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In Pakistan, Volunteer Doctors Try to Fill Health Care Void After Floods

November 9, 2010 at 12:00 AM EDT
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Special correspondent Saima Mohsin traveled with a team from the humanitarian group Doctors Without Borders as it worked to treat Pakistan's flood victims, many of whom have had little access to health care months after the waters first rose.
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GWEN IFILL: Next: a day in the life of an international medical team working in one of most remote flood zones in Southern Pakistan.

Special correspondent Saima Mohsin traveled with a team from Medecins Sans Frontieres, MSF, also known as Doctors Without Borders. A warning: Some of the images in this story are quite disturbing.

SAIMA MOHSIN: Cut off and left to fend for themselves, 2,500 families have been stranded on the border of Sindh and Balochistan since the floods first hit in August, until MSF discovered them.

SYLVIE BACHMANN, nurse, Medecins Sans Frontieres: There were two persons coming. They went by car when it was possible, but this road was completely flooded, so they went through the water. And then — then they had to take a boat as well.

And they took, I think, the boat, and they went by horse as well, I think. And they were reaching the place at the canal. And at the canal, it’s possible, because there are two big roads. So, then they could continue by rickshaw, I think.

And when we came the first time, it was already accessible by car. So, we didn’t have any problem. And, for us, it was important because we have all the medication. We have one truck with all the supplies, so it’s necessary to have a road to have access.

SAIMA MOHSIN: Sylvie Bachmann is a 30-year-old nurse from Switzerland who’s been working with MSF for the past two years and came to Pakistan as part of the flood response team. The road is narrow, bumpy and precarious. Much of it is washed away, with only enough room for one car. But this is a two-way street.

It takes us five hours to get to Imam Bakhsh Jamali from MSF’s base in Sukkur. It’s uncomfortable and tiring, but the hard work is yet to begin. Stealing the shade of a tree, the team gets to work immediately. There are two doctors, three nurses, two dispensers, and four health educators overseen by Sylvie.

SYLVIE BACHMANN: Over there, we have the triage. There is one person to check the patients. All the patients are waiting there. If there is a child with high fever, for example, or we can to measure with this thing how is the nutrition.

If it’s severe malnutrition, for example, we can see it quickly. Then they can come first. Otherwise, all the patients from there, children and adults, they can come to the doctors.

We go to this table. The doctors, they take the history. They write down the medication they need. And then, from the doctor, if it’s necessary, they go to the nurse. The nurse can do dressings or a malaria check. And after this, they go to the dispensary. The dispensary has the medication. He is going to give them the right medication. It’s written on the cart. And he is able to give it to the patients. He explains how to take the medication.

SAIMA MOHSIN: Lined along a canal 25 kilometers long, thousands of people are living in shacks made from sticks and blankets. They had been here for eight weeks surviving on what little they’d managed to salvage, and a few bags of food they’d managed to catch from the military’s initial aid drops.

Cuts and wounds are finally being treated months after they first appeared. Children are tested for any serious conditions. Malaria is an increasing concern.

SYLVIE BACHMANN: We have mostly skin diseases. We have upper respiratory tract infections. And we have about 6 percent to 8 percent malaria cases.

SAIMA MOHSIN: How worried are you about that?

SYLVIE BACHMANN: It’s quite a big number, actually. It’s because the people, they are living here in the tents, they don’t have any protection of the mosquito. We are distributing mosquito nets. But they’re using — now they start to use it, but we’re still teaching them how to use the mosquito nets in a proper way.

SAIMA MOHSIN: We met Zareena. Her daughter is 3 years old, lethargic, and doesn’t eat. They have been here for two months without any help.

ZAREENA GULAM MUHAMMAD, flood victim (through translator): Whatever we had is gone. All we could save is our children, nothing else. I have lost my parents, brother. I have no idea where they are.

QUESTION (through translator): And you stayed here, but no one came to help?

ZAREENA GULAM MUHAMMAD (through translator): Yes. We have had no help and no idea if my family are dead or alive.

SAIMA MOHSIN: The local doctor is recommending Zareena’s daughter has an immediate blood transfusion, but MSF wants further investigation before making such an important decision.

ZAREENA GULAM MUHAMMAD (through translator): I’m worried about my child. If they are ill, I am ill. And, if they are nothing, I am nothing.

SAIMA MOHSIN: The people here belong to both the Sindhi and Baloch provinces and speak at least five different languages, which can be difficult when trying to understand complicated medical conditions.

SYLVIE BACHMANN: So, I, all the time, need a translator, because I don’t speak any Sindhi or Urdu. And, as well, sometimes, there are misunderstandings, even if they speak English. But it’s difficult to communicate properly.

And with the patients, sometimes, they don’t ask exactly — for example, when a baby has diarrhea, then the mother says, yes, it’s having diarrhea. But we really have to make sure that it’s really diarrhea.

SAIMA MOHSIN: Working in conjunction with local medical staff is the backbone of MSF’s work. Communications is just one of the reasons.

SYLVIE BACHMANN: We want to train them, that they know how is MSF working, how we do it in Europe, so they can learn it, and, when we leave, MSF if leaving, then they can continue with the same work. We want to give them the knowledge to do it in a proper way.

ABDUL MAJID, local nurse: I learned many things from MSF. First, we are starting work in Sukkur for feeding and we opened a feeding center. And I learned how to feed a baby, and learned how to educate mothers about feeding and about hygienic condition of the baby.

SAIMA MOHSIN: The team has only a few hours to get the much-needed treatment to the flood victims. They have to pack and get back to base before nightfall because of highway robberies.

Back in Sukkur, MSF has set up a nutritional program to tackle the devastating malnutrition in the area.

SYLVAIN GROULX, project coordinator, Medecins Sans Frontieres: What we do is, we have teams that are screening within the camps, and when they find severely or moderately malnourished children, and there are no medical complications, we are able to provide right away a regimen of therapeutic food.

It’s called plumpy’nut, basically. And it’s a ready-to-use food. There’s no water that is necessary. The child just opens up the envelopes and eat it. Its kind of like a peanut butter paste. And it’s high in vitamins and all the necessary nutrients for the child to grow rather quickly and gain the weight that’s necessary.

And when the children do have severe medical complications, then they are referred here to our intensive feeding center, where we have to treat the child for medical complications and also for malnourishment.

SAIMA MOHSIN: Too weak to cry, babies are only spoon-fed drops of water here.

DR. ERIK HOCHHEIMER, Medecins Sans Frontieres: So, the problem with this one is it has more than a month profuse diarrhea. So — and other kids, we have to patient with.

And what we’re doing is trying to get the G.I. tract working again a little bit, because, in other hospitals — I mean, there are good hospitals, proper hospitals in Sukkur. They get the medical care. But if they see a child like this, it immediately gets…

SAIMA MOHSIN: A drip.

DR. ERIK HOCHHEIMER: A drip.

SAIMA MOHSIN: Yes.

DR. ERIK HOCHHEIMER: And then the kid is a little bit better. But when the kid goes home, of course, they fall, because, with the drip, you never train the G.I. tract to start working again.

SAIMA MOHSIN: G.I. tract, you mean the whole…

DR. ERIK HOCHHEIMER: The stomach and the intestines.

SAIMA MOHSIN: … indigestion system.

DR. ERIK HOCHHEIMER: Yes. It’s the gastrointestinal tract. So, you need to train that.

And if it keeps diarrhea for days and days, you have to look for the cause of it. And, mostly, a kid that comes from other hospitals here has seen every antibiotic in the book already, so it’s not a question of giving more antibiotics. It’s much more observing.

But it’s out of the danger zone now. Anyway, let’s go and see this baby. This is one of our — this is actually a problem child.

Can I see the baby, mama?

And this little one, she is doing quite well right now. It’s a four-and-a-half-months baby who had a failure to thrive actually since she’s born, typical for many of the babies we get and young children.

SAIMA MOHSIN: How old is she? Because…

DR. ERIK HOCHHEIMER: Four-and-a-half months.

SAIMA MOHSIN: She’s tiny.

DR. ERIK HOCHHEIMER: Yes, 2.2 kilograms. And when it came here, it was 2.0, so it’s already a success.

But it’s typical for many of the kids we get. It gets worse because of the flood situation. But the ones that fall first are ones with some co-morbidity, kids that have some other reason for failure to thrive, as we call it. And this one needs a lot of patience, of course, and a lot of extra feeding. But she’s doing well.

SAIMA MOHSIN: And how does she compare with the size of a normal baby, in terms of the limbs and…

DR. ERIK HOCHHEIMER: Well, the average weight of a child born — born in the United States — is much more than the weight this child has now. As you can see very well, you can see the little arms. It’s just all very, very weak. I mean, but the face is the most impressive, is the sunken eyes, the big eyes, and, you know, the grandfather face.

SAIMA MOHSIN: And we saw many more babies in a similar condition that day.

Water levels remain high in many remote areas of Pakistan, in particular in Sindh, and, with it, thousands of people cut off for weeks on end, waiting for help.