The Ripple Effect: 2 Years On

This picture from Safya's house just makes me so happy. Safya is standing in front of the blackboard,reading aloud the new topic, she was a teacher in our first session.

This is the article I sent to the national newspaper about my experience at PHC:

144 uneducated, marginalized women empowered, 13 others made into community leaders.

In April 2016 I was interviewed by Talloires Network for the MacJannet Prize for our work in Sikanderabad, 

the squatter settlement behind Ziauddin University. Talloires Network is an international association of different institutions who encourage university students around the globe to be actively involved in their community. The secretariat of Talloires Network is based in Tufts University, USA. MacJannet Prize recognizes exceptional member universities of Talloires Network and awards them a monetary prize to aid them in their work.

Our Director of Students Affairs, Mr. Raza Abbas registered us for Talloires Network. Out of 47 original nominations 10 were selected for the second round which was followed by interviews of each member organization. My Skype interview was supposed to last for 15 minutes but by the time I was done talking to the wonderful interviewer it was past 50 minutes. There was so much to say. I had been involved with Siaknderabad since my first year at Ziauddin. KaraHealth Welfare Organization was a student run organization that held health awareness camps in the area and I joined them. In my fourth year of med school, I was chosen to be the president of the society and I decided to focus all my energy on this area. All the fundraisers that we conducted were mainly to pay for the medical and surgical bills of these patients for treatments at tertiary care hospitals. I had an amazing group of juniors with me and we did regular awareness camps on hygiene and preventable diseases including TB, hepatitis, polio, malaria, typhoid and dengue among others and called in my friends from dental schools to do sessions on oral hygiene. Having no gap between pregnancies, most children in the area grow up without a childhood. We started weekly art sessions for the kids to go wild in art and imagination. We provided sewing machines, monthly groceries, school fee, rent money and money for surgeries and rehab to all those who were needy. KaraHealth is not functional anymore but the students are still very much involved with the community. There was always something more that we wanted to do but we were limited because of our funds. There were so many more people to help and personally I wanted to give them something that stayed with them and made them self-sufficient. This is where the MacJannet Prize came in. We were awarded the second prize of $5000 in June 2016. This had been the stimulus we needed at Sikanderabad.

Glushan-e-Sikanderabad, home to 130,000 residents from all ethnicities of Pakistan, including thousands of Afghan refugees, is the place of poorest of the poor who moved to the metropolis in hopes of a better life. The average number of children per house is 7 and the families on average, earn less than Rs.10,000 a month. Two sides of the settlement are bordered by huge water bodies of sewage and the houses with electricity face about 8 hours of power cuts a day and since there is no water supply, the residents have to purchase water from hydrants daily.

Since 1996, Ziauddin University has provided medical consultation and medicines for minimal fee at the Primary Healthcare Center built in the area. The department of Family Medicine, that runs under the supervision of Dr Jawaid Usman, conducts clinics and ensures all children are vaccinated based on WHO’s Expanded Program of Immunization. Free of cost medicines are provided for TB, hepatitis C and asthma. Besides health related work, the center has also held computer classes and sewing courses for women to train them to become financially independent.

We knew that to help the women stand up for themselves and take control of their lives they needed education and there was no school for older women in the area. Because of the MacJannet Prize we were able to open five different schools for 2 hours a day which ran simultaneously in 5 different blocks. We started with Urdu and Mathematics so that the women could at least be equipped to do their daily work efficiently. The curriculum we used is specially designed by Jugnoo for people who have never attended school. After learning for just two hours a day for 90 days the students are able to read Urdu newspaper, write a letter and do everyday math. For the first session we identified in the neighborhood and from the patients who came to PHC, five women who had at least completed their matriculation. We then asked them if they had an open space in their homes where they could conduct the daily classes. Their houses were inspected and the family members were informed of the program and the plan. We could have hired teachers from other schools or the university studnets could have taught them but our plan was to keep it completely community oriented and to encourage them to stand up for themselves. In the past we have noted that some of our plans could not be implemented as they seemed too foreign and the residents could not relate to the teacher/organizer and always saw them as an outsider who was unaware of their background and cultural limitations. The university students then visited them for regular guidance. Each teacher was paid Rs 5000 per month and held classes for 2 hours daily. The women coming to the classes were above 15 years of age and most of them had never even held a pencil in their hands before. At the beginning of the session each student was given a school bag, books and stationery. Each school was given an attendance register, mats, black board, fan, dustbins and watercoolers for their sessions.

In the time since then two sessions have graduated and third one starts in August. Our initial plan was to have fifteen students per school and have the session run for six months. Due to unforeseen reasons schools have run longer and few students did not continue their studies. The first session ran for eight months and the second for seven months. We have certified 144 women who cleared the post session exam. Those who did not take the exam or failed it were advised to join the session again. 13 fine teachers have lead these eager women to the gates of knowledge. Our youngest student was 15 and the oldest was 70.

I wanted to know why they never went to school when they were young. One of them said back in their village only boys could attend school and it has been the way since. Another said she go did go to the school but her father was let go from work so they let her brother finish his education while she did household chores so the mother could go out and work. Another one of them said their father let them go to madrassah but thought we would be corrupted by attending school. What is commendable now is that they are doing their best to send their own children to school. They were all so grateful that they could attend school for free now and that too so close to their homes and for a few hours so that their daily chores could still be finished. Women who had no one else at home brought their babies along and we encouraged that so they could still attend classes. This was the first time most of them were doing something for themselves and it was all new for them and we tried to accommodate them in every way. We have also had a lot of pregnant ladies attending school and I felt they were the keenest to grasp classwork before their due dates.

We met with the ladies weekly and they are all exceptional women who had to fight the society barriers and some had to overcome family resistance to seek basic education and now they are on the mission to impart it to others.

Safiya who is forty years old was the teacher in one of the schools in the first session. According to her it felt like a party every day at her house and she wishes she could continue teaching. Twenty women started coming to her house from her lane and she did it as she wanted her neighbors to become more aware of their surroundings and learn new things. She said she felt proudest when her students graduated and now they are texting her and taking care of their expenses on their own. Her fond memory is of her student Zahida who was thirty five years old and came from a different block every day and was keen to be called to the blackboard and when she got it right she would dance on her way back to where she was sitting. Safya informed me that earlier when she used to visit her 50 year old neighbor Nasreen she would only be slicing onions and it made her so happy that when she visited her yesterday she was holding a pen and writing about how much she spent when she bought onions and potatoes that day.

Shakira, a twenty five year old fierce student had always been my favorite. She had attended school in the village before she got married at 13 years of age but could not continue her studies when she came to the city. She told me she could not read properly earlier but because of attending the session she now can read newspapers daily. Cooking recipes are her favorite now which she tries on special occasions for her family. Her husband who is a mechanic also looks for old cook cooks at the hawker and gets them for her.

Jantaba, a 30 year old student told me how she used to set up a small stall outside her house to sell chips and candies. On most days she would end up losing profit as she could not subtract properly and would end up returning extra change. Now she can subtract properly whenever someone hands her Rs. 100 and she is making profit now. The best thing according to her is that she can read the rates when she goes to buy chicken at the store.

Another 40 year old teacher Mudassir told us that she was proudest of her student Fozia who could not see or hear as well as other students but had the most determination and surprised her when she cleared the session with the best marks.

Nimrah and Ayesha, the sisters who ran the school together in block 2 said most of the students that graduated from the classes are interested in coming back for a higher level curriculum now. She said it made her very happy that her neighbor told her that she exchanged the box of medicine at the pharmacy which was expired and asked the shopkeeper to give them the right medicine. Another success story for them is their neighbor Fatima who was not allowed to attend school there initially. She insisted and her family eventually let her and now the family is seeing how much it helped her in a few months that they are sending the rest of the children in the family to school now.

Another 16 year old student said that now her father allows her mother and her to go to shopping without him as she can read the bus numbers now and knows which buses to take on the way.

The backbone of the entire program is the 32 year old Shehla Baji who is from the area and an employee of the Family Medicine department at PHC for more than fifteen years. To me she is a Super Human and I am so grateful that she is my friend. She has a killer work attitude and no one matches her drive to improve the community around her. She came from Kohat with her family members and has seen very tough financial times, including the time when her family was eating one good meal a week. Since she was educated she started teaching the children in her lane. After her son was born with cerebral palsy she was often at the clinic to get him assessed. When she heard there was an opening at PHC for a woman from Sikanderabad, she immediately signed up to learn more for her son and to help her community members. Since we set up the schools, she was in charge of their smooth running. Each day after winding up morning clinic work from PHC around 10 am she visits two different schools, one nearby, and the other a block far away. There she checks attendance, asks the teacher if they are having any problems, then she asks the teachers to leave for a while and asks the students if they are having any problems with the teacher. She says initially the women were very shy and could not hold the pencil properly but as the days went by and she asked them to come to the blackboard to write the answer, they have become much more confident. Not only does she teach them about the daily course work, she even has discussions on how to cross the road, how to cook different foods and basic humanity etiquettes. In the afternoon Shehla Baji is back at PHC ensuring that the school, sewing class and computer class is run smoothly. Out of all the teachers, her favorite Teacher is Ayesha who according to her went beyond her course work and taught the ladies extra stuff and even few lessons in English.

Shehla Baji says this prize has helped her fulfil the dream of providing education to those who had no access to it and she will forever be grateful for it. A lot of university students join her for various sessions to these schools where they talk about health and hygiene and tips for disease prevention. Most students also chip in money to pay school fees of children enrolled in the private schools in Siaknderabad. Even for the hygiene camps, they take in soaps and toothpastes for distributions.

I conduct sessions at PHC on health topics and I am so grateful that they are taking control of their health and suggest me topics about which they want to know more about. Among our major sessions were those from the CompassionIt.com curriculum from Sara Schairer, visit by Nusrat Hidayatullah from 42 Day Challenge and Skype session with Zain Maken, a teacher from Teach for Pakistan in Islamabad.

The MacJannet prize money has ended but we have anonymous donors funding the program now so that the mission keeps on going. What has started off as a much step in the right direction will continue to create ripples and impact more women. Educating one woman and informing her about healthy habits means one family will face less disease burden and live better consciously.

Like Shehla Baji we all our incredibly grateful to Talloires Network for encouraging us to do more in the community. And as she says “I do not understand a person who eats three full meals a day and fails to notice that their neighbor is hungry since the morning”. She hopes that people stop living in their bubbles and take a moment to look around them, there are always people around who need help but are shy to ask for it.

 By Zainab Faiza

Session with Zain

On the 8th of May the women at PHC had their first ever session on Skype. To the younger audience members, technology is not relatively new, they all actively use whatsapp and facebook to make video calls but for the older women in the audience, this was very amusing. As mentioned in our previous posts, the population of Sikanderabad is comprised of families living below the poverty line and most people in the area are uneducated or have just attended primary school. The families who have money are now ensuring that all their children attend school. And for the older uneducated women, we are already running five schools in the area.

The Skype session was conducted by this amazing human being, Zain Maken. Zain and I met in Pune, India, in 2008 at Initiative for Peace conference. This year marked the tenth anniversary of the conference and we decided to do an online event where each one of us would try to collaborate with another participant of the conference. Zain volunteered to do a Skype session with the women of PHC on how parents can give feedback to children at home for academic and non academic tasks. This was a very different and interesting topic for this audience. We had previously talked about health prevention and cultivating compassion so I was very excited to finally have a behavior modification session.

Zain had already emailed me his plan for the talk and I was thrilled to go over it. It was unlike anything I had done at PHC and I was really looking forward to the impact it would create.

The session started a bit later than usual and Zain was kind enough to wait for all the audience members to gather at PHC. The laptop and speakers were set up but unfortunatley he could not hear us. It would have been more fulfilling for him to listen to the audience question him and participate in the discussions, but that is the plan for next time now. During this session I typed back all the responses that he was getting and he continued on from there.

As Sikanderabad is an area where men and women do not engage socially and women cover themselves from head to toe in front of strangers, I informed the women that he could see some of them the way they could see him so if they wished to cover their faces, they should.

I started by introducing Zain, telling that he had worked for this brilliant organization called Teach for Pakistan and how he will share with the audience some of the things he learned while working there. Zain started by sharing an incident. He remembered going to a class where the class teacher proudly introduced the children sitting at the front as being excellent while he called those at the back failures. When the teacher left the room Zain asked a kid at the back a question to which a student from the front bench responded by telling Zain not to ask the question from that kid as he did not know anything. He then paused and asked the women to ponder over what just happened and had they ever heard talk like that or have they ever said something like that. He then asked the audience what they did when their child scored poorly on an exam. He got a variety of responses. One of them said I scold them if they get poor grades and hit them if they fail. One girl said her father did not let her watch TV after she flunked. Another woman said I scold them and give examples of the other siblings who excel in school. One of the responses was that the woman tried to identify the real problem and addressed that. A participant said she could never go to school and now her children have that chance so she makes sure they do not take it lightly. Zain applauded these responses and told them how children learn more at home than at school and everything a parent says or does is important in their learning and their evaluation of themselves. He kept on discussing various scenarios and asked what the audience thought about it and I typed back responses and he discussed them. He then showed how these response can be altered to make them better for their children which would identify the current problem and motivate them to be better next time. He made the talk very relatable and all of the audience members could identify the problems in the scenarios and learned how to best respond to them for better results in the future.

At the end he asked if they had any problems teaching their kids. One of them said that she understands the child is smart and works well when he wants to but often times he gets super lazy and says he will finish work the next day but never does. Another one talked on the same lines saying her daughter is very moody when it comes to studying. One of them said in their Pushto culture they are very blunt in their criticism and we often tell the children they are stupid just like their father or grandfather and how could they stop such talk. Zain answered all these questions very patiently although we were going above his allotted time.

It was incredible to have Zain talk to the women at PHC and I was so grateful for the way they were responding to him and asking great questions. Zain was kind enough to announce that he would do a similar session in the future and asked them to suggest few topic. He got a bunch of requests: "how can mothers train their children properly", "how to motivate stubborn children", "how to reward good behavior", "how can children be more respectful towards their parents" and "how to evaluate the psyche of students". I hope we can set up a session soon after the vacations.

By Zainab Faiza

Session with 42 Day Challenge

To our great pleasure the team of 42 Day Challenge joined us at Sikanderabad for a health awareness session on 20th of March . 42 Day Challenge  is one of a kind fitness boot camp that started from Karachi and has encouraged hundreds of people to train intensely following a fixed diet plan in exchange for healthier bodies. The amazing Nusrat Hidayatullah, founder and trainer at 42 Day Challenge joined us for a very informative session with her colleague Alizey.

A big crowd of very eager ladies was gathered at PHC as the visit from a health trainer was announced a day before.The age of the audience members ranged from 13 to 65 years. I was very excited that so many women of different ages were present and had decided to take health issues in their own control. This was an insanely different population to what 42 Day Challenge was used to. These women at the clinic at Sikanderabad had never known that trainer was a profession and that women could be one too. The houses that have difficulty making ends meet for basic food each day cannot in their wildest imagination think of joining gyms or buying fitness equipment. I was very grateful that they all showed up as they benefited immensely from the experience. 

I introduced Nusrat and her friend to the audience. A lot of them had stood up to take a better look at them, in awe of their ripped bodies. They began by asking the ladies what they ate in a day. The ladies excitedly shared their main dishes of breakfast, lunch and dinner. Nusrat also inquired how much sugar were they adding to their tea and how much oil they used to make bread or to make different dishes. She then told them about a simplified and healthier version of their own daily food consumption. This led to a long discussion where each one of them approached her with how to cut down the sugar or fat in various food items. It was so gratifying that all of them were approaching her with ease and so much confidence which is new for them, specially if they are meeting a person for the first time and one who does not follow a lifestyle like theirs. Nusrat and Alizey were so humble throughout, they were enjoying the numerous questions that the ladies kept on throwing at them. 

After discussing the basic meal plan, Nusrat then demonstrated a few exercises for burning belly fat. Exercises to target belly fat was a popular request from the audience. She did them in the center of the gathering so everyone could see and then she made one person from each row stand up to show what they learned and she fine tuned their movements by telling them where to point the toes or how far to bend. Most of them then called her to where they were sitting and inquired about exercises for fat in other areas of the body. Nusrat replied to this by telling the ladies that she was so thrilled at the audience members' willingness to learn and she wants to come again for a proper exercise session with more trainers which received an electrified response from the audience. 

Nusrat (extreme right), presenting a student (center) with her certificate 

On this day we were also supposed to distribute the certificates to all the ladies who had successfully completed the computer training classes. Being fortunate that Nusrat was amongst us, we requested her to hand out the certificates. This made our ladies feel very honored that they received it from her. On a side note, I was so impressed by Nusrat and Alizey, they only took a single sip of the soft drink that was served to them, that too just to not hurt the ladies for serving it to them. Ha I need to cut down on my soft drinks consumption too!

It was an absolute pleasure to have Nusrat and Alizey at PHC. I was really moved at how humble they were and how frankly they interacted with  the ladies of Sikanderabad. In the past I have noticed some outsiders to think of themselves as being superior to the people of Sikanderabad but this day was truly the opposite of that. After the distribution of certificates, one of the students from the computer training class informed her that they did not have any internet connection at the PHC. Without a seconds delay Nusrat informed her that they will have it tomorrow and true to her word, she got it set up the following day. We hope we can have them over soon and they continue to inspire all these women on their journey to healthier bodies. 

From the left: Neelam-sewing teacher, Huma-computer teacher, Shehla Baji-the backbone of PHC, me, Nusrat and Alizey.

By Zainab Faiza

First Class with the Compassion Curriculum

On the 6th of February I conducted the first session with Sara Schairer's curriculum. As I mentioned in one of my previous posts, Sara is this amazing gift to humanity who started CompassionIt.com. She is a Stanford trained Compassion Facilitator and has been kind enough to share her curriculum with us so that I can then talk about this before our weekly health awareness sessions.

The topic I chose from her curriculum was Interconnectedness. I was really excited to see how the women would react when they would be thinking about this.

Like always we started off with breathing exercises. I got really excited when one of the students informed me that she has been doing it daily and she feels much more alert and energetic because of it. I then asked them about what I talked about last time, diarrhea and Chikungunya and they told me how they are washing their hands for at least 20 seconds now and are taking all preventative measures against mosquitoes. I then inquired about gratitude and self love about which I had talked about in the previous sessions and one of them coincidentally told me that she called her tailor of a few years and thanked her for her service.

Based on Sara's curriculum I gave a brief introduction on Interconectedness and told them that today we will be talking about a very interesting topic which will make us realize how we are connected to each other without even realizing it. I told them to close their eyes and take deep breaths and then continue to breath normally while keeping their eyes shut. I then asked them to think about the clothes they were wearing today. According to cultural standards, all the women at Sikanderabad wear Abaya over their regular clothes when they go out of the house. Most of them wear a black Abaya which is basically a loose outer garment like a gown and then they cover their heads with a black headscarf. I asked them to think more about the clothes they were wearing under the Abaya. They were asked to think about where did they get them from, who gave it to them, who stitched it up, who chose the buttons, lace, zipper, thread, the colour. Most women of Sikanderabad still wear the bright colourful embroidered clothes that are common in their villages so a lot goes in planning and making of these clothes so I asked them to think about all of that. Then I asked them to think about how it reached the store and if they purchased it from Karachi, think about all the transport that was involved in getting it here. I then asked them to open their eyes. They were all smiling and were intrigued by this train of thought. I asked them if they had thought on these lines before and they denied. I then asked them to think about all the people who made it possible for them to have these clothes today, the farmers who grew the cotton, the people in the factories who made thread and then weaved it into cloth and then the shopkeepers and the tailors and the people who gave it to them. One of them said her aunt from the village sent her the shirt. One of them said she went with her dad to purchase the cloth and stitched it herself. Two sisters were wearing identical shirts and they told me their aunt did the embroidery and their mother stitched it up for them. I then told them this is how we are connected to the world. The cloth that was made in Korea was sold in Peshawar and their aunt bought it from there and embroidered it and sent it to Karachi and their mom stitched it up for them. I asked them how this made them feel and one of them just smiled and the other said "small" followed by "but good, like we are part of something". I was delighted to hear her response. I told them to thank their mom when they get home and then call their aunt and thank her too, imagine how good she would feel knowing that you called just to thank her.

I am so excited that all of them would be benefiting from the amazing compassion curriculum from Sara. I can't wait to see how their lives would be enriched in the following sessions.

Beautiful embroidery done on a shirt for me by one of the students.

Our health topic on this day was diabetes. A lot of older women had requested me to talk about it. I am just so thrilled when they suggest new topics now as they are growing more and more interested in their own and their family's health.  They all listened patiently and did stop me a couple of times to ask very smart questions.

Our last topic as always was the thing about self love that I make them do each time. I read aloud the same self love sentences from before and they repeated after me. This post has more about the first self love session https://sikanderabadhlp.blogspot.com/2018/02/chikunguya-diarrhea-and-self-love.html.

Pointers on diabetes:

-Diabetes is a long lasting disease that affects how your body turns food into energy.
-Most of the food you eat is broken down into sugar (glucose) and released into bloodstream.
-Pancreas make a hormone called insulin which acts like a key to let the sugar into cells to use it for energy.
-In diabetes you either do not have the key or cannot use it anymore which causes a buildup of sugar in the blood which ultimately leads to heart disease, loss of vision and kidney disease.
-Type 1 diabetes is an autoimmune condition, where the body attacks itself and cannot make insulin.
-5% of diabetics have type 1 diabetes and it mainly affects children, teens and young adults and they need insulin everyday.
-Type 2 diabetes is the more common one where the body is unable to use insulin properly hence unable to keep the blood sugar down.
-Gestational diabetes is when pregnant women develop diabetes which increases their risks of complications for the baby. It goes away after delivery but these women have an increased risk of developing type 2 diabetes later in life. Babies born to mothers with gestational diabetes can be obese and themselves develop type 2 diabetes later in life.
-Pre-diabetes is when the blood sugar is higher than normal but not high enough to be called diabetes.

-Risk factors for type 1 diabetes:
*Family history
*Age

-Risk factors for type 2 diabetes:
*Pre-diabetes
*Being overweight
*> 45 years of age
*Parents or siblings with type 2 diabetes
*Physically active less than 3 times a week
*Gestational diabetes or baby born >9 lb

-Risk factors for gestational diabetes:
*Gestational diabetes during previous pregnancy
*Given birth to baby >9 lb
*Overweight woman
*>25 years of age
*Family history of type 2 diabetes
*History of polycystic ovarian syndrome

-How to prevent complications:
*Eat well: Consume a diet with low salt and sugar
*Get physically active.
*Check lipid levels every year, if they are deranged, start medicine to lower them.
*Do not smoke
*Maintain appropriate blood pressure levels
*If you are overweight or obese loose wight with the help of a dietecian
*Get HbA1c checked
*Get your eyes tested every year
*Get your blood and urine checked for kidney problems each year
*Take care of your feet: Look for cuts, sores, red spots. Wear comfortable shoes at all times.
*Take care of your gums and teeth
*Manage stress properly

By Zainab Faiza

Chikunguya, Diarrhea and Self Love

This fun health awareness session on Chikungunya and Diarrhea was held on 12 December. This was conducted on the request of a lot of our audience members. I am so glad that they are confident and forthcoming now to request what they want know more about. A lot of them have suffered from Chikungya and some of their family members are still recovering from it. Chikungunya is a virus spread by the bite of  mosquitoes.

We started the session off with me conducing breathing exercises as usual. They still giggle and smile while doing it but at least they are doing it with me and one of them made me so happy by telling everyone that she does it every morning when she wakes up. I then questioned them about what I taught them regarding gratitude in one of our previous sessions and they shared their beautiful experiences again. The lady who told me about thanking her husband the last time said this time he thanked me and we are much happier now. I then questioned them about what they remembered from my last talk on flu and asthma prevention and they listed the preventative measures and if they performed any.

At the beginning of the blog I said it was a fun session as this time after discussing the disease prevention stuff I talked about Self Love. They were all more confused than ever when I brought up this topic. As I have mentioned before theses breathing exercises, gratitude, self love are insanely new and super weird concepts for them. They have all followed a set pattern of life where since they are women they are expected to care about others and let go of  things that bother them. I took this list from a picture on Pinterest. I translated it into Urdu, read each sentence loudly and made them repeat after me. They were intrigued as to what all I was saying but they were beaming with joy as they repeated it after me. Never before had someone talked to them about believing in themselves and accepting themselves as they were. When they were all saying it together the place resonated with such hope and beauty that I cannot put the feeling in words. Can't wait to see what the future holds for them.

Photo submitted by one of the audience members. 

These are the pointers from the discussion that day.

Chikungnya:

-Spread by the bite of mosquitoes.
-Abrupt onset of fever, usually with joint pain. Can also present with muscle pain, headache, nausea, fatigue and rash
-Fever lasts for a few days, may even last a few weeks.
- Most patients recover fully, in some cases pain may persist for several months or even years.
-Eyes, heart, GI, neurological complications are rare.
-Can present with low white blood cells and platelets.
-Persons at risk of severe disease include neonates exposed in utero, >65y olds, patients with underlying medical conditions including DM, HTN, CVD.
-May give rise to latent Rheumatoid Arthritis.
-Mosquitoes can be found biting throughout daylight hours, there may be peaks of activity in the early morning and late afternoon.
-Onset of illness between 4-8 days after bite, can also take 2-12 days.
-Joint symptoms are usually symmetric and often occur in hands and feet.
-Same mosquitoes which also spread Dengue.
-Patients can present with both infections together.
-Aspirin and other NSAIDs  can increase the risk of hemorrhage in patients with dengue.
-If patients have Dengue, no aspirin or NSAIDs until after >48h of being afebrile.
-Treatment: Joint pain analgesia, antipyrestics, physiotherapy for persistent joint pain
-Prevention:
*Water filled containers should be covered at all times.
*Insecticide sprays.
*Mosquito repellents
*Coils
*Mosquito nets.
-People suspected to have Chikungunya or Dengue should be protected from further mosquito exposure during the first week of illness to reduce the risk of further transmission.

Diarrhea:

-Second leading cause of death in children under 5 years of age. 52,500 children die each year from diarrhea.
-Can last several days and leave the body without water and salts needed for survival.
-3 or more loose stools in a day.
-Inflammation of intestinal tract caused by a variety of viruses, bacteria  and parasites.
-Spreads through food, water and person to person.
-ORS + zinc is the mainstay of management.
-Persistent diarrhea is that which lasts for more than 14 days. If there is blood in your stool, go to the hospital immediately.
-Malnourished children are at an increased risk of dying from diarrhea.
-Always boil water before drinking.
-Cover it properly.
-Do not dip dirty dishes in the clean water.
-Wash hands for about 20 seconds.
-Flush, each time.
-Exclusive breastfeeding for first 6 months of life.
-Wash the meat and vegetables properly, cook in clean pots.
-Refrigerate food, do not leave it out for long.
-Get your children vaccinated against Rota Virus.
-During diarrhea consume yogurt, bananas and Kichri (local dish where rice and lentil are boiled together ill they are soft)
-Wash infant feeding bottles carefully.
-Prevent bees from sitting on your food, bottles, glasses.
-Do not eat antibiotics, antimicrobials for diarrhea unless prescribed by your doctor (here all medicines are available over the counter)
-ORS: One sachet dissolved in four glasses of water.
-Go to the hospital if you cannot drink or eat.
-Do not give tea, coke, juice to patients as these can cause more dehydration.
-Check for dehydration in children:
*Alert/irritable/floppy
*Eyes: Are their tears
*Mouth/ Tongue: Is it dry?
*Skin pinch
*Anterior fonanelle
*Pulse
*Breathing
- For children <2 y give 1/4 to 1/2 cup ORS after every stool
-For children >2 y give 1/2 to 1 cup of ORS after every stool
-If ORS packet is not available then use 6 leveled teaspoons of sugar and half leveled teaspoon of salt in one liter of boiled water.

Self Love:

1.I shall lovingly accept myself as I am right now.
2. I shall appreciate all the beauty that makes me who I am.
3. I shall regularly give thanks for all my blessings.
4. I shall trust in my ability to take care of myself.
5. I shall not criticize myself.
6. I shall not criticize others.
7. I shall forgive myself when I make a mistake.
8. I shall be kind to others without sacrificing my own needs.
9. I shall take the responsibility for my life.
10. I shall love myself to the best of my ability.

 By Zainab Faiza

Breathing Exercises and Flu Prevention

This health awareness session was held on 28th of November. It was a very special camp for us as a lot of friends from outside Ziauddin were present in the session. This best example of a human being, my friend Sukaina who has been involved with multiple social works over the years was finally in Karachi. She is a Chemical Engineer by profession and currently she mostly volunteers with Rotract Club in Islamabad. She had heard about our work in Sikanderabad and we were so glad to finally have her with us. We also invited three very eager medical students from Bahria University, Eeshal, Ibtesam and Namra. They too had heard about our work and wanted to check it out for themselves and we are hoping that they can become our permanent members for the sessions. It was a new environment for all our guests but they were welcomed by all the women and soon they were all talking like old friends. The thing about the women in Sikanderabad is that they usually mingle with the other women in Sikanderabad only or the families they go to work for. When outsiders come to meet them they are shy at first but they soon warm up and feel amazing that someone cares for their well-being.

We also had our usual Ziauddin students and this time there were six of them present. We are planning more activities for the future so we will be recruiting even more volunteers. 

I started the session by teaching the women about some basic breathing exercises. As I have mentioned in my previous posts a lot of them complain of psychosomatic pains and are trapped in the rut of excessive negative thoughts which present with physical symptoms that leads to health burden for their already poor families. Breathing exercises were such a foreign concept to them and they were all were exchanging confused looks with other audience members and eventually started giggling. I aimed to bring them at ease before the main medical talk so that was already achieved but I will be repeating these exercises each time now so they can do them to instantly feel better and change perspectives about the events in their lives.  

  Permanent junior members of the sessions

                                                  

I then asked them about gratitude which was our topic at the last session. I made them to quote examples of how they practiced gratitude. One of them said I thanked my sister for being there for me when I need to vent, another one said I was thankful to the garbage collector in my lane. The funniest was when one of them said I thanked my husband for providing for the family and buying me new clothes which made him so happy that he gave me extra money for myself. 

We discussed breast exam in the last session too so I asked how many of them performed it and what steps they followed. I reviewed the steps and will ask the other women next time if they performed the exam on themselves. 

The main topic of this day's talk was flu and asthma prevention. Flu vaccine is a new concept for them although they are very keen on getting all the other vaccines. I first told them what exactly flu is and how it is transmitted. I then went over the list of ways to prevent it. This is such a common disease which is prevalent in all their homes and they listened very attentively on how to avoid getting sick. I then talked about what asthma is and how it is spread. We then covered the preventative steps together. I asked if anyone in the audience used inhalers and one of them stood up with an inhaler in her hand. I wanted to check if they knew the proper technique to use it. Thankfully she did and she even demonstrated the proper technique to others. Turns out there is a weekly asthma clinic at PHC and that woman was one of their very compliant patients. 

This is a small clip of me discussing how to cover up the sneeze and then Shehla Baji stepping in and reinforcing the message in Pushto. The sessions have become funner now as the women are not as shy anymore and specially with the guests present, they were all in really good spirits throughout. 

After the session I asked Shehla Baji to give our guests a tour of the area as they had never seen the poverty and simplicity of the people of Sikanderabad before. We went to a very long lane that was all dug up because of sewage problems. The officials concerned were working on snail pace and there were huge black dumps of soil soaked in sewage. As I have mentioned in previous blogs, this is a very neglected area of the city. Each pile was about 5 feet tall and there were more than ten of them in that lane alone and Shehla Baji informed us it had been like this for days. The stench was unbearable, imagine having to live with that in-front of your house for days and walking through it. This could be a nidus for so many new diseases for these people.

First Shehla Baji took us to her sister's house who had opened a mini beauty parlor in her house. It was really inspiring that she was running such an organized place and was earning for herself. We then went to a woman's house who sells water to the other residents. She purchases it from the water hydrant in-charges and then sells it from her house. She was also selling clothes in her house too. It is very nice to see how they are starting small businesses to support their families. The third house we went to was the house of one of our old patients, back then as KaraHealth we had payed for her entire hysterectomy surgery. Then we went to a nurse's house who works at  PHC. Most of my friends had never been to 1-2 bedroom houses specially in sewage infested areas before. They were absolutely in awe of the people though who were so welcoming and genuinely happy to have them as guests. They were moved by their spirit and are working towards helping them somehow. Sukaina has already begun fundraising for them and Eeshal and her friends cannot wait for next awareness camps. 

This is what I discussed during the session:

"How does flu spread?

It spreads through droplets when people with flu cough, sneeze or talk. It spreads when they touch something with those droplets and then touch their eyes, nose or mouth. It starts to spread 1 day before the onset of symptoms and 5-7 days after being sick.

How to prevent flu?

1. Avoid close contact with people who are sick. When you are sick, avoid close contact with others. 

2. If possible stay at home to prevent infecting others. 

3. Cover your mouth and nose when you sneeze/cough. 

4. Clean your hands thoroughly after sneezing/coughing. 

5. Avoid touching your eyes, nose or mouth.

6. Regularly clean frequently touched objects and surfaces, including doorknobs, switches and phones. 

7. Do not share handkerchiefs (This was specially for this population)

8. Specially prevent the elderly, the very young, people with chronic conditions and pregnant women from developing flu.

9. If you have flu, have a good sleep, drink plenty of fluids and eat healthy foods.

How does asthma present?

Wheezing, breathlessness, chest tightness and cough.

Asthma triggers:

1. Tobacco smoke.

2. Dust mites: wash clothes, bed sheets, pillow cases with warm water every week.

3. Air pollen; wear masks.

4. Cats, dogs, other pets.

5. Mold; fix water leaks.

6. Smoke from burning wood (Again very applicable for this population)

7. Bad weather, cold air.

8. Intense emotional state.

9. Cockroaches

10. Food coloring

11. Air freshners, perfumes

How to prevent asthma?

1. Get flu and pneumonia shots

2. Monitor breathing

3. Identify attack before it gets worse

4. Use prescribed medicines correctly

5. Use inhalers appropriately

How to use an inhaler correctly?

Take off  the cap, make sure it is clean. Shake 10-15 times. Without the inhaler, take a breath and breath out all the way. Put inhaler in the mouth, seal lips around it, breath in slowly and press down. Keep breathing in. Hold breath for 5-10s. Open your mouth and breath out slowly."

This information was taken from cdc.gov 

 By Zainab Faiza

Compassion Training Session

Robin Williams with the real Patch Adams

Patch Adams is one of my absolute favorite movies and that is what introduced me to compassion in medicine. Patch Adams is a doctor in US who rightly saw a need for doctors to be more compassionate and wanted to treat the patient as a whole instead of just the disease. Based on his ideals we started a small society in medical school encouraging medical students to be more compassionate to other doctors and to their patients. In my search to gather more data on this I stumbled upon CompassionIt.com It is a brilliant initiative by Sara Schairer who is a Stanford certified instructor of Compassion Cultivation Training. She introduced these wrist bands which have different colors on each side and they remind you to do an act of compassion each time you look at them, once you are done, you flip it to a different color.

I contacted her when I was in US the last time. This time I finally ordered the wrist bands and got so much more from the package. Fortunateley I got to meet the amazing director of Compassion It Chicago, Burrell Poe, and we discussed a couple of ideas for a hospital in Chicago. That work is still to happen but I decided to introduce our ideas in Sikanderabad.  

A lot of the women here suffer from nonspecific chronic headache, backache and indigestion. They have tried multiple medicines for a while now but they feel like they are in a trapped in their thoughts and sick bodies. Long term depression and anxiety go undiagnosed here and they cannot talk about it easily in this area so most of these problems then manifest in physical forms.

I read this amazing article by Sara on Chopra.com (https://www.chopra.com/articles/25-simple-ways-to-practice-gratitude) and I decided to start off with gratitude as their first step. The session took place on the 16th of November at PHC. It was weird for me to be asking them to be grateful when they are poorer than most of the city and are  surrounded by so many problems but the response I received was amazing! It was probably the first time someone from the health field was talking about being grateful daily and they listened with the biggest smiles. Sara's concepts were super simple but impactful and I discussed each of them with these women. I asked them to give me examples to make sure they understood and they were always spot on. They listened eagerly and by the end I could feel they were a bit more relaxed just after listening about this amazing practice.

The next half of the session was dedicated to breast cancer. Again it was such a taboo topic for this population although according to the most recent research, every 8th woman in Pakistan will have breast cancer at some point in her life. We discussed the increasing incidence in our population and how they can detect it early. I taught them the breast exam and how they should perform it often to look for lumps Although it was an only-women gathering most of the women were still so shy just to hear me talk about it. In the following sessions I would ask them if  they tried it themselves and if they passed the message forward to others.

I'll soon be posting about our next session on compassion.

By Zainab Faiza