Date: Wed, 20 Jan 93 18:23 PST
From: Julian Macassey 
To: awerling@nmsu.edu
Subject: For Junk List

     
     
                         Public Health in Pakistan
     
     
     Returning from Afghanistan I entered Pakistan via the border town  of
Wana.  This  is a town in what  is  known  as  "Tribal Territory".  The
tribal  areas  are  areas  where  the  Pakistan authorities have no
jurisdiction and affairs are run by the local Pathans.   Most  of  the
Afghan  border  area in the  North  West Frontier is tribal territory.

     I had a rather bad case of dysentery, and the locals manning an  ad
hoc  road  block who kept  leaning  over  me  with  their Kalishnikovs
seemed to think it would be a good idea if I saw  a doctor.  The Pathans
once they have decided you are not an  enemy will do anything to protect
you. I was assigned a bodyguard  from the group standing around and a
turbaned gentleman complete  with automatic rifle and bandoleer slid in
beside me and popped a  wad of tobacco in his cheek.

     They knew that in the town there was an ICRC  (International Committee
of  the  Red Cross) hospital that  took  care  of  war damaged  Afghans  so
we drove there. The  Afghan  guard  at  the hospital explained that it was
a surgical unit only and suggested we  go  to the "Civil Hospital" in town.
No one  seemed  to  know where  this hospital was. We drove around and
eventually found  a driveway  that said "Diarrhea Treatment Unit". We drove
in.  The place was in darkness, but we pulled up outside a door that  said
"Emergency Treatment Unit". There was an armed guard sitting next to his
Lee Enfield. He opened the door and turned on the lights.

     I  was shown a bed to lie on while the guard went  to  fetch the
doctor. The bed had recently been vomited on. It had only  a mattress  on
it. The room was lit with a single tired forty  Watt fluorescent  light.
The tube was black with flies.  The  concrete floor was covered with
discarded drug cartons, to keep the  flies down,  three  frogs  were
hopping between  the  cartons  gobbling flies.

     Before  the doctor arrived, various people, some armed  with
Kalishnikovs,  came  in  and looked at  me.  The  doctor  finally arrived
and  I  was  moved  to another  room  and  laid  on  the examination table.
This room had its own frogs hopping around  on the floor. The doctor asked
what the problem was and did all  the temperature  and blood pressure
things. His  immediate  diagnosis was malaria. When I questioned him about
this he said that eighty percent of admissions were malaria.

     The  doctor wrote a prescription and someone was  dispatched to  the
local pharmacy. There was some concern that  I  had  not eaten  for  three
days and I was asked what I wanted  to  eat.  I compromised  and  agreed
to eat plain boiled rice.  One  of  the nurses  went home to cook the rice.
All the nurses were men.

     The staff whiled away the time by taking turns on the prayer mat  in
the corner of the examination room. The  runner  returned from  the
pharmacy and the doctor set up  a  disposable  glucose drip.  After  some
rummaging through a drawer  of  old  fashioned syringes  a disposable IV
needle was located. The  doctor  opened the  hanger  loop with his teeth
and I was set up.  A  disposable syringe  and  needle  was also found after
much  chatter  and  an antibiotic  and analgesic were injected into the
drip bag. I  was left alone with the drip.

     After  a while the nurse arrived with the rice and a  spoon. The  rice
was not fully cooked, the last thing I felt like  doing was  eating. The
only thing I could possibly eat was rice. I  ate some of the rice. The
Pathans have the same ideas of  hospitality as  the  Bedouins. This means
if they offer  you  something,  you accept it.

     As  I was sitting unsteadily on the edge of the bed  chewing the  rice
people started drifting in and out again to  view  the "foreigner". They
don't get many tourists in places like Wanna. A few  of  the curious
onlookers had AK-47s casually  slung  across their shoulders. One of the
visitors was an earnest looking young man  who came up to me and asked if I
was a Christian. I was  the most  Christian  person I had met for a few
weeks  and  certainly wasn't  a  Moslem, so I said yes. He excitedly told
me he  was  a Christian.

     The  young man was a Punjabi, and said he was one of  twenty eight
families  of Christians in the Wanna area. He told  me  he worked in the
hospital and taught the doctors English. He said he was very excited to
meet another Christian, he had the fervor  of a  young  fundamentalist.
Apparently the word was all  over  town that  there was an American in the
hospital. It seems that  small town Pakistan was like a small town anywhere
else in the world. A stranger in town was a big event.

     I  ate all I could of the rice and was told I  should  spend the
night  in the hospital. I asked to use the  toilet  and  was shown a "hole
in the floor" flush toilet. There was no light  and of course no toilet
paper. I had my own toilet paper, I left  the door open for light.

     I  was  escorted to the ward where the doctor wanted  me  to spend
the night. The ward was a relic of the British Empire.  It was  a long room
with a row of beds against each long  wall.  The beds were the old iron
hospital beds. On each bed was a mattress. There  was  no  bedding. There
was no  mosquito  netting  on  the windows or doors. There were three
overhead fans for ventilation.

     The ward was partly filled. The occupants were men and boys. The far
end of the ward was screened off. Behind the screen was a young  boy  and
his mother. The mother was wearing a  burqa.  The floor of the ward was
also littered with discarded drug packages. Under  my bed was a discarded
disposable syringe and needle.  For mosquito  control,  there were three
bats  flying  backwards  and forwards.  During the night one of the bats
failed to  dodge  the fan  blades and expired against the blades with a
loud  clatter. Bat bits were scattered across the room.

     Just  before  dawn the call to the faithful was  made  by  a nearby
muezzin.  This started activity in the ward.  Those  that could  started
their  morning  devotions.  One  of  the  praying faithful was the mother
at the far end of the ward. As dawn  rose various  visitors  started
wandering into the ward. Most  of  the visitors were armed with
Kalishnikov's - the male jewelry of  the Pathans.  One  of the young boys
got up and found  the  discarded disposable  syringe under my bed. He
grabbed it and went back  to his  side  of  the  ward where he  and
another  boy  entertained themselves playing with their new toy.

     My driver and guide arrived to pick me up and drive me  back to
Peshawar.  As I walked through the hospital grounds I  saw  a sign above a
door, it said: "Intensive Care Unit". Regretfully, I didn't peep in.

                               END