Dera Murad Jamali; Gulshan’s Story

It is a particularly hot day in Balochistan’s Western District of Dera Murad Jamali. Forty-year old Gulshan has come to the MSF facility to give birth to her tenth child. She feels tired and weak and wishes for the pain to end.

Inside the delivery room, Gulshan’s mother and maternal aunt are fussing around her trying to get whatever information they can from the doctors and nurses. This is after all, the first time in her twelve pregnancies that they have had to bring her to a hospital.


Finally, a baby girl is born.
Gulshan’s mother explains their reason for not having a home birth;

“Last year she lost her baby in the eighth month of pregnancy and five months later when she became pregnant again we noticed she was very weak and sickly which is why we thought it would be better to bring her here for the delivery.”


Gulshan got married as soon as she became a woman. This is determined by the first menstrual cycle and usually by the third or fourth, women in her community are married off.

“I think it has been around twenty five years since I got married and I started having children immediately.”

The concept of time and age is confusing for many women like her since none of them keep a track of it. They have no need to. Gulshan struggles to remember how many children she has and how old they are.


“Two of my sons are working and one daughter is married with two children of her own, but the rest are still quite young.”

 Gulshan is exhausted. Her diet these past years has been basic potatoes and lentil with meat maybe once a week and no fruits of any kind at all. She has to make sure 12 mouths are fed before she eats and usually ends up with leftovers – sometimes not even that.


Her 22-year-old son, Hamza, is outside the birthing unit waiting for his mother to be discharged. He will take his grandmother, aunt, mother and new born sister home in a rickshaw they have hired. At home, the entire family of nearly 25 people is waiting for their arrival.


Gulshan’s aunt proceeds to give the baby an oil massage after which the baby is taken to her exhausted mother.


The family has lots of plans for the baby.
On day 6 of her birth, they baby’s ears will be pierced as per tradition popular in Balochi culture. The MSF health educator explains to Gulshan’s mother and aunt that the baby is too small for such piercings and that there is a high risk of developing tetanus as a result which could cause her to go in shock.


“But it is our tradition which we enjoy following, if they baby has fits then that is God’s will,” explains Gulshan’s aunt.

Tetanus in the first 28 days of life (neonatal tetanus) is an important cause of neonatal death. However, since babies affected by this disease usually are born at home and die there without registration of either event, the true burden is unknown. According to the doctors at MSF, it is a common cause of death in DMJ.

The family also plans on feeding the baby some herbal concoction.

“We will feed the mother and the baby ‘sutti’ so that the baby’s digestive system develops well.”


These herbal concoctions are potentially dangerous for babies but its hard for health educators to convince families not to practice age old traditions like these.


Lack of education is one of the biggest issues in Dera Murad Jamali. Pakistan Education Statistic 2016-17 launched by the National Education Management Information System (NEMIS) – a subsidiary of the Ministry of Federal Education and Professional Training revealed that 70% of the children in Balochistan were not in school.
This kind of illiteracy leads to men and women never learning about basic health practices that result in lack of proper hygiene, acute malnutrition and following of dangerous cultural practices that are harmful to children. In addition to that, lack of family planning lead to large families that are ultimately difficult to provide for. These factors also contribute to the high infant mortality rate in Pakistan.

MSF has been working in Pakistan since 1986. In eastern Balochistan, MSF runs an inpatient and outpatient therapeutic feeding programme and a paediatric care unit for children under five, as well as a neonatal ward in the District Headquarters Hospital in Dera Murad Jamali. In the nearby locations of Dera Allah Yar and Usta Mohammad, MSF also runs outpatient therapeutic feeding programmes.

Photos and text ©Khaula Jamil

(On assignment for Medicin Sans Frontiers/ Doctors without Borders)



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