I arrived in Pakistan just over two weeks ago. This is my first mission with MSF, and prior to leaving home, I faced a multitude of anxieties. Will I be able to do the job well? Will I be of any use to the MSF clients and staff that I will meet? Will I cope with the pressure of being in such a confined and restricted environment for nine months? Given the security context, movements are very restricted. How is the concept of mental health viewed in a place like Balochistan? I am a strong believer that a healthy mind and spirit is equally as important as a healthy body, but so often mental health services play the poor cousin to physical health. Surprisingly, as soon as I boarded the plane, the fears dissolved. It’s funny how the buildup of an event is often a period of far greater stress than the event itself.
The project I have been “matched to” spans across two sites. MSF runs a 60 bed paediatric hospital in Quetta, focusing on neonatal care and operating a therapeutic nutrition program. In addition, MSF also runs a health clinic in Kuchlak (about 30 minutes outside of the city centre, on the road leading to Afghanistan), with a heavy focus on maternal and child health. The mental health program operates at both these sites.
Since arriving in Quetta I have already experienced much in the way of confronting images and information. I spent the day with one of the national staff counselors at the Kuchlak clinic, sitting in on her sessions. I admire the strength that she has to do this work.
The cultural composition of clients at the hospital in Quetta is fascinating. Languages are varied and cultures are diverse. In contrast, many of the clients coming to the Kuchlak clinic are originally from Afghanistan. It is described as a “conservative” area, though I am always fascinated by how this is defined. The word has so many connotations, and is so subjective.
There are so many stories. A woman in her 40s whose husband has been beating her so severely for so many years, tying her up in chains and leaving her out in the cold that she is now suffering memory loss, confusion and bouts of aggression. This woman barely communicates with her father, or her brother. In fact, when a male walks into the room, she hides her face with her dupata and retreats to the corner of the room. When asked about her husband, she looks to the roof of the counseling room, then to the walls, then back to the roof, as she giggles and says, “I can’t see him. He is not here. Where is he? Why did you make me come here?” This woman doesn’t eat anymore. When food is put in front of her, she doesn’t know what to do with it. She refuses to wash herself or change her clothes.
A 13 year old girl was married at 12 years of age. Pregnant and petrified, she has barely gone through puberty. A child giving birth to a child.
Despite these confronting stories, I have also been exposed to generosity and kindness in a way that I wish everyone in the world could experience. There is a constant stream of offers of tea and biscuits everywhere we go. In a large gathering, we all sit on the floor and eat from the same plate. This sharing of food highlights so beautifully just how important community and connection is in this part of the world. The hugs that I receive from the women feel heartfelt. I smile when I see the spirit of brotherhood between the men. There is no shame in hugging each other.
I suppose that just like everywhere else in the world, here you find compassion and cruelty; love and hatred. It just happens to manifest in its own unique way.