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The Pediatric ward in Shikarpur

Date: September 3, 2010

Location: Shikarpur city, Shikarpur district, Sindh

It was my third day in Sindh and I was in Shikarpur with the OffroadPakistan team from Karachi.

Who knew that I would witness one of the most appalling sights at a tucked away hospital ward in this small town famous for its Achar (pickles).

I was with the Offroader Taimur Mirza in his custom made green Jeep as we drove into the District Hospital of Shikarur. TM had a load of medicines which he intended to donate to the hospital. This sack full of medicines was collected by school children from Karachi who scavenged through their homes in search of unused medicines which usually lie around in every house until it’s discovered that they have expired.

As the pampered Jeep drove into the gates of the hospital we could see scores of flood affected IDPs camped in the front lawns of the old hospital building. The sight of people camped under the open sky with their livestock and little of what they saved from their drowning homes was quite depressing. But nothing prepared us for what we would witness in the children’s ward at the end of this road behind the main hospital building.

The flood water was still passing through the eastern parts of the Shikarpur District when I reached the area; this was almost a month after the flooding had started. Westward, Jacobabad district was still disconnected from the rest of the country via any land route. Shikarpur city was the first main city east of Jacobabad towards which the displaced flood affected had fled to.

The floods had completely destroyed 44,000 houses in Shikarpur district alone where 550,000 people were displaced (46% of the total population). The district had 308 registered relief camps housing 80,400 IDPs and several other unregistered spontaneous camps all over (like the one in the lawns of the hospital). Like any other frontline city of the flood affected region, Shikarpur had got more than its share of displaced people. The district administration was struggling to cope with the burden, this was evident from the informative session I had earlier today with the DCO (District Coordination Officer, the big boss of the district administration).

Just as the desperate IDPs cramped in relief camps, schools, parks, vacant buildings and open spaces for shelter; so too the families of ailing displaced people congested the hospitals, hopeful to get their beloved treated. With dwindling district administration funds it was simply impossible to provide relief to everyone. The DCO explained that the priority was to feed the IDPs (in Shikarpur dist. 40,000 people were being fed by the local government 2 times a day costing the DCO office Rs. 2.2 million daily). In turn the health sector had to suffer, there weren’t enough beds in the hospitals to accommodate the influx of patients and the rate of dispersal of medicine from the dispensary was much higher than that of replenishment of the stock.

I witnessed this first hand as I walked into an 11 bed room in the children ward of the Shikarpur District hospital. Each bed on an average had 3 patients, some had even more. There were children of all ages packed in the tiny space and they had all sorts of infectious diseases. The stench was so strong that I couldn’t even stand there to have a full look around the room. Some beds had sheets on them and others didn’t. The ones that had linen weren’t any luckier because it seemed they weren’t washed even after they had been urinated and vomited upon multiple times. How was anyone going to get cured here? Won’t these inhuman conditions worsen the conditions of the already fragile minors?

With a heavy heart and moist eyes I sank into the comfortable leather seat of TM’s 4×4 ride, I knew I had to do something but for now was unable to think straight. The sight had touched both of us and we preferred silence on our way out of the hospital. We drove past the front lawns of the hospital where the IDPs were camped under the open sky and where their kids played in the dirt with used hospital syringes.


Pakistan Flood – September 6, 2010 report

I have decided to move to a blog instead of using Facebook notes to keep you posted on the latest about the floods In Pakistan. I request all friends to spread the word.

(This will be a continuation to my first Facebook update given on the 5th of September).

Date: September 6 (Day 6 in Sindh)

From: Khairpur city, Khairpur district, Sindh

The weather is quite harsh as compared to the cooler climate I left in Islamabad last week, today in the shade of a Neem tree (which is suppose to have a cooler shade then most trees)it was 36.6 degree Celsius. This might not be as hot as the 50 degrees this region gets in peak summers but combined with the humidity this was enough to completely drench my shirt in sweat in less than 5 minutes.

Nevertheless, today was the most exciting day as I found thousands of flood affected IDPs who haven’t received any aid by the government or NGOs. Also met up with an amazing team of IRC (Indus Resource Centre) welfare workers who are doing a great job in Khairpur district. Following is a brief about my findings.

Why district Khairpur?

All the major flooding in Sindh has been to the west of the Indus River therefore the main aid work and flood relief efforts are focused on the districts west of the mighty river. However, there have been several hundred thousand on the east banks of the river that have also been affected and have been ignored since they don’t belong to any major town or village. In fact the area they live in is not even registered as habitable land in the books of the government of Pakistan. Why?

Let me try to explain. The mighty Indus has a river bed which is several hundred kilometers wide at places. These natural banks of the river mark the widest areas uptill which the river once use to flow and upto which it swells when flooded. But the river does not expand to its complete width in normal conditions and therefore the water flows in much narrower stream(s) inside this area. This leaves an expanse of highly fertile riverbed which attracts hundreds of thousands of farmers. These areas are called “Kucha Areas”; technically they are part of the river bed and are not suppose to be developed or zoned. But the reality is that some of the poorest settlements of the region are in the Kucha area.

So when the river flooded, its waters tore through the Kucha areas and rightfully claimed the land that always belonged to the river bed. The embankments prevented the water from entering the zoned land on the east of the river and therefore it seemed that all is well on the east bank of the Indus.

The people of the Kacha area had to rush across the embankments to safety and were left homeless. Marooned on the bank of the river with no shelter or food many turned to neighboring cities/ towns which could accommodate them in relief camps. Some had took refuge on the embankment themselves or in the villages along the bank in the Pakka area (safe zone beyond the embankment) and waited for the water to recede and aid to come. But the water never receded completely and the aid never arrived.

I was in Sukkur all this time which is west of the Indus and found out about the conditions in District Khairpur (just across the Indus east of Sukkur) by a medical team of CDRS (Comprehensive Disaster Relief Services). I was told of stories of villages which have not received any aid till date in the western most Union councils of the district. This is where I had always wanted to go, to get to the people who needed the most help. And so I came here last night in search of the people who had somehow got missed out by everyone.

And this is why I am here, in Khairpur on the east bank of the Indus.

Today’s activities summary :

1. Drove 2 hours from Khairpur city westwards to the bank of the river to find the areas where thousand of IDPs of the Kacha areas were. This area has mud houses just like the ones we would see in movies with straw roofs and entire villages with all clay architecture. The IDPs here are not living in the well funded and well managed relief camps. They are living in the homes/ courtyards/ lawns of friends, relatives and other sympathetic hosts. Their hosts are villagers who already have scarce resources and therefore several families are cramped in small houses. There is a dire need of medical attention. A mobile medical team was here but was pulled out 8 days ago, in this brief period there were 13 deaths in just one village (shahnawaz khaloro village).  There are 25,000 to 30,000 IDPs in this area with an URGENT need of a relief camp for a minimum 3000 people Or at least a full time medical relief camp.

2. I met up with a local smalltime landlord (Wadera) who has housed around 50 people in his courtyard. Met the IDPs at his place and was shocked to find out when the group of 30 odd men pointed out 6 people amongst themselves who had lost a family member; this is a death rate of 20% far more than the numbers I heard of before. Amongst the 50 people in this place there were 10 pregnant women with 3 expecting within 4 days. Also there were 3 newborn in the group, one infants mother had died while giving birth and the newborn was in urgent need of medical attention. This small group represents for the general IDP population of this entire region and reinforces the dire need for a medical camp.

3. Liaised with the fantastic CDRS 3 men medical team (see photos). These guys are doing a great job and each day they put up a mobile medical camp in the western most villages of Shikarpur district treating the IDPs of the Kacha areas. Just 2 days ago they checked 357 patients (an all time high) in this area, in comparison on that same day the IBA medical camp in Sukkur city which I was visiting had just 32 patients coming in. Today’s count in Shikarpur for the CDRS mobile medical team was 198, another indicator of the high number of cases needing medical attention. So far there are no cases of Cholera, the news I was reading of the potential Cholera outbreak doesn’t seem to be true for this area. But to identify a potential cholera case these mobile medical teams wont be effective since at minimum a Stool culture test is required to identify a positive case for cholera. Only two medical facilities in this district have such testing facilities. Yes! Again, need for a medical camp with proper laboratory facilities.

4. No matter how much I stress on the need for medical attention in this area it is insignificant against the need that I feel is the most important not just for this area but for all flood affected regions. Yes, medical camps and mobile medical units are crucial but they all are treating the diseases. They are all curing the outcomes but no one seem to focus on the root cause of the diseases. In all these days I have been here this point seems to be the most important of all. We need to target the root cause of the diseases, to avoid future outbreaks and disease spread. And guess what 95% of the diseases in these areas have a simple root cause; its poor hygienic conditions.

No, its not drinking water. So please don’t spend heaps of money buying fancy water purification products like LifeStraw. They are NOT REQUIRED, all the hand pumps and water bores are now working and the flood has actually been good, in that the subsoil water table levels have increased bringing in more water into the aquifers. The root cause of cases for the diarrhea is not water borne diseases rather its stale food. People who are getting cooked food from the government and donors are getting sick from that food. The time it takes the food to from being cooked, to being put in those ugly plastic bags, to being distributed and till being finally consumed, in this heat, it gets rotten and it starts messing around with the bodies of the poor IDPs. In other cases where fresh food is being distributed, the IDPs are hoarding food (probably because they aren’t sure when they will get the next round of free food or maybe because it free food), in their tents for consumption at later times and in this heat under the sun in those tents it is a matter of a few hours before germs are partying in that food. And so, it’s not a problem of drinking water that is the root cause of disease, so please don’t waste your money and use it more effectively.

Coming back to hygiene, ever since my second day of research in the field areas I had gather enough data to support the premise that the most effective use of funding for long term medical aid would be to invest in hygiene. Who knew today would be the day when I would find the only 2 expert in this line in the field. I spend the rest of my day with a team of IRC whose job is to go to remote areas and have sessions with the locals telling them how simple hygiene and cleanliness could be the best tool to prevent disease.

This team was amazing; comprising of one male and one female project officer and then 3 locals trainers (2 females, 1 male) who have been trained to conduct the brief informative sessions. These days the team is working with the IDPs which is a blessing in disguise that the IDPs from all the remotest areas have gathered here and are easily accessible by this team. Otherwise this team could not have ever been able to reach out to this many people from remote areas. Anyway, their method is extremely affective and I could see the change taking place in the sessions. They don’t deliver the information in a lecture mode, rather they sit down have a joint brainstorming session leading the audience to reach to the desired conclusion themselves. (see photos)

5. Towards the end of the day headed back to Khairpur city with the two officers of the IRC hygiene information team and the Incharge of the CDRS medical team. With these experts developed a comprehensive Hygiene kit comprising of 15 items (see the list below). The only way to ensure maximum effectiveness of this approach is to ensure that a comprehensive information and awareness session is provided along with these kits and who else would be able to do a better job than the expert team of IRC.

The field data collected by IRC has identified around 5,000 IDPs from the Kacha area in Khairpur district. The kit has been designed for a family of 10 (this is the average in this area) and I have set the target to get 5000 hygiene kits to these people before Eid. Each kit is costing us around Rs. 400 until now I have got funding for 350 kits which will be purchased first thing tomorrow morning and will be distributed the same day. So friends start working, lets get these people clean and healthy. All I need to do is to come up with a cheap tag line for this first formal project initiative of mine, “Safai Nisf Iman Hai” or maybe we could say “Rooz nahayen jaan bachayen”, what do you reckon?

Once again, it’s almost 2am and I am dead tired. Until tomorrow.

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Please spread the word and share this with as many people. I hate writing, the only reason I am doing this to get the information across to people so that they don’t waste their money and efforts on stupid things. My aim is to identify the areas which need the most help. In this disaster we are stretched on the funding and resources in comparison to the earthquake, there demand is much more than the supply therefore I rather put my money in helping those who have need it the most as opposed to those who might not be that desperate in need.

A friend of mine is collecting money to buy Eid clothes for a village in Kashmir, no doubt it is a very noble thought. But the way I see it, I rather use the same money to get the basic things in some other part of the country where maybe no help has reached yet or maybe the same money could be used for much better usage.

Item list for Hygiene Kits:

  1. Dettoll Soap (4 large)
  2. Laundry powder (500 grams)
  3. Soap for washing clothes (4 large)
  4. Dish washing soap and dish washing scrub (1 each)
  5. Shampoo bottle – Anti-lice type (1 large)
  6. Muswak of neem tree (quantity 10) – best dental hygiene option for local requirements
  7. Mosquito repellent coil (1 box) – for indoor usage only
  8. Flannel napkins (quantity 10) – cost affective local alternative to sanitary napkins
  9. Hair removing cream (1 tube)
  10. Razor with a pack of blades (quantity 1 razor and one pack of 10 blades)
  11. Vaseline bottle – for rashes, foot cuts and diseases etc (1 bottle)
  12. Hair comb (quantity 1)
  13. Nail cutter (quantity 1)
  14. Cloth for Chaddis – local underwear (12 pieces)
  15. Hand fan (quantity 2) – to help them survive in this heat without electricity!