Yesterday we made a field visit to Thatta located in interior Sindh province of Pakistan. As part of the Maternal and Newborn Health Registry in Thatta, the purpose of this visit was to visit households in various villages to conduct post-partum follow up assessments and monitoring adverse events. This also entails health education and health promotion.

No difference is made between urban and rural parts of Thatta as both are considered to be slums. Sure you can notice some differences with regards to health and socio-economic factors, but these differences are minimal. What I saw yesterday and what I see in almost every field visit since I have been here should seriously be considered a public health emergency. Disease-infested sewage water (the remains of recent torrential rains) almost anywhere you look. Piles of garbage scattered all along the streets. Swarms of flies and other disease-carrying vectors trying to get a piece of you. Poor literacy rates. Stray cats and dogs, also carrying God knows what, roaming freely around in search for some human blood and flesh. Below poverty line. Traditions and beliefs interfering with health and well-being. Complete lack of awareness. Ignorance. I can go on...I really can...

All this makes providing health care such a challenge! Villages are located so far away in isolated areas that health care workers have to travel afar just to conduct health assessments. Roads are poorly constructed, requiring health care workers to travel by foot for hours. Monsoon seasons make it impossible to travel, leaving villagers with health concerns stranded for days, even weeks. Government-run Basic Health Care units and Hospitals are so poorly equipped with inadequate human resources and supplies that they do more harm than good. From the 400 NGOs that are currently working in Thatta, only a few are actually serving people rather than themselves. This has been proven by poor health indicators which have not improved for years. To top it all off, it is difficult to provide health education to individuals who refuse to believe that one has some form of control over their own health and well-being. Sure God is Omnipotent and Ever-Powerful but human beings have also been given an intellect. That is why God has created human beings at a higher status than animals, because of our ability to use our intellect. So what is the purpose of this blessing when we leave our faith to jinn or some other supernatural power. This is definitely a complex matter with multiple factors involved. Families through generations and generations have accepted this way of thinking and passed it along to their children. We should not tell them that their way of thinking is wrong but work with them and use the "yes...but" approach.

I would like to end with an experience at one of the home visits. The mother has three surviving children and two that have passed away. The baby that recently passed away (5-7 days ago) was actually doing well right after birth but later that night, the baby passed away after experiencing seizures. It is believed that the child may have received a BCG immunization a few hours after birth, resulting in a fever right after. It is being speculated that the child may have experienced a febrile seizure. This child was in the womb for more than 9 months, in fact 10 months. The doctor had suggested a Cesarean section to the woman but she refused as she was deeply concerned about her remaining children and who would take care of them. Also, it is a known fact that surgery is much more expensive than a natural birth by a Dai (which is also not the safest in this part of the world). Therefore, the mother was induced into pregnancy via Oxytocin. One of the three surviving children of this woman was in severe health condition. I will never forget her face. I will never forget her eyes. Nor will I every forget her cries. Imagine a young girl with a severe skin infection from the time of her birth. Her skin has peeled away with ulcers throughout her body. Her fingernails and toenails are completely gone. She only has patches of hair on her head. More than half of her teeth are gone, exposing her raw gums. Ulcers are also located inside her mouth. It appears that she has not taken a shower in years and the clothes on her back have not been changed. Dirt has accumulated from head to toe. She has dirt caked on to her feet. She is surrounded by flees. They all are attracted to her and sticking to every inch of her body. They are entering her mouth, hovering around her eyes and on the sticky, brown 'Popsicle" she is sucking on. These flees are basically eating her up. She cries as she holds on to her stomach. We ask what is the matter. The mother says she has a "stomach ache" which is fairly common for her. We ask if she has seen the doctor but mother says she has no money. If she takes her to the doctor, then the rest of her children will suffer. The child cries...but there is something unusual in her cries. This is not merely a cry of pain..but a cry of despair. A cry begging us to "save her." This was the most heart-breaking experience. I wish I could just take her in my hands and cuddle her and tell her that everything will be ok....but her eyes say something else. She knows everything is not going to be ok...she herself has given up hope. How easy would it be to just take her to the hospital myself but her family wont let me. If we offer free health services and transportation to the family, the family will not take it for reasons unbeknownst to me. This has happened several times before. If this was the case in any other part of the world, I am sure that social services would have stepped in by now. But what right do we have to take this child away from her mother. I will not dare claim that this mother is neglecting her children as her hands too are tied. She is part of the vicious cycle where the poorest are neglected and the family members show love in the only way they know how. She has her family to feed and the rest of her extended family depend on her as well. She too is fighting an infection for days and for that she is not seeking health care as that too is expensive. This situation all too common here...

Oh how I wish I could do something! How horrible this feeling of knowing that I can do something but not being able to. However, I will not lose hope...I will not despair...

“There are those …who enter the world in such poverty that they are deprived of both the means and the motivation to improve their lot. Unless they can be touched with the spark which ignites the spirit of individual enterprise and determination, they will only sink back into renewed apathy, degradation and despair. It is for us, who are more fortunate, to provide that
spark.” - Aga Khan, India 1983