“In reality, they are the nine months of pregnancy and it is a bit difficult for me to travel,” says the midwife of Fatima, as she carefully makes her way down steep stone stairway to the door of his clinic.
“But I come here for the good of my patients.”
It is thought that up to 99% of maternal deaths could be avoided if a doctor or trained midwife present.
In Pakistan, a woman dies every 20 minutes from complications during pregnancy or childbirth, says the Centre of Excellence for Rural Development.
Fatima works with Sehat Kahani, a Pakistani organization that trains community midwives, and connects them to the female doctors through a video link.
These video consultations cost by Rs50 ($1.30; 96p), making basic health care accessible for many women in rural areas.
Today Fatima is to see Rubina Mukhtiar, who lives in Mansehra, a city 71km (40 miles) north of Islamabad.
“I had two boys deaths and four miscarriages, and now I am two months pregnant,” says Rubina.
Rubina is lucky to be alive.
She describes severe headaches, swelling of the limbs and dizziness during a previous pregnancy. These are all classic symptoms of pre-eclampsia, a form of very high blood pressure that can kill the mother and the child.
By the time he reached the hospital in Islamabad, it was too late for her twins.
“When they did my ultrasound they told me that the children were dead for 15 days.
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“I wanted so much for a son…but this is the will of Allah.”
This will be Rubina tenth of a pregnancy, but it will be the first with regular checks and antenatal with an experienced midwife and doctor.
Fatima controls Rubina blood pressure, and then reports back to the doctor on the screen of his laptop. Everything appears to be normal.
“There is a lady in my neighborhood who recommended that I go and see Sehat Kehani,” says Rubina.
“Coming here I am pretty confident that, in spite of my previous miscarriages, this time I will give birth to a healthy baby boy.”
“I feel a lot of pain for them,” says Fatima after Rubina left the examination room.
“If you’ve had multiple miscarriages, only a mother knows the pain that it causes.”
Fatima adds that she was not able to work in the past, because she could not get permission from my family.”
“Why do I have to do only with women I am authorized to work here. I do not have permission to work with men.”
This reluctance to grant permission for women to leave the house means that there are thousands of qualified female doctors and midwives are missing from the Pakistan of the work.
According to the Pakistan Medical and dental Council, over 70% of medical students are women, but only half will ever be in practice as doctors.
Sehat Kahani was founded by doctors, Sara Saeed and Iffat Zafar.
“We are doctors, we are both graduates from the best universities in Pakistan,” says Sara.
“We both happened to return to the world of work after marriage or having children, then we have to relate to those that lack doctors who are not working today.”
They set DoctHers in 2014, which has allowed them to practice from home, using video links. This has also helped to tackle the shortage of affordable health care in much of Pakistan.
In 2017 Sara and Iffat decided to focus on primary care for women, and set Sehat Kahani – which means “health history” in Urdu.
“We realized that there are more people that do not reach the clinics,” says Sara.
“Health is not important to their family, or never get permission to get out of the house.”
“So we came up with the idea of a midwife or lady health workers [transportation] a tablet [computer], and a bag. She travels door-to-door to provide advice at home for patients who can’t make it to the clinic.”
Tayyaba Anjum Ali, is one of Fatima’s patients. She has four children, including a newborn son.
“When I was pregnant the first time I was in a lot of pain, but this pregnancy has been much easier,” says Tayyaba.
“If I am not able to leave the house because my children are alone, then I can call the midwife comes over to my house and do all the tests.”
Fatima looks at both the mother and the child, and then shows Tayyaba a short video about the breast-feeding on his tablet.
“I work in a city where the women do not consider it important to go to a doctor,” says Fatima. “I work for a company that provides the awareness of these women, together with the good doctors.”