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Tag Archive: "interburns"

Lateral thinking and innovation in health care delivery

Coverage of the British Burn Association Meeting, Liverpool, 15-17 May 2013

Narration by: Shariq Ali
May 22, 2013
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The theme of this year`s British Burns Association meeting which was held in Adelphi Hotel, Liverpool between 15th to 17th May, 2013, was the use of innovation and lateral thinking in burn care. It was an honour for me to be invited as a Guest Speaker to share some innovative ways of burn care we used in our centre in Karachi to reduce cost. In addition, I also shared some of my observations spanning many years while working as one of the Co Founder of Interburns (International Network for Training, Education & Research in Burns) in various countries of Asia, Africa and South America.

Using lateral and innovative thinking to minimise healthcare delivery cost is not an option for doctors working in LMICs (Lower and Middle Income Countries). It is, in fact, the only way to cope with the day-to-day health care issues for them. They innovate, beg, borrow and sometime forced to do undesirable to provide for and manage their poor patients.

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It was a pleasant surprise for me that the points I made in my talk generated a significant amount of enthusiasm and attention. Many burn care experts from United Kingdom and abroad approached me after my talk during the tea break and later on during the reception at Liverpool museum

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The city of Liverpool was created in 1207 and was once the “Second City of Empire”, eclipsing even London for commerce at times. Liverpool holds the Guinness Book of Records title for being the Capital of Pop. More artists with a Liverpool origin have had a number one hit than from any other location. And of course, Liverpool legends The Beatles changed the face of popular music.

Main reception dinner was arranged in Liverpool’s Anglican Cathedral, the largest cathedral in Britain and the fifth largest in the world. I was told that it was designed by Giles Gilbert Scott in 1904. As we walked into the main hall of the largest cathedral of England for the main reception dinner that night, I was stunned with the brilliant architecture of Gothic arches and coloured glass paintings on the wall

 

 

Liverpool Cathedral is a versatile space with a seating capacity for 2000 guests. It hit me as one of the most striking concert venues in the world. The stage set for us was colorfully illuminated and was looking out of this world with a background of coloured painted glasses of the cathedral. The Beatles performed and their performance was not far from the original.

 

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The array of candle lit tables were waiting for us. My reserved place was on the first table alongside the main host of this years BBA, the Clinical Director of Alder Hey Burns and Plastic Surgery Unit, Dr Sian Falder and on my left was the Professor of Plastic Surgery Mr Ian Whitaker and a very famous author and Consultant Plastic Surgeon Dr Kayvan Shokrollahi. For me, it was a matter of great pleasure and delight as all three of them are very close friends of mine and we had so much in common to talk about.

 

My three days stay in Liverpool was a memorable trip for me. Paradoxically I came to know about expensive ways of hosting a scientific meeting. The hospitality I received and the warmth of friendship I felt will stay with me for a long time.

Along the Nile, in search of a civilised world

Narration by: Shariq Ali
March 12, 2012
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By Shariq Ali

I was woken up suddenly by a knock at the door of my cottage in Jinja, a small town close to the source of river Nile and not far from the shores of lake Victoria. It’s about seventy-five kilometres from Kampala, the capital city of Uganda

It was a real struggle to come round so early in the morning as when I went to sleep the previous night I was totally exhausted after a 13-hour journey from London to Entebbe airport and then a further two-hour drive to Jinja. The purpose of my visit was to attend a week-long meeting of six African and seven other countries. Interburns was hosting this meeting and being one of the Co Founders, I arrived a day earlier to make sure that the necessary arrangements of this retreat were in place.

The knock on the door was gentle but repeated. After about a minute of listless denial and resistance, I finally accepted the bitter reality that I must leave the bed and answer the knock.  When I opened the cottage door, to my surprise, there was no one outside. The fresh morning breeze took no time to freshen me up and I stepped down from the small front balcony on to the small glistening grassy patch in front of my cottage. I saw nothing except a lone nine feet tall tree covered with a fresh generation of newly emerged green leaves.

Suddenly, I discovered them. They were comfortably sitting on one of the horizontally oriented branches of this tree.  Young bright green leaves were utterly unsuccessful to hide these three almost similar size monkeys. One of them was staring at me and showing his teeth with a meaningful smile. All of them had an inquisitive glow in their eyes.

Last night when I arrived here, it was almost to pitch dark to make out any details about the surroundings. But even then, the overwhelming sound of the flowing Nile in the background was the most striking feature of this resort. The morning breeze was very fresh and now, I was fully awake – thanks to my monkey friends – to explore the surroundings.

The view was joyfully inviting and beautiful. I looked around and the first few steps of a four thousand miles long journey of River Nile was in front of me. I started to walk along gently. I was in no rush as there were about two hours still remaining for me to be ready for the breakfast meeting. But it took me few minutes to draw its attention towards me.

The seasoned and very wise river was in its full flow and appeared very self contented and not interested in conversation. As we walked along together for a little while, it seemed to have somehow recognised the similarity between us. The on and on flow of its waves was no different than the unending stream of thoughts in my mind. This commonality soon brought us together and we started to chat.

The river asked me “why are you here for?” I replied “to build bridges across the global disparity in healthcare. I am here as the part of a global team of burns specialists. You may call us dreamers! We are here for five days of meetings of experts representing six African and three South East Asian countries from one side of the divide of our current polarised global healthcare system and the experts from US, Canada and UK from the other.

Though we have all agreed to build bridges across this divide of global injustice which is causing deaths and suffering of millions of innocent people, the struggle now is to formulate plans and strategies to succeed in our mission.

Then I asked the river, And why are you here? ”The river smiled and replied “ Exactly for the same purpose. I’ve been here for so many thousands of years, to build bridges” I said, “But apparently you look like more of a natural divide than a bridge to me, especially when I saw you from the aeroplane” It smiled and said “But the world is not what it appears from above. I will share my story of building bridges with you.

Thousands of years ago, people were scattered as individuals in deep jungle. They were the slaves of their survival, imprisoned in their own personal needs. They learned nothing but cruelty from the surrounding harsh environment. Survival for the fittest remained their guiding principle. People from one side of the river looked at the people on the other side with suspicion and fear. They were obsessed only about their own survival. It was their jungle instinct. This feeling of persistent threat kept them separated from each other and they remained lonely.

I felt the pain in my heart for them and decided to move forward with the help of love. I thought they needed to know how to communicate with each other and how to build bridges. My waters then flooded the banks across the jungle and deserts alongside both edges and converted it into a fertile land. They responded with their intrinsic human goodness and intelligence. Very soon they learned to grow abundant food and created shelters for themselves. Soon, they left the lonely and savage life of jungle and became a community. They developed new skills and learned to explore their environment. Finally they achieved a breakthrough of access to their emotions. They created words and very soon mastered the art of weaving them together into language. This enhanced their strength of exploration and discovery into themselves and in their environment.

 One day, a few of them, a handful of dreamers like you all, discovered something very powerful within their hearts. The power of love and goodness which is the driving force for humanity, in fact, the universe. These emotions emancipated them from fear and suspicion about each other. They found the courage and willingness to build bridges across the apparent divide of my flow. They brought their canoes of determination together and tied them with the ropes of their faith in human goodness and created a bridge of compassion and love.

And that was the happiest day of my life. I felt as if the purpose of my existence is served that day. Although I knew that there were many oceans dividing this world, but I also knew that now they have learned the process to overcome it. By using the same principles and same skills, they can cross any divide. The power of communication will help them to overcome all the differences. They will become mature and start thinking harmoniously. And finally, they will be able to love each other. Remember, communication is the key. Talking to each other and becoming friends is miraculous and it is the most powerful way of building bridges.

I said to the Nile “I did not know that you are also a dreamer like us. We have the same dreams and hopes and desires that our world must learn to live and learn and love together. We need to learn to build bridges in the face of global healthcare disparities. This global injustice in healthcare is resulting in tragic deaths and disabilities of millions of innocent people. This suffering because of the burns injuries, trauma and disparity of global health care and inaccessibility of essential medicines must come to an end. In order to become a civilized world, we must now learn to cross the oceans divide.

The Nile said to me, I think you are right. When I look at the present day world, on the one hand I feel proud that they have achieved remarkable success over thousands of years, but on the other hand, it breaks my heart when I see them forgetting the lessons of harmony I taught them through history. They seem to sometimes forget that together they did defeat the scarcity and achieved abundance.

Let’s be together in our hopes that one day, people of this world will identify their intrinsic compassion for each other and the power of goodness. They will be able to overcome the divide of race, religion, colour and creed. They will finally learn the universal language of love. And there will be new songs and unheard melodious music in the air. That day, all of us will join the dance of global harmony together.

Useful Links:

http://www.interburns.org/

http://bpa.uoftplasticsurgery.ca/main.php?p=1617

acknowledgement: we are grateful for few images from the free access internet websites

The Art of Human Care

Narration by: Shariq Ali
July 5, 2011
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Brecon Beacon National park was the perfect venue for the European Club of Paediatric Burns meeting hosted in 2009 by Interburns in South Wales.

It was a wide-ranging participation of 55 experts from not only Europe e.g. Italy, Switzerland, Germany, Holland, Sweden, Poland etc  but also from USA, Canada, Australia, South Africa, India and Bangladesh. Although most of the delegates were typical of such conference participants i.e. highly focused, very successful burn experts  but amongst them were few who are a special source of inspiration for me personally. Let me introduce two of them to you.

Fiona Proctor is an occupational therapist from Liverpool . We (Interburns) met her in Dhaka in the corridor wards of Dhaka Medical College Hospital Burns Centre. Corridor wards mean no available beds but patients are nursed on the floor in their moms lap and the relatives are the main carer.

Fiona was surrounded by smelly and sick burn children of all age groups. Most of the time as she was working almost the entire day and sometime at night as well as her accommodation was also in an adjacent dark side room of this corridor with no electricity or running water etc. She spent four months there in that corridor.

I have spent 18 years of my professional life with burn patients and burn wound smell and suffering is a business as usual for me.  But at that moment, in that corridor, there was so much accumulation of innocent and helpless suffering that I just wanted to cry like a baby.

Fiona is an artist and her art is human care.  While working in Dhaka, she discovered that her training as an Occupational Therapist and the expensive techniques and equipment she used in United Kingdom is not sufficient and relevant to alleviate the disability and pain here.  The challenge in front not only required the scientifically trained mind but also a warm and caring heart. She had the both.

In order to cater the need of her poor patients, she went to the local hardware shops in the slums of Dhaka and bought drain pipes of different sizes in few takkas and with her scissor and innate brilliant creativity, developed very effective and extremely low cost splints that helped her to minimize the contractures and related suffering of her patients. The effort was in accordance to her passion and dream to minimize the human suffering!

Dr Kishore is 35, a hindu family man, born and educated in Dhaka , his salary is 15000/= takkas per month. He works in the same hospital for the last ten years where Fiona worked for four months. His hospital has 100 beds for Burn patients and the day he left for this meeting there were 229 in patients, mostly in corridor wards.

Kishore`s visit for this meeting was fully funded by Interburns and Interburns in collaboration with Zürich Children Hospital , have offered Kishore a four months Fellowship in Switzerland with free travel and accommodation and a  modest monthly allowance during his stay.

Is McDonald’s a solution for African hunger?

Narration by: Shariq Ali
June 29, 2011
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Recently I was invited to give a talk and share our (Interburns) experience of imparting surgical training in Africa. The venue was the Royal Society of Medicine (RSM) in London and the occasion was a joint meeting of Royal College of Surgeons of Ireland (RCSI) and The College of Surgeons in East, Central and Southern Africa (COSECSA).  Representatives from many global organizations active in surgical training were also present.

RSM is located in Wimpole Street London and was originally founded on 22 May 1805 in the era of King George as an institution that would bring together branches of the medical profession “for the purpose of conversation on professional subjects, for the reception of communications and for the formation of a library”. It adopted the current name of Royal Society of Medicine in 1907

After the talk, I was sitting in the expert panel along with other speakers and the discussion was about finding the ways to impart effective surgical training in Africa. There was a remarkable enthusiasm on the floor and a variety of opinions came through. It was not at all a surprise as it was a gathering of global elites on the subject of surgical training.

Few experts from USA were understandably proud and very vocal of their model of trauma training. My point was simple. Although universal principles of good practice transgress the boundaries of time and space, but meticulously prepared protocols and thoughtfully designed standards and gradually developed piles of knowledge over the years in the west cannot be applied unchanged in the developing world scenario because of the simple fact that the perspective is different.

It requires flexibility and contextual understanding of the working environment where this knowledge and skills and attitudes are going to be ultimately practiced.

Food is understandably an answer to hunger.  But Mc Donald`s is surely not the best choice for the hungry African population in Sub-Saharan desert!

Effective education can be life saving and transformational

Narration by: Shariq Ali
June 23, 2011
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Dear Readers,

I would like to share the following email and the article written by one of my medical student who attended one of the Excellence in Medical Education (EME) workshop in Karachi, Pakistan. This highlights the basic philosophy of Valueversity that an effective education can be life saving and transformational.

Dear Dr. Shariq,

I had an experience where I was able to apply the principles of First Response and BLS that you taught us. It was a public place and nobody there was ready to help. I wrote my experience about it which I am also posting on your Facebook and here.
 
Please give it a read. Thank you again for inspiring us to save human life. Your contribution to society will always be remembered.
 
 
Regards,
Jahanzeb Effendi.
Final Year MBBS,
DMC.
The following is the verbatim from the above link of Jahanzeb’s article in The Express Tribune:

A little knowledge and its due application can make a difference in someone’s life.

I was enjoying a wonderful meal at the new food street on the pier with my family last week when I heard people gasp as two men carried another young man to the green sidewalk. They dropped him and disappeared. My first thought was this man had fallen into the water – but I was wrong.

I rushed to assess the casualty. Eager spectators had gathered around the young man – some of them instructing others to perform maneuvers which were extremely contraindicated in the given situation. I pushed through the crowd only to find the young man hyperventilating, followed by loss of consciousness. Before I knew it I was ‘in control.’

There seemed to be no one, out of the 200 plus people present, who knew how to handle an emergency situation – or they just did not act. Most just stood and watched what happened in the next 20 minutes – the longest 20 minutes of my life.

I shouted at someone to call an ambulance while I assessed the airway, breathing and circulation. Someone said the young man’s name was Wasim. He was a kebab maker at the restaurant, and had collapsed suddenly while cooking in the hot, humid night.

I called out to him but there was no response. Before I knew it, he had stopped breathing. My mind was racing at the protocol I have rigorously practiced on mannequins as a certified first responder. This was the moment to act. I checked the airway, it seemed clear but he was not breathing. The chin lift-head tilt did not help.

Next thing I knew, his pulse was rapidly falling. I had to make a decision within the next few seconds. Clearly, I could not deliver mouth-to-mouth since I was  and since about to start chest compressions and no one was accompanying him.

I asked one of the guys to raise Wasim’s legs to help the shock he might be in. Fortunately, and with quite a show of bravery, my uncle who was present at the scene offered to breathe him. Then followed aCPR, which went on till we had a response. Twice he gained consciousness and took a couple of breaths, but then again stopped breathing.

We did close to eight cycles of CPR till the Edhi Ambulance made its well pronounced loud entry in to the scene. Two workers came out with the stretcher and whisked him away before I could say a word.

The last I could see to my extreme disappointment was the lack of an oxygen cylinder in the ambulance. Furthermore only one person sat at the back with Wasim and I wondered how he would handle resuscitation.

As the ambulance left, everyone around me seemed to heave a sigh of relief. Some people came forward to ask me his chances of survival. Disappointed as I was, I just shook my head to most people and asked them to pray. I hoped that the closest ER of the hospital would give him the oxygen which I thought would reverse his symptoms.  My basic fears were carbon monoxide poisoning or a heat stroke. Bothcould be lethal if not managed properly in an ER.

How to react in emergency situations

This experience taught me a few things:

1. In an emergency situation, there is no use of bystanders, unless you are calling for help, or helping clear the way for traffic etcetera. If you are not useful, kindly continue to do what you were doing and do not clog and confuse the situation.

2. We have a terrible ambulance system. Our ambulances are mere taxis that help move the injured from one place to another (I mean Edhi, Chippa and KKF etc). The exception to these is the Aman Foundation Ambulances which are fully equipped including paramedics. There may be more, but not within my knowledge.

3. We lack a First Response center which uniformly co-ordinates emergency situations. For example in this case, someone called Edhi – the ambulance took 25 minutes to reach the site. This is not at all efficient. When I left the place I noticed a Chippa kiosk right around the corner – and I could not be more disappointed. Had we contacted Chippa, it would not have taken more than three minutes to reach the site. A simple helpline could designate the site of casualty and direct the closest ambulance service to reach over radio.

4. We need to train as many people as we can to deal with trauma. This incident is not the first of its kind in a public place. I am sure there has been loss of life before because of unavailability of medical care during the first few crucial minutes of trauma. As First Responders, we plan to teach the medical students of Karachi the basics of First Response and Primary Trauma Care. These Medical Students would be vectors to teach to a larger population of individuals, thus creating a safer place for the citizens.

5. Public entertainment places, like food streets, malls and dining restaurants should have first aid facilities – at least an artificial respiration material. Emergencies can take place anywhere. A common incident of choking could be life threatening if not managed properly.

Two day after the incident, a friend of mine visited the same food street. I had avoided thinking about the probable death of the young man by not reading the newspaper. But, I couldn’t resist asking her to find out his fate from the restaurant.

My heart leapt in delight when I heard the news. Wasim survived and was actually back to work, grilling kebabs at the famous eatery. I could not believe it.

I am glad a little knowledge and its due application saved someone’s life.

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