RMF-HF Health Project Talhata, Balakot Mansehra NWFP, Pakistan 3- Months Consolidated Morbidity Report st th Reporting Period: April 1 2008 to June 30 2008
Background
The October 8, 2005 earthquake destroyed large portions of the NWFP and Kashmir (AJK) regions. Widespread death and devastation affected an area of approximately 30,000 square kilometers, home to more than 3 million people living in hamlets spread in Himalayan slopes and valleys. This disaster was described as the world’s third deadliest natural disaster in the last 25 years: it killed more than between 73,000 and 80,000 people, injured more than a 100,000 and made 3 million homeless in the highest mountain ranges in the world (Brennan RJ and Waldman RJ, New England Journal of Medicine , April 2006). Thousands of people were left injured. Most of them suffered even more as they were subjected to extremely harsh living conditions.
In October 2005, Hashoo Foundation established a medical relief camp in Jabri (UC Shohal Moizullah, District Mansehra) where 10 to 15 doctors volunteered to help alleviate the sufferings of the residents coming from remote villages located in the mountains surrounding Balakot. The medical camp ran for more than three months. During that period, patients were treated for crushed injuries, infected wounds, orthopedics problems, post operative care and acute illnesses sustained as a result of the earthquake; others underwent treatment for chronic diseases which had gone untreated for years due to the remoteness of the region. As the BHU established by the government had been completely destroyed , the need for sustained health care for the residents of the area was felt strongly.
RMF-HF Health Care Project
The RMF-HF Health Care Project resulted from a partnership between Real Medicine Foundation USA and Hashoo Foundation in mid-January 2006. A formalized RMF-HF Health Care Unit was established in Shohal Moizullah in February 2006. This health unit employs a full time MBBS doctor, a medical technician, two LHVs and a dispenser.
The health unit is equipped with a complete range of medical equipments, including a nebuliser , glucometer , deep freezer/refrigerator (for medicines and vaccines), an oxygen gas cylinder , a complete ENT diagnostic set , and a well-equipped room for examining gynecological cases . The health unit is also furnished with two room coolers, heaters, and an electric power generator to face drastic weather conditions. An ECG machine and a laptop assist in diagnosing ischemic hearth disease patients and reduce referral load to other hospitals.
Quarterly Morbidity Report April-June 2008
In December 2006, considering the catchments area size, the health unit was shifted from Jabri, Shohal Moizullah to UC Talhata where a larger population could be served. Through this move, patients from Jabri, UC Shohal Moizullah and Union Council Talhata could be served simultaneously. The health unit is now accessible to a population of 44,000 people, twice as more as in the previous location.
The most common health problems in the area include Acute Respiratory Infections (ARIs), diarrhea diseases, infectious diseases, gastric diseases, gynecological diseases, skin infections and cardio vascular diseases. The health unit is regularly supplied with IV drips, IV antibiotics, IV sets, oral re-hydration salts, anti-hypertensive, oral antibiotics, antipyretics, analgesics, examination gloves and masks, and vitamins.
As the terrain extremely difficult, a jeep has been modified as an ambulance . This vehicle can easily access remote places, transporting referred patients to secondary and tertiary care units in neighboring larger cities and towns.
PROGRAM STRUCTURE
Goal To improve the health and well-being of those affected by the October 2005 earthquake, with a focus on the 120,000 persons in five union councils of tehsil Balakot.
Target Population: 120,000 persons in five union councils of tehsil Balakot.
Project Objectives: o To provide a standard package of primary health care incorporating disease prevention, health promotion and health education o To improve: a) the coverage and utilization of services by remote village populations; b) access to healthcare for girls and women; c) the standard of health care o To involve the government and local communities in the health care system and build their capacity to take ownership of the system after completion of the project. o To involve and train government health workers who wish to work in this area.
3- Months Consolidated Morbidity Report from April to June 2008
During the quarter under review the OPD of the health unit went to 5,411 patients .
After the patient surge of the previous reporting period, due to the closure of other health units operated by NGOs since the 2005 earthquake, the level of activity have come back to the regular rate of 50 to 60 patients a day.
RMF-HF Health Unit, Talhata 2/6 Quarterly Morbidity Report April-June 2008
During the reporting period, the unit slowed down its activities due to security concerns and political instability. The unit remained partially open, but only accepted emergency cases during the weekend.
The new mountain ambulance donated by Vital Edge to the RMF-HF Health Unit is working well and has been a real asset for the project. The ambulance links the surrounding basic health units and remote areas to secondary and Tertiary Care Hospitals. The local mountain Jeep is converted to this special mountain ambulance which is fully air conditioned and medically equipped with Oxygen Cylinder with mask, emergency first aid box and a full resuscitation kit. A full movable stretcher is also fitted in the ambulance where patient can be easily laid.
From 1st April 2008 to 30 th June 2008, 5,411 patients were diagnosed and treated at the RMF-HF Health Unit. During the quarter under review, the figures show that the patients visiting the unit consist of 44% male, 56% female and 20% children.
In this quarter, 115 women came for antenatal visits, 204 women visited the health unit for gynecological problems, and 134 women visited the RMF-HF health unit for family planning.
Most of the diseases diagnosed and treated result from the weather and living conditions of the patients: Acute respiratory infections (ARI): 30% of cases treated Diarrhea (bloody and non bloody): 10% Dyspepsia: 7.85 % Scabies 9%, General body aches and weaknesses: 7.5% Constipation: 2.5% Urinary tract infections: 7.6% Hyper-tension and Anxiety : 7.11 %
Cases of suspected meningitis (3), acute abdomen (9), burns (4), RSA (2), acute appendicitis (6) and acute jaundice syndrome (5) were less frequent. These cases were subsequently referred to secondary and tertiary care hospitals for further treatment.
10 to 15 patients are benefiting from home consultations each month.
The health unit has generated Quarterly Morbidity Reports (QMR), which were shared with the Ministry of Health (MOH) and the World Health Organization (WHO).
RMF-HF Health Unit, Talhata 3/6 Quarterly Morbidity Report April-June 2008
Annex
Chart 1: OPD activity since February 2006
Note: the health unit moved from Jabri to Talhata in December 2006.
OPD Activity
7000
6000
5000
4000 Total # of patients Female 3000 Male 2000
1000
0 Feb 06 April - July - Oct - Jan - April - July - Oct - Jan - April - - March June Sep 06 Dec 06 March June Sep 07 Dec 07 March June 06 06 07 07 2008 2008
Chart 2: Gender-wise break-up of patients during the reporting period
Gender-wise breakup of patients
44% Female Male 56%
Chart 3: Age-wise break-up of patients during the reporting period
RMF-HF Health Unit, Talhata 4/6 Quarterly Morbidity Report April-June 2008
Age-wise break-up of patients
13% 7% children under 5 between 5 and 12 Above 12
80%
RMF-HF Health Unit, Talhata 5/6 Quarterly Morbidity Report April-June 2008
Picture Gallery
RMF-HF Health Unit, Talhata 6/6 Sex Total % Total Female 3041 56% Male 2370 44% Grand Total 5411 100%
Male Female 44% 56%
Grand Date Female Male Female Male Total 1200 Apr 1134 815 1949 1000 May 957 685 1642 800 Jun 950 870 1820 600 Grand Total 3041 2370 5411 400 200 0 Apr May Jun
0 to 5 5 to 12 12 and Grand Date % years years above Total Apr 310 145 1494 1949 36% May 279 100 1263 1642 30% Jun 284 87 1449 1820 34% Grand Total 873 332 4206 5411 100% % 16% 6% 78% 100%
Apr May Jun Grand Total 1600
1400
1200 Jun Apr 34% 36% 1000 800
600
400 May 30% 200 0 0 to 5 years 5 to 12 years 12 and above Grand Age Date Female Male % Total 0 to 5 years Apr 175 135 310 6% Jun 0 to 5 years May 158 121 279 5% 30% Apr 37% Jun 140 144 284 5% Total 473 400 873 16% Apr 77 68 145 3% May 5 to 12 years May 63 37 100 2% 33% Jun 39 48 87 2% Total 179 153 332 6%
Apr 882 612 1494 28% 5 to 12 years Above 12 years May 736 527 1263 23% Jun Apr Jun 771 678 1449 27% 22% 43% Total 2389 1817 4206 78% Grand Total 3041 2370 5411 100%
12 years and above May 35% Jun Apr 32% 37%
May 31% Date Female Male Total 1-Apr-08 94 57 151 2-Apr-08 39 38 77 3-Apr-08 28 42 70 4-Apr-08 55 22 77 7-Apr-08 57 32 89 8-Apr-08 34 46 80 9-Apr-08 40 32 72 10-Apr-08 82 39 121 11-Apr-08 51 49 100 12-Apr-08 16 9 25 14-Apr-08 42 25 67 15-Apr-08 39 27 66 16-Apr-08 43 53 96 17-Apr-08 53 37 90 18-Apr-08 46 31 77 21-Apr-08 31 30 61 22-Apr-08 31 25 56 23-Apr-08 39 37 76 24-Apr-08 49 26 75 25-Apr-08 81 68 149 28-Apr-08 65 36 101 29-Apr-08 72 18 90 30-Apr-08 47 36 83 Total 1134 815 1949
Female 100 Male 90
80
70
60
50
40
30
20
10
0 4/1/2008 4/8/2008 4/15/2008 4/22/2008 4/29/2008 Date Female Male Total 1-May-08 70 4 74 2-May-08 40 30 70 5-May-08 78 12 90 6-May-08 42 55 97 7-May-08 52 40 92 8-May-08 44 44 88 9-May-08 53 27 80 12-May-08 30 46 76 13-May-08 29 41 70 14-May-08 47 23 70 15-May-08 33 33 66 16-May-08 38 30 68 19-May-08 42 23 65 20-May-08 53 20 73 21-May-08 40 31 71 22-May-08 44 16 60 23-May-08 37 36 73 26-May-08 39 31 70 27-May-08 39 27 66 28-May-08 28 48 76 29-May-08 37 35 72 30-May-08 42 33 75 Total 957 685 1642
Female Male 90
80
70
60
50
40
30
20
10
0 5/1/2008 5/8/2008 5/15/2008 5/22/2008 5/29/2008 Date Female Male Total 1-Jun-08 71 44 115 3-Jun-08 62 45 107 4-Jun-08 52 45 97 5-Jun-08 53 35 88 6-Jun-08 56 24 80 7-Jun-08 16 12 28 9-Jun-08 40 36 76 10-Jun-08 45 28 73 11-Jun-08 84 65 149 12-Jun-08 51 49 100 13-Jun-08 63 33 96 16-Jun-08 26 45 71 17-Jun-08 37 31 68 18-Jun-08 20 50 70 19-Jun-08 29 40 69 20-Jun-08 13 48 61 21-Jun-08 7 9 16 23-Jun-08 42 27 69 24-Jun-08 42 28 70 25-Jun-08 36 31 67 26-Jun-08 22 33 55 27-Jun-08 59 43 102 30-Jun-08 24 69 93 Total 950 870 1820
Female Male 90
80
70
60
50
40
30
20
10
0 6/1/2008 6/8/2008 6/15/2008 6/22/2008 6/29/2008 Provisinol Diagnoses Apr May Jun Total % A/N Visit 40 38 37 115 2.13% Acute Abdomen 6 1 2 9 0.17% Acute Appendicitis 4 1 1 6 0.11% Acute Jaundice Syndrome 2 1 2 5 0.09% Anxiety 27 12 14 53 0.98% ARI (Acute Respiratory Infection) 558 470 503 1531 28.29% ARI (Pharyngitis/ Sore throat) 1 53 80 134 2.48% Arthritis 1 2 1 4 0.07% Backache 37 32 49 118 2.18% Boils 10 6 13 29 0.54% Burn 1 1 0.02% Burn 1 1 1 3 0.06% Conjunctivitis/Allergic 7 5 12 24 0.44% Conjunctivitis/Mucopurulent 12 8 9 29 0.54% Constipation 32 56 47 135 2.49% Diarrhoea (Bloody) 56 20 33 109 2.01% Diarrhoea (Non Bloody) 154 182 88 424 7.84% Dyspepsia 176 106 142 424 7.84% Epilepsy 2 2 0.04% Family Planning Visit 42 34 60 136 2.51% Fungal (Oral Thrush) 4 17 5 26 0.48% Generaliesd Body Aches 80 59 58 197 3.64% Generaliesd Body Weakness 71 64 75 210 3.88% Gynecological problems 69 73 64 206 3.81% Headache 4 11 13 28 0.52% Hypertension 106 121 103 330 6.10% Injuries/wounds 16 6 7 29 0.54% Knee Joint Pain 1 4 5 0.09% Road Side Accident 1 1 2 0.04% Scabies 202 107 178 487 9.00% Suspected Meningitis 1 1 1 3 0.06% Toothache 32 30 27 89 1.64% Urinary Tract Infection (UTI) 156 101 157 414 7.65% Worms Infestation 37 24 33 94 1.74% Grand Total 1949 1642 1820 5411 100.00% Provisinol Diagnoses Female Male Total % A/N Visit 115 115 2.13% Acute Abdomen 5 4 9 0.17% Acute Appendicitis 4 2 6 0.11% Acute Jaundice Syndrome 4 1 5 0.09% Anxiety 34 19 53 0.98% ARI (Acute Respiratory Infection) 734 797 1531 28.29% ARI (Pharyngitis/ Sore throat) 64 70 134 2.48% Arthritis 3 1 4 0.07% Backache 70 48 118 2.18% Boils 12 17 29 0.54% Burn 1 1 0.02% Burn 1 2 3 0.06% Conjunctivitis/Allergic 10 14 24 0.44% Conjunctivitis/Mucopurulent 13 16 29 0.54% Constipation 81 54 135 2.49% Diarrhoea (Bloody) 58 51 109 2.01% Diarrhoea (Non Bloody) 219 205 424 7.84% Dyspepsia 234 190 424 7.84% Epilepsy 1 1 2 0.04% Family Planning Visit 136 136 2.51% Fungal (Oral Thrush) 10 16 26 0.48% Generaliesd Body Aches 113 84 197 3.64% Generaliesd Body Weakness 114 96 210 3.88% Gynecological problems 206 206 3.81% Headache 16 12 28 0.52% Hypertension 183 147 330 6.10% Injuries/wounds 10 19 29 0.54% Knee Joint Pain 2 3 5 0.09% Road Side Accident 1 1 2 0.04% Scabies 256 231 487 9.00% Suspected Meningitis 1 2 3 0.06% Toothache 50 39 89 1.64% Urinary Tract Infection (UTI) 224 190 414 7.65% Worms Infestation 56 38 94 1.74% Grand Total 3041 2370 5411 100.00% 0 to 5 5 to 12 12 and Provisinol Diagnoses Total % years years above A/N Visit 115 115 2.13% Acute Abdomen 1 8 9 0.17% Acute Appendicitis 6 6 0.11% Acute Jaundice Syndrome 5 5 0.09% Anxiety 53 53 0.98% ARI (Acute Respiratory Infection) 650 161 720 1531 28.29% ARI (Pharyngitis/ Sore throat) 1 133 134 2.48% Arthritis 4 4 0.07% Backache 118 118 2.18% Boils 29 29 0.54% Burn 1 1 0.02% Burn 3 3 0.06% Conjunctivitis/Allergic 3 21 24 0.44% Conjunctivitis/Mucopurulent 9 7 13 29 0.54% Constipation 4 2 129 135 2.49% Diarrhoea (Bloody) 46 16 47 109 2.01% Diarrhoea (Non Bloody) 123 50 251 424 7.84% Dyspepsia 3 6 415 424 7.84% Epilepsy 2 2 0.04% Family Planning Visit 136 136 2.51% Fungal (Oral Thrush) 13 3 10 26 0.48% Generaliesd Body Aches 197 197 3.64% Generaliesd Body Weakness 9 9 192 210 3.88% Gynecological problems 206 206 3.81% Headache 28 28 0.52% Hypertension 3 327 330 6.10% Injuries/wounds 29 29 0.54% Knee Joint Pain 5 5 0.09% Road Side Accident 2 2 0.04% Scabies 3 22 462 487 9.00% Suspected Meningitis 1 2 3 0.06% Toothache 1 1 87 89 1.64% Urinary Tract Infection (UTI) 1 2 411 414 7.65% Worms Infestation 3 46 45 94 1.74% Grand Total 873 332 4206 5411 100.00% 0 to 5 5 to 12 12 and Village Total % years years above Allari 5 3 9 17 0.31% Andrasi 50 18 260 328 6.06% Baga 5 5 0.09% Bajmoury 6 2 24 32 0.59% Balakot 11 4 34 49 0.91% Banda 2 2 0.04% Batangi 1 1 0.02% Batora 24 4 83 111 2.05% Besiyan 1 6 7 0.13% Chapra 14 8 107 129 2.38% Codi Pata 1 1 0.02% Dara 1 1 3 5 0.09% Dodyal 1 1 0.02% Garih 29 4 126 159 2.94% Garlat 1 1 2 0.04% Guldairy 2 4 6 0.11% Gulmira 1 1 0.02% Gultary 2 2 26 30 0.55% Hangray 4 4 0.07% Hasa 6 6 0.11% Hasari 1 1 2 0.04% Hasary 5 2 18 25 0.46% Hungray 1 1 2 0.04% Jabbi 1 1 8 10 0.18% Jabree 21 7 88 116 2.14% Jagir 37 14 165 216 3.99% Jana 1 1 0.02% Jania 153 63 762 978 18.07% Juma 3 3 0.06% Kagel 11 6 24 41 0.76% Kaghan 1 3 4 0.07% Kalish 15 12 109 136 2.51% Kashiyan 2 7 9 0.17% Kashtara 40 17 211 268 4.95% Khoti Pata 3 3 0.06% Kotbala 141 54 656 851 15.73% Machipura 1 1 2 0.04% Manour 1 1 2 0.04% Mansehra 3 3 0.06% Nala 9 2 48 59 1.09% Naran 1 1 0.02% Noora 4 2 5 11 0.20% Noura 3 1 15 19 0.35% Pateka 11 1 46 58 1.07% Patsiry 1 1 0.02% Sarwai 42 10 166 218 4.03% Shawel 25 12 141 178 3.29% Siryan 1 2 5 8 0.15% Soum 46 15 205 266 4.92% Sugdar 4 4 0.07% Survia 31 14 179 224 4.14% Talhata 122 47 608 777 14.36% Zaire 1 1 0.02% Zamery 4 1 13 18 0.33% Grand Total 873 332 4206 5411 100.00% Village Apr May Jun Total % Allari 8 7 2 17 0.31% Andrasi 108 98 122 328 6.06% Baga 1 4 5 0.09% Bajmoury 12 11 9 32 0.59% Balakot 12 5 32 49 0.91% Banda 1 1 2 0.04% Batangi 1 1 0.02% Batora 32 27 52 111 2.05% Besiyan 7 7 0.13% Chapra 37 60 32 129 2.38% Codi Pata 1 1 0.02% Dara 5 5 0.09% Dodyal 1 1 0.02% Garih 60 47 52 159 2.94% Garlat 2 2 0.04% Guldairy 4 2 6 0.11% Gulmira 1 1 0.02% Gultary 15 13 2 30 0.55% Hangray 4 4 0.07% Hasa 3 3 6 0.11% Hasari 2 2 0.04% Hasary 18 2 5 25 0.46% Hungray 1 1 2 0.04% Jabbi 10 10 0.18% Jabree 39 48 29 116 2.14% Jagir 96 59 61 216 3.99% Jana 1 1 0.02% Jania 386 260 332 978 18.07% Juma 1 2 3 0.06% Kagel 11 11 19 41 0.76% Kaghan 3 1 4 0.07% Kalish 53 37 46 136 2.51% Kashiyan 4 5 9 0.17% Kashtara 105 111 52 268 4.95% Khoti Pata 3 3 0.06% Kotbala 337 258 256 851 15.73% Machipura 2 2 0.04% Manour 1 1 2 0.04% Mansehra 1 2 3 0.06% Nala 15 22 22 59 1.09% Naran 1 1 0.02% Noora 3 6 2 11 0.20% Noura 11 1 7 19 0.35% Pateka 15 25 18 58 1.07% Patsiry 1 1 0.02% Sarwai 44 60 114 218 4.03% Shawel 57 74 47 178 3.29% Siryan 6 1 1 8 0.15% Soum 98 43 125 266 4.92% Sugdar 1 3 4 0.07% Survia 95 69 60 224 4.14% Talhata 240 269 268 777 14.36% Zaire 1 1 0.02% Zamery 5 4 9 18 0.33% Grand Total 1949 1642 1820 5411 100.00%