Helping the War Afflicted- Refugee Camps in Jalalah

Mardan, Pakistan

The war against terrorism reached its peak last year when the military began its operations in the Swat region of Pakistan. Every day brought news of death and suffering. Besides those who were killed or injured, there were those four million who had left their homes in search of a shelter. Some settled in refugee camps set up by governmental and non-governmental organizations. A few rented houses in other cities. But initially, many had to spend their life in open grounds until help arrived.

In July 2009, I happened to visit one of the refugee camps in Jalalah, Mardan, as part of team of faculty and students of Peshawar Medical College, who were conducting a survey of the psychosocial services for IDPs. The survey was completed successfully, but we had a heart wrenching experience. The camp’s physical structure was commendable, which I believe was the result of the countries experience with a major earth quake in the recent past. However, the services were nowhere near enough. Several NGOs were running small health centers in the camp, with a basic set of services and very limited supply of drugs. A number of refugees, when learned that I am a physician, came running after me, pulling my arm begging me to help their loved ones. I saw a very old lady who had suffered a stroke ten days ago and was lying in scorching with no medicine. I heard the story of a young woman who gave birth to a baby with no medical assistance, and the baby died of infection. Psychiatric services were non-existent, as were any special facilities for the disabled. During our survey, we identified many children who were still not able to sleep because of what they had seen. The stories went on and I started getting uncomfortable. Luckily then, I got the chance to work on a collaborative project of International Development & Relief Foundation (IRDF) and Pesahwar Medical College. The project involved establishment of a Maternal, Neonatal & Child Health Center for these displaced persons. The project began in August 2009. Equipment was purchased and staff was hired. A reporting system was put in place and services started by end of August. These included services for expecting ladies and their newborn children, as well as children in general. A general medical outpatient clinic was also functional. Laboratory and pharmacy services were added alongside and by end of September home visits of Lady Health Workers had also started.

The greatest contribution of this project, I believe, is the provision of maternity services to the IDPs when there were none available inside or outside the camp. The free laboratory services provided by the center are also the only facility for the IDP population in the area. Since the arrival of IDPs in the region, drug prices in the market had risen due to high demand, and in this time, provision of free drugs to the needy by our MNCH center was of extreme importance.

Near the end of 2009, the IDP population had started decreasing and our project team decided to open up the services for local population with minimal user fees. From a sustainability point of view, the continuation of this center as a permanent facility is ideal. Since the locality of Jalalah until this time, lacked a well equipped maternal and child health service, the establishment of this center has been a significant contribution in improving the health care of this community. The general medical clinic is also now open to the natives of Jalalah and surrounding region and benefiting the host community as well.

It has been a satisfying experience helping those in great need. The war is not over though, and I hope to see a peaceful Pakistan someday.


Usman Raza, MD MS
Harvard School of Public Health Alumnus



1: A child in Jalalah IDP camp, trying to cool himself by bathing under a hand pump on a hot summer day.



2: Children of displaced families in a play area inside the IDP camp, trying to entertain themselves.


3: A doctor attending to a young boy in the MNCH Center of Jalalah.




4: A happy mother, after delivering her baby in the MNCH Center under supervision of qualified staff.



5: Polio vaccination drops being given to a baby at the MNCH Center.



6: Medical assistants registering patients in the waiting area next to the medical clinic.



7: IDPs being given vocational training at a center inside the Jalalah camp.

Original article can be found on Harvard affiliate Dr. Sabeena J. Khan's website: http://beatdisability-byembracingit.posterous.com/11587140

Voices beneath the rubble!

Courtesy twitpic http://twitpic.com/photos/LisandroSuero?page=11


Vwa anba debris- (Voices beneath the rubble!) by Joel Theodat!

Anmwey! Nou tande m?
Eske n tande rèl mwen?
M pa konnen si nou ka tande n men mwen anba debris yo
Eske tande m anba debri yo?
Mwen la, mwen pa mouri
M gen blok sou tout kò m epi yo lou
M pa ka vire
Gen sant kò pouri anba kote m ye a
Gen yon moun ki akote m ki pa vire
Li pa pale
Li kouche la rèd
Eske n ap vin chèche m? N ap vini?
M pè
Poukisa pa gen okenn moun ki vin pou mwen?
M tande vwa deyo a.
O! O! M tande vwa manman m.
"Manman! Manman! Mwen la
Manman, wi?"
Mwen swaf anpil. Gòj mwen sèch
Mo paka soti nan bouch mwen ankò
M pa ka respire
Manmi, ou kwè m ap janm we figi w ankò? Ou kwè?
M santi m anci dòmi, manmi. Toutbagay nwq.
Tanpri manmi, tanpri, pa kite m mouri
Lè,lè, lè...pa gen ankò..................................

Translation

ANMWEYY!!!!!!!!!!!!!!
Can you hear me?
Can you hear my cry?
I don't know if anyone can hear me but
I am beneath the rubble
Can you hear me beneath the rubble?
Mwen la, mwen pa mouri. I am here, I am not dead.
I have blocks all over me and they are heavy, I can't move
There is the smell of rotten flesh beneath where I am
There is someone next to me who is not moving
No word is coming out of his/her mouth
He/She is lying there still
Will you come for me? Will you?
I am so scared
Why isn't anybody coming for me?
I hear voices coming from outside
Oh! I hear Mom's voice
Mamma! Mamma! I am down here
Manman wi!
I am so thirsty. My throat is dry
No words are coming out anymore
I can't breathe
Ma! Will I ever see your face again? Will I?
I am feeling sleepy, Ma! Everything is turning dark
Please Ma, don't let me die
Air, air, air, no more.................

This poem brought tears to my eyes! The people of Haiti need your help and as the writer of this poem who is also my Kreyòl teacher told us after class today, everything you give is like a drop from a bucket which touches a life. Our reward he says is the Smile of God which we can see on the faces of those whose lives we reach with the gifts of our money, prayers and ourselves!
Orevwa! Byebye!

Olaoluwatomi Kehinde Lamikanra

MPH Candidate, 2010
Health Policy & Management
olamikan@hsph.harvard.edu

Incredible India!

I spent three weeks of the winter session in Mumbai, India. It was an amazing experience and one that opened my eyes to the numerous possibilities of public health practice.

We spent our time working on group projects at two health centers located within slums about an hour by train from Southern Mumbai.We also visited several non-governmental organizations working on urban health issues that a city like Mumbai faces. We had new insights and some experiences which I'll share in the pictures below.

India is one country with a diverse group of people and Mumbai is the melting pot of so many groups different languages and tribes.

The gateway of India!



Outside the Govandi Station!



Three gracious women on the train to CST!



Making naan the ubiquitous bread eaten at every meal!



Inside the Shivaji Nagar Slum!


Lovely floor designs at a conference made with grain.


A sugarcane stand!


Enjoying the juice from the cane!

















Olaoluwatomi Kehinde Lamikanra

MPH Candidate, 2010
Health Policy & Management
olamikan@hsph.harvard.edu

HSPH Students Lead Health Reform Rally in Philly

 

Sybil Hyppolite a current HSPH student gets marchers fired up 

at Monday's Health Care Reform Rally in Philadelphia, PA

On Monday, November 10, a throng of marchers left from the 137th Annual Meeting of the American Public Health Association at the Philadelphia Convention Center and headed to CIGNA headquarters to promote keeping the public option in health care reform.

I had the opportunity to interview the organizers after the rally to hear how it went (it was over email). Below is our Q&A. If you'd like to view some of the rally videos, you can visit YouTube.

Q. Who organized the rally? 

A. Public Health Practitioners for Reform, a group of students at HSPH who were inspired and challenged by Marshall Ganz when he came to speak at an event here at school. We believe in health care for all and we support the public option as a first step to improving access. Key organizers included Aaron Holman, MS2 HPM, Sybill Hyppolite, MS2 SHDH, Michelle Lugalia, MS2 SHDH, Lindsay Schubiner, MS2 SHDH, Mark Brewster MS2 SHDH, and Tim Cunningham ScD SHDH, among many others. We received invaluable support from organizations such as the Health Policy Forum at HSPH, Health Care for America NOW! (HCAN), American Federation of County, State and Municipal Employees (AFCSME), and several members of the American Public Health Association (APHA).

Q. Why did you think this was important to do now, at APHA? 

A. Public health practitioners have an enormous stake in guaranteeing access to health care for as many people as possible, and we occupy a unique position as experts in the field.  It is essential that we make our voices heard at this crucial moment in the legislative process.  For the first time in 60 years, legislation around health care reform in Congress has progressed further than before. The level of cooperation between our legislators around this issue is also unprecedented. We are witnessing history in the making and we want our voices and our demands to count. As public health students, our voices have been missing from the debate and we felt we could not passively watch this moment pass by. We felt the need to step up and get involved.  We chose to organize the demonstration at the APHA Annual Meeting because of its nation-wide membership and its timing, as well as its symbolic relevance to the debate.

Q. How did the event go?   

A. It went very well!  Some of us have not been this intimately involved in organizing and so we were learning as we were planning.  We wanted to engage APHA members as much as possible, to get attention from the press, and we wanted it to be a meaningful experience for all the marchers. We met all of our expectations! We attracted two media sources, engaged respected members of APHA, had close to 100 people join us, and recruited great and diverse speakers to address the crowd. The group was energized during the event and several attendees thanked us for organizing the effort.

Q. What are you planning to do next?  

A. PHPR is determined to stay active in this issue. We are planning our next steps in light of the status of the bill and the President's desired deadline: Christmas 2009. Important aspects of the House bill, for example concerning reproductive rights, were cut from the version that passed, and even if the current bill makes it through the Senate without further cuts, it still fails to guarantee health care coverage for all.  We already know that this bill, as it stands, leaves us short of where we need to be.  Follow us on Facebook to get involved in our future activities. We want health care for all and we want it now!

APHA 2009 -- Water, Water Everywhere...

I am joined by many HSPH students, faculty, and staff at the 137th Annual Meeting of the American Public Health Association in Philadelphia, Pennsylvania.

There are lots of exciting social media tools being used by public health organizations and attendees at this year's annual meeting (you can follow what's happening at #apha09 on Twitter).

Additionally, a group of HSPH students who formed a group, Public Health Practioners for Reform, will be marching to CIGNA headquarters tomorrow (Monday, November 9th) at 4pm. So, if you are in Philadelphia and want to advocate for a public option you can get the details at the Organizing for American website by clicking here.

So if you can't make it, you can still find out what's being talked about. And if you're interested in getting more of a student's perspective on this year's Conference, check out my blog posts at Veritas Health or follow my Twitter feed @veritashealth.

Thoughts on Health Care Reform

As boxes and arrows and words scribbled in chalk rapidly took over the board, I was once again struck by the same uneasiness I had been feeling for a while whenever the topic of health care reform came up: will we be changing anything at all?

We were drawing a diagnostic tree in class, pinpointing potential causes behind the discrepancy in what the U.S. pays per capita and our health outcomes. Words were scrawled hastily across the board as we brainstormed – lack of fee for service, fragmented financing, lack of access. I want these words to be huge, bright, flashing neon signs in the face of U.S. citizens. But they are getting buried – buried in rhetoric, in scare tactics, in sensational statements instead of an articulation of the facts.

The fundamental misalignment of incentives at every stage of the healthcare system – specialists being paid far more than general physicians, physicians being paid for quantity instead of quality, patients not seeing the true costs of procedures and medications due to insurance coverage – is not what the health care debate seems to be about. The absurdity of inequalities in health – by socioeconomic status and by race, among other things – is not what the health care debate seems to be about. The structural, environmental, and societal factors that combine to make us unhealthy are not what the health care debate seems to be out.

Insuring everyone is important, but we must consider – what does having insurance mean? Having insurance doesn’t change the fact that some people can’t get out of their sprawling suburbs without a car. Having insurance doesn’t change the fact that some neighborhoods are incredibly unsafe. Having insurance doesn’t change the fact that some people’s nearest hospital is miles and miles away, understaffed, and underfunded.

While I am incredibly, incredibly grateful to all those who are working to change our system for the better – including so many here at our school, as well as President Obama and his administration – if the health care debate thus far is indication of what the health care bill that eventually passes will look like…I have to wonder, will we be changing anything at all?

[Disclaimer: I am not as pessimistic as all that makes me sound – I firmly believe that public health can improve things, and I do think health care reform will change some things (and that having health insurance changes some things!), just not enough things or to an adequate extent. And I’m not at all arguing against taking quick action on health care reform. Best case scenario – the voices of public health experts and others get heard, and we get a bill that, though far from perfect, actually addresses some fundamental problems and affects some real change. Some of the bills under consideration now do address at least some fundamental issues, despite the lack of focus on these issues in the debate, and for that I am very grateful! Worst case scenario (assuming a bill passes) - a bill, any bill, would serve as a starting point – if we can change something about health care, it is no longer untouchable, and hopefully iterations in the future will bring us closer to the kind of health outcomes our country should have. ]

Vinu Ilakkuvan
ScM Candidate 2010
Society, Human Development, and Health

Comments?

Protect Insurance Companies PSA from Will Ferrell

So, what is YOUR opinion?