Sometimes when Dr Muhammad Tahir is out and about in Peshawar, Pakistan, his phone rings. When that happens, he knows that time is of the essence.
A child has spilled boiling water on themself, a car has burned out in an accident, or there has been an explosion in which people have been injured by fire. Sometimes this will have happened hundreds of miles away from Peshawar and its hospital, the Hayatabad Medical Complex. Tahir is well aware that in the case of burns, the first twelve hours are critical. He is a doctor, specialising in burns injuries. Sometimes there is not enough time to transport the patients from the isolated regions of Pakistan’s highlands or the Afghan border region to Muhammad Tahir in Peshawar. On some days, all the beds on his ward are simply occupied. The Burn and Trauma Centre at Hayatabad Medical Complex (HMC) currently only has 14 beds.
In the words of Jens Clausen, “The need is immense”. He is the Vice Chair of the PATRIP Foundation, which is implementing and monitoring the project on behalf of the Federal Foreign Office and the KfW Entwicklungsbank (KfW development bank). The NGO estimates that there are around 30,000 burns injuries in the region each year, and not enough experts like Tahir by far. The region on the border of Pakistan and Afghanistan is one of the poorest in the country. It has a reputation as a Taliban breeding ground. Clashes between Afghans and Pakistanis are frequent, and care for the sick and injured is inadequate. “Medical care is very poor, particularly in more specialised medical fields such as trauma injuries and burns,” Clausen states.
Since 2014, with the support of the Federal Foreign Office, five Burn-Trauma/Reconstructive and Plastic Surgery Centres (BTRPSCs) have been established, initially three in Pakistan, and then two more in Afghanistan in 2016.
Tahir has been working as a surgeon for almost 20 years. His specialisation is complicated skin transplants for burns. He is regarded as a renowned expert in his field. He was born in Peshawar and completed his schooling there, before studying medicine at the prestigious Royal College in Dublin. In Glasgow he learned how to perform skin grafts and then returned to his home city to develop the department of plastic surgery at HMC.
Jens Clausen also heard about his work. When planning the development of the BTRPSCs in Afghanistan with the NGO Wish International, he was confronted with a major problem: the doctors and nurses in the remote regions have no training in the area of burns or trauma management: “They lack know-how,” Clausen says.
The idea with which Wish International approached the PATRIP Foundation was this: Tahir could play a kind of satellite role, be a sort of interface, as Clausen describes him.
He trained the doctors in the five BTRPSCs through workshops and seminars.
They travelled to Peshawar to Tahir’s hospital, where he trained them: He showed them photographs of burns injuries. He taught them how to recognise the different degrees of burns, how to clean a wound, when antibiotics are necessary, how the skin can be fixed in place. “The initial care following an accident is particularly important,” Tahir explains.
“The project and the centres are helping to reduce tensions between the countries”
Afghan and Pakistani doctors sit together in Tahir’s workshops and seminars. That is another idea of the project: that doctors from the two countries should learn together. “One of our priorities is to contribute to international understanding and to improve the integration of the remote areas,” Clausen states. Around 27 percent of the patients in the Pakistan centres are Afghans. The Vice Chair of the PATRIP Foundation explains, “The project and the centres are helping to reduce tensions between the countries”.
Tahir hopes that soon it will no longer be necessary for doctors to undertake the often long and arduous journey to Peshawar for their training – but instead that he will be able to train them via video conference.
Seven months ago, Tahir and his colleagues in the smaller wards were provided with telemedicine equipment. The Federal Foreign Office has made available 150,000 euros in funding for the project.
The doctors and Tahir were given the necessary technical equipment, such as scanners, monitors and computers. Now, if an emergency case arrives in one of the BTRPSCs and cannot be transported further, the doctors can phone Tahir. So far, a total of 1005 cases have received support through the telemedicine concept.
During his visit in conjunction with the Federal Foreign Office, Clausen witnessed a telemedicine conference between the HMC in Peshawar and a BTRPSC doctor in Bannu, in north-western Pakistan. “The connection was very good”, he says.
Tahir explains, “I can then help the doctors, particularly with more complicated cases.” They can describe the accident to him on the phone, he can receive photos via WhatsApp or Skype, view the patient and their injuries on a screen – and even speak to them. All this can be life-saving. Telemedicine enables a diagnosis to be made at a distance.
In an emergency, he will also guide the doctors through an operation by following the procedure on video. He can monitor the patient’s pulse and blood pressure and ask to see the site of the burn. “I can always be contacted, even when I’m no longer at the hospital,” he says. The doctors have his private phone number.