Doctors Diary

 

Diary of Volunteers in the field

LETTER 001

Sent: Thu, 5 August, 2010 17:53:24
Subject: The Waters are Rising, The Road is a River

Dear family, friends, readers,

(sincerest apologies once again to all receivers if these are or become unwanted emails - please contact me if you do not want to receive these)

I write from Birmingham airport, I am soon journeying to Pakistan with an international organisation assisting in the current humanitarian crisis after the floods.

Yesterday morning I truly was as giddy as a schoolboy. It felt as though I was wearing my school uniform with my trusted satchel as I jumped into my father’s car as he drove me to the train station for my first day at school. As a child, I waited at this station’s platform for seven years, usually tired and usually late, ready for the train to kidnap me away to a school far away and my future education. However, on this morning, my first day at school was at the Birmingham Childrens Hospital, working as a paediatric orthopaedic registrar. I felt at peace, as though I was finally returning home, working in Birmingham, the beloved city of my birth and ready for the challenges ahead.

I was fortunate enough to be working with an old and trusted friend of mine on the same rota. We discussed our respective fortunes, misfortunes and future aspirations. I described some of my recent experiences and my current dedication towards my new post.

However, by mid-day of the induction programme, I was informed that some of my routine application forms were delayed in processing and it would take up to four weeks for me to be able to start my post. I shrugged and smiled, knowing I could at least use this time to complete some of my rather less glamorous writing projects.

And at this very time, my friend remembered an e-mail he received that very morning, requesting immediate medical assistance in the developing catastrophe of floods in Pakistan. They wanted medical staff who could travel within 48 hours. I scratched my head and heart before making the relevant phone calls. Pakistan is a country that has always scared me. It is a poor nation. From the media, it is a country plagued by the destruction of constant turmoil, gruesome internal conflict and political instability. It is a tragic nation. From the recent earthquake, to the very recent plane crash to the latest disaster of the floods, the people of Pakistan seem to be besieged with on going suffering. It was actually just over 48 hours ago that I decided not to follow any more news reports of Pakistan, such was the constant tragedy that poured from the country. And yet it is the country that holds the final resting place of my grandparents, inspiring humans that I have met and never met. It was only this year that I discovered the diaries of my maternal grandparents, discovering how they fought through individual struggle and strife for a better future in the land that is now wrought with so much misery. And reading their words from as early as the 1930’s, made me realise that for all its crippling flaws, it is still my past that the country houses and cares for. So as I returned as a giddy schoolboy to Birmingham just yesterday morning, today I sit at the airport ready to return as a grown up man to the land of my forefathers.

I am travelling with Doctors Worldwide, (www.doctorsworldwide.org), an established organisation in the country who are already operational on the ground already in assistance of the flood victims. I am not a hero nor ever will be or ever want to be. Through my recent experience in Haiti and subsequent education in catastrophe medicine, I have learned that it is this activity that ultimately brings me a semblance of peace in this unexplainable world. And if others around me benefit from my activity, it is merely a side effect of the activity that brings me peace.

I travel for two weeks and realise two weeks is merely a moment in the lifetime of the lives of those suffering in Pakistan. For what I may be able to contribute, if anything at all, I know it is fleeting. But I hope you do not think me an attention seeking maverick (or perhaps I am), for since my return from Haiti I have tried to stay involved with the project there as much I can. I hope I have been useful to them with what little knowledge I have and I am sure the Welsh surgical team that followed my journey found my descriptions to be accurate and helpful.

I know it may seem this random email is unsurprising from me but sometimes I genuinely am surprised how I have lurched and fallen from one ridiculous and heartbreaking scenario to another over these short years of my life despite my best attempts not to. I hope to document the experience in Pakistan in a similar fashion to that of Haiti if it is possible. And yet for no other reason than to clear these thoughts that whir and whirl within my head. For those readers whom allow me to do this, I cannot thank you enough. I am aware of the hazards and dangers involved, although I am sure all will be well, with the grace of God. So I will leave with the same statement I wrote before I left for Haiti, that should I ever lose touch or contact, it is the ones I love the most who will be the last thought on my mind before I close my eyes to sleep at night. For those that know me best, you know who you are.

With love, from Birmingham airport,

Saqib

"So open up your morning light, And say a little prayer for I, You know that if we are to stay alive, And see the peace in every eye."

LETTER 002 

Sent: Fri, 6 August, 2010 20:42:08
Subject: The God of water

(I have arrived safely with very little sleep on the flight. I decided to move straight up to the affected area with my colleagues after completing some formalities in Islamabad. I am currently staying comfortably in a guest house near Noshera (a city in shock). I am however awakened and refreshed by an unavoidable cold shower!)

I have always been fascinated by water, its formations and its freedoms. For me, there is always a wonderful feature about it, a majestic, hypnotic, God like quality. The endless horizon of the Indian ocean viewed from a deserted South African beach represented the infinite, the endless, the known and the unknown - for I could never know what was on the other side of the horizon but the water surely knew what lay beyond. The bobbing waters of the Swansea marina were calm, tranquil and peaceful whereas the fountain displays outside the tallest building in the world were full of mesmerising grandeur and elegance.

But today I witnessed the ugly, demonic side of water and my admiration of it has vanished. If it has God like qualities, then the floods in Pakistan were its power, its ferocity, its total and ruthless ability to destroy. As we drove through the remnants of a devastated city, the water had all but fled to its lower grounds, leaving behind just murky and dirty pools of brown water amongst drenched buildings, accompanied by a foul smell just as an added measure of unnecessary punishment. My colleague showed me photographs of the very city taken by himself 3 days ago as people waded and battled through rising water levels just to survive.

We visited some of the existing camps within the city, the largest housing 600 displaced and now homeless families with an estimated 3500 population within the walls of the camp. Conditions were bleak, the basics of sanitation, clean water, food and health care all stretched to the limit. Tents clustered together with little space between them within each tent nothing but a mat a human being sitting, staring vacantly. There is spots of litter and stagnant water. However there is general order and calm. And as always within these horrific situations, there are those care free cheeky kids whom I couldn’t resist myself to take a cheeky photo with.

Tomorrow we travel to the surrounding villages and areas where support has not yet arrived. We have acquired some equipment and medications as well as food aid. The descriptions from other organisations and local sources suggest there are large amounts of skin infections (scabies), gastrointestinal infections and injuries. I have been humbled and blessed by the moral, emotional and physical support already offered to me by countless people in Pakistan whom I know only through family and friends. I cannot thank you enough.

With love always,

Saqib

LETTER 003 

Sent: Sun, 8 August, 2010 2:59:07
Subject: The Waters are Rising, The Road is a River

Dear readers,
Heavy rains did not wake me on my first night as I slept
comfortably through a severe downpour. By the morning, the
water levels had risen somewhat again, swamping the very
area we had planned to visit and assess for our proposed
clinic site.

As we waited for the weather conditions to improve, we
hurriedly transferred all our equipment and medication
stock into one central location, allowing us to
systematically calculate which supplies we had in order to
be an effective functional unit and which supplies we were
still missing. My colleague and veteran of Doctors
Worldwide projects in Pakistan then scoured through the
local town collecting further vital supplies whilst I was
joined by a retired army medical dispenser, whose home had
been destroyed. Together we organised all our medications
and documented them into a pharmacy inventory. This time I
remembered to check for and note the expiry dates of the
stock, a mistake I had previously made in Haiti.

By the afternoon, the rain had ceased and we decided to
drive towards our proposed clinic site. Along the journey,
there were makeshift tents dotted around the countryside
as a man washed his clothes in a stagnant pool of mud and
a baby was being washed in an adjacent pool of murky
water. As we ventured further, the small puddles on the
road started to unite into larger puddles and the larger
puddles into a shallow stream. Believing this was the
worst of the conditions, we crept forward before the
shallow stream that was previously a road became a deeper
stream and at its worst, 2-3 feet deep. This road, 48
hours ago, was perfectly driveable.

As I rolled up my trousers and was prepared to jump out to
wade back, expecting our car to start swimming then
driving, miraculously we pushed forward through many
streets and found higher ground again. The scenes either
side of us were chaotic as people carried their
possessions back and forth through floating rubble,
buildings and houses destroyed on either side of the road.
Occasionally a truck managed to pass through, distributing
food and water but these people were clearly isolated from
significant aid.

We passed through a further village before arriving at the
suggested makeshift clinic site at dusk. However, the
fields were waterlogged, and although the river flowing in
the vicinity was beautifully serene amidst the backdrop of
rising hills, the location was not comforting for our
purposes.

We made a quick decision to abandon this location as night
was soon approaching and we still had a the road that was
a river to cross. On the return journey, we passed many
people that again were carrying their possessions out of
the area. They had only just returned to reclaim their
homes and dried their possessions as this second water
rise occurred.
On the way back we picked up a family of 5 with three
small children who were evacuating the area for the second
time, making a three hour journey by foot with their
meagre possessions on their backs and ones heart couldn't
help but bleed for them.
We made it safely back as we re-evaluated our position,
our equipment and inventory is ready to be functional, it
is matter of finding a place of need in such dire and
unpredictable circumstances. Safety is of course
paramount. Tomorrow morning we get up early and drive to
an abandoned district hospital to see whether it can be
rejuvenated into life.
On a lighter note, for those who do not know me, I am
proud to be cofounder of a comedy football team, the
Dadyal Dice Rollers in Birmingham. Before I left for
Pakistan, I had proudly designed a team-shirt with logo.
The shirt image arrived by e-mail and I was so happy I
placed it as my desktop wallpaper. My colleague noticed
this badge and asked me what it was. After explaining, he
said he too was a keen footballer and asked whether we
should play football sometime. So one of my new objectives
is to organise a local football match with the kids, I
always knew the Dadyal Dice Rollers would be an
international team!
With love always,
Saqib.

LETTER 004 

Sent: Sun, 8 August, 2010 21:27:55
Subject: Indiana Jones and the Raiders of the Drowning Hospital

Dear readers,

72 hours ago, whilst in Birmingham, before I had any idea
I would be in Pakistan, I described to a friend an awesome
medical career. I suggested a medical version of Indiana
Jones - that he would spend most of his time teaching at a
University but then when the need arose, he would travel
to find the medical holy grail. I got duly laughed at!

This morning, after four hours sleep (don't worry, I have
napped throughout the day! jet lag or laziness?), we
ventured back towards the same flooded village we visited
yesterday. After another rickety one hour drive, we
arrived behind the fields of an apparent abandoned
hospital. We trudged through vast amounts of mud and large
puddles before passing a cemetery.

Within the cemetery, many of the graves had crumbled,
caving in, crushing the insides of the grave, leaving it
exposed to the open air. It was an eerie and disheartening
site. I asked permission to take a photograph and although
it does not feel right to photograph and share, the images
are so sad and worthwhile for others to see. I read a
silent prayer for those hopefully still resting in peace
(picture).

We then made our way to the hospital. Across the ten foot
walls and barbed wire were debris from the floods,
indicating the water had passed over the entire building.
Inside the compound a few locals were sheltering amongst
litter and stagnant water.

We trespassed through to the back, where we discovered
another building, a suitable size for a clinic. Again mud
and slime covered the walls like a monstrous painting. The
doors were jammed, locked shut, stuck in inches of slime.
My colleague climbed over the back gate in his bare feet
and tried from the other side as we kicked the doors open,
one after the other. And at that moment it felt totally
surreal, kicking down the doors of a hospital and I
wondered if Dr. Jones would be doing the same!

Inside there was battered furniture (picture) and more
slime then outside. I was told to look out for snakes and
I started laughing before thinking, "snakes, I hate
snakes" in true Jones style. The compound has enormous
potential. It needs a serious work up but we can get it
functional very quickly. The cleaning process has already
begun  (picture) and the difference is phenomenal after a
few hard working volunteers contributed to the cause.

Having surveyed the region very quickly, it is apparent
this hospital is the only one in the area, and it serves a
population (before the flood) of at least 100,000 people.
The demand is therefore likely to be huge. The facilities
here are terrible. Our aim is to get the clinic
functional, bring basic health care as soon as possible as
well as start a food programme from within the quarters.
Our deadline is 48 hours, but hopeful for 24.

I am aware of the high quality care our organisation wants
to bring to the people of Pakistan and so it will be my
duty to ensure we make this project start with rigorous
standards. I know that once standards drop in this type of
system, it is difficult to retrieve. Hygiene is our number
one priority.

However, the major concern is the entire region once again
is on high alert and the hospital that has just begun
being cleaned may again be flooded as I type this very
letter.

Further good news regarding the surging Dadyal Dice
Rollers Football Club. I have identified a youth team
programme in the area so we may start scouting for players
to take over from our already ageing squad (picture) and I
have also discovered Tiger biscuits (picture). For those
that do not know what Tiger biscuits are, they are
biscuits that give Dadyal players super-strength. However,
they were banned for being an illegal performance
enhancing substance. Our scout said they were no longer
available but clearly they are. I will sack the scout once
I return to the UK.

With love always,

Indy.

LETTER 005 

Sent: Tue, 10 August, 2010 3:49:23
Subject: Even simple village medicine is complicated

Dear readers,

The current job at hand and workload is enormous and
almost overwhelming. There is so much to do and such
little time, effectively we are starting to run a hospital
from scratch, from the back of a hotel room. It is hard to
know where to prioritise ones energy and yet have enough
rest to maintain energy levels. It is for this reason I am
going to cut my diary for today into bullet points.
Writing this diary does offer some internal relief of the
jangling mind so I feel it necessary to plough on.

1. We cracked open the other hospital building and found
some wonderful goodies covered in slime. An upside down
doctors desk, a drip stand, an examining table and most
importantly, a dysfunctional light box (for viewing
x-rays). I have always insisted that a functional hospital
can only be considered functional if it has a
dysfunctional light box. So we are fully established now!
 (pictures)

2. The clean up process of the buildings continues. Simply
spraying the walls with water is not enough. We need to
disinfect and repaint also as soon as possible.

3. The clinic has begun! Despite the work around us,
 patients have started to arrive and I started seeing
patients. From complex orthopaedic trauma surgery in the
NHS to backyard village medicine is quite a jump. However
local doctors are soon to be employed and hopefully I will
learn from them as well as oversee the running of the
clinic. The patients I am seeing so far are skin
infections, multiple foot problems (thats what happens
when you wade around in flood water for hours) and
diarrhoea.

4. As stated earlier, hygiene and mentality is key. Too
many times in Pakistan I have seen people throw litter. A
staff worker drank his carton of juice and promptly threw
into into the wet fields. I explained this is
unacceptable, firstly its not clean and secondly some poor
worker will have to now pick it up. Its time certain ideas
need to be modernised, simple, basic ideas. (call me
infection control nurse!)

5. Each day on the drive to the hospital we drive past a
cemetery. And each day there are new graves. I have no idea
if that is standard here or flood related.

6. We still have so much administrating to do. Cost
analysis, clinic data collection, rapid needs assessment
of population, inventory checks, accommodation for
volunteers and daily reporting to the base.

7. I finally got a warm shower as the weather is now
improving and its hot, hot, hot

8. If on any of the pictures you see me wearing a South
African rugby cap, it is because I saw one in the local
market and bought it. Having worked in South Africa for a
year and really watched Invicticus on the plane from
Dubai, I thought it was ironic that they were selling a
Bokke Rugby cap in Cricket mad Pakistan in the times of
floods! The bokke will bring me luck! Anyhow, it will go
nicely with my UN cap from Haiti now!

9. Help is on its way, I am in good health and well looked
after! I am getting a few insect bites which is a bit of a
concern given the amount of stagnant waters! I am fully
aware the utmost priority is myself. Yesterday I was
feeling a bit dehydrated and lacking sleep so I came back
to the hotel to load up on fluids and take a nap. I will
take care of myself, promise.

Work to do, apologies,
With love always,
Saqib

LETTER 006 

Sent: Wed, 11August, 2010 21:07:11
Subject: In tribute and admiration

Dear readers,

As I drove the Doctors Worldwide Suzuki van at sunset on
the M1 highway back up towards Noshera (after greeting our
new volunteer and crucial team member in Islamabad airport
the night before), I had the first opportunity to gather
some thoughts that had been tinkering within my head and
heart.

In Haiti, when I attended the collapse of a primary school
and attended the subsequent funeral of one of the
children, I wrote with such sadness that I know many
readers cried at my emotional outpourings. In these
diaries, I have written optimistically and jovially about
the positive aspects of the aid effort for I have realised
in these extreme circumstances, words that make people cry
only adds to the collective unhappiness in the world.

But it has been a few days since I learnt of the deaths of
the medical workers in Afghanistan, a location with a
similar geopolitical climate to the one I am working in
right now and it has plagued my mind. Some would say their
work is rather worrying similar to mine. But rather then
dwell on this, I wanted to pay tribute to these amazing
people who tragically lost their lives whilst assisting
with and improving the lives of others. I wanted to thank
them, if somehow I could, for the commitment and ultimate
sacrifice they made for a cause they believed in. But most
of all I wanted to congratulate them, for being those
human beings in this crazy world that realised that what
they had been given in this life was enough for them to be
happy, that they needed no more and would rather give away
rather than accumulate, that they had found peace in
finding a role to play in this world.

I will not write for others but I often forget in the
trivias and trials of my busy life that the opportunities
and possessions I have are the unreachable aspirations of
millions if not billions of less fortunate people in this
world. When I remember this simple fact, I try to be
thankful for what I have and not be too disheartened if
and often when I cannot achieve more.
 
I have also wondered if I would have any regrets should
the worst happen to me in this or any other situation. My
only regret would be the pain I would cause deep in the
heart of my parents for putting myself at risk. But yet it
is the combined hearts of my father and mother that have
led to the creation of this heart that writes these very
words in this very situation. The end of my life is an
inescapable fact, this cannot be changed. However what can
change is what can be achieved in the time I have been
given. I would rather have a productive shorter life then
a longer time in which I did not utilise the precious time
I had for the objectives I want to achieve.

Although I was hoping to leave this story til the end of
my journey, I want to share with you the story of my
colleague with Doctors Worldwide whom has been working
tirelessly with me on the ground. He has worked for the
organisation for 8 years in the region, including being
involved in missions in Afghanistan in 2002 and
Muzaffarabad after the earthquake in 2005. It was whilst
working for Doctors Worldwide on different programmes he
was unable to return home to say his farewells to both his
dying mother and on a separate occasion, his dying 3 year
old son. He speaks Urdu, English, Parsi, Pashto, Punjabi
and is learning Turkish happily.

At the time of the floods in Noshera, he was once again
working on a Doctors Worldwide programme to build a
childrens hospital in a different region, 2 hours drive
away. On that tragic day, he received a phone call from his
family that the waters were rising nearby. He told them to
monitor the situation closely. At nine am, he received a
further phone call from his family, the waters are still
rising. It was at this stage he realised something was
drastically wrong and drove back as fast as he could. But
due to the weather conditions and traffic, it took him 5
hours to return home. By that stage, the water in his
house was waist deep. He quickly organised his family away
from the area (including his 1 day old daughter - yes 1
day old daughter) and proceeded to return to the house. He
climbed over walls and rooftops to start retrieving
possessions from his house and take them to higher ground
on the third floor in hope that the water would not rise
so high. This included his most prized possession, a 20
year collection of books, his personal library.
But the water kept rising and rising and it was apparent
he too needed to escape whilst his books drowned. He again
climbed over sinking walls, running towards the car and
fled with his family. All 8 members of the family stayed
in the car that night, in a tent the second night and the
third day he took them to his family village for a place
of safety (he was one of the lucky ones who had family in
an unaffected area).

The next day he returned to the region and Doctors
Worldwide mission began. He picked me up from the airport
and the story you have read since is my diary. He has
looked after me and watching him work is an inspiration,
from his hard work to his resourceful ability to manage a
project like this in such dire circumstances. He still has
not had a chance to name his new baby daughter and has not
seen her since the floods. "Afia", he says, "I have
decided to name her Afia".

Dear readers, this is the true hero of this Pakistani
tragedy and I enclose a photograph of him and myself, both
standing on the roof of his house where the water level
still remains dangerously high. Jeremy Brown, the topi
(hat) he is wearing is your hat you wore on the 3 peaks
challenge. I found it in your raincoat you gave to me
before I left. I gave it to him, I hope you do not mind.

To those celebrating Ramadan - Ramadan Mubarak. To those
who are not celebrating Ramadan - Ramadan Mubarak!

With love always,
Saqib.

In further updates on our activity: our clinic is starting
to look remarkably different already. In the room that
only 48 hours before I was kicking the door in and finding
pools of slime, I saw 71 patients with very little
equipment. The consultations I performed were not of a
high standard but children got calpol and vitamins, skin
infections got some sort of cream. However, it is a symbol
of hope for what we hope to achieve (picture). I have some
major plans for this clinic and we have a team working
really well together, in the field, in Islamabad and in
the UK coordinating this.

The cooked food programme that Doctors Worldwide is
running remarkably well. It was a wonderfully uplifting
sight to see people returning home with their bowls of
cooked rice and lentils. (pictures)

LETTER 007 

Sent: Sun, 10 August, 2010 3:49:23
Subject: The meaning of Iqra – To read a holy book

Dear readers,

This evening I have internally debated and pondered in
depth as to the appropriate title of this diary entry. I
seriously toyed with the title "Children are dying,
Ramadan Mubarak" and although this is an accurate
description, I did not choose this clichéd phrase because
it would place a feeling of guilt into your mind and this
is not my wish or objective. I toyed with the title
"Village Centre of Excellence" because this is the
objective I truly want to achieve and I want to promote
hope in your mind that something worthwhile can be
achieved here. However, this title masks the vast problems
we are facing and so in the end, I have chosen the name of
the girl whom I met today. The feeling of guilt or hope, I
leave entirely up to you.

Iqra (meaning: to read a holy book), is a one and a half
year old girl who attended our clinic today.  I arrived to
the clinic in a rather optimistic mood. We had purchased
some basic thermometers and some linen for the patched up
examination table. Just as I carried the examination table
indoors into our newest and latest clinic room, a
commotion began outside that there was a sick child. I
hurriedly put my brand new sheet onto the examination
table and asked the mother to bring her in.

She carefully placed Iqra on my fresh examination table as
I asked what was wrong. "Fever, diarrhoea, watery" was the
translation followed by a history of severe diarrhoea for
3 days. Iqra's mother then told me a mobile camp had been
in the region four days ago and had given the child an
injection of some sort.

I looked at child, slightly nervously, knowing I was not
and never have been a paediatrician. She was limp,
lifeless, floppy, her arms and legs not flinching. Her
mouth was closed, unable to open it to neither scream nor
cry. Her only moving body parts were her eyes that would
roll in her head and then occasionally gaze up at me with
fear. She was hot and my new flimsy thermometer confirmed
her fever. Her pulse was difficult to feel.  (pictures)

She was grossly dehydrated and it did not take a
paediatrician to know she was dying in front of me. I
searched inside the unopened boxes of my pharmacy,
convinced I had forgotten to pack the basic intravenous
fluid equipment. Iqra's only hope was for us to transfer
her as soon as possible - to where I did not know. "Take
her now" I said to my colleague as the mother, child and
my co-worker rushed to the vehicle. I chased after them
remembering that without a referral letter in a place like
Pakistan, things did not work.
"Doctors Worldwide", I wrote, followed by "UK Doctor" in
big letters, hoping it would have some sway with the
bureaucracy Iqra would meet along the way. "Dear Doctor,
patient pyrexial, grossly dehydrated, I do not have the
basic equipment to treat this". Iqra was bundled into the
car and I turned to go back into the hospital compound. No
sooner had I set foot into the entrance, a man grabbed me
and said his wife was in trouble. "She is trying. Her
pregnancy is overdue. She can't give birth." Again I knew
I was out of my depth, I quickly called my colleague
telling him to hold the vehicle and that another patient
is coming. I wrote a second flimsy referral in the hope it
would help.

I continued the rest of the clinic of on-going skin
infections and foot problems with sadness that I did not
even have the basic interventions to treat such
emergencies and also a little annoyed I have not had a
chance to stock up properly - our hotel room remains a
backyard of boxes of medicines and equipment that I have
systemically gone through but not organised to transfer.

My colleague arrived a few hours later, explaining the
patients had been accepted in a strictly military hospital
(not to be used by civilians) which was 30 minutes away.
Once the morning shift was over, we visited Iqra.

She was in the hospitals version of ITU, with an IV drip
connected to her foot. She was moving her arms and legs
freely, looking around and responding with verbal noises -
a totally different girl. She is by no means out of the
woods yet but I will visit her tomorrow to see her
progress. (pictures)

  I found the doctor who accepted my referral, thanked him
enormously and have arranged a meeting with the colonel
tomorrow to see if it is possible to arrange a temporary
or permanent referral centre for us in case of civilian
emergencies.

A few hours later we received the good news the pregnant
lady I had referred had given birth to a baby girl. We
also received the bad news that the baby girl was in
trouble and needed referring on again with a proper
ambulance. The military hospital would not provide an
ambulance for her. So my colleague once again fled our
work and somehow started a search to find a fully equipped
ambulance. After making requests to another hospital and
being denied, he amazingly found an ambulance on the road
owned by a local Islamic charity. And amazingly, he had
the number of the charity's director on his mobile phone.
After making a phone call, he gained permission to use it
and quickly transferred the new born to the local
government hospital another 30 minutes away.

Tonight, the baby is in the government hospital in the ITU
along with the girl's impoverished father who is staying
in a hotel nearby. The baby's mother remains in the
military hospital. And Iqra, I hope is at least improving.

With love always,
Saqib

On a lighter note, I am attaching the pictures of my new
cleaning staff for the clinic and also my first patient
who has come back to my clinic with a complaint. Her feet
still hurt she says!

LETTER 008 

Sent: Sun, 15 August, 2010 13:12:39
Subject: Meet the team

Dear readers,

This post is dedicated to the best NGO team in Pakistan in my opinion, the
Doctors Worldwide team.

The last 48 hours have posed the greatest challenges and headaches to me since I
arrived in Pakistan. I was not worried about suddenly dropping my plans in
Birmingham and totally deviating course to fly to Pakistan amidst the disaster.
I was not worried by my lack of local language skills, I knew I would cope and
learn for my background in Urdu was there. I was not worried about the well
described dangers in the country, I knew that I was careful enough and well
travelled enough to survive. I was not worried about flying out on my own with
an NGO I knew very little about. I was not worried about not knowing who my team
members would be on the ground when I arrived. I was not worried about having a
very nonspecific mandate and I was not worried about being assigned the team
leader role to get the mission off the ground.

The small team that we have, as you have seen from the work I have presented in
this blog are exceptionally efficient and organised. Our team originally was
just 3 in the whole of Pakistan (a medical student, the local Doctors Worldwide
coordinator and myself) and within 3 days, we had cleaned out a destroyed
health care centre, restocked it and began seeing patients. We were also
regularly informing the media, both on Al-Jazeera and through various other
websites of our activities. We were co-ordinating closely with our support team
from the UK and most importantly, we were looking after each other and having
fun with a great team spirit. Our e-mails were both filled with essential
information but also jokes, poems, haikis and Shakespearean quotes. Our team
became four with the arrival of another doctor from the UK who blended in
beautifully to our work ethic and psyche. Our objectives became more defined,
more streamlined and our machine was working very well. We gathered resources
from local people and local volunteers who all have contributed an enormous
amount.

So it was as almost as though we were a victim of our own success, for our
reporting, communication, and field successes led to an influx of interest in
our work. It was the sudden arrival or a Turkish team to join ours with very
little warning which blew the well oiled machine apart. Myself and my colleague
in the field were working almost 18-20 hours a day with many different aspects
of the plan to think about, working whilst eating lightly, working whilst
driving and preparing for a larger team to arrive soon with more specific
goals,Turkish included. We knew timing was essential. However, we were not
prepared at this stage for more volunteers especially ones without language
skills to communicate with.

Being the team leader and suddenly being responsible for another 4 men (2
doctors, 2 search and rescue staff) in the field of which 3 I could not
communicate with as they did not speak English or Urdu (only Turkish) and the
4th volunteer speaking only slow conversational English and Urdu suddenly ground
my speed down.

I believe my utmost priority is the safety of the staff under my care and it
became apparent that this suddenly became an added burden and worry for I could
not utilise them without worrying about them and their well being. Furthermore,
we would have to ensure they are well looked after and have the local logistical
support to fulfil their own objectives as well as ours. This became difficult
when there was only two of us and a handful of locals we had employed whom
Doctors Worldwide had known and trusted. Our timings of work became delayed as
we also shared facilities, moved out of our own hotel room to accommodate their
presence and ensured their cooking requirements were met.
The project suddenly became difficult to manage. However, this is the nature of
disaster medicine and I have learnt a wonderful word from my Pakistani colleague
– "Jigar" – it means improvise and this is what we have done. I must ensure the
project goes ahead as planned but also accommodate everyone on the ground in a
useful way. For these volunteers do not mean to be a hindrance and in fact our
Turkish friends are a wonderful, noble and kind team. I am very happy they are
here, just a little early unfortunately. However they have great talents and
skills too.

There are many definitions of leadership and one which I was taught recently at
the Diploma in the Medical Care of Catastrophes was (slightly paraphrased
because I cant remember the definition exactly) "a psychological ability to get
others to complete specific tasks successfully". However, for me, although
probably a good and accurate definition was not romantic enough. My definition
is "Having the ability to bring out the best in others whilst simultaneously
bringing out the best in yourself". And so I introduce the Doctors Worldwide
Team:-

(These are the names we use in our e-mailing banter to cheer each other up)

The Fantastic Mr Fox

Mr Fox is a post graduate 4th year medical student from Leeds University who
happened to be on his medical elective in Islamabad during the time of the
flood. He urgently looked around for others to help and found no assistance
from local NGOs. Since he knew the Doctors Worldwide organisation in the UK, he
appealed for help. It was he who got the project started. He has predominantly
been working in Islamabad co-ordinating the mission from our HQ there and also
making trips up to the affected region.

In his spare emailing time he quotes Shakespeare making me look particularly
uncultured. He has a wonderful sense of humour and tolerates my teasing of him
very well. My only criticism of him is that he does not stroke his beard when he
sits in ponderment!

The Pakistani Bond

This man is the life and blood of the Pakistani Doctors Worldwide presence. He
is a veteran of missions in Afghanistan and post earthquake Pakistan. I have
never quite met such a hard working, passionate and truly resourceful man. His
home was destroyed by the flood and it is him and I that have been working on
setting up this flooded clinic.

He is Bond because he drives his Suzuki car through rivers and climbs over walls
like a secret agent.

Indiana Jones

This is me. This is because I wear silly hats, kick down doors and I hate
snakes.

Cat woman

Cat woman joined us 5 days into our mission and her role is also in Islamabad,
co-ordinating with other NGOs, attending WHO meetings, organising volunteers and
obtaining resources. She has an Accident and Emergency background and is
currently completing a full time Masters programme in Public Health Medicine.

She is Cat woman because she says she is sassy but her claws and her teeth are
pretty feisty. She can certainly leap from meeting to meeting and still land on
her feet.

Charlie

Charlie is one of the most experienced members of Doctors Worldwide and has been
on previous missions to the Congo and Pakistan. He also has an accident and
emergency background. He has been imparting his wisdom from the UK, ensuring our
safety and giving important directions in our many different and difficult
challenges.

He writes beautiful Haikis to summarise the events of the day and also has a
wonderful sense of humour (anyone who tolerates my nonsense qualifies for this)
Louis Lane

She is a journalist in the UK with a great deal of NGO experience. She rolls the
media machine and helps our diaries get published including on Al-Jazeera. Her
work is invaluable.

She is a stand up comedian in her part time but more importantly, she keeps our
feet firmly on the ground.

The Ottoman Cooks

There are four Turkish Doctors Worldwide team members. 2 are doctors, 2 are
paramedics / search and rescue specialists. I can only communicate with one. I
have just begun implementing a role they can play in this mission and have today
sent them with some interpreters to the static clinic we are rebuilding to see
patients as our local doctor will have the day off. They will become part of our
mobile team as soon as we put together a safe and suitable itinerary with
logistical support. We are hoping to start a health care education programme of
which they will play a big role in distribution of both aid but also education.

They are a wonderful people and eat beautifully. Even in the hotel they insist
on cooking their own food and even bought supplies from Turkey. We sit and eat
together and have now started laughing together. I am very hopeful they will
make a very positive impact now that our objectives have accommodated them. They
have offered me a Turkish bride but Indiana Jones only gets married once his son
has grown up. So first I will need a son and I am not rushing!

The Pakistani Support

I cannot thank my friends and others in the region whom have helped, although I
have no code names, Farooq, Zeeshan and Faraz have all helped significantly in
their own way. I have now begun learning how to delegate not just to our team,
but also utilise the wonderful support we have here by the local people.

The newcomers

More doctors are arriving. I do not know what talents and challenges they will
bring to our team.

I would just like to thank this small team whom have done an absolutely
wonderful job. We visited the hospital MSF have taken over in Nowshera, and
although we are just a miniscule of the size and only recently started, our work
parallels theirs significantly and in some ways is an improvement to what they
are also achieving.

With love always,
Saqib

LETTER 009 

Sent: Sun, 16 August, 2010 21:50:08
Subject: Of Life and Death (warning: some images are disturbing)

Dear readers,

Our project is bursting into life. From an unlikely trio
we have now become an eclectic mix of international
volunteers and local staff. Our numbers now exceed over 20
and the complexity of our mission increases by the minute.
Each contributor to our greater good has a significant
role to play but also has their unique and specific needs
which they naturally prioritise above all else. It is
becoming more apparent to me that my position is now to
try and keep all these colourful threads together to form
a strong and beautiful rope that will hopefully help lift
some of the Pakistani people out of the floods and their
misery.

It is for this reason that I am seriously considering
staying for another 2 weeks to help this splendidly
stuttering machine move forward whilst the wheels are
frantically being put on in true Pakistani style - by
improvising! It is not the most glamorous position as I am
often lumbered with some of the administrative or
technical aspects of the mission but if it allows the
others' hard work to materialise, it is worth it.

I have not been to the main clinic for two days whilst
being stuck with paperwork and planning. Instead this has
allowed the Turkish contingent an opportunity to thrive
and thrive they have. On their first day on the site, they
returned buoyant with pictures of the first child to be
born in our clinic. I watched a video of the Turkish
doctor reading an azan into the baby's ear as the Turkish
team also proudly watched the footage. It was at this
moment I believe, that our clinic too was born and a new
hope for the Pakistani people began.

The Turkish team again returned today with wonderful
pictures of their work ethic, distributing balloons to
children as the doctors in the team performed our first
minor operations - a drainage of a terrible abscess on a
childs head and a removal of a foreign body from a man's
foot.

But as they cycled through their images of the day, they
showed me some rather disturbing photos. It was that of a
man, or rather, that of a corpse, clinging to his dear
life with his left hand onto higher ground as the flood
swept him under. As the river water now begins to recede,
his body that had been under water has now become visible
but still too dangerous to reclaim. Bystanders look
helplessly on. And this for me has been the most striking
reminder of why I as a person, Doctors Worldwide as an
organisation, and we as the united world, are here
supporting the people of Pakistan during what is an
absolutely horrific event.

Today I thanked the Turkish team for coming and told them
I was happy they were here on our team and also thanked
them for cooking great food for us every day. I have also
assigned an experienced doctor from Dubai who has just
arrived to begin our mobile educational program and the
Fantastic Mr Fox is organising a rather delightful food
package for the poor and hungry in our region.
We have now moved into our unfurnished house and office,
leaving the bomb site of the hotel room behind from where
we running the show. I spent a long hour without
electricity whilst sweating buckets staring at the ceiling
fan just now, firstly wishing for the fan to start but
secondly deciding whether I should stay or go.

I think I need to stay to see the birth of a braver
Pakistan but I cant help but wonder how many dead are
still clinging on under the flooded Pakistan.

Saqib

PS - My URDU is coming along nicely but I have already
kicked my football over the fence into the neighbours
garden (whilst teaching the Turks how to play of course)
and I don't think I know how or have the confidence to say
"please sir, can I have my ball back"....

LETTER 010 

Sent: 23rd August 2010
Subject: It is not Pakistan, it is Perishanstan. Perishan – Sadness, Perishanistan – The land of sadness

Dear readers,

I was watching the pictures of the flood on the TV with my colleague Abdul Wahab in the first few days of arriving, and he said something I quite liked: “It is not Pakistan, it is Perishanistan.”

I have not seen myself in the mirror for over two weeks, I wonder how I look. All I feel is the hair on my face growing longer and more uncomfortable, almost in direct partnership with my unhappiness at the magnitude of the situation we are facing here. I wonder, if I were to fiand a mirror and look myself directly in the eye, would my eyes be floating on hope over the flooded rivers of this land or would they sink under the water with the weight of despair. I have always lived by the belief that as humans, our love, our hope and our endurance can overcome any bridge, no matter how smashed it is. And throughout the simple trials of my life, I have always been proven wrong in this idealistic mantra. Now I fear for the people we are trying to help, I fear we cannot cross this bridge and I once again fear for my already battered ideals.

It is not the floods directly that is overwhelming this belief. It is the previous 50 years, the previous 100 years, the previous lifetimes and generations of the people of this troubled land that worry me. It is the man made disasters, the regional wars, the millions of refugees and internally displaced peoples that are hosted here. It is the natural disasters, the drought, the earthquake and the flood. It is the governmental instability and ineptitude of leadership. It is the rise and fall and rise of extremism. It is the growing population, the lack of education, the basic healthcare that is missing. It is the extreme poverty, its cycle and recycle. It is the lack of understanding, the lack of co-operation, the destruction of good will.

How do I tell our patients they deserve so much more than they ever got or are ever going to get? How do I tell the mother that just lost her new born it did not have to be this way without hurting her? How do I tell the man that his condition should have been treated many years ago without hurting him more? How do I tell our dispensers not just to mumble the instructions of the medicines but to explain it thoroughly so the patient may understand the treatment when the dispensers do not understand this logic themselves? How do I ensure the patient understands the instructions when she cannot read or write? How can I tell my staff it is not acceptable for 15 people to be in one crowded con salutation room or that hygiene is of utmost importance, only for them to agree, solve the situation temporarily and return back to their ways when there is no supervision? How do I change the psy che of the Pakistani people after years of neglect?

And with all these questions, one continuously asks what are we trying to achieve here and can we be successful? Do we provide care for a day, a week, a month and leave, waiting for the next disaster to hit these poor people? Do we stay longer and if so, will the government assist or continue its rather ridiculous love story with drama and corruption?

Even the positive work by great people in this country is disorganised, chaotic and not always well thought out. If there were lessons to be learnt from the humanitarian relief aid from the previous earthquake in 2005, I doubt they have been learnt. I wonder if we are contributing to the chaos too. However, with all this confusion, I still have a small vision for our basic health unit with a fading sparkle in my eye. The same health clinic we found rotting in flood waters will hopefully rise to better than it ever was, for the short term and long term use of the people it serves for years to come. And in this little, seemingly insignificant project, despite so many setbacks, I still have my hope. I attach a picture of us trying to organise 57 boxes of aid. It is not glamorous moving and unpacking boxes whilst organising a workable system to allow our inventory to be managed, long after we are not  here. But it needs to be done. And that ultimately, is why we are here.

With love always,

Saqib

 

LETTER 011 

Sent: 25th August 2010
Subject: Sim Pakistani BHU (the computer game)

Dear readers,

For those that do not know me, I am a proud computer geek. I always have been a geek ever since my mother bought me NHS glasses with thick brown frames and lenses the width of jam jars when I was a little boy.   And with this ridiculously short sighted handicap, I began my adventure into the world of computers and their wonderful games. I immigrated from the Sinclair to the Amstrad to the Atari, Nintendo, Sega and eventually the PC.

Although my favourite games were always sports related, I developed a fascination for simulation games, spending hours upon hours sacri?cing my youth playing games like Sid Myer 's Civilisation,Railroad Tycoon, Theme Park and Sim City. The objective of these games was to develop an all con- quering organisation from scratch with absolutely minimal resources. In Civilisation, you would lead a civilisation to world domination starting from just a peasant, or Railroad Tycoon you would create a railway empire from one train   or Sim City you would try to create a world class city from just one building. In Theme Park, you would build rides and facilities for your theme park visitors and monitor their happy or sad faces from their enjoyment of your park.

For the last 3 weeks of my life, it seems I have spent every minute and hour playing Sim Pakistani BHU (Basic Health Unit).   The computer game's objective is to locate the site of a battered, ?ood smashed basic health care unit in Pakistan and re- habilitate it, rebuild the infrastructure, start treating patients, monitor their experience and with the knowledge gained from one BHU, expand the empire.

Now, in these simulation games, there is always the competition who you must compete against to pro- vide the best service. In Sim Pakistani BHU, you are not competing with anyone but there are other players in the region, all trying to provide a health service. However, from the day I arrived, the emer- gency health care provided I saw was not the one I thought would provide the biggest and best impact for the people affected by the ?oods. All other serv- ice providers in the region are organising mobile health camps, where a health team of variable ex- perience arrive in a van, locate an affected village or region for one day, chaotically (or sometimes well organised) review 100-150 patients, supply basic medications and then leave for a new destina- tion the next day.

The patients receive their medication in an often rushed or haphazard manner and there is no secu- rity or follow up to know whether these medica- tions are being taken properly or the conditions be- ing treated are actually worsening. The players in the region are not greatly centrally co-ordinated from what I have seen and the patients of the re- gion have no guarantees of if, when or where an- other mobile clinic might arrive. Asides from being slightly concerned of the efficacy of such treatment and whether good clinical medicine was being practiced, I ?rmly believed from the start that al- though the mobile clinics had their uses as they could reach larger people faster, they did not pro- vide quality care in the short term and in the long term because after the mobile teams leave for good, the people would still be left with nothing.

And so my game plan became the BHU empire.

Now I am midway through the game and we have had some amazing successes. The word of mouth in the region is spreading about our service, just as we anticipated, and people as far as 8-10km are making their way to our static health care site for treatment and to be seen by our doctors. When ini- tially 50 people came, now 240 people arrive. Vis- its from other NGOs completely agree with this philosophy and they are impressed with our work so far. Reports have suggested we are already functioning better than government BHUs in the region that were not even affected by the food. Donators who come to see the work in progress are inspired, they donate more and our strength of service in- creases.

We are becoming established and we can expand, hoping to provide more services, vaccination pro- grammes are now being considered, maternity care, education programmes are potentially on the horizon. And whilst other players rove around with the same mobile clinic philosophy, spot diagnosing, spot treating and leaving with no real contingency plan, we can now consider taking our service and ex- panding into other areas, thus establishing a pri- mary health care facility that reaches out to these needy people right now and long into the future, perhaps helping to establish and promote other health centres that are struggling to treat the ?ood affected people.

However, there are still many hurdles in this game. I have not completed the water, electricity or sani- tation mini-puzzles properly and so cannot move on to the next level.   I leave you with my score and current picture progress.

With love always,   Saqib

Sim Pakistani BHU Score:

BHU Medication supply....75%.. (Good stock, pre- carious supply chain). Status: BHU Journeyman

BHU Hygiene...63% (Flood waters, mud, slime and swamps cleaned, clinical waste not managed well). Status: BHU Amateur

BHU Water...77% (Water well pump, lifesaver jerry cans to clean water available, washing facili- ties and toilets not yet functional). Status: BHU Journeyman

BHU Electricity...80% (Generator functioning, government electricity returning, still not 24 hours) Status: BHU Professional Medical equipment...95% (Sats monitor, portable oxygen, nebuliser, tympanic thermometers (not seen before in region!). Status: BHU Tycoon

BHU furniture...82% (Locked drugs cabinet, Hos- pital beds, patient screens, drip stands) Status:

BHU Professional

Patient numbers and satisfaction.... 93%... (Almost at full capacity, crowd control poor but much better then last week). Status: BHU Tycoon

BHU Staff...85% (empoying 8 local staff members including doctor, dispensers and female nurse...lacking a female doctor, staff happy with progress) Status: BHU Professional

LETTER 012 

Sent: 29th August 2010
Subject: Heroes and waving goodbyes.

Dear readers,

The last diary entry I wrote before I left Haiti in
February 2010 was titled "Heroes and Goodbyes".
Although the title of this post is similar, I hope it
will not be my anal ramblings of this trip in Paki-
stan for there is still so much work to be done. I
have been here for over three weeks and only have
a few days left in the ?eld before my minor contri-
bution towards the relief of the Pakistani people
comes to an end.
During this time, I have seen a simple idea grow
from the depths of the dirty murky food waters
into a blossoming project. I have witnessed that
even amidst the suffering, the chaos and the panic
of not just the affected but those that that are fran-
tically assisting, logic combined with tireless pas-
sion can begin to succeed.
The healthcare concept was simple. Firstly, do no
harm by not providing a haphazard and clinically
unsafe service. Secondly, to work within our re-
sources and difficult circumstances to provide the
best possible care to the most amount of people in a
sustainable, controlled manner. Thirdly, to realise
that our energy  and work  should not only contrib-
ute towards the short term relief of these deserving
people but give them an opportunity to access im-
proved basic healthcare long after the world has
forgotten about them. Fourthly, to utilise the good-
will and contributions of our many supporters in a
caring and constructive manner. And lastly, with
the possibility of growing resources and support,
expand the concept urgently in collaboration with
others.
We are rapidly moving towards the anal objective.
A memorandum of understanding signed with the
relevant government offcials has now allowed our
organisation to work in two basic health clinics
serving populations whose lives have been de-
stroyed by the foods. Further discussions are tak-
ing place with other NGOs to urgently establish
quality maternity care in these units as well as rees-
tablishing a vaccination programme (for another
baby boy was born on our site just two days ago).
And I have been further approached by other
NGOs to export this idealogy and experience we
have gained to other affected areas further south, in
Punjab and Sindh. And thus by treating a symbolic
few thousand patients well, we may soon be able to
treat tens and hundreds of thousands of patients
well.
Although it is only the first step of a proverbial
1000 mile journey, an identifiable footprint has
been made into the mud left by the aftermath of the
receding water. There is a real opportunity created
here to make a long lasting difference to the lives
of some of the poorest people in the world. But it
will require tremendous strength, relentless energy,
unheard of organisation in disorganised Pakistan,
luck blessed by God himself, generous support and
an undying passion for the people that need our
help. In my brighter, more hopeful, more optimistic
moments, I still believe it is possible.
And the reason I believe this vision is possible is
that during my three weeks here, I have met many
heroes, both from Pakistan and abroad. Indeed, I
can count at least ten volunteers from the UK, Tur-
key and Dubai that had arrived after me and de-
parted before me, contributing significantly in their
own unique way to this project. Furthermore, an-
other seven volunteers have just begun their much
needed contribution. Beyond this, there have been
countless wonderful people in Pakistan that have
supported us to help us achieve what we have so
far.
I have always lived by the philosophy that every
human being I meet along my journey in life is my
teacher. No matter if I personally enjoy or dislike
their company, no matter if agree or disagree with
their thoughts or actions, every person will always
have a quality or virtue better than mine that I can
learn from to improve myself - whether it be an
aspect of their personality or an aspect of their
knowledge. And on this journey I truly have learnt
so much.
I have been here three weeks and witnessed heroes
and teachers come and go. One of the greatest joys
of living in this world is being able to meet these
great and amazing people. And one of the greatest
sorrows is having to wave goodbye.
With love always.
Saqib

 

 

LETTER 013 

Sent:
Subject:

Dear readers,

LETTER 014 

Sent:
Subject:

Dear readers,