Field notes from Tharparkar

Three days in Tharparkar reinforce one’s conviction that the empowerment of the region’s women will be the principal catalyst to replace high infant mortality with high standards of mother and child health.

One reads with distress the ‘Death list of 49 children under 5 years’ at the Mithi Civil Hospital for January 1-February 5, 2016 handed over by Dr Iqbal Bhurgari, a capable, experienced doctor working under severe pressure.

The visible column of ‘Cause of Death’ of infants and the invisible column of ‘Mother’s Health’ become conjoined when one reads the first column alone. Sepsis. Neonatal Sepsis. Encephalitis. Septicemia. Severe Birth Asphyxia. Low Birth Weight. Bleeding Disorder. Severe Pneumonia. Anaemia. Acute Gastro Enteritis. Meningitis. Severe Diarrhoea. Dehydration. Congenital Lethyosis. Etc. Or, in other words: Nature’s ‘Chamber of Horrors for Infants’ – facilitated by adult human failures.

In the list of probable causes for the alarming incidence of baby-deaths, three of the most potent causes arise directly from maternal health. These are: malnutrition; very early marriage (before 18 years of age); and too-frequent pregnancies.

One met Gulaba, seated on the verandah of the infants ward, wife of Dodo Bheel from Goth Chahchaar, near Nafeesnagar, Umerkot. She said she had never been to school and thought she was about 21 years old. She had already given birth to five children, three of whom had died at or soon after birth. The fifth child born five days ago was suffering convulsions and was in an incubator. As per custom, the baby will be named only after nine days have passed. Gulaba herself is one of four brothers and four sisters.

Seated nearby was Sita, wife of Jumman Bheel from Goth Pario near Islamkot. She had studied up to Class V but said she had long forgotten how to write. Her husband dropped out after Class I. Fortunately, after the birth of three children, with spousal consent she had tubal ligation to prevent further pregnancies. The couple were waiting for their most recent born to recover from jaundice. This writer also saw, for the first time, a baby with a birth-weight of only 600 gms, barely the size of two palms. Born prematurely to Hussain Nabi’s wife whose profuse bleeding led to premature delivery, this miniature gem of humanity was given zero chance for survival.

One empathises with the government of Sindh as it faces the onslaught of unrelenting, non-contextualised media reportage and criticism from opposition political parties. After all, there are 23 other districts of Sindh, in some of which infant and maternal mortality rates are probably higher than Tharparkar. A reliable source has revealed that specific and general health indicators, including mortality rates for children under five years and for mothers in Kashmore, Kamber Shahdadkot, Shikarpur, Larkana are most likely to be higher than in drought-affected Tharparkar.

While the provincial government is making extraordinary efforts to improve health facilities in Tharparkar, little independent recognition is being afforded to such actions. Unfortunately, in overall terms the infant mortality rate in Sindh for 2014 was probably about 80 to 82 per 1000 live births (whereas it had gone down to 74 about five years ago). Punjab is reported to have improved from 88 per 1000 live births to 76 in 2014. Khyber Pakhtunkhwa is said to have the lowest at 58 while Balochistan is the worst at 97 per 1000 live births.

Even though there are more incubators (13) at Mithi Civil Hospital than there reportedly are at the Liaquat Medical University Hospital in Jamshoro (only five) there are six functional ambulances and three 100kw generators to provide mobility and power round-the-clock at Mithi. Despite the availability of four paediatricians and three gynaecologists, several posts remain unfilled apart from a lack of enough qualified female nurses.

One major reason for the shortage of specialised healthcare personnel may be the anomaly that the special hardship allowance for a doctor posted to Mithi or elsewhere in Tharparkar is only Rs200 per month. There should be at least one, if not two more, zeroes in that figure. Most doctors have families, and children studying in schools in other cities in Sindh; these children cannot be transferred to schools in Mithi and have their studies disrupted. Most such doctors have to maintain two households, one in Tharparkar and one in the other part of Sindh, thus justifying the need for a far larger hardship allowance.

While hospital ‘care and cure’ quality, water scarcity, impurity, infection, and physical infrastructure aspects such as distance, cost of road transport etc are relevant to assess the current situation, the irreducible core factor is the status of the average poor village woman of Tharparkar. ‘Poor’ is as operative as ‘woman’. One has not heard of any woman from a middle-income or upper-income family – and there are several thousand such families in the region – suffering the loss of an infant in the ongoing issue in Thar.

Despite decades of effort and investment – meagre or substantial, sporadic or sustained, by government or by NGOs working on a smaller scale – and despite some notable gains in girls’ education and some other indicators, the harsh reality is that today too thousands of poor village women live steeped in pervasive poverty. More than economic poverty. The poverty of illiteracy, poverty of social justice, poverty of non-enforcement of legal rights, poverty of oppressive customs and practices which continue in the name of tradition, honour and faith.

If we collectively want to save babies, we have to first rescue their poverty-stricken mothers.

The writer is founding president of Baanhn Beli which has been working in Tharparkar since 1985.

www.baanhnbeli.org.pk