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

Awareness Camp on Congenital Infections

My nephew was born with congenital rubella and it was undiagnosed before his birth. Congenital infections are all preventable but if they infect the mother the baby can heave serious diseases.

I conducted a session at PHC on this to prevent anymore women becoming infected and transferring diseases to the fetus. A large group of women showed up and actively took part in the conversation. They asked questions and shared their own stories with other participants.

The talk ranged from various congenital infections to the need for immunization. Major chunk of the presentation was on prevention. Daily habits to maintain hygiene can greatly reduce multiple diseases. And these are all very simple steps that prevent major infections.

A very brave woman stepped up and told about her four children who all have Cerebral Palsy. She requested every woman there to go to trained midwives or doctors for the births of their children. Another woman mentioned how she had miscarriage after acquiring measles during pregnancy.

The participants were keen to follow the prevention steps and I encouraged them to carry this message forward to their sisters, neighbors and other women they know.

As a social awareness thing, I posted all the key points on my Facebook so that more people can read and share it with their friends. Here is the post:

"Congenital diseases are diseases present from birth. Congenital infections are infections which a woman acquires during pregnancy and transfers it to the fetus, hence the baby is born with them. These are real and can cause SERIOUS problems for newborns. I am listing some major ones and their prevention. If you know anyone getting married soon or planning a baby please make sure they read this. This can save lives.

Congenital infections are broadly listed as ToRCHeS which are Toxoplasmosis, Rubella, Cytomegalovirus, HIV, Herpes Simplex Virus 2 and Syphilis.

1. Toxoplasmosis Gondii: Mainly caused by cat feces or ingestion of undercooked meat. Most patients do not have any symptoms. In babies it can present as choreoretinitis (inflammation of the choroid and retina of the eye), hydrocephalus (a condition in which fluid collects in the brain) and calcifications within the brain.

How to prevent toxoplasmosis:

Do not drink unfiltered water. Wear gloves when you are gardening or handle soil and wash hands thoroughly afterwards. Wash raw fruits and vegetables properly. Do not eat raw or undercooked meat (a lot of women while cooking taste raw meat to check for spices and taste. Always taste the gravy and not the meat). Meat should be cooked to 152ºF (66ºC) or higher, or frozen for 24 hours in a household freezer (at less than -12ºC). Freezing meat before consumption appears to be the most effective intervention in preventing toxoplasmosis transmitted by meat. Wash the utensils, knives, basin that handled the raw meat. Do not drink unpasteurized milk. Stay away from cats during pregnancy, specially do not clean their litter boxes yourself (fresh cat feces are not infectious).

2. Rubella: Caused by respiratory droplets. Patient presents with rash, swollen lymph nodes and swollen and painful joints. Babies born to mothers who had rubella can present with cardiac defects, cataracts and hearing loss.

How to prevent rubella:

MMR vaccine is the main tool to prevent rubella. It is given at one year of age and then again at 3 years. If someone has never received it, it can be given at any age, until a month before pregnancy. Pregnant women should be tested for rubella immunity. If they are not immune, they should be counseled regarding avoidance of exposure to patients with rubella and receive postpartum rubella immunization. If a child has rubella keep him away from babies and pregnant women.

3. CMV: Caused by sexual contact and organ transplant. Usually does not show any symptoms. Babies can present with hearing loss, seizures, rash and calcifications in the brain.

How to prevent CMV:

Practice good personal hygiene throughout pregnancy, especially hand washing with soap and water after contact with diapers or oral and nasal secretions (particularly with a child who is in daycare). Wash well for at least 15 to 20 seconds. Avoid kissing children under age 6 on the mouth or cheek; instead, kiss them on the head or give them a hug. Do not share food, drinks, or oral utensils (eg, fork, spoon, toothbrush, pacifier) with young children. Clean toys, countertops, and other surfaces that come into contact with children's urine or saliva.

4. HIV: Caused by sexual contact and used needles. There are variable presentations in the patients. Babies present with recurrent infections and chronic diarrhea.

How to prevent HIV:

Practice safe sex. Wear condoms. Always use clean needles for bloodwork. Male circumcision greatly reduces HIV incidence in males and hence protects their female partners. Prevention of mother-to-child transmission of HIV involves Antiretroviral therapy for the pregnant woman and post-exposure preventative medicines for the infant.

5. HSV-2: Skin or mucous membrane contact. Patient usually does not have any symptoms but can present with rash. Babies present with meningioencephalitis (swelling in different layers of brain).

How to prevent HSV-2:

Screening has been proposed to identify women without HSV so they can take precautions to avoid acquiring the infection. Women with past history of HSV should be identified so they can be offered suppressive antiviral therapy, examined carefully for lesions at the onset of labor, and offered cesarean delivery, if indicated. Postnatal transmission of HSV can be prevented by counseling family members with active HSV lesions or a history of cold sores or HSV lesions in the recent past to avoid close contact with and avoid kissing the newborn infant. Women with herpetic breast lesions should not breastfeed from the affected breast until the lesions have resolved because direct contact with the lesions may transmit the infection to the infant. Mothers should use careful hand hygiene and cover any lesions with which the infant might come into contact.

6. Syphilis: Sexual contact. Can cause rash and various swellings. Often results in stillbirth; if the child survives he has facial and limb deformities and deafness.

How to prevent Syphilis:

Screening, contact tracing, contact precautions, and monitoring of close contacts of infectious patients for clinical or serologic evidence of disease. Practice safe sex.

Zika virus can cause miscarriages and smaller brain/head sizes of the babies. It is caused by mosquito bite and usual mosquito contact prevention should be followed (as done for malaria/dengue).

Group B Strep colonizes vagina and can cause pneumonia, meningitis and sepsis in babies. Pregnant women should be screened at 35-37 weeks of gestation with rectal + vaginal swabs.

Prenatal visit to the doctor should be made within 8-10 weeks of the pregnancy. They will rule out rubella, chicken pox, HIV, Hepatitis B, Herpes, sexually transmitted diseases, thyroid problems, sickle cell disease, thalassemia, etc. If you have epilepsy, high blood pressure, diabetes or thyroid disorder see your doctor before conception to get on the correct medicines which can be used during pregnancy. Take Folic acid 0.4 mg tablets from 3 months before conception for proper brain and spinal cord development. Avoid alcohol, smoking and gutka before and during pregnancy. Being overweight or underweight can increase other risks during pregnancy. Certain fish contain high amounts of mercury so check on them before eating. Get your gum diseases treated as they can lead to low birth weight and pre term labor. Majority of the women in this area have iron deficiency anemia so get tested and start the appropriate treatment.

The above information is verified and contains supportive data from UpToDate."

By Zainab Faiza

The Good Work Never Stopped

I have to apologize for blogging after so long. Back in February I had to leave on a day's notice for Houston. My nephew was born with congenital rubella and had to undergo multiple surgeries. Although I was away the work went on smoothly. Shehla Baji would call me with updates all the time and we would discuss coming weeks' plan.

The first session has graduated. They performed amazing on the final exam and we all are really proud of them! The second session has already started. We have 3 different teachers now as the previous ones could not continue. These are equally smart and driven teachers and we would do posts about them too. The prize money from MacJannet is about to end soon but we have more money from anonymous donors so that these schools can go on.

Apart from regular school days, multiple health awareness sessions were held throughout these months by the amazing med students. Stay tuned for all the photos and posts.

Source: Etsy

By Zainab Faiza

Things are getting really good!

I am so glad that the students are enjoying each day at their new schools and are loving that they are learning something new everyday. Over the past month there has been a health and hygiene awareness camp for the ladies at PHC, multiple New Year parties at each school and I am so grateful that bookgroup has offered to donate books to us in Urdu for our students. Another awesome news is that I was looking online for NGOs to help us with health promotion pamphlets in Urdu so that we can teach our students the latest guidelines and in Urdu so that they understand it better and share them with their friends and family members. I contacted USAID and they were amazing and informed me about this program being run by Johns Hopkins University in Pakistan and they have prepared a lot of health education material for our population and I should contact them. I contacted the head of the program and he was very kind and told me that they would be helping us! It is going to be a brilliant  learning opportunity for our students. 

I have been busy with other projects so could not blog earlier but here are some photos from one of our visits to the schools. I'll be blogging about the health awareness camp and the parties later.

These are some of the works of our students. Ha, the ones who know that their handwriting is neat eagerly wait for me to take photos of their notebooks.

This is a sample of hand embroidery by one of our students and soon she will be getting orders for shirts. She is in a bad financial crisis right now and I am so glad she would be able to earn on the basis of her talent now.

And as I wrote about it earlier too, these people do not have enough money to afford bills but whenever a guest is over they will greet you with the best smile and make sure they feed you before you leave. This is another such photo of the awesome food we were served on one of the visits.

Ha this is the cow with fabulous horns outside Safiya's alley:

The is a super small video I recorded while going into Safiya's alley. They women had not covered their faces and the class was going on so I did not want to record them. The alley has open drains and it is slightly cleaner than most alleys but we will soon be launching the hygiene program where we will first inform them about the need for cleanliness, how it eradicates diseases and we will encourage them to keep their houses and alleys clean to encourage a sense of ownership. 

By Zainab Faiza