In June 2015 Karachi was hit by a blistering heat wave that triggered a healthcare emergency. The extreme temperatures caught Pakistani citizens and health sector officials by surprise resulting in hundreds of deaths attributed to heat stroke and heat exhaustion.
In the wake of this humanitarian crisis, public health experts from Aga Khan University, Johns Hopkins University, the World Health Organization and the Aman Foundation collaborated to assess how healthcare authorities around the world deal with extreme heat exposure (temperatures over 37°C).
Interesting facts emerged:
Pakistan is among the top ten countries worst-affected by weather hazards and is at long-term risk from extreme climate events. They also noted that there are no clear set of evidence-based public health interventions or clinical protocols available to tackle diseases caused by extreme heat (EH). In other words, there were no guidelines for hospitals or local authorities to tackle the public health threat posed by heat waves.
Health awareness and evidence-based strategies represent a vital step in tackling EH illnesses caused by heat waves, said Dr Nadeem Ullah Khan, associate professor in emergency medicine at AKU.
Inadequate awareness about early signs of EH conditions in 2015 prevented people from implementing simple, yet effective preventive measures against heat exposure at home. As this influx of patients with advanced symptoms arrived at hospitals, already overwhelmed ER doctors lacked a precise protocol to treat these illnesses. Dr Khan adds that EH diseases need special attention as besides being life-threatening themselves, they can also increase the danger posed by cardiopulmonary (heart and lung) and cerebrovascular diseases like stroke, which are common in South Asian countries.
In light of these challenges, researchers from the four organisations jointly developed HEAT (Heat Awareness and Treatment): a research study designed to generate knowledge through two interventions:
1. A community-based programme among 16,000 people living in a low-income locality in Korangi, in eastern Karachi.
2. A clinical intervention in major hospitals in Karachi.
In HEAT’s community-based arm of the project, researchers will use Aman Foundation’s operations and infrastructure in Korangi to disseminate EH education messages through community leaders, bulk text messages, telehealth systems and special information sessions in schools and mosques. They will monitor the public’s recall of measures to counter EH diseases and will also evaluate the effectiveness of these campaigns by tracking data on hospital admissions and deaths. The most effective measures will then be implemented in the same community through a pilot project ahead of the next summer in 2018.
In the hospital-based component of the project, researchers will build capacity among emergency department physicians on the management of heat emergencies. Trainings will revolve around issues such as emergency department preparedness as well as key skills such as rapid cooling, triage and resuscitation. Eventually, evidence from the emergency room will be used to develop a focused guideline to improve the treatment of EH illnesses. Once protocols are prepared, further training sessions will be held in four major hospitals in the city.
“Our intervention aims to tackle heat exposure at the earliest stages through a range of preventive measures. Lower hospital admissions mean that doctors trained under HEAT can focus on treating the most severe cases of heat exposure,” Dr Khan added.
Goal 13 of the Sustainable Development Goals places special emphasis on preparedness for climate-related disasters. HEAT’s objectives will inform efforts under target 13.1 which specifically requires countries to strengthen their resilience and adaptive capacity to climate-related hazards and natural disasters.
In the long-term, Dr Khan believes that findings from the study can be used to strengthen public health systems in other cities in the developing world and contribute towards developing a global response to weather emergencies caused by climate change.
HEAT’s principal investigator (PI) is Dr Junnaid Razzak, Professor of Emergency Medicine at Johns Hopkins University. Dr Nadeem Ullah Khan, Dr Uzma Rahim Khan and Dr Shahan Waheed from AKU’s Department of Emergency Medicine are co-PIs on the project.