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Monthly Archives: June 2013

I killed my unborn baby because I have too many

39 minutes ago

The conditions under which these abortions are carried out are horrendous. PHOTO: REUTERS

She had no remorse on her face as she sat in front of me sharing the story of her third induced abortion she had gotten done a few weeks earlier.

 “I already have five children. I am working for your mother in Karachi. My family is in a village near Rajanpur. Who’d look after the baby?” said Sughra, my mother’s maid, when I asked her why she kept having abortions.

“In my village, it’s a done thing baji. Every woman gets it done. All married women. The daai (midwife) takes Rs 300. She uses dawaai (medicines) or any sharp instrument. I nearly died in the second one, I bled so much,” she shared the details as I looked on in horror.

I had my first detailed one-on-one meeting with Sughra amongst the one million Pakistani women who have unsafe abortions every year. Over the years, as a journalist working on maternal health issues, I have met scores. The stories have multiplied. The commonalities are many. And it sends shivers down my spine every time. These women are lucky to be alive to tell their stories. Others are not so fortunate. The conditions under which these abortions are carried out are horrendous. They ingest chemicals. They jump and skip ropes. They let unskilled hands plunder their most sensitive organs. They often bleed uncontrollably. They develop complications that often lead to near fatal problems.

Out of the 30,000 maternal deaths yearly in Pakistan, a substantial part is related to unsafe abortions. Yet, it goes on. In shady places. At homes. In small so-called clinics.

Breaking many stereo-types, Sughra taught me a lot that day. For starters, mostly unsafe abortions are used as a form of contraception. Instead of a precautionary method, they think of getting rid of the foetus once it has been conceived. Ironically, many feel it is against religion to practice contraception, but go ahead with an abortion which is strongly discouraged in most religions, while temporary contraception is not prohibited. Other reasons for avoiding timely Family Planning (FP) are husbands refusing to use condoms, myths about contraceptive pills and other forms of contraception, a lack of awareness or simple laziness.

Needless to say, after visiting some of the small abortion clinics, my research left me quite worried. The unhygienic surroundings, the very obviously untrained women posing to be doctors or nurses, and the sheer number of patients are cause for concern. I have walked into such clinics, with the natural advantage of being a woman, and quietly observed what goes on, without having to lie that I am a patient. All this goes on openly. It is known. But not much is done about it.

And this happens across the board, though 96.1 % of the women getting induced abortions in Pakistan are married. The list includes unwed mothers-to-be, commercial sex workers, rape victims and victims of incest. Inevitably, it is the woman’s body that suffers and her soul.

There has to be a solution to this insanity, I always think, frustrated, every time I meet such a woman, or the family of a woman who lost her life or developed a lifetime debilitation. Little Sajid, five-years-old, had lost his mother to an induced abortion in a village in the Bhit Shah vicinity. If only she had practiced contraception in time, Sajid would not be motherless; I thought as I looked at his pale face that had deprivation scribbled all over it.

The answer lies in awareness at many levels. People need to be sensitised to the fact that religion does not prohibit temporary contraception, which includes most forms. Those forms of FP need to be talked about. An example would be the cycle bead rosary which has worked in many developing countries – a simple rosary like string of 28 beads that allows a woman to calculate her fertile days. The shame associated with talking about contraception even within married couples has to be tackled. The mutual decision of birth spacing should be taken by the couple, not the mother-in-law as happens in a lot of families. For this, the men of Pakistan will have to be brought on board.

A holistic solution includes training midwives and traditional birth attendants to perform procedures hygienically, guide families about FP and refer them to the nearest health facility in case of complication.

But to me, the central piece of the puzzle lies in the women prioritising their own health, especially in their child bearing years, and making very careful choices when it comes to their reproductive health. The woman of Pakistan needs to know that she is the most important person in her life, and live her life that way. Only then can she be the backbone of her family.

Unsafe abortions: Risky business

Published: June 25, 2013

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Nearly a million Pakistani women resort to abortions annually due to absence of timely contraception. PHOTO: FILE

Nearly a million Pakistani women resort to abortions annually due to absence of timely contraception. PHOTO: FILEA view of a shady clinic located in Lahore. PHOTO: SARAH MUNIR/EXPRESS

LAHORE: The beads of the tasbeeh in her hand are beginning to move faster. She wipes off sweat from her forehead with her lawn dupatta, due to anxiety and the intense 48 degree heat of Lahore, with load-shedding in its 5th hour in a house in Safanwala Chowk.

The dark magenta bedspread seems to intensify the heat in this bedroom on the second floor that serves as a makeshift waiting room for families of “patients”. What is allegedly an “operation theatre” is a tiny claustrophobic room constructed on the roof.

“It’s been almost an hour. Safaai normally doesn’t take so long,” says the worried middle-aged mother, looking out of the semi ajar window overlooking a lane off Temple Road. Her 27-year-old daughter is a mother of five, getting an abortion done. The infamous abortion clinics of this area still exist, but most have been relocated into lanes to avoid attention of the media and health officials concerned. It was after an hour of asking around and driving in the area that a shopkeeper in a secretive manner guided The Express Tribune team in. Immediately, a female gatekeeper locked the gate from inside. “We don’t want anyone to know this is a clinic,” said the over-worked woman who introduced herself as a doctor, but had no degree, certificate or anything that confirmed that she is a medical doctor. The clinics of this area have had thousands of abortions take place in them, some as late as in the 5th month; while the clinicians advise against abortions at an advanced stage, they oblige for some extra money.

Tales of Horror

Timely FP could save lives of not just the unborn foetuses but a multitude of Pakistani women. A national survey of public-sector health facilities estimated that about 200,000 women were hospitalised in 2002 alone for abortion-related complications. “We get cases of perforated uterus, guts, intra-abdominal complications, all complications of unsafe abortions,” says Dr Nadeem Khalid of Family Health Hospital, Lahore.

The methods used are unthinkable. Ingesting large doses of drugs, inserting a sharp object into the uterus, drinking or flushing the reproductive tract with caustic liquids, vigorous movements like jumping or physical abuse, and repeated blows to the stomach are some of them. Incidents have been reported where bowels of the patient are pulled out by mistake through the reproductive tract.

If the woman survives, she can suffer from long-term disabilities and infertility. Incomplete abortion, hemorrhage, trauma to the reproductive tract or adjacent organs and sepsis (bacterial infection) are common. Post-abortion complications, experts say, account for a substantial proportion of maternal deaths in Pakistan.

Numbers and reasons

Out of the 2.4 million unwanted pregnancies in Pakistan in 2002, some 900,000 were terminated by induced abortions (Studies in Family Planning 2007). The actual number is definitely higher, considering the unaccounted for cases. In a country where only an estimated 30 percent women use contraceptives (NIPS study: 2006-2008), induced abortion is used as a form of contraception. Contrary to popular belief that most abortions are the last resort of promiscuous women, a Population Council study shows that a staggering 96.1 percent of the women who get abortions done are married women.

The abortion rates in the more urban provinces of Punjab and Sindh are substantially lower than those in the Khyber-Pakhtunkhwa and Balochistan. In urban areas, the contraception rates are higher.

The reason why shady clinics and unskilled women end up performing these abortions are two, the main one being simple economics. A doctor in a lower income area would charge an average of Rs2,600, whereas a traditional birth attendant (TBA) would charge as less as Rs770, says a study by Marie Stopes Society, 2008.

Secondly, most certified medical practitioners avoid performing an abortion not just because of religious reasons, but also because they are afraid of legal complications. Under the 1990 revision in Pakistan’s Penal Code with respect to abortions, the conditions for legal abortion depend on the developmental stage of the foetus. Since 1997, under certain circumstances, abortion is conditionally legal in Pakistan to provide “necessary treatment”.


Women seeking induced abortion

– Highest in age group (30-34) yrs 39.6 % and lowest in (15-19 yrs) 3.9%

– Higher in married women (96.1%) and for single women    (3.9%)

– Highest in women with no education    (62.5%)

– Highest in people with already 5 or more children   (68.2%)

(Source: Population Council)



Can you live with each other’s imperfections?

People don’t change. Period.

We can only alter and change ourselves….alter our expectations. Adjust. Make space, give space and fit ourselves in the space we are given.

Yeah yeah….we have heard that a thousand times already.

Yet, humans will be humans. And what makes us human is that even the brightest of us have these convenient strains of naivety and stupidity when it comes to wishful thinking. Specially when it comes to intimate relationships.

“He will ‘change’ when we get married”. “She will no longer be manipulative when I give her enough love and security”. “She will adjust in my surroundings, with my family”. “His temper will cool down once we have children, specially if it’s a daughter”. “We will develop a mind-boggling soul-matish understanding”. “Chemistry will come…”. “Fidelity will be his new mantra”. “He will develop a love for books”. “He will leave smoking”. “We will laugh on each other’s jokes”. “She will be more emotionally available”. “He will be more communicative”. “She will become this awesome juggler….she will be pretty and thin and bright and work and manage home and learn to cook like my mom and be fun and adjust with my friends…..her passive aggressive streaks will go away…She will develop class….I will be a family man…..”.

The fairytale dreams go beyond the Karan Johar movie wedding…..married or not.

I am not implying that we don’t evolve….we don’t improve. We even may change.

But it is a mistake to assume, with happy idealism, that anyone’s inherent nature or qualities or the inherent combination of two people and what they bring out in each other will change. We may learn to adjust and “handle” situations better. But basics are basics. If you can live with those basics, also bearing in mind your own basics and how they will interact with her/his basics, go ahead. Then it’s worth it. If not, what one will be left with is resentment as the mouldy residue that eventually takes the spark out of relationships.

Disappointment. Disillusionment. Sadness.

And that horrid “C” word: Compromise.

You see, with the word “compromise” comes a sense of something being coerced….forced.

But if it is an informed decision you make of working on a relationship, and take ownership of this choice, you are not angry at that person for not meeting up to unrealistic standards.

It is important, then, to not say “I am living with a compromise”. Instead, say to yourself “It is my choice to work on this because this is worth it”.

Do people really ever change? I doubt.

They may improve….adjust….modify….morph. Two people may just learn to synergize beautifully, despite inherent differences.

But making a choice to be with someone long-term should be realistic – based on “What if this person doesn’t change at all? Can I live with the irritating habits or whatever puts me off?’ If not, best to be honest to one’s self and your significant other. But if the overall package is worth it, one must go for it.


Even if imperfect, some people and relationships are worth hanging onto and fighting for.

Why should we settles for less than perfect? Simply because perfection is for God alone.

The careful choice, then, is to know whether you can and want to live with the imperfections of this person or not.

Know the deal-breakers, all you bright people. And if they are not there, then make it work.

It’s very worth it in the end to have someone who validates you and believes in you, especially if this person knows your short-comings, and still loves you.

Only fools let that go.

Why is SINDHRI the sweetest mango in the world – The magical secret

They are a generous size….and sweet but not sickeningly, so you can have more than one, unlike any of it’s more sugary counterparts….other mangoes may be more sugary but none is sweeter than the Sindhri to me. Or may it is just the Sindh running through my veins that gives me biased taste buds. It doesn’t have irritating fibres that get stuck between the teeth….it allows itself to be eaten in so many forms…You can slice it, cube it, blend it. It is such a cooperative variety.

But then, can we really blame it for being so amiable?

It is from the land we call Mehran…..and so the Sindhri is a reflection of the people that sow it and care for it and pluck it off trees and keep it wrapped in hay shreds till the green becomes a vibrant yellow, bit by bit.


Sure, it has it’s shortcomings like it’s people, and it’s not perfect. Too fattening, too addictive, a bit overly sensitive.

But seriously very pluralistic, congenial and adjustable.

I have been taught to eat the Sindhri in every way possible by my parents….at breakfast with paratha, at lunch with boiled rice, at dinner chilled with cream….or just as is. And it adjusts! That’s what’s beautiful about it….maintaining it’s own but mingling and letting itself be moulded.

But the real secret of the Sindhri is, and it is no surprise there, that it bears so much heat.

“The hotter the summer, the sweeter the Sindhri,” my father used to say, every time he returned home from orchards he caringly looked after. Standing for hours at stretch in the sizzling 45 degrees plus heat of interior Sindh in summers had him many shades darker every time. “You’ll get sick, abba. They can do it! Why must you stand in that heat?” we’d say to him. “Sons of the soil don’t fear the heat. It makes the mangoes only sweeter,” he’d say with a smile.

I am biased towards the Sindhri.

But that is true for all mangoes of Pakistan…..just like the country….just like it’s people.

The heat of difficulties, I pray to Allah, will eventually make us sweeter. May be we are not ripe yet. Still a little green. Still a little undone.

But given time, we will be the best in the world, because the heat “only makes the mangoes sweeter”.

Working mom dilemmas: A life in progress

2 hours ago

You need energy to be a caring and involved parent – simple as that!

There are too many things on my plate. That’s how it has been for as long as I can remember. Selected highlights of a typical day of mine make me feel sorry for myself. I am a working woman and this is my life.

My day revolves around handling my maid’s mood swings and training her to make Thai food or gajar ka halwa, while I make Thai food and gajar ka halwa, and masoor ki daal that happily simmers on the other stove. Amidst this cooking and cleaning, I take out an hour to do aerobics a few times a week. This involves stretches and workouts that leave me sore till the next class. As well as laugh therapy that involves sticking out your tongue and yelling out your lungs in front of a gigantic mirror in order to relieve your stress.

Next, a visit to my mom; which I enjoy best. Then comes, attending numerous calls every day –I sound like a complaint centre and a sister, a friend or a relative tells me how I must “time nikaalo” (take out the time) to meet them.

You have to spend time with family, run darzi errands, sabziwala errands, and dry cleaner errands. Inescapable are the Khadda market and Sunday bazaar errands. Changing the newspapers of the almaari or organising the bedside drawer is also on my to-do list.

Let’s not forget replenishing the kitchen ration, especially because in Karachi, you never know.

Then there is counselling a few needy venting friends partly because I love them and partly because they have to do the same for me on my needy, venting days.

Every few weeks the overhaul that makes me look human is a must at the salon. On top of it, I must read enough to be intellectual, must watch enough TV to be aware enough, and must socialise enough to be…well, social enough.

Shaadis – they are late night, exhausting and depleting in terms of energy and wardrobe. Of course, they do have the “all-you-can-eat” additional factor.

But how much can one smile? How many times can one meet the same people day after day with the same verve?

On top of that, I have a demanding day job.

Initially, the sentence “I am taking a hiatus from work” sounded as cool as saying “I am taking a gap year”. But eventually, I knew I had to be honest to myself – I’m not disciplined enough to harness my time well enough to forever work from home. Hence, I added another ball to the many balls I am juggling; another plate to the plates perched on my head as I walk the tightrope; ok I’m running out of clichés here, you get the idea right?

Due to of all of this, what ends up not getting enough time is the most important thing for a mother – spending time with one’s little one, the little one being a teenager in my case. Motherhood’s not a coercive responsibility – it’s one of the fun and rewarding ones- one that makes the world go round and the sun shine and all that jazz.

It also induces one of the worst forms of guilt; the “working-woman’s mommy guilt”. It can get so bad that a mom is tempted to indulge in self-flagellation. Yet, to stay sane and happy and comfortable, mothers often have to work full-time jobs. But everything comes with a price tag. The price tag in this case is time with your kid and that can make you feel horrible!

Answer? Manage!

Manage your time, your patience, your mood swings and your energy levels.

I have learnt over time that the person who will end up suffering the most if my kid does not see enough of her mother is none other than me. I feel depleted of all happiness and sense of purpose in life if I don’t see enough of her. Time spent together has to be ‘quality time’ which means I cannot and should not be a cranky, irritated or moody mother. Or else, I will end up raising someone who equates a mother’s impatience and grouchiness with her working.

Being energetic helps with this; you need energy to take your child for random drives, shopping sprees, the beach and photo walks. You need energy (along with patience) to be able to listen intently even when you think they are just talking about random stuff like the rage over printed pants, and remain genuinely interested, because children ‘know’ when mothers feign interest.

You need energy to be able to talk enough with your kid about things that matter like poetry, literature, culture, society and religion. Yes, all of this, unless you want to raise hermits that live in bubbles. You need energy to cook for them enough times a week to appease their appetite for mom ke haath ka khaana (food made by your mother)

You need energy to be a caring and involved parent – simple as that!

I do not find any better use of a mother’s time and energy. That is the ultimate anti-aging regenerist the world ever knew!

Read more by Farahnaz here or follow her on Twitter @FarahnazZahidi

Of Daal Chawal and Rumi…..

My back aches as I get up….a remnant reminder of the eight hours I spend every day in front of a computer in a chair with a straight back, the only luxury being its wheels that I use to swing myself around in moments of utter boredom or frustration. 15 minutes after shutting down the AC, the heat has begun to show a teaser…..It is almost mid June….we have no pre-Monsoon rain in Karachi. Dousing down the lure of more time in bed  with a cup of chaai, I’m up. It’s another day…..Is it a new day? That’s debatable.

A malaai lawn shirt is picked up for ironing. The phone is switched on….messages of early risers await to be answered. The tv is switched on; the newspaper breaks free of the stifling hold of the rubber band. The pressure of “knowing” mounts as usual…..what kind of journalist are you if you do not know what’s going on in this world?

It’s just another day. Or is it?

The phone vibrates. A Whatsapp message awaits. I read it. My inner pace simultaneously slows down and speeds up.

We search for Him here and there
while looking right at Him.
Sitting by His side we ask,
“O Beloved, where is the Beloved?”

Enough with such questions! –
Let silence take you to the core of life.

All your talk is worthless
When compared to one whisper
of the Beloved.

The message is Rumi’s poem: One Whisper of the Beloved.

The message has opened a door inside me……a door that best remain shut if the usual business of life is to carry on.

Yet, I cannot unswitch……a weakness by default.

So Rumi it is, sporadic but sure, all through the day. He’s got me thinking. And thoughts overlap. Dots are connected. The heart is on a roll. The mind follows suit.

With Rumi come all his friends….some more spiritual than others, but all masters of words, raising existential questions: Why am I here? What am I doing? Who is my beloved? Is He my Beloved? What does the wind mean and the sunlight say and the lark sing?

My inner questions are beautiful but exhausting. Worst of all, they don’t gel with what’s happening around me. A long queue at the fuel pump, cars honking at other cars – all owned by impatient drivers. I must go to Mangal bazar to buy veggies & fruits for the week. The tailor had promised to give the clothes today. Three stories wait to be edited and I have to file a report today.

And I find myself zoning out repeatedly….like one in love.

But this is love, isn’t it? For a centuries’ old soul had once told me that “love is love….majazi (for a worldly beloved) or haqeeqi (for God)….and one who cannot love humans cannot aim to love God”. And all that poets, writers, philosophers and the important people in life have talked about is….well….love.

The work day is trudging along. Inside me, a dervish longs to whirl. On the outside, the world continues to go round.

Once back home, I long for some solitude.

But the daal chawal and qeema must be made.

I am walking toward the kitchen. And Rumi refuses to be silenced.

Out beyond ideas of wrongdoing and rightdoing,
there is a field. I’ll meet you there.

When the soul lies down in that grass,
the world is too full to talk about.
Ideas, language, even the phrase “each other” doesn’t make any sense.


My Soul Preached Me – By Khalil Gibran



My soul preached me and taught me to love that which people abhor and befriend him whom they revile.

My soul showed me that love prides itself not only in the one who loves, but also in the beloved.

Ere my soul preached to me, Love was in my heart as a tiny thread fastened between two pegs.

But now Love has become a halo whose beginning is its end, and whose end is it’s beginning. It surrounds every being and extends slowly to embrace all that shall be.

My soul advised me and taught me to perceive the hidden beauty of the skin , figure and hue. She instructed me to meditate upon that which the people call ugly until its true charm and delight appear.

Ere my soul counseled me, I saw Beauty like a trembling torch between columns of smoke. Now since the smoke has vanished, I see naught save the flame.

My soul preached to me , I heard naught but clamor and wailing. But now I eagerly attend Silence and hear its choirs singing the hymns of the ages and the songs of the firmament announcing the secrets of the Unseen.

My soul preached to me and instructed me to drink the wine that cannot be pressed and cannot be poured from cups that hands can lift or lips can touch.

Ere my soul preached to me , my thirst was like a dim spark hidden under the ashes that can be extinguished by a swallow of water.

But now my longing has become my cup, my affections my wine, and my loneliness my intoxication: yet, in this unquenchable thirst there is eternal joy.

My soul preached to me and said, “Do not be delighted because of praise,and do not be distressed because of blame.”

Ere my soul counseled me, I doubted the worth of my work.

Now I realize that the trees blossom in Spring and bear fruit in the Summer without seeking praise, and they drop their leaves in Autumn and become naked in Winter without fearing blame.

World Environment Day: Parched in the 21st century

Published: June 5, 2013

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n the harsh desert climate, the little rain that Tharparkar receives in the monsoons, if collected in natural depressions or manmade water reservoirs, lasts hardly a few weeks. PHOTO: FILE

KARACHI: Lali’s hands are chafed, as this 11-year-old helps her mother pull out water from an underground well in her village by the help of ropes – water that is almost poison. As people round the globe celebrate World Environment Day, Lali’s biggest dream remains clean water, even if she has to continue to walk three hours daily to get it. Where 89% of the water is unfit for human consumption in this district of Sindh, the dream of this daughter of Tharparkar is almost too idealistic.

A lot has happened in the last two weeks. The lower house of parliament has been sworn and new beginnings are underway. Yet, much is the same for the residents of village Samoo Rind in Tharparkar. They still walk with their spines bent. They still spend hours pulling out water from wells. It is two weeks since The Express Tribune published the story of this village in Tharparkar.

With dangerously contaminated underground water which contains high levels of fluoride and is unfit for human consumption, the result is generations of people crippled and disabled, with multiple health issues.

The only alternative to underground water would be rainwater. In the harsh desert climate, the little rain that Tharparkar receives in the monsoons, if collected in natural depressions or manmade water reservoirs, lasts hardly a few weeks.

A Ray of hope

Following Express Tribune’s story, the Association for Water Applied Education & Renewable Energy (AWARE) working in the area was thrilled when a team of the Pakistan Army reached them after reading the story. “On the second day of the story, a team reached. We are hopeful that the report of the said delegation will have far-reaching effects because at a distance of 24 km from Samoo Rind there is a water supply line of the Pak Army,” shared Wali Mohammad, the Communication Officer at AWARE, after the Army visit.

“We have presented the findings of the visit to our commander along with all the facts and figures. The water samples we collected have been given for laboratory testing. Inter Services Public Relations (ISPR) has been given the report,” says an Army officer, who was part of the team who visited Samoo Rind, on condition of anonymity.

“For underground water, desalination is the best option and among the available solutions Reverse Osmosis (RO) system is the best method. AWARE mobilised resources from philanthropists and installed a RO plant in 2008. But that is operated on diesel and monthly expenses are Rs50,000 which we cannot afford. The AWARE team got earlier offers for financial support to meet the recurring cost of the RO plant but being local and conscious about repercussions, we decided against temporary solutions. Creating dependency will have its own drawbacks; we don’t want to make our community a parasite,” says Ali Akbar, Executive Director, AWARE.

“Our first recommendation is simple and practical. At a distance of 11 km from the village, there is an electric supply line. If the village gets electricity, the RO plant can become functional,” says the Army officer.

And where is the Sindh Government?

“Pakistan People’s Party (PPP) is in a very strong position in Tharparkar now. If they want they can fix this within no time,” says Amar Guriro, President of National Council of Environmental Journalists (NCEJ) and a son of the Tharparkar soil himself. “Jobs and economic security, on the list of priorities, comes after water. This is a basic human right,” adds an impassioned Guriro.

At least some 70 villages in Tharparkar suffer at the hands of unsafe water-borne diseases, and governments come and go, as do promises.

Till the going of this story into press, repeated attempts were made to get a statement from the media department of the Chief Minister House, but no timely response was received.

Published in The Express Tribune, June 5th, 2013.

Lifesaver: Keeping mothers in better shape

Published: May 27, 2013

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A cheap tablet and better care can help save thousands of women. PHOTO: FILE

JAGLOTE / GILGIT: “Hassan’s wife has died while giving birth to a baby this morning. She died due to excessive bleeding. The baby has survived.” Those words hit Azeema so hard that she sat down as her husband Manzoor Khan uttered them on entering his house in Jaglote Valley, about 60 kilometers from Gilgit. Azeema, 26, has herself been in the clutches of death twice during childbirth. She knows what Hassan’s wife would have gone through in those last few moments as she bled to death. Out of the four babies Azeema has given birth to, two died in the course of delivery, and she almost never made it.

“Azeema’s delivery became complicated when initially the midwife assured the family wrongly that everything was under control, but after wasting considerable time, she expressed her inability and advised us to take her to a specialist doctor. We rushed her to Gilgit but it was too late,” says Khan. The experience taught Khan better, but not many get second chances. If her husband had not put in extra efforts to save her life and get her treated in time, Azeema, like her friend would today be just a statistic, a story.

In such remote rural areas, every mother has a story to tell – stories of deaths that could have been prevented.

Bleeding to death

Azeema’s unnamed friend is one of Pakistan’s 16,000 women who die annually during childbirth. Out of these, some 5,000 die due to Postpartum Hemorrhage (PPH), the leading cause of mothers dying. If the woman needs emergency surgical delivery, in most cases she never makes it to the nearest hospital in time and bleeds out and dies at home or on way.

Hope in a miracle drug

It’s inexpensive and almost free of side-effects. Helping the uterus to contract after childbirth and therefore reducing blood loss, Misoprostol can save lives. It has been included in World Health Organisation’s (WHO) model list of essential medicines. The National Committee for Maternal and Neonatal Health (NCMNH) has been advocating for the inclusion of Misoprostol in the national essential medicines list of Pakistan. “I instruct doctors and midwives attending childbirth to carry these tablets in their purse at all times to save lives of their patients,” says Dr Sadia Ahsan Pal, gynaecologist and obstetrician.

Distant treatment

“If the mothers have regular checkups the complexities could timely be addressed,” says Dr Shujaat Ali of City Hospital Gilgit. “In most cases, they come to doctors at the 11th hour when things have already deteriorated.” “We are trying to address issues within the given resources but it’s really a tough job,” said Gulbar Khan, health minister in Gilgit-Baltistan.

Published in The Express Tribune, May 27th, 2013.

Water woes: When heads cannot be held up high

Published: May 19, 2013

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Almost all of the 3,000-plus people in the village walk with their spines bent. PHOTO: AWARE

ISLAMKOT: As he tries to get up from his bed, no more than a threadbare ralli on the floor, Ramesh reaches out for his cane. Once up, he cannot stand straight. Though his full height is some 5 feet 8 inches, he is bent over so much that he seems only half as tall as he really is. He tries to manage a smile which only exposes discoloured and decayed teeth. He is 34 years old.

Nearby his mother, 53-year-old Hurmi, cannot walk at all, and is forced to crawl on the ground. This is not just the story of one house or one family. This is the story of each and every household in village Sammon Rind in tehsil Chachro, Tharparkar, about 480 km from Karachi. Almost all of the 3,000-plus people here walk with their spines bent, unable to stand up straight. The reason for their suffering is the very substance that sustains life itself: water. And in this village, every drop is tainted.

A timeline of Ramesh’s life is typical of almost all residents of this area. The highly contaminated water first affects the teeth, which start becoming deformed around the age of five to seven. Between 12 to 15 years of age, bone deformities start setting in. Coupled with the harsh and hot desert climate and chronic malnutrition, even adolescents start acquiring a shriveled appearance, mimicking old age. By the time they are 25-year-old or above, almost all of them walk with their spines bent. Water, the source of life, has ended up crippling not just their bodies but their dignity and their chance at a normal life. And no one seems to care.

Former Secretary General of the United Nations Kofi Annan once said that contaminated water jeopardises both the physical and social health of people, and is therefore “an affront to human dignity”. The reality of this remote part of Pakistan is that no head is held up high, literally.

Almost poison

Seeing the standards the World Health Organisation (WHO) has set for water safe for human consumption, one is forced to wonder how people in villages like Samoon Rind and Mau Akheraj in parched Tharparkar are still alive. But a look at their lives makes one wonder if this can be called life at all.

High fluoride content is mostly the culprit. According to the WHO, fluoride levels above 1.5 mg/l cause Fluorosis resulting in the pitting of tooth enamel and deposits in bones. Above about 10 mg/l causes crippling skeletal Fluorosis. In Tharparkar, fluoride content is found to be up to 31 mg/l.

Many of these victims suffer from diseases of “jaws, bones, teeth, liver, kidneys – contaminated water can affect all organs and these effects can be irreversible,” says orthopaedic surgeon Dr Tayeb Asim.

The arsenic contamination of underground water in Thar has been confirmed by United Nations International Children’s Education Fund (UNICEF) and chronic arsenic poisoning is considered to be a serious health emergency.

The WHO consumption limit for Total Dissolved Salts (TDS) is 1500 mg/l. But more than 50% of the population in Tharparkar is getting water that has TDS of more than 5,000 mg/l. In village Narowari, the water’s TDS content can go as high as 20,000.

A worthless struggle?

“The people of this area have been struggling to draw attention to these problems but all we get is promises. Governments come and go but no one does anything to help us,” says Ali Akbar, Executive Director, Association for Water Applied Education & Renewable Energy (AWARE), who has been working closely with effected communities.

He mentions the likes of Nisar Khuhro and Sharmila Faruqi giving commitments that never materialised. In January, locals went on a hunger strike in Mithi when they heard that President Asif Ali Zardari was expected to visit, but he never came.

Talking solutions

The preferred option is to find an alternative water source with lower Fluoride levels, as it is difficult and expensive to reduce a high natural level of fluoride in water. If there is no other possible or cost-effective source, de-fluoridation must be attempted to avoid the toxic effects. Digging deeper wells, rainwater harvesting, and installation of de-fluoridation and desalination plants is what should be done urgently.

A parched life in Tharparkar

•  Tharparkar is ranked by the World Food Programme as the most food insecure of Pakistan’s 120 districts.

•  89% of underground water in Thar is not fit for human consumption.

•  On an average, 3 people from each household spend 3-5 hours daily to fetch water for human consumption and watering the animals.

•  Women and children have to pull the rope by hands.

•  High maternal mortality rates in Tharparkar are related to lifting heavy water-carriers for hours and miles. Pregnant women suffer the most

•  The bones of these women are not well- formed, which is why they often cannot sustain child-bearing and die

•  No one wants to marry girls and boys of this village after ages 12-15 as because of brackish water, they acquire the appearance of old age. The result is high incidences of child marriage

•  Drought causes fodder shortage and animals get weaker, which is why livestock keepers migrate to barrage areas

•  High incidences of migration disrupt normalcy of life, which is why dropout rate of school-children is high

•  Due to difficulties of collecting water, people use it sparingly, which results in unhygienic conditions leading to diseases

•  The men suffer more as they do more physical work, hence they feel more thirsty and consume more water which is highly contaminated, and develop debilitating diseases

Published in The Express Tribune, May 19th, 2013.