Where women get a lifeline

A majority of poor women in Pakistan have a faint hope of living a better life. If they suffer from a disease that carries some stigma, their lives become even more miserable.

Fistula is one of those diseases that affect women belonging to the lower strata of society, and, if left untreated, can cost them their lives.

Koohi Goth Women Hospital in Malir Karachi is the brainchild of the Abu Zafar and Atia Zafar family who boasts nearly a dozen doctors within the family. Their story is amazing, as Abu Zafar was a school teacher who supported his wife and children to become doctors. Atia Zafar and her son Tipu Sultan became medical students almost at the same time. She was raising her children and studying medicine not for gains or glory but purely to serve humanity. Other family members such as Dr Sher Shah, Dr Shaheen Zafar, and Dr Sirajud Doulah and other show a keen sense of history too.

This family of doctors initiated a project in 2005 by the name of Koohi Goth Women Hospital, which is now a 200-bed healthcare centre. On my recent visit to Karachi, I made it a point to visit there. Dr Shoaib Subhani and Abdus Salam Salami were kind enough to show me around at the behest of Dr Sher Shah who was out of the country.

As you approach the hospital, the first thing that strikes you is its locality which is overwhelmingly low-income and diverse, with ethnic groups such as Baloch, Kashmiri, Pakhtun, Punjabi, Sindhi, Saraiki, and others, all living in harmony.

The second aspect is the rush of women to receive medical treatment at the hospital, as it is one of the very few free hospitals that exclusively treat only women without discrimination of capacity, caste, colour, community, or creed. Calling these women underprivileged would be an understatement as most of them appear to have no privilege at all. In the past two decades, this hospital treated nearly 30, 000 patients and handled over 10, 000 cases of surgery. More than 15, 000 pregnant women have availed the pre-natal and post-natal facilities on offer.

With thousands of deliveries to its credit, the hospital has a staff with the highest level of health and hygiene protocols. Its rehabilitative surgeries for fistula and other urinary tract problems in women are perhaps unparalleled in Sindh, if not in Pakistan. Routine obstetrical care and life-saving support to pregnant women under the supervision of skilled staff and free medicines is an added feature.

Dr Sher Shah is the moving force behind the nursing college that has so far trained over a thousand midwives and imparted competency-based training to hundreds of trainees. The Abu Zafar Institute of Medical Sciences (AZIMS) has also been offering quality education to learners from less- privileged areas across the country. The Pakistan Nursing Council recognizes AZIMS several health education courses that are not only free but also rewards students with scholarships and stipend during their stay at the hostels for female students.

Since these are all full-time residential courses, it is imperative that a congenial, safe, and secure environment is in place. One notices a small park within the premises of Koohi Goth Hospital where animals such as ostriches, deer, cows, ducks, and even peacocks roam around offering pleasant views to patients and students alike.

The nursing college has also put in place a swimming pool and a tennis court where students can go to relax and refresh themselves with exercises and friendly matches. A well-equipped library and an ORIC (office for research, innovation, and commercialization) are also functional with staff active in their routine matters. The best feature of the library that I liked was that it has a diverse collection of books not only focusing on students’ academic and medical training but also on literature; Dr Sher Shah himself is a short-story writer of considerable repute.

In a country such as Pakistan which is fairly conservative in its social mores, a male gynaecologist like Dr Sher Shah is a rarity. Women tend to trust female doctors more for their intimate health issues. But Dr Sher Shah has earned an impeccable reputation of being one of the best gynaecologist in the country who goes beyond his call of duty to help women in need. Such trust is hard for even a lady doctor to earn.

Since Dr Sher Shah specializes in fistula, let us learn more about the medical condition. Medically speaking, if two body parts develop an abnormal connection, it becomes a fistula. If an organ or a blood vessel and another structure nearby within the body have an unhealthy link, they form a fistula which are usually the result of an injury or surgery. Sometimes an infection or inflammation can also cause a fistula to form. In women, an anal gland infection may trigger an anal fistula resulting in an abscess that drains on its own or is drained surgically through the skin next to the affected area. That means a fistula is the tunnel that forms under the skin along this drainage tract.

In Pakistan, thousands of women report obstetric fistula cases every year, but there is an uncanny stigma attached to this condition. Women either feel shame in reporting it or lack a sympathetic ear to narrate their ordeal to. Their husbands shun them as dirty and unclean as an incontinent woman can hardly attract attention or sympathy. Koohi Goth Hospital is one of the few large and well-equipped facilities in Pakistan, and Dr Sher Shah has taken it upon himself to treat as many of the suffering women as possible for free.

The hospital and its doctors and paramedic staff specialize in treating obstetric fistula and detaching women from the stigma which the condition brings with it. Dr Sher Shah has also been stressing upon the need for more nursing colleges in the country. However, unfortunately, each new government is more interested in granting charters to new universities and hardly any new and fully equipped nursing colleges come into being. It is hard to find properly trained paramedical staff in this country while every year we churn out thousands of medical graduates who opt to leave the country for greener pastures.

While Pakistani doctors are performing fairly well in other countries, our trained paramedical staff is nearly invisible in comparison with such staff from India and the Philippines. The Pakistan government must realize that it is the skill development of our youth that should be our top priority rather than drafting a new ‘education policy’ every now and then, just to be curtailed by a new government. Ideally, every district in Pakistan should have at least one nursing college to enhance the clinical skills of our youth who can join paramedical profession both locally and abroad.

Koohi Goth Hospital is also actively involved in community engagement through its health outreach programmes. In most other hospitals this engagement is conspicuous by its absence; barring a few, hospitals in Pakistan are seldom concerned about the community they are supposed to serve and treat.

Another notable feature of the Koohi Goth project is its consistent commitment to set up medical camps for wider communities especially in backward areas which need free medical aid the most. This project remains in a constant need for resources as it has no cash counter at all.

Unlike many other hospitals which claim to be serving ordinary people but charge hefty amounts, Koohi Goth Hospital only claims what it does and has no pretentions of doing anything it does not do.

The writer holds a PhD from the University of Birmingham, UK. He tweets/posts @NaazirMahmood and can be reached at: mnazir1964@yahoo.co.uk