While reading the news paper i came across with this article by Fatima Zehra, thought of sharing with peoples who are not aware of this harsh reality.A couple of weeks back, a tragic incident splashed across the daily newspapers. A plane had crashed in Punjab and 77 people on board lost their lives leaving behind hundreds of mourners. All of us were moved. The government compensated the grieving families with lakhs of rupees. The President and various other officials expressed their deep sorrow. Now keeping this scenario in mind, picture another stark reality. According to various available local data, approximately 30,000 women lose their lives during pregnancy or while delivering their babies. Roughly it means that daily more than 70 mothers lose their lives in this country. So well, see it this way that every single day, a plane carrying more than 70 pregnant women crashes in this country! Here, we need to ask ourselves and we need to ask each other that do we really care? In fact does anyone really care that dozens and dozens of women lose their lives every single day in this country just because they get pregnant?!
For our rulers, ever since the very inception of the country, the priorities have never included basic education and primary health facilities - let alone specialised health services. "In 1947 there were about seven maternity homes in the country. Over the years, more than 40 different maternity homes were built but the fact is that they are just 'ghost structures'. Almost none of them are functional or even running for that matter! The builders have indeed enjoyed the commission." This was Dr. Sher Shah's observation. Based in Karachi, he is a senior member of the Pakistan Medical Association (PMA) and has worked extensively as a practitioner for better maternal health and safer pregnancies all over the country - especially in the rural areas. He made the above mentioned observation during a five-day interactive workshop held in Karachi recently. It was organised by the British Council with the collaboration of the Commonwealth Press Union. It was specifically on 'Health Reporting: Saving Mothers and Children'.
In general you go for a sensational story - that's what sells newspapers doesn't it? Now nothing overtly wrong with it but reporting on health issues 'must' be something beyond highlighting 'miracle cures' or 'deadly scares'. And this was exactly the 'theme', around which this workshop was designed. It was aimed at sensitising health reporters and journalists towards putting together their respective features and stories with a sense of responsibility and the kind of seriousness that health issues deserve!
Reporting on health and that too on maternal health in an apathetic society like ours, is a tough task to tackle. "You need to find the right 'peg' onto which you hang your story - you must remember that 'timing' is everything," aptly put the conductor of the workshop Jeremy Laurance. All the way from London, Jeremy Laurance (Health Editor of The Independent, UK) was flown in to conduct this workshop. He proved to be the right choice for this training session - primarily because he was assertive and his experience in health journalism showed in the way he went about those five days.
Now it's alarming that with around 158 million people, Pakistan is one of the most populous countries in the world. Pakistan's high fertility rate of 5.4 births per woman means that the population is likely to double over the next two decades. And yet our 'official' policy makers largely ignore the sexual and reproductive health (SRH) sector. Furthermore, low levels of knowledge about SRH are a major barrier to women and their parents and partners in accessing SRH services.
According to Dr. Shah, "We have around 65,000 villages and at least 30, 000 midwives must be made available for this number in these areas. Can you believe it that in the country originally there were not even textbooks available in Urdu and regional languages on midwifery! Now we have worked towards it and at last some translated work has been made available. But we have such a long way to go. This country is full of quacks; probably more than 600,000 but what about qualified midwives?"
According to some statistics available online, more than 89 percent of deliveries and 80 percent of maternal deaths, occur at home. Some figures suggest that only one in more than 30 women with complications of pregnancy or childbirth reaches any kind of facility with emergency obstetrical care - if any at all! According to a survey carried out in Mardan (in 2003) by Pakistan's National Commission for Human Development (NCHD), at least 80 percent of the population has no access to health-care facilities.
Dr. Shah shared that one of the many cases that he has dealt with was of a 14-year old girl Gul Bano, belonging to the remote area of Khuzdar in Balochistan. She became pregnant at the age of 15. After two days of an excruciating labour, poor Gul Bano delivered a dead baby! There are no 'accurate' statistics on maternal mortality in Pakistan, as a comprehensive study has never been carried out. But we know that the main reasons for the high rates of maternal mortality and morbidity are lack of prenatal care, of properly trained birth attendants or medical facilities and of transport to the nearest properly equipped hospital. Yes it's indeed a crucial factor that fuels maternal mortality in Pakistan - the cost (or lack) of transport to the nearest hospital!
During the workshop, Consultant Pediatrician at Aga Khan University, Dr. Gaffar Billoo highlighted the appalling state of health-affairs in the country. "In our country, infant mortality rates are very high, at 81 per 1000 live births as of 2003, as per UNICEF figures from 2004; in Nepal that figure stands at 61 and in Sri Lanka at 13. Mortality rates for children under the age of five are 103 per 1000 live births, as per UNICEF's 2005 figures, again high for the region. Malnutrition is the reason for half of these deaths. In our country only about 20 per cent of children get delivered by trained medical personnel."
In 2001, less than one percent of the GDP was allocated for public healthcare, whereas expenditure on debt servicing and defence exceeded the country's total revenue. Pakistan's total health expenditure per capita was only USD 13 for 2005, having declined from USD 16 in 1998. In comparison, in Sri Lanka that amount is USD 32, and in Maldives it is USD 120.
The Ministry of Health recently organised a 'Health Expo' in the federal capital with much pomp - music and food along with a certain dose of information about preventing deadly diseases like AIDS and hepatitis etc. Now, if in the name of 'creating awareness' such costly affairs could be arranged then how come, all these leading pharmaceutical companies, manufacturers of surgical equipment and health care service providers can't seem to get any 'real' work done by creating awareness at the grass root level for a better maternal health? Problems in the country's healthcare are not simply a matter of inadequate funds. According to Dr. Sher Shah, "We lack the 'collective' and political 'will' to take action."
The situation regarding the maternal and child health is crucial in Pakistan. The dilemma is that people sitting abroad are realising the gravity of the issue while we are sleeping. One wonders as when our government will wake up and realise that a healthy economy is impossible without a healthy populace, and a healthy populace is not possible without providing necessary healthcare to women who give birth to the future generation.
A lack of attention to public health amounts to condemning a large section of the population to difficult, short and unproductive lives and adding more to the national economy. Ask anyone, do we really care enough?
