By Karin Ronnow | Sonia Shah Organization | 11 Feb., 2017
KANGRA, Pakistan — With promises of fewer stomachaches and more energy, the students at Sonia Shah Memorial School (SSMS) lifted the small plastic bottles of deworming medicine to their lips.
Some of them took a first tiny sip, cautiously testing the white liquid. Others turned their faces toward the sky and bravely poured it into their mouths, their Adam’s apples jiggling as they swallowed.
Deworming was the first order of business at SSMS’ recent one-day “Medical Checkup, Screening and Supplementation Camp,” part of the Sonia Shah Organization’s (SSO) effort to augment the limited healthcare options for the poor in Kangra.
“Many of our students are malnourished and anemic,” SSO chairwoman Iram Shah said. “We cannot turn our faces away. We have to take care of the children who come to our school.”
Sadly, in Pakistan, a rapidly developing country of nearly 200 million people in an area half the size of Alaska, most indicators of the nation’s health “are either failing to improve or worsening,” according to the World Bank. For example:
- Pakistan spends 99 percent less per person ($36) than the United States ($9,403) on health, according to the World Bank. The World Health Organization prescribes a minimum of $44 per capita for essential health services.
- Nearly half, 44 percent, of Pakistan’s children are chronically malnourished (stunted), the third highest rate in the world and the highest in South Asia.
- Only 60 percent of the nation’s children have been fully immunized.
- Worm infestation is widespread in Pakistan, especially in rural areas. Recent studies indicate roughly 70 percent of all children have worms.
- Pakistan’s infant mortality rate is 66 per 1,000 live births, compared to 6/1,000 in the United States.
Women’s life expectancy is 67 years, compared to 81 years in the United States.
- Pakistan spends just 0.8 percent of its GDP on health, the least of all countries in the region.
The solutions to this reality are complex, but school-based medical visits play a significant role, said Dr. Ashfaq Utmanzay, who organized SSMS’ medical camp.
His most distressing, and urgent, discovery was that Ursula, a girl in class two, has a rare heart condition known as Tetrology of Fallot (TOF), “a serious congenital heart disease,” Utmanzay said.
TOF is caused by four heart defects present at birth that reduce the oxygen in the blood. Surgery is typically performed in the first year of life, so Ursula’s late diagnosis makes her situation even more urgent. “She needs surgery, cardiac repair for TOF,” Utmanzay said.
Good health = good learning
In the developing world, people primarily suffer from avoidable health problems simply because they are poor, according to the Population Reference Bureau in Washington, D.C. Poverty is the cause of or a significant contributor to hunger and malnutrition, illiteracy, lack of clean water and a scarcity of qualified health workers.
Intestinal worms — hookworm, roundworm and whipworm — exemplify the profound links between poverty and health. One of the most comment ailments among children in the developing world, worms are typically seen as a “disease of poverty, affecting the poorest and most vulnerable people on earth.” Worm infections cause anemia and malnutrition, impair cognitive development and make children more susceptible to other infections and diseases.
At Sonia Shah Memorial School, the medical team found “about all” of the children were anemic, most probably caused by malnutrition and worm infestations, Dr. Utmanzay wrote in his final report.
Each child was weighed and measured, had their blood drawn and tested, and received a physical exam. Other findings included:
- About half of the children had seasonal allergies and/or respiratory-tract infections;
- About half the children suffered from recurrent diarrhea;
- Four of the children had P. ovale malaria;
- And, in addition to Ursula, six students had chronic health problems that required hospital referrals for specialized treatment.
Although the results were not surprising, given the high rates of disease and ill health in Kangra and much of rural Pakistan, they merit immediate attention. After all, good health is directly linked to children’s ability to learn.
“That’s why bringing a medical team to the school, right to the children, makes all the difference,” Shah said. “We know that healthy students do better academically, are better behaved and have fewer absences. We want our students to have the best possible shot at a brighter future.”
Treatment & prevention
In addition to deworming, all students who tested positive for seasonal and endemic diseases received medications such as ibuprofen, cough medicine or rehydration formula for rotavirus (a highly contagious gastrointestinal disease with acute diarrhea). The medical team also provided a two-month supply of supplements — multivitamins, iron, calcium and vitamin D — for each child.
“These medications and supplements are given to students every day at school,” said Mahnaz Qureshi-Ishaq, who oversees school operations as a member of the volunteer management team.
That decision was made jointly by SSMS Principal Serish Hussain, Qureshi-Ishaq and the doctor.
“If we give the everyday supplements at the school, there is less waste and kids learn how to take them,” Utmanzay said. “Also, there is concern that if we send medicine home to illiterate parents, they will not be able to read instructions. Or the whole family ends up drinking the cough medicine in one day. Or they just won’t give the medicines to their children; parents already believe, wrongly, [that] polio vaccine makes their children infertile.”
The medical camp is an integral part of SSMS’s approach to quality education, Qureshi-Ishaq said. The school also operates a water-treatment plant, providing potable water for the school and the village.
“Child malnutrition is also a serious problem so we are also working on providing lunch for all students this year,” she said. “All of these tools — deworming, vaccinations, vitamin supplements, clean water and improved nutrition — help children reach thrive physically and intellectually.”
The medical team prepared a report on each child’s health and delivered two copies, one for the school and one for parents. The doctors and principal are working to schedule vaccinations for hepatitis B and typhoid. And in late spring, the medical team will return and check for improvement.