Mariam Mehdi and Sania Nishtar
Bai Khatoon was married off at the age of fourteen and was abandoned by her husband for being mentally challenged. Her resilience and determination led her to move to the city where she sought employment. However, her disability was a disadvantage in finding a job as a domestic worker in people’s homes. Her only recourse to support herself was to beg in the streets of the city.
She was able to join the homeless community of an area outside the city, built by slumlords who have made vast profits from building shacks on contested land and using the notoriously corrupt police to protect their ‘investments’ and exploit the poor dwellers. There, she lived in a shack that could barely keep the sun and rain away.
One day, she intervened in a fight that broke out between two men, in order to pacify them. Little did she realize that she would come out a victim. She had her right wrist fractured by a blow from a stick.
She was dropped at the hospital and lay unattended in the ward for over two weeks without any financial or moral support. When the Heartfile volunteer met her, she said: “If I am not helped, I will have go back to my shelter, maimed with another disability, and perhaps this time not even be able to continue begging for a livelihood.” Heartfile covered the costs of her operation”. However we also discovered that she had high blood pressure, which was never diagnosed and treated.
Sania’s comment:
We have seen many other cases like hers. Women in particular are taken away from hospitals bed-ridden for life, or with hands tied in bandages because families can’t afford to pay for their operations. A health system which cannot aid a patient in such distress doesn’t deserve to be called one—and in most cases the solutions are fairly straight-forward.
In Pakistan’s case, the infrastructure of publicly-owned and funded tertiary hospitals are the only recourse for the poor; here there are no bed charges for the poor and the doctor sees them free; basic medicines are also sometimes provided free of cost. However, costs incur when expensive medicines, disposables and implants are needed for treatment and surgery. And the simplest way to overcome that barrier is to provide these free of cost at the hospital. I personally believe controlling pilferage from the system alone can generate some resources to meet these urgent needs.
A health system can’t be fixed without changes in overall governance, which is why some of us advocate for better governance and anti-corruption alongside the need for health reform.
A excerpt from Mariam Mehdi's book who is a senior volunteers at Heartfile and compiling a book on cases she has seen as a volunteer assessing the eligibility of patients for financial access to treatment through Heartfile health Financing.