Beat Disability-By Embracing It

It was a Sunday morning when the navy lieutenant was driving four doctors to Thatta for the Pakistan Navy flood relief medical camp. To me the vision of Thatta or Thatto as the natives call it, was that of the historical town. Emperor Shah Jehan ( Moghul dynasty)  built a mosque during the 1600’s , which comprised of 101 domes  is designed in such a way that imam's voice can reach every corner of this building without the help of any loudspeaker. In August 2010 Thatto was one of the worst affected districts of Pakistan as a result of devastating floods. The sea was on high tide when flooded river water reached it multiplying the damage manifold. By August 28, 175,000 people had left their homes camping on the main road under open sky. Most of them have been rescued by the navy personnel .

The reason for holding medical camps in such areas extended beyond the liberation theology – to provide a preferential option for the poor and homeless- rather it encompassed keeping the threat of looming epidemics at bay, Particularly after the floods, gastroenteritis, skin infection and respiratory infections were turning into a hopeless scenario.

Dr Farooqui- a surgeon, has been actively involved in extending help to areas where inaccessibility and lack of means had been remarkably active in aiding diseases causing distress. Arranging and coordinating the availability of doctors, surgeons and ob gyn for the refuges of Pakistan Navy Medical camp has been on Dr Farooqui priority list ever since august 29^th , since the camp became operational.

We reached the camp site . The steep gradient of inequality became evident. However, the lieutenant Noman told us that the whole area was covered with thorned , wild bushes , which the personnel removed over night  and set up 1000 tents. Amazing how quickly and durably 2000 families were accommodated. Three meals a day were being provided to the refuges, drinking water had been made available , a generator provided light at night, walking sticks for the elderly were also distributed, a shed for keeping the bulls and cows of the refugees was also set up, plus a medical camp. The camp was run on the funds accumulated as donations. As people feel reluctant to give to the government owing to corruption, they readily give to the reliable sources.

On Sunday we saw 250 patients.  So far the public health training has made realize that a great “ epi divide” ( epidemiological) divide exists in the developing world. And the epi  divide usually has brown or black skinned people on the “other” side. The scenario of post floods emphasized all such caveats. These refuges , some of them not willing to go back to their homes , felt very safe in this camp. Flood had exposed them to the lack of almost every necessity, clean water , shoes , medicines , food and shelter. 

Almost every third woman coming to the medical camp was pregnant. Made me think how far do we need to go in terms of population control. We were giving out folic acid and iron supplements to them. But what will happen once when they return “home”.  The sights at the camp site were rather dramatic, children and adults with no shoes lugging water, people sleeping in the tents floor. It was a depressing sight. But I had to remind myself that these people were better off than so many others. But some how as humans it was not enough.

The lieutenant said that the rescue was so difficult. There was an incident where about 15 navy people escorted by a native sindhi went looking for a submerged – flooded village and after several hours of looking around for any sign of life, their guide says, “ mathay pheray weyo”…. Meaning he cannot understand nor recognize where to take them. As he recognized nothing.  I learnt that heroes were many. Whether it was the lieutenant and his fellows trying to save lives, whether it was Dr Farooqui, leaving the benefits of the elite surgeons life and coming and working here, whether it was the locals, supporting one and other….most stories were inspirational and had a hero. I stared out at the tent city, tent after tent sprawling with people busy in their every day life, struggling to recover , an alarm system went on inside me…. How to long term rehabilitate them. World and we should not forget Pakistan. Post flood rehab would need us for a long time to come.

 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.