MSF’s all-female staff in Kuchlak: Assisting women to deliver safely day and night

In Balochistan, Pakistan's largest and least developed province, most people have very limited access to health care. Médecins Sans Frontières (MSF) supports a mother-and-child health care programme in Kuchlak, a remote settlement outside the regional capital Quetta made up mostly of Afghan refugees. Here, the all-female staff in the delivery unit offer free and much needed obstetric services.

“Life for women is easier now compared to when I was young. We were nomadic then. I gave birth while we were on the move, travelling from one place to another. We used to deliver the babies without any help. We would cut the cord with a stone or a knife. We kept our babies with us in the tents and started travelling again immediately afterwards. Here, when a woman gives birth here in the birthing room, it is safe. She is taken home to rest for 40 days.  The family will take care of the new mother and give her a good diet, whatever they can afford.”

Farzana* has just become a grandmother again. Her daughter-in-law, a young Kuchi Afghani nomad, has just given birth to a healthy little boy at the MSF birthing unit in Kuchlak, on the Afghan border.

Descended from the nomadic tribes of eastern Afghanistan, Farzana still wears traditional, elaborately embroidered clothes, but she has abandoned her nomadic lifestyle and lives in a house nearby.  She now brings many women from her community to the MSF clinic here for deliveries, vaccinations and ante-natal care.

The clinic is part of a maternal health programme set up by MSF in 2006 to improve extremely low birth rates in the region. Between five and seven women in labour come to the centre each day, some from as far away as Ziarat, a mountain town 3 hours away by car in a region recently hit by an earthquake. Almost every woman who comes to the clinic has lost babies or children.

Like Farzana and her daughter-in-law, seventy per cent of the population in Kuchlak are Afghan refugees. People here have very little, and women and children often suffer the most. Healthcare access is extremely limited, and seeking care in the regional capital, Quetta, is still not an option for most refugees. Women frequently die during pregnancy or deliver still-born babies for a host of reasons: pregnant women continue to do heavy work, such as fetching wood and water; and they tend to give birth at home, so by the time a woman knows she needs medical help, it is often too late.

And, as MSF doctor Zardana FAHM WARDAK explains, many young girls become pregnant dangerously early:

 “Marriage age is 20 years, 18 to 20, but we see some people who were married at a much younger age. It’s a very big problem for the families.”

Early pregnancy can lead to a host of problems, including complicated deliveries that require safe facilities, where necessary for surgical intervention. And youth can mean a lack of knowledge – girls may not recognize the signs that mean they should go to a hospital.

MSF provides women like Farzana’s daughter-in-law with care during delivery, and a hygiene kit – a soap and towel – which can be very valuable. If there are complications, the clinic staff can refer the woman for surgery and provide transport to the hospital in Quetta. After the delivery, mother and child go home, and two to three days later, return for postnatal check-up. Later, MSF lady health visitors will visit the woman’s home for further health education.
Since MSF opened its project, the number of live births per month has climbed from 10 (in May 2006) to an average of around 100 per month throughout 2008.

“This improvement is a sign of the good trust people have in us. It is our work that has established trust between us and the community of Kuchlak,” explains MSF project officer Aleem SHAH.

A critical part of building that trust has been the practice of having a female-only department with an exclusively female staff. Women will not seek healthcare if there are only male health practitioners available, so the MSF birthing unit has one midwife and 11 “lady health visitors” who have two years of training in basic midwifery skills. They work in shifts and offer a free 24-hour service so that pregnant women can deliver safely day or night.

*Name changed