La réanimation dans les systèmes de santé à ressources limitées : expérience d’une coopération francopakistanaise en réanimation

Abstract

Intensive care medicine is poorly recognized as a medical specialty in resource limited health sytems. Between 2000 and 2010 a French-Pakistani cooperation program in intensive care medicine was launched between the Pakistan Institute of Medical Sciences (Islamabad teaching Hospital, PIMS) and the medical intensive care unit (MICU) of Saint Antoine hospital in Paris. It allows understanding the different challenges created in Pakistan by patients requiring intensive care, the weaknesses of the public health system and the slow uprise of this medical specialty. The sociocultural context is an important factor to explain the failures and successes of this program. The interventions focused on the creation of a 9-bed medical intensive care unit organized in a closed system with a dedicated team, the advocacy for recognition of intensive care medicine as a medical specialty, the creation of one formal training program and writing of a medical department project submitted to the health ministry. Sustainability of the results achieved by this cooperation program is questionable, but we obtained the recognition of intensive care medicine as a medical specialty and young doctors are now joining specific training programs. In 2014, the MICU of PIMS still works as a closed unit.