Published: June 21, 2016
SHARDA: “We
are afraid we could die,” says Asmat Nisa, a mother-of-five set to give birth
again. It is a dangerous prospect for women in the remote mountains of Azad
Kashmir, where doctors are few and help is far.
“There is no
hospital here and I have never seen a female doctor,” explains Nisa, who is
from the village of Arang Kel in AJK’s Neelum Valley.
That her doctor
be a woman is important: local customs dictate that male doctors are not
permitted to examine women during pregnancy or labour.
This restriction,
combined with the isolation and severe weather of the plunging, remote valleys
makes giving birth one of the deadliest moments in the lives of its women and
newborns.
“The major reason
for the deaths of mothers and newborn babies in the remote areas of Neelum
Valley is unskilled and untrained midwives assisting the pregnant women during
delivery,” says Farhat Shaheen, director of maternal, newborn and child health
for AJK.
Fifty-four babies
out of every 1,000 are stillbirths or first day deaths in Kashmir, she said.
In 2014, a report
by the charity Save the Children stated the country had the highest rate
of first day deaths and stillbirths in the world, at 40.7 per 1,000 births.
In Europe,
according to the same report, 5.9 babies for every 1,000 do not survive the first
28 days. Even neighbouring Afghanistan, torn apart by decades of war, does
better than Pakistan, with a rate of 29 first day deaths and stillbirths for
every 1,000 births.
In this photograph taken on May 26, 2016, pregnant
Kashmiri women work in a field in the village of Arang Kel in the
mountainous Neelum Valley. PHOTO: AFP
“The numbers of
the deaths are very high,” Shaheen says.
In the village of
Sharda, some 20 kilometres from Arang Kel, inhabitants scattered across two
mountains face life and death with a single Basic Health Unit (BHU).
The facility has
one male doctor rendered useless for pregnancy and childbirth by his gender,
and three “Lady Health Visitors”, as they are known locally — women whose job
is to create awareness about health and hygiene, but who do not give treatment
and are not medically trained.
That leaves a
lone midwife to help the women of Sharda and the surrounding areas — a
population of around 17,000 — through childbirth.
The isolation of
the region, which is covered with four to five feet of snow in winter, is a
significant factor in medical staff’s reluctance to work there, says Dr Sardar
Mahmood Ahmed Khan, director general of the health service in Azad Kashmir.
There is no
electricity save a handful of small turbines used to generate hydropower from
the streams and rivers sparkling through the valleys — enough to fuel lights,
but not much more, even in the BHUs.
Pregnant women
fight to scrape a living on the plunging slopes of the unforgiving mountains:
carrying wood, cutting grass, working in the fields, says Riffat Bibi, a Lady
Health Visitor at the Sharda BHU, adding that poor nutrition is also a factor
ruining maternal health.
“We have to do our
hard daily household routine work during our pregnancies,” adds Rubina Bashir,
a mother-to-be in Sharda.
The figures Khan
cites are stark: of an estimated 4.4 million people in Azad Kashmir, he says
there are a mere 1,050 doctors.
Some 758 health
units — ranging from first aid centres to hospitals — serve the area, with
around 3,000 Lady Health Visitors.
Last year, said
local resident Habibullah, his wife’s delivery ran into complications. His
newborn child did not survive the eight-hour journey to a hospital in the main
city of Muzaffarabad, with its better facilities and larger proportion of women
doctors.
“My wife was near
to death, but she luckily survived,” he says, adding that he had to borrow some
200,000 rupees ($2,000) to pay the medical bills — roughly 20 times what he
earns in a month.
Another Sharda
resident, Jahangir Lone, described how his sister-in-law died during the birth
of her eighth child.
Her husband, he
says, could not afford to move her to Muzaffarabad. “If there were any hospital
in Sharda where her delivery could have been performed, then her life could
have been saved.”
Khan said a
special Reproductive, Maternal, Newborn, and Child Health (RMNCH) programme
launched in 2007 has been offering special incentives to persuade doctors to
the area.
Doctors who do
go, be they men or women, get higher wages than those who work in cities.
The government
has fixed the average wage at Rs80,000 per month in the rural areas of Azad
Kashmir, compared to Rs65,000 in the towns, Khan said.
For specialists
the wage in far-flung areas is set at Rs150,000, compared to Rs100,000 in the
cities, he said.
Pakistan’s
government had provided Rs500 million ($5 million) to run the RMNCH programme,
run by Shaheen and which sought to train medical staff.
But the money,
donated in different phases, dried up earlier this year.
Tufail Ahmed, a
postman in Kel Sehri village in the outskirts of Shardah town, says his wife
had suffered complications during her pregnancy but he could not afford to move
her.
Their child was
stillborn, he says.
“I appealed to
the government to provide us female doctors in our region so that no one else
has to lose his child.”
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