Field notes from Tharparkar

The Pak Banker - - 4EDITORIAL - Javed Jab­bar

THREE days in Tharparkar re­in­force one's con­vic­tion that the em­pow­er­ment of the re­gion's women will be the prin­ci­pal cat­a­lyst to re­place high in­fant mor­tal­ity with high stan­dards of mother and child health.

One reads with dis­tress the 'Death list of 49 chil­dren un­der 5 years' at the Mithi Civil Hos­pi­tal for Jan­uary 1Fe­bru­ary 5, 2016 handed over by Dr Iqbal Bhur­gari, a ca­pa­ble, ex­pe­ri­enced doc­tor work­ing un­der se­vere pres­sure.

The vis­i­ble col­umn of 'Cause of Death' of in­fants and the in­vis­i­ble col­umn of 'Mother's Health' be­come con­joined when one reads the first col­umn alone. Sep­sis. Neona­tal Sep­sis. En­cephali­tis. Sep­ticemia. Se­vere Birth As­phyxia. Low Birth Weight. Bleed­ing Dis­or­der. Se­vere Pneu­mo­nia. Anaemia. Acute Gas­tro En­teri­tis. Menin­gi­tis. Se­vere Di­ar­rhoea. De­hy­dra­tion. Con­gen­i­tal Lethyosis. Etc. Or, in other words: Na­ture's 'Cham­ber of Hor­rors for In­fants' - fa­cil­i­tated by adult hu­man fail­ures.

In the list of prob­a­ble causes for the alarm­ing in­ci­dence of baby-deaths, three of the most po­tent causes arise di­rectly from ma­ter­nal health. Th­ese are: mal­nu­tri­tion; very early mar­riage (be­fore 18 years of age); and too-fre­quent preg­nan­cies. One met Gu­laba, seated on the veran­dah of the in­fants ward, wife of Dodo Bheel from Goth Chahchaar, near Nafeesna­gar, Umerkot. She said she had never been to school and thought she was about 21 years old. She had al­ready given birth to five chil­dren, three of whom had died at or soon af­ter birth. The fifth child born five days ago was suf­fer­ing con­vul­sions and was in an in­cu­ba­tor. As per cus­tom, the baby will be named only af­ter nine days have passed. Gu­laba her­self is one of four brothers and four sis­ters.

Seated nearby was Sita, wife of Jum­man Bheel from Goth Pario near Is­lamkot. She had stud­ied up to Class V but said she had long for­got­ten how to write. Her hus­band dropped out af­ter Class I. For­tu­nately, af­ter the birth of three chil­dren, with spousal con­sent she had tubal lig­a­tion to pre­vent fur­ther preg­nan­cies. The cou­ple were wait­ing for their most re­cent born to re­cover from jaun­dice. This writer also saw, for the first time, a baby with a birth-weight of only 600 gms, barely the size of two palms. Born pre­ma­turely to Hus­sain Nabi's wife whose pro­fuse bleed­ing led to pre­ma­ture de­liv­ery, this minia­ture gem of hu­man­ity was given zero chance for sur­vival.

One em­pathises with the govern­ment of Sindh as it faces the on­slaught of un­re­lent­ing, non- con­tex­tu­alised me­dia re­portage and crit­i­cism from op­po­si­tion political par­ties. Af­ter all, there are 23 other dis­tricts of Sindh, in some of which in­fant and ma­ter­nal mor­tal­ity rates are prob­a­bly higher than Tharparkar. A re­li­able source has re­vealed that spe­cific and gen­eral health in­di­ca­tors, in­clud­ing mor­tal­ity rates for chil­dren un­der five years and for moth­ers in Kash­more, Kam­ber Shah­dad­kot, Shikarpur, Larkana are most likely to be higher than in drought-af­fected Tharparkar.

While the pro­vin­cial govern­ment is mak­ing ex­tra­or­di­nary ef­forts to im­prove health fa­cil­i­ties in Tharparkar, lit­tle in­de­pen­dent recog­ni­tion is be­ing af­forded to such ac­tions. Un­for­tu­nately, in over­all terms the in­fant mor­tal­ity rate in Sindh for 2014 was prob­a­bly about 80 to 82 per 1000 live births (whereas it had gone down to 74 about five years ago). Pun­jab is re­ported to have im­proved from 88 per 1000 live births to 76 in 2014. Khy­ber Pakhtunkhwa is said to have the low­est at 58 while Balochis­tan is the worst at 97 per 1000 live births.

Even though there are more in­cu­ba­tors (13) at Mithi Civil Hos­pi­tal than there re­port­edly are at the Li­aquat Med­i­cal Univer­sity Hos­pi­tal in Jamshoro (only five) there are six func­tional am­bu­lances and three 100kw gen­er­a­tors to pro­vide mo­bil­ity and power round-the-clock at Mithi. De­spite the avail­abil­ity of four pae­di­a­tri­cians and three gy­nae­col­o­gists, sev­eral posts re­main un­filled apart from a lack of enough qual­i­fied fe­male nurses.

One ma­jor rea­son for the short­age of spe­cialised health­care per­son­nel may be the anom­aly that the spe­cial hard­ship al­lowance for a doc­tor posted to Mithi or else­where in Tharparkar is only Rs200 per month. There should be at least one, if not two more, ze­roes in that fig­ure. Most doc­tors have fam­i­lies, and chil­dren study­ing in schools in other cities in Sindh; th­ese chil­dren can­not be trans­ferred to schools in Mithi and have their stud­ies dis­rupted. Most such doc­tors have to main­tain two house­holds, one in Tharparkar and one in the other part of Sindh, thus jus­ti­fy­ing the need for a far larger hard­ship al­lowance.

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