Super Woman

Standing with me is the awesome human being Shehla Baji. I call her Baji as she is older than me and in Urdu we use this word as a sign of respect for elder sisters. I met her briefly in my first two years of med school during some awareness camps at PHC but we became friends during my third year clinical rotation in Family Medicine at the PHC three years ago. Then in my fourth year when I was president of the school welfare society she was my partner for all the community work, house visits and identifying patients in need. Since then we have always worked together for the community. When we were awarded the 2nd place MacJannet prize Dr Jawed Usman identified her as our main helper as she was from the community itself and no one matched her passion or amazing work ethic. 

I have never met anyone who works for their community with such enthusiasm as Shehla Baji. This blog is about her life and all the amazing things she does. 

Initially from Kohat, a beautiful small village in Northern Pakistan, Shehla Baji moved to Karachi with her family about 17 years ago. She has two sisters and two brothers. In Kohat she finished tenth grade but her father ended up in a debt of Rs. 500,000 and could not pay it off with his employment in the village so he set out for Karachi to earn more money. She tells me it had gotten so bad for them in Kohat that her mother would make tea without milk and give them dry bread along with it as they did not have any money for real food. They could only afford a decent meal once a week and they lived off it for the rest of the days. Their aunt loaned them the money to travel to Karachi. When they reached Karachi they stayed for three months at another aunt's house in Sikanderabad. Since she was educated, she immediately posted ads to tutor children of her lane. At night she and her mother would wash and iron clothes of truck drivers for more money. By the end of three months the family had enough money to rent a house. Within a few months she got married to her husband at the age of 16. The cultural practice there is that once girls get older, family members find suitable husbands for them and they get married off. After she got married she registered to give Intermediate level examination privately and she did all this while she was pregnant. Within a year of her marriage she had her first son Shariq who unfortunately has Cerebral Palsy. Shariq used to be sick quiet often since birth and Shehla Baji was always there at PHC to consult the pediatricians for one thing or another. During one of her visits she was asked if she knew someone from the community who would like to work for PHC and she excitedly told them that she would. She wanted to be trained to learn more for her son and wanted to help her community members.

This was back in 2003. Since then she has worked diligently, and harder than anyone else there. She is always keen to learn new things so that she can educate her community members regarding that. Now she is working full time to ensure that the MacJannet prize money is being spent in the most efficient way at Sikanderabad and maximum people get benefit from it. From Monday to Friday she is visiting schools daily to ensure that everything is being run smoothly. Everyday she visits two schools in the morning and interacts with the students and solves any problems being faced by the teachers. In the afternoon she is at PHC ensuring that the three sessions: the school, sewing class and the computer class is being run smoothly. 

Apart from all the assigned work she has been doing voluntary work for years for the community. She has herself identified 60 very needy children for whom she arranges school fee each month. At the beginning of every year she takes them to the uniform shop herself to get their uniforms. She knows 7 destitute families and she arranges monthly grocery for them. Just recently she collected funds to set up small businesses for two women so that they can earn from home. One of them now sells stationery and the other one sells chips and biscuits. Whoever she thinks is needy or can earn more, she collects funds to get sewing machines for them so that they can begin earning by stitching clothes. She also collected money to set up 2 French fries selling stations so that two teenage boys could start working and earn for their families. Whenever any house is in danger to get their power, gas or water cut off because of the many outstanding bills, she gets on it to ensure that they have enough money collected to pay off their bills. There is poverty everywhere in Sikanderabad but Shehla Baji is working hard to prevent anyone from becoming its victim. In the last blog I mentioned how some women died while giving birth because of the unsafe cultural practices and she is the one who notified other pregnant women to not undergo that practice and registered them with Edhi foundation for a safe and free of cost birth of their children. As her own son has Cerebral Palsy, she is very eager to help other CP children too. She took on the responsibility to arrange for wheel chairs, wheel cycles, diapers, Iron and Calcium supplements and food for 24 other CP children. Sadly, only 17 of them are alive now. 

Today I sat down with her and asked why she was doing all this and she said she was always into helping other people but she became more motivated after her son was diagnosed with CP. She said hopefully someone will benefit from some of this and say a prayer for him and his condition will improve a bit. She said she also felt that it was her responsibility to spread awareness among other people as she was more educated than the rest and she wanted to guide them towards the right thing. Shehla Baji absolutely hates it when people beg and having seen some harsh financial crisis, she wanted people to get out of it and work towards financial independence. This woman is a firm believer of community strengthening and she always tells me that these are her people, if she would not work for them then who will.

On talking about the MacJannet prize Shehla Baji happily told me that she always wanted to do more for her people but never had enough resources and now this gift is actually beyond her wildest expectations. She told me that she has never been more grateful in her life than right now because she is seeing older women who had never held a pencil in their hands are showing up to schools daily and are so interested to learn more. She is confident that this will create a ripple effect and all these women would be more keen towards the education of their own children and others around them.

I asked her if she wanted to give any message and she laughed and said she hopes that there are more people out there like those of  the MacJannet Foundation. Getting serious she said that I do not understand a person who eats three full meals a day and fails to notice that their neighbor is hungry since the morning. She continued and said that she just hopes that people stop living in their bubbles and take a moment to look around them as there would be someone who would be shy to ask for help but it would mean the world to them if you went ahead and helped them. She is 32 years old and one of the most jolliest people I know but when she says all this profound stuff she leaves me speechless. 

Shehla Baji restores my faith in humanity every single day and I hope that she continues to do this forever. She is a real treasure for Sikanderabad and I am so fortunate to know her as my friend. 

 By Zainab Faiza

These Strong Women

At least 5 of the women coming to our schools are pregnant. And they are among some of the keenest students in our classes. I really admire their courage and dedication to battle all the household chores, their morning sickness and back pains, needs of their other children and some even have some less than optimal domestic situations at home. Yet they all come eagerly with finished home works. I asked one of them if it was easy with everything going and she laughed and said absolutely not. She said she never really had any chance to receive education before and now when she has this opportunity she will not let this one go. One of the students is approaching her due date soon and her teacher tells me that she is so keen to learn everything as soon as possible as soon she would not have enough time to come here. I told her that we can adjust her in the following session if she would be willing to attend then. 

Most of the pregnant women in Sikanderabad choose traditional midwives and give birth at home only. These midwives are not trained and have just began doing what they saw the elder midwives do. Because of Ziauddin PHC clinics a lot of women have began coming in for antenatal visits and they are all advised for regular ultrasounds and prescribed folate and iron tablets. Over the last few months only we heard that the two pregnant women who went to local midwives died during child birth and even three other babies saw the same fate. It was just such a big shock for us and now all pregnant women who are coming to PHC are insisted upon to go to a tertiary hospital for child birth. 

Our five pregnant students were specially counselled to seek proper medical care. Shehla Baji took them herself to get all their blood tests done and then she had their name registered in the OB/GYN wards so that when the time comes, they deliver in the hospital. Shehla Baji registered them through the Edhi foundation which is the largest NGO in the country and they have received confirmation that all their child birth expenses would be borne by the NGO. This is a great news and such a relief for us that our students would be looked after properly when the time comes and the cost would not be a burden on them. We also conducted awareness sessions for all of them and we instructed them to carry the message to all the other women they know so that no one has to see the same fate as those unfortunate women who went to the untrained midwives.

We are very hopeful that our pregnant students in the future would be equipped to educate their own children when they are older and help them in their homework and encourage them to study more and build better lives for them.

By Zainab Faiza

Their spirit of Hospitality

Sheen Chai is Pahto for green tea. Pashto is the most widely spoken language in Sikanderabad as it is the language of Northern Pakistan and most of the residents hail from there. It is also understood and spoken by most of the Afghan Refugees so that is a plus. Whichever house or school you visit they'll stand up to greet you with the most gorgeous smiles, and ask you to sit on the nicest room in their houses. Although most houses face power cuts when we go meet them in the afternoon, they'll turn on the small generators which can power one fan and bulb just for you. 

Most of them insist to serve you food no matter what time of the day it is. If you say no, they always have tea ready. I personally do not like tea but my other team members go for it happily. They began offering me flavored juice instead and even flavored milk once ha. I tried settling in for water instead until one day they said have Sheen Chai which is their traditional drink and it was absolutely heavenly. I had had a big breakfast before going to the school that day and after i drank it I felt so light and refreshed. My mother generally drinks the commercially available green tea at home and this one was much better because it was straight from where it is grown in Northern Pakistan and it is not sold under any label, just by its weight. Guess I know what I'll be asking for every time I am there now.

I feel bad that they are all poor and cannot afford to go out of their way to feed us every time we visit but I had quiet an interesting conversation with this elder from the area about it. She said we are Pashtun and it is in our blood to serve our guests better than we eat. We consider it our good fortune if we have visitors, that way we have a chance to serve others. And she said do not say no when you are offered food fearing that it is expensive for us, we do it gladly. And we feel respected when an outsider eats with us and from our house. And what you eat was already given to us from God, just for you, so it is our good fortune that God chose us for this. 

Their simplicity in daily life continues to amaze me. 

  By Zainab Faiza

Love learning new things!

This photograph is from Mudassir's school. She has herself attended school up till high school. For now she is also running a small business at her house where she stitches clothes for other women in the area. Her stitched clothes are very fine and over the past few months she has been able to take orders from female doctors at the PHC too. She wakes up early and is at the sewing machine at exactly 7 am after sending her children to school. Initially this school was being run in the afternoon but now as more students wanted it early, it is conducted in the morning too. The only problem is that she faces power cuts during the morning in her area and students have to sit without any lights or fans. As you can see they are sitting along the window and doing their work with what little sunlight enters the house. We will get her an emergency light so that the students do not have to strain while working.

One of her students, Saima Tania eagerly wants to finish Math and Urdu so that she can start on with English. Sania's mother works as a cook and her employer used to give her children's books for her children so Saima has learned basic English language form those books on her own. I told her I will get her more English books so that she can practice and continue reading English in her spare time.

This was on the blackboard when I entered this school. They are learning how to join alphabets in Urdu to form words. The top one is Anaar which means pomegranate and the bottom one is Batukh which means duck in English.

This photo is from Bukhtawar's house. She is an exceptionally strong woman who will always greet you with a big smile. On this visit she had to go to the hospital for a follow up so her daughter Noor was conducting the session. She is the one who is standing draped in lime yellow on the right and Shehla Baji is the one in black who visits them everyday to see how the program is running. 

Both these women I talked to are loving the new classes and always demand more homework. To think that just a few days ago most of them did not know how to hold a pencil and now they are writing and reading words and going crazy colouring in their workbooks is so heartening.

The best thing about my visit this Tuesday was Dr Imran Sheikh. He is the new head of Community Health Sciences at the University. He had previously worked for 15 years here in this community with the university but he went abroad for a couple of years. Now that he is back and was visiting the area with us, so many people recognized him and were glad that he will work with the community again. As we have always wanted to include more university students for this program he has a plan of initiating more health awareness sessions that would be conducted by those students who will train the teachers and then they will train the students at their own school. For now we are working on a questioner to be filled out by each school student regarding their base line knowledge regarding disease prevention and then we will fill it out again after a few months after all the awareness sessions are conducted and then we will see if they have retained anything and are actually implementing health promoting habits or not. I am so excited to impart all this to them so that we decrease the disease burden of preventable diseases and they are able to spend money on better things. I have contacted a couple of NGOs regarding health material for these people and I will post what I receive from them.

By Zainab Faiza

Nosheen's School

This video is from the school Nosheen and her sisters are running. Nosheen is 17, has finished high school and is waiting to apply to College. Her mother is uneducated and attends her daughter's classes. After coming to the city their father realized how much education had changed other members of their community in the city and he vowed to educate his children. He did extra jobs to ensure that his children stayed in school. Now two of his daughters have completed Bachelors degrees and one of them is planning to apply to work at Ziauddin Hospital. The other one is planning to get into Government Service after she clears the entrance exam. Nosheen is currently home full time so she is the one mainly running this school.

Being so young it was initially a challenge for her to teach women older than her specially those who had no basic education. Most of them laughed at themselves and at each other because learning to hold a pencil and to trace on dots and then to formulate words was all very new to them. With time they have become confident in their skills and Nosheen has proven to be a very smart teacher who understands each student individually and guides them accordingly.

 The woman in black dress is Shehla. She is the backbone of this entire program. Soon I will write a detailed blog about her, she is my greatest inspiration here. She goes to theses schools everyday and helps teachers and instructs students. Nosheen is the girl sitting on the chair and her mother is the student facing me in pink dress.

Nosheen runs the school in her courtyard. The photographs are from when they had not received the mat to sit on. Most of the women in her school are from the Pathan ethnicity. They are beautiful people inside out and are the most hospitable to their guests. Every single time I visit they make sure I eat with them and if I am there for a short duration, they will give me some food to take away. Most of them follow staunch religious and cultural believes and always cover their faces while being photographed.

 Women who have no one else at home who would look after their children bring them along. We do not discourage them as this would mean that they would stop attending classes. We understand this is all new for them and their families and before this they did not do anything which was for their own selves so now we try to be accommodating just so that they would come and attend school. The seemingly young girl in blue pants is actually 18 and has achondroplasia. Before this she never got any chance to receive education. Her parents believed there was no need to get her educated considering she was disabled. Now since this school was free and her own lane, her mother let her go and she is very excited to learn Urdu and Maths and interact with other students around her.

The students are happy they are learning new things and have others around them who share the same experiences with them. Some of them are super eager and keep on pestering me as to what we will do after we are done with their course work. I have told them that we are learning along them too and we will see how it can then be taken forward in the future and where we will place them then.

By Zainab Faiza

What's in the bag?

We set up five schools in Sikanderabad for older women who had never received formal education. This is some of the stuff that was given to each school. Each school currently has 15 women over the age of 15. Each of them was given a bag-pack, a stationery box, one maths notebook, one Urdu notebook and a set of three books for Urdu and one math workbook. The teachers were given attendance registers, blackboard, chalk, coolers and a pedestal fan. Students from Ziauddin University school of Dentistry also gave a generous donation for these new students so that we could buy additional stuff for them. The first thing we bought were color pencils and number blocks so they can learn better by visualizing it.

The curriculum we are teaching is called Jugnoo which means firefly in Urdu. It is very symbolic in Urdu literature and has always been used to imply something that gives light and leads the way even though it is so tiny. This curriculum has been introduced by literatepakistan.org. The Urdu course is specially designed for people who have never been to school and after learning for just two hours a day for 90 days they would be able to read Urdu newspaper, write a letter and do everyday maths. The maths workbook also starts with basic principles and would make them skilled in simple math by the end of the workbook so that they can manage their daily and monthly expenditures better.

This is Samina's Urdu notebook. She is 19 and soon to be married. Before this she had never been to any school because the village she came from had age old traditions which never allowed women to attend school. Now since one of these new schools is right next to her house in Sikanderabad she is super excited to show up every day. Unfortunately she had the nasty habit of chewing Gutka which is a stronger form of tobacco chewed by some people in South Asia. Our student volunteer counselled her regarding the harmful effects and she was shocked and has vowed to cut down and eventually quit. It is not just the basic education we are trying to impart but also awareness regarding healthy habits too which is lacking in this area. Gutka chewing is a prevalent habit in slums as it is a cheap form of drug and is easily available. What most of them do not know is that it has a very high chance of causing oral cancers. Soon we will hold a proper awareness session for all students regarding Gutka and other drugs and all their lethal side effects.






These are photos from Samina's maths notebook. We are very proud of her for learning so quickly. She is a hard-worker and we are so grateful to have been able to bring her this opportunity.

This picture was taken at the school that is run in the afternoon at the PHC after the clinics for the day have ended. Samina and her friends study in this branch and absolutely love their teacher Gulnaaz. Gulnaaz is another hard worker and almost a superhero without a cape who deserves a special post just discussing all that she done and continues to do. We are very prevailged to have people in our corner who go out of their way to make other's lives better. They may not have enough but they are leading way for other women to learn from them and strive to be better.

By Zainab Faiza

The Plan For Now

I am a doctor. My sister has an MBA, my mother has an MSc, all my female cousins and aunts have Masters degrees too. Education for women is very important in my family and most other families I know here in Karachi, Pakistan. We do not have a system of student loans so all the educational expenses are borne by the families. For those students whose families are not able to pay for the college, they can get scholarships but unfortunately most of them then have to apply to smaller programs.

But there are still certain factions of the society which up till today feel that educating girls is a waste of money and effort. This mindset has vastly changed over time with conscious effort of government authorities and NGOs specially in the bigger cities here. Sikanderabad on the other hand is a squatter settlement where mostly uneducated people from small villages all over the country have emigrated to in search of small jobs. Most of their views are those that have been prevalent in their villages for decades based on how their ancestors saw and did things.

This photo is from the earlier meetings I had with some of the women here who had never attended school. I told them that I would be taking a photograph at the end and they insisted that their faces would remain covered for it. They were a group of 10, ranging from 15-45 year olds who had the most beautiful smiles and met my team with utmost humility. I wanted to know why they had never attended school when they were young. One of them said that back in their village only boys could go to school and so they never thought it was even possible for them. One of them said she started school here but her parents did not earn much so they decided to continue her brother's education and made her in charge of household chores so her mother could work as a maid. One of them said her father let her and her sisters go out to attend classes for religious education but feared they would not listen to him anymore if he sent them to a school. What is commendable now though is that all of them are doing their best to send their own children to local schools. They understand the importance having been uneducated themselves and when I asked them if they would like to enroll into school despite their busy schedule, they all very excitedly agreed.

In order to empower half the population of this area we have decided to start with basic education of older women with the grant received from the amazing MacJannet Foundation. The initial idea is to have five schools being run simultaneously in five different blocks of this area so that maximum women can benefit. At the Primary Healthcare Center (PHC) this idea was discussed and five women were identified who had at least completed their basic primary education. We could have hired professional teachers or even the University students could have taught them voluntarily but our plan is to keep it completely community oriented and to encourage them to stand up for themselves. In the past we have noted that some of our plans could not be implemented as they seemed too foreign to them and they could not relate to the teacher/organizer and always saw them as an outsider who was unaware of their background and cultural limitations. University students would visit them for awareness programs and other activities.

These women from different blocks were then met at their homes to see where they would be conducting classes. Their families were also invited to the PHC where they were informed about the plan and all their reservations and concerns were discussed with Dr Jawaid Usman who is the Head of Department of Family Medicine at Ziauddin University. An ideal time suiting the women had to be set for all the schools. Most women send off their kids to school in the morning and then begin doing their daily chores. Some of them work as cooks and maids in other parts of the city and are not home in the morning, It was decided that 3 of the schools would be run from 10 am to 12 pm and the other 2 would be run from 3-5 pm based on the teachers and students availability.

Four schools would be run in the teachers' homes and one in the PHC after the clinics have ended. Each teacher would be payed Rs. 5,000 (US $50) from the grant money every month. For now they will be teaching 15 women each from their lanes who are above 15 years of age and have never received any formal education before. I have been meeting them every week and all of them are extraordinary women who fought with the society barriers and some even their own family members to seek basic education. All four of them have also graciously offered to conduct classes in their own homes without any charge. With the prize money they will be provided with books, copies, bags, stationery and black boards. Some awesome person even donated mats and pedestal fans so these new schools so the students would be able to study comfortably.

For now the students would be taught Urdu and Mathematics as the basic subjects. Most of them speak Urdu as their second language so starting them on with English would take a while. All the new teachers are extremely excited to be able to help others like them and are determined to ensure that they will make a positive impact in their society.

In the coming weeks I will post how the University students are doing their part for their neighbors.

By Zainab Faiza

The Back Story

This photo is from my favorite place in the city. I graduated from a private college in Karachi. Most of my class-fellows were from well to do families, we had our own cars, wore the latest trends, ate out almost everyday and we were studying in the second most expensive school in the city. Right next to our school though is a squatter settlement. Gulshan-e-Sikanderabad, home to 130,000 residents from all ethnicities of Pakistan, including thousands of Afghan refugees, this is the place of  poorest of the poor who moved to the metroplois in hope for a better life. The average number of children per house is 7 and the families earn on average, less than $100 a month. Two sides of the settlement are bordered by huge water bodies of sewage and the houses with electricity face on average 8 hours of power cuts a day. Since it is a squatter settlement it was never planned out and tiny houses after houses just popped up so they have no underground water supply and the residents purchase water from the hydrants every single day. 

Yet amidst all this I have found the happiest people I have ever met. This photo is from the Primary Healthcare Center Ziauddin University built for this population. Since 1996 the center has provided medical consultation and medicines for minimal fee. The current clinic fee is 50c and the medicines are provided on 1/3 of the price in the market. The clinic ensures that all children are vaccinated based on the special WHO program for Pakistan called EPI and the center is specially supplied with all free of cost medicines for Hepatitis C, TB and Asthma from the government and other NGOs. Besides health related work the center has also held computer and stitching-sewing courses for the residents to train them to earn for themselves.

As a student I entered the area during my first year when we went there to hold a Dengue awareness camp for about 60 people. They all looked at us as if we were celebrities in our white coats, Most of them were barefooted but they had the biggest smiles on their faces when they greeted us. I had never met anyone this simple and more satisfied with life than these people yet compared to us they had literally nothing good going on in their life. After that every chance I got, I was back there, be it awareness camps for TB, Malaria or hand-washing techniques, Polio vaccination rounds or just visits to their schools. Contrary to popular belief the locals very much want their children to be vaccinated and I've seen them willingly wake up their children from sleep just so they could receive their polio drops when we went door to door for the campaigns. Though uneducated they are well aware of the harsh realities of these preventable diseases and are always keen even for booster follow ups.

During my third year we had our Family medicine rotation at the center and I finally got a chance to interact with the population on a patient-doctor level. The respect I've seen these people give their caregivers is not seen in the private hospitals I have rotated at. When my fourth year started I became the president of this welfare society at my school called KaraHealth Welfare Association and I decided to focus on them once again. All the fundraisers that we conducted were mainly to pay for the medical and surgical bills of these patients for treatments at tertiary care hospitals. I had an amazing group of juniors who helped me do monthly awareness camps at the center. We even called in our friends from dental school for free consultation who came in with a ton of supplies for the patients. Oral health clinics have now become a norm at the center. I realized that having such a short gap between each pregnancy has caused the children to grow up without a childhood as even a 3 year old kid has two siblings after him. For this reason we started weekly hour long sessions for children at the center. Any child could come, we'd give them paper and colours and ask them to go wild while discussing their dreams with our student volunteers. It was all new for the children and they really looked forward to this one hour every week. We provided sewing machines, monthly groceries, school fee, rent money, and money for surgeries and rehab for all those who approached us.

KaraHealth is not functional anymore but the students are still very much involved with the community next to their school. In all my time there I had always wanted just a little more help despite our fundraisers because there was always so much to do and so many more people in need. In the most exciting phone call of my life, back in March, I was told by the head of department of Family Medicine at my school that we were nominated for the MacJannet Prize 2016 for the community work and he wanted me to be interviewed by them. I had never heard of this program before and I was so infinite-ley grateful to have been chosen for this. The amazing Amy Newcomb took my interview and told me it was to last for 15 minutes. Hats off to her patience she listened to me babble for 50 minutes about all this! It was indeed a pleasure to talk to her. It was a huge honour to be even nominated for this, never did I think we would actually win the second prize and get the grant for $5k. Ha that was the second best phone call and I was just so thrilled that someone was helping us to help this community better!

I, with all the doctors and workers at the center are forever grateful for the prize money as it will help us serve this growing community. There is a lot to do but we have started with baby steps and I will try to upload regular posts with photos and videos to show how it is coming along. I plan to do individual profiles of our helpers and the community members so that a two-sided view is uploaded.

A big thank you to the MacJannet Foundation again for considering, choosing and helping us. Here is a link to their announcement: http://talloiresnetwork.tufts.edu/blog/2016/06/06/winners-of-the-2016-macjannet-prize-for-global-citizenship/

By Zainab Faiza