Pakistan - Six months after the floods: Medical care

Ensuring immediate access to healthcare

“I had been sick for a week and I didn’t have enough food for my six children, let alone to pay to see the doctor. I am glad that now we can get medicine for free in this centre.” - Patient at an MSF diarrhoea treatment centre in Kot Addu, Punjab.

During the floods, numerous local health clinics were damaged by the floodwater, and many collapsed. MSF teams worked to ensure that health facilities could function again: cleaning them, providing a safe supply of water and electricity, donating equipment and stocking them with medicines. MSF doctors also provided medical support to several hospitals, in outpatient departments, emergency rooms and medical wards. In the camps for displaced people, and in remote areas, where many people were without access to healthcare, medical teams ran 15 mobile clinics to make sure that people had the medical support they need.

By the end of January 2011, medical teams had provided a total of 106,616 health consultations to victims of the floods. Many of the health problems they saw were directly flood-related, including diarrhoea, skin infections, eye infections and trauma. Other conditions were unrelated, such as acute respiratory infections, dengue fever, measles, tetanus and jaundice.

Where people have returned to their homes, MSF teams have rehabilitated local health clinics to ensure that returnees have the same level of healthcare as they did before the floods.

Responding to outbreaks of diarrhoea

People displaced from their homes by the floods often had to cope with poor living conditions in temporary camps, as well as a lack of food, clean water and adequate sanitation, all of which caused a rise in the number of patients suffering from diarrhoea. MSF teams set up seven diarrhoea treatment centres to provide intensive care to those in need until they were fully recovered.

Teams also set up 22 rehydration salt points and provided hygiene kits and water purification tablets to halt the outbreak. Health messages promoting hygiene and sanitation were disseminated in several camps and villages to stop the diarrhoea outbreak from spreading.

Responding to malnutrition

“Treating malnutrition in children under the age of five is essential. If it is not treated in time, the damage malnutrition leaves on their physical and mental state is irreversible.” Dr Ahmed Mukhtar, MSF medical coordinator

The floods destroyed the harvest, as well as damaging farmers’ fields and affecting the next harvest season too. As a result, malnutrition has been a problem amongst flood victims. From the earliest days of the emergency, treating malnutrition was a part of the mobile clinics’ activities in Sindh and Balochistan. Medical teams began by screening children under five years old and pregnant and lactating women. This was done by measuring their middle upper arm circumference and calculating their height-to-weight ratio.

People identified as malnourished were provided with ready-to-use food and weekly check-ups at MSF’s outpatient feeding centres. Those who were severely malnourished and suffering from medical complications or opportunistic diseases such as malaria, tuberculosis or pneumonia were admitted to inpatient feeding centres. There they received specialised care until they were well enough to join the outpatient feeding programmes. MSF also ran a centre in one of the camps for displaced people that provided daily care for malnourished children who were refusing to eat or were failing to gain weight.

Those affected by the floods frequently moved from place to place, and it was a challenge for the nutrition teams to make sure that malnourished children completed their full treatment programme. MSF health promotion teams, working in the camps and in the inpatient therapeutic feeding centres, helped to boost mothers’ understanding of the treatment process, and raise their awareness of the importance of breastfeeding, good nutrition, hygiene and disease prevention measures.

By the end of January 2011, MSF medical teams had screened over 97,000 children and pregnant or lactating women for malnutrition, and had treated 8,800 malnourished children. Teams in Jamshoro and Karachi are continuing to monitor the nutrition situation closely in case the need for further assistance should arise.

Looking after the health of mothers and children

In the rush to escape the floodwaters, expectant mothers and babies were particularly vulnerable. With mother and child healthcare projects already running in different parts of the country, MSF teams scaled up their efforts to care for the health of mothers and children in the wake of the floods. A large influx of people in Dera Murad Jamali saw a significant increase in the number of births, caesareans and complicated deliveries. Between August 2010 and January 2011, the team assisted with 516 deliveries, 82 of which were caesareans and 434 of which were complicated deliveries.

Babies whose mothers had had complicated deliveries were transferred from the MSF-run maternity ward in Dera Murad Jamali to an around-the-clock nursery next to the inpatient department. Between August 2010 and January 2011, 339 newborns were admitted to the nursery.

“I was very worried that neither my baby nor I would survive because of the problems with my pregnancy, but the caesarean section saved both of us. He is healthy and safe and I am now a happy mother.” Patient at the MSF-supported hospital for mother and child healthcare, Dera Murad Jamali, Balochistan

Mental health support

For many people, coming to terms with the losses they had suffered during the floods and the hardshipsof displacement caused feelings of anxiety, stress and depression. To help them, MSF integrated a mental health element into its emergency response, with psychologists providing individual and group counselling to those in need of mental health support.

Health promotion activities

MSF health promotion workers played a vital role in raising people’s awareness about health risks in the wake of the floods. They worked with both the medical teams and the water and sanitation teams to address knowledge gaps among people displaced from their homes. At the beginning of the emergency, health promotion workers developed health messages to promote hygiene and sanitation in various camps and villages to mitigate the risk of an epidemic. As the emergency phase wound down, the health promotion workers adapted their work to people’s needs, from raising awareness about hygiene and disease prevention measures to increasing knowledge about breastfeeding issues, malnutrition and chronic diseases.

Since 1988, MSF has been providing medical assistance to Pakistani nationals and Afghan refugees suffering from the effects of armed conflicts, poor access to health care, and natural disasters in Khyber Pakhtunkhwa, Balochistan, Punjab, and Sindh provinces, as well as the Federally Administered Tribal Areas and Kashmir.

MSF does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations.