"I have learned some hygiene rules that I didn't know before, like how to wash my hands," explains Wajid, 12, rubbing his hands together. "It's the first time that anyone has come to explain that to us. I think it's important, because dirty people can catch illnesses!"

The Land Rover stops, as the road is blocked by a mound of earth and an enormous rock. In this remote region of Pakistani Kashmir in the rainy season, roads are often made impassable by landslides. Shazira, Irfana and Nayab, who are employed by Medair on its health and hygiene promotion programme, get out of the vehicle. "When we arrived in the region we immediately realised that a great deal of work needed to be done in these two areas to prevent illnesses like cholera, diahorrea and malaria. So we launched this programme, and our staff will talk about personal hygiene, nutrition and family planning to the women and children," explains Matthew Thomas, the manager of the project in Abbaspur.

It takes Shazira, Irfana and Nayab two hours to get to the village of Khariam on foot. Their brightly coloured traditional garments stand out in the mist as they follow the road which snakes around the mountain. Since September they have already visited 166 communities in the Poonch district in the vicinity of Hadjira.

They drink a glass of water on their arrival and after a few minutes' rest they begin work. Soon about fifty children, aged between 5 and 15, are lined up in the yard by the only teacher, squatting, with their arms crossed.

Squashed together, they listen carefully to the advice Shazira gives them about washing their hands with soap, wearing a clean uniform to school, cleaning their teeth every night, cutting their nails once a week and eating everything to grow up big and strong. "Here," explains Shadid, the teacher, "women have not necessarily received any education, and do not know the rules of hygiene, so it is important for the children to receive this sort of information". Nobody moves while Shazira is talking. The children, and in particular the girls, are shy, and do not even have the courage to reply to the questions which the health workers ask them. Mist covers the mountain and a warm, light rain begins to fall again. The children go back into the school, a stone building whose metal roof has a hole in it. A few goats have come to take shelter under the canopy while Irfana continues the lesson by showing some pictures. "Which do you prefer, this clean tidy house, or this dirty untidy one?" she asks. Little by little the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.tle the children lose their shyness and begin to participate.

"I have learned some hygiene rules that I didn't know before, like how to wash my hands," explains Wajid, 12, rubbing his hands together. "It's the first time that anyone has come to explain that to us. I think it's important, because dirty people can catch illnesses!" "I'm going to teach what I've learned today to my sisters" says Khalida, 12, who has 8 brothers and sisters and lost her mother in the earthquake. "I'd like to be a doctor like my uncle and help people". When the lesson ends, the children return home, while Nayab, Irfana and Shazira wait for the women of the village. One by one, in the rain, they arrive and sit under the canopy of the school building. "There is a big difference between the women here in the mountains and the women in the towns" explains Nayab. "Here they know very little about health, the world, our country, or their own rights. Their lives centre on cooking, their homes and their children."

The health workers begin their well-rehearsed speech to about twenty women, all concentrating just as hard as the children before them. They talk about boiling drinking water, nutritional balance and personal hygiene. The few curious men who have come along are asked to leave before the subjects of pregnancy and childbirth are tackled. At this point Irfana gets out her book illustrated with large drawings.

The pictures show a medical examination, resting during pregnancy, breast feeding rather than bottle feeding, signs of illness in infants and hygiene during childbirth. Sometimes the women laugh and draw their scarves over the lower halves of their faces with their hennaed hands. "We also talk about methods of contraception like the pill, IUD and injections. When we introduce the topic, the women laugh and are embarrassed but I tell them that contraception is their right as women!" says Nayab.

"It's good when they come to talk to us about these things. I didn't go to school, but my daughter-in-law is pregnant, and what I learned today will be very useful to me" explains Afsa Jan, 50. "I didn't plan my pregnancies, but fortunately I always had two or three years' gap between by nine children. I don't want my daughters to have nine children, three is plenty!" The lesson ends, and the three women have been invited to lunch. Naturally, before beginning the chapattis, vegetables and rice, everybody goes to wash their hands.

"The women are always pleased to be given this information" says Nayab, "They know that it is for their benefit and they are very grateful. Little by little things are changing!"

When they have drunk their sweet tea, Nayab, Irfana and Shazira do not delay, as they have two hours' walk to get back to their Land Rover.

Medair's activities in Pakistan are supported with the assistance of ZOA Refugee care, Red een Kind, Dorcas Aid, Tearfund NZ, EO Metterdaad and Woord en Daad. However, Medair's life-saving activities are also dependent upon private financial donation. To contribute to this work, please visit http://www.medair.org/

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Founded in 1988, Medair is a non-governmental organisation (NGO) independent of any political, economic, social or religious authority. Its international headquarters are based in Switzerland. Its mission is exclusively humanitarian and it accomplishes its work in a spirit of dedication and solidarity, inspired by its Christian values.

Medair's objectives are to respond to suffering victims in war and disaster situations (especially those which have been forgotten or neglected) through various kinds of emergency and rehabilitative projects.

Medair employs 50 people in Switzerland, United Kingdom, Germany, France and Holland. In the field, 120 full-time expatriates help populations in difficulty, with the support of 1600 local employees.

The organisation has obtained the ISO 9001 certification at world wide level for its quality management system.

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