December 22, 2005
In Bagh and Mansehra, Doctors Without Borders/Médecins Sans Frontières ( MSF)
supports district hospitalsdisrupted by the earthquake. Two MSF field hospitals focus on surgery, emergencies and intensive care, enabling other departments of the district hospitals (such as pediatrics and maternity) to start functioning again.
MSF teams are providing primary health care in areas where Pakistani health facilities were severely damaged, and are following up on the situation in tented settlements where survivors have gathered. MSF teams carry out an average of one thousand consultations every day in
10 permanent sites. The teams are discovering that poor living conditions—rather than the earthquake itself—are causing increasing numbers of pathologies.
To avoid possible outbreaks of disease, MSF is vaccinating children against measles and polio, and the wounded against tetanus. The organization also continues to provide
mental health supportto traumatized victims.
MSF is also improving hygiene conditions in settlements housing internally displaced people (IDP), and the water supply in several additional locations.
Distribution of relief goods (non-food items):
MSF has now completed the distribution of
construction kits—including iron sheets, plastic sheeting and construction tools (see sidebar)—and
blanketsto earthquake survivors in remote areas of Pakistan-administered Kashmir and in the country's North West Frontier Province. Relief items such as
cooking kits(16,563) and
hygiene kits(42,576) have also been distributed. Distributions will continue over the coming weeks in order to ensure that families have adequate shelter through winter.
Staff and material:
international staff, including doctors, nurses, surgeons, psychologists, social workers, logisticians, and water-and-sanitation experts, are working together with over
450 local staffin MSF's earthquake relief operations in Pakistan.
The organization has already brought more than
1,115 tons of relief goodsinto Pakistan including medical items (emergency medical kits, drugs, surgical material, dressings, plaster, dialysis machines, high-protein food, oral rehydration solution etc.), logistical material (especially water and sanitation material such as tanks, pumps and water treatment units) and shelter (tents, blankets and sleeping mats). Additional relief items, such as hygiene, cooking, and construction kits, are being purchased locally.
DETAILS OF THE OPERATIONS IN PAKISTAN
Bagh district (452,531 inhabitants):
Bagh town,MSF has set up a tented medical facility outside the compound of the collapsed district hospital. MSF's structure, made of 25 tents, includes an operating room, laboratory, delivery room, intensive care unit, emergency room, and an approximately 40-bed inpatient department. MSF's primary activity in the hospital is inpatient nursing care; a nurse-led triage system has been set up to accelerate patient processing and to save time for doctors. MSF has agreed with Pakistan's Ministry of Health to set up as soon as possible a more permanent 60-bed capacity hospital, made up of containers.
Health centers are working well, and are receiving fewer cases of
skin infectionsthanks to efficient interventions.
Permanent outpatient facilities are operating in
Bagh town, Bir Pani, Mallot Chikhar and Bheidi.Between 100 and 200 consultations are carried out every day in each of these locations. In Chikar and Mallot, MSF medical teams are conducting outreach work to improve access to medical care for these isolated communities.
Muzaffarabad district (894, 364 inhabitants):
MSF has set up permanent outpatient facilities for consultations, vaccinations and referrals in the villages of
Saidpur, Hattian, Lamnian,and
Chakmukam(near Leepa). Teams travel to the surrounding settlements by foot or by car
.In each of these locations, 50 to 150 consultations are carried out every day.
Mobile clinic are now operating in
Timi Bhana,and a permanent clinic is operating in one of the IDP sites of
Muzaffarabad town; a mobile team follows up the situation in other settlements of the city. A pediatric ward has been opened in Hattian, and a permanent clinic is functioning in one of the IDP settlements of the locality. A mobile medical team also performs outreach activities by car in the environs of Muzaffarabad. Rapid transport in Muzaffarabad district is facilitated by the use of two MSF helicopters.
The MSF team in Mansehra continues to provide care for patients injured by the earthquake. Many were operated upon in poor conditions with little or no post-operative care, leading to infections and requiring additional surgery. Of these patients, 80 are currently hospitalized in the MSF field hospital set up over one month ago for trauma patients. MSF is also identifying patients residing in camps around Mansehra, Balakot, Atar Sheesha, and Gari Habibullah, in order to transfer those requiring further care. Teams are also distributing relief items to the displaced population.
Medical villageshave been created in Mansehra town to discharge patients no longer in need of hospitalization but who still require regular follow up.
Field hospital set up for surgery, emergencies and in-patient facilities
The field hospital, composed of
nine inflatable tents,serves as the main orthopedic referral center for the wounded in Mansehra district. The hospital houses four operating rooms, an intensive care unit, and an emergency room. There are also five wards with a 120-bed capacity.
The MSF surgical team, together with Pakistani hospital staff, carries out an average of 14 interventions per day, 70% of them related to earthquake-associated wounds. Between November 24 and December10, 251 surgical interventions were conducted on earthquake survivors, of which 159 were major orthopedic operations.
The teams are also working in the new intensive care unit and the emergency room. An MSF physiotherapist, together with a team of Pakistani volunteers, carries out rehabilitative care for post-operative patients. A total of 750 patients are currently receiving physiotherapy treatment in the hospital and medical villages. An MSF psychologist team carries out support for traumatized earthquake victims.
Additionally, a temporary outpatient department for the district hospital has been established, as well as a laundry room. MSF has also begun restoring the x-ray room and the internal medical wards of the district hospital. Patients are now being admitted into the gynecological-obstetric wards and the pediatric ward of the district hospital. These wards had not been functional since the earthquake as a result of overcrowding by wounded patients.
Medical villages to discharge patients
In association with local organizations, MSF has begun installing medical villages in Mansehra town, each with the capacity to accommodate
25 families. Patients from Mansehra hospital no longer requiring hospitalization, but who cannot yet return home, are transferred to the villages. MSF provides the tents, water and sanitation equipment, as well as blankets, hygiene kits and cooking sets. Patients who decide to return home are provided with relief kits consisting of tents, blankets, cooking sets, and hygiene sets. An MSF physiotherapist, psychologist, and doctor conduct follow-up consultations with patients.
Transfer of patients and distribution of relief items in makeshift camps
Approximately 100,000 people who have lost their homes and have traveled down from mountainous areas are settled in hundreds of camps around Mansehra, Balakot , Atar Sheesha and Gary Habibulah. The camps, with varying living conditions, range in size from 25 to 5,000 people. MSF is distributing relief items based on identified need. As of December 26, kerosene heaters will be distributed to 12,000 families to help them cope during the winter months. Patients in need of specialized orthopedic care are being transferred to the MSF hospital in Mansehra. In the past ten days 111 patients have been identified for transfer.
Mental health support:
MSF continues to provide mental health care to hundreds of traumatized victims in
Muzaffarabad, Mansehra and Baghdistricts. The main conditions are psychosomatic symptoms, sleeping problems, body pains due to stress, intrusive sounds and images (from the earthquake), and grief.
Distribution of relief goods:
MSF is currently distributing family tents, plastic sheeting, construction kits, blankets and hygiene and cooking kits to thousands of affected people in
Bagh, Muzaffarabad, Mansehradistricts:
Water and sanitation and hygiene promotion:
MSF's approach combines hygiene promotion with water and sanitation work. Special attention is given to women and children by promoting safe excreta disposal, regular hand washing, and awareness of infectious diseases.
Muzaffarabad, MSF is following up closely on hygiene conditions in several IDP sites. Water bladders have been set up,
900 latrinesinstalled, and hundreds of hygiene kits distributed in ten tented settlements. MSF is also supporting two water-truck points with chlorination capabilities. Additionally, 19 hygiene promoters have been trained and are operating in eleven camps in
Muzaffarabad. So far, they have carried out visits to 2,838 tents, reaching 13,400 individuals. Activities include a "cleanliness drive," with prizes for children who collect garbage, and bucket distributions for poor flush latrines.
In Hattian, MSF ensures water supply to the hospital and performs water and sanitation activities for the town. MSF has also set up water supply and sanitation facilities for Bagh and Mansehra district hospitals.
Several water supply ramps have been installed in
Bagh townand water and sanitation facilities have been established in the town's IDP sites and in many villages and camps around
Bir Pani, and
Chikar. MSF is also supervising operations in those localities to repair water supply systems. MSF has installed more than 380 latrines for an estimated population of 12,000.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)