Awareness through education is the key here. Women
have power when it comes to pinpointing health needs, as they
are the main health care providers in rural areas. Unfortunately,
their biases and folklore complicates health issues, and nothing
can really happen without the men's help and themother-in-law's
permission! We at KCH are trying to redress this imbalance
in our community health work, and by using CHOs under the
Mother and Child Welfare Association to set up Mother and
Child Health Centres. This strategy is ongoing and has been
operational for two years. But it is when women have some
education that they will be able to stand up for themselves
and their children and improve their health. Women health
workers are currently doing a wonderful job of bringing health
education to rural women's doorsteps.
How do
you feel your training at AKU's Postgraduate Medical Education
Programme has helped you in your work?
AKU's prestigious name often helps span the "credibility"
gap a female doctor faces with the public. I can stand up
in a meeting and defend myself because my broad-based training
at AKU has given me the confidence to speak out. However,
a lot of "high tech" medical practices I learnt at AKU often
have little relevance to the type of care patients can realistically
receive in a rural setting. I have therefore had to adapt
my approach to diagnose and treat patients. But none of my
postgraduate training is wasted. I can advise patients better
because I have the necessary expertise.
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