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Hello, this is Claudette Banda, midwife and psychiatric nurse-practioner, writing a guest blog post about the recent team expedition to the Koohi Goth Hospital in Karachi, Pakistan. This was my first year joining in, but IMR has been visiting this site since 2023 to support their efforts to improve women’s access to high quality, evidence-based care in Pakistan. This year’s team consisted of Dr. Ambereen Sleemi, Dr Ralph Chesson, Mayano Ochi, CNM and I.

Koohi Goth is a lovely hospital in urban Karachi. Whereas the streets of an urban area are crowded and dusty, Koohi Goth’s campus is grounded in nature with shady trees and small zoo! The campus includes a hospital, pharmacy, dormitories, and a nursing school. I was most impressed by Koohi Goth’s commitment to not just quality care, but equally to elevating the prospects of the surrounding community. Housekeeping staff receives free basic education as a part of their work day. Young women from the neighborhood are invited on campus for 6 months at a time for basic classes in reading, writing, sewing and marketable skills. The campus restaurant provides food to all present. Care at Koohi Goth hospital is free for patients, including supplies, space, food and staff services.

The surgeons spent their days teaching a 3-day seminar to resident physicians and attending physicians on the management of complex fistula cases as well as taking complex cases to OR so that the learners might have the opportunity to observe varying operating techniques. Mayano and I spent our days at the nursing school.   

Pakistan currently has a national health agenda to encourage more midwifery-led obstetric units. Eight midwives from around Pakistan, but mostly from the Punjab region, came to Karachi to take a 10-day seminar coined ‘Training of Trainers’ (ToT). Participants were lecturing and clinical faculty at various nursing schools. We delivered 4 days of didactic and skills content as a component of the ToT program. Our topics included CMQCC standards in sepsis care and ALSO standards in the management of shoulder dystocia. We were able to set aside long sessions for postpartum mental health management as well as hands on training in optimizing fetal position - which of course might serve to reduce the work load for the fistula surgeons! All fistula surgeons look forward to going out of business.

I had so many remarkable moments along the way, it’s hard to narrow it down to just one thought to end this blog post. So, I end with gestalt. A midwife’s work is broad, profound and recognizable across space and time: to walk with, defend and serve women, the world over. Sometimes, that might look like training trainers. I felt as much the midwife this week as I did the first time I received a newborn or the hundreth time I placed an IUD or the thousandth time I wrote down “24 YO G2P1 here for routine care.”

- Claudette Banda, 2026

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