(Photos and story by Khaula Jamil for MSF Pakistan)
After two years of marriage, 26-year-old Zaiba, finally conceived a baby. Hailing from a small remote village in Bajaur District, Pakistan, she grew up in abject poverty with her three brothers and four sisters. Life was never easy for Zaiba. At home, she had two brothers with mental illnesses and was eventually married off to an unemployed sick young man from a neighboring village. Uneducated herself, Zaiba is dependent on her father-in-law to provide for her and her husband while she stays at home and helps her mother-in-law with household chores.
On the night of 10th December, the end of her pregnancy term, Zaiba started feeling a nagging pain in her back. She sought medical help from a private clinic for which she had to travel four hours by road to the nearest city.
“The doctor gave me 3 injections and two tablets and told me I would be fine in a few hours. I did not get better! I went to a Lady Health Visitor at another place and she gave me two drips and told me to keep walking in order to deliver the baby.”
It was several hours before the traditional birth attendant (TBA) told her she needs to go to the MSF facility in Timergara (a six hour drive away from the clinic) because her situation was beyond their abilities to care for.
What Zaiba did not know was that she had been terribly mishandled by both the TBA and the LHV. After gathering the patient’s history, Esther, MSF’s midwife manager at the maternity unit in Timergara, shared her assessment of what happened;
“Zaiba received a very high dose of Oxytocin and Misoprostol tablets which induced premature labor. When she arrived at MSF, the baby’s heart beat was faint and the patient had developed complications.”
Oxytocin is a medication used to begin or improve contractions during labour. If used incorrectly can lead to the uterus rupturing and neonatal death. In Khyber Pakhtunkhwa, exposure to unregulated treatment with labour-inducing medication is common. Despite carrying high risk for mother and child, the traditional birth clinics tend to use this drug without much caution.
“The baby was in severe distress and the patient was bleeding. Luckily, we delivered the baby and he is alive (for now) but his oxygen levels are low and he needs to be observed closely over the next 48 hours,” continued Esther.
Zaiba’s baby will be in the neonatal care till he stabilizes. His birth weight was 4kg – too big for a normal delivery for a woman as petite as Zaiba, therefore delivered through an emergency c-section. She will also be receiving counselling in regards to birth control and spacing since she needs to allow her body to heal from this trauma.
Birth trauma aside, Zaiba’s abdomen is full of blood post-delivery. She will remain admitted at MSF in the post-op ward for several days till her urine is clear. A very worried mother-in-law is by her side with not just her daughter-in-law’s condition to take care but also the finances it cost them to get her here.
“My husband is the only earning member of the family and he works in another city. We paid the LHV Rs 1,300/- and it cost us Rs.5000/- ($40/-) just to get here after driving almost 7 hours. I don’t know how we will pay this amount but my husband will have to arrange it somehow,” she says.
She regrets not bringing Zaiba to MSF directly when she did not get better after the first three injections she received. However, thinking they could save the expense of travel, they decided to keep on waiting – till the situation got out of hand.
After her near death experience, Zaiba is finally gaining her strength back – enough to feel angry about what she was put through by the Lady Health Visitor and TBA before she came to MSF; “If I could, I would go back and strangle them for what they did to me! They kept saying push and walk till I collapsed due to exhaustion.”
Over the next two days, Zaiba started walking and eating. With her stitches healing slowly, her mother-in-law and the MSF midwives help her with her movements. What she has not been told yet, however, is that after two days of fighting for his life, her baby did not survive.
“Médecins Sans Frontières has provided an emergency medical assistance programme in Timergara District Headquarter Hospital since October 2010. This assistance includes support to the Maternal and Child Health (MCH) department,, in the form of human resources, provision of medical and logistical supplies, as well as rehabilitation of the emergency operating theatre, recovery room and acute post-operative wards and full support to sterilization, hygiene and waste management. The hospital is meant to cater to the inhabitants of Lower Dir (where Timergara is located), but patients also come from neighboring districts, with the majority coming from Lower Dir, followed by Upper Dir and others within KPK as well as the Federally Administered Tribal Areas (FATA). All services are provided free of charge.
Use of labour-inducing medication by insufficiently trained cadres of healthcare workers is prevalent in a vulnerable population of Pakistan. The stakes are high, with unregulated usage of such medication resulting in severe consequences for mother and child. Tighter regulatory control measures for the use of labour-inducing medication, as well as better training and awareness among healthcare workers and the community are critical to improve this situation.”
©Khaula Jamil/MSF Pakistan