Emergency health care in Pakistan: A look at the Lady Reading Hospital

20 July 2018

In 1926, when Lady Reading started collecting funds to establish a hospital in Peshawar, no one could have anticipated that the facility would one day provide medical care to 28 million people. The hospital meets the health-care needs of people from across Khyber Pakhtunkhwa (KP) and the former Federally Administered Tribal Areas. Today, this 1,600-bedded tertiary care hospital is one of the main referral hospitals for 26 districts of KP.

Lady Reading Hospital (LRH) has stood the test of time – from dealing with mass casualties due to bomb blasts, suicide attacks, fires, displacements to disease outbreaks and accidents. The guards have handled the growing siren of ambulances and the doctors have treated throngs of patients wounded by weapons and bombs. The hospital staff have seen thousands of traumatized family members crowd the Accident and Emergency Department (A&E) at the hospital in the hope of getting urgent and quality medical aid for their loved ones. Approximately, 267 incidents of mass casualty were managed at the hospital between 2007 and 2017.

The A&E department at LRH is the central point for providing 24x7 free-of-cost care to people affected by conflict and other violence. This 172-bedded facility can be considered "a hospital within a hospital" and is a sign of hope for the people of KP who have dealt with the toughest humanitarian crises. The department was handling more than 8,000 cases of emergency – both urgent and non-urgent – each day. However, this number was reduced through the triage system, ensuring that the urgent medical cases received timely treatment.

This quality delivery of emergency health care was achieved as a result of interventions that are systematic, operational and focused on capacity enhancement of health-care workers.

Dr Hamid Shahzad, the director of the A&E department, said, "There was a need to realign the systems and procedures to facilitate the best of critical care. This was only achievable through skilled and committed emergency professionals working in a conducive environment."

The International Committee of the Red Cross (ICRC), with its vast experience in providing emergency health care, stepped in as a partner with LRH and signed a Memorandum of Understanding in 2016. The focus was to implement modern scientific interventions that were tailored to the local context. This led to the development of sustainable systems using existing infrastructure and capacities through the provision of equipment and lifesaving medicines, clinical support services, surgical services, infection control and emergency preparedness and response.

"It is satisfying to see the changes in the A&E department as a result of this meaningful collaboration that has had a direct impact on the quality of health-care delivery," said Felicity Machoka of the ICRC who has led the project since its inception two years ago.

Interventions such as the addition of a triage system have proved to be monumental in the delivery of emergency health care. The four-tier evidence-based triage system has greatly improved the provision of timely care to emergency patients by decreasing the flow of non-urgent patients through the department. The introduction of directional signage in the emergency department has further streamlined things. In addition, more than 2,300 staff have been trained in mass casualty response and trauma care, weapon-wound surgeries, basic life support, intravenous therapy and other relevant topics.

"The triage system, trauma care and medical care have benefitted from the cooperation with the ICRC," said Dr Mukhtiar Zaman, the medical director at LRH.

LRH is the sole public sector A&E department that has recently been recognized by the Pakistan Medical and Dental Council as a training centre for postgraduate studies in emergency medicine. For the ICRC, the collaboration is the best example of relying on local agility for addressing the needs in a sustainable and cost-effective manner.