The Hospital (SCH)
Many of our regular patients are flood affected. One woman told us that the army awakened them in the night and warned them to leave. They fled in the darkness with only their clothing and children. Their house was destroyed and their animals drowned. In the camps, most have malaria fevers. There are many cases of eye, respiratory and skin infections. The number of malnourished children continues to be astonishing. I have seen more perforated and infected eardrums in the last month than in my entire career.

The second batch of food packets was delivered September 13, precipitating a small riot. Just before Eid another riot ensured when fruit, soap, noodle packets and used clothing were delivered. R. did his best to control the crowd of women around the clothing van, but reported to us that it was a “contact sport”! Friday and Saturday we welcomed four short-termers from the U.S. and Canada, and spent most of Saturday getting them settled, clothed and housed. I heard from one of them today that they drilled another bore for “our” camp.

After my trip to the Railway Hospital (last Tuesday), we opened our unit for malnourished children on Monday. The preparation involved researching and reading several different protocols and coming up with our own, including admission orders and a medical history/physical form. We also had to devise recipes for feeding formulas, as we don't have access to the packaged baby formulas. I got samples of Nido and Ensure and made a table comparing the contents, then chose the one that seemed closest to those and figured out a way to modify them. Dr. P. came up with a very tasty substitute for PlumpyNut—we call it “toffee.” That’s where all the peanut butter is going.

Monday opened with a bang as about eight kids showed up at the malnourished children's ward. We admitted them at the same time we were training the nursing staff in the new program, all while running our regular clinic. Our first patient was only partly conscious, so his care took precedence over the in-service. In fact, the in-service turned out to be a demonstration. He revived, and we planned to start him on TB meds the next morning, but his mother left with him in the night.

At least once a week we do a medical camp in our camp, where we have been seeing over 100 patients each time. Last week I did the medical camp on Thursday, while Dr. P. handled the entire clinic by herself. Then, in the afternoon after regular clinic, we all walked across the street and saw the flood refugees in the girl’s high school across the street. The next evening we went to the other school across the street to do another clinic.

Every day a few more kids come for admission to the malnourished children's ward, but about ¼ of them leave almost immediately against medical advice. Tonight I saw a 3-year-old girl who weighed only about 4 pounds; however, her grandmother left with her just hours after being admitted. Most of the children who remain on the unit have been started on TB meds. Two of our short-termers are working on our Operating Room (OR). We had hoped to do some surgeries Tuesday, but the OR wasn’t ready as the anesthesia machines still require quite a bit of work. Preparations involve drilling a hole in the OR wall.

The two nurses from Canada are working in the malnourished children's ward, and have already been a big help. After a 10-minute orientation, they were cut loose and pitched right in. We hear that a Dutch doctor will come October 3, and that a surgeon from the U.S. and his wife might come down to help us for two weeks. We’re still seeking additional midwives.

Hyderabad
We continue to visit “our” camp to provide medical care. J. saw around 15 patients today, mostly skin and fever cases, and provided money for a critically ill mother and premature baby to go to the hospital. She also paid the way for another lady to go to the civil hospital to deliver her baby, and gave tents, mats, cooking sets and mutkas (traditional brass containers) to three newly-arrived families. We recently received some materials from the UN cluster here, including 100 kitchen sets, 100 tarps, 200 blankets and 200 jerry cans.

Sept 17 - Distributed ration packs to 10 families in Mehar, Dadu district. It was extremely difficult to do distribution here—trucks are constantly being looted—even shops that try to sell items for distribution are looted. They had to put the 10 packets together quietly in a shop with the shutters down before taking them out and giving them to the families very discreetly.
Sept 18 – Distributed rations to 100 families from the towns of Ahmed Ali Laghari and Haji Leghari near Old Hala.

Dadu
G. distributed ration packs to 56 tribal families on the bund north of Mehar and on the main Dadu road. He also gave out rations packs to 69 tribal families on the Sitan Rd. area and distributed tents to 23 families, plastic mats to 19 families and cooking sets to 12 families. He has surveyed for another distribution to 49 tribal families who have just been displaced from the Manchar Lake flooding.

Thatta
Sept 20 – Overview of water pumps installed to date.
1st pump—got sweet water at 45’ feet (a few days later, it got bitter)
2nd—hit sweet water at about 20-25 feet
3rd—sweet water
4th—sweet water
5th—sweet water (Sept. 20)

We have done a total of seven borings, two were bitter from the start, one turned bitter after the pump was installed, which leaves four good pumps. The 5th will be moved. The pumps cost between 3,500 and 4,000 rupees on average.

LifeLine
Last week our team was able to do a medical camp in the Karampur area, with 219 patients seen. There is still a great need for medical care in this area and we’re considering doing a second trip, but there is some risk to foreigners. We’re amazed that nobody else is going in here yet. There are also many medical needs in Larkana, and we’ve been invited there, as well; however, we’ve been advised to wait a few days, due to many robbery cases.

Friday, Dr. T. and M.S. joined us from the USA. Today our medical team was in Silani Camp (a camp arranged by a big NGO). Almost 6,000 people are in this camp, and our medical team was able to see 288 patients. It was a very sad sight, with almost no medical care or facility provided. We were glad that our surveyor suggested this locale. Many people came and said that their religious leaders are wrong in preaching against the “white-faced people,” and that they see that these “white-faced, Christian people are so kind with us and our children.” When Dr. T. prayed for one or two children, three other families came with their children and requested, “Please also pray for our children, too.”