Abstracts
Theme: Health
Panel: Critical Issues in Pakistan’s Health Care
Session I: Earthquake, Injuries/Disabilities and Rehabilitation
 The Symptoms and Severity of Earthquake Victims admitted in Hospitals of Rawalpindi/Islamabad:
A Fatima Jinnah Women University Experience
Iftikhar. N. Hassan*
Life will never be the same for thousands of survivors of earthquake of the North West Frontier Province of Pakistan and Azad Kashmir. The entire generation of school and college going children and youth has been buried alive. The second major group is women who were indoors along with their infants when the quake hit. Most men who were working in the fields or were outside their homes survived. Some perished along with their families. This was the biggest disaster Pakistan has ever faced for which the country was not at all prepared. After the initial shock both the government and the civil society scrambled to their feet to help in whatever way they could. The destruction in most of the areas was so complete that all the communication networks including roads were destroyed in fifty seconds.
As the injured started arriving in Rawalpindi and Islamabad hospitals in large numbers the hospital infrastructure got stretched to capacity. While the medical teams were busy in saving the life of the injured, there was nobody to pay attention to the psychological trauma these survivors were going through. Feeling the need of trauma counseling, the Fatima Jinnah Women University faculty and staff volunteered its services initially to the three major hospitals in Rawalpindi for trauma counseling, namely Rawalpindi General Hospital, Rawalpindi District Hospital and the Holy Family Hospital. Later these services were extended to Pakistan Institute of Medical Sciences (PIMS), Services Hospital, and the CDA Hospital in Islamabad on request of hospital authorities. Some of the counselors are working with CMH Rawalpindi and Azad Kashmir University survivors in Islamabad also. Additionally, we have deployed our teams to Balakot and Abbotabad hospitals also. This has provided a very unique opportunity to counselors and the University has collected very valuable data.
Procedure
The student counselors were given intensive one-day training in trauma counseling before sending them to hospitals. We developed two proformas to be filled in by the counselor on each admitted survivor. One dealt with personal needs of the patient and the other for recording the mental state of the patient, the counseling technique used and details of the counseling process including progress or failure in recovery. The case studies are also written at the termination of counseling. Daily debriefing sessions at the university are also part of the routine.
Initial Finding
The nature of psychological problems and the intensity of the shock appears to be related with the following:
- The death of family members and the deaths of others in class rooms.
- The lone survivors were experiencing lack of sleep and flash backs of tragic scenes.
- Guilt of survival was found in female patients more frequently.
- Serious injuries, amputations and paralysis were cause of serious depression and hopelessness about future.
- Fear of unknown is common in all survivors whether hurt or normal. They do not want to move out of the hospital or get shifted to temporary shelters.
There is a very large number of survivors who have become paralyzed due to spinal and head injuries. There are large numbers of amputations due to infections of the wounds. It will be very difficult for these people to survive back into mountains with one leg or one or both arms missing.
For surviving young girls and children there is question of safety and finding a role for themselves. Who is going to marry a woman who is crippled? And would they be able to become a useful member of the society?
Civil Society in general, and Pakistan government in particular has to ponder over this colossal problem and find a solution on a long-term basis.
* Prof. Dr. Iftikhar N. Hassan is Director, Women Research & Resource Centre, Fatima Jinnah Women University, Rawalpindi.
Health and Gender responsive Budget: Alternative Ways of Listening to Needs
Muhammad Sabir
Good health is a basic right of a person and a critical determinant of economic productivity. Therefore, policies to improve the health status of the poor have been an important focus of development policy. However, health systems are facing issues of equity, effectiveness and efficiency in many countries including Pakistan. It is argued that the resources devoted to health systems are unequally distributed, and not in proportion to the distribution of health problems. A range of environmental, social and cultural factors affects the health care seeking behavior of individuals and households. In addition, women’s health problems and access to health care are affected not only by these factors, but also by gender inequality.
Studies of health care seeking behavior suggest that it is poor women (and girls) who are least likely to have access to appropriate care and to seek adequate treatment. The range of factors which limit access for poor women include time constraints, intra-household resource allocation and decision-making relating to health care, and legal and socio-cultural constraints. Issues of health policy, financing and service delivery also have important gender aspects, particularly in relation to budgetary allocation, the impact of user fees on poor women, and the quality of care.
This paper provides an alternative way to understand the women and men health problems through a relatively new concept of Gender Responsive Budgeting GRB. GRB provides an alternative way to assess the needs of women and men and address them through changes in budget priorities. An example of funds’ allocation based on gender awareness is explored for recent earthquake in Pakistan.
* Muhammad Sabir works as a National Expert on a Governmental Development Project “Gender Responsive Budgeting Initiative” sponsored by UNDP. Before joining the project, Mr. Sabir has worked for the Social Policy and Development Center (SPDC) in the capacity of Senior Economist. He was also the member of visiting faculty of Bahria University and the University of Karachi.
The Impact of Noise Pollution on Patients’ Health and Recovery in Rawalpindi General Hospital, Rawalpindi: A Case Study
Nazima Shaheen*
To study the impact of noise pollution on patients’ health and recovery in Rawalpindi General Hospital, Murree Road, Rawalpindi, a case study was conducted in two phases—13th February to 20th July 2004, and October to November 2005 for the October 8th earthquake victims.
The prevailing noise conditions in Rawalpindi General Hospital were determined with a standard Phonometer. Daytime ambient as well as peak noise levels was measured from 7 am to 7 pm whereas the nighttime noise levels were also measured from 7 pm to 7 am. According to that, the ambient equivalent noise levels (dBA), and peak noise levels (dBA) were measured at selected locations inside and outside the premises of the hospital. The daytime average ambient noise levels ranged from 65 dBA to 97dBA, while the daytime average peak noise levels varied from 80 dBA to 111 dBA. 70 dBA to 99 dBA was the range for night-time average ambient noise levels, and 85 dBA to 113 dBA was the variation of night-time average peak noise levels. The value of L50 fluctuated from 69 to 83, and the value of L90 ranged from 56 to 73.
The traffic flow was also counted along the double roads surrounding the Rawalpindi General Hospital from 7 a.m. to 7 p.m.
To study the human responses towards noise in terms of psychological and physiological impacts, a specific survey sheet was designed and distributed among medical, paramedical, non-medical hospital staff and patients. The results of the study showed that the major impacts of noise pollution indicated by the respondents are discomfort/annoyance, distraction in sleep or rest, discomfort in communication with colleagues in wards/operation theater/laboratory/office, difficulty in attending patients, ear irritations, headache, stomach upsets, nausea and high blood pressure. The results obtained from noise level measurement survey call for an urgent attention of authorities.
* Nazima Shaheen is Assistant to Sustainable Development Conference Coordinator at Sustainable Development Policy Institute, Islamabad. Situation Analysis: Injuries, Disabilities and Traumas of Pakistan’s Recent Earthquake
Shafqat Shehzad*
On October 8th 2005, a catastrophic earthquake hit Pakistan, causing significant loss of human lives, and for the survivors, leaving behind a life full of pain and misery. People were forced to evacuate their hometowns, in search of food, shelter and medical treatment. Many children were rescued to hospitals in Islamabad, unaccompanied by any of their family members. Dismantled houses, disfigured bodies, and displacement are the new dimensions of life after the earthquake. Just not prepared for the situation, hospitals in Islamabad are working beyond their full capacity. There are temporary wards, in the corridors, hallways, and even outside to handle the influx of patients from earthquake affected areas. Doctors, nurses and paramedical staff are working day and night to save human lives, but the figure for amputation, disabilities and injuries is consistently on the rise.
This report will present evidence of the situation in Islamabad’s hospitals, and will document data on injuries, disabilities, amputation and displacement from (published) government and private sources. A chronological record of patients has been maintained in all the hospitals and the study will present preliminary analysis of disabilities, injuries and displacement for devising short and long-term rehabilitation policy for those affected by the earthquake.
* Dr. Shafqat Shehzad is Research Fellow (Health) at Sustainable Development Policy Institute (SDPI). |
