Caught into healthcare in Pakistan

Fr Robert during a visit to Pakistan in 2021. Photo: Fr Robert McCulloch

Fr Robert during a visit to Pakistan in 2021. Photo: Fr Robert McCulloch

I don't really know whether being "caught into healthcare" or "swept up into healthcare" is the better way to describe my getting seriously engaged in healthcare in Pakistan since 1980. There was then and still is an enormous need for healthcare for those who have nothing, and that is what being "swept up into healthcare" could refer to as regards logistics, funding and planning. But I choose to believe that I have been guided by God as a Columban missionary priest "to be caught" into responding to this immense need of the poor, a response to the cries about human ecology, which seems to be sorely overlooked in the contemporary emphasis on the planet while intellectually marginalising the most marginalised who live on the planet.

There are three highlight periods for my being caught into healthcare in Pakistan. Firstly, from 1980-1983 in the Punjab where I came face to face with endemic and widespread TB, then in 1983 when I was transferred to Badin in the south-eastern province of Sindh where children in village after village of semi-nomadic Parkari Koli tribal people were dying of whooping cough and measles, and again in 1986 during a month of civil warfare between Pakistani ethnic groups in Hyderabad which overwhelmed the medical services being given by St Elizabeth Hospital and resulted in a major healthcare crisis surround by hundreds of wounded and 125 dead bodies. 

Through all this, I had typhoid, typhus, amoebic dysentery, night blindness, malaria and heart surgery.

After completing 18 months of rigorous Urdu language study in 1980, I was appointed to the parish of Narowal, 100 km north of Lahore, where the borders of Pakistan, India and Kashmir meet. It was a big parish, 150 kms in length, with more than 20,000 Catholics. Infrastructure had not been been repaired after the war with India in 1970-71. I travelled on a 70cc Yamaha motorcycle which was light enough to be floated across wide fast-flowing rivers on the backs of buffaloes because bridges and roads had been destroyed. Amongst the Catholics, I saw three things: an intense devotion to their Catholic faith, widespread illiteracy due to the absence of educational possibilities, and rampant TB. Illiteracy and TB were equally widespread amongst Muslims. I responded to the religious needs by continually travelling from village to village with the full-time parish catechists. I worked with the Adult Literacy Teacher Training Centre run by the Presbyterian Church in Lahore to set up a successful program of adult literacy courses throughout the parish.

I couldn't see any way to deal with the widespread TB amongst the Catholics, but all was solved in 1981 when a community of St. John of God Sisters arrived from Australia and Ireland to take over Bethania Hospital, a Catholic hospital in the nearby city of Sialkot. Very quickly, the Sisters re-organized the hospital and gave it a new forward direction. This included recommencing the TB mobile care, which was part of the big TB department at Bethania Hospital, and setting up a mobile vaccination programme for infants and children in collaboration with the government's district health office, which also covered Narowal. TB diagnosis, availability of medication, and hospitalising as needed began in full swing for everyone, Christians and Muslims. And it was the same for the vaccination programme. Bethania Hospital became a centre for preventative health care and curative healthcare. The St John of God Sisters became familiar faces and voices as they travelled long distances while working closely with the people. It was easy to work with them in suggesting schedules of visits to villages in Narowal where I knew there was great need. I learnt a lot from them about strategies to respond with little resources and few personnel to crisis healthcare situations.

Bethania Hospital was a great preparation for what I found when I arrived in Badin in November 1983. TB was rife, just as in Narowal in the Punjab, but what shocked me was the number of children from tribal families dying from measles and whooping cough in village after village.I still have the horrible memory of staying in one of these villages overnight and hearing all through the night children coughing themselves to death with whooping cough. I knew that the district health office in Badin had many teams of vaccinators going out to vaccinate children against polio, TB, measles and whooping cough. This was generously funded by WHO and Rotary International. When I asked about this, I found out that all the vaccinators were Muslim, and they refused to touch Hindus and Christians from tribal families. These tribal families are descended from the Dravidian people who became the marginalised outcaste "untouchables" after the Aryan invasion of India.

Caste prejudices were very much alive 40 years ago in Badin. One result was that tribal children who were regarded as "untouchable" were not being immunised by Muslim vaccinators. So they just died. Looking for a solution, I discussed with people in Badin what was happening at Bethania Hospital in Sialkot and that training would be available there. Four Christian tribal men agreed to go 1,200 km into what was for them far off in the unknown Punjab. They went for six weeks and were well-trained and cared for by the St John of God Sisters. When they returned from Sialkot, I took them to the officer of District Health Officer. I explained how we wished to collaborate with him and his department to extend the programme of immunisation more widely and at the same time give all the statistics to him to improve the extreme low ranking of Badin in the federal government's annual records for all Pakistan. At that time, Badin was constantly last in the national ranking. But the District Health Officer flatly refused. It was obvious that the funding being received from Islamabad for the vaccination purposes was being used in a "different way". Without comment, I drove to the nearby office of the chief martial law administrator, a Muslim graduate of St. Anthony's Catholic High School in Lahore. He immediately phoned the District Health Officer to say that we would be at his office in 30 minutes and that everything, including a refrigerator for the vaccines, was to be ready. And so, it was! Our vaccinators collected it all, including the official register books and vaccines... and the refrigerator. They started vaccinating two days later, making sure that the necessary follow-on vaccinations would take place in time. There was no looking back. Infants and children were protected, infant mortality decreased, the District Health Officer was delighted because the statistics from Badin soared and he was off the bottom rank and could negotiate a transfer to a less isolated posting, the chief martial law administrator became sure support in many ways, the pride of the 4 Christian vaccinators in achieving so much was well earned, and Muslim families began to ask the Christian vaccinators, even though they were tribal and formerly regarded as "outcaste and unclean", to come to their villages to vaccinate their children "because you do it so much better than the others".

TB remained a problem until Columban Fr Dave Kenneally in the neighbouring parish of Matli extended to Badin the successful TB programme that a German sister, Sr Beatrix of the Daughters of the Cross, had commenced. TB care came from Matli to Badin, and the vaccination programme spread from Badin into Matli. It was all done with minimal funding and with the personnel available, and it succeeded because people could think big and across boundaries.

In 1986, I got caught again into healthcare in a way totally unexpected. Bloody and dangerous ethnic riots suddenly erupted In Karachi and Hyderabad. By coincidence, all priests were out of Hyderabad city at the time, and the bishop was doing visitation in Quetta in the other side of the country. I had finished a week of lecturing at the Major Seminary in Karachi and was returning to Badin. Instead, I accompanied a Pakistani Franciscan back to Hyderabad on a near-empty bus, which, with great difficulty, was able to get through the military cordon that had been put up around the city. During the one-hour break in curfew, the Franciscan priest went to the cathedral parish, and I went to the parish based at that time at St Elizabeth Hospital. I could not believe what I saw when I arrived at the hospital. Injured people in all the rooms and corridors and lying on bedding on the driveways, 125 dead bodies outside the hospital office, frantic and shouting relatives, overworked and shocked doctors and nurses, and the hospital fittings being pulled apart. It was chaos needing care, seething hatred about the killings, and medicine and dressings that had run out. Gradually the military got control of the situation. Seriously wounded patients were moved by relatives to hospitals in Karachi, the dead were taken for burial. The doctors and the nurses and the Holy Family Sisters at St Elizabeth were exhausted and traumatised. The hospital interior was a wreck and most of the hospital equipment and fittings had disappeared.

Staff hands out medical supplies at a mobile camp in Pakistan. Photo: St Elizabeth’s Hospital in Hyderabad/Fr Robert McCulloch SSC

Staff hands out medical supplies at a mobile camp in Pakistan. Photo: St Elizabeth’s Hospital in Hyderabad/Fr Robert McCulloch SSC

My continuing connection with St Elizabeth Hospital and its School of Midwifery began then. As the years moved on and especially since 2019, St Elizabeth has moved up and on and is now the leading Catholic healthcare institute in Pakistan. It is served by dedicated Muslim and Christian healthcare professionals and is led by young, competent professional Catholic lay people.

I was caught three times into healthcare in Pakistan. I learnt a lot each time.

Columban Fr Robert McCulloch

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