Biggest emergency on the planet declared by UNICEF - The 2010 floods along the banks of River Indus. Can the country and its people be the same?  About 3 weeks post floods :20 million displaced…. 

“The loss of life, disease, poverty, and human misery themselves are going to take years to overcome. But the costs of desilting, cleaning up, and reconstructing Pakistan's most fertile and potent highways, canals, and waterworks will be exhausting just to calculate.  The actual task of building back this critical infrastructure is a challenge of unprecedented proportions.” Foreign Policy august 21,2010. Since mostly the farmers have been affected by the flood – their land, crops and cattle destroyed; both their assets and income generators for Pakistani villagers along the Indus River are no more. Twenty million people are now struggling to find a dry place to sleep, a morsel of food to eat, a sip of clean water to drink -- and the questions we are asking, have to do with politics and international security- and reliability or the lack of it in dealing with funds.

Immediate Requirement:

FUNDS: donations as money is desperately needed to buy food, medicines , shelter, transportation and supplies and hire local people to assist. Having finances mean they can buy whatever is needed. Coordination between humanitarian relief organizations is important to ensure effective delivery of services and efficient use of scarce resources as emphasized by UN.

 We have to see whom the people of Pakistan trust most- which governing body in the country is least corrupt:

 (a)  Pakistan Army

 (b)  EDHI ( may not have the time to take up this responsibility as they are working endlessly- man power may be an issue.).

  In Pakistan army corruption is marginalized. Hence, funds would be most reliably  collected and handled by the army. A flood relief account should be set up in the National Bank with branches all over the country. In this case , the national Bank can serve as the Central Bank- State Bank. This would add transparency and accountability.

Reasons for making Army the central coordinating body for collection and utility of funds:

 1)    Corruption is marginalized

2)    Most man power to deal with this colossal calamity

3)    Helicopters , boats , planes – all logistic support

4)    Hence, money can move faster on ground to reach the afflicted.

5)    Currently , funds are threatened by “choors and decoits” -  Army can give security to the goods collected.

6)    Trained to deal with various terrains

7)    Army has a department Signal Corps- this department can help in communication in areas which are too far flung and difficult to reach. This would enable a very effective communication.

8) Army has service corps , engineering batalion ( which can help with reconstruction of roads and bridges) and Military police to check any mishappenings.

Body within army:

 Would constitute of brigadiers and majors: people with  good reputation should be made incharge.

 Role of NGOs:

 NGO’s get their funds from foreign agencies. They can work parallel with the Army and Edhi. However coordination is required- they all need to work as partners and share their information.

 Media:

The media giants can set up coordination cells. Coordination cell would have 24 hours coverage by three shifts of operators and a log would be maintained either district wise or for every 10 km radius.

Where Army , Edhi and NGOs and hospital - medical camps: all share the information of provision of relief goods and Aid is shared. So that duplication of effort is minimal and maximum population is covered and no one is left out.

 Media controlled website:

 A website need to be continuously and vigilantly updated, that would show the utilization of funds and supply of resources and disease outbreaks, nutrition and malnutrition and also the need for the basic items: like clothes, medicines, vaccination, food.

 And every NGO or philanthropic individual/group efforts , should get an ID number and password to access it and upload their information on the ONE common website. Hospitals holding medical camps should also upload their information about the services provided in various flood affected areas and services still needed. GIS mapping can be used as a tool.

Develop a Volunteer Cell:

During and after disaster what is deperately needed is equipment, supplies and expertise in disaster situations. They require skills , qualitfications and long term commitment, not just good intentions, there should be a sence of urgency and short term availibility. Volunteer with an orgnization or government ideally, so that the efforts do not become sporadic but are rather coordinated.

Boy scout and girl scout, community health workers and Medical University students .... could be very effective.

How to long term rehabilitate:

 So besides immediate needs , i.e, rescue, tents , food , medicines , what shall we give the flood victims?

 Money in cash? Not a good idea as they might spend it without having tangibles remaining with them. NGOs already working to supply family packages of food and medicines.  Medicines can be bought from pharmacies at subsidized rates by the NGOs or philanthropists and distributed thorugh medical camps.

If we are to prioritize for long term rehab between : Food, Clothes- by giving them cash packages;  and Shelter: SHELTER is what army should aim at providing them- not temporary one, like in schools or mosques- Army should help build one to two room houses and allocate them based on the family size. Mostly displaced people are farmers: so with the funds donated for the flood victims, buy them animals, fertilizer and seed- depending on how much money is available after shelter provision. This will help the flood victims get settled back into normal life. We have to keep in mind how this huge bulk of population of survive in the long term? It is a matter of addressing urgent needs, immediate needs , short term and long term needs. All this translates into national security.

Hand-cycling event to be held in capital tomorrow

Saturday, March 27, 2010
Myra Imran

Islamabad

Opening a new page in disability sports in Pakistan, a brave heart and certainly a pride for the country, Sarmad Tariq will organise first of its kind hand-cycling event in the capital on Sunday March 28.

Sarmad is a quadriplegic (paralysed shoulder down), on a wheelchair for the past 18 years. His disability never stopped him from spending his life in a way better than majority of normal human beings. His achievements are indeed an inspiration and motivation for those who want to overcome their disability.

On March 26, 2004, he drove a distance of 1,847 kilometre non-stop from Khyber to Karachi in his hand controlled car. He covered the distance in 33 hours and made a world record by being the first ever quadriplegic to cover the distance in such short time.

He is also the first ever Pakistani wheelchair-bound athlete to complete a full marathon distance of 42.192 kilometres in Standard Chartered Lahore Marathon on January 30, 2005. He was the only wheelchair athlete to represent Pakistan and complete the New York City Marathon (US) in November 2005.

Hand-cycling is a relatively new adaptive sport for people with physical challenges. The event on March 28 will be a symbolic event to mainly highlight the challenges brought about due to spinal cord injury.

It will also underpin the positive role of sports in rehabilitation of people with physical disabilities and their integration into mainstream society. It will also contribute in breaking the taboos and cliches about how our society perceives people with physical challenges.

Some supporter on regular cycles will also escort Sarmad as a show of solidarity that will start from E-9 gate of Fatima Jinnah Park (F-9) at 4 p.m.

source : http://www.thenews.com.pk/daily_detail.asp?id=231120

BMA Fair Medical Trade: Child labour and poor working conditions in the production of NHS supplies

The war against terrorism reached its peak last year when the military began its operations in the Swat region of Pakistan. Every day brought news of death and suffering. Besides those who were killed or injured, there were those four million who had left their homes in search of a shelter. Some settled in refugee camps set up by governmental and non-governmental organizations. A few rented houses in other cities. But initially, many had to spend their life in open grounds until help arrived.

In July 2009, I happened to visit one of the refugee camps in Jalalah, Mardan, as part of team of faculty and students of Peshawar Medical College, who were conducting a survey of the psychosocial services for IDPs. The survey was completed successfully, but we had a heart wrenching experience. The camp’s physical structure was commendable, which I believe was the result of the countries experience with a major earth quake in the recent past. However, the services were nowhere near enough. Several NGOs were running small health centers in the camp, with a basic set of services and very limited supply of drugs. A number of refugees, when learned that I am a physician, came running after me, pulling my arm begging me to help their loved ones. I saw a very old lady who had suffered a stroke ten days ago and was lying in scorching with no medicine. I heard the story of a young woman who gave birth to a baby with no medical assistance, and the baby died of infection. Psychiatric services were non-existent, as were any special facilities for the disabled. During our survey, we identified many children who were still not able to sleep because of what they had seen. The stories went on and I started getting uncomfortable. Luckily then, I got the chance to work on a collaborative project of International Development & Relief Foundation (IRDF) and Pesahwar Medical College. The project involved establishment of a Maternal, Neonatal & Child Health Center for these displaced persons. The project began in August 2009. Equipment was purchased and staff was hired. A reporting system was put in place and services started by end of August. These included services for expecting ladies and their newborn children, as well as children in general. A general medical outpatient clinic was also functional. Laboratory and pharmacy services were added alongside and by end of September home visits of Lady Health Workers had also started.

 The greatest contribution of this project, I believe, is the provision of maternity services to the IDPs when there were none available inside or outside the camp. The free laboratory services provided by the center are also the only facility for the IDP population in the area. Since the arrival of IDPs in the region, drug prices in the market had risen due to high demand, and in this time, provision of free drugs to the needy by our MNCH center was of extreme importance.

 Near the end of 2009, the IDP population had started decreasing and our project team decided to open up the services for local population with minimal user fees. From a sustainability point of view, the continuation of this center as a permanent facility is ideal. Since the locality of Jalalah until this time, lacked a well equipped maternal and child health service, the establishment of this center has been a significant contribution in improving the health care of this community. The general medical clinic is also now open to the natives of Jalalah and surrounding region and benefiting the host community as well.

 It has been a satisfying experience helping those in great need. The war is not over though, and I hope to see a peaceful Pakistan someday.

 PHOTOS:

Article Written By SJ and Dr Wajid

SPORTS medicine is difficult to define because it is not a single specialty, but an area that involves healthcare professionals, researchers and educators from a wide variety of disciplines. Its function is not only curative and rehabilitative, but also preventative, which may actually be the most important of all. A Sports Medicine specialist – either an orthopedist or a primary-care sports medicine expert – is usually the leader of the sports medicine team, which also includes physicians and surgeon specialists, physiologists, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.

Until the second century, when the first team doctor, Galen, was appointed to the gladiators, the physician only became involved when there was an injury.

Today, in the United States of America, doctors wishing to specialise start with a primary residency program in family practice, internal medicine, emergency medicine, pediatrics, or physical medicine and rehabilitation, and then generally obtain one to two years of additional training through accredited fellowship (subspecialty) programs in sports medicine. Physicians who are board-certified in family practice, internal medicine, emergency medicine, or pediatrics are then eligible to take a subspecialty qualification examination in sports medicine.

Additional forums that add to the expertise of a sports medicine specialist include continuing education in sports medicine, and membership and participation in sports medicine societies. Sports medicine has been a recognized subspecialty of the American Board of Medical Specialties since 1989. Currently there are more than 70 sports medicine fellowships and approximately one thousand certified sports medicine specialists in the United States.

Sporting glory is something which most nations want to achieve. In the nearly 60 years of Pakistan’s existence, we have had our fair share of international sporting success. Arguably this is one field in which Pakistan has achieved more than in any other field! Pakistan’s success has been mainly in three sports – one individual and two team events, namely, hockey, squash and cricket – with some success in other individual events like snooker, wrestling, weight-lifting etc. at regional and international levels.

Pakistan has an enviable record of success in international hockey arena. We first participated in the 1948 London Olympics and were placed fourth on the table. We won an Olympic silver in 1956 and the crown itself at the 1960 Rome Olympics, repeating the feat in 1968 and 1984.

Moreover, we have had four world hockey championship titles (1971, 1978, 1982 and 1994) in addition to the seven Asian crowns – 1958, 1962, 1970, 1974, 1978, 1982 and 1990. Add to them the three Champions Trophy titles – 1978, 1980 and 1994 – and we can see beyond doubt that Pakistan was among the top few till mid-1990s.

Similarly in squash, the Khans from Pakistan have ruled the game single-handedly for a long time, starting with Hashim Khan’s British Open title in 1951 and then achieving the impossible – ten consecutive British Open titles from 1982 to 1991 by the one and only Jahangir Khan. Hashim Khan won the title seven times in all, while Jansher Khan did it six times and Azam Khan, four times. Not only that, Jahangir Khan won the World Open crown for eight times. But the glory years of Pakistan Squash also came to an end in the 1990s.

Pakistan’s cricketing success has been a bit more chequered. We played our debut Test match in 1952 and our first success came in only the second Test. In the shorter version of the game, who could forget the historic six on the last ball in Sharjah by Javed Miandad in 1986. The 1992 World Cup success, of course, was the stuff dreams are made of, but that also represents our last hurrah on the world stage. Since then we have not been able to stamp our authority like we used to do on global sports. Things are much better in cricket than what they have been like in hockey and squash, but in absolute terms it may be argued with some justification that we have receded in cricket as well since the 1990s.

It is interesting that most of the nation’s sporting achievements were secured when the country was getting over the initial troubles after Partition and we had very little in the way of infrastructure, training and facilities for our sportsmen. Perhaps it was shear determination and the will to succeed that helped our sportsmen bring all those laurels. But that is also a reflection on the way I which international sporting activities were conducted then and the manner in which they are managed now. Our sportsmen made it big till the world remained amateurish in approaching sports. Once the world moved forward and went for scientific approaches and professional training regimes to achieve sporting excellence, we failed to follow suit and the result is that we have stopped winning as consistently as we used to do. In fact, we have stopped winning for most part.

In the modern world, competitive sports demand high level of fitness that can only be acquired through a punishing training regime. Modern athletes push the boundaries of physical tolerance of their bodies to its limits to gain the competitive edge. This is due to the fact that unlike previously now success or otherwise is measured in hundredth of a second. A change of minimal percentage point in performance is enough to make a telling difference; the difference between winning a gold medal or nothing. This level of competitiveness by its very nature exposes them to injuries.

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The world is not beating us in sporting skills as much as it is beating us because of poor training regimes and the resultant lack of fitness

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An athlete’s technical ability and skill in his or her individual sport is of paramount importance, but it is of no use if the player gets injured. With the rapid proliferation of dedicated sports channels, commercialism and increasing endorsements from business, professional sports is turning into big business, thus demanding more and more from athletes to generate more and more heroes. This exposes them to various injuries and unless preventive and curative methods are adopted, their careers may end prematurely.

Injuries to these competitive athletes can be grouped into three distinct groups:

Injuries due to: Sports Equipment; Direct Contact; or Repetitive Stress

Those caused by sports equipment include the ones that result when, say, the ball hits a batsman, or a hockey stick strikes a player. These injuries have been minimized over the years due to the development and widespread use of appropriate protective gear – helmet, shin guard etc. – and sporting regulations like discouraging bouncers in cricket and penalizing lifted balls in hockey. However, such injuries can not be and have not been eliminated.

In the second group are injuries arising out of direct contact between players or a player slipping or tripping during running. Perhaps this is the most difficult to control of all injuries, if not impossible because in almost all field sports, players have to run at very high speeds and change their direction suddenly which puts extra pressure on physique. Likewise, collision between fielders in cricket or between players in other field games can, and do, cause players to fall and injure themselves.

The third group covers the most common injuries in sports. Professional athletes have to train very hard for long stretches of time. For each particular sport there are specific body areas which are more vulnerable – shoulder joint in swimmers and bowlers, spine in gymnasts and so on. Such sportspersons are more prone to stress-related injuries. These injuries can be minimized and adequately treated with appropriate rehabilitation and good techniques under the supervision of qualified trainers and physiotherapists.

In cricket, we generally see shoulder afflictions, glenoid labrum injuries, cuff tendonitis and shoulder dislocations. Other injuries among cricketers include muscle pain and spondylolythesis in the back, as well as several ankle injuries including ankle sprains, stress fractures, ankle tendonitis and the subluxation of the tendon. Ideally speaking, every athlete at the top level needs to have – and generally does have – a general fitness training program tailor-made in accordance with his own profile. In the absence of such a specific training programme, the chances of injuries are that much higher.

In modern day sports, there are a lot of professionals involved in the care of an athlete. They include orthopedic surgeons, sports medicine specialists, nutritionists, physiotherapists, and even sports psychologists, to name a few.

With scientific developments coming at fast pace, newer techniques are being used to improve the skill levels of international athletes and sportspersons. Unfortunately, most of these are not available in our country even though the popularity of various sports among the masses in general and the youth in particular has been on a steady rise. In fact, it is much more in the subcontinent than in most other parts of the world. It is necessary to have such facilities if we wish to compete at the international level and achieve success like we used to do in the past. The world, we need to understand, is not beating us in sporting skills as much as it is beating us because of poor training regimes and the resultant lack of physical fitness.

There are less than ten qualified Sports Medicine physicians in Pakistan today. A general lack of understanding on the part of the government as well as private sports associations and organizations about the important role Sports Medicine can play to find, train and groom the vast human potential means young doctors are discouraged to specialise in this particular field of medicine.

The government as well as the various sports federations, organizations and bodies can, and should, effectively use proper and professional pre-qualification methods to screen the potential talents to produce sportsmen and athletes at par with global standards. It may also help in saving the careers of many outstanding talents which otherwise get wasted due to an acute lack of professional and qualified medical help. The wastage of talents, as we all know, is limited to the mainstream sports like cricket and hockey, but encompasses all fields of sports. This highlights the need for an effective induction of Sports Medicine in the country for the development of sports along professional lines.

Contributed By Dr Wasif Shahzad , MD , MHA ( Cornell )

The Aga Khan University Hospital –Pakistan

 As he joined his hospital’s team of Physicians and surgeons to serve in the Earth quake stricken Areas- an account of how the medical services were delivered. 

Article Written By Farah Imam

Airline tickets were provide free of cost by Airblue (only the taxes had to be paid. AKUH paid the taxes for 3 employees). A large consignment of medications and supplies was provided by AKUH and the Tabba heart institute for the team to take with them. Besides this, the team was able to collect a little over Rs 300,000 donated by various individuals (from within and beyond AKUH) for the purpose of buying medications, supplies or to be used as required and where needed. Money was also donated by individuals to distribute to the needy people in the affected areas. The teams left Karachi in 2 batches (due to airline seat availability).  

 The first team arrived in Islamabad at around 9.30 am. We took a coaster through Abbotabad, Mansehra, Balakot and then on to Muzzafarabad. Some observations that we made were: 

The destruction was selective. A building reduced to rubble could be right next to another whose glass was still intact. 

Aid agencies sent by the UN, NGOs from various countries were primarily focused in the main cities. Not many were present in the “hard-to-access” areas. 

• A lot of work was being done by the local NGOs. 
• It was like a war zone that recently had gone through an air raid.
• The army was mostly involved in opening roads and evacuating patients in choppers 

 Our base camp was in Muzzafarabad. Sina healthcare had arranged for the logistics. That inlcuded local guides, our accomodation (in tents), food, and the basic medical infrastructures. A hospital in Lahore had donated a container converted in to an OT with general anesthesia facilities, autoclave etc. The base camp had 2 other operating areas (the container OT was for the Ortho cases), 3-4 OPD tents, and a few tents dedicated to inpatients. Our residential tents were located at about a 10 minute drive from the base camp. 

We sub-divided the team in to groups. One group stayed and worked at the base camp. This was were the surgery and anesthesia facility was available. The rest went to a place called “Camsur” located at about a 20 min drive from the base camp. There were hordes of people at camsur. There was a dispensary in a tent that was catering to the patients. Part of the group stayed at camsur to set up a medical OPD manned by doctors along with a pharmacy. The other part of the group started trekking up a mountain to a place called “Butbung” which was at a height of about 7,500 feet. The trek took 2 hours and was at a very steep incline. No medical or relief team had been to this area at all.  

 The reat of the team arrived on Wednesday. Most of the members of this team proceeded to a place called “Patika”. This was an 8 hour trek from Camsur and included trekking over mountains and crossing a river on a broken briedge. Again, the area targetted by this team was hardly accessed by doctors. This team worked there till Saturday morning. They were airlifted by an AKDN chopper back to the base camp on Saturday. Another area accessed by the team was Gharhi Duppata. Medical OPD was held there for 2 days. The activity on the various days was as follows: 

Wednesday: 

 Base camp: 

•  Medical OPD : 125 patients Surgical OPD + related procedures: 40 patients 
•  Women and Child OPD: 50 patients 
•  2 patients given General anesthesia 
•  2 patients given spinal anesthesia 
• Surgical ward round 
•   Dispensing medications 

 Camsur: 

 Set up the medical OPD and pharmacy  

 Butbung: 

•   3 man team left for Butbung 
•   15 patients seen on arrival 

 Thursday: 

 Base camp: 

•  Pediatric OPD : 40 patients 
•  Surgical OPD + related procedures: 46 patients 
•  1 patients given General anesthesia 
•  2 patients given spinal anesthesia 
•  Dispensing medications 

 Camsur: 

 200 patients seen 

 Butbung: 

 65 patients seen on arrival 

  Patika: 

  7 man team left for Patika 

Friday: 

 Base camp: 

• Pediatric OPD : 90 patients 
• Surgical OPD + related procedures: 36 patients 
• 1 patient given General anesthesia 
•   2 patients given spinal anesthesia 
•   Dispensing medications 

 Camsur: 

 130 patients seen 

Patika: 

250 patients seen 

Gharhi Dupatta: 

90 patients seen 

Saturday: 

 Base camp: 

•  Pediatric OPD :60 patients 
•  Surgical OPD + related procedures: 15 patients 
•  1 patient given General anesthesia 
•  Dispensing medications 

Camsur: 

 400 patients seen 

 Patika: 

 50 patients seen (2 hour OPD before being airlifted) 

 Gharhi Dupatta: 

 225 patients seen 

The disease pattern was varied and included cases of fractures, infected wounds, URI, scabies, dysentry, pain, G.I diseases etc etc. The stage of intense ortho related disease is slowly being replaced by medical and phychiatric related problems.  

Some of the things we learnt was: 

• The difference in lifestyles, mindsets, world views, life aims can not be overstated. 
• How much we take for granted (e.g. running water, hot water, a warm house etc). 
• How little we actually need to survive, and how we have surrounded ourselves with luxuries.  
• The extent the human body can adapt and modify depending on circumstance. 

 For future teams, they need to know: 

•  Unless there is access to the local network one can not just turn up to help. This can be done by linking with the army, or the local NGOs. 
•  Logistics is a very important issue. Where to go, how to get there, the supplies present, supplies that will  be needed, where to stay, how they will eat etc etc all need proper analysis. Linking with a local NGO or a system already there seems the best bet. 
•  There is no use of sending used clothes…most do not wear used clothes. Piles of clothes are seen everywhere. They are burnt at night for generating heat. 
•   A lot of medication has already been sent. Be sure of what is needed before blindly sending medications. 
•   The # 1 & # 2 most wanted items are: tents and blankets. 

 The best thing AKUH can do if they want to provide continuity is link with the army and send medical teams (by chopper) to far off areas that have not been accessed. The teams can be deployed for 2-3 days and work in a camp set up by the army. The composition of the camp can be designed by AKUH and may include a number of tents for OPD, surgeries, equipment and medications. The areas that have been minimally accessed is known to the locals as well as the army. 

 The intention of the team was to  treat humans needing treatment. The names of who did exactly what is being held back so that no hero emerges from this trip. There will be those who question our intentions, our sanity, of how we should have directed resources and manpower to suit the skill sets of the various individuals. But those people who we saw needed medical help. They too needed qualified doctors to see them instead of dispensers. Not many were reaching out to them, we wanted to. Within ourselves we know we did the right thing. The trip was fulfilling and worth it. Infact, many in the team realized that maybe the only reason we became doctors was for this event.