Date: Wed, 20 Jan 93 18:23 PST
From: Julian Macassey
To: awerling@nmsu.edu
Subject: For Junk List
Public Health in Pakistan
Returning from Afghanistan I entered Pakistan via the border town of
Wana. This is a town in what is known as "Tribal Territory". The
tribal areas are areas where the Pakistan authorities have no
jurisdiction and affairs are run by the local Pathans. Most of the
Afghan border area in the North West Frontier is tribal territory.
I had a rather bad case of dysentery, and the locals manning an ad
hoc road block who kept leaning over me with their Kalishnikovs
seemed to think it would be a good idea if I saw a doctor. The Pathans
once they have decided you are not an enemy will do anything to protect
you. I was assigned a bodyguard from the group standing around and a
turbaned gentleman complete with automatic rifle and bandoleer slid in
beside me and popped a wad of tobacco in his cheek.
They knew that in the town there was an ICRC (International Committee
of the Red Cross) hospital that took care of war damaged Afghans so
we drove there. The Afghan guard at the hospital explained that it was
a surgical unit only and suggested we go to the "Civil Hospital" in town.
No one seemed to know where this hospital was. We drove around and
eventually found a driveway that said "Diarrhea Treatment Unit". We drove
in. The place was in darkness, but we pulled up outside a door that said
"Emergency Treatment Unit". There was an armed guard sitting next to his
Lee Enfield. He opened the door and turned on the lights.
I was shown a bed to lie on while the guard went to fetch the
doctor. The bed had recently been vomited on. It had only a mattress on
it. The room was lit with a single tired forty Watt fluorescent light.
The tube was black with flies. The concrete floor was covered with
discarded drug cartons, to keep the flies down, three frogs were
hopping between the cartons gobbling flies.
Before the doctor arrived, various people, some armed with
Kalishnikovs, came in and looked at me. The doctor finally arrived
and I was moved to another room and laid on the examination table.
This room had its own frogs hopping around on the floor. The doctor asked
what the problem was and did all the temperature and blood pressure
things. His immediate diagnosis was malaria. When I questioned him about
this he said that eighty percent of admissions were malaria.
The doctor wrote a prescription and someone was dispatched to the
local pharmacy. There was some concern that I had not eaten for three
days and I was asked what I wanted to eat. I compromised and agreed
to eat plain boiled rice. One of the nurses went home to cook the rice.
All the nurses were men.
The staff whiled away the time by taking turns on the prayer mat in
the corner of the examination room. The runner returned from the
pharmacy and the doctor set up a disposable glucose drip. After some
rummaging through a drawer of old fashioned syringes a disposable IV
needle was located. The doctor opened the hanger loop with his teeth
and I was set up. A disposable syringe and needle was also found after
much chatter and an antibiotic and analgesic were injected into the
drip bag. I was left alone with the drip.
After a while the nurse arrived with the rice and a spoon. The rice
was not fully cooked, the last thing I felt like doing was eating. The
only thing I could possibly eat was rice. I ate some of the rice. The
Pathans have the same ideas of hospitality as the Bedouins. This means
if they offer you something, you accept it.
As I was sitting unsteadily on the edge of the bed chewing the rice
people started drifting in and out again to view the "foreigner". They
don't get many tourists in places like Wanna. A few of the curious
onlookers had AK-47s casually slung across their shoulders. One of the
visitors was an earnest looking young man who came up to me and asked if I
was a Christian. I was the most Christian person I had met for a few
weeks and certainly wasn't a Moslem, so I said yes. He excitedly told
me he was a Christian.
The young man was a Punjabi, and said he was one of twenty eight
families of Christians in the Wanna area. He told me he worked in the
hospital and taught the doctors English. He said he was very excited to
meet another Christian, he had the fervor of a young fundamentalist.
Apparently the word was all over town that there was an American in the
hospital. It seems that small town Pakistan was like a small town anywhere
else in the world. A stranger in town was a big event.
I ate all I could of the rice and was told I should spend the
night in the hospital. I asked to use the toilet and was shown a "hole
in the floor" flush toilet. There was no light and of course no toilet
paper. I had my own toilet paper, I left the door open for light.
I was escorted to the ward where the doctor wanted me to spend
the night. The ward was a relic of the British Empire. It was a long room
with a row of beds against each long wall. The beds were the old iron
hospital beds. On each bed was a mattress. There was no bedding. There
was no mosquito netting on the windows or doors. There were three
overhead fans for ventilation.
The ward was partly filled. The occupants were men and boys. The far
end of the ward was screened off. Behind the screen was a young boy and
his mother. The mother was wearing a burqa. The floor of the ward was
also littered with discarded drug packages. Under my bed was a discarded
disposable syringe and needle. For mosquito control, there were three
bats flying backwards and forwards. During the night one of the bats
failed to dodge the fan blades and expired against the blades with a
loud clatter. Bat bits were scattered across the room.
Just before dawn the call to the faithful was made by a nearby
muezzin. This started activity in the ward. Those that could started
their morning devotions. One of the praying faithful was the mother
at the far end of the ward. As dawn rose various visitors started
wandering into the ward. Most of the visitors were armed with
Kalishnikov's - the male jewelry of the Pathans. One of the young boys
got up and found the discarded disposable syringe under my bed. He
grabbed it and went back to his side of the ward where he and
another boy entertained themselves playing with their new toy.
My driver and guide arrived to pick me up and drive me back to
Peshawar. As I walked through the hospital grounds I saw a sign above a
door, it said: "Intensive Care Unit". Regretfully, I didn't peep in.
END