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