I spent a week doing medical relief work for a British NGO, Muslim Hands in the earthquake zones of Balakot and Mandiar. I arrived in Islamabad (14 Nov 2005)…
I arrived in Islamabad 5 weeks after the devastating 7.6 Richter scale earthquake struck the region. I didn’t know quite what to expect. Before I left I had spoken to a relative Mr Asad Syed an Orthopaedic Consultant who had just returned after working for 3 weeks at the Ayub Teaching Hospital in Abbottobad. He described Balakot as being completely razed to the ground, a scene from the end of the world. At the time I tried to picture that scene in my head and remember feeling numb. As we entered the outskirts of Balakot, driving along the winding mountain road that runs from Mansehra, I was mesmerised by the dramatically beautiful landscape. Steep mountain slopes, some terraced others tree-covered, overlooking the glistening Kunhar river that runs along the valley. This must be one of the most beautiful sceneries on earth I thought.
The stretch of road from Mansehra to Balakot had taken days to clear after the earthquake on 8 October. Massive rocks and rubble had slid down and completely blocked the road. The road was now clear but rocks lay along its side, there were holes and cracks in the road and the mountain slopes looked angry. Where slices of the mountains had been sheared away during the landslides the mountain face was left a raw white colour. Twisted trees and electrical masts along the road prepared me for what awaits. As we drove rows of white tents became visible in the valley below.
Balakot is a town in the North West Frontier Province; it is about 90 km from Islamabad and was a popular tourist spot for Pakistanis. Advertisements for hotels that no longer exist are sketched on the mountain slope sufaces. Lying within 15 miles of the earthquake epicentre, it was one of the worst devastated victims of the earthquake. Over half of the town’s 20,000 inhabitants are estimated to be dead. Almost every patient I saw in Balakot told me about a dead child, brother, sister, wife, husband or sometimes their entire family were dead. About 90% of the town’s buildings are flattened. I have never seen destruction on such a massive scale. Hotels, large houses, shops lie collapsed along the road in hills of rubble. Three-floored buildings seem to be swallowed into the earth. All that remains of them are the signs on their roofs. The three schools in Balakot became massive graveyards as the earthquake struck at 8.50 am when the children were in classes. A banner hangs in the main road, the meaning of the translation of which is ‘Oh Lord, whatever condition you put us in, we are pleased with You’. From my experience of dealing with the people in the area this phrase adequately expressed their attitude… The Muslims Hands Medical camp is situated next to the Pakistani army medical camps and one of the helipads. It consists of two tents, providing basic healthcare for the sick and injured. It is well-stocked with medicines, dressings and bandages. There is no electricity and obviously there are no investigation facilities available. The tents were manned by myself and an assistant who helped with the dressing of wounds. When I arrived the facility had been closed for 10 days as there had not been doctors available to run it. With the help of one of the Pakistani army doctors I organised the tents, arranging the medicines in order. In the immediate aftermath of the earthquake, Dr Yasmin Qureshi an A&E consultant from the UK and her husband Dr Zahid Nawaz had gone out and set up this facility with the help of the Pakistani army and Muslim Hands. At that time they had been seeing hundreds of wounded casualties daily, many of whom had been flown down in helicopters from destroyed mountain villages to the nearby helipad. Several doctors from the U.K and from Pakistan had volunteered their time at the medical camp. I met Dr Sohail Ahmad, an ENT consultant at Ayub hospital, Abbottabad who has been spending his weekends working at the camp and coordinates volunteers from the U.K with Dr Nawaz…..
Five weeks on the profile has changed from an emergency service to much more of a primary care facility dealing with the everyday illness of the increasingly cold and unhygienic tented village environment. The patients were from Balalakot itself and from destroyed villages further up in the mountains. Many would walk for miles to come and see a doctor. They were very simple, poor people who worked off the land. They were illiterate and had no idea of their date of birth and only a rough idea of their age. Once the people knew there was a doctor back at the tent, there were plenty of customers, up to 60 patients a day. In terms of illness, there was a lot of scabies, vomiting and diarrhoea, Upper respiratory tract infections, pneumonias, asthma, suspected urinary tract infections (no dipstick or urine sample bottles available) and aches and pains due to injuries sustained in the earthquake. There were cases of infectious diseases such as measles, chicken pox and mumps. There was a lot of paediatrics, mainly infections. Then of course there was the ongoing management of wounds and the horrific fracture injures.
I saw a beautiful 11 year old girl with Right femur fracture injury. A rod had been inserted 4 weeks ago at the Ayub Medical complex in Islamabad and she was brought to me because she was still unable to weight bear. Due, presumably to the load of cases she had been sent back to Balakot with instructions to do daily exercises but without any further follow-up. Her mother’s case was even more tragic. She had a previous neurological deficit and during the earthquake sustained terrible crush fracture of the tibula and fibula. Her leg was now held in an external fixator. Stuck in a bed in her tent, unable to manage her injury she was deteriorating daily, and transfer back to Abbottobad was arranged…..There was a lot of psycho-somatic illnesses such as headaches, aches all over the body, heart burn. Many people were just at their wit’s end. They did not know what to do next. Old women who had lost their sons, young mothers who had lost their children, a father whose three teen-aged daughters lay in an Abbottabad hospital paralysed with spinal injures. They cried in front of me, telling me they could not sleep at night. People were not hopeless or suicidal and retained a strong faith in God. I tried to provide whatever little comfort I could. I wish I had more time and better counselling skills to help these people. There is such a need for counsellors in the area. On Monday 21 there was an earthquake in Balakot about 6 on the Richter scale that lasted for only approx 30 seconds. The ground beneath my feet shook. The patient that I was seeing at the time became very panicky, frightened and described the sensation of palpations….
In association with Convoy of Mercy a school has been set up in the camp which my grandmother, Saida Sherif is running. There are about 150 students. The school takes place in 2 large tents. My grandmother is training the teachers, providing teaching materials and uniforms and shoes to the children. The children are bright and eager to learn. When I see these children I think of the children I see in the camp in Balakot. No one has set up a school for them-yet. I remember a little boy who came for dressing of a wound and told me he wanted to learn and whether I could help him.
In the afternoons I did a session in the Mandiar Muslim Hands camp setting up a ‘clinic’ in the school tent. There were queues of people waiting to be seen. During the week I was there the WHO was doing a vaccination programme, immunising against measles, DPT and Polio. Medicins Sans Frontiers came to the camp and distributed brilliant hygiene kits consisting of soap, washing powder, sanitary pads, shavers, towel, hair brush and tooth paste.
I also visited the thousands of feet high mountain village of Mang up above Balakot. The winding roads from Balakot though Angrai up to Mang are completely destroyed. One of the roads caves into a heap of rubble. A road that leads to nowhere. The mud huts that stood on the terraced slopes have been replaced by white tents. Landslides of rubble, once vast houses on the mountain slopes remain untouched 5 weeks on. If the entire family perished under that rubble then who is left to clear it up? The drive up to Mang is depressing. I see a man sitting helplessly on the roof of wreckage that once was his house. Fresh graveyards lie on either side, decorated with sliver tinsel.
We arrive in Mang, the snow-capped mountain peaks of the neighbouring range seems close by. A helicopter flies around in the valley below. There are no tented-villages in Mang and these people have chosen not to come down to the populated areas below. Instead they live in tents where there simple homes once stood. I visit a truly impressive camp school for 200 students. There are beautifully painted tents, children dressed in new uniforms and the assembly being led by the head boy and head girl is currently under way. The school has been set up by an amazing lady, Khawla Shah an educationalist from Abbottobad who runs the Iqra Academy schools in the NWFP. This school in Mang is a real ray of hope amongst all the devastation. It is an inspiration to continue life here and build a better future for the children. I pray that these children who look so bright and seem to have so much desire to learn can lift themselves out of their poverty and re-build their destroyed villages….. (606)