AT THE age of 12, Aoibhinn Walsh read an article about the work being done by the international charity, Medécins Sans Frontieres (MSF) doctors in Azerbaijan. She never forgot it. Now, the 28-year-old trained doctor from Rathfarnham, Dublin, is working with MSF in Timergara, a strongly conservative Muslim town in Northern Pakistan, just 30 kilometres from the Afghan border.
There, MSF expat and national staff operate a delivery room and an operating theatre.
"It has always been something I wanted to do," says the young paediatrician who graduated from UCD in 2010 and now fights to save ailing babies in a culture where the death of an infant is not unexpected.
"It's still the norm here for women to deliver their babies at home. However these women can experience many complications and sometimes arrive at the hospital close to death."
Walsh, who previously worked in the Emergency Department at Dublin's Temple Street hospital as a paediatrics registrar, continued: "It is an accepted part of childbirth and pregnancy. Yes, babies die. Some babies were never meant to survive – whether it is due to an overwhelming infection or a malformation or abnormality that is simply not compatible with life.The vast majority of these deaths are preventable with basic intervention and care."
However, points out Walsh, in Northern Pakistan, many women leave hospital with their newborns as early as two hours after birth, unless they have had a Caesarean section or are very unwell. "If the mother cannot be discharged, the babies are still often taken home by a relative, against medical advice. This can include premature babies, babies weighing less than two kilos at birth, or babies who needed to be resuscitated at birth.
"Leaving the hospital puts the babies at risk of developing an infection or having issues with feeding. Some survive, but some die at home and others are brought back to the emergency room (ER).
"The mortality rate of babies aged less than 27 days who are brought in to the ER is 50pc. The inescapable truth is that by the time these babies come back, they are too sick, and no treatment or intervention will make a difference."
But why would premature babies be taken home too soon? "Firstly, you have to understand that there is very poor education here for women. Only about 10-15pc are literate so their understanding can be very limited. If they see a baby that looks perfectly well, even though it's very small, it can be very difficult to explain that you just want to prevent any harm to the baby. All they see is a seemingly well baby.
"Also, these women can travel for hours to deliver in the hospital, sometimes leaving more than 10 other children at home, so you can understand why they would want to take the baby and return to their families.
"Finally, the decision ultimately does not lie with the mother. Family hierarchy is the core of their culture. If the husband or mother-in-law want the mother to leave, there is no arguing with that decision." Walsh's role, she says, is to provide quality basic care to infants, especially those born prematurely or with low birth weight.
"These babies can be perfectly healthy but just need a little help feeding or keeping warm, so most of our interventions are simple, but very rewarding."
There are many factors contributing to the high infant mortality rate in the area, she says, including an overcrowded ER, a lack of facilities, and doctors overwhelmed with patients who have little or no experience with sick infants. "Babies that do stabilise in the ER are transferred to the nursery – a baby ward run and staffed by the Ministry of Health. This room has space for seven or eight babies.
"There are, in fact, three more rooms, purpose-built over the last year to create a neonatal unit with a room for premature infants, one for jaundiced babies, and one for sick babies needing intensive care."
But lack of basic resources, such as a steady electricity supply, means crucial equipment is not used: "Incubators stand in their packing, unused. Phototherapy beds for jaundiced babies are gathering dust.
"The one room in use is filthy. The power is cut several times a day and the nurse relies on a gas heater (which is a fire hazard, given these babies are sometimes on oxygen).
"There is one bin, often overflowing, used needles left on the beds, and a dirty sink that doesn't work. You can imagine that if a sick baby stabilises long enough to make it to this 'nursery', it is still fighting against the odds. Twice already, I have lifted a blanket and found a dead baby underneath, unnoticed by parents and staff," she says.
The babies that don't improve in a day or two are transferred to a hospital in Peshawar, up to four hours away, in whatever vehicle the parents can obtain, with no medical support.
There are many reasons for MSF's presence in the region, Walsh says, and it initially provided healthcare to people displaced by fighting in 2008. Now, she explains, there is more of a focus on the emergency and surgical needs of the wider population. Walsh's clients are Pashtuns, the same ethnicity as the people in north-eastern Afghanistan: "The Pashtuns are beautiful people. I don't know if you remember the famous National Geographic photo of the Afghan girl with the blue-green eyes? That is how all of these people look; apparently the eyes are leftover from the invasion of Alexander the Great and the Macedonians.
"They are also incredibly friendly, polite, generous and emotional. Nothing is done with a handshake, always a hug!"
They are also very conservative Muslims with a strong faith. "Women in public places wear burquas or are covered up with scarves with only their eyes showing, and men can have multiple wives. In Pashtun culture, family is everything. Most decisions are only taken after consulting and gaining the approval of the family elders – this can sometimes make our job a bit more difficult, but we have to accept that is how things are done here."
* Médecins Sans Frontières /Doctors Without Borders, www.msf.ie, phone 01 660 3337 or 085 106 9132
Health & Living