PROGRAM STRUCTURE. Target Population: 44,000 persons, Union Council Shawal Muizullah and Union Council Talhatta

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2 RMF-HF Health Project Talhatta, Balakot Mansehra NWFP, Pakistan 3- Months Consolidated Morbidity Report Reporting Period : April 1,2007 to June Background The earthquake of October 8, 2005 destroyed most of the Frontier (NWFP) and Kashmir (AJK) regions of Pakistan and caused widespread death and devastation. An area of approximately 30,000 kilometers was affected where more than 3 million lived in hamlets perched on Himalayan mountain slopes and valleys. This catastrophic disaster was described as the world s third deadliest natural disaster in the last 25 years that killed more than 87,000, injured more than a 100,000 and made 3 million people homeless in the highest mountain ranges in the world (Brennan RJ and Waldman RJ, New England Journal of Medicine, April 2006). Aside from the loss of life and property, this natural disaster also left thousands of people injured. Most of these people s suffering increased further as they were subjected to the harsh natural elements. Hashoo Foundation (Formerly HOAP) established a medical relief camp in Jabri (UC Shohal Moizullah), District Mansehra) where doctors volunteered their services to help alleviate the sufferings of the residents of remote villages atop the mountains close to Balakot. The medical camp ran for more than three months. During that period, patients were treated for crushed injuries, infected wounds, orthopedics problems, post operative care and acute illnesses sustained as a result of the earthquake, others experienced treatment for chronic diseases lying dormant for years due to the remoteness of the region. As the BHU established by the Government had been completely destroyed, the need for sustained health care for the residents of the area was felt strongly. RMF-HF (HOAP) Health Care Project The result of this was a partnership with Real Medicine Foundation USA in mid-january This partnership resulted in the establishment of RMF-HF Health Care Unit (Previously called RMF-HOAP Health Care Unit) Shohal Moizullah. This Health Unit employs a full time MBBS Doctor, a Medical Technician, two LHVs and a Dispenser.

3 The Health Unit is outfitted with a complete range of medical equipments, including a Nebuliser, Glucometer, Deep Freezer/Refrigerator (for some medicines and vaccines), an Oxygen Gas Cylinder, a complete ENT Diagnostic set, and a well equipped room for examining Gynecological cases. Considering the weather conditions, the Health Unit is also furnished with two room coolers, heaters, and an Electric Power Generator. An ECG machine and a laptop computer have recently been added to the list of equipment in the Health Unit. This assists in diagnosing Ischemic Hearth Disease patients and reduce referral load to other hospitals. In December 2006, considering the size of the catchment area, the health unit was shifted from Jabri, Shohal Moizullah to UC Talhatta where a larger population base could be served. Through this move, patients from Jabri, UC Shohal Moizullah and Union Council Talhatta could be served simultaneously.the health unit is now serving a larger number of people as the catchment area was smaller in Jabree. It is now accessible to a larger number of people. Major health problems in the area include Acute Respiratory Infections (ARIS), Diarrheal diseases, Infectious diseases, Gastric diseases, Gynecological diseases, Skin Infections and Cardio Vascular Diseases. This Health Unit is regularly supplied with IV Drips, IV Anti-biotics, IV sets, Oral Re-hydration Salts, Antihypertensive, Oral Anti-biotics, Anti-pyretics, Analgesics, Examination gloves & Masks, and Vitamins. As the terrain of the area is rugged and mountainous, a Jeep has been outfitted as an ambulance for the Health Unit. This vehicle can easily negotiate the difficult terrain, transporting referred patients to secondary and tertiary care units in neighboring larger cities and towns. PROGRAM STRUCTURE Goal To improve the health and wellbeing of those affected by the Pakistan earthquake of October 2005, particularly the 44,000 people located in the Union Council Shohal Muizullah and Union Council Talhatta. Target Population: 44,000 persons, Union Council Shawal Muizullah and Union Council Talhatta

4 Project Objectives: o To provide a standard package of primary health care incorporating disease prevention, health promotion and health education o To improve a) the coverage and utilization of services by remote village populations; b) access to healthcare for girls and women; c) the standard of health care o To involve the government and local communities in the health care system and build their capacity to take ownership of the system after completion of the project. o To involve and train government health workers who wish to work in this area. 3- Months Consolidated Morbidity Report from April to June, 2007 From 1st April 2007 to 31st June 2007, 4043, patients were diagnosed and treated at the RMF-HF Health Unit. Since its relocation in December 2006, the RMF- HF Health Unit is more accessible to the people of this area, especially women and children. During the last quarter of 2006, the figures showed 55% male, 45% female and 22% children visiting the RMF-HF Health Unit. However, the new location of the Health Unit saw a greater number of women and children diagnosed and treated at the RMF-HF Health Unit. The numbers included 59% females, 28% children and 41 % male patients from the surrounding villages during April June The diseases diagnosed and treated in the area were a result of the weather and living conditions of these people. Most patients complained of Acute Respiratory Infections (ARI), making up more than 24 % and Diarrhea (Bloody and Non Bloody), making up 11.6 % of the total consultations. At the same time, Dyspepsia stood at 10.3 %, while Scabies constituted 11.9%, General Body Aches and Weaknesses made up 6.2 % and 2% were treated for Constipation.5.1% patients were treated for Urinary Tract Infections(UTIs).Considering the trauma these people had been through, Anxiety and Hyper-tension were also among the major conditions treated at the Health Unit making up 9%. Cases of suspected Meningitis(1), Acute Abdomen(3), Mumps(5), Burns(3), Acute Appendicitis(3), Spinal Cord Injured(SCI) and Acute Jaundice Syndrome(2) were few in number. The Health Unit played a pivotal role in diagnosis and initial treatment for these conditions. These were subsequently referred to Secondary and Tertiary Care Hospitals for further treatment. Around 10 to 15 patients are seen at their own locations each month The Health Unit has generated Monthly Morbidity Reports(MMR) for patients and diseases treated at the Unit. These reports have also been shared with the Ministry of Health (MOH) and the World Health Organization (WHO).

5 % of Male & patient ( April-June 07) Gender Total % % Male % Grand Total % % of Male & patient ( April-June 07) Male 41% 59% Monthwise flow of patients Date Male Grand Total % Apr % May % Jun % Grand Total % Monthwise flow of patients Male Male Male Apr May Jun

6 Age and monthwise flow of patients Age Apr May Jun Grand Total % 0-5 years % 5-12 years % 12 and above % Grand Total % Age and monthwise flow of patients ( April-June and above 0 Apr May Jun 5-12 years 0-5 years 0-5 years 13% 5-12 years 9% 12 and above 78%

7 Weekwise flow of patients ( April to June 07) Date Male Grand Total % 4/1/2007-4/7/ % 4/8/2007-4/14/ % 4/15/2007-4/21/ % 4/22/2007-4/28/ % 4/29/2007-5/5/ % 5/6/2007-5/12/ % 5/13/2007-5/19/ % 5/20/2007-5/26/ % 5/27/2007-6/2/ % 6/3/2007-6/9/ % 6/10/2007-6/16/ % 6/17/2007-6/23/ % 6/24/2007-6/30/ % Grand Total % 6/24/2007-6/30/2007 Weekwise flow of patients- gender based 6/17/2007-6/23/2007 6/10/2007-6/16/2007 6/3/2007-6/9/2007 5/27/2007-6/2/2007 5/20/2007-5/26/2007 5/13/2007-5/19/2007 5/6/2007-5/12/2007 4/29/2007-5/5/2007 4/22/2007-4/28/2007 4/15/2007-4/21/2007 4/8/2007-4/14/2007 4/1/2007-4/7/2007 Male

8 Age, Month and genderwise flow of patients Age Month Male Grand Total % Apr % 0 to 5 years May % Jun % Total % Apr % 5-12 years May % Jun % Total % Apr % Above 12 years May % Jun % Total % Grand Total %

9 Daily # of consultancies ( Apr - Jun 07) Date Male Total Date Male Total Date Male Total 1-Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Apr May Jun Total May Total Total Average flow of patients- per day 45 Average flow of female patients- per day 26 Average flow of male patients- per day 18 Average flow of patients- per month 1348

10 Daily # of consultations ( Apr-07) Male 0 Daily # of consultations ( May-07) 4/1/2007 4/8/2007 4/15/2007 4/22/2007 4/29/ Male /1/2007 5/8/2007 5/15/2007 Daily # of consultations ( Jun-07) 5/22/2007 5/29/ Male 0

11 Annex 1 Provisional monthwise diagnosis Provisinol Diagnoses Apr May Jun Total % A/N Visit % Acute Abdomen % Acute Appendicitis % Acute Jaundice Syndrome % Anxiety % ARI (Acute Respiratory Infection) % ARI (Pharyngitis/ Sore throat) % Backache % Boils % Burn % Conjunctivitis/Allergic % Conjunctivitis/Mucopurulent % Constipation % Diarrhoea (Bloody) % Diarrhoea (Non Bloody) % Dyspepsia % Family Planning Visit % Fungal (Oral Thrush) % Generaliesd Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Knee Joint Pain % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

12 Provisional agewise diagnosis Provisinol Diagnoses 0-5 years 5-12 years 12 & above Total % A/N Visit % Acute Abdomen % Acute Appendicitis % Acute Jaundice Syndrome % Anxiety % ARI (Acute Respiratory Infection) % ARI (Pharyngitis/ Sore throat) % Backache % Boils % Burn % Conjunctivitis/Allergic % Conjunctivitis/Mucopurulent % Constipation % Diarrhoea (Bloody) % Diarrhoea (Non Bloody) % Dyspepsia % Family Planning Visit % Fungal (Oral Thrush) % Generaliesd Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Knee Joint Pain % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

13 Provisional genderewise diagnosis Provisinol Diagnoses Male Grand Total % A/N Visit % Acute Abdomen % Acute Appendicitis % Acute Jaundice Syndrome % Anxiety % ARI (Acute Respiratory Infection) % ARI (Pharyngitis/ Sore throat) % Backache % Boils % Burn % Conjunctivitis/Allergic % Conjunctivitis/Mucopurulent % Constipation % Diarrhoea (Bloody) % Diarrhoea (Non Bloody) % Dyspepsia % Family Planning Visit % Fungal (Oral Thrush) % Generaliesd Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Knee Joint Pain % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

14 Villagewise flow of patients Village Male Grand Total % Alari % Andrasi % Baga % Bajmury % Balakot % Balola % Banda % Batora % Chapra % Dara % Dodyal % Garhi Habibullah % Garlat % Gulmira % Gultairy % Hangrayi % Hasa % Jaba % Jabree % Jagir % Jania % Juma % Kagal % Kalish % Kashiyan % Kashtara % Khaghan % Khoti Pata % Kot Bala % Mansehra % Nala % Naran % Noura % Pateka % Sarwai % Sath Bani % Shawal % Sirya % Soum % Sugdar % Talhatta % Zamiry % Grand Total %

15 Provisional agewise diagnosis Village 0-5 years 5-12 years 12 & above Grand Total Alari Andrasi Baga 2 2 Bajmury Balakot Balola 3 3 Banda 3 3 Batora Chapra Dara Dodyal 1 1 Garhi Habibullah Garlat Gulmira Gultairy Hangrayi Hasa Jaba Jabree Jagir Jania Juma 1 1 Kagal Kalish Kashiyan Kashtara Khaghan Khoti Pata Kot Bala Mansehra 5 5 Nala Naran 1 1 Noura Pateka Sarwai Sath Bani 3 3 Shawal Sirya Soum Sugdar 3 3 Talhatta Zamiry Grand Total

16 Provisional monthwise diagnosis Village Apr May Jun Total Alari Andrasi Baga Bajmury Balakot Balola 3 3 Banda 3 3 Batora Chapra Dara 4 4 Dodyal 1 1 Garhi Habibullah Garlat Gulmira Gultairy Hangrayi Hasa Jaba Jabree Jagir Jania Juma 1 1 Kagal Kalish Kashiyan 2 2 Kashtara Khaghan Khoti Pata 3 3 Kot Bala Mansehra Nala Naran 1 1 Noura Pateka Sarwai Sath Bani 3 3 Shawal Sirya Soum Sugdar Talhatta Zamiry Grand Total