Global health: Flood illuminates the struggles of Pakistan’s women

September 22, 2010 — The scene that confronted Nabeel Zafar, MPH ’10, in southern Pakistan’s flood-ravaged Khairpur district was devastating. While visiting displaced persons camps on a medical aid mission, he and his fellow physicians found hundreds of homeless flood victims — mostly children and pregnant or nursing women — living in “subhuman conditions,” crowded together amidst cattle and rampant garbage. Toilets were inadequate and unsanitary, no one washed with soap, and poorly drained areas full of stagnant water created breeding grounds for malaria-spreading mosquitoes.

Already desperately poor before heavy monsoon rains overflowed Pakistan’s rivers in late July, rapidly covering more than one-fifth of the country with water, many flood victims are malnourished and suffering from diarrhea and skin infections. Two months into the disaster, the United Nations estimates that more than 21 million Pakistanis have been significantly affected by the floods and as many as 1,750 people may have died. Those displaced by the flood are highly vulnerable to malaria and waterborne diseases such as typhoid. Maternal mortality was already high in Pakistan, and now more than 500,000 pregnant women in flood-affected regions face risky births with little hope of aid if there are complications.

“There were so many heart-wrenching stories,” Zafar said. A father brought his five-year-old daughter to see the doctors. She needed daily medication to keep her heart condition stable. “All her father wanted was two medicines to keep her alive. We gave him money to buy a month’s supply, but what is going to happen to that pretty, five-year-old jolly girl? I cannot stop thinking about that.”

Zafar, a physician and surgery instructor at Aga Khan University in Karachi, Pakistan, visited more than 15 camps between August 20-25 on a mission organized by the Pakistan Medical Association and the Society of Obstetricians and Gynecologists, Pakistan. The group of five doctors examined and treated more than 500 patients, and also trained about 100 of the area’s Lady Health Workers — a national corps of women who provide basic primary care services — in conducting routine public health tasks at the camps, such as giving vaccinations, administering oral rehydration salts to people suffering from diarrhea, and providing education about health and hygiene.

“We explained to people how to take care of themselves — basic but important things like using the pit latrines, and washing their hands and bodies with soap,” Zafar said. He was encouraged to see that when displaced people had this information and were empowered to perform tasks such as cleaning and security at the camps, they were able to improve their living conditions and take steps to prevent disease.

Now back in Karachi, Zafar is adapting his field reports into training materials for the medical workers, who will continue to face daunting challenges even as the flood waters recede. “The best thing to do to prepare for disasters is education,” Zafar says. “If people are motivated and educated enough they can help themselves.”

Even when the short-term crisis abates, deeper societal changes will be needed before the health of this population can be improved, Zafar said. He believes that educating and empowering women, including encouraging them to have smaller families, is key. He noted that women in rural areas routinely have 10 or more children — more than they can care for even under normal circumstances, he said — which takes a toll on their health.

With fewer children to care for, and education in the basics of disease prevention and hygiene, women would stay healthier. And should disaster strike again, they would be better equipped to help their families survive, he said. Now that the flood has illuminated the lives of these forgotten women, he hopes that something will finally be done to make their lives better.

— Amy Roeder

photo courtesy of Nabeel Zafar