ActionAid, Shifa College Provide Health Care to Pakistan’s Displaced People
Written for ActionAid by Dr. Ahsan Hameed, a professor at Shifa College of Medicine, Islamabad
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Relief for Pakistan’s Displaced Civilians
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June 11, 2009 -- The Shifa College of Medicine and the Shifa College of Nursing, in collaboration with ActionAid, have been sending volunteer medical teams to Swabi daily to provide health care to those affected by the Swat conflict. So far, more than 3,500 patients have been provided medical care.
The plight of the internally displaced persons is far from over, and we see no imminent let up in their miseries and sufferings. According to a rough estimate, around 3 million citizens have been displaced from their hometowns as a result of the calamity, which was brought on by extremist elements that challenged the writ of the state and terrorized the civilian, innocent population.
From our first-hand experience of the internally displaced persons residing with the hosts, what stands out prominently is the fact that these people still have a faint hope for things to get better soon. We have found them to be simple, humble and determined people, though badly scarred by what they have been through.
Traumatic stress disorder is the single most prevalent disorder in this community. I don’t call it post-traumatic because the trauma is far from over; they are still going through it.
One can see the scars not only on their bodies, in the form of shell injuries, but also on their psyche; in the womenfolk trying to hide their psychological trauma under the garb of their heavy “burqas” in the blistering summer heat.
Abdul Jabbar, 41, with his children after their medical examination and receiving free medicines at the Kotha Swabi camp.
One sees the internal scars of infants and children clinging to their elder brothers and sisters, who are no taller than them, trying to find security and comfort in the fragile but determined clutches of their siblings. The innocent faces of the children betray the fear and helplessness gnawing through their minds.
These children no longer behave like normal children. Some have spun a cocoon around them, not communicating with the outside world, while the others have prematurely assumed the roles of the adults, using the language of the adults and taking on the same responsibilities of protecting their younger family members. When asked about their complaints, the children either keep silent or stare at their elder siblings as if asking, “Should I speak? Should I tell how I feel?”
The children most commonly complain of aches and pains, vertigo, weakness, loss of appetite and sleep disturbance -- symptoms that are generally attributed to adults. Mothers frequently bring their limp and dehydrated children, drenched in sweat and complaining of prolonged diarrhea. We would frequently run out of the rehydration salt, despite our initial strong assessment and preparation for a high prevalence of gastroenteritis.
During my few recent visits to Swabi as a member of the medical team, I noticed that almost three-fourths of the patients would ask for an energy boosting pill, and on our next visit they would be too eager to show that the medicine has worked.
In women and the elderly, the most prescribed medicines were multivitamins and painkillers.
A smaller minority of patients suffering from chronic diseases like diabetes and hypertension were expecting to get a refill of their prescription medicines, but we were not geared for that kind of a commitment during our first few visits.
I recall an elderly patient, Moosa Khan, who suffered from Parkinson’s disease when I first visited. He came out very explicitly with his symptoms, explaining that his legs have jammed and rusted and he has great difficulty initiating each step, though there was no pain.
The mask-like face, so characteristic of Parkinson’s disease, was hiding the agony that he must have been feeling for not being able to walk despite having no pain in his limbs. Even more frustrating for me was the fact that I had not brought any medicine for this disease.
I was cursing myself for not caring for him, but I had no way of knowing if I would encounter such a patient. We were only prepared for the common emergencies and illnesses. It was mind-wrecking to realize that this old man with jammed and rusted limbs could have walked all this distance amid the volleys of shells and bombs, to an unknown destination, and will be walking all the way back to his homeland once it is over. How I wished I had put just a bottle of his pills in my pocket; that would have lasted him a month.
Ismat Bibi, a mother with three children clinging to her, explained how she had hurriedly left her house when it was hit by three bullets fired from an aircraft. With no men around at that moment, all the women and children left their damaged house and walked alongside the other fleeing people. None were sure of where to go. The entire family was stressed out, looking for somebody to talk to and share their miseries with.
The younger men were shuttling back and forth between Swabi and their hometown to look after their crops and whatever belongings were left behind, and that left us predominantly with women, children and the elderly to be taken care of. We have been moving from village to village with a team of doctors, nurses and final year medical students. The team members showed no sign of fatigue and showed their resolve to come repeatedly and help these poor and destitute but determined souls.
As the first two weeks of medical camps reach their completion, we are now turning our attention towards preventive health care: We will organize talks with the village people, including both the guests and the hosts, and educate them about common illnesses and their prevention.
We will discuss subjects like using boiled water, keeping food covered, using soap and brushing teeth. We will also have special sessions with children and women to listen to their problems and identify their specific psychosocial needs.
After meeting with the internally displaced people who have been coming to the Shifa-ActionAid medical camps as patients, and listening to their stories of pain and homesickness, I strongly feel that in addition to the very basic things such as food, clothing, bedding, cooking pots and basic hygiene items, these people need to be mobilized and organized so that they can actively participate in the relief and support work being carried out by the government and national and international humanitarian/relief agencies.
Sitting helpless in their tents or Hujras struggling through each day is not something that these people had anticipated. Although homeless and clueless about their future, the innocent people of Malakand who braved terrorism and sacrificed the comfort of their homes so the military could take out the “bad guys” are still trying to make it through the tough days.
The humanitarian assistance is coming in, but more is needed, and urgently so. The little support that we are providing must not stop.
One way or the other, we have to find a way to keep doing what we are doing and perhaps more -- for the valiant women, men and children of Malakand, the internally displaced persons as we now know them.
