The Hushé Project by the Sarabastall Foundation, thanks to the collaboration of entities such as Meiji, brings healthcare to the Pakistani village, covering prevention, care, and training.

Hushé Project: 24 years of international healthcare cooperation to bring health and training to Pakistan’s most remote valley 

This project by the Sarabastall Foundation, thanks to the collaboration of entities such as Meiji, brings healthcare to the Pakistani village, covering prevention, care, and training.

The project by Sarabastall Foundation, thanks to the collaboration of entities such as Meiji Pharma Spain, brings healthcare to the Pakistani village, covering prevention, assistance and training. Hushé is the highest village in the valley of the same name. Located in northern Pakistan, its topography makes it a place that is difficult to access. In addition, its proximity to several glaciers means the climate is characterised by freezing temperatures, often several degrees below zero in winter, with snow dominating the valley slopes. 

Despite these challenges, the Sarabastall Foundation carries out an expedition to this area each year, with healthcare provision and training as key objectives. Dr Paula Peña Calvo, anaesthetist and member of the Sarabastall Foundation, was part of the team that travelled to the area this year. “Reaching such a remote and isolated place is always difficult, but overall, we make a positive assessment of this year’s intervention”, she explains. 

The specialist notes that she had not visited the area for several years and observed improvements made during that time, particularly regarding the roads leading to Hushé. Nevertheless, she emphasises that it is not an easy journey. Dr Peña specifies that the group she joined departed from Barcelona, taking a seven-hour flight to Abu Dhabi. From there, they took a similar-length flight to Islamabad, and from the Pakistani capital, a domestic flight to the city of Skardu. There, they collected school and medical supplies to take to Hushé, completing the final part of the journey by car.    

Dr Paula Peña, a member of the project, makes a positive assessment of this year’s intervention despite the difficulties in accessing Hushé.  

Before reaching Hushé, it is necessary to collect certain supplies and medication in Skardu, as weight limitations prevent transporting everything needed from Spain, despite the better availability and quality of some treatments and materials there. “There, we buy certain items that we know are available, although intravenous antibiotics and other specific treatments are transported from Spain”, explains Dr Peña. 

The doctor emphasises that “the condition of the roads and paths has improved considerably, except for the stretch from the penultimate village we have to cross to reach Hushé, which is abandoned; but this year the river level had risen due to increased snowmelt, cutting off the path”.

To navigate this section, the team faced difficulties: “On the way there, we managed to pass, although the water reached above the car wheels, but on the way back, we had to cross on foot with the loads on our backs, as the vehicles could not pass”, recounts Dr Peña. 

Healthcare provision: 400 patients in eight days
The healthcare intervention in the area covers several aspects. From a purely medical standpoint, during the eight days the team was there, around 400 patients were attended to. “We mainly assisted children, and given the high number of gastroenteritis and diarrhoea cases, we performed more than 100 rapid tests to detect intestinal infections; for those testing positive, the test was extended to the whole family, as there are cases where up to 17 people live in the same household”, explains Dr Peña.

Due to the type of work and the climate, there is a high prevalence of osteoarthritis in the area; for this reason, Meiji contributes by donating intra-articular hyaluronic acid, with a proven efficacy of over 12 months, especially useful given the difficult access to Hushé.

In addition to the work in situ, in which the specialist explains that in some cases samples were difficult to collect, the team also took some of these samples back to Spain for PCR analysis; here, the anaesthetist emphasises that this was made possible thanks to the collaboration with an association that funds the reagents.  

One of the peculiarities noted by Dr Peña is that, now that they are awaiting results, “a system has been devised to identify the people from whom the samples were taken, since everyone there has the same name; photographs were taken of the children with their parents or responsible adults alongside the sample number so that, if positive, the correct treatment can be administered”. 

Donation of intra-articular hyaluronic acid for the treatment of osteoarthritis
Another of the most prevalent conditions in the area is osteoarthritis, a consequence of the work carried out by the local inhabitants. The men work as porters; the women, in the fields. Dr Peña highlights that this is compounded by the “extremely cold winter, so we have to administer infiltrations to porters and also to many women, especially in the knees”. 

To carry out these infiltrations, Meiji Pharma Spain contributes by donating intra-articular hyaluronic acid, a treatment indicated to reduce pain and the loss of mobility resulting from degenerative changes in knees and other synovial joints due to osteoarthritis. One of the factors that makes this particularly useful given the difficult access to the area is that intra-articular hyaluronic acid is the only commercially available option with proven efficacy for over 12 months. 

In this regard, Dr Peña notes that “several types of infiltrations were carried out, mainly intra-articular hyaluronic acid in the knees and, in some cases, in the shoulder, with very good results; the following day, some patients came to show how they could already kneel or move their arm, highlighting how quickly they noticed the effect”.  The doctor also explains that during the days they remained in the area, it was not possible to administer all the doses donated by Meiji. “Those doses that could not be used in time were taken to the reference hospital along with other materials we had, to be administered when necessary”, she specifies. 

Prevención y formación sanitaria
As well as the medical aspect, prevention is also a key element in healthcare. “In addition to providing healthcare, we held sessions at the school with the children to encourage tooth and hand washing and to instil other basic hygiene practices”, explains Dr Peña.  

Following this approach, the specialist indicates that specific interventions are also carried out with the women of Hushé. She explains that this year, at their request, the activities were divided into groups of single and married women so that everyone felt comfortable discussing different topics.

Beyond providing the healthcare assistance, the project also carries out hygiene and prevention interventions across different population groups.

Here, Dr Peña highlights the role played by Zubaida, a translator into Balti (a dialect of Urdu, the national language of Pakistan), who was of great help in facilitating communication during the intervention. Also, as part of these actions, the doctor states, “we provided them with soap, which we requested from the pharmacy, and tea tree essence for its antiseptic properties, to support hygiene routines”. 

Training healthcare workers is another key part of the project. For this reason, Dr Peña emphasises that they have worked closely with the figures known as lady health workers and lady health visitors (roughly equivalent to midwives and maternal nurses, respectively), offering training on the interventions they perform most frequently.

Dr Peña also points out that Meiji has donated an ultrasound device for the area, which requires specific knowledge but can be of great utility. “This can be left there for the winter and provides better results; the person who will use it most is the midwife to monitor pregnancies periodically, which will be an improvement since the device they had before was portable and of lower quality”, she states. 

Training is one of the pillars of the project, teaching professionals the basic principles for managing the conditions most prevalent in the area. 

The Sarabastall Foundation team also provided training to a total of 17 healthcare workers from the Hushé valley. Dr Peña explains that this intervention focused on practical training, with these professionals present in the dispensary to be shown the different procedures, and allowing them to carry out the tasks themselves under supervision during the days they remained in the area. They were also given written instructions detailing the recommended dosages for different cases, with doses established by age —a methodology used when weighing patients is not possible— so that it could be useful during the winter months. 

Furthermore, the work carried out by the Sarabastall Foundation in the area also contains an educational component. In this regard, the team brings school supplies, reviews the activities taking place, and promotes initiatives such as play centres with games or sports activities for the children in the area. 

Continuity of the project
After this 2025 expedition, the Sarabastall Foundation has now carried out this initiative for 24 years. With the exception of 2020 due to the pandemic, the project has taken place annually, which is one of the keys to its success. “It’s not just about going and doing things; it’s about teaching them so they can do it themselves”, asserts Dr Peña. In addition to the intervention during the days the team stays in the area, they provide tools to the lady health workers, lady health visitors, and other dispensary staff so they can act independently for the rest of the year.  

In all of this, collaboration with different entities, such as the partnership with Meiji, plays a vital role. “Collaboration between entities is essential to keep building on efforts, since everything contributes and opens new avenues of work; improving one aspect affects others, and all of this is necessary to continue advancing the work carried out in the area” concludes Dr. Peña. 

Via: https://isanidad.com/345348/proyecto-hushe-24-anos-de-cooperacion-sanitaria-internacional-para-llevar-salud-y-formacion-al-valle-mas-remoto-de-pakistan/