Sunday, October 17, 2010

The Legacy of Avicenna

Ali al-Hussain Abd-Ulla Ibn Sina, also know as Avicenna, was born in Bukhara during the time of the Persians. His family was from Balkh, a province of northern modern day Afghanistan. His travels in pursuit of higher knowledge and understanding bares resemblance to that of Rumi, but their philosophy and interests in study differed quite a bit. Instead of pursuing spiritual purity, poetry with a distinct tenacity to fulfill the senses, and a constant longing for a direct path to the One, Avicenna is instead known for his treatise on philosophy, paleontology, inertia and momentum, and of course: Medicine. Though Avicenna was born some 300 years before Rumi, they may not have drawn such distinction between them as I have; science and spirituality have drifted apart relatively recently.
As a tribute to his contribution to medicine, Ibn Sina General Hospital was built half a century ago during a more peaceful Afghanistan. Today it's original buildings still stand among ruins in its neighborhood--a reminder of a more recent tribute to the civil war that ravaged Kabul after the collapse of the Communist regime. Some 500 patients pass through its main gates every day, coming from all over the country with hopes of receiving treatment for a broad array of ailments. Of course the actual delivery of treatment is relative and ranges from denial of entry from the doorman, to a week-long stay to get blood work done, to surgery with counterfeit pain medications from Pakistan that have recently flooded the markets.

Patients from the main gates are ushered to seven 'emergency' rooms that are designated for each specialty: Internal medicine, general surgery, neurosurgery, dermatology, psychology, and cardiology/pulmonary (housed in a separate building and functions independently.) Interns and second year residents staff the rooms where patients with complaints that pertain to their specialty are sent to them, they evaluate the patient and determine whether they are to be admitted, sent out for labs/imaging, transferred, or sent home. There is no standardized system for receiving, triaging, stabilizing, or disposing of patients at hospitals and there is tremendous variation between hospitals. At Ibn Sina, aside from a obligate lack of general supplies, this was a more functional model for Emergency Medicine I've witnessed in Kabul thus far. The specialists where all right there waiting for their patients to arrive. These residents were some of the most clinically astute doctors I've ever come across: they could recite the entire patient presentation, etiology, pathophysiology, diagnosis, and a treatment plan that could be implemented by their history and physicals--the way were all thought in 3 year of medical school but never perfected. For these guys, that's all they have, and they are very good at it. Also of note is that they are the country's only pshych ER facility.

The Dam at Qarga: We drove about 15 minutes north of Kabul and spent Friday this beautiful body of water. The turquoise is unbelievable.
Their model for emergency care is by no means ideal; the specialized treatment rooms felt more like clinics; there was little communication between specialties; there were many complaints about lack of oversight and training; there is no functioning laboratory on site and most labs around town are not reliable; they don't have basic medications on a regular basis (i.e. nitroglycerin); there is a lack of security (from patients and their families who enter with guns); etc. All of this was relayed to us in a two hour conference where all the residents, attending, and nurses gathered in a huge conference room; we had asked for a small group of doctors and nurses for a discussion but the entire staff came. They had a lot to say and wanted to be heard. It was a humbling experience. A significant amount of data for our research will come from this hospital.

This blog was supposed to be about Afshar and Cure, but I wanted to give a brief presentation of Ibn Sina. You will likely hear much more about it from us. There are some very basic things that can be done to bring significant improvements.  Ibn Sina's 'emergency' rooms will become our side project to improve, develop, and hopefully restructure.