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Swat  Earthquake  Relief  Project,  KPK,  Pakistan    

Establishment  of  Medical  Clinic    

  Prepared  by:    REAL  MEDICINE  FOUNDATION,  Pakistan  328,  Main  Service  Road,  St  67,  Sector  E-­‐11/3  Islamabad,  Pakistan  

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TABLE  OF  CONTENTS  

 1     BACKGROUND       1.1   Government  and  Civil  Response   3     1.2   RMF  Response   3     1.3   Collaboration  between  RMF  and  LDS   4          2     ESTABLISHMENT  OF  SWAT  MEDICAL  CLINIC       2.1   Groundwork  for  Clinic  Site   6     2.2   Clinic  Human  Resources   6     2.3   Procurement  of  Clinic  furnishings,  Medical  equipment  and  supplies   7     2.4   Inauguration  of  Clinic   7          3     ANNEXURES         Clinic  Furnishings   12       Medical  Equipment     12       Medical  Supplies   12  

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I:  BACKGROUND  

On   October   26,   2015,   an   earthquake   of   magnitude   7.7   hit   the   Hindu   Kush   region   of  Afghanistan.  Sustained  tremors  were  felt  all  the  way  down  to  Islamabad,  Lahore  and  New  Delhi  in   India.   Emergency   responses   by   the   National   Disaster   Management   Emergency   Response  teams  and  Pakistani  Army  Rapid  Response  units  were  the  initial  face  of  the  rescue  operations.  Mortality   and  morbidity   figures   rose   to   nearly   300  dead   and  over   2,000   injured   in   KPK’s   key  affected  areas  of  Districts  Dir,  Chitral,  Buner,  Swat,  Shangla  and  Malakand.  

Due   to   the   depth   of   the   earthquake,   the   damage   impact   of   this   otherwise   powerful  earthquake  was  controlled,  but   the  main  quake  was   followed  by  87  aftershocks,  which  along  with   the   winter   rains   and   snowfall   triggered   off   a   series   of   landslides   in   the   mountainous  regions  causing  weakly  structured  houses  build  on  hill  slopes  to  collapse.  Approximately  59,000  houses  have  been  destroyed  rendering  nearly  600,000  people  homeless  or   living   in  makeshift  shelters.        

1.1:    GOVERNMENT  AND  CIVIL  RESPSONSE  

Although  no  formal  request  was  made  by  the  Government   for   international  assistance,  a   fact  attributable   to   the   security   concerns   related   to   these   previously   Taliban   infested   areas,   local  NGOs   and   CSOs   along   with   the   Government   and   the   Pakistan   Army   provided   rescue   and  immediate   relief   services   to  victims.  Relief  efforts   included   supply  of  winterized   tents,  plastic  matting,   food   packages   and   bottled   water.   According   to   OCHA,   a   total   of   4,876   households  were   served   by   several   local   CSOs.  Medical   care   services   were   provided   by   augmenting   the  Government  health  facilities  with  nearly  5  tons  of  medical  supplies.  Volunteers  registered  with  the  government  health  facilities  assisted  in  easing  the  burden  on  the  health  facilities.  

1.2:  RMF  RESPONSE  

Detailed  data  of  affected  populations  in  terms  of  shelter,  food  and  health  needs  was  lacking  in  the   immediate   aftermath   of   the   disaster   when   people   were   in   most   dire   need.   So,   Real  Medicine   Foundation   Pakistan   carried   out   a   needs   assessment   survey   from   29th   Oct   to   2nd  November  2015.  A  total  of  100  households  were  identified  and  registered  with  RMF,  using  the  National   Identification  Card  number   (NIC)   of   the  head  of   the  household.   Their   demographics  and  needs,  both  short-­‐term  and  long-­‐term,  were  collected  using  survey  forms.    

We  identified  30  households  in  Mohalla  Bhakharawan  in  Union  Council  Kabal,  Tehsil  Matta,  and  70  households  in  Mohalla  Akhonbaba,  Union  Council  Shagai,  Tehsil  Saidu  Shariff.    The  average  household  size   is  composed  of  7-­‐11   family  members  with  an  average   income  of  USD  100  per  month.  The  occupations  of  these  people  range  from  daily  laborers,  carpenters,  farmhands  and  sweepers.  Most   of   their   houses   were   weak   structures  made   from   a  mixture   of   baked  mud,  stones  and  brick  houses,  often  built  with   their  own  hands   that  collapsed  at   the   first   tremors.  Some  people  lost  their  livestock  which  was  being  kept  indoors  to  protect  them  from  the  cold.  Their  hand-­‐to-­‐mouth  existence   (average   income   is  100  USD  per  month   for  an  average  of  7-­‐9  

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member   families)   meant   that   their   entire   existence   collapsed   with   the   rubble.   The   needs  assessment  report  identified  the  following  needs:  

Short  term  relief  needs:  

1. Tents  and  plastic  mats  –  People  need  winterized  tents  which  they  intend  to  put  up  in  the  same  place   till   a  more  permanent   structure   is  made  possible.  Matting   for   the   floor  of  the  tent  in  the  face  of  the  impending  winter  months  and  protection  in  the  rain.  

2. Food   rations  –  Most   families  have  managed   to   salvage   some  of   their   home   furniture,  cooking   utensils   etc.   from   the   rubble,   hence   are   able   to   cook   for   themselves   using  firewood  as  was  their  normal  practice.  They  need  uncooked  food  rations  for  the  family.  

3. Health   services   –   Families   located   in   Mohalla   Akhonbaba,   UC   Shagai   in   Tehsil   Saidu  Shariff  are  close  to  a  large  teaching  hospital  and  hence  have  access  to  medical  services.  However,  families   in  UC  Kabal  are  at  a  distance  from  this  facility  and  need  health  care  services.  Beyond  Kabal  are  remote  villages  which  are  still  not  accessible  but  we  expect  that  people  will  need  help  as  days  and  weeks  go  by,  and  they  will  need  healthcare.  

Long-­‐term  Rehabilitation  needs  

4. Rebuilding   of   homes.   Currently   winter   is   setting   in   which   lasts   for   an   average   of   3  months.  By  March,  the  snow  thaws  out  and  construction  can  begin.    

1.3:  COLLABORATION  BETWEEN  RMF  AND  LDS  

A  MOU  was  signed  between  RMF  USA  and  Latter-­‐day  Saint  Charities,  Inc.  (LDS),  a  not-­‐for-­‐profit  organization  organized  under  the  laws  of  Utah,  USA  on  1st  December  2015  for  a  relief  project  for  earthquake  affectees   in  District   Swat.   LDS   is   the   funding  partner  and  RMF  Pakistan   is   the  implementing  partner.    The  project   is  taking  place   in  two  sites,  mainly  Mohalla  Bhakharawan,  Union  Council  Kabal,  Tehsil  Matta  and  Mohalla  Akhonbaba,  Union  Council  Shagai,  Tehsil  Saidu  Shariff,  District  Swat.  The  project  goals  and  objectives  are:  

Project  Goal:  To  rehabilitate  2015  October  earthquake  affected  victims  of  District  Swat,  Province  of  Khyber  Pakhtunkhwa  (KPK),  Pakistan.  

 Project  Objectives:  

1. To  provide  immediate  relief  shelter  2. To  provide  immediate  relief  food  3. To  provide  immediate  health  care  4. To  assist  in  rebuilding  of  destroyed  homes  

The   project   was   launched   within   ten   days   of   MOU   signing   on   10th   December   2015   with  initiation   of   Objectives   I   and   II   that   were   implemented   in   Mohalla   Akhonbaba,   UC   Shagai.  Objective  I  of  distribution  of  winterized  tents  and  blankets  was  conducted  in  this  site.  Tents  left  over  on  the  distribution  day  were  handed  over  to  the  local  army  brigade  to  distribute  to  needy  families  in  the  more  remote  regions  of  UC  Shagai  which  are  accessed  only  by  the  Army,  due  to  

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security   reasons  as  well  as   the  geography  of   steep  mountain  areas.  Blankets   left  over  will  be  distributed  from  the  RMF  Clinic  site  over  the  months  of  December  2015  and  January  2016.    

Objective  II  of  providing  food  rations  is  being  conducted  over  both  sites  over  the  entire  project  period  of  3  months.    

Objective   III  was   initiated   on   21st   December   2015   in  Mohalla   Laloo  Bandee,  UC   Kabal,   Tehsil  Matta,  District  Swat.  

 

A  scenic  view  of  Mohalla  Laloo  Bandee,  UC  Kabal  

 

 

 

 

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II:  ESTABLISHMENT  OF  SWAT  MEDICAL  CLINIC  

2.1:  GROUNDWORK  FOR  HEALTH  CLINIC  SITE  

For  selection  of  a  clinic  site,  RMF’s  policy  is  to  choose  a  site  that  is  located  outside  a  minimum  of   20   km   radius   of   the   nearest   health   facility.   Once   on   ground,   we   evaluated   the   initially  selected  Mohallas  for  a  clinic  site.    

Mohalla   Akhonbaba   of   UC   Shagai,   Tehsil   Saidu   Shariff   revealed   that   the   government   based  Akhonbaba   BHU   was   closely   situated   to   the   mohalla   (village).   In   addition   the   tertiary   care  teaching   hospital   was   within   a   distance   of   8   km   from   the  mohalla.   Our   interviews   with   the  women  of  the  area  revealed  that  they  were  relatively  satisfied  with  the  health  services  and  6  out  of  8  of  the  women  interviewed  had  had  hospital  based  births.    

Mohalla   Bhakharawan   of   UC   Kabal,   Tehsil   Matta   was   re-­‐evaluated   and   we   came   up   with   a  similar  result.  A  local  NGO  was  already  providing  free  healthcare  services  to  the  people  and  to  their  satisfaction.  This  meant  that  we  then  moved  on  further  inwards  towards  the  more  remote  regions   of   Tehsil   Matta.   After   several   days   of   snowballing   technique   of   identification,   we  finalized  our  site  in  Mohalla  Laloo  Bandee  of  the  same  UC  and  Tehsil  where  the  nearest  health  facility  is  beyond  a  radius  of  nearly  20  km.  

Our   initial   proposal   had   envisioned   a   large   tent   to   house   the   clinic.   However,   the   reality   on  ground  was  quite  different  and  the  option  to  take  up  a  permanent  structure  was  possible.  We  took  up,  on  rent,  a   local  house  centrally   located   in   the  mohalla   for  our  clinic  site.  Technically  this   is   not   a   complete   house,   but   a   part   of   a   larger   house   that   was   being   used   for   storage  purposes.   The   clinic   portion   has   a   separate   entrance   from   the   back   and   is   composed  of   two  rooms  and  a  shared  compound.  Intensive  cleaning  over  two  days  made  the  space  habitable  for  a  clinic  setting.  The  compound  is  divided  by  a  curtain  into  two  gender  segregated  waiting  areas.  One   room   is   for   the   female   patients,   and   the   other   room   is   the  male   doctor   as  well   as   the  pharmacy  stand.    

2.2:  HIRING  OF  CLINIC  HUMAN  RESOURCES  

The  RMF  team  travelled  from  Islamabad  to  Swat  for  two  days  to   interview  candidates  for  the  doctor,  LHV  and  medical  technician  posts.    The  call   for   interviews  had  been  made  in  the  local  media  on   the  1st  of  December  and   interviews  conducted  on  a   first   come   first   served  basis.  A  selection  criterion  was  based  naturally   first  on  qualifications  but  with  a  strong  emphasis  on  a  compassionate  and  empathetic  nature  of  the  incumbent.    

We   selected  a  husband  and  wife  doctors’   team   since   the   couple  not  only  belonged   to  Tehsil  Matta   but   had   decided   to   give   up   lucrative   careers   in   the  main   cities   to   come   back   to   their  hometown  to  serve  their  people.  So  instead  of  a  LHV,  we  have  a  fully  qualified  female  doctor  in  her  place.    

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Since  the  clinic  site  was  now  not  a  tent  service,  we  hired  a  cleaning  lady  for  the  sanitation  of  the  place  and  a  security  guard  for  the  night.  

2.3.  PROCUREMENT  OF  CLINIC  FURNISHING,  MEDICAL  EQUIPMENT  AND  SUPPLIES  

The  bare  minimum  clinic  furnishings  were  procured  from  Mingora  city  and  transported  to  the  clinic.  The  doctors  set  up  the  clinic  as  to  their  requirements.  At  this  stage,  we  limited  purchased  procurement   of   furnishing   to   a   bare   minimum   and   took   up   several   items   from   our   existing  inventory  of  the  Nowshera  Health  Clinic  that  were  not  in  use.  The  same  approach  was  applied  for  medical  equipment;  medical  supplies  were  procured  from  our  Peshawar  based  vendor  who  has  been  supplying  us  with  medicine  for  our  Nowshera  Health  Clinic  since  the  last  two  years.  He  happily  agreed   to   transport   the  monthly  medical   supplies  directly   to   the  clinic.  For  details  on  the  furnishings,  medical  equipment  and  medical  supplies,  please  refer  to  annexures  1,  2  and  3,  respectively.    

 2.4:  INAUGURATION  CEREMONY  

We  were  ready  to  begin  operations  on  21st  December  2015.    

 

 

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The   formal   inauguration   took   place   at   10.00   am   with   the   following   guest   of   honor   and  participants:  

Chief  Guest:  Mr.  Lajbar  Khan,  Local  General  Councilor,  Laloo  Bandee,  Matta,  Swat    

Participants:    

1. Dr.  Nasar  Khan  (Medical  Officer  RMF)  2. Dr.  Fatima  Nasar  (Women  Medical  Officer  RMF)  3. Mr.  Mujeeb-­‐ur-­‐Rehman  (Project  Coordinator  RMF)  4. Mr.  Adnan  Khan  (Medical  Technician  RMF)  5. Ms.  Afshan  Bhatti  (National  Research  Manager  RMF)  6. Mr.  Ijaz  Khan  (Volunteer  RMF)  7. Mr.  Mahwish  Shamim  (Volunteer  RMF)  and      8. Twenty  community  men  and  women.    

Inauguration   ceremony:   The   Medical   Centre   was   formally   inaugurated   by   Mr.   Lajbar   Khan,  Local  General  Councilor  of  the  area.  Twenty  local  men  and  women  were  also  present  during  the  ceremony.  After  the  inauguration  Dua  was  performed  and  talks  were  given  by  Mr.  Lajbar  Khan,  Ms.  Afshan  Bhatti  and  Mr.  Mujeeb-­‐ur-­‐Rehman.    

Mr.  Lajbar  Khan  thanked  RMF  for  the   initiative  and  said,  “We  are  very  grateful   to  RMF  as  we  always  needed  such  a  service  and  after  the  earthquake  the  need  has  increased.  People  of  this  area  are  extremely  poor  and  have  no  means  to  travel  to  the  nearest  facilities,  which  are  very  far  away.”  Mr.   Lajbar   Khan   also   ensured   his   cooperation   and   said   that   he   looks   forward   to   the  extension  of  this  Medical  Centre.  

Ms.  Bhatti  thanked  Mr.  Lajbar  Khan  and  the  local  people  for  taking  the  initiative  so  positively.  She  also  thanked  the  RMF  staff  and  volunteers  who  worked  really  hard  to  establish  the  center.  Ms.  Bhatti  introduced  the  staff  of  the  Medical  Centre  to  the  local  community  and  requested  the  staff  to  work  hard  and  reach  to  the  poorest  of  the  poor  population.    

Finally  Mr.  Mujeeb-­‐ur-­‐Rehman  thanked  everyone  and  closed  the  ceremony.  

After  the  ceremony  the  Medical  Officers  formally  started  seeing  patients.    

 

 

 

 

 

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III:  ANNEXURES  

Annexure  1:  Clinic  Furnishing    

1. Three  tables  2. Four  chairs  3. Two  patients  stools  4. One  pharmacy  cupboard  5. Folding  curtain  separator  6. One  examination  couch  7. Two  bench  seating  (metallic)  

Annexure  2:  Medical  Equipment  

1. Two  Stethoscopes  2. BP  Apparatus  3. Examination  instruments  kit  4. Surgical  instruments  kit  5. Thermometer  6. Weighing  machine  7. Nebulizer  8. Sterilization  machines  (Boiler)  9. Sterilization  trays  and  kidney  bowls  10. Tongue  depressors  11. Otoscope  

Annexure  3:  Medical  supplies  

    Form   Generic  Name  of  Medicine  

1   Injection   Lignocaine  2   Injection   Adrenaline  3   Injection   Dexamethasone  4   Injection   Gentamycin  5   Injection   Diclofenac  6   Injection   Gravinate  7   Injection   Metomide  8   Injection   Lincomycin  9   Injection   Chloropheniramine  10   Injection   Cyclizine  11   Injection   Cimetidine  12   Injection   Aminophylline  

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13   Injection   Ampicillin  14   Injection   10%  Dextrose  Water  15   Injection   5%  Dextrose  Water  16   Injection   Dextrose  N/Saline  17   Injection   0.9%  Normal  Saline  18   Tablet     Paracetamol  19   Tablet     Diclofenac  Sodium  20   Tablet     Aspirin  21   Tablet     Trisil  22   Tablet     Metronidazole  23   Tablet     Ciprofloxacin  24   Tablet     Oflaxin  25   Tablet     Salbutamol  25   Tablet     Atenolol  26   Tablet     Glibiclamide  27   Tablet     Metformin  28   Tablet     Hyrscin  29   Tablet     Ferro  Sulphate  30   Tablet     Folic  Acid    31   Tablet     Calcium+  Vitamin  D  32   Tablet     Biscodyl  33   Tablet     Cloroquine  34   Tablet     Cloropheniramine  35   Tablet     Albendazol  36   Capsules     Amoxil  37   Capsules   Amoxil  38   Capsules   Doxycycline  39   Capsules   Transamine  40   Syrup     Amoxil  41   Syrup   Paracetamol  42   Syrup   Metronidazole  43   Syrup   Aminophylline  44   Syrup   B  Complex  45   Syrup   Promethazine  46   Syrup   Sodium  Acid  Citrate  47   Syrup   Trisil  48   Syrup   Anti-­‐acid  Syrup  49   Syrup   Albendazol  (Anti-­‐helminthic)  50   Syrup   Cremafin  51   Powder   Oral  Rehydration  Salts  52   Eye  Drops   Chloramphenicol  53   Eye  drops   Polymyxin  Eye  Ointment  

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54   Ear  Drops     Chloramphenicol  55   Surgical  items   Cotton  Bandage  56   Surgical  items   Cotton  wool  57   Surgical  items   Povidone  solution  Bottle  58   Surgical  items   Tincture  Benzoin  Co  59   Surgical  items   Disposable  Syringes  60   Surgical  items   Disposable  Syringes  61   Surgical  items   Spirit  Methylated  62   Surgical  items   Disposable  Gloves  63   Surgical  items   Surgical  gloves  64   FP  items   Contraceptive  pills  65   FP  Items   Inj.  Depo  66   FP  Items   Norigest  67   FP  Items   Copper  T  68   FP  items   Multiload  69   FP  Items   Condoms