Dr. Syed Yousuf Iftikhar, Chairman, Midland Doctors has placed MDMI on level Amber with staff readiness and protection. Routine activity has been ceased and now we are shifting to pre-crisis mode. The medical staff has undergone necessary training to keep themselves and the patients protected. The MDMI will follow standard procedures as instructed by WHO and the government of AJK.
The Midland Doctors is now participating in its fourth humanitarian mission for Pakistan. The medical team including Doctors and nurses at the forefront of this fight world over is fighting a united front to contain the spread any further. The foe is invisible but the strength of the fight needs to be persistent and The Midland Doctors need your Duas and support to help people overcome this tough time.
Day 2 : 16th March
Screening of patients as they approach the MDMI
Day 3: 17th March
A representative from the WHO came on an inspection visit to see if we should be a designated center for children’s immunizations – he was not expecting to see our COVID-19 measures, which haven’t even come into practice in government hospitals, though COVID-19 has entered into AJK. We managed to requisition a thermal thermometer to catch fevers at the door and to protect others. Ferocious activity before the storm for a foe that you can’t directly see. The young healthcare workers are frightened – they have never faced such uncertainty. The WHO official was impressed by our no-handshake policy and took pictures to show his government colleagues. We are now a designated center for WHO immunizations – an activity that will have to await the aftermath of what is to follow.
Day 4: 18th March
A visit today from the Army: Commandant of CMH and Deputy Commissioner to see the current process for COVID19 at the hospital. Like our patient’s all visitors are screened at the hospital entrance, a thermal scanning thermometer in use. The visitors appreciated the screening efforts and looked at the OPD and were interested to know what capacity we could AJK and wanted 50 bed capacity. The Midland Doctors have planned all week to have the facility ready, now we are deep conversation as to the level of their requirements. OPD workflow has been adjusted to protect against cross infection. Covid19 screening only began yesterday at the hospital and already delegations have been and have been impressed with Midland Doctors Medical Institute. The hospital and the trained staff are a testament to donors across the world who have donated and supported this facility. We are already a model for how things can be. COVID19, takes everything to another level, a level we never thought one day would be required in anticipation of what may come. The next phase is to secure processes for in-patients and to see if we can support the AJK effort as a whole.
Day 5: 21st March 2020
The Midland Doctors Medical Institute is screening patients in full blow. The Administration of the MDMI Mr. Bilal Hussain, CEO; Mr. Syed Shahbaz Shah, COO; Mr. Ahmed Najam, HR Administrator are doing excellent preparations in acquiring all the necessary equipment, protective gear, masks and medications so as to receive patients affected with the COVID-19. The MDMI will be the first unit in AJK to develop and run a COVID -19 program and a model for other to follow. the challenge faced by the hospital now is to keep regular patients at home and keep them from gathering in multiples. We are advising the patients with multiple warnings to stay at home. Our staff has shown a lot of dedication to the local community, despite the challenge befalling all communities near and far. For the first time we are facing a humanitarian crisis with the rest of the world- local impact with global consequences. The MDMI is dedicated to serve the community at this testing hour and we are thankful to the medical team at the MDMI for what has been achieved in overcoming this massive challenge.
AJK Chief Secretary Mr. Mathar Niaz Rana visits MDMI
The MDMI facility is to fully equipped to accept and treat COVID-19 patients. The preparations at the MDMI were examined by the authorities including the AJK Chief Secretary Mr. Mathar Niaz Rana. The government inspections ensured that we are equipped and trained to handle such an massive disaster response that the world is challenged by. The necessary medications, equipment and protective gear is being set up as the week comes to an end.
28th March 2020
Virtual Training for Medical team and Administration at MDMI for COVID Response
The MDMI received Virtual Training for the process of receiving patients and management of the facility during this time of crisis. The training was conducted by Dr. Farhan Rashid, Consultant Surgeon, UK; Dr. Nauman Rashid (Emergency Medicine consultant), UK; Dr. Rahim Kayani (Anaesthetist), UK, Dr. Asrar Rashid( Pediatric Intensivist, Pediatrician), UAE, Ms. Faiza Ahmad (Emergency Unit Nurse), UK and the medical team including nurses, urologist, physician and the administrative staff at MDMI. They were educated in the process of managing the hospital, safety measures to be taken and the procedure of donning personal protection equipment.
The team was educated in the process of administering and filtering patients in the front line entrance of the hospital. They were given a detailed understanding of the medical symptoms to look for in COVID affected patients and to identify their condition if they need to isolated or they need breathing intervention.
The medical team will be accessible by telephone during this period for any emergency response. The hospital will be converted into an isolation ward and will not be delivering regular medical check ups. Any patients requiring medical attention may contact the emergency numbers as being circulated in the region by our staff and also mentioned on our website home page.
4th April 2020
Virtual Training for MDMI by Dr. Farhan Rashid
Time: 12pm Pakistan Time/ 8am BST
Training Moderator: Dr. Farhan Rashid (Consultant Surgeon, UK)
- Dr Asif Malik, MBBS, FCEM, Dr Nauman Rashid MBBS, FCEM; Consultant Emergency Medicine, Queens Medical Centre Nottingham, UK
- Dr Asad Malik, MBBS, FRCPsych, Consultant Psychiatrist, Assistant Professor (Hon) University of Nottingham, School of Medicine, Nottinghamshire Healthcare NHS Foundation Trust
- Dr Amna Malik, Department of Obstetrics and Gynaecology, Sherwood Forest NHS Foundation Trust, Kingsmill Hospital, UK
- Mohsin Iqbal, Psychologist, Pakistan, Red Crescent Society, Pakistan
- Suhail, Pulmonologist, Pakistan
Participants: MDMI staff, MDMI Exec. Trustees, Dr. Javed Ahmad, Dr. Asrar Rashid, Dr. Syed Iftikhar
Dr. Asif Malik speaks about the Pathway of the treatment protocol of COVID-19 patients. He explained there is general uncertainty regarding the correct approach for treating this disease, it is a shared learning experience for medical officers world over. The PPE for the front line staff – to emphasize the need to keep distance, the PPE categories according to the zones the staff will be working in. The Assessment of patients to be contact less as possible while taking temperature, history etc; assessing breathing of the patient with or without a stethoscope. The parameters checked are temperature, coughing, Oxygen saturation, Physiological assumptions, chest X-ray, throat swab, nasal swab, Blood count, CRP.
Dr. Asad Malik speaks with the help of a presentation about the importance of mental well being in general of the community and how patients and families may be affected due to the isolation procedures. The disease is affecting millions in a similar manner, people are anxious about testing, availability of treatment. It is important for health systems to guide the public with correct information and for the public and medical teams to follow trusted sources. Effective communication between hospital administration and medical staff helps reduce professional stress and helps to control unwanted anxiety. The other important advice given was the relevance of physical well being as a step towards mental well being. The need to assure patients that there’s no need to panic and that most people are able to get cured, successful cases need to be highlighted to the patients. No visitors allowed at the premises. Family to be contacted daily by a staff member to convey news about the patient. Avoid sharing too much not to increase the anxiety of the loved ones. Support forums for people who need counselling and advice, also to share the experiences of people who have recovered will be very effective in tackling anxiety as well.
Dr. Amina Malik spoke about handling patients and staff that may be pregnant during the period. There is not enough evidence yet to show the effect of Corona-virus on new born babies. If pregnant patients show symptoms, they need to be isolated ans continue as same for any other patient. If the patient is in the third trimester, normal delivery is recovered for patients who are COVID positive, early epidural can be used and in emergencies, C-section may be proceeded. Neo-natal team should be informed of the COVID status and the patient may need extra help in handling the baby after delivery. Treatment of the patient and well being discussed.
To view the full video of the training conducted please use the link https://www.youtube.com/watch?v=22v9uo7hmJE
7th April 2020
Midland Doctors Medical Institute (MDMI) Isolation Wards
The MDMI will be divided in to zones to isolate patients that will be received as a part of the COVID-19 response. The various departments will include Red Zone consisting of the High Dependency Unit (HDU) and the Intensive Care Unit (ICU); the Yellow and Green Zone will have patients will have patients with less sever symptoms and will comprise the Low Dependency Unit (LDU). The HDU will 6 beds and the ICU will provide 4 beds with the provisions of Ventilators. The Yellow Zone and Green Zone together will accommodate 30 patients and they will be provided the necessary care and medications depending on the severity of their symptoms. In total we will start the MDMI COVID-19 response with 40 beds and will not be receiving walk in patients. The MDMI will be working in tandem with the Pakistan Health Authority to isolate patients and we will ensure the patient are treated with the best possible guidelines shared with us from world over.
There will be strictly no permission to visitors at the hospital. The hospital staff will inform the family of the status of patients with daily calls and update the condition of their loved ones. All the necessary laboratory and testing equipment have been made available at the MDMI. The premises is clinically ready to receive patients. The MDMI Exective Management will continuously update the clinical guidelines for the medical officers and nurses. The trustees have made all the necessary precautions to ensure the safety of the satff and the patients and strict protocols will be maintained to ensure that there is no community spread.
25th March 2020
MDMI Virtual Training Session for Management of patients in HDU and ITU
Time: 12pm Pakistan time/ 8am BST
Moderator: Dr. Farhan Rashid, Consultant Surgeon UK
Emerging emergency Medicine perspective for COVID-19 in UAE, Dr. Muhammad Saif Rehman MBBS, PhD, FCEM
Consultant Emergency Medicine Cleveland Clinic Abu Dhabi, UAE.
Emerging Emergency Medicine perspective for COVID-19 in the UK, Dr. Nauman Rashid, MBBS, FCEM
Consultant Emergency Medicine, Queens Medical Center, Nottingham, UK
Critical Care for COVID patients, Dr. Zahid Sheikh, MD, FRCA
Royal Derby Hospital, Derby, UK
Participants: MDMI staff, Dr. Syed Yousuf Iftikhar, Dr. Asrar Rashid, Specialists from the Muzaffarabad region.
The medical specialists who spoke at the training are front line medical staff in Emergency Departments in the UK. They explained about the various symptoms that are commonly presented when a patient walks in to the ED. They also warned about certain patients being asymptomatic and some having varied symptoms than that is generally known. The medical team advised the staff to treat any patient that walks in as a Corona positive patient. The medical supporting staff should be well protected to receive the patients with surgical masks and gloves.
The various symptoms and treatment procedures for the patients at the various stages of the disease was discussed. the main issues seen by the COVID-19 patients is the difficulty of breathing, body pain, fever. The breathing should be monitored, Pulse Oximetry should be checked and Respiratory rate compared from time to time to assess the patient. The Radiology tests of Chest X-Ray and CT Scan are recommended for confirming the COVID and assessing the severity of the case.
Depending on the clinical condition and the Pulse Oximetry and respiratory rates, the patient can be kept in Low Dependency Unit (LDU) or if he or she needs breathing assistance , then they are moved in to the High Dependency Unit (HDU). The patient in HDU may need assistance in breathing with help of Nasal and needs to be connected to a Nippy or CPAP. The use of various masks were also discussed depending on the requirement of the Oxygenation for the patient. If the patient was still not breathing and after regular checks is not improving, then they need to be shifted in to the ICU for Intubation and Ventilation.
The various stages of the severity of the cases, the medications to be used, tests to be performed for continuous analysis of the patient were discussed. The importance of regular monitoring of the patients were stressed. The training included a demonstration at the HDU of the Ventilators available at MDMI and a brief video explaining the readiness of the facility to accept the patients was displayed.
30th April 2020
Midland Doctors distribution of Ramadan Food Packs to the Poor and Needy
Midland Doctors identified 500 families with widowed mothers and families who are in dire need of help affected by the lock down as they are daily wage workers and unemployed at present. The Midland Doctors went to these villages with the identified families and distributed Food packs with all essentials for the month of Ramadan. The packs included Rice, Flour, oil, sugar, tea etc. The essentials were distributed in safe manner keeping all the recommendations of social distancing in place.
Please visit the link https://youtu.be/CMo3ddHO3S0 to know more.
Kindly donate to this cause and support our efforts with your Zakat and charitable donations. Donate to Midland Doctors.
11th May 2020
MDMI COVID Ready
High Dependency Unit (HDU) and Intensive Care Unit (ICU)
The Midland Doctors has trained its medical and tertiary staff towards the handling of patients paying attention to all the aspects including Donning and Doffing of PPE for the staff, segregation of the MDMI hospital into Low Dependency and High Dependency Units. The High Dependency Unit (HDU) will have patients with more aggressive symptoms and will be dependent on external oxygen for breathing. The ICU has been prepared and staff has been regularly verifying the working status of all equipment to be ready to receive patients at any time.
The ICU has 3 functional Ventilators and can accommodate severely affected patients. The medical team have been undergoing training by experts who are front line healthcare workers in the UK, US and the UAE.
Low Dependency Unit (LDU)
Patients with lesser symptoms shall be attended to in the Low Dependency Unit, where their symptoms will be assessed and will be admitted in the isolation ward. These patients may not be suffering from underlying diseases and their condition may be more stable, hence they do not require help to breathe. The patients will be given necessary medications and tests will be conducted on patients to ensure their conditions remain stable and their health improves.
18th May 2020
MDMI- Emergency Department Training –
Moderator: Dr. Farhan Rashid
Session 1 – Critical Care for the Non Intensivist
Dr. Alan Askari, Specialist Surgical Registrar, Cambridge Rotation; Dr. Tanveer Adil, Consultant Surgeon, Luton and Dunstable University Hospital, UK
Session 2 – Clinical Staff ATLS Training
Dr. Nauman Rashid, Consultant Emergency Training, Queens Medical Center, Nottingham UK.
19th May 2020
MDMI Medical and Paramedical Staff ATLS Training
Moderator: Dr. Farhan Rashid
Faculty members: Dr. Amie King, Emergency Medical Department, Queens Medical Center, Nottingham, UK; Dr. Nauman Rashid, Consultant Emergency Medicine, Queens Medical Center, Nottingham, UK; Dr. Rahim Kayani, Consultant Anaesthetist, Firmly Park Hospital, Surrey, UK.
The faculty discussed about the various patients that present at the Emergency Department on a regular day and how to identify their treatment process. The session included an interactive session to cooperate the current COVID -19 patients who may also present themselves both with symptoms and asymptomatic. The medical team also were trained to respond to emergency situations that may have resulted from burns, accidents, etc. The video for the training has been provided below.
21st May 2020
MDMI Medical and Paramedical ALS Training
Moderator: Dr. Farhan Rashid
Faculty members: Dr. Nauman Rashid, Consultant Emergency Training, Queens Medical Center, Nottingham UK; Dr. Rahim Kayani, Consultant Anaesthetist, Firmly Park Hospital, Surrey, UK.
12th June 2020
MDMI Triage Training – Primary Care in times of COVID-19
Moderator: Dr. Farhan Rashid
Faculty Members: Dr. Sajjad Sarwar, General Practioner, NHS, Birmingham, UK.
The Midland Doctors Medical Institute is opening Outpatient Clinic strictly to patients with appointments. The staff is trained to run Triage services to filter patients and advise them over the phone if necessary and not make a personal visit to the hospital. The MDMI will follow strict policies to maintain Social Distancing and flow of patients will be maintained in away that there is no crowding in the premises.
There will be limit in the number of patients that will be attended to in a day . Please contact The following numbers for appointments.