RMF Mother & Child Health Center, Union Council Taru Jabba, District Nowshera

Transcription

1 PAKISTAN HEALTH PROJECT FOR IDPs RMF Mther & Child Health Center, Unin Cuncil Taru Jabba, District Nwshera Secnd Quarterly Mrbidity & Prgress Reprt Fr the Perid f April June 2014

2 I: BACKGROUND An estimated 5 millin peple have been displaced due t the Taliban- military cnflict and sectarian vilence within the Nrthern parts f Pakistan since The wrst affected areas are the Khyber and Khurram Agencies and residents displaced are hsted in the districts f Peshawar, Nwshera, Khat, Hangu, Tank and Dera Ismail Khan. Accrding t the IDP Vulnerability Assessment & Prfiling Prject (IVAP), 66% f KPK s displaced ppulatins are registered with the authrities. Displacement leads t a hst f serius challenges such as threat t life, restricted mvement, and inadequate access t fd, husing and basic services including healthcare. The average IDP family lives belw pverty line with an incme f Rs /- (USD 25/- t 50/- ) per mnth. The key fcus f the gvernment is safe and vluntary repatriatin f IDPs; hence respnses t the IDP crisis are mainly prvisin f emergency relief such as fd, healthcare, sanitatin and clean water rather than lng term slutins as the hst regins face increased pressure n infrastructure by the chrnically burgening ppulatins. District Nwshera has a ppulatin f 310,899 IDPs hused in hst cmmunities and Jalazi Camp which is the largest IDP camp in Pakistan with a ppulatin f 75,595. Nwshera s ttal area f 1,748 square km is divided int tw Tehsils (Pabbi and Nwshera) and 47 Unin Cuncils. The health department f District Nwshera which has an infrastructure designed t serve a ppulatin f 1.4 millin peple in frm f 5 secndary and tertiary level Gvernment Hspitals, 7 Rural Health Centers (RHC), and 32 Basic Health Units (BHU). In 2010, a large number f these health facilities, mainly BHUs and RHCs were destryed in the flds and althugh mst are under the prcess f revitalizatin led by the semi- gvernment PPHI, the services are inadequate fr the added burden f the IDPs. This added pressure has been eased by a cluster f NGOs under the umbrella f the WHO. Real Medicine Fundatin is a member f this cluster and plays a rle in the addressing the gap in MCH care fr the wmen and children f the IDP cmmunity. II: PROGRAM STRUCTURE In December 2013, Real Medicine Fundatin established a MCH Center in Unin Cuncil Taru Jabba at a central lcatin n the main GT rad, accessible t IDPs in bth surrunding hst cmmunities as well as the Jalazi Camp, 10 km away. Prject Gal: T imprve the health f the IDP wmen and children, living in Unin Cuncil Taru Jabba as well as the surrunding areas, thereby cntributing t the KPK Gvernment s mandate t address immediate needs f this vulnerable grup with the repatriatin t their hmes being the ultimate gal. Prject Objectives:

3 T prvide MCH services, including antenatal care, gyneclgical/bstetric care and family planning t IDP wmen. T prvide high quality primary health care services free f cst t the pr and vulnerable frequenting the clinic. T develp a strng referral system t secndary and tertiary care facilities fr cases needing advanced care. T prvide a basic pathlgy labratry fr rutine diagnstic investigatins that will augment bth primary healthcare and MCH services. T cnduct utreach activities fcused n preventive health/hygiene educatin & prmtin and capacity building by training f cmmunity health wrkers. T implement a sustainable and scalable mdel that is in chesin with ther members f the WHO and the KPK health system. Target Ppulatin: The prject cvers 45,000 IDPs and lcal ppulatins in Unin Cuncil Taru Jabba; hwever, as per ur previus experience in similar prjects in ther parts f the cuntry, it is expected that cmmunities frm surrunding Unin Cuncils will als access this health centre. The MCH cmpnent f the PHC will address the unmet needs f the wmen and children f the IDP cmmunities living in UC Taru Jabba neighburing Unin Cuncils. At an average, 29% f the female ppulatin is in childbearing age and 18% is pregnant r lactating. These wmen f childbearing age and children under 5 are the direct target ppulatin f the MCH Centre. Mdel f Care The mdel f care implemented is based n the RMF CPHRS mdified t be culturally sensitive t ur target ppulatin s sensibilities. Given that the gvernment MCH cmpnent f the partially functinal BHU in UC Taru Jabba is nt nly cmpletely insufficient but it als lacks culturally sensitive service prvisin as it nly has male staff. The majrity f the IDP wmen cme frm the tribal areas f Pakistan that are highly patriarchal and extremely cnservative in their sci- cultural practices. Displacement has made this tribal custm vulnerable t change, a fact that is bitterly resisted by these ppulatins and this resistance ften manifests in restricting the wmen s health needs t a lwer pririty, thus subjecting them t turn t untrained birth attendants fr their reprductive and maternal needs.

4 RMF s MCH center is run mstly by female staff. We have an in- huse pathlgy lab t carry ut all rutine investigatins. A cmmn trend we have bserved in ur previus facilities is that many patients, mstly uneducated and unaware, tend t ignre requests fr bld tests as this means either travelling lng distances t gvernment hspitals fr their tests r their inability t affrd the csts f tests frm private facilities. In this manner, we tend t lse these patients as they d nt return t the center making them vulnerable t unexpected mrbidity and mrtality. Offering this facility and ensuring that the tests are carried ut within the hur facilitates their participatin and ensures an effective service delivery. In additin t MCH services, in respnse t lcal demand, minr primary health prblems presented by wmen, children and accmpanying men are als addressed. Mrbidity Reprt frm 1 st April t June 30 th, 2014 Demgraphics: Frm 1 st April t 30 th June 2014, 3,485 patients were diagnsed and treated at the Nwshera Health Center fr a variety f medical cnditins. Of the patients wh visited the hspital during this perid 3,076 (88.3%) were wmen, 407 (11.7%) were children. Of the children 243 (66.7%) were male children while the rest 136 (33.3%) were girl children. There were n adult male patients, perhaps because it was nw established within the cmmunity that this is a wmen s health center and they chse t stay away. In the first 4 mnths we had adult male patients, mstly elderly men.

5 MCH Statistics: In this reprting perid, 257 and 183 wmen came fr antenatal and pstnatal visits, respectively. Abut 163 wmen sught family planning services and 56 wmen came seeking treatment fr infertility, a substantial increase frm the previus figure f 19 wmen. Many f these wmen were referred t the Lady Reading Hspital in Peshawar fr tertiary level treatment as we d nt have the expertise r facilities t address issues f infertility. A ttal f 1,898 wmen visited the center fr gyneclgical prblems. The breakdwn f the variety f these gyneclgical prblems presented is summarized in the table belw. Gyneclgical Presentatin Amenrrhea 188 Dysmenrrhea 251 Leukrrhea 261 P/V Discharge 115 P/V Bleeding 67 Ovarian Cyst 58 Irregular Menstruatin 113 Plymenrrhagia 73 PID (Pelvic Inflammatry Disease) 86 Fibrids 27 Ttal 1,898 Primary Health Statistics: An additinal 1,546 wmen and children were treated fr a variety f primary health prblems; mst were the result f pverty and unhygienic living cnditins f the patients living in this cmmunity. The mst cmmn cmplaint (17.4%) was generalized bdy aches, weakness and malaise. These are symptms f depressin but are nt recgnized as such by the lcal culture where depressin is cnsidered a weakness f character. Rather they prefer a pathlgical finding fr their symptms. Hence we prescribe these patients vitamins as placebs in additin t the fact that their pr diet dictates vitamin supplements fr cmplete health. The secnd cmmnly presentatin was diarrhea (15%). Other ailments presented include: Primary Health Presentatin Anemia 96 Abdminal Pain 154 Respiratry Tract Infectins 138 Enteric Fever (Typhid) 93 Dyspepsia 61 Vmiting 75 Scabies 100 Fd Pisning 22 Urinary Tract Infectins 166

6 Hypertensin 97 Suspected Meningitis 6 Burns 15 Acute Appendicitis 0 Jaundice 31 General bdy aches and weakness 269 Diarrhea 233 Eleven victims f rad traffic accidents were als brught t ur health center fr immediate emergency care while nn- RTA related injuries were presented by 16 patients. The ttal number f referrals, minus thse made fr infertility made during these three mnths was 14 patients. Pathlgy Lab Statistics: The pathlgy lab cnducted a ttal f 509 rutine investigative tests in this 3- mnth perid. The table belw shws the breakdwn Lab Tests Perfrmed frm 1 st April t June 30 th 2014 Pregnancy Urine Test 145 Urine Rutine Examinatin 43 Bld Gruping 45 Bld Hb 105 Bld Glucse 32 Vidal Test 53 Bld Malarial Parasite (MP) 37 RA Factr 14 Txplasma 22 SGPT 13 Ttal Tests 509 Fr additinal details please find attached the Mrbidity Matrix as Annex 1 This prject significantly imprved the access fr wmen and children f the IDP cmmunity t quality primary level healthcare. The RMF health centre is slwly but surely building a gd will in the cmmunity and as a sign f the health centre s engagement with the lcal cmmunities, it ften received vlunteers frm the surrunding villages t help with its services and utreach activities which are currently limited t health educatin n hygienic living cnditin fcused mstly n a scabies free envirnment and clean water/fd t avid diarrhea.

7 The RMF health centre als interacts and crdinates with lcal health authrities at the district and prvincial levels. We are currently in the prcess f btaining cllabratin frm the KPK EPI prgram t set up an EPI desk and technician in the centre. Hwever fr this t materialize we are in need f a refrigeratr t maintain the cld chain. Annex 1. Mrbidity Matrix RMF Health Centre Nwshera frm April t July 2014 Mnths Apr- 14 May- 14 Jun- 14 Ttal Ttal Patients fr the mnth Female Male Ttal Adults Children (Male) Children (Female) Ttal Children MCH Details 1 Antenatal Care Pstnatal Care Family Planning Infertility Amenrrhea Dysmenrrhea Leukrrhea P/V Discharge P/V Bleeding Ovarian Cyst Irregular Menstruatin Plymenrrhagia PID Pelvic Inflammatry Disease Fibrid Ttal MCH 1898 Primary Health Details 15 Anemia Abdminal Pain Respiratry Tract Infectins Enteric Fever (Typhid) Dyspepsia Vmiting Scabies

8 22 Fd Pisning Urinary Tract Infectins Hypertensin Suspected Meningitis Burns Acute Appendicitis Jaundice General bdy aches & weakness Diarrhea Ttal Primary Health Nn- RTA Injuries RTA Rad Traffic Accident Referrals Lab Tests Perfrmed frm April t July 2014 Tests Apr- 14 May- 14 Jun- 14 Ttal Pregnancy Urine Test Urine Rutine Examinatin Bld Gruping Bld Hemglbin Bld Glucse Vidal Test Bld Malarial Parasite (MP) RA Factr Txplasma SGPT Ttal Tests Perfrmed