March 2007
Report from visiting medical student Brent Mittelstaedt

I approached my trip to the Northern Areas of Pakistan with a bit of apprehension. I was a mid-twenties, bright-eyed, idealistic, American in a land which, for all I knew at the time, may not wish to have such a visitor! On CNN and in the news all you hear of Muslim countries are reports of sectarian violence, and kidnappings of Westerners. Those do happen in some areas of these lands, but this is not the side of Pakistan that I witnessed; the side which has given me an understanding of the culture that I will never forget.

I learned immediately that in this area (as is many developing areas of the world), regular flights to anywhere you hope to end up (I stress HOPE!) are few and far between and depend on the weather and a multitude of variables. Buses and private vehicle are the primary modes of transportation, despite the cliff-like roads which they must traverse to reach the northern valleys. I made my way north with the private car of a hospital worker and back south by bus when my trip was nearing completion.

My first impression of the area was the sheer vastness of the terrain. There’s nothing like it I have ever seen. The valley walls are just as steep and high, more so than Alaska and Idaho. I encountered gorgeous terraced farms of newly planted crops, waterfalls, the most picturesque small towns imaginable, and of course the stray cow or two walking in the road!

In the Northern Areas, March is when planting is just beginning in the villages and the apricot blossoms are in full glory. Cricket is the sport of the season, coinciding with the recent World Cup of Cricket. There were after-school and after-work pickup games around the city. We even had our own game on the hospital grounds each day. I participated quite often, but was never sure if I ever understood all the rules!

The Gilgit Eye Hospital, where I worked and lived, is a one story structure which houses 4 examination rooms, 2 operation room (OR) suites, waiting areas, procedure rooms with laser equipment, a blind school, a cafeteria and offices. There are roughly 30-40 local employees working at any time at the hospital. This allowed for much interaction between the local staff and me.

During my visit I had the privilege of seeing the blind school in action and the joy of learning about their school. The handicapped are a sub-class in the Northern Areas and their parents were content with leaving them in a dark room of the house, sometimes chained, for years. The blind school gave those children a life.

My hospital days consisted of clinic where we saw patients (with supervision by the local ophthalmologist) three days a week, and OR time 2 days a week. There were two research projects I had made a goal to complete while in Pakistan and they are progressing well towards publication.

Riding around the city on a mountain bike afforded me an opportunity to get out and see the culture in its day to day workings. I believe I enjoyed that part of the trip the most. The second official language of Pakistan is English, so most children were able to converse with me, and understand that I was from America. This blew them away! They couldn’t ask enough questions. I stayed with them in the streets until beyond dark because I simply wanted to leave with them an understanding of my culture that would last a long time. I did that several times and each interaction increased my understanding of them as well! As I rode around, men women and children alike would say ‘hello’ as well as ‘goodbye’ and ‘how are you?’ in the same sentence as if to show their welcome with as much English they could fit in one phrase!

My medical work would have been done without me; there wasn’t anything I did in the Northern Areas medically (short of bringing a large duffel bag of supplies and recording data to publish two papers) that the hospital wasn’t going to do without me. I functioned as a technician in most regards, but this was still more hands on opportunity than any of the four ophthalmology rotations I’ve done in the states, at my medical school or on interview rotations!

I highly recommend that any medical student who can take out some extra loans or raise the funds and donations necessary to come to this area to do so. It has changed my impression of what I want my practice to involve. The lasting understanding between cultures was something I know I will have for the rest of my life and hope they will as well. I pray that one day I will make it back to the Northern Areas, even just for a short time!

Sincerely,

Brent Mittelstaedt