Pregnant and displaced

‘When I entered the tent, I saw Amna Bibi lying in a pool of blood, the newborn by her side and her three toddlers completely bewildered. The newborn baby girl had not even been wiped clean or covered up. The place was swarming with flies and a crowd of women had gathered, waiting for the young mother’s imminent death,’ narrated Bagh-i-Gul, a lady health visitor (LHV) working in the Yar Hussain camp, for the internally displaced people (IDPs), in Swabi.
According to Dr Jehanzeb Orakzai, focal person for health cluster in the Special Support Group (SSG), formed by the government for the IDPs, there are some 35,000 pregnant women among the 3.5 million IDPs who will deliver in the next seven months. So far he has had no report of even one mother or neonate dying during childbirth.
‘As I began to examine Amna, the women told me to leave her alone and not put her through more pain…they said her time was up,’ recalled Gul. ‘The placenta was still inside the mother and she was in a state of shock, needed to be hospitalised urgently.’ After getting permission from the husband, she quickly put her in the ambulance and brought her to the mother and child (M&C) centre set up in camp, by the United Nations Population Fund (UNFPA).
Amna had been assisted by a woman from the nearby tent who was not experienced or skilled and therefore unable to recognise or even refer her to a trained person when the case became complicated. The woman just left her, for fate to take its course.
‘She was very weak and had not eaten for the past three days. Even after delivery, because she was in such a bad shape, they were not giving her anything.’
The incident took place on June 19, but since then, word has spread, said Gul, and women have been thronging to the centre for antenatal checkups.
The M&C centre at Yar Hussain, which began functioning early this month, has a fully equipped air-conditioned labour room to carry out safe deliveries. There are five more delivery points set up by UNFPA in Jalozai, Sadbarkaly, Jalala, Palosa and in Nowshera’s Pabbi Satellite Hospital.
The health cluster is making sure that fewer deliveries take place in tents. ‘Safe delivery is not possible in tents,’ observed Dr Aurang Zeb, Executive Director of Health Society, an NGO working in IDP camps in Mardan.
He knows that for many women this is the first time they are visiting a health facility.
‘But it is a good opportunity to teach this important lesson,’ said Dr Orakzai.
‘However, due to cultural taboos, language barriers, fewer female staff and lack of health education awareness many mothers reach the facility at the eleventh hour. Fortunately, there are enough ambulances and the distance from the camps to the facilities is negligible, so we are encouraging the IDPs to avail the facilities, which are completely free.’
For thirty-something Sayab Bibi, fleeing Swat on foot and taking refuge in Jalozai camp in Nowshera, may have been a perilous journey, especially since she was nine-months pregnant. Hers was nothing short of a miracle, insists Dr Tayyaba Rashid, a gynaecologist working in the Pabbi Satellite Hospital, in Nowshera. Sayab not only survived the travail of the exodus, but gave birth to a healthy baby girl on May 26. All her earlier four pregnancies had ended in miscarriages.
Had circumstances not forced her to deliver in a hospital, Sayab’s story may not have had a happy ending. Hers was a risky pregnancy as the baby was breach and she had to be operated upon.
According to Dr Tayyaba, a majority of the pregnant women IDPs suffer from depression. They complain of loss of appetite and body aches and most are anaemic.
No wonder Tahera Bano, an LHV in the same camp as Gul’s, says that lactating mothers insist she give them baby formula milk. ‘They keep telling me they cannot nurse as their milk has dried up.’
Dr Tayyaba has also noticed that quite a few women have come to her complaining of irregular menstrual cycle. ‘Many have developed urinary tract infection, itching and complain of discharge,’ said Dr Tayyaba.
Church World Services-Pakistan, a non-governmental organisation, reported of the difficulties faced by women in IDP camps. ‘Women desperately report the need for sanitary napkins,’ said the report published recently.
Without any money and their purdah compromised living closer to strangers, CWS said women immediately require a solution. ‘Some women are using and washing the same cloth repeatedly and as a result, increase their risk of infections.’
While working in camps it was realised that while the camp population was still looked after, it was the majority of the displaced who were living with host families who also needed the same services.
‘It was decided then to strengthen the existing health facilities including the district and the taluka hospitals as well as the rural health centres,’ said Dr Orakzai.
The Mardan Medical Complex, sprawled over 57 acres, was nothing more than a ‘ghost’ facility when Dr Amatullah Zain, head of the Gynae Ward at Jinnah hospital, and associate professor at Allama Iqbal Medical College, first went there to volunteer her services.
When the Punjab chief minister, Shahbaz Sharif, visited the IDP camps on May 15, he noticed the dysfunctional facility and pledged to give it a new lease of life. The following week a team of 140 healthcare providers including doctors, surgeons and paramedics, including some 30-40 females, landed in the medical complex with essential drugs, machines and ambulances. Dr Zain was among that first batch.
‘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.
‘The most expert hands perform safe deliveries,’ said Dr Islam Zafar, director health, Punjab, who heads the team in Mardan. The gynaecological facility, confirmed Dr Amataullah, is nothing less than state-of-the art.
‘That is what we are aiming at, to strengthen existing hospitals through our partners so that even those living out of camps can avail the facilities, and when the IDP crises is over, the locals have fully functional, fully equipped healthcare facilities,’ summed up Dr Orakzai. Currently, there are 617 public health facilities (75 hospitals, 54 rural health centres and 488 basic health units) in districts hosting IDPs.