Coups and Contrecoups

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

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Source: Federation Internationale de l'Automobile

Back while I was doing my house job, what most people would call a clinical internship, I worked for six months in the surgical ward of a government hospital in Lahore. Working in the surgical emergency meant witnessing, receiving, and managing patients with surgical injuries, ranging from minor wounds, to firearm injuries (FAI) and road traffic accidents (RTAs) besides other conditions requiring a clinical diagnosis. Indeed studies indicate that most of the cases presented in the emergency department are due to RTAs (Khalid et al., 2015).

Some of the worst cases I remember seeing were RTAs. Most of these patients ended up in neurosurgery as a consequence of head trauma. If one were to take a tour of the neurosurgery ward and go through case files or talk to the attendants, one would discover that most of the cases have a history of RTA. If you were on call and were awakened during the night by women crying, you would speculate that it is probably a life lost on the neurosurgery floor. Patients often stayed in the ward for long periods with an uncertain prognosis.

With urbanization of an exploding population and motorization, the world has also witnessed an increase in RTAs (Atubi, 2012). In Pakistan, the number of motor vehicles on the roads is high and the implementation of traffic rules is low. Road safety is not a prevalent concept and in some places it appears to be completely non-existent. Road injuries rank 9th among the top Disability Adjusted Life Years (DALYs) per 100,000 in Pakistan. Since men are the primary bread-winners, the proportion of male to female casualties is disproportionate; more males suffer disability and death than females (Abdul & Tehreem, 2012). Therefore disability, hospital bills, death and funeral expenses often leave families in bankruptcy.

The situation of road traffic injuries is not very hopeful worldwide either. According to WHO 1.25 million people lose their lives as a result of road injuries and most of these casualties are in low and middle-income countries. Sufficient to say that road traffic injuries are a rather neglected area of global health. Recently there have been efforts to rectify this oversight as RTAs have now been identified as a major cause of death and disability besides communicable and non-communicable diseases. The Sustainable Development Goals (SDGs) presented in September 2015 show an advance towards recognition of the dilemma of RTAs and aims to decrease the number of deaths by 2020 (Cossio et al., 2015). Steps will hopefully be taken towards creating policies that make roads and vehicles safer for people across the world. One can hope that these policies will ultimately rub off in low and middle-income countries where the most lives are lost due to RTAs.

References:

Abdul, M. K., & Tehreem, A. (2012). Causes of Road Accidents in Pakistan. J. Asian Dev. Stud, 1(1), 22–29. Retrieved from ISSN 2304-375X

Atubi, A. (2012). Determinants of Road Traffic Accident Occurrences in Lagos State : Some Lessons for Nigeria. International Journal of Humanities and Social Science, 2(6), 252–259

Cossio, M. L. T., Giesen, L. F., Araya, G., Pérez-Cotapos, M. L. S., VERGARA, R. L., Manca, M., … Héritier, F. (2015). Global Status Report on Road Safety 2015. World Health Organization (Vol. XXXIII). doi:10.1007/s13398-014-0173-7.2

Khalid, S., Bhatti, A. A., & Burhanulhuq. (2015). Audit of surgical emergency at Lahore General Hospital. Journal of Ayub Medical College, Abbottabad : JAMC, 27(1), 74–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26182742

The Cinderella of Health Issues in Pakistan

~Written by Sarah Khalid Khan (Contact: sk_scarab@yahoo.com)

Lahore Mental Hospital

Source: CNN.com Available at http://i2.cdn.turner.com/cnnnext/dam/assets/150812114127-01-cnnphotos-lahore-mental-hospital-restricted-super-169.jpg  

As a Global Health student with a background in medicine I find all health issues interesting. Especially interesting are the mental health issues because of their lack of somatic manifestation like other physical ailments. It is surprising to know that depression alone affects almost 350 million people worldwide (WHO 2015). Even though I have been related to the medical field for quite a while, I underestimated the state of mental health in Pakistan. The fact that I grew up with a family member who was under treatment for bipolar disorder for many years did not do much to change my opinion. I am also related to a few undiagnosed cases of clinical depression but I still did not consider mental health an issue. During my medical college, the clinical rotations in the psychiatric ward also failed to show me the true picture of the burden of mental disease partly due to its scarce patient numbers.

I realise my ignorance even after becoming a clinician reflects poorly on the level of awareness of this issue in the medical community and the general population. I would have continued to be ignorant had it not been for one particular day in the Outdoor Patient Department at Services Hospital Lahore with one of the heads of medicine.

As the last patient left, the professor looked around at all the junior doctors sitting around the table, picked up one of the physician samples and said that if it were up to him, he would make the drinking water of Lahore enriched with it. Surprised at what could possibly plague our part of the world and cure it according to him, we looked at the sample. It was an anxiolytic. An anxiolytic is sometimes prescribed for people suffering from stress and often given to patients with depression (Pietrangelo 2013).

The fact that the number of mental disorders is increasing worldwide is not a secret. According to some sources, the number of people suffering from mental issues in Pakistan is estimated to be around 15 million (Anwar 2015). Most of these remain undiagnosed, often in the shadows of stigma and shame. Pakistan has many reasons to have escalating mental illness; political unrest, internal conflict, economic instability, rising poverty and crime rates, unemployment, natural disasters, the list goes on.

Unfortunately most of these cases are attributed (by the general public, doctors or both) to black magic and evil spirits (Gadit and Callanan 2006). Many such people end up at shrines and the doorsteps of spiritual healers. Some receive holy verses to recite while others get beaten, to scare away the evil spirit or “jinn” as it is called in this part of the world. While religion is good for many reasons, the fact that mental health involves underlying biochemical pathophysiology that could be treated with medical intervention needs to be addressed urgently.

But what about the people who specialize in managing and treating such disorders? According to WHO there are less than 350 psychiatrists in Pakistan, only 0.2 per 100,000 (Jooma et al. 2009). The numbers are worse for pediatric psychiatrists. With only five psychiatric hospitals in the country, the state of psychiatric wards and mental institutions is appalling (Anwar 2015).

Although psychiatry might be an area of increasing interest in medicine in Pakistan, the availability of opportunities that provide better compensation and benefits abroad cause many of these doctors to leave the country to work in “greener” pastures (Imran et al. 2011). With the prevailing conditions for doctors in general, Pakistan might even become an exporter of psychiatrists, which will only worsen the situation within the country.

The time to deal with the multi-headed monster of mental health in Pakistan is now. Raising awareness about mental issues is primary but the need to remove the stigma associated with it is a bigger concern. The truth about fraudulent spiritual healers also needs to be addressed vehemently. The number of psychiatric wards needs to be increased. Finally, the medical workforce needs to be given better incentives to stay within the country.

References:

Anwar, Komal. “Mental Health Care: Mind Matters.” The Express Tribune. Web. 26 Oct. 2015.

Gadit, Amin A Muhammad, and T S Callanan. “Opinion and Debate Jinni Possession : A Clinical Enigma in Mental Health.” Journal of Pakistan Medical Association 56.10 (2006): 476–478. Print.

Imran, Nazish et al. “Brain Drain: Post Graduation Migration Intentions and the Influencing Factors among Medical Graduates from Lahore, Pakistan.” BMC Research Notes 4.1 (2011): 417. Web.

Jooma, Rashid, Fareed Aslam Minhas, and Shekhar Saxena. WHO-AIMS Report On Mental Health System In Pakistan. N.p., 2009. Print.

Pietrangelo, Ann. “Anxiolytics | Definition and Patient Education.” Healthline. N.p., n.d. (2013) Web. 26 Oct. 2015.

“WHO | Depression.” Fact sheet N°369. World Health Organization, n.d. Web. 26 Oct. 2015.