The past two years for Frontier Primary Health Care (FPHC) has suffered from bomb blasts, insecurity and generalized mayhem resulting from the ongoing humanitarian crisis in the Northwest Frontier Province.
FPHC Manages IDP camp of 12,000 in Sheikh Yaseem
In 2009, during the evacuation of four million internally displaced people (IDPs), mainly women and children, who fled Taliban fighting north of Mardan district, FPHC provided 24-7 medical coverage for 12,000 people in the largest of the tent camps in Sheikh Yaseem city for more than nine months.
Initially their own staff did double duty in the IDP camp but with a formalized contract with UNICEF was finalized, they were able to hire 90 temporary staff members including physicians, dispensers, lady health visitors (LHVs), assistant LHVs, EPI technicians and nutrition assistants. Many of the needs in the camp were maternal and child as whole families made the long journey on foot and arrived exhausted with only the clothes on their back. FPHC coordinated services in the camp with local and international organizations including specialist physicians from government hospitals outside the area including the Punjab.
As FPHC staff number only 120 this was an heroic effort. FPHC were also contracted based on their previous response to quakes in Kashmir to establish nutrition services in six IDP camps. The comprehensive nutritional services included screening children and pregnant women, providing nutritional supplements, demonstration kitchens and assisting the IDPs to prepare healthy balanced diets with what was available to them.
FPHC Camps, Clinics and Staff Homes Flooded in August 2009
No sooner were the refugee repatriated back to what remained of their homes in the north, than massive flooding in August 2009 destroyed most of the mud and waddle structures in several FPHC refugee camps, clinics and housing of staff.
Although Dr. Emel Khan and FPHC have never had any training in disaster response, they responded immediately on both occasions. During the flooding, they helped people move, set up feeding kitchens, cleared away the debris, established mobile clinics and assisted in rebuilding.
In March 2010, UNICEF contracted FPHC to train and establish nutritional services at ten government health units in Mohmand Agency in the Federally Administered Tribal Area (FATA) near the border with Afghanistan for the returning IDPs there. This is important recognition of the quality and effectiveness of FPHC services and training, and serves to make them more visible and credible but places their staff at considerably more risk.
Training of Traditional Birth Attendants
In 2009, with funding from the Hillman Medical Education Fund and SRPC donors, FPHC ran 10 three-week training courses for Female Health Workers in 3 communities in Northwestern Frontier Province, Pakistan. 83 Female Health Workers were trained for less than $150 per FHW. The training cost included training for their midwife supervisors; a Clean Delivery Kit for each FHW; and a one year supply of Mommy Kits for each pregnant woman containing soap, sanitary tie, razor and gloves. The FHWs are now linked to and supervised by midwives in the health system.
Already the numbers of women accessing ANC and referred for delivery in the four communities, two of them Afghan refugee camps, has increased by more than 30% and the number of children being brought to clinic for immunization has increased.
While the training of traditional birth attendants is no longer seen as an effective way to increased skilled attendance at delivery by many international NGOs, Frontier Primary Health Care appears to have enhanced their success by ensuring they are supervised regularly by midwives and linked to the health units. By having the community members choose their own FHW, they are assured access to the women in their homes and thus able to have remarkable influence on hygiene and nutrition as well as clinic attendance.
CIHR Grant on Using Participatory Action Research in MCH
The ongoing collaboration of SRPC with FPHC focuses now on the $25,000 CIHR grant to develop participatory action research in MCH. This grant partners us with Simon Fraser University and UBC but has been somewhat delayed in implementation due to the insecurity. However the background paper on us of participatory research in MCH in the developing world has been finalized and FPHC has recently completed the community focus group discussions that are part of the environmental scan. Following analysis of the results of the focus group discussions we hope that Dr.Khan and colleagues from FPHC and Khyber Medical College will be able to meet with the team in Canada in the next few months.
Understandably given the current insecurity and levels of stress and exhaustion, moral of staff is low and depression not infrequent. Delivering health care services at such a time can be a strain, however Dr. Khan remains hopeful about the future, drawing strength from his ongoing relationship with SRPC and the support he has received.
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