Background. RMF-HF Health Care Project

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2 RMF-HF Health Project Talhata, Balakot Mansehra NWFP, Pakistan 3- Months Consolidated Morbidity Report Reporting Period: July 1st 2007 to September 30th 2007 Background The October 8, 2005 earthquake destroyed large portion of the NWFP and Kashmir (AJK) regions. Widespread death and devastation affected an area of approximately 30,000 square kilometers, home to more than 3 million people living in hamlets spread in Himalayan slopes and valleys. This disaster was described as the world s third deadliest natural disaster in the last 25 years: it killed more than 87,000 people, injured more than a 100,000 and made 3 million homeless in the highest mountain ranges in the world (Brennan RJ and Waldman RJ, New England Journal of Medicine, April 2006). Thousands of people were left injured. Most of them suffered even more as they were subjected to extremely harsh living conditions. In October 2005, Hashoo Foundation established a medical relief camp in Jabri (UC Shohal Moizullah, District Mansehra) where 10 to 15 doctors volunteered to help alleviate the sufferings of the residents coming from remote villages located in the mountains surrounding 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 underwent treatment for chronic diseases which had gone untreated 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 Health Care Project The RMF-HF Health Care Project resulted from a partnership between Real Medicine Foundation USA and Hashoo Foundation in mid-january A formalized RMF-HF Health Care Unit was established in Shohal Moizullah in February This health unit employs a full time MBBS doctor, a medical technician, two LHVs and a dispenser. The health unit is equipped with a complete range of medical equipments, including a nebuliser, glucometer, deep freezer/refrigerator (for medicines and vaccines), an oxygen gas cylinder, a complete ENT diagnostic set, and a well-equipped room for examining gynecological cases. The health unit is also furnished with two room coolers, heaters, and an electric power generator to face drastic weather conditions. An ECG machine and a laptop have recently been added to assist in diagnosing ischemic hearth disease patients and reduce referral load to other hospitals. In December 2006, considering the catchments area size, the health unit was shifted from Jabri, Shohal Moizullah to UC Talhata where a larger population could be served. Through this move, patients from Jabri, UC Shohal Moizullah and Union Council Talhata could be served simultaneously. The health unit is now accessible to a population of 44,000 people, twice as more as in the previous location. The most common health problems in the area include Acute Respiratory Infections (ARIs), diarrhea diseases, infectious diseases, gastric diseases, gynecological diseases, skin infections and cardio vascular diseases. The health unit is regularly supplied with IV drips, IV antibiotics, IV sets, oral re-hydration salts, anti-hypertensive, oral antibiotics, antipyretics, analgesics, examination gloves and masks, and vitamins. As the terrain extremely difficult, a jeep has been modified as an ambulance. This vehicle can easily access remote places, transporting referred patients to secondary and tertiary care units in neighboring larger cities and towns.

3 PROGRAM STRUCTURE Goal To improve the health and well-being of those affected by the October 2005 earthquake, with a focus on the 1,20,000 persons in five union councils of tehsil Balakot. Target Population: 1,20,000 persons in five union councils of tehsil Balakot. 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 July to September, 2007 From 1st July 2007 to 30th September 2007, 3,009 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 quarter under review, the figures show that the patients visiting the unit consist of 38% male, 62% female and 26.2% children. During the quarter under review, general political instability hampered the work of the health unit. In July and August, the monthly patient load dropped below 1,000, in clear contrast with the previous reporting period. For security reasons, the health unit could open only partially (2 to 3 hours per day) and staff had to be moved to Mansehra for overnight stay. This situation affected all the NGOs operating in the earthquake zones, especially in the regions of Battagram. However, with a monthly case load of 1,447 patients, the month of September witnessed a return to a more normal situation. Most of the diseases diagnosed and treated result from the weather and living conditions of the patients: acute respiratory infections: 23% of cases treated diarrhea (bloody and non bloody): 15% dyspepsia: 7 % scabies 9%, general body aches and weaknesses: 6% constipation: 2% urinary tract infections: 8% anxiety and hyper-tension: 8%. Cases of suspected meningitis (2), acute abdomen (6), mumps (3), burns (6), acute appendicitis (7), spinal cord injuries (2) and acute jaundice syndrome (5) were less frequent. These cases were subsequently referred to secondary and tertiary care hospitals for further treatment. 10 to 15 patients are benefiting from home consultations each month. The health unit has generated Quarterly Morbidity Reports (QMR), which were shared with the Ministry of Health (MOH) and the World Health Organization (WHO).

4 % of & patient ( July-Sep 07) Gender Total % % % Grand Total % 38% 62% Monthwise flow of patients July- Sep 07) Month Grand Total % Jul % Aug % Sep % Grand Total % Jul Aug Sep

5 Age and mothwise flow of patients ( July - Sep 07) Age Date Grand Total % 0-5 years 0-5 years Jul % Aug % Sep % % Jul % 5-12 Aug % Sep % 5-12 Total % Jul % 12 and above Aug % Sep % 12 and above % Grand Total % Months 12 and above 0-5 years 5-12 years 12 and above Total % Jul % Aug % Sep % Total 5-12 years % Sep Aug Jul 0-5 years Jul Aug Sep

6 Weekwise flow of patients ( Jul - Sep 07) Date Grand Total % 7/1/2007-7/7/ % 7/8/2007-7/14/ % 7/15/2007-7/21/ % 7/22/2007-7/28/ % 7/29/2007-8/4/ % 8/5/2007-8/11/ % 8/12/2007-8/18/ % 8/19/2007-8/25/ % 8/26/2007-9/1/ % 9/2/2007-9/8/ % 9/9/2007-9/15/ % 9/16/2007-9/22/ % 9/23/2007-9/29/ % 9/30/ /1/ % Grand Total % 9/30/ /1/2007 9/23/2007-9/29/2007 9/16/2007-9/22/2007 9/9/2007-9/15/2007 9/2/2007-9/8/2007 8/26/2007-9/1/2007 8/19/2007-8/25/2007 8/12/2007-8/18/2007 8/5/2007-8/11/2007 7/29/2007-8/4/2007 7/22/2007-7/28/2007 7/15/2007-7/21/2007 7/8/2007-7/14/2007 7/1/2007-7/7/

7 Daily # of consultanices ( July - Sep 2007) Date Grand Grand Grand Date Date Total Total Total 1-Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Aug Sep Jul Total Sep Jul Sep Jul Total Total Average flow of patients - per day Average flow of female patients - per day Average flow of male patients - per day Average flow of patients - per month

8 Jul-07 8-Jul Jul Jul Jul-07 Daily # of consultations - July Aug-07 8-Aug Aug Aug Aug-07 Daily # of consultations - Aug Sep-07 8-Sep Sep Sep Sep-07 Daily # of consultations - Sep 07

9 Provisional monthwise diagnoses (July- Sep 07) Provisional Diagnoses Jul Aug Sep 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) % Generalized Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

10 Provisional agewise diagnoses (July- Sep 07) Provisional Diagnoses < >12 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) % Generalized Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

11 Provisional genderwise diagnoses (July- Sep 07) Provisional Diagnoses 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) % Generalized Body Aches % Generalized Body Weakness % Gynecological problems % Headache % Hypertension % Injuries/wounds % Mumps % Scabies % Suspected Meningitis % Toothache % Urinary Tract Infection (UTI) % Worms Infestation % Grand Total %

12 Village monthwise flow of patients Village Jul Aug Sep Grand Total Allari Andrasi Baga 1 1 Bajmoury Balakot Batangi Batora Chapra Dara 4 4 Dunkacha 1 1 Garhi Habibullah Garlat Guldairy Hangray 4 4 Hasa Jabbi Jabree Jagir Jania Kagal Kalish Kashiyan Kashtara Kot Bala Koti Pata 4 4 Machipura 1 1 Manda Mansehra 1 1 Nala Noora Pateka Patsiry 1 1 Sarwai Shawal Sirya Soum Talhatta Zamari Grand Total

13 Village and gender-wise flow of patients (July- Sep 07) Villages Grand Total % Allari % Andrasi % Baga % Bajmoury % Balakot % Batangi % Batora % Chapra % Dara % Dunkacha % Garhi Habibullah % Garlat % Guldairy % Hangray % Hasa % Jabbi % Jabree % Jagir % Jania % Kagal % Kalish % Kashiyan % Kashtara % Kot Bala % Koti Pata % Machipura % Manda % Mansehra % Nala % Noora % Pateka % Patsiry % Sarwai % Shawal % Sirya % Soum % Talhatta % Zamari % Grand Total %

14 Village and agewise flow of patients (July- Sep 07) Village < >12 Grand Total Allari Andrasi Baga 1 1 Bajmoury Balakot Batangi Batora Chapra Dara Dunkacha 1 1 Garhi Habibullah Garlat Guldairy Hangray 4 4 Hasa Jabbi Jabree Jagir Jania Kagal Kalish Kashiyan Kashtara Kot Bala Koti Pata Machipura 1 1 Manda Mansehra 1 1 Nala Noora Pateka Patsiry 1 1 Sarwai Shawal Sirya Soum Talhatta Zamari Grand Total