Message from the Chairman

The new year brings the continuing challenge of building a charity hospital in Muzaffarabad, in Pakistan administered Kashmir.

Once the necessary paperwork had been given due diligence by the Pakistani and Kashmiri authorities we have been carefully trying to select the right contractors for the important job of construction. However we soon realised that this would be too expensive.

Therefore in order to ensure that all funds are used on the hospital project and the fact that we are a 0% administration charity the pace of the project has been slower than we had ideally preferred.

Thankfully, you would have been receiving the regular emails from the MDAUK News desk to keep you updated with the project and  you would have seen our progress.

I have made numerous visits to the facility and am due to go again very soon
as the project is at a critical and important stage.

You will see from the pictures attached that the foundation stage is almost complete and soon the structure
will start to take shape. I personally negotiated a consignment of steel for the facility.

Now that the project has started to take on momentum, we need your help more than ever before.

We are focusing on constructing a part of the front of the facility so that at least some clinical work can begin.

Secondly I will be working in Pakistan undertaking charity surgical work aiming to impact women's health in Pakistan,  an area which is rather neglected. Further, MDAUK team members are focusing on providing a clinic in Mirpur for the needy. Canadian doctors have taken on fundraising for the project for Feb 2010.

More than ever, and especially at this critical juncture, I must ask for your help in this project. Please support us as much as you can.

Please log onto to the website and register the emails addresses of friends so that
we can keep all past and future supporters of the project abreast with developments. The website will be undergoing important changes over the next few weeks as a means of communicating.

As we are a 0% administration charity, we undertake all the admin, site visits and charity work in our own time and our own expenses and therefore we are dependant on your good will and generosity.

I must thank all our donors, supporters and workers without whom this all would not be possible.

With kindest regards and best wishes for 2010.

At your service

Dr Iftikhar
Consultant Surgeon and Chairman
Midland Doctors Association UK

Iftikhar Ali's Diary - Day 5

We said farewell to Karachi early in the morning and boarded a flight to Islamabad. Our next destination was Muzaffrabad the political capital of Azad (free) Kashmir.

This was very close to the epicentre of the 2005 earthquake. 

MDAUK was first set up in response to this earthquake and this is the location of the hospital project currently under way.

Muzaffrabad is set in a beautiful valley in disputed territory in the foothills of the himalayas. As we drove out of Islamabad the road turned twisty as the climb began, one hairpin after another higher and higher with the Jhelum River in the valley below. We noticed whole chunks of the road that had fallen into the valley during the earthquake.

There were visible marks on the rock face where the mountains had been torn apart; such was the power and magnitude of the quake. In fact we were told by the locals that recently, whilst repairing a fallen strip of road, a digger hit something metallic. Further excavation revealed a van buried deep below the road with the passengers still inside.

So it comes as no surprise that the doctors from MDAUK had performed over 100 operations on the injured on the first day of their arrival in 2005.

Our purpose here was to see the hospital site, the construction so far and to speak to some of the locals. We were also meeting some local government officials to gauge their support. We have been raising money for the Flood relief but here we were going to witness critical work that MDAUK have done and are doing long term for a devastated community.

Muzaffrabad sits well into the foothills (in Europe these would be mountains) and overlooks the Jhelum River. The town has an air of tranquillity about it that I hadn't experienced so far on our trip and it felt very safe. We were told that it was one of the safest places in the region. Perhaps that is because it is not so easily accessible. Nevertheless the locals were friendly and extremely hospitable. 

Shortly after our arrival we went to visit the hospital site, and what I expected to find was a patch of land designated for a hospital. What we actually found was much more. Muzaffrabad sits on a major fault line and sitting lower in the valley on a plateau just above the river was the solid reinforced concrete foundation for what will be a quake proof building (less than 5 buildings in the region are quake proof). We watched as the builders, engineers, joiners, and welders worked on building the steel and concrete superstructure. So far no less than 250 metric tonnes of steel have been used to strengthen the foundations.

We walked around the ground floor as the project manager pointed out the various areas, out patients, x-ray, wards, research labs, teaching area, etc, etc. This hospital will not only serve the locals but also provide teaching to them. There will be at least one UK consultant level doctor/ surgeon present every 2 weeks out of 4 here. The equipment will be of western standards, there will be a school of midwifery and all treatment will be free of charge.

Being there and speaking to the local politicians and people just brought into focus how much time effort and anguish the doctors had been through to get the project to this stage. What this hospital will mean to Muzaffrabad and to Pakistan cannot be overestimated. The level of professional medical treatment planned here will not be available anywhere else in Pakistan. Moreover, with the teaching element, this will become a self sustaining centre of excellence.

The doctors at MDAUK have been tireless in their efforts to help the underprivileged in this part of the world. Their selflessness and dedication is staggering. I feel humbled by the work they have done and are doing. Doctor Ifti, our main host, for example on his way back to Karachi was supposed to meet a friend for lunch. He cancelled at the last minute to carry out a 4 hour operation at a hospital in Islamabad free of charge; he just made it in time for his flight.

Having seen all the work on the ground, the food distribution and the longer term projects I can safely say that the money with MDAUK is reaching the people it was donated for. There is a lot of manoeuvring required to ensure it gets there and in this respect the network MDAUK has is adept at achieving this. 

Returning home to the relative luxury of England it is easy to fall back into a normal routine. But before we left we made a quick stop at Mirpur close to the place of my birth and my parent’s village. But for a few kind twists of fate it could have been me carrying my children through the water.

If you'd like to help the flood victims with a donation, please do so on my just giving site.

Iftikhar Ali's Diary - Day 4

Early morning flight to Sukkur, we ventured into the heartland of the Sindh province. These are the agricultural flatlands of Pakistan producing vast quantities of rice wheat, corn and more recently an abundance of dates.

The waters of the Indus have flowed north to south and in sindh the levies have been broken to leave entire villages underwater. Despite being October it is still hot (about 35c) and the waters have started to dry however broken roads and standing pools in these flat parts still make many places inaccessible.

We met with the DCO (district co-ordination officer) who would provide a police escort for the day. The escort was for our security, but more importantly to do anything in these parts one must pay homage to the powers that be and gain their blessing to ensure smooth passage.

The DCO’s office like many buildings in Sindh was a throwback to colonial times and was in what we came to expect as a usual state of disrepair. We were eager to move on to the camps and villages but were told we must have tea first. The lack of urgency we have encountered is so frustrating but we went through the motions to not upset the protocol.

Late morning we arrived at the first camp, here we distributed winter packs and 1 month food packs. This was no easier than the first day with the same heart wrenching pleas from destitute people. We had also brought some colouring books and pencils which we gave to the children. All the smiles made us wish we had brought more. A box of Cadburys celebrations caused further squeals as the kids tucked in.

The IDP's (Internally Displaced Persons) are being encouraged to return to their villages and those that can have started to go. Some of the other NGO's have been distributing money or monthly rations to facilitate their return and are then closing the camps. 

The last few days has made us realise that food packs and handouts despite being necessary are not a sustainable solution. MDAUK have been working on adopting a village which would be rebuilt with input from the villagers thus empowering them to be self reliant. We went to see two villages one of which would be rebuilt using our donors’ money.

The first village was surrounded by water and we had to cross a narrow walkway, part of which had been patched up a few hours earlier. These was a village of about 250 mud brick houses of which only 30 or so were still standing. The villagers were eager to tell their story however they seemed to be losing hope as one man said, "Lots of important people have been here taken notes and left, and we have seen nothing. We are far from the city, we have not been given rations, we have eaten what we have and now we forage for fish in the standing dirty water." We saw many such makeshift fishermen standing waist deep in the burning sun. 

The second village was no different in the level of devastation but was bigger in size. We were met by a similar throng of people each person recounting their losses. The legal rights to land can be complex so it is vital for MDAUK to select the village location carefully to avoid disputes in the future. The villagers of Sindh vary from owning scraps of land on which they live and farm to the 'Hari' people, landless folk who live in mud houses on the landowners land and work the land in return for a wage. Bonded labour in one form or another is still alive.

As we were leaving other villagers tugged at us, "Please come and look at our villages..." Fingers pointing this way and that, as we drove out a group from another village stood in front of our car begging us to see their village, men women and children all in a huddle, their pleas becoming more desperate as we moved on... One could sense the desperation turning to anger as our driver manoeuvred the car through.

Once again we felt desperate to help them all but now had the knowledge that we would in fact only be helping a tiny minority. We were supposed to take a boat to a stranded village but that was not possible as the boat was leaking. God only knows what state that village was in.

It was time to go, we’d had a long and arduous journey and as the shadows lengthened, all along the roadside we could smell wood burning as the tent people settled in for the night. Soon we would be in the comfort of Karachi but we owe it to the people to keep the story of their plight alive.

Tomorrow we head north.

If you'd like to support what we're doing with a donation, please do so on my just giving site.

Iftikhar Ali's Diary - Day 3

Today started with a visit to a hospital in Karachi. Here we saw children from flood affected areas suffering from typhoid, malaria and dengue fever (otherwise known as bonecrusher disease). We were told the cases have just started coming in and will grow in numbers.

These kids were getting immediate treatment but as the numbers grow it will become more difficult  to treat all. It was strange to think of these kids as 'lucky'.

"A kids ward with no toys" said Ivor...."I wish we had brought some toys"

Next stop was north of Karachi to another IDP (Internally Displaced Persons) camp. This was a bigger one than yesterday but out in the open with ramshackle tents housing families of 5 or sometimes 10. We helped prepare typhoid vaccinations for a hundred children as the doctors administered them. The children jostled for position, "Me first, me first...." no fear of needles here. We looked through the records but some of the children have no surnames and illiterate parents, the doctors will keep the records but with a fluid moving population of no fixed abode how can they track who has been vaccinated and who hasn't.

We walked through the camp, and spoke to a middle aged man, who was from Khairpur about 350km away. He was in the camp with his wife and nine children. "We only got our tent 3 days ago he said". In Khairpur he was a worker on the land and his boys worked on the land too. "We have lost everything, and the landowner won’t let us go back until we repay his loan."  We asked how much the loan was ....fifteen thousand rupees (GBP110). He was waiting for his watan card from the government (A card issued by the government allowing IDP's to purchase goods to the value of approx GBP735). "I just want to go back and work on the land again"

Shazad gave out some sweets to the children and this created a little noise, the reaction from our host was one of consternation. He said "It’s time to leave now" and ushered us out . The concern on his face was very visible and he later explained that an aid worker had been kidnapped from that very camp the previous day. Attracting any attention was not advisable.

Tomorrow we fly into the heart of the floods where the water is yet to recede, I do not think we are prepared for what we are about to see.

Iftikhar Ali's Diary - Day 2

We arrived in Karachi this morning.

Our first visit was to the compound of the Pakistan Medical Association, this is the body working directly with MDAUK. We inspected nutrition and shelter packs bought for distribution. MDAUK provided a short briefing to prepare ourselves for the next few days of relief work.

We then proceeded to an area just outside of Karachi where we visited an IDP (internally displaced person) camp. This was very basic shelter containing 150 families including a mix of men, women, children and the elderly. We were there to distribute shelter packs (duvets, pillows, blankets and sheets). To maintian some order a ration card system is in place. No card no pack!

Amir was a young boy of no more than 7, he had come from Jacobabad some 6 hours away with his family in search of food and shelter. Luckily his mother and father were still alive and he was the eldest of three children. I asked if he liked the camp and if he was eating well. He smiled through a weather-beaten face saying "it was acha (good) in the camp". His was a genuine smile...

We clambered on the MDAUK lorries and lowered the packs. Keeping order was the first challenge as people without cards begged for packs.No one was violent but a heart wrenching plea from a toothless old woman is difficlult to ignore. We stuck to the protocol and tried not to be emotional. But how do you refuse a 7 year old girl with one eye when she has no card and her mother is too illiterate to get one??? This is no professional beggar...this is the true destitute.

As the heat beat down and the remaining packs diminished, a sense of panic simmered in the air. Looking into the eyes of those that had gone without and no words to comfort them (or ourselves) we walked over to the second lorry.

As the crowd descended on us Dr Iftikhar, Chairman MDAUK, said these people are much calmer than the first days we came, but even now a couple of police officers entered the camp sensing the crowds disappointment. Balancing between doing the right thing, a desperate desire to help all of them and the disappointment of leaving some without we distributed the rest and left. Who was more disppointed them or us???

In the evening, we visited a hospital set up for Women suffering from obstetric fistulae. An affliction affecting some 25,000 Pakistani women per annum, during childbirth resulting in constant urination. These women were truly abandoned by all and this hospital has begun to change that dramatically  MDAUK has been instrumental in supporting this.

Tomorrow we go to a bigger flood relief camp with more supplies.

If you'd like to support our work with a donation, please do so on my just giving site.

Project Update & Ramadan 2009

Message from Chairman, Dr Syed Iftikhar Yusuf

It seemed to donors that the MDAUK charity hospital project in Tandiali (Muzaffarabad) had stalled. However, the delay has been due to stringent and a very proper planning process.

The structural, mechanical, public health and HVAC drawings have been vetted several times by NESPAK to ensure that the hospital building would be able to sustain a future earthquake up to Richter scale 9.

Furthermore, during the last twelve months tender was sought and several meetings were held between MDAUK executive members and construction companies.

The quotations from companies ranged from 1.8 million pounds to 4.3 million pounds. After proper consideration it was felt that even the lowest bid was unreasonable.

Therefore, we have had to select team members consisting of a project director, engineer, supervisor, accounts manager, driver, cook and a labour manager to construct the hospital ourselves.

The initial layout has been minimal and recoupable.

We have bought a vehicle for goods transportation, on-site diesel operated generator, water pump, compressor, vibrator, mixer and we have rented a digger on an hourly cost of Rs1800 (£13.60).

It will take approximately 50 hrs of work to complete the digging and leveling process.

Furthermore, an on-site office has been established with a wireless telephone facility.

Four guards have been recruited with the help of Mr Javed Iqbal (IG police Muzaffarabad) to protect the site which has been completely walled off as well.

Surveyors undertook the initial preparatory work between 06/07/09 till 10/07/09. Marking of the site was completed during that week and the work of digging was commenced on the 14th of July in my presence with the construction of an on-site water storage facility. Digging for the foundation has also commenced.

Following structural excavation anti-termite treatment will be put in place thereafter concreting will begin. With the grace of Allah we managed to reach this far and Inshaallah the project will come to fruition within next two years.