He’s pale and floppy. He’s not moving. His primate reflexes are barely present. This is a case of hypoxic ischaemic encephalopathy - brain damage due to oxygen deprivation at delivery. I’ve seen a lot of it here in Balochistan, where home deliveries are the norm and mothers rarely receive antenatal care.
My phone rings one evening - the familiar old Nokia tune. It’s the doctor on call - she tells me a new baby has just come into the nursery. What’s the main problem, I ask. Bleeding, is the unexpected response. Where? Why? I ask. From the mouth, from the nose, in her nappy. There is profuse bleeding, I am told. Can you come now?
We gather around his cot, and it’s clear to us all that this child has severe acute malnutrition. Malnutrition affects different children in different ways. Most become thin and wasted, but some children, when starved, become swollen with excess fluid. Bilal is a very severe case
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Health services in Pakistan are often unaffordable and in many regions, conflict and insecurity further restrict access.
In many parts of Pakistan sectarian violence is rife. Government forces are also engaged in military operations against armed opposition groups.
Médecins Sans Frontières/Doctors Without Borders (MSF) programmes focus mainly on meeting urgent needs among communities affected by insecurity.