UNITED NATIONS RESOLUTIONS.

http://www.un.org/Docs/sc/unsc_resolutions10.htm

Health Needs Assessment in Dadu and Thatta Districts of Southern Sindh October.

http://pakresponse.info/LinkClick.aspx?fileticket=-IHuifaSpAQ%3d&tabid=86&mid=548

Health Services Minimum Standards In Emergency & Disasters for Public Health Services.

http://www.sphereproject.org/dmdocuments/handbook/hdbkpdf/hdbk_c5.pdf

Safe Drinking Water For Flood Victims: Some Practical Methods For Communities.

It is increasingly identified that in order to mitigate the mortality due to contaminated drinking water needs of flood affected communities especially vulnerable populations of women and children, there is need to offer and train communities in safe, easy, cheap methods of improving drinking water quality. Some methods are as follows:
Boiling: After passing the water through some clean muslin cloth, boil it for at least 10 minutes. Cool and resieve if needed.
Disinfection: This method is more suitable in the present circumstances as fuel for boiling is in short supply and many areas the cooking arrangement maybe deficient. Use household bleach. Liquid containing a 5.2% solution of sodium hypochlorite is safe and effective.
Method: Place water in a clean container. 4 drops for one litre (litre water bottle for measurement or litre Pepsi bottle can be used). Mix thoroughly and leave to stand for 30 minutes. If water is cloudy or very cold leave for standing to 60 minutes. If water does not have a slight bleach odour after the standing time , repeat the bleach treatment and let water stand for another 15 minutes.
Bore Holes: In places where urgent water bore holes can be dug, a hand water or machine water pump can be installed.This is also relatively safer for drinking than surface water.

Solar Energy For Disinfection: Put water in transparent .plastic water bottles for at least 6 hours in sunlight. This is enough to disinfect for safe drinking. (WHO, UNICEF).
Source DFID document on flood mitigation. and Mr Akhtar Ali http://developmentpakistan.blogspot.com/).

Health Information 30th August . Pakistan Floods.

http://www.pakresponse.info/sitreps/Health_Cluster_Bulletin15_29August.pdf

Development Pakistan: Is Land Reform off the Menu?

Development Pakistan: Is Land Reform off the Menu?

Pakistan’s Floods 2010: Historical Background and Current Challenges.

 Pakistan’s Floods 2010: Historical Background and Current Challenges

DR.Meher Zaidi.

In August 2010, as Pakistan reels under the devastating flood of depair and catastrophy of Biblical proportions, there are some real questions that need to be answered and some urgent trials that will eventually have to be put in place both for the administration and to the people in a socio-moral perspective.

In 2006, the World Bank  Report on Pakistan’s Water Economy (Oxford) emphasized the creation & training of a new generation of multidisciplinary water resources specialists and promised the stimulation of “ centers of excellence” for water resources sciences. It concluded  that over the recent decades the capacity for modern resource management has not evolved rapidly enough to meet the emerging challenges.

As I watched the interview of Mr. Nizamani, director, Sindh Irrigation Authority (SIDA)  to Sindh television anchor while sitting on Kotri barrage with a piece of paper in his well fed pudgy  hands , on the very, very ample girthed-belly, saying that Inshallah Kotri barrage will see this flood pass and nothing will happen, I was thinking about the plans to train the new generation of multidisciplinary water scientists as envisaged in their report.

In Thul thousands are trapped with sudden inundation of their area and even cutting of gas supplies. How will they cook or even boil the unpotable water that is flooding with the cattle dead in the water. There are thousands of pesticide bags, many of them even expired (My husband had done a study in 1997 which showed 1000 tons of expired pesticides over Sindh and Punjab of which 300 tons were sent for disposal to Germany).The elected representative Dr. Shoaib Sarki has given a few rusks to a very few people gathered in a small piece of land that was not submerged when they were telling them their difficulties Another man even said something about him giving him a hundred rupee note to get something for himself.. So much for the relief with food supplies. This was shown on Mehran television. The residents of Thul do not want to leave now. They just want their gas restored and they want some food and medical relief. They appear very angry with the elected representatives leaving them in times of dire need.

On another channel, the KTN news network there were live call in from various people including a PPP MPA, complaining how some influential parliamentarians and feudals  had tempered with the dykes and bunds and saved their own  lands and inundated very large areas of other people. This is a widespread complain now. By August 9^th this was only starting. The Mounder town with 10,000 residents had to be emergency evacuated by the army because five private bund breaches were made there without warning to the residents.

All over Sindh people are sitting helplessly on bunds or the little available high ground, without shelter or relief. The government agencies and infrastructure as it is dilapidated, corrupt and weak, seem overwhelmed. The lack of local bodies and any community based organization at the village level is reflective in the disorganized and helpless plight of millions of people in Sindh. These people who were living off the land, farming, cattle herding and sustaining their poor livelihoods are suddenly ravaged with the floods. The question now arising is that was this scale of flooding envisaged in Pakistan or Sindh? Was there a flood disaster management plan? What did we actually do to prevent or contain such a catastrophe? What ugly truths have been laid bare by this enormous calamity?

From the perspective of a citizen, I did try to study the few documents available on the net  and some books and reports, out of which some things I will share with the reader.

The World Bank did emphasize the fact that “ in service delivery the state water institutions have not made the transition from the era of development & construction to the era where management of resources and services is the primary challenge”. This has become so obvious in what has really happened in Sindh. Here the primary layering and repair of water channels has not happened. The transparency and fairness in water allocation has resulted in “illegal” bunds and dykes which the feudal landlord has without coordination and warning with the authorities, broken to let the ravaging waters loose on the hapless other neighbors. The decentralization of irrigation management along modern management lines has not occurred at all. The corrupt practices of the irrigation department has added to the disaster impact.

 In a country like Pakistan wherethe World Bank says “ the Indus plain offers the most complex challenges in water management”, the priority and the resolve of the Pakistan’s military & political forces to manage this complex challenge is evident from the fact that less than ----amount of the development budget is spent on the priority of improving the infrastructure like the repair of dams and barrages, cementing of the water courses etc. In its report it says that “Pakistan has a large endowment(with an estimated replacement value of US$ 60-70 billion) of water resources infrastructure, most owned and managed by the provinces , and much of it is quite old. As described in this report, the condition of this stock  of infrastructure is a major cause of concern. In some instances- such as Taunsa and Sukkur barrages, the precarious state of major structures puts the well being of tens of millions of people at risk”.

It identified the increase in water lending to Pakistan from 2000-04 to about US$ 1 billion. The Sindh Water /Irrigation Sector Improvement Program (US$ 140 million) was to improve water productivity through a reform agenda/ investments leading to a better management system that would link canal command areas, the distributary, and the water course level. Components included were; capacity building; civil works, agriculture & irrigation technology; and management and & administration.

As always discretion and lack of accountability are handmaidens to corruption. As seen in this report the facts are evident as to what really happened in the implementation of the civil works  and improvement of management program.

Mr Nawaz Sharif in his utter niavette is opposing the Flood Disaster Relief Commission, to which the prime minister Yusuf Raza Gilani has responded with the word “Council”. The fact is that ;

Federal Flood Commission (FFC) was established in 1977 to provide the necessary infrastructure at the federal level to help

the provinces in meeting the technical and financial resources required to carry out the Flood Mitigation Measures.

The lack of transparency and non-merit appointments of the irrigation department especially in the Sindh province where such a large network of waterways is spread to provide livelihood to such a large population and where the major dams and barrages are structurally in very old and poor state is beyond imaginable and sane comprehension. The ingrained culture of corruption, nepotism, sycophancy and feudal mentality is so obvious now that the way the floods were or are being managed in the whole of Sindh. It is a shame and a time of deep introspection for all of us that claim to love and live of this beautiful tolerant land, that gives us so much. Who will answer this? Can we truly blame the new government? No, not really, as the Sindhi nationalists are vocalizing. What have they really done to fight off corruption and nepotism. What have they done to envisage  any disaster and prepare the local communities to mitigate its effects. Just by racist remarks and violent expressions of hatred the pain and miseries of the folks cannot be removed. The sheer lack of any food, medical relief to the people who are being affected shows the apathetic communal cushion of support to the average resident.

The people of rural areas that have been badly damaged in Sindh are complaining that their standing crops, entire villages are inundated at the expense of the larger towns. This has a background.

 This mainly happened because the provincial relief organization as part of the plan was almost non-existent.

Provincial relief organizations were envisaged with the responsibility of disaster preparedness, emergency response, and post disaster activities

including floods. Flood preparatory actions required to be taken by the relief Commissioner included

(i) Arranging inspection of the flood protection.

(ii) To establish flood warning center and the flood centers at the district and Tehsil levels.

There  is a very large population in Kacha areas and along bunds which have established residential villages and were not included in the earlier disaster relief map. (As such there is no mapping along modern GIS lines in any part of Pakistan including very populous Karachi, where cantonment including Defence , civilian, residential areas are secret to GIS mapping)

 As I studied the disaster mitigation plan document the following facts were seen:

The FFC prepared the National Flood Protection Plan 1978 (NFPP-1978), that comprised of a viable future flood protection plan.

The main thrusts were:

a) To reduce the flood losses

b) To give priorities to flood protection to the areas of greatest economic risk

c) To provide protection from flood damages to areas out side flood plains i.e. cities & vital infrastructure installations.

d) Improvements in existing flood protection/flood control facilities.

The other background is as follows:

Pakistan faced much damage from floods in 1973 after which the federal government decided to strengthen all mechanisms of flood warning system and also initiate a flood disaster response system.

The army is playing a vital role in rescue and relief of the flood affectees. It was given a role in the 1977 plan which it has fulfilled with diligence and utmost valor. Its flood related function encompasses all the three phases of flood operations from the pre-flood to post flood.

 After reading the documents available and seeing the real time damage and evolution of the current flood disaster I have reached the following few conclusions:

-That there is a need to devolve the disaster management plan to the lower community level, including the revival of the local government right now without elections so that some structure is in place for relief and later rehabilitation.

-That there is an urgent need to complete overhaul and restructuring of the technical and manpower human resource of the irrigation department.

-There is urgent need of capacity building & training of existing staff in modern management practices.

-There is urgent need of reforms and restructuring of the water distribution and resources such as water rights etc.

-There is urgent need to develop political consensus on all water issues in order to early development of new infrastructure.

-Last but not the least there is a need for accountability, transparency and merit in appointments of all manpower in water and irrigation departments.

In the end a few words about Mr. Zardari. As he was so defensive about his presidency in the news conference today with Mr. Kerry Lugar on being questioned by a foreign journalist and links it to the derailment of democracy and his contribution to the averting of civil war post Benazir’s killing, he needs to realize that his label as a corrupt person is now a dead weight on the government of Pakistan Peoples Party and the whole of the relief funding  effort in Pakistan and the world. The prime minister is the CEO and in his own words the government is of consensus. If he leaves the presidency and as the unanimously elected prime minister is favored by all so can a president be chosen. In no way the democratic government will be derailed. He needs to make a dignified exit. His expression of resolve and passion to build new villages in place of the ones inundated maybe sincere but a more viable and tenable is a social and political contract to remove corruption especially in all government departments in Sindh, bring about meritorious appointments of all staff  irrespective of ethnicity or religion, transparency in all public dealing and true accountability at all levels. May God give us all to bear the brunt of the devastation of floods in Pakistan with courage and hope.

The Role of Occupational Therapist in Disaster Management.

http://www.aota.org/Practitioners/PracticeAreas/Emerging/39659.aspx

This is a good concept paper. All people can gain insight into disaster handling and preparedness.

Children's Health In Pakistan.. A UNICEF article.

There is a dire and urgent need to address the Child Health Issues in Pakistan. UNICEF gives a timely, comprehensive background and describes the avenues to work in.

Background

Pakistan Water Woes

Pakistan’s Water Woes.

Dr Meher A. Zaidi.

As Pakistan faces acute water shortages and crises in distribution and division of water resources occurring, the following misunderstandings need to be cleared , problems addressed and clear solutions and remedial plans of actions  made to be taken .

1.    The Indus  Water Treaty / partition of waterheads and river flows in Pakistan:

On Pakistan’s creation in 1947, the Punjab was an irrigated heartland and supplied by rivers Indus, Jhelum, Chenab, Ravi, Beas, and Sutlej. A treaty between India and Pakistan was negotiated bt the World Bank to give Pakistan the rights to use water in Indus, Jhelum, Chenab which comprises some 75% of the whole flow of the Indus water system.Large dams like Tarbela were built and link canals were built which supplied Punjab’s agricultural  fields. India eventually built dams over the rivers Ravi, Beas and Sutlej water heads which emanate in India and China. Eventually these rivers have run dry in Pakistan.
The debate raging in Pakistan and especially the Sindh province which is at the tail end of Indus, is that what is the future of this river and why was the Indus Water Treaty negotiated in which we sold these rivers to India. Recently due to stoppage of water in large areas in Pakistani Punjab, large crops were destroyed and effected the already deteriorating economic situation.

2.    Sindh is opposing the Kalabagh dam as there is  a perception that it’s construction will further decrease downstream flow to Sindh province, particularly the deltaic area.

(see article Sindh’s opposition to dams by Akhtar Ali  http://developmentpakistan.blogspot.com/)

3.    Pakistan is already  one of the most water stressed countries in  Asia, and according to the     World Bank due to a high population growth, water will become a scarce commodity.

How does water become scarce in Pakistan?

Pakistan is one of the world’s most arid countries. The average rainfall is under 240 mm per year.The Indus river system supplies 180 billion cubic meters of water.the population is 160 million people. As there is only one river system which caters to the whole country, the decrease in rainfall, environmental effects, wastage of water and misuse will result in acute water scarcity.

4.    salinity is a major problem.approximately 15 million tons of salt are accumulating in the Indus basin every year, and the saline water ingresses into overpumped fresh water aquifers. Delta is degrading by silt and ocean is coming up. Pollution, industrial waste and agricultural pesticide use is also affectingthe quality of water for drinking purposes.( See Guidelines for drinking water quality.http://www.WHO.org/)

5.    The massive disconnect between public, bureaucracy and policy makers adds to the already chaotic deficiency in indigenous experts  on water management. Due to the lack of problem- solving and  consensus building approach, the water woes are compounding.

Recently on a  Karachi visit, the president made some statement about cutting down Punjab’s water in certain river and a very pungent conflict situation developed between Sindh and Punjab. This somehow ‘put the lid on’ situation is controlled for a while  but the simmering continues. Lack of political consensus leads to lack of political will.

6.    Governance issues are affecting the  implementation of quality projects. The world Bank states that the factors affecting implementation are;

·       Weak planning and management.

·       Litigation related to land acquisition

·       Non-compliance with agreed resettlement and rehabilitation programs

·       Lack of attention to environmental issues

·       Delays in procurement.

·       Delays in preparation of accounts and carrying out audits

·       Lack of preparation for transition from construction to operation.

7.    Financing problems of water infrastructure. Corruption is also a major  hurdle here as there is a lack of transparency in all such programs.

8.    India produces more crops per acre per cubic meter of water while Pakistan has much less productivity.

Solutions and Plans of Actions on Some of the Above Mentioned Problems:

The need for urgent action on solutions ha sto be taken as conflict resolution measures as Pakistan is already riddled with conflicts and add to it the future of food shortages and we will be unable to handle any conflicts.

We have to take the  ‘Problem Solving and Consensus Building Approach’

The first priority is developing a socio-political consensus of all the stakeholder provinces and building an adequate political will to resolve the water division issues.

President Zardari and the Pakistan Peoples Party stand at the advantageous prepice of history today, where they will be able to solve the  Sindh’s water issue and amicably resolve the conflict of opposition to dams and develop building of Dam’s infrastructure for the benefit  of Pakistan as a whole.

For the first time in Pakistan’s history and at a crucial  juncture, the World Bank and ADB and all the other developmental bodies should help Pakistan build it’s water infrastructure as a representative government is in place to carry out a consensus approach.

This opportunity lost will be disaster.due to environmental effects, the glaciers will melt and there will be flooding of the rivers. This will be the opportune time for dams’ and reservoir storage. These will have to be in place already. The next phase will be that of drought . Many areas of Pakistan especially those in Baluchistan are already in drought phase next to Afghanistan.Water management and use practices will have to be inculcated beforehand.

The  antagonistic attitude of Sindh’s nationalists to Indus Water Treaty has to be changed and countered in  the true context of what this treaty actually means.What is India’s stand on this issue and what is Pakistan’s stand.

As most of the 90% irrigated land in Pakistan with rivers with heads not inside it’ s territory, a major challenge was created. Both Pakistan and India agreed to work with the World Bank to solve the issue and equably and amicably resolve the water division issues. The first proposal was of a asingle integrated basin authority. This was impractical and was rejected. During the negotiations the following things were noted;

Pakistan was given 75% of waters of the system including full use of Indus, Jhelum and Chenab except for some use by Kashmiris.This was not driven by legal principles by principles of  water engineering and economics. India was permitted to tap the considerable hydropower potential of Pakistan’s three rivers before they entered Pakistan. ( the current Daimler- Bhasha dam is one such contentious project over which negotiations are being done in a very large influx of water to Pakistan irrigated crop is blocked.).

This treaty was not first but best for either side.

Indian parliamentarians objected to Pakistan’s 75% water share  as violations of principles of ‘ equitable utilization’. Ironically speakers in Lok Sabha in 1960  debated the same way and criticized the government of India for a policy of appeasement aned surrender to Pakistan and ‘other ‘ Indian interests had been let down in the same way as Sindhi nationalists accuse the Pakistan government nowadays. However, President general Ayub Khan said ‘we have been able to get the best that was possible ‘.’ Very often  the best is the enemy of the good and in this case we have accepted the good after careful and realistic appreciation of our entire overall situation’.They based the agreement as realistic and pragmatic.

The treaty was again reaffirmed by the presidents of both the countries in the recent past.

After this as part of the Treaty , the canals and Dams’ infrastructure was built. This brought a fundamental change , where storage and dams is the main feature of development and management of water resources.

The Tarbela dam has given both direct and indirect benefits ( direct benefits assessed by Pervaiz Amir exceeded 10%. It’s impact on economy is massive, about 40% of population benefits from it’s water, 30% of installed generation capacity.

Indirect benefits are increased outputs of agricultural commodities, increased seeds, fertilizers, pump sets,deisal engines, electric motors, tractors, fuels, and electricity, increased job creation, increased food processing such as sugar factories, oil mills, rice mills, bakeries etc,.

Electricity production( Hydropower) directlyimpacts and increased output of industry such as steel, chemical, textiles. Pervaiz Amir in his study for the World Bank says that the indirect impact is considerably  larger and adds to the benefit by dams.

The Sindhi peoples should take this into consideration and the federal government should devise ‘ an industry or income generating opportunity to Sindh in exchange  for consensus for a dam’ program. This income generating opportunity/ industry should be set up in rural and under –developed areas of Sindh where local crops such as sugar cane, cotton etc., should be utilized.

The Water Accord 1991 does solve a lot of problems  like entitlements, use of water by other provinces till the province uses full quota of it’s share etc and should be followed.

Some measures to reduce water stress suggested by experts are;

·       Development of more dams and storages,

·       Dater entitlements, and water rights,

·       Unbundling, and competetiveness,regulation,

·       Transparency in governance,

·       Building up water knowledge base and capacity for water management,

·       Financial and investment improvement,

·       Human resource base

·       Linking agriculture and industry.

Water management awareness and improved practices should be devolved at community level. The local bodies , councilors, nazims are a good base at grass roots level. Sustainable use of water resources should be taught and practiced at the community level.

As many measures of water logging and salinity reduction previously improved the land especially in Sindh, same measures and also the management and abatement of pollution in drinking water reservoirs and sources should be improved.

Governance in water issues should be improved and all things should be mad transparent .Public information on all issues should be available easily, corruption should be addressed immediately and very sever punishments instituted.

Effective measures to improve yield/production per acre of crop per d4rop of water should be taken.

Only urgent and consistent measures to improve the water crises taken now , will reduce conflict looming large on the horizon.

( Source: World Bank, Internet, Akhtar Ali, Dawn Newspaper.)

Barack Hussein Obama brings news on Climate Change talks on his latest blog entry.

http://www.whitehouse.gov/blog/2009/12/18/a-meaningful-and-unprecedented-breakthrough-here-copenhagen

see the news and post for yourself.

This Year’s Sachs Student Lecture

This Year’s Sachs Student Lecture

Women's Health, A Most Vulnerable Hinderance In Socio- Economic Development.

The United Nation's Women's health report is released.The various aspects of women's health and how it affects the development paradigm are reflected in the initial press release.http://www.un.org/ .The point  I noted most is that no matter what paradigm you see it from, human development and social justice are directly affected and very seriously affected by women's health.

In Pakistan there is a true picture of this reflected in every aspect of a person's life. If the mother is young she is affectted by morbidity ,childbirth complications, anemia,mental health problems like depression, osteopenia etc. Her productivity both as a homemaker and her work like in agriculture,worker in factory, house help etc is severely affected. She is under constant stress to provide income to support the family and now increasingly in large urban areas. The domestic or household help workorce is coming  from  Southern Punjab where poverty is leading the rural population to increasingly migrate to urban areas like Karachi, Lahore, etc to  f ind jobs as domestic help..These women constitute  a major household help workorce and are not registered as such. Their work carries no acknowledgment from the labour department and they get no benefits as a group of workers. For health needs they visit private practitioners ,often quacks in 'Katchi Abadis' or slums where they are residing in overcrowded , unhygeinic conditions. Their water supply is often contaminated and they use unboiled water for drinking and cooking also. It is to be mentioned here that the girl child is equally vulnerable as she often goes to 'work' with her mother and if she stays back often 'looks after' her other younger siblings. The staying back ordeal exposes her to hazards such as child abuse, fire or c ooking accidents and other mental stresses and problems. Not going to school is just one aspect of her deprivation.The irony is that the religious people in Pakistan who are otherwise so vehement in opposing UN and WHO work are not even inclined to acknowledge this problem. They are not concerned with addressing the health issues and neglect and poverty related issues in Pakistan. They can do much to help as they have vast resources, means and influence in Pakistani society.
The health issues faced by poor women in Pakistan are kaleidoscopic. All aspects as mentioned by Dr. Chan are represented here. It is high time that the governments, civil society organisations and religious groups realize the gravity of the situation and address these issues in an urgent basis. The incidence of violence against women, now also in the context of conflicts of terrorism targetting girls education is increasing . This will again adversely affect womens health and thus the health of the nation that is Pakistan.
We need to prioritize and devise a plan o action to improve the health and well being status of Pakistani women keeping in mind the millineum development goals. The UN and WHO are already working to help in Pakistan.We can gain much from them. There is a dire need to take the religious groups and organisations on board and build their confidence in institutions to improve women's health and socio-economic status in Pakistan.

Videos - The Earth Institute at Columbia University

Videos - The Earth Institute at Columbia University

Shared via AddThis

Millineum Development Goals Report 2009..A Short Synopsis.

As the MDG report is released, the G8 Summit is over in LAquila, Italy.
Mr Ban Ki-Moon in his foreword of this report stressed the need to strengthen global cooperation and solidarity and to redouble our efforts to reach the MDGs and advance the broader development agenda.He urged the global community ,in view of the global economic crises, not to turn its back on the poor and the vulnerable. It seems that the leaders of the G8 have listened to his advice and pledged some aid like $20 billion especially for food growing in Africa.
This economic crises has slowed and reversed progress on some of the eight goals as commented in the report.
Poverty: It was seen that from 1990 to 2005, the number of people living on less than $ 1.25 a day, decreased from1.8 billion to 1.4 billion,but due to the crises ,in 2009 this will be increased to an estimated 55million to 90 million people.This was not anticipated.
Hunger: The earlier trend of decrease in hunger was reversed in 2008 due to high food prices and even falling food prices in 2008 have not been translated into benefit for the poor.
Children: These are the most vulnerable and most in developing regions are underweight for their age, stunting their prospects for survival,growth and long term development.This report emphasises the fact that the child nutrition target will not be achieved and will be eroded by higher food prices and economic turmoil.
Gender Equality and Unemployment: The unemployment in 2009 could reach 6.1 to 7.0 % for men and 6.5 to 7.4% for womenWomen also emain trapped in underpaid and insecure jobs.
Maternal Health and Mortality: This area has made least progress so so far.The reduction in donor funding will further aggravate the situation.
Export Revenues: This has decreased and this will further deteriorate.
Environment: The measures to achieve environmental goals will not improve and deforestation will continue. Water crises looms large.
The lower level of aid may reverse the gains made so far.

It lists the successes so far as:

• Those living in extreme poverty in developing regions has decreased slightly more than a quarter in 2005 compared to almost half in 1990.
• Major accomplishments were also made in education,where primary education enrolement reached 88% in 2007 especially from 83% in 2000.Sub-Saharan Africa and Southern Asia enrolement increased by 15 percentage points and 11 percentage points respectively from 2000-2007.
• Under five mortality rate declined from12.6 million in 1990 to 9 million in 2007.Key interventions like insectiside treated bed nets to fight malaria ,second chance immunisations to fight measles hav e made a remarkable difference.
• Environmental actions like 97% reduction of consumption of substances that deplete Earth's protective Ozone layer by global actions and cooperation.
• Efforts to improve the living conditions of the urban poor must pick up speed and extend even further.As the developing countries' cities rapidly expand this improvement has to keep pace.
• Preservation of natural resource base such as fisheries, forests ,water must be priority.

Carbon Sequestration animated webiosode from Earth Institute.

Carbon Capture, Sequestration and Reuse: The Basics from Earth Institute on Vimeo.

Prevention Of Typhoid in Pakistan

As discussed in seminar on Typhoid in Pakistan. ,Typhoid is a major disease burden in Pakistan. It is almost endemic in urban densely populated slum areas of major cities like Karachi, Hyderabad, Lahore, Rawalpindi.(http://Dawn.com /National).The mechanism of safeguarding the water supply of drinking water is deficient. A new safe drinking water policy is bieng announced ( see pg 3 of Dawn newspaper/National) but let us hope this is carried in its true spirit.
The true picture is that the urban workers be they domestic servants, cooks, resturant and eatery workers are never screened for Typhoid and Hepatitis. Inspite of appearing to look modern no safety precautions, screening , vaccinations are carried out. Most are carriers of Typhoid and these bacilli are secreted in stools . As no standard operating procedures are carried for pre food handling there is abundant carraige under finger nails. The excreta contamination of drinking water supply is also massive as most pipes for fresh water supply and waste disposal are running parallel in urban areas with frequent overlapping and mixing of two streams. Also sewerage and waste is bieng disposed without treatment directly into rivers and streams. This is bieng taken directly into drinking water supply. The chlorination and some substandrd cleaning is bieng done. This is never made public and no public interest group or government agency is monitoring this. This has to be made public so that there is pressure from public for improving standards. Only doing conferences and announcements of policies by ministers will not solve the problem. Our whole attitude to safeguarding health of the people has to be more proactive with open access to cleaning procedures with more awareness of these issues. Also the affluent citizens need to take more of these issues up as causes and help the administration and the public health officials in a more problem solving way.
There is a need to take up public health issues as serious priority and increase the budgetary allocation .Also there is a dire need to be more proactive in fighting Hepatatitis and Typhoid.only a thrust on war footing will help fight theses menaces.

Water An Expensive Commodity.

Pakistan is facing acute water shortages already. Due to climate change the precipitation will decrease in Pakistan. Already there are many areas facing a drought like situation.As each Pakistani city is teeming with millions of people and there is acute shortage of clean drinking water, the conservation measures have to be taught and taken by the municipalities as a priority task.Pakistani cities are bieng polluted by industrial and chemical wastes,all ending up in drinking water reservoirs. there are no laws and no treatment facilities. The water bieng supplied to large cities like Karachi with a population of over 16 million people is not passed through a very stringent or modern treatment plant. The piped water is also supplied to very large worker population which live in large urban slums mainly by hydrants and tanker mafia. the quality of this large water supply is very questionable. non of the tankers are owned by any companies. There is no water testing of the drinking quality of these tankers. The inner tank cleaning is neither checked or tested by any inspector or any administrative authority. The hydrants where these tankers are filled from are also not checked for the quality of water, whether fit for drinking or not. The water supplied to such a large population results in diseases of stomach and intestines both of the men workers and their families. As I work on social basis as doctor with some of these people I have seen over the last 30 years the growth both physical and mental slow down amongst the children of such areas. These children due to repeated stomach and intestinal infections,suffer from malnutrition and anemia. Malnutrition is also due to the fact that an average family size is atleast 8 persons including parents and the GDP is very low and a large number(40%)live below poverty line that is less than $1 a day.There is no food shortage as such but as Roti(bread) prices have increased the food intake is also lessening. Due to anemia and malnutrition especially protein calorie malnutrition ,these children have less resistance to infection and infestation. As the water is polluted and contains worms etc.,there is a vicious cycle of disease and diarrhoea and anemia and malnutrition. The average worker family spends about 40% on medicines and that too preferably on the earning member. The child and the female child especially remains the last priority for medical treatment.
I need to write a seperate post on the health access and services to these families. So the water shortage and its pollution impacts negatively on the these slum dwellers health. This will manifest in so many problems which I will discuss later.
There is a dire need for the city government to link up development plans with access to clean drinking water and health.For providing better water environment and clean drinking water in such communities I have few suggestions:

The idea of water board as a supplier organistaion should be changed and made an user organisation.The areas should be under control of regional communities which should form water clubs at very small areas level. In Karachi we have local bodies such as councils, which are perfectly suitable to manage their water problems. These groups will not only monitor their supply but also be able to check and standardise water quality.These should then have link with local health officer so that the incidence of diarrhoeal diseases is monitored and controlled. This kind of activity does not need a new infrastructure or money input. All these systems are in place it only needs awareness in communities and they will form their own bodies once they know the advantages in combating water pollution and maintaining water quality.
The mayor of Karachi(Nazim) should form water checking team under his direct care which checks the water tankers water quality also.On this he should not compromise anymore as the burden of disease is increasing and taking its toll on the productivity of the city. All social aspects are directly linked to water quality.
These ideas will be further elaborated in later posts.
As a commodity the value of water is not only increasing in the pricing context but as a value for decreasing or affecting other development parameters such as productivity,health index, morbidity, mortality,burden of disease etc. We need to approach this problem in a more holistic and sociological way in order to find solutions in way of human progress and harmony.

Impending Water Crises In Pakistan

As Pakistan faces an impending water shortage, the emphasis should be on conservation and good water management. Some household tips to reduce wastage are as follows:
Keep the physical count of amount of water used for different purposes such as drinking,cooking,kitchen washing, linen washing, lawn watering, porch washing,car washing, toilet flushing .We have installed brackish underground water pumps and seperate storage which we are using for garden watering, toilet flushing, porch washing. Toilet flushing consumes a lot of water so the use of brackish water helps a lot.
It is essential to train children to turn off the tap while applying toothpaste to brush, while brushing teeth, using shower water judisciously like wetting body and head quickly and then applying shampoo and soap over body while the shower is turned of . Rinsing head and then body sytematically. I have seen if water is mixed in a bucket and then used, water is saved much easily.
The children should be shown the water sources and how they are depleted and we should make them realize conservation.
Children should be taught to wash dishes at an early age so that they understand water conservation.

Developing medical record keeping software

The need for keeping short, comprehensive, useful medical records has become so acute that the electronic medical record keeping has become s important as water. The issues are easy user friendly data entry formats, easily transferable information codes,security, standardisation, insurance accessibility and above all completeness of examination and history taking. With the advennt of tele medicine as part of medical care we have to focus on good history taking and physical exam.I have developed a software as part of EMR to use these important inputs.
The culture of meticulous record keeping has to be encouraged especially in Pakistan.