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LAHORE: Punjab Rural Support Programme is
continuously monitoring the provision of primary health care in twelve
districts of the province under the Chief Minister’s Initiative for
Primary Healthcare. The Project Director publishes monthly proceedings
of the meetings held in various districts which give an insight
regarding the functioning of various basic health units, the problems
and difficulties faced if any and the measures undertaken to solve them.
As a part of capacity building measure and continuing medical education
of the in charge Medical Officers of the Basic Health Units, diagnosis
and management of common diseases is also discussed by various resource
persons.
The report for the month of May 2009 provides an insight in to the
working of this project in Districts of Rahim Yar Khan, Chakwal, Vehari,
Lahore, Faisalabad, Sahiwal, Kasur, Mianwali, Toba Tek Singh, Lodhran,
Hafizabad and Pakpattan.
At one of the meetings basic tools for the newly inducted in charge
Medical Officers were discussed in detail and they were asked to ensure
their implementation. Punctuality, timely arrival of the staff, timely
provision of services to the patients, reporting late arrivals to the
DSU was emphasized. It was also observed that though most of the Basic
Health Units were doing a commendable job, some of the BHUs were
reported closed due to late arrival of the concerned staff. Casual leave
by the staff members, it was stated, should not affect the functioning
of the Basic Health Units.
In the Continuing Medical Education programme, Dr. Raja Mehdi Hassan
Consultant Cardiologist at DHQ Chakwal delivered a lecture on Acute
Myocardial Infarction and Coronary Heart Diseases at a meeting held in
Chakwal. The typical and atypical symptoms which he mentioned include
chest pain which may radiate to arms, jaw, neck and epigastrium, profuse
sweating and palpitation, nausea, vomiting, dyspnea etc. The risk
factors which he highlighted included hypertension,
hypercholesterolemia, obesity, smoking, family history, diabetes
mellitus, stress and lack of physical activity. For diagnosis of acute
myocardial infarction or heart attack, clinical history, ECG changes and
raised enzymes levels are the well known indicators. During initial
management these patients, he said, must receive reperfusion therapy
with injection streptokinase. It should be administered in coronary care
unit under proper cardiac and BP monitoring. Complications include
cardiogenic shock, cardiac arrhythmias, pericarditis, pericardial
effusion, pulmonary embolism, ventricle septal defect and acute miteral
regurgitation.
It was heartening to note that while talking about initial management of
Acute Coronary Syndrome, he did mention the use of oral aspirin therapy
which often proves to be life saving and is the most cost effective
treatment in such conditions. Despite numerous studies proving its
safety and efficacy, Aspirin is still under used in ACS and particularly
in AMI by the patients themselves or by the Family Physicians, a
situation which needs to be rectified. Pakistan Aspirin Foundation has
been holding seminars in different cities of the country as well as at
various medical institutions to promote the use of Aspirin in its well
established indications but still a lot more needs to be done to ensure
optimum use of Aspirin in ACS and AMI. He also laid emphasis on regular
walk, use of healthy and balanced diet and compliance with drug therapy.
District Nazim Vehari Syed Shahid Mehdi Naseem addressing the
participants of the meeting held in Vehari commended the working of the
programme. He specially praised the doctors working in the Basic Health
Units in far flung rural areas looking after the poor who cannot afford
doctors fees as well as drugs. By helping these poor, these doctors were
in fact helping in alleviating poverty for which they will be rewarded
by God Almighty. He also promised to help the doctors solve their
problems if any while efforts are on to regularize the services of
doctors appointed on contract basis, he remarked.
Prof. Ziauddin Ahmad delivered a lecture on diagnosis and management of
common eye diseases at a meeting held at Faisalabad. He talked in detail
about the causes of red eye, conjunctivitis which could be bacterial,
viral or allergic, acute congestive glaucoma, corneal ulcer, scleritis
and episcleritis, trauma of different kinds, diseases of the eyelids,
cataract and glaucoma, squint or strabismus, causes, signs and treatment
of retinal diseases etc.
Dr. Muhammad Saeed discussed allergic rhinitis and opined that those
patients who complain of persistent dysphagia for more than four weeks,
persistent hoarseness of voice for more than four weeks, unilateral
blood stained nasal discharge in an adult, patients with inspiratory
stridor, deaf and dumb children, ear discharge with vertigo, recurrent
epistaxis, patients with cervical lymphadenopathy should be referred to
the ENT surgeons.
Dr. Shahid Hussain spoke on Enteric Fever at a meeting held at a meeting
in District Hafizabad. The common symptoms which he mentioned included
severe headache, fever, loss of appetite, general discomfort, uneasiness
or malaise, rash appearing on the lower chest and abdomen, constipation
, blood in stools, fatigue, weakness, chills, confusion and agitation
etc. Treatment is with intravenous fluids and appropriate antimicrobial
agents. Its complications include intestinal hemorrhage, intestinal
perfusion, kidney failure and peritonitis, he added. |
