Dr. Sanam Shah
Two and a half
years of my residency in Family Medicine drew close and I looked
forward to embark on my rural journey as part of my rural health
rotation. The stark contrast in the rural urban divide in almost
everything including healthcare was no surprise due to my own rural
heritage. However, the healthcare experiences first hand were a real eye
opener to mobilize a paradigm shift in my own perspectives. There is no
one event that I could focus on right now but a composite of my entire
rotation as well as other opportunities thereafter to attend to rural
communities that have helped build me professionally as well as a person
and contributed immensely to give due attention to this area of
practice.
So I was off to a small region
tucked away in a remote northern area of Chitral, the high mountains
towering above circumferentially. The nearest secondary and tertiary
care centers were an hour and a half drive from there provided there
were no roadblocks due to landslides and inclement weather conditions.
There were two doctors and a midwife attending to the local community
and I was an extra pair of hands to elaborate their provision of care as
well as my practice in this low resource setting. We saw the usual
common ailments from communicable diseases like pneumonia,
gastroenteritis, enteric fever, viral infections to the more prevalent
conditions like diabetes, hypertension, asthma,COPD as well as a high
burden of depression and somatoform disorders. On the other end of the
spectrum were emergencies that we had to manage as well as we could
despite lack of basic medical facilities sometimes.
It
brings to memory a young boy accompanied by his male relatives, in a
state of severe dehydration and decreased consciousness. He was
diagnosed type 1 diabetes mellitus and was on insulin later found be
expired. Lack of insulin at our own facility drove us in frantic efforts
to resuscitate him with IV fluids and empiric antibiotic followed by
transfer to the closest well equipped centre more than an hour away
compounded by the dangers of night time travel in the difficult
terrain.
Communication with the rest of the
world was limited to an hour a day of net connectivity, sometimes none
and intermittent access to wireless phones which was a problem if
specialist colleagues had to be approached for any queries. However,
they were quite eager to help us there sharing the latest evidence from
infective endocarditis to severe pregnancy induced hypertension, when
hydralazine was the only drug available and we were looking up whatever
limited literature to decide between IV infusion and bolus therapies.
Insight
into local cultural practices was equally important. Losing a patient
to “kala pathar” poisoning, a common component mixed with henna for hair
dye, that too cheap and easily available , underscored the importance
of community education for such problems. Another common practice was
the high intake of salty tea as well as butter tea and its association
with cardiovascular diseases.
The situation in
the rural South is not much different. The lack of sufficient primary
and preventive health services has translated into a high burden of
preventable diseases. The lack of good specialists in the area has also
compounded the problem. The appeals of a mother of a child with cerebral
palsy from birth asphyxia to prescribe something to cure him, to a
young lady, unaccompanied, who went into a seizure episode when no
sedative was available in the clinic and the presence of inexperienced
staff to provide first aid, all highlight lack of empowerment of the
local populace and general medical unawareness.
Basic
understanding of the local area language was imperative and from the
limited basic exchanges it was almost clear that the rural population
has strong faith despite adversity. The ruggedness of their local areas
and resilience in the face of inaccessibility is reflected in their
enduring interiors.
Rural health is certainly
on the list of priority areas for my attention and I hope this small
piece as well as more upcoming stories could empower us to motivate
others to look beyond the challenges and serve the communities there.
Last
but not the least, the opportunity to explore the untouched beauty
nature has to offer from the roof of the world surrounded by snow capped
peaks to basking in the pure surroundings of the agrarian regions, one
can certainly make a lasting connection with this area of practice.
____________________________________________________________
Dr. Sanam Shah
Current association: Associate Consultant, Family Medicine Department, The Indus Hospital, Karachi - Pakistan
Wonderful...!
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