2019 - Confidence with your patients: an interview with Fardin Fazl

September 11, 2019
Fardin Fazl is a practicing Family Medicine Physician in Afghanistan.

Fardin Fazl is a practicing Family Medicine Physician in Afghanistan.

What is your professional background?
I'm from Afghanistan where I practice family medicine and serve as Vice President for the Afghanistan Medical Association. I'm affiliated with Cure International Hospital, as well as the Firuzkoh Family Health Clinic. Under the Afghanistan Family Medicine Association, we run two teaching hospitals which offer family medicine residencies.  We also have several family clinics all over Kabul, the capital city of Afghanistan.
Currently, I mainly work in an urban clinic in the old city of Kabul, the Firuzkoh Family Health Clinic, which is supported by the Turquoise Mountain Trust. Our coverage area is Murad Khani, where about 900 families live, and we have patients from all over Kabul City and all over Afghanistan.
What are some challenges you face in your daily work?
Afghanistan is one of the top 10 poorest countries in the world, and the health system is not very strong there. For example, considering maternal health, we have over 300 deaths per 100,000 women. There are other health problems there, and most of the people do not have access to health facilities due to economic security and geographical challenges. For me as a doctor, practicing in a country like Afghanistan has always been challenging.
 Practicing as a doctor in a low- or middle- income country is a challenge. There are a lot of myths, a lot of different beliefs, traditional healers, and complicated cases that need resources that patients can’t afford. Seeing dying patients in front of you is the worst thing to experience as a physician. 
Traditional medicine is a challenge for us in Afghanistan because people rely on home remedies then only if they're not getting well, present their issues to doctors. As a result, patients often present at stages where many complications have developed.
Another problem is poor practice which results from many of our physicians being poorly trained. As a doctor, it's very difficult to accept that malpractice exists but to convince the patient is even more difficult. We have to tell them, "The way you are treated is not good,” or “You could have been treated in a better way."
What made you want to apply to GHDI?

When I was in residency we had visiting physicians from the US in global health rotations in our hospital, but I didn’t really know what the term global health meant. Then In 2012, I joined the GHDonline communities of practice in order to access UpToDate (now available through Better Evidence at www.ariadnelabs.org/better-evidence).  I received emails from GHDonline about global health topics, which made me more curious and more interested to global health. 
The vision and values of global health were exactly what I was working to achieve as a primary health care provider.  It made me think, we are a part of the field of global health. Why shouldn’t I be part of that team? 
I went to UCSF for a boot camp in 2017. It was an amazing experience and changed my overall view about medical practice and care delivery. I learned that as a family doctor, I have a great foundation for global health. Family medicine aims to improve care, to fight disparities, and to provide longitudinal care. In my country, we have many poor people; we have deep inequalities and disparities at every level and in field, including health care. This means I need to work on policies and change them and fight against the unfairness. 
Family medicine is a field that sees everything, so it’s a great fit for global health. I believed that attending GHDI would further help me know how to strengthen the health care systems and primary care service in my country, that’s why I attended GHDI. 

How will GHDI shape your career?
Participation in GHDI helped me sharpen my vision and encouraged me to consider where I want to be in the next few years. Research and evidence-based practice aren’t common in my country. homebased on my learning in GHDI, I will plan to work on research proposals that incorporate evidence-based practice. I will contribute to the development and implementation of effective, sustainable and context-appropriate health care intervention programs nationally and globally. 
I plan to focus on my own career path as a primary health care provider and at some point, in my career I would try to travel throughout my country and the world, working in the field, advocating for to primary health care and family medicine. For me it’s humanity that matters. I’m committed to help all human beings, from the cradle to the grave, regardless of age, gender, religion and race. I will also share what I have learned from this course with my colleagues in Afghanistan upon my return. 

How has UpToDate helped you in your challenges?
UpToDate has helped both me and others in my association that have a Better Evidence UpToDate subscription. It has helped all of us to overcome the complexities and challenging situations we face in our practice. It has helped us to improve our knowledge. It has helped us to improve our self-confidence as physicians and helped us build trust between doctors and patients. On occasions where there are lots of complications for the patient, the confidence that UpToDate has given me and my colleagues as physicians has helped us to deal with those most complicated cases and take care of those complications.
The Cure and City Hospitals are teaching hospitals that train doctors in family medicine.  Through our association we oversee these hospitals, both of which receive the most complicated patients from all over the country. The reason doctors have the courage to care for these patients properly is UpToDate. Every time you see doctors, they have their smartphones or iPads open to UpToDate. They’ll say, "I have a patient and he has this problem, so I am checking that am I doing the right thing for that patient, know what's next, and understand how I can treat the patient well."
I greatly appreciate GHDonline for providing us free UTD subscriptions that have made medical practice easy in a resource-limited country like Afghanistan. If we are saving lives, the credit directly goes to kind people in GHDonline.

What are some specific instances where you’ve relied on UpToDate?
While there are many examples, one specific example that was a life lesson for me. In my second year of residency, I had been to a very remote area in a rural district hospital in the south of the country as part of my rural health rotation. One night when I was on duty, I received a 25-year-old female patient. She was a nursing mom complaining of lower abdominal pain. She was treated by a doctor in an outpatient setting with the possible diagnosis of a urinary tract infection two days before presenting to us. She was given several antibiotics, but unfortunately, she had not improved.
We retained the patient in emergency room. Although she was stable initially, her vital signs were deteriorating gradually each hour. We reevaluated the patient several times. Given her breastfeeding status and that her last baby born was five months ago, we did not think of pregnancy as a possible factor in her illness. I went to UpToDate, my number one reference and one resource for addressing my patients’ needs. It taught me that in any child-bearing age woman presenting with acute abdominal pain, pregnancy should be ruled out first in order not to miss the life-threatening condition of ectopic pregnancy. UTD urged me to reevaluate the patient and to test the patient for pregnancy. We were at a district hospital in a rural area and did not have access to ultrasound, so I did just a simple urine pregnancy test which it was positive. The patient was immediately shifted to the surgical suite to undergo an intervention with likely diagnosis of ruptured ectopic pregnancy. That proved to be the correct diagnosis. Fortunately, we saved the life of that 25-year-old woman.
UpToDate helped us to make a right diagnosis in a critical time that dark night in that very remote area, on a young breastfeeding mother of three children and ultimately saved her life.

What makes UpToDate Special to you?
UpToDate is very simple. It has the tables; it has the algorithms; it has the graphics. Unlike other medical applications or textbooks, searching on UpToDate is easy. This easy allows you learn how to approach the patient and gives you the confidence to provide care. As a doctor, when you help and treat any your patients, a sense of pride and also calm. If you save lives, especially the life of a young person who has lots of hope and ambitions to continue her life, that's amazing and the happiest moment in the life of a doctor.