AAI ACTIVITIES PER PROGRAM AREA:
1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES
AAI facilitated the delivery of government stock of essential medications to the First Aid Post at Chireekot.
In direct collaboration with the DHO in Bagh, AAI facilitated the transport and delivery of over 200 hygiene kits to the BHU Gugdar. These kits will be distributed by Lady Health Workers to pregnant women and families of newborn babies.
AAI distributed and constructed winterized tents from IOM/WHO to the following health facilities in Haveli Tehsil: Chireekot.
While AAI attempted the delivery of another winterized tent to Naga Nari, due to snow and road conditions, this was unsuccessful. Naga Nari will most likely remain unreachable until the spring season prevails.
AAI also attempted delivery of a winterized tent to Bhatakot, however due to snow and road condition, this was unsuccessful.
AAI will re-attempt delivery of both remaining winterized tents for the above facilities when weather conditions improve in the coming weeks.
AAI medical teams have visited the following health facilities in Haveli Tehsil providing direct bedside supervision, teaching in clinical practice, and direct support to health care providers:
- Gugdar
- Hallan Shamali
- Khursidabad
- Pallagi
- Soli
- Tungari
Access to certain health facilities has been limited secondary to weather and road conditions.
AAI teams have developed educational materials in areas identified by needs assessments of health care facilities. These include: hypertension, diabetes, universal precautions, and sterile technique for injection. AAI are distributing these materials to all health facilities visited and to all levels of health care worker.
AAI team members are currently investigating breastfeeding and weaning-food practices from all mothers who present to health facilities.
AAI medical teams distributed all currently available AAI inventories of medical supplies to the health facilities listed above, in addition to THQ Kahuta and MST hospital facilities. While the current supplies are limited, AAI hopes to provide whatever medications possible during these winter months.
2. DISEASE SURVEILLANCE/EDUCATION & TRAINING
AAI successfully held a training program in Surveillance and Reporting of WHO Notifiable Diseases. Sixteen participants were trained, including THQ Kahuta Doctor, THQ Kahuta Lady Health Visitors, THQ Kahuta Lady Dispensers, THQ Kahuta Nurses, and Lady Health Visitors from Gugdar and Soli.
- This program was very well received by all levels of health care providers.
- This training will be repeated for Dispensers of health facilities, Lady Health Worker Supervisors, and all Lady Health Workers in the Haveli Tehsil area.
- One of the primary objectives of this training is to reinforce disease definitions and improve surveillance reporting. LHW's are not primarily diagnosing patients' conditions, however as they are the key links to communities, their education and referral abilities are absolutely essential.
- Participants completed evaluations which identified and reinforced topics for further educational programs.
AAI analysed data on the Priority Diseases Identified for Haveli Tehsil Facilities in December 2005. Click here.
- While scabies appears to be less prevalent compared to November 2005 statistics, ARI continues to dominate as a major etiology of morbidity.
- The rise in percentage of cases of Fever raises concern regarding the usage of the actual clinical case definition. AAI teams hope to further investigate this finding. In addition, AAI has made refresher training in case definitions a priority for teaching clinical practice guidelines.
- Diarrhea and dysentery continue as major causes of morbidity as well.
AAI has been collecting WHO surveillance data from the THQ Hospital in Kahuta, with many thanks to Dr. Majeed. No significant outbreak has been reported. ARI, diarrhea, and scabies still account for majority of notifiable cases treated at this facility.
Click here to see Appendix 1: WHO Surveillance data from THQ Hospital , Kahuta, Nov/Dec 2005.
3. COMMUNITY HEALTH
AAI has partnered with the Cuban Hospital to distribute Community Health education materials through health facilities as well as schools. Topics include personal hygiene, sanitation, pregnant women, safe water, and EPI vaccinations.
AAI has completed the design, translation, and distribution of community education materials on hypothermia, scabies, and frostbite. These will be distributed through the Shelter and Health Programs, through DHO facilities, through DHO health facility staff as well as given to the WHO and UNICEF to share with other agencies.
AAI has been distributing community and primary health provider information on Acute Respiratory Infection and Winter- and weather-related conditions. AAI thanks both WHO and Colonel Habib, Pakistan Military Hospital Bagh, very much for the provision of these excellent educational materials.
AAI has developed and will begin implementation of a school hygiene education program, targeting the following schools in the Kahuta area: government girls' school (1), government boys' school (1), government girls' college (1), government boys' college (1), and private co-ed primary schools (4). This program will include didactic teaching as well a contest in the creation of artistic posters to be used as further teaching tools.
Neena Rohs , MD MSTPH
Country Medical Director
4. SHELTER PROGRAM
Previous IRAS Situation
In total there have been 411 IRAS Shelter kits distributed in the following locations:
- Kahuta
- Lower Bella
- Lasdana Road
- Malot
- Topi
- Dhare
As of 4 th January 2006, Bagh District underwent a major weather change, with 5-6 ft of snow falling in high areas over night. Bagh town itself experienced 1-2 ft of snow. As a result, all roads out of Bagh were closed, and distribution of all shelter material temporarily ceased.
This rapid and dramatic weather change caused some initial delays in the distribution of shelter kits to our target areas. These delays have presented the AAI shelter team with several issues:
- AAI's limited ability to transport IRAS kits from Islamabad to Bagh.
- AAI's limited ability to distribute IRAS kits from Bagh town to height affected villages (above the snowline).
- As a result of the snow, there was a sudden increase in IRAS demands from other Union Councils (UC's) within Bagh District.
Current IRAS Situation
This reporting period (10 Jan -- 16 Jan 06) has been significantly affected by the Eid celebrations in Pakistan . Most of the key stakeholders in the IRAS program have taken their leave from work or have traveled home to stay with family. This has included:
- logistic staff in Islamabad
- local staff in Bagh,
- UN staff in Bagh,
- Pakistani Military staff in Bagh
- logistic staff in Bagh
All shops and services were shut for at least 3 days from 11 Jan 06 until 13 Jan 06. AAI staff continued to maintain contact with as many stakeholders as were available over this period.
Anecdotally, the Eid period also affected attendance at medical centres and distribution points. Interestingly the high demand for medical attention and pharmaceuticals dropped to almost nothing during the Eid period. Since the conclusion of Eid, the attendance and demand for pharmaceuticals has risen to pre-Eid levels again.
There have also been a number of local issues that affect the capacity of all NGOs in the region to deliver on specific shelter program outcomes. These are:
Village representatives are approaching NGOs and stating that they have not received shelter assistance from any organizations. On further investigation and comparison to the data currently maintained by IOM, ESC (Emergency Shelter Committee) Coordinating Organisation, it has been discovered that a number of these villages are attempting to "double dip" with different NGOs. These have not been isolated incidents and it appears that this trend is on the rise.
Recipients of shelter kits are stockpiling the material in preparation for the Spring thaw. It appears that these individuals are living with relatives in less affected areas during the winter.
Recipients of shelter kits are delaying construction of emergency shelters in anticipation of a second round of distribution. It has been stated that they feel if they construct a shelter, then they may not be eligible for a further round of distribution.
Some areas see the provision of some shelter kits as for permanent use as opposed to the intent of providing recipients with emergency shelter kits. As such, they feel that this may affect their entitlement to Government compensation.
The Pakistani Military are unable to affect a change in this mindset. and have also expressed their frustration at the attitudes they are beginning to face in the region.
There has been a paradigm shift in attitude from one of acceptance of relief material to one of demand. Even at the most basic level AAI staff are witnessing this in our campsite. We frequently are faced by people asking for shelter goods and clothing despite the fact that we have none for local distribution.
This has led the ESC (Emergency Shelter Committee) as well as AAI staff to the conclusion that there is a trend of feigned dependence. This has manifested itself in the attitude of demand and helplessness that is being displayed for the reasons listed above. It has been stated that the only way in which it is possible to effectively ensure construction of emergency shelter will be to finalise the distribution process and withdraw these programs from the region.
Due to all of these factors, full implementation of AAI's shelter program has become extremely difficult. There are some affected areas where IRAS is being constructed as originally intended; however, the majority of cases exemplify attitudes as stated above.
Immediate future of the IRAS Program
AAI staff have had the opportunity to consolidate our information and to plan for the next phase of operations in the district.
Our members are now attending the villages where IRAS has been received, and inspecting already constructed shelters as well as those currently under construction. They also liaise directly with the Pakistani Military to assist their members with the distribution, recording and monitoring processes.
Discussions with the Pakistani Military have identified an immediate need to provide shelter to two major regions around Bagh:
- Topi
- Dhare
AAI have completed initial training in these areas. This has included the construction of demonstration shelters as well as teaching the Pakistani Military in the construction process.
In both Topi and Dhare, AAI has distributed 100 shelter kits. As of this report these 200 kits have been distributed to those most in need of emergency shelter. AAI discussions with the Pakistani Military have led to the immediate planned distribution of 500 to the Topi area and a further 200 to the Dhare area.
AAI staff will be attending both of these areas and ensuring that our construction standards remain high. They will ensure that the distribution information is being recorded correctly, and that those families most in need receive shelter kits as a priority.
To assist in the recording process, AAI staff will be conducting an inspection program over the next two weeks. With a focus on each area, AAI aims to obtain documentary and photographic confirmation of our distribution and construction information.
Distribution Plan
Whilst difficult, the distribution of IRAS to both Topi and Dhare will be accomplished rapidly, weather permitting.
An initial 200 shelters will be delivered directly to the base camp of the Topi Military. They will be splitting this between two affected sites in the vicinity of Topi.
An additional 300 shelters, which are designated for the same area will be delivered directly to the town of Bagh . This will be handed over to 27 SIND , local Pakistani Military, who have been highly motivated in the distribution and construction process within their areas of responsibility.
After this, an additional 200 will be brought to the district. AAI discussions with the Pakistani Military in the coming weeks will focus on the most efficient means of transporting the material to those in need.
It is anticipated that the distribution and construction of the IRAS shelters will be almost complete by the end of January 2006.
As stated earlier, the weather presents an impediment to this process. This has been factored into our planning process. Even with significant delays caused by snow and ice, AAI will be well placed to have the shelters distributed and under construction during the month of January.
Summary
AAI are currently conducting training, distribution, construction and monitoring of IRAS throughout the Bagh District. We have finalised the distribution plan for the remaining IRAS material.
This enables the AAI Shelter Team to focus on the ongoing monitoring of IRAS construction throughout the area.
James Judge
Emergency Shelter Program Coordinator