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Pakistan is said to be one of the world's most dangerous countries for women. A survey from the Thomson Reuters Foundation shows rape, mutilation and honor killings are only part of the problem. Poor health also jeopardizes millions of Pakistani women.
NPR's Julie McCarthy reports on the acute problems of rural women and one frontier hospital trying to improve their physical wellbeing in the culturally conservative northwest.
JULIE MCCARTHY: In a landscape where decent clinics are scarce, the Umrana Mumtaz Healthcare Trust Hospital is a beacon of hope.
(Soundbite of baby crying)
MCCARTHY: Worried mothers wrapped in traditional white robes and headscarves clutch their ailing babies as they crowd a shaded amphitheater, a respite from the searing heat. More than 120,000 patients, mostly women and children, have received free basic health care at this facility since it opened just three years ago. The two-story philanthropic outpost was set up in the memory of a wife and mother.
Hospital Founder Mumtaz Ali says his wife's dying wish was to bring medical services to impoverished rural Pakistanis who he says cannot reach hospitals in the urban areas.
Mr. MUMTAZ ALI (Founder, Umrana Mumtaz Healthcare Trust Hospital): They couldn't afford it. We are right here on their doorstep.
MCCARTHY: Saleha Ahmed Ali has come here from her village several miles away seeking formula for her month-and-a-half old twins, who look no bigger than kittens. The face of this young mother is already etched with the hardship of rural life. Saleha was only 11 when she married, eight years ago. Her two year old son Junaid appears robust, but Saleha cannot produce enough milk to feed her crying infants. The hospital's Dr. Qasim Nasruddin suspects she is malnourished. Dr. Qasim, as he's known here, says there's not enough food, and the typically short interval between pregnancies here doesn't give women time to recuperate.
Dr. QASIM NASRUDDIN (Umrana Mumtaz Healthcare Trust Hospital): And this is quite common. We often see 50 to 60 percent of the mother - young mother that we see with young babies are undernourished.
MCCARTHY: The women confirm that here in the Northwest Frontier on the outskirts of the city of Mardan, the conservative culture often dictates that men eat first, the women last, which may mean just scraps. And many like Saleha face grueling daily regimens, which include the ordeal of fetching water. Dr. Qasim helps interpret for Saleha.
Dr. QASIM: She has to bring potable water to her home, because they don't have a water supply at home.
Ms. SALEHA AHMED ALI: (Foreign language spoken)
MCCARTHY: Saleha is telling us she carries large, earthen jars of water down from the side of a mountain five or six times a day. That takes about three hours out of her day, just to get the water.
Dr. QASIM: And when they get sick, they can't even take days off. She kept on doing those things, even when she was, you know, expecting.
MCCARTHY: Dr. Qasim says the challenge for Pakistan is to make men feel responsible for the well-being of their wives and families. He says members of the hospital staff - most of whom grew up in this conservative corner of the country - are trying to change the attitudes in the decidedly patriarchal Pashtun society. But he says it's delicate, because they must not antagonize the men.
Dr. QASIM: It's a very big challenge because, you know, they would consider that as part of their honor, the men. And if we take the side of the women, they would not see that as someone asking for more rights for the women. They would see that as someone who is trying to decrease the rights of the men in the society. They would see it in the opposite way.
MCCARTHY: Husbands generally don't come to the hospital to discuss their wife's ill health or family planning.
Dr. QASIM: Unless they're feeling ill themselves, and then they'll say, OK. It's a good opportunity. We can both go.
(Soundbite baby crying)
MCCARTHY: In the bright lobby of the Mumtaz Hospital, cranky toddlers clamber over weary mothers. At a rate of one patient every eight minutes, they are shuttled off to the examination room to see one of two staff doctors. The huge caseload - some 120-plus patients per day - speaks to the trust the local population has in the hospital. But Dr. Qasim says that doesn't always translate into trust in male doctors. The taboo against women being touched by anyone other than their husband extends to male physicians. The hospital's one female doctor stepped down in June.
Dr. MUHAMMAD ARIF KAHN (Umrana Mumtaz Healthcare Trust Hospital): (Foreign language spoken)
MARCIA: (Foreign language spoken)
MCCARTHY: Dr. Muhammad Arif Kahn consults with Marcia, a 25-year-old expecting her first child. She's also anemic. It's her third check-up here. But because Marcia will not allow Dr. Arif to perform a gynecological exam, it's not possible to know the full picture of her unborn baby's health.
That must be a big handicap for you as a doctor when you're trying to treat pregnant women.
Dr. ARIF: Yeah, this is, of course, it's a big handicap, because we can't expose her. We will just examine her over the clothing.
MCCARTHY: Even an examination through her clothes takes negotiating with the hesitant mother-to-be. As Dr. Arif gently presses her belly, Marcia pulls her veil up to conceal her face.
MARCIA: (Foreign language spoken)
MCCARTHY: Marcia says she would be ashamed if a male doctor saw her unclothed, or if anyone knew she had been examined by a male doctor.
So the pressure on her is intense.
Dr. ARIF: Yeah. It is intense pressure. And, you know, it is not only from the husband, her mother-in-law, even her own mother will say that you should not go to the man doctor.
MCCARTHY: Dr. Arif says the time will come when women allow males doctors to touch them.
Dr. ARIF: Yeah, this - a time is coming, Insha'Allah, in the next 10, 15, 20 years 20 years. But her children will do this, Insha'Allah.
MCCARTHY: Her children will have a different attitude.
Dr. ARIF: Yeah. They will have a difference, if they are educated.
MCCARTHY: If they're educated.
But the Mumtaz Hospital is already circumventing social restraints and improving women's health. With the help of technology and the Internet, this hospital has developed its own virtual battalion of doctors across the globe that is sharing expertise online.
Dr. Qasim says we are never alone, and cites the case of a woman who had developed serious gynecological problems. He contacted the National University Hospital in Singapore, where an OB/GYN doctor helped him treat the patient.
Dr. QASIM: She corrected my misdiagnosis. After this, when another patient of similar symptoms comes, I will know what to rule out. What happened was when we were starting, we faced many challenges and hurdles, and - but the thing is we did not let ourselves be dragged down by those challenges.
MCCARTHY: This private endeavor in Pakistan - the dying wish of one privileged woman to improve the health of the rural poor - is now harnessing the world, treating problems, even problems that doctors here are not allowed to see.
Julie McCarthy, NPR News.
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