I blame the Dom Perignon.
The urgent faculty call out came through by email somewhere above the Austrian Alps while heading home from Dubai in January, enjoying our first class upgrade on the A380. The hospitality was second to none, as was the quantity of the first class champagne. By the time I leaned across the aisle to consult my wife on the practicality of going to Pakistan in February she was ready to agree to anything!
So here I am.
The shortage of volunteers for the Life-Saving Skills Course in this country is not surprising. The media coverage in the UK has hardly paved the way for casual visitors since we hear almost exclusively of terrorist activities. There has been unrest of other kinds – public protests over unreliable services such as electricity, and some of the doctors have recently been on strike over working conditions and job security. The reality is that life goes on pretty much as normal for the great majority of people. Most live in the lowlands rather than the lawless tribal areas of the mountainous north and west. It is reminiscent of the UK at the height of the troubles in Northern Ireland when most of the UK was unaffected although the military were active and there were isolated terror incidents in cities far from the centre of the conflict.
Foreign visitors still need to take sensible precautions of course and we have generally not ventured out of the hotel or training venue unless in a group by vehicle to a safe restaurant or shopping mall.
The standard of medical knowledge, experience and skill in the Pakistan faculty is excellent. We have been delighted with the enthusiasm and commitment shown by our partner colleagues and our first course has gone very well. Two of the four visitors have travelled from the UK to their home country to deliver this course which means that we have been able to give 90% of lectures and practical training in the local language. Doctors here are trained through English but midwives and nurses are still much more comfortable in Urdu. Language difficulties do give rise to some amusing misunderstandings such as the candidate who, among the things which might be found during an intimate examination in a case of septic abortion, included ‘a cup of tea’, a startling object for such a location!
She was referring of course to the very real problem of pregnancy outside of marriage in a culture where induced abortion is both illegal and condemned. Unfortunate young women will resort to a variety of unsafe methods one of which is the insertion of an intrauterine contraceptive device such as a ‘copper T’. Great sensitivity and appropriate confidentiality must be exercised in managing these desperate cases aside from the treatment of life-threatening infection, haemorrhage and internal trauma.
Once again this opportunity to teach others is providing me a new opportunity to learn and we have had great fun and camaraderie sharing together in this training programme. I have had the usual encouragement and invitation to return with my wife and the ratio of female to male faculty might provide an additional incentive, to keep an eye on me, though I feel it would also take at least another first class air fare and a case of good quality champagne…