WONCA South Asia Region: May 2023

Dr. Tariq Aziz, President WONCA South Asia Region (SAR)
Dr. Hina Jawaid, Chair WONCA SAR Primary Care Research Network
Dr. Ramakrishna Prasad, Editor WONCA SAR Journal

Research Publications from Family Physicians in South Asia

1- Views of South Asian Physicians on Climate Related Health Effects: A Multinational Cross-Sectional Pilot Study. Tehzeeb Zulfiqar, Hina Jawaid, Abdul Jalil Khan, N. Waseem Ahmed, Asif Rehman, Muhammad Hassam Khan, Kinley Bhutti, Md. Ferdous Rahman, Saadia Mustafa, Husnulmaab Ali, Tariq Aziz American Journal of Climate Change > Vol.12 No.1, March 2023 DOI: 10.4236/ajcc.2023.121004

Contribution in Newspaper columns by Family Physicians in SAR (Dec 2022-March 2023)

By Drs: Hina Jawaid, Abdul Jalil Khan, Naseem Amin Dhedhi, Dr Naureen Kazim, Dr Sobia Jawaid and Dr Zaineb Hafeez

Please see published column titles & links.

1- Myths and misconceptions- Misinformation related to diabetes and its management can prove detrimental to the well-being of a patient. Published December 2022 https://www.thenews.com.pk/tns/detail/1023403-myths-and-misconceptions
2- Cervical Cancer Prevention - Timely vaccination against cancer-causing HPV and regular screenings can prevent cervical cancer and save lives. Published 15th Jan 2023
3- Unmet Need for Contraception - Counselling by trained professionals can enhance contraceptive use- Published March 2023
4- Cervical Cancer Prevention- A preventable disease, cervical cancer continues to claim lives- Published March 2023
5- Making Health Accessible - There is a need to generate awareness about the utilisation of reproductive healthcare services among women in remote regions- Published March 2023
6- Smoking Induced diseases- The burden of tobacco use-induced diseases remains a serious concern- Published February 2023
7- Understanding Meningo-encephalitis- Vaccination and timely treatment can help reduce and prevent the risk of severe brain damage due to meningo-encephalitis- Published January 2023
8- Cardiopulmonary Resuscitation- One of the most challenging tasks confronting first aid include understanding basic life support courses- Published February 2023
9- Staying well in winter- The cold season brings with it many health challenges that can be managed and prevented through proper care and precautions- Published January 2023
10- Diabetes Care and education- Awareness and improved diabetes education is needed to prevent disease-related complications- Published in December 2022
11- Colorectal cancer awareness - Regular screening and early detection can significantly reduce the risk of morbidity and mortality associated with colorectal cancer- Published in March
2023 https://www.thenews.com.pk/tns/detail/1053858-colorectal-cancer-awareness
12- Providing Care - Healthcare providers and caregivers must be well-trained to provide care to patients with colorectal cancer- Published in March 2023 https://www.thenews.com.pk/tns/detail/1053861-providing-care
13- Coming Home - A fortuitous encounter proves a much-needed reaffirmation - Published in March 2023 https://www.thenews.com.pk/tns/detail/1053878-coming-home

South Asian Women as Leaders

Author: Dr Naseem Amin Dhedhi, Family Physician & member Spice Route Movement YDM & SIG health equity.

Around the globe women are breaking barriers in a number of fields including medicine, education, science & technology, sports and leadership roles. The South Asia region is no different, today we see women participation and representation in a vast number of fields. Air force female fighter pilots, Ayesha Farooq and Maryam Mukhtiyar, who have set an example of courage and bravery. Likewise, Sania Mirza was a successful professional tennis player. Over years women have gained a lot of confidence and have dared to enter the horizons which were forbidden to them earlier. Medical and surgical field is the same, we have seen competent female doctors in orthopedics, urology, cardiovascular surgery and related specialties which were thought to be best served and managed by male surgeons only. In South Asian countries including Pakistan we have formal sports training and dedicated academies for girls and women. Our girls are representing their countries in national and international sports competitions like cricket, volleyball and taekwondo.
In this era of modern technology, there are many options for girls and women when it
comes to working from home. Government and some private organizations are offering free of cost online courses in Information technology and related fields.
Choosing a career and advancing a career can be challenging for women, maintaining work life balance can be a task. Global communication and social media has helped women a lot in making progress in their respective fields through innovative ideas and making clients
accessible. Similarly, WONCA (an international forum) has made it possible to bring doctors from different regions of the world together. It allows health care professionals to discuss and discover new avenues and together they try to bring solutions to the local healthcare problems. Conferences are regularly arranged for growth of doctors in academia and research.

Conference on Non-Communicable Diseases: Role of Primary Health Care in Chronic Disease Management

Authors: Dr Muhammad Hassam Khan, Lecturer Family Medicine and Dr Abdul Jalil Khan, Assistant Professor & Head of Family Medicine Department, Khyber Medical University, Peshawar, Pakistan

Khyber Medical University recently hosted a two-day conference on non-communicable diseases (NCDs) with the aim of highlighting the importance of primary healthcare in disease prevention and management. The conference, which took place in Peshawar, was attended by a range of healthcare professionals, policymakers, and researchers. The president of Pakistan, Dr. Arif Alvi, was the chief guest, underlining the significance of the event for the healthcare sector in the country.

The conference shed light on the high burden of NCDs in Pakistan and emphasized the need for a shift in the healthcare paradigm. Instead of focusing primarily on hospitals, the speakers advocated for greater emphasis on prevention strategies at the primary care level. One of the notable discussions during the conference was breaking the mannikins of NCDs. The speakers underscored the importance of family physicians in educating patients, promoting healthy lifestyles, and providing counselling services to manage and prevent NCDs. The establishment of a proper structure and recognition of family physicians could lead to significant improvements in patient safety, disease prevention, and cost savings in the healthcare sector.

The conference marks an important step towards a more holistic approach to healthcare in Pakistan, emphasizing the role of primary healthcare in managing and preventing NCDs. With the insights gained from the conference, policymakers and healthcare professionals can work towards implementing effective prevention strategies and reducing the burden of NCDs on tertiary care.

Pre-conference workshops conducted by Family Medicine department

The Department of Family Medicine at Khyber Medical University also hosted pre-conference workshops on 21 February on a variety of important topics. One such workshop focused on de-escalation of violence in healthcare, in collaboration with the International Committee of the Red Cross. The ICRC's "Health Care in Danger" project focuses on training healthcare professionals in conflict and post-conflict zones, and the Department of Family Medicine is collaborating with the organization to provide such training in healthcare institutions across Khyber Pakhtunkhwa. According to recent data, around 49.6% of healthcare workers in Pakistan have experienced violence in the workplace, with a third of these incidents occurring within the last six months. Healthcare workers face a range of violent behaviors, including verbal abuse, physical assault, and false claims. The workshop provided training to healthcare professionals on how to recognize potentially violent situations and how to de-escalate them to promote safety in the workplace. The workshop was attended by healthcare professionals from a range of institutions, and they provided positive feedback, stating that similar training should be conducted in their institutions as well

Another workshop at the conference focused on medical and research ethics. This workshop was designed to provide training on ethical issues and professionalism in medical research and practice. Attendees included doctors, dentists, public health professionals, and allied health science professionals.

A third workshop focused on basic life support training, which is a critical skill for healthcare professionals. The workshop covered topics such as cardiopulmonary resuscitation (CPR) and choking emergencies.

The importance of these workshops cannot be overstated, as they provide healthcare professionals with essential skills and knowledge that can improve patient safety and care. The Department of Family Medicine is committed to providing such training to healthcare professionals across the region and playing a role in improving safety and professionalism in the healthcare sector.

Basic Life Support workshop for healthcare professionals by Department of Family Medicine
At Khyber Medical University, Peshawar, Pakistan.

Stay tuned to a new Featured Quarterly Case Series in the Journal of Family Medicine & Primary Care (JFMPC) titled, "Family Health in the Hinterland"

Authors Dr. Ramakrishna Prasad, Chair, AFPI National Centre for Primary Care Research & Policy, Bangalore, India; Visiting Faculty, Basic HealthCare Services (BHS), Udaipur, India and
Dr. Pavitra Mohan, Co-Founder & Director, Basic HealthCare Services (BHS), Udaipur, Rajasthan, India

Over the last two decades, despite significant advances, rural health is particularly plagued by Urban-Rural Maldistribution and Misplaced priorities of the medical education system.

The current medical education system doesn’t give adequate exposure to the students in the practice of primary health care with professional identity, mentorship, peer recognition (in the medical profession), training is effective teamwork, and career growth. The practice of family medicine and primary health care that is accountable and addresses needs at the point of first contact, based on continuity of provider-patient relationship, is comprehensive, coordinated, and sensitive to the local context is not experienced by students or young health professionals.

Community Oriented Primary Care (COPC):

In its most general definition, COPC is the “provision of primary care services to a defined community, coupled with systematic efforts to identify and address the major health problems of that community through effective modifications both of the primary care services and other appropriate community health programs”. Towards this, the conceptual framework for COPC is based on 5 principles: (a) responsibility for comprehensive care of a defined population; (b) care based on health needs and its determinants; (c) prioritization of those needs to implement health programs; (d) programs that integrate promotion, prevention, and treatment; and (e) community participation.

Conceptual Framework of COPC applied to primary care mental health services

The Role of the Family Physician in Rural Practice:

In rural areas, family physicians in rural practice need to play several roles including: 1) Proving Direct Clinical Care; 2) Consultant to nurses, interns, junior medical officers and community health workers; 3) Capacity builder; 4) Supervisor; 5) Clinical governance/Continuous Quality Improvement (CQI) lead; and 6) Champion of COPC. These demand a range of clinical skills, social skills, leadership skills and to be able to work in teams, understand community needs, and engage with the community actively.

Our Rural Primary Care & Community Oriented Primary Care (COPC) Practice Context:

BHS is a not-for-profit organization which provides a These are led by qualified Nurses, and supported by a Family Physician. Community health workers and volunteers (Swasthya Kirans) further extend the community reach of services and promote healthy behaviors.

Each AMRIT Clinic, managed by Basic HealthCare Services (BHS), provides primary health care that is responsive, empathetic primary health ‘circle of care’, that is rooted in the community including provide preventive, promotive and primary curative services. to a cluster of about 3000 tribal families. Most of these families own small unirrigated farms and have limited employment opportunities. Such a situation forces many young men to migrate to cities for labour. Food is scarce, and malnutrition levels among children and adults are high. Terrain is hilly, and habitations are scattered. Nearest functional government health facilities are 20-30 kilometers away.

AMRIT Clinics also utilize a range of innovations including HR Innovation, Partnership innovation, and Technology innovations to address a range of day to day situations that are highly challenging such as: What does a mother do when the child is sick, father is away to a city for manual labour, and there is no health facility for 20 kilometers, and no transport? How does a health provider manage an elderly woman with severe pneumonia when there is no X-Ray machine, no blood gas analysis and there is no referral possible? What nutrition advice do you give to the family of a severely malnourished young man with silicosis and tuberculosis, who cannot afford any milk or oil or egg? How do you maintain your sanity when you see a woman in labour walk 5 kilometers to reach the Clinic at night across the hill?

Intent of the Quarterly Rural Health Feature Series:

This quarterly feature series on rural health intends to inspire students and practitioners to engage in rural community practice, dive into a unique opportunity to observe from close, healthcare of adults, children, and whole families from remote communities, gain insights on delivering healthcare in places with limited resources, to learn and impart lessons on what changes in clinical approach, programs and policies might be required to improve the care for these neglected and often forgotten, populations.

In each article, we will provide a case study, try to locate it in a wider context, discuss learnings from clinical, epidemiological, health systems, and policy lenses, and propose a call for action. Each case study will illustrate the principles of family practice such as "deep generalism"; "person and family orientation"; "continuity of care"; "community based care"; "building a trusting relationship"; "counseling"; and "an effective steward of resources" are highlighted. Additionally, these articles will: (1) reflect on the clinical insights, joy, challenges, and dilemmas of physicians in addressing health needs of the rural communities; (2) contrast between a disease-oriented (specialist approach) and a person-oriented approach combined with COPC; and (3) suggest a course correction to the existing paradigms in medical and health sciences education of both generalists and specialists.

Ultimately, our hope is to enable students and practitioners of medicine to be more effective in delivering primary care and appreciate the privilege they have of serving as physicians in the community.

So please stay tuned!