MHU

Project Summary

Organization profile

Project Rationale

Problem statement

Project Intervention

Activities during the year

Team of professionals

Creating a difference in life of patients

Graphical Evaluation

Training sessions of Lady Health Workers

Health and Hygiene Education services

Focus on Health Education

Determinants of Health

Community coordination

Details of MHU record

Site Map

Case studies

Analysis and family response

Health interventions

Plan for next year

Recommendation

Project Summary:

Project Name:	MOBILE HEALTH UNIT (MHU)
Location	UC Malal, Tehsil Fatehjang, District Attock
Target Group	A deserving community with no health facilities
Objective	To stabilize health conditions in deprived villages
No. of Beneficiaries	About 5700 patients till date
Sponsored by	ICNA Relief Canada
Implemented by	Helping Hand-Pakistan
Lead Responsibility	Dr. Atifa Raees ( Medical officer Health)
Support Responsibility	i) Muhammad Zahoor- Dispenser ii) Samreen Rizvi- Staff Nurse
Budget of the project	US$ 20,000
Key Aspect of the project	The key aspect of our intervention in the community was that we provide complete medical services along with lab facilities. This project was focused on neglected members of community, i.e. females, elderly people and children. Apart from treatment offered to the patients, it also focuses on epidemic control, health awareness, antenatal and postnatal services, health maintenance and rehabilitation.

Organizational profile:

Helping Hand is a worldwide non-political, non-profitable charity, devoted to humanitarian relief and development, responding to human sufferings in emergency and disaster situations at home and abroad. With a mission to strengthen the bonds of humanity and mercy, Helping Hand embodies the ideals of sustainable development through combined efforts, active involvement and interaction of all segments of society. MOBILE HEALTH UNIT is milestone providing efficient medical services to cater poor masses of community in far flung areas.

Project Rationale:

The prosperity of mankind is dependent upon the physical, mental and social activities of individuals, that is why WHO defines health as a state of complete physical, mental and social well being. Considering the importance of health, it has always been a major issue in the history of mankind.
It is unanimously agreed upon that health is a ‘basic right’ for all and that is the motto of this mobile health unit of helping hand for relief and development.

Tehsil Fateh Jang is located at a distance of 55km from Islamabad, the capital city: it has14 union councils and 152 villages.Having a population of about 3 lacs but it is still deprived of basic health facilities.Each union council has one BHU(Basic Health Unit), but its access is limited due to lack of transport in remote villages.

Despite its proximity to the capital, no apparent improvement is visible in health facilities. Due to poverty and limited income, the local people have to struggle a lot to make both ends meet. The initial random sampling surveys conducted have revealed that conditions related to health and hygiene is poor.
Most of the women and children are anemic in these areas, and bone pains are quite common even at an early age. Sadly, tuberculosis is still prevalent in these areas.
The entire scenario results in high morbidity rates thus affecting the capacity of individuals and reduction in their contribution to the development of the nation.

Problem Statement:

Project Intervention:

Our foremost aim is to help people of the most deserving villages in terms of health care facility, a step to attain a state of complete physical, mental and social well being. We have targeted to treat 1000 patients per month in the area under consideration.
This project is specially focused on the health of neglected members of the society including women and elderly patients who are suffering from chronic diseases. This is a well planned project implemented after proper survey and need assessment. Apart from treatment offered to the patients, it also focuses on epidemic control, health awareness, health maintenance and rehabilitation. This project not only enables people to enjoy a better state of health but also enhances the productivity of the individuals contributing to the development of a nation.

Incidence rates of various food, water and air borne diseases reflect the level of public health surveillance. Organizing a clinic in certain remote areas provides a complete picture of major existing diseases, health issues, hygiene conditions as well as indicating critical problems including outbreak of a certain diseases, exacerbating factors and sanitation problems. A strategy is hereafter developed to control specific strains of viruses that help reducing social menaces as well .From a health perspective, community is encouraged to undergo screening tests for Diabetics and Pregnancy. Antenatal and postnatal services are among the few services provided to the local people. It encounters diseases ranging from an acute attack of minor episodic illness to chronic ailments persistent for several years. It aims to ensure that the communities enjoy a disease free environment. Coordination with nearby Government health care facilities is established for sustainability of the project.

Activities during year (Jan-Dec 2007)

Team of Professionals:

Right to left: Staff Ambreen, Dr.Atifa and Dispenser Zahoor

Creating a difference in one's life:

We have been successfully conducting two mobile health clinics in two villages - Marri and Qolyar of tehsil Fateh Jang for the last one year. We have conducted about 90 clinics till 1 September 2007 and a great number of patients benefited from this facility.

We have achieved marvelous results in organizing clinics in Fetah Jang (Marri and Qoliyar Villages). During my first visit there were 68 patients in Qoliyar but after a couple of successful visits, the number of patients have drastically reduced to 38 and simultaneously in Marri in the beginning there were 62 patients which now declined to 32. The people of the area highly appreciate and confirm that due to good medical facilities their families have recovered from illness. A positive trend is obvious as it reflects from the eyes of the patients; they look more satisfied with the clinic services. A family consists of 9 members came to our clinic and they all were suffering from different diseases – 2 grand parents with chronic COPD and parents with upper GI Bleed cases, their 5 children were afflicted with the skin diseases. All kids recovered drastically and parents problem were also settled. Now, only one of the grand parent’s visits to our clinic, eventually the no from 9 has fallen to 1. This is one example whereas there are so many families that recovered from acute illness and applauded our services.
Similarly, numerous obstetrics and gynecological cases were examined in homes during our visits; they are thoroughly advised about precautionary measures to conduct a safe delivery to avoid any PPH complications. . Thus, a Quality health services created a marked difference in life of patients.

Relieving the pain of deprived communities

Graphical Evaluation

The above graphical representations indicate the flow of medical intervention in last year. In Marri apart from few months the graph bar reflects high numbers of patients were checked and cured but the reason for high number is due to high population of the area.

Contrary to Mari, the situation in Qolyar is opposite. The reason for that is the patients were low due to the fact that the population of the area is also less. The ratio of curing the patients remains the same.

The doctor spends about 5 minutes per patient and an average 350 patients per month were checked and medicines given in Mari whereas in Qolyar an average 250 patients per month are checked and medicines given. The cost incurs is Rs.46 per patient.

This graph demonstrates that during the treatment, no. of females exceeded no. of children and males. Female cases include general cases as well as antenatal, postnatal and mother feeing problems were highly reported. The no. of children ranked second in this regard and males the third one.

Focus on Health Education

Health Education is an integral component of health care services. It is a paradox of our times that despite unprecedented development in medical science and knowledge, the people in the developing world still deprive due to their ignorance in health and hygiene practices. This situation can only be improved through health education.

Every time a patient visits a doctor, he/she is always advised and given proper guidance regarding the necessary preventive measures to tackle the illness in very simple terms along with the concerned prescription. Similarly, a mother is always informed of her child ailment and remedies are suggested to prevent the diseases for future. By strictly observing preventive measures, one can avoid future risk of affliction of diseases and thereby improving his/her health standard and save money on medical expenses. Thus, the issues of parental education, child development, health maintenance and negligence with regard to preventive measures should be emphasized.

The people of these villages were deprived of medical facilities as there was no health care unit available. The level of education of the people of that area is very low. They are unaware of the hygiene practices, which have led their living conditions to be extremely miserable. Since when we started our clinic over there, the big change occurred in the lives of those people. With our continuous and uninterrupted visits it was so useful that many chronic patients were recovered from their long and uncured illness.

Determinants of Health:

Training Sessions of Lady Health Workers

We not only provided them medical services, but also imparted them training on health issues. We conducted four sessions on training of lady health visitors and lady health workers. The training session includes how to examine the female patients and handle the obstetrics and gynecological cases. Simultaneously, a large number of patients were checked in the BHU. The exercise of organizing a mobile health clinic is still going on and it would bring a positive change in the lives of the people every day that comes in their life.

MHU efforts made a great difference in lives of patients who have lost all their hopes. Not only provided them medical care by specialized medical team but also counselling services were provided to boast up their morals against their illness.

Health and Hygiene Education Services:

Dr.Atifa Raees and Dr.Fozia Aziz conducted master training workshops on different topics in HELP IN NEED offices. Once the master training workshops were conducted, these hygiene promoters visit their allotted schools and deliver the health and hygiene lectures to the school children and the teachers. Activities relating to hygiene practices were highly appreciated. Supervisory team of Helping Hand which comprises of doctor and associated staff visited the training sessions in schools of Fateh Jang, Muffazarabad and Bagh. Feedback taken from school staff and children were positive and our services were applauded. The master training curricula was completed and now workshop sessions in schools are being carried on.

All topics presented in curricula for the year 2007 were completed. The average attendance per training session in the workshop was 25-28 participants. The causes, symptoms, treatment and preventive measures of abdominal pain, skin diseases and tobacco inhalation were discussed in detail as well as dental hygiene; personal hygiene and healthy food were highlighted. Their health risks were discussed in detail. Main objective was to create awareness among school teachers and children to maintain hygiene practices, as children are most vulnerable to illness. This would not only propagate healthy campaign but also prevent the outbreak of any fatal disease.

After the session, an evaluation performa was given to get feedback from the participants. The participants highly appreciated the presentation that was an interactive one. Question and answer session was highly commended. Before the session, the hygiene manuals were distributed among the master trainers to promote health and hygiene education services.

The topics covered so far include:
• Skin diseases
• Our five senses
• Common Cold
• Tobacco and Inhalants
• Personal Hygiene
• Abdominal Pain
• First Aid
• Clean Water

Outcome of HHES

Children can take action in different places
At School children can	At home Children can	In the community Children can
•Learn together actively •Help and teach their Friends •Help and protect younger children •Help to make the surroundings healthy	•Describe and demonstrate what they learn •Help their families with good hygiene practices •Teach and help younger brothers and sisters •Play with children who don’t go to school •Keep the home surroundings healthy	•Pass on messages through plays and gatherings •Act as messengers and helpers •Participate in healthy campaigns

Snapshorts of the Training Program

Community Coordination:

Health committees were formed in the communities for active involvement and participation of the community members in health care services. This facilitates towards the sustainability of the project and ensures the collaboration within the society.
In each area where clinic is conducted, two committees were formed - one of males and the other of females to get active feed back from the community. The committees are also given the task to select 2 volunteers from the community which will be trained by us as health workers for future.

MHU Record:

Donation through wire transfer	Rs. 1,130,555
Expense	Amount
Expense on Doctor & Paramedical Staff	639,134
Medicine Expense	119,497
Ambulance Services	141,546
Fuel Expense	63,642
Repair & Maintenance	6,579
Mobile Phone Expense	6,749
Printing & Stationery	14,792
Food Refreshment	6,57
Total exp.	992,596
Remaining Balance	137,959
Income received by patients fee	62,425
Total balance carry forward to 2008	200,384

An amount of Rs.1130555 was allocated for this project, out of which Rs.992,596 have been consumed that stands for 93% utilization of budget. This included the expense on medical team, medicines and ambulance services were consumed.

Site Map:

Case Studies:

Cure of Chronic Hypertension:

Hypertension, commonly referred to as "high blood pressure" or HTN, is a medical condition in which the blood pressure is chronically elevated. Hypertension is considered to be present when a person's systolic blood pressure is consistently 140 mmHg or greater, and/or their diastolic blood pressure is consistently 90 mmHg or greater. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or tinnitus. Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy.
Mild hypertension is usually treated by diet, exercise and improved physical fitness. A diet rich in fruits and vegetables and low fat or fat-free dairy foods and moderate or low in sodium lowers blood pressure in people with hypertension. There are many classes of medications for treating hypertension, together called anti hypertensives.These must be given after proper check up and follow up is mandatory for adjustment of medicine dose.

Case no.1:

A patient named Mohd Yar 70 years of age is continuously suffering from high blood pressure known as hypertensive for last 5 years but he was not on any medication. Off and on, he suffered from headache and severe pain. His blood pressure remained very high i.e. 220/ 110. Despite having medicines, his BP couldn’t be controlled. During my first visit to Marri on 2 July 2007, his medicine regime was changed. He was strictly advised diet chart, which he followed and after 1 month of proper treatment, his BP was fallen to 140/90; his general health also improved and he gained strength. Three weeks later his recovery was evident as all his symptoms diminished and blood pressure was reduced to normal range.

Analysis And Family Impact:

Belonging to an extremely poor background and without any medical facilities, Mohd yar has been suffering for last 5 years; his ailment had made him very sick and weak; his body resistance has drastically reduced and he became inactive and pessimistic about his life. Due to his frail condition that prevented him to go to work has further enhanced his financial problems and consequently his illness aggravated. MHU services provided a ray of hope in his life and he was able to come over his ailment. Counseling sessions were done to boast up his morale and encouraged him to continue his treatment. His family commended medical services and had a sense of relief on seeing him back to his normal routine of life

Management of Skin Infections:

Skin infections are one of the common infections prevalent today, most common in poverty stricken areas. The first symptoms are redness, pain, and tenderness over an area of skin. These symptoms are caused both by the bacteria themselves and by the body's attempts to halt the infection. The infected skin becomes hot and slightly swollen and may look slightly pitted, like an orange peel. Fluid-filled blisters, which may be small (vesicles) or large (bullae), sometimes appear on the infected skin.

The treatment for skin infections is intravenous antibiotic therapy and surgical removal of the dead tissue. Large amounts of skin, tissue, and muscle must often be removed, and in some cases, an affected arm or leg may have to be amputated
If timely treatment is not given, then these skin infections can result in the follicullits, skin abscesses and carbuncles, so proper treatment must be given in time to prevent from any complications.

Mohd yar having BP monitoring

Medical checkup and Counseling Session

Back to normal life again

Case No.2:

A patient named Ajmal, 12 yrs of age presented with extremely deteriorated condition having boils and pimples on his skin. He presented with multiple skin infections. If one infection or spot subsides, there emerges a new one. His hygienic conditions were extremely deteriorated. He was briefed about hygienic practices. Infact, all his classmates were affected by his infection. These skin infections were not only limited to Ajmal, but also extended to his other six class mates. All were treated accordingly and were briefed about hygienic practices, how to prevent further from deterioration? They all responded very well and their ailment was totally cured with proper medication.


	Medical checkup of ajmal in marri

Family Impact and Analysis:

The families of all the students were thankful as they were happy to see their kids back to normal. After getting cured, the student’s conviction become stronger on hygienic principles and whatever they were told about hygiene, they followed it rigidly; as a result they are now passing a healthy and active life. Their parents are also happy to see their kids in good health. They highly applauded our services and as a result, these young boys started practicing the hygienic principles in their homes too.


	Counseling Session of School Boys

Misguided Case of Respiratory Tract Infection

Respiratory tract infection symptoms mimics tuberculosis in some cases but a professional physician eye can distinguish between the too. Same cases were reported in MHU clinic but detailed account provided a different story. Respiratory infections must be differentiated from tuberculosis on clinical and pathological bases to guide patient for proper treatment. According to WHO, TUBERCULOSIS, an air borne disease spreads like common cold afflicts about 9 million people and has caused more than 2 million deaths world wide.TB ranked 7th on list causing global mortality.

Case No: 3

A young girl RABIA, 23 years visited our clinic on 2nd July 2007. I was told by her relatives that she is suffering from PULMONARY TUBERCULOSIS. An extremely weak, deadly pale, lethargic girl presented with history of weight loss, dry cough for two months. On examining patient, I figured out she was suffering from Superadded Respiratory tract Infection. Broad Spectrum Antibiotics were given; simultaneously she was advised to undergo few screening tests to exclude pulmonary kock’s. On her next follow up visit, she responded remarkably well and test reports for tuberculosis were negative.That was very cheerful moment for her family as their predictions were proved wrong. Again, she was treated on same lines along with hematanics and multivitamins to raise her Hb level.

Analysis and Family Response
On first visit her parents were very nervous as their daughter’s condition was getting worse and worse day by day. Moreover, they were misguided and apprehended of
PULMONARY KOCK’s fear. They had no resources to acquire medical aid; they had a sigh of relief when they saw that situation is being tactfully handled. Patient improved drastically, all her symptoms subsided and she came out of her miserable phase. COUNSELLING SESSIONS were done in which her morals was boasted and she was brought out of her depressive phase. Her relatives were strictly advised not to believe on layman stories. Her family was very thankful to see Rabia Happy and back to her lifeagain. Hence, not only adequate treatment is required but proper DIAGNOSIS at the proper time can give patient a new life with new hopes.

Management of Anemia

Anemia is from the Greek (Ἀναιμία) meaning "without blood", is a deficiency of red blood cells (RBCs) and/or hemoglobin. Anemia goes undetected in many people, and symptoms can be vague. Most commonly, people with anemia report a feeling of weakness or fatigue, general malaise and sometimes poor concentration. People with more severe anemia often report dyspnea (shortness of breath) on exertion. Very severe anemia prompts the body to compensate by increasing cardiac output, leading to palpitations and sweatiness, and to heart failure. Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia, but it is not always apparent. Other useful signs are cheilosis and koilonychia. Pica is the consumption of non-food such as dirt, paper, ice, wax, grass and hair. It is a rare but characteristic sign of iron deficiency anemia. It must be properly diagnosed and treated accordingly. Similiar cases were reported here as well.

Rabia having a medical check up in Marri 2 July, 2007

Confirmation of diagnoses on 16 July 2007

Happy Rabia back to her life again 23rd July 2007

Case No.4

A child named Bilal, 3 yrs of age resident of village Marri visited our clinic on 9 July 2007 with complaints of extreme fatigue, weakness and breathlessness. He was having pain in legs and eats sand. On examination, it revealed he was markedly pale and abdomen was tender too. Clinically diagnosed as a case of Anemia, he was put on iron deficiency treatment and his worm infestation problem was managed too. His mother was very upset as his health was declining day by day. He couldn’t eat anything with feeling of nausea. His treatment was carried out and Bilal‘s health showed marked improvement. His appetite increased and problem of pain also settled. Later his mother was counseled about his health and was advised his diet plan.


	Bilal having medical check up on 9 July 2007	Counseling session for bilal’s mother

Analysis and Family Impact

Bilal‘s health was in danger and if he were not treated within 2-3 months, he could only be saved by blood transfusions; but MHU timely service saved Bilal to suffer from any further complications. He was advised treatment for 3 months. All the medicines were provided as their financial condition didn’t allow them to purchase medicines on their own. On having proper hemetanics, his cravings for non nutritive substances like pica, sand diminished as his body requirements were fulfilled. Later, Counselling Session was done and her mother was briefed about his diet chart which should include red meat, poultry, eggs and green leafy vegetables. His family highly appreciated our efforts and was thankful to see their son Bilal in active life again.

Health Interventions:

* Getting proper nutrition.
* Keep yourself neat and clean.
* Exercise by health care professional.
* Adequate sleep.
* Drink lots of fluids.
* Avoid contagius diseases.
* Promote Hygiene awareness.
* Effective health counselling services.
* Live in healthy and smoke free environment

Plan for Next Year:

* Ensure sustainability of the project.
* Encourage community mobilization with the help of social organizer.
* Continue Mobile Health Clinics services.
* Training of LHW’s and LHV’s in BHU’s.
* Meeting with Help in need about health and hygiene project and work plan.
* Continuation of health and hygiene educational workshop sessions in HIN.
* Workshop for capacity building of Helping Hand staff on weekly basis.
* Selection of deprived villages for expanding the MHU clinics.
* Survey of selected villages where there is extreme dearth of medical facilities

Recommendations:

By the grace of Allah Almighty, we are successfully organizing these clinics with good community cooperation. The quality of the services we are providing can still be improved if more funding is available to cater the need of more people. The donors are requested to come forward to lend more money to help ease the pain and sufferings of the poor and deprived masses. For Helping Hand, the motto of life is to serve humanity as it believes to provide comfort and health to the needy ones that require affection and support from the affordable people. MHU provides efficient medical services to the deprived, the destitute and the deserving communities to give them new life and new hopes. Thus, implementations of health interventions and education system should be done in order to provide a quality life style.The project is also re sponsored by ICNA Relief Canada for the year 2008.