PESHAWAR: It was during the months of April and May last year that the situation in Khyber Pakhtunkhwa’s biggest hospital, the Lady Reading Hospital (LRH), seemed to be desperate.
The first wave of COVID-19 had hit the province and the hospital’s performance in treating patients suffering from the deadly disease was noted to be abysmal.
The personal protective equipment was in short supply, staff were not trained about how to protect themselves from getting infected; it was chaos all over.
The situation was worse where it needed to be most efficient and best: the Intensive Care Unit (ICU) of the hospital. The high mortality rate there was a huge embarrassment for the administration and most agonizing for the families of the sick. It was reported that the ICU mortality rate was 100 percent or very close to it.
The patients needing critical care because of COVID-19 were all dying at the hospital. In those days, the other two hospitals in Peshawar, the Khyber Teaching Hospital and Hayatabad Medical Complex, were comparatively better than the LRH.
It was at that time that a group of doctors from the Khyber Medical College Alumni Association and Association of Pakistani Descent Physicians of North America (APPNA) stepped forward to help.
These were ex-graduates of Khyber Medical College or other Pakistani medical colleges, having specialised in the fields of Critical Care or ICU medicine in the USA and practicing there. Some of them were nephrologists as well. These highly specialised doctors read about the agony of the patients at LRH and decided to help.
Dr Rashid Hanif is the president of KMCAANA, said: “We already had a Memorandum of Understanding or MOU with the administration of LRH dating to a few years ago. As per the MOU, critical care doctors visiting Pakistan from the USA would spend a week or so doing rounds at the LRH ICU and interact with the doctors there. It was, however, not happening on a frequent ad regular basis.”
“When news of the COVID-19 situation in LRH reached us, we were very concerned. Professor Aamir Ghafoor, a faculty and former Medical Director of the hospital, called us and asked us to see if we could help in that emergency like situation,” Dr Hanif further explained.
Dr Rashid Hanif, Dr Sharif-uz-Zaman Khan and Dr Sajjad Savul of KMCAANA reached out to their critical care and nephrology colleagues in the USA. Dr. Savul talked about the enthusiasm of their colleagues, “It was overwhelmingly positive.”
The team assembled comprised of some of the most highly specialized and accomplished ICU doctors. These include Dr. Abrar Khan, Dr Attiya Siddiqui, Dr. Fuad Gillani, Dr. Majid Mughal, Dr. Ghulam Khaleeq and Dr. Sumera Ahmed.
The nephrologists stepping forward were Dr. Tausif Zar, Dr. Abdul Moiz Khan, Dr. Behram Mohmand, Dr. Hameed Ahmed, Dr. Zeeshan Pervez, Dr. Zubair Khan and Dr. Hashim Mohmand.
These volunteer doctors drew up a schedule and paired up in teams of one intensivist and one nephrologist. After getting the nod from the hospital administration through Dr. Nausherwan Burki, chairman of the Board of Governors LRH, a plan was devised to start remote or the tele-rounds in the LRH ICU.
The team would connect through to the local ICU rounding team on internet and make virtual rounds with them. They would take part in the discussion about the patient’s history, clinical examination, laboratory findings and clinical status. A treatment plan would then be formulated in collaboration with the doctors on the ground.
The teams rounded on every single patient in the LRH ICU every single day from May 2020 through October 2020. From November 2020 to date, the rounding continues but two days a week. Dr. Behram Mohmand, one of the rounding doctors, said: “The initial situation demanded that we round every day. After six months of daily rounds, it was felt that the doctors on the ground could be guided through twice-weekly rounds only. That is what has been happening from November of 2020.”
Dr. Sheheryar is an anesthesia consultant at the LRH. He is one of the consultants managing the COVID-19 ICU. “The help from our colleagues in the USA has been most invaluable. They would discuss each and every patient with us and guide us through their management. We learnt a lot from them. It is like doing an advanced critical care fellowship,” Dr Sheheryar explained.
KMCAANA is very appreciative of the role of Prof Aamir Ghafoor. According to Dr Sahrif-uz-Zaman, Prof Aamir Ghafoor has been their pivotal contact and go to person at LRH. Speaking of his role, Dr Rashid Hanif says: “Dr Aamir Ghafoor is the most enthusiastic and energetic person. Being a gastroenterologist, he could have stayed away from COVID-19 patients, but he felt he had a duty to perform and he did it. In the beginning, he would himself physically join the rounds at the ICU and make sure that everything goes smoothly.”
The success of the virtual rounds by the USA-based doctors shows in the improved mortality numbers in the LRH COVID-19 ICU. From a situation where almost all Very-High-Risk patients were dying, four out of 10 lives are now being saved. For those classified as High-Risk, seven out of ten lives are being saved in the LRH ICU.
Dr Arshad Rehan is the secretary of APPNA. He is all praise for the team assembled by KMCAANA. “What these colleagues of ours did and still doing is unprecedented in the history of Khyber Pakhtunkhwa and probably in Pakistan. Their voluntary work is unparalleled.”
Dr Haroon Durrani is the president-elect of APPNA. According to him, one cannot thank this KMCAANA team enough. Per him, for doctors to log on for voluntary virtual rounds every night at 10 or 11 pm at night in the USA for so long is most remarkable.
The government needs to acknowledge the services of these doctors. They have given their time and expertise to improve critical care in one of the biggest hospitals of KP. It is due to their efforts that the COVID-19 ICU at LRH is now in a position where it can rightly claim to be the best run amongst both public and private hospitals in the province. One way of thanking them and encouraging others would perhaps be giving civil awards to the doctors involved in planning and executing the virtual rounds.
