SHINE Humanity

Mission: SHINE Humanity's mission is to provide compassionate and sustainable preventive and primary healthcare to the underserved by collaborating with key partners. Goal SHINE Humanity's goal is to improve the health status of underprivileged and crisis-stricken communities by providing support for: Sustainable, affordable, and quality healthcare services. Under-funded and/or damaged public healthcare infrastructure. Staffing, resource, and management gaps in the healthcare system. Comprehensive training and public education campaigns. Communities to manage and fund their own long-term healthcare needs.
Oct 25, 2010

Small MIracles in Shikarpur, Sindh

 Field Report from Oct 16th, 2010 - Shikarpur District Hospital

Pediatric Ward Receives new Lease on Life

Seeing is Believing - please take a moment to view the attachment below which captures the before and after of our Shikarpur project. The focus of our efforts has been the Pediatric Ward that has been supported by SHINE Humanity and CDRS.  There is an obvious change in the ward and there is a general excitement among the senior hospital officials and staff because the changes have given them a lot of hope and pride in regards to the place they work in.   Since the improvements on the wards have been completed, there has been a notable change in the patients who come to the hospital for medical services  - they now include residents from local villages and Internally Displaced People(IDP) communities.  Today, for example 50 per cent of the beds were children from flood-affected areas and the other 50 per cent from children living in the city. Several months ago, this would not have been the case as the facility was not considered by local residents as a place to send their children. 

 

A “First Class” Facility

The new Pediatric Ward has successfully completed its transformation into a “first class” facility (quoted by senior physicians and health officials). In addition, the existing ward has undergone major physical upgrading, raising the quality of the hospital facilities.

We would like to note that Government officials have shown great satisfaction from the work of the local SHINE Humanity/CDRS team on the ground and are very supportive of the team that has been able to make this transformation happen in roughly two weeks. Several officials have made a tour of the ward a periodic event keen to show off the significant changes, including the Provincial Director General of Health having compared the facility to the standards of the Aga Khan Hospital in Karachi. 

The support to the organization at the moment is very strong and hospital are very keen for us to continue to work with them, to the extent that we are seen as stronger partners in comparison to other international NGOs present such as Save the Children. 

Troubling Disease Trends

On the medical front, when speaking with the doctors of the ward, it has been noted that there has been a change in the trend of diseases since the beginning of October, and many of the new cases coming in include malaria, acute respiratory infections, enteric fever, measles and meningitis.  Many of the diseases are directly related to personal hygiene and there have been some reported cases where a child will come in more than once for a hygiene-related disease.  The longer IDPs are staying in the camps, it is projected that more and more diseases will be related to personal hygiene and in the near future there will be a need to focus on some preventive/awareness program.   

 

Gap in Maternal Healthcare

After our initial tour of the ward,  Umair (a CDRS staffer) and myself visited and met with different senior and district health/hospital officials to discuss gaps and areas where possible interventions are required at the District Hospital.  Unanimously, the gap identified by the officials is in response to mother, maternity health care.  We are still in the process of collecting some more information, but what we learned today is that there is one ward for women that cover’s everything from maternity, gynecology and other women’s health issues.  Due to the lack of space, all this women are lumped together in one space which can hold 50 women.  

Discussions with health officials have identified that the number of premature births at roughly between 10-20 per cent due to the current nutritional health of women.  It is estimated that from the 70,000 women in IDP camps, about 10 per cent are pregnant and can be subject to premature births due to their present conditions.  This brings us to the second gap, which is a growing need for a Neonatal Intensive Care Unit(NICU).  The location for this facility is in place and it is a matter of equipment.  

Taking this all into consideration, we think the immediate step will be that the two remaining rooms in the building where the new pediatric ward is are  upgraded and refurbished to hold a total 20 additional beds, which will allow for Pediatrics to be located in one building.  We spoke with DCO (District Coordinating Officer) who immediately spoke with the Civic Works Department to start the work.  This would also mean that the dispensary would move into the building as the current location we have is only temporary as its part of the NICU facility.

On a closing note we have begun to identify an interim strategy that would take SHINE Humanity and CDRS from this phase of the emergency to the next phase.  The strategy roughly would build on what work has already been done at the hospital but would focus on the return and basic health needs of villagers (children and mother) from the most heavily affected flood areas.”

Report prepared by Sherine Zaghow. Ms. Zaghow is a volunteer from Egypt serving with SHINE Humanity. As a development consultant, she is works in the designing and developing of programs, running emergency operations and the development and implementation of monitoring and evaluation systems. We would like to thank Ms. Zaghow for giving of her time to us. 



Attachments:
Oct 17, 2010

Medical Assessment of Pakistan Flood Victims

Hunger through the eyes of a child
Hunger through the eyes of a child

 Introduction

Pakistan is currently the sixth most populous country in the world and projected to be the fourth such by 2050. This large population puts enormous social and economic pressure on Pakistan’s fragile infrastructure which has currently been ravaged further with the worst flooding in its history. Pakistan’s  population problems are compounded by a lack of healthcare and educational facilities, two of the key determinants of human development that  lead to a self-propagating cycle of  ill-health, lack of education, poverty and consequent lack of development. 

With a population growth of 1.7 per cent annually and the total fertility rate per woman of 4.1 in Pakistan, much attention is required for population control and thereby the maternal and child services, especially since a third of the population is under the age of 14,  and  infant and under five mortality continues to be high  despite the reduction over the past few decades.  The life-time risk of maternal death in Pakistan is one in 74  mainly because of the lack of maternal healthcare services and skilled birth attendants, cost of care and physical accessibility of these services. 

It is against this background that Pakistan was affected by the worst-ever floods the world has ever seen. Beginning August 2010, rivers swollen by record rainfalls have overflowed their banks and swept away over 1,600 lives, damaged 1.2 million homes, swept away 3.6 million hectares of crops and dislocated over 17 million people. SHINE Humanity, with the support of grassroots donors has over 50 staff and volunteers working on the ground in eight locations spread over the length and breadth of the country.

Medical Assessment of Flood-Affected Population

Preliminary analysis of the medical diagnosis data collected by the  SHINE Humanity and its  partner, Comprehensive Disaster Response Services (CDRS) in collaboration with SRSP and UM Trust Flood Relief Field teams from  August 4th to 15th, 2010 showed 46 disease condition encountered in 3,927 cases. Ten diseases were responsible for 75.47 per cent of the cases, and these were as follows: allergic skin rash (14.6%), upper respiratory infection (13.57%), scabies (8.96%), acid peptic disease (7.43%) and muscular pain (6.85%) followed by urinary tract infection (6.16%), acute diarrhea (5.78%), general weakness (5.27%), injuries/wounds (3.62%) , and anemia (3.23%).

This, however, was an  analysis from the very initial days of the flooding, reflecting to some degree, diseases that could have been prevalent in the area (e.g. acid peptic disease, anemia). 

Subsequent reports gathered from IDRF-supported efforts in Charsadda,  Nowshera, Khairpur,  Sukkur, Kohistan, and  Balochistan show 17,187 patient contacts between Aug 4th to Sep 17th, with 91 disease categories accounting for 72.04 per cent of the diseases encountered.  The top ten ranked diseases were acute diarrhea (19.18%), URTI (11.16%),  allergic rash (9.39%0,  acid peptic disease (6.55%), scabies (5.4%), general weakness (5.32%), unexplained fever (4.82 %),  muscular pain (4.10%), urinary tract infection (3.69%), and lower respiratory tract infection (2.43%0. Bloody diarrhea (1.37%), suspected malaria (1.29%) and 154 maternal and child health contacts and 31 cases of malnutrition were also dealt with.

The rise in diarrhea seen by our teams is now more in line with the World Health Organization (WHO) report dated September 10th, 2010. Our teams, however, have not yet reported a rise in bloody diarrhea/ dysentery, suspected malaria, dengue, cholera, measles, and viral hepatitis which are epidemic prone diseases under surveillance by WHO and expected to rise as is an expected rise in malnutrition and conditions related to maternal and child health.

Planned Activities 

In order to deal with the current and ever-evolving disease and morbidity situation, we need to focus our finite resources to effectively and efficiently grapple with the topmost disease conditions i.e. water and food-borne diseases and infectious diseases and diseases related to nutrition and to maternal and child health, in a cost-effective and sustainable manner while maintaining the highest level of quality to which we have always been committed. In the remaining weeks of the disaster deployment, our teams will pursue  the following course of action:

Enhance the provision of safe water supplies and water purification solutions

Increase the supplies of oral rehydration kits.

Increase simple hygiene techniques: washing both hands with soap and water, covering the mouth and nose while coughing and sneezing, proper garbage disposal, etc.

Prevention activities to avoid malaria and possibly dengue which are liable to increase with the stagnant pools of water. This includes education, spraying,  mosquito nets,  and medications.

Coordinating for the provision of specific medicines and vaccines for the commonest infections and conditions and at all camps, depending on the caseloads at each camp.

Dealing with endemic and new-onset malnutrition by increasing the supplies of nutritional supplements.

Planning and providing for the safe antenatal, natal  and postnatal care of mothers and newborns. 

 

Conclusion

Given the background laid out earlier in this proposal, as well as the on-going health challenges facing the flood-affected populations, SHINE Humanity believes Maternal Child Health (MCH) forms the single most urgent healthcare need going forward into the long-term rehabilitation phase. At present, our teams are already supporting partial and full-service mother child initiatives in the following locations: the District Hospital in Charsadda (Khyber-Pakhtunwa province), Bagh Deri (in Swat Valley, Khyber-Pakhtunwa), Jaffarabad  (Balochistan) and  Shikarpur (Sindh province). We hope some or all of these will evolve into long-term rehabilitation projects. 

SHINE Humanity doctors in Balochistan
SHINE Humanity doctors in Balochistan
Skin infections are rampant
Skin infections are rampant

Attachments:
Sep 23, 2010

Field Report Part 2

Basic living conditions in Interior Sindh
Basic living conditions in Interior Sindh

Sep 22nd, 2010 Field Report 2

Here is the second installment of news updates from the ground:

Date: Sep 5th, 2010 Location, Khaipur, Sindh Summary: “The situation around Khairpur District is extremely dire. There is extreme concern for the spread of communicable disease in camps that lack basic hygienic facilities including clean water and proper latrines. The SHINE Humanity/CDRS team forward operating mobile medical camp has been on the front lines of treating the acute medical conditions of  IDPs  and has stressed proper hygiene to prevent disease and malnutrition. Every time our camp has been established in a neglected area, we have been warmly received by the destitute populations. Our goal in the upcoming days is to continue to work closely with our NGO partners and continue to focus on treating these needy under-served populations.”

Report: “As our flight from Islamabad was approaching Sukkur's Airport, we could clearly see the destruction caused by the Indus River from our airplane. The extent of the destruction is difficult to describe. Even from the air, we could see hundreds of acres of land submerged by the floods. Whole villages have been destroyed by the unrelenting water.

“Once we landed, we were greeted by  CDRS's first mobile medical relief unit that is based in Sukkur, Sindh. We unloaded our medical relief supplies, including essential antibiotics, and began our trip into interior Sindh. As we made our way to Khairpur District, which is approximately one hour south of Sukkur, we could see hundreds of IDPs in tents and makeshift habitats lining the roads.

“SHINE Humanity/CDRS had been contacted by a local  NGO, the IRC (Indus Resource Centre) to assist with medical relief operations throughout the district of Khairpur. Thus when we arrived in the city, we were debriefed about the situation by a representative of the IRC. Approximately 193,931 people have been displaced  and are currently scattered in makeshift government or  NGO camps in this district. The damage of the flooding in Khairpur district alone includes the destruction of approximately 12,584 houses and approximately 46,055 acres of crops. The situation is dire and appears to be worsening as there are reports of disease spreading through the IDP camps.

“After the debriefing, we decided that it would be necessary to coordinate both with the IRC and the local health officers in creating an effective plan to focus on those IDPs that have yet to receive adequate medical attention. The decision was jointly made to go to the outskirts of Khairpur (approximately 2 hours away from city-centre) and run mobile medical camps in those areas that border the flooded villages. Many of these areas have not receive any medical care at all and the majority of the IDPs at those sites are living in makeshift camps.

“As we made our way out of city-centre, we could see with our own eyes that acres of land continue to be submerged under water. And unlike the city of Khairpur, we began to realize that most of the displaced outside of the city were living in makeshift camps that had no access to adequate sanitation or clean water. The lack of basic hygienic conditions was quite evident as we saw the the victims of the flooding utilizing the same stagnant flood water for drinking, bathing, excretion, and washing livestock.

“We set up our camps on high ground bordering the low lying flooded areas. All of our mobile medical camps have been created in makeshift shelters. The process of patient care includes registration of the patient and obtaining statistical information, assessment and evaluation of the patients  by myself and our EMT, and then proper dispensation of medical supplies and medications by our pharmaceutical dispenser.

“Once word spreads through the populace that a mobile medical camp has been set up, hundreds of individuals inundate our medical camps. Almost all of the flood victims state that we are the first medical team they have seen since the devastating floods. The majority of the patients are women and children whose overall health and nutrition has been poor to begin with. Now after the flooding, their medical problems have been exacerbated.

“In the heat without any proper shelter, most of the patients we see are in some state of dehydration regardless of their actual medical complaints. In addition to providing medical care, our team stresses the importance of clean water and we educate our patients on utilizing water purification tablets or boiling water before drinking. In addition,  the importance of hygiene is also reviewed including bathing in clean water and not contaminating bath or drinking water with human/livestock waste.

“In regards to the medical situation, it is quite evident that these individuals are suffering from not only nature's wrath but disease. In our first camp we saw approximately 88 individuals with almost half of the patients being children. The major complaints included severe dehydration, weakness, fever, diarrhea/gastroenteritis, and respiratory tract illness. In addition to providing appropriate antibiotic coverage and pain/ fever relief we also provide an abundance of ORS packets and water purification tablets as we realize that in this intense heat, being well hydrated is key to maintaining good health.

“One particular case that is difficult for me to forget was when we saw a lethargic infant who was barely moving and was severely dehydrated. After seeing the severity of the case, our team acted quickly and provided appropriate acute medical care. In addition we educated the mother of the child and referred her to the local government hospital for ongoing therapy.

“As we continue our mobile medical camps, our patient numbers have continued to increase. In the past few days, we have seen 191 patients in one day and the subsequent  day we have seen an all time high of 357. Once again, the great majority of our patients are women and children who are suffering primarily from dehydration, presumed malaria, respiratory tract infections, gastroenteritis/ diarrhea, and skin infections. Once again, in addition to treating their acute medical conditions promptly and effectively, our mobile medical team has continued to focus on hygiene and safe water education. Report prepared by Dr Rafi Ahmed, resident UCLA Medical Center, volunteer

Date: Sep 3rd, 2010 Location: Sibi and Jaffarabad, Balochistan “Today, our medical team saw 270 patients. We are based at a camp that houses 1,000 people. The doctors used up $1,200 in medicines which we were able to procure in the markets in Quetta, which is a three hour drive from where we are based. Temperatures outside are a scorching 50 degrees, and several of our staff members suffered heat stroke from prolonged exposure.

“The people here have lost everything and have no money to buy food or basic necessities, though all of that they would need are available in the open markets. They have no shelter, and are sleeping under plastic sheets and wooden cots. There is no supply of clean drinking water, and we have seen people defecating in the same river as they draw drinking water from. To complicate matters, many of the children have severe dental problems, no basic hygiene items; lost everything. We desperately need to get infant formula - the children are so malnourished that we can’t find veins to inject IV fluids. The mothers can no longer nurse as they to have nothing to eat or drink. Our doctors came across a severely dehydrated woman who was nine months pregnant, and had no shelter to sleep. We did give her some IV fluids, and the next day, when we revisited, she appeared much better.

We also came across a man with gangrene. The doctors tended to his open wounds and he is now healing. The most heart-breaking story we heard was of a 13 year old girl. She was referred to us by her mother-in-law - the girl had been sold as a child bride by her parents and was being repeatedly raped and abused by her now “husband”. We arranged a lady health worker to visit her, with the aim of stabilizing her condition and removing her from danger, but the family fled with her from their temporary location once they realized they were in violation of child protection laws. The children here are very emaciated and need iron supplements.” Report by Rasha Tarek, Volunteer

Date: Sep 2nd, 2010 Location: Ganju Takkar, District Hyderabad “Today, we have checked 74 patients in camp near OGDC Office Ganju Takkar Hyderabad where around 200 IDPs are living. The patients were suffering from diarrhea, chest infection, flue, anxiety and skin diseases. We have provided them medicines. The community received 200 kg of flour, 112 1.5 liter bottles of water, 10 kg of sugar, 3 kg dry milk and 2 kg tea,” Report prepared by Dr. Muhammad Sharif, USI Field Officer, Mirpurkhas, Badin & Tando Allahyar

Date: Sep 1, 2010 Location: Hoosri, District Hyderabad “There were forty five tents and around 200 IDPs of flood effected areas. Our team checked 67 patients in a tent colony suffering from chest infections, diarrhea, skin diseases and flu. After treating the patients, we distributed 100 bottles of mineral water. We distributed the following food items: 10 kg of dry milk, 20 kg of baby cereal, and 5 kg of tea.” Report prepared by Dr. Muhammad Sharif, USI Field Officer, Mirpurkhas, Badin & Tando Allahyar

Flood waters in Sukkur
Flood waters in Sukkur
An infant facing severe dehydration receives care
An infant facing severe dehydration receives care
Dislocated communities with nowhere to go
Dislocated communities with nowhere to go
Women and children patients
Women and children patients
Dispensing medicines
Dispensing medicines

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