My experience with pathology in MSF’s Hangu project has already been phenomenal. There is always that nerdy, guilty feeling of being a doctor; I can’t help but be fascinated by things we otherwise only hear or read about in textbooks, but I know that it is at the cost of a person’s suffering.
The spectrum here is huge: we’ve had gunshot and bomb blast victims with compound fractures; traumatic amputations and airway compromise; road traffic accident victims; patients suffering from electrocution with the attendant problems of arrhythmias, broken bones and soft tissue damage; heart attacks and the spectrum of cardiovascular complications. Hypertensive crises are all too common, as is reduced consciousness, secondary to hypoglycaemia; meningitis; malnutrition; end-stage Wilson’s disease; obstetric complications including haemorrhagic shock secondary to placenta previa, eclmapsia, placental abruption; and the need for neonatal resuscitation multiple times every day. The list could go on and on. Too many patients. Too many problems. Some we can help. Others we can’t. Learning which is which is a hard lesson.
Despite the immense pleasure I am getting from working here, I am also experiencing a profound sense of sadness and frustration on an almost daily basis. So much of the pathology and illness we see here is so preventable. And this couldn’t be more true of the local practise of “Oxytocin clinics” run by people without medical qualifications. Ultimately they use a drug called Oxytocin to speed up the labour process, often giving Diazepam (Valium) to help with the pain. This practise is very dangerous, causing significant stress to the baby being born, often resulting in very poor condition at birth, including the absence of respiratory drive, due to the Valium. It also places the mother at significant risk of rupturing her uterus and life-threatening bleeding. I have already seen too many lives lost due to this.
I knew I would be faced with more death than I have ever seen before, but to try and grapple with death due to malpractice is something I hadn’t — and don’t think I could have — prepared for. Another great source of distress for me is being faced with families taking patients home against medical advice, often to an almost certain death. This occurs on a daily basis, despite our attempts to convince them otherwise. I appreciate the reasons for this are multifactorial and incredibly complex. I am slowly trying to understand some of the forces which shape the decision-making here and can only begin to fathom the challenges so many of our patients and their families face, and the backgrounds they have come from. Lack of education, poverty, family dynamics, cultural beliefs, conflict, violence, displacement: these are all a reality for the people here. These things shape daily life, values, survival.
However, I do feel incredibly privileged to share the lives of the people here, to learn about the culture, their religion, their beliefs. I have always had a passion for travel as I see it as one of the most wonderful ways to immerse yourself into the world of another, and therefore begin to skim the surface of that world and all it entails.
Before coming here I told the MSF office that I wouldn’t go somewhere if I had to wear a burka. You still won’t see me in a burka, but I perhaps no longer see them as the prison I used to and have even taken to covering my face with my headscarf, after been told it was an improvement (not sure whether or not to take that as a compliment!); a simple action that generates a lot of pleasure and respect among the patients and Pakistani staff alike. The people here are so strikingly beautiful with their light eyes, dark olive skin, henna in their hair and beards, mehndi on their hands, piercings in their nostrils. And beneath the burka are vibrant coloured clothes and shawls, lined faces that could tell a thousand stories, shy smiles. The veil gives them a privacy and protection from unwelcome attention, and yet generates no barriers between us. Together we have held hands, shed tears, shared laughter.
So, my impression, not quite one month in? I wouldn’t want to be anywhere else right now. Every day I learn more Pashtun, bringing me a great sense of joy and providing a great source of amusement to those around me as I stumble my way over the unfamiliar sounds. I share sweet tea with my Pakistani colleagues; I skip through the compound with the children that live here; I share stories and frustrations with my fellow expats; I am being challenged personally and professionally in every respect, every day.