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Trauma Training in Pakistan

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I'm sure you've seen the recent news of unrest in Pakistan. As things were coming to a head, I was part of a team that was conducting the inaugural ATLS program in Karachi, Pakistan. As the president of Pakistan was declaring a state of emergency and suspending the constitution, the last of us were on our way home.

We were working at the College of Physicians and Surgeons Pakistan, which is a secure facility in Karachi that provides training and testing for doctors in Pakistan and several other countries. The facility has classrooms, libraries and e-learning facilities, as well as living quarters for faculty and students. With all that was going on while we were there, we felt quite safe in these facilities and the attention of our hosts.

An international team consisted of Dr. Christoph Kaufmann (ATLS International Coordinator) from Portland, Ore.; Dr. John Kortbeek (ATLS Chair) from Calgary, Canada; Dr. Jameel Ali from Toronto, Canada; and Dr. Subash Gautam from United Arab Emirates. It also included Prof. Zafarullah Chaudhry, Prof. Mahmood Ayyaz and Prof. Irshad Waheed -- Pakistani physicians trained in the U.S., -- and Dr. Mohammad Farooq Afzal and Dr. Kamran Khalid Khawaja -- Pakistani physicians trained in Saudi Arabia.

What we found when we arrived was a dedicated staff; the doctors and nurses we worked with were committed to working toward improving opportunities for improved trauma outcomes and to participate in the international community that focuses on improving those outcomes.

Although the attention to trauma in much of Europe and the Americas has resulted in a reduction in deaths due to trauma, in this part of the world death due to trauma is on the rise. In his address to the media during a recognition of the inaugural ATLS program, Professor Zafarullah Chaudhry, the president of the college, described the country's recent history of earthquakes, road traffic injuries and other examples of trauma that require an organized approach. He continued that countless lives could have been saved with the training that 16 Pakistani doctors went through during the week. The course is the beginning, and trauma systems planning and prehospital education are the keys to the overall plan for Pakistan.

Given the diverse populations -- including congested urban settings and sparsely populated rural areas -- getting EMS organized in Pakistan is a huge undertaking. In the vicinity of Lahore, a system similar to 9-1-1, called 1122, was recently inaugurated. Results of implementing the 1122 system have been encouraging, and Pakistani officials hope to expand further as they learn.

Hopefully, things will settle down quickly, and organizers will be able to continue their plan, which includes PHTLS for prehospital providers and training for nurses as well.

The program in Karachi may sound like an example of a rare occurrence -- representatives from various countries coming together to improve prehospital care in developing countries. However, it's just a personal and recent example of international cooperation that takes place all over the world. On any given day, it's likely that U.S. paramedics, physicians and nurses are working with our brothers and sisters in established and developing countries.

Back at home, I'm happy to have been a part of this and feel strongly that this type of cooperation -- especially when it's not easy -- will save lives in many ways. First, the training will give the country's medical personnel a chance to use their skills and passion to give the best possible care. Second, these types of international cooperatives teach all of us about one another and the benefits of sharing knowledge of science and culture -- bridging gaps, and finding common missions and passions.

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