Letter from Pakistan

Dear friends, It was mid-June when I received a call from the Field Human Resources Department in Hong Kong. The project proposed was Pakistan, as an outreach doctor …It took me two days to decide and accept the mission, but lo and behold I was only able to get approval for the NGO visa at the end of September, a few days after the Marriott Hotel bombing in Pakistan’s capital, a scary prospect. Pakistan is a different mission altogether as observed by more senior and experienced fellow international team members. The cultural aspect in itself is sometimes hard to deal with and add to that security issues that are not really apparent or visible, but you know are there anyway. The project I work in is in Malakand, northwestern Pakistan. The project in itself is a mix of primary healthcare, maternal and child health, emergency and surgical care. Two more projects deal mainly with internally displaced persons and the conflict areas. As an outreach doctor I do mainly primary care with a bit of the administrative and logistic work. I handle four centres and divide my week depending on the needs of each centre. The first one, Agra, was initially the field base.  This is where the Malakand project started.  It can run independently because it has its own team of national staff. I act mainly as a liaison with the field base in Dargai. Two more centres are kind of satellite centres to Agra, namely Totai, where we do outreach twice a week and the other one is Inzargai, which we support the medicine supply. The last one is Palai, considered the baby among the projects I handle. This project started in mid-September, a couple of weeks before I arrived. The community appreciates our presence as proven by the exponential increase in the number of patients that we have seen over the few months. The supervisory role of the outreach doctor is a bit of a grey area. I have to make sure that the projects are running smoothly with the help of the respective department heads. Medical issues or problems including pharmacy, laboratory, water and sanitation, health promotion, nutrition program, in-patient and out-patient wards. I also need to handle administrative, personnel and logistic issues with the field coordinator and the field logistician. Meetings with the local leaders are also essential. When I was offered the mission in Pakistan, I had some reservations and kind of mixed expectations.  I have to admit that I had some biases that now I have proven to be baseless. But coming from a fairly liberal society I had a bit of a hard time reconciling some things considered as “routine” by the locals. For instance, you will hardly see women walking around by themselves; much less doing things on their own. They are tied up with their families, with Pakistan being a male-dominated society. I’m not saying it’s bad, I just think it’s excessive. A lot of times they are confined to the four walls of their houses, which is fine by them, I guess. There are times that I hear from patients that going to the clinic is like a social thing for them; they visit the clinic just to have someone to talk to. That is why there is no single memorable patient for me.  The thing that keeps me going more is the thought that I’m making bit of a difference in some of these patients’ lives. Recently as you already know the security context of the project is changing.  A lot of things are happening and they are happening fast.  Sadly, the most recent of which has cost us two lives just doing their jobs.* So understandably the mood has been a bit down for both national and international staff. The projects have been suspended for a few days.  But as of this writing we’re trying to get the projects running again as normally as we could. Take care. Rey