109 Social Emergency Medicine: Pakistan Perspective

Abstract

WHO defines Social Determinants of Health (SDH) as “conditions in which people are born, grow, live, work and age, shaped by the distribution of money, power and resources at global, national and local levels.” The term “Social Emergency Medicine (SEM)” caters to the concept that emergency departments (EDs) provide resource intensive, critical care to high risk patients but also address social health determinants. In USA, ACEP has an established SEM section .with Social Medicine and Population Health Interest Group at SAEM. Fellowships in SEM also focus on incorporation of the patient’s social context into Emergency management. The Indus Hospital (TIH) is a 212 bed, tertiary care center, providing quality treatment, free of cost in Pakistan where social determinants of health result in multiple ED visits, bounce back and loss of income for both the patient and care giver. TIH is in the unique position to address SDH and affect masse, resulting in improved patient outcome. The specialty of emergency medicine (EM) in Pakistan is in its early years and lack of well established primary care has traditionally placed a huge burden on EDs. Preventive role of ED is not taught at undergraduate or postgraduate level. Bedside application of social determinants of health and using it to reach out into the community with well formulated plans will reduce the burden of disease and cost of managing it. The introduction of SEM at national level will develop emergency physicians cognizant of social determinants of health and better trained to address them. a) Collection of data on social determinants of health through ED centered studies with interventions to show improvement in SDH over one year. This data shall be shared with other hospitals in Pakistan running EM programs and presented to local and international donors to secure grants. b) US based fellowship programs in SEM will be approached for collaborative partnerships with the ED at TIH. With our history of collaborative programs, rotating international EM faculty can be engaged to provide training to our residents. c) The College of Physicians and Surgeons (CPSP), the national residency accrediting body has a well-defined EM curriculum. We have designed a three-month module based on SEM which will be used to teach and train our residents as a pilot. It will be presented to CPSP as a proposal to incorporate into the EM curriculum. This will ensure that all Emergency physicians being trained across Pakistan receive a formal education in SEM. d) Similar ED based programs that have met with success can be used as reference and models to develop our own programs. Examples of Chicago based “Better Health through Housing” and “Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage to Care) can be used to develop local programs focused on our social determinants of health. The concept of SEM is the need of the day in LMIC like Pakistan where recognizing and preventing progression of disease and the factors that influence it can be cost-effective. Resources in health care, especially in the public sector are scarce and their wise utilization has to be practiced. By focusing on the vulnerable population presenting to EDs, it is hoped that social determinants of heath can be improved and this can result in shifting the paradigm from cure to prevention