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October 25, 2005

Report from the Field by Irshad Shaikh, MD, PhD, MPH

I had just returned back to Nairobi, my duty station, after attending a conference in Amman, Jordan when I received the orders for immediate deployment to Pakistan from our Regional Advisor (RA) for Emergency and Humanitarian Action (EHA) in the Eastern Mediterranean Regional Office (EMRO) of the World Health Organization.

I arrived in Pakistan within the first 24 hours of the disaster and the immediate task assigned by the RA (who himself had arrived as well) was to establish and get up and running a Health Emergency Operations Center (HEOC), in collaboration with the Federal Ministry of Health of Pakistan (MoH), to serve as a control and command center for planning and operations in the health sector. With excellent cooperation and assistance from the MoH, the Operations Center was established and operational by early morning of October 10. WHO had initiated mobilization of relevant experts from EMRO, headquarters and all other regions and in a show of solidarity; and more and more staff were volunteering their services for deployment.

As reports from the field started trickling in, it quickly became apparent that the health care delivery systems in affected areas had collapsed from a variety of reasons, ranging from physical damage to unavailability of health manpower; this latter both because of access constraints to sites as well as mortality and injuries among health workers. Coupled with the expected exponential surge in demand for trauma and surgical care and other ailments among the affectees/vulnerable subgroups, the supply deficit looked very ominous.

Thus, the next top priority for us (in WHO), in consultation with MoH, was to establish alternate ways to deliver health services (primarily surgical, medical and public health) and to mobilize tens of national surgeons, general duty medical officers, and public health specialists from other parts of the country to shoulder core functions in such a complex emergency.

Again, one of the tasks assigned to me was to explore the possibility of massive deployments with academic institutions having commensurate capacities. The presence of another senior Hopkins faculty, Gregory Pappas, MD, PhD, chair, Community Health Sciences (CHS) at Aga Khan University, came in very handy and we were able to arrange for mobilization of the required staff from CHS.

A parallel concern was to immediately establish an active surveillance system to capture and monitor cases of concern—Tetanus, Cholera, Pneumonia, etc.—and to have the capacity to investigate any reported outbreaks at the field level in affected areas  Here again, because of CHS's proactive stance, we were able to bring in experienced field epidemiologists to lead a team of surveillance officers seconded by the MoH. My job during the first 72 hours in this area, in collaboration with two other WHO epidemiologists, was to plan and design the necessary tools and impart training to the first batch of public health specialists mobilized for field deployments. It should be said that the disease surveillance and response team has also been supported by one other seasoned Hopkins faculty member, Aamir Khan, MD, PhD.

As more and more WHO colleagues have arrived and positioned themselves in the field, the joint WHO/MoH field operations have grown rapidly and now we have self-sustaining hubs in all major town and district HQs in the affected areas.

Both I and Dr. Khan have also been part of the UN Interagency team assigned the task of conducting rapid (health) assessments in farflung, peripheral areas of those affected districts rendered inaccessible by road because of  the earthquake. For four days, we would fly out by helicopter and land in valleys to visit isolated communities. We found this firsthand exposure to the magnitude and cope of the disaster and human suffering very challenging and emotionally draining, especially since, in quite a few areas, we were the first to arrive.

Nevertheless, these missions proved very beneficial and rewarding both from an organizational as well as a personal perspective; along with conducting initial assessments, we were also able to help the Pakistan Army deploy advance units to some of these communities so as to secure these and facilitate the shipping of relief supplies by the Army, the MoH and other NGOs. We were also able to airlift a couple of serious trauma patients and their families from these communities to Islamabad for propoer treatment and care.

As the operations have become smoother and field activities stronger, my current assignment is to serve as the WHO team leader for coordination and health information management at HEOC.