Celebrating New Beginnings!!
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November 1st, 2010 marked the end of the emergency phase of the Pakistan flood relief work. Millions of men, women and children are returning to their homes to find lands water-logged and houses, schools and businesses destroyed. Poor mother and child health is a major concern in Pakistan, and will now worsen due to poor living conditions and inadequate food supplies.
SHINE Humanity has focused on advancing primary and maternal-child health in Pakistan since 2005. The agency's strategy is to revitalize healthcare infrastructure in disaster-affected areas. We work with credible partners to rehabilitate facilities, train local medical staff, put in place efficient management systems, and build sustainable healthcare initiatives.
SHINE Humanity is achieving this by running the pediatric ward of a district hospital in Shikarpur (Sindh), a mother-child initiative in Charsadda and Swat (Frontier), and developing a parallel program in Neelum Valley. We also support a Rural Healthcare Center and 10 other facilities in Kashmir which we successfully rehabilitated after the 2005 Earthquake. Through our sustainable healthcare program and disaster relief activities, SHINE Humanity has serves over 150,000 patients across the world and provided humanitarian assistance to thousands more.
This Holiday Season, become a donor with SHINE Humanity, and your contribution will advance mother-child health in disaster-affected Pakistan. Donate now, and you have the option of sending a token of our appreciation to family and friends. Make $30 donation and receive a mug. Make a $50 donation and receive two scented candles. Learn more by visiting us on our new page, http://goto.gg/7004
Shikarpur DHQ Updates Date: November 14, 2010 Prepared by: Umair Jaffar, Senior Program Volunteer, SHINE Humanity-CDRS Intensive Care Pediatric WardFirstly, I would like to congratulate the entire SHINE Humanity-CDRS team especially the staff in Shikarpur. Due to the good quality of service, a well-stocked dispensary, and 24 hour availability of a doctor and medical staff, we have developed a very good reputation in the Shikarpur region. The most serious cases are being referred to our ward and it is being used effectively as an intensive care pediatric ward. We have received cases where children came to us with no blood pressure and no pulse. They are now completely recovered and have been discharged. One such child in particular had serious meningitis. Before coming to us the parents had been informed that there was no hope of survival. Due to the efforts of our staff, the child recovered and his father was so happy that he brought rose garlands for the staff on the day the child was discharged. Nutrition WardWhen we visited Shikarpur two weeks ago, there were an alarming number of malnourished children. It was like a scene from sub-Saharan Africa (see attached photos). Before leaving, we had made an arrangement with Save the Children and the Executive District Officer (EDO) for health to help us establish a nutrition ward. A nutrition ward is now operational inside the SHINE Humanity-CDRS ward. Save the Children has provided highly specialized feeds/formulas and training for the SHINE Humanity-CDRS staff and the EDO has provided two nurses per shift. With this additional help our staff can now provide the dedicated attention required for the nutrition ward. Nutrition for MothersDr. Zahra Shah, a fellow volunteer in Karachi will be sending specialized formula for lactating and pregnant mothers to Shikarpur. We will provide the formula to malnourished mothers in our ward. In addition, we are in the process of working with the EDO’s department to provide a regular supply of BP-5 biscuits (high-calorie, vitamin fortified biscuits) for the Nutrition Ward. We hope to get our first consignment this week. MalariaWith the rise in the number of malaria cases (currently 25% cases in our ward are suffering from malaria) making our ward insect free was very important. We had major repair work done to the insect screens on the windows and put insectocutors (insect control devices) at the entrance of the ward. We also met with the Regional Officer of the malaria program who will spray our ward tomorrow and will provide all support to our staff in the future. We had a suspected case of dengue fever in our ward. We immediately isolated the patient on the isolation bed which is covered with mosquito nets provided by the EDO. The EDO’s department will supply more mosquito nets and our staff has been instructed to cover all beds of suspected malaria/dengue cases in order to prevent the disease from spreading. Therefore, we will also have a small malaria isolation ward within the SHINE Humanity-CDRS ward as well. We are hopeful that with these changes will help prevent a major Malaria outbreak. Acute Respiratory InfectionThe majority of our cases are Acute Respiratory Infection (ARI) patients and we are getting the worst of these cases. Children are coming to us gasping for breath. Unfortunately we are not well equipped to handle such a large number of serious ARI patients. CDRS’s field officer Afzal Makhdoom is working on acquiring the necessary equipment to help these patients. The main items are a suction machine, nebulizer, and oxygen tanks. The equipment will cost us a maximum Rs. 75,000 ($875 USD). Medical Testing Fund We have established a small fund to aid patients from extremely poor backgrounds. Although we provide free medical aid to patients they still require blood tests and other services that we cannot provide. This money allows them to cover those costs as well. We established this fund after my last visit. A mother whose child had severe meningitis left the ward after she was unable to buy blood for her child. When she returned her child’s condition had worsened. Miraculously we were able to help the child and the child survived. In this case the mother and child were both lucky, but we did not want to see this situation repeat itself, so we established this fund.
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.
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.
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.
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.
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