What killed Muskaan?

Her pulse was 172. Her blood pressure was 80/40. Her respiratory rate was 56. In medical language, this 13-year-old girl I was attending to was vitally unstable. Surrounded by her malnourished parents in clothes they must have been wearing for a couple of days, the girl stared at me and cried in pain every time I tried to draw blood.

Pale, thin, weak, in pain, wearing a kurta with multiple tiny flags of the PTI printed on it, she squeaked every now and then asking for water. I was supposed to prepare her for surgery and so couldn’t let her have that one sip of water she longed for. I had to counsel the parents and take ‘high-risk consent’ from them, which is a fancy way of saying that their daughter might die on the operating table. The father’s tears fell on the sheet of paper right next to his signature.

I didn’t want to leave this tiny human’s side and held her little hand in mine as she lay on the table ready to undergo anaesthesia. I had hope she would survive.

And she did. The surgeons fixed the three perforations in the intestine caused by typhoid – a very common in this part of the world, and curable if detected and treated early. She was shifted to the ICU and put on a ventilator. She was critical but alive.

I was posted in the ward the next day but kept visiting the ICU. She was conscious when I saw her. Still on the ventilator but better. The doctor on duty gave me the good news of her slow but steady progress. Like her parents would ask me, I forgot I was a doctor myself and asked him: will she be okay? The answer was yes. Relieved I walked out, completed my work, went home, came back the next day and before going to the ward went straight to the ICU hoping to see her off the vent smiling and blinking those round eyes with no fear in them.

Instead what I saw were two nurses wrapping her body in a white sheet. tying the head end and foot end. She was dead. It doesn’t matter what I felt at that time and so I wouldn’t describe the horrors of the scene before my eyes. What matters is why this innocent human died.

Who killed her? Was it the typhoid she got from the unsanitary conditions she lived in such as the water she drank or the food she ate being from a less privileged family? Or was she killed because of those who are responsible for providing her with clean drinking water and clean food but didn't? Was she killed because the medicines she took earlier didn’t work on her and so her disease progressed or was it because of those doctors who misuse antibiotics that resulted in the spread of a resistant typhoid not treated with basic antibiotics?

Was it because of the poor ICU management that exists in government hospitals or just the fact that she was unfortunate to be among that majority of the population of this country that cannot afford first-class hospital care because of it being ultra expensive?

People in her funeral might tell each other that she died of typhoid; her medical file and record might say she died of typhoid but typhoid was just a ready excuse for her death.

The increasing disparity and lack of health facilities for the poor is extremely disturbing. In Pakistan, the main cause of death in over 70 percent children are infectious diseases.

Where children in the world are doing wonders, our children are dying of diseases like diarrhoea, dysentery, measles, typhoid etc. It’s time practices such as misuse of antibiotics are put an end to. It is time the elected government focuses on health reforms and puts an end to the growing disparity between classes.

May Muskaan be the last victim of this horrible socio-political system. But for that to happen, people will have to launch mass movements based on class and lead those themselves. That will be the day – when the exploited will find their voice. For that to happen, people from all professions, big or small, will have to participate in active politics – every citizen truly being a member of a political party. Only then will they strive to resolve their issues with their own hands because they will recognise their stake and the power of collective human struggle. May Muskaan rest in peace. But can all others after her live in comfort, health & prosperity? We need to start thinking about this – now.

The writer is a doctor based in Karachi. Email: seepakhtar@gmail.com