The dai - Photocrati Fund Submission 2012 (25 images)

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  • An empty food stand in the drug infested area of Rehri Goth. Poverty and high food prices threaten food security and fuel inflation. The majority of Pakistanis spend half of their income on buying essential food items and are left with very little for health care and children's education. Karachi, Pakistan, 2011

  • A matt is laid on the sandy floor when a woman comes in to give birth at Halima's home. <br /> Halima has been a dai (traditional birth attendant) for 20 years and learned her skills from her mother without any formal training. Like most dai, Halima says she never handles cases with complications, yet every 30 minutes a woman dies during or shortly after childbirth in Pakistan. Bad hygienic conditions, unskilled assistance and untimely referral to the hospitals in cases of complications and post partum bleeding are some of the main reasons why dai are partly blamed for this high morbidity rate. Rehri Goth, Karachi, Pakistan, 2011

  • Halima has been a dai (traditional birth attendant) for 20 years and learned her skills from her mother without any formal training. Like most dai, Halima says she never handles cases with complications, yet every 30 minutes a woman dies during or shortly after childbirth in Pakistan. Bad hygienic conditions, unskilled assistance and untimely referral to the hospitals in cases of complications and post partum bleeding are some of the main reasons why dai are partly blamed for this high morbidity rate. Rehri Goth, Karachi, Pakistan, 2011

  • 21-year-old Suni is 7 months pregnant and expecting her second baby. Her dai Afroos checks the position of the baby. <br /> In the Orangi slum only one government hospital has to provide care for millions of inhabitants, so most women still rely on their community dais to assist their deliveries. <br /> Afroos has been a dai for over 20 years and learned her skills from her blind grandmother. Even so, she works as a dai in the government hospital as well and has followed courses provided by the hospital. Orangi town, Karachi, Pakistan, 2010

  • A delivery room at home of a local dai (traditional midwife) shows the poor and unhygienic conditions in which most women deliver their babies in the rural areas. Lack of medical knowledge and poor hygiene are the major causes of the high maternal and neonatal mortality rate. Kandiaro, Pakistan 2010

  • A woman with traditional bangles around her arms leaves the local doctors' office. Traditional customs like these bangles often create problems in emergency situations, making it hard to take the blood pressure or give injections. Mithi, Tharparker, Pakistan, 2010

  • Fatima checks the heartbeat of the baby in her clients' belly. She loves bringing new life into the world and her most memorable delivery were twin male babies. Karachi, Pakistan, 2011

  • Neighbors and family members of Fatima. Fatima Kaniz, became a dai after her husband died. Most women don't trust the hospitals or can't afford the proper care and therefor still rely heavily on the community midwifes and dai. Karachi, Pakistan, 2011

  • A dusty delivery table at home where a dai assists women during childbirth. Most dai are unskilled and uneducated, learning their trade from generation to generation. The new young women however are going to midwifery schools and starting to use more hygienic techniques and referring patients to hospitals in case of complications Kandiaro, Pakistan, 2010

  • Mirzada has no training whatsoever when she started working as a dai 10 to 15 years ago. 'Everything goes from Allah. God does this work, I just help out. I leave everything up to him'. Karachi, Pakistan, 2011

  • A family member making a family visit to Mirzada's home shares the latest gossip with her family members. <br /> Most people in Pakistan live in a joint family system. <br /> Women take care of the households and raise the children at home. Elderly people heavily rely on their children and grandchildren to provide for them when they get older. Karachi, Pakistan

  • One of Mirzada's grandchildren plays around with her mothers dress making it into a veil. <br /> Karachi, Pakistan, 2011

  • A ventilator hangs between a poster of Benezir Bhutto and the Kaaba (cube) of Mecca on the wall of the delivery room where Sherbano conducts her home deliveries. <br /> Due to lack of electricity and heavy power cuts, the ventilator hardly ever brings any relief to the woman in labour. Rehri Goth, Karachi, Pakistan, 2011

  • Sherbano has been a dai for over 40 years. She doesn't know her age but recounts many of the deliveries she's handled over the years. <br /> Trained by her mother and grandmother, she conducts both normal and breach deliveries. Most dai deny delivering any complicated cases and say they refer the patients to nearby hospitals. Yet most maternal deaths happen due to untimely referral or the lack of skill by the dai. Rehri Goth, Karachi, Pakistan, 2011

  • Sherbano shows the cord clips she received from a foundation. Other then scissors to cut the umbilical cord, she has no instruments at hand to use while she assists the deliveries. Rehri Goth, Karachi, Pakistan, 2011

  • A young pregnant woman visits the local dai for a medical check up. <br /> Young birth attendants today are becoming more educated and work in a professional manner. They use the right equipment and work in better hygienic conditions. <br /> Most midwifes of the new generation have gone to school and followed a proper course instead of learning the trade from their mothers or grandmothers. Kandiaro, Pakistan, 2010

  • Two cows and a goat in the courtyard of Sherbano's family living unit. <br /> Most people in Pakistan live in a joint family system. Elderly people heavily rely on their children and grandchildren to provide for them when they get older. With poverty rising and the drug mafia souring in their neighborhood, the animals are a sign of wealth. Rehri Goth, Karachi, Pakistan, 2011

  • A basket with some medicine, cord clips and injection needles to use during a home delivery are all the instruments Sherbano has. Lack of hygiene and re-usage of the needles is dangerous and raises the odds to various complications like hepatitis. Rehri Goth, Karachi, Pakistan, 2011

  • Rehana (left) and her cousin Sharifa (right) have both been dai for over 12 years and carried on their family tradition having learnt by watching their mothers and aunties. <br /> They say they want to help women who can't afford hospital care and offer their deliveries for free. <br /> Most dai lie about the fees they charge and most women become dai to earn an extra income. Karachi, Pakistan, 2011

  • Tara's (nickname meaning 'Star') hands.<br /> With no instruments of her own, Tara lets the patients buy blades and the necessary medicine, shifting part of the responsibility in case things go wrong.<br /> Lack of sufficient hospitals and affordable medical care are major reasons why women still rely heavily on the services of a dai who are very important and respected figures within their communities. Orangi town, Karachi, Pakistan, 2011

  • 21-year-old Sadef has just given birth to her second baby at Tara's home. <br /> Her auntie and mother take care of the newborn baby boy and assemble their things, while Tara finishes up the care for Sadef. <br /> Both times the births were assisted by Tara, and Safe wouldn't want to deliver in the hospital, putting full confidence in her dai. Karachi, Pakistan, 2011

  • 70 year old Samani has been the village dai (traditional midwife) in Mithi for the past 40 years. With her hands she is demonstration how she uses her hands instead of instruments in post-abortion care to clean the whomb. After having learnt the skills from her mother in law, she is now passing on her knowledge to her own daughter in law. Mithi, Tharparkar, Pakistan 2010

  • A young member of Ghair Bibi's family sweeps up dirt in the alley outside their family living unit. Karachi, Pakistan, 2011

  • Dai Ghair Bibi sits among some of the female members of her family. She doesn't know her age and how many deliveries she assisted over the years, but most fondly remembers assisting the births of her family members. Karachi, Pakistan, 2011

  • Ghair Bibi's daughter wraps her two-month-old baby in a towel. <br /> Ghair Bibi assisted the delivery herself at their home without any complications. Karachi, Pakistan, 2011

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