I arrived at the MSF facility in the District Head Quarter Hospital in the western district of Balochistan (Dera Murad Jamali) on the 16thof November 2018. A quick tour later, I found myself heading right for the nursery. The newborn babies are always the first ones I like to see when on a health assignment.
After seeing and getting a short history on the ten or twelve babies there, mostly premature or recovering from infections, I saw one baby behind a closed door in a dark room. She was in quarantine.
Baby Aiza* (name changed) was born normal and healthy a few weeks prior of being admitted to MSF. On the sixth day of her birth, her family pierced her ears as per popular tradition in their community. After that the spasms started. She went into shock.
Dr. Barkat, a consultant for MSF, has been monitoring her progress and told me she had greatly improved.
“When she first came, we couldn’t even stand in the same room as her for too long- even our breathing would trigger fits. We still keep her in a dark room because she is very sensitive to light and noise. It will take atleast another two weeks of antibiotics and hopefully she will improve some more.”
Since I was to stay in DMJ for one week, I decided to check up on Baby Aiza every day and document her recovery. I saw her mother come to check in on her every once in a while but she was suffering from a fever and too weak to be interviewed by me. I spoke to the baby’s grandmother who kept asking me when I thought they would be able to take her home.
The day before I left DMJ, as per routine, I went to see the baby again. The room was bright and surprisingly empty.
The doctor on call looked at me and simply said, “LAMA”.
LAMA. A dreadful word I had come to learn that stood for “Leave Against Medical Advice.” LAMA is fairly common occurrence in DMJ (especially in children suffering from malnutrition). Baby Aiza’s family stopped her treatment, which needed to go on for at least another two weeks, signed the documents and took her home.
As wrong as that may sound, women do not have the luxury of staying at hospitals while their child gets better. 100% of the time, they have at least 5 or 6 other children (if not 8 or 9) at home who need their attention. They possibly have to go back to work in the fields too. Their husbands need them back to take care of the house and also them. One of the doctors told me he had a case once where his patient who delivered premature twins had to stay at the hospital for several weeks. After some time the patient grew frantic and went into severe depression when she heard her husband had decided to marry another woman because he needed the help and attention at home.
Treatments at MSF facilities all over Pakistan are absolutely free. Mothers are given a common room right outside the nursery to stay for as long as they need to. Even their meals are free. And yet, it is time that becomes the thing that they cannot spare despite all medical expenses being taken care of.
How does one battle that?
Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries.
In a WHO report as recent as 24thJanuary 2019; Pakistan is one of 14 countries where Maternal Neonatal Tetanus is still a public health problem.
Photos and text ©Khaula Jamil
(On assignment for Medicine Sans Frontiers / Doctors Without Borders)