The Glasgow – Lahore children’s hospital twinning programme

Overall goals

The purpose of the twinning is the mutual education of the staff in Child Health services in NHS Greater Glasgow & Clyde and in Lahore. This arrangement links us to an important emerging institution in one of the poorest countries in the world. However it is equally beneficial to the service provided at Yorkhill. The Pakistani origin community (Glasgow’s largest single ethnic minority) are substantial users of Yorkhill and come mainly from the area around Lahore. The twinning increases staff knowledge and understanding of the cultural origins of this quite vulnerable group as well as enhancing relationships with the community.

Achievements: We have sustained a partnership with colleagues in Lahore for 24 years, including periods of significant international challenges. We have developed strong personal relationships with colleagues in Lahore in multiple specialties and many individual health professions. Our partnership working has extended beyond medical staff to nursing and many allied health professionals. Many individual departments in Lahore have developed because of training opportunities in Scotland. Two examples relate to infant feeding in Lahore where education programmes and health policy have been greatly strengthened. This project won a Scotland Health Award for Global Citizenship in 2024. The neurology department in Lahore is led by a child neurologist who has visited Glasgow for 2 periods of training. There have been 3 neurology related visits to Lahore and there are now dedicated specialist neurology wards and services for the children of Lahore. The Royal Hospital for Children’s relationship with the Glasgow Pakistani origin community has strengthened greatly and Glasgow staff have gained perspective on global health issues and how priorities in different parts of the world may differ.

Key UK Colleagues and Partners

• Paediatricians, paediatric surgeons, nursing staff, and Allied Health Professionals within Royal Hospital for Children, Glasgow
• NHS Greater Glasgow Health Board
• Glasgow Children’s Hospital Charity
• UNICEF UK baby friendly initiative
• National Education Scotland
• SE Glasgow HSCP
• Newton Mearns Islamic Centre
• Dept. Human Nutrition University of Glasgow

International Partners

• Child Health University and Children Hospital, Lahore , Pakistan
• Ganga Ram Hospital and Fatima Jinnah Medical University, Lahore
• UNICEF Punjab, Pakistan

Sustainable development goals

• SDG 3 - Good health and well-being
• SDG 4 - Quality education

Funding source

The twinning has been supported by various charitable donations, mainly from the Glasgow South Asian community, administrative support and contributions from Glasgow Children’s Hospital Charity, as well as grants from NHS GGC endowments and the BMJ humanitarian fund.

Project origin

This twinning Programme was originally an initiative of the Trust board who were seeking to increase Yorkhill’s international profile. The Children’s Hospital and Institute of Child Health, (CHICH) Lahore, was then a newly opened, purpose built specialist government hospital, serving both the city of Lahore (pop 10 million) and the state of Punjab (pop 60 million), Pakistan.

Evidence of need

see above

Project areas

Service improvements / Education

Project activities

2001 – Memorandum of agreement signed

2001-2004 – Individual visits for teaching and clinical work
Nurse, dietician and pharmacist from Lahore on placement in Glasgow

2005 – 1st large group delegation to Lahore, 8 people for 8 days

2006 – 2nd delegation to Lahore, approx. 8 people for 8 days

2007 – 3rd delegation 3 people for 8 days (5 dropped out due to political situation)
Two doctors from Lahore on placement in Glasgow

2008 – Fundraising and awareness event in Glasgow, with visit by Dean of CHICH
Two doctors from Lahore on placement in Glasgow

2009 – Visit by Professor Zuberi

2010 – Lahore annual symposium – 2 Glasgow speakers vial telemedicine link

2012 – Lahore annual symposium – 4 Glasgow speakers vial telemedicine link

2013 – Visit by Professor Wright

2014 – Delegation of 3 NHS plus 2 university staff to Lahore;
Six Lahore staff visited Glasgow
Glasgow / Lahore working group on improving nutritional practice established

2015 – Lecture to Lahore Nutrition symposium via telemedicine link

2016 – September: Two Glasgow staff Visit Lahore

2017 – March: Three Glasgow staff Visit Lahore
April: New memorandum of understanding signed
July: Two doctors visited from Lahore

2018 – Mayor of Lahore visits Royal Hospital for Children
Visit to Lahore by Professor Charlotte Wright, Dr Ada Garcia, lecturer in Human Nutrition to lecture and supervise PhD research & Linda Wolfson, National Maternal & Infant Nutrition Coordinator, Scottish Government to observe breast feeding practices.

2019 – 2 Lahore staff visited Glasgow
Visit to Lahore by two Glasgow staff for lectures and clinical mentorship
Visit to Lahore by Professor Charlotte Wright and Dr Linda De Caestecker, to speak at Pakistan Paediatric Association Annual Scientific meeting. Meeting with Punjab minister of Health
First breast feeding educational delegation to Lahore – 4 delegates

2020 – 2021 COVID epidemic prevented in person trips, contact maintained via zoom meetings

2022 – Second breast feeding educational delegation to Lahore – 4 delegates. Professor Samir Zuberi, and Professor Wright visited CHUCH at the same supporting other aspects of education at CHICH.

2023 – ongoing Quality improvement work and planning for 2024 visits via zoom

2024 – May: Visit by 3 Lahore staff to London to meet UNICEF UK baby friendly team and observe baby friendly practices in London and Glasgow. Also visited Scottish parliament to meet met MSPs and civil servants.
October Visit by 4 Glasgow staff to Lahore. Visited maternity units, met with senior government and other policy makers and senior managers to advocate for affordable, sustainable change in their health systems.
November Received the Global Citizenship award at the 2024 Scotland Health Awards

Changes

To continue to raise the level of child health education in Lahore and services to the children of Punjab. The Children’s Hospital in Lahore acts as a centre of excellence and model to all the hospitals serving the 60 million population of Punjab. We have raised the profile of the Scottish Health Service in Pakistan and demonstrated the importance of engaging with Scotland’s Pakistani origin community.

Next steps

We will continue to develop the Twinning in a flexible way guided by colleagues in Pakistan and from knowledge gained by visits to Lahore.
Each year Children’s Hospital Lahore decide on which specialties or areas of practice they would like to develop, and we assess how this can be achieved. Infant nutrition and promotion of breast feeding has important public health implications in Scotland and Pakistan. Through training academics interested in infant nutrition in Pakistan we hope that good evidence-based practice can be disseminated through educational institutions as well as through the hospital.

Challenges

Visits to Lahore have been affected by international events since 2001 and anxiety about risks to safety. We have faced challenges in gaining short educational visas for Pakistani visitors to Glasgow particularly for nursing staff. We thus also initiated a telemedicine link with equipment bought by the twinning fund which has allowed us to meet periodically with the staff there and contribute to symposia and lecture programmes in Pakistan.

Mitigating challenges

We worked hard with the Pakistani consulate to facilitate visits of UK staff to Pakistan however help with short term visas for staff from Pakistan, particularly nurses, may have been beneficial.

Partnership principles

• strategic
• harmonised
• effective
• respectful
• organised
• responsible
• flexible

Project gains

• leadership
• teamwork
• clinical
• academic
• patient
• resilience