Authors: S. M. Qaisar Sajjad  ( Secretary General, Pakistan Medical Association (PMA), Karachi. )

Ever since the coronavirus outbreak in late 2019 and the World Health Organisation's subsequent declaration of the disease as a global pandemic, the world is passing through an uncertain phase with a deadly virus to fight against without much medical knowledge about the virus itself.

A pandemic is a disease prevalent over the world at large. Just like humans, infectious diseases are spread across the globe. From the Antonine Plague (165-180) through to the Italian Plague (1629-31) and Spanish Flu (1918-19) right down to Swine Flu, Severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and Novel Coronavirus (2019-nCoV) and its outcome disease COVID-19 in the last ten years, pandemics and humans have travelled together.

Covid-19 hit the Chinese city of Wuhan in December 2019 and, according to the World Health Organisation (WHO), it has since affected over three million people, leaving over 200,000 dead. Other estimates have been even higher across 210 countries and territories. Pakistan has had its share of COVID-19 troubles - though the spread has been on the lower side compared to various countries and regions.

While the community of medical researchers and scientists is busy finding some clue to the killer virus and its management, national medical associations round the world have been busy carrying out the tasks of generating awareness among the masses, providing guidance to their fellow physicians, advising the decision-makers and lobbying with them to provide enough equipment and supplies to the medical workers - the doctors, the paramedics and, indeed, the ancillary staff - so that they may carry out their duties without having to take unnecessary risks.

Like its counterparts elsewhere, the Pakistan Medical Association (PMA) has been active on all these fronts. To do this in a resource-constraint setting is the biggest fight any medical association in the Third World is waging in this scenario. While PMA is different on this count, it is a measure of some relief that it has not been found wanting in this regard and is continuing to do what needs to be done as the country moves towards taking the proverbial hit on the chin in terms of facing the peak of the dreadful pandemic.

Ever since its inception in 1948, PMA has remained a platform open to all those people who are willing to make a positive difference in the national health sector. Trying its best under all circumstances to be true to the words of Quaid-e-Azam Muhammad Ali Jinnah, who founded not just Pakistan, but also the Pakistan Medical Association and hoped that PMA "will serve earnestly to organise the medical profession in Pakistan on a high level befitting our State."

With country-wide presence large cities and small towns, PMA- the largest representative network of the medical profession - has been in the forefront of healthcare policy-making lobbying, generating awareness among the masses on key issues, keeping the doctors community abreast with professional development by conducting Continuous Medical Education (CME) sessions and seminars, and, indeed, keeping a check on possible professional negligence by encouraging the patients to send their feedback in case they think they have been hard done by a medical professional. Be it flood-relief efforts or earthquakes, PMA, just like Pakistan Army, is the first one to volunteer its services, and the current pandemic was no different.

The low numbers in the country are not truly reflective of the problem's magnitude because of the low testing capacity. Prevention was, is and will always be the key word in the Pakistani context, and this is what PMA and allied health bodies have worked hard to make the authorities understand and execute. Medical associations by their very nature are not decision-making bodies. They try to create awareness among the masses on health issues, provide guidance to fellow physicians, and lobby with the decision-makers to focus on healthcare delivery mechanisms and to protect the rights of the healthcare providers. PMA has been active on all these fronts. In the country's fight against COVID-19, PMA, like its counterparts in the United Kingdom, the Unites States and elsewhere, issued various advisories for the masses and guidelines for the healthcare professionals.

In view of the resource-constraints afflicting the national health sector, PMA made its first attempt at alerting all concerned when even the death toll in China was just six. Subsequently, PMA held public awareness sessions and its officials appeared on various platforms to do the same. Professional interaction was initiated with a number of bodies, like the Pakistan Islamic Medical Association (PIMA), the Sindh Chapter of Young Doctors Association (YDA), the College of Family Medicine Pakistan (CFMP), the Young Nursing Federation, the Midwifery Association, as well as the Sindh High Court Bar Association and the Karachi Bar Association for mass awareness on COVID-19. The next step was collaboration with organisations and institutions to guide the authorities and help establish a field isolation centre in Karachi, which in many ways was in the eye of the storm.

The Central PMA leadership motivated PMA branches, especially those in Karachi, Lahore and Quetta as well as those in the interior of Sindh to take similar steps in their respective areas. The whole activity was professionally coordinated by PMA Centre. PMA's top priority in this hour of national emergency is to ensure that doctors are able to go about their work in the knowledge that they are as safe and supported. While the authorities were time and again urged to provide Personal Protection Equipments (PPEs) to all healthcare workers, PMA Karachi, PMA Lahore and even the smaller PMA chapters have started distributing PPEs to healthcare workers.Masks have been distributed by PMA among the masses at different places.

PMA has worked actively with the community of healthcare workers, requesting them not to let the heat of the moment get to them so that they may continue serving the nation in this difficult time.

PMA delegations have met Sindh Chief Minister and the provincial Health Minister to demand the implementation of the announced Incentives / Risk Allowance for doctors and paramedics who have been serving as frontline soldiers. The PMA success in such endeavours went a long way keeping the healthcare workers focus on their job knowing that PMA was taking care of their professional interests.

In the current phase, PMA is working closely with the authorities to work out standard operating procedures (SOPs) so that the network of community clinics run by Family Physicians and General Practitioners as well as the out-patient departments (OPDs) of hospitals may be made functional under proper and detailed guidelines and with proper protective gear. Telemedicine facilities are also being discussed at appropriate forums.

 

What is needed?

 

Designated hospitals/centres have to be developed and equipped for managing COVID-19 patients. Testing capacity should be expanded at the district level; private labs should be allowed to conduct corona testing utilising polymerase chain reaction (PCR) and serology examination; and specific areas should be placed under lockdown on the basis of hot spot identification of corona-positive clusters.

 

The days ahead

 

The experience of the Chinese Centre for Disease Control and Prevention will help the medical scientists to understand the epidemic and learn from the Chinese experience. The major goal presently is to curb the wide spreading epidemic.

Currently, PMA's energies are directed towards the vital question as to how soon we can establish robust testing for the novel coronavirus in every part of the country, which, combined with contact tracing, is necessary to monitor community spread of the virus until there is a vaccine.

The PMA is in the forefront of the fight both in terms of generating mass awareness and keeping the healthcare workers motivated by taking up professional issues with the relevant authorities. There will be a time to work on ways to improve health spending in the long run, but right now, the COVID-19 fight is far from being over and the target is to live to fight another day.