Wedding festivities!

Dr. Arshad, CDRS’s medical director, got married this weekend and we were privileged to be honored guests. It was a most amazing event and a wedding unlike any we have ever attended.

Saturday night we had a conflicting engagement, so we missed a lot of the activities, but we arrived at midnight and got there to see a few fireworks and the groom’s family’s flat roofed house, all lit up with little lights looking like some amazing birthday cake since there were lights on the roof too. We were into bed by 0200.

Sunday AM, we were up early to return to the groom’s house to attend a breakfast which was normally only for the men, but due to our ‘honored guest’ status, we were graciously included. The groom looked magnificent in his wedding clothes, complete with turban and golden sequined slippers with curled ends.

Soon after the first photo session we followed the procession of about 50 men as they walked to the bride’s house, about half a mile away. It was a lovely spring morning with the green valleys, plowed fields and snow peaked mountains adding to the whole picture. The women then followed in their colorful shalwar kameezes looking like delicate butterflies as they adeptly walked up and down the steep dirt track in their fancy high heels.

When we arrived at Nighut’s, the bride and first cousin of Dr. Arshad, we were taken off to be sequestered with the women inside the house. The men were served another meal outside and out of sight. The bride was dressed in a most elaborate gown and she seated on a dais by herself on display while about 100 women and children were crammed indoors sitting on the floor and standing on the verandah. It was very hot and we felt that the poor girl would keel over from the heat. Somehow, it was remindful of a bee hive with the queen in the middle, while her drones busied themselves around her.

After about an hour the groom came in and sat beside her, with her father was on her other side. They drank out of a golden cup. She proceeded to sob and cling to her father which apparently is a tradition ‘show’ as well as a display of genuine emotions. After the groom departed the bride was placed into a ‘dolly’, which is a chair covered with a cloth so that she was not visible, and carried back to her new home. As per the tradition in Pakistan, the bride moves into the groom’s family’s house.

We walked back to the house with a bevy of women and then enjoyed the company of children and a few women on the verandah as breezes kept us cool while our hands were hennaed (mandee) with amazing designs.

Meanwhile, the men were all being served another meal on the roof of the house while most of the women were once again sitting inside the house on the floor. Men were doing the cooking outside in huge cauldrons over fires. Before we ate lunch we visited the bride (still dressed in her gown) who was sitting on her new bed surrounded by her close friends and sisters. At 3:00 we were served a delicious lunch with the rest of the CDRS female staff, sitting cross legged around a tablecloth on the floor. At 4:00 we said our ‘goodbyes and thank yous’ (allah hafiz and meherbani), reconvened with the men and piled into a jeep and drove back to CDRS.

Tomorrow we head off for 5 days to another remote area where there have been as yet no women health care professionals. There will be no internet access. We cannot believe our time here is rapidly coming to a close. Kashmir is certainly in our hearts.

We wish you all peace. Helen & Judy

Photos & a Last Trip. . .

As reported in the previous posting, the Health Fair went very well. Here are a couple photos.


Helen speaking about iodine awareness at the Health Fair.

Schoolgirls who received awards for their speeches at Health Fair.

Women seated at the Health Fair, with the men on the wall in background.

Our chefs: Toqeer (sitting) and Raja Naseem in the kitchen in Chikar.

We are going Monday AM until Friday to Pandu with Zubair and maybe Aneela to some very remote clinics. The women there have never had female health people visit them, never mind gories. It ought to be amazing. We will be safely under the wings of the Pakistani Army. Not to worry. Then back here for a day and off to Islamabad on Sunday the 6th. Depart Tuesday night late for NYC. We will be updating our journals and posting more upon our return from the outstations.

Lots of love, Helen & Judy

CDRS Iodine Awareness Health Fair


We seem to have gained a bit of momentum in the community. The village students, the lady health workers and the shopkeepers, are all uniting in the iodine cause.

Last night we met with some shopkeepers and they informed us that they had sent back a truckload of salt after they tested the iodine content and found it nonexistent.

Today's health fair in Chikar went very well thanks to the efforts of many. There were three excellent speeches made by high school girls informing the audience of about 175 people about the necessities of iodine. Dr. Tihara, the medical officer responsible for nutrition this in this district, came to the fair and gave a speech. It sounded excellent although our Urdu is a bit rusty. We also gave speeches which were translated by Zubair. We gave out iodine test kits and people seem motivated to use them.

This afternoon we are going back to the waterfalls and then we’ll start to get ourselves ready for the upcoming 3 day wedding festivities of Dr. Arshid, the medical director here. We think that being gori women, we will be able to shuttle back and forth a bit between the men and women's parties. We feel very fortunate and privileged to be included in the activities.

Photos. . .

Here a couple of photos they have managed to send through. They look great standing there by that little hut by the stream, don't they. . ?

Iodized Salt Report. . .

Preliminary Report from CDRS
(Comprehensive Disaster Response Services)

Lack of Iodine in Salt Which is Packaged as Iodized
in the District of Muzaffarabad, Kashmir

By Judy Sandick MD, Helen Weld RN, MPH
& Muhammed Zubair Makhdoom BSc
April 2007

“Never doubt that a small group of thoughtful
committed citizens can change the world. . .
Indeed, it is the only thing that ever has.”-- Margaret Mead

The issue of iodine deficiency disorders (IDD) in Pakistan has been recognized, studied and discussed at length since the 1970s, yet the situation has not been remedied. It is alarming to see a very high prevalence of goiter, the overt sign of IDD, in the population, which includes small children and adolescents.

IDD, which results in hypothyroidism, can be manifested as both mental and physical growth retardation in children, resulting in lower IQ and poor educational performance. Serious consequences in newborns include stillbirths, low birth weight and poor resistance to infection. Females of reproductive age, who are already severely comprised by iron deficiency and other micronutrient deficiencies, are prone to extreme fatigue and miscarriages.

IDD can be easily corrected by the addition of at least 75 parts per million (ppm) of iodine to salt.

An informal and preliminary survey of salt has been undertaken in Muzaffarabad, Chikar, Reyat, RahimKot and KatKair. We tested one sample of all brands of iodized salt found in each shop in the villages. In MZD we tested random samples from the main wholesale district. Overall, twelve different brands of salt comprising 61 samples have been tested with an iodine test kit from the National Institute of Health, Islamabad. It is extremely disturbing that salt which is advertised on the package label as iodized is either substandard or completely lacking in iodine. One brand, Phool, supplied by AR Foods Pty. Ltd. consistently meets the standard of 75 ppm..

A strategy is being implemented in Chikar to ensure iodization of the local salt. This can be used as a model for other communities and will help create a ‘grass roots’ demand for iodized salt. Meetings have been held with local Chikar shopkeepers who now recognize the problem and are willing to supply ONLY iodized salt. They are prepared to test salt for iodine in the warehouses prior to purchase.

Consumer awareness and education is also an important approach in overcoming IDD. A community health fair will be held in Chikar on 27 April, 2007. This will include the distribution of information and test kits to lady health workers (LHW) who will disseminate and sustain the education initiative. Schoolchildren will bring salt to the fair to be tested, will give speeches, and have educational sessions.

Government agencies and the salt suppliers must ensure strict enforcement of food fortification laws and stop fraudulent package labeling.

IDD can be prevented inexpensively through the universal use of iodized salt. It is time for the people of Pakistan to have the basic right of proper nutrition.

Boston slide show. . .

This just in:

Todd Shea will be giving a slide presentation about CDRS at UMASS Boston on Wednesday, April 25. The work Helen and Judy have been doing in Kashmir will be featured during his narration. The presentation is on the Boston Campus at Wheatley Hall, 1st Floor, Room 5 from 11:30 am until 2 pm. Anyone in the area who may want to attend can call Todd at 718-809-5381 if they need any further information.

Hospitality Unsurpassed. . .

We are back in Chikar after our 10 day stint at Reyat, RahimKot, and KatKair, the three remote CDRS clinics. The hospitality was unsurpassable. We stayed at CDRS staff homes and were treated to the best food and lodging to be found. We most enjoyed being included in the family circle as meals were prepared around the open hearth. Yoghurt was made from fresh buffalo milk with spices and vegetables added. Home grown apple blossom honey was a delectable after dinner treat. The chappatis were made from the family's wheat ground at a local stone water powered mill. OK, we got spoiled.

We stayed 2 nights at IRC (International Rescue Committee) headquarters and learned about the great work they do. They have several projects underway including supplying clean spring water to the local communities. IRC locates the water source, designs the system, and provides tools and education to the locals. The locals are responsible for the labor and upkeep. This works well as the locals have a huge vested interest in the project. The women are thrilled to have to carry water less of a distance. Another project is culturally appropriate, earthquake resistant homes. IRC provides subsidies and advice and the homes are built in the traditional way but with a light weight metal roof.

IRC also starts Women's Empowerment Centers. These are safe buildings where women can congregate to socialize, learn skills such as sewing and knitting, and are taught small business strategies. All the staff are young and highly motivated, energetic and a real testimony to the best in humanity. With Aneela's help they surprised Helen with a wonderfully warm birthday celebration, complete with cake and pressies.

We spent three days at each clinic. Judy's exam speed increased until she saw over 100 patients one day. It is a bit of a cosmic shift from medicine as usual at home. As everywhere we have been, the major health care issue (and a great sadness) is that preventable, inexpensive to treat diseases such as goiter, iron deficiency, and poor nutrition are the norm. All the women have total body "dard" (aches) due to their anemia at high altitude, carrying 50 pound water containers up steep mountains, etc. while being almost continually pregnant or nursing. Helen was able to do some health teaching while the patients waited to be seen. Irfan, a young man from Lahore who works with ADN (Al-Mustafa Development Network) translated for her. ADN provides latrines and hygiene education to local schools and mosques.

A highlight of the ten days was being able to go on great hikes, one to a high ridge overlooking the valley. our guide for the walk was the niece of our host Altaf. We passed several homes, all of which belonged to her extended family. Offers of chai, beautiful stonework, and reconstruction in progress were to be seen at every house. Every house has its own family cemetery, planted with irises. Another day we hosted a clinic several hours walk from the clinic. We followed the valley floor along a river, saw a local water powered grist mill in use, and managed to get in a swim on the way home. We barely made it back before dark as we had chai at several houses along the way.

Now that we are back in Chikar, we will work on some public health issues (iodine, prenatal care, etc) prior to leaving for another outback trip next week.

Lots of love and we love getting emails on the occasions when we get on the internet.

Peace,
Helen and Judy

Drawing a crowd. . .

Judy and Helen are now in the village of Kathai, where CDRS has a clinic. As a traveling medical act, they have been attracting large audiences. In the remote clinics they are visiting, more people than they can see in one day gather to see them. Most come to be examined, but there are also those who come to do the examining. The arrival of two western women in this part of the world is apparently a significant event and not to be missed. A considerable percentage of the disease and illnesses they are seeing are preventable, due to a lack of basic things like iodine, calcium and folic acid.

Things got a bit dramatic in Riyat, the last village. A young woman was brought to the clinic to give birth to her child. In the initial confusion Judy and Helen thought it was a premature delivery. The mother was carried in strapped upon her bed, and things seemed rather urgent. The baby, a girl, was born in the middle of the night. As it turned out there were some complications and Judy had to travel with the new baby and mum back down the road to Chikar. Helen said they were picking up more Urdu words as things progressed and learned how to say ‘push it down’. . . The phone line was fading in and out at that point and the translation was lost.
This just in from commenter Tasneem:
"In urdu,the Pakistani national language(we have more than five regional languages...and about a hundred or more of dialects in the same!!) the term for encouraging the woman to 'push down' at the time of delivery would be 'ZOR LAGAO'!! 'Zor' meaning 'exerting power', or pushing down hard, in this instance!!". Thank you Tasneem.


Kathai is at about 2130 m, or 7000 ft, there are pine forests and fruit trees. Helen and Judy have been able to stay in the International Rescue Committee house. Somewhere along the way they managed to give the locals a shock and a laugh by jumping into the river for a bit of a swim, fully clothed of course. They have been making good use of the solar shower they brought with them as hot water plumbing is one of the things they are doing without.

That’s all for now, hopefully there will be some photos coming along soon.

Hidden hunger. . .

Venus has just risen over the mountains and the cool breezes of this spring evening are keeping us very content as we sit on our host’s verandah. Looking out over the green Kashmiri valleys, we now have a brief interlude to recount some of the past week’s highlights.

Currently we are in the village of Riyat, seeing patients in one of CDRS’ satellite clinics. Riyat is only about 30 km from Chikar, but it takes 1½ hours to get here along the winding mountain road. Today was our second day here. There was an announcement posted in the local bazaar regarding the 3 day visit of two female, ‘gori’, health care professionals. As a result, 79 patients were seen in a six-hour period today.

Of these 79 patients, all but one individual, including small children, had a goiter. Some were the size of a grapefruit. . . it is so distressing. The local heath workers are educated and the people seem motivated to use iodized salt to prevent thyroid dysfunction and its ubiquitous ramifications.

Last week we began our crusade to understand the high prevalence of iodine deficiency here. We met with several district health care officials in charge of health care delivery and nutritional deficiencies. We learned that micronutritional initiatives have been on paper since the 1970’s. We took it upon ourselves to investigate further. We’ve checked numerous bags of salt in several scattered townships. Of the 11 brands we tested, only one brand met the recommended standard of iodization.

Bags of salt, which claim Pakistan National Institute of Health, WHO and UNICEF endorsements for iodine, actually contain no iodine. It appears that packaging is being manufactured fraudulently and as a result the population suffers. The problem is exacerbated because some local people believe that iodine in the salt is a covert method of birth control. Unfortunately, a logo on iodized salt showing two parents and two children has apparently helped in promoting this misconception, pardon the pun.

Upon our return to Chikar from the remote clinics, there is a Health Fair planned to reinforce education and awareness of the iodine issue. We have hopes to connect with people ‘in high places’ to finally get iodine to the people. It seems so simple. If anyone out there has any expertise, suggestions or connections in dealing with this issue, please let us know. We, and the people of this region, would be most grateful for any help you can provide in dealing with this problem.

Meanwhile, we continue to be very well taken care of, spoiled actually, by our Kashmiri hosts. Lovely evening walks (always accompanied by male protectors) are punctuated by passersby thanking us for coming to their community. Offers of chai (tea) abound. The book about our time in Kashmir could be called ‘TEN Cups of Tea’!

Much love to you all, Helen and Judy

Photos. . .

Helen and Judy have begun a trip to visit 3 remote area clinics. They will stay 3 days at each one and plan

to return to Chikar on the 22nd. In her last email, Helen said that it seemed they would have phone coverage out

in the remote clinics, so hopefully we can post another update in the next few days.

Just before they left, they managed to send out some

photos which illustrate the living conditions in the earthquake affected area, 18 months on. . .

Day to day business continues despite the near complete collapse of some shops. Homes and shops on the steep slope are completely gone, leaving nothing but the

foundations, while many people are living in rather

precarious conditions.

Your comments are appreciated and Helen and Judy thank everyone for being so supportive.

From Todd Shea of CDRS

On behalf of the staff and patients of CDRS, I wanted to impart the universal gratitude we feel towards Dr. Judy Sandick and Nurse Helen Weld. They are doing AMAZING work for CDRS and the people of Kashmir. In addition to their day to day work taking care of female and child patients in remote areas, their collective expertise will help CDRS immensely in terms of developing and implementing long term Public Heatlh initiatives designed to address pre natal care, iodine and iron deficiency and other important issues critical to the optimum health and development of people living in the earthquake affected areas. I am very glad they came to CDRS and am proud of the professionalism, dedication, commitment and courage they have displayed during their deployment in Kashmir.

I also wish to say THANKS! to all the friends and supporters who gave medicines and funds to Dr. Sandick and Nurse Weld for CDRS. Your generous contributions are really appreciated and will be fully utilized.

CDRS is being partially funded this year by UNICEF, however, in order to successfully fulfill our mission and meet our goals, we still need additional support in order to continue operations at their current strength and expand capabilities in certain high need areas. Please support CDRS in any way you can (and please check out our photos/reports at www.cdrspakistan.org). The following is detailed info about a fundraiser for CDRS to be held in Washington, D.C. this Saturday, April 14th. I hope you can be there! Or, if you are interested in holding a fundraiser for CDRS in your area, please contact me at toddshea@cdrspakistan.org or 718-809-5381.

Best Regards,
Todd Shea
Executive Director
Comprehensive Disaster Response Services (CDRS)

Fundraiser Details:
---------------------------------------------------------------------
The GWU Student Chapters of The American Islamic Medical Association (AIMA) and The Islamic Medical Association of North America (IMANA)
Presents
“When the Mountains Moved”
A Benefit Dinner for Comprehensive Disaster Response Services (CDRS) Pakistan Earthquake Relief Healthcare Program

Saturday, April 14, 2007 @ 6:30 PM
George Washington University
Grand Ballroom at the Marvin Center, 3rd Floor, Washington, D.C.

CDRS is a non-profit organization registered in Pakistan. As a charitable organization, CDRS responded quickly and extensively to care for victims of the October 8, 2005 earthquake in Kashmir . To this day, CDRS has been instrumental in providing medical assistance and has been fundamental in managing health care crises (cholera endemic, scabies outbreak, etc.) in the region.

*** The event includes:
Exquisite Kashmiri Cuisine and Chai
Entertainment by Traditional Kashmiri and Pakistani Performers and Todd Shea, Executive Director of CDRS and Musician by profession
Photo presentation of CDRS operations and clip from the Asia Foundation/Eckova Productions Documentary Film "When The Mountains Moved"

Contact persons:
Fatema Bukhari (813) 334-1541 and Ayesha Mian (202) 309-2276
Payment:
Price for Professionals
BEFORE Wednesday, April 11, 2007: $15, AFTER: $20
Price for Students:
BEFORE Wednesday, April 11, 2007: $10, AFTER: $15
Registration:
http://240fm.com/todd3/feedbacki/skin/feedback.htm

This fundraiser's organizational sponsor is The Islamic Medical Association of North America (IMANA)
Donations to CDRS are tax deductible to U.S. citizens by making checks payable to IMANA (with "Chikar CDRS Project" in the check's memo field)

As-Salaam Alaaikum. . .

Greetings from Chikar. Communication has proven to be challenging due to many variables, all of which must synchronize. The other day we saw a boy enthusiastically using a major phone line as a jump rope. – a new variable we hadn’t pondered. Inshallah we will get this blog posted today.

This is an exciting time to be in Kashmir as the acute phase of the zelzelli (earthquake) is past and now the transition to the health maintenance phases are in process. Already the health care in the region supported by CDRS is better than it was pre-earthquake and will continue to improve as new programs are initiated.

We have been doing home visits (Judy calls them house calls) escorted by local Lady Health Workers and an interpreter (RN Aneela or Zubair, the resources procurement officer and gentleman extraordinaire) Word gets out that the gori are in the neighborhood and soon the doorway and verandah are filled with women and children waiting patiently for their turn. Some have complicated problems requiring specialist care and others just want to meet the local attraction. It seems that over 90% of women of reproductive age are severely iron deficient. We acquired a hemoglobinometer yesterday from the District Health Officer and are anxious to get some numbers.

Almost everyone, including little children, has a goiter due to iodine deficiency. Iodine is an essential micronutrient required for normal growth and mental and physical development. The corollary is that a lack of iodine increases fetal deformity, growth retardation, poor school functioning, etc, etc. We are trying to determine why iodine is not routinely supplied in the salt. There has been a micronutrient initiative which was to be implemented around Jan 1, 2006, but the earthquake of Oct. 05 preempted this program. As we talked with different administrators in various agencies, the plot thickened and challenges we could not have imagined came to the fore. We were so naïve in thinking that getting ALL the people in this region iodized salt would be a simple and non-controversial process.

On 6 April we went to a nearby (25 km, 2 hours by vehicle) to assess the reconstruction efforts post earthquake. Constant landslides make travel slow and uncertain. The devastation (we seem to use this apt word a lot) is still mind boggling. In these Himalayan foothills, entire hillsides lie at the bottom of deep gorges, the slides having swept away buildings and everything else in their path. We saw a baker making chapattis under a mostly crushed closet sized storefront. The tons and tons of rubble have yet to be removed from his roof.

Zubair took us on a walk to a 1.5 km long lake, newly formed when a whole part (think Mt Battie or Mt Baldy) of a mountain fell into the valley. Its serenity belies the fact that approximately 1,460 people are buried under it.

We continue to be impressed with the dedication and commitment of the CDRS staff. They treat each other and us as family. Although it is the only NGO to have been formed after the earthquake, it is highly regarded for its fiduciary efficiency, logistical competence, and health care delivery.

3 Cups of Tea by Greg Mortenson gives a great description of this area. We recommend it highly. We’ll sign off with hopes of getting this out.

Kuda Hafiz
Helen and Judy

Wed. 4th of April, 2007

Spring blossoms and tremors. . .

Helen called from Chikar this morning, a few hours ahead of our scheduled time, about 3:30 AM Kashmir time. She was on the flat roof of the Centre in the chill pre-dawn air, the moon and stars brilliant above the glowing mountains. She had awakened early and since she was up thought she might as well call while things were relatively quiet. I did hear a horn from a passing vehicle of some sort and then some dogs barking in the background, so even that early in the morning, Chikar has some activity going on.

Yesterday morning, there was a bit of an aftershock/tremor which gave the residents a bit of a worry. One can only imagine how even a small shaking would create feelings of insecurity in an area previously hit so hard. Also, recent heavy rains create the potential danger of landslides, adding to the level of anxiety.

In the next day or so, Helen and Judy will accompany a group of officials on a tour of the local Chikar area to help assess the current situation. Next week, they will make an 11 day trip to visit 3 remote area clinics, staying a few days in each spot. Traveling on the mountain roads can be difficult due to landslides cutting the roads and while they are away from the CDRS Centre in Chikar communication will be restricted.

They have been making some home visits and feel very much welcomed and appreciated by the community. Todd has posted some great photos on a photo site at http://www.flickr.com/photos/cdrschikar but here are a few to see.

More Photos. . .

For more photos, go to:

flickr.com/photos/cdrschikar

Worlds away. . .

Tonight is April Fool’s Eve and the moon is almost full. Hard to believe that we are all under the same moon, because it feels as though we are literally worlds away from home. We have only been here for 4 days and it feels we have been here for a month.

Chikar, Kashmir, the community where we are based, is about 4,700 people (over 20,000 in the Chikar Union Council) and already it seems that all are aware of our presence. Since the earthquake on October 8, 2005, they have been used to seeing foreign humanitarian aid workers, but due to the fact that most NGOs have left here by last May and the harsh winters, we are basically the first to return this spring. The fact that we are female foreigners (gories) ads an extra touch of inquisitiveness. Everyone has been extremely open and welcoming to us. We have had the opportunity to walk around the town, see patients (always female), go in to a home and today there was a health fair and celebration of the first anniversary of CDRS of which we were honoured as VIP guests.

We are living in the Rural Health Centre which is a huge 4 story concrete mansion formerly a private residence. The family who owns the house is too traumatized to return, so leased it to CDRS for peanuts. We have the penthouse with views of the 20,000 ft. Himalayan foothills. Spectacular!!!

Most of the 18 staff of CDRS live in this building (30 total staff inncluding all 4 facilities). We eat together, play cricket and carom and work together. The atmosphere is like a big family and we already feel like a part of it. Aneela, the RN and interpreter and Farah, a lady health visitor (LHV), are our constant companions, best friends and guardian angels, ensuring our comfort in every realm of life (including serving us tea as we write this). We’ve almost learned all the names, but words like Shazia, Touqueer, don’t spring to mind easily, and Afzal, Abrar, Abaid, Abbas, Asif and Ali Ahmed all become a jumble in our addled brains. We will do a whole blog entry about Todd Shea, the American cofounder of CDRS. He is a noble and extraordinary soul who is adored by the people. He arrived here a week after the earthquake as a volunteer and has now committed himself to this community and region.

Our senses are being bombarded with the sounds of the singsongy truck horns blaring as they zigzag down the mountain (cliff) side. These trucks are each a work of art with elaborate and colorful paintings on each small panel, including the wheel wells and hubcaps. The call to prayer at the 3 mosques is heard over loudspeakers throughout the town 5 times a day. The food is spicy and filling, lots of curried rice and chicken and wood fire baked chapattis. The scent of spring blossoms would permeate the air if the odor of burning refuse wasn’t so ubiquitous. This ain’t Switzerland despite the alpine magnificence! The mountain views rival some of the best in the world. The people are extremely handsome. Many have the famous “National Geographic” cover girl emerald green eyes. These are apparently a genetic legacy of Alexander the Great’s troops.

We haven’t really gotten into a work routine yet. The plan is for us to assist the staff seeing female patients in the outpatient clinic (about 150 people come through between 9-2 5 days a week). We will also be doing home visits; try to do some education in the schools and the week after next we will go to three outlying clinics and see women where there are no female health practitioners. These are very remote places, though only 20 Km. distance from Chikar, it apparently takes about 2 hours to get there in a 4WD vehicle. Thus far in the out patient clinic, we have seen a lot of anemia and upper respiratory problems, as well as a probable case of lupus. Since there is no lab or X-ray available here, all diagnostics are based on subjective and objective assessment. All the women are eager to be heard and seen by us and seem very grateful of our presence and willingness to be with them.

Since our arrival the CDRS staff has been busy preparing for today’s health fair which celebrated the first anniversary of CDRS and also their merger with the government's newly established Rural Health Center, a UNICEF pediatric program and UNFPA Mother/Child health center (United Nations Population Fund). The staff put on a series of skits in which we were included; Helen, playing a wife and Judy an ailing patient (both wearing local dresses!). Aneela and Farah took us on a shopping spree, to get the appropriate Kashmir attire. We chose the fabric and were fitted on Thursday, and picked up the amazing 3 piece outfits on Friday. We had “beauty treatment” done by a 14 year old girl who drew traditional henna designs on our hands. Today Helen’s virgin lips were lipsticked and eyelashes mascaraed (don’t worry we have photos). We were bejeweled, given fancy shoes- we were afraid maybe we were actually going to get married off! Everyone was quite amused and glad to see we were integrating into the local custom. Helen has had a stomach upset and managed to discreetly vomit backstage prior to her stage debut. What a trooper but the show must go on. After the dignitary speeches we were unexpectedly requested to address the 200 or so crowd with our words of wisdom. We managed to pull it off and were rewarded with a warm round of applause.

There is so much to tell! Hopefully this gives everyone a bit of an idea of this amazing experience to date. Thinking of family and friends in between all that is happening.
Miss you and we send much love, Judy and Helen