“It was august 10, 2018 Saturday morning. A young patient of 32 years was brought to the emergency room District Headquarter Hospital Chitral. He had electric shock at his shop and was unconscious. Two male nurses rushed to the patient. One of them with a blink of eye identified that he is pulseless he started CPR the other pulled crush cart. He attached the defibrillator in seconds and identified that the rhythm was ventricular Tachycardia and gave a shock without wasting any time. I could see the father of this young patient weeping like a child sitting at the bench. Let me remind you ,this is a public sector secondary care hospital at Chitral where it’s inappropriate, but culturally acceptable and allowed that attendants and family members be there with the patients in a life threatening situation. Secondly, there is no separate resuscitation room. You have to do it out in the open in front of other patients, attendants and other people who have come in the hospital for one reason or the other. You can’t imagine how difficult it is to move around with mob of attendants around you and how vulnerable you are if this mob gets angry. Any how a physician, remember a physician;not a cardiologist, rushed in and took the lead. Multiple shocks were given, antiarrhythmic agents were given and after a CPR of about 40 minutes the patient took a spontaneous breath. His circulation came back and further treatment was initiated. In the evening the patient was relatively stable to refer so was referred to Peshawar. When I inquired from one of the attendants about the patient, he told me that he is at Rehman Medical Institute. He also elaborated that they didn’t have to intubate him even andthe doctors are hopeful that he will recover soon. He also told me that the doctors at the Lady reading Hospital and Rehman Medical Institute appreciated the efforts of the DHQ hospital Chitral. We pray and urge everyone to pray for his health.”
This is not a single case that these male nurses have a handled miraculously well rather there are countless such cases. One such case was an old patient who was brought to Emergency a year back. Back then there were some more young male competent nurses from down district. “This old man had cardiac arrest and was brought to emergency. He was pulseless and one of these boys was present at the bed he ran for defibrillator and attached it. Patient was in ventricular fibrillation. He immediately defibrillated the patient and meanwhile all the male nurses rushed in and CPR was initiated and the patient got resuscitated in 15 minutes. He was admitted at the CCU for five days and then discharged home. He is still alive and living a happy and healthy life.”
Male nurses Aftab and Hayat with the resuscitated patient when he was going home
Cardiopulmonary resuscitation was not done with such intensity, competence and organized team work before. Even it was and still is discouraged by some health care professionals including doctors, and they have this view that it is disrespect to the dying. No one was aware of the nitty-gritties of this life saving intervention. The doctors would be aware of it but they themselves are not well trained. Among nurses at the public health sector there is a dearth of basic knowledge of resuscitation even. So, due to religio-cultural reasons, lack of well-trained team, and less knowledge of lifesaving drugs there was reluctance to do CPR or even if it was done it was not done with the intensity and organization which is required. It is when these professionals joined the health department the myths took a back seat and competence and dedication took the driving place. Their competence, professionalism and confidence pushed the physicians to join them. They updated the Coronary Care Unit with their knowledge and experience. New defibrillators, cardiac monitors, crash carts and ventilators were installed. Most of the lifesaving drugs were made available and regularly purchased and updated. The quality of care particularly critical care has drastically improved over the last two years. The credit also goes to the physicians, hospital administration and provincial government. The government has injected trained human resource, money and equipment into the public health care sector which is paying off.
Professions are like individual human beings. Respect can be commanded by any profession if its practitioners are competent and professional in their approach. In Pakistan most of population avails public sector health facilities, and on the basis they form a general perception of nursing.That perception unfortunately is a bad perception. It is true without any doubt that nurses at the public health sector are incompetent and professionally not well-groomed.When one tries to dig it down to understand the reasons he/she certainly ends up at the nursing schools and colleges. Nursing schools and colleges at the public health sector compromise on merit; they lack a curriculum that can bring about overall professional development and well trained faculty members. So, the benchmarks for nursing shall be high as there at the Aga Khan University. When the nursing schools and colleges set the standards high, have challenging curriculum and well equipped faculty members the nurses will be competent and professionally well groomed. That eventually will lift the image of nursing. Secondly there is a dire need of continuous nursing education in the public health sector. Nursing knowledge is continuously evolving, new researches are done, and new evidence based practices are introduced. So, lack of continuous education at the public health sector keeps nurses away from up to date knowledge and skills.
Through their competence, professionalism, dedication and leadership skills these two boys have introduced altogether a new image of nursing. They have earned respect for themselves and as well as for their profession. They have also formed a district nursing association named as Chitral Nursing Association which is striving for the betterment of both nursing andnurses in the district. One of these nurses is the president of the association and the other is press secretary.
After their undergraduate degree in nursing and mandatory work at The Aga Khan University Hospital they returned home to serve their own people. This initiative in itself is so noble, because not so many return and that to serve their own community. This return of them was rebelled by their friends and families. Their friends and families had big dreams and they had associated big booming careers with them. They too are ambitious but their ambitions do not alienate them from their origin, their people and community.
They both have qualified the written test for Masters in Science of Nursing of the prestigious Aga Khan University and I have no doubts what so ever in my mind that they would be selected. I hope and pray for theirflourishing careers and life ahead and I urge the government health department to take care of such professionals and help them grow in their careers. This willbenefit the professionals themselves, the profession of nursing andthe department of health too. Eventually the general population will be benefited.
Male nurses Sohail Nasir {Press secretary CNA} and Aftab Ahmad {President CNA}
