Her story started with a young girl leaving home during the India partition. She travelled to the UK as a young woman to learn further about medical practice, then returned to share this information with those in her profession in Pakistan. Her knowledge grew and she returned to the North West of England where we have benefited from her passion for her vocation and then the expertise and commitment of daughter and grandchildren. We thank her family for allowing us to print part of an incredible story of movement across borders that started in conflict but ended as a fable of how immigration enriches the human experience.
I practised my profession with heart and soul. But you can’t forget about yourself. If you did, then the system wouldn’t protect you. I had always been strong and so all of this seemed fine. But my mother saw. If she was with me, she would tell me, ‘sit down, talk to your daughter.’ She would get me some food. It was easy to forget to eat. Faria, my daughter, was often looked after by my sister Farzana before Farzana moved to New York. Faria soon called her, ‘mother, aunty, baby.’ Baby was her nickname from when we were growing up.
It was tough but this was my work. I had to save mothers. And if I was needed, I could not go home. I remember there was a woman I stayed with throughout the night who had postpartum haemorrhage. This meant she was constantly losing blood that was not easy to replace. If her blood pressure had not been checked every minute, throughout the night, then we would have lost her. There were no guarantees I would have left her with somebody qualified to understand the need. How could I go home to sleep.
So, all this was on my mind in 1976 as I travelled by plane to the first conference of the newly formed Gynaecology and Obstetrics Society in Multan. The conference had been titled, ‘Reducing the level of perinatal morbidity and mortality.’ I had been back in Pakistan for less than two years, but as head of department I was invited to speak at this historic event. My paper was entitled ‘The brutality of TBAs.’
At the time most births occurred at home conducted by traditional birth attendants. These TBAs were appointed privately by the family. There was no professional monitoring of their behaviour, and most of our emergencies were the result of it. There was little or no ante-natal care that took place. Maybe they would arrive two months before due date to massage the mother’s legs and feet, checking for circulation, but nothing else would be diagnosed. There was a shocking rate of prenatal deaths, all complications from the final 6 weeks. When the baby was due, they would inject their patients with Oxytocic’s to speed up the process. These drugs were readily available to buy but should never have been prescribed outside of hospital. The TBA’s would use far too large a dose and cause violent pain and ruptures. The decision to send a woman to a professional doctor in the hospital would be in the hands of an in-law who could be governed by tradition, culture and fear. These in-laws could bring a bad name on the doctors. ‘She operates, don’t go to her.’ Operations were never used unless the woman and baby were in danger, but we were portrayed as these monsters who would cut people open for no reason.
Women would arrive as a last resort. They would often have been bleeding at home and continued to do so on the journey. Such matters should have been treated at source. Arrangements for an infusion were complicated. You needed to consider whether blood types of the parents are RH negative or positive. Negative is dangerous for the mother and detrimental to a baby’s health as it will not combat anti-bodies. Blood cells breakdown. All this knowledge is crucial and the TBAs would have none of it. A little knowledge is a threat to us all.
So, this was my passion at time, and informed the paper I was to read. I had sent the abstract of my paper ahead. And that was that. I knew my speech was powerful, but I planned to deliver it in a calm, professional manner. It was meant to be a small step for me. I had returned from my time as a doctor in England with ideas we could adapt, but I presumed these learned professors would know most of this.
The conference was an impressive, solemn occasion. It was so busy, but there was very little chattering. Many well-suited people all sat respectfully on benches across the grand hall. Nearly all men, as women were encouraged to work in private hospitals not government ones. It felt like
a huge move forward for our profession. I was full of hope. There were other heads of departments, medical students and delegates from abroad. All I presumed eager to learn from each other.
So, I listened as one well rewarded head of department after another spoke. One woman had spoken, Dr. Altaf. She had set up a ‘flying squad’ in Faisalabad which was an early form of emergency service. This impressed me. It was much needed, and she had been thinking of how to prevent and how to innovate. Other than this, men spoke. Each one would elaborate on their cases. ‘This happened, and so we did this.’ No talk of why it happened. No talk of the conditions leading to these cases, or the lack of awareness in these women’s lives. Most horrifying to me, there was no talk of change. These professors appalled me. How could they carry on in this way with women dying in their homes. And so, when I spoke, I was emotional. I was angry. I told them that we had studied for a reason. I reminded them that we were well rewarded for our chosen profession. We should be working.
I questioned who had access to drugs without prescription. I spoke of the need to go out and educate. I wanted the knowledge of obstetrics and gynaecology to be at international standard. I wanted everything we had learnt abroad to be applied in our homeland. More than anything I wanted the process to be run by those who understood the suffering of women. There are people who care for others, and people who don’t.
After the speech so many foreign delegates rushed to the stage to talk to me. They wanted to know what I intended to change and how it could be done. They said, ‘this is what we wanted to hear.’ Nobody would forget my first speech.
From this point on, my mission changed. I focused on awareness, spoke to families, wrote a book for my patients. I became a consultant, advising from the start on diet, social conditions and the need for proper prevention of complications. We started to be pro-active. Go to the patient. Never wait. Visit and check.
Many years after this I heard of the murder of Dr. Altaf. The details weren’t clear, but it had happened in her own home. She had been working door to door, trying to save lives. That had been her reward.