"The real accolades should be for the local staff who work hard... through thick and thin"

I am currently working as Midwife Activity Manager in Kuchlak, Balochistan Province. I usually work as a midwife in Toronto Canada. This is my first mission with MSF as well as my first time in Pakistan.

I work in a town near Quetta (in Pakistan) where MSF provides free maternity and child health care to the local population. Most of our patients are very poor and not formally educated. In this particular part of Pakistan, local culture practice is strictly enforced greatly limiting the health care we are able to provide to our patients. Naturally, such a context can sometimes lead to very frustrating patient encounters. When I share some of these frustrations with friends and family back home, I am often admired for my courage. Indeed, international staff such as myself are often viewed as the ‘heroes’ of humanitarian aid. While I understand this perception, my daily experience working in Pakistan has proven to me that the real accolades should be for the national staff who work hard, and for many years, through thick and thin. Their knowledge and experience is incredibly valuable to the organization, and indeed I (and the organization!) would be lost without it. I could write so many things about the wonderful work I have witnessed, but a recent situation made me particularly proud and I really want to share it.  
One Saturday afternoon during Ramadan, as many staff members of the Maternal Child Health Centre (MCH) were getting ready to leave for the day, a woman came by rickshaw from a private clinic where she had been refused treatment. This woman was 5 months pregnant with twins and she was in labour. 
En route to our MSF facility, the woman gave birth to the first stillborn baby. She came into the birthing unit holding this baby. She was obviously in shock. Once in the birthing unit, the midwives helped deliver the second stillborn twin. Unfortunately, the placentas would not deliver despite the best efforts of the midwives. This is a very dangerous situation; if the placentas are not delivered, the woman can start to bleed uncontrollably. This patient needed to be transferred to a hospital quickly—both to remove the placentas and to get a blood transfusion. The midwives discussed the need for transport with the patient, but she refused. She does not have a male attendant with her, she said, she has no money—how could she go to a hospital? Could they not just take her home instead? The midwives asked if they could have the phone number of a male family member, but the woman replied she did not know any phone numbers. She has a brother working in a village close to Quetta but no phone number. Could they not just take her to him instead?
Aisha, the midwife supervisor, called me to inform me of the situation. Aisha is a very experienced midwife and has basically seen it all, but I could tell from her voice that she was very worried. I advised her to keep trying to convince this patient that she should go to the hospital even without a male attendant, but beyond that I was helpless. I wished desperately to be there with the staff so I could help, but this was impossible; due to the high insecurity context in this region of Pakistan, I am not allowed impromptu visits.


Group photo of MSF staff at the Kucklak maternity centre
MSF staff in the Kuchlak Birthing Unit. From left to right: Naeeta, Hameeda, Khadija, Fahmida, Aisha
The midwives were scared for the woman’s life but they also could not force her to go to the hospital. They understood that going to the hospital alone without a male attendant was simply not an option for this patient (the reasons are numerous and I shall leave out of this blog)—however they, as well as other MSF staff, would not give up. While the midwives (Aisha, Shazia, Shahida) stabilized the patient, Laiba Kasi, the mental health worker stayed with the patient, explaining what was going on and getting more information from her.
Fahmida, another senior midwife, meanwhile went to discuss the situation with Malik the mental health worker. Even though he was fasting and on his way home to offer prayer, he started calling around to see if anyone was available to help locate this brother. Malik remembered that a former MSF employee, Razmohammad, works in the same vicinity as this patient’s brother. He quickly called him and explained the situation. Without hesitation, Raz went to search for this man.  
In the meantime, some staff started collecting money so that if she really did not go to the hospital they could at least pay a rickshaw to get her to her family home. Others organized juice for the patient. 

More than 30 minutes went by and the situation with the patient was becoming critical. Radi Gull, a long-time health educator with MSF, offered to accompany the patient to the hospital.  Finally the call was received that the brother had been located and that he would meet them at the hospital!


Staff outside the MSF mother and child centre in Kuchlak
Malik and Radi Gull in MSF’s mother and child healthcare facility in Kuchlak
So that the patient would not be alone in the ambulance, two cleaners, Khadija and Rukhsana, switched shifts so that one of them could accompany the patient to the hospital along with the midwife Asifa.  
If it was not for this compassion, team work and quick-thinking on the part of the MSF team, this story would have likely ended very sadly. On the contrary, the patient received the care that she needed and she lived.  
I was so proud and humbled when I heard how all the staff members of the MCH gathered together to help this woman in her time of need. From a Western perspective it is difficult to understand why the woman would not consent and it is easy to judge. However, people’s lives here are often complicated and difficult in ways we also cannot imagine. The staff at the MCH are professional, resourceful and work hard to provide the best care possible for all patients no matter how challenging the situation might be. For me they are heroes.