Ejaz, Kiran

Siddiqui, Emaduddin

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eCommons@AKUDepartment of Emergency Medicine Medical College, PakistanSeptember 2013Strengthening paediatric emergency medicine inPakistan is our need to reach millenniumdevelopment goal 4.Emaduddin SiddiquiAga Khan University, emaduddin.siddiqui@aku.eduKiran EjazAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_emerg_medPart of the Emergency Medicine Commons, and the Pediatrics CommonsRecommended CitationSiddiqui, E., Ejaz, K. (2013). Strengthening paediatric emergency medicine in Pakistan is our need to reach millennium developmentgoal 4.. journal of Pakistan Medical Association, 62(9), 870-871.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_emerg_med/68870 J Pak Med AssocBy year 2015 United Nation targets to achieve theMillennium Development Goal (MGD) 4, of reducingmorbidity and mortality in children. Achievement of thisgoal especially in the low income countries (LIC) requiressubstantial strengthening of the health care system.1Paediatric Emergency Medicine (PEM) needs growth inmany aspects in our country. PEM in LIC such as Pakistanis at its weakest edge.2In 1959, United Nation passed a declarationstrengthening the fundamental needs and rights of childrenas a separate entity.3 The basis of this declaration was that,the children are different from adults in their anatomy andphysiology, endocrine, psychological and behaviouralvariations. Their disease pattern, presentation andcomplications are all dissimilar from adults.4 Children atdifferent ages have diversified symptoms of the samedisease. Critically ill children have to wait in clinics and areadmitted to general wards, which wastes precious goldenhours of initial management.2 Consequences of these delaysresults in poor outcome. This often results in increasedchronic illnesses, disability and mortality. PEM physicians improve the quality care of ill orinjured children in a timely fashion.5 If our physiciansespecially those dealing with children in acute distress arebetter trained to handle such problems, many morbiditiescan be prevented. PEM physician not only works within thepremises of Emergency Department, but he acts as acounselor, advocator and social worker. Disease advocating,managing and dealing the critical Paediatric disease/injuriesremains the greatest challenges of future in the ultimate careof children even in the developed countries.6There are numerous training programmes for acutecare management of adult patients i.e. Basic Life Support,Advance Cardiac Life Support, Advance Trauma LifeSupport, Emergency Surgical Skills (Emergency Maternaland Child Health), Fundamentals of Critical care andEssential Burn Care and are designed for the early detectionand immediate emergency and critical care management foradults. In most emergency rooms of Pakistan, experiencedphysicians in acute care management of adult patients arealso managing Paediatric patients without formal training orexperience in PEM. Due to wide variation of uncontrolledemergent Paediatric situations specialized programmeshave been implemented and formulated for more concise,acute and accurate assessment and management. They areexclusively different from those practices in controlledsettings of general Paediatric ward based on the préciseguidelines of Paediatric Advance Life Support, AdvancePaediatric Life Support and Advance Trauma Life Support.7Thirty percent of all emergency department visitscomprise of Paediatric patients.8 To date we have beenmanaging this academic and administrative problemwithout any specific PEM training available in Pakistan.Condition of PEM is far behind a satisfactory benchmark inmajority of our hospitals. These problems can partially beexplained by massive lack of resources for health care inLIC.9 There are undersupplied laboratories and supportservices, hospital management, and equipment supplies.10This further makes management of poor and vulnerablePaediatric patients even more difficult. Our need is to develop the infrastructure and buildhuman resources and skills at a national level. This can beaccomplished through a structured and aspiring PEMresidency/fellow training programme. Paediatric traumacare, Paediatric formulary, pain management, toxicologyand ambulatory services further build the decipline.4 Policymakers of LIC have unfortunately been unable to recognizethe importance of PEM as a highly impactful stake holder toachieve the MDG4. Formulated and focused corecurriculum, training programmes and workshops along withprivate and public sector collaboration is indeed essential toachieve our goals efficiently. It is time for PEM to step outof its embryonic and evolving phase to a recognized,matured and established specialty. References1. Millennium Development Goals: progress towards the health-relatedMillennium Development Goals Fact sheet N°290: World HealthOrganization; May 2011. (Online) (Cited 2011 June 28). Available from URL:http://www.who.int/mediacentre/factsheets/fs290/en/.2. Baker T. Paediatric emergency and critical care in low-income countries.Paediatr Anaesth 2009; 19: 23-7.3. Feigelman S, Marcel V A. Growth, Development and Behavior. KliegmanNelson Text Book of Paediatric. Philadelphia Saunders/Elsevier publication,2007. Vol. 1 Part 1- XVI, 18th edi. Chapter 1, Page 1-12.Strengthening paediatric emergency medicine in Pakistan isour need to reach millennium development goal 4Emad uddin Siddiqui, Kiran EjazDepartment of Emergency Medicine, Aga Khan University Hospital, Karachi. Pakistan.Corresponding Author: Emad uddin Siddiqui. Email: emaduz@yahoo.comEditorial4. Siddiqui EU, Razzak JA. Paediatric emergency medicine--an evolving sub-speciality in Pakistan. J Coll Physicians Surg Pak 2008; 18: 135-6.5. Walker MD, Tolentino RV, Teach JS. Trends and challenges in internationalPaediatric emergency medicine. Curr Opin Pediatr 2007; 19: 247-52.6. Rivara FP, Grossman DC. Prevention of traumatic deaths to children in theUnited States: How far have we come and where do we need to go?Paediatrics 1996; 97: 791-7. 7. Ralston M, Hanzinski M F, Zaritsky A L, Schexanyder S M, Kleinmman M E.Paediatric Advance Life Support Manual. American Heart Association Dallas.Provider Manual 2006; Chapter 1, page 1-32.8. Sinclair D, Sub specialization in emergency medicine. Where do we go fromhere? Can Emerg Med 2005; 7: 344-6.9. Kobusingye OC, Hyder AA, Bishai D, Hicks ER, Mock C & Joshipura M.Emergency medical systems in low- and middle-income countries,recommendations for action. Bull World Health Organ 2005; 83: 626-63.10. Jochberger S, Ismailova F, Lederer W, Mayr V D, Luckner G, Wenzel V, et al.Anesthesia and its allied disciplines in the developing world: a nationwidesurvey of the Republic of Zambia. Anesth Analg 2008; 106: 942-8.Vol. 62, No. 9, September 2012 871

Strengthening paediatric emergency medicine in Pakistan is our need to reach millennium development goal 4.

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Strengthening paediatric emergency medicine in Pakistan is our need to reach millennium development goal 4.

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