The village of Rawal Kandra has had no medical care since the flood hit in September 2010. The village is in a state of disrepair and there are clear signs of where the water had inundated the village. In light of the hardship, the village has a strong community spirit with traditional values that will enable standards to improve over time. The power is in the process of being re-established. At present, wash areas for women are being built and further reconstruction is being undertaken.
On arrival to the village there was an overwhelming sense of willingness from the community to enable the AAI team to commence clinic in an appropriate manner so that the women and children could be seen as well as the men. Due to the community's lack of previous healthcare, it was apparent that many of the presenting health issues would be beyond the scope and resources of the AAI team.
The complexity of medical presentations was evident when a mother brought her baby to the clinic with severe malnutrition and several other medical problems. The mother was unable to take the child to hospital as her husband was working in the fields and she required his permission to take the baby to hospital. The AAI team will conduct further clinics in the village with the aim to follow up with children such as this one.
During the clinic, a young girl by the name of Naveeda was brought in. Neveeda was only six years of age and was being raised by her grandmother as her mother had past away during childbirth. It was apparent that Naveeda was extremely unwell, she presented with pneumonia as well as a previous brain injury most likely from meningitis that has affected her physical and mental ability from the age of three. Up until the onset of the pneumonia she had been managing to eat soft food but was still severely malnourished. Upon examination, Naveeda was febrile, gasping for air and having clonic seizures. It was apparent that Naveeda required further treatment at a referral hospital. Upon discussion with the family and the AAI team, it was decided to stop clinic and to take Naveeda to the United Arab Emirates (UAE) Field Hospital in Makli. Even though this hospital does not cater for over night stays, it was felt that the initial assessment was vital for continuing care that would be provided at the local hospital.
The initial assessment conducted at the UAE Field Hospital confirmed pneumonia, malaria status was negative and she would need ongoing care for sometime. Treatment commenced at the field hospital, an intravenous line was inserted and intravenous antibiotics as well as a nebulizer of ventolin was administered to help open the airway.
As the UAE is only a field hospital, Naveeda was then transported by the AAI team to the local hospital in Makli. This proved to be a difficult admission to hospital due to the poor relationship the hospital has with the local villages. The doctor in charge was very reluctant to admit the child due to her severe condition which may have resulted in a poor outcome. This could potentially lead to endangerment to the staff at the hospital and damage to the hospital buildings.
The patient was eventually admitted when it was confirmed that the AAI team would take her to the National Institute of Children's Health (NICH) in Karachi the following day. The condition of the hospital is extremely poor with little or no equipment and the little equipment that does exist is shared between patients. Very little further treatment was administered except the insertion of a nasal cannula for oxygen which only worked occasionally. As the initial treatment had been commenced, the AAI team was comfortable with the plan of action that had been undertaken and felt the patient would be safe for the night.
The following day, the need for long-term care as well as the immediate need for hospitalisation due to the pneumonia was discussed at length with the family. After discussion, it was decided that the patient needed to be transported by the AAI team to the NICH. Upon arrival at the NICH, the patient was further assessed and treatment commenced in a competent and professional manner.
As discussed with the family, treatment would be for one week which would include physiotherapy for her disability. The family was assisted with basic living needs which enabled them to stay with Naveeda while in Karachi.
AAI is working with some of the most affected populations and is providing essential care to those most in need. There is an ongoing need in areas such as Rawal Kandra and AAI requires ongoing international support to be able to continue to provide lifesaving care to children such as Naveeda.