Day 11 - Weekend in Islamabad and Rawalaphindhi

Today we travelled from Faislabad by motorway to the capital city Islmabad and its twin Pindhi. Islamabad is so strange. Its a new city, built on the edge of the himalayas. Its really beautiful, lots of green green parks, and wide boulevards. It looks like some European or American city. Even the traffic is less. But look again. Everywhere, tucked into every bit of green, is shanty towns. Strange mix again of a 21st city merged with a deeloping world city.

Its mostly the wealthier people who live in Islamabad, but all the workers and the usual chaotic, crowded, colourful Pakistan lives in Rawalapindhi.

My next stop, after we had got comfortable in our hotel, was off to a conference In the Pearl Continental to meet Professor Foster.

Professor Foster is a well known Hepatitis C researcher and consultant in London. After he moved from woking in the Royal Free in West London to working at the The Royal London, he noticed a change in his patients. No longer were they all from the drug using population. Suddenly he was confronted by many many ptients from Pakistan. Similiarly to me he wanted to find out more, and has done some imprtant research into the field (see D'Souza et al (2005) Prevalence of Hepatitis C–Related Cirrhosis in Elderly Asian Patients Infected in Childhood Clinical Gastoenterology and Hepatology Volume 3, Issue 9, Pages 910-917 ). So it was great to meet him. He's been at the conference for a few days, Honourable Guest, so he spoke with great enthusiasm about what her'd found out, and I spoke about the sad experiences I had meeting patients and clinicians on the front line.

Then one of orgainisers spoke to me about speaking at the conference on the sunday. Why not, I'd never get such an opportunity otherwise, so I jumped at it!

Day 10 - Listening to the stories

Spent today meeting people with Hep C in Faisalabad. In the morning a car load of people came, mother daughter son and his wife. The wife was a relative of somebody at one of the meetings in Yorkshire. 3 of the group have Hepatitis C. They had driven for 2 or 3 hours from a village in the countyside, i guess wanting treatment. All we could give them was some answers. We interviewed them about their symptoms and how they might have caught and then showed them our health education presentation. It was so very sad. We worked out that they had all caught it from the same untrained medic who worked in the village. They all used to go to see him about their everyday ills. They would always get an injection. And everybody in the village knew he reused needles. And everybody in the village went to him. Does the whole village have Hepatitis C?

Next we went to visit a family with a very ill mother, a huge abdoment filled with fluid. She was just out of hospital. She was so ill. Amongst the saddness of the family dealing with their beloved mother, looking so ill, so old. And dying aged 45. Amongst all this they ed us and made us tea and made pleasant conversation. Again we answered questions, interpreted their medical notes, gave nursing advice. We interviewed them. And educated them all.

Finally I spent a few hours with MsSB's family. She has 3 aunts with Hep C and an uncle. And one of the aunts husbands died of it. As have 2 other aunts, both in the week we have been there. And Baby, my favourite relatives mother in law did of it too. Again questions and education.



I feel so hopeless. What can I give these people? Advice about unaffordable drugs? Information about how they caught it? Its too late for them. So much illness. So much sadness. So much tragedy. I say at the end of each training session: " Right, now you know more about Hepatitis C than almost everybody else in Paksistan. You now have a duty to pass this information on. You have a moral duty. This information will save lives.

Day 9 - resting in Faisalabad

After a long drive we spent the next few days we at Faisalabad. In Faisalabad Ms SB has a family home and a small bit of land in a nearby village. Her aunt and her large family live in the house, added to by many many relatives passing by. They are not well off, but they were so genorous and kind. I quickly became very close to this wonderful warm family. We spent half the day sitting under a tree in the country, enjoying the warm sunshine and the differrent country sites. We weere busy on the phone making appointments, and relaxing a little.

Day 8 - sight seeing in Lahore

I really love Lahore, I think everybody does! It has some amazing Moghul architecture, and the whole city is buzzing with life! We spent the day looking around the magnificient Fort and mosques, finishing up in a fantastic traditional restaurant. Here's some photo's!

Day 7 – Meeting with Rotary Club

Had interesting meeting with these important philanthropist businessmen. They are eager to part fund a Project for raising awareness about Hepatitis C in Pakistan. They suggested that a small area is chosen, and a model of awareness rising is developed. This is certainly something that I will consider.

Day 7 – meeting with Chairman of Sheikh Zed hospital, and meeting Dr Alam, Consultant Gastroenterologist

Dr Altaf Alam and myself

We jumped into our cars and raced off to the nearby Sheikh Zed Hospital, a large Private Hospital with Lahore’s only Hepatology Department. There I had a brief meeting with Dr Anwar, where we talked of the epidemic happening in their country, and the difficulty thay were having taking control of it. The Sheikh Zed Hopistal have been instrumental in the drawing up of a Green Paper being considered by the Punjab Parliament. The Green Paper considers legaslisation to stop the spread of Hepatitis. This would include the disposal of sharps, the re-use of needles and the terrible situation where herbal healers or quacks promise 100% cures for Hepatitis C with the use of herbs. The newspapers and street signs are full of these, bringing false hope and exploiting the poor.

I then spent time talking to Dr Altaf Alam Consultant in Gastroenterology. We discussed the difficulty in giving health promotion campaigns with a country with one of the lowest levels of literacy in the world. He shared with me some of the leaflets and posters that they have developed. He was a kind and interesting man, but obviously overwhelmed by the epidemic. He invited me to speak to the Dr’s next Friday at 8 a.m. He also promised to show me around the Gastroenterology Ward so I could see the epidemic for myself.