Note from Author:  This is Number Two in a 5-part series on Medical Flood Relief in Pakistan. For those who are just beginning the series please feel free to reference the first post .

We woke at the first Call to Prayer from the neighborhood mosque.  Echoes of the call from other mosques all over Shikarpur were like hitting the snooze button on an alarm.  As I would fall back into a doze I would hear another.  For me a sure sign that I had come home. I drowsily recalled the controversy that had made headlines in the US when President Obama described the Call to Prayer as “one of the prettiest sounds on earth….” thinking “But it IS!”

Our sleep had been fitful.  The Hindu temple next door was in full event mode with singing until 4am.  Electricity went on and off throughout the night and using the generator meant a trip to the porch, stepping on a 3-foot high stool, and taking a wrench to move the handle to generator mode.  Despite these interruptions, we were ready to begin Day Two and prove our newly acquired ability to work with a portable clinic, communicate with rusty language skills and  face the challenges that were sure to be a part of our day.

The streets were already crowded as our van inched its way to our destination through a traffic jam of donkey carts, rickshaws, bicycles, women in burqas, children holding tightly to the  flowing fabric, and a sea of men.  We arrived at a Baluch village 20 minutes outside of the city limits and were immediately surrounded and greeted by women and children.  “Kush ha?”.  “Ha Kush ha” we would reply.

It became acutely apparent to us that if there was any shade in the area it would be given to the doctor;  the nurses?  Umm, not so much!  This day we were lucky and a charpai (rope bed) was set up under a small thatched roof area where we quickly organized our pharmacy and created a space for our community health worker to advise patients and make sure babies and children were immediately taking their malaria medication.  The thatched roof proved to be a challenge for us but  high on entertainment value as one of the beams was in a perfect place for an adult to hit their head – and it HURT!  The giggles it provided for children and women surrounding us forced us to laugh rather than cry when the collision was particularly hard.

The medical problems were much the same as we had seen on day one and a pattern emerged.  Each person  came to us with a paper in their hands containing:

• their name
• who their father was
• chief complaint
• the doctors quick notes
• the treatment plan

Usually it was a group of around 5 – A mom, a baby and her 4 or more children.  Today we began to grasp the toll the flooding and resultant lack of food and close quarters had taken on people.  There was Mohammad, 3 years old, looked like he was 10 months old; Samara, 1-year-old, appeared to be 4 months. Not only did everyone have malaria, but along with the high fevers they were itching from scabies, runny nosed from colds, and most had worms. Tears seemed to come quickly this day – was it because I was so tired?

Let your heart break for things that break the heart of God went through my head.  Mother Theresa said that didn’t she?  If she could do this kind of work for years then surely I can do it for two weeks!

Every malnourished child received vitamins and Plumpy’Nut.    I had only heard of Plumpy’Nut the day we arrived but it was already my favorite treatment.   A READY TO USE THERAPEUTIC FOOD! (RUTF) developed by a French pediatrician as a wonder drug for malnourished children, the French government had distributed a gazillion packets to Pakistan and we were the grateful recipients of hundreds of these.  Better still, one of the doctors at the hospital had figured out how to make it with local ingredients. Once the precious supply was gone we would still have this available for these kids.

This pint-sized packet of goodness was full of peanut butter, oil, nutrients, powdered milk and more and had already proved its value in other areas where malnourishment claimed childrens lives and if not their lives then certainly their IQ’s and any chance for normal development.

(To see more on Plumpy’Nut – Take a look at this CBS News Clip “A Life Saver Called ‘Plumpynut'”)

As the day moved on, we were better able to enjoy those around us – the smiles,  stares, the laughing at our fumbling attempts at communicating in Sindhi and along with that we began to hear their stories.  We were sustained with humor and Grace far more than our human capability. Around 1 in the afternoon we said our goodbyes, packed up our mobile clinic and moved on to another clinic, not initially planned but brought about by the tenacity of a widow who had walked over a mile in 98 degree heat to urge us with passion that:

Our village has needs too! You need to come to our village!” The request was too emphatic and the need too great – and so of course, we went.