Reaching the Unreached with Basic Health Services in Earthquake-Affected Areas
By Sandra Bisin
Allai Valley, North West Frontier Province - Her face remains impassive, as 25-year-old Habiba describes her life since the earthquake destroyed her home, taking the lives of her husband and their four year-old daughter. “I had just given birth to our son. He survived, but my husband was badly injured.” Her voice fills with sadness: “We managed to keep him alive for four hours. But there were no health facilities, no doctor around. So he died.”
The 8 October 2005 earthquake claimed the lives of over 73,000 people in Pakistan - 384 in Ganthar - the majority of which were children and women. Even before the earthquake, the community of Ganthar (16,000 people), nested in the Allai Valley in the North West Frontier Province of Pakistan, had very limited access to basic health facilities. Only one doctor had been appointed by the Department of Health to respond to the needs of the entire population of the valley – 145,000 people scattered over 300 square kilometres of mountainous terrain. What is more, in winter time every year, the whole area is inaccessible for three months due to snow fall and landslides.
“It is the first health centre that has ever existed this high-up in these valleys. Before UNICEF set up this facility, it was taking people a minimum of three to four hours to make the journey to the nearest health centre. From now on mothers and children here will have immediate access to professional health services”, says Dr Tamur Mueenuddin, UNICEF Emergency Health Officer.
For UNICEF, the earthquake created a window on the long-existing health needs in remote locations of Pakistan, and an opportunity to reach the “unreached” with health services.
In February 2007, UNICEF opened Ganthar transitional health centre, which combines basic preventive and curative services for children, women and men by providing antenatal and neonatal care, gynaecologic and obstetric services, breastfeeding support, growth monitoring for children under five, regular immunization, basic health information and hygiene promotion.
The two-room steel and wood building is used for surgeries, outpatient visits and as a dispensary. UNICEF also provided an ambulance for emergency transportation. While most of the twenty transitional centres built by UNICEF will eventually be replaced by permanent structures, no other agency is committed to construct a longer-term building in Ganthar. For the community, this clinic is their only local health facility and all services provided are free.
Specific care is provided by three health staff: a Lady Health Visitor, a Female Vaccinator and a Medical Technician.
Ganthar is located in a very conservative area of the North West Frontier Province where an austere interpretation of the purdah system, which limits a woman’s mobility outside her home, is the rule. Most women from the community would rather stay home or travel long hours to the nearest health facility staffed with female specialists than see a male doctor.
“The deployment of female health staff in the affected areas has enhanced access to health care by women, some of whom saw a female health provider for the first time in their lives. These female staff are also tremendous agents of change for Ganthar community”, says Dr Wali Mohammad, UNICEF Assistant Project Officer Health and Nutrition. “Seeing other women working for the benefit of their village and earning a living so their children have better prospects for the future encourages local women from this very conservative community to also engage in income-generating activities.”
“I wish the centre had been there before, then perhaps my husband could have been saved”, says Habiba. “This is the first time I have come. Yesterday, a health worker visited our home and vaccinated my son, Wasif, against measles and other diseases. He told me about the centre and I decided to come.”
Since February 2007, the centre has vaccinated 750 children in Ganthar who had never before been exposed to immunization.
In another room, Rizwana, the 35 year-old Lady Health Visitor is providing health and hygiene advice to a young mother. “Wash your hands before eating and after using the toilets and bathe regularly”. She gives the woman a soap bar. “We see a lot of skin infections such as scabies”, she says. “A phenomenon which stems from lack of good hygiene practices, and is unfortunately very common in these areas.”
“We have around 60 visitors every day. Everyone in the community knows that there is a brand-new centre”, Rizwana says.
To ensure quality of service, and as part of a long-term recovery plan, UNICEF in collaboration with federal and provincial health authorities and NGO partners is rolling out an extensive training programme for healthcare providers. In the aftermath of the disaster, over 600 health facility staff were trained in the essential health-related knowledge and skills - benefiting over one million people.
In addition, 2,600 female community health workers have been trained in basic first aid, health monitoring and the provision of essential health services in the home, such as vaccine and essential medicines, and newborn care. They have also been trained to encourage pregnant women to engage skilled birth attendants for home deliveries. This programme needs urgent funding to ensure that families living in remote communities continue receiving these essential health services. Community health workers are expected to reach about 200,000 families.
“This lady is very nice, I can tell her about all the medical problems I have. And the centre is so close to my home. It is such a relief for all women in the community”, says Habiba.