THALASEMMIA, HEMOPHILIA & BLOOD CANCER AT HAMZA FOUNDATION PESHAWAR FIELD WORK REPORT BY FAKHRE ALAM...

8/10/2019 THALASEMMIA, HEMOPHILIA & BLOOD CANCER AT HAMZA FOUNDATION PESHAWAR FIELD WORK REPORT BY FAKHR

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Field Work Report Hamza Foundation

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Institute of Social Work, Sociology and Gender Studies

Field Work Report On

THALASEMMIA, HEMOPHILIA & BLOOD CANCER AT HAMZA

FOUNDATION PESHAWAR

Submitted by

Fakhre Alam

B.S Social Work

5th Semester

Roll Number 09

Submitted to

Sir Faiq Sajjad Sir Dr. Tariq

Lecturer in ISSG Medical Director Hamza

University of Peshawar Foundation Peshawar

INSTITUTE OF SOCIAL WORK, SOCIOLOGY ANDGENDER STUDIES

UNIVERSITY OF PESHAWAR


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HAMZA FOUNDATION

Origin of the Name

Hamza Foundation name has a very interesting story. Hamza is the son of Mr. Ijaz Ali Khan

(chairman of Hamza foundation Peshawar).Hamza was born on World Thalassemia Day which

is 8 of May, thats why this name was suggested.

Hamza Foundation started its services from July 2006. Main office is situated in Peshawar

Khushal Khan Khattak Road, Old Bara Road University Town Peshawar. Hamza Foundation

building is a non-governmental organization and it gives the rent of its building. Hamza

foundation supply blood to different hospitals of KP. There are 27 to 28 hospitals in which the

blood is supplied free of cost. There are three ambulances in Hamza foundation one is for staff

member other is for blood camps and third is for other needs of Hamza foundation.

Introduction to Hamza Foundation

Hamza Foundation Welfare Hospital and Blood Services is a charitable organization, runs

through public Charity, Zakat, Sadaqat, Qurbani Hides and Donations of kind hearted people of

the society. The health department is providing annual Grant-in-Aid of Rs: 15, 00,000/-, which is

the expenses of hardly 2 months. The organization is registered with Social Welfare Department,

Health Regulatory Authority (HRA) and SAFRON-Government of Pakistan. Hamza Foundation

transfuses healthy and fully screened Blood/Products, according to WHO required standard,

screened for Hepatitis "B", "C", HIV/AIDS, VDRL and MP, on Elisa computerized equipment.

Hamza Foundation is playing a vital role in the society by providing its free services to the ailing


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humanity; therefore the organization is a "HOPE OF LIFE" for deserving and poor patients of

the society. There is no permanent source of income of the organization, except public Charity.

The monthly expense of the organization according to present number of patients is Rs: 6 to 7

lakhs. These expenses are increasing day by day with the new registration of new diagnosed

Patients.

Goal

Our goal is to create awareness of Thalassemia, the most common single gene disorder

worldwide, to aid the prevention of its occurrence amongst high-risk communities, and to help

advance medical research dedicated towards finding an effective cure and safe treatment of this

illness.

Founder/ Chairman

Mr. Ijaz Ali Khan is The Chairman and Founder of Hamza Foundation. He is also the Executive

member of Thalassemia Federation of Pakistan.1

1http://www.hamzafoundationhosp.org/joomla/


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Process of Registration

Majority those patients are registered who belong to poor family. Registration is two types. One

is referral and other is for fresh. Following is the procedure of registration.

The first step is Zakkat form and diagnostic test .Then three photocopies of patient and father

CNIC is necessary. Agreement related to treatment is also important in registration from parents.

Pre natal diagnoses then register then make a card for patient.


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Services and Facilities

There are two wards in Hamza Foundation. One is for Thalassemia patients and other is for

Hemophilia patients.

An indoor Cartoon service is also available to entertain patients.

Lunch and night service is also available for patient and their close relatives.

Basic medication, Modern laboratories and blood service is also available in Hamza

Foundation.

Free doctor check up services is also a part of Hamza foundation. Doctor deal patient from

10 am to 11 am. Doctor performs their duty 5 days in a weak in Hamza Peshawar and two

days in Haripur.

Following are the some services which are provided by Hamza Foundation.


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Hamza Foundation Staff

S.No Name Designation

1 Ijaz Ali Khan Chairman

2 Aleem Gul PA to Chairman

3 Dr. Tariq Medical Director

4 Sajjad Haider Medical Officer

5 Javeed Iqbal Laboratory Technician

6 Shiraz Laboratory assistant

7 Ibrar-Ul-Jan Blood Team Incharge

8 Atiq-u-Rehman PRO(Public Relation Officer)

9 Atif-ur-Rehman Staff Member

10 Allem Gul Reception

11 Umar Javeed Accountant

12 M.Shiraz Awan IT Manager

13 M. Faqeer Khan Medical Technician

14 Mr. Imran Blood Technician

15 Senior nurse Miss Lailoma

16 Male Nurse Sadam Khan

17 Data entry Operator Tariq Saeed

18 Senior Driver Mubarak Ali

19 Assistant Driver M. Yaseen

20 Senior Cook ShahidUllah

21 Assistant Cook Akbar Said

22 Sweeper M. Nazeer Maseh


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Structure of Hamza Foundation By Designation Wise

Structure in Picture Literature

Reception

Chairman

Medical

Director

Medical

OfficerNurse

Other

Staff


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Data and Entry Operator

Laboratory

Account Office


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Wards

Canteen and Ambulance Services


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What is Thalassemia?

Thalassemia is derived from two words thalassa which mean the sea and haima which mean

blood.

Thalassemia is a group of genetic blood diseases that vary widely in severity involving decreased

and defective production of hemoglobin, a molecule that's found inside all red blood cells and is

necessary to transport oxygen throughout the body.2

Hemoglobin is the oxygen-carrying component of the red blood cells. It consists of two different

proteins, an alpha and a beta. If the body doesnt produce enough of either of these two proteins,

the red blood cells do not form properly and cannot carry sufficient oxygen. The result is anemia

that begins in early childhood and lasts throughout life3

Signs of Thalassemia

Following are the signs of Thalassemia

(1) Pale discolor of the skin

(2) Irritable

(3) Weakness

(4)

Not eat food etc

(5) Chest infection

(6) GIT(Gastro infection track)

2http://www.utoronto.ca/kids/Thalassemia.htm

3http://www.thalassemia.org/learn-about-thalassemia/about-thalassemia/


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Test of Thalassemia

There are three tests of Thalassemia available

(1)

Prirpel Smire

(2)

HB Test

(3) DNA

Prirpel Smire

It is a complete blood picture of patient. All elements of blood are shown in this test. E.g. red

blood cell white blood cell

HB Test

It is an electro process of homo globins. There is three types of hemoglobins

(1) Adult homo globins

(2) Pietism homo globins


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(3) Compensative homo globins

DNA

It is the most modern test .it is the test in which patient is first examine by test and laboratorial

investing.

Examination of patient

Look the appearance of patient, skin color age, and abdomen.

History

Information taken from parents that whether the baby is cousin marriage, first case, second case

etc.

Laboratory Investigation

By laboratory investigation of these tests we knew about Thalassemia if present in patient.

Treatment

There are two types of treatment

(1)

Curative treatment(2) Supporting treatment

We will explain both these two in details

(1)

Curative treatment

In this type of treatment disease became totally finished. Bone marrow transplantation process is

used here. Bone marrow transplantation is also called BMT. BMT is like surgery. In this process

patient bone marrow is replaced by healthy bone marrow, In this treatment first selection is

patient brother and sister, which are healthy and matching.5-7 year is favorable age of giving

bone marrow. The duration of this operation is 1 year. There are two of operations. One is called

free of care and other is called post of care. In Pakistan there are three places where this

operation is possible they are following.

(1) PMS Islamabad


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(2) CMH Islamabad

(3) National Institute of Blood Diseases & Bone Marrow Transplantation Karachi

Why not BMT IN Hamza Foundation

There are different reasons but some important are following

(1) 70 % of bone marrow is success.5 %is expiry of Childs. People afraid from 5 %

(2) This operation is very expensive. About 20 to 30 lakhs expenditure come on this

operation. In Pakistan majority of population are poor and 90 percent of patient of Thalassemia

are zakkat abler. So therefore it is not practiced in Pakistan. Another reason is uneducated

patients.

(3) Cross match blood is another problem; also people wanted 100 percent result.

(2) Supporting Treatment

Supporting treatment are three types

(1)

Blood Transfusion

(2)

Iron Chelation

(3)

Viral Screening

What is Blood Transfusion?

Blood transfusion is the process of transferring the healthy blood of donor to patient

(Thalassemia).According to World Health Organization there should be following screening of

bloods

(1)

HBSAG (Hepatitis)

(2)

HCV(Hepatitis C)

(3)

HIV(AID)

(4)

VDRL(Syphilis)

(5)

MP(Malaria Patient)

After these testing when blood is pure, then red blood cell are separated and transferred to

patient.


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Iron Chelation

It is the process in which excess iron is removed from the body. It is basically a therapy. Here a

question rises that why it is removed the answer is that that Iron is also one element of red blood

cell. Iron Chelation also causes heart diseases, bone fraction.

Viral Screening

Viral screening is test of hepatics B and C.

Prevention

Following are some basic steps for prevention of Thalassemia

(1)

Cousin marriages should be discouraged.

(2)

There should be a test of Thalassemia before marriages.

(3) There should be registration of marriages.

(4)

There should be chronic valic semplin test. It is a test type when a baby in feet of mother

is affected by Thalassemia then he/she is wasted. From Islamic point of view it is also correct.

(5) Awareness and education about Thalassemia to community.

Role of Social Worker Regarding Thalassemia

Social Worker can play a very important role to overcome and reduce the blood diseases. there

are certain role which we have performed like interview with client and also tool of awareness

motivations education etc but still some were left like organizing blood camps ,homes visit etc it

is due to shortage of time ,A lot of holidays, lack of required knowledge and also bad situation in

Peshawar. Some main roles are following

By interviewing a patient the social worker find his social conditions which are also a very

important factor in disease. For example if we look to our own society cousin marriage is a

very common and its a big cause of Thalassemia, so awareness is the main tool through

which social worker can play its role.

Social worker can play its role to motivate different type of organization that to work on

Thalassemia.


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Some time the disease is present but the people are not aware about that, for example Pre natal

test etc.

Social worker can educate patient and its parents that what should be done for effective

treatment? And also give awareness before disease in the community.

Blood donation is also very necessary for Thalassemia, Hemophilia and blood cancer .Social

Worker can provide this by organizing blood camps.

In our own field session we did not visit home of patient but its also a very important role of

social worker. Form this patient complete history can be taken which is necessary in

diagnoses and treatment.

Social worker makes the policies, so by their regarding and up to date knowledge they can

make a comprehensive policy which importance cannot be neglected.

As majority of blood diseases patients are poor and cannot afford their treatment service in an

effective way so Social Worker can utilize the resources of community by which poor and

needy patients can be treated.

In short we can say that Social Worker main role in blood diseases is Awareness, Motivation,

Education and counseling.

BLOOD

What is Blood?

Blood is a connecting tissue circulating in the arties, vanillas, veins and capillaries. In normal

human being total blood is from 4-6 liters. When it less it causes the illness and when

increases also causes the disease. Blood colure is red because of hemoglobin figment. Heart

pumps blood to all body .In 1875 different types of blood was recognized. Blood grouping

were discovered by Karl Landsteiner in 1901 and he was an Austrian. There are eight types of

blood in human being. They are A+, A-, B+, B-, AB+, AB-, O+ and O-.there are two types of

blood.

(1) Circular Part

(2) Waterial Part


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(1)Circular part

Circular part consist of three types

(1)

Hetrocytes(RBC)

(2)

Leukocytes(WBC)

(3)

Thrombocytes(platelets)

(2)

Waterial Part

It is composed of plasma 90 % of water and 10% proteins waste product etc. It is 55% of whole

blood and 45 % cellular potion. Our body 8 % weight is blood.ABO system discovered by Karl

Landsteiner.ABO system is the meaning of blood group

FUNCTIONS OF BLOOD

(1)

Heterocyst(RBC)

RBC is responsible for gas exchange. it inn oxygen and out carbon dioxide .blood color red to

hemoglobin .Half life of RBC is 120 days. In Thalassemia after 10-15 days its break down

started.

(2)

Leukocyte(WBC)

Leukocytes consist of Lymphocytes, Monocytes and Gernocyte. Leukocyte provides defense to

the body (Immunity)

(3)

Thrombocyte

Thrombocyte function is to prevent bleeding from the body. Circulation of blood is also another

function of Thrombocyte. Red blood cell can be separated while white blood can be separated

Motivation

The first thing which is very important is that your personality and style should be impressive.

There are a few things which should be kept in mind while denoting blood from the male. They

are following.

(1) Healthy adult can denote blood after three months


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(2) Blood can be denoted from a healthy adult. Healthy adult is from 19-50 years, and should

be free from Hepatics B and C Tuber closes malignancy/Cancer.

(3) Last surgery duration should be two months

(4) Last blood donation is also very important,

For female not only the above points but some extra should also be kept in mind. They are

(1) After 4 months blood can be denoted by a female. Healthy women is that when she has no

mentuscycle, pregnancy and Lactation(feeding women)

After denoting blood 20 minutes rest is very important. In Thalassemia patient as usual the bones

are flat this is due to preserved of nervous system by Aoita

Benefits of Blood

(1)

Reduce obesity/overweight

Weight can be find by a formula BMI (body mass index) .normal weight depend on body

structure

Weight=Height in foot/kg .20 is normal, 23-25 is overweight and 26 or above is obesity

(2) Maintain blood preserve

If blood preserve is not in range blood maintain it in range

(3) Reduce cloistral level

(4)

Reduce extra iron(5) Increase life spin

In Europe by research it has been proved

(6) Early screening

By blood we can also check off ourselves if we have Hepatics B and C HIV AIDS (acquired

immune defiance syndromes)

If we look to Islamic point of view that is also clear that those who served one human being

have served whole humanity


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HEMPOPHILIA

Hemophilia is a conjunctive (inherited) bleeding disorder disease transferred from parents to

offspring especially to mother career.

According to World Federation of Hemophilia in 2012 about 1 in 10,000 people is born with

hemophilia A. About 1 in 50,000 people is born with hemophilia B. Blood contains proteins

called clothing factor work to stop bleeding. There are 13 different types of factors. These are

responsible for blood clothing. Hemophilia is rear disease. In some cases there is low level of

clothing factor or some time absent. The lack of clotting factor causes people with hemophilia to

bleed for longer periods of time than people whose blood factor levels are normal. The main is

bleeding internal. Bleeding in joint is calledintra-articular bleeding.

Classification

There are two types of hemophilia

(1)

Hemophilia A(Classical Hemophilia)

(2)

Hemophilia B(Christmas Hemophilia)

In hemophilia A factor VIII is deficient, and it is common than B. In hemophilia B factor IX is

deficient, and it is 5 % less common than A

Both are caused by low level of proteins (Factor level)

As we have discussed that there are 13 types of clotting factors, and these work with platelets to

help the blood clothing. They are I, II, V, VII, X, XI and XIII.

Signs of Hemophilia

The signs can both be internal and external

Generalize body broses

Bleeding in the large joint elbow and shoulder

Bleeding in the urine(Hemocholia)

Bleeding in the pieces(Malesia)

Bleeding in the brain(Hembreg,strok)


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Diagnosis

First bloods symptoms are taken for measuring level of blood factors. Following are the

screening for hemophilia

CBC(Complete blood count)

PT (Prothrombin Time )

BT (Bleeding Time)

APTT (Activated Partial Thromboplastin Time

Some bleeding can be life rating and very dangerous like in Head, throat, Gut, etc and required

immediate treatment.

Treatment

Both A and B are replacing by the massing clothing factor As we have discussed that

Hemophilia are three type Mild, Moderate, and Severe. Mild and moderate are treated by

replacing plasma and severe is treated by the injection of deficient factor. FFP, CP, CS and

injection factor.FFP stand for fresh frozen plasma, CP stand for cryoprecipitate

BLOOD CANCER

Blood cancer is a form of cancer which effect blood, bone marrow and Lymphatic System.

Lymphatic system is responsible to normalize fluid, in simple it is a defense mechanism. Every

organ can have cancer and can attack every system of human being. There are more than 50

cancers but in general cancer is categorized into following kinds.

1. Leukemia-With spurt in the multiplicity of cancerous cells affecting either the marrow or

the blood; the ability of the circulatory system to produce blood is severely impaired with.

2. Lymphoma- The cancerous formation affecting the lymphocytes is referred to as the

lymphoma. Lymphocytes are one of the varieties of white blood corpuscles.

3. Myeloma- As part of Myeloma, the plasma (another variety of WBC) is affected by the

cancerous formation.


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What is Benign and Malignancy?

Benign

In general language benign is called Tumor. It affects one place in the body. It is Very wellcurable and a very good prognosis rate, if it is pick on time, by surgery itcan be removed. If it is

not treated on time then it changes to malignancy. It takes two to three years

Malignancy

In general language its called cancer. It is curable when it is pick on time. It can be spread

through lymphatic system, blood near about different organ. By blood it can be Spread through

kidney and liver and can also spread also through lampooned.

Stages of blood Cancer

There are four stages of cancer

Stage one

Stage two

Stage three

Stage four

In stage one prognosis rate (after treatment successful rate) is from 80-90, in stage Two

prognosis rate is from 50-60, in stage three prognosis rate is from 40 -50, in Stage four the

prognosis rate is from 5-6 percent.

Symptoms of Blood Cancer

Following are the symptoms of blood cancer

Abdomen pain specially in upper abdomen

Bone or joint bruising

pain in large liver and glands such as spleen and lamp node

Unexplained weight lose

Frequent infection

Frequent urination

Nazia emitting(not emit but deserved)


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Night sweating

Cancer can be conjunctive as well as can be acquired. Both are in equal figure for the causation

cancer. We can say that exist cause is unknown, but still there are some deposing factor like

smoking, several causation (substance which produce cancer like carbon, silicon etc).these things

are related with industry.

Treatment

Several therapies are available for treatment they are following.

Biological therapy is available to attack cancer cell.

Chemo therapy is available to attack cell.

Participation in clinical drawl testing promising treatment for blood cancer.

Radiation therapy to attack cancer cell.

Stem system transplant to provide healthy stem cell that can make healthy cell.

BMT (bone marrow transplantation).

Targeted therapy to attack cancer cell.

Watchful waiting to identify when to start treatment.

ROLE OF SOCIAL WORKER REGARDING BLOOD CANCER

Social worker role is very important to aware and counsels the community. Following are some

role of social worker to reduce cancer from our society.

Social Worker can create awareness to individual

For example if a person progressive weight is lost, Social Worker can advice him that this person

should be refer for doctor.

Social Counseling

Social Worker can aware community as well.

Bone Marrow Donation

Social Worker can denote Bone marrow if the tissue is matching with patient.

Reduce Staff Smoking

Social Worker can play a very important role to reduce staff smoking. For this purpose Social

Worker can conduct seminars, workshops etc.


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Observation

Hamza foundation is in small area; as a result it cannot fulfill the need of large patients. Now

a day the admission of patients are closed. Almost Every day a large number of patients came

but due to no place they are admitted.

The ward is in ground floor which is very good, easy for patient to handle.

The services are limited but cover the basic requirements of patients.

Hamza staff members are very friendly to each other, also to patients and also to students

who perform their field work there.

Now a day the admission of patients is closed, but whenever a client came the staff guide and

refer it to another suitable place.

I personally observed that one doctor is not enough for whole patients. Another thing whichis that Doctor spent 5 days in Peshawar Hamza foundation while 2 days in Haripur, so it is

very difficult to handle.

Communication among staff member is very progressive and nice. All Staff members

Work as team.

There should be a separate room for those students who perform their field work in Hamza

foundation. In office lecture is disturbed when a patient came.

Suggestions

Hamza foundation is a charity organization so government responsibility became greater, but

Also we cannot neglect national and international organizations and also local community to

Fulfill the needs of this foundation. In Light of above sentences I will give some suggestions.

As we discussed that Hamza foundation is in small area so Government should have to

provide an area for Hamza foundation

There is always need of improvement and that improvement is possible when you are

running with modern world. So in Hamza there is need of Laboratory services, modern

medicines and research centers

In Hamza foundation there is no physical indoor games. although Television service is

available but it cannot fulfills the requirements


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Case History 1

Name: Abdul Basit

Father Name: Nasir Muhammad

Address: Gul Bahar Peshawar

Disease: Thalassemia Major

Blood group: A Positive

Registration No: 418

History:

According to his father other children are not affected, and they do not know about Thalassemia.

Professor Dr. Laiquat Ali diagnoses the disease and after that he admitted in Frontier Foundation

Peshawar.


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Case History 2

Patient Name: Hazrat Abu-Bakr

Father Name: Shiraz

Age: 1 Year and 5 month

Residence: District and T/h Nowshera Aman Gar

Registration No: HFTP775

Disease: Beta Thalassemia

Admitting date: 11/3/2013

Blood Group: B Positive

History:

According to his mother there is no cousin marriage and child was also normal till 5 months but

after that he became ill. The patient family did not know anything about Thalassemia. His father

is daily wager belong to poor family. Refer to Hamza by Doctor Rohal Amin(doctor in CMH).

Treatment:

6 Months


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References

Tariq, D. (2013-2014, Sept-Jan 06). Thalasemmia, Hemophellia & Blood Cancer. (F. Alam,

Interviewer)

Greenberg, D. S. (n.d.). kids/Thalassemia .htm.Retrieved January 06,2014, from

www.utoronto.ca:http://www.utoronto.ca/kids/Thalassemia.htm.

earn-about-thalassemia/about-thalassemia/. (n.d.). Retrieved January 06, 2014, from

www.thalassemia.org: http://www.thalassemia.org/learn-about-thalassemia/about-thalassemia.

joomla/index.php. (n.d.). Retrieved Jnauary 06, 2014, from www.hamzafoundationhosp.org:

http://www.hamzafoundationhosp.org/joomla/index.php

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