Written by Anisa Jafar, ST7 in Emergency Medicine & Houghton Dunn Fellow, North West deanery & University of Manchester
Edited by Philip Delbridge
For the linguists amongst you the wordplay of the 1st international cHALO conference will not be lost. For the rest: in Urdu, “chalo” means “let’s go”. And what could be more fitting an acronym for an emergency medicine (EM) conference whose purpose is to really propel the progress of the speciality in Pakistan? What it actually stands for is ‘collaborative Hubs of Academic Learning Organisations’ which is a bit less catchy than cHALO!
The theme of the conference, which took place in Lahore’s prestigious King Edward Medical University, was ‘Emergency Care: Excellence in the Golden Hour and Beyond’. Its programme took place over 2 days with a prior day of pre-conference workshops (split into 4 streams: arrhythmias, trauma, leadership, and sedation). The faculty included a mix of international and national experts in different aspects of emergency care.
Many of these veritable heavyweights in our EM speciality and its allied areas, made the journey to Pakistan: certainly with John Heyworth, Fergal Hickey and Taj Hassan (the latter, Chair of the Scientific Programme) it was hard to move without tripping over past-Presidents of UK/Irish EM colleges/associations.
The development of emergency medicine in Pakistan, as with its development the world over, brings with it some inevitable challenges. Whilst there are some early adopting supporters from allied specialities, there are of course tensions and turf wars over where boundaries lie and what constitutes this “new” speciality. Certainly the Pakistan Society of Emergency Medicine itself is very young, forming only in 2017, and therefore creating a foundational identity and streamlined approach to training takes time.
Furthermore, Pakistan serves a huge 240 million population and the distance between major cities in different provinces is represented not only in hundreds of kilometres, but also by differences in culture, because Pakistan itself is a hugely diverse country – with up to 80 languages being spoken. In fact, another diversity mirror was held up to the patchwork of lead-cause mortality across the country by a 2023 Lancet study, demonstrating that barring the top two, priorities are quite distinct from one area to another in terms of statistical burden. To complicate matters further, the healthcare system is not truly free at point of entry for most people: whilst public health facilities may exist, the provisions within them are frequently limited by what items the patient can afford to purchase. At the same time, emergency departments are overburdened and minimally staffed. In comparison, at the other end of the spectrum there are some state of the art private facilities. In between the two are various models whereby an attempt is made to level the playing field such that richer patients’ contributions can offset the need for poorer patients to pay for care. The financial models making this work are as diverse as the country’s landscape. Whilst this in itself enormously complicates any attempt to harmonise a training approach, what is heartening is that so many people are trying hard to make the process work: those who believe in providing emergency care to the most vulnerable exist everywhere in Pakistan. The challenge of the next decade will of course be to resolve the identity of a single speciality.
Back to the conference itself – our hosts were gracious and generous, especially to the international faculty who comprised a mix of Pakistani diaspora (removed generationally in different ways) alongside those with no link to the country, but with an interest in supporting its EM development. Getting the chance to fit in a visit to some historical sites, in between a packed programme, was a highlight. The Lahore Fort, Badshai Mosque and Wagah-Attari border are all world-renowned. And whilst not necessarily a world heritage site, we were also privileged to be able to visit the Mayo hospital’s newly refurbished Emergency Department situated very close to the Paediatric Emergency Department which is supported by Childlife Foundation. Let it be said that no matter the newness of the building, the stark reality of the burden of emergency cases even in the few minutes spent looking around the departments, gives a sense of the enormity of the challenge which faces our EM colleagues in Pakistan, a country where half cannot even access healthcare services.
The challenge is very much on, and the dial will be slow to move, but move it will – and watch this space for more from cHALO in 2025.
