Call to the Minaret

Elsewhere, World Aids Day is celebrated on Dec 7th, but in Frontier Primary Health Care (FPHC) units in North West Frontier Province of Pakistan, a whole week is devoted to spreading the word and activities are legion. Wall chalking, that will last for at least a year, is put up on walls in a number of sites, banners are strung at the entrance of each health unit, quiz competitions are held and a cricket match between men at two of the camps highlights the week long festivities. Information meetings are held for both men and women in the communities and a two special seminars have been organized for religious leaders. Staff sport homemade badges with this years WHO slogan, Keep the Promise.

The youth quiz competition is won by a group of pre-teen girls attending the literacy class in the Kagan refugee camp. They pose proudly with their gold cup.

While Pakistan presently has relatively low rates of reported HIV and AIDS cases with an estimated prevalence of 0.07% in 2001, the rapidly escalating rates in neighbouring India has those concerned on edge. The risk factors in Pakistan are many. They include low condom use rates, low education and literacy especially among women, patterns of labour migration both within and outside the country that result in men living away from their families, low status of women and increasing intravenous drug abuse and commercial sex work.

A number of known risk factors are of special concern to health workers. An absence of universal blood screening results in contaminated blood and blood products that is estimated to be responsible for approximately 17.6% of current known HIV infections. Lack of appropriate infection control and waste disposal is widespread. Poor disinfection practices and lack of protective clothing such as gloves puts clients and health workers at added risk. The high number of medications given by injections by government health workers as well as traditional healers compounds the problem.

To slow the HIV epidemic, health workers and community members need to become more informed. Some of the most influential people in the community are the religious leaders. Every Friday, the entire male community gathers for noon prayers at the many mosques. The potential the religious leaders provide for wide and rapid distribution of health information is enormous.

The seminars for religious leaders sponsored by FPHC are attended by 90 religious leaders from the mosques in the refugee camps and surrounding villages. The seminars have been organized for a full day. The event is hosted on the porch of the main office building in Mardan which has been screened off with stripped canvas siding. Banners proudly welcome the visitors.

The staff of FPHC are all proud multipurpose workers. They demonstrate their skills by organizing the seminars themselves. The medical storeman sweeps up the leaves in the compound. The financial officer prepares the mammoth cauldrons of meat for the noon meal. A chowkidar cooks up the biriyani in the enormous clay pot in the back yard while drivers arrange tea cups and biscuits for the morning break.

I have been joined for the final two weeks of my stay by Maggie, a colleague and friend who represents the International Health Committee of the Society of Rural Physicians of Canada. Besides the two of us, there are two other females, a pair of Master Trainers, working out of the main office. As the only females, we have been asked to keep out of sight at the back of the building. The Western toilet we normally use at the front of the building is off limits today so an Asian toilet has been marked with a Ladies sign for us.

When we come and go on our visits to the field, we are spirited by drivers through the side door. As the day wears on, it is clear that not all of the clerics read English. Maggie passes by and notices that our designated toilet has become unisex. We don't mind but we think they might not be pleased, so we make other arrangements. Yet this enforced separation is more ritual than absolute for a few of the religious leaders greet us in passing and the male staff continue to mingle easily with us.

It is however the first time Maggie and I have experienced personally the exclusion of purdah and as mild as it is, it has an impact on us. I realize I have been regarding much of the separateness of women here as somewhat self-imposed, something they choose to do, such as covering their heads, excluding men from the obstetrical wards, wearing a chador and covering their lower face in public. Most of the time as western women, Maggie and I are treated with the courtesy and protection afforded to women but also given the status of "honorary" males. This organized separation feels different and puts another perspective on the issue.

The seminars are facilitated by a local physician who is a well-known Koranic scholar. The discussion we are told has been spirited. The religious leaders are pleased to have been included in this workshop. Many of them feel they will have opportunities to educate the faithful both during Friday talks and during individual counseling sessions.

Later, a number of the questions raised by the ulema (religious leaders) are discussed with Maggie and me. They reveal an appreciation for the complexity of HIV/AIDS and a lively curiosity. A couple of queries, we have to admit we can’t answer, including how we can be sure mosquitoes will not transmit HIV when they have developed a very sophisticated means of transmitting malaria.
Following the seminars, a short article is prepared by the director for the prestigious English language newspaper, The International Times. Maggie is asked to assist in editing it. As a skilled composer of op-ed pieces and news releases, she knows what is needed to get articles published. She adroitly shortens it and inserts a couple of quotes summarizing the highlights. Staff are delighted the next day when it appears in full under the byline of Our Correspondent. We tease them that they will have to submit regular articles now that they have been identified as a correspondent. It makes a fitting closure to World Aids Week in Pakistan.

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