Pakistan is divided into four provinces: Sindh, K.P.K, Balochistan, and Punjab. With 235 million inhabitants, Pakistan is one of the most populous countries in the world. Currently, Pakistan’s population is growing by about two percent annually, and the average age is 22. Family planning is often a taboo subject and intra-family marriage is widespread. Nowhere in the world is marriage among relatives as firmly rooted as in Pakistan: 56 percent of marriages take place within the family. In rural areas, four out of five marriages are between cousins (source: Martina Merten, Global Health Specialist). The consequences are fatal: the percentage of children who are born with genetic defects, such as cleft lip and palate, is significantly increased. Educating people about this is part of our work. But breaking with such long-established traditions is a long journey. And broaching the subject is a tightrope walk if you don’t want to lose people’s trust.
Pakistan also holds a leading position in another statistic: Pakistan has the second-highest out-of-school rate in the world. Many children still drop out of school prematurely or receive no education at all. The illiteracy rate is 42 percent, and as high as 53.5 percent for women (sources: BMZ, unicef).
The current living situation in Pakistan is difficult due to high inflation (as of February 2023: almost 40 percent). Many of our patients’ families are moving to the countryside because they can no longer afford to live in Karachi. But due to the high cost of gasoline, even transportation to the city is almost impossible to afford. This is a far-reaching problem, whose impact we feel in our work as well: It is becoming increasingly difficult to motivate parents to take their children to the follow-up appointments after the operation. Or an operation cannot be performed as planned because it is discovered during the preparation for the surgery that the child is ill, and the parents cannot afford the cost of a second trip.