Pakistan Day 1 - Nov 13, 2005
My stomach is in knots. It has been that way for days. I don't know if it is from excitement or fear. I've been wanting to do something like this my entire life. I feel so blessed to have this opportunity but I'm afraid I won't be of much use. I have a lot of knowledge in my field but most of the knowledge has to do with the technology of health care. I don't think there will be much need for technical knowledge in Pakistan . I'm unsure of what to expect. I am having a hard time seeing what my role will be. I know there will be some public health nursing (the one area of nursing in which I have absolutely no experience -- figures). I think for the first couples of days we will be working with a female doctor seeing women. I don't think we will be dealing with any trauma (although I brought lots of sutures and splinting material), rather people will be coming to see us with general health problems. Then there is the language barrier. I guess the only thing to do is wait and see. The plane ride is nice anyway. I think I'll try to get a little sleep.
Pakistan Day 2 - Nov 14
So far everything has been perfect -- not one hitch. I was able to sleep for about four hours on the last flight. I was sitting next to a couple of young Spanish speaking guys -- they slept most of the trip as well. At Heathrow Sarah found me right away. We had a nice lunch together and now we are on our way. Less than eight hours left before we are in Pakistan . We will arrive there at 0600 a.m. tomorrow morning. I think tomorrow will be an extremely full day. Hopefully we'll get some sleep on this flight as well.
Pakistan to Kashmir Day 3 - Nov 15
Lasdana
0600 -- the sun has not yet risen but there is enough light to see the country as we fly over. The plane will be landing in just a few minutes. Below us lights dot the ground -- a familiar, comforting feeling from the air. Sarah points out scattered lights in the distance, up in the hills. We speculate where we will be stationed. As we come in closer we are able to more clearly discern the terrain. The ground is rough, hard. Deep gorges etch the land. Small villages perch on any available spot. Nothing like anything we have ever seen before. From here travel looks very difficult as we are seeing very few roads. The houses and roofs are in great need of repair. No luxury homes or estates here.
0645 -- Our plane lands. The sun is just coming up as we make our way off the plane. Our first Pakistan sunrise. A tram is waiting to take us from the plane to the terminal. it is packed. Sarah maneuvers us next to a window so we don't miss anything. We see an American cargo plane parked next to a plane from Saudi Arabia . Both are being off loaded of supplies .. some are marked ''Earthquake Relief''. Just a little further down the way sit four war planes.
The most interesting thing are the trucks. They re all ornately decorated -- they look like they would be better placed in a circus rather than in an airport.
0830 -- We found our luggage, obtained our Visa and were met at the airport without any problem. Our driver is a nice young man but he does not speak any English. We are rather confused as to what is going on. Luckily our driver seems to have it all under control.
He drove us through a small part of the city to a house on the outskirts. The house was gated with a guard (unarmed). He parked in front, took us in and had us sit in a very elegant room. Tea was offered then he disappeared. We were in that room for just a short while before another man came in. He introduced himself as the owner of the house and moved us to a more comfortable room. His two young children sat on the floor watching TV. His wife soon joined us. Together they explained that they had to leave but we were to make ourselves at home. They had the cook make us breakfast and told us that a different driver would take us to our base once we were ready. We were anxious to be on our way so we ate quickly then went out to find the driver.
The drive was about two hours, mostly in mountainous areas. He pulled into a small complex and asked what number we were. There was then quite a bit of confusion, him talking with people there then a phone call. It was finally determined where we were to be dropped off at. Another gentleman helped us with our luggage carrying it into a house and up stairs into a bedroom. We were very pleasantly surprised. This house did not look anything at all like Dr. Stock had described to me. There were flush toilets, beds, and hot water.
No one else was here which was a little discerning. Here we were, two females, alone in a foreign country, not 100 percent positive we are where we were supposed to be. Couldn't do anything about it so I decided to take advantage of the bed and stretch out. It had been well over 30 hours since I had done so.
About an hour later Sarah woke me telling me she heard voices downstairs. I went down and met Frank and Judy. Frank is medic who seems to be in charge of all of the logistics. Judy is a doctor from California . I was hoping we would be working together but I now discover that she is on her way home. We were able to spend some time talking and she filled us in on what to expect. The first thing I learned was that this was not our base. We still had a four to six hour drive ahead of us. Frank told us that there was a delay -- the car was being repaired. He was hoping that it would be done quickly and that we would be on our way by 2:00 .
Two o'clock came and went so Frank decided we would spend the night here and go up tomorrow. There was some talk of going to Islamabad for shopping and he had a meeting to attend there. He and Judy then took showers (very welcome after a week without).
Just before we were to leave Frank told us that he had been in touch with the driver and that he would be here any minute. Frank felt comfortable with us going as long as we left before four. The driver showed up at 3:15 but said that there was a leak that he needed to fix. He spoke some English but not enough to make communication effortless. While he was working we went up took quick showers and tidied up. At 3:45 he still was not finished -- ''5 more minutes''. Many more ''5 more minutes came and went. Finally at 4:45 he looked as if he was winding things up. Since Frank was rather adamant about us leaving by four I tried to call him to see if that was still the plan. I was unable to get a hold of him, so not wanting to waste another day I made the decision to go.
After riding 15 minutes I was already regretting not only my decision to drive out there tonight but I was also questioning my decision to come here in the first place. The road was extremely narrow, steeps cliffs, no guard rails. One false move and it was over. Sarah was almost to the panic stage so I had to keep my cool to keep her calm. Outside I stayed under control but inside I was a mess. And this after just 15 minutes -- we still had 4 - 6 hours of this ahead of us. Frank had mentioned to us back at the house that this driver was not the best and tended to drive quite slow. Slow was just fine with me at this point. On top of being narrow and next to a cliff the roads were in very bad condition before the earthquake -- then the earthquake which resulted in the mountain coming down on the road in many places. It had been cleared but just enough for one vehicle. Soon the sun went down. There were several advantages to the dark. We could no longer see how steep the cliffs were, we had warning of approaching cars by their headlights and there were probably less cars on the road. After about 3 hours of agonizing over whether or not we were going to survive this drive I came to the realization that there was nothing I could do about the situation so I laid down and slept the rest of the trip
2200 -- We finally arrived at the base at 10 p.m. Dominic (the sit. ops. dir) met us at the car. He introduced us to Jamin - a fourth year resident from Australia - and to Jason - a paramedic also from Australia . Dominic gave us a brief tour --. our room first. We were pleasantly surprised -- we each had a bed and we had our own bathroom. The bathroom had a squat toilet and a sink with running water (cold). Dominick pointed out some pretty substantial cracks in one wall of the bedroom letting us know that should there be another quake the wall will definitely come down so the first tremor felt needs to be our cue to get out now. He then took us into the next room and showed us the other side of the wall - it had already come down -- the floor was covered in rubble. Sarah leaned over and whispered to me sarcastically ''I feel really safe now''. Then there was the boys room, slightly larger than ours otherwise the same. We then went to the big room. One side was like a living room, with a couple of coffee tables and assorted couches and chairs gathered around them. The other side a dining room with a large table and six chairs.
We all sat down together and Dominic went over the plans for the next two days. Tomorrow we were to go to two villages and work with the dispensers -- the men in each town who see patients and give out medicine. They usually have little formal training, maybe six months, but they have a lot of experience. Dominic went on to say that he didn't care what time we got up in the morning (I was relieved as it was almost midnight and we had had very little sleep over the last 48 hours) but then his next words were ''as long as you are ready to leave no later than 0645''.
It wasn't as cold as I had expected it to be. I was happy about that. We were both a little hungry as we hadn't eaten since lunch time (we ate a small lunch with Frank and Judy at the ENI guesthouse earlier) but we were so tired we didn't care. We arranged our sleeping bags, packed up an emergency backpack and went off to bed.
0200 -- I am freezing. It is so cold I can't move. There are extra blankets on a chair across the room but I just can't talk myself into leaving the small amount of warmth that has accumulated around me to go get the blankets. I also have to pee but again I'm not about to leave this sleeping bag to face the freezing air outside of it.
0400 -- Still freezing. I'm able to doze off once in a while but my shivering pulls me back awake. Sarah seems to be sleeping okay though.
Kashmir Day 4 - Nov 16
Bhata-Kot and Budhal
0600 -- Time to get up. I was able to get about an hour and a half of sleep after my last entry so I am good to go. Plus I have a bit of an adrenalin rush going on due to my excitement and anticipation as to what this day will bring. We quickly dress -- thankfully we had the foresight to put our clothes for today in our sleeping bag otherwise they would have been almost frozen. We get dressed, grab a muffin and a juice box for breakfast and we are on our way.
Our first stop is to a small village called Bhata-Kot. It takes us two hours to get there. The distance is not that great as the crow flies but the condition of the roads are so bad (I have never four-wheeled like this before) that we are forced to drive slowly. I 'm glad that we have to drive slow -- it gives me a chance to absorb a little bit of the country.
This country is amazing -- it is different from anything else I have seen. The terrain is very rough, the mountains are comprised of mostly large boulders with a little dirt thrown in. There are a lot of trees -- mostly pines. There are some deciduous trees as well -- their leaves are changing so there is a smattering of color amidst all of the rocks. This country is actually quite beautiful in a rugged sort of way. There are deep valleys and in the distance you can see the snow capped Himalayas . In places the land is forested quite thickly -- reminds me of the High Sierras. There are a lot of little streams so every so often we will come across picturesque waterfalls along the road. During the spring, after the snows melts these little waterfalls are probably quite impressive.
Occasionally we see people sitting on the side of the road. There is nothing around for miles so I don't know where they have come from nor what they are doing. They just seem to be sitting for a lack of anything else to do. Mostly men. They are all wearing the clothes traditional to Pakistan -- large pants held up with a string and a matching shirt that extends below the knees. Many will have a shawl for warmth (the fabric of the clothes is very thin). Almost all have some type of head covering, either a turban type cloth wrapped around their heads or one of several types of hats, although it is not uncommon for a man's head to be uncovered. Their faces are all quite interesting -- weatherworn and curious. I am able to capture some on film. I hope I will get the chance to know some of the people while I am here. Just by what little I have seen, the conditions of the homes and the type of lifestyle I know that these must be remarkable people. Its inconceivable to me what they have been through.
We see a few women as well. They too all dress traditionally in the shalwar kameez -- a long dress-like tunic covering large pants. The men's clothing is always made of coarse, drab colored material. The women's clothing on the other hand is usually bright in color, made of softer material and often with embroidery or other ornamentation. All women wear a dupatta (long scarf) to cover their heads. Once in a while I see a young girl whose dupatta has slipped down and that seems acceptable but never a woman -- their hair is always covered.
No one is overweight -- nor does anyone seem malnourished. For the most part the people look healthy. They are strong -- I see even old men carrying very heavy loads on their backs with apparently little difficulty. Women carry water in large pitchers on their heads but never anything on their backs. Their lives are very physical and hard. There are no machines to help with the work. Corn has to be cut and harvested by hand. Trees cut and wood carried off by men. A walk to the store could take hours. Water is brought up from streams. Nothing is easy.
Devastation from the earthquake is everywhere we look. Many homes completely demolished, the ones that weren't demolished have been damaged -- most to the point of being uninhabitable until they've been repaired. I look into the eyes of the people and wonder how many loved ones they have lost. One of the drivers we had yesterday said that his immediate family was fine but he had lost almost 100 other relatives -- some distant but many not. The earthquake only lasted 28 seconds but what horrific results came from it -- over 70,000 dead. Unknown how many thousands or hundreds of thousands were injured. Every single person in this area has been affected in one way or another. So incredibly sad.
0900 -- We arrive in Bhata-Kot at the dispensary. A dispensary is the place that all the villagers go for medical care. There is usually one dispenser, a water carrier (the assistant -- this person carries water, and does other menial tasks for the dispenser), and hopefully a LHW (Lady Health Worker) or LHV (Lady Health Visitor). The difference between the two is that a LHW lives in the village and works at the dispensary every day seeing female patients while the LHV makes rounds to many of the villages without an LHW so the female patients at those villages only have the opportunity to be seen once a week to once every three weeks. The LHWs and LHVs have even less training than the dispenser but they are vital to these communities as the women will not go to the dispenser (male) to be seen, many won't even take their children.
Anyway back to the dispensary. The dispensary is just below the road. We hike down to it. The building is damaged -- like so many of the others. One wall has completely fallen. Now just a pile of rubble. We discover that the dispenser is not there. That was an awfully long drive only to find that he didn't come to work today. We leave a message with several of the villagers to tell the dispenser that we will be back at noon .
We get back into the trucks and head over to our next town. This road is very rough. It is hard to discern the road from the rest of the terrain. The inevitable happens -- our truck gets stuck. We are unable to get it over the rocks. First we hop out and try to move the boulders around but it makes no difference -- just more boulders under the ones we just lifted off. Then everyone hops into the back of the truck to try to lift the front wheels so that the front wheels can get over the rocks and then hopefully the back ones will follow. After several attempts it works but now the truck is over heated. We leave the truck and the driver and we all get into the second truck. It's crowded so a couple of the guys hop in the bed of the truck and again we are off.
1100 -- Budhal -- it takes longer than expected to get to here. The driver got lost. Really pretty easy to do. There are no signs. To find a place one has to continually stop for directions.
We do eventually get to the dispensary. This one is up on a hill. It too has some damage but not as bad as the last. The dispenser is here but as it is so late we will not be able to see any patients with him. The atmosphere is confusing and hectic. There are a lot of people milling about. Dominic asks that we be taken to a room so we can talk with the dispenser alone. Well, we are taken to a room but we are not alone. It seems that anyone that can speak any English, plus some, are also in the room with us. We are all given tea and cookies. I'm a little worried about drinking it -- I don't want to get sick on this trip. Jason and Jamin drink. I just pretend. I'll see what happens to them over the next few hours -- if all is okay I'll drink next time. During tea Dominic and Jamin try to talk with the dispenser but everyone else keeps butting in and offering their two cents. After we are there a short time an official from the Pakistan Army comes in. He definitely has his own agenda. AAI's objective is to try to schedule a time that we can work with the dispenser to increase his skills and education so that he can better serve his community. What the army official wants though is for all the women in the village to be seen. He is concerned that it has been too long since a female provider has been in this village and he is worried that there may be some very ill women here that no one is aware of. We arrange to come back next week -- Sarah and I will see all the women, Jamin and Jason will work with the dispenser. I ask for a female translator as I expect that will be a very busy day.
After that has been agreed upon we are finally left pretty much alone with the dispenser. We go into the dispensary and see what drugs and supplies he needs. We say our goodbyes, give our promise to return next week and we are off again to Bhata-Kot. Hopefully the dispenser will be there this time.
1230 -- We're back in Bhata-Kot. We check on the truck and our driver on the way. He was still waiting. He had a couple of guys hanging out with him. We let him know our plans then we went on to the dispensary.
The dispenser was here this time. So were quite a lot of other people. There was some discussion as to how we were going to see all these people. We only had one translator and there were many women to be seen as well as quite a few men. I could not see any alternative so I said that Sarah and I would start seeing the women without a translator in an undamaged room in the dispensary while Jamin, Jason and Dominic saw all the men up in an open air area above. My expectation was not to work as a doctor but as I said I could see no alternative.
My first patient was brought to me by her husband. She appeared very ill. The story I got though was that she was here for back pain. She was injured in the earthquake, spent three days in the hospital but has been having pain since (pretty good information getting without a translator huh? Actually Sarah was getting most of the info -- she was much better at it than I). I then examined the woman and found her to have a fever, a respiratory rate of 60, heart rate of 120, and lung sounds that were horrendous. The poor woman had pneumonia but thought she was so sick just from the back pain.
I went up to the top to get antibiotics for her. Jamin was in the middle of doing an I&D (cutting open an abscess and letting it drain) on a child. I discussed my case and we decided what meds to give her. She ended up with an injection and two types of oral antibiotics to be sure she was covered. On my way back down I wondered if maybe I was in over my head. My first patient having pneumonia, his first needing an I&D. What if everyone else is sicker? What if I miss something? This lady was easy -- although the diagnosis was quite a bit different from the complaint. And then trying to work without an interpreter made my chances of screwing up that much greater. I was getting scared. These people had been through enough -- I didn't want to add to their misery by misdiagnosing something. But there was nothing I could do about the situation except be very careful. There was quite a line forming. My gut feeling was that I was bound to do more good than harm -- I did help my first patient. Maybe God is here looking over my shoulder and making sure that I do the right thing and don't make any mistakes. I can only hope (and pray of course).
Sarah and I see 26 more patients over the next few hours. After we had been working alone for about an hour the villagers were able to find another translator so we had our own. Things went much quicker then. Sarah was a great help. She took vitals and did all the scribing. I was able to bounce ideas off of her and before we had the translator she was amazing -- she was great at figuring out what the women were trying to tell us. Sarah did a lot of running too. All the meds and supplies were kept up with the guys so whenever I needed anything she would run up and get it for me. We were a great team.
None of the other patients were a challenge to me. I only needed to discuss one other case with Jamin. It was a lady with a goiter. Of course I learned about goiters in school but had never actually seen one. And then after her I got two more patients with goiters. Very interesting. All the other patients I was able to handle. I don't think I misdiagnosed anyone -- I'm fairly certain that I got through the day without causing any harm.
Before today I was curious as to what my role would be. Now it is very clear. I just hope every day goes like today -- ending with me feeling like I've done more good than not.
1500 -- We're finally finished. The last patients have been seen. We pack up and head back to the base (stopping of course on our way to pick up the other truck and driver).
1700 -- Back at Lasdana. It is so much colder up here than down where we were. I think when I arrived last night I had so much adrenalin pouring through me (both from the fear of the drive up and the anticipation and excitement of actually being here) that I did not really feel the cold. Sure feel it tonight though. I'll be piling ALL of those blankets on me tonight.
We get cleaned up then Jamin asks if we would like to go for a little walk with him. We hike up the hill to the west of us and sit and watch the sunset. It is beautiful. It is so calm up here. We're pretty much isolated. There is a police communication station just below us. The drivers and the cook stay in their house. But other than that there is nothing but mountains and trees as far as the eye can see. I feel very safe here though. So far my impression of this country and these people is that it is a peaceful and serene country. The people are kind and generous. I am so very thankful that Sarah and I were given this opportunity. I know this will be an experience we will treasure for our entire lives.
1830 -- Dinner. Our cook is named Amir. He is 26 and unmarried. He knows a little English -- not a lot. Tonight he cooks us rice, chapattis (flat round bread), and a type of Dahl (lentils). The food is delicious. I don't eat much -- a bit worried about the bathroom situation. The running water we had yesterday is now gone. Apparently the earthquake messed something up and our water supply has been used up. We'll be getting water from the streams I guess, just like the locals.
During dinner the lights go off. I learn this is a common occurrence. So now we have no running water, sporadic electricity, cold weather -- this is more like what I expected. I feel better. I didn't relish the thought of having so much luxury when the people living around us had nothing.
2000 -- After dinner and learning what we will do tomorrow I head off to bed. I'm tired and cold. I'm hoping by getting into bed I'll warm up a bit. Sarah stays up with the guys. She is the social one -- plus she slept well last night. Her sleeping bag kept her really warm. Funny -- mine was rated to minus 15 degrees Celsius, hers to minus 20 -- just that extra five degrees made a big difference. Tonight I put so many blankets on that I could barely move my legs -- no matter, I'll be warm -- that's what counts.
0200 -- I wake up sweating. I think I was a little over zealous with the blankets. I throw half off and go back to sleep. It is so quite up here -- almost eerie.
Kashmir Day 5 - Nov 17
Soli and Hallen-Shilmali
0600 -- Another early day. I have the sinking feeling that all of the days will be early. No sleeping in until I get back home. That's okay -- I'm not here to sleep.
0930 -- The drive to Hallen-Shilmali is long -- almost two and a half hours. The roads are mostly paved but still not the best. It is very mountainous. I feel like we go up several thousand feet before we drop down again. Our driver points out a village high on top of a mountain. He says just behind that village is the Line of Control. I didn't realize we were so close.
We get to the dispensary and again find that the dispenser is not there. We talk with the villagers and learn that this dispenser is often late, sometimes doesn't come at all. Jamin gets very annoyed and tells the villagers to find him and tell him that we will be back this afternoon and that he had better be here.
So now our plans have changed. We head off to Soli to work there this morning then we will come back this afternoon and finish up the day here.
1000 -- Soli is much closer than we thought it would be. The dispenser is there and the dispensary is in pretty good shape. There are no women waiting to be seen but once the word spreads that there are female providers a line quickly forms.
There is a young man in the village who speaks excellent English so he translates for Jamin and Jason leaving us with Ashen (our driver). Sarah and I are very happy with the arrangement as we worked with him for a while yesterday and found him to be quite good.
Between Sarah and myself we see close to thirty patients again. Because it is so busy Sarah and I are working side by side seeing the women and children. She is pretty good with her assessments and she bounces everything off me plus she is still doing all of the scribing and most of the vital signs so she is really helpful. I don't think I could get through all of the patients without her.
No really sick patients today. We've given out a lot of Tylenol for back pain. These women have such a difficult life its no wonder they have pain. I'm thankful I can give them a little something to help ease their discomfort. We saw two more women with goiters, several cases of scabies, and a young girl with a fractured fourth metacarpal (broken hand). The girl broke it when a boulder fell on it during the earthquake. She still had not been seen by a doctor. I went ahead and splinted it and referred her to the hospital for x-rays. She was very unhappy with the splint. She told me she needed to work so could not wear it. I knew as soon as she walked out she would pull it off and throw it in the trash so I showed her how to apply it and asked her to at least wear it at night. She agreed but who knows.
1300 -- We finished seeing patients at about 1:00 so headed back to Hallen-Shilmali. The young man who translated for Jamin and Jason offered to go to the next dispensary with us. He was so helpful that they jumped at the offer. On the way there he sat next to me so we had quite a conversation. I feel bad though -- I can't remember his name. He told me his story of the earthquake. He was attending college. He is getting his Masters in English. At the time of the earthquake he was in his classroom with his 34 classmates. The earthquake hit and 28 seconds later 24 of his classmates were dead. Only 11 students survived. This young man was completely uninjured. He talked about the pain of having to pull his classmates from the rubble, of picking up boulders hoping to save lives only to find his dear friends dead. When he found himself becoming too emotional he changed the subject. He then talked of his family -- not a single death. Many homes were destroyed but no one died. He said that is what has gotten him through the death of all of his friends -- the fact that no one died that was related to him. He then went on to talk of his future and left all thoughts and memories of the earthquake behind. He had an avid love of language -- and he loved practicing. He talked the entire trip -- of anything and everything. He said that he was the only child in his family that was sent off to school. I have a strong suspicion after spending just a half hour with him, that his family sent him away because they couldn't bear his incessant talking. He was a very nice man though, and so very helpful. By him coming to Hallen-Shilmali it allowed Sarah and I to have our own translator so I was thankful. I do have to admit that he was interesting to listen to (I can't say talk to because I couldn't have gotten a word in edgewise even if I had tried).
1310 -- Hallen-Shilmali -- the atmosphere here is quite tense. We talk with the dispenser plus another man who says he is also a dispenser but our driver whispers to us that he thinks this man is a fake. We have the feeling that we are not welcome here. We go into the dispensary and see what supplies they have. We find that this dispensary is very well stocked but the two men are saying that they need more medicines that they don't have enough. They bring out a list of all the supplies they want. It is quite a long list and most of the items on it we find in the storeroom. We are not sure what is going on here. Later Ahsen tells us that the villagers told him that most of them go to other dispensers in other villages because they think these men are bad. We tell the dispensers that we are here to help him see patients and to help with any training he might want or require. They agree to us seeing patients but the dispensers hold back and just watch what we do.
I am told that I only have three ladies waiting to be seen. Jamin is told that the dispenser has already seen most of the patients so he won't have much to do either. My three quickly becomes 6 then 12. The only really sick one is a baby with pneumonia. I give an injection of antibiotic and some oral as well and have his father promise to follow up the next day. The dispenser (the fake one) is questioning my every decision. He doesn't think the baby needed the injection. I pointed out my reasoning -- fever, tachycardia, irritability, coarse lung sounds -- and he finally conceded that the baby was better off with some treatment. As soon as the patients were finished they helped us pack our stuff in our car and said goodbye. We told them we would be returning next week with supplies. They still didn't look happy.
1530 -- we're on our way back. We have a long drive ahead of us. Hopefully we'll get home before the sun sets (1730) just in case there is no electricity. I nap a little on the way home.
1930 -- Dinner is a little later tonight. There doesn't appear to be any set schedule -- I think Amir serves us whenever he thinks we are all ready. Tonight it is rice, chapattis, and a potato dish. Again excellent. Amir is a very good cook.
After dinner Jamin teaches Sarah and I to play a game called 500. It turns out to be a lot of fun. Jamin and I are partnered against Jason and Sarah. It is a close game but Jamin and I win. A good ending to another adventuresome and interesting day.
Kashmir Day 6 - Nov 18
Gugdar
Last night Dominic talked to us about going on an overnight trek up into some remote villages to care for people that no one has been able to reach. As he was talking I wasn't sure if he was trying to talk Sarah and myself into or out of wanting to go. He told us that we would have to make a decision by this morning so that he could make arrangements. Sarah and I talked quite a bit about it during the night. We both wanted to go but my fear was that I wouldn't be able to keep up. We would not only have to carry our own gear up but also the medical supplies we would need. Our final decision then was that if Dominic wanted us to go we would go -- if not we would stay back.
I got up and went to talk to him while Sarah was getting ready. After a long discussion I finally realized that only two or three people would be going so since both of the guys wanted to go and as they were both spending more time here I felt that they should have the opportunity before we did, so having both of them going meant there would be room for only for one of us. I didn't want us split up so I told Dominic that neither would go -- we would both be okay staying back.
Today we go to Gugdar. Last week they held a clinic here and about 300 people showed up. The volunteer staff at that time was only able to see half of them -- today's clinic was scheduled so that the rest of the patients would have an opportunity to be seen. It could prove to be a very busy day.
This was the shortest trip so far we've made to a village. Still over an hour and the roads were not that bad (or maybe I am just becoming accustomed to them?). I look for the hordes of people I am expecting but find no lines. I ask about the lack of people and am told "they will come". Since no patients are here yet we have time to set up, have tea, and sit and talk with the dispenser. Shortly after we arrived a LHW shows up. I was surprised -- I had taken for granted that there was not one here as when Judy came last week there were so many women needing to be treated.
The name of the LHW was Kousar Nisa. She spoke some English and as the morning progressed I learned she was very good at what she did. True she did not have much formal training but her experience more than made up for it. The only thing she did not catch was a goiter. She thought it was an abscess. The first goiter was smallish -- a perfect one to use as a training model. The second one though was huge. This patient was starting to have some difficulty swallowing. I was worried that there might be some airway compromise within the next few days or at least within a week. I sent this patient on to the hospital. Great opportunity for the LHW to see both the simple and the extreme of a condition she was learning about.
Sarah and I both really liked Kousar. As well as being on top of things she was also very compassionate. She truly cared about her patients and would listen sincerely to each and every one of them. After they would leave she would tell the stories of some of them -- the lives they had lived, the troubles they have had. She would speak even of the "frequent flyers" with sympathy, understanding how hard their lives are and wanting to be able to help them in any small way.
The clinic here is very organized. There are four rooms -- a front reception room where a WC (water carrier) writes down everyone's name in a register and also on a small piece of paper which are numbered (keeps everyone in place in line) to give to the provider once it is their turn to be seen. The patients are then brought in one by one so we don't have a room full while trying to see each one. The three other rooms are being used by each of us (Jamin, Jason, and the last for Sarah and me) to see the patients. It is a very controlled environment. Very relaxing in fact. After all the other clinics I would leave exhausted. I can already tell that this day I will leave feeling great.
Late morning Jason came to me and asked if he could use the bed that was in my exam room for a procedure. He had a patient with a abscess over his jaw that needed to be lanced and packed. Remember Jason is a paramedic so he had never had the opportunity to do something like this. I showed him how to infiltrate and to set up a sterile field. Jamin then came over and showed him how to first cut the skin then to use hemostats to open it up and let the pus drain. Jason had a blast doing it. Plus he knew he was helping the patient. After it was completely drained and packed Jason dressed the wound and instructed the patient to come back to the dispensary tomorrow to have it repacked. The patient left with a smile.
This same patient had the worse club feet I had ever seen. I didn't see how he made it onto the bed so Sarah and I speculated how this young man was able to get around. After he left I saw him walking on the street -- he used no stick, had no support at all but seemed to be walking fine -- just a slight limp was noticeable. Amazing.
Today is Friday -- prayer day -- the clinic is open for only half a day so we are finished at noon . We go back to the base, restock our medical kits and decide to go on a hike. It's just the four of us as Dominic went this morning to Bagh to pick up another volunteer.
The hike is long. We go up to the top of a tall hill that is nearby (no small feat at this altitude). I have a lot of trouble keeping up. I expected to do better -- after all I am the queen (almost) of the stairs at work, a few hills shouldn't pose this much of a problem. The guys try to make me feel better by saying that they had a rough time as well when they first came -- I don't believe them. The hike is beautiful though. We get to the crest and discover an abandoned military base. There are bunkers and fox holes -- a perfect place for a base - impenetrable as far as I could see. There was no way for the enemy to sneak up -- the vantage point from here was fantastic.
We continued along the crest for awhile before heading down. At the time the three of them reached the road I was only about a quarter of the way down. I was taking my time, being careful not to trip. Out of nowhere I hear a male voice yell out "Hello". I look across a small gorge and see two Pakistani men headed in my direction. I'm not really frightened but I can see the potential here for a bad outcome so I yell down to Jamin (the only one of the three that I can see) and ask him if he can see the men up here. He answers that yes he is aware of them and that I need to come down now. At that I hauled myself down that mountain at record breaking speed. I got down to the bottom just seconds before the men did. They asked if we were Muslim -- Jamin said no but that we were here to help Muslim people. They asked a few more questions then one of them smiled and asked if we needed assistance getting back to our camp. We told them that we were okay so they headed off, back up the mountain they had just climbed down from. It wasn't funny at the time but after the men left us there were quite a few jokes made about how fast I could move when the need arose.
Dinner tonight is rice, chapattis and curry chicken. Delicious of course but I am getting a little tired of the chapattis. A fresh sourdough roll would be a nice change.
We stay up and put statistics in the computer. I play with my radio for awhile trying to find an American station -- no luck tonight. Jamin had an I-pod which together with my radio he is able to place CDs he has stored on the I-pod. Its nice hearing some music.
Kashmir Day 7 -- Nov 19
Mirch-Kot
Up at six again. The alarm woke me -- every morning prior to this I have been laying in bed waiting to get up. I didn't sleep very well last night -- I thought I would after that hike.
Speaking of hikes today we go for another one. We are going to hike down to a very small village called Mirch-Kot and check on a woman who fractured her femur in the earthquake. I'm not sure I'm looking forward to this little trek. Dom told me last night it was about six miles -- I don't know if that is round trip or one way -- I was afraid of the answer so I didn't ask.
We walked on the road for a bit then started down the mountain. Everyone had full-sized backpacks except for me. I had started out with one but Dom kindly traded my large one for his small. The mountain was very steep to my perception, no one else seemed to think so though, they all trekked down like it was nothing. I think the reason I was having such a hard time was due to my lack of depth perception (sounds good anyway). We had one of the police men with us to help us interpret, as soon as he saw I was having difficulty he came to my aid. He helped me all the way down the mountain. I was still very slow so the rest of the group had to wait on me several times but at least I made it down without losing my footing.
The police man's name was Farruhk -- a very nice young man. He has been at this station for one year. He has a daughter, just two and a half years old. He says he lives close so is able to see her frequently (his job requires him to be there 24 hours a day 6 days a week).
As we are hiking down I can't help but think of the trek back up. Farruhk is worried about me falling so he offers to carry me -- I laugh and tell him maybe on the way back up. He laughs at that. Sarah is hopping off the rocks like a mountain goat. Farruhk notices as well and points out how tough she is.
We get to the Mirch-Kot in just an hour and a half (must be six miles round trip -- thank God). It is very small and very spread out. We come up on two makeshift tents. One is where the lady with the femur fracture resides. Her family helps her out of the tent. It is very difficult -- painful even to watch. She is youngish, in her 40's I think. She is unable to bear weight, even setting her foot down gingerly causes her to grimace in pain. They support, half carry, her over to an area a few yards in front of the tent and gently set her down. Jamin examines her over her pants. Her thigh is extremely swollen and there is a hardened area which feels like a large scab. She won't expose her leg until Sarah and I come over. Once she pulls down her pants and we can visualize her thigh we realize it is much worse than we had thought. The scabbed area is about 7x3 inches. Looks like a necrotic pressure sore but it may be a healing wound from the initial injury. Her thigh is swollen to twice it's size from her hip down to her knee. She was complaining more from the pain in her knee than from the pain in her femur. It's possible that the swelling had created a splinting effect so the femur was somewhat stabilized.
Dr. Stock had seen this same lady when he was here. The picture of her splinted fracture is the picture I used to obtain the donation of ortho supplies that I brought here (along with many other medical supplies).
This was the saddest case I had seen. This poor woman was obviously in so much pain that she couldn't move. There was also the potential that the femur was fractured in such a way that without treatment the woman would never again be able to walk. This was probably a death sentence in this country. With the bad weather coming and her inability to move around there is also a good chance that she would get pneumonia. Jamin and Dom explained all of this to the family through Farruhk. It was very slow going but finally the seriousness of her condition was conveyed and the family agreed to help us get her to a hospital. In the past couple of weeks there have been teams who have come down and tried to get her to go but it has not been successful for one reason or another. The plan is now for Jamin and Dom to go down early Monday morning and give her a nerve block then her family will carry her to the road (they won't be able to take the route we came because it is too steep -- there is another road about three hours away but it is downhill). We will meet them with a truck on that road then transport her to the hospital.
While all this conversation and translating was going on I was getting to know the family. There were ten people present while we were there. A grandfather and grandmother, the woman with a femur fracture, her husband, another woman with her husband, and four children from about nine to fourteen. The other woman came up to me first -- we greeted each other then she took me on a short walk. I didn't know where she was leading me but she was insistent that I follow her. We hadn't walked far when we came to what used to be her home. It was completely flattened. It was devastating. I don't know how the one woman got out with only a femur fracture. The weight of the roof had caused the walls to completely disintegrate. We stood there for a few minutes just staring at the house, my mind in turmoil imagining what it must have been like for this family, hers going over the images that have been permanently ingrained into her memory. She then was able to pantomime that her family now has nothing but the clothes on their backs -- everything was lost. She praised Alah that her husband and children had not been injured, but expressed worry that her family would not survive the winter due to lack of food. There was a large blanket in front of the tent where corn was laid out but it was not enough to get the family through the winter. The bad weather coming up is an issue that cannot be ignored. They have to get a better shelter -- I can't see them surviving the elements in that makeshift tent. Such a devastating situation.
We walk back over to the tent to find that tea has been made for us. I worry about drinking the water but cannot be rude. The tea is actually quite nice. Sarah drank a cup as well - - if we do get ill we can suffer together. I go up to the backpacks and gets balloons for the kids. They are hesitant to take them at first -- their shyness is endearing. Finally the youngest girl accepts one that I've blown up. The other children then follow suit. I blow up one for each of them (no easy task in this altitude) and hand them several more. The mother asks for some for children who are not here so I give her several handfuls. The father is standing nearby so I hand him several as well. He laughs as he slips them into his pocket.
Several of the other family members want to be seen so Jamin and Jason are seeing to them as I play. The old woman wants me so I check her out. She was also injured during the earthquake. There is a healed L-shaped gash under her eye as well as a still swollen area over the same eye. I couldn't palpate any facial fractures so I let her know she was doing good. She then complained of her back. There was still some soft tissue swelling over her left flank but she wasn't tender and I couldn't palpate any deformity so all I could offer was some pain medicine. I did spend a few minutes giving her a backrub which she seemed to enjoy.
It was now time to leave. The woman offered to feed us lunch -- I declined as tactfully as I could. There was no way that I could take from their meager stores -- they don't have food to feed themselves much less enough for all six of us. How very kind of her to offer though. I sit for a while with the woman who fractured her femur. I hold her hand, we just look into each others eye, both of us trying to communicate feelings that words cannot express. She seems to be somewhat comforted by our presence -- I think maybe she was feeling hopeless and now some hope has been renewed.
All too soon we say our goodbyes and head back up the mountain. I leave with a very heavy heart. I feel at a loss as to what can be done for this family. There are so many in need with so few resources. It is truly heartbreaking.
The hike back up is steep and very soon I am out of breath. Farruhk sees my struggle and takes my backpack from me. I am extremely grateful. Sarah is still doing great. I'm so proud of her. Farruhk is right -- she is a tough girl.
About halfway up I feel blisters starting to form. I'm having to take more frequent breaks but everyone is being patient with me. One good thing about being my age -- special allowances are made for the elderly.
Sooner than I expected we make it to the road. It took about 3 hours to get back up. I now know what all the people are doing that we see standing on the edge of the cliffs and on the sides of the roads -- they've just trekked up the mountain and are now resting. I can now feel their pain.
Once we get back up to camp we all do our chores, take showers (more on that in a minute), then lay out on the grass and chill. It was a good hike but now it is time to rest.
Okay now about ''showers''. The concept of ''shower'' here is totally different from that at home. Remember there is no running water here so water has to be carried from a stream or sometimes the military will give us some -- anyway water has to be conserved. We have about a five gallon bucket in our bathroom that is used for flushing the toilet and bathing. So to take a shower a small tin bucket (about 20 oz.) is filled and just that small amount is used for bathing. For the first couple of days we used cold water (that was miserable) but then one of the guys gave us a heating element which works wonderfully. So to bath myself I scrub down with soap then I use the cloth to rinse off as good as possible then I pour whatever water is left over me. All the while I am shivering so bad that I'm afraid my teeth chattering is going to result in a few chipped teeth.
Marc, Frank, and Omar come up tonight. Marc is the CEO (he keeps trying to get Sarah and me to extend for another three months), Frank is the director of operations, and Omar is the man whose home we stayed at for a couple of hours when we first arrived.
Omar has come up with a unique type of shelter that is warm enough and sturdy enough to get some of the people through the winter. The walls are constructed of empty cement bags filled with dirt. Each layer of he wall is attached to the next by placing barbed wire between them. There is a metal door and a corrugated tin roof that is bent into an upside down U shape. They are large enough for probably 5 - 6 people to sleep in. Omar and the AAI group are constructing the first one at the UN sight. They are hopeful of getting a sizable donation from the Australian government -- enough to buy the supplies for four hundred of these shelters. Although Omar designed them he does not want any monetary reward -- he is a really nice man -- he just wants to do what he can for the people of his country. AAI will deliver a few up at a couple of sights near Lasdana over the next couple of days and we will help build them, showing the locals how to do it so that they can continue building the rest as they are delivered. They will go to families whose homes have been completely destroyed. These families are now living in tents, one family has moved into their stable -- none of their temporary shelters offer protection from the cold. These shelters will save many lives I am sure.
We all have dinner together then we play another game of 500. Jamin and I win again. I think we will stay the undefeated champions on this trip. Marc has a bottle of whiskey. They all get started on that -- my cue to head off to bed.
I lay in bed for quite a while tonight going over everything that has transpired today. It was an amazing day. I am so glad that I was able to go down into the village and meet the family and the woman with the femur fracture. She was so brave. All the people here are stoic. I am inspired by them -- their strength, their generosity, their kindness. I felt very lucky to have had the opportunity that this day presented to me. I didn't start out feeling this way.
Yesterday afternoon Ahsen came to me and asked if Sarah and I would like to go to the wedding of his cousin with him. A wedding in a country such as this is a cultural experience that I have always wanted to take part in. It almost made me sick to decline the invitation. I wanted to go so bad that I could taste it. But I was not here to go off pursuing my private quests -- I was here for a reason. It might have been different if we would have been gone for just an afternoon but Ahsen wasn't going to return for 2 ½ days. It was too long to be away from what we were here to do. Still though I was saddened by this missed opportunity. Such an opportunity would probably not ever be presented to me again. My first thought this morning was the wedding and what I was missing. Now though I am happy with my decision. We are here for a reason and today we were able to bring hope to a woman who most needed it. We met with a family so destitute and were able to let it be known to them that there were people who cared for them and are trying to improve their situation. I went to sleep tonight feeling at peace with myself and with the world.
|
