The following morning we left Alam Jan and his family and headed down valley.
We had a very productive meeting with the chairman and other board members of the CLSO at Spenj.
We discussed many topics including the selection of a LHV/midwife (one person) from the Chipursan Valley. We discussed the criteria for the selection process.
BHI is prepared to spend up to 480,000 rupees (20,000 rupees/month x 2yrs) towards the training of one selected candidate from the Chipursan Valley to complete the combined LHV/Midwife 2 year program at the Aka Khan University in Karachi. The selected candidate will need to commit to working in the Chipursan Valley for a minimum of 3 years after completing the program.
We also discussed the setting up of an LED lantern manufacturing and marketing microcredit program in the area.
Samples of a Canadian designed, affordable LED lantern donated by Faith and Anthony Harkham of Canmore, Alberta, Canada was left at the Aga Khan Health Centre. This is a template to base future customised designs from the area. In the meantime the health centre staff can use it when their power is out.
Mubeen, CEO of KADO made the very practical suggestion that they add a mobile phone charging outlet to the device.
We discussed ways to increase vegetable and fruit production in the Chipursan Valley, taking into account its higher elevation and longer winters. We discussed different affordable greenhouse designs, based on my experience working with Cynthia Hunt in Ladakh.
We completed the meeting with an agreement that the CLSO would select the LHV/Midwife candidate and report back to KADO who would confirm with BHI before announcing to the selected candidate and community.
We then moved on to a meeting with the health care staff at the Aga Khan Health Centre. There are two very competent health care staff currently working at the AKHC. There is a Community Health Nurse and LHV. Both are experienced and contribute a lot to their community. Currently there is no internet connectivity in the Chipursan Valley, so e-health support is not an option at present. We discussed future e-health possibilities once internet connectivity becomes available including health care staff accessing the KADO IT program at Gulmit. We arranged to have a LED lantern left at the centre.
We had a long discussion re current health issues in Chipursan Valley. More common medical conditions seen included hypertension, bronchitis/pneumonia (especially winter), gastritis, anemia, eye and skin infections. There were no recent cases of TB reported.
A very concerning issue was the recent increase in depression and suicide among young adults especially. There were 9 suicides reported in the Chipursan Valley in the previous 3 months. This is very concerning. There appeared to be an increase in associated domestic violence and alcohol use. The staff at the HC do provide an ongoing counseling service for people with depression and anxiety. However, they do not have access to antidepressant or anti-anxiety drugs. People need to travel to Gulmit or Gilgit to access such services. BHI is certainly willing to work with the CLSO on exploring ways to improve access to mental health services for the people of Chipursan Valley. There is an urgency in this matter to prevent further preventable, unnecessary deaths in the area.
We then traveled back down valley to the KKH and then onto Sost. There we had a meeting with Mr Abdullah the Dispenser in Misgar. He also has a medical clinic in Sost. We met him at his office in Sost.
We discussed current health issues related to the people of Misgar Valley and future health needs of the Misgar area. The current population of Misgar Valley is approximately 1,500 people. It lies approximately 23km from Sost, 16 km of which is a narrow gravel road up valley.
We visited the busy Aga Khan Health Centre at Sost. Currently they have no doctors working at the centre.
There is currently a community health nurse and LHV working at the Sost Health Centre. They are responsible for all the medical care in the area. With the expansion and upgrading of the KKH the Sost Health Centre is much busier. The number of road traffic accidents has increased significantly with more vehicles and increased speed. Most people riding motor bikes do not wear helmets.
When I visited the Sost HC in September 2013 they had started an e-health program. With the loss of a doctor the program is currently not operational. I discussed with the Sost staff the future e-health program at the KADO IT centre in Gulmit. The Aga Khan Health Services has an expanding e-health infrastructure already in place. Hopefully Sost will get a doctor again soon and a more vibrant e-health program could be reactivated and expanded in Sost. The existing staff at the Sost HC would benefit from reactivating the program now.