Dr Jamin Mulvey's Blog
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Dr Jamin Mulvey is an Australian Registrar in Intensive Care Medicine. He completed his Bachelor of Medicine and Surgery (Hons) from Sydney University and has completed a Bachelor of Science (Hons) from Queensland University. Jamin has medical experience in Papua New Guinea and South Africa, has travelled extensively including Indonesia, Canada, USA and New Zealand. Jamin has multiple research publications in Shark Neurobiology, Surgery and Intensive Care Medicine. |
This is my last week in Azad Kashmir working in the Medical Program of Australian Aid International, as I unfortunately depart home to Australia . The program is still working hard providing first class care for Kashmir after the October 8 th disaster. This week all dispensaries have been serviced as the weather has remained crystal clear with picture perfect skies. The locals thank Allah for each day without snow and (relatively) warm days.
Most dispensaries this week have made travel plans to the major centres of Khahuta and Bagh to obtain medical supplies as the days are numbered before the road become difficult or impossible to pass due to snow but also landslides to the increased winter rains. This has allowed us to reassess the pharmaceutical needs of the clinics as we prepare to order six months of medical supplies for the Haveli Tehsil region of Azad Kashmir.
Early this week, the AAI medical team attended the Military Hospital to assist in three major cases needing urgent surgical intervention. Under quite different conditions compared to Australian operating theatres, AAI's help was greatly appreciated and it was a great experience. I have also been working closing with one of the Anaethetists at the hospital, analyzing data from the initial earthquake response, looking at one particular method of anaesthesia used with great success under very trying conditions. Just talking with him about his experience during the first 72 hours after the earthquake, operating literally continuously for that whole time, seeing 1500+ critically injured people, inspires respect and awe for what the Military team (of only 4 doctors!!) achieved. They truly deserve to be congratulated.
I also had the pleasure of distributing 30 Gore Tex Jackets, 10 pairs of Gore Tex gloves and 15 pairs of leather boots donated from various Outdoor companies from Sydney , Australia . The items were donated to the Sydney-based, Medical and Rescue company, Immediate Assistants ( www.ias.com.au ), who have very generously supported AAI's relief work in Pakistan . Apart from sending Paramedic Jason Talbot and myself to work in Kashmir , Immediate Assistants have provided emergency medical equipment and the shipment of the abovementioned donated items for distribution. Certainly one of my highlights has been seeing local people one day after distribution, walking through town with a Mountain Designs Gore Tex Jacket….a Kodak moment.
With my departure, a new member to the AAI medical program has arrived, Dr. Neena Rohs. Neena is an Emergency Physician and Public Health specialist from America . She will be here for six months, leading from the front as the Country Medical Director. I will be watching eagerly from the comfort of Australia to the progress of the already successful and essential medical program of AAI, and wish the company the best of luck in the near future.
The weather has improved this week meaning access to all our clinics within the Haveli sub-district, Kashmir . With the reprieve in weather, AAI, WHO and local organisations have increased supplies of vital medications to major distribution points, allow regional dispensaries to restock before the winter finally closes in. Also associated with the warmer weather, the incidence of acute respiratory illness has stablised for the week, although this too is certain to change. In some ways, this period of warmer weather is the calm before the storm. Shelter provision continues to be pivotal to the wellbeing of the community and many families throughout Kashmir remain without suitable winter accommodation, increasing the likelihood of pneumonia and hypothermia in the weeks to come.
We have visited all clinics this week, reviewing their patient presentations, medical stores and advising them of our education program to be initiated in the coming weeks. As always, medications were accepted with much gratitude, particularly paediatric paracetamol, paediatric antibiotics and scabies treatment, all of which are constantly in low supply within the Kashmir region. Earthquake-related injuries have mostly been diagnosed and treated, and most illnesses are back to pre-quake levels. The AAI team this week saw a variety of patients, including numerous lacerations and one elderly diabetic male with a dense hemiparesis (stroke) requiring urgent referral and treatment. The AAI health program continues to give much needed support to the local people and improving medical care.
I have had the opportunity to work closely with the Military Hospital in Kahuta, analysing data from the initial earthquake and the use of ketamine in emergency field surgery for 150 patients. Major Anjum (anaesthetist) and myself are closely reviewing this information, with the aim to publish results in the near future. This week I will be working with the understaffed surgical team at the Military hospital, assisting in major cases. This collaboration strengthens AAI's commitment to the Kashmir region and improves our relationship with the military hospital and local health providers.
Sasha Poll, our most recent addition and Medical Coordinator, is closely liaising with the local District Health Officer both in our region, in Bagh, and in Islamabad . Here for up to six months, Sasha is developing and instituting an Education program for the local medics and lady health workers. As medicines and disease treatment has changed somewhat, and many workers have not had further education for up to 25 years, this training and education program aims to improve health care provision and allow for sustainability after AAI leaves the Kashmir region. The aim of this program has been discussed with local health staff and authorities and they are eager to participate. The curriculum is currently being discussed with the Pakistani Government District Health Office.
With the Department of Foreign International Development (DFID) funding being approved this week, our medical program stepped up a notch and is full steam ahead. AAI continues to fully assess, support and work with the local health care providers in difficult circumstances, leaving its mark of world standard health care in Kashmir .
It's finally arrived. Our forward operating base in Lasdana this week suffered the beginning of the snow season with 10-12 inches of light white stuff. As a consequence, the roads have become impassable for 4 days, limiting our medical operations. Both army and civilian vehicles are unable to cross the mountain pass from Lasdana into the valley where our medical operations have been based. The picturesque, snow covered mountain peaks and valleys provided a spectacular vision. However with the beauty meant cold, freezing, conditions with long nights for the Kashmiri's with poor shelter and limited blankets. Thankfully the weather warmed quickly, opening access after 4 days and allowing still much needed supplies to be urgently distributed.
The arrival of snow however, didn't mean that all work was suspended. For the AAI team concerning all field operations, diversity and flexible is the key. The AAI team has demonstrated traits of perseverance through the coming snow. Our shelter program, currently led by Jim Thynne, has been suppling emergency shelters, the IRAS, to those whose homes have been destroyed by the 8 th of October earthquake. With the fall of snow at higher elevations and cold rainfall in the valleys, the urgency of shelter provision and distribution was palpable. Our medical team, stranded by the snow, immediately responded providing help to the shelter team.. Coordination with other NGO's and the military allowed AAI to distribute 40 shelters to high priority families in the Bagh Tehsil, with another 200 due for distribution in the next few days. Jim and myself hiked into a remote village to monitor progress of shelter construction. The program is progressing well and families are grateful for the kindness and the protection of the emergency shelters before the height of winter.
Our medical program recommences tomorrow with Dr Bryan Chaffee, and Sasha Poll joining the team. Hopefully with the cold weather this week, and our inability to access clinics, that the community are fairing well. We all pray for clear skies but the snow is inevitable..
It's been almost three weeks since my arrival from Australia to work as a Doctor for Australian Aid International (AAI) in the rugged mountains of eastern Kashmir . What an experience so far! Although I have never participated in relief health care before, having worked in remote places such as Papua New Guinea, Southern Africa and Central Australia has been great preparation. Now acting as Medical Director for AAI, I can say that it's been a great adventure from the first day I arrived.
Moving from the initial emergency phase of relief work to primary health care assessments, outbreak surveillance and medicinal support for Basic Health Units (dispensaries), the work here in Kashmir has been both varied and interesting. Working with AAI and as part of a dedicated team of nurses, paramedics and logistical personnel, we are continuously providing much needed assessments and support to the local people in the current natural disaster. As with all third world countries, the majority of morbidity in eastern Kashmir arises from infectious diseases (such as measles, malaria and gastroenteritis), malnutrition (such as iron-deficiency anaemia and iodine-deficiency thyroid enlargement), and poor antenatal/postnatal care. Compounding the usual pattern of these conditions, earthquake related issues have complicated matters. These include major soft-tissue and bony injuries, infected wounds, lack of usual shelter and the ever-present threat of a long, cold winter. This is putting strain on an already burdened health care system, and AAI is doing our part of help the plight of the Kashmiri people.
Whether driving around the mountains to run clinics with the local dispensers, or hiking to remote villages, the needs of these people are a continuous reminder that our efforts are required and the local people are always forthcoming in their gratitude. Equally expressing gratitude are those not directly affected by the earthquake including senior military personnel and even taxi drivers in the cities. They all know the devastating affect that this tragedy has had on its people and the huge effort put in by the national and international community.
Although my time in Kashmir comes to a close in 4 weeks, AAI will continue to assess and treat the Kashmiri people, and work closely with governmental health care providers to stabilise the current health care crisis into the next phase of relief and beyond.