Dr. Rick: What is the first thing you do? You make sure that what you are doing is what is needed, you try to address gaps and you try to be as effective as possible. They ended up serving 103, 000 refugees. They had to do Rapid Assessments, using Quick-and-Dirty methods rather than formal epidemiology. And they had to make sure they delivered aid as they did this.
In the area they focused in, the information they gathered in the three weeks they did the survey, their results included:
* 22 communities, 17 healtth facilities
* 231,000 population (media, 2000)
* 800-900 acute deaths
* Mortality not elevated two weeks post-EQ
* ARI, diarrhea, skin infections
* No acute outbreaks
First few weeks, focus was rescue and retrieval. But most of that happens mostly in the first 48-72 hours. Once that was done, the focus had to majorly be infections.
First assessment of Enviromental health was:
* >90% houses non-habitable
* less than 10% in normal structures
* 75-90% in makeshift shelters
* less than 10% had useable latrines and toilets
* 67% had access to clean water--actually better than expected.
Of the health facilities hey visited:
* 82% were destroyed or damaged
* 50% had adequate staffing
* 43% had inpatient services
But when they asked around, the thing everyone wanted was shelter, shelter, shelter. And the thing was that they needed first of all to get remaining health staff with shelter so that they could stay in the area. These are people usually better off than the rest of the community and could very easily go somewhere else--say, Peshawar--and get a new place.
Gender issues are big. In some clinics only 10% of the patients were women--but IRC made sure they had female doctors and therefore had about 55% women patients. Very difficult to convince female doctors to go up there and live in a tent. Still is a challenge.
They had Afghan refugee staff and Pakistani staff working 12 hour days in cramped conditions while fasting in Ramazan.
In October 2005, only 10% off what they say was injuries.
One of the major killers in refugee populations is measles, so on of the priority health interventions was Measles and Tetanus vaccinations. Asked the authorities to give them the vaccines. 2000 measles shots and lots of tetanus. One other agency started a tetanus hospital just focused on that.
Assistance with Health Strategy
* Basic Package of Health Services
** Infectious disease control
** Child health
** Reproductive health
* Geographic distribution of responsibility for health services between the NGO's, signing MoU's with the Ministry of Health in Mansehra District and Azad Kashmir.
Currently working in both Mansehra and Kashmir with a total population of 115-150000 people. Trying to make sure that permanent health facilities are rebuilt and reset up.