While there are numerous private maternity hospitals in Pakistan’s Peshawar district, specialized obstetrics units are often out of reach of the country’s most vulnerable women. As a result, the maternal mortality rate is around 276 per 100,000 live births, compared to just nine out of 100,000 in France.
To fill this gap, Doctors Without Borders/Médecins Sans Frontières (MSF) provides free care at a 30-bed obstetrics and gynecology hospital in the city. From July to December 2014, Dr. Yasmine Ley headed up the 15-bed neonatal unit at this facility. Here, she looks back at her six-month mission.
“Her father hadn’t whispered Allah’s name at her birth*,” says Dr. Yasmine Ley. In her soft, precise manner, she recounts the story of Irfan’s baby daughter. “He did it on the twenty-fifth day, when we were absolutely sure she would live, without any long-term repercussions. It was a big moment for all of us. When the mother came in, she must have been in her twenty-ninth week of pregnancy. At birth, the infant didn’t even weigh one kilo [less than 2.2 pounds]. She was the smallest premature baby I’d ever seen.”
The MSF medical team organized the best care treatment for the infant. Fortunately, the baby responded well. "We did a blood transfusion and kept her warm," Dr. Ley explains. “She wanted to live."
But she wasn't out of the woods yet: “After two weeks she started to suffer from apnea,” says Dr. Ley. “So I spent a whole afternoon at her bedside, waking her up each time she stopped breathing. It was a difficult time for her family and for us.”
The mother, who had other children at home, remained at her baby’s side in the maternity unit for two months. And then, one cold sunny day in November, Irfan was able to take his wife home with their daughter, who had grown to 1.6 kilos [about 3.5 pounds]. He whispered the name of Allah in her ear and gave her a name.
Thousands of Very Premature Infants Each Year
Every year in Pakistan, thousands of infants are born premature and die due to a lack of appropriate care or medical facilities available to the family. In more remote regions, mothers must sometimes walk several hours to reach a health center. In winter, the cold and snow make matters even worse.
Serious complications can also arise after the administration of oxytocin, a hormone used to stimulate contractions of the uterus and quicken labor, in conjunction with diezapam, an anxiolytic, to relax women giving birth. This combination may stop newborns from breathing.
“After birth we end up admitting infants who have already been in respiratory distress for several hours,” says Dr. Ley. “Owing to a lack of oxygen, they suffer from irreversible sequelae [chronic conditions related to injury or illness] and many don’t survive. It was my first mission with MSF and that was the most difficult aspect to live with. As medical personnel, we are there to provide care [and] save lives, not lose them.”
“Fortunately we have a fantastic team,” she continues. “Four doctors, eight nurses, and eight midwives rotate around the clock to give patients bedside care. Our priorities are to place mothers and at-risk newborns under continuous observation during the 24 hours following delivery and ensure impeccable hygiene. And through our rigorous approach and methods we have saved lots of lives.” Innovative care and policies have helped as well. For example, in some cases MSF has authorized fathers to visit the women's hospital, resulting in fewer women leaving the facility against medical advice.
Frequent Multiple births
"In Pakistan, not only do women have lots of children—seven or eight for some mothers—but in addition to problems with premature births, there are often multiple births too,” Dr. Ley explains. “For example we saw three sets of triplets born in one month, all delivered naturally. Unfortunately, we had one woman whose infants we were unable to save. They must have been around thirty weeks, they were too tiny, their lungs not properly formed."
Due to poor medical records and widespread substandard care during pregnancy, MSF medical teams do not always know the exact age of mothers or newborns, particularly in the case of people living in the country's tribal areas. Many patients are referred by MSF's hospital in Hangu, located two or three hours away by road, which does not have a neonatal care unit.
“One day, a woman gave birth to twins, a boy and a girl each weighing in at barely a kilo,” Dr. Ley recounts. “The husband—she was his fifth wife—only had daughters. And it was wonderful, each time he visited, to see him tenderly holding his daughter in one arm and his son in the other. He would sit there, next to his wife, simply happy to be a parent. It was a beautiful picture.”
*Customarily, the father or a respected member of the local community whispers a prayer, or azan, in the baby’s right ear.
In 2013, 374 newborns and 3,717 women were admitted to MSF's Peshawar hospital, 40 percent of whom presented complications related to pregnancy. Each week, the team helped deliver an average of 62 babies (double the 2012 figure), including 10 by Caesarean section.