Kuchlak is a town of 120,000 people located 30 minutes from Quetta, the capital of Balochistan Province. Situated on the border with Afghanistan, it has become a permanent home to Afghan refugees who fled to Pakistan during the civil war in the 1980s and later conflicts. MSF has been providing medical care in a maternal health and a rural health centre here since early 2005. Most of the patients are women and children from Kuchlak and surrounding towns and villages. On a dusty gravel road leading to the Afghanistan border, in between the horn blasts of passing trucks, the faint cries of newborn babies can be heard from inside the Médecins Sans Frontières (MSF) birthing unit in the town of Kuchlak – located in Pakistan’s south-western Balochistan province. Inside a neat and newly painted room a young mother in her twenties has just given birth. It is her third child. She lies down, exhausted by the effort, while midwives attend to the newborn. It is a boy and she is happy that she has given her labourer husband a son who will grow up to look after the family. There should be nothing extraordinary about her delivery, but this young mother has just survived an event that claims the lives of thousands of women in rural Balochistan, the largest and least developed Pakistani province. Here childbirth is a deadly part of life – claiming women’s lives because they cannot access proper, timely maternal healthcare. In 2007 the maternal mortality rate in Balochistan was an alarming 637 deaths per 100,000 live births, while infant mortality figures are estimated to be 65 deaths per 1,000 live births. The rate of maternal mortality in Balochistan is more than double the national average. In 2005 Pakistan had the eighth highest number of maternal deaths worldwide, at around 320 per 100,000. This, coupled with the low number of nurses and midwives in the country (5 nurses and midwives per 10,000 people),  make clear the dangers of childbirth and the serious needs found here. Many people in Kuchlak live with hardship or abject poverty. Several parts of the town resemble a makeshift camp that has become a permanent settlement for some of the Afghan refugees who fled to Pakistan. MSF began its project to assist Afghan refugees, particularly for women and children, who face socio-economic exclusion and restricted access to health care. MSF has been operating a maternal and child health centre here since 2006. MSF is the one of the very few organizations offering free medical services, ranging from ante-natal consultations, obstetrics and gynaecology, post-natal care, vaccinations and general health consultations for children under five. Doctors assess patients and are able to prescribe and dispense medicines from the pharmacy, while a laboratory performs tests to detect malaria, cutaneous leishmaniasis, tuberculosis, hepatitis B, diabetes and anaemia in pregnant women. Every week about 1,000 patients seek treatment at the outpatient facility, where children up to five years old are also treated. At the birthing unit an average of 150 to 170 women give birth every month. For a community living in perpetual poverty, free medical services are a lifeline that they would otherwise struggle to afford. Women here, whose husbands earn a pittance as labourers, have to pay thousands of Rupees to give birth in public hospitals. They have to borrow money from relatives and neighbours to receive proper medical attention, which they invariably struggle to repay. “Most pregnant women here still have to journey for up to an hour or more to give birth, and many women still give birth at home, because they have no choice,”  explains Dr Amna Hammad, a female medical doctor working at the centre.. A short distance from the maternal and child health centre, past a small bustling market place, lies the MSF supported rural health centre run by the Ministry of Health. MSF offers a nutrition program here because needs are acute: over 30 percent of children under five in Pakistan are underweight for their age. Two tiny infants, twins Hamida and Ansa, have just been brought into the clinic by their gaunt, breastfeeding mother. She is an Afghan refugee who settled here in Kuchlak, but lives a hard nomadic life. The twins are 10 days old. Ansa is visibly smaller and malnourished. “I married at 13 or 14 years old. I am now about 38 years old. It took me over an hour to walk here. I came alone,” the twins’ mother said. So far she has given birth to five boys and four girls. Three of her babies died before reaching their first birthday because she could not afford formula milk or produce enough breast milk. Staff nurse Hamdullah Kaka oversees the nutrition project that has treated 1,200 severely malnourished children since it opened in 2006. Currently 60 children are enrolled in the program, which ensures recovery by monitoring the children’s progress with follow-up visits. The patients here have taken to calling Hamdullah “uncle” because of his gentle and caring way with children and mothers alike. Although poverty is the leading cause of malnutrition in this community, some mothers only feed their children when they think the infants are hungry. Others give their babies painkillers to prevent them from crying when they are hungry. “We are trying to change that by providing them with a quality service and guidance,” Dr Mirwais Wardak, senior MSF doctor at the project, explained.

MSF medical teams see more than 10,000 patients every month, mostly women and children from Kuchlak and surrounding towns and villages. 300 antenatal care consultations are performed and between 150 and 170 women come to the maternal health centre for deliveries. Mental health counsellors also organize up to 600 counselling sessions providing psychological support for men and women every month. In September 2008, MSF started treating cutaneous leishmaniasis, with 15 to 30 patients are treated per month.  MSF also runs a program to treat malnutrition, receiving patients from Kuchlak and the surrounding remote districts where poverty, poor land and conflict severely affect living conditions.

MSF does not accept funding from any government for its work in Pakistan and chooses to rely solely on private donations. MSF has been working in Pakistan since 1998.

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