KARACHI: Lack of paediatric experts causing problems
KARACHI, Oct 2: Rapid and massive brain drain of medical professionals — ranging right from budding surgeons and anaesthetists to nurses and technologists — is hampering the efforts to promote paediatric cardiac surgery in the country.
The situation is all the more severe in Pakistan as it has considerably high incidence of congenital heart diseases among children — coming to no less than 10 per 1000. Ironically, timely surgical interventions, particularly during childhood is globally registered to have much better success rate compared to procedures performed on adult population, yet lack of proper infrastructure and dearth of qualified professionals often deny the affected children a chance to live to their optimum or even grow up as normal adults.
Delay in timely intervention is not only due to a shortage of qualified professionals and absence of required facilities but also a lack of perception regarding importance of ante-natal and post-natal examinations, which deny protection against preventable conditions.
Experts deliberating on the issue of paediatric cardiac surgery in Pakistan — during the third international symposium of the Pakistan Paediatric Cardiology Society held at the National Institute of Child Health auditorium on Thursday — suggested a phased programme to develop an option on strong lines in this regard.
Pakistan already had a structural programme to develop paediatric cardiac surgery units in the cardiology hospitals of the country, they said. Acknowledging the fact that a few institutions had taken some initiatives, but they too were exposed to serious handicaps, the speakers called for close coordination between different cardiac surgery institutions working in the country.
It was repeatedly mentioned during the proceedings that an efficient paediatric cardiac surgery programme had to be necessarily a team effort with close coordination between paediatric anaesthesiologists, neo-natal intensivist, paediatric cardiologists, paediatric nurses, technicians and a well-trained surgeon.
Prof Kalimuddin Aziz from the National Institute of Cardiovascular Diseases (NICVD), in his presentation entitled “Should Paediatric Cardiac Surgery be a National Priority”, pointed out that eight to 10 per cent of all newborns in the country had some sort of congenital heart disease. Against all odds and deficiencies, the corrective procedures during infancy or childhood were low as compared to the cost incurred during adulthood.
“The fact, however, remains that 50 per cent of the newborns with congenital heart anomalies die without treatment,” he added in the same breath. According to him, the backlog of those suffering from congenital heart diseases is further supplemented by those patients who are diagnosed later during the adolescent stages or after attaining adulthood, with compromised quality of life.
Rheumatic fever was said to be the most common problem among those of adolescent age with a heart-related complication. Poverty, poor hygienic conditions and congested living were cited as major contributors.
Mitral valve dilation or balloon mitral commissurotomy being performed at the NICVD and discussed by Dr Najma Patel, chief of its paediatric surgery department, was said to be an effective intervention with high success rate.
Prof Muhammad Rehman said Pakistan, having a population explosion, was exposed to congenital diseases and defects which in most cases could be effectively treated.
Maj Gen Syed Afzal Ahmed of the Armed Forces Institute of Cardiology (AFIC) said the voluntary surgery approach under which foreign experts were witnessed visiting local units and performing a few surgeries with little provision for follow-up needed to be substituted with long-term programmes.
Without undermining the sincerity of expatriate Pakistani surgeons or those with American, British or Australian origins, he said, a more pragmatic approach was required for training of local surgeons.
Dr Jim Wilkinson from Australia, Dr Shakeel Qureishi from the UK, Dr Masood Sadiq (Punjab Institute of Cardiology, Lahore) Dr Saulat Fatimi (AKUH), Dr Abdul Aziz from Punjab Institute of Cardiology, Prof Zeenat Issani (NICH), Dr Hasina Chagani (Civil Hospital Karachi) and Dr Mehnaz Atiq (AKUH) were among the other speakers.
Earlier, during the inaugural session, Dr Shakeel Qureishi reminded the participants of acute shortage of qualified and trained manpower in the field of paediatric cardiac surgery. — APP
