Kashmir: healthcare for women and children
Sarah Baumgartner, a Swiss nurse and an ICRC delegate, recently returned from a remote region of Pakistan-administered Kashmir where she spent six weeks working in a clinic specifically targeted at women and children. In this interview, she talks about her experiences there.
Can you describe the programme you were involved in?
We were involved in setting up a clinic for mothers and children in the mountains of Kashmir, eight kilometres from the Line of Control with India in the Cham valley. There are twelve villages here with a combined population of around 20,000 people. Until the end of 2003 when the ceasefire agreement was signed there was a lot of fighting and shelling there. Because of the conflict the Ministry of Health had no access to the area and there was just one military doctor – a man. The women were reluctant to see him because of cultural constraints and this meant the children lacked medical care as well. Even if they walked four or five hours to see him it was often too late and appropriate treatment couldn't be administered. Preventive health care for women and children was non-existent. After the earthquake things opened up and the military invited us in to provide healthcare for women and children.
What services did you offer?
We provided ante-natal care and post-natal care and were able to offer safe deliveries for pregnant women. We had an oral re-hydration tent to treat all the cases of diarrhoea after the earthquake and we had an Expanded Programme for Immunization aimed at childre n and pregnant women. We carried out some hygiene promotion -- distributing kits, raising awareness of safe motherhood amongst the community, providing safe delivery kits to pregnant women, promoting the benefits of immunization and the advantages of breastfeeding. In December, which was the opening month of the mother and child health post in Cham, there were 988 consultations and 980 vaccinations were performed.
How many people were working in the clinic?
There were three nurses. Two women from the Swedish Red Cross and one from the Australian Red Cross - I was more involved in administration. There were also a male technician from the Finnish Red Cross as well as many local workers and female translators. We had to do a lot of confidence building among the women at first and of course, within the clinic, it was an all-female staff. The patients wouldn't come to see male doctors or undress in front of a man for examination. It was quite difficult to find female translators at first as they had to be flown in from Muzaffarabad and Pakistan is a very traditional society. Women rely on men entirely. Every important decision is taken by the husband, father or brother. So often, male members of their families would come to inspect the clinic first but all but one family agreed that their female relatives could work with us.
Did you hire local women for other purposes too?
Yes. We had a lot of local women support staff to help us with cleaning and doing the laundry for example. I employed women who'd lost their husbands and had families to support. We had to be flexible sometimes of course. We ha d to employ a male cleaner for the tents that housed the clinic because the work could only be done after closing time and the elderly woman we originally employed did not like having to walk home afterwards in the dark. We found her another part-time job though.
How long will the clinic stay open?
It is expected to operate for three years but of course the situation might change and we could be asked to leave. For now, though, the authorities have said we can stay for three years. We have a lot to do – right from the very basics. A lot of the time it is a question of education and that takes effort. Women give birth in a field during the working day, go home in the evening and go back to work the following day. Maybe three children in a family have died but for them it's normal, they don't know anything else. So often they see no reason to visit some foreign woman for advice on how to give birth and raise children. It starts with education on hygiene, how to take care of the family and what kind of food to provide. Education is a long-term commitment. We also discovered that many people only trust medicines given by injection – they don't have any confidence in drugs given in tablet form. So there's a lot to be done. What we plan to do as well is to work with local people and to train some traditional birth attendants at the community level.
What was your overall impression of your stay in Kashmir?
It was a very positive experience. We were amongst the first foreigners to access this area in years. Suddenly we arrived in this remote area with our helicopters and generators to heat tents – a huge set-up – and of course there was a lot of curiosity about us. But the people are very kind. They have nothing but they are extremely generous. We had excellent relations with the military but also with civil leaders, with the imam and with the head of the village. The imam was the first to come to the clinic on opening day to have his children immunized. They were really happy to see us and they gave us a warm welcome.