HELP PAKISTAN NHF & KOOHI GOTH HOSPITAL GETS ASTOUNDING RESPONSE FROM CONGRESSMAN MIKE HONDA OF BAY AREA AT DOW BANQUET

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1 NHF & KOOHI GOTH HOSPITAL GETS ASTOUNDING RESPONSE FROM O n July 18th, 2009, The New York Times OpEd columnist Nicholas Kristof published a feature on the efforts of Dr. Shershah Syed, an obstetrician in Karachi. The NYT column lauded his endeavor to treat impoverished women of Pakistan. Dr. Shershah Syed specializes in repair of vesicovaginal fistula, an abnormal connection between urinary bladder and vagina, which renders females incontinent and socially stigmatized. National Health Forum was mentioned in the article as an IRS registered nonprofit organization, which helps medical charities such as Dr. Shershah Syed s Koohi Goth Hospital. NHF received an overwhelming response on Mr. Kristof s blog and received a donation of over $11,000 from readers of New York Times. The donations will be transferred to Koohi Goth Hospital in compliance of the IRS regulations. We are grateful to Nicholas Kristof for demonstrating the exigency of common Pakistanis. HELP PAKISTAN CONGRESSMAN MIKE HONDA OF BAY AREA AT DOW BANQUET National Health Forum hosted Congressman Mike Honda from San Francisco Bay Area, at the DOGANA summer meeting. Dr. Tanveer Imam, Editor-in-Chief of Health Beat, welcomed the Congressman to address DOGANA (Dow Medical College Alumni Association of North America) members at the banquet. Congressman Congressman Mike Honda and Dr. Shekhani Honda stressed on the importance of expanding health care to 47 million uninsured Americans. National Health Forum supports reduction of health care cost and to universal healthcare coverage to all Americans. Congressman Honda was very appreciative of the philanthropic work done by Dow Medical College graduates like Dr. Bari in Pakistan. Congressman showed his support for NHF initiative to help promote health care in Pakistan. NHF would continue the tradition of interacting with lawmakers so that they could be apprised of health care conditions in Pakistan and when possible partner with US in promoting health care in Pakistan. CDC RECOMMENDS SWINE FLU VACINATION The Advisory Committee on Immunization Practices (ACIP) has recommended voluntary novel H1N1 vaccination for target groups. ACIP is a group of 15 experts in the field of immunization appointed by the Secretary of U.S. Health & Human Services, which provides guidance to The Center of Disease Control. The immunization drive will begin in the coming fall. 160 million people equaling half the population will be targeted. The groups initially targeted for the swine flu vaccines are: 1) Pregnant females, 2) Care givers for children less than 6 months of age, 3) Everyone between 6 months and 24 years of age, 4) People between 24 years and 65 years of age with chronic medical conditions, susceptible to complications of influenza. It is believed that older people may have higher level of natural immunity to the virus and their chance of exposure is less than the younger population. Swine flu incidence peaked about 10 weeks ago and is decreasing. It is expected to surge in the coming flu season. For information on vaccination and immunization contact: cdcinfo@cdc.gov

2 EDITOR-IN-CHIEF Tanveer Imam EDITOR Shamim Ahmed Emad Khan PUBLICATION COMMITTEE Raheel Rasheed Khan Mujeeb-Ur-Rehman Amir Raza Rizwan Ali Salma Haider Khan Wamique Yousuf Mansoor Abidi Naseem Shekhani Junaid Syed ARTICLE SUBMISSION We encourage every reader to send articles throughout the year on healthcare issues in Pakistan and the U.S. Articles can be ed as text or in MS Word format to The Editor reserves the right to edit content of all articles that are submitted. FOR ADVERTISEMENTS For advertisement rates, submission and schedule please DISCLAIMER Health Beat, the NHF newsletter, is a bi-monthly newsletter and provides health information to its readers. The views expressed are those of authors and do not necessarily represent the official position of either the editor or the editorial board. NATIONAL HEALTH FORUM PO BOX Ballwin, MO Volume III, No. 3 September 2009 Issue EDITORIAL ROLE OF MEDICAL CHARITIES IN THE THIRD WORLD It is repugnant to a civilized community for hospitals to have to rely upon charity. I have always felt a shudder of repulsion when I have seen nurses and sisters who ought to be at their work... going about the streets collecting money for the hospitals... Aneurin Bevan, Founder of NHS There are countless examples in history of citizens stepping up with their givings to relieve fellow citizens of disease and misery. Major corporations such as of Bill Gates, Warren Buffet, Ted Turner and others, have formed charity foundations that have helped development across the globe. Private citizens have been donating to charities now as never before. These are both large donations by a few rich donors as well as modest gifts by a large mass of people. A new phenomenon named Philanthrocapitalism has emerged which is to apply the power of business and market values to bring about social change. It is also referred as responsible capitalism. However it has been a subject of debate, as often the interests of the corporations and populace do not converge. A social change in most instances may bring about tighter governmental regulations, which is not conducive for private enterprises. What makes an individual donate to a particular charity? One motive is a feeling of goodness about oneself, i.e. warm glow and the other impetus is the fact that it may potentially bring relief to the public, i.e. public good. Common people donate to charities on the belief that their donations will bring meaningful change or a sustained response. But do charitable donations bring about a sustainable benefit? What then is the role of governments in social welfare? How should governments and charities interact in a society? Should charities strive for a social change? Medical charities have contributed enormously throughout the world. For instance, in the U.K., especially in London, charity contributions make up almost 10% of NHS funding. In the last 10 years, funding for medical charities has gone up 3 folds. The total annul contribution is almost equal to 200 million British Pounds. In the field of research, 80% of funding comes from medical charities such as the Wellcome Trust and Arthritis Research Campaign, while the National Health Services( NHS) funds only 20% of the research. Charities are unlikely to keep up with the pace of need of the society. It seems that the governments rest too much on medical charities shoulders. These issues do generate a debate about the role of charities in shaping public policies. Legally, because of their tax-exempt status, a non-profit organization is not to indulge in politics and should never endorse a particular party line or candidate. However, reliance on charities for essential services as health care makes the donor ponder on the priorities of the government. The situation is at its extreme in the Third World, where social security is a no less than a fairy tale. Government hospitals are overflowing with patients and resources have dried up. Various small and large medical charities work hard to keep the decaying system afloat. The system is heavily reliant on foreign aid and global charity. In Pakistan, The Bilquis Edhi Trust runs the largest fleet of ambulances in Asia. They take part in every relief effort, from train wrecks to major earthquakes. Life has become dependant on Edhi and charity synonymous with his name. Dependency is one of the drawbacks of established charity. As illustrated by the United Kingdom example, the government rests too much on their shoulders and in extreme cases such as in the developing countries, seemingly renegades on its responsibilities for providing essential social services. It is not the charter of medical charities such as National Health Forum to strive to change government policies, but it is a fact that medical charities can only support an established health care system. Charities as well as the healthcare system are likely to fail if the need far exceeds the capacity to provide services. Tanveer M. Imam, M.D.

3 HIS MATERNAL INSTINCT BY: NICHOLAS KRISTOF OP ED COLUMNIST, NY TIMES K ARACHI-PAKISTAN: July 18th 2009: She is an illiterate woman from the tribal areas of Pakistan who almost died in childbirth a year after marrying at the age of 12. She suffered a horrific injury during labor called a fistula that left her incontinent and smelly, and for the next 13 years she was confined to her house never stepping outside for shame at the way she was leaking wastes. husband divorced her. Embarrassed and humiliated, Ashrafi fell into a deep depression. She locked herself up in her parents home and refused to see anyone. Thirteen years passed. Ashrafi says she didn t leave the house once. I asked her, and a cousin of hers whom I reached by telephone, how she spent her days. The answer: sewing, caring for her sick mother and crying. He is a famous Pakistani obgyn who was educated in Ireland. After spending eight years there, he returned with plans to set up a fertility clinic for rich patients and zip around in a Mercedes-Benz. But he was so shattered by the sight of women dying unnecessarily in childbirth that he decided to devote his career instead to helping impoverished women like her. Finally, she prevailed upon her brothers to take her to Karachi, where she was examined by Dr. Shershah. At 56, he is one of his country s best-known doctors and is president of the Society of Obstetricians and Gynecologists of Pakistan. But three times he has been pushed out of his job, he said, for saying that resources would be better spent on education and health than on atomic weapons or F-16s. So they met in one of the hospitals established by the doctor, Shershah Syed, and he has been helping the young woman, Ashrafi Akbar. She is scheduled to undergo a final repair of her fistula in that hospital today. With government support nine years ago, Dr. Shershah started a top-level maternity wing in a public hospital in Orangi, an impoverished Karachi neighborhood that by some reckonings is the largest slum in the world. The hospital now handles 6,500 deliveries a Dr. Shershah Syed with a patient. year yes, 6,500 and accepts women from hundreds of miles away. Several years ago, a half-dead woman came from Baluchistan Province by camel. People in the West are properly outraged by Taliban oppression of women in parts of Pakistan. But some of the greatest suffering of women here isn t political or religious. It comes simply from the inattention to maternal health care. Here in Pakistan, a woman dies every 35 minutes because of problems from pregnancy or childbirth, according to United Nations figures. The underlying reason is that maternal health has never been a priority globally, either to poor countries or to foreign aid donors like the United States. The only exceptions are Britain and Norway, and I hope the Obama administration will back them up. In this part of Pakistan, Sindh Province, there is a saying that goes: If your cow dies, that is a tragedy; if your wife dies, you can always get another. This is simpler than an atomic bomb, Dr. Shershah said, speaking of improving maternal health in Pakistan. We have an atomic bomb, but we haven t done this because the government isn t interested. The day the government decides it doesn t want maternal deaths, we will have no more mothers dying. Ashrafi s case was typical: She tried to deliver at home with the help of an untrained birth attendant. But her pelvis wasn t big enough to accommodate the baby s head, so four exhausting days of labor produced nothing. Finally, the family took Ashrafi to a clinic, and the baby was delivered dead. Then she found that she was dribbling urine and stool through her vagina. She smelled, and the salts in her urine left sores on her thighs. Ashrafi had heard that doctors in Karachi might be able to cure her, and she asked if someone could take her. Instead, Ashrafi s In addition, Dr. Shershah is hitting up friends to try to build a new maternity hospital on the grounds of a former madrassa on the edge of Karachi. So far, he has built a wing to repair fistulas free of charge and to train midwives. He says that in five years or so, as the money trickles in, the hospital will be complete. (Friends in America have set up a tax-deductible charity, National Health Forum. For more information, please go to my blog, In addition to his regular work, Dr. Shershah repairs fistulas there every Sunday, and that is how he encountered Ashrafi. Her case turned out to require a series of operations because of the long wait. But after six months of surgeries, she should be repaired and ready to go home by the end of this month. Already, the nurses say, she is different from the shy, morose young woman who arrived. Now she smiles and sometimes laughs, and she spends her days outside in the hospital courtyard, bathing in the sunlight that she missed for 13 years. Reprint with the permission of New York Times. VISIT:

4 INTERVIEW WITH DR. SHAHNAZ KHAN Recently visited North West Pakistan and refugee camps By: Nadeem Ahmed Dr Shahnaz Khan is the Chair of Board of Directors of Human Development Foundation of North America. She is also a board member of HDF Pakistan in Islamabad. She was recently in St.Louis for an HDF fund raising event for IDPs in Swat valley. I had a chance to sit down with her and ask her few questions about the role of HDF for IDPs. Here is what she had to say. The war on terror to dismantle Taliban, which began in early 2009, has displaced estimated three million people. It has affected not only people of Afghanistan but also directly affected people of Pakistan in all walks of life. Especially affected are the people living in NWFP. There are estimated 4000 families displaced as a direct result of atrocities committed by Taliban in Swat Valley. Only about 20% of IDPs are living in Sheikh Zaid and Sheikh Yasin camps. There are large numbers of families who are living out side these camps. These displaced people are being taken care of by the families that are hosting them. It is extremely difficult to provide help to them, as it Dr. Khan & Dr. Nadeem Ahmed is difficult to communicain an Interview tion with those families. Dr. Khan feels that peace in Pakistan is not possible unless conflict in Afghanistan is resolved. She feels if the current crisis continues unchecked Pakistan may become another Somalia. Dr.Khan suggested that here in the USA, we should all talk to our congressman and senators to apprise them on the ground realities of that region, i.e. Northwest Pakistan and Afghanistan. There are several NGOs working in the area. Government of Pakistan has divided the area among various NGOs. The registration of NGOs is not complete and the government is slow to respond in discharging its duty. Once again majority of relief work is coming through charities, while governmental agencies seem to lag behind. Vocational School in Mardan: This project is providing sewing and other basic skills to women, which can be utilized in obtaining a livelihood. HDF Social Work unit in Mardan: This is providing basic services to help IDPs.such as providing clean drinking water and schooling for children. Besides these projects, HDF is operating health clinics to provide everyday health care needs. Dr. Shahnaz Khan felt that although the medical crises resulting from mass displacement of the population is not catastrophic; there is a need to provide them with basic health needs and psychological support. HDF along with other NGOs is playing a crucial role in providing basic and very much needed services to fellow Pakistanis. It has offices in all four provinces of Pakistan including Kashmir. PICTURES WORTH A THOUSAND WORDS HDF is concentrating on a few projects. These projects are especially focusing on the needs of women and children. Mobile Health Unit: Estimated 80% of displaced families are living out side the refugee camps. This project provides an ambulance service to meet basic health needs. Local residents joined hands with the volunteers of IDP to help out. Dr. Rehana Zohra was such an example. She herself had to leave her home with no belongings. Her newly built house in Swat was destroyed in the conflict. She volunteered for a month for HDF until she was recalled to her hometown of Swat. ABOUT THE AUTHOR: Dr. Nadeem Ahmed is a practicing Pulmonologist in St. Louis, Missouri and also is current President of APPNA St. Louis Chapter.

5 REPORT OF KOOHI GOTH WOMEN S HOSPITAL By: Dr. Habib Soomro Koohi Goth Hospital is located 5 miles north of Landhi. It is built on a 16 acres land, which was bought in 2001 for a sum of 16 million Rupees. An additional sum of 25 million Rupees was spent on constructing the 40 bed hospital and school of nursing and midwifery. HOSPITAL ADMISSIONS OUT PATIENT VISITS ,032 28,080 The hospital specializes in vesico-vaginal fistula repair. Patients from farflung areas are referred to the hospital. The average length of stay for fistula repair patients is 14 days. The hospital has 4 full time paid junior doctors, while the OB/Gyn, Medicine and Anesthesia consultants volunteer their time. Administrative Block Midwifery Student s Hostel Attendant s Waiting area Out doors Total monthly expenditure is Rs. 107,0000 for the hospital, Rs. 2,50,000 for School of Midwifery and Rs. 7,40,000 for School of Nursing and Teaching. Total annual cost of the project is approximately Rs. 2,06,000,000 (21.6lak rupees per annum) The hospital does not charge a penny from its patients and runs entirely on charitable donations. Some of the main expenditures are given below. EXPENDITURE PER ANNUM (IN RUPEES) FOOD FOR INPATIENTS TEACHER S SALARY AND BENEFITS STIPEND FOR MIDWIFERY STUDENTS *SCHOOL OF NURSING & teaching FOOD AND LODGING FOR STUDENTS Anesthesiologist at Work Cafeteria for all 2,102,000 (21 laks) 720,000 (7.2 laks) 540,000 (5.4 laks) 880,0000 (88 Laks) 108,000 (10.8 laks) Out patient Block

6 No More Tears By: Somy Ali N o More Tears is a 501 (c) (3) tax-exempt non-profit organization based out of Plantation, FL. Its focus is to help immigrant women in the United States who are victims of domestic violence. Many of these women are brought to the U.S. through arranged marriages and are scared to speak out against their oppressors due to the ramifications they will face in their home country or for the fear of being sent back. Although our mission is to rescue South Asian and Middle Eastern women we assist women from any culture who would benefit from our services. No More Tears works with these women in helping them with transportation, psychotherapy, and assistance with bills, including but not limited to electric and water, grocery money, assistance with obtaining and paying for personal care items, clothing for victims and children, payment for daycare and aftercare, assistance with fees for school and college, and monetary assistance with legal fees. How we work: When we receive a phone call from our victims we immediately send a taxi to have them picked up and then they are taken to the shelters of our partner called Women in Distress. If the shelters are full, we take the survivor to a motel and in a week s time we find an apartment for the survivor and their children to live in. All the women we have rescued have been abused verbally, emotionally and physically, and in many cases, sexually. Since most are not from the U.S., English is not their first language. Therefore, we have volunteers to help them with translation. We then help the victims file a restraining order against their abuser, if this is desired. Next, the woman meets with a family law attorney to file for divorce, again if this is desired. The goal of No More Tears is to empower the women and to help them become independent. We begin by enrolling them, if needed, in English classes. For those who do not drive, we have volunteers that help the women study for their driver s license. Once the written test is passed, we help them to drive. Some of the women are from villages in Pakistan and India, with very little education. We help them develop their skills for employment. We help set up food stamps for the women and their children until their hearing takes place and the attorney is able to get child support. Our aim is to help the women become completely independent and get a job. The relationship that No More Tears develops with the women and their children does not end there. Our survivors become a part of our family and we try to have one survivor support another with friendship and moral support. We encourage their children to befriend with one another as well. Mental State of our cases: Aside from the physical and sexual abuse, the psychological abuse that our survivors have experienced is brutal. In many cases when they talk about the abuse and their abuser they have a tendency to selfblame and also defend the abuser. Their selfworth is significantly damaged and there is a great deal of shame within their psyche, some of this is brought forth due to cultural norms. We have found that the women from South Asia and the Middle East that we have helped find it more difficult to break free and have a harder time moving towards independence. One woman that we rescued was brought to the U.S. via an arranged marriage from Jordan. She had great difficulty because even after ten years of abuse, her family kept telling her to go back to her abuser. No More Tears strongly believes that culture plays a pivotal role when it comes to the psychological state of our survivors. Another difficulty is the lack of support, since abuse and the abuser is the only social and family support system they ever knew of in the U.S. In some instances, they do not want the husband to know that they have moved on with another man as their belief is that it will tarnish their character forever in their husband s and their relatives eyes. The women, No More Tears works with, tend to vacillate between how good and how bad of a person their abuser truly is. They sometimes defend the abuser as being an awful husband but an excellent father. Often, once rescued, they are in a state of disbelief, as they never believed their lives would change so drastically or that there would be an end to the years of abuse. ABOUT THE AUTHOR: Somy Ali is a human rights activist who resides in Florida and is the President and Founder of SoMe Designs and No More Tears. National Domestic Violence Hotline Million Voices Campaign NDVH are dedicated to signing up one million people who are willing to educate, inform, and raise awareness about the problem of domestic violence. - 33% of women across the globe will be the victim of some form of domestic violence. -5% of women in the U.S. will experience an abusive relationship in their lifetime. -Over 5 million women are abused every year. - Domestic violence is the leading cause of injury in women. If you or someone you know is frightened about something in your relationship, please call the National Domestic Violence Hot line at SAFE (7233) or TTY

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8 NATIONAL HEALTH FORUM PO Box St. Louis, MO FOR ALL INTERNALLY DISPLACED PEOPLE NEWS visit: SUPPORT KOOHI GOTH HOSPITAL FISTULA REPAIR PROGRAM KARACHI-PAKISTAN Conference room with all Audio Visual Aids Library for Post graduates physicians and nursing staff Out Patient Pharmacy Needy Patient DONATE GENEROUSLY