COVID-19 Significantly Affects Maternal Health: A Rapid-Response Investigation from Pakistan

Why May COVID-19 Overwhelm Low-Income Countries Like Pakistan?

Since the coronavirus disease 2019, called COVID-19, has overwhelmed the high-income countries with ample resources and established health-care system, we argue that there are plausible concerns why it may devastate the low-income countries like Pakistan. Focusing on Pakistan, we highlight the underlying reasons, eg, demographic features, ineffective health-care system, economic and political inequalities, corruption, and socio-cultural characteristics, that create fertile grounds for COVID-19 to overwhelm low-income countries. This study presents Pakistan's brief profile to demonstrate these underlying structures that may make low-income countries like Pakistan more vulnerable in the face of an unceasing COVID-19 pandemic. The study concludes that the country may make appropriate and possibly effective short-term preparedness measures to halt or slow the transmission of the virus, and deal with its current implications as well as it may pay significant attention to long-term measures to deal effectively with COVID-19's longer-term effects. These measures will help them, including Pakistan, to deal appropriately with a similar future critical event.

Syndemics at play: chronic kidney disease, diabetes and COVID-19 in Pakistan

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair's syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.

COVID-19 in Pakistan and Papua New Guinea: reflections on mass testing and challenges

The 2020 COVID-19 pandemic continues during 2021. Some countries are revisiting their containment measures to be eased or re-imposed after massive testing programs. Yet is testing itself a solution? Testing may be an important containment step, yet in low-income countries (LICs), it may be substantially challenging to carry out. This is because the situation in LICs is complexified by inadequate and corrupt economic, political, and healthcare systems in which testing is often beyond reach. Focusing on Pakistan and Papua New Guinea (PNG), we contend that the sparse number of recorded COVID-19 infections may demonstrate that both countries lack the required resources to conduct effective testing and deal with the pandemic. To appropriately tackle the pandemic, such countries need focus on implementing the measures they can and on public education about how viruses work and why it is so important to seek to contain their spread. Furthermore, we invite thorough studies to examine and analyze massive testing from various perspectives.

Local Perceptions of COVID-19 in Pakistan's Sindh Province: "Political Game", Supernatural Test, or Western Conspiracy?

OBJECTIVE

The coronavirus disease 2019 (COVID-19) has received various distinct perspectives and responses at the local as well as global levels. The current study pays attention to local perspectives, which have appeared in the Sindh Province of Pakistan.

METHODS

Given the constraints of the pandemic, and using convenience sampling, we conducted 10 online group discussions, 7 one-on-one interviews, and 30 cellphone discussions from a small town of Sindh Province. We made every effort to make our sampling inclusive in terms of decisive sociocultural factors: gender, religion, level of formal education, and occupation/job. We obtained data from women, men, Muslims and non-Muslims, the formally educated and noneducated, government employees, and daily wage laborers. Moreover, to perform content analysis, we used social media such as WhatsApp and Facebook.

RESULTS AND DISCUSSIONS

We have found that some people consider COVID-19 a "political" game, "supernatural test" or "Western plot". The given perceptions then guide further actions: either ignore or adopt the preventive measures or take supernatural preventive measures. Considering it as a test of God, Muslims perform prayers, while the Bāgrrī community who practice Hinduism are taking cow urine to deal with the virus. This study brings these perspectives to the center stage; yet, the results cannot be generalized across the country, or within the province. Moreover, the study situates these perspectives within the global and socio-cultural, economic, and political contexts and invites more in-depth studies to inquire why such perspectives emerge.

CONCLUSIONS

We discuss different narratives concerning COVID-19 in a small town of Sindh Province. We maintain that documenting these various perspectives and analyzing their impacts on the preparedness programs is essential, yet understanding the causes behind the stated standpoints is equally essential, if not more so.

Birthing Between the "Traditional" and the "Modern": DāĪ Practices and Childbearing Women's Choices During COVID-19 in Pakistan

Pregnancy and birth are biological phenomena that carry heavy cultural overlays, and pregnant and birthing women need care and attention during both ordinary and extraordinary times. Most Pakistani pregnant women now go to doctors and hospitals for their perinatal care. Yet traditional community midwives, called DāĪ in the singular and Dāyūn in the plural, still attend 24% of all Pakistani births, primarily in rural areas. In this article, via data collected from 16 interviews-5 with Dāyūn and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DāĪ and the doctor. We ask, what does the maternity care provided by the Dāyūn look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DāĪ has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dāyūn we interviewed, all from Pakistan's Sindh Province, we demonstrate their practices and show that these have not changed during this present pandemic, as these Dāyūn, like many others in Sindh Province, do not believe that COVID-19 is real-or are at least suspect that it is not. To contextualize the Dāyūn, we also briefly present local mother's perceptions of the Dāyūn in their regions, which vary between extremely positive and extremely negative. Employing the theoretical frameworks of "authoritative knowledge" and of critical medical anthropology, we highlight the dominance of "modern" biomedicine over "traditional" healthcare systems and its effects on the Dāyūn and their roles within their communities. Positioning this article within Pakistan's national profile, we propose formally training and institutionalizing the Dāyūn in order to alleviate the overwhelming burdens that pandemics-present and future-place on this country's fragile maternity care system, to give mothers more-and more viable-options at all times, and to counterbalance the rising tide of biomedical hegemony over pregnancy and birth.

COVID-19 and Vaccination Campaigns as "Western Plots" in Pakistan: Government Policies, (Geo-)politics, Local Perceptions, and Beliefs

Vaccination encounters multiple context-specific challenges-socio-cultural, economic, and political-that substantially affect its uptake. Likewise, natural disasters and health emergencies considerably impact immunization endeavors, such as the coronaviurs 2019 (COVID-19) pandemic that has overwhelmed the entire world. It was already anticipated that the pandemic would severely affect Pakistan's vaccination programs due to interruptions in routine vaccination and the overstretching of healthcare systems. Consequently, there are anticipations of outbreaks of other vaccine-preventable diseases (VPDs). Yet empirical evidence is missing. Drawing on qualitative research, this article focuses on the impact of COVID-19 on routine vaccination programs in Pakistan. Our data come from a small village located in Pakistan's Sindh province where local people refused the routine polio vaccine that was stopped for a while, then resumed in July 2020. They suspected both the vaccine and COVID-19 to be a "Western plot." We argue that these perceptions and practices can be seen against the backdrop of economic, socio-cultural, and (geo)political forces, which are encoded in "societal memory." Not only is there a need to reverse the significant impacts of COVID-19 on routine vaccination by arranging supplementary immunization activities (SIAs), but also the government must deal with other pressing issues that affect the vaccination programs in the country.

From Normal to Viral Body: Death Rituals During Ordinary and Extraordinary Covidian Times in Pakistan

Death is far from being simply a physiologic event; it is a complex phenomenon with sociocultural and politicoeconomic aspects. During extraordinary times such as the 2020 coronavirus pandemic, death becomes a contested site. I argue that the Pakistani government's dealings with the bodies of people who die from COVID-19 have shifted the meaning of a normal dead body to a viral body that poses particular challenges to cultures and people, including the government. This article is both autoethnographic and ethnographic. It concurrently draws on my observations and participation in death rituals in a Pakistani village in Sindh province as a member of that society, and on a recent experience that I faced after the death of a gentle lady of my acquaintance due to COVID-19. I also build on my previous long-term ethnographic research in Pakistan and my ongoing research on COVID-19 in that country. I discuss the death rituals and ceremonies performed during "ordinary" situations as background information; and the changes in these rituals that have resulted from the coronavirus pandemic. My data demonstrate significant differences between usual and customary death rituals and those performed during Covidian times by government mandate, which have severely and negatively affected people's mental health. I show the government's "symbolic ownership" of the viral body, in that the government can control how people deal with their viral dead.