Pakistan - Expect the Unexpected

Bart is a project coordinator for MSF in Balochistan, in the south west of Pakistan. He blogs about taking a road trip with the mobile clinic team, and the fight against childhood malnutrition...


I look outside my window and enjoy the view.  As far as I can see there are fields. I can see a lot of green trees, a clear blue sky, water canals, buffalos and people who work on the farms. The wheat harvest has come to an end and preparations for the rice fields are being made.

I enjoy being outside. I enjoy the freedom to move and I enjoy the trips with the national staff while we talk about many things. We pass lively villages with busy markets and shops as we drive towards our destination.
The roads are busy, with a lot of motorcycles, donkey carts, some tractors and also beautiful, colourful decorated trucks with huge loads, sometimes twice the size of the truck itself. I am impressed that these trucks can even load that much and are still able to drive.
Photograph of two colourfully decorated trucks
Photo: Susan Tector / MSF
Children are playing and enjoying cooling down in the water canals while the temperatures rises. At around 50 - 53 degrees, this area in Pakistan is among the hottest places in the world.
And while I enjoy the hours spent on these road trips, the reason we are on the road is a serious one. Today we have planned a visit to one of our 10 mobile clinic sites, part of our therapeutic feeding program.
It still surprises me and when I talk with my friends and family back home and it surprises them as well. Who expects malnutrition in this area and in Pakistan as the rapidly developing country that it is?
But surprisingly, in East Balochistan we run one of MSF’s larger malnutrition programmes. This project treats up to 10,000 children every year. 
It is difficult to say exactly why there is malnutrition here. I think it is a combination of cultural, economic and sociological aspects. 
Women tend to have many children, on average between 7 and 10. Often they don't breastfeed their babies and have to be busy working the fields instead of taking care of their children. These factors, combined with a lack of safe drinking water and hygienic practices, mean that young children often suffer with diarrhea. It puts them in a vicious circle of not having enough resistance to illness, becoming sick and not having enough to eat. Being underfed and unwell makes it more likely they’ll die from the illness, and of course increases the risk of severe malnutrition.
The lack of access to basic free healthcare, the poverty, the vastness of Balochistan province in particular, plus the condition of road infrastructure doesn’t make the situation any better.
A tiny baby lays in a crib
Photo: Nasir Ghafoor/MSF
As MSF we try to explain that breastfeeding is very important for building up a newborn’s immune system, as we often see that breastfeeding isn’t done or we hear the women say that they don’t have breast milk. Through health education both in our hospital and in the communities, we hope to increase the awareness of the importance of breastfeeding and therefore reduce the likelihood of severe malnutrition. We also spread other health messages and actively screen for malnutrition to improve the overall health situation in this area.
Besides our activities related to malnutrition, which covers two districts (Naseerabad and Jaffarabad) and an area of around 4,500 square km, we also run a nursery ward, a paediatric ward, and we recently re-engaged with the ministry of health to start needed maternity services. 
In the first few days we have supported nine deliveries. All of the newborns are healthy, one of them has been referred to our nursery. I hope with the efforts we take in their care and with health education for their families, these babies won’t ever have to be admitted into our therapeutic feeding programme.
A doctor uses a stethoscope to check a toddler's heart rate
Photo: Nasir Ghafoor/MSF
As our car bumps along, I continue to look out of the window and enjoy the view, while thinking over this project and Pakistan’s challenges with healthcare, high infant mortality rates and the security situation. 
We leave the main road and the driver tells me we are almost at our location. When we finally arrive at the mobile clinic site I can see from the car that many mothers are already waiting outside with their malnourished children, ready to be helped by our team. 
At that moment I feel so proud of our mobile clinic teams: our national staff and international staff who continuously work hard towards what we are trying to achieve here, and who I know will continue to do so.