UNRESTRAINED children are a usual sight outside the gynaecology department at the Jinnah Postgraduate Medical Centre (JPMC), followed by frazzled fathers seen searching for their offspring, clearly out of their element. An overflowing garbage disposal can, breeding ground for a range of diseases, is strategically placed in front of a sign that boldly reads “Cleanliness is half of faith”. Then one has to navigate one’s way through the rows of women perched on sidewalks or leaning against semi-constructed walls, all trying to escape the scorching sun, while they await their turn to be ushered in to the newest OPD block of the department.

Anila Rehman is exhausted, after having stood in line since before 9am to register herself and qualify for a 10-minute conversation with a doctor. Any doctor, she says, as on every trip she makes a new one examines her. She is eight-month pregnant and, with only a few more weeks left, she is so exhausted that she needs to brief a new practitioner every time. “How can I possibly remember all the problems I have faced? They don’t even let a family member inside to help.” The lines are long, but thankfully the new ward has enough allotted space for her to sit for a breather. “The nine-month process isn’t as dreadful as the process of accessing a doctor can be,” she quips. I am in awe of her stamina, and her optimism. But this may be because it is only her second child, with a gap of four years, she proudly proclaims; she doesn’t look as worn-out as most of the others do.

Also read: Repeated unintended pregnancies in poor, illiterate women endangering lives

The state of reproductive health in the country is no surprise. The narrative is overwhelmingly clichéd — botched-up deliveries, a complete absence of antenatal care, lack of post-operative care, ignorance around contraceptive use and, of course, the whole religious debate concerning conception. Hospitals are understaffed and overworked, and with thousands of women coming in, only a fraction is allowed access to a medical health professional. “There does not seem to be enough time to explore all the nitty-gritty,” says a resident, in a hurry to reach the emergency ward of the department, and not very keen to help untangle the chaos I have found myself in.

The smell permeates the open air, signalling the arrival of the gynaecology emergency ward a few minutes before it comes into view. The contradictions are overwhelming. For some, it seems to be a picnic spot, for others a place to quietly mourn whatever cards life has dealt them with on that particular day. Most women have a sound support system that tags along from counter to counter and at times department to department. “Not here, go there,” shouts one nurse, clearly losing her patience as the line grows longer. For others, lone figures, who try hard to blend into the background, the real test lays ahead.

The bruises on Aisha’s face are hard to miss. Clutching tightly the dupatta against her face, she doesn’t establish eye contact, for fear of giving away too much. But the marks reveal more than what she can ever say. She has come alone, only to check up on the baby she is carrying. Her back story is anybody’s guess, considering her unwillingness to reveal many details about herself. She hopes no one will care enough to ask these particulars. The aim is to just safely deliver the child she is carrying so she can head on her way.

Pregnancy among victims of gender-based violence is a common occurrence. Though organisations have been set up to provide improved choices in reproductive healthcare by offering various mediums of counselling and access of information — face-to-face, telephone and virtual. However, targeting women from a lower socio-economic background can be a tough task. Aisha shares this dilemma too. “I have no one to turn to,” she says ambiguously.

Moving further on in the line I find out that establishing eye contact and smiling usually gets a warm response. Women become chatty and share refreshments they have carefully packed away, having prepared to spend a large portion of the day at the hospital. “It took us ages to find the place as there are no markers and hardly anyone knows the location themselves,” laments Razia. “We would otherwise be much ahead in the line.” She has come to get her daughter examined, who is inching towards her third trimester. She is joined by her daughter’s mother-in-law, and both women promptly go back decades to the time when they also came to the JPMC for their respective deliveries. “It was much easier during those days though we did not have the facilities that are available today. There were hardly any fully constructed buildings and was just an open ground.” However, “once the baby is delivered, and the mother safely home, all the problems you face in the process become a distinct memory”.

Though the JPMC is known for providing extensive natal care, the doctor-patient ratio leaves much to be desired. A large percentage of women were turned away when the clock struck one. Dejected, though undeterred, the next day for them will begin on a similar note, though, hopefully, not end on one.

Published in Dawn, April 7th, 2015

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