AAI in Pakistan

15 May 2006

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

The refurbishment at the Soli dispensary is almost complete. A water tank has been built and the bathroom is under construction. Painting has been finished inside the main building with only the roof repairs remaining.

Soli clinic a pleasant transformation!

The 600 Gallon water tank being constructed...

2. INCINERATORS RUNNING HOT

10 of the 12 brick incinerators for clinic infectious waste have been constructed. Only the installation of steel lids remaining. The incinerator lids have a large bore 1.2 meter flu to discharge smoke at a safe height to avoid public inhalation. The steel has been difficult to source, and finally AAI has supplied local the welder with 12, 3mm steel sheets to finalise the project.

The incinerator almost finished at Soli...

An incinerator being constructed in Hillan...

3. AAI GOES TO THE REMOTE AND ISLOATED REGION OF BEHEDI

With the road to Behedi finally opened this month after being blocked by snow and landslides since December, the AAI team at Kahuta packed up the office for three days, taking along all staff. Also along for the ride was Behdi's Lady Health Supervisor, Arifa, who had not been back to Behedi since the earthquake. Whilst at Behedi the AAI team carried out the last of the deliveries of DRI donated medicines and equipment. Whilst the deliveries were taking place the training team held training sessions for 7 Lady Health Workers (LHW) covering Hygiene and Sanitation, Disease Surveillance and bird flu information. This was a significant achievement as these were all the LHW's in the local area and this was the first training they had received since well before the earthquake.

The AAI team carrying medical equipment to the clinic at Kwaja Bandi...

4. MEDICAL DISTRIBUTIONS

DRI donated medicines and AAI purchased medical equipment deliveries were completed to the 8 remaining clinics, bringing to total of 18 clinics that received medications from DRI and medical equipment purchased from AAI funds. The team at AAI is in the process of distributing medical equipment donated by DRI to 19 clinics in the local area.

The Civil Dispensary at Hillan...

5. CELEBRITY CHEF

On the 6th and 7th of this month AAI hosted the famous Pakistani TV chef, Madam Fawzia Tariz in Kahuta. Madam Fawzia was kind enough to donate her time to present three sessions including two sessions of cooking demonstrations and nutritional information and one session on tie-dying as an income generating activity. In total 75 women from the Kahuta area attended the two day activities. This was well received by the local community and an event of such that has never occurred before in this remote region.

Madam Fawzia presenting her lessons...

6. HYGIENE KITS

The long awaited UNICEF 3400 hygiene kits were delivered to AAI for distribution this week. AAI has arranged the distribution in collaboration with union councils and other Community Based Organisations (CBO's). AAI will start delivery in the coming week to an eagerly awaiting community of whom have already completed hygiene training by the AAI training team.

7. VOLTAGE STABALIZERS

AAI provided twelve voltage stabilizers EPI vaccination centers to enable them to operate their medicine fridges at constant temperature. AAI was approached by Sub-district Hospital (THQ) to fill the funding gap, which would have seen the centers go without functioning fridges essentially rendering the vaccination program for the district non existent.

Dispensers receive EPI Voltage Stabilizers at THQ from AAI...

Gugdar BHU Dispenser receives 3000W Stabilizer from AAI Staff members Karen and Basit...

AAI Staff Karen, Basit and Qamar deliver essential 7000W Voltage Stabilizer to Mr Aslam EPI THQ...

8. AAI PREPARES TO LEAVE

AAI 's current DFID funded program for Community Health Initiatives is due to finish on the 31 st May 2006 . Whilst AAI are awaiting the outcome of additional proposals to potentially extend our stay, with no definite funding to extend the program the Kahuta office will complete operations on Thursday 25 May 2006 , centralizing in Islamabad until our future in Pakistan is decided.

30 April 2006

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

•  AAI has selected the clinic at Soli to refurbish. Soli, a Civil Dispensary, which was not covered by Pakistan Government reconstruction and rehabilitation program (ERRA). Many clinics that AAI chose to rehabilitate were covered by ERRA and therefore would have to wait for lengthy approvals before works could begin. A building contractor is currently rendering the walls, repairing the earthquake damage and repainting. AAI is will also supply a permanent water system, re-equip the clinic with new beds, desk and all new medical equipment.

•  In terms of the problems with solid waste management and infection control AAI is in the process of finding constructing brick incinerators at 12 of the clinics in the district. This will greatly assist with more sanitary disposal of medical waste and providing a clean environment around the clinics.

•  AAI is also investigating the possibility of providing to the Sub-district Hospital (THQ) Kahuta with 1700 meters of ½ inch pipe to provide the hospital with constant running water through the summer period.

Soli clinic before rehabilitation works

Soli clinic on day 3 of rehabilitation works

Click here to view a map showing clinic locations.

The remaining 8 major clinics in the Haveli Tehsil will be visited in the upcoming fortnight. The donations are being well received particularly from the clinics that are not accessible by road.

Delivery of medical supplies and equipment to Degwar clinic

2. COMMUNITY HEALTH

•  In this two week period AAI held 4 Hygiene and Sanitation training sessions in Changal, Kahuta and Soli, with 50 Lady Health Workers (LHW) and 1 Lady Health Visitor (LHV) being trained in the delivery of hygiene and sanitation education to their communities. In these sessions four new master trainers were involved in presenting the training to the other LHWs.

•  AAI attended the inaugural meeting of the Women's Community Based Organisation (CBO) in Kalsan, set-up by 2 LHWs as part of the hygiene and sanitation program. The 15 women at the session received hygiene education and discussed their role in assisting the LHWs to deliver hygiene education in the Kalsan community.

•  AAI circulated updated information on Bird Flu to the health facilities in Haveli and was invited to present a Bird Flu information session to 16 LHWs in Soli.

•  All training sessions for reproductive health, family planning and primary health have been cancelled, as directed by DHO and WHO, while they develop a more coordinated program with partners.

AAI interpreter Mr Basit, leading an education session

Education of Lady Health Workers in Soli.

1. Hygiene and Sanitation

2. Bird Flu information sessions

4. DISEASE SURVEILLANCE

Havali Tehsil enjoys the highest reporting rates in the Bagh District (10 out of 12 reporting stations).

With the arrival of the warmer weather AAI have seen an increase of suspected malaria cases.

16 April 2006

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

•  The AAI Field Site received a mass delivery of priority medicines , equipment and supply essentials thanks to AAI procurement and DRI donor support. Equipment includes sterilizers, syringes, IV sets, kidney dishes, antibiotics, topical scabies treatments etc.

•  AAI 's medical team will now gear up to deliver the much anticipated goods to the 12 Haveli Sub district health clinics over the next fortnight.

•  AAI team members continued to work with local providers in assessing the nutritional status of Haveli children. AAI teams are in the first round of gathering and analysing data on the height and weight of children entering local clinics. The analysis of such data will be passed on to District health officials and UNICEF to monitor trends and support nutritional supplementation where needs are identified .

•  AAI 's training programme and initiative for capacity building has received much attention from national and international partners. The awareness of the need for education revitalization to national providers is rapidly being identified as the relief effort and international community begins to pull out of the Bagh district. In response, AAI has been asked to facilitate our training theories and actual trainings to partner organizations. Liz Headley, AAI 's public health nurse, conducted training in disease surveillance and outbreak control for the staff of Quetta Red Crescent who currently run a remote tent hospital.

•  AAI continues its efforts in bridging the gaps between the Ministry of Population Welfare and the District health authorities in an effort to create and sustain a collaborative effort in preventative and curative MCH and family planning health initiatives. AAI continues to advocate for both parties and is working with the WHO in linking the efforts of the two health networks. As a first step, the providers will be brought together in a joint training session to be held in Bagh in the coming weeks.

•  The director general for livestock in Azard Jammu and Kashmir hearing about AAI 's educational information about bird flu requested AAI 's materials be disseminated thorough all of AJK in health facilities and among his staff to further enforce essential preventative measures.

•  AAI staff member Liz Headley on a visit to the Cuban tent hospital met the arrival of a trauma case. At that time most of the Cuban doctors were involved in meetings leaving only one on duty for such cases. Immediate attention was needed, as such, Liz jumped in and aided the Cuban physician in the assessment and stabilization of the 12 year old girl who fell from a Kahuta cliff side suffering multiple crushing head injuries, and a severely broken arm among other injuries.

•  AAI have done extensive surveys and structural assessments of health facilities in the Haveli Tehsil. In close collaboration and partnership with the DHO, local government and ERRA AAI have chosen to do a number of small scale rehabilitation projects. The first project to commence will be the Soli BHU. AAI have committed to fully rehabilitate and beatify the building including development of a water system and construction of incinerators. Furthermore AAI will be supplying medicines, medical supplies and equipment and furniture for the clinic.

2. TRAINING PROGRAM

•  AAI in partnership with UNICEF continues Hygiene and Sanitation education sessions. AAI master trainers are working through sub-district clinics providing training to all local Lady Health workers. AAI continues to monitor and support the master trainers in organizing and implementing the workshops. Future training sessions are scheduled throughout April to follow Polio NID programs with an expected involvement of 100 LHWs.

1. Hygiene and Sanitation Training Statistics

Click here to see results.

2. Maternal and Child Health Training Statistics

Click here to see results.

•  AAI facilitated the attendance of 9 female health workers from Haveli sub-district to the WHO/DHO Phase 1 training, in Bagh, for MCH/Family Planning Train the Trainer workshop. Three Master Trainers are now providing training to LHWs in Haveli Tehsil. During this training the topics covered are

•  Maternal and Child Health
•  Family Planning
•  Disease Surveillance
•  Newborn Care and Resuscitation
•  HIV / AIDS and STI's
•  Adolescent Health Issues
•  Introduction to IMCI, EPI diseases and gender issues.
•  HIS Health Information System

•  AAI attended the planning session of the training in Bagh on 7 th April to be involved in planning of support to the step-down training program to other health workers in Haveli in the following months.

3. COMMUNITY HEALTH

Hygiene Kit Distribution

At the Health and Hygiene UN cluster meeting lead by UNICEF, AAI was identified as being a forerunner in our efforts to identify utilize and strengthen local infrastructure and government systems by the facilitating and mobilising local community based organizations in the distribution of hygiene kits.

•  The Hygiene Kits comprise of soap bars, towels, toothbrushes, toothpaste, lavatory wash jug, cottonwool, cloth, cotton gauze and other hygiene items. Each household in Haveli will receive one hygiene kit.

•  AAI continues to strengthen relations with local government officials through our distribution efforts supporting and empowering the people of Haveli to get involved with supporting their own communities.

•  AAI have distributed all of 2500 received Hygiene Kits from UNICEF in 4 of the 6 AAI supported Union Councils;

AAI will now await the second delivery of 3500 kits from UNICEF to deliver in the coming month.

•  For a database of the distributions, please refer to Attachment 2, Distribution Plan, and Distribution Timetable.

•  AAI has completed hand washing station water tank distributions to the local schools which have had little or no access to running water. In combine efforts, UNICEF has donated large scale water storage tanks to further support access to clean water.

Hygiene Kit Distribution  

DISEASE SURVEILLANCE

•  ARI, watery diarrhoea, fever of unknown origin and injury continue to be the major contributors to overall consultations.

•  Haveli sub-district reported two deaths over the past two weeks; neither related to communicable disease.

Attachment 1. AAI Supported Health Facilities

Click here to see results.

Attachment 2. 1.1 Hygiene Kit Distribution Timetable

Click here to see results.  

1.2, Hygiene Kit Distribution Plan

Click here to see results.

19 March 2006

AAI ACTIVITIES PER PROGRAM AREA:  

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

•  AAI facilitated the delivery of paediatric and other priority medicines (ie: antibiotics) to 12 Hevali Sub district health clinics from the DHO and WHO. Click here to view the Clinic Details.

•  AAI teams continue to distribute the educational materials mentioned in previous reports to all levels of health care workers including key community members. Recent materials and support have concentrated on providing information regarding Bird Flu since the confirmed presence in areas of the NWFP. In fear of spread to an already vulnerable population, most chicken distribution pipelines have been stopped into these areas. However rumour has sparked concern with in all areas of Kashmir including Kahuta. The aim of these educational materials is to educate the local community on prevention, identification and management measures.

•  Education materials continue to be created concentrating on tropical illness suspected to be seen as spring and summer approach.

•  AAI team members have distributed both standing and baby scales along with tape measures to begin assessing the nutritional status of Hevali children. AAI will facilitate gathering and analysing data on the height and weight of children entering local clinics and or seen by local health care professionals. The analysis of such data will be passed on to partners supporting nutritional supplementation and will be used to watch trends for the future.

•  AAI's community team has completed assessing the 126 health houses from which the lady health workers provide their services. AAI intends to disseminate the assessment information through the UN teams and local partners facilitating the acquisition of support and assistance where possible. AAI is currently prioritizing need and evaluating where our team can help.

•  In follow up to the last situation report, the UN special operations team has successfully reopened the road to Behdi. This task was by no means an easy feat. The team suffered set backs including a vehicle break failure that due to JC's cunning judgment resulted in an accident seeing only minor injuries for two of the UN ops team members. AAI thanks them for their perseverance and dedication. AAI wants to also take this time to send our most sincere condolences to UN ops for the loss of their brother and our dear friend Paul.

•  Danger is a reality that AAI may face everyday in Kashmir . On that note, AAI sends our love and respects to the Haveli Cuban field hospital team who were involved in a tragic accident when a landslide slammed into their mobile medical team vehicle injuring many and claiming the life of one doctor.

**AAI will remember fondly our friends and co-workers for their commitment to providing AID to the people of Kashmir in this remote and often unforgiving region of the world.

2. TRAINING PROGRAM

•  AAI in partnership with UNICEF has begun implementing Hygiene and Sanitation education. Progressing into a more natural and sustainable system, AAI is facilitating master trainers in attending the initial training sessions. AAI will then monitor and support the master trainers in organizing and implementing community level workshops through Haveli health clinics to the remaining health care providers.

Hygiene Sanitation Workshop

•  Of the targeted health care providers, AAI only had one missing Master Trainer due to weather constraints. Snow high in the Kahuta hills made travel impossible.

•  For both days of the workshop, participants completed evaluations which identified and reinforced topics and their importance in combating public health issues.

•  The AAI training team, assistant district health officer, local medical technician and master trainers have completed the design of an IMCI adapted program. IMCI training is programed to commence in the coming week.

•  AAI will continue to be a resource, providing educational materials, as well as general support and supervision where necessary.

•  A new member has joined the WHO team specializing in Reproductive health. Currently Anna, AAI's training coordinator, is pushing for a Master training session to be held in Bagh and opened to all district providers to then provide the opportunity to bring the training into Haveli.

•  Anna has also been closely liaising with the district level officials to assist in building networks and relations between the local staff Ministry of Population and Welfare and the Ministry of Health to improve access to family planning and STI services.

•  AAI supported the second phase of the Polio campaign by proving cold chain capabilities.

3. COMMUNITY HEALTH

3.1 Clean The World Program

•  Mellissa Tylee working in schools throughout Pakistan donated her holiday time to visit Kahuta. During her brief visit, she coordinated and implemented a “clean up Kahuta” program in line with the international Clean Up the World programmes. The AAI team spent 2 days visiting 4 of the largest local area schools working with the school children to clean their school grounds. AAI also requested from the local military metal drums to be delivered to the schools to be used as incinerators for rubbish. In a few days time AAI revisited the schools to check on the maintenance. We were more than pleased to see that each of the schools have continued to keep their areas rubbish free.

•  AAI 's school hygiene education program has completed sessions now at 21 schools covering 2458 children (Refer to Attachment 2, School Hygiene Program Database). This program has been an outstanding success and will be wrapped up in the next week. AAI would like to thank Bill and Neena Rohs, Denise Elzinga and Azhar–Ul-Islam for designing and implementing this fantastic program. The feedback from not only the schools, but from the local community has been remarkable. All members involved with seeing this program to fruition should feel a true sense of accomplishment in combating public health issues within the community at the most basic levels through reaching out to the Haveli children.

•  AAI has continued to distribute a full cricket set to each of the schools that participated in the program.

•  AAI has given 10 water tanks to the local schools which have had no access to running water. AAI hopes that this will improve the children in complying with hand washing practises.

3.2 PUR Water Distribution Pilot Program – Ahkori

•  AAI in a joint venture with UNICEF is trialling a pilot water purification distribution program. After natural disasters, contaminated water often presents a major problem. Two major sources of contamination are microbial pathogens and suspended matter.

•  PUR is a water treatment program, used to remove harmful pathogenic micro-organisms (bacteria, protozoan parasites, viruses), and suspended matter (solids and organic matter) from water.

•  The local community of Ahkori was selected for the trial by AAI. Ahkori has a population of 200 people. A small community allows for effective product delivery, management, and further data collection for an accurate measure of the trial.

•  AAI has co-ordinated on behalf of UNICEF, the distribution of 2100 PUR water sachets and 41 water buckets, reaching 224 people amongst 41 households in the community of Ahkori. These supplies are intended to last one month from distribution.

3.2.1 PUR Product Delivery and Education

•  AAI staff invoked the assistance of Akhori community leaders to facilitate a day where PUR water training could be carried out to each household leader.

•  Training was run by a local AAI staff member Mr Baber.

•  The training was well received by members of the community. AAI feels confident that the PUR water technique for use of the product was grasped by the household leaders in attendance. AAI staff will observe the usage and effectiveness of PUR water in the community of Ahkori on a weekly basis and report all findings to UNICEF.

4. Morbidity and Mortality

•  AAI analysed data on the Priority Diseases Identified for Haveli Tehsil Facilities.

Click here to see results.

Notes:

Notes:

Sasha Poll
Medical Director, AAI, Pakistan

4 March 2006

AAI ACTIVITIES PER PROGRAM AREA:

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

AAI facilitated the delivery of blankets to 26 Haveli Sub district clinics. Local authorities prioritized the clinic needs providing AAI with the distribution plan allocating each clinic anywhere from five to forty blankets.

AAI distributed and constructed the last of the initial allotment of winterized tents from IOM /WHO to the very appreciative Bhata Kot clinic.

AAI is currently working with the Sub District authorities in making plans for the distribution of 38 more tents to clinics that are accessible for the first time since winter.

AAI teams continue to distribute the health promotion materials mentioned in previous reports to all levels of health care workers now including key community members.

Health education materials have recently been developed covering Basic first aid; accidental amputation, snake bite, wound care, choking, chest pain, bee stings and other related topics. In response to the start of spring, our educational materials will begin to focus on addressing tropical infections and diseases. Leishmaniasis Dengue fever and Malaria materials are currently being disseminated.

AAI team members are beginning to implement measures to assess the nutritional status of Haveli children. AAI is partnering up with 12 dispensaries and lady health workers to collect the height and weight of all children. The analysis of such data will likely show where support is needed.

AAI medical director has made an appeal to the UN special operations unit to reopen the road to Behdi. Behdi is a highly populated area of Haveli that has been completely shut off since the start of winter. After hearing about AAI training sessions, the lady health visitor from Behdi made an extraordinary journey to Kahuta in order to participate. In response to her dedication to better serve her community AAI is honoured to help increase access to and from this region.

In a continuing effort to support the lady health workers, AAI is assessing the 126 health houses from which the lady health workers provide their services. AAI intends to prioritize the needs and provide assistance where possible. Some health houses will need provisions for safe water, such as pots for water boiling, while other houses have been completely destroyed and would greatly benefit from CGI or tents.

2. TRAINING PROGRAM

AAI has now successfully completed 2 training programs

1. Surveillance and Reporting of WHO Notifiable Diseases

The training team is currently pushing toward handing over the training program (needs assessment, design and implementation) to the master trainers and local authorities. AAI will continue to be a resource, providing educational materials, as well as general support and supervision where necessary.

AAI clinical nurse specialist and training program coordinator Anna Dyer met with a local nutritionist this week in Rawalpindi . Anna has coordinated a special 3 day nutrition training that will be presented by a local Pakistani specialist to the health care professionals of Haveli on March 14, 15 and 16.

AAI plans to support the second phase of polio vaccinations starting Monday 6 th March 2006 .

3. COMMUNITY HEALTH

Food Distribution Program

School Hygiene and Health Promotion Program

AAI 's school hygiene and health promotion program has completed sessions at 13 schools covering 1841 children. This program has been an outstanding success. In response, AAI has expanded the program now targeting all of the schools in Haveli sub district.

The children from surrounding schools have started delivering beautifully decorated waste bins to the AAI office. In recognition of their dedication to clean up Kahuta, AAI has begun distributing the waste bins through Kahuta town bizarre.

AAI continues to distribute a full cricket set to each of the schools that participates in the program.

As a result of the efforts and interests of schools in cleaning their environment AAI lunched a pilot program of Clean Up the World this week. The pilot was tested at a school at the Gramma School , Rawalpindi which proved to be very successful and gained significant media coverage in local news. Many thanks to Nasreen Iqbal, School Director, and Melissa Tynne, Australian School volunteer for their fabulous efforts in making this such a successful program. This program will now be implemented throughout the schools in Kahuta next week and again in September for the Clean up the World Day.

This week AAI ordered 10 water tanks for distribution to local schools. The tanks will be a part of hygiene stands to be constructed at schools in need of running water for hand washing stations.

4. MORBIDITY AND MORTALITY

AAI analysed data on the Priority Diseases Identified for Haveli Tehsil Facilities during this reporting period.

Click here...

Notes:

Sasha Poll, Medical Director, Pakistan
and,
Frank Tyler, Director of Operations

19 February 2006

AAI ACTIVITIES PER MIDQUATER REVIEW
1 December – 19 Feb
REVITALIZATION

AAI remains committed to mitigating the double burden of inequity and poor access to quality health care and aims to improve the level of health for the 122,000 people of Haveli Tehsil. Using a multi-faceted approach AAI engages the community in health activities encouraging sustainable solutions.

Revitalization of the Primary Health Care services

Assessment and Monitoring of Primary and secondary Health Care Facilities:

•  A total 13 health facilities and the THQ hospital have been assessed.

•  12 health facilities and the THQ hospital have been supported by AAI .

•  12 health facilities have been provided with direct bedside supervision, training in clinical practise, and support to the health care providers.

•  100% of the population have had access to curative PHC service in the clinic catchment areas supported by AAI . These clinics have remained open throughout this quarter and stocked with medical supplies. Clinic catchment areas range from four thousand to 22000 people with monthly clinic visits averaging between 250 to 600 per clinic.

•  An estimated 75% of population have had access to secondary level health care service through THQ Hospital , MST, and Cuban field hospital.

Meeting Priority Needs

•  AAI distributed 9 winterized tents to BHU's, RHC's and the THQ hospital.

•  The AAI health team is currently assisting the distribution of a further 41 donated winterized tents. The tents will be delivered according to priority as designated by the DHO and WHO.

•  Chlorine tablets and hygiene education has been provided to 12 PHC facilities and THQ hospital. Catchment area of 122,000 people.

•  AAI have maintained the distribution to 12 heath facilities of essential drugs

•  100% of BHUs and RHCs are providing and having in stock Amoxicillin and Cotrimoxazol

•  AAI assisted with the distribution of governmental supplies of essential medication to the First Aid Post in Chireekot.

•  AAIs previously procured medical supplies were distributed to 12 PHC facilities, THQ and MST hospitals.

•  During the worst phase of the winter AAI facilitated the distribution of 250 blankets donated by WHO and UNICEF to various primary health facilities throughout the area.

•  Over 200 hygiene kits where distributed to the BHU Gugdar. Kits were further distributed by the Lady Health Workers (LHW) assessing pregnant women and families of newborn babies.

•  AAI implemented the family hygiene program in Haveli Tehsil in accordance with the MoU signed with UNICEF. AAI have attended phase I of training and are awaiting phase II to begin training of the Lady Health Supervisors (LHS) and distribution of hygiene kits.

•  In partnership with the WFP, AAI is currently implementing a school supplementary feeding program. This will consist of caloric biscuits and dates to be provided to the children on a daily basis in effort to compliment daily nutritional intake.

•  Expanded Program of Immunisation (EPI) Services were provide directly by AAI to:

•  11 EPI centres are partially functional

•  186 children vaccinated during AAI supported Polio campaign

Strengthening Local Health Systems & Building Capacity

•  14 training sessions have been held in disease surveillance, outbreak control and reporting of WHO notifiable diseases. Of the 154 targeted health care providers, 135 have attended the training to date with a total participants now projected at over 200. These training sessions have included healthcare providers not currently supported by AAI . The participants represent every level of health care provider from LHWs to doctors and DHO officials.

•  AAI conducted the identification, training and use of local DHO master trainers to facilitate AAI training programs; these trainers included the Assistant District Health Officer (ADHO), medical technician, 3 LHVs, Vaccine inspector, and 2 LHWs.

•  AAI completed the design, translation, and distribution of community and primary health provider information documents concentrating on the needs as identified by morbidity mortality reports and assessment of the health care facilities. Distribution of these materials to date includes: 12 PHC facilities, 127 LHWs, 1 midwife, 46 Dispensers, 5 Female Dispensers, 5 nurses, 6 LHVs, 6 LHWS, 4 Doctors, 1 ADHO, and 3 Medical Technicians. The materials have been shared with UNICEF and the WHO to utilize and further distribute.

•  The school hygiene program concentrating on personal hygiene and waste management has now reached 3 school and 465 children.

Disease Surveillance and Early Warning System

Establishment of Disease Early Warning System and Timely and appropriate response to outbreaks with pre-positioned supplies & drugs

•  Enhance Disease Surveillance activities

•  Support of Sentinel Surveillance Reporting Sites: Initially 4 sentinel sites were identified by the DHO and requested to provide weekly reports at the District level. Of the 4 sites, none of the dispensers received formal training in accordance with WHO protocol. To this date AAI have now trained the 12 dispensers serving AAI supported clinics and 18 dispensers from other clinics in Haveli Tehsil. All AAI supported clinics are currently reporting directly to DHO level on a weekly basis. Previously 1 site has also been reporting to AAI while we expect all 12 clinics to report this week and for the upcoming future. AAI would like to extend a grateful thankyou to Dr. Quadoos, Mr Kasim for their support and assistance.

•  AAI is progressing at the Tehsil level with the process of data collection, management, analysis, and response. Provider staff have been trained in case definition, thresholds, and referral from 12 PHC facilities and THQ hospital.

•  AAI provided support of a Disease Early Warning System , Outbreak Task Force and Alert System through assisted with training at the WHO and analysed data with the health care providers.

Refer to Attachment 6 for Current THQ WHO reporting

DISEASE SURVEILLANCE/EDUCATION & TRAINING

•  AAI Surveillance and Reporting of WHO Notifiable Diseases training has added more clinics and clinicians to the growing roster of participants. Assessment of knowledge by pre-test and post-test questions are included in the following Attachments. Assessment of further training needs remain ongoing.

•  Please refer to the following for complete details:

3. COMMUNITY ASSISTANCE

AAI saves the day with assistance to a Pakistan Jingly Truck!!!!

•  On a routine drive with the medical education training team to THQ, AAIs long term driver, Mr Ahassan found himself at an impasse with a Jingly truck in one of Kahutas' tiny roads. The Jingly was deep in mud created from the recent rains. Before long the traffic back logged and the crowd gathered to watch an unsuccessful unrest of the heavy beast.

•  Mr Ahassan attempted to unwind the vehicle winch to no avail. Regardless, he attached a half metre tow rope to the front of the truck leaving no room for error in co-ordinating the movements of each vehicle. With delicate care and much grunting and heaving the Jingly was freeded and the road was cleared. We were so excited we forgot to take a photo of our number 1 driver. Thanks Mr Ahassan.

AAI delivers a WHO donated winterised tent to the Dispensary of Naga Nari… 

•  The oncoming spring and melting of snow has finally provided AAI with an opportunity to assist the people of Naga Nari in the aftermath of the earthquakes. While the road to Naga Nari has been cleared, new land slides from the recent rains have left in places only the smallest of margins on the mountain side road to pass. This made for some hair raising driving to say the least. Soon after leaving the bitumen the sleet fell heavily and the muddied track deteriorated, however the help and assistance of the local residents AAI made for a safe journey to the clinic.

•  Upon meeting the Health Dispenser and other village seniors, AAI discussed a suitable site and plan to return early next week to assist in pitching of the tent. We are looking forward our return of this beautiful village.

•  We would like to offer our sincerest thanks to the WHO for their donation to the Naga Nari dispensary.

•  AAI receives new team member: With bounding energy, a mind for logistic support, and the eagerness to jump right in we are pleased to welcome Michael Mchale to Kahuta. Michael has already made his mark on the community being instrumental in the distribution of winterized tents, blankets, and cricket sets not to mention schmoozing daily with the community elders and local authorities.

Sasha Poll
Medical Director

4. EMERGENCY SHELTER PROGRAM 

AAI successfully completed the IRAS shelter program on, 11 Feb 2006 . The IRAS shelter program has consisted of supplying and distributing approximately 1300 emergency shelters to homeless families. 450 IRAS shelter kits were distributed to individual families during this week through the assistance of the Pakistan Military. This distribution was the final phase of AAI 's emergency shelter program which has concentrated on filling the gaps for families whom have missed out on previous rounds of emergency shelter distribution. AAI would like to thank Captains' Cheema and Imran for identifying needy families and arranging the distribution and monitoring of the emergency shelter kits. Furthermore, with the assistance of Captain Imran's men from the 21 st Sind Regiment of the Pakistan Military, AAI masons built ten IRAS's for vulnerable families all consisting of female headed households.

As the weather in Kashmir is greatly improving and most needy families have received some type of emergency shelter AAI have decided to finish the IRAS emergency shelter program. The program has been a great success and AAI would like to thank the IRAS designers, Mr Umar Iqbal Khan and Mr Hammad Husain , who provided the first round of operational support to ensure that AAI could get IRAS's out to homeless families living at high altitude before the onset of the Kashmir winter. AAI would also like to thank all members of the Pakistan Military that assisted and supported the program. Lastly we would like to thank the AAI family which consisted of many volunteers (Jim Thynne, Gordon Willcock, David Wegman, John Weil, and Jim Judge) all from Australia contributing there own time and money to come out and help get shelters to homeless families in Kashmir.

Frank Tyler
Director of Operations

A. AAI SUPPORTED HEALTH FACILITIES

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7 February 2006

AAI ACTIVITIES PER PROGRAM AREA:

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES
AAI health teams have visited the following health facilities in Haveli Tehsil providing direct bedside supervision, teaching in clinical practice, and direct support to health care providers:

Access to certain health facilities remains limited secondary to weather and road conditions.

AAI team members are also investigating breastfeeding and weaning-food practices from all mothers who present to health facilities.

For a summary of findings, click on Appendix 1, Summary of Clinic Visits .

In addition, AAI teams are educating health care providers at facilities in the following topics : hypertension, diabetes, universal precautions, hypothermia, scabies, diagnosis and treatment of paediatric ARI, and sterile technique for injection.

Through the generous donation of chlorine tablets by Colonel Habib , Pakistan Military Hospital , Bagh, AAI team members have promoting safe water usage and hygiene education to all health facilities visited, including THQ Hospital Kahuta.

AAI team members were poised to assist and facilitate the WHO/UNICEF/DHO Polio Campaign beginning 24 th January. However, as Haveli Tehsil was not included in this polio round per WHO, AAI staff continued normal daily operations instead of polio immunization monitoring and supervision.

AAI supported and monitored the Polio Campaign in Haveli on February 3 rd , 4 th , and 6 th . AAI thanks Mr. Aslam, Asst Superintendent Vaccination, and Mr. Farooq Mir, Vaccine Inspector in Charge, greatly for their cooperation in these activities.

AAI has signed an MOU with UNICEF to implement a family hygiene program in Haveli Tehsil and already received the first donation of family hygiene kits. AAI will send a team member to attend the UNICEF meeting regarding hygiene promotion in early February. This AAI team member will then implement hygiene education in the field utilizing Lady Health Worker Supervisors and Lady Health Workers. At the completion of hygiene training done at health facilities, community members will then receive one UNICEF hygiene kit per family. AAI thanks Mr. Julian Parker for his assistance and cooperation in this program.

AAI will facilitate the distribution of blankets donated by WHO and UNICEF to ADHO, Haveli Tehsil. These blankets will be given to various primary health facilities throughout the area.

2. DISEASE SURVEILLANCE/EDUCATION & TRAINING

AAI successfully training programs in Surveillance and Reporting of WHO Notifiable Diseases. The beneficiaries were many levels of DHO health care staff. Assessments of knowledge were made by pre-test and post-test questions. Assessments of further training needs were completed by final evaluations. Overall, these training sessions have been met by overwhelming approval and desire for more.

Please refer to the following for complete details:

3. COMMUNITY HEALTH

AAI has created community education materials on hypothermia, frostbite, and scabies, diabetes, hypertension, and universal precautions. These are being distributed through the Shelter and Health Programs, through DHO facilities, and through DHO health facility staff. In addition, these materials have been shared with WHO and UNICEF to utilize and further distribute.

AAI has implemented a school hygiene education program , targeting the following schools in the Kahuta area: government girls' school (1), government boys' school (1), government girls' college (1), government boys' college (1), and private co-ed primary schools (4). This program includes didactic curriculum as well a contest in the creation of artistic posters to be used as further teaching tools.

Neena Rohs , MD MSTPH
Country Medical Director

4. EMERGENCY SHELTER PROGRAM

AAI successfully completed the IRAS shelter program this week, 7 Feb 2006 . The IRAS shelter program has consisted of supplying and distributing approximately thirteen hundred emergency shelters to homeless families. 450 IRAS shelter kits were distributed to individual families during this week through the assistance of the Pakistan Military. This distribution was the final phase of AAI 's emergency shelter program which has concentrated on filling the gaps for families whom have missed out on previous rounds of emergency shelter distribution. AAI would like to thank Captains' Cheema and Imran for identifying needy families and arranging the distribution and monitoring of the emergency shelter kits. Furthermore, with the assistance of Captain Imran's men from the 21 st Sind Regiment of the Pakistan Military, AAI masons built ten IRAS's for vulnerable families all consisting of female headed households.

As the weather in Kashmir is greatly improving and most needy families have received some type of emergency shelter AAI have decided to finish the IRAS emergency shelter program. The program has been a great success and AAI would like to thank the IRAS designers, Mr Umar Iqbal Khan and Mr Hammad Husain , who are the IRAS designers and provided the first round of operational support to ensure that AAI could get IRAS's out to homeless families living at high altitude before the onset of the Kashmir winter. AAI would also like to thank all members of the Pakistan Military that assisted and supported the program. Lastly we would like to thank the AAI family which consisted of many volunteers (Jim Thynne, Gordon Willcock, David Wegman, John Weil, and Jim Judge) all from Australia contributing their own time and money to come out and help get shelters to homeless families in Kashmir.

Frank Tyler
Director of Operations

A. AAI SUPPORTED HEALTH FACILITIES

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31 January 2006

Mavericks who punch well above their weight.

The AAI shelter team continues to build and distribute shelters in the Bagh District of Kashmir at a rapid rate. Two days ago a further 200 shelters were moved from Islamabad to Bagh and immediately distributed to various surrounding villages. Dave Wegman and Marc Preston, with assistance of the soldiers from the 21 st Battalion, The Sind Regiment constructed an IRAS shelter in 4 hours to demonstrate the efficacy of the IRAS emergency shelter system.

In addition to building these shelters the team has been monitoring and supporting villages where shelter kits have already distributed. The team have been more than pleased at the manner in which the IRAS system has been used either in itself or modified by the resourceful villagers.

AAI has also arranged for the delivery of a further 600 shelter kits within the next 2 weeks and will continue

In addition to shelter tasks the team also arranged for the transportation and distribution of 1000 hygiene kits to villagers in the Kahuta region where the medical team is continuing to implement its community initiatives program to train and support 12 Basic Health Units in the District. In addition, Dr Neena Rohs is developing further programs to augment this project including water sanitation and small camp hygiene assessments.

The 4 volunteer nurses from Dynacare in the US have found their feet in an environment far different from their native Chicago and have provided indispensable expertise to our medical capabilities. Medical stalwarts Sasha Poll and Anna Dyer continue to provide the backbone of the team and are at home in one of the more remoter parts of Kashmir close to the Line of Control.

The team have continued to receive accolades and have been described as “Mavericks who punch well above their weight”

8-22 January 2006

AAI ACTIVITIES PER PROGRAM AREA:

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES

•  AAI facilitated the delivery of government stock of essential medications to the First Aid Post at Chireekot.

•  In direct collaboration with the DHO in Bagh, AAI facilitated the transport and delivery of over 200 hygiene kits to the BHU Gugdar. These kits will be distributed by Lady Health Workers to pregnant women and families of newborn babies.

•  AAI distributed and constructed winterized tents from IOM/WHO to the following health facilities in Haveli Tehsil: Chireekot.

•  While AAI attempted the delivery of another winterized tent to Naga Nari, due to snow and road conditions, this was unsuccessful. Naga Nari will most likely remain unreachable until the spring season prevails.

•  AAI also attempted delivery of a winterized tent to Bhatakot, however due to snow and road condition, this was unsuccessful.

•  AAI will re-attempt delivery of both remaining winterized tents for the above facilities when weather conditions improve in the coming weeks.

•  AAI medical teams have visited the following health facilities in Haveli Tehsil providing direct bedside supervision, teaching in clinical practice, and direct support to health care providers:

•  Access to certain health facilities has been limited secondary to weather and road conditions.

•  AAI teams have developed educational materials in areas identified by needs assessments of health care facilities. These include: hypertension, diabetes, universal precautions, and sterile technique for injection. AAI are distributing these materials to all health facilities visited and to all levels of health care worker.

•  AAI team members are currently investigating breastfeeding and weaning-food practices from all mothers who present to health facilities.

•  AAI medical teams distributed all currently available AAI inventories of medical supplies to the health facilities listed above, in addition to THQ Kahuta and MST hospital facilities. While the current supplies are limited, AAI hopes to provide whatever medications possible during these winter months.

2. DISEASE SURVEILLANCE/EDUCATION & TRAINING

•  AAI successfully held a training program in Surveillance and Reporting of WHO Notifiable Diseases. Sixteen participants were trained, including THQ Kahuta Doctor, THQ Kahuta Lady Health Visitors, THQ Kahuta Lady Dispensers, THQ Kahuta Nurses, and Lady Health Visitors from Gugdar and Soli.

•  AAI analysed data on the Priority Diseases Identified for Haveli Tehsil Facilities in December 2005. Click here.

•  AAI has been collecting WHO surveillance data from the THQ Hospital in Kahuta, with many thanks to Dr. Majeed. No significant outbreak has been reported. ARI, diarrhea, and scabies still account for majority of notifiable cases treated at this facility.

•  Click here to see Appendix 1: WHO Surveillance data from THQ Hospital , Kahuta, Nov/Dec 2005.

3. COMMUNITY HEALTH

•  AAI has partnered with the Cuban Hospital to distribute Community Health education materials through health facilities as well as schools. Topics include personal hygiene, sanitation, pregnant women, safe water, and EPI vaccinations.

•  AAI has completed the design, translation, and distribution of community education materials on hypothermia, scabies, and frostbite. These will be distributed through the Shelter and Health Programs, through DHO facilities, through DHO health facility staff as well as given to the WHO and UNICEF to share with other agencies.

•  AAI has been distributing community and primary health provider information on Acute Respiratory Infection and Winter- and weather-related conditions. AAI thanks both WHO and Colonel Habib, Pakistan Military Hospital Bagh, very much for the provision of these excellent educational materials.

•  AAI has developed and will begin implementation of a school hygiene education program, targeting the following schools in the Kahuta area: government girls' school (1), government boys' school (1), government girls' college (1), government boys' college (1), and private co-ed primary schools (4). This program will include didactic teaching as well a contest in the creation of artistic posters to be used as further teaching tools.

Neena Rohs , MD MSTPH
Country Medical Director

4. SHELTER PROGRAM

Previous IRAS Situation

In total there have been 411 IRAS Shelter kits distributed in the following locations:

•  Kahuta
•  Lower Bella
•  Lasdana Road
•  Malot
•  Topi
•  Dhare

As of 4 th January 2006, Bagh District underwent a major weather change, with 5-6 ft of snow falling in high areas over night. Bagh town itself experienced 1-2 ft of snow. As a result, all roads out of Bagh were closed, and distribution of all shelter material temporarily ceased.

This rapid and dramatic weather change caused some initial delays in the distribution of shelter kits to our target areas. These delays have presented the AAI shelter team with several issues:

• AAI's limited ability to transport IRAS kits from Islamabad to Bagh.
• AAI's limited ability to distribute IRAS kits from Bagh town to height affected villages (above the snowline).
• As a result of the snow, there was a sudden increase in IRAS demands from other Union Councils (UC's) within Bagh District.

Current IRAS Situation

This reporting period (10 Jan – 16 Jan 06) has been significantly affected by the Eid celebrations in Pakistan . Most of the key stakeholders in the IRAS program have taken their leave from work or have traveled home to stay with family. This has included:

•  logistic staff in Islamabad
•  local staff in Bagh,
•  UN staff in Bagh,
•  Pakistani Military staff in Bagh
•  logistic staff in Bagh

All shops and services were shut for at least 3 days from 11 Jan 06 until 13 Jan 06. AAI staff continued to maintain contact with as many stakeholders as were available over this period.

Anecdotally, the Eid period also affected attendance at medical centres and distribution points. Interestingly the high demand for medical attention and pharmaceuticals dropped to almost nothing during the Eid period. Since the conclusion of Eid, the attendance and demand for pharmaceuticals has risen to pre-Eid levels again.

There have also been a number of local issues that affect the capacity of all NGOs in the region to deliver on specific shelter program outcomes. These are:

•  Village representatives are approaching NGOs and stating that they have not received shelter assistance from any organizations. On further investigation and comparison to the data currently maintained by IOM, ESC (Emergency Shelter Committee) Coordinating Organisation, it has been discovered that a number of these villages are attempting to “double dip” with different NGOs. These have not been isolated incidents and it appears that this trend is on the rise.

•  Recipients of shelter kits are stockpiling the material in preparation for the Spring thaw. It appears that these individuals are living with relatives in less affected areas during the winter.

•  Recipients of shelter kits are delaying construction of emergency shelters in anticipation of a second round of distribution. It has been stated that they feel if they construct a shelter, then they may not be eligible for a further round of distribution.

•  Some areas see the provision of some shelter kits as for permanent use as opposed to the intent of providing recipients with emergency shelter kits. As such, they feel that this may affect their entitlement to Government compensation.

•  The Pakistani Military are unable to affect a change in this mindset. and have also expressed their frustration at the attitudes they are beginning to face in the region.

•  There has been a paradigm shift in attitude from one of acceptance of relief material to one of demand. Even at the most basic level AAI staff are witnessing this in our campsite. We frequently are faced by people asking for shelter goods and clothing despite the fact that we have none for local distribution.

•  This has led the ESC (Emergency Shelter Committee) as well as AAI staff to the conclusion that there is a trend of feigned dependence. This has manifested itself in the attitude of demand and helplessness that is being displayed for the reasons listed above. It has been stated that the only way in which it is possible to effectively ensure construction of emergency shelter will be to finalise the distribution process and withdraw these programs from the region.

Due to all of these factors, full implementation of AAI's shelter program has become extremely difficult. There are some affected areas where IRAS is being constructed as originally intended; however, the majority of cases exemplify attitudes as stated above. 

Immediate future of the IRAS Program

AAI staff have had the opportunity to consolidate our information and to plan for the next phase of operations in the district.

Our members are now attending the villages where IRAS has been received, and inspecting already constructed shelters as well as those currently under construction. They also liaise directly with the Pakistani Military to assist their members with the distribution, recording and monitoring processes.

Discussions with the Pakistani Military have identified an immediate need to provide shelter to two major regions around Bagh:

AAI have completed initial training in these areas. This has included the construction of demonstration shelters as well as teaching the Pakistani Military in the construction process.

In both Topi and Dhare, AAI has distributed 100 shelter kits. As of this report these 200 kits have been distributed to those most in need of emergency shelter. AAI discussions with the Pakistani Military have led to the immediate planned distribution of 500 to the Topi area and a further 200 to the Dhare area.

AAI staff will be attending both of these areas and ensuring that our construction standards remain high. They will ensure that the distribution information is being recorded correctly, and that those families most in need receive shelter kits as a priority.

To assist in the recording process, AAI staff will be conducting an inspection program over the next two weeks. With a focus on each area, AAI aims to obtain documentary and photographic confirmation of our distribution and construction information.

Distribution Plan

Whilst difficult, the distribution of IRAS to both Topi and Dhare will be accomplished rapidly, weather permitting.

An initial 200 shelters will be delivered directly to the base camp of the Topi Military. They will be splitting this between two affected sites in the vicinity of Topi.

An additional 300 shelters, which are designated for the same area will be delivered directly to the town of Bagh . This will be handed over to 27 SIND , local Pakistani Military, who have been highly motivated in the distribution and construction process within their areas of responsibility.

After this, an additional 200 will be brought to the district. AAI discussions with the Pakistani Military in the coming weeks will focus on the most efficient means of transporting the material to those in need.

It is anticipated that the distribution and construction of the IRAS shelters will be almost complete by the end of January 2006.

As stated earlier, the weather presents an impediment to this process. This has been factored into our planning process. Even with significant delays caused by snow and ice, AAI will be well placed to have the shelters distributed and under construction during the month of January.

Summary

AAI are currently conducting training, distribution, construction and monitoring of IRAS throughout the Bagh District. We have finalised the distribution plan for the remaining IRAS material.

This enables the AAI Shelter Team to focus on the ongoing monitoring of IRAS construction throughout the area.

James Judge
Emergency Shelter Program Coordinator

A. AAI SUPPORTED HEALTH FACILITIES

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7th January 2006

GENERAL OBSERVATIONS

Beginning 5 January 2006 , AAI welcomes two new team members: Jim Judge, Shelter Program Coordinator, and Anna Dyer, Nurse Educator.

AAI Shelter Program shifted primary location of operations from Forward Kahuta to Bagh as of 26 December. The Medical Program will remain based in Forward Kahuta.

Snow and rain came New Year's Day to Kahuta bringing fiercely cold weather and harsh conditions. Roads in and out of Kahuta remained closed for 5 days due to slides and snow. Although there were many fears of landslides, there were no major events reported. Cases of ARI are expected to rise due to the climate change, and general inaccessibility may cause further morbidity due to lack of access to higher levels of care.

The AJK Government was due to complete distributions of flour to communities near Hallan Shamali on Wednesday, 4 January 2006 .

The Pakistani Military base has been able to undertake air operations. AAI received visits from Major Shakeel and his Commanding Officers from Bagh.

The Cuban Hospital stationed near the THQ Hospital suffered tent collapse and grounds' damage due to snow and rainfall. With various Kahuta community leaders, AAI is assisting their move to a safer, more secure structure.

AAI ACTIVITIES PER PROGRAM AREA:

1. REVITALIZATION OF PRIMARY HEALTH CARE FACILITIES =

Since Dec 26 th , AAI health teams completed visits to the following health facility locations with AAI's Area of Operations (AO):

• Tungari
• Palangi
• Degwar
• Gugdar
• Hallan Shamali
• Badhal Sharif
• Soli
• Kalamula

While AAI awaits the receipt of a full 6-month supply of medications for each facility, team members distribute limited medications currently available in inventory.

The need for pediatric medications has been particularly high.

AAI plans to continue distribution in the coming week as well.

AAI distributed and constructed winterized tents from IOM/WHO to three health facilities in Haveli Tehsil: Tungari, Badhal Sharif, and THQ Hospital .

Note that a 2 nd winterized tent constructed by another agency at THQ Hospital did not withstand the recent snowfall. AAI will attempt to facilitate reconstruction of this tent with new materials as available.

AAI had intended to distribute and construct three more winterized tents from IOM at Chireekot, Naga Nari, and Batakot. However, due to winter conditions and heavy snowfall in these locations, this plan will need to be revised after further discussion with IOM, WHO, and DHO.

2. DISEASE SURVEILLANCE/EDUCATION & TRAINING

AAI has added an Addendum to the original MOU as signed by AAI, ADHO, and THA (Tehsil Health Authority). This Addendum correctly states the 12 health facilities as supported by AAI.

In collaboration with DHO, AAI analysed data from the National Programme for Family Planning and Primary Health Care.

The following data have been reported from Haveli Tehsil by LHW's for November 2005:

• 118 Live births recorded
• Of 99 newborns weighed, 8 (8%) low birthweight babies born
• Of 2405 children >3 yrs weighed, 346 (14%) children noted to have low weight for age
• 2 stillbirths
• 5 early new natal deaths (defined as within 1 week of life)
• 0 child deaths
• 0 maternal deaths
• 192 cases of TB diagnosed
• 40 deaths overall

AAI analysed data on the Priority Diseases Identified for Haveli Tehsil Facilities in November 2005. Click here to see Figure 1.

The main diseases reported reflect findings elsewhere in Bagh district, with ARI, scabies, and diarrhoea being major concerns.

For further disease information, please refer to Appendix 1: Figure 2, Disease Category per age group, for Haveli Tehsil data reported to the DHO, November 2005. Click here...

AAI has been collecting WHO surveillance data from the THQ Hospital in Kahuta, with many thanks to Dr. Majeed. No significant outbreak has been reported. ARI, diarrhea, and scabies remained major causes of morbidity of cases treated at this facility.

Please refer to Appendix 2: WHO Surveillance data from THQ Hospital , Kahuta, Nov/Dec 2005. Click here...

AAI team members attended the WHO Training session on Outbreak Control in Complex Emergencies on 28 December 2005 . This training was designed for all members of investigative and response teams in the three subdistricts of Bagh.

AAI's Health Program has made disease surveillance and reporting the first priority for the six-month training and education program. The targets of these trainings will include

• Nurses from THQ Hospital
• Head dispensers from each health facility
• Lady Health Visitors (LHV's)
• Lady Health Worker Supervisors
• Lady Health Workers (LHW's)

AAI aims to support the training and education of all of these LHW's as the primary link to the health of community members. Each LHW is assigned 120 families, or 800-2000 individuals.

AAI has been working closely with the Head of THQ Hospital, ADHO Dr. Quddus, and DHO Dr. Latif to develop and implement data collection, disease surveillance, and primary health care training and education programs.

• As part of primary health training, AAI plans to support education for vaccinators within Haveli Tehsil and the 11 identified EPI centers, as feasible: THQ Hospital , Hallan Shamali, Soli, Khursidabad, Tungari, Gugdar, Degwar, Changal, Bhedi, Cherikot, and Sirsian.

3. COMMUNITY HEALTH

AAI has completed the design of community education materials on hypothermia in Urdu. These will be distributed through the Shelter and Health Programs, as well as given to the WHO and UNICEF to share with other agencies, and are appropriate for community members of many levels of education.

AAI is partnering with the Cuban Hospital to distribute Community Health education materials through health facilities as well as schools. Topics focus on personal hygiene, sanitation, pregnant women, safe water, and EPI vaccinations.

AAI plans a hygiene education program in Kahuta-area schools through art classes, thus promoting creativity and local dissemination of knowledge to combat the high rates of diarrheal diseases reported.

SHELTER PROGRAM

AAI has distributed and constructed 189 IRAS (Improvised, Rapid, All-weather Shelter) units to date in Haveli Tehsil and Bagh district areas.

Please refer to Appendix 3: IRAS Register. Click here...

AAI will continue to distribute IRAS shelter units, and monitor the construction of 200 more shelters in the Bagh district area.

AAI has been operating in the Bagh district with the cooperation of 27 th Sindh Pakistani Army unit, assisting in construction and distribution of shelter units. In addition, Major Shakeel and 21 AK Regiment continue to be of great support to AAI in the Kahuta region.