Pakistan Picaresque

By Samia Altaf

A chat over tea at a government office in Islamabad reveals why billions in aid have done so little for Pakistan’s poor.

Not enough nurses. Not enough jobs. Nurses working as “doctors.” Trained nurses being encouraged to leave the country. Untrained and uncertified “nurses” being recruited in sheer desperation by private hospitals. What a strange and paradoxical situation! Yet there is no discussion of these crucial issues. And new training programs are being developed, because there is pressure from international organizations to include more women, supposedly to meet the human resource ­shortage.

My companion sat shaking her head. Mrs. S. was starting to look restless. She signaled to the attendant for tea. In a government office, a tea break can become a project unto ­itself.

“The problem with women,” Mrs. S. volunteered conversationally, again adjusting the dupatta delicately on her hair as the tea service was laid out, “is that they all want to get married.” Quite a problem, and one the world over. “So eventually they must leave the profession to take care of their husbands and children.”

We let this pass, and raised another possible solution to the “problem” with women: training more male nurses. As the primary wage earners, they would not be compelled to leave once they married, and they could tend to the male patients, making it easier to attract women to the ­profession.

“Not a good idea,” according to Mrs. S. And why ­not?

“Because men are very unreliable. As students, they will agitate the girls,” she continued in the same conversational mode, oblivious to the effect of her remark on her audience. “If they are in classes together, they will induce them to strike on petty matters.”

“But the girls are under no obligation to do their bidding,” Lucymemsahib ­said.

“Yes, but the poor girls have no choice but to follow the boys. It is natural for them to do so. By themselves, girls never cause any problems. They quietly do what they are told or get married and go away.” Mrs. S. warmed to her subject. “Look what is happening in Liaquat National Hospital, Karachi.” Liaquat hospital is a major training institution for nurses, one of the few in the country that prepare male nurses. About a third of each entering class was male (as is still the case today). During the weeks before our visit to Mrs. S., the nursing students at Liaquat had gone on strike, demanding better living conditions, apparently at the instigation of male ­students.

“All because of these boys!” Mrs. S. continued. “So many headaches these boys are causing us.” She struck her forehead with the palm of her right hand in the traditional gesture of frustration, causing the dupatta to flop off her hair. She hastily retrieved it. “And the girls are not listening to us either. They are naturally listening to the boys. Stupid things!” She shook her head in ­indignation.

Lucymemsahib looked at Mrs. S. as if she had come from another planet. Thankfully, the tea arrived at this point, and we fell to it with gusto, under Mr. Jinnah’s enigmatic smile from his perch on the wall. Mrs. S. very generously ordered her attendant to run out for some mint chutney to go with the samosas, which were really out of this ­world.

[The complete article can be accessed at the Wilson Quarterly (Winter 2008) here.] 

Samia Altaf was the 2007-2008 Pakistan Scholar at the Woodrow Wilson International Center for Scholars in Washington, DC. Her book (So Much Aid, So Little Development: Stories from Pakistan) was published by the Johns Hopkins University Press in 2011).

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  • Ali Sohail
    Posted at 07:13h, 17 January Reply

    A fascinating article, which broadly highlights the roots leading to the mentality issue that persist in pakistan, regardless of the sector in question. At some level, all sectors are plagued by this mentality virus stemming from the colonial years.

    However the real question is, whether to purely criticize it from a radical view, or to move towards a second best mentality framework- second best institution rather than a radical shift to a first best system, which is not and will not be a easy transition and does not seem to be plausible the near future- as it is cultural issue!
    The preference of a second best institution is based on a recent essay by Dani rodrik.

    On the other hand, packaging aid from training to payment of workers seems like a progressive strategy to break this mindset, which for instance can be taken as the example of the radio ‘fm’ industry in pakistan. Employees of FM 89 got paid very well- which somehow automatically provides respect to the profession and a break away from the stereotype and influx of the elite!- get the big boys involved.

    Loooking forward to your book.

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