THARPARKAR, PAKISTAN - In a small nursery with dubious hygiene conditions, an 800-gram baby, listed only as “Girl D/O Mahmood” struggled to breathe as the doctor tried to clear her wind pipe.
The nursery, with 13 incubators holding under-weight babies, was part of the main hospital in Mithi city, headquarters of the Tharparkar district of Pakistan. The district, which lies in a desert-like region in Sindh province in southern Pakistan, has faced severe drought-like conditions for the last two to three years.
Many villages in this almost 20,000 square kilometer area are far from cities, with little or no access to a road network. People mostly rely on livestock they keep or crops they grow. Little or no rain has meant no grass for the livestock. The animals are dying. The ones still alive are giving less milk. The crops are failing.
The villagers eat a diet of lentils or vegetables with bread when they have a good crop. When they don't, they are forced to eat crushed peppers with bread.
The resultant malnutrition among pregnant mothers, like everyone else, has had an impact on their babies. The number of infant deaths has risen to more than 200 this year alone.
Selling food instead of making it
The malnutrition, however, is not just linked to the drought, according to Sonumal Khangarani, a development professional who has worked with multiple NGOs in the region for the last 30 years. He also blamed it on social changes.
"If I had two kilos of milk at home, ten years ago I would have used it. Now I sell it to get instant cash,” he said.
The region’s economy, and the social behavior linked to it, have evolved during the last couple of decades from a barter system to a cash economy. The development of new roads has linked more villages to their closest cities, making market access possible.
Whereas previously, left over milk was turned into milk products, like yogurt or butter, and left over vegetables were dried and saved for later, anything that is not used instantly at home nowadays can be sold in a nearby market. That lure of instant cash has exacerbated malnutrition among the poor population, according to Khangarani.
Local health officials, however, blame several other factors as well for low birth weights and high infant mortality rates. At the top of their list are early marriages and lack of access to birth control.
"The pregnant mother usually has six, seven kids already. There’s no family planning. She looks after the house, the kids, the livestock, so the workload on the mother is very high," said Dr. Mohanlal Kati, a pediatrician in Mithi’s hospital.
He also pointed out that most of the mothers were illiterate and did not have pre-natal visits to the doctor.
It is hard to blame that on the mothers though, when medical facilities outside of cities are rare and access to them expensive for villagers living far away.
Not enough doctors
Just 20 kilometers outside Mithi, in a village called Haryar, the building of a medical facility showed signs of abandonment. Its walls were crumbling. A big padlock on its main door had become rusty.
Sindh Bai, an old woman from the village, complained that they had to spend $30 for a taxi to go to a hospital in Mithi, an amount they could hardly afford. They were forced to rely on home remedies except in extraordinary circumstances.
In fact, most women living in villages in Thar never get pre-natal visits because the doctor is usually too far. They deliver babies at home.
The provincial government in Sindh has hired more doctors, particularly gynecologists and pediatricians, since the crisis broke. It has also provided more incubators, medicines, and supplements to local hospitals to be provided free of cost to their patients. It also claims to distribute free wheat among the population.
Locals say, though, that the efforts are too little too late, and are concentrated in cities where people already have better access to food, water, and health facilities. The real problem, they say, lies in far off villages where the government is not doing much, if anything.