This is a post for my mother. Everyone who hears that Real Medicine Foundation is working in Pakistan wonders about the security. All we hear about Pakistan in the media is about the violence and War on Terror. I have to admit, despite being a seasoned traveler, as a blonde American I was a little worried about my trip to Pakistan to visit RMF’s clinic in Balakot, KPK (formerly NWFP), especially when blast went off at a famous Sufi shrine in Lahore a day before my arrival. After two weeks in Pakistan however, I have to say that I’ve been completely safe and have enjoyed a warm reception everywhere I’ve gone.
In Balakot, I was greeted with nothing but hospitality and gratitude. While the kids stared and giggled, the mothers eagerly spoke to me about their problems and thanked me for RMF’s help. No one asked about my nationality or politics – they only cared that I was there to help. Dr. Martina Fuchs also had a similar experience visiting the Balakot clinic last year. On her visit the local leaders organized an unprecedented community meeting, bringing together a variety of stakeholders (who often can’t be in the same room together) from the community to talk about the health care needs of Balakot and the roll of our clinic. A few of the patients I met on my visit to Balakot remembered Martina and enthusiastically asked about her, her family, and sent their best wishes.
This kind of hospitality is not unique. The people of Mansehra and Pakistan as a whole are known for their warmth and care for visitors. It’s only in the past few years, with the encroachment of the Taliban into KPK that this area has gotten a dangerous reputation.
Today I had the privilege of visiting RMF’s Clinic in Talhatta, Balakot, KPK (formerly NWFP). I have to admit I didn’t quite believe the RMF team when they said that we’re the only health care provider in Balakot, the valley worst hit by the 2005 earthquake and with a population of over 120,000 people. While I had no doubt that RMF must be doing amazing work in Balakot, I assumed there had to be other NGOs providing health care. Hadn’t the whole world run up to the mountains of NWFP after the earthquake? Doesn’t USAID give billions to Pakistan? I was incredulous.
Today I got the chance to not only see for myself the amazing work we’re doing, but also see for myself that we are the only ones providing health care. Driving through the valley, the roadside is littered with placards announcing the donation of every NGO and government under the sun but five years later everyone has pulled out. There is one small government hospital, a beautiful brand new facility which is tragically underutilized: the x-ray room and laboratory remained locked, the doctors too busy in their private practices, and OPD hours shortened.
One of the most touching events of my life happened today at the RMF Nutrition Rehabilitation Center at Jeevan Jyoti Hospital. The mother of one of our patients decided to name her new baby, Jyoti, after our NRC.
Neha came in 18 days ago as one of the most serious cases we had seen yet at the NRC. Neha, two years old, weighed just 4 kgs, had a blistering fungal infection, a fever, and lymph nodes which suggested TB. She was immediately admitted to a private room to avoid possibly spreading her infection to other patients and was started right away on therapeutic milk, an antibiotic, and anti-fungal medication.
At admission, Neha’s mother, Hakari, told us that she was about 7 months pregnant, but wasn’t exactly sure because she never had a pre-natal exam. We scheduled one for her the next day and then settled the patients and their families down for the night. We were in for quite the surprise! That first night Hakari started having contractions while Premlata, our staff nurse, was giving the children one of their 2 hourly nightly feeds. At 5am, our first NRC baby was born (upstairs in the delivery room)! A healthy baby girl weighing 2.9 kg!
“Creating linkages” is ones of the favorite buzzwords amongst NGOs. Linkages are referred to at big conferences and in widely distributed concept papers. A concept that seems quite simple – connecting people to the resources they need from across programs and sectors – has become a development field in itself with its own set of experts, grants, and conferences.
At RMF we don’t write proposals about linkages, start separate programs to promote them, or hire new staff specializing in linkages – they just happen in RMF’s programs because of our incredibly resourceful staff who focus on the person as a whole. While our HIV/AIDS and malnutrition programs are primarily health focused, we do everything we can to link our patients and the families we meet to other resources available to help them where we can’t. Part of the definition of RMF is that our programs do not exist in silos.
Two weeks into our NRC and our programs are already complimenting each other. Our CNEs, the field staff of our malnutrition program, are bringing in children from their villages to the NRC and spending all their non-field time in the NRC, hanging out with the mothers and giving one on one counseling. One of the children we admitted in the NRC was brought in by one of our HIV counselors, an HIV+ malnourished child. This child is doing well with the therapeutic nutrition we’re offering but will require much more extensive follow-up than the non HIV positive children. Our nutrition staff will train our HIV counselor on how to work with the family to ensure that this child gets proper nutrition and will also make home visits to follow-up.
Two weeks ago the children we admitted we listless and dull-eyed. Many were so dehydrated that when they cried there were no tears; the children were often too weak to make much noise at all. Now as I write this I’m sitting in the middle of recovery – and its very loud. After two weeks of therapeutic milk, micro-nutrients, and medicines, the children have gained weight and found new energy. Two year old’s who have never walked are teetering on the edge of chairs, about to take off. Toys no one touched are now being fought over. They have the energy to fight! And to cry! It’s absolutely magical to see how two weeks of good medicine and therapy can transform a child – it’s brought their spirit back. The energy of this chaotic room is tangible. So tangible that I have quite the headache.
The mothers too are now at ease and starting to enjoy this process. These women who have so much housework at home on their farms and with their multiple children now have the time to sit and bond and play with their children and get to know other mothers. They’re all hanging out in our breezy, cheerful recreation room, spending time together while the kids play, and taking turns learning how to cook nutritious meals for each other. They’re asking questions, getting more and more involved in group discussions and jumping in to counsel the parents of new patients about the importance of staying at the NRC for the full course of treatment.
by Caitlin McQuilling, Director, South Asia
It has recently been estimated that there are approximately 2.8 million female sex workers in India, an estimated 36% of whom are under the age of 18. These women are some of the most vulnerable in India to HIV/AIDS and STIs and some of the most underserved, especially in rural areas where their networks are more difficult to target and their access to health services most limited.
Real Medicine Foundation is proud to announce that we’ve tied up with UNFPA and our local partner Jeevan Jyoti Health Service Society to provide access to HIV/AIDS, STI, and basic women’s health services for some of the most vulnerable female sex workers in the country. Our goal is to provide these women with the knowledge and tools to prevent HIV/AIDS and STIs and also to provide and facilitate access to counseling, testing and treatment when required.
We will be working in two districts, Jhabua and Nimach in Western Madhya Pradesh where we are targeting two very different communities, the Banchhara tribal community in Nimach where sex work has been an accepted community tradition for generations, and the tribal communities in Jhabua, where female sex workers have mobile networks of regular clients. While both communities are located in “low prevalence” areas, they are extremely vulnerable to HIV, the Banchhara because of their location on one of the most congested trucking routes in the country, the Bhils because of high levels of migration in their area, and both because of their low literacy rates and scarcity of health services.
Setu and Matt in Bhil Academy's Health Center
Matt Oerti and Tyler Cherin just graduated from Harvard Medical School and are bracing for their next big step, beginning their residencies, moving to new cities, and giving up sleep (which they already sorely miss). While many of their classmates decided to take this time between the pressures of med school and the hectic life of residency for well-deserved rest and relaxation, Tyler and Matt flew across the world to return to the sweltering heat of Jhabua, a rural town in Madhya Pradesh, India, to help RMF for a month.
At the same time, Setu Patel, an American Physicians Assistant, decided to also generously donate her vacation time while visiting family in India, to come to Jhabua and lend a much needed hand.
Today Michael and I joined our team of Community Nutrition Educators in Barwani district in the field to see how their work is going. We set out to Dekhaliya village in the Parti Block of Barwani district, considered one of the most remote blocks in all of India. After leaving the paved road behind and travelling across a pitted tractor path, our jeep could not continue any further, leaving us on the banks of a bridgeless, dry riverbed. With no other choice, the entire team took off on foot up craggy hills and across streams. We battled blinding sandstorms and 118 degree heat, without a complaint from our bubbly, enthusiastic staff. We spent the day watching how each worker approaches a household, measuring each child using a MUAC tape (measurement of mid-upper arm circumference), and counsels the family on good nutrition and overall child health. We continue to be immensely impressed by the staff, not only for their great communication skills and ability to connect with the families of malnourished children, but also for their willingness to endure these extreme conditions and terrain.
A few pictures from our day:
Its as hot as it looks
As our teams have finished their baseline surveys and are now moving on to the intervention stage of our childhood malnutrition program, we’re excited to already be seeing successes. A few days ago I went out with one of our community nutrition educators, Priyanka, from Alirajpur, to see how the team is doing with their trainings and individual household counseling sessions.
Priyanka, one of RMF's Community Nutrition Educators, Kashish, and Ranu
Priyanka and I visited Chota Undava village which Priyanka had already visited twice, once during the baseline and once to follow-up with malnourished patients she identified. We entered the village and Priyanka knew exactly which households to go to where children with moderate or severe acute malnutrition lived. The first house we stopped at was the home of Kasish and Kishore, who’s youngest child Ranu, 1 ½, Priyanka had identified as severely malnourished one month ago. Ranu measured a 110mm around her mid-upper arm (MUAC), and while Priyanka spent hours trying to convince the family to go to the Nutrition Rehabilitation Center, the family refused to go because of their 4 other children at home and work commitments. Priyanka counseled this family extensively on the effects of malnutrition and ways in which they could improve their child’s health at home, including improved breastfeeding, regular supplemental feeding using locally available nutritious foods, and improved sanitation and hygiene. She coordinated with the local anganwadi worker (village health worker) to follow up with the family every day in between her visits to check up on the family and make sure the child was receiving adequate nutrition and didn’t develop any complications. On our visit 4 weeks later, Ranu had improved from a 110 to 113 mm. Modest weight gain, but proof that Ranu is on track towards weight gain and that the family is putting into practice the tips we’ve given them to ensure that all their children are healthy and happy.
We visited three more houses in this small village where children had had significant weight gain over the past month. At Sursingh and Shada’s home, Asha, had improved from 115 (the borderline of severe to moderate malnutrition) to 125 (the borderline from moderate to normal). Sushila and Raman’s daughter Saraswati had improved from moderate to normal and Gudu’s son Ravi improved from severe to moderate.