Give Health Services to Pakistan Flood Victims

 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. 

• Shikarpur - before and after (PDF)

 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. 

• Disease Report (PDF)