“I always wanted to do something for those whose needs are overlooked,” said Dr Naseerudin Mahmood, MBBS ’88, as he recalled a documentary that changed the course of his life.
The feature film by CNN’s Dr Sanjay Gupta depicted an alarming state of affairs in one of Karachi’s major public sector hospitals: there were too few beds for too many patients and the children’s emergency room was in disrepair.
“A crowd of children and their parents were inside the ER but there were few doctors and an acute shortage of medicines. There was garbage and stray cats near the beds and the state of the roof was so bad that I feared it could come crashing down at any moment,” he added.
For Dr Mahmood the footage was yet another sobering reminder of the need for quality paediatric emergency care in Pakistan’s public hospitals which cater to the majority of the country’s population.
With a couple of like-minded individuals, Dr Mahmood, a practicing paediatrician, set up the
ChildLife Foundation, a philanthropic enterprise committed to expanding access to quality, affordable healthcare for children. Dr Mahmood and his team’s first project was the renovation of the Civil Hospital, Karachi, (CHK) in partnership with the Sindh government. Together, they overhauled CHK’s paediatric ward in 13 months by introducing modern emergency care systems and processes, with a focus on staff training and the application of new management practices.
In this interview, Dr Mahmood talks about his commitment to revamping public health initiatives for children and opens up about the challenges he has faced to date.
Q. Why is ChildLife Foundation focused on paediatric care?
According to a
UNICEF study, Pakistan is the riskiest country to be born in. For every 1,000 babies born in Pakistan in 2016, 46 died before the end of their first month – an alarming 1 in 22.
Many children suffer from infectious diseases such as diarrhea and pneumonia that can be easily prevented if a diagnosis is made in time. Since most of these children are from disadvantaged backgrounds, there is a great need for establishing emergency paediatric care for these low-income groups.
ChildLife Foundation is committed to adapting and applying international healthcare protocols and standards in the public sector emergency rooms where you will find the sickest and poorest children of Pakistan. To do this, ChildLife is partnering with the Sindh government.
To date, we have established and are managing five ERs in Karachi and one each in Nawabshah and Larkana. Two more ERs are planned for Hyderabad and Sukkur. ChildLife has also partnered SINA Health Trust, a premier primary care not-for-profit organisation in Pakistan, to reach out to underprivileged communities.
Today, there is a network of 30 high quality primary care clinics in the slums of Karachi. In fact, many AKU medical students spend some of their primary healthcare rotation in them.
Q. What were some of the challenges you faced while revamping these ERs?
First of all, my colleagues discouraged me from working with the public sector. However, I knew that impact required resources and scale which only the government could provide. That’s why we collaborated with them under a public-private partnership.
Another challenge was the lack of trained human resource to meet the needs of Pakistan’s sizeable population. So we provided specific training programmes to the existing staff and today, all ERs supported by ChildLife Foundation have Basic Life Support (BLS) and Paediatric Advanced Life Support (PALS) certified physicians and nurses.
Our qualified pharmacists are also picking up at least one prescribing error every hour. As a result, the survival rate in the resuscitation rooms of our seven ERs has now gone up to 90 per cent.
Q. How are you ensuring the long-term sustainability of ChildLife Foundation’s initiatives?
The project will become truly long-lasting if it is sustained through the public sector. For instance, four of the emergency rooms that the Foundation has helped establish are now part of the Sindh government’s health budget, a milestone for us.
The availability of trained specialists in paediatric emergency care is another way to ensure that processes run smoothly in the long run. This is why the Foundation has invested in capacity-building and developed a diploma programme in paediatric emergency medicine in collaboration with the Dow University of Health Sciences which we are hopeful will be approved.
We have also set up a paediatric emergency medicine certificate course that has trained 70 doctors so far while our paediatric emergency medicine nursing course has trained 64 nurses. Both these programmes are through Dow.
Q. Any advice for those looking to partner with public sector hospitals?
It is vital to be patient, non-judgmental and sympathetic to the constraints of the public sector. If you focus on building trust, everything else follows. Transparency and credibility are essential.
Finally, remember that there will be challenges at every stage but you need to perceive these obstacles as opportunities to make a difference. The public sector holds the greatest potential to make an impact and it’s important to not lose sight of this.
Q. Do you think your training here at AKU had an impact on the work that you do?
My training and the time I spent working at AKU has been instrumental in shaping the course of my work. AKU is my alma mater. I have been a medical student here, an intern and am still a member of the faculty here.
I was extremely fortunate to have mentors who taught me the value of empathy and compassion in medicine. They taught me the importance of passing on my knowledge to those who need quality healthcare and the importance of ensuring that healthcare is within everyone’s reach.
Universities create impact through their alumni. I am just trying to pay my dues, both to AKU and Pakistan.