by Samia Altaf
Some months ago, on a sunny Sunday afternoon, I went to my bank’s ATM in the main market close to where I live in the Defence Housing Authority, Lahore’s latest fancy suburb, which is organized and managed by the military.
The market, usually bustling, was quiet that day. There was barely anyone around, and no one at all where I was, at the end of the building. When I came out after withdrawing my cash, I saw a rickshaw parked between me and my car. The rickshaw driver was leaning out of his vehicle, his eyes red, hair dirty and uncombed, his clothes mismatched (a shirt of sorts, alternate buttons missing, and scruffy cloth trousers); he looked completely demented. He was looking intently at me.
Oh no, I thought. This is a holdup. There is no one around except the two of us, and this fellow knows I have just taken money out of the ATM and have to go past him to get to my car. I tried to be brave, and, clutching my purse tight, said in a gruff voice, “I do not need a rickshaw, I have my car right here.”
He stepped out in front of me, forcing me to stop, and said in Punjabi, “I am not offering you a ride, I need your help.”
“What kind of help?” I asked, stalling while contemplating a quick dash past his left side.
“My wife is sick and I need money for the doctor.”
“What is wrong with your wife?”
“She is to have a baby in a month but she started to bleed this morning. I took her to a doctor near where I live, a private doctor, her fee is ten thousand rupees and I have only two.” He turned his trouser pockets inside out, revealing crumpled bills of assorted denominations. I must have looked skeptical, for the “sick relative emergency” has become more or less a standard prop for people asking for monetary help. For the one making the plea, at times it works. The driver lifted the flap of the rickshaw and said, “Look, you can see for yourself.”
What did I see? A skinny young woman, pale and anxious, her head and shoulders wrapped in a grimy chador sat on the hard seat, holding her bulging abdomen, breathing audibly and rapidly. She looked like she was no more than fifteen or sixteen—and probably wasn’t, for the man himself looked barely out of his teens.
There were many things wrong here, but the first priority was to get this girl to a place where she could get obstetrical care—including a blood transfusion. I knew that there was a newly renovated government maternity hospital just a mile from where we were standing. This hospital had been recently renovated by the Punjab government and specifically offered obstetrical services, or so it said. A new redbrick building had been constructed and its management handed over to a private company, which would be an improvement over the government’s management abilities. The Punjab chief minister was present at the opening of this hospital, as were other senior officers of his administration, including doctors. All had admired the new building, the renovated delivery rooms. They were given a detailed briefing on the newly installed IT system; they shook hands with representatives of the new management, who were well known for successfully running a large hospital in Karachi. There were many speeches and sumptuous tea.
You are in luck, I said to him, and explained how to get there. We exchange phone numbers. For a minute I contemplated going with them just to make sure—as I used to do in my younger days—but changed my mind and gave him my card and some money to help out and get something to eat. I told him he wouldn’t have to pay any doctor’s fee or for medicines. This was a government hospital and its services were free for citizens, the authorities had announced. He wiped his nose on his sleeve and thanked me, his brow unfurrowing as he wheeled his vehicle around.
Thinking or hoping things had gone well for them, I called the next morning and inquired about his wife. “Gone,” I think I hear. Gone? Where?
The woman died sometime in the night and this morning the family was headed to the village to bury her.
What happened? Well. He had gotten her to the hospital, but there was no doctor there, and after waiting for some hours for one to show up, not knowing what to do, he brought her back to the house late in the evening. He had planned to take her back the next morning, but she never woke up.
Did anyone else, maybe a nurse, see his wife? One did talk to them, and on learning that his wife was bleeding, since there were no arrangements to give blood transfusions there, told him to take her somewhere else.
Lahore, a cosmopolitan city of 12 million, capital city of Punjab province has 22 medical universities and colleges that produce close to 8,000 medical graduates each year, majority of whom are women. The city has 23 public-sector tertiary care hospitals, two of them liver-transplant centers, and also has about 65 private-sector tertiary care hospitals. In addition, it has numerous small-sized maternity homes and small hospitals. Punjab has almost seven government and non-government monitoring organizations that are supposed to regulate and monitor health services.
Lahore is a historic city with ancient monuments from most religious faiths–Hindu, Muslim, Christian, Sikh, dating back to the sixteenth century. It is home to spectacular mogul architecture. It’s a modern city with flyovers, underpasses, signal-free corridors where latest cars whizz by. It has high rise buildings and shopping malls lined with fancy shops that sell the latest cell-phones.It has newly developed suburbs that easily rival those in California with sprawling golf courses and palatial houses with manicured green lawns and exotic plants.
Pakistan, a nuclear power, admits it has unacceptably high maternal mortality rates, the highest in the South Asian region. It has obtained millions of dollars from the international community to fix its obstetrical services. The US government gave a grant of $92 million between 2006 and 2011 in support of the government’s maternal, neonatal, and child health program—yet here we are.
This young woman was now one of the faces of maternal mortality. But had she become a statistic? Actually no. This young woman was born at home in a village in southern Punjab, and given the patchy vital registration system, her birth was not registered. Her death would not be, either, since she died at home.
Who determines the cause of death in such a case? “It is God’s will,” said her husband. So she is not even included in the numbers that make up maternal mortality. Nor will many others like her. I can bet she did not have a national identity card. She never went to a school, so there would be no enrollment record. Officially, this young woman, though she was born, lived, and died in this country, in this city never existed.