It was in the wee hours of the morning that 19-year-old Zarina was brought to the emergency department of a local public hospital.
Clearly in pain, this young girl was emaciated, wrinkled and going in and out of consciousness. Her clinical history notes made a bulkier pile than Zarina herself. “It’s been two years since her illness began…she was a beautiful child…please bring her back!” Zarina’s mother sits pleading by her bed side. After having a thorough look at her notes and examining her; Zarina’s doctors could see what had brought her down to this state. Zarina had tuberculosis and it had spread in her body beyond control.
Zarina’s story is not any different from that of many other women, who fall prey to the potentially fatal illness called tuberculosis. Being highly prevalent in Pakistan, TB kills around 48,000 Pakistanis every year (WHO report), posing an immense burden on Pakistan’s health landscape. While men are at almost as much at risk as women, the latter are faced with additional trials and tribulations.
Zarina was engaged when she was 16 and she knew wedding bells were not too far away for her. However, she was not prepared for this hitch in her fairy tale. What started with cough and fever turned into a deadly disease; thanks to home remedies, quacks and some unqualified doctors and several half-hearted attempts at getting things right, just so Zarina’s in-laws won’t get wind of her condition.
“Who would marry a sick girl…that too a girl with TB?” This is how Zarina’s mother could best justify their delay in bringing her to a hospital in the city.
“This is the tragedy with our women folk,” explains Dr Shaheen Shoaib at the Dow University of Health Sciences (DUHS). “Any illness, especially something like TB, brings them to such a weak condition that it eventually becomes a stigma just to talk about it. Many of them, even after diagnosis, keep their condition a secret until it gets unbearable or untreatable,” she adds. In Zarina’s case it was both.
It is not just the fear of being ostracised but also a general disregard for personal health that keeps women (especially from the lower socio-economic strata) from seeing a doctor. A son’s health or that of the male bread earner is more valuable in a patriarchal set up than that of a female. “Most women come in for treatment in the later stages of the disease while men come to us sooner rather than later,” remarks Shoaib.
Females in our society tend to be in close contact with children and do most of the household chores and therefore, a woman with tuberculosis could easily put her family at risk.
At times, women even end up suffering at the hands of the tribal setup and culture prevailing in some parts of the country where females are discouraged from consulting male doctors despite urgency or even dire need. In another hurdle to treatment, many women still prefer seeing female doctors despite their limited availability.
Dr Zunaira Subhan, a resident at a local public hospital draws just the right picture, “If there are two doctors sitting in the OPD and a female patient walks in; chances are she would most likely walk up to the female doctor even if the male doctor is not attending anyone.”
This not only limits women’s control over their own health needs but also places an extra burden on female health practitioners. According to estimates, there were just 800 female doctors catering to over a million women in Khyber Pakhtunkhwa alone last year.
Suggesting a practical solution to this problem, Shoaib says, “Aggressive door to door screening for the disease should be promoted.” However, even she realises that the change wouldn’t come unless patients’ compliance with medicines doesn’t improve. “The patients almost never complete the course and leave the medicines in the middle of the treatment paving the way for a more vicious relapse by drug resistant strains. That is our biggest limitation and challenge as health practitioners,” laments Shoaib.
Even Zarina had committed the same folly. She had started on her TB medication course twice, yet she chose to stop the treatment halfway. The consequences were disastrous. So, this World Tuberculosis Day on March 24, let’s stand up for a healthy society where no one misses out on treatment just because of their gender.
Published in The Express Tribune, March 20th, 2011.
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