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Society
In Pakistan's Camps, Birth Could Mean Death
by Zofeen T. Ebrahim
"When Taj Bibi came to us
she had already been in labor for two days. And in this extreme anguish,
she walked barefoot for one kilometer to reach our medical camp," said
Dr Khalid Khan, District Programme Officer, United Nations Population
Fund (UNFPA), Swabi, North West Frontier Province (NWFP). While praising
the young woman's resilience, he added that Bibi had found good medical
assistance thanks to the fact that the UNFPA had just set up a Mother
and Child (M&C) centre at Yar Hussain camp in Swabi district of the
strife-torn North West Frontier Province (NWFP). The centre has just
begun work and is equipped to handle deliveries.
At the moment, the Yar Hussain camp is home to some 24,000 Internally
Displaced Persons (IDPs).
According to the United Nations High Commissioner for Refugees (UNHCR),
approximately three million people have so far fled the conflict zone in
the Malakand Division of NWFP ever since fighting broke between the
military and the militants of the Tehrik-e-Taliban Pakistan (TTP). There
are more than 69,300 pregnant women among them.
Only 10 per cent of the IDPs live in the 21 government-run camps set up
across the five districts of NWFP. Most are either living in schools, in
makeshift camps or with relatives and friends. Living in temporary
settlements, with limited medical facilities has put literally thousands
of expectant mothers at great risk. "Of the 6,000 women who will deliver
babies this month (approximate estimate), some 15 per cent are in danger
of developing complications. They may require blood transfusions or even
surgery," observed Khan. He said in a conflict situation,
pregnancy-related complications only get exacerbated.
"Ideally, we would have referred Bibi to the nearby rural health centre
since she was hypertensive. But there was danger of her delivering on
the way and it may have endangered her life or that of the baby or
mother or both," said Tahera Bano, a woman health visitor working in the
M&C centre.
Within half an hour of her reaching the labor room, Bibi delivered a
healthy baby girl, her second, and in a couple of hours she even
insisted on going back to her tent. "When we asked her why she hadn't
sought any help when her pains had started, Bibi just said there there
was no female in her tent to whom she could confide and her husband
didn't know about these things," said Bano.
This was Bibi's first delivery at a facility. Her first child was born
at home in Swat even though her home was just a walk of 15 minutes from
the local Saidu Teaching Hospital. According to Dr Sadiqua Jaffery,
chairperson of the National Commission on Maternal, Neonatal and Child
Health, Karachi, 80 per cent of babies are born at home in Pakistan, and
this is not a practice peculiar to rural areas but also to peri-urban
and urban slums.
The Pakistan Demographic and Health Survey - 2006-07, carried out by the
National Institute of Population Studies (NIPS), reports the maternal
mortality rate (MMR) at 276 per 100,000 live births. However, many
experts remain skeptical about the figures and argue that if rural areas
are taken into account separately, the numbers would be far higher.
When Punjab chief minister Shahbaz Sharif Khan visited the IDP camps
last month, on May 15, he decided that in addition to helping the NWFP
government with relief goods, his province would concentrate on
providing quality healthcare by reviving the dysfunctional facilities in
the region. The first beneficiary of this initiative was the sprawling
government-owned Mardan Medical Complex in the district of Mardan.
Spread over a massive 57 acres (275, 880 square yards), there was no
doubt that the complex was big but until his visit it had no labor rooms
and even the other wards were barely operational.
Within a week of his visit, the Punjab chief minister had sent a medical
team of 140, which included 30-40 women, in a bid to refurbish the
Mardan Medical Complex. Besides doctors, surgeons and paramedics,
essentials such as drugs, machines and ambulances were also made
available. "By May 20 we had begun the OPD (Out Patients Department),
sent teams for outreach to camps and conducted surgeries. On May 22, our
doctors carried out their first delivery, which was a caesarean section
and the father, Ali Ahmed Khan, decided to name his son Shahbaz Sharif
Khan, after the chief minister," said Dr Raja Shafiq, who had been
deputed at Mardan that week.
After these improvements, an institution that Dr Amatullah Zain had
described as "completely deserted" when she first arrived at the Mardan
Medical Complex, is now bustling with activity. Ever since Sharif's
namesake was born, they have delivered innumerable babies and performed
several C-sections here.
Zain meets all sorts of women, who come clad in heavy 'burqas' (a piece
of clothing that covers a woman from head to foot). Said Zain,
describing her daily interactions with women IDPs, "When they come here
many are in advanced stages of labor, even obstructed labor; they are
dehydrated and often complain of not being able to eat well. Quite a few
have gastroenteritis as well. Many also say that this is their first
visit to a hospital."
Zain admits though that it
was not easy to leave the comforts of her home in Lahore, where she
heads the Gynecological Ward at Jinnah Hospital - she is also an
associate professor at Allama Iqbal Medical College. But she volunteered
to do this. As she put it, "It is my honor to serve these people, who
have suffered such huge losses."
She also makes sure the women who come to her for check-ups and
deliveries do not go empty-handed. "I had brought light, loose cotton
clothes for women and children, dried milk powder and some toys to give
to them because when they fled, they had nothing but the clothes on
their backs," she said, adding, "But it's all done very discreetly, so
that their dignity is not hurt."
"For the first time, not just the IDPs but even the local residents are
getting a state-of-the-art gynecological facility here in Mardan. The
most expert hands perform safe deliveries," said Dr Islam Zafar,
Director, Health, Punjab, who heads the team at Mardan. And all this is
absolutely free of cost. "We do not charge them even for a syringe. It
is free for everyone, not just IDPs," added Zafar.
According to the good doctor, despite bringing in many female health
providers from Punjab, they are still outnumbered by the growing
populace here. "Even for ordinary ailments, women in these regions
refuse to be examined by male doctors let alone seek help for
reproductive health issues," he said.
Right now, the number one priority is to ensure that there are no
deliveries in tents. "Safe delivery is not possible in tents and the
distance between hospitals and camps fortunately is not too much,"
observed Dr Aurang Zeb, Executive Director of Health Society, an NGO
working in IDP camps in Mardan.
"There are enough ambulances and the deliveries are free. So we are
encouraging the IDPs to avail this facility," said Zain.
While the pregnant women in the camps are getting the best available
reproductive facilities, accessing the out-of-camp population is
difficult, remarked Dr Zafar. The good thing is that word is spreading
and every day their patient load is increasing. Said Dr Zafar, "There
are vaccination teams that are going from door-to-door. Now it is
generally known that women can now have access to safe deliveries
carried out by female healthcare providers."
June 21, 2009
By arrangement with
WFS
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