When Hassan* first heard his 11-year-old daughter crying, he knew it was serious. But after rushing outside to see what was wrong, he realised her condition could be fatal. It was a warm September day and Ayesha* had been playing outside her home in Pakistan-administered Kashmir when she’d run into a small clump of grass after her ball. In her excitement, she didn’t spot a deadly snake coiled there and stepped on its tail. The reptile’s reaction was swift, sinking its fangs into the little girl’s ankle before slithering away.
By the time Hassan reached her, Ayesha’s ankle was already swelling. “Baba [father],” she said, crying in pain, “I can’t feel my leg.”
It wasn’t clear what sort of snake had bitten her, but most attacks in the Kashmir region can be put down to the highly dangerous Levantine viper. She needed anti-venom or there was a risk she might die. How quickly she needed this would depend on how much poison entered the body and how the body reacted to it. Some people die within hours of a snake bite. Others survive without ever having anti-venom but, generally, doctors advise administering anti-venom as soon as possible.
Hassan knew – as the people of his village, Pathan Khan in the Sudhnoti district, had known for decades – the nearest place to get anti-venom was Islamabad, some 100km away. But, like most people in this impoverished mountain region, he had no way of getting her there. The family didn’t have a car, nor the money for a taxi. Emergency services would not make the journey along the perilous rural roads for a single snake bite. So the father did the only thing he could think of: he carried his little girl to a village elder known for being able to help in such situations.
The older man – a scholarly and philosophical fellow – would use a tourniquet on the child’s leg to prevent poison travelling further into the body. He would then drain the affected limb of blood sometimes by literally sucking it out. If the victim was lucky, it worked; often it didn’t.
But when father and daughter turned up at his door, the old man looked doubtful. The bite was bad, he said. The poison would be too much.
Then his face brightened. The district’s first-ever clinic – The Al-Rafiq Medical Centre – was being built in a derelict house just a couple of miles away, he told the family. They may have anti-venom there. Not wasting any time, the trio set off to the site with Hassan carrying Ayesha.
“We were having dinner when they turned up,” remembers Shahid Ilyas, the 25-year-old UK student who set up the small Birmingham-based charity, Building Lives, which is behind the free centre. “They were desperate. Snake bites can kill in Kashmir [this is caused by a combination of the region being home to particularly deadly snakes like the Levantine viper and the Himalayan pit viper and the lack of health facilities]. Often there’s just no way to get them properly treated.”
The centre – a rudimentary four-room place – had the anti-venom stocked, but there were no doctors at that time to administer it safely. They would not arrive until the next day, the clinic’s first official day. No one there was qualified to administrate the anti-venom. No one knew how much would be an appropriate amount or where in the body it should be injected. Obviously, as with most medical operations, giving someone a dose of anti-venom needs a certain amount of medical knowledge or the injection may end up doing more harm than good.
“The scholar said ‘It’s okay, tomorrow’s okay’,” remembers Shahid. The tourniquet, he was sure would work and keep the kid alive until the injection was administrated. The girl would be in discomfort over the night but she would live.
They returned early the next morning and a doctor saw to them. “I remember how they looked as they left, so grateful. I just thought ‘Well, that’s not a bad result. Our first patient and we’ve already saved a life’.” And if all goes well, it is hoped the facility will save many more – and help thousands of other patients – in the coming months and years.
That was the aim in 2013 when Shahid and two friends – Umbreen Hussain, 29, and Bushra Jahangir, 26, also from Birmingham – first formulated their grand ambition to open a health centre in one of the world’s most impoverished regions.
The trio had long wanted to do something to make a difference in this part of Asia, where their parents’ families are originally from.
But instead of simply donating money to a large multinational charity, something that most of us would generally do, the three decided to do things a little differently.
They decided, in fact, to start their own charity, raise the funds, source the land, buy the equipment, hire the doctors and finally build the clinic they had envisioned. All from scratch. All in their spare time while studying at university. And all in a land none of them really knew.
“Was it hard work?” ponders Shahid. “It was the toughest thing any of us have ever done.”
Indeed, along the way there were near-death illnesses, 24-hour fund-raising sessions, and not a little frustration at the relaxed approach to timekeeping among the labourers they hired in Kashmir.
“When we were renovating the centre we’d ask them to be there at 9am,” remembers Shahid. “Generally, they’d start rolling in around midday.”
More of all that shortly, though. For now, there is little doubt the clinic was needed. Health issues in this district of Kashmir are many. Illnesses such as extreme diarrhoea, hepatitis and typhoid are common due to sewage systems that aren’t fit for purpose and poor access to clean water. TB remains prevalent despite vaccination programmes, and the region is one of the only three places in the world where polio has never been eradicated – the several reasons for this include poorly managed and ineffectively administrated vaccination programmes, which have failed to wipe out the disease completely, and attacks on health workers running programmes by terrorist sympathisers.
Malnourishment too is a problem. In 2012, the World Health Organisation estimated 43.7 per cent of people in Sudhnoti – which comes under Pakistan administration – were not getting the basic minimum calories.
Natural disasters have only added to the woe. A 2005 earthquake left more than 75,000 people dead and three million homeless; while floods just this September killed 500 people and displaced half a million more. Water-borne illnesses, like cholera and jaundice, are feared to be spreading. By contrast health care is basic at best.
Before the centre opened the nearest medical facility to Pathan Khan was in the city of Rawalakot, some 50km away. There is no national health service and doctors’ charge for their time and medicine is expensive.
Simply getting some cream for a rash – once transport costs and GP charges are taken into account – can, says Shahid, amount to more than a month’s wage.
It is just a small drop in a vast ocean of health-care needs, but The Al-Rafiq Medical Centre – named after Bushra’s grandfather – has already started to make a difference.
Research suggests it is the first clinic ever opened in Sudhnoti, a mountain district with a population of some 650,000; while its location in the village of Pathan Khan means it is within 32km of 10,000 rural people.
Since the place opened on September 14, over 800 patients have already been treated. On the first day alone 52 people suffering from flu, colds, rashes and rheumatism (as well as that snake bite) were all dealt with. In Week 2, a 90-year-old woman was found to have two lumps on her breast and sent to Islamabad for further diagnosis. At the time of going to press, it remains unclear what this further diagnosis turned out to be.
Indeed, the overwhelming response of locals is perhaps captured in a letter sent to the Building Lives HQ in Birmingham.
“Thank you very much for opening this health centre,” Naveed Iqbal writes in Urdu, the local language. “We are very grateful and hope for the best for your great achievement. God bless.”
Not bad, all in all, for an idea that first came about while Shahid himself lay in a hospital bed in Birmingham.
It was January 2013 and he’d been feeling ill with headaches, chills and joint pains for some time when, one morning, he found himself struggling to breath. Fearing he was incapable of getting to a doctor, he called for an ambulance – and then lost consciousness.
“The medics found me at home and rushed me to Queen Elizabeth Hospital in Birmingham,” he recalls. “It was all a blur. I was in and out of consciousness for several days but eventually they told me I had [bacterial] meningitis. They said I was fortunate to be alive because I’d left it so long to see a doctor.
“Something like that really opens your eyes. At that point, I’d been working for a marketing company before going back to university and I realised that’s not what I wanted to be doing with my life. So I asked myself: ‘well, what do you want to do, then?’ And the answer that kept coming back was help people.”
He told Bushra and Umbreen when they visited him. Both had been brought up by parents who instilled in them an ethos of help and aid. The trio agreed they should work together to do something that was more meaningful. “That’s when we came up with the idea of starting our own charity,” says student nurse Umbreen, taking up the story. “We actually registered it with the Charity Commission before Shahid was even out of hospital. The funny thing was at that point we still didn’t know precisely who we wanted to help.”
Modelling themselves on institutions such as the Rotary Club, they decided to support both a local cause (which led them to fund-raising for St Basils homeless centre in Birmingham) and an international one.
For the latter, they eventually decided they would like to do something for the people of Kashmir.
“It was an emotional and a practical decision,” says Shahid. “Emotional because we can all trace our heritage back to that region. But practical because Bushra’s dad still had contacts there.
“This was our first international project and we felt we would have more chance of success if we already knew people on the ground. As we were inexperienced, having those basic links would make things easier.”
They began fund-raising in the UK with cake sales and sponsored auctions selling used items that were still in good condition, while finding a building to buy in Sudhnoti.
“It was hard work,” says Bushra, an accounting student. “You have to remember we were starting with nothing. All three of us put in some money but that was it – there was no big backer. Our first ‘office’ was Shahid’s hospital room. All we had was a laptop and our enthusiasm.”
All the while, they were liaising with people in Kashmir to find a building. They needed one that could be renovated and was within their Dh115,000 budget. Eventually a derelict house was sourced.
“It was perfect because it was so close to so many people, was in relatively good condition and there was room to expand in the future if needed,” explains Shahid. They snapped it up.
The next step was to travel to Pakistan, hire two doctors, buy the basic equipment and medicine following extensive consultations with medical experts in the UK and in Pakistan, and then head to Sudhnoti to actually turn the building from abandoned homestead into modern health centre. Shahid did this in September. He was there for a busy fortnight, without the other two so as to reduce costs.
“Doing the renovations was probably my favourite bit,” he says. “I love my DIY but we also wanted to engender a sense of local ownership so we hired local labourers to work on the job.”
That’s when those timekeeping issues arose. Although, fortunately, when the men did eventually arrive, they worked hard. Refurbishments, plumbing, roof repairs, signage, landscaping and installing furniture were all completed on time and in the Dh60,000 budget.
By the end of the work, which took a week of 16-hour days, the place had been transformed. Included were a doctor’s room, dispensary (where medicine is sold at cost price), waiting area and a specific women’s clinic.
It was not long after they had added the last licks of paint on the evening before opening that Hassan turned up with his daughter.
He wasn’t the only person to come that first Sunday either. Far from it. The grand opening saw dignitaries from across the region arrive to take in this astonishing new facility.
They applauded the announcement that two doctors (one male, one female – who are both paid for by the charity) would spend four days a month here. That may not sound like much, but in a region that’s never had a GP clinic it is expected to be, quite literally, a lifesaver.
The 52 patients who turned up on the first day, meanwhile, queued out the door.
“It was probably the best day of my life,” says Shahid. “Certainly the proudest. I was just looking at the place, thinking ‘We did this, we actually did this’. It was amazing to witness.
“But, in many ways the hard work starts here. It costs just £250 (Dh1,470) a month to run the place – that’s for upkeep, and the wages of the doctors and a caretaker – which shouldn’t be too difficult to raise. But it’s been such a success we’re already thinking about how we can expand. An ambulance is needed, really. But before then we need to have a doctor based there more permanently, and I think a gynaecology unit would be good.”
This is because there is no prenatal care in the region.
While the facility belongs to the local people, he adds, it will be micro-managed from the UK by himself, Bushra and Umbreen.
“We will receive monthly reports on the stock of medication, how many patients are being treated and for what,” says Umbreen. “In this way we hope to identify areas that can be improved.”
And then? This trio see no reason why similar projects can’t be repeated elsewhere. The look on Hassan’s face after his little girl had been treated was certainly enough to convince Shahid the time and effort taken to do this was worth it.
“If this is a success,” he says, “I would like to duplicate the project elsewhere in the world where there is the need and demand.”
If you would like to help, visit http://building-lives.org/.
* Names have been changed.