South Asia region Montegut Scholar Report - Dr Sanam Shah

Dr Sanam Shah of Pakistan was awarded the Montegut Scholarship for the South Asia region. She is the national secretary, Pakistan for the WONCA Spice Route Young Doctors’ Movement and report on her attendance at the recent South Asia region conference in Nepal.

I was extremely delighted and humbled to receive the Montegut Scholarship Award courtesy of The American Board of Family Medicine Foundation (ABFM-F) to attend the WONCA South Asia Region (SAR) Conference in Kathmandu, Nepal in November 2017, themed “GP Specialist Pro-gressing Towards Universal Health Coverage”.

It has been my first WONCA Conference as well as my first time in Nepal!

The WONCA SAR was centred around The Spice Route Young Doctor’s Pre-Conference followed by the main Conference and saw attendance from all South Asian countries as well as globally.

I was honoured to represent Pakistan and speak about the Spice Route accomplishments in Pakistan thus far, despite numerous challenges; from holding the first Spice Route workshop in Karachi in December 2016 to setting up Family Medicine Departments in the city. It was really humbling to speak before Dr Garth Manning, Prof Amanda Howe, Prof Kanu Bala, Prof Narayan Prasad and other great physicians in the audience!

Since I am providing tertiary hospital based care as a GP, I was fascinated to hear from GPs in Nepal about their tremendous contributions in primary care, made more incredible as it has flourished and continues so, despite infrastructure and resource challenges. Especially moving was the video of the plight of Nepalis to access basic medical care as presented by Dr Mark Zimmerman. It was enlightening to learn how doctors saved Nepal’s rural hospitals and the “8Cs Bundle” of comprehensive healthcare provision.

The main conference spread over two days had excellent plenary and scientific sessions. There was a grand Cultural Opening Ceremony and excellent oration on “Opportunity comes but does not linger” by Prof Amanda Howe.

I was honoured to again represent Pakistan during the WORSA - Rural young doctors and students in rural practice workshop alongside Dr Raman Kumar and other GP colleagues from India, Sri Lanka, Bangladesh and Nepal. I believe that in Pakistan, GPs are doing a great service to rural communities but as always there is a magnetism toward urban practices because of better amenities. Therefore we need to encourage rural GPs to associate with the present WONCA members in Pakistan and regionally, encourage learning from experiences and research and academic collaborations as our working conditions are more alike than different and the support drawn from WONCA can positively impact the present primary care and family medi-cine landscape in Pakistan.

During the scientific sessions, I delineated the opportunities for exchange programs in family medicine in Pakistan during one of my oral presentations (pictured) and reiterated the need to develop “FM 360” to fully accomplish the aims of any exchange in the region. My second oral presenta-tion the same day was centred around the E- Learning initiative by College of Family Medicine Pakistan. Since it has had much positive impact in Pakistan, I concluded with the need to develop more E- Learning programs, delivering education to GPs outside Pakistan and encouraging E-Conferencing amongst different countries.

The scientific sessions drew attention to some urgent but rarely vocalised issues like “patient initiated violence” in Bangladesh, which is as much of a concern in Pakistan. It was disheartening to hear about the lasting psychological impact it can have on healthcare personnel. Other useful themes covered during the scientific sessions included clinical skills of GPs in rural Nepal, competency based medical education in General Practice Residency Program in Nepal and Evaluation of the rural staff support program (RSSP) amongst others, all equally vital to bring back lessons to Pakistan.

The second day of the Conference was equally impressive. Among other excellent talks was one by Prof. Kanu Bala about the “Hippocratic Family Physician” and his words resounded wide when he relayed that “ physicians always be well-kempt, honest, calm, understanding and serious”. There was a diverse range of topics from the supportive and palliative care indicator tool (SPICT) that particularly caught my attention as it is a resource to enable GPs to provide palliative care as part of Universal Health Coverage; to collaborative intervention of GPs and social workers to improve occupational health.

I am more determined to improve the quality of healthcare in Pakistan and one aspect that particularly concerns me is rural health, especially so because I belong to a village in the Sindh province of Pakistan, and how to garner support for rural healthcare. I have most certainly to take a lot from my Nepal experiences, from meeting and networking with the world leaders in family medicine and primary care, meeting the pioneers of The Spice Route Movement and having renewed vigour to take their efforts forward in Pakistan and regionally, to following the exceptional work conducted in Nepal and other South Asian countries to improve health indicators in Pakistan as well. I am really fortunate to meet GPs from different countries and being able to share experiences from Pakistan and discussing about ways to encourage bilateral networking in academics, research and exchange programs in family medicine.

Lastly I would again thank WONCA, The American Board of Family Medicine Foundation (ABFM-F) for their generous Scholars Program in Family Medicine, Dr Shehla Naseem, General Secretary College of Family Medicine Pakistan, for her support and guidance and all my colleagues who have helped and motivated me all the way.