Dilshad Ladhani, Dr Nasir Jaffer and Dr Alim Punja generously contributed their time and expertise recently at the Aga Khan Health Service,Pakistan’s (AKHS,P) health facilities in Gilgit-Baltistan (GB) and Chitral. These dedicated TKN volunteers came at a time when AKHS,P is significantly expanding its footprint in GB and Chitral. New wings recently opened at the medical centres in Gilgit and Booni that include additional specialties and facilities. Diagnostic centers have started services in both regions and construction of a purpose built, modern facility to house the Aga Khan Health Centre,Aliabad, is in process. These are indeed exciting times for AKHS,P.

The model that AKHS,P uses to provide critical services to communities in GB and the two districts of Chitral has been dubbed the “hub and spokes model.” The smaller health facilities are managed by Lady Health Visitors or community health nurses who refer the more complicated cases to the larger secondary care health facilities. Select smaller health facilities also offer teleconsultations with specialists at Aga Khan Medical Centre,Gilgit (AKMC,G) and the Aga Khan Medical Centre,Booni (AKMC,B). These larger healthcare facilities in turn are connected with the Aga Khan University Hospital in Karachi.

Ms Dilshad Ladhani - Senior Microbiology Technologist

In 2011, Dilshad travelled to Nairobi to volunteer at the Aga Khan University Hospital laboratory, where she helped the lab achieve the South African National Accreditation Standard. With her rich experience as a medical lab technologist that spans 20 years, Dilshad has also worked in mentorship roles to train microbiologists.

Dilshad’s recent visit to GB gave her an important glimpse into the operations of the laboratories at the AKMC,G and at the Aga Khan Diagnostic Centre, Jutial. This was Dilshad’s first trip to GB and her second assignment as a TKN volunteer. The remoteness of the region, coupled with the rocky terrain and vast distances, presents a challenge for healthcare delivery.

This assignment was a very positive experience for Dilshad and her colleagues. The staff were kind, respectful and polite. Most importantly, they had a willingness to learn and adopt new procedures to improve the function of the lab. Her assignment objectives were to: a) review the existing standard operating procedures in microbiology; b) assess the microbiology section of the lab to ensure it is compliant with SafeCare accreditation; c) advise on instrumentation and organization of the lab once it is expanded; and d) to engage in knowledge sharing with lab employees.

This trip helped Dilshad form a baseline of where the microbiology unit stands. “It is my wish for the AKHS,P lab in Gilgit to become an accredited, gold-standard lab that provides quality testing for the people it serves,” says Dilshad when asked about how she sees the laboratory in the long term.

Commenting on lasting impressions of the trip Dilshad said: “In sharing my knowledge I feel that I learned a lot too. It was a very fulfilling trip, and I will surely miss the time I spent here.”

Dr Nasir Jaffer – Radiologist

Dr Nasir Jaffer has specialized in Vascular Interventional Radiology and currently practices medicine as an Abdominal Radiologist at the University of Toronto. He is passionate about teaching at Undergraduate Medicine and Post Graduate Radiology. Dr Jaffer is no stranger to volunteering his time and skills. His first TKN assignment was in 2007 when  he spent four weeks teaching radiology residents at the Aga Khan University (AKU) in Karachi. His most recent assignment was in 2016 to assist a team to conduct an audit at the faculty of medicine’s undergraduate medical program at AKU Karachi.

This was Dr Jaffer’s first assignment with AKHS,P. It included reviewing the radiology program, capacity building and  assessing opportunities in educational enhancement of radiologists, physicians and paramedical staff at AKMC,G, AKMC,B and AKHS,P’s other secondary care facilities in GB and Chitral. He also explored developing a new program of enhanced ultrasound curriculum (POCUS) for Lady Health Visitors and nurses, with guidance from AKU Nairobi.

Speaking about what he hoped to accomplish, Dr Jaffer said, “Apart from my TKN assignment related to health services, I hope to continue learning about the history and culture (of the people of GB and Chitral), by visiting their towns and villages and to observe how the communities have successfully dealt with the challenges of living in remote regions. This knowledge will, hopefully, help me inspire and guide future TKN volunteers, specifically in the area of radiology.”

Dr Jaffer visited GB in 2005 but he was pleasantly surprised by how the region has changed since. He says, “this visit has allowed me to see the tremendous positive change both in the physical environment and human potential and confidence in the community and the youth. Our health Institutions and the Jamat have garnered deep respect and admiration from the community at large.”

Dr Alim Punja – Consultant Anesthesiologist

Dr Alim Punja has fellowship training in interventional pain management and a master’s degree in public health. Although he wanted to volunteer for some time, this first TKN assignment for him happened just at the right time.

Dr Punja’s main objective was to assess the current state of anesthesia and perioperative medicine practice at AKHS,P facilities in GB and Chitral where AKHS,P has been active for a number of decades. In addition, AKHS,P requested Dr Punja's input on a realistic approach to increase anesthesia and perioperative care capacity in the area.

Speaking about his experiences in GB and Chitral Dr Punja said, “the distances I was looking at on the maps of the area were short, but the landscape made it take much so much longer to travel those short distances than I had anticipated. The people are strong and resilient. I knew that they would be before visiting; they have to be living in this environment which, because of its terrain and climate, is beautiful and awe-inspiring, but also harsh and difficult.”

Dr Punja believes that AKHS,P's current model of health service delivery is effective. “There are multiple services being offered in various disciplines of medicine and surgery and the model (hub-spoke) is providing an interesting and context specific method of delivery,” but there is always room to improve services. This meaningful change will take time, since nothing lasting happens overnight.

Dr Punja views this as an initial site visit to assess the current capacity and practice in the GB and Chitral regions. “I’m looking forward to understanding the geography and the distribution of specialized medical services within this large area. I’m hoping to build some relationships with key individuals to develop delivery of better care within their own areas of expertise so that there is a broad and integrated approach to perioperative care,” said Dr Punja commenting on his long term goals of the collaboration with AKHS,P.

AKHS,P is immensely grateful to Dilshad Ladhani, Dr Nasir Jaffer and Dr Alim Punja for their exemplary contribution of time, knowledge and extensive expertise during this visit. Their remarkable dedication and inspiring passion to train the local team members was deeply appreciated.