32 year old Abdul Wahab works as a daily wage laborer in Muslimbagh in Quetta. He is married with four children and the sole breadwinner for his family.
One day 7 months ago when he came home from work, he noticed a few bumps on his nose. He didn’t think much of it till they started growing. Seeking the advice of his friends and neighbors he went to a few private doctors who gave him a variety of diagnosis. Some even told him to go get help from a local talisman. As the condition grew worse, Abdul Wahab feared the worst.
“I thought I had developed cancer and that this was going to be the end of my life. People told me not to wash my face or touch anything- I was so disturbed I did not know who to believe or listen to.”
Abdul Wahab finally managed to get a proper diagnosis at a hospital in the city.
“They told me the treatment would cost me Rs.30,000/- and I thought to myself, I can’t even pay Rs.30/- at this point. I am a poor man.”
Finally, someone recommended he go to Kuchlack to the MSF facility for CL and receive free treatment.
“By the third visit, I could see the improvement on my nose. It was such a huge relief.”
Aside from receiving treatment for his lesion, Abdul Wahab received counseling at the Kuchlack Mental Health Centre also, the only one of its kind in the district.
The counselors talked him through his fears of death and worked with him on his feelings of stress he felt because of the appearance of his lesion.
“I stopped socializing for a while because people passed too many comments about the appearance of my nose. My wife told me to ignore everything but I couldn’t do that either- I had to find a solution and I consider myself blessed that I finally found it here.”
It is not easy for Abdul Wahab to come to the Kuchlack facility. He lives a good hour and a half away (by road). He has had to refuse day labour jobs that come his way in order to complete the full treatment properly. However, he remains positive and motivated.
“I don’t have a choice in this matter – my health is important and I must do the treatment properly. I have to do it to take care of my family. ”
Life took and unfortunate and unexpected turn for the worse for Nazar Gul, a daily wage labourer from Muslimbagh, when 8 of his 9 children were bitten by infected sand flys.
“It had been 6 months since my children were bitten and the bites got worse over time. My neighbors advised me to go to a private clinic but I couldn’t afford the treatment there. Then someone suggested I go to Quetta because there is a clinic that treats this condition for free.”
Determined to seek proper treatment for them, Nazar Gul has had to drag his young ones on an uncomfortable three-hour bus ride to the MSF clinic in Kuchlack. For a person who gets paid Rs.500/- for a full day of labour, just a bus ride alone which costs him Rs.600/- per trip has been a huge financial burden.
“As a labourer, getting a job is pretty erratic and ever since my children have been suffering from this condition, I haven’t been able to actively seek work. I’ve been borrowing money from people and now am close to Rs.300,000/- in debt.”
The stress for Nazar Gul does not end there. His 7 year old son, Gul Mohammad, is traumatized by the appearance of the bites on his face. Mehwish, a counsellor at MSF, who has been present since the first day Nazar Gul’s family came to the clinic thinks that Gul Mohammad may have faced bullying at the hands of his friends because of marks on his face.
“When he first came here I could only see his eyes because he had wrapped a cloth around his face. It is clear that he is very embarrassed and scared by his appearance. The hat he wears now indicates an improvement in his attitude, it shows that he is slowly learning to accept the situation as his bites heal.”
The MSF team has helped Nazar Gul and his family in all possible ways, from facilitating some of his travel to the clinic to providing counseling sessions for him and his children that has helped them understand CL and not fear its consequences.
For 15 year old Saeed Rehman, life has never been easy. One of twelve siblings, he had to start working early on in life foregoing his childhood in order to earn for his family to survive. Never having gone to school, Saeed developed his skills as a baker and works at a shop near the bypass in Quetta.
Working 12 hour shifts doesn’t leave Saeed much time to do anything else. A few months ago he woke up to find numerous bites on his body.
“I thought I had been cursed so I went to a talisman to have him cure me. I met another man there who recognized the lesions and told me to come to Benazir Hospital to get treated.”
The information proved useful since he noticed two of his younger siblings had the same symptoms and brought them along with himself to the MSF clinic in Benazir Bhutto Hospital.
“My friends make a lot of fun of me because of the bites on my body. They laugh at me and tell others to not sit with me because I have germs. I avoid all of them now.”
Initially, Saeed’s main reason for avoiding his friends was because he was uncertain about the fact whether he was in fact contagious or not.
The MSF doctors who treated him reassured him that this was not true which made him relax about his condition.
22 year old Nematullah works at his uncles carpet shop in a popular marketplace in Quetta. His 14 year old brother, Hamdullah, studies at a local madrassah (religious school for Quranic teachings).
Roughly 8 years or so ago, both brothers contracted leishmaniasis and after learning what it was, sought private treatment for their condition.
“Many people had told my parents that our bites would heal on their own. No one knew what this really was though. When it started to get worse, they realized these were not ordinary bites.”
The elder and luckier of the two, Nematullah, fully recovered with only a scar near his mouth as the tell tale sign of his ordeal.
Hamduallah, however has not been quite as lucky. Eight years on, the twenty injections he received to rid him of the infection proved to be insufficient as it re-developed in the form of a ring around his existing scar.
Dr Shakeel Ashraf, a dermatologist who consults with MSF on identifying leishmaniasis cases, describes this condition as the type that is resistant to therapy. It stays in the dermis of the skin and grows slowly. In such cases, Hamduallah will need to go through some more treatments.
Even though other children at the madrassah tease him about his face, Hamdullah has learnt to be patient.
“People think I was injured or burnt in the past and that’s what the scar is from. I don’t discuss the details with anyone. When people stare, I tell them that my scar is something God bestowed on me and I have no other explanation for it.”
Whereas Hamdullah still has to live through hearing comments about his appearance, Nematullah’s much smaller scar had largely been accepted by his friends and family over the last decade as a part of his face.
“As a child I used to be so conscious about it doesn’t matter at all to me especially when I see my brother and what he still has to go through.”
Iranian born Ali Sina moved to Pakistan with his family when he was only two years old. As the years went by and the sectarian violence in Quetta grew, his father was one of thousands of men who jumped on a ship and sailed off to Australia to find work. He was one of the lucky few who made it. Soon after, his elder brother did the same, leaving Ali and his other brother in charge of their mother and younger sister.
These events in Ali’s life have made him a strong and motivated young boy with a sense of purpose and ambition.
His practical attitude is reflected in the way he reacted when he was faced with CL.
“I discovered this bite 6 months ago. I had been in a fight with a friend and he hit me near my eye. I thought his punch had caused it but then when I went to the doctor he explained what it was.”
Ali is lucky to live in a community of Hazaras, an ethic minority in Pakistan, who are relatively well-educated people.
“Maybe one or two children in my class tease my about my scar but majority of the people in my community know that this is a bite that will go away within a year. I have never had to face any bullying.”
This comes as a refreshing change from the usual social stigma attached with lesions caused by CL, particularly affecting young girls with scars on their faces who fear it has reduced their chances of getting married.