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TR on CNN: Bringing a much needed medicine to Pakistani flood victims

Bringing a much needed medicine to Pakistani flood victims
September 9, 2010
American Morning – amFIX blog

CNN correspondent, Kaj Larsen is traveling to Pakistan and will be blogging about his experience. Catch all his stories here and on CNN’s American Morning.

Kaj preparing ORS medicine the night before heading out to deliver medical aid to flood victims.

Why is a CNN reporter sitting around a table in rural Pakistan filling up little baggies with white powder? Had it been another story, it would look really bad. But after almost three days of straight travel, over 8,000 miles and several questionable modes of transportation we had arrived at our destination, and these little baggies of white powder were the reason for us being here.

We met up with Team Rubicon earlier in the week on their mission to Pakistan. They had traveled to Pakistan to help with the victims of the flooding that began with the monsoon season earlier this summer. The mission of Team Rubicon is to provide emergency humanitarian relief in disaster zones. They were on the ground in Haiti within just a few days of the earthquake performing dozens of amputations (often with only Motrin) to save the lives of earthquake victims.
Unlike Haiti, where the disaster happened instantly creating a major trauma situation, Pakistan is a natural disaster happening in slow motion before the world’s eyes. Watch Video

It’s less a trauma situation then a long slow crisis whose medical consequences are increasing even thought the physical disaster is ebbing. Now that the floods are beginning to recede, the real medical emergency is emerging. The threat of waterborne diseases from the lack of access to clean drinking water, and the rise in people who need food, water, and medical care is pacing way beyond the ability of the Pakistani government and international aid organizations. The second wave in Pakistan is going to be worse than the first. There has been an acute increase in gastrointestinal diseases and even a few scattered cases of cholera (51 cases of cholera were documented by aid organizations in Northwest frontier province as of last week).

People, especially children and the elderly are extremely vulnerable to dying of dehydration from what the medical world calls AGE (acute gastroenteritis). The issue is that people are dehydrating so fast that they can’t keep enough fluids to sustain them. In the case of Cholera, the instant electrolyte imbalance can actually stop their heart. People can “drain out” and die within 24 to 48 hours. The medical intervention is like in so many effective things, simple and elegant. A solution mixed to the correct ratio of water and sugar, a slightly more sophisticated medical Gatorade, combats the effects of rapid dehydration and allows the body to retain fluids. Its called ORS, Oral Rehydration Solution. Technically it uses a complicated co-transport feedback system involving sodium. Practically, its believed to have saved millions of lives in different places around the world since its invention in 1979. The key is of course early intervention, and in Pakistan the challenge of getting aid and ORS to the effected population is significant.

Which brings us to the little baggies of white powder and Team Rubicon. We spent yesterday traveling from a major city in Pakistan to the outskirts of some of the effected flood plains. As we pulled in late at night, we started to unload the 200 kilos of proprietary ORS solution that we had brought with us. Late into the night with the assistance of local Pakistani doctors, the members of Team Rubicon filled up bags of ORS solution— A little white powder that has the potential to save thousands if we can get it to them. Tomorrow we head out to do just that.

TR on CNN: In Pakistan, a life can be saved in 15 minutes

REPORTER NOTEBOOK: In Pakistan, a life can be saved in 15 minutes
September 14, 2010
American Morning – amFIX blog

By Kaj Larsen, Correspondent

Editor’s note: Kaj is covering the aftermath of the flooding in Pakistan. Watch his reports on AMERICAN MORNING at 6:00AM Eastern.

We awoke at 0515. Breakfast at 0700. Conducted interviews from 0800 to 0900. Our caravan rolled out to a remote area of southern Punjab at 0930. By 1100 we had set up a remote clinic.

By 1115, our team had saved a life.

Now I use that phrase pretty liberally. It was really Dr. Eduardo Dolhun, the lead physician on Team Rubicon, who saved a life.

I’m currently embedded with Team Rubicon in Pakistan, where I have the privilege of working alongside them while covering the flood disaster for American Morning. It allowed me to see the effects of the natural disaster through a humanitarian lens.

When we arrived at the impromptu clinic, we began to set up our equipment and see the first patients. Almost immediately, a crowd formed. Americans in this part of the world attract a ton of attention, and the people of this area, which had been severely impacted by the floods, were in dire need of medical attention. Even as we made our way to the staging area for delivering medicine, we crossed rivers and washed out homes, and saw hundreds of people living in tents and makeshift shelters along the side of the road. Bottom line, the need was great.

The military members of Team Rubicon fanned out and tried to organize the crowd while Dolhun and another Rubicon paramedic examined patients. I noticed that all of the patients were men. I had seen this before in rural Afghanistan. In highly conservative rural Muslim societies, often women would wait to be treated until the men were gone.

While the rest of the team held security, I surveyed the area. Under the shade of a tree, I found about 50 women and children sitting, waiting to be seen. In the extreme heat and humidity, many of the children were lying around or sleeping, but earlier in the day Dolhun had briefed us to be especially attentive to babies that were “floppy.” At the time, I thought to myself that floppy didn’t sound like a proper medical term. Aren’t all babies kind of floppy? Sure enough, among the dozens of children, one woman was holding her listless baby who appeared exactly how the doctor described—a little “floppy.” His eyes were rolled back in his head, and when I shook him or played with his arm there was no response.

I grabbed another Rubicon member who brought a translator over to the child. We were told that the baby had been vomiting for days and would not drink or eat anything. At that point we grabbed Dolhun.

He assessed the baby, and said that the child required fluids but suggested we try a little ORS solution first. ORS, or Oral Rehydration Solution, is one of those simple life saving tools that is extremely important in Pakistan, where the incidence of gastrointestinal disease is extremely high.

Dolhun is a passionate evangelist of ORS. On all three flights I have been on with him, I’ve seen him explain to strangers why ORS was one of the most important medical inventions of the 20th century. He says it may have saved as many as 2.9 million lives. He’s so passionate about ORS that he invented his own ORS solution that tastes better than standard ORS. If you met him, you could very easily conjure an image of the mad scientist pipetting away on some solution in his lab in the middle of the night.

So here is Dolhun, a physician from San Francisco, administering ORS to an infant in the flood-affected areas of rural Pakistan. And this is where the timing gets interesting.

Dolhun estimated that it usually takes several hours to get a response from a dehydrated patient after treatment. But within minutes, we saw some improvement in the child (which was good, because the doctor was close to administering fluids intravenously).

Within 15 minutes, the baby was suckling on the ORS solution, alert and oriented. After 30 minutes, he was playing.

It was an extraordinary, dramatic and rapid turnaround. Dolhun said that considering the baby’s severe dehydration, it was possible the baby wouldn’t have survived the night without intervention. Dolhun went on to treat other patients; I took over administering ORS to the baby for a few minutes, then had the mother take over after that.

Disaster medicine is an exercise in triage. You don’t always get to see the outcomes of medical interventions. But here was a case where this child was at death’s door, and within 30 minutes had a chance at survival. That one child made the entire journey worth it.

I’m naturally pretty skeptical. I was initially suspicious of Dolhun’s ORS evangelism. It sounded too simple. But I became a convert when I watched that child come back from near death. I pity the next person who sits next to me on a flight. They may just get an earful about the health benefits of a little something called ORS.

Drip Drop, DOCS, and Team Rubicon in Pakistan September 2010

TR on CNN: Humanitarian ‘A-Team’ hits Pakistan (Part 2)

http://cnn.com/video/?/video/world/2010/09/13/am.larsen.a.team.pt2.cnn

The baby was near death — dehydrated, unresponsive. But, in an instant, he was revived by a mere syringe full of fluid. CNN’s Kaj Larsen of “American Morning” reports on humanitarians helping flood victims in Pakistan.

Thank you Dr. Yasmin Raashid

Team Rubicon departs Pakistan
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TR on CNN: Humanitarian ‘A-Team’ hits Pakistan (Part 1)

http://www.cnn.com/video/#/video/world/2010/09/09/am.larsen.pakistan.a.team.cnn?hpt=C2

Watch Team Rubicon’s Kaj Larsen report LIVE from Pakistan on CNN.com
PLEASE CLICK ‘LIKE’ ON FACEBOOK!!!

Pakistan Medical Association and Thal Limited

I mentioned in an earlier post about the importance of developing a local partner, or a trusted source as we call it. Team Rubicon reached out to a number of Pakistani organizations prior to our arrival. We were most impressed by the Pakistan Medical Association (PMA) and Dr. Yasmin Raashid. Dr. Raashid, the President of the Lahore chapter of PMA, had an extensive network in southern Punjab, where she introduced us to Mr. Muhammad Saqlain of Thal Limited. Mr. Saqlain provided TR with a secure and discrete base of operations, from which we launched our daily medical operations. I want to express my sincerest appreciation to these individuals, without them Team Rubicon wouldn’t have been able to reach victims of the Pakistani flood.

William McNulty
Team Leader TR Pakistan
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Drip Drop Rehydration

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TR partners with Pakistan Medical Association

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Waiting to see the Dr

Men wait in line at the front of the clinic. Women and children wait in a courtyard behind the clinic.
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