THE cotton fields are partly submerged in rainwater after a downpour the night before. The path leading to Zahid Khan Mari hamlet in Mirpurkhas district is all muddy, giving even a four-wheeler a tough time. Straw has been tossed over the mud and puddles of water on the track from the unplastered road to the settlement. Stepping carefully, we enter the compound of the only proper plastered house there. In the covered veranda are about 25 women, sitting on mats with their children either in their laps or playing around.

From the easy and cheerful atmosphere you would think it’s a social event but they are here to learn how to prepare an oral rehydration solution (ORS). Rekha, a matriculate volunteer trainer from a neighbouring village, is showing them how to prepare ORS, referred to as ‘nimcol’ by them. Using just boiled water, sugar and salt, Rekha prepares ORS and instructs them about its administration. This is the second round of the National ORS Campaign which aims at educating at least one woman in every household about the signs, treatment and prevention of diarrhoea.

With the monsoon underway, diarrhoea has started troubling this community which, like other countless villages nationwide, has just the right conditions for the ailment to flourish. Unhygienic lifestyle, unsafe drinking water, poor sanitation, poor food handling practices and other such conditions make diarrhoea and a host of other illnesses an everyday threat for them. Add to these the inaccessibility of medical facilities and lack of funds to spend on treatment, and the situation becomes quite grim.

The ORS campaign has made a difference in the lives of these villagers. Armed with the knowledge of the preparation and administration of ORS, and identification of the danger signs that necessitate proper medical attention, these simple rural ladies have been able to handle the diarrhoea cases that have surfaced in this community.

Guddhi, a young woman with a sari draped in Rajasthani style and thick bangles going way up to her upper arms, smiles shyly from behind her pallu that is half covering her face. She points to the six-month old daughter in her lap and says proudly, “Two days ago she had diarrhoea and I gave her nimcol. She is better now. We give nimcol to even the elders when they have diarrhoea.” The others around her promptly nod in affirmation.

Davi, another woman in the crowd, quickly calls her seven-year old son and declares that a week ago he too was suffering from diarrhoea and was helped by their newly-learned skill. “Since our children too are around when we are given this training, they also know about it and urge us to give them nimcol when they have diarrhoea. And sometimes if we make a mistake in making nimcol, they quickly correct us,” Davi informs.

Turning to the children who are watching our interaction with keen interest, I ask them if they know how ORS is made and when to take it, they eagerly nod their heads while the bold ones muster a “Yes”.

Sajida, one of the literacy coordinators who are supervising the current campaign and training the trainers, adds, “They have even told their men all the things we tell them about hygiene and handling of diarrhoea cases.”

The people of this hamlet are all Hindus, Meghwar by cast and haris by profession. The nearest hospital is in Mirpurkhas, about a distance of 10 kilometres and in the past they had to rush there when the diarrhoea patients got very serious. As without vehicular transport this option is not easy to undertake, sometimes it leads to such a dehydrated state of the patient that a precious life is lost.

In Pakistan infant mortality and under-five mortality rates are 79 and 99 per thousand live births respectively, according to the report State of the World Children, Unicef 2007. And among these, 35 per cent of infant deaths are due to diarrhoea or its complications.

The ORS campaign is being conducted in various districts across Pakistan by the National Commission for Human Development (NCHD). Mirpurkhas is a district that is being covered in the second phase of the programme, other districts in Sindh include Thatta, Badin, Dadu, Khairpur, Sukkur and Larkana.

First a basic demographic profile of the district is prepared, followed by selection and training of master trainers, trainers and volunteers, and finally the training of women. Women are trained in groups and there are three rounds of ORS training in each district, meaning that each woman is trained thrice. During the training each woman is given a coloured chart that carries all the required information about ORS and diarrhoea management. This is the second round of training in Mirpurkhas District.

“Diarrhoea is a disease where effective and affordable prevention and control exist, and mortality can easily be prevented by creating awareness about its management,” asserts Allah Nawaz Samoo, the District General Manager, NCHD.

“The management is not costly because basically replacement of liquid in the body is timely needed, and a dose of homemade ORS for one day costs about Rs2.50. However, the sad part is that most people in the rural areas have no access to packaged ORS and do not know how to make it. Thus a lot of cases become complicated and by the time the patients reach the hospital, they are in the last stage of dehydration.”

Sammo also reveals that while there is no gender difference in terms of susceptibility to diarrhoea, there is a marked different in the attention that is given to male and female children.

“Girls, particularly under five, are considered a burden. A poor man will spare money to buy ten cigarettes but he will not spare it for the treatment of his little daughter. So health and education of girls in the rural setup hold no priority for the family. A visit to the nearest hospital, which is likely to be miles away, can lead to an expense of a few hundred rupees that a poor can barely afford, or is reluctant to spend on a girl-child,” he explains.

Ghulam Hussain Khwaja, the media coordinator of NCHD, Sindh, informs that the ORS campaign is not in isolation but connected to the NCHD’s adult literacy programme focusing on girls and women.

“The women who attend our adult literacy programme are also given the ORS training. We select the trainers from among them because these people tend to be more comfortable and communicative with them. The rural woman is very eager to improve her condition and that of her family. Learning basic literary skills like writing their name, reading, doing simple calculations and leaning about health and hygiene makes them feel empowered,” he informs.

As more rain is going to follow this season, and safe drinking water and hygienic conditions are not easy to find in rural Pakistan, or even urban areas for that matter, diarrhoeal cases are not easy to eliminate all together. But with the knowledge of oral rehydration therapy, these women, and many across different districts, are well-prepared to manage this aliment.