Public Health in Pakistan
     
     
     Returning from Afghanistan I entered Pakistan via the border town  of
Wanna.  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 Pushtuns. Most of the
Afghan border area in the North West Frontier (Now known as
Khyber Pakhtunkhwa) is tribal territory.

	This area has a long history of local independence. The
British gave up trying to subjugate the local Pushtuns so
created these tribal areas with an uneasy truce. In the 1920s
the Royal Air force bombed the tribes people. This aerial
bombardment continues a hundred years later, with USA doing the
job with drones. 

     I had a rather bad case of dysentery, and the locals manning an ad
hoc road block who kept leaning over me with their Kalashnikovs
seemed to think it would be a good idea if I saw a doctor.

	The Pushtuns once they have decided you are not an
enemy will do anything to protect you. They are known not only
their ferocity, but their hospitality.

I was assigned a bodyguard from the group standing around and a
turbaned gentleman complete with a fully automatic rifle and
bandoleer slid in beside me and popped a wad of tobacco in his
cheek. The chewing tobacco in that part of the world is locally
made and can include chilli and opium.

     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
Kalashnikovs, came in and looked at me, the foreigner. 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. It
seems he was right with his diagnosis although I disputed it at
the time.

     The  doctor wrote a prescription and someone was  dispatched to  the
local pharmacy. He also pricked my finger and smeared a
microscope slide and told me to have it checked for malaria in
Peshawar, which I didn't do. I should have, I was having some
malarial symptoms but I was taking an anti-malarial that has
side effects similar to malaria so wrote them off.

	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
Pushtuns 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
Kalashnikovs - the male jewelry of the Pushtuns.  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.

	Pakistan, one of the poorer countries in the world has
universal healthcare. I was treated without even having to show
indentification and my drugs and treatment were free.
                               END