Understanding Post-earthquake Gender Susceptibility in Balakot Tehsil, Khyber Pakhtunkhwa, Pakistan

Drawing on the theoretical perspectives of structural vulnerability and violence, this study examines how the ‘2005 earthquake’ in Pakistan affected the female gender. It aims to find out the unique experiences of the socio-cultural vulnerability of gender, which led them to migrate towards other places. It attempts to identify those factors which contributed to women's vulnerability. Qualitative research methods, such as key-informant and in-depth interviews, were used in this research. In-depth interviews were conducted by using a purposive sampling technique with thirty highly affected women of Balakot belonging to twenty-five households. The present study finds out six major themes, almost all dealing with a lack of privacy and females’ private domain. These include: a) gendered migration; b) ethnicity; c) problems of toilet and bathing; d) problems for pregnant women; e) difficulty in looking after the family; and, f) forced sexual relations. Data collection from respondents of different ages, class, and caste helped us to understand the lived experiences of the women of Balakot. The study finds out that gendered vulnerability plays a very important role in making decisions to migrate. This study might influence governments to bring the required changes in their policies to serve the women population better during and after disasters.

A Randomised Controlled Trial Comparing the Effect of Adjuvant Intrathecal 2Mg Midazolam to 20-Micrograms Fentanyl on Post-Operative Pain for Patients Undergoing Lower Limb Orthopaedic Surgery under Spinal Anaesthesia

Background: Intrathecal adjuvants are added to local anaesthetics to improve the quality of neuraxial blockade and prolong the duration of analgesia during spinal anaesthesia. As an intrathecal adjuvant, fentanyl improves the onset and quality of spinal blockade as compared to plain bupivacaine and confers a short duration of postoperative analgesia. However, its use is associated with several adverse effects that range from pruritus to life threatening respiratory depression. Intrathecal midazolam as an adjuvant has been used and shown to improve the quality of spinal anaesthesia and prolong the duration of postoperative analgesia. No studies have been done comparing intrathecal fentanyl with bupivacaine and intrathecal 2mg midazolam with bupivacaine. Objective: To compare the effect of intrathecal 2mg midazolam to intrathecal 20 micrograms fentanyl when added to 2.6 ml of 0.5% hyperbaric bupivacaine, on post-operative pain, in patients undergoing lower limb orthopaedic surgery under spinal anaesthesia. Study design: Single blinded Randomized Controlled Trial Methods: A total of 40 patients undergoing lower limb orthopaedic surgery under spinal anaesthesia were randomized to two groups Group 1; 2.6mls 0.5% hyperbaric bupivacaine with 0.4mls (20micrograms) fentanyl Group 2; 2.6mls of 0.5% hyperbaric bupivacaine with 0.4mls (2mg) midazolam Results: The duration of effective analgesia was longer in the midazolam group 384.05min as compared to the fentanyl group 342.6min. There was no significant difference (‘P’ 0.4047). The time to onset was significantly longer in midazolam group 17.1min as compared to the fentanyl group 13.2min (‘P 0.023’). The visual analogue score at rescue was significantly lower in the midazolam group 5.55 as compared to the fentanyl group 6.35 (‘P - 0.043’). Conclusion: On the basis of the results of this study, there was no significant difference in the duration of effective analgesia between adjuvant intrathecal 2mg midazolam as compared to intrathecal 20micrograms fentanyl for patients undergoing lower limb orthopaedic surgery.