The final report of the research
by the Afghan refugees support advance troop
of the Japanese Pharmacists

February 15, 2002

Afghan refugee support advance troop of the Japanese Pharmacists
The Ordinary Members of Japan Pharmaceutical Association

Yozo Machida
Fumihiko Takemasa
Masaru Sakamoto

Proposals

1. Systematical examination and improvement of drinking well water and temporary urgent tactic tanks in the refugee camps in Pakistan are urgent businesses.

2. We need to give medicaments which target children, women and elderly people.
And we could see several defects of dispensary equipment of the refugee camps in functions and sanitary sides.
We thought up improvements of dispensary equipment immediately at the spot.
We would like to propose that the easy dispensary units(opens for necessary) should be considered.

3. There are necessities to prepare hygiene surroundings equipment in the refugee camps and medical facilities and hygiene education for the staff.

4. They need to check health and improve hygiene customs of refugee support staff, especially for those who are concerned to health hygiene related business.

5. There is big significance to line up Japanese generic products for the Essential Drugs which are used in the refugee camps.
We have to start examination with English notes of labeling and instructions.

6. Japanese nutrition controlled food (solid type) are possible to cook half and they have the same level of ingredients to Italian CRICH.
We should consider encouraging them to adopt Japanese nutrition food to the item list of WFP for refugee emergency food.

7. We think it is necessary to monitor continuously that the local situation will be estimated scientifically and externally in order to contribute to improvement of refugees' life after the above-mentioned items have been done.

We think there are much possibilities for Japanese pharmacists who have the talent to make a contribution to the above-mentioned duties, and we request them to start real examination. At that time, we propose that pharmacists associations which are the member nations of FIP should join the project.

Consideration
Why we reached those proposals.

Consideration 1

We did easy water tests with random sampling in the refugee camps and we found drinking water in several wells which was not to be suited comparing with the standard of UNHCR urgent means(Japanese version, pp240-241). And moreover it seems that there is no staff member who does the water test and secures the quality of water regularly and irregularly.
To prevent diarrhea, dysentery and hepatitis caused by infections of bacteria polluted drinking water, we reached the conclusion that improvement of well drinking water is the most important task which should be given priority. >>> proposal 1
c.f. for detailed data, refer to 'Report of water investigation in Afghan refugee camps'

Consideration 2

Most of the inhabitants who have standard medical exams are children, women and elderly people.
The female life expectancy is estimated 47 years old and men's is 43 years old in Afghanistan.
The shortage of medicaments is indisputable and especially camps where new refugees were sent have serious problems.
We could see UNISEF gave actual things in kind to local medical staff and there are difficulties of proportion such as a shortage in syrup for children.
Therefore we came to the proposal that we should take measures to meet the stable supply of the Essential Drugs which are corresponded to demand.
And the local dispensary in tents is the place that has only a table and chair. They prepare medicine with pill counting by hands in raising clouds of dust and that is the present condition.
We had the conclusion that we need to take fundamental reform measures in 1. pollution prevention of medicine 2. efficient preparation 3. theft prevention 4. check medicaments shelf life 5. quality control of medicine 6. control to patients' information which pharmacists have got. >>> proposal 2

Consideration 3

The floors of the medical tents in the refugee camps are not lifted up (actually they are dirt floors) to prevent rainwater from streaming.
It is the present condition that patients and medical staff themselves do not have the custom of disinfection such as washing their hands and even the disinfecting equipment is in need.
When we classified morbidity in the refugee camps, now there are mostly infections, mainly respiratory infection [e. q. pneumonia], secondly gastrointestinal diseases [e. q. diarrhea], still more we need the repletion of medical unit disinfecting equipment and education of hygienic notion for staff and refugees. >>>proposal 3 and 4

Consideration 4

The medicaments used in medical tents were generic drugs labeled IDA(Dutch). The medicaments served by Japanese AMDA were the only Japanese products.
They used Non-Essential drugs which didn't attach English instruction, too.
Japanese products are of good quality, but the law rate of use for generic products is a theme for the Japanese pharmaceutical system.
If Japanese products can join the international supply system in refugee support, the evaluation of Japan will be raised and that will also contribute to promotion of the generic drugs manufacturing industry in Japan. >>> proposal 5

Consideration 5

We took nutrition controlled food with us from Japan. And when we showed that to local staff of UNHCR and WFP, they had a great interest.
Now Italian CRICH (like cracker) is introduced as emergency food. The biscuit contains 450kcal, protein 12g, carbohydrate 65g and fat 15g per 100g.
Japanese products have qualities that are not at all inferior to CRICH in taste and possibility of cooking. We should try to request for UNHCR and WFP. >>> proposal 6

c. f.
Nutrition controlled food made by a certain Japanese manufacturer is 450kcal, contains protein 10.75g, carbohydrate 61.25g, and fat 28g per 100g. Local Pakistan and Afghan people use a lot of oil for cooking(supply of vegetable oil to refugees is 5 liter per one week for one family.)
It may be healthy to introduce products which have less fat.

Consideration 6

It is obvious that improvement and betterment of refugees' life can not be achieved by casual ideas or one-time support.
Therefore, we should support and monitor continually, and make a recommendation for people who have responsibilities. >>> proposal 7

Concluding Remarks

2002 years. In Japan the rate of separation of dispensary from medical practice is close to 50%. The nation are wondering about the meaning of existence of Japanese pharmacists. The strict critical eyes are growing strong.
If our hearts are taken by protecting past result and we continue a self-defensive attitude from beginning to end, Japanese pharmacists' future will be gloomy. If the Japanese pharmaceutical system grows such pharmacists, it should have to be worried that it will fall into instability and unsuitable situation for a developed country.

This time, we investigated Afghan refugee camps which are dotted in the Islamic Republic of Pakistan from the view point of refugee support, we came up with several proposals in which Japanese pharmacists can make a contribution.
Besides the proposals have the meaning of collaboration with pharmacists all over the world.
Although our proposals are from the view point of international support, they also require the Japanese pharmaceutical system should be reformed and will have the nation know the new role of pharmacists in the 21st century.

If not only Japanese pharmacists show their inｔerest naturally but also health care professionals and administrative officers show their interest widely, to our proposals and considerations, and it develops into a constructive argument, the mission of the advance troop will be achieved sufficiently this time.
What is more, it is what we, who investigated with preparedness for risk, do hope that somehow reaction programs will be organized based on our proposals.

Acknowledgements

If you close your eyes to the past, you'll be blind to the present time at all・・・・ Richard von WEIZSACKER, the former president of GermanyHow much freedom do you give up for security and safety? And if you give up too much, do you in the end have security and safety? ・・・・ United Nations Secretary-General Kofi Annan

INTERNATIONAL PEACE ACADEMY SEMINAR ON 'THE RESPONSIBILITY TO PROTECT' 15 February 2002

I would like to introduce to those people who read this report.
That is that the UNHCR staff gave us over all supports to our investigations.
There is no doubt that we, Afghan refugee support advance troop of the Japanese pharmacists, couldn't have achieved our investigations safely without their sincere and devoted support.
And if our proposals and reports of investigations would make a form in some how, that is also thank to Mr.Yusaku Hanyu and the UNHCR local staff.

And when entering Pakistan and making a contact with the local embassy, the certificate which had been received from Mr.Saya, president of Japan Pharmaceutical Association was a great help. I would like to express my thanks to him again.

In this report we express our opinions severely about refugee camps' hygiene surroundings from the position of pharmacists. But they are not to blame UNHCR, each NGO or government persons concerned for their attention.
Those expressions came from our hope that not only the living environment of Afghan refugees but that of the nation of Afghanistan will be improved and that they can live healthy life.
We reported openly based on a faith that actually UNHCR would want us to lead those results.

Once we express our proposals, we should take some actions in the position of Japanese pharmacists. And the chance has arrived.

We human beings are creatures who have the destiny, learn something from the past and act for the future. It is the fact that we make some sacrifices to achieve a purpose.

And Chapter of the United Nations says " promote social progress and better standards of life in larger freedom" , now is the time to spare no pains for keeping efforts.
We would like to express our gratitude to all the people who cooperated in the Afghan refugee camps investigations again and we would like to promise to act together for "Better than yesterday".

Afghan refugee support advance troop of the Japanese Pharmacists
Commander Yozo Machida

Purpose of investigation

The purpose of this voyage is to have tests of the following items about the degree to which Japanese pharmacists can cooperate with Afghan refugee camps which are dotted in Pakistan and do a little bit support activities.

1. OTC drugs and medicaments (and imitation or counterfeit) which came via complicated routes and process from many foreign countries. Condition of marketing (mainly bazaars)

�@ Effect indications of the above medicaments. Untrue advertisement. Shelf condition of medicaments. Coming routes.
�A Present condition of sales people and sales institution equipment.

2. Well water and condition of water which is called drinking water on the market.

3. Disposal of excrement and so on. Health hygiene several problems

4. Uproar of malnutrition of refugees which streets make a fuss about

5. Characteristics of dotted tribes

6. Joint to WHO, FIP and the state of contact.

Members

Yozo Machida (Commander)
Fumihiko Takemasa
Masaru Sakamoto
Toyoichi Shikanai (The Non Ordinary of Japan Pharmaceutical Association)

Investigating period

From 18/January/2002 to 31/January/2002

Cooperation

The Japan Pharmaceutical Association
United Nations High Commissioner For Refugees (UNHCR)
Yusaku Hanyu ( Chief of UNHCR Afghan representative Islamabad connect post )
Takeshi Moriyama (UNHCR Senior Program Officer)
Hironobu Kubota (Free Photographer)

Investigation Areas

Islamic Republic of Pakistan

Roles

Daily Schedule

1. Rising, washing face and preparation
2. Breakfast(a meeting about the day's schedule)
3. Morning meeting, roll call and departure
4. Investigation, check and support on the schedule
5. Lunch(Reflection of actions taken in the morning and confirmation of the schedule in the afternoon)
6. Investigation, check and support on the schedule
7. Check how much time is left to sunset
8. Withdrawal, check and report
9. Dinner(Reflection of the day and a meeting about the next day's plan)
11. Free time(sorting out records)
12. Sleeping

Reminds for behavior

1. Be in behavior not to against culture, customs of Pakistan or Afghan refugees.

2. Don't exaggerate cultures of mother country.

3. First think for independence of refugees.

4. To be suspected by refugees that we do some investigation is out of the question. We should feel dangerous.

5. It is prohibited at all to test at the spot when we collect well water. We should do confirmation tests when we return to the hotel.

6. We should be aware of not causing accidents for wrong use and that we should hand medicaments to local staff carefully.

7. We should take well consultation with local staff and consider the best way.

8. As regards the action in the area, we should adapt ourselves to the rules of climbing the mountain.
That is 「not overwork, not in hurry, be secure」
For attacking the top of mountain (investigation in the area), we should not cause the danger for human life.

Results

Progress and collected contents (in order of the schedule)

19/Jan/2002 (sat)
[Outline of briefing from Mr. Yusaku Hanyu, who is the chief of UNHCR Afghan representative Islamabad connect post]
First of all, he gave us an outline of Afghan short history. We had an explanation of its old history, early modern history and modern history.
To begin with in 1979 Afghan was attacked by the Soviet Union and that occurred over 6,000,000 refugees. That is the beginning of this issue.
After the Soviet Union left, the puppet Communist political power of Afghan collapsed in 1988, and after that a civil war occurred in 1992.
Mental movement by students of the Madrassa( Theological college) burst out. That is what is called Tariban. But their political power doesn't have justice, and only 3 countries, which were Saudi Arabia, Iraq and Pakistan, recognized it as a legal government.
UNHCR Afghan representative section has 700 million yen for estimation last per year. And sometimes they were lacking in an office maintenance fee, but nowadays the situation has improved pretty much.
Can you imaging how ------ the Afghanistan economy force is ? In 1999 statistics showed that they cultivated 4,700t poppy R annually. However one piece of cake is sold for 60 dollars and if we estimate that there is a population of 22,000,000 people, 4,700t times 1,000kg times 60 dollars divided by 22,000,000 is 12 dollars and you can understand that can't afford their lives. They depend on financial supports from Arabian countries.
UNHCR prepared the representative section for Afghan refugees in Pakistan. After that to support refugees' repatriation they opened the UNHCR Afghanistan Office in Kabul of Afghanistan. The civil war occurred after that, and UNHCR Afghanistan was moved from Kabul to Islamabad and the situation that there were two offices of UNHCR in Pakistan happened for a while. But in Sept, 2001, they resumed an office in Kabul and the office in Islamabad became a liaison office.
There are three methods of refugee support.
1 Local integration
2 Resettlement(1000-some millions people)
3 Repatriation
One of the targets which UNHCR holds up is to remove the barrier which prevents repatriation.

When the first task has been done, they try to hand over that to the United Develop Project, and they ask WFP to make a contribution of wheal for a few months to promote refugees' repatriation.

20/Jan/2002(sun)
[Outline of Peshawar Suburbs]
People were thronged to Sunday fairs and we were choked with crowds and the glitter of bill boards reminded us of the 1960's. In this country, we can buy driver's licenses in cash and most people learn driving after they have got their license. One who honks a horn first and makes a way will win. Strange to say but it is difficult to find accidents. Suzuki as cabs run over in both sides of cars, showing bright body decorations and Rikisha as auto three wheel cars bustle around in half way.
On the other hand wagons drawn by donkeys or horses are carrying baggage and people with the feel at ease. Gas stations (30 rupees per one liter).
GT road that connects Islamabad to Peshawar has a very old origin and that goes back to B. C. 4,000 years. And it flourished around B.C.300 The base of the road is said to have been constructed in the era of Alexander the Great and Ashoka．

[Outline of drug store streets of Peshawar]
The first pharmacy which we stepped in was a 'Pharmacy in front' that stood in front of a hospital which was one of three hospitals in the city. There were some pharmacists. They responded neatly. Outpatients and inpatients handed the pharmacists prescriptions and picked up medicine which had been prepared here. They had injections and patients were given an injection at hospital.
Refugee support needs a great amount of medicaments. The pharmacists said that they didn't have any problem such as a poor sale however much support was introduced.
The second pharmacy was run by an only 23-year-old pharmacist who had inherited it from great-grandfather. It seemed that he was feeling unpleasant about the existence of pharmacies which sold medicine irresponsibly. They have to study for 2 years to become a pharmacist (later we confirmed that to Quetta general hospital pharmacists and they said they had a 4 years education system) and there are national exams, too.
Most superior students study abroad and few return. Because of poor rewards.

[Outline of Pakistan doctor]
The contents below are information from a local guide.
-In Pakistan to become a doctor they have 7 years university education and graduate. Doctors, especially national hospital employees, get poor rewards because there isn't a universal national health insurance system and people's living standard is low. Many employed doctors own their clinics separately and they make up another rewards. And doctors of national hospitals write a prescription with expensive brand medicine.-
(There in no fact support.)

21 / Jan/2002 (Mon)
[Outline of briefing at UNHCR Peshawar branch office]
Mr.HERRMANN, Roy L who is the director of the bureau was absent and his substitute was in charge. Mr.Shahmaz Parveen a nurse and UNHCR assistant program officer, took us to the WFP logistic area.
Exclusive trucks were lined up in good order and most of them were Japanese Hino automobiles.
They were printed in white and the characters of 'WFP' in blue were on them.
In warehouses, the large amount of food such as wheat and non-food materials were stocked. Trucks are the lifeline of transportation and car parts were set by perfectly. We could find even bonnets. We asked Ms.Shamaz what the biggest problem of refugee medicaments was. She answered that it was a shortage of overwhelming amount of medicaments. She would be thankful if there was a pharmacist, but there had not been a chance to work together. She replied that it would be a good idea that pharmacists who have education in Japan can work in Pakistan. In refugee camps, the knowledge of medicaments use is not enough.

[Outline of briefing from Ms.Asako Okai Embassy of Japan Head of Economic and Development Section]

To grasp the condition of Afghan refugees, they united medical investigation team last year and they investigated in ten days. And the results were reported as 「medical investigation team reports for suffered refugees (2001.Dec)」

Japan embassy interpreted that the basic health care unit is enough for medical treatment and they have been planning focus on about the support for district hospital arrangements.

They will arrange the progress from today and to exam the attendant from now on; they called together concerned people and NGO representative. They would open human development session forum.

There are transfer from the Ministry of Agriculture, Forestry and Fisheries, the former Ministry of Posts and Telecommunications and the Ministry of Economy, Trade and Industry　in Japan embassy staff, but there isn't transfer from the ministry of Health, Labor and Welfare. They ask for dispatch to Japan government based on reports of investigation team, and they will be welcomed because it is very busy in present time. Especially for highly ability of coordinate.

[Outline of Rajah Bazaar drugstore streets investigation in Islamabad suburbs]
The shopping street was mixed up and we had a try at buying in 2 drugstores, one place, the shopkeeper could speak English and had the knowledge of law exactly. Without diagnosis, they can't sell western medicines. They also need prescription. And the other, the shopkeeper sells with answering the phone. He sold us anti-biotic without prescription.

22/Jan/2002(Tue)
[Outline of Kotki refugees camps investigation]
The road was one paved road. We can see villages sometimes. That is the group which was just surrounded by sand wall. People are watching us very interestingly. The scenery is just like the mountain village of Japan Tohoku area long ago. They may live on cultivation of few fields.
We could find the winding flock of white tents on the left hand a long way when we passed two big dried up river.
There is the Kotki Afghan refugees camps which is our destination.
We were in amazement for overwhelming majority of tents that we couldn't predict from TV or newspapers.
At there, medical unit staff welcomed us. Maybe there are 13,000 refugees and they consult in two medical units and the patients who were given up in despair send to Peshawar Hospital. Most diseases are infections. Next are skin diseases, gastrointestinal problems (such as diarrhea). There are tuberculosis patients.
The consultation tickets and medical records (c.f.data) are made in family unit. Patients came to the tents where the doctor is in with tickets. The doctor may write prescription in need. Patient will take the prescription to neighbor tent of pharmacy. In pharmacy they prepare the medicines and hand to the patient. That is just regular separation of dispensary from medical practice. They said the medicines are enough but we don't know the truth. We couldn't confirm the sort of medicines, but several bottled syrups were lined up on the table and they hand the syrup by hole.
Tablets are counting by hands from bottle and gather into plastic bag which has zipper and they write name of medicine and dose on it. Patient's name shouldn't write on bags. They write by hands.
In Pharmacy tent, there were lockers of medicaments and special UNHCR staffs take in charge of supply, but they aren't pharmacists.
When we had a look, we were anxious about the hygiene of consult tent. The floor was sand.
There is washbowl of disinfection in entrance but that seems not to be used. There is no place to wash for consulting doctor and just refrigerator was in it. I should pay attention to the words that the concerned people said that. There aren't equipments for injections, treatment and operation, so there is no need to sterilize of room.
From words that UNHCR staff said that are in trouble that medical attendant themselves have poor hygiene ideas.
Toilets are pit type. Basically it is used by one household, but toilets are not enough and they use public lavatory by 10 household.

[Outlines of NHK satellite broadcast in Hotel Pearl Continental]
The News 10 which is the TV programs of NHK reported thing of Afghan revival support conference which was held in Tokyo for 20 minutes.
Over 4.5 billion dollars. It was decided that over 600 billion yen support funds were contributed from 83 countries. Mr. Karzai , the chairman of the Afghan interim government showed satisfaction and said this all funds would be used for standard funds to Afghanistan revival. They would try to gather all arms which got scattered and lost and organize the united national army as soon as possible and re-employ before soldiers as national soldiers and policeman. He recognized that guarantee of peace is the key to promote support from each countries smoothly.
Later on, monitoring and controlling business interior will take a big role to use their support funds surely.
Japan Ogata special representative announced most important thing is that every support countries shouldn't leave from Afghan since now.
And she showed her philosophy that time and persistence will tell the good condition.

[Coffee break]
In this country they dive to make their ways with honking a horn and push others a side. They took no account of distance of cars and get ahead no and on. But we realized one point. Yes, there is no traffic jam in spite of majority of cars and wagons. We had clear reason. There is no traffic light in intersections. If there is the light was off. Sometime the traffic police did some regulate traffic. We made a big discovery.

23/Jan/2002
[Outline of Jalozai camp visit where stands south east of Peshawar]
On the way to camps we saw about ten buses that transported refugees.
That camp wasn't admitted officially by Pakistan government. They try to transported refugees to Kotki refugees camps. To live in order those transportation is necessary.
The road which connect to New Jalozai was surrounded by sand wall and narrow and rough road that only one car can pass through.
We drove about 1 km and we could see refugee's tent which lined disorder.
Suddenly our car was surrounded by 300~400 crowd of people and we cannot move in inch. They thought our baggage which was carrying on the roof, as support goods and close to us. And more filming by accompany Japanese TV cameraman stimulate their irritated emotion. We were stopped by local policeman who were in guard and took us to control place.
He asked some questions and solved the mis-understandings. We were released at last.
[Outline of WHO afghan office briefing in Islamabad]
The person in charge of region office in Cairo attended to us. He once visited Japan and worked with JICA staffs. He knows Mr. Peter Kielgast, FIP president and Ton Hoek ,General Secretary each other.
We reported hygiene control condition of Kotki refugees camps that we examined and he seemed seriously and admired that hygiene education are not going out thoroughly. WHO can supervise and advise to government but they cannot intervene directly. He demanded us any good ideas.
WHO says that they opened workshop for technical betterness but that is not seems to throughout. He knows well about joint forum of WHO and FIP. The forum that was programmed this month was postponed. We didn't ask for reason.

24/Jan/2002(thu)
[Outline of UNHCR Quetta sub-office briefing]
We had easy explanation about position connection to refugees camps around Quetta and inflow condition of refugees. After that we did pretest for one hour to grasp the out line of local place that we will visit next day. Sun will set around 5:30 to 6:00 pm, and after that it will be dangerous so we got a strict order that we should do field investigation in local till sunset.

-We offered actual things to Japanese who do the support activities in this area and gave her standard directions for use. While we explained two refugees camps to office with prescription and asked for those medicines. We realized fully of economic poverty even if they got prescriptions.

26/Jan/2002(sat)
[Outline of investigation Chaman camp that neighbor to Afghanistan]
We visited clinic of borderless Medicins san Frontiers. Staffs are doctors, pharmacists, and others.
Essential drugs were used which come from IDA in Holland.
They gather tablets in plastic bags which have zippers and hand in with pill counting. Our simple question is whether they could clean preparation in tent where a cloud of dust will raise.
If there is portable preparation table, they can control of contamination, storage, and supplement rationally.
Roghani Refugees camp
We collected water from supply tank for washing teacups.

28/Jan/2002(man)
[Outline of Muhammed Kheil refugees camps investigation]
This camp was used for refugees who refuged from attacking of Soviet Union and made up sand wall. The camp has capacity of 100,000 people. Now 42,000 people are living in. After that population was decreased gradually for repatriation.
But in this area the population is increasing again for bombing by American army this time.
The construction of population is 9% for old refugees, 91% for new refugees. There are some old refugees who got the handicaps and they can't go back to homeland if they want to.
To get on well with new refugees and old refugees , families or relatives will mediate between those refugees. Registration Point has terrific aspect, that every 500 families were relocated by bus each day.
The household goods were carried by trucks (one truck for 20 families) after them. We just wondered how to discriminate their stuffs. (The way was identified in Jan 29)
There are 460 shallow well but only 4 wells are useful. Others were dried up or recover for prevent from danger.

[The situation of OPD (Out Patient Department)]
There is shortage of antibiotics such as ampicillin or amoxicillin in clinics of camps. They spend stock of three months for one month and half.

In regulation, doctor's duty hours are from 8 to 16. But actually they leave at 14 and after that there is no consulting. Doctors commute from house in the camps
BHU : Basic Health Unit is established one each for 10,000 refugees. Doctors, nurses and PT are attached.
The flow chart of refugees receive is below.
�@ Refugees will gather in Departure point → �A Temporary registration of refugees → �B Transfer to camp by bus → �C Do the refugee registration work → �D Health screening for mainly children (AMDA was in charge at this camp) → �E Vaccination to children who need preventive in inoculation → �F Distribute one set of tent, blanket, heater, pot, kerosene, coal, salt, cloth. (Islamatic Relief; Birmingham that is the head office in England was supported at this camp)

[Medical support and medicaments of AMDA]
When AMDA will do the medical support at refugees camps, they will make a contract with UNHCR. Cost will be provided by contribution from private or enterprise. The support to this camp will be Sept. Medicaments will be provided by beforehand and contribution from UNICEF, this time. Children medicines which were offered are all tablets and syrups are in shortage. They are trouble because local provide is expensive.
And AMDA carried in medicaments from Japan, that are Nichiiko products and provided by Japanese cooperate doctors this time. They are diclofenac sodium, zopiclone and iron pills. Those products were carried without connection to Essential drugs.
We had impression that nurses were in trouble that those products are not familiar to them and the lack of products information.
In this camp three doctors (two for male, one for female) nurses, project coordinator are working. Doctors were employed in local.
Japanese staff Ms. Kudo is working as a nurse and she also has qualification for clinical laboratory technologist。
She doses training to test task local technician in Quetta. Those works are volunteer that are almost free of charge.
Japanese project coordinator Mr.Yamagami is engineer for infrastructure arranges or works training. He worked in Myanmar before and this time, he applied for dispatch of AMDA and adapted.

[Repatriation promote methods for refugees]
1. Repatriation in groups. First take a contact with an elder of tribe and he asked the refugees for condition to repatriate in family unit UNHCR will do the field test based on it. With that resolution, they propose the definite plans and repatriate in 100 people unit.
2. Matching list method. If the birthplace of husband and wife and the place where they want to go those family. That method was succeeding in Myanmar.

Problems
1. How to carry supply goods that are 100kg per each family, to their living place smoothly.
2. Kerosene is difficult to control wick of heater will be burnt. Is there any good idea to use coal better?

29/Jan/2002(tue)
At 8:00a.m. We investigated the Departure point of Ghousabad and Pantifty .
Here the place where Afghan refugees who lived with relatives would say good-bye and move to official refugees camps by family unit.
Is this day mainly for Tadzhik people, 201 families that move to Ratifabad refugees camps en Ghousabad and 120 families were gathered in Pantifty
The liaison of gather time and place were doing by handing in invitation that has photo of face.
They load baggages into trucks and they recognizer them for bags that name on it.
All buses for refugees and trucks for house hold goods were hired by UNHCR that make a contact with transfer cooperation (here is Al-yousaf coach c/o) Of course UNHCR pay the cost and transfer is 4,500Rs per bus or truck. The general fee is 13,000Rs, so you'll see how much the discount price.
After they took refugees to camps they should return by air plane, but some driver earn extra money to take passengers to city in charge of 30~60Rs each passenger.
Don't over look of such injustice is the work to UNHCR field officer, too.
In March the internal auditor will visit to investigate whether the condition of refugees transport is held fair. After that the external auditor will visit.
We explained the results of well water tests that we did the day before. We detected colon bacteria and he was very interested in detecting of NO2-N.

C.f 　Add　materials for official reports of investigation.

Attached Whether pharmacists can contribute to public health promotion?