تقدم الأمم والشعوب ونمو إقتصاد الدول لا يتم إلا بتوفر فرص التعليم والرعاية الصحية المستدامة المجانية لتشمل جميع المواطنين فى القرىوالحضر. ماضي السودان ( أيام الإعتماد على الزراعة ومشروع الجزيرة) كان أفضل من حاضره بما يخص التعليم والرعاية الصحية رغم ظروف الماضي مقارنة برغم الكم الهائل من المدارس والمستشفيات المتوفرة فى يومنا هذا لأنها خاصة وعالية التكلفة ولا تتوفر لغالبية الناس. الأستاذ حسن نجيلة رحمه الله ألف أجمل كتاب ( ذكرياتي فى البادية) رغم صعوبة ترحاله معلماً راكباً الجمال أو الحمير مع البدو والرعاةخلال الوديان والسهول والصحاري أثناء تنقلهم طلباً أماكن العشب والماء. رغم شظف العيش وصعوبة تلك الظروف قام بدوره معلما مسؤلاًخرج أجيالاً وخرج لنا بأجمل الذكريات عن جمال تلك البقاع السودانية وجمال أهلها وكرمهم وعاداتهم. كانت توجد أنذاك نقاط طبية متحركةلتخدم هؤلاء الرحل والتعليم كذلك وكانت الرعاية الصحة كلها والتعليم مجاناً لكل المواطنين. حتى السينما المتجولة كانت تصلهم لترفيه عنهم!

مع. تدهور الوضع التعليمي والصحي فى السودان أثناء حكم الإنقاذ جعل بعض أطباء المهجر يتفاكرون فى ما بينهم فى كيفية إصلاح ذاتالبين رغم ظروفهم المحدودة ورغم رأيهم المغاير لنظام الحكم السابق. من الذين أحرقوا سفنهم تاركين رغد العيش فى بلاد الغرب وأميركازميلتنا الطبيبة النابهة هالة أبو زيد إستشارية طب الطوارئ للباطنية. هي من الأطباء المميزين فى بريطانيا وكان بإمكانها البقاء والعمل هناإلى ما يشاء الله كإستشارية محترمة لكنها قررت التضحية بكل نفيس لتحاول تأسيس وحدة حديثة لطب الطوارئ بمستشفى الخرطوم التعليمي، بل كان هدفها أكبر من ذلك. وبعد جهد ومعاناة تم لها ما تمنت فولدت على يديها أحدث وحدة طوارئ نموذجية وكانت ترجو لهاالنماء والفائدة الطبية للمواطنين والتعليمية للأطباء تحت التدريب. شهد لها الناس بالنجاح الباهر لكن تأتي الرياح بما لا تشتهي السفنوجزاء سنمار وقع بفأسه على تلك الطبيبة من قبل الذين يصطادون فى الماء العكر لتضطر أن ترفع يدها فتلقفتها معززة مكرمة إحدي دولالخليج الغنية فى أحسن وظيفة وأرقى مستشفى مرجعي. هذه قصة حقيقية.

بعد هذه المقدمة الطويلة أرفق رسالتي أدناه التي كانت مشاركة الدكتورةهالة خاصة وغيرها ، وكذلك ردها عبر منتدى الميديكس ببريطانيا ( تأسيس الاخ دكتور ابراهيم الفحل) عندما كانت تشاورنا من على البعد إن كانت لدينا مقترحات قد تستفيد منها أثناء كفاحها المستميتلتأسيس تلك الوحدة من عدم
فى مناخ الخدمات الصحيةفيه غريبة عليها. إنني أعتقد أن ما بعثته لها (كما هو أدناه) يصلح إرساله خاصة للسيدوزير الصحة الجديد كما ورئيس الوزراء علهم يستفيدون منه، بل لكل مواطن يهتم بأمور الرعاية الصحية مع أطيب التحيات

Dear Dr Hala Abuzeid
Salam
RE: My thoughts
February 2008

Part I
Congratulations Hala for the big responsibility you are undertaking as a head of A&E and Trauma at KTH . May Allah help you! I agree with you that it is wise to listen to different views and suggestions. I understand that it is difficult to come with radical changes upon the first day of taking a new administrative post (one needs about 3-6 months to understand what is going on, about the facilities, capacity and the staff Quality under ones care, their characters, standard, talents etc, also what improvements or changes are to be considered etc).

Myself trend is usually to be as pleasant as possible with my team at work and adopt the attitude of listening to their suggestions , but at the same time they should understand that I am straight in consideration of my responsibilities (punctual, formal, vigilant , creative and very serious in my decisions )

As I mentioned previously, I left Sudan 6months following completion of my housemanship training to the UAE. Believe me it was for the first time in my life to see and put my hands on a modern ECG machine and defibrillator! I learnt how to take an ECG and perform a cardio- version. I discovered that there was a good system of primary health care which was applicable even in the remote villages of the beduines in UAE. Each residence in the UAE has a medical ID card (with a portrait photo) and a unique serial number. The health centres cater all the residents of each allocated area (e.g say like Alsahafa in Khartoum). The doctors treat simple acute emergencies and each Health centre has own ambulance service for urgent transference of patients to the referral centres. In each hospital there are proper units for A&Es and ICUs.

After this introduction (excuse me if I am wrong in my perception of what is actually going on in Sudan because I have been away for three decades) I just drop for you some suggestions about what is required for the promotion of the health services in Sudan:
(1) Ambulance service should be a priority to cover the whole catchment’s areas.
(2) Recruitment of well-trained (top class) paramedics and staffs to perform their duties around the clock is necessary
(3) Recruitment of doctors interested in acute medical emergencies(or want to specialise in that area)
(4) The venue of the A&E should be up to the standard of what we are seeing abroad (you can design this as from what you have learnt from your experience in the UK).
(5) There should be a direct hotline contact number for ambulances and reporting of sickness
(6) A&E acceptance should be for all the exceptionally life threatening conditions , namely chest pains, GIT bleed, abdominal pains , vomiting; gastroenteritis etc
(7) The A&E should have its own lab for urgent analysis of blood gases, U&Es and FBC, urine dipsticks, cultures etc (Cardiac enzymes of course are top priority).
(8) You can create outreach stations in Khartoum to be considered as first-line referral centres for acute problems in which doctors can diagnose, manage and filter the only cases that should be transferred to KTH A&E and to manage themselves minor emergencies.
(9) The STATE must give you the free hand to furnish the A&E with the equipments you feel should be available. The STATE should facilitate the adequate funding so that treatment should be free for all.
(10) Adequate clean toilets and waiting halls with comfortable seating and cafeterias.
(11) AMU and MDT meetings
(12) Modern filing system(patients notes, preferablly electronic records).



Part II
Refering to my last Weekend case presentation in the SMS forum I do agree with you and Dr Tarig that the ABCs of practicing medicine are in great danger, and that was my message. I think this is an outcome of the recent Education policy of opening many private medical schools instead of increasing the intake capacity of the already existing and well established ones (U.O.K, Algeziera, & Umdorman Alislamia). The quality of education as such is rather inadequate and poor. Also rotations of the internship should be in hospitals and departments where there are very efficient consultants who have time, interest and dedication for teaching (i.e. recognised hospitals for teaching). "Khidma Ilzamia" for doctors and dentists should be reconsidered for evaluation in order not to waste their time and forget what they have learnt. It should not be more than three months in my opinion and to arrange it as part of their summer vacation while they are still medical students ( not after graduation).

A proper Primary Health Care system should be a must to implement so that each Sudanese citizen should have a family doctor to be completely responsible for his health issues and referrals to other specialties when needed. Services in the health centres should be improved in order to relieve the burden of the overwhelming referrals to the hospitals. Regional Hospital should be up to the standard (by standard I mean enough advanced facilities and sub-specialities). E.g. a patient shouldn't leave Atbara Hospital and to die in Khartoum because of bleeding post tooth extraction (it is a great shame that it happened a few months ago!)

Ambulance services should be a top priority and the MOH should do its best to convince the government and to spread such service all over the country in order to be affordable to every individual.

There should be catchment’s area-special centres for acute conditions e.g Chest pain and stroke so that a referring GP or even ambulance staffs know exactly what to do and where to take a patient. Issues of negligence etc in the private hospitals and medical centres should also be discussed. Why people seek private hospitals while it is the responsibility of the state to take care of the health of its nationals? Private hospitals must guarantee availability of all medications for emergencies and if they fail they should be closed. It is the responsibility of the MOH to do surprising visits to make sure that such private hospitals and other health centres are up to date.

Specialist and high nursing training should be encouraged first locally and as much as possible less internationally (to be 100% supported by the state)

Each department should develop a system to fulfil the criteria of a real high standard clinical governance. A monthly mortality meeting should be a must in each department (it is very useful).

Part III
What do you want ( or fancy) if you are to return home? If I am asked such a question,
This is a challenging question. It should be addressed in another round.

Thank you for your patience. Please consider what you think is useful in my thoughts or discard it all together

Kind regards and good luck

Abdelmoneim Alarabi

Dr Hala Abuzeid ( my thoughts)
Thanks ya Dr Arabi,
I will take every bit of your kind and wise thoughts onboard.
Thanks for spending and sparing some time trying to help me out.
I will surprise you one day i am hoping that what you have mentioned is along the same strategy i am adopting and i will refer to you whenever i need you if you donot mind.
GOD bless you.
Hala
ولا أنسي أهمية تشجيع البحث العلمي ودعم المجلس القومي للبحوث بالمال والكفاءات العالية
" نحن شعب نكثر الإنتقاد , للأسف إنه عدو التقدم"

عنوان البريد الإلكتروني هذا محمي من روبوتات السبام. يجب عليك تفعيل الجافاسكربت لرؤيته.