Therefore, today we decided to revisit this locality again. It is a few kilometers further on from our yesterday’s camp site at Eisoghay village. Mianwalay vilage has about 85-90 homes where about 165 families are housed. There had been some progress in the area since our last visit. Although most walls and structures were still in a collapsed state, the locals had managed to clear out the streets and yards of their homes.

On our last visit we had examined two critical patients. The first was an elderly man who was bed-bound and suffering from high grade fever due to an exacerbation of chest infection. He had been misdiagnosed at a local clinic as having symptoms of dyspepsia whereas actually he had enteric fever which was proved by a lab test we advised. We had empirically started him on intravenous anti-microbials and oral anti-pyrtics. We started by visiting the home of this patient and were pleased to find out that he had made an uneventful recovery. He was only complaining of mild weakness after his protracted illness so we prescribed some multivitamins and made some changes to his prescription.

The other patient had been and elderly lady who had presented to us last week in a dehydrated and malnourished state and collapsed while arriving to our medical camp. We made a home visit to her as well. The lady was feeling much better and the gastroenteritis which had been the cause of her dehydration was now cured. It was interesting to note that she had followed our instructions to the letter and was now washing her hands with soap before each meal and after using the toilet. The family was enthusiastic about her new hygiene awareness.

After that we continued with our routine camp activity. The breakup of patients is as follows:

Total patients: 128
Male: 69
Female: 28
Paeds male: 21
Paeds female: 10

This time we saw improvement in symptoms of our patients from last time, but on the other hand there were also quite a number of new cases that needed medical attention. Many of the children were suffering from sores and blisters which due to neglect had become infected. Our staff dressed the wounds of all patients and we gave them anti-microbials where appropriate.

Infectious diseases still form a major portion of the disease burden that plagues the inhabitants of these flood affected villages. Despite awareness campaigns and counseling the people are slow to adapt their ways due to a number of reasons, but the positive thing to note was that at least some of the people had benefited from these efforts of health staff.

Our team returned to Charsadda today with a target to reach out to two villages by the banks of River Swat. These are the Eisoghay and Sarasan villages with a combined population of about 1,000. Temperatures in the area have soared again for the past couple of days, making it difficult for residents to work on rebuilding their homes.

Almost all houses in these hamlets have been damaged to a large extent. People have lost their livestock and belongings. Despite these hardships the locals had a very friendly and positive attitude and were working to clean out their neighborhood in the wake of the flood.

We reached in the first village (Eisoghay) in the morning. Most of the villagers had been busy working in small teams for clearing out the rubble from a few of the homes. On our arrival they took a break from their work and lined up for medical checkup. A few of the men went door to door to announce arrival of medical team in the homes nearby. We examined and wrote out medicines to about 60 patients in this village, before moving on to Sarasan village which is nearby. The rest of the patients were treated there.

The locals had piled up driftwood from the flood in their homes and yards. We were informed that this was expensive wood which is fetching a good market price these days. Mr. Salim, a local told us. “I have managed to sell wood worth Rs. 15,000 till now. But the loss of my crops has cost me Rs. 250,000. So I am in debt now and most of my land is non-arable for at least 1 year.”

We were told that 60 residents of the area had to seek refuge for 2 days on the roof of the local mosque, which was the only sturdy structure around. They were only able to come down once the waters had receded since no rescuers had come to this village, either through helicopters or boats.

A team from another NGO also arrived during our visit. They were focusing on providing durable shelters to the locals to help with the rebuilding process. They assessed the damage to houses and registered homeowner names in their database.

The breakup of patients at our camp was as follows:

Total Patients 133
Male 67
Female 32
Paeds Male18
Paeds Female 16

 

We saw the same disease patterns that are now associated with the flood hit areas. There were cases of gastroenteritis, scabies and respiratory infections. There were also sporadic cases of bacterial conjunctivitis and fungal infestations in some patients. Five of the patients needed intravenous fluid replacement which was administered to them promptly. One patient needed a consultation with a specialist so we inducted him in UM Hospital’s telereferral program and his clinical details were sent to Siwinfen Charitable Trust, UK for onward advice. We prescribed him based on our working diagnosis and promised to contact him about changes to his treament plan based on response from specialists.

 

  

We provided water cleaning solutions to all the patients arriving at our camp and wound up after we had examined all the villagers who sought medical advice.

Report written by Dr. Qasim Nasr, Medical Officer in Charge, UM Healthcare Trust Hospital.

 

 

On Thursday, our team went to village Ghazodheri to establish a medical camp.  Our team comprised of Dr. Haidar Ali, nurse Mr. Noor Jamal, pharmacist Mr.Bakhtyar and registration clerk Mr. Abdul Malik.  As we have seen in other villages, area people were informed about the camp by loud speaker.

We treated a total number of 216 patients, with eye infections, skin diseases, respiratory tract infections, and gastroenteritis due to constant exposure to dirty and stagnant water.

A very interesting case was a young boy who presented to Dr. Haidar with severe bone deformities.  We suspected a case of rickets, but due to poverty, his family was unable to take him toa tertiary case hospital fir further diagnosis and management.  We gave him treatment for his immeadiate symptoms and hope to do telemedicine consultations to develop a treatment plan for this boy. 

Other cases were skin infections that had not been treated and thus resulted in large pustules all of the body, gastroenteritis and severe vomiting, and infected eyes that had turned green and swollen due to lack of care.  All of these patients were treated with i/v fluids, antibiotics, and given medicines to take home to continue their treatments.  We also delivered water purification tablets and prophylactic doses of anti-malaria drugs to prevent the outbreak of diseases going forward.

At the end of the day, despite precautionary measures, Dr. Haidar also contracted eye infections.   This speaks to the very contagious nature of the conditions in the villages that were affected by the floods, and how desperately basic aid is needed there.

report written by Dr. Haidar Ali, Medical Officer, UM Healthcare Trust.

Here is a list:

#	Logo	Organization
1		Comprehensive Disaster Response Services (CDRS) To provide quick, efficient and compassionate medical and humanitarian relief while helping to rebuild and strengthen healthcare delivery systems and empowering communities to take charge of their healthcare destiny.
2		Disaster Relief by Irish Pakistanis (DRIP) DRIP is founded by the Pakistanis and their Irish supporters, which plan to work in the effort of rehabilitation in Pakistan and anywhere else if it is needed. DRIP represents all Pakistanis working so far in this relief effort in Ireland. DRIP is Irish wide and has representative in all four provinces. DRIP plans to work solely on voluntary basis. It has its constitution which is unanimously approved by the members.
3		Disaster Management Center (DMC) Abbottonians Medical Association, a registered NGO, established a Disaster Management Center [DMC] through the active support of Direct Relief International USA, Association of Pakistani Physicians of North America USA, Association of Pakistani Physicians of New England USA, Disaster Relief by Irish & Pakistanis [DRIP] Ireland, IslamiCity.com USA, Islamic School of Miami USA, Ayub Medical Institution and Philanthropists from all over the country and abroad.
4		Pakistan Software Houses Association (PASHA) Pakistan Software Houses Association for IT and ITES (P@SHA) aims to protect the rights of its members; P@SHA lobbied with the government to initiate policies and create an environment that would attract more firms to join the industry. Over the course of the last fifteen years, P@SHA has broadened its scope to include other IT enabled services companies such as Internet Service Providers, Call Centers etc.
5		Global Giving: GlobalGiving connects you to over 1,000 pre-screened grassroots charity projects around the world. It’s an efficient, transparent way to make an impact with your giving.
6		Kalamazoo Citizens and KIC The Citizen of Kalamazoo and Kalamazoo Islamic Center” with their generous donation helped UM Healthcare Trust to provide a water filtration unit. Kalamazoo is a University town in South West Michigan, USA.
7		Association of Pakistani Physicians and Surgeons, UK: The aims of the association of Pakistani physicians and surgeons (APPS) of the United Kingdom are to build bridges among the doctors of Pakistani heritage and deliver the highest standards of patient care and education.
8		Pakistani Citizens: One of our major contributers are Pakistani citizens who have not only donated financially to the cause of Flood relief, but also clothes, food rations, drinking water, kitchen utensils among other things.

Date: Wednesday, August 25, 2010

Today was another rainy day, and our team set out for Sangerh for our medical camp. Sangerh was in the direct path of the flood and was severely devastated by the fast flowing Swat river. Our team comprised of Dr. Haidar Ali, nurse Mr. Noor Jamal, pharmacist Mr. Bakhtyar, and registration clerk Mr. Abdul Malik.

70% of the houses in this village were obliterated by the flood flow and the village is now no longer easily approachable by road. Our team established the camp in a flood shattered home within the village. The electricity is still not restored in the area (despite being 4 weeks since the flood first reached this village) and therefore, the option of announcing our medical camp through loud speaker was not possible. Hence, we sent out volunteers door to door to inform the residents of our medical camp.

A male patient treated by Dr. Haidar with a high grade fever, cough, and conjunctivitis. He was treated with i/v antibiotics and given medications to take home. An elderly female presented with a headache, but on examination her Blood Pressure (BP) was highly elevated (210/100) and was in a state of depression. After giving advice on how to manage her high BP, our medical team counseled her as to how to manage her health better.

There was an air of depression and death in the atmosphere. Almost all the villagers here have lost everything in the flood- including shelter, clothes, and all of their savings. Having nothing left, they have a difficult time ahead of them on how to rebuild their lives.

We treated a total number of 110 patients with eye infections, skin diseases, respiratory tract infections, gastroenteritis, and a few cases of malaria.

This report was prepared by Dr. Haider Ali, Medical Officer at UM Healthcare Trust.

Click here to see our Photostream of our activities.

Date: Tuesday, August 24

On Tuesday our team went to Jalhar to establish a medical camp. Our team comprised of Dr. Haidar Ali, nurse Mr. Noor Jamal, pharmacist Mr. Bakhtyar, and registration clerk Mr. Abdul Malik. Through a loud speaker at the village mosque, our medical camp was announced so that maximum people could benefit from it.

One male patient who was treated by Dr. Haidar with gastroenteritis was extremely weak. He had been suffering from constant diarrhea, vomiting and fever. He was treated with i/v antibiotics and fluids, and medications were given to him to take home. He had not seen a doctor in weeks since the floods had begun and was now in critical stage.

A female patient was presented with pustules covering her body from contact with dirty water. She was also treated with antibiotics and anti-malaria drugs.

We delivered water purification tablets and prophylactic doses of antimalarial drugs to all of the patients to prevent any further outbreaks.

We treated 172 patients with most patients suffering from skin diseases, respiratory tract infections, eye infections and gastroenteritis.

This report was prepared by Dr. Haider Ali, Medical Officer at UM Healthcare Trust.

Click here to see our Photostream of our activities.

Monday, August 23, 2010

Our team established a camp in Namo today, comprising of Dr. Haidar Ali from UM Healthcare and paramedics from CDRS.  The locals were very happy when they heard about the camp, as there were many people with skin diseases and gastroenteritis due to the stagnant water remaining after the floods.

The village relied heavily on water from open water wells for hundreds of years. After the floods, almost all of them were contaminated, clogged or no longer functioning. There was a lot of mud, debris (including bricks and trash) and sections were broken up.  Therefore, drinkable water sources were limited and many of the villages were suffering from dehydration.

Dr. Haidar saw one young woman semi-conscious with severe dehydration who was unable to move her limbs due to weakness.  The team treated her with an i/v line of fluids, and she was able to leave the camp by foot after an hour. A male patient came in with an infected wound on his left foot.  We dressed his foot, gave antibiotics and pain killers, and he was also able to leave shortly.

We delivered water purification tablets and prophylactic doses of antimalarial drugs to prevent any future outbreaks, and our team also vaccinated the people against typhoid cholera and influenza.  We packed up around noon and reached home before evening.

We treated 152 patients there, with skin disease as the most prevalent ailment, followed by eye infections and gastroenteritis.

This report was prepared by Dr. Haider Ali, Medical Officer at UM Healthcare Trust.

Click here to see our Photostream of our activities.

District: Nowshera
Team: UM Healthcare (Dr. Qasim and paramedical staff)

Our relief teams had received requests from local people in Nowshera to arrange visits there, due to dearth of medical teams in the region. We had been to several villages and some parts of the cantonment in Nowshera last week but our primary focus this week had been Charsadda District.

The team therefore decided to revisit certain areas in Nowshera that had not received any help, viewing the local’s concerns. The temperatures had risen again after spells of intermittent rainfall and it was a hot day. We had selected Kheshgi Payan as our camp site this time. Kheshgi is a village situated on the bank of River Kabul between Nowshera and Charsadda. It has a population of about 50,000 depending primarily on dairy cattle for a living. Most of their livestock and farms have been destroyed by the floods.

Due to its location by the river bank, the village was one of the first to get flooded. And since it took very long for the water to recede from these areas, it was one of the last to receive aid from relief agencies. One villager Mr. Asif Ali recalled, “We woke up to find water entering our houses. By the time we roused our children and started to move out, the water was already knee deep. The flood caught us totally without warning and water was rising very fast.”

We could still observe large areas of land covered by stagnant water three weeks into the disaster. Kheghgi Payan is a medically underserved area. Even though the locals donated precious land for a Rural Health Centre which was constructed three years ago, lack of medicines and equipment meant the sprawling building was of no use to the people who took their patients to Nowshera or Peshawar.

This camp had been coordinated by Mr. Mohabbat Khan of Rustum who lives near UM Healthcare Hospital. He had arranged for our camp site through the primary school teachers of Kheshgi, Mr. Ghazi Marjan and Mr. Muhammad Ashraf Ali. Mr. Ashraf gave us a tour of the nearby alleys and homes to give us an understanding of the extent of damage that the area had suffered.
“I was going back and forth over this roof in a rented boat, looking for my neighbors and family.” He said, pointing to his house. Most houses were in pretty bad shape and boundary walls of many had collapsed under the force of water.

Our camp was in a house next to the Government Primary School, which has also been converted into a refugee shelter. The ground all around was covered in 3 to 6 inches of silt deposited by the flood water, which makes walking difficult at times. The place we were housed in had been completely submerged at the peak of the flood, but the villagers had cleaned it out for our arrival. The water marks on buildings were a grim reminder of the conditions his area had seen just a few days back.

We started with the male patients. Most were suffering from skin diseases, notably Scabies. Also we examined cases of anemia, respiratory infections and acute diarrhea. After that, we moved our team to an adjacent house where the women and children were residing. The people have shifted women and children to their relatives’ houses in the same village while the male members are engaged in removing debris from their houses. and also treated patients there. One of the old ladies was a hypertensive who had lost her medication in the flood resulting in spike in her blood pressure. We managed to bring her BP down by the time we were leaving and also gave her two weeks supply of suitable anti-hypertensive medications Some of the affectees living in the adjacent school needing medical treatment also visited our camp and received medication.

The breakdown was as follows:
Total Patients= 144
Males 44
Females 36
Peds (male) 47
Peds (female) 17

Alongside the medicines, we distributed food supplies and bottled water to everyone arriving at the camp. This was supervised by Mr. Mohabbat Khan and his colleagues.

While returning, we conducted a house call on an elderly lady who was too weak to come to camp. She was febrile and malnourished and therefore intravenous fluid replacement was done. She was stable but needed hospitalization for a couple of days so we counseled her family.

Poor hygiene and lack of insight into disease spread patterns is causing the outbreak of diseases like cholera and scabies in flood affected areas. We are trying to mitigate this by counseling people on good hygiene practices and preventive measures to adopt. In this time where government and private sector resources are over-stretched this is the only way forward.

Today’s camp was directed at medical and relief activities in Village Totakai which lies in District Charsadda.  Charsadda has been the worst hit district in the recent monsoon floods. According to government sources 60% of the local population has been affected, putting the figure at around 700,000 affectees. Part of the reason for theses staggering numbers is Charsadda’s geography. The district is flanked by three main rivers; Kabul River, Swat River and River Jindi. These rivers then merge south of the district and join the Indus river. Although this makes it one of the best irrigated and most fertile areas in Khyber Pakhtunkhwa province, it also renders the region vulnerable to flood waters. River Jindi particularly, broke its banks and affected a large area around Tangi Tehsil.

There has not been much improvement in the situation yet. People are still awaiting relief even 2 weeks after the floods caused massive devastation to their houses and crops. Although flood waters have receded, it will take a long time to rebuild the area and rehouse the displaced people. Most of the scenic villages along the river banks now lie in ruins.

UM Healthcare and CDRS joined forces to provide relief to yet another village in Charsadda, called Totakai. It lies in Tehsil Tangi, which was particularly hard-hit. Many houses and boundary walls lay in ruins. We had already established our field office at the beautifully designed haveli (mansion) of Dilawar Khan, a landlord of the area, where we had stored supplies of medicines for onward distribution. We left early and had arrived at the camp site by 9 in the morning. The camp was at the place of a local elder, M Zeb Khan. His house is situated in the center of the village Totakai and refugees living with host families were quickly informed of our arrival. By noon we had treated 118 patients, mostly women and children.

Among the women a significant number were suffering from anxiety and stress.

Dr. Qasim examining an elderly patient

The loss of loved ones and property has also increased the incidence of depression here. We provided counseling to them, suggesting ways to focus on rebuilding activities and to help maintain the health and hygiene of their dependents. The support of local community is also helping in giving affected people a sense of hope amid the grief and devastation.

Most of the children were suffering from gastroenteritis and respiratory tract infections, as they are more vulnerable to these illnesses in monsoon season. There were also many children who were anemic, depicting the poor health status and inadequate nutrition of this population, even before the floods. Our team also vaccinated the patients against Tetanus and distributed toys among the children.

The villagers are trying to cope with a lot of stress and difficulties. They keep scavenging in mud and flood water to look for any belongings that were spared. Thus the incidence of dermatitis and scabies is on the rise and we heavily prescribed skin lotions and emollients to them.

Food is scarce and it’s the month of Ramadan. I asked a frail, elderly lady why she was fasting in spite of her illness. She replied, “There’s hardly any food to feed our children and there’s no help from the administration. I might as well fast so my grand children can have more to eat.”

We had anticipated this by our experience at previous camps and now we carry extra rations of bottled water and water purification tablets at each camp. We had brought along a truck load of water and milk and food items to be distributed among the affectees. Alongside our medical camp, one of UM Healthcare’s Trustees, Mr. Zahid Khan supervised the relief goods distribution to the locals,  with help from local school teachers in record-keeping. A local Councillor visited our camp during the day and appreciated efforts of the organizations in bringing help to their area.

On our way back the road was blocked temporarily by a group of protesters demanding he government to intervene and send help quickly to flood victims. We observed the River Jindi level had risen again since morning. This regular surging of the rivers is one reason why the people still can not return for rebuilding their homes, for fear of a second wave of floods.

Protesters demand more support from the Government

Report prepared by Dr. Qasim Nasr, Medical Officer, UM Healthcare Trust

 

Date: Saturday, 14 August
Village: Mian Sahib Garhi
Tehsil: Tangi
District: Charsadda
Like all of the areas affected by the flood waters, Mian Sahib Garhi has no drinkable water and has not had electricity for the past 14 days.  Our medical teams saw a total of 101 patients, primarily with respiratory tract infections, gastroentritis and skin diseases.  There were also cases of malaria and typhoid seen.  We vaccinated children and adults against  cholera, typhoid and teatnus and packed up the camp at noon.

Date: Saturday, 14 August
Village: Gul Abad
Tehsil: Tangi
District: Charsadda
Our team treated 76 patients among the displaced people staying at the government primary school for girls in Gul Abad.  Again, the primary issues here were skin diseases and dehydration, followed by gastroenteritis and respiratory tract infections.

Report prepared by Dr. Amna Haleema, Medical Officer, UM Healthcare Trust