Inter Press Service - December 11, 2003
Zofeen Ebrahim

If there is pain on one, there is excitement on the other. There are worried faces and faces devoid of any expression too. Mostly clad in black 'burqas' with the veil up since it it is an all-female domain, there are those who wait patiently.

The timid ones among the women who have come for checkups and advice on pregnancy, childbirth, breastfeeding and health problems are usually the newcomers. Then, there are the more belligerent ones who try to jump the line, that too, under the very eye of the doctors.

Amid the cacophony, the silver screen mechanically goes on, showing various films and documentaries one after the other variously on HIV/AIDS, on the government-run Expanded Immunisation Programme and a few made by various NGOs related to maternal and child health.

"You should've seen this place two years back," says Shershah Syed, head of the department. "It was just one big room - more like a fish market -- with a corner designated for examination which had a dirty rag of a curtain used as screen. Doctors would sit around the room behind desks. There was complete mayhem with patients surrounding the doctor and all talking at the same time."

All of it seems to have changed with the introduction of the slip system and someone at the door to let the women through after they show the slip. Women have to sit on benches till their number is called.

Thanks to UNICEF's Women's Right To Life and Health project, the outpatient department has been given a new lease on life, improving its utility in helping give women more access to health services and information.

Only eighteen percent of births in Pakistan are attended by skilled personnel, according to statistics by the Washington-based Population Reference Bureau (PRB). That is quite below India's 42 percent and just a little above Bangladesh's 12 percent.

The country's maternal mortality figure however is 200 per 100,000 live births, better than India's 440 or Bangladesh's 600.

Five cubicles in the outpatient department are now used as doctors' examination rooms. The place is airy and well-lighted. The new paint job gives an added clean look to the room.

"It's become quite organised and has led to time-saving. We are able to see more patients, are less irritated and give more time to individuals as we are not harangued or harassed by the impatient women. In fact, the number of women coming to this OPD has increased manifold," says Dr Yasmin Wajahat.

In a small room attached to the ward, Dr Musarrat Hasan goes about advising mothers, specially first-timers and prepares them for childbirth, identifying risk factors involved in pregnancies and the rewards of breastfeeding.

She also helps shed myths and misconceptions -- like discarding colostrums or giving honey to the newborn or not to have milk if the mother has delivered by Caesarian section as they believe that the stitches would go bad, among others.

How does she know her lecture is not falling onto deaf ears? "I've got a perpetual sore throat," she says with a twinkle in her eye, "but I'm optimistic. They respond, they listen and best of all -- ask questions."

After winning their attention, she introduces the novel and innovative 'gulaq' (earthenware money-box) scheme, which has its origins in an emergency the ward in the past. "A year back Sakina, a young woman, in labour, was dumped at our hospital in the thick of the night. That was one of our busiest nights," recalls the doctor.

"We had performed some 22 deliveries and not only were the doctors exhausted but so were the supplies. The woman had no money and no one to get her the supplies. The labour was getting delayed and she had started bleeding," she continues.

"So the doctors pooled in whatever they had, bought the required medicines and she delivered," Hasan remarks, adding that the staff then endorsed the idea soon after.

"We give one each to the pregnant woman and ask her to save and at the end of the ninth month when she comes for the delivery, to bring her 'gulaq' along. We break it in front of her and double whatever she's collected over this time period. That money is then used on her - for her delivery," adds Hasan.

It has been a year since this scheme was initiated. So far, Hasan has given away 132 of these clay money-boxes.

"Of course some have been returned by the new mothers on the plea that their family thinks it's bad luck to save prior to the birth of the baby or that God will provide for the newborn," she explains.

But some 30 women have brought their money-boxes at the time of delivery, which Hasan said is "a pretty good sign that the scheme is taken up seriously". Still, a few forget to bring them on time.

They also give 'gulaq' to those women who give their home address, since this allows women health workers to visit them, counsel them on other mother and child health issues and encourage them come for follow-ups to the hospital for prenatal checkups.

"The idea is not only to inculcate in them the virtue of saving, but also for them to realise that unpredictable emergencies may arise anytime. Anything can go wrong but in a crisis, if they have ready cash, they don't have to plead with others to lend money," explains Dr Syed.

"You can't imagine even begin to imagine how poor most patients are. Some don't even have clothes for their newborn. We arrange money from the 'zakat' (mandatory charity for well-to-do Muslims) funds but even that gets exhausted," Dr Syed adds.

"Sometimes we are in such dire straits as all our energies are consumed arranging for money for the C-section, blood, and medicines because the husband just leaves the woman at our doorstep. They know if nothing else the woman's life will be saved!"

This government-run outfit charges four Pakistani rupees (07 U.S. cents) per bed a day, but even that many of the women cannot afford.

Meantime, there is more that needs to be done. Dr Farah Khan says: "A pap smear facility should be made available for these women."

Adds Dr Shershah: "A cardiotograph (GTG machine that allows the doctors and midwives to monitor the baby's heart rate during labour) machine and a small ultrasound machine and later perhaps a laser colposcope would be extremely welcome."

"But no government hospital has it, how can we expect that?" Shershah says resignedly.
031211
IP031216

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .