Transcript Obstetrics in Northern Pakistan at Bach Christian Hospital

MORE THAN
MEDICINE
Dr. Patti Giebink
September
2016
PAKISTAN
Khyber-Puktoonwha
(Formerly NWFP)
Islamic Republic of Pakistan
162 million people
Size: Nevada+Utah+Colorado
Religion: 97% Muslim
Capital: Islamabad
Largest city: Karachi
5 Provincial Areas
Official language: Urdu
Other dialects: Pashto, Hinko etc
Scenery and people
Both men and women, girls and
boys wear “Shalwar Kamiz”
Women wear Dupatta (head scarf)
or full Chader; men a ‘Pakhol’
T.E.A.M.
TEAM.org
Established 1890
Built hospitals where maternal &
infant mortality are extreme such as
Zimbabwe, Bahrain, UAE, Pakistan
and others.
Looking for nurses, midwives,
doctors, PTs, community health
workers, and non-medical.
BACH CHRISTIAN HOSPITAL
(BCH)
• Built in 1956 by TEAM.
• Named for Thomas J. Bach:
missionary & director TEAM 1928-1946
• 60 beds; 2 ORs; 1500 deliveries/yr;
200 surgeries/mo; lab/ultrasound;
PT; pharmacy; clinic Mon-Fri.
• 3-9 doctors + med. Students.
• 9-12 midwives, mostly Pakistani.
INSIDE THE HOSPITAL
Postpartum ward
Labor and delivery
Midwives: Lubna and Jasmine
Charge nurses
The OR/surgery building
Teatime
Dr. Elspeth Paterson
Scottish OB/GYN
OB at BCH since 2000
Developed OB/GYN protocols
(see notebooks on the table)
Updates protocols per BJOG
Trained in the UK
Only permanent OB missionary at BCH
Challenges in Labor & Delivery
Malnutrition
Anemia
Transportation issues
Lack of education
Consent issues
Outside influences
Outdated equipment
Lack of medications
Electricity cuts out
Staffing
No blood bank
Grand multiparity
‘Dai’ handled
Prior c-sections
‘Fits’
Language difficulties
including dialects
PPH
NORMAL NURSERY
NICU
OR Building
2 operating rooms
Sterilizing & break room
Re-use, re-cycle
Photos c-sections:
Breech
Twins and baby warmer
STAFF
Doctors
Anesthetists
Resident doctors
(nurses and midwives in
previous slides)
CLINIC
Segregated like the hospital
400 patients per day
4-7 doctors working each day
OB summary in patient “chart”
Name this disease
Barriers to Health Care in
Pakistan
Lack of education
Lack of transportation
Lack of income (few can afford Rhogam)
Lack of safe water and sanitation
Language barriers: Urdu and dialects
such as Pashto, Hinko…
• Malnutrition
• Diseases: Tb, polio, measles, anemia,
diabetes, hypertension, etc.
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Barriers continued:
Lack of electricity and fuel for heat
No blood bank: “standing donor” or blood
from Bazaar (store)
Lack of bona fide medical facilities with
adequately trained personnel.
Limited medications available
Limited cancer screening: no Pap or
mammograms for most people
Lack of medical equipment
Cultural Barriers:
Large families-many grand multips
Pressure to have sons
Folklore/traditions
Status of women: cannot give consent
Different calendar
“Dai handled”- lay midwives
Very remote, inaccessible areas
Tribal society
Can have up to 3 wives at a time
SOME
SOLUTIONS:
Goals for decreasing maternal and infant
mortality in 3rd world countries:
Education, education, education!
Community health programs & providers
Trained birth attendants
Centralized places to deliver known high
risk pregnancies: primiparous, grand
multips, PIH, etc.
“In a community where girls
are educated through 5th grade,
infant mortality drops after a
single generation.”
African saying: If you teach a boy, you
educate an individual; but if you teach a
girl, you educate a community.
Some positives:
Sweet people
Relational culture
Hospitality
Women don’t smoke or do drugs
Not drug seeking
Simpler life style
since EQ accepting of more change
No EMR!
Make a real difference
What can you do?
Find time to go on a mission trip:
7days, 2 weeks, 1-2 months…
CMDA.org
TEAM.org
doctorswithoutborders.org
Save equipment and donate.
Educate and inform yourself: many
books and articles.
Consider becoming a full-time
missionary.