Kinza Khan

Phase 1 and Phase 2 were very effective in my opinion, but as for any intervention, it was necessary to do an analysis of the situation to determine the impact. Going back three weeks after the last workshop was a lovely experience because they ran their hands across my head, which is a way of giving someone prayer and blessing in Pakistan, showing their immense gratitude, while reciting a few prayers for success.

Oral surveys before and after the workshops showed a much better understanding of the symptoms and causes of diabetes and hypertension, although the motivation to change their situations was constant. The measure of the agency to improve their situation, however, did change. These women also reported feeling much better, which can be attributed to both physical and psychological states. The results of this data analysis indicated a tangible impact, thus fulfilling the goal that I set out to achieve.

My overall feelings throughout this project ranged from hopelessness to overwhelming anxiety to happiness and hope. It was definitely a roller coaster ride of emotions, often all of those at the same time, but that’s what showed me that I was truly invested. It’s been truly an honor working with a community that is steadfast and persistent, and despite everything going wrong, keeps a smile on their faces at all times. I hope to return back in December when I get back to Pakistan again, and just speak to them about their lives. I also hope to scale up this project in different slum areas in Pakistan in addition to starting a culture of preventive medicine in schools and hospitals all over. There’s a long way to go, but certainly one that can be covered to reduce health disparity within my city and my country. I am very excited to see what the future holds!

The last few days have been spent spreading awareness for the two metabolic diseases that run rampant in this part of the world: diabetes and hypertension. I was so happy to see at least a general awareness that these diseases are common, exemplified when the women I was talking to started off with ‘Hamain tau batayen hum kya karain sugar aur bp kay baaray may’ (please tell us what we can do about diabetes and hypertension). Recognizing that diabetes and hypertension are a hinderance to everyday activities is, in my opinion, the first and most important step needed for these women to actually play an active role to control their health, which is a big step forward as compared to two months ago, at the medical health camp, when most of the community members didn’t even want to address the issue. I guess the mere act of letting them know at the camp that their troubles are caused by these two things, was enough for them to want to tackle it on their own.

I was also very impressed with the amount that these women trusted me. I didn’t expect for them to open up to me as quickly as they did, and I feel like part of that had to do with the fact that I made it very clear from the get-go that if they wanted to improve their situation, it had to come from them. As soon as I floated the idea of regular and consistent exercise, they began to ask me and show me different stretches that they knew about to see if they ‘counted’ as exercise. The feeling of engaging with these women in a workshop that would impact them positively was very invigorating, and one that I knew I wanted to feel again by scaling up the project.

Even before they left the room to leave for home, I could feel the positive impact it had on them. They were, for one, smiling bigger, and their eyes reflected a new-found hope and optimism for the abysmal physical and social conditions they lived in. It made me wonder how much more could be achieved if people came in regularly to simply just talk to these women about their lives, and things they could do themselves to better them. It is maybe that same wonder that encouraged me to talk to a local nurse in the region about conducting monthly sessions with these women to talk about self- care and preventive medicine when I wasn’t there.

One woman came up to me and narrated her experience about her ill father in law who suffered from tuberculosis but refused to see a doctor. She told me that her husband had died some time ago, and there was nothing she could do to force her in law to go to the doctor because it would be deemed as disrespectful. In the conditions of this slum neighborhood, patriarchy prevailed, and the social norm was to just go with the situation and accept it. She was worried about her kids as she realized that they could also be infected, and although there was nothing I could say her except to persist, the idea of her opening up to a complete stranger like me and allowing me to share in her concern and grief showed me that this community was willing to invest in change and self-betterment.

In addition to sessions with the mothers, we also held sessions with students at the School of Sciences where the workshops were being conducted. Students, especially the younger ones, always went home and told their parents what they learnt in school, and so this would provide reinforcement of the methods we talked about with the mothers. Obviously, it wasn’t in as much detail, but they seemed very excited about the new information that they were learning and were participating actively in the discussion. A few students even came up to me and made a pinky promise that they would go home and tell their moms, which made me smile a lot.

Phase 2, in my opinion, was a success and I can really see a scaled-up version of this project being implemented in neighboring communities. I do wish to continue this every time I’m back in Pakistan, and to assign someone to carry on these sessions even in my absence. These two months have convinced me that preventive medicine has a really wide scope in Pakistan, and Is the best possible method to help low income communities take matters into their own hands. It is also a means of empowering these women, and better health outcomes that are spurred by their own initiative will go a long way in increasing their self-esteem and convincing them that their social conditions don’t define them. I end Phase 2 of this project with a whole lot of optimism and hope for a future where global health equality can be made a reality if there is a hard enough push towards it.

The medical camp was very instrumental in determining what main problems of the Gohawa community members are. They range from lack of hygiene to unawareness, and a lot of people have simply adopted attitudes of indifference to the ailments that they suffer from, dismissing it as a problem with no solution. Diving directly into the problems of the community has made it much easier for me to see a clear and simple way to help tackle the problem, and that is directly from the source.

I spent the entire last week devising a syllabus and printing out huge and colorful posters in preparation for the workshops I wish to hold with the community members. I am scared and nervous, however, as I feel that their reaction to my workshops will simply be ‘in from one ear, out from the other’. After talking to the principal of the charity school that is going to serve as the location of the workshops, I have concluded that the community members and the students don’t implement any of the knowledge that they are made aware of unless this is by force. I don’t want my workshops to be just another lecture that the community members are forced to attend and pay no heed to. I want it to be something that leaves a marked effect on the community and increases the general health of the population of people there. In order to do this, I am putting a lot of my efforts into trying to make this workshop as interactive as possible and have also created some worksheets for the students and community members to work on to assess how many of the tips for preventative healthcare they have followed.

I recently visited the school and was overwhelmed by the amount of love and hospitality shown by the kids there, who instantly rushed to meet me and tell me their names. I have taught at this school before, but it is usually to the older kids in the high school section of the school at a time when elementary school children are on vacation. The principal of the school, Ma’am Rabia, often tells me that these students look towards me as a role model and that they follow everything I say very closely. Seeing the little kids and their excitement to meet me, was proof of that very fact, which kindled within me a great deal of optimism that perhaps my workshop and the information I dispel will have a lasting effect and will help them identify and combat diseases like hypertension and diabetes.

Although the main crux of my program focuses on these two metabolic diseases, I also have included hygiene measures for the community members to take, for things like using soap, brushing teeth, covering ones mouth while sneezing and coughing etc, are not common practices in this region. Good hygiene will help protect them from communicable diseases, which is important because bad health would exacerbate diabetes or hypertension as well.

I look forward to the coming days with immense hope and optimism that this preventive health model will be a sustainable one and one that created a measurable impact. Until then, here I am, sweating it out in the 400C weather, happy to be home and among people I love.

I am currently lying in bed, exhausted from a really tough day at the basic health camp. In the 110oF scorching heat outside, we set up a tent at TABA medical center where we served more than 400 patients from the surrounding basti (slum) over the past two days. Patients came in for multiple concerns and were then referred to relevant doctors who were present at the health site. These doctors diagnosed their illnesses, wrote them prescriptions and sent them to the onsite present pharmacy where they received their medicines free of cost. The point of Phase 1 of the project was to narrow down the diseases that are prevalent in the area, so that phase 2 of the project can focus on the dispensing knowledge of how to recognize those diseases and what measures can be taken to reduce the onset or the symptoms of them.

The camp was nothing short of an adventure. I never understood the strength needed to remain calm when 30 patients, with no concept of a line, made extra aggressive due to the heat, are badgering you to take their blood pressure and suddenly both the BP apparatus at the camp stop working. Must I say, it was an experience to have to tell people who had already been waiting in the heat for a while that they need to wait longer while some volunteers rushed to the pharmacy to get a new sphygmomanometer. More importantly, however, I never understood true contentment until an old lady, around 80, moved her hand over my hand, a local gesture to display love, as she recited a hundred prayers for me in her mouth, for this little medical camp. She held me close and told me that I should take a break because of the heat, but her sweet smile conveyed how grateful she was for us being there.

Throughout these 10 hours I spent at the camp, I learned a great deal about the issues that people faced, ranging mostly from communicable diseases such as hepatitis B and C to non- communicable diseases like diabetes. Almost everyone who came suffered from hypertension, and were doing absolutely nothing to solve this problem, particularly because in their list of priorities, their health was not as important, and so they often let the dizziness and irregular heart rates slide. I did feel frustrated at many points about how nonchalantly these patients took their health, but I knew it was because they did not know any better and the idea that people’s ability to practice self-care was limited by the struggle of living in poverty. For one patient, I remember the blood pressure meter showing a reading of 220/100, and when I expressed concern and informed her, she told me that its nothing to worry about, ‘hota rehta hai khudi chala jayega’ ( It happens often, it’ll go away on its own). The question then was to what extent these people would even take phase 2 seriously if for them, health was not high on their list of priorities. I did notice, however, that when we explained to the patients what could potentially happen if they let their respective diseases remain, a lot of their expressions changed from indifference to fear. I feel that the idea of their disease making them incapable of productive work scared them the most because this meant there would be no way to earn the limited income that they do. I believe that this fear would be incentive enough for them to make Phase 2 effective.

At many points in the past two days, I felt very helpless because I realized that no matter what I do, the world has too many problems to fix. If the problems in this little community in the outskirts of a small town in one country out of 195 countries felt so big and innumerable, then scaling this up to every community of people meant that there was very little hope to rid the world of global health inequality. At the same time, however, I saw the dedication and energy in the eyes of every single volunteer there and realized that even if we do our own little part to uplift a community, we may not be able to change the world, but we would be able to change someone’s world.

What I realized more than anything from this experience is how passionately I want to become a doctor. A great number of people came to me, thinking I was a doctor already, and the entire idea that one day, hopefully iA, that’ll hold true made me really happy. I’ve always wanted to serve humanity from a young age, and medicine is a definite way of doing that.

The results of this medical camp really will help in phase 2 of the project. Diabetes and hypertension are both very prevalent in this region and I’m thinking of an self-sustained educational intervention to bring both blood pressure and glucose levels into control. A lot of planning needs to be done over the next week, but this project is finally more streamlined and is going in a direction that I am pleased with.

Home is wonderful as usual. I can finally sleep for more than three hours and my sustenance comprises of more than just junk food and coffee. My family doesn’t want me to go out in the scorching 110o F heat, but the work must go on. The first few days at home, I’m immensely pampered because absence makes the heart grow fonder, but that’ll wear off soon enough when they realize I’m here for the next four months. It’s time to start planning this project, and a lot needs to be done before we can physically make any progress.

My project aims to implement an educational intervention within a slum neighborhood on the outskirts of Lahore, with the end goal being that those who are affected or at risk for metabolic diseases like hypertension and diabetes learn how to reduce the chances of a fatal outcome.
In order to identify the affected population, it is necessary for my team and I to first hold a basic medical health camp, which will be phase 1 of the project, and so much of the meetings in the coming days are dedicated to setting up this medical camp.

Something I knew going into this project was that I would not be able to do everything on my own, and so I contacted Next Generation Pakistan members to help me. It was so wonderful reconnecting with them, many of whom became my close friends in high school due to our commitment towards the same causes. It was quite easy to convince them to take up this project because one of their projects, called Quwat-e-Nisa, already focuses on increasing medical aid in impoverished communities and giving the women and children in these regions, a safe space to discuss diseases, illnesses and pains, that are otherwise left ignored by the males of the household upon whom they depend. This collaboration will help me a great deal because not only do I work really well with the volunteers of NGP, but also, more volunteers means we can have a more focused, but wider impact.

More than anything, I’m very excited to meet the people of Gohawa village. It’s been six months since I’ve been to the School of Sciences, the local trust school in the area, and it’s always a pleasure reconnecting with the students and their families. We exchange stories and they’re always keen to learn more about the world around them. It’s refreshing to see people, who are surrounded with so many other problems, with a passion to acquire new information and learn about the world. It’s this same passion and vigor that makes me confident that they’ll welcome the educational sessions and prevention and symptom reduction methods that we impart to them.

A part of me is afraid, however, that regardless of my longstanding presence in the community, the people will still be distrusting of us and the doctors we bring along, simply because the essence of this project revolves around the very sensitive issue of health. In order to solve this problem, my team and I plan on talking to a team of medical experts at a pre- existing medical center located near the region, run by an international organization called TABA. TABA has organized medical camps in Gohawa before, and therefore, people do trust them because of the benefit they derived from it. Familiar faces in this case will help to communicate better with the people. Secondly, School of Sciences serves as a central institution that most people look towards as symbol of help and progress, especially because most of the neighborhood children who do study, go to school there. My team and I will ensure that this school plays a central role in the multiple phases of this project, perhaps as a site of action. The involvement of this school in this project will go a long way in increasing participation and response from the Gohawa community. Getting the school on board won’t be a tough task in my opinion, considering that the school has always tackled issues that extend far beyond just education. The school is meant to be a positive force in the slum community and always welcomes any ideas that uplift the community as long as the means to do so are introduced by external forces due to limited faculty bandwidth and resources.

After careful thought and consultation with my team, we have concluded that phase 1 of the project will involve setting up a basic health unit with the assistance of medically certified doctors. A very precious quality within Pakistani people is their desire to help out in whatever capacity they can, and so convincing the doctors to provide services gratis did not take much more than appealing to their moral conscience and the positive impact they would be bringing about. This medical camp will serve as the first phase to identify pre-hypertensive, hypertensive, pre-diabetic and diabetic patients, who will be prescribed proper medicines, based on the need of the patients, by the certified doctors. In other words, instead of referring them to a clinic that they may not go to due to transportation problems and financial burdens, we are bringing the clinic to them. These same people will also be asked to join us for phase 2, which will be conducted within the school, soon.

The next two weeks will be pretty hectic, with numerous emails needing to be sent out, multiple meetings to be held and a number of collaborations to be guaranteed. Phase 1, however, is beginning to take shape, and I hope that all goes well. I have a wonderful team of people who are helping me plan the project: Sarah, Laiba, Sundas and Hamza. There’s a lot of enthusiasm, passion and dedication to make a difference. As always, lets change tomorrow, let’s begin today.

As I sit on the plane, on my way to Pakistan, I’m excited as always. Duke is always a wonderful experience, but I miss my family who lives in Pakistan, and so I always look forward to the warmth and comfort of my home during the holidays. This time, though, I take with me not only the expectation of proper food and family hugs, but also of hope. Hope for a potentially better and healthier future for an entire community of people. The Kenan Institute was gracious enough to fund my vision of an education-based, civic engagement model to implement in a slum region in Pakistan, and although I know I will face a number of problems, I am optimistic that I can help make some sort of difference. The aim of the project is to make possible and current hypertensive and diabetic patients aware of the multiple ways in which they can reduce the onset and symptoms of these diseases. There’s a lot left that needs to be sorted out though, and I’m a little nervous about all the meetings that remain to be planned out. A few things are clear though. This project means a lot to me and I will try my best to ensure it has a successful outcome.

I grew up in one of Pakistan’s largest metropolitan cities, Lahore, but even though it was among the most developed cities, poverty was still very evidently present everywhere I went. Large areas of land were devoted to large slums, a number of people fell asleep at night under bridges or on the soft padding of the green belt, and there was entire army of beggars pleading for money on the streets. Poor parents would rather have their children work in wealthy people’s homes as maids to earn a nominal wage rather than send them to school. Starvation was common and poor health meant death at a young age was more or less inevitable. For a lot of people, this constant display of poverty desensitized them as they went about their daily work, but for me, it didn’t sit well. I couldn’t and still do not understand why I am in this place of privilege and comfort just because of ‘accident of birth,’ while people don’t know where their next meal is coming from. It was this privilege, I realized earlier on, that meant I was in a position of responsibility to help those who needed support. Throughout high school, I was affiliated with a non-profit organization called Next Generation Pakistan, which aimed to bridge the gap between different classes of society via education. More importantly, however, it served as a platform for the youth to work towards causes they wanted to promote, and gradually bring a change. I think my passion to help different communities arose from there, because the more I pursued multiple problems, the more I realized how much work is to be done, and how even a lifetime would not be enough to make a mere dent.

The particular community I want to work with for this project belongs to a small slum in the outskirts of Lahore, called Gohawa. I’ve spent the last four years teaching at a school built on charity money (trust school) in a region, where children of the Gohawa area studied. I care deeply for these students, and every time I have walked into a classroom, I have gotten nothing but love and respect. Interaction with students in the area also translates into interaction with their family members, and they have always welcomed me like one of their own. A lot of them suffer from poor health and disease, and many of these can be avoided very easily if they were more aware of the nature of the diseases they are plagued by. Belonging to a family of doctors, I was always taught that prevention is better than cure, and I believe that prevention through awareness can go a long way in helping reduce poor health in the neighborhood, and thus allow for a healthy population capable of 100% productivity.

I realize the next few weeks within the motherland are going to be quite difficult and strenuous, and the planning, followed by the implementation of the planning will be a challenge, but it is a challenge I welcome with open arms. I hope for a day where every single individual has access to their basic rights, and although I know we are far from that place, I won’t stop trying. Disillusionment is the enemy of progress, and even if its one step at a time, every effort is worth it. Let’s change tomorrow, let’s begin today!