In Machar Colony, knights in scrubs have come from far away




This is a story of a few good doctors who left their comfortable European lifestyle to aid suffering humanity in Karachi’s impoverished slum of Machar Colony.

In the process, they learnt to adapt – shed their western clothes for a modest shalwar kameez and headscarf, bear the intolerable May heat, and eat roti and spicy lentils for lunch.

Situated next to the Lyari Station on a service road off Mauripur Road, a clinic has been quietly, but efficiently, providing primary healthcare to the residents of the squatter settlement for over a year now.

The white single-storey unimposing structure in its first year delivered 498 babies, held 5,833 health sessions and treated 14,816 patients at its emergency room.

For the people living in Machar Colony where a preventable disease like measles claimed several lives last year, this is good news. For pregnant mothers, it is their only access to quality healthcare.

Inside the spotless labour room, Shamshad Begum has just given birth to her seventh child – a beautiful baby girl.

“It’s a girl again. I have five girls. Two of my children died. Because I wanted a boy so much, my sister gave me one of her sons to take care of,” she says lying on a hospital bed, surprisingly cheerful for a woman who has just given birth.

A nurse instructs her to use birth control. “I will have to ask her father,” says Shamshad pointing at her newly-born baby.

Her doctor, Katrina Nelson, does not understand a word of Urdu. It has been only a month since she arrived in Karachi. Originally from Denmark, when she signed up for the Doctors without Borders (MSF), an international not-for-profit organisation which works extensively in Asia, Africa and South America, she knew she would be travelling all around the world.

So how has the city been treating her? “It’s exciting work. Women have many more child complications in this part of the world. Many of the women we receive here are extremely anaemic,” she says.

“It’s not that they don’t know that they should rest or take breaks while having babies. But the fact is that their living conditions don’t let them take care of themselves or make decisions when it comes to childbearing.”

Marlies Degroote, a doctor from Belgium, heads the vaccination programme at the clinic. She has just returned from a long meeting planning the measles vaccination drive that will start in a few days. Dressed in a blue shalwar kameez and beige dupatta wrapped over her head, Degroote can pass for a Pakhtun woman.

“Last year we could only cover 29 percent of the population in Machar Colony for our vaccination drive against measles. Several children died last year. This year, we plan to vaccinate 69,000 children,” she says.

The colour of their skin was something that none of the locals at the squatter settlement liked. They viewed the doctors with suspicion – foreigners there to spy on them, take their pictures and sell them to America or worse, instil western ideals into their women.

“Every time you begin working in a locality, people view you with suspicion. They feel that we are intruders. It’s only natural. That’s why we need to play safe. The reason for our low vaccination coverage last year was precisely this,” says Degroote.

This year the team is prepared. They have talked to the community leaders and clerics and visited schools, madrassahs and mosques. Now they feel that the community trusts them.

They will go out in the field for vaccination without any security guards. Display of weapon or even carrying one is against their policy.

“That’s why you don’t see a security guard at our gate. We believe if the community understands that you are there to help, they will not attack.”

There was time when the clinic began receiving extortion threats from various crime gangs operating in the locality. The workers at the clinic say that the doctors invited the extortionists to the table to talk. “When they understood that the doctors did not charge patients for treatment, they apologised and never troubled us again,” says Mona Korejo, a health promotion supervisor.

So that the MSF does not become a tool for spy agencies of the world to collect information, it runs only through private donations.

Degroote excuses herself. Ruth and the others are waiting for lunch. She is hungry, “and the daal roti we just ordered is getting cold”.

originally published here


Being transgender is not a choice






Payal* was born a boy. But at 33, she looks like any other woman with her long hair and carefully applied pink lipstick. The transformation cut her off from her family and ostracised her from the society.

“Those were tough times,” she recalls. “It was only when I reached the sixth grade at school I began to feel uncomfortable in my body.”

She would hide from her family and apply makeup on her face. Or stand in front of a mirror and cover her head with a dupatta. “I felt like an alien. I could not picture myself as my father when I grew up. I wanted to be like my mother. It was a feeling no one understood.”

At school she was bullied for being a sissy. The neighbourhood boys made fun of the way she walked. That she would always be an outcast was a fact she settled down with early on in life… until she was introduced to a community of transgender people where she found peace. “I could wear makeup and talk like women – without being judged,” Payal says.

But the ghettos that they lived in had problems. The society had reserved certain roles for them: they could dance at weddings, beg on the streets or sell cheap sex. There was a time when Payal got a job as a receptionist at a private office for Rs15,000 a month, but as her identity was revealed and rumours started spreading at the workplace, she was asked to resign quietly.



Who are they?

There are 70,000 transgender people in Sindh alone, according to the community leaders. As their movement to get equal rights in the society and acceptance in public space picks up, there is a need to understand who they are. Is being transgender a physical or mental disorder? Is it nature or nurture?

Nausheen Salim, a senior instructor at Aga Khan University Hospital who specialises in sexual health, says being a transgender person is a physical condition rather than a psychological problem. She divides the transgender people into three broad types.

“The first kind is hermaphrodites. This is a rare disorder where a person may have both male and female organs. A person who looks like a male and has male sexual organs may internally have female anatomy. So there have been instances that a young boy when he hits puberty suddenly begins to menstruate.”

The condition is rare, only 1 in 1,000 transgender people may have it. Most have a hormonal imbalance and so don’t feel comfortable in their bodies. “When a child is born, he has equal amounts of the male hormone, testosterone, and the female hormone, oestrogen. As one hits puberty, oestrogen levels increase in females while testosterone levels increase in males.”


In case of an imbalance, there will be visible problems in both women and men, such as overgrowth of hair in women or a female voice in men. “But when the imbalance is drastic, a person may want to copy the opposite sex,” says Salim. “It is not something that an individual can control. You are born with an identity disorder.”

The third kind is a different story altogether. “Young boys are picked up by gangs and castrated. They are then used by the begging mafia. Others dress up as women due to severe poverty and beg for a living.”

Dr Ayesha Mian, the head of the Aga Khan University Hospital’s psychiatry department, states that being transgender is something that cannot be undone. “If a child is copying another sex, it may be because of anxiety or some other factors. This can be treated. But if the cause is because of hormonal imbalance, it cannot be cured.”

“It is not a mental state like depression which can be fixed. If a parent finds his child acting like the opposite sex after he hits puberty, he should seek professional help. And then the transformation should proceed in a healthy way,” said Mian.

Salim also agrees. “Even in normal circumstances, puberty is a confusing phase for children. Most parents don’t inform their children about why their body is undergoing changes. And in the case of a transgender, it is even more difficult, because no one understands them.”

Payal is hopeful of the campaign her friends in the transgender community have started. It has managed to get them a legal identity, voting rights and government jobs. But she understands that the time when she can compete on equal terms for a job as a doctor, engineer or journalist will take years to come. “After all even women are not taken seriously yet. And they have been fighting for their rights since the 80s.”

*Name changed to protect privacy

originally published here