Had an opportunity to visit few #MTIs in #KPK with the purpose to explore #PedsICU infrastructure & need assessment and collaboration for capacity building. 1/12 
Overall basic infrastructure is there and the need is unmet. And there is a desire on ground to build this field of #Pediatrics which is encouraging. The management is excellent and there is an #EHR in place. All these make an excellent starting point. 2/12
We need to keep few facts in mind while embarking on this challenging and but truly rewarding journey of providing quality acute hospital care to #children in #KPK & #Pakistan 3/12
1: availability of #PedsICU facility in a hospital is considered a mark of quality care for children so it’s a must thing to have
2: Starting and sustaining this requires commitment, measurement of certain performance indicators and continuous improvement.
2: Starting and sustaining this requires commitment, measurement of certain performance indicators and continuous improvement.
3: Basic #PedsICU care is simple and inexpensive, which must be the starting point (timely recognition and simple interventions like oxygen, fluids, antibiotics, continuous monitoring etc) frontiersin.org/articles/10.33… 5/12
4: As these services become established it becomes more complex and requires certain minimum requirements than just a bed with a monitor and ventilator. Most important is skilled Human Resource (physicians, nurses, other providers), lab, pharmacy, radiology, inventory and more.
Adding beds without adding all these resources is counterproductive
5: Peds critical care is more of a mindset/ culture (bringing icu reflexes out of the icu) than a physical space, once that culture is built in a hospital then quality of all aspect clinical care improves. 7/12
5: Peds critical care is more of a mindset/ culture (bringing icu reflexes out of the icu) than a physical space, once that culture is built in a hospital then quality of all aspect clinical care improves. 7/12
6: This field in #Pakistan in its infancy at max, & it takes 12 yrs to train a physician in this speciality (including medical school) & 3-5 years for a nurse. So these are finite and precious resources & need to be taken care of well (career growth, monetary, avoiding burnout).
7: Solutions can be short, medium & long term.
8: Short term solution include short hands on courses for providers and peer to peer Tele consultation and mentorship. 9/12
8: Short term solution include short hands on courses for providers and peer to peer Tele consultation and mentorship. 9/12
9: Medium term include starting small units (few beds as dedicated peds icu) and building master trainers for on ground training and refreshers with Tele supervision and mentorship. 10/12
10: Identifying people to get formally trained in this speciality, come back and start training there and expanding the services
11: Encouragement of collaboration at the govt/ decision/ policy maker levels as well as data sharing and development of research infrastructure. 11/12
11: Encouragement of collaboration at the govt/ decision/ policy maker levels as well as data sharing and development of research infrastructure. 11/12
12: Inclusion of all essential peds icu care in Sehat card and disbursement based on provision of quality of care. The future is bright 🙂 12/12
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