Indus Watch
Healthcare for all – one community at a time
A group of young volunteers proved that teamwork and community participation can go along way towards helping marginalised communities by recently setting up a free medical camp in Mori Manger village, Taluka Tando Hyder, district Hyderabad
By Urooj Zia
As many as 942 patients were diagnosed by expert doctors between 10am and 5pm during a one-day free medical camp, which was set up at the end of February in a village near Hyderabad; 600 children and 700 adults were vaccinated against HBV; and free medicines were provided to the community.

Let there be light!
Zahid Jalbani writes about the efficient utilisation of available natural resources to meet challenges such as the looming energy crisis
The electricity supply situation in the country has deteriorated rapidly over the past two decades; and the 12- to 16-hour-long power load-shedding, particularly in the rural areas, has paralysed the lives of the poor. This crisis, however, can be mitigated to a large extent by the efficient utilisation of alternate options, such as wind and solar energy-generation, especially in Sindh, which is rich in terms of biodiversity as well as natural resources.

The inauguration and functioning of the Benazir Bhutto Medical College (BBMC), Lyari is not only being held up due to recognition from the Pakistan Medical and Dental Council (PMDC), but qualified doctors do not want to work for a meagre pay being offered to them for their services, BBMC Principal and Project Director Hassan Dost Afridi told Kolachi.

Afridi said that after a month of being inaugurated, the college is still struggling to be recognised by the PMDC. "PMDC has very clear guidelines regarding the registration of medical colleges, which is not a problem; the issue is the low salaries being given to professionals, which is not according to the remunerations being offered in the market."

The principal maintained that prior to the inauguration of the college, a selection board comprising of five members had been formed. "The board had selected almost half of the faculty on the basis of the required criteria, but for some unknown reason, the selections made by us were cancelled, and now the process is being started again, without taking into account the waste of time and exertion," Afridi said dismally.

The previous selection board included Special Health Secretary Captain Majid, anatomy, physiology and biochemistry professors from Dow University, and Afridi himself. This board was reconstituted, with Dow University Vice-Chancellor Dr Masood Hameed Khan and Additional Health Chief Secretary Fasih Uddin Khan being added to the board.

Meanwhile, Special Health Secretary Captain Majid admitted that they had selected faculty members independently and from private universities, but their selections were cancelled afterwards. "The reason for that was that the salary rates we were offering wer less than what they were getting at other universities."

Majid maintained that the new committee will come up with "proper incentives" for the faculty, which will hopefully make the college functional. He rejected the notion that tension and strife in Lyari is the main reason behind doctors’ demand for a hefty package, and insisted that the matter was basically low salary rates.

Health Chief Secretary Fasih Uddin Khan said that salaries have been increased by 20 per cent, and the department had advertised the vacancies at BBMC in newspapers, so that they don’t have to rely on private professors as such.

Meanwhile, Afridi claimed that the administration at the college is ready with almost everything, from the prospectus to the curriculum being finalised. "Just because of this delay in the selection of the faculty we have to sit back and see what happens."

Afridi maintained that the medical college, which is one of the ambitious projects of the Lyari Development Package announced in early 2009 by the Pakistan People’s Party (PPP), keeps running into delays and management problems - all of which seem workable and achievable.

"Right from faculty appointments to yet to be decided admission policy, the list goes on," he said. "We are determined to see this project through, no matter how many problems we face. It is after all for the people of Lyari and we have seen it all in the past too, so it shouldn’t be a problem at all."

I closed my eyes a few days ago, only to find myself as a happy-go-lucky young man about to join Minnesota State University as a freshman. This tale is about 38 years old, when I was moving to the United States to start my undergraduate studies in Aviation Management, a four-year programme.

Things would have been different if I had registered in the same programme three decades later. Back home, things were changing quite rapidly. One liberal dictator was about to be dethroned, and the civilians era was about to start - albeit for a short span of time. Another dictator was yet to come with his recipe of disaster: religion in politics

Pakistan was about to break up, and so was the Pakistani nation. I was leaving the country, but not for good, as most did at that time. Migrating once, when I was only three, was enough for me. No second migration, for good or for bad, I resolved

It was a smooth Alitalia flight, directly from Karachi to Rome. Those were the good days when foreign airlines operated from Karachi, without fear and hesitation, and their crew would mostly be found at a five-star hotel.

After a night’s stopover at Rome, the plane took off for Chicago early morning. The aircraft was full of perhaps the sixth and seventh generation of Italian Americans. They seemed to be proud of their hyphenated identities, and their overall appearance was unlike their first generation.

"Change is inevitable in every nation, and those who stick to old traditions and mythical rituals, and those who furiously resist the wind of change, are ultimately wiped out from the world," I thought to myself back then.

At Minnesota State University, there were about 100 foreign students from places as far as Outer Mongolia and Falkland. Among them, nearly one dozen were from Pakistan. Summer vacations had started, so most kids had left their living campuses for their states and the countries of origin.

Mankato was Minnesota’s small southern sleepy university town back then, with a couple of movie theatres and one or two shopping malls. The town was also named in the Guinness Book of World Records; the hanging of as many as 38 Sioux Indians was ordered in 1862 on charges of illegal deer hunting. The order was issued by US President Abe Lincoln. Interestingly, hanging ropes were in short supply, and thus the lives of these poor Indians were spared.

Summer used to be very brief but hot in Minnesota. It was Sunday then and Mankato was unusually warm on June 11, 1978. I was in my Bermuda shorts, working in my backyard, sowing turnip seeds, and eyeing the roses in the neighbour’s garden. Our neighbour, an old lady, had even caught me red-handed once with a rose bud while I was trespassing.

After watching the thrilling final between two famous tennis stars in our sorority’s huge living room, I planned to go to a nearby church for spaghetti and loaf dinner only for 99 cents with my Japanese friend. I used to call him ‘Yoshiro - The Mathematician’.

Our former mathematics professor, Pessanen, with his family was also in the queue at the church. We all sat together on one of the church’s large wooden benches placed outside, with paper plates full of spicy Italian dishes and plenty of loafs. Soon Yoshiro got embroiled in a heated argument with the professor over some math equation.

People in United States are not generally class-conscious, and it was amazing to find a university professor (earning $60,000 annually, by1978 standards) standing in the same line with a hobo in rag tag clothing for a cheap food.

After the lunch, we went to see our Nigerian friend, Ebo. He was in the kitchen, cooking some Nigerian delicacy. Its smell, however, was pungent, and Yoshiro started sneezing. We had to leave Ebo’s kitchen, and made ourselves comfortable in his sitting room, one which was decorated with voodoo stuff.

In the evening, we all together went to see the movie ‘Grease’. We ran into Samina Khan*, a girl from Lahore, loitering around near the movie hall. I invited her to watch the movie with us, which she accepted. The movie was just released and mainly attracted the young crowd since its cast included John Travolta and Olivia Newton John.

The hall became quiet unruly and there were some fist fights. Two female cops arrived and charged a girl and two young men for not only being rowdy, but also severely injuring a fellow viewer with a broken beer bottle. The accused were handcuffed, and politely escorted out of the movie hall to waiting police cruisers.

By the time the movie was finished, we were pretty hungry. We walked to Sergeant’s Pizza, owned and operated by a Korean War veteran, Sergeant Shultz. He was married to a Korean lady, whom we passionately called ‘Ma’. One thing that was peculiar about Sergeant was that he kept telling us about war stories, even though we were more focussed on the pizza. The bottom line, always, was that your pizza may have finished, but not his war stories.

After dropping Samina off to her college, some ten miles north of Mankato, we headed back to campus. It was late in the night by then, and I was thinking about returning home for good, as my father was prematurely retiring from his FIA services. General Zia had imposed Martial Law in Pakistan, and many well-wishers advised me to change my plans. I had made up mu mind, however, and soon, I headed back, into the eye of the storm.

* name changed to protect privacy

Indus Watch

As many as 942 patients were diagnosed by expert doctors between 10am and 5pm during a one-day free medical camp, which was set up at the end of February in a village near Hyderabad; 600 children and 700 adults were vaccinated against HBV; and free medicines were provided to the community.

The camp was organised by a young group of volunteers, called the "Angels Group," with the objective of focusing on public health in an area where a number of diseases are adversely affecting the lives of the entire community. Around 51 brick kilns function in the area; the working conditions at these kilns, coupled with the smoke that is constantly emitted from 51 chimneys, has wreaked havoc with the lives of the residents of the area.

"We had initially conducted a survey in the area, and met with a number of people at their homes. Our group collected primary prevalence data of a number of diseases rampant in the area, and then decided that a free medical camp would be extremely beneficial for the community," Ghulam Murtaza, the leader of the group, told Indus Watch. "Our objective was to increase healthcare awareness in the community and provide free medical treatment and medicines to these people."

Local problems

During the initial survey, the group met with a number of residents of the area. Among them was 70-year-old Ramzan, who works at a local brick kiln. He had been suffering from scabies for the past three years. "He said that he had visited the government hospital several times, but did not get proper treatment," Murtaza said. "Plus, the government hospital is far from the village, and Ramzan could not afford to spend money again and again on transport."

Amazingly, a three-year-old also worked at the kiln. Allah Dita’s mother informed the survey team that the child suffered from scabies on both legs. She complained that she had taken him to governmental hospitals in Hyderabad and Jamshoro several times, but Allah Dita did not recover.

The team also met 50-year-old Maqsooda and 68-year-old "Baba," residents of Azad Nagar, a camp for former bonded labourers. Around 30 families moved here after they were released from various private hails. Most of the residents of the camp, including Maqsooda and "Baba", suffer from skin and eye problems.

Seven-year-old Amir Khan, a resident of Mori Manger village, suffers from a number of skin diseases, which have affected different parts of his body. His mother told the survey team that the diseases were contagious, and had passed on to the rest of the family too.

Twenty-five-year-old Zakir Ali works at a brick kiln in the area. He suffers from a number of skin condition due to the health hazards at the kiln. Fifteen-year-old Waseem Ahmed works with Ali. Both of his eyes have been severely affected by smoke at the kiln. "While we were talking to Ahmed, the owner of the brick-kiln came over, and told us to go away," Murtaza said. "He did not permit us to survey or speak to other families who were bonded to the kiln."

Lending a helping hand

Given all of these factors, the team decided to set up a free medical camp in the area in the last week of February. The camp was divided in to four portions: one each for women, men and children; and a section for vaccination. A total of 942 patients were registered at the camp: 400 of them received treatment for skin conditions; 340 were children; and 202 were general patients. Among the adults who received treatment at the camp were 289 men and 308 women.

The monitoring officer of the camp, Mariam Khan, was shocked to find that more than 70 per cent of the patients at the camp tested positive for Hepatitis.

Medicines and a team of expert doctors were provided by Hyderabad’s executive district officer (EDO) for health. Medicines for scabies were provided by the medical superintendent of the Civil Hospital Hyderabad. Vaccinations of Hepatitis were provided by the programme manager of the Hepatitis Prevention and Control Programme, which is part of the Sindh Chief Minister’s Initiative for Hyderabad.

"We received a total of 700 one-millilitre Hepatitis-B vaccines for adults; 600 vials of 0.5-millilitre vaccines of children; 1,000 auto-destructive 2cc syringes; 600 auto-destructive 0.5cc Syringes; and three HBV ICT Kits (each kit with 40 tests)," Murtaza said. "Our objective was to vaccinate 1,500 adults and child. I’d say we achieved our target. The manager of the Sindh government’s Hepatitis Prevention and Control Programme also visited out camp and said that he was very satisfied with the work. He promised us tat his department will provide the next two dosages of hepatitis vaccines for the community -- these are required to complete the hepatitis course."

Other community welfare organisations also helped: the Young Social Welfare Association provided a vehicle to pick and drop volunteers and doctors to and from their homes; the RDCC provided two doctors for the camp.

Professionals pitch in

Ten medical practitioners -- Dr Om parkash (paediatrician), Dr Kamran Shaikh (general physician), Dr Muhammad Aslam Memon (skin specialist), Dr Sayed Azhar Shah, Dr Muhammad Sharif (general physician), Dr Ashfaque Mirjut (cardiologist), Mohab Ali (vaccinator), Masood Ali (vaccinator), Bhagwan Das (dispenser), Amtul Rahim Shaikh (lady health worker) -- provided their services for free at the camp, which was set up at the Mother Child Health Care Centre in Mori Manger village.

The electricity supply situation in the country has deteriorated rapidly over the past two decades; and the 12- to 16-hour-long power load-shedding, particularly in the rural areas, has paralysed the lives of the poor. This crisis, however, can be mitigated to a large extent by the efficient utilisation of alternate options, such as wind and solar energy-generation, especially in Sindh, which is rich in terms of biodiversity as well as natural resources.

To this end, the Gharo Wind Corridor was identified recently in district Thatta, and contracts have been awarded to some private companies to install wind turbines throughout the corridor to generate electricity. Five 1.6-Megawatt (MW) turbines have already been installed in the area by a Turkish company, and are functioning well.

The power of the sun

The option of power-generation through solar energy is also available throughout Sindh, particularly in sunlight-rich district. The World Wide Fund for Nature (WWF-Pak) decided, therefore, to test village electrification through solar units in all four sites that fall under its Indus for All Programme. These include Keti Bunder, Keenjhar Lake, Pai Forest and the Chotiyari Reservior of districts Thatta, Shaheed Benzirabad (formerly Nawabshah) and Sanghar.

The model was initially piloted with support from the Pakistan Council for Renewal Energy and Technology (PCRET), and solar energy was provided to mosques and schools in these areas. The model proved to be extremely successful, with mosque units getting a 400-Watt (W) output (to run a loud speaker, two bracket fans, and three energy-saver bulbs), while schools units received electricity for two bracket fans and six energy-saver bulbs.

Eight-year-old Aliya, who is enrolled at a school in village Jakhro, was all smiles too. "It used to be hard to attend classes, particularly during the summer season because of the heat. Now, however, we have bracket fans in our classroom; we have a good environment for learning," she maintained.

Forty-five-year-old Abdul Ghafoor, the Peshimam of a mosque in village Daulatpur of Keenjhar Lake, has other reasons to love solar power. "It was previously difficult to offer Fajr and Isha prayers because of the lack of proper lighting. With the installation of the solar unit, however, these problems have been solved," he said. "We can even here the Azaan through the loudspeaker now, and more people come to the mosque to offer prayers."

Saving money in the long run

I visited a few other villages, such as Khipri, Karo Dhandhail, Umar Manchari, and Lal Bux Manchari where centralised and household solar units have been provided by the WWF under its Indus for All Programme.

Fifty-five-year-old Khadijat, a resident of village Lal Bux Manchari, said that before a solar unit was installed in her house, the family used "kerosene light." Not only was this a health hazard, the emitted smoke was also blackening the walls of all their rooms. "Also, we were spending Rs2,500 to Rs3,000 per month for kerosene and diesel. Now we have clean and green energy in our house," she said joyously.

She added that after the installation of the solar unit, the family is able to repair fishing nets in the night; cooking after-hours is also much easier now, as is praying, she said.

Lal Mohammed Manchari, a 60-year-old resident of the same village, said that with a solar electricity unit, his family is able to save Rs3,000 per month. "We are also able to participate in socio-economic activities at night; we switch on our light bulbs from sunset to midnight. During this time, we sort fish species from our daily catch, and the women prepare mats from the locally-available typha reeds. Each mat measures four feet-by-eight feet, takes about three hours to make, and sells at anything between Rs150 and Rs200," he said. "With the help of this solar unit, we are safer from snakebites as well as from thieves. The Aako light is also used for watching over our livestock."

Self-help

The solar units, which has a capacity of 20 watts, and provides electricity for one mobile phone charger, two energy-saver bulbs, and one Aako light, cost more than Rs20,000 plus. They weren’t, however, simply donated to the community. "We participated in installing the units," Lal Mohammed Manchari said. "The community also contributed Rs2,000 as a one-time cost, and are saving Rs100 per month in repair and maintenance charges."

The residents of Lal Bux Manchari village seems extremely happy because most of the households have been provided with electricity now. ‘We are also extremely thankful to our community-based organisation (CBO), the Keenjhar Dost Welfare and Development Organisation, as well as to WWF-Pakistan,’ they said.

Small initiatives of this sort, therefore, can and do bring about positive change for the most deprived segments of society, who live hundreds of kilometres away from grid stations.