The sun’s heat, absence of sea breeze, lack of monsoon rains and the effects of a miserable power and water infrastructure for Karachi's residents totalled into the terrible disaster last week. The lack of awareness on prevention of heat-related conditions, complicated further by fasting, added to the colossal death toll.

The biggest cause, though, was the lack of preparedness and disaster anticipation by the state health department, which issued no televised warnings and established no city-wide first response centres to help its people.

Even inside public hospitals, there was an absence of ‘cooling’ equipment and adequate training of healthcare staff in dealing with heatstroke patients.

A total of over 1300 lives have been lost in the province of Sindh since 20th June, 2014 and more continue with the absence of sea breeze in Karachi. Temperatures, for the first time in a decade, touched 115°F (45-46°C).

Also read: Karachi, an 'urban heat island'

Our organisation, the First Response Initiative of Pakistan (FRIP), decided to take over the relief and rescue efforts at the Civil Hospital Karachi, which is the second largest public sector hospital. Through our social media page, an event was created 'Beat the Heat', and we made a call for volunteers and the donation of water bottles, oral re-hydrating solutions (ORS), ice, towels for sponging, water coolers and tubs for ice, juices and other fluids, drip sets and normal saline.

FRIP had a 3-pronged strategy:

1. To support the emergency room with skilled volunteers, medical students and doctors.

2. To periodically provide water, ice, ORS and towels to the ER, medical, surgical, neurology and ICU, where the patients were being treated.

3. To educate the victims, their attendants and all other patients about the symptoms and first response to heat stroke and exhaustion, and the importance of replacing electrolytes.

We set up camp outside the Medical 5 Unit of Civil Hospital Karachi (CHK) right in the field of vision of the medical superintendent’s office. This location was easily accessible from the Baba-e-Urdu Road entrance.

​Morning meeting: Briefing and dividing the FRIP volunteers into three teams for the day's activities.

Instructing the volunteers.

The volunteers were quick on their feet.

Distribution point.

The three objectives: ‘ER Rescue’, ‘In-patient Relief’ and ‘Education & Prevention’ were tasked to three teams each day.

‘ER Rescue’

During the peak hours of the day, the Emergency Room was flooded with hundreds of patients, some unattended, coming in to the ER at the same time.

We established two stations, one at the triage desk at the entrance and one inside the patient-holding unit of the ER. Our volunteers had ice, cold sponges and towels and drinking water and they would start the cooling process immediately on patient arrival.

Donated towels ready for soaking in ice water.

Collection of water bottles, ORS sachets, towels, sponges, ice boxes at the base camp - ready for distribution.

​Ice is delivered at the base camp where the volunteers crush it ice and send it on to the victims.

A FRIP Volunteer waits for patients in the Emergency Room of the Civil Hospital.

The towels were cut up into smaller pieces before soaking.

The other team inside the ER had volunteers dedicated to each bed, and would continue cold water sponging of unattended patients and teach and educate the attendants of other patients.

We were able to bring the core temperature down and awaken a number patients who were brought in unresponsive and with high fever. In the busiest hours, we found the ER to be short of trained staff and were able to supplement their services.

‘In-patient Relief’

We were lucky to have many volunteers of the FRIP completing their 1-year house jobs in various medical and surgical wards of the Civil Hospital Karachi. These house officers would give us the exact figures of patients admitted to their wards.

They would also alert us on the burden of patients during their Emergency Calls on each day of the week. This gave us a great head start in our relief effort, as we were able to triage our supplies with respect to the needs of the wards.

Explore: Hospitals and graveyards — the heatstroke in pictures

We distributed thousands bottles of water, ORS sachets, and towels to sponge the patients. We also delivered ice to the different units, and placed coolers to store the ice for the next few hours. The attendants could use the coolers, kept in each medical and surgical unit, to wet the sponges and also keep drinking cold water.

Towels and cloths being soaked in ice water before being dispatch to the Emergency and Medical Units.

Chilled water and juices were on the ready.

‘Education & Prevention’

Besides proving supplies to patients, our teams also counselled the victim’s attendants on effective methods of sponging to dissipate heat (fever) quickly. We held small awareness sessions on the bedsides of all patients, on the prevention and recognition of the symptoms of heat cramps, exhaustion and strokes.

Most patients and their relatives that we spoke to were unaware of the risks, causes, mechanism or treatment of the condition.

One lady believed her husband, who suffered from a severe heatstroke, ate 'fatty food' the other night and could not be woken up in the morning. Another told us that her mother was bit by an insect and was brought to the hospital with high fever.

With this came the realisation that we desperately needed to educate the people in the long run, and spread awareness about the risk of getting heat exhaustion and stroke. With the help of Dr Saeed Minhas, who published a first aid manual, ‘Aiye Zindagi Bachain’, we designed a brochure on the awareness of heat related conditions in Urdu and started its distribution. We are also planning to use the print, radio and television media to spread awareness.

​A brochure adapted from the First Aid Manual of Dr. Saeed Minhas which was distributed to all patients and their attendants.

​A brochure adapted from the First Aid Manual of Dr. Saeed Minhas which was distributed to all patients and their attendants.

During the rescue and relief efforts, we were very concerned about the safety and health of our own volunteers as they worked under the sun. We took precautions against the heat and advised them accordingly.

Also see: Is Karachi experiencing climate change?

The rescue and relief efforts continue today, and have been able to help save many patients in the ER and are supporting many other in-patients on a daily basis. Fortunately, the heatwave was broken and for the first time, we did not receive heatstroke patients in the ER for the peak hot hours of the day on 30th June, 2015.

We believe our effort is a like drop of water in the sea compared to the colossal work done by many other welfare organisations, army and rangers and welfare wings of political parties. They have been instrumental in reducing the number of potential victims. Many heat stroke centres are currently operating throughout the city. The contributions of organisations like the Patient Welfare Organisation (PWA) and KaraHealth Welfare Organisation should be appreciated.

In the long run, the state should implement sustainable polices to anticipate, plan and manage a heatwave disaster in the future. Many such proven and successful model plans are available from cities all over the world.

In the meantime, I salute the volunteers working in all the hospitals in Karachi for their funds, spirit, time and effort. Nothing beats the satisfaction of seeing a smile on the face of a suffering patient. Their humanity makes one certain that we have it in us to take Pakistan through adversity to a better future.

—Photos by author

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