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Real Medicine-HOAP Primary Healthcare Project in Pakistan

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Update August 4, 2008
By Dr. Rubina Mumtaz

Our primary healthcare clinic is expanding at a tremendous rate. In the first quarter of 2008, the OPD showed an 80% increase which means from an average of 40-50 patients 140-150 patients a day. In the second quarter, the OPD slowed down slightly due to security concerns and political instability but was still higher than the previous year.

This increase can be attributed to the fact other health units operated by NGOs and the government after the earthquake have gradually phased out as their funding interests changed and moved to other parts of the world. The few government health units currently open are functioning without doctors and proper medicines plus they charge an entry fee to the patients. This has diverted a large flow of patients towards the RMF-HF health unit from across Tehsil Balakot and today we can safely say we are catering for119,364 people from five union councils including Talhatta, Shohal Moizullah, Garlat, Gari Habibullah and Balakot. Naturally this has put enormous burden on the supply and consumption pattern of medicines for the clinic staff. The economy of the Pakistan has been spiraling down at an alarming speed resulting in unprecedented price hikes of practically all necessary items. The combination of these factors is putting a tremendous strain on the RMF clinic budget.

Amidst this gloomy picture is a sliver lining where RMF-HF health unit received a mountain ambulance. We are very grateful to Vital Edge for this donation; the ambulance has proved to be a very real asset to the project. It links the RMF-HF health unit to surrounding remote areas as well as secondary and tertiary care hospitals in the region. The ambulance has been specially converted to the mountainous terrain and is fully equipped with machinery for first levels of basic life support. The initial benefits of the ambulance are monthly home visits of 10-15 patients who are house-bound by a variety of diseases.

Currently plans to incorporate a dental clinic within the existing health unit are underway. A fully equipped dental unit chair has been donated by Dr. Ayyaz Ali Khan, National Oral Health Coordinator for the Joint WHO-MOH Collaborative Program. This donation created a demand for trained dental professionals. The THQ hospital (secondary level government health unit) in Balakot has been taken over Islamabad based philanthropists who are working to spruce up the health services. An MOU is currently underway between RMF and these philanthropists whereby the THQ hospital will send their resident dental staff (a dentist and an auxiliary) to the RMF-HF dental section since the THQ hospital has machinery that it non-functional and inadequate. On the other hand, the RMF-HF clinic will refer their MCH patients to the THQ hospital. A positive conclusion of these negotiations is expected in the next couple of weeks.

Update January 2008
By Rubina Mumtaz
Country Director, Team Pakistan

Benazir Bhutto is dead. She was brutally murdered on 27th December 2007 and Pakistan was plunged into darkness. For my country, 2007 was a year full of sorrow and bloodshed and as a gesture of farewell, left by extinguishing our last ray of light.

Shocked, stunned and speechless are three words which completely define my feelings when I heard about her death. I was never a Bhutto fan; in fact I was a vocal critic. Her two tenures as Prime Minister were disappointing, marked with corruption and personal gains and despite all her promises; she had made no tangible attempt to address the issue of women’s rights. Yet, her death felt like a personal blow, as though I had lost a family member who is a key provider. The depth of grief was intense and tears flowed for a long time after. The entire country came to a crippling standstill, mourning for hope lost; mourning for the three young children she left behind; mourning the legacy that was yet to deliver; mourning the rape of Pakistan by terrorists.

Her death has left a void in our hearts, fans and critics alike. This beautiful, charismatic Oxford and Harvard educated woman was the only Pakistani leader of international stature, a platform which no other Asian woman had reached. She was a salvage for the image of Pakistan; an image that has been badly tarnished with suicide bombings, terrorist activities and abuse of human rights. I don’t see any leader of her caliber, male or female, from the current crop of politicians. She was a rarity that comes once in centuries. Amazingly she stood as a symbol of hope for both the downtrodden and the liberals, groups on opposite ends of the spectrum. That I believe was her magic. She spoke the language of all the people of Pakistan, irrespective of ethnic, socio-economic and religious background. She had her faults but we loved her.

Her previous tenures had tarnished her reputation but this time round, Benazir was finally in her element. As a politician, she was wiser, older, more cautious and diplomatic but alongside equally loud in the face of injustice. She had polished up her act and finally balanced her personal and professional life. Immensely courageous, she was ready to jump headlong back into the office that had twice unceremoniously thrown her out. She had battled out all the shackles that had previously hindered her professionally. Perhaps this time round, she would have finally done all that she had been promising Pakistan for the past twenty years. Perhaps is such a powerful word and we will never know.

Usually in times of civil unrest, NGOs in Pakistan have often become targets for anti-American sentiment but our healthcare unit in Balakot has passed this litmus test. Our two years in this region after the earthquake have entrenched us well in the community we serve, therefore we enjoy the protection. Our collaboration with Hashoo Foundation, the Islamabad based NGO, with its established reputation of caring for the needy and vulnerable, further ensures this protection. Therefore, it gives me great satisfaction to say that RMF project is weathering well in these uncertain times and based on this indication, we hope it will continue to do so in the future.

Liberals, like me, despite all opportunities have made Pakistan their home. I want to live in this country, to raise my children here and to serve my people. Through RMF, I live out my philanthropic dreams and ambitions. I hope 2008 will be a year that will rid this sadness that engulfs us and bring about peace so that we can all live out our little dreams.

Update October 10th 2007
By Rubina Mumtaz

The second anniversary of the devastating earthquake came and went by with no more than a whisper of its mention. A few sporadic news articles focused on remembering those who lost their lives were found in the local dailies. Pakistan is too busy in balancing its unstable political situation and fragmented judiciary to give any attention to those survivors living out their shattered lives.

Real Medicine Foundation strives to be one of the few that still extends its hand of care, long after the disaster is over and forgotten by the rest of the world. The Talhatta healthcare clinic is operating on full swing with a current OPD of nearly a hundred patients every day.

In the past two months, HOAP, our collaborating NGO in Pakistan has merged with a larger philanthropic organization called Hashoo Foundation. The merger fortunately was without any major change in personnel, programs or commitments. The chairperson of HOAP, Ms Sara Hashwani will now function as the Chairperson of Hashoo Foundation but the Chief Executive Officer has been replaced with Dr. Imam Yar Baig. The MOU between RMF and HOAP remains unchanged except for the name, as is the staff set-up of the clinical unit.

Dr. Zeba Vanek of UCLA made Pakistan the destination of her summer holidays this year. She came charged with energy focused on rehabilitating the paraplegic victims of the earthquake. We spend three hectic weeks meeting up Hamid Jaffer of a Karachi-based organization called CHAL, professionals from the AFIRM (Armed Forces Institute of Rehab Medicine) Rawalpindi and Dr. Bakht Sarwar of PIPOS (Pakistan Institute of Prosthetic & Orthotic Sciences, Peshawar. CHAL is committed to extend rehab services to physically challenged persons, and is working closely with AFIRM to build capacity and reach out to SCI patients registered in the PIPOS (Pakistan Institute of Prosthetic & Orthotic Sciences) Rehab Centre in Balakot and Bagh. Positive meetings paved the way to setting up a proposal to address the comprehensive rehabilitation of SCI patients to become independent and productive members of society. Dr. Zeba, with her boundless compassion for these vulnerable people, is currently raising funds to make this proposal a reality.

Pakistan is in political turmoil. Civil unrest in the Swat district of the northern province of Pakistan caused by the invasion of Taliban-backed forces has led to common citizens to flee their homes. Dr. Khifayat’s (our doctor in the clinic) family was one of these unfortunate people who have been forced to take refuge down south in Lahore. Therefore, Dr. Khifayat was compelled to resign to enable his family to settle in their new home. He has decided to take advantage of this transition by pursing his post-graduate training in Orthopedics in Lahore. We take this opportunity to wish him all the luck in his future endeavors. Luckily a new doctor, Dr. Mohammed Ayaz was hired immediately and our OPD continued without a break.


Update October 2007 (1.5 Kb .pdf)


Dr. Martina Fuchs - March 2007 Visit to Pakistan


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The massive earthquake that struck Northern Pakistan on October 8th, 2005 caused death and devastation at an unprecedented scale. Everywhere, buildings have collapsed and landslides have blocked access to remote Himalayan valleys, leaving people without shelter, food and healthcare.

The Real Medicine Foundation is participating in relief efforts in the worst hit mountainous region (Mansehra, Balakot, Kotbala, Jabri).

The Real Medicine Foundation's Team Asia has been working in collaboration with the HOAP Foundation in Pakistan's capital Islamabad, an organization which has been running emergency relief operations on the ground ever since the October 8 earthquake killed more than 80,000 persons and left more than three million without shelter. The relief efforts have been targeted at the worst-hit areas and have offered services like food, clothing, shelter, tents and medical camps.

A team of volunteers comprising of Dr. Giorgio Pietramaggiori of Boston's Brigham & Women's Hospital, Dr. Fabian Toegel, Dr. Helen Ouyang and Mr. Omar Amir from the Harvard School of Public Health flew to Pakistan for several weeks in January 2006 to help set up medical camps in collaboration with the HOAP foundation.

How Real Medicine is colloborating with UNICEF, Oxfam and the World Health Organization:

  • Workshops for proper wound care, primary prevention of ARI, skin diseases, and sanitation will be conducted.
  • Health education materials for primary prevention and early warning signs for disease developed by W.H.O. and the government of Pakistan will be used.
  • In consultation with UNICEF, a vaccination program against measles will be implemented by conducting surveys using HOAP's volunteer network together with the nurses and doctor coordinating the process.
  • Oxfam will help HOAP/Real Medicine implement a water and sanitation project.
  • HOAP/Real Medicine will implement a basic health education component in the 25-30 schools that are being rebuilt by HOAP in Shawal Moizullah.
  • W.H.O. in collaboration with the government of Pakistan will rebuild the basic health unit using a prefabricated structure by mid February at which point the HOAP/Real Medicine medical staff will work there.
  • In the meantime W.H.O. will provide 1-2 medical tents to HOAP/Real Medicine that will serve as OPDS for the basic health unit until the prefabricated structure is ready.
  • After 6 months, the government and local community will take over the health care apparatus once they have recovered sufficiently from the earthquake.

Previous Updates

Update 30th July 2007
By Rubina Mumtaz

The RMF-HOAP Home Tuitions Project was launched off this summer. Hundreds of earthquake survivors suffered spinal cord injuries, many of which are children. SCI is a lifelong disability that confines the victim to the home, requiring constant management and attention. This burdens the poverty stricken families with additional responsibilities.

Many SCI children are then naturally deprived of an education. Quadriplegics cannot leave their homes at all. Paraplegics have wheelchair mobility but this too is limited due to the mountainous terrain. Most SCI children have lost more than one year of schooling since sustaining their injuries last year. If their present circumstances continue, these children will grow up to be not only home-bound, but also illiterate and an added burden to their families.

The Home Tuitions Project’s aim was to sponsor teachers to give home tuitions (tutoring)to home bound SCI children. The teachers will go to each child's house every day, Monday to Friday, for a predetermined number of hours and teach the local school curriculum according to the relevant grade. They will also get permission from the local board of education to conduct the examinations at the homes of their students. Children from the neighborhood, especially girls have been encouraged to join. Boys' education is, unfortunately, considered more important in Pakistan, so when parents cannot afford to send both boys and girls to school (as is often the case) the boys are given the opportunity. Also the ratio of boys’ schools to girls’ schools is 5:1, which makes the distance traveled for girls to get to school greater. Additionally girls are needed for household chores. Home Tuitions addresses all these real life problems without upsetting the cultural gender equilibrium, since girls will actually only spend a few hours a day on studies which will not affect their contribution to the labor in the households.

Funding for this project has come from a delightful source. Young students of Patana Primary School in Bangkok, in response to the earthquake, collected to raise funds to help the children victims. They wanted these funds to address the education of earthquake affected children. Marc Gold from “100 Friends Project USA’, who visited the RMF-HOAP health unit in Balakot last year, mediated this collaboration, making it a reality today. It is a two year funding grant.

Out of the four SCI children identified, three of their families agreed to Home Tutoring. Unfortunately although our aim of addressing as many girl students in the neighborhoods, has not been very successful. Most of the neighborhood families preferred to send their sons to participate in the home tuitions. We have a total of 7 boys and 4 girls in the project. Two local qualified teachers have been hired, giving them an opportunity to employment within their home towns. Stationary and uniform was purchased by the HOAP staff. The staff will also monitor the teachers’ attendance, progress of the students as well as to ensure their registration with the local school examination board and obtain permission to conduct the exams in the homes of the SCI patients.

Classes are being held over summer, to address the gaps of the last year. The teachers thought it would be a good idea not to indulge in summer holidays as the children fall back into the sync of schooling again.

Volunteer for RMF, Dr. Laila Gulzar, collected donations from Dr. Joanne Dish, Ms Rozina Bhimani, Aparna Godavarthy, Dr. Ruth Ross and Kay Wicker and contributed them to RMF. I take this opportunity to thank them all for their generous contributions. These funds have been incorporated into the Home Tuitions Project and will address the stationary needs of any additional children that may opt to participate in the tutoring. We are hoping the smooth and successful imlementation of the project will encourage more families to allow their daughters to enroll.

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