I had only been back in Islamabad for a few hours when I was invited to a goodbye dinner for another staff member who was finishing their mission. I met quite a few unknown faces at that dinner, including one person who coordinates all the medical services for all the MSF Paris projects. They were desperate for another Obstetrics/Gynaecologist doctor in their Peshawar project, and here I was, fresh from Chaman, not knowing when I would possibly return. It only took a few days, but the different heads of missions and medical coordinators spoke and negotiated a deal to borrow a staff member. I was being loaned to Peshawar.
In theory, when you work remotely you can do it anywhere. What is the difference between working in Chaman to Islamabad compared to working Chaman to Peshawar? I knew I was being given a great opportunity to see how another project manages our issues and learn from their examples. Plus, as a medical/surgical junkie, I get restless in an office, so any excuse to get back into the labour room is enough for me. I was excited for a new experience in a new part of the country.
Travelling to Peshawar is completely different to Chaman. I jumped into the back of a comfortable air-conditioned sedan on a sealed tarmac highway and enjoyed the leisurely two hour drive to my new ‘home.’ The scenery also provided an excellent contrast, as Peshawar is located on the convergence of multiple rivers, there is an abundance of greenery. I always delight in the simple things, such as interesting shop names, e.g. the Sham Wedding Reception venue.
I was quickly welcomed into the team, shown around and briefed on the new context. My roster is mostly covering the night duty clinical skills, such as instrumental deliveries, caesarean section and complicated births. I had an interesting first night on call, with undiagnosed twins delivering without incident in Chaman, while assisting the delivery of more complex twins in Peshawar. The first child was not getting enough oxygen so I performed a vacuum delivery, while the second child was completely happy and delivered breech in caul [a membrane that covers a newborns head on delivery], a rare and beautiful delivery.
Within a few days, I noticed that there were an exceptional number of women pregnant with twins and triplets. I jokingly asked one of the staff if there was something in the water here. She seriously explained that ovulation induction drugs are very easy to come by, so the staff suspected they were often used to increase the number of children a woman could have with each pregnancy. This may or may not be true, but it is a shocking concept all the same. The risks for mothers and babies alike are much increased with any non-singleton pregnancy.
An Afghan refugee was referred to our project from the Hangu team, as she was pregnant with triplets. As if this is not a high enough risk as it is, she had not had any antenatal care and was pregnant for the second time, after having a caesarean for twins last time round. The team were anxious that she would go into labour in Hangu, and given the staffing and resources needed to care for one preterm birth baby, keeping three alive would prove a monumental challenge. Within a day of transfer to Peshawar, she went in to labour. Three beautiful skinny babies were born into the world, weighing a far-too-small 1.6, 1.8 and 2.1kg, two petite little girls and a boy. Trust the boy to steal all the food!