Towards a cure for traumatic paraplegia - Is there cause for hope?

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in clinics round the world to desperate patients. The internet by allowing the dissemination of non-peer reviewed information of experimental interventions catalyses this process. Physicians must be informed of developments in this area to offer appropriate advice and counsel to their patients

Cost-effective practice of neurology: an idea whose time has come

Pakistanis spent $7.2 billion on healthcare in 2013 (3.1$ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP

Surveillance in the service of safety

The World Report on Road Traffic Injury Prevention of 2004 recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify highrisk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This presentation shares the results of an urban RTI surveillance program that has been running for the past 8 years since 2007 in the emergency departments of five major hospitals in Karachi, Pakistan. We describe the process of establishing the road injury surveillance system incorporating a multi-institution research group including physicians and transportation engineers. Data was collected from 5 city-wide hospitals with details of the injury, severity scoring and information of the circumstances of the crash. Site visits supplemented this data and the results were disseminated to municipal authorities along with low cost engineering solutions to rectify hazards in the road network. In the 8 years between 2007 and 2014, 262,269 road injury victims were registered by the surveillance system. Though 76% of the injuries were categorized as “minor”, 20% led to hospital admission and in 3% deaths occurred. The information on location of crashes and site visits led to an extensive catalogue of road network hazards and their rectification led to demonstrated reductions in crash frequency. Data was also used for safety advocacy in groups found to be vulnerable in the surveillance, such as motorcyclists, road sweepers and school going pedestrians. We demonstrate that a functional RTI surveillance program can be established and effectively managed in a developing country. The data collected and analyzed from the victim’s perspective can be a potent tool for effecting safety education and hazard rectification

Polio travel restrictions: A sledgehammer to crack a nut?

Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country\u27s image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. Vaccinating all air travelers is unnecessarily punitive besides being probably ineffectual in halting exportation. The unrelenting focus on polio eradication may have negative impact on fragile health systems besides arousing suspicions of religious elements opposed to vaccination. Routine vaccination and polio campaigns as part of community development measures such as provision of clean drinking water and elimination of surface sewage drainage would be more accepted. The government would be well advised to assume control of the polio eradication program and make it a national development issue

Political determinants of health: Lessons for Pakistan

There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world\u27s nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental right and the recently adopted 18th constitutional amendment missed the opportunity to extend access to primary health care as an obligation of the State. It is argued in this communication that missing from the calculations of policy formulation and agenda setting is the political benefits of providing health and other social services to underserved populations. Across the developing world, many examples are presented of governments undertaking progressive health reforms that bring services where none existed and subsequently reaping electoral benefit. The political determinant of healthcare will be realized when the political leaders of poorly performing countries can be convinced that embracing distributive policies and successfully bringing healthcare to the poor can be major factors in their re-elections

Designing the first ever health insurance for the poor in Pakistan - A pilot project

Several developing countries lack a medical insurance system with universal coverage, so access to medical services is not easy, principally for people living in poverty. One of the biggest issues for designing healthcare systems in developing countries is how to include those not formally employed. Therefore, it is important to implement targeted interventions so that the most in need are not left out. The World Health Report 2000 distinguishes four functions for the health system to fulfill: (i) the provision of health services; (ii) the creation of the necessary investment and training resources for health; (iii) health financing; and (iv) government stewardship. The need for Health insurance in the developing world is again relevant because there is no compulsory health insurance in Pakistan. This special communication is a discussion of how we in Pakistan have proposed a design for the first ever indigenous health insurance system for the poor. What various other developing countries have done and the policies adopted to provide health coverage to their people have also been reviewed

Why we must provide better support for Pakistan\u27s female frontline health workers

Svea Closser and Rashid Jooma argue that achieving polio eradication and strengthening Pakistan\u27s health system must focus not just on international engagement but also on local partnerships with Lady Health Workers and other ground-level staff. Please see later in the article for the Editors\u27 Summary