The first health institution built by Aga Khan Health Services in present-day Pakistan was a 42-bed maternity hospital in Karachi that dates back to 1924.  In Gilgit, the first maternal and child health centre was set up in 1974. While maintaining that early focus on maternal and child health, Aga Khan Health Services, Pakistan (AKHS,P) also offers services that range from primary health care to diagnostic services and secondary curative care. It reaches over 800,000 people across Pakistan.

AKHS,P has been implementing the Northern Pakistan Primary Health Care Programme since 1987 in Gilgit-Baltistan and Chitral – regions that have some of the most remote areas and rugged terrain in the country. Working in partnership with local communities, the government and other AKDN agencies, the goal has been to find sustainable ways of financing and delivering primary and secondary health care.

The varying disease burden in these unprecedented times, changes in the health service delivery landscape and access to healthcare led AKHS,P to implement a ‘hubs and spokes model.’ By adopting this model, AKHS,P has been successful in linking smaller health facilities with larger ones, which ensures optimal use of resources and results in spokes referring serious cases to hubs.

Since the establishment of the Aga Khan Medical Centre, Gilgit (AKMC,G), a number of specialties have been added along with diagnostic and imaging services. For specialties that are not yet available in Gilgit-Baltistan, the facility of teleconsultations with the Aga Khan University Hospital is available, saving the residents of this region time and money that they previously had to spend to travel to other cities to seek specialist care.

In response to the shocking magnitude and repercussions of the Covid-19 pandemic, AKHS,P acted swiftly and six Covid-19 response centres were rapidly set up. Forty-four beds for Covid-19 patients were set up at AKMC,G; eight beds at Aga Khan Health Centre, Singal; and six beds at Aga Khan Health Centre, Aliabad. AKHS,P has also played a key role in the Government’s vaccination programme. To date, more than 42,000 persons in Gilgit-Baltistan have received the first dose of a Covid-19 vaccine and 40,000 persons have received the second dose at an AKHS,P health facility.

Additionally, in a first for the region, critically ill Covid-19 patients were treated at AKMC,G in collaboration with specialists at the Aga Khan University Hospital, Karachi through a live video link. These tele-ICU services are groundbreaking for this region.

Although the vaccination effort undertaken by AKHS,P was widely appreciated, it was decided to transition from molecular testing to RT-PCR testing in order to improve the accuracy and acceptance of results. RT-PCR tests are widely recognized and they process more test samples simultaneously. In fact, for every GeneXpert machine that can process four test samples at a time, RT-PCR testing can process 96 test samples simultaneously. This increased capacity, coupled with wider acceptance, provided the impetus for AKHS,P’s Covid-19 response to set up a modern RT-PCR laboratory. RT-PCR testing is not just limited to Covid-19 and can include testing for HIV, Hepatitis C and other viruses.

It was difficult for AKHS,P to identify a local subject matter expert who could help set up an RT-PCR lab. Having worked with highly skilled TKN volunteers in the past, AKHS,P requested Sehreen Ali to serve on this assignment in November. Sehreen, based in Houston (Texas), has a proven record of accomplishment in clinical diagnostic laboratories and specializes in Flow Cytometry. Before visiting Pakistan, Sehreen successfully set up a Flow Cytometry laboratory in Kenya and trained a team there. Sehreen is a dedicated professional and an incredibly generous person. Commenting on her personal philosophy, she says, “My personal goal is to empower myself and others and share my knowledge with as many people as possible.”

Sehreen’s trip to Gilgit-Baltistan was short but fruitful, with some challenges. Although the equipment had been procured, it had to be set up. In addition to the laboratory staff at AKMC,G, two staff from the City Hospital Gilgit also provided their support. Sehreen and her team had to trouble-shoot a few hardware issues before they could have a running laboratory. She trained the testing team on RT-PCR testing and highlighted the measures required to ensure that the test samples in the laboratory environment were not at risk of contamination.  At the end of Sehreen’s visit, a batch of samples were tested and the results sent to the National Institute of Health (NIH) in Islamabad for cross-referencing. The NIH response is being awaited as it takes a few weeks.

Sehreen Ali says, “All in all it was a great experience and the staff were very helpful.” She plans to return to Pakistan in a few months to check on the progress of the RT-PCR laboratory and advise on any additional measures for improvement.

AKHS, P is immensely grateful to Sehreen for travelling to Pakistan for this assignment and for her exemplary commitment and contribution as a TKN volunteer.