PROJECT- PIPOS REHABILATION CENTER, BALAKOT PAKISTAN

1. PROJECT- PIPOS REHABILATION CENTER, BALAKOT PAKISTAN Site visit by Dr. Rubina Mumtaz, Country Director, RMF Pakistan

2. Background on PIPOS • PIPOS (Pakistan Institute of Prosthetic and Orthotic Sciences) is a non-profit, internationally recognized (by ISCO-International Society for Prosthetics & Orthotics), autonomous Institute in the Health Department of the Government of NWFP Province of Pakistan. • Established in 1989, it is based in Peshawar and in conjunction with GTZ, a German based NGO, it has worked extensively on amputee & paraplegic victims of the Afghan-Soviet war. • In affiliation with the University of Peshawar,it awards a BSc degree in Prosthetics & Orthotics.

3. The Oct 8th 2006 Earthquake, Pakistan • Majority of paraplegic and amputee victims are children and women, who were indoors during the earthquake • Initially orthopedic surgeons engaged in providing immediate care and a limited number of prostheses in the relief stage. • The demand soon arose for providing long term rehabilitation involving prosthetic and orthotic services, physiotherapy and gait training.

4. PIPOS RESPONSE TO OCT 8TH 2006 EARTHQUAKE • Recognized by the ‘National Committee for Rehabilitation of Amputees’ as one of the premier institutes, the PIPOS strategy of rehabilitation is as shown:

5. RESPONSE -II • In collaboration with HI - Handicap International, 5 Rehab centers were set up in Mansehra, Batagram, Besham, Bagh and Balakot. • Presently HI is reaching the completion of the MOU with PIPOS , leaving PIPOS to seek funds for all the centers. • So far, four centers have found funding: Mansehra: Partner APPNA for 3 years Batagram: Partner CHAL+Direct Relief, 3 yrs Bagh: Partner CHAL+Pakistan Burma Shell Co Besham: Partner Direct Relief International, 3 yrs

6. Project proposal Outline • Balakot Center is yet to be funded. It is presently under construction and will be available for partnership on 1st January 2007. • HI funding will complete the construction and fully equip the center with machinery and equipment necessary for the manufacture of prostheses (Artificial legs) and orthoses (Body supports) • Collaboration with RMF will rename the project as PIPOS-RMF Rehabilitation Center. This joint venture will broadly be divided whereby PIPOS will provide all technical assistance and ownership responsibilities and RMF will provide funds.

7. Project proposal Outline- II • Funds are required for 3 years, after which the center will be handed over to the local public hospital to become part of that hospital whereby its inclusion in the regular budget is insured by the Health Department , NWFP provincial Government. • If this option fails, then the center will be taken over by PIPOS who will run it on a no profit-no loss mechanism as a PIPOS Patient Care Center.

8. Site Visit • All the rehabilitation centers are operative on the same plan, so a visit to the Mansehra center gave a comprehensive outline of the rehabilitation operations. • Site visit was carried out by Dr. Rubina Mumtaz, Country Director, RMF Pakistan and conducted by Dr. Sarwar Bakht, Director, PIPOS, Peshawar.

9. Mansehra Rehabilitation Center APPNA – American Physicians of Pakistan Descent, North America

10. Dr. Bakht Sarwar, Director PIPOS, (center) introducing the main reception area of the center to Dr. Rubina Mumtaz (far right).

11. Fully computerized patient record keeping.

12. The main lab for manufacturing of Prostheses and Orthoses

13. MAKING OF A PROSTHESES (ARTIFICAL LEG) Starting from making a plaster model of the amputated stump Making a fiber cast

14. Finishing touches to the fiber cast Adding the knee joint

15. Final product is light- weight, stronger and fits directly into stump without need of hand support typical of the older version of a prostheses (seen by the arrow)

16. A quick look at the machinery and equipment installed

18. Material stock storage

19. PIPOS, aware of the gender sensitivity of the region, trains female Technologists who are given secure living accommodation and transport, all arranged and paid for by PIPOS

20. Showing the detailed procedure of record keeping for every patient by each technologist. This data is computerized at the end of each day.

21. Fitting of a new prosthesis in a 9 year old boy Gait training begins the same day

22. The boy’s grandmother awaits her turn.

23. Some success stories of PIPOS-HI centers Mr. Shariff, a bilateral amputee is today back on his job as a cross country Truck driver.

24. Baby Imtiaz gets a second chance at a normal life Pictures courtesy of PIPOS Besham Center

25. Instruction Chart for prostheses/ orthoses wearers. Obtained from Handicapped International, translated into the local language, Urdu

26. VISIT TO BALAKOT CENTER. Presently housed in a tent

28. So far, it has only the physiotherapy component of rehabilitation. The prosthetic and orthotic procedures are referred to Mansehra center, 90 Km away on a winding mountain road.

29. Chatting with the physiotherapists on ground. The Handicap International representative (right) with the local physiotherapist (center)

30. Balakot Center building under construction further down the same compound, using prefabricated materials. Permanent building construction is not yet allowed by the government.

31. A quick inspection on the inside and backside of the construction.

32. THANK YOU REAL MEDICINE FOUNDATION PAKISTAN A special thanks to Dr. Zahoor of HOAP for making this visit possible.