The existing field team shift from Lasdana
to a house we are leasing in Forward Kahuta, 38kms southeast of Bagh (as
the crow flies) and approximately 6kms from the Line of Control.
PERSONNEL
The last two weeks has seen significant movement in the personnel department. Tuesday also saw the arrival of the Site Manager, John Weils and Community Liaison Officer, Corie Waddell to the already talented team operating in the field (Forward Kahuta Office).
We said goodbye to Dr Bryan Chaffee on Saturday 10 th December followed closely by Dr Jamin Mulvey on Monday the 12 th December. Both were instrumental in providing expertise and commitment to the cause. They provided the much needed data/statistics in relation to each of the clinics so that Sasha Poll and Dr Neena Rohs can continue developing and now implementing their medical program. See Dr Jamin's medical update below.
We were joined in the field by Dr Neena Rohs and Owen Wolahan, our Information Officer, on Wednesday 14 th Dec and look forward to Bill Rohs, Site Manager, joining the field team today. Bill's arrival is the last of the permanent crew who will spend the next 6 months implementing the numerous initiatives started by the immediate response team.
Wednesday 21 st December will see four team members return home. Gordon, Marcus, David and Corie will complete their volunteering tenure with the hope of assisting in some capacity, with AAI, in the future.
SITUATION UPDATE
COMMUNITY LIAISON:
Corie Waddell
After a recent misunderstanding with the military based in Bagh, about the route taken from Islamabad to Kahuta on Tuesday 6 th December, we relied on the relationship building and expertise of the existing team with the locally based military here in Forward Kahuta.
In an attempt to cut traveling time between Islamabad and Kahuta, we took the road east of Islamabad to Rawalkot via Mandi. This section is closed to foreigners due to security concerns. It became increasingly apparent for the need for AAI, and all NGO's, to work with the military police effectively as their main priority is to protect all foreigners working/volunteering in this region.
As a result, we need to check in with the military on a daily basis to inform them of our movements so they can assess whether or not we require an escort or provide us with important information. The Shelter Boys have built firm relationships with the military, in order to promote the IRAS Design as the ideal shelter program to see the local community through the coming winter. They are currently gathering information on the families in most need in the immediate area. See below for a more detailed update on the IRAS program.
The urgency of getting these shelters built is increasing daily as we are expecting more snow in some of the higher regions within the week. The past week here in Kahuta has already exhibited a shift to the lower end of the thermometer. Despite some sunny days, the nights are cold.
Yesterday saw our first altercation with ice while leaving the village of Mirchkot . Albeit small, it was a good indication of what is to come and a timely reminder to ensure all vehicles are fitted out with the necessary equipment to combat icy conditions on the roads.
While the transition phases are winding up with many volunteers having to return home, transferring all the knowledge including contacts and statistics is in full swing. The office in Kahuta will be receiving some much needed equipment and supplies in the form of desks, couches, heaters and IT equipment as well as alternative means of communications as currently we only have satellite services. We are also investigating the possibility of setting up an office in Bagh to facilitate the need to attend meetings and liaise with partners more efficiently. Currently, it takes three hours, one way, to commute from Forward Kahuta and Bagh meaning we are often driving at night and with the weather deteriorating, this will become extremely difficult if not at times, impossible.
We are starting to hear some unfortunate stories from around the area. A tent fire on the hill above Kahuta on Saturday night claimed the life of one child while the mother and two other children are in hospital in Rawalpindi with serious burns. This may become more prevalent as locals desperately try to keep warm and may be oblivious to the hazards of living in tents.
Other news is that the Cubans are in town. They have set up a tent hospital adjacent to the crumbled THQ (Tehsil Headquarters-which is equivalent to a sub district hospital). This tent hospital will consist of a surgical theatre and xray and ultrasound facilities. It is expected they will be fully operational to inpatients late next week and are currently providing assistance to outpatients at a very macro level. This will be incredibly beneficial to the many cases whereby patients who received pre-liminary treatment, were asked to return in a week or two but did not, only to return at a later date with additional ailments as a result of not following instructions or contracting new infections.
Adding Spanish to the flavour of languages and/or accents currently in Forward Kahuta, they are said to have two English speaking team members of a total of 70 staff. After some impromptu discussions with them yesterday, there are at least five members who can have varying degrees of English comprehension which should make communication with them relatively easy once key contacts are established.
We look forward to developing a very strong relationship with the Cuban Tent Hospital as they will relieve some of the pressure we are receiving to actually treat people and enable us to re-direct our efforts back into our training program for long term sustainability. We will continue to stock each clinic with the necessary supplies however, having a point of contact for referrals and medivac assistance/support is fantastic for us.
Much of my week has been spent accompanying both the doctors and the shelter boys on route to some of the villages for assessments. An eye-opening experience personally and affirmation to the extraordinary team working hard to meet both the immediate need for shelters and emphasis on the long term sustainability of our medical program in an attempt to decrease the current level of dependency on NGO's.
A recent interview conducted for Incommunicado with 19 year old Thir (Ta-er) Riz from the village of Nakr , just above Palangi, brought understanding of the devastation of the earthquake to a new level. Hearing a personal account of what it was like during the actual earthquake was intense and hearing about the recurring nightmares many of the villagers are experiencing is heartbreaking. Thir watched a wall of his classroom fall on four of his friends. Only one of them survived. A short exerpt of the interview is below:
Crying earthquake is coming, to his father, and horribles, dead body, dead body, very horribles...
Our roof is very telling. I have 3 friends. I stand near the wall. I am standing at this point, friends are standing over at wall, I say come here, come here but they do not come, wall falls on his friends. wall falls on me. Please somebody give me help.
Thursday also saw us evacuate a 12 year old girl from Mirchkot with suspected hepatitis. Sasha and I came across this little girl (Tasleem Nakir) after our visit to the dispensary in Mirchkot on Tuesday. On arrival yesterday, she was walking and had taken both fluid and solids since our last visit. While still very fragile, her condition had improved. We took her directly to the Cuban Hospital with the intent to get some blood tests and confirm our initial diagnosis as well as admit her. They were unable to admit her as their inpatient service was not ready. We tried the THQ but that too proved fruitless. We then relied on contacts made with Major Anjum at MST (Mobile Surgical Team) who, while predominantly a surgical hospital, set us up with their medical consultant, who graciously accepted to see her. Her prognosis was better than expected, she received some new treatment and we were able to take her home again. Should time permit, we will endeavor to visit her again in a week or two and see if she has improved. If not, then the Cuban Hospital will be operational and be able to run the lab tests we were initially hoping to do yesterday.
Some other projects in the pipeline include collating GPS coordinates, primarily of the medical clinics, in order to produce a detailed map of the region (cluster) AAI is covering. The objective is to illustrate some key detail that will enable the medical team to plan their visits to the clinics from both a time and locality point of view. We will also attempt to provide as much geographical detail as possible to provide safe and/or alternative routes should the snow prevent access on familiar roads. This information will be additional to the data collected and maps produced during the immediate response phase.
I plan to continue assisting the medical team and the IRAS's if applicable in the form of training documentation and modules to support the training they will be providing to the dispensar's. It will involve translating simple instruction sheets into Urdu. Whether it can be done in time to provide assistance to the shelter program is unclear as yet but it will be considered a priority on my return to try and turn it around as soon as possible.
MEDICAL UPDATE:
Dr Jamin Mulvey
The weather has improved this week meaning access to all our clinics within the Haveli sub-district, Kashmir . With the reprieve in weather, AAI, WHO and local organisations have increased supplies of vital medications to major distribution points, allow regional dispensaries to restock before the winter finally closes in. Also associated with the warmer weather, the incidence of acute respiratory illness has stablised for the week, although this too is certain to change. In some ways, this period of warmer weather is the calm before the storm. Shelter provision continues to be pivotal to the wellbeing of the community and many families throughout Kashmir remain without suitable winter accommodation, increasing the likelihood of pneumonia and hypothermia in the weeks to come.
We have visited all clinics this week, reviewing their patient presentations, medical stores and advising them of our education program to be initiated in the coming weeks. As always, medications were accepted with much gratitude, particularly paediatric paracetomol, paediatric antibiotics and scabies treatment, all of which are constantly in low supply within the Kashmir region. Earthquake-related injuries have mostly been diagnosed and treated, and most illnesses are back to pre-quake levels. The AAI team this week saw a variety of patients, including numerous lacerations and one elderly diabetic male with a dense hemiparesis (stroke) requiring urgent referral and treatment. The AAI health program continues to give much needed support to the local people and improving medical care.
I have had the opportunity to work closely with the Military Hospital in Kahuta, analysing data from the initial earthquake and the use of ketamine in emergency field surgery for 150 patients. Major Anjum (anaesthetist) and myself are closely reviewing this information, with the aim to publish results in the near future. This week I will be working with the understaffed surgical team at the Military hospital, assisting in major cases. This collaboration strengthens AAI's commitment to the Kashmir region and improves our relationship with the military hospital and local health providers.
Sasha Poll, our most recent addition and Medical Coordinator, is closely liaising with the local District Health Officer both in our region, in Bagh, and in Islamabad . Here for up to six months, Sasha is developing and instituting an Education program for the local medics and lady health workers. As medicines and disease treatment has changed somewhat, and many workers have not had further education for up to 25 years, this training and education program aims to improve health care provision and allow for sustainability after AAI leaves the Kashmir region. The aim of this program has been discussed with local health staff and authorities and they are eager to participate. The curriculum is currently being discussed with the Pakistani Government District Health Office.
With the Department of Foreign International Development (DFID) funding being approved this week, our medical program stepped up a notch and is full steam ahead. AAI continues to fully assess, support and work with the local health care providers in difficult circumstances, leaving its mark of world standard health care in Kashmir .
IRAS PROGRAM:
A very slow week in terms of the construction of IRAS's in and around the Bagh area. Initial complications with securing funding for the equipment then lead to hold-ups at the border for items such as CGI sheeting for the roof of the IRAS. However, a great deal of work has been spent developing mutually beneficial working relationships with the military in Kahuta to identify the areas and families most in need. We now have a list of around 25 families to add to our register in the Forward Kahuta region and we will endeavor to focus on building these IRAS as soon as possible. As of Friday 16 th December, we completed our first IRAS in partnership with the military in the tiny village of Kalsan , above Forward Kahuta. Gordon was instrumental in making this happen with assistance from contacts he made through the military, primarily with Major Shakeel. Knowing how to play cricket is a distinct advantage. Marcus is currently coordinating the construction of IRAS's in the area known as 27 Sindh, just west of Bagh and David is currently working in Rawalkot/Bakaram with the same intent. We look forward to an update in both these regions next week.
These areas have been identified as key areas for some time, however, the distribution of materials has been the main challenge, monitoring the distribution extremely difficult and maintaining timeframes virtually impossible. We are in discussion with partners such as the UN (logistics), IOM and the military on a regular basis to shift these materials where they are most needed.
The longer the distribution issue exists, the more difficult it will become to implement the IRAS initiative as we are currently going through a transition whereby our enthusiastic shelter boys will be leaving us in the next week. Our priority now is to train and/or instruct as many masons, military personnel and locals on how to construct the IRAS so we can step back and take on a more supervisory and/or guidance role.
This issue has also made negotiations with our partners a little tedious at times and we have learnt not to promise anything. However, the shelter boys have continued to reassure their relevant contacts of our commitment to the IRAS program and the completion of the IRAS at Kalsan has come at a very opportune time.
As of today, there is movement in the wings and delivery of supplies is imminent.
Morale or motivation amongst the locals in engaging in the construction of their IRAS is not as prominent an issue as previously. Of the few IRAS we have constructed in the last week, the locals have been very keen to assist and are extremely appreciative of our assistance. It will be important to continue exhibiting the necessary influencing skills to continue momentum. This will become easier as they begin to understand the benefits of the IRAS design and how it will see them through the impending winter.
It is incredibly rewarding to see an IRAS completed with acknowledgement of the recipient and their family. This alone will make phase two of this initiative a very exciting one to watch unfold.