Pakistan

The HOAP-Real Medicine health project in Jabri, Pakistan is in full operation. With the change in the weather, the tent structure has been replaced with a transition structure of wooden frames and metal sheets, as the Government has not yet approved of permanent structure building in this earthquake affected area. With the burgeoning number of patients, there is a need to expand this structure further, a proposal that is under consideration.

With the recent onslaught of the monsoons hitting the northern part of Pakistan, our visit to the HOAP-Real Medicine Health Project was delayed. A brief interlude of sunshine for a couple of days made it possible to drive up the six hour journey on the winding and at times absolutely treacherous road. On our way, we picked up an LHV (Lady Health visitor) from Abbottabad, Ms. Nargis who had been selected by HOAP for her experience in a similar healthcare setting in a neighboring Union Council.

The clinic was packed with patients waiting patiently for their turn. The line spilled out of the waiting room into the courtyard. The doctor, Dr. Kifayat, was able to give us only less than half an hour of his time during our six hour stay on the site but who nonetheless provided us with valuable insight to the gender limitations of his practice. The LHV aided him in diagnosing a gynecological condition which otherwise would have alluded the doctor due to the reasons of 'purdah'. However, to be the only female member of the medical staff at this isolated hill spot is a daunting aspect, therefore it was decided that another LHV would be hired and a separate living arrangement would be constructed for them. This will address most of the sensitivities of the gender issues. An equally experienced LHV has been identified but has yet to be finalized.

The computer system purchased for the project is dependent on the sporadic supply of electricity which at times comes for only 2-3 in a 24 hour cycle. This reduces the efficiency of the daily report writing by the staff. A suggestion to replace the desktop with a laptop was requested by the staff and is under consideration.

The four-wheel drive jeep for the project is the perfect vehicle for this terrain but is not fitted to transport supine patients. A proposal to convert the jeep to a fully equipped ambulance has been suggested and is under consideration.

The trend of disease distribution in the latest morbidity report shows little or no variation whereby infectious preventable diseases dominate as the most commonly reported condition. Keeping that in mind, RMF has decided to introduce a Preventive Health Education (PHE) aspect to the clinic. The PHE program will be developed and executed by the Director of RMF Pakistan who will then train the medical staff. Innovative health education strategies will be adopted and key players from the surrounding villages will be included. Key players have been identified as the few selected individuals who have at least a high school diploma. One such person is a young girl from Jabri village who has completed her undergraduate studies and is presently in the LHV training program in Mansehra.

The HOAP-Real Medicine Health Project has had four success stories of recovery of SCI (Spinal Cord Injuries) children who have been given another chance at life. The monthly upkeep of their rehabilitation takes place in Peshawar and is being sponsored by Dr. Zeba of UCLA. However, due to their relative immobility in this handicapped unfriendly mountainous terrain, they are unable to go to the local schools. A proposal of home tuitions by local teachers has been suggested and is under consideration. Such a development will benefit both the children and the local people, many of whom have been rendered jobless by the devastation of the nearby towns which used to provide local employment.

As a damper to this otherwise successful trip, we had some bad news. The hard hitting monsoon rains resulted in flooding of the rivers and caused many landslides in this area. One such landslide occurred near the clinic base which exposed the bodies of four herdsmen who had been missing since the earthquake. They were from the same family from the Jabri village.

On a bureaucratic note, ERRA (Earthquake Rehabilitation and Reconstruction Authority), the government body authorized to issue the license to make permanent building structure has reached a decision to give selective licensing.