U.S. helps Pakistan, Afghanistan improve trauma care

U.S. doctors who have been working with Pakistan to improve emergency medical care are expanding into Afghanistan with hopes of helping trauma treatment in the war-torn region.

With support from the U.S. National Institutes of Health, Johns Hopkins University is expanding the International Collaborative Trauma and Injury Research Training Program — an advanced research-and-doctoral training program in Pakistan. After working with Aga Khan University and others in Pakistan for 12 years, it will expand to some leading public health institutions in Afghanistan.

“Creating in-country experts who can help identify, develop and implement strategies to prevent and treat injury and trauma is key to reducing death and disability,” says Dr. Roger Glass, director of Fogarty International Center, the arm of the National Institutes of Health that supports research and training in the developing world.

Emergency workers on road in bomb aftermath (© AP Images)
Research into emergency medical services in Afghanistan may improve the treatment of trauma victims at scenes like this, the site of a suicide attack in Kabul. (© AP Images)

Afghanistan has an exceptionally high injury rate. There are 4.5 million Afghans living in conflict-affected districts with limited access to trauma care. The World Health Organization reported 2,181 civilian casualties due to injuries sustained from terrorist attacks in the first quarter of 2017.

Dr. Adnan Hyder, director of Johns Hopkins University’s International Injury Research Unit, hopes the program can have as big an impact on public health policy in Afghanistan as it has in Pakistan.

“To me, the fundamental innovation here is to stop the … brain drain,” said Hyder, adding that all trainees from Afghanistan will be asked to do work that will not only contribute to their degrees but also to the important policies around injury and trauma in their country.

Pakistan model

Over the last decade, Hyder and his colleagues have trained 25 specialists who have gone on to conduct some of the first comprehensive research on trauma care in Pakistan — from studying the treatment of near-drowning incidents to the outcome of bomb blast injuries.

“We’ve been an important part of the story of studying emergency medical services in Karachi,” says Hyder. He believes that more research must be done for trauma and injury to become health-care priorities in the developing world.

Ninety percent of the world’s 5 million injury-related deaths that occur each year happen in low- and middle-income countries, where hospitals have limited resources and trained staff is stretched thin.

People looking at a blast site in Pakistan (© Arif Ali/AFP/Getty Images)
Bombs contribute to high rates of trauma cases in Pakistan. (© Arif Ali/AFP/Getty Images)

While traffic accidents are the leading cause of injury worldwide, countries like Afghanistan and Pakistan have the added challenge of chronic violent conflict. The program’s research repeatedly cites terrorism as a leading contributor to injury in Pakistan.

The program, which Hyder launched in 2005 with physicians from his alma mater, Aga Khan University, has made its mark. After publishing a report on ambulance use in Pakistan, one of the collaborators helped launch emergency medical services in Karachi, a city of more than 18 million people that had no existing formal emergency services.

When Pakistan passed a National Health Vision policy in 2016, several program participants were invited to write the chapter on injury, ensuring that it was recognized as a national health issue alongside other noncommunicable diseases.

Hyder says his program is assembling a forum in Kabul in early 2018 with policymakers to discuss how injuries and trauma are affecting Afghan people.