In the early afternoon of August 11 in the Labour Room at the Family Wing of Gilgit Town’s District Headquarters Hospital (DHQ), Gilgit-Baltistan’s only tertiary-level referral hospital, a Lady Health Visitor (LHV) doubled-up in pain from stomach cramps while waiting to help deliver ‘Shaista’.  The frightened young mother, expecting her first child, had been brought by her family to deliver at the DHQ from Shikyot, a 35-minute drive from Gilgit Town.  Following the birth of a healthy baby girl, a Senior LHV stitched ‘Shaista’s’ episiotomy wound under the weak light of a cell phone held by a trainee midwife. Without electricity or overhead fans, the room was darkened and stifling; two small curtained windows were open to catch what was only a light summer breeze.

Many of the DHQ’s Family Wing staff complained that, due to contaminated drinking water, they are falling ill with dysentery. They added that, as a result of a total lack of in-town electricity and running water, they are also unable to clean the Labour Room or adequately sterilize surgical instruments. The Labour Room’s one small autoclave is now non-operational so, between patients, the DHQ’s Lady Health Visitors resort to bathing instruments in a sterilising solution of Biodine. Attending staff attempt to offset the potential for postpartum infections by giving prescriptions for antibiotics to every patient. However, in light of high regional rates of Hepatitis, the risks facing delivering mothers and attending staff at the under-equipped DHQ are now significantly amplified.  Because no generator is available to supply power to the Family Wing’s Operation Theater, delivery patients are being shifted by the hospital’s one working ambulance to the DHQ’s primary Operation Theater, a short drive down the road from the Family Wing. Women arriving at the hospital during the overnight shift are being delivered by candle-light.

In the ante-natal and postpartum suites adjacent to the Labour Room, flies circled over beds covered by soiled and wrinkled sheets. Without water or power, the beds had not been changed in over a week.

In between patients on what turned out to be an unusually busy day, the Labour Room staff spoke emotionally about the challenges they face while handling numerous complicated delivery cases over extended shifts in the total absence of basic necessities. Given nearly non-existent supplies of diesel and petrol and a shortage of public transportation, they also shared the difficulties they experience trying to reach the DHQ from in-town mohallas and the villages surrounding Gilgit’s outskirts. Some also personally recounted the troubles posed by the recent crisis. Speaking to me from a patient’s bedside in the postpartum recovery room, a dayah (midwife), her eyes red from exhaustion, recounted how her family has recently lost most of their agricultural fields to a surge of floodwater in Nomal, a village above the Hunza River a short drive to the north of Gilgit.

Following the start of rains yet again today, the situation at the DHQ continues to deteriorate. With Gilgit-Baltistan’s maternal mortality ratio (MMR) already hovering somewhere between 250 and 600 per 100,000 live births – among the highest in Pakistan – one can only imagine how many women will lose their life to pregnancy or childbirth complications during these trying days.

In the meantime, with the Karakoram Highway still blocked, the supplies necessary to ensure safe deliveries at the DHQ are quickly disappearing. The pressures placed on this hospital by the needs of an estimated 1.5 million residents – especially at a time when floods and landslides are directly and indirectly affecting hundreds of thousands throughout Gilgit-Baltistan – are profound.

As of August 13, methergine (to prevent postpartum hemorrhage), aldomet (to treat hypertensive patients), buscopan (an antispasmodic), socigone (a painkiller), dextrose IVs and injectible antibiotics are not currently available and are urgently needed.

Update: As of August 13^th, Gilgit Town’s hospitals have begun closing. The Rahnuma-Family Planning Association of Pakistan’s Family Health Hospital which, after the DHQ, boasts the highest regional OB-GYN outpatient attendance rates, has closed as a result of acute supply shortages. And the Aga Khan Health Service’s Gilgit Medical Center, which had shifted from its original riverside location to the Family Health Hospital building in May due to the impending threat posed by the Attabad dam, has also shut down. The only remaining maternity hospitals are the DHQ, which continues to suffer from no power and water, and the fully-operational Combined Military Hospital (CMH), where patient access is limited due to the comparatively high cost of its services.

On a day ordinarily marked by festivities, and with streets free of traffic, this increasingly silent city demonstrated no signs of Jashn-e-Azadi celebrations.  The flags and banners characteristic of previous years’ events were not to be seen.

Dr Emma Varley is a Killam Post-Doctoral Fellow, Department of Bioethics (Dalhousie University) and a visiting professor, Dept of Humanities & Social Sciences (LUMS).

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