A 20-BED facility that started off as a dispensary and was given the status of a hospital in 1983 is struggling to meet the needs of Nagarparkar, a small town at the foothill of the Karoonjhar mountains, which are famous for pink granite and Jain temples.

Nagarparkar (also known as Nangarparkar), the headquarters of Tharparkar district, is some 129km from Mithi and around 20km from the Pakistan-India border. The area with 51,428 households has a population of 260,170, according to the last year census.

A road trip to the area in an air-conditioned vehicle is an Instagram worthy adventure, but in case of emergency it can be nightmarish especially if you happen to be a poor resident of Nagar­parkar with the nearest medical facility available being the taluka hospital.

Mothers-to-be in need of C-section travel around 129km to reach civil hospital in Mithi

While the news of child deaths in Thar desert is often flashed in the media, miseries of small towns and their struggling basic health units (BHUs), rural health units (RHUs) and hospitals, including those in Nagarparkar, remain largely neglected.

With one female and 12 male doctors, besides two dentists, the OPD of Nagarparkar taluka hospital struggles to manage the daily load that often crosses 200 patients. As the hospital is not equipped to carry out emergency medical surgeries, patients in need of operation are referred to Mithi.

Talking to Dawn, senior medical officer Dr Chuni Lal says the hospital desperately needs specialist doctors, especially a paediatrician, more female doctors and an anaesthesiologist.

“Every time there is a drought, some specialists are sent our way but this isn’t the solution. The place needs more doctors and specialists who are committed and will not leave this area soon after they are posted here,” he says.

Dr Lal, himself a resident of Nagarparkar, was the first member of the marginalised Kohli community to become a doctor and continues to serve the local population as a physician. He proudly says that he had reported the last polio case in Tharparkar district, which has been polio-free since 1998. “But the area has many health issues. There is chronic malnutrition and anaemia. The disease-burden of typhoid, tuberculosis and Hepatitis B is on the rise with water-borne infections being one huge issue,” he says.

In the infants’ ward of the taluka hospital, two young mothers fan their sons. Lachmi, in her early 20s, anxiously stands by the side of her baby, Lajbat, weighing barely 2.2kg. Newborns weighing less than five pounds are classified as low-birth-weight (LBW) babies. She travelled from Kapora village after a home birth. Being severely malnourished herself, she got iron therapy at the hospital. In the same room is another mother, Wadhvi, with her 14-day-old baby, Hemu, who weighs less than 2.4kg.

According to Unicef, birth weight is a good indicator of “mother’s health and nutritional status but also of the newborn’s chances for survival, growth, long-term health and psychosocial development”.

“A lot of babies in Nagarparkar are LBW. Many are premature. Many newborns suffer from pneumonia and sepsis,” says a visibly frustrated Dr Lal, adding that the chances of survival become bleak depending on how long it takes to reach the hospital. “The serious cases are referred to Civil Hospital, Mithi.”

According to the 2014 Sindh Multiple Indicator Cluster Survey, the province has an infant mortality rate of 82 per 1,000 live births. When compared to the 52 per 1,000 rate of Sub-Saharan countries, these numbers are damning.

Talking to Dawn, Nazia Khoso, project in charge at the Thardeep Rural Support Programme and a resident of Nagarparkar, says female doctors are badly needed at the hospital. Her works as a social mobiliser in the taluka since 2011 has given her valuable insight into the plight of residents and the misery inflicted on them due to poverty. “There are some 40 villages near the town while hundreds of small settlements are scattered all over the remote region. The biggest issue is when women are due. Every time there is a serious complication or a C-section is needed, women have to be transported to Mithi, which is a long journey for a woman in labour.”

She says doctors at the hospital do a good job in dealing with many diseases but the obstetrics and gynaecology department needs more female doctors, an ultrasound facility as well as a standby generator.

“There is a private hospital in Nagarparkar, but even that cannot handle complicated cases and send women to Mithi for Caesarean,” she adds.

The trip to Mithi, which is a two-hour drive from Nagarparkar, costs between Rs4,000 and Rs5,000 depending on the time of the day (or night) and the type of vehicle hired. This amount is out of reach for many families who visit the taluka hospital at the last minute after a traditional birth attendant is unable to help them.

The situation for accident victims and cardiac patients is far worse in the absence of specialists in the area, as they have to be rushed to Mithi. In cases of emergency, locals say, the Rangers and police are kind enough to let them go without wasting time at checkpoints.

Published in Dawn, November 19th, 2018