It is a small unit with about 120 births per month. The unit is an old building which is currently being renovated. So what with all the noise, dust and the heat, it is not a comfortable place to work and live. The care provided is mostly primary care - women whose pregnancies become complicated are transfered to the bigger hospitals in Karachi.
The local community is a poor one, and beset with political strife. Whenever the local political parties have a falling-out, someone gets shot. This poses additional security probems to the staff who work in the hospital. Many staff commute at least an hour daily to the hospital. They do not feel safe to live in the community, but they are very committed to working in the hospital. The local community wants the maternity unit because many of them cannot afford to pay for care in the bigger hospitals.
The midwifery students and educators are similarly dedicated. The educators work six days per week...three teaching and three days working in the hospital. When they are done for the day, they go home and look after their extended families...study...and do voluntary work in their communities. They are wonderful young women and a real credit to the midwifery profession.
Midwives are well regarded in the community, and I think a midwifery caseload approach will go down really well with the women. Now, Rafat and her team have to work out how a midwifery 'continuity' model will work in Pakistan.
I really liked the hospital. Clearly, it has huge challenges and the working conditions are far from ideal. But the community feel of the place and the dedication of the staff set us all an example to aspire to.