Obs & Gynae à la Pakistan

As I now write, I have been in Islamabad for one week. I wear shalwar kameez every day, loose baggy trousers covered by a long ankle-length shirt-dress.

As I now write, I have been in Islamabad for one week. I wear shalwar kameez every day, loose baggy trousers covered by a long ankle-length shirt-dress. Here in the capital, a headscarf can be worn loosely draped around the shoulders but ready to cover the head if your hair is drawing too much attention. When I go to my project dress is more conservative still; trousers must cover the ankle, sleeves must cover the wrist, the dress stops mid shin with a side split no higher than the knee. And a headscarf must be worn at all times. Currently it is summer, more than 40 degrees every day, with glorious thunderstorms and sheet-lightning some nights. Wearing all these clothes in the heat will take some getting used to!


The food here can be a challenge for vegetarians and those intolerant of spice. I, on the other hand, am in heaven. Every day our chef cooks another curry delight with aromatic spices, usually followed by fruit. Chicken biryani is the only meal I have recognised so far, the rest a curry dream of flavour, spice, naan and rice. As with all travel to locations where precious foreigners bellies are not used to a relaxed level of food hygiene, I have been thorough warned about Pakistani belly. Thankfully, no sign just yet!


My role here with MSF is something I am still trying to understand. I have had a whirlwind week of briefings, leaving me with a feeling of excitement for the task at hand and impatience to reach the project. I am to spend the next few days receiving handover from my predecessor, who can hopefully arm me with vital knowledge of the project and lessons learned. I know I am to face numerous challenges in the field, ranging from learning to work wearing a headscarf (no simple task), to managing patients with diseases not seen in Australia. Whilst the medical side of my brain is excited to see these conditions in the flesh, the empathetic side of my brain would do anything to stop their suffering. Eclamptic seizures, neonatal congenital abnormalities and breech deliveries are just a few of the conditions I am apparently soon to become accustomed with. However all of this is conditional to receiving a visa.  As fellow blogger Cindy has described at length, I face a waiting period of no defined timeframe. People talk as though I will be in the field next week, and although I certainly hope so too, the lesson from my colleague’s experience is that realistic expectations are good expectations.


Until then I work remotely, with no visual understanding of the layout of the birth suite, the skill level of the midwives, the stock levels in the cupboards, or the conditions in which patients present. Verbal cues provide vital information on how to assess, manage and care for a patient. Vital clues I need to gather over the phone when remotely managing the unit from 1000 kilometres away. The next few weeks are going to be an exponential learning curve.


As I sat down to write this afternoon, I had just returned from my first solo expedition – we are allowed to walk alone in the nearest market. As I headed out, the head security guard says with a smile on his face “be careful, you look like a foreigner!” I know he is joking, but I am not sure what he is suggesting, so I am ever so slightly petrified for my safety. I decide to wrap myself extra tight, with the scarf over my head, and I watch the streets diligently with hawk-eyes. I quickly dart in and out of the shops, buying only the necessities. As I return to the gate at the house, arms laden with shopping bags, the guard gets up only at the last minute, “I did not recognise you! I thought you were an elegant tribal girl!”  If I can manage to wear a headscarf convincingly, ­ maybe I will be fine here after all.


However, I think I spoke too soon about not getting diarrhoea. The best part about being stuck in the capital awaiting an elusive visa is that we can adventure around the city and go to the markets. Anyone reading this who has been to an Asian market knows the delights I am talking about. Fruits and vegetables of every size and variety, fabrics, tailors, jewellery, spices, furniture, suffice to say, markets generally provide a feast for the eyes. At dinner on Saturday night a group of long-term Islamabad expats realised there was another market a little further afield that had not yet been explored. Excitedly a group of us decided to go the next day, myself included.


Mistake number #1, due to various people’s commitments we decided to go during the hottest part of the day. It was a toasty 44 degrees and Mistake number # 2, I had not brought my water bottle. We casually walked around the long rows of tailors’ stores, beautiful fabrics on displays. Shoes were tried on, cakes were bought, prices were negotiated; we were all having a leisurely Sunday afternoon. In the last few moments before heading back, as we waited for the car to come collect us, I made an impulsive decision to buy some mangoes and bananas from a stall that I had seen a few streets back. I quickly walk over, a little ahead of the group, in order to make my purchase before the car arrived. After I placed my order with the shopkeeper I had the dumb realisation that I was being a dumb tourist. Behind me was a vegetable stall and an isolated man selling semi-rotten mangos from a wagon, thus I had assumed this adjacent business was a fruit stand. In fact I was asking a juice seller if I could purchase his supplies. What followed was an embarrassment ridden charades game with many giggles from the store operator and his nearby colleagues, as I stubbornly followed through with my order for a bunch of bananas and 4 mangoes. I was suddenly handed a mango shake to drink as he ran across the street to weigh my purchases on the mango mans’ scales.


The silly foreigners’ shame was spreading further was about to spread further as my expats colleagues caught up. The Head of Mission (a.k.a. the BIG boss) came up and whispered in my ear “I think you are buying fruit from a juice man. I have heard they are reluctant to sell their fruit.” I hung my head in shame, drunk the juice in my hand in 3 large gulps (remember Mistakes #1 & #2, I was really thirsty!), then big smiles all round as I handed over the cash and he handed over the goods. I was very relieved to get into our air-conditioned car back to the house. And of course naturally, within a matter of hours I realised I would not be leaving the bathroom any time soon, as I had completely forgotten about Rule #1 of travel – don’t drink the local water unless you are absolutely sure that it is safe to drink.


As miserable as I felt this morning, as my stomach churned and I finished my third roll of toilet paper in 24 hours, I realised there was nowhere better for me to be right now. Many people say that you feel the most homesick when you are unwell, however today I realised that was not me. When I left Melbourne, I had to give up the share house where I have lived for years, with housemates whom I love, so unfortunately my house is no longer my house.  Most of my family are dispersed around the world at them moment, so even if I went ‘home,’ I’m not sure I’d be nursed upon. Not to discredit my Dad, Grandparents and many great friends, but Dad especially is not the type to dab my forehead with a cold face washer or make me chicken soup. Not that I would necessarily let him. Instead, I live in a house above one of the MSF offices here in Islamabad. A co MSF doctor, my angel, has become mother-in-lieu of my mother who obviously cannot be here to nurse me. Throughout the day, sweetened tea, home-made (yes, real life home-made!) chicken soup, crackers, diced fruit, Oral Rehydration Salts, antibiotics and anti-diarrhoeals were delivered to me in bed. Colleagues regularly checked in with me to see if I needed anything.


I genuinely feel I could not have been better cared for anywhere else in the world. It is a great sensation to know that here in the field, your colleagues become more like a family. You rely upon each other through the good times, the bad times, the boredom, the laughter, the frustrations and the triumphs. Close bonds can be made in a short period of time, developed over a defining experience. You learn who you can trust in a bind, and who will be there for you in times of need. I’m lucky to be with a good team.