TWENTY years ago, nearly 400 mothers out of 100,000 giving birth in Pakistan died. This phenomenon, referred to as the maternal mortality rate, has come down to 178 per 100,000 today. This is remarkable progress when seen in our own context. One may attribute this to better childbirth practices and immunisation of expectant mothers.
Who should get credit for this improvement in an area of healthcare when the statistics in almost all other health subsectors continue to worsen? Ms Imtiaz Kamal, no doubt. She has trained millions of midwives (including those from 24 countries who attended her courses when the World Health Organisation appointed her as a trainer in Oxford in 1972). Two weeks ago, the Pakistan Medical Association (PMA) acknowledged in a fulsome way the services of this nonagenarian who may rightly be called the mother of midwifery in Pakistan.
The hall was full when members of the PMA and midwives from all over Karachi gathered to pay tributes to their mentor. Some had not even been her students as one young woman who had come from Kharadar informed me. “But I know all about her work and just wanted to come to tell her how important she has been for us,” she added.
Laurels were showered on her as speaker after speaker recalled her kind gestures, her excellent teaching skills, her commitment to her work, her compassion for the mothers giving birth and her students. Some also spoke of the reprimands they received for not being meticulous enough — for instance, for failing to distinguish between midwifery and nursing. Her studies in England included courses in nursing, midwifery and public health, regrettably the three most neglected areas of the healthcare sector in Pakistan. Imtiaz Kamal understands their worth and wants them to be recognised as such. One may add that on them depends the health of the nation.
A skilled midwife must be able to recognise the danger signals at once.
Her biggest contribution has been to set up the Midwifery Association of Pakistan which provides a platform for midwives to raise their voice and make their presence felt. But she considers her academic contribution as a teacher more significant. That is understandable, for one’s real worth is determined by what one leaves behind. In the speech she made to acknowledge the honour bestowed on her, Ms Kamal advised midwives to have “eyes like a hawk’s, ears like a dog’s and hands like a lady’s”.
Imtiaz Kamal is a pioneer. While talking to me, she recalled how Begum Liaquat Ali Khan, the wife of the first prime minister, had sent her along with three others to England in 1948 to study. Ms Kamal later went to Columbia for her BSc and MSc degrees. The four women returned home to serve the women of Pakistan for long decades. They became founder members of the Family Planning Association of Pakistan. The others now rest in peace but Imtiaz Kamal slogs on for the country. Today, she is the secretary general of the National Committee on Maternal and Neonatal Health.
When Imtiaz Kamal returned in 1953, she joined the JPMC where, she told me proudly, she set up a modern labour ward. Thereafter, she served in various positions; one she recalled with fond memories was when she was attached to the obstetrics and gynaecology ward of the Civil Hospital where the writ of the formidable Dr Sara Siddiqi prevailed.
I asked Imtiaz Kamal how she felt when a mother she was attending to died during childbirth. She promptly replied that not a single woman had lost her life at her hands. “I was very careful and alert to any complication that appeared to be setting in. I would immediately send for the doctor and her timely intervention saved many a life.” Imtiaz Kamal further explains that childbirth is a natural process. A midwife is a specialist in obstetrics. A skilled midwife, however, knows how far she can go when delivering a baby. She should be able to recognise at once the danger signals. Thereafter, a gynaecologist is needed to take over.
She is dejected at what she terms as her failure to gain recognition for midwifery as a profession in Pakistan. “People still believe we are either nurses or dais,” she remarks bitterly, attributing this mindset to rampant illiteracy and ignorance in the country.
The fact is, that the midwife’s role is vital to the maternal health sector. But if the presence of midwives is to have an impact, they must be well-trained, be there in sufficient numbers and the worth of their status must be recognised.
How does she see the future? Her inspiring reply is, “Lagay raho, lagay raho!” (persevere). That is what is needed if Sustainable Development Goal 3, which is about good health and well-being, is to be achieved by 2030. Target 3.1 calls for a reduction in the maternal mortality ratio to less than 70 per 100,000 live births. Still a tall order and we need more Imtiaz Kamals if these targets are to be met.
Published in Dawn, August 16th, 2019