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Hilal Her

The Nightingales of Pakistan: Armed Forces Nursing Services

June 2023

The process of evolution of the nursing services in Armed Forces of Pakistan started with its inception in 1947. Initially, the nursing services started with only twelve trained nurses who served in various military hospitals. This shortage led the military authorities to recruit nurses from abroad. The difference of culture created adjustment issues resulting in unsatisfactory and inefficient performance. Competent authorities were compelled to develop the nursing force, which led to the formation of Auxiliary Nursing Scheme (ANS) in 1948 with a six months training program deemed appropriate at that time. In 1949, Pakistan Army had an agreement with the Holy Family Hospital, Rawalpindi, and Mayo Hospital, Lahore, to develop a better and competent workforce. The training program aimed at training two batches of 20 nurses in the domain of General Nursing for about three years. 
After completion of training, only 30 nurses joined the Armed Forces, which led the authorities to change the policy and led to the development of nursing training institutes. All the nurses serving in Pakistan Army, Air Force and Navy were brought under the central command of one director and the newly formed entity was named Armed Forces Nursing Services (AFNS) in 1952. Concurrently, DGMS (IS) Lt Gen (Late) WA Burki officially approached Queen Alexandria Royal Nursing Corps to send experienced nursing officers from United Kingdom for the purpose of training and development of effectual nursing services in Pakistan Army. In response, four senior nursing officers of major rank were sent on deputation to Pakistan and were posted to Rawalpindi, Lahore, Quetta and Abbottabad. Over time, second batch of foreign nurses of four senior nursing officers (one colonel and 3 majors) were also sent on deputation to Pakistan Army Medical Corps in 1957. The first nursing school of Army approved by Pakistan Nursing Council was established in 1956 at the Combined Military Hospital (CMH), Rawalpindi, and affiliated with Punjab University, where the first batch of six trainees was run independently in the same year. The formation of a similar facility at CMH Lahore followed soon. These trained nurses were offered commission into the Armed Forces with permission to wear military uniforms and given the ranks of Nursing Officers in 1959. The first director of Nursing Services, Col CP Maudsley took charge on November 27, 1959, holding the distinction of rendering meritorious services for nursing personnel in Pakistan. In 1964, Col Mehboob Fatima Qureshi replaced him and thus became the first Pakistani Muslim female Director of the Nursing Services. Director Col Safdari Beg, was the first Nursing Officer promoted to the rank of Brigadier on January 17, 1978. Training of military nurses shifted to Armed Forces Medical College (AFMC) Rawalpindi in 1959, later named as Armed Forces Post Graduate Medical Institute (AFPGMI), while the school at CMH Lahore also kept functioning. Passing out parade of nursing cadets also started in 1980 at AFMC Rawalpindi.

Three more schools of nursing were opened at CMH Quetta, CMH Malir and CMH Multan. Eight more schools started functioning in 1990 at CMH Abbottabad, Muzaffarabad, Peshawar, Sialkot, Gujranwala, POF Hospital Wah, and Jhelum. Initially, diploma was offered by them Hospital–based Nursing Schools and the nurses who completed diploma were recognized as registered nurse (RN). After completion of three years training, these nursing cadets were granted Short Service Regular Commission in the AFNS in the rank of Lieutenant in the Army or equivalent rank in Navy or Air Force. Later in 2005, 3-year diploma in RN phased out and was replaced by 4-year BSc nursing degree program throughout the country. Currently, almost 3318 AFNS officers are serving in all forces across Pakistan and 902 Nursing Cadets are under study in Military Colleges of Nursing.
AFNS officers are the backbone of the healthcare system of Pakistan Army. The contemporary changes, challenges and software technologies requires nursing services to enhance and upgrade their educational standards and clinical competencies so that quality patient care can be delivered. Considering this, Pakistan Army replenished AFNS with seven colleges of nursing (CON) at different locations in Pakistan.
The role of AFNS has been commendable both in times of peace and in war. The AFNS officers have always worked with fighting spirit, extraordinary courage, exceptional dedication and devotion. Their unwavering courage and endeavors are highly appreciated by the Pakistani government and military leadership. 
In war times, they were responsible for the maintenance of medical camps, provision of emergency care and evacuation of wounded soldiers from war areas to safe zones. During the war of 1965 between Pakistan and India, AFNS officers were deployed in different hospitals across Pakistan. In this criticality, the Army nurses stood the test of time, proved their mettle and worked extremely hard. The services and sacrifices made by nurses during the tumultuous days of wars were acknowledged by the government. For outstanding performance of duty and devotion Capt Nusrat Jahan Beg was awarded with gallantry award Tamagha-e-Imtiaz, making her the first recipient of this honor in AFNS.
In 1971, Pakistan entered into war again with India. The nurses in this colossal war, did not lag behind in their efforts to serve and support their brothers in arms. Unfortunately, seven nursing officers fell into the hands of enemy, who were brought to India as prisoners of war. These nurses endured mental torture but demonstrated high level of patience and endurance. Maj Salma Mumtaz, one of the imprisoned nurses, was honored with the Florence Nightingale Medal by the Government on her release.
AFNS officers also worked actively in the war against terror at different levels. They worked with counterterrorism teams to provide emergency medical care to injured civilians and soldiers. They have been deployed in areas where terrorist activities are at high level.
Pakistan has gone through multiple natural calamities including earthquakes (e.g., 2005), floods (e.g., 2010, 2022), drought of Thar (2014) and pandemic of COVID (2020). The AFNS officers performed their role effectively in all times of need with true strength, devotion, dedication and commitment.
During the earthquake of 2005, Pakistan faced massive loses of all resources. AFNS officers, on duty and off duty, were among the first respondents. They worked with national healthcare teams and nongovernmental organization to save lives by providing emergency services.
During the floods as well, they remained part of evacuation teams, mobile clinics, particularly for maternal child services. AFNS officers worked tirelessly and enthusiastically while providing emergency care to affected communities, particularly the malnourished children. They worked in collaboration with other healthcare teams to minimize the risk of spread of water-borne diseases during the floods.
AFNS officers have always remained first line clinical warriors in all times of need. The contribution and work done by AFNS officers cannot be overlooked. AFNS officers were in direct contact with patients of COVID-19 since the first case was reported. They worked extra hours leaving their families at homes unattended. These officers performed duties on quarantine patients, fulfilling their basic needs of nursing care, medication, food and all required facilities. They remained actively involved in vaccination and testing at all levels despite the extreme burden and stress. Since, contact tracing remained a significant element in COVID-19 control, AFNS officers helped other healthcare team members in this as well.
AFNS also plays a crucial role in the United Nations (UN) peacekeeping missions by providing healthcare services to the local populations and military personnel. Initially, nurses were deployed in Somalia and Liberia for UN peacekeeping missions. UN mission to Darfur Sudan, Congo, Mali, and CAR were also added in the list of UN missions later on in 2018 and 2019, respectively. The role of nurses at UN missions is in the establishment of medical camps and mobile clinics for the civilian and those affected by ongoing conflicting issues, provision of basic and emergency healthcare services to the mothers, infants and children, and dissemination of information through educational campaign and 
AFNS officers play a significant role during the annual Hajj Medical Mission, organized by the Ministry of Health, Kingdom of Saudi Arabia (KSA). The Hajj Medical Mission is a massive undertaking that provides medical care to the millions of pilgrims who visit Mecca and Medina every year for Hajj. AFNS officers are responsible for providing comprehensive medical care to the pilgrims, including managing emergency medical situations, providing preventive healthcare, conducting health education programs and medical facilities set up. They also work in collaboration with other medical professionals to manage day-to-day operations including staffing, inventory management, and equipment maintenance. Their expertise and dedication are essential to ensure smooth functioning so that the medical needs of the pilgrims are met. 
The AFNS plays a significant role in providing healthcare services to the military and their families, as well as in times of national disasters and emergencies. They work at different military hospitals and institutes to deliver quality nursing care as per needs of patients. AFNS officers are acknowledged for their hard work and devotion to duty. Nominations of outstanding AFNS officers are received from all Military setups across the country for which they are awarded the Rufaida Medal by the Surgeon General/DGMS (IS). HH