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

Super Woman

Standing with me is the awesome human being Shehla Baji. I call her Baji as she is older than me and in Urdu we use this word as a sign of respect for elder sisters. I met her briefly in my first two years of med school during some awareness camps at PHC but we became friends during my third year clinical rotation in Family Medicine at the PHC three years ago. Then in my fourth year when I was president of the school welfare society she was my partner for all the community work, house visits and identifying patients in need. Since then we have always worked together for the community. When we were awarded the 2nd place MacJannet prize Dr Jawed Usman identified her as our main helper as she was from the community itself and no one matched her passion or amazing work ethic. 

I have never met anyone who works for their community with such enthusiasm as Shehla Baji. This blog is about her life and all the amazing things she does. 

Initially from Kohat, a beautiful small village in Northern Pakistan, Shehla Baji moved to Karachi with her family about 17 years ago. She has two sisters and two brothers. In Kohat she finished tenth grade but her father ended up in a debt of Rs. 500,000 and could not pay it off with his employment in the village so he set out for Karachi to earn more money. She tells me it had gotten so bad for them in Kohat that her mother would make tea without milk and give them dry bread along with it as they did not have any money for real food. They could only afford a decent meal once a week and they lived off it for the rest of the days. Their aunt loaned them the money to travel to Karachi. When they reached Karachi they stayed for three months at another aunt's house in Sikanderabad. Since she was educated, she immediately posted ads to tutor children of her lane. At night she and her mother would wash and iron clothes of truck drivers for more money. By the end of three months the family had enough money to rent a house. Within a few months she got married to her husband at the age of 16. The cultural practice there is that once girls get older, family members find suitable husbands for them and they get married off. After she got married she registered to give Intermediate level examination privately and she did all this while she was pregnant. Within a year of her marriage she had her first son Shariq who unfortunately has Cerebral Palsy. Shariq used to be sick quiet often since birth and Shehla Baji was always there at PHC to consult the pediatricians for one thing or another. During one of her visits she was asked if she knew someone from the community who would like to work for PHC and she excitedly told them that she would. She wanted to be trained to learn more for her son and wanted to help her community members.

This was back in 2003. Since then she has worked diligently, and harder than anyone else there. She is always keen to learn new things so that she can educate her community members regarding that. Now she is working full time to ensure that the MacJannet prize money is being spent in the most efficient way at Sikanderabad and maximum people get benefit from it. From Monday to Friday she is visiting schools daily to ensure that everything is being run smoothly. Everyday she visits two schools in the morning and interacts with the students and solves any problems being faced by the teachers. In the afternoon she is at PHC ensuring that the three sessions: the school, sewing class and the computer class is being run smoothly. 

Apart from all the assigned work she has been doing voluntary work for years for the community. She has herself identified 60 very needy children for whom she arranges school fee each month. At the beginning of every year she takes them to the uniform shop herself to get their uniforms. She knows 7 destitute families and she arranges monthly grocery for them. Just recently she collected funds to set up small businesses for two women so that they can earn from home. One of them now sells stationery and the other one sells chips and biscuits. Whoever she thinks is needy or can earn more, she collects funds to get sewing machines for them so that they can begin earning by stitching clothes. She also collected money to set up 2 French fries selling stations so that two teenage boys could start working and earn for their families. Whenever any house is in danger to get their power, gas or water cut off because of the many outstanding bills, she gets on it to ensure that they have enough money collected to pay off their bills. There is poverty everywhere in Sikanderabad but Shehla Baji is working hard to prevent anyone from becoming its victim. In the last blog I mentioned how some women died while giving birth because of the unsafe cultural practices and she is the one who notified other pregnant women to not undergo that practice and registered them with Edhi foundation for a safe and free of cost birth of their children. As her own son has Cerebral Palsy, she is very eager to help other CP children too. She took on the responsibility to arrange for wheel chairs, wheel cycles, diapers, Iron and Calcium supplements and food for 24 other CP children. Sadly, only 17 of them are alive now. 

Today I sat down with her and asked why she was doing all this and she said she was always into helping other people but she became more motivated after her son was diagnosed with CP. She said hopefully someone will benefit from some of this and say a prayer for him and his condition will improve a bit. She said she also felt that it was her responsibility to spread awareness among other people as she was more educated than the rest and she wanted to guide them towards the right thing. Shehla Baji absolutely hates it when people beg and having seen some harsh financial crisis, she wanted people to get out of it and work towards financial independence. This woman is a firm believer of community strengthening and she always tells me that these are her people, if she would not work for them then who will.

On talking about the MacJannet prize Shehla Baji happily told me that she always wanted to do more for her people but never had enough resources and now this gift is actually beyond her wildest expectations. She told me that she has never been more grateful in her life than right now because she is seeing older women who had never held a pencil in their hands are showing up to schools daily and are so interested to learn more. She is confident that this will create a ripple effect and all these women would be more keen towards the education of their own children and others around them.

I asked her if she wanted to give any message and she laughed and said she hopes that there are more people out there like those of  the MacJannet Foundation. Getting serious she said that 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 continued and said that she just hopes that people stop living in their bubbles and take a moment to look around them as there would be someone who would be shy to ask for help but it would mean the world to them if you went ahead and helped them. She is 32 years old and one of the most jolliest people I know but when she says all this profound stuff she leaves me speechless. 

Shehla Baji restores my faith in humanity every single day and I hope that she continues to do this forever. She is a real treasure for Sikanderabad and I am so fortunate to know her as my friend. 

 By Zainab Faiza

These Strong Women

At least 5 of the women coming to our schools are pregnant. And they are among some of the keenest students in our classes. I really admire their courage and dedication to battle all the household chores, their morning sickness and back pains, needs of their other children and some even have some less than optimal domestic situations at home. Yet they all come eagerly with finished home works. I asked one of them if it was easy with everything going and she laughed and said absolutely not. She said she never really had any chance to receive education before and now when she has this opportunity she will not let this one go. One of the students is approaching her due date soon and her teacher tells me that she is so keen to learn everything as soon as possible as soon she would not have enough time to come here. I told her that we can adjust her in the following session if she would be willing to attend then. 

Most of the pregnant women in Sikanderabad choose traditional midwives and give birth at home only. These midwives are not trained and have just began doing what they saw the elder midwives do. Because of Ziauddin PHC clinics a lot of women have began coming in for antenatal visits and they are all advised for regular ultrasounds and prescribed folate and iron tablets. Over the last few months only we heard that the two pregnant women who went to local midwives died during child birth and even three other babies saw the same fate. It was just such a big shock for us and now all pregnant women who are coming to PHC are insisted upon to go to a tertiary hospital for child birth. 

Our five pregnant students were specially counselled to seek proper medical care. Shehla Baji took them herself to get all their blood tests done and then she had their name registered in the OB/GYN wards so that when the time comes, they deliver in the hospital. Shehla Baji registered them through the Edhi foundation which is the largest NGO in the country and they have received confirmation that all their child birth expenses would be borne by the NGO. This is a great news and such a relief for us that our students would be looked after properly when the time comes and the cost would not be a burden on them. We also conducted awareness sessions for all of them and we instructed them to carry the message to all the other women they know so that no one has to see the same fate as those unfortunate women who went to the untrained midwives.

We are very hopeful that our pregnant students in the future would be equipped to educate their own children when they are older and help them in their homework and encourage them to study more and build better lives for them.

By Zainab Faiza

Their spirit of Hospitality

Sheen Chai is Pahto for green tea. Pashto is the most widely spoken language in Sikanderabad as it is the language of Northern Pakistan and most of the residents hail from there. It is also understood and spoken by most of the Afghan Refugees so that is a plus. Whichever house or school you visit they'll stand up to greet you with the most gorgeous smiles, and ask you to sit on the nicest room in their houses. Although most houses face power cuts when we go meet them in the afternoon, they'll turn on the small generators which can power one fan and bulb just for you. 

Most of them insist to serve you food no matter what time of the day it is. If you say no, they always have tea ready. I personally do not like tea but my other team members go for it happily. They began offering me flavored juice instead and even flavored milk once ha. I tried settling in for water instead until one day they said have Sheen Chai which is their traditional drink and it was absolutely heavenly. I had had a big breakfast before going to the school that day and after i drank it I felt so light and refreshed. My mother generally drinks the commercially available green tea at home and this one was much better because it was straight from where it is grown in Northern Pakistan and it is not sold under any label, just by its weight. Guess I know what I'll be asking for every time I am there now.

I feel bad that they are all poor and cannot afford to go out of their way to feed us every time we visit but I had quiet an interesting conversation with this elder from the area about it. She said we are Pashtun and it is in our blood to serve our guests better than we eat. We consider it our good fortune if we have visitors, that way we have a chance to serve others. And she said do not say no when you are offered food fearing that it is expensive for us, we do it gladly. And we feel respected when an outsider eats with us and from our house. And what you eat was already given to us from God, just for you, so it is our good fortune that God chose us for this. 

Their simplicity in daily life continues to amaze me. 

  By Zainab Faiza

Love learning new things!

This photograph is from Mudassir's school. She has herself attended school up till high school. For now she is also running a small business at her house where she stitches clothes for other women in the area. Her stitched clothes are very fine and over the past few months she has been able to take orders from female doctors at the PHC too. She wakes up early and is at the sewing machine at exactly 7 am after sending her children to school. Initially this school was being run in the afternoon but now as more students wanted it early, it is conducted in the morning too. The only problem is that she faces power cuts during the morning in her area and students have to sit without any lights or fans. As you can see they are sitting along the window and doing their work with what little sunlight enters the house. We will get her an emergency light so that the students do not have to strain while working.

One of her students, Saima Tania eagerly wants to finish Math and Urdu so that she can start on with English. Sania's mother works as a cook and her employer used to give her children's books for her children so Saima has learned basic English language form those books on her own. I told her I will get her more English books so that she can practice and continue reading English in her spare time.

This was on the blackboard when I entered this school. They are learning how to join alphabets in Urdu to form words. The top one is Anaar which means pomegranate and the bottom one is Batukh which means duck in English.

This photo is from Bukhtawar's house. She is an exceptionally strong woman who will always greet you with a big smile. On this visit she had to go to the hospital for a follow up so her daughter Noor was conducting the session. She is the one who is standing draped in lime yellow on the right and Shehla Baji is the one in black who visits them everyday to see how the program is running. 

Both these women I talked to are loving the new classes and always demand more homework. To think that just a few days ago most of them did not know how to hold a pencil and now they are writing and reading words and going crazy colouring in their workbooks is so heartening.

The best thing about my visit this Tuesday was Dr Imran Sheikh. He is the new head of Community Health Sciences at the University. He had previously worked for 15 years here in this community with the university but he went abroad for a couple of years. Now that he is back and was visiting the area with us, so many people recognized him and were glad that he will work with the community again. As we have always wanted to include more university students for this program he has a plan of initiating more health awareness sessions that would be conducted by those students who will train the teachers and then they will train the students at their own school. For now we are working on a questioner to be filled out by each school student regarding their base line knowledge regarding disease prevention and then we will fill it out again after a few months after all the awareness sessions are conducted and then we will see if they have retained anything and are actually implementing health promoting habits or not. I am so excited to impart all this to them so that we decrease the disease burden of preventable diseases and they are able to spend money on better things. I have contacted a couple of NGOs regarding health material for these people and I will post what I receive from them.

By Zainab Faiza