Real Medicine Foundation is part of a team of local and international NGOs who are supporting the government of Pakistan in tackling the challenge of internally displaced population, which has been a chronic challenge plaguing the country since 2004.
Internal displacement has affected an estimated 20 million people within Pakistan since 2004 due to military conflict, sectarian violence, and human rights abuse. The IDP problem was further aggravated by natural disasters, such as the 2005 earthquake and the 2010 floods.
WHO is responsible for addressing the pressure on the healthcare system, and leads a cluster of health-oriented NGOs to fill the gaps in service delivery. As part of this cluster, RMF has been providing high quality, free mother and child health (MCH) primary health care to IDP women and children in Union Council Taru Jabba, District Nowshera since December 2013. Our MCH clinic operation is being successfully conducted to date.
According to the latest OCHA repatriation reports of December 2016, a total of 227,843 families have been successfully repatriated back to their homes. These are estimated to be 75% of the total families that were displaced.
With the reducing IDP population, the pressure on the healthcare system has lessened, and WHO has announced a reduced urgency of additional healthcare services by cluster NGOs. RMF’S MCH center in Taru Jabba has two key components that make its services valuable despite the changing face of the situation: it is the only primary level healthcare facility in the Union Council of Taru Jabba that provides pathology lab services for routine investigations and ultrasound services. By virtue of these two services, patients are referred to our center by other healthcare facilities, including some private practitioners, making this a valuable addition to the healthcare service infrastructure of the union council.
RMF Pakistan has decided that we should continue our operations in this area for as long as we are needed, but with key changes to the operations. In August 2016, we began to include a small token fee for the above two services, as well as an OPD consultation fee. However, given that the average income of the local region is well below the poverty line, only those who can afford to pay are subject to these token fees.
A total of 761 women sought MCH services. Of these were 228 pregnant and 52 lactating women who sought antenatal and postnatal services respectively. Family planning services were provided to only 11 women in these three months, which is a common trend since family planning is the least sought out MCH service in the clinic.
A total of 1,642 women and children sought primary healthcare services, most of whom were children. The key case presentations were a variety of respiratory infections at 433 (26.4%), followed by the complaint of general body aches and weakness at 211 (12.8%). Diarrhea was the 3rd most commonly presented complaint at 157 (9.5%), with cases of anemia not far behind at 148 (9%).
There were 6 traffic accident victims who reported to the center, all with minor injuries. There were 8 non-TRA accident victims who were provided with immediate first aid. Referral to secondary and tertiary care hospitals in Nowshera and Peshawar for additional treatment was given to 7 patients.
The pathology lab conducted a total of 206 routine investigative tests during these three months. A total of 253 ultrasounds were conducted during this quarter. The number of ultrasounds has remained low ever since we introduced a fee for this service.
Cases for primary and secondary infertility were also 15 women, but they were not new cases. These 15 were women who have been frequenting our clinic with the same complaint. We continue to see them, since they just need an understanding, non-judgmental shoulder to cry on.
The trend of a reduced number of patients frequenting the clinic (observed in August and September when the new protocols were put in place) has reversed and is comparable to earlier months. However, a deeper analysis into the trend shows that our policy of exempting the poor from paying our OPD and other fees has led to a large percentage of women obtaining free treatment by pledging their financial poverty. Naturally, the number of patients has resumed, because most of them are refusing to pay our fees and we cannot turn them away.