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Real Medicine-HOAP Primary Healthcare Project in Pakistan
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Press for Real Medicine Pakistan
December 3, 2009
By Dr. Rubina Mumtaz
Country Director, Pakistan
It has been 4 years since the ill fated earthquake that killed over 80,000 people. The memory has faded not only for the world but even for most of Pakistan. The 4th anniversary was acknowledged by only those who lost loved ones. Even the rudimentary remnants of the camps/offices held by foreign funded agencies have practically disappeared from the landscape. The only exception is the RMF-HF clinic. RMF, as per our mission statement, is the only one that has been constant and resolute in providing healthcare for all despite the fading interest of the funding agencies. Although it is becoming increasingly difficult to seek funding for the Pakistan project, RMF is steadfast in its pledge to continue this project.
The OPD of the clinic has maintained the patient load since the beginning of the year. From July to September, 5,544 patients were diagnosed and treated. Of these, 39% were males, 61% females and 28% children. Amongst the women, 244 came for antenatal visits, 177 for gynecological presentations and 141 sought out family planning. We had 23 cases ranging between suspected meningitis to acute appendicitis that were referred to secondary and tertiary care hospitals for further treatment. Home visits by our staff were carried out for 12 bed-ridden patients in several neighboring villages.
The war on terror in Pakistan has rendered road travel to the northern part of Pakistan dangerous. Therefore extra kudos must be given to the staff of Hashoo Foundation who has not faltered in their fortnightly visits to the clinic to keep the stock of high quality medicine up to date. However, despite the insecurity abound in the country, our staff at the clinic feel safe and secure. This can be attributed to the good will earned over the past four years and the fact that our healthcare approach does not transgress on the cultural boundaries of this area.
Update for the RMF Flood Victims Community Health Outreach Program
By Dr. Rubina Mumtaz
Country Director, Pakistan
June 17, 2009
The freak monsoon of 2008 wrecked havoc across Pakistan. The North West Frontier Province and its adjoining tribal areas had the most casualties where flash floods killed 200 people overnight, literally sweeping away property and livestock of over 114 villages comprising of 11,200 houses affecting over 67,000 people. Scores of people were marooned by the floods and had to be rescued by military helicopters over several days. The scale of damage was declared high since there was no effective warning mechanism and many of these people living below poverty line had encroached into waterway active flood plains living in makeshift mud houses. 40,000 acres of cultivated land were also badly affected ruining the crops and making the survival of these already homeless people all the more stark.
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The National Disaster Management Committee of Pakistan and the Emergency Relief Cell housed these homeless flood victims in tent villages in Charsadda and Mardan. It is a well established fact that unhygienic and crowded living conditions of tent villages render its populations vulnerable to a wide range of diseases.
RMF collaborated with Relief Foundation, a local, private, non-profit NGO that works for poverty reduction, improving quality of life of the ultra-poor and provides free medical relief to the vulnerable in far flung areas of Pakistan, to set up four free one-day medical camps for these flood victims. With a volunteer team of 15 male and female doctors and 9 paramedics and a coordinating team of RMF health staff, over 2,800 flood victims were treated during the first 2-day camp of Feb 15-16, 2009. The doctors covered all specialties inclusive of orthopedic surgeons, dentists, ophthalmologists and pediatricians. The process conduct of patient flow followed a simple systematic route. All patients after initial registration were screened by general physicians in the filter clinic who also provided PHC. Subject cases were referred to the relevant specialist. Complicated cases were referred to tertiary level hospitals in Peshawar and Mardan. Prescriptions were taken by the patients to the pharmacy where free medicine was distributed. Most of our volunteers are physicians on the faculty of tertiary level teaching hospitals in Peshawar, thereby in a position to facilitate the referral cases on their home grounds.
Two weeks later, another 2-day follow up medical camp was set up in the same place on March 7-8, 2009. This proved to be an even greater success where 3,178 patients were treated. The total number of prescriptions dispensed was 3,034. The most common diseases presented in all four camps were gastroenteritis/diarrhea, respiratory tract infections, and dyspepsia with malnutrition and worm infections mostly in children. However the most common complaints were general body weakness and depression, the former merely a symptom of the latter.
The medical camps proved to be very successful having had intensive pre-camp processes of announcing the upcoming events via media, pamphlets, radio and local cable providers, mobile car-loudspeaker announcements as well as mosque announcements prior to every prayer call. All volunteer doctors were awarded certificates of appreciation. The credit for the well management of the camps actually goes to Relief Foundation whose staff is well trained and has conducted about 30,000 camps since its inception in 1988.
The specialty wise patient flow is shown in the table.
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Specialty
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OPD
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% of total
patients
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General Medicine
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807
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25.0%
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Dental Section
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763
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24.0%
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Pediatric section
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468
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15.0%
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Orthopedic section
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270
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8.5%
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Gynecology/Obstetrics
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246
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8.0%
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ENT
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232
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7.0%
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Dermatology
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180
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6.0%
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Ophthalmology
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63
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2.0%
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General Surgery
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150
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4.7%
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TOTAL
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3178
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100%
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The response from the local community was overwhelming in their appreciation for this direly needed facility. The gender-wise flow of patients showed a near equitable number
of women (45%) visiting the camps, a factor that can be attributed to the significant number of female doctors/dentists (7) available.
War In Pakistan And Its Internally Displaced Victims
By Dr. Rubina Mumtaz
Country Director, Pakistan
June 17, 2009
Displacement is an inadequate, meaningless word when it is used to describe the trauma of being wrenched from your home and forcibly dislocated to a far flung place not of your choice.
Imagine an ordinary day in your life. Food is warm on the table, the children are out playing and you’ve send your other half or your teenage son to get bread from the bakery. Suddenly the shrill explosions of bombs landing in your backyard break the tranquility. The panic, the chaos, the screaming, the children outside; are they alive or not, people running helter-skelter. In an instant, life becomes all about survival, the very lives and safety of your loved ones. What do you pick up from your abode as you make the panic-induced on-spot decision to run for your life? Your clothes? Your money? Your identity papers/credit cards? Or do you just grab the hands of your loved ones and run? This is what happened to over 2 million people. They fled for their lives with nothing on them except the clothes on their backs.
Hence the words ‘inadequate and meaningless’ to describe displacement. The internally displaced people (IDP) are people like you and me, who had perfectly good lives till the Taliban decided to invade this tranquil scenic mountains of Swat in Northern Pakistan. The Taliban did not come overnight. They slowly insidiously infiltrated into the area, preaching about Islam, missionary in their approach to impose the Islamic Sharia (Islamic law) that assured peace, quick justice, law and order plus the promise of heaven hereafter. They recruited the bright eyed youth with immediate lucrative economic and power-based returns. The government of Pakistan initially turned a blind eye; it began to acknowledge the Taliban only when the metastasis of their networks reached into neighboring districts of Malakand. However, for the people of Swat, the true nature of the Taliban became evident within a short time when public beheading of suspected spies and floggings of young girls for walking on the streets unescorted became commonplace events. Yet the government chose to flirt with the Taliban negotiating with them by giving them a legal status under the Nazm-e-Adl Regulation. Only when this agreement failed and the Taliban showed their true intent of spreading their violent leanings to the rest of Pakistan did the government respond with the long overdue military response. This too was badly timed and with no prior warning, the military attack on the Taliban took place literally overnight resulting in the fastest displacement of over 2 million people in just one month. According to the UN, the IDP situation in Pakistan has been categorized as the worst human displacement of the world in the last fifteen years. It is considered to be more critical than the 1994 displacement in Rwanda. Yet, hundreds of thousands of people are still stranded in the war zone, living in terror of the Taliban who are stopping them from migrating out by resorting to violent beheadings on the premises of their potential worth as hostages.
Today the IDP are living in tents established in the safer districts of NWFP in this scorching heat where temperatures run into the range of 38-44oC, without extra clothing, food, clean drinking water or health care. Displaced children are believed to be facing severe acute malnutrition with dozens of children dying due to diseases such as gastroenteritis, typhoid and respiratory infections. Women from this highly patriarchal tribal of Pakistan where the ‘purdah’ of a woman is of extreme importance, sometimes even more than life and death, face the dual problem of maternal and child health problems as well as the reluctance to unveil themselves in front of male health care givers. According to the UNFPA, there are about 69,000 pregnant women in the displaced population with over 6,000 expected to go into labour within the next one month. They will need surgical care with blood transfusion but most important of all, they will need female health care givers. Already many women have died in childbirth or have lost newborns.
Today the IDP are living in tents established in the safer districts of NWFP in this scorching heat where temperatures run into the range of 38-44oC, without extra clothing, food, clean drinking water or health care. Displaced children are believed to be facing severe acute malnutrition with dozens of children dying due to diseases such as gastroenteritis, typhoid and respiratory infections. Women from this highly patriarchal tribal of Pakistan where the ‘purdah’ of a woman is of extreme importance, sometimes even more than life and death, face the dual problem of maternal and child health problems as well as the reluctance to unveil themselves in front of male health care givers. According to the UNFPA, there are about 69,000 pregnant women in the displaced population with over 6,000 expected to go into labour within the next one month. They will need surgical care with blood transfusion but most important of all, they will need female health care givers. Already many women have died in childbirth or have lost newborns.
About half a million individuals are living outside the camps relying on the hospitality of friends, families and tribal networks while those in camps are receiving assistance from international and national aid agencies. The government has appealed to the international community, development agencies and the general public to share the burden of managing IDP. They need food, shelter, bedding, clothes and all things for basic living. Their children need to be in schools instead of loitering in the camps. Help needs to be delivered all the while maintaining their dignity and purdah of their womenfolk.
RMF Pakistan office has collaborated with several grass-root organizations working on different aspects of aid to the IDP. We have collaborated with Relief Foundation to set up free medical camps with volunteer doctors. Funding is required mostly for the cost of medicine. We have connected with the Quaid-e-Azam University which has set up a food and roof fund. A donation of US$ 100 will feed a family of 12 for a month. Similarly a donation of US $100 will provide a safe and decent shelter for 3 families. Three monthly pledges are recommended to ensure sustained and systematic aid.
Update first quarter 2009
By Rubina Mumtaz
Country Director, Pakistan
For Pakistan, 2008 was yet another year wrecked with turmoil and violence; our hopes to see a stable, peaceful and prospering nation are yet to be fulfilled. Despite the inherent security risk offered by a country labeled as the hub for terrorists, the very brave Dr. Martina Fuchs visited us in January.
The six-day visit began on 14th Jan with a visit to Hashoo Foundation where Dr. Baig, the Executive Director made a presentation reporting the progress of the project. The next two days were dedicated to meetings with potential funding agencies within the country. We met with Mr. Ghulam Panjwani, CEO of Focus Humanitarian, an independent subsidiary of the Aga Khan Foundation. However their arenas of interest differed from the RMF scope of work. We also met Ms. Abira Sher Afgan, the President of the Islamabad Rotary Club. This meeting was facilitated by Rotary member, Dr. Fabian Toegel, country director of India who networked the Indian Rotary club with the Pakistani counterpart. Although the Rotary Club has the budget, their basic criterion was funding health projects affiliated with the Government of Pakistan in order to ensure sustainability. Unfortunately, RMF Pakistan has no links with the government health system but this is an avenue that needs to be looked into. Mr. Zafar Omar, a local philanthropist who has adopted the THQ hospital in Balakot was particularly inspiring to meet up with over dinner Friday evening as he had single handedly transformed the non-functional hospital to a busy health care center.
Over the weekend of 17-18th January, we took the 6-hour drive up to the health camp in Talhatta. The reception was heartening to say the least. The entire community leaders of more than a dozen had gathered early that morning to collectively receive us. Dr. Fuchs was first taken on a complete detailed tour of the camp and its daily progress. The meeting with the community leaders began with a very articulate opening speech by the local landlord and the new religious leader who surprised us with his progressive views. The goodwill RMF has earned in this region over the past few years is amazing and of priceless value in these times of insecurity and senseless persecution of international NGOs by the Taliban. Unfortunately the demand of the Talhatta community was still the same which was the need of an MCH clinic to be incorporated into the center. We desperately need this budget. A sumptuous lunch followed where the community leaders shared the table with us. This one act was indicative of the love and respect we have earned as it is goes against the local tradition of segregation of sexes.
Zafar Omar joined us from Islamabad early Sunday and we spent the morning visiting the THQ hospital in Balakot. The original hospital had collapsed completely during the earthquake and a philanthropist form Karachi had rebuilt it completely in an earthquake proof structure within the first couple of months after the earthquake. Despite the restored building, it lay vacant with no staff or medicines. Zafar adopted it in 2007 and with funds raised by his groups of friends in Islamabad, single-handedly equipped the hospital with staff, equipment and supplies. It has a fully equipped operating theatre and incubator facility for an MCH care service. Unfortunately he ran out of funds due to the waning interest of philanthropists’ aid and the hospital has swung back to an inadequate level. We inspected the place with a view to adopt it in the RMF health arena. The biggest hurdle in this step is the government bureaucracy which will be inherent in this project. However, we are looking into this avenue keeping in mind funding from the Rotary Club whose mainstay was a government backed set up.
After another lovely lunch at the RMF-HF clinic and a meeting with the camp staff most of whom professed a high level of job satisfaction, we set back to Islamabad. The few problems presented by the camp staff were taken up with the meeting we had with Hashoo Foundation in Islamabad the following morning. The budget was analyzed and revised and anew memorandum of understanding with Hashoo Foundation was signed.
A very tired but satisfied Dr. Fuchs flew out of Islamabad on Monday evening. Her visit left us infused with much needed renewed energy and enthusiasm in this negative time.
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| The meeting with community leaders |
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| Lunch with the community leaders |
Martina with few camp staff members |
Third Quarter 2008 Update
Dr. Zahoor Uddin and Dr. Rubina Mumtaz, Pakistan
Despite restricted movement throughout the country due to increased security and political instability, the Real Medicine Clinic continues to see signs of it growing importance as one of the only sources of primary care in the region. During this last quarter it saw an 5% increase in visits up to 5,672 for the quarter. 34% percent of this increase was related to antenatal visits and family planning, new and critical services now provided by the clinic. This particular increase underscores the need for a fully staffed MCH center in this area.
Most of the diseases diagnosed and treated continue to result from the weather and living conditions of the patients. The majority of visits (34%), were attributed to acute respiratory Infections (ARI). Please refer to the morbidity report (link below) for more details information.
Another notable success is the mountain ambulance donated by Vital Edge. Having been put to great use already, a total of 31 emergency cases were referred to secondary and tertiary hospitals where critical care could be provided.
While our clinic continues to realize many successes it is still faced with considerable challenges. In additional to the volatile political climate, country-wide inflation, power outages that interrupt patient care, and the need for computer literate personnel for reporting continue to strains budget considerations as we seek to establish more stability and additional services to our ongoing operations.
For additional information on specific treatment frequencies, project history, or to make a donation please click on the desired link below:
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.
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