Pakistan being a developing country has been facing numerous problems which directly affecting the routine functioning of local masses especially the poor and neglected segment of the society.

Pakistan ranks 144 on Human Development Index and 120 on Gender Development Index. Health is one of these problems, too miserable and needs more concentration rather than before due to fast growing population. Regarding Pakistani population, number of hospitals and health care centers are not enough to fulfill the needs and proper treatment of patients. Infant as well as maternal mortality rate is alarmingly higher as compared to other developing countries.

Health care situation in slums is even worsened and miserable. These areas are lacking the health care infrastructure as well as know how and knowledge.

Situation and ground realities of slums are as much severe as one can imagine. Social indicators do not match with the rest of the population. Literacy ratio between males and females is 71: 56 respectively including those people who ever attended school in their life. Only few no of schools are there in the area which lacking basic facilities.

Health condition in these areas needs rigorous interventions. Due to cultural practices women mostly get married before the age of 18, which adds to the poor health of women and ultimately leads to high maternal and infant mortality and morbidly rates. That is why, early age pregnancies, chances of high risk factor are at higher level. Situation also enunciates that only 25 % women are aware of the high risk pregnancies. Knowledge about reproductive health problems, STDs including HIV/AIDS is also scarce in these slums. Most of the people in these areas are working as daily wage laborers or sanitary workers, so health has never been a priority area for them as they hardly make their ends meet.

Hygiene conditions do not match the basic criteria of cleanliness due to which people especially women and children have to suffer from different disease.

Over viewing the covert as well as overt factors a need has been observed to counter the problems faced by the community of the described area.

To Promote Responsible and Healthy Behaviors in the targeted communities.

• To raise awareness and sensitization level among women of reproductive age on the health issues (Nutrition including 6 month exclusive breast feeding, nutrition during pregnancies).
• To increase awareness and sensitization level to 75% among Women of Reproductive Age about Antenatal Care, Post Natal Care, child spacing in the targeted communities.
• To improve primary health care services for children, adolescent and women of reproductive age in the targeted seven communities
• To enhance knowledge and awareness level to 70% of adolescent girls and boys on Sexual & Reproductive Health issues (Life skills, nutrition required for that age, STIs and HIV/AIDs, Family Planning etc).
• To increase immunization rate up to 90% among children under 2 in the seven targeted slums of Islamabad.
• To monitor growth of 90% children under 5 and primary school age.
• To facilitate communities in understanding of importance of balance diet including micronutrients
• To facilitate vaccination of children (age 2-18) against hepatitis in targeted 7 localities.
• To enhance and build the capacity of existing health workers to reduce malpractices.
• To build capacity of 35 mothers on parenting and behavior change communication.
• To train 7 community health committees.

• Training
• Behavioral Change Communication (BCC)
• Community Mobilization and Organization

Almost 70,000 inhabitants of seven targeted slums (100 Quarters, 66 Quarters, Tent colony, WAPDA store colony, Hansa colony, France colony, 48 Quarters and Alipur Frash) have benefited from the project.

Children

• Under 3 years
• Preschool age children(3-5)
• School age children(5-11)

Adolescents

• Adolescents 11-13 (puberty age)
• Adolescents 14-17 (aggressiveness)
• Adolescents 18-22 (worried for livelihood)

Married women of child bearing age

• Mothers of children under five
• Pregnant women
• Married women likely to be a mother in future

Male

• Youth (23-30) likely to be married in future
• Married men

We are working at micro level with mega objectives. Need less to emphasize that community participation would be the key to success of the project. To achieve maximum community participation, project has formulated seven community health committees includes social workers, religious leaders, community elders and health workers. The project implements its activities with the support of the community health committees. The project has organized two capacity building workshops for the members of community health committees in order to sensitize and train them in different health and management issues followed by refresher training.

Project has established seven primary health care outlets to provide quality health care facilities with the special focus on antenatal and post natal, family planning services, high risk pregnancies services at door steps to the inhabitants. Project organized growth monitoring and de-worming camps in each slum on biennial basis. A number of sensitization and awareness sessions on High Risk pregnancies, child spacing, Family planning, TT coverage, immunization, Nutrition, personal and community hygiene and STDs. The project organized two capacity building workshops for mothers to training them in parenting skills. Screening and vaccination camps of hepatitis B have been organized in all communities for children aged 1-18 years. Health workers from seven targeted communities have been training through a month long training course to reduce malpractice. Project provided micro nutrient to children under 5 to reduce iron, phosphorus and calcium deficiencies. It also organized one day training sessions for youth about nutrition requirements for the children. DIYA Theatre group performed theatrical performances to raise awareness about different health issues. Health baby shows, best committee awards, sports competitions and youth assemblies are the other features of the project.

• One hundred and eighty nine awareness and sensitization session on nutrition, high risk pregnancies, child spacing, immunization, communicable diseases, management of diarrhea, importance of TT vaccination in pregnancy, STDs have been organized in which 5481 women and girls participated
• Through more sixteen deworming camps, more than 6160 children were provided medical care against abdominal worms
• Fifteen introductory meetings and big gathering with community influential, CBOs members and religious leaders were conducted and briefed them about health interventions for their communities Nine hundred persons participated out of which 70% were females and they showed keen interest and their support for the project implementation
• Seven youth talent and community health shows were organized where 2570 individuals from communities participated.
• Two capacity building workshops followed by refresher training were organized for members of community health committees. Seventy nine committees were trained through these trainings,
• Micro nutrients were distributed by launching nutrition initiative among 2450 children for a period of two to address protein, calcium and iron deficiencies.
• DIYA theatre group organized 15 theatrical performances in different communities to create awareness among masses. Some 3900 women, children, girls and men witnessed these performances.
• Through primary health care outlets, more than four thousands patients were provided medical care. 85% of patients were female and children.
• One training of health workers were organized to reduce malpractices in which 18 health workers including dispensers, homeopathic doctors and TBAs participated
• A number of screening and vaccination camps were organized. Through this initiative, more than nineteen hundred children under age of 18 were screened and vaccinated against deadly epidemic.
• Some twenty three youth assemblies with both boys and girls were conducted to sensitize them about HIV/AIDS. More 644 boys and girls participated in the assemblies.
• Two one week capacity building workshops were organized to train 30 mother about parenting skills.
• Nine healthy baby shows were organized during the period under review in which more than twenty seven hundred women and children participated.

• Training for Community Health Committees on management of health system
• Training of mothers on Parenting skills
• Training of Health workers
• Training of young boys and girls on Nutrition

Hina, a cute little girl , 4 years of age, is a daughter of Ms. Shakeela (33 years old, currently working as a CHC in SACHET and lives in 48 quarters ,Islamabad.

According to Shakeela, her daughter Hina has been suffering from abdominal pain , which comes and goes off and on for the last 1.5 years. she often complains of generalized body weakness followed by loss of appetite.

Hina’s mother has taken her to a number of doctors but none of them have ever thought of WORMS!!! This time she visited SACHET PHCO(primary health care outlet) situated in 48 quarters, Islamabad. After taking a short history ,I examined the little girl thoroughly, she was pale, weak, lethargic, could not even walk actively. Her mother told me about her habit of eating mud .On abdominal examination, her tummy was bloated, slightly tender, with no other diagnostic signs. I prescribed her medicine containing Ferrous Sulphate ( iron ) and multivitamins along with a medicine to cure her abdominal pain as well.

It was her luck that the very next day we had a Deworming Camp in 48 quarters. I asked Shakeela to bring her daughter to the Camp. This Camp was organized by Mr. Wajid Ali , working as a Field Coordinator at SACHET, and made a tremendous effort in arranging medicines and organizing camps. Hina and hundreds of other children were given drops Zental, to get rid of worms residing in their digestive systems.

The very next day of deworming camp, Hina complained of dry cough to her mother and vomit out a live worm. Another few minutes passed and she ran to the toilet to pass stool, as she was having an abdominal pain. According to her mother, she screamed from the toilet,

“mama saanp saanp,jaldi ao bohat saray saanp agaye hain” (hurry, mother,so many snakes have come out).

When Shakeela rushed to the washroom she saw a cluster of 7-8 live worms lying with the stool.The worms kept on excreting in Hina’s stools for 4-5 days in a cluster form, sometimes twice and sometimes thrice a day. A total number of 3 live worms expelled out of her mouth ,one by one on alternate days. All worms were live except for the last 2 which were dead when excreted out in stool.

IT has been almost 20 days and Hina’s health is on the path of improvement. We should be all grateful to ALLAH Almighty who saved her from a deadly , disease, which might have had fatal effects on that small girl, in future.

Hina came to me with her mother at our clinic in 48 quarters, and Shakeela told me the whole story and in the end said that she was never aware of the benefits of deworming medicines and now that she has witnessed her daughters condition herself,she would love to disseminate this information to other mothers too, and thanked SACHET for providing such facilities in their communities.”]

Shan, a 12 years old boy, is a son of Mr. Younas Gill, resident of 66 quarters,Islamabad.Since,Shan was 5 years old, he had been suffering from chest infection off and on, accompanied by dry to productive cough, fever (low grade, sometimes high grade if infection becomes severe),followed by general body weakness and lethargy. According to his father, Shan had been getting treatment from various hospitals and clinics, but unfortunately, he was never cured for more than a week or two, for the last 6-7 years.

He fell ill again this time and came to our SACHET PHCO (Primary Health Care Outlet) established in 66 quarters. The moment he entered my room, I saw a weak, lethargic, ill looking boy, who was constantly coughing. He looked pale with sunken eyes and fed up of his illness. After a quick general physical examination, I moved on to his proper clinical chest examination. On examination, there were decrease respiratory movements bilaterally, although the shape of the chest was normal. On chest auscultation, were found wheeze and bilateral crepitations more at basal areas. At that moment, I made a list of differential diagnosis in my mind i.e. bronchitis, asthma and tuberculosis.

On the contrary, his pallor and dyspnoea forced me to think in terms of anaemia too. However, after a thorough history and clinical examination of chest, I ruled out tuberculosis and asked his father to get his chest x-ray done and show me in a day .Meanwhile, I prescribed him syrup KEFRIL 125mg/ml. with some antipyretic and anti-allergy, to make sure if it covers the infection or not.

The very next day , shan’s father came to me and showed me the chest X-Ray. The X-Ray confirmed my diagnosis and revealed chronic Bronchitis. The only group of broad spectrum antibiotic I wanted to prescribe shan, was Tab. LEFLOX 250 mg. given in a B.D dose(twice a day),as it covers a wide range of gram positive, gram negative ,aerobic and anaerobic bacteria and even some of the viruses as well. It is a Quinolone group of antibiotic. His father told me that he had never taken that medicine before.

Fortunately, it worked, and to my surprise just after taking 2nd dose his condition was very much stable. Shan along with his father visited me the very next day and I was amazed after auscultation of his chest. His symptoms and signs were dramatically improved. Wheeze was decreased and there was improvement in crepts too.

At least 35-40% of his illness or disease was cured, and he continued the same treatment for 10 days. It has been 1 month now and he is 100% cured ,and is leading a healthy life .I am grateful to ALLAH who gave him SAHAFA.His father, who was so disappointed and worried because of his son’s illness said,

“Mein Sachet or unkay doctors ka shukar guzar hoon,jin ki wajah say aaj meray betay nay pehli baar sukoon say saans liya hai or sehatyaab hua hai…Sachet ka mazeed shukriya kay jis nay aisay project chalaye kay hum jaisay ghareeb logon ka bhala ho sakta hai” (I am thankful to SACHET and its doctors who helped make my son lead a healthy life and I’m grateful that it is running projects which benefit us, the poor).