In a landscape where decent clinics are scarce, the Umrana Mumtaz Healthcare Trust Hospital is a beacon of hope.
And a bustling one: on a sweltering afternoon worried mothers wrapped in traditional white robes and headscarves crowd the hospital's shaded amphitheater clutching their ailing babies. More than 120-thousand patients, mostly women and children, have received free basic health care at this facility since it opened just three years ago.
Mumtaz Ali built the hospital in Khyber Pakhtunkhwa, formerly called the Northwest Frontier, on the outskirts of the city Mardan. A well-off resident of Islamabad, Ali said his wife's dying wish was to bring medical services to impoverished rural Pakistanis.
"They couldn't afford it. We are right here on their doorstep," Ali said.
One of his sons, Adeel, an architect, designed the two-story hospital. Another son, Atif, pioneered high-tech projects that have put the clinic on the cutting edge of health care in Pakistan.
Women Especially Vulnerable
Women throughout Pakistan face staggering challenges. In rural areas especially, most women are illiterate, job opportunities are scarce, and conservative traditions in places like Mardan mean women must spend most of their lives in their homes tending to arduous chores. Health care for women in such regions is at best an afterthought. But this frontier hospital is battling all these obstacles as it tries to improve the physical wellbeing of women.
Saleha Ahmed Ali has come here from her village several miles away seeking formula for her six-week-old twins, who look no bigger than kittens. The face of this young mother is already etched with the hardship of rural life. Saleha was only 11 when she was married eight years ago.
Her 2-year-old son Junaid appears robust, but Saleha cannot produce enough milk to feed her crying infants. The hospital's Dr. Qasim Nasruddin-- who has treated thousands of women like Saleha — suspects she is malnourished. Dr. Qasim – as he's known at the hospital — says many women suffer from the lack of a proper diet as well as short intervals between pregnancies, which doesn't give the women time to recuperate.
"This is quite common," he said. "About fifty to sixty percent of young mothers that we see with children or young babies are undernourished ... or they have iron deficiency or they have malnutrition," said Dr. Qasim.
The women confirm that here in northwest Pakistan the conservative culture often dictates that men eat first and the women last, which may mean they just get scraps. Many like Saleha are also expected to keep physically grueling daily regimens. Dr. Qasim helps interpret for Saleha, who says fetching water is among her most taxing chores.
"She has to bring potable water to her home because they don't have a water supply at home," said Dr. Qasim. Saleha says she carries large earthen jars of water down from the side of a mountain, five or six times a day, and that takes about three hours out of her day.
And there are no rest days when she is sick.
"You can ask her when she was pregnant did she leave her chores, did she continue doing the fetching of water?" the doctor said. "She'll tell you she kept on doing those things even when she was expecting."
Dr. Qasim says the challenge for Pakistan is to make men feel responsible for the well-being of their wives and families. He says members of the hospital staff, most of whom grew up in this area, are trying to change the attitudes in the decidedly patriarchal Pashtun society. But he says it's a delicate balance because they must not antagonize the men.
"It's a very big challenge because they would consider that as part of their honor, the men," Dr. Qasim said. "If we take the side of the women they would not see that as someone asking for more rights for the women. They would see that as someone who is trying to decrease the rights of the men in the society."
Husbands generally don't come to discuss their wife's ill health or family planning, the doctor said. Unless, he added with a chuckle, "they are feeling ill themselves and then they'll say 'Okay, it's a good opportunity, we can both go and get treatment."
A Long Line of Patients
In the bright lobby of the hospital, cranky toddlers clamber over weary looking mothers. At a rate of one patient every eight minutes, the women are shuttled off to the examination room to see one of two staff doctors. The huge caseload — some 120 plus patients per day six days a week — speaks to both the demand for medical care and the trust the local population has in the hospital.
But Dr. Qasim says that doesn't always translate into trust in male doctors. The taboo against women being touched by anyone other than their husband extends to male physicians. The hospital's one female doctor stepped down in June.
One of the doctors, Mohammad Arif Kahn consults with a woman named Marcia, a 25-year-old expecting her first child. She's also anemic. It's her third check up here, but because Marcia will not allow Dr. Arif to perform a gynecological exam, it's not possible to know the full picture of her unborn baby's health.
The doctor acknowledges the obvious – that such restrictions create "a big handicap."
"We'll just examine her over the clothes," he says.
Yet even an examination through her clothes takes negotiating with the hesitant mother-to-be. As the doctor gently presses her belly, Marcia pulls her veil up to conceal her face.
Marcia says she would be ashamed if a male doctor saw her unclothed, or, if anyone knew she had been examined by a male doctor--
Her husband is not the only one insisting on such restrictions.
"Her mother-in-law, even her own mother will say that 'you should not go to a male doctor,'" Dr. Arif said. "It is a tradition here, you can say, that ladies should not go to a male doctor."
But the Mumtaz Hospital is circumventing social restraints and improving women's health. With the help of technology and the Internet, they have developed their own virtual battalion of doctors around the world who are sharing their expertise on-line.
Sitting before a computer Dr. Qasim displays the communication between himself and the National University Hospital in Singapore. "We are never alone," he says. "Having them on board is like having a cutting edge hospital at your doorstep."
When he disclosed to a Singapore university doctor the case of a woman who had developed serious gynecological problems last year, the specialist helped solve the difficult-to-diagnose case.
"After this when another patient of similar symptoms comes I will know what to rule out," Dr. Qasim said.
This private endeavor in Pakistan — the dying wish of one privileged woman to help the rural poor-- is now harnessing the world, treating problems that most doctors here are not even allowed to see.