Aasi was 26 when she he arrived at the hospital emaciated, frail and in poor health.
As her doctor, I tried to elicit a response but she was too dazed. She had finally reached a tertiary care hospital in Karachi after a lengthy and gruelling journey.
Aasi came from a remote village in Balochistan with her husband. His meagre resources were fully exhausted in bringing her to the city for treatment.
Her kidneys had failed and she was severely septic. Like many other women, she had no access to basic healthcare when she became pregnant in a remote region in Pakistan.
She suffered from prolonged labour with profuse bleeding from her placenta. No doctor was present to treat her as she endured agonising pain.
Although the bleeding eventually waned, her blood pressure remained below the threshold for several hours, which caused her kidneys to shut down due to protracted lack of blood supply.
She finally delivered a dead foetus, while some parts of it were still inside her uterus, ensuing a persistent cycle of infection.
It was a struggle to explain the situation to Aasi’s husband due to the language barrier. His apprehension and fear was palpable as the ICU staff started to put tubes into Aasi.
To make things worse, the toxins from her body couldn’t be cleared as her kidneys were impaired.
Our team frantically pushed fluids into Aasi’s feeble body in a desperate attempt to sustain a minimum blood pressure. This would thrust her blood through the dialysis machine to artificially cleanse her blood.
Unfortunately, Aasi’s body was incapable of coping with a large quantity of fluid like a healthy person of her age due to kidney failure. Soon her lungs started filling up with excess water.
We had no choice but to put Aasi on a ventilator machine to help her breath artificially as her lungs were soaked.
Aasi's husband looked bereft as he held her limp hand and watched her small, cataleptic body hooked to several machines.
He listened to everyone carefully, hanging on to each word. Although he was not cognisant of the medical jargon, he understood that his time with Aasi was limited.
After juggling between life and death for hours, Aasi expired the following night.
Another patient I recall, Jan Bibi, was 21 when she arrived at the hospital. She was unable to breath, leaning on her brother’s arm. She also had delivered a dead foetus prematurely.
An ultrasound of her uterus showed bits and pieces of the septic fetus still inside of her. Her kidneys had failed due to low blood pressure because of the ongoing infection in her uterus.
It had remained untreated for several days as she dodged the terrains of rural Sindh to reach the coast for medical help.
Although she was too fragile to speak, her eyes were hauntingly intense as if she was pleading to live. Her blood was accumulating large quantities of toxins that would normally have been cleared by the kidneys, which had shut down.
“Jan Bibi will need dialysis and we need to remove the contents in her uterus,” I told her brother, who was still trying to understand what was going on.
Like many others who come from outside of the city, he didn’t have any place to stay.
He joined the innumerable families sprawled outside the hospital on the roadside as his sister was being treated.
With a valiant resolve to get better, she gradually improved. Her brother would be amongst the first ones in the colossal crowd everyday that poured into the hallway of our patient’s ward at 3PM, the starting time of visiting hours.
A few days later, Jan Bibi started having laboured breathing again. Her blood tests showed a very virulent hospital-acquired germ in her blood, a complication of extended hospital stay.
An ultrasound of her heart established our worst fears. One of the vital valves of her heart had been destroyed by this germ.
Without this valve, her heart was rapidly weakening, unable to push blood forward and causing it to pool backwards in her lungs, making it hard for her to breathe. Jan Bibi had to be connected to an artificial breathing machine.
Her brother was in shock. He thought he would be taking her home soon, but now we had to tell him that his sister may not survive.
Despite her organs failing one by one, Jan Bibi was still too young and tough to give up fast. Potent tranquillisers had to be used to keep her writhing body still.
She grappled for life for three long days before being pronounced dead.
Bakht Mina, another patient from a remote village in Sindh, was 24 when she came in with a distended belly and failed kidneys. She was unresponsive with a thready pulse.
She had an abortion earlier and a crude attempt had been made by an untrained individual to remove her uterus.
The sharp instruments used recklessly to empty her uterus without any sterilisation had stabbed through the uterus wall.
The instruments had inadvertently pushed deeper into her belly, piercing through her gut wall.
She now had a perforated uterus and gut with its contents spilling ceaselessly inside her belly, causing severe infection.
Bakht Mina needed critical surgery to patch-up her internal organs. Unless they were sealed, her infection wouldn’t be cured.
Unfortunately, despite the surgeon’s efforts to undo the atrocious damage, she remained unstable with a feeble blood pressure and knocked down kidneys.
After several rounds of antibiotics, fluids and numerous attempts to dialyse and purge the toxins in her blood, Bakht Mina passed away.
19-year-old Sodhi is our success story. She survived against all odds.
She came in severely septic with retained parts of her foetus and failed kidneys. The timely emptying of her uterus and antibiotics led to her recovery.
As she slowly recuperated, she would try to take short walks in the hospital corridor with her father, dragging the pole with her IV lines.
It was several enervating weeks before she was able to go home.
But we could not salvage her kidneys and they are permanently wrecked.
Sadly, Sodhi cannot get a kidney transplant, the only known cure of irreversible kidney failure.
Her potential kidney donors are a brother and an old and ailing mother who cannot donate a healthy kidney to her.
Her brother is reluctant to donate a kidney as he is the only earning member of their small family. He fears that if he gets sick, they will have no support.
Sodhi will need dialysis for the rest of her life for several hours every week to stay alive.
Being dependent on weekly dialysis, her life span will be shortened and her body will age faster. It is also nearly impossible for her to be able to bear children in future.
These appalling stories echo the government’s criminally negligent and callous attitude.
They denote the ugly and shameful reality of our country that cannot be swept under the rug or be casually overlooked.
If women’s health is not urgently prioritised, this brutal cycle of misery will continue.
Hundreds of other women like Aasi, Jan Bibi, Bakht Mina and Sodhi will continue to die and endure inconceivable torment, simply because they are born in a part of the world where human life is easily dispensable.
Names of patients have been changed to protect privacy.
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