Medical aid agency a life-saver for Kashmiri villagers

MACHIARA, Pakistan, Oct 7: When the earthquake hit a year ago, the walls of the government dispensary in the remote mountain village of Machiara crumbled.

No one knows when it will be rebuilt, and people from the cluster of villages in Machiara Union Council fear they will soon lose a clinic set up by British medical aid agency Merlin that has been providing them healthcare for the past eight months.

''In future, I don't think it will be possible to offer the same level of health services as Merlin does now,'' said health ministry employee Mohammad Sain.

This mountain community of around 11,000 people in the Neelam valley of Pakistan's occupied Kashmir lost 500 people during the 7.6 magnitude quake struck on October. 8, 2005.

The total number killed in Pakistan occupied Kashmir and North West Frontier Province was more than 73,000, while a further 1,500 perished in Kashmir.

The road twisting up the mountains to Machiara either fell away or was covered by landslides in the quake.

While many relatives carried injured down the valley in their arms or stretchered on rope beds, those who stayed in Machiara received very little help until Merlin arrived in February.

''We found someone who had suffered with a hole in his back since the earthquake, and this man had received no treatment.

He had just been lying in bed,'' explained Ihsan Ullah, the Merlin clinic doctor.

STAYING THROUGH WINTER

Seated in his tented consultation room, Ullah says he sees a lot of patients who continue to experience trauma symptoms stemming from the earthquake.

Other common problems include scabies, diarrhoea and respiratory infections.

Heading into the winter, there's also a risk of pneumonia.

Despite the near certainty that roads will become impassable due to snow and landslides, the health team has decided to stay, and will stock food and medicines to last for eight to 12 weeks.

''The number of patients will rise in the winter, as the villagers come down from their summer dwellings higher up the mountain,'' says Ullah.

The clinic averages between 40 and 60 patients a day, and is open six days a week.

Even before the quake, access to healthcare was poor in Machiara because the dispensary didn't have a resident doctor, and visits from the government's health worker were infrequent.

Medical supplies often ran out.

PREGNANCY RISKS

The lack of services was dangerous for pregnant women, who had to give birth at home. If there were complications, they would travel to the town of Pattika, about an hour's car journey, or make a three-hour trip to Muzaffarabad. As a result, Sain estimates there were three to four deaths of mothers and babies each month.

Since April, things have changed for the better. A midwife has been working full-time at the Merlin clinic, offering deliveries, ante-natal and post-natal care, and family planning.

So far, Rakhil Mukhtar has carried out 15 deliveries and provided contraceptive advice to 92 women.

She also works with two health promoters who visit women at home to educate them about hygiene and encourage them to use the clinic's services, something they were reluctant to do at first.

Naseema Yaseen is also spreading the word among her relatives and friends in the village of Panjoorgali.

The 40-year-old mother of six became pregnant again during the winter after the quake when her family was living in a tent.

On July 5, after being in labour for two days and starting to bleed, she walked for two hours to reach the Machiara clinic.

By the time, the midwife delivered the baby, it was dead.

A month later, when a relative experienced extended labour, Yaseen persuaded her family to carry her to the clinic on a cot.

Baby Nosheen was delivered safely.

''I'm so glad I had my daughter here, because if I had gone to Muzaffarabad, I would probably have died on the journey,'' said Saleema Bibi.

Since Yaseen's still-birth, she has been taking a contraceptive pill. Akhtar Bibi, 30, who has two boys and two girls, uses the same birth-control method.

''A smaller family is easier. I'm doing this so I can have a better life,'' she explained.

The women had no problem gaining their husbands' permission.

Most female patients say they want the aid agency to carry on the clinic permanently. But it only has funding until next March.

Unless more money is secured, the clinic will have to close before a permanent one is constructed.

Although Merlin is training local health workers to improve their skills, it is unlikely the village would be allocated a full-time doctor or midwife.

If services are cut back, it would be yet another blow for Machiara's women, who are starting to enjoy a better level of healthcare for the first time in their lives.

REUTERS