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38

Mazhar Hussain Qureshi, a young man from a small village named Hassan Qureshi, in Sindh’s Khairpur district, had spent most of his life struggling to make ends meet as an unskilled labourer. He worked 10 to 12 days a month, barely able to support himself and his family with a meagre daily wage of PKR 400-500 (approximately USD 1.44-1.8). Much like the rest of his community, his village had little economic opportunity beyond agriculture, and most residents relied on sporadic labour work on nearby farms.

The devastating 2022 floods in Khairpur severely impacted the community’s livelihoods, shelter, and agricultural activities, including crops and livestock. Mazhar’s family, reliant on daily wage labour, was among those affected, losing their home and income sources. In 2023, Community World Service Asia (CWSA) launched a livelihood recovery project to support flood-affected individuals. Mazhar was selected for motorcycle repair training based on specific criteria. These included being between 18 and 40 years old, having at least primary-level education, belonging to a vulnerable group, coming from a large family (seven or more members), being a daily wage worker interested in learning new skills, or being part of the flood-affected community. This initiative aimed to equip participants with sustainable skills to help rebuild their lives and restore their independence.

In April 2024, Mazhar training commenced at the Skill Development Centre in Sobhodero. A total of 450 graduates were enrolled in three-month batches at the Kingri and Sobhodero Centres, established in September 2023. Each centre offered three trades—electrical, motorcycle mechanics, and mobile repair—with 25 trainees per trade, totalling 75 graduates per batch. Over nine months, three batches completed their training from October 2023 to June 2024, with 150 individuals trained in each trade. The purpose was to train unskilled labour and flood-affected communities, enabling them to enhance their livelihoods.

Mazhar joined the program in its third batch, driven by the high demand for motorcycle repairs in his area and his interest in learning a skill that could improve his family’s financial future. Although he knew the basics of motorcycle repair, Mazhar’s time at the centre introduced him to new techniques, covering theory and hands-on training over six days a week. Mazhar’s commitment to the training program[hI5] [S6]  was exceptional. He attended every session with discipline, encouraged by a daily transportation allowance of PKR 550 (approx. USD 2). Through his hard work, he earned the top position in his class, a proud achievement that marked his entry into the skilled labour population upon completion of the program and received a certificate from the Trade Testing Board Sindh, along with a specialised toolkit essential for his new trade. This acknowledgment of his abilities boosted his confidence and marked the beginning of his entrepreneurial journey.

CWSA and the Catholic Agency for Overseas Development (CAFOD), the organisations behind the Skill Development Centre, saw Mazhar’s potential and extended further support to help him establish his business. He was awarded PKR 50,000 (approx. USD 180) in cash assistance, which enabled him to rent a small shop for PKR 5,000 (approx. USD 20) per month and buy necessary tools for his new venture. With this setup, he opened his motorcycle repair workshop, providing a valuable service for residents and creating a stable source of income for himself and his family.

“Before I joined the training program, I didn’t have the technical or business skills,” Mazhar reflects. “Now, I am confident, skilled, and capable of handling all technical aspects, managing my business, and understanding market and customer needs.” The training and support from CWSA transformed his ability to navigate the business world, from dealing with customers to managing finances. Mazhar now earns an impressive daily income of PKR 1,500-2,000 (approx. USD 5-7), far more than he could have made as an unskilled farm labourer.

Apart from Mazhar, 26 other graduates, nine from each trade were given a cash grant of PKR 50,000 (approx. USD 180). They were selected based on being top performers in their final exams, having sustainable business plans and feasible locations, and demonstrating a strong interest in establishing small businesses. Around 36% of the 450 graduates now work in the market either as skilled laborers or have set up small shops, earning daily incomes ranging from PKR 500 to PKR 1,200(approx. USD. 1.8 to 4.3).

As his business flourished, Mazhar didn’t keep his success to himself. He began training his brothers and other young people in his community interested in motorcycle repair to help them gain the same skills he had acquired. So far, he has trained three individuals who now assist him in the shop, and he takes pride in seeing them improve daily. “It feels good to pass on the skills I’ve learned,” he says, “and it’s rewarding to watch them get better in their work.”

Mazhar’s journey has had a positive impact on his entire community. His reputation for skill and reliability quickly spread, with residents trusting his work and frequently recommending his services. He is now a source of inspiration, showing others that with hard work, determination, and the right support, it’s possible to transition from struggling labor to skilled business ownership.

Looking ahead, Mazhar has ambitious plans to grow his business further. He envisions adding more services, such as selling spare parts and offering maintenance contracts for local businesses, to support long-term growth. He also hopes to hire more individuals from his village, allowing others to escape the cycle of poverty and contribute to the local economy. “My goal is not just to grow my business,” he explains, “but to create a space where others can learn, earn, and build better lives.”

Mazhar’s story highlights the impact of skill development initiatives on entire communities and the role of timely, yet sustainable support. Through his workshop, Mazhar is building a legacy of skill and self-sufficiency, proving that with access to training and resources, anyone can rise above their circumstances and thrive.

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Laali, 25, lives in the remote village of Sohbat Khan Laghari, UC Dolatpur, Tehsil Shujabad, District Mirpurkhas, where life presents daily challenges, especially for someone with a physical disability. Laali has lived with a syndactyly disability since childhood, where the fingers of one hand are fused. This condition significantly impacts her ability to perform daily household chores. She struggles with tasks requiring fine motor skills, such as cooking or using small tools, and finds it challenging to carry or lift items with one hand. Activities that require both hands, like buttoning clothes, tying knots, or lifting heavier objects, are particularly difficult for her, further compromising her ability to manage routine responsibilities.  For years, accessing healthcare was an uphill battle, with the nearest medical facilities located far away. Laali often had to endure long, costly journeys, covering expenses for travel, doctor visits, and medicines, or waiting weeks for even basic medical attention.  

Laali is married and a mother to two young sons, her eldest is four-years-old, and the younger is two and a half. Unfortunately, she cannot afford to send them to school due to financial constraints. Her husband, Ramesh, works as a daily labourer, earning a modest PKR 400-500 (approximately USD 1.5 to 2), while Laali manages their household chores. They care for four rented goats, owned by someone else, in exchange for free milk—a small but vital support for their family.  

The nearest healthcare facility is located approximately 20 kilometres from Laali’s village. She visited it once last year when her elder child fell ill with respiratory illness but found the experience deeply unsatisfactory. Despite being a government hospital, she had to purchase medicines worth around PKR 2,000 (approximately USD 7.3) rupees from outside the facility and spend an additional PKR 1,000 (approximately USD 3.7) on travel expenses. The hospital staff were unresponsive and inattentive, and the treatment provided was ineffective as her child did not recover. That visit was both her first and last to the government hospital.  

Laali has also sought help from a private health clinic, but the cost was significantly higher. The visit, which included transportation, doctor’s fees, medical tests, and medicines, amounted to PKR 3,500 rupees (approximately USD 13). To cover these expenses, Laali had to borrow money from her brother. She observed little to no improvement in her child’s health despite visiting both government and private clinics, leaving her deeply dissatisfied.

On August 15, 2024, Community World Service Asia (CWSA), with support from Catholic Agency for Overseas Development (CAFOD), brought two mobile health units in different villages of Mirpurkhas under a humanitarian and early recovery project, eventually coming to Laali’s village which was a milestone for the community. For the first time, residents had access to a team of dedicated healthcare professionals who set up a temporary clinic offering free check-ups, diagnostic services, and treatment advice. On the first day, a total of 206 people attended the mobile health unit. Among them, 146 patients (49 women, 9 men, and 106 children) received medicines.

When Laali visited the mobile clinic with her family, she was met with warmth and understanding. The staff listened attentively to her concerns, conducted thorough examinations of her children, and provided medication to relieve their cough and flu symptoms. 

As part of the CAFOD project, the mobile health unit continues to conduct daily free camps across flood-affected villages in District Mirpurkhas until 31 January 2025. Between September 2023 and October 2024, the unit provided free consultations to 62,279 individuals (31,875 women, 6,948 men, 11,291 boys, and 12,165 girls) across 412 villages. Additionally, 445 persons with disabilities (PWDs) have been facilitated, ensuring inclusive and accessible healthcare for all.  The Mobile Health Unit ensures priority care for PWDs and pregnant women. They are not required to wait in the general waiting area but are attended to immediately by the doctor. The unit is equipped with wheelchair access for PWD patients, and in cases where commuting proves challenging for them, the doctors personally visit their homes, bringing essential medicines along.

Laali and her family also participated in the Health Awareness Session conducted by a Lady Health Visitor (LHV) and a social mobiliser (woman). The session covered topics such as family planning, malaria, skin diseases, and cold and flu prevention. “The LHV explained the benefits of a small family, and I feel more confident now, understanding that a smaller family means fewer expenses and the ability to afford healthier food,” Laali shared.  

She also learned about the importance of health and hygiene, particularly handwashing before and after meals. Inspired by the session, she began implementing these practices, including washing hands after using the restroom. Laali noticed an improvement in her family’s health as a result of these changes.  

“Dr Misbah (Woman Medical Officer) diagnosed us, and LHV Stella guided us on how to use the prescribed medicines. The service was excellent, and my whole family was satisfied,” Laali said. She expressed her gratitude and requested that the mobile health unit return regularly to their village for follow-up medical camps. She also suggested including nutritional support for children, as her family currently manages only two meals a day, typically consisting of wheat and local vegetables.  

“This service was a blessing,” Laali said, her eyes lighting up with gratitude. “They treated me with kindness and provided care I never thought I could receive so close to home.”  The visit not only offered medical support but also restored Laali’s sense of hope. For the first time, she felt truly seen and supported. The team guided lifestyle changes and follow-up plans to improve her family’s health in the long term.  

Now, Laali actively spreads the word about the mobile health unit, encouraging others in her village to seek the help they need and benefit from the life-changing services.

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In the village of Sagiyon in District Khairpur Mirs, 38-year-old Malka has transformed her life and community. A mother of eight, Malka lives with her husband, Niaz Ali, and relies on farming on their two-acre agricultural land to provide for her family. While her husband earns a daily wage of PKR 400–500 (approximately USD 1.4-1.8) by running a small fruit stall in the village.

Until recently, she struggled with financial burdens, poor yields, and limited resources. But with the support of Community World Service Asia (CWSA) and the Catholic Agency for Overseas Development (CAFOD), Malka’s journey from a struggling farmer to a celebrated “Lead Farmer”[1] is a beacon of empowerment, resilience, and sustainable agriculture.

Before receiving training from CWSA, Malka knew little about the harmful impacts of chemical pesticides and fertilisers on health and the environment. She also found herself stuck in cycles of debt, often needing to borrow money to cover sowing season expenses. In November 2023, with her dedication to improving her family’s life, Malka enrolled in CWSA’s Climate-Smart Agriculture training. She was one of the 20 women farmers participating in this session.

As part of the project, 900 women farmers from flood-affected communities in 40 villages of District Khairpur received agricultural inputs and a cash grant of PKR 15,000 (approx. USD 54) each to support land preparation. Among these, 120 women farmers (two from each village) were selected as lead farmers based on their enthusiasm for learning and willingness to share their knowledge with other farmers in their communities.

Malka learned essential skills through the training like composting and biological pest control methods that would allow her to cultivate healthier crops while preserving the environment. CWSA provided her with agricultural inputs, including two bags of wheat seeds, four bags of Urea fertiliser, two bags of DAP fertiliser, and a bag of CAN fertiliser, each weighing 50 kg. Additionally, she received a cash grant of PKR 15,000 to support her agricultural activities. She learned important techniques in crop selection, soil preparation, and water conservation management. She also gained knowledge in sustainable agricultural practices, integrated pest and disease management, as well as harvest and post-harvest management.

Applying her newfound skills, Malka planted wheat on her two-acre farm and achieved an impressive yield of 80-90 mounds—a substantial increase from the previous year’s 30-40 mounds, which had suffered due to devastating 2022 floods. This was a much-needed financial boost; Malka sold 50% of her wheat yield, earning around PKR 100,000 (approximately USD 360). She paid off previous loans with this income and saved for the upcoming crop season. She stored a portion of the harvest for her family’s consumption and set aside seeds for future planting, creating a sustainable cycle for her family’s food security.

“Before, we struggled to feed our family. The wheat seeds and training from CWSA have changed everything. Now, I’m not just a farmer—I’m a lead farmer, showing others what is possible,” Malka shares with pride.

Apart from this, Malka diversified her farm by starting a kitchen garden with seven vegetable varieties provided by CWSA in September 2024, including cauliflower, turnips, and spinach. The kitchen garden brought a steady supply of fresh vegetables, enhancing her family’s nutrition and reducing her daily vegetable expenses of PKR 250-300 (approx. 0.90-1 USD). This initiative became a model for other women in her community, encouraging them to grow their food and reducing dependency on market-bought produce.

Malka’s dedication didn’t stop with her success. As a “Lead Farmer,” she has taken on the role of a mentor, teaching other women in her village sustainable farming practices. She has trained seven other women farmers till now, imparting essential knowledge on water conservation, soil management, crop rotation, and organic farming. After adopting these eco-friendly practices, Malka’s mentees are also seeing improvements in crop yields, food security, and health. “When other women see what I’ve accomplished, they ask me how to do the same. I tell them that with the right knowledge and support, we can thrive together. Teaching others has been one of my greatest joys,” she says.

Malka’s success as a Lead Farmer has inspired over 45 farmers in her village to adopt sustainable farming practices and start kitchen gardens. Malka has strengthened her community’s resilience against food scarcity and financial instability by spreading knowledge and promoting sustainable agriculture. Her leadership has enhanced the role of women in agrarian communities by showcasing innovative farming techniques that have led to improved yields, inspiring others to adopt these practices. Malka’s journey exemplifies how women can leverage their skills and knowledge to drive agricultural development and make a lasting difference in their communities.

However, this path had its challenges due to limited access to land, agricultural resources, and financial services. But through persistence and support from CWSA, Malka tackled these challenges and paved the way for other women to take up leadership roles in agriculture.

Malka’s journey from a farmer with limited knowledge to a lead farmer and community mentor showcases the transformative power of education and support. Her story reflects the profound impact sustainable farming practices and community collaboration can have in building a stronger and more resilient future. 

The farmer hopes to continue expanding sustainable farming and helping other women gain the skills and confidence to succeed. Malka’s dream is to build a resilient community where families thrive, free from the economic challenges they once faced. “My vision for the future of our village is to see every farmer—especially women—adopting sustainable farming practices that protect our land, increase our yields, and ensure food security for generations to come. Together, we can improve our economic conditions and create opportunities for our children to live better lives,” she reiterated. 

[1] A lead farmer is a trained and experienced community representative who participates in Training of Trainers (TOT). After completing their training, they serve as role models, mentors, and extension agents, sharing knowledge with other farmers in their villages. They promote sustainable agricultural practices, improve crop yields, and work to enhance livelihoods within their communities.

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Quality and Accountability in humanitarian work are essential to ensure that aid effectively supports and empowers the communities it is intended to help. Community World Service Asia (CWSA) provides technical support and guidance to local humanitarian agencies in Pakistan, Afghanistan, and across the Asia-Pacific region to enhance quality and accountability by applying the Sphere Minimum Standards.

In partnership with Concern Worldwide, CWSA conducted a three-day workshop from 21 to 23 February 2024, in Umerkot, Sindh, titled “Integrating Sphere Technical Standards in Project Cycle Management”. Eighteen participants enrolled in the workshop, including 12 men and six women. The training focused on enhancing participants’ understanding and skills in applying the Sphere Minimum Standards throughout different Project Cycle Management (PCM) stages. It aimed to explain the philosophy and approach of Sphere and guide participants in navigating the Sphere handbook to help them integrate the standards into the humanitarian project cycle more effectively.

Local and national humanitarian practitioners were equipped with the technical, management, and programmatic skills required to enhance the quality of their internal operations and improve their effectiveness in disaster preparedness and response through the three days. Participants gained a thorough understanding of Sphere’s core principles and learned how to apply the standards across key themes such as water and sanitation, health, shelter, and nutrition. They also worked towards developing skills in needs assessment, response planning, and program implementation following Sphere guidelines.

“As humanitarian workers and development practitioners, we are all familiar with the various stages of project management. However, this training was especially valuable for understanding the practical application of Sphere standards during the project design and implementation stages,” said Harris Najeeb[1], Manager of Networking and Partnerships at ARTS Foundation, who participated in the training.

ARTS Foundation is a non-profit, indigenous civil society organisation based in Sindh. It focuses on capacity development, action research, policy advocacy, and humanitarian response. The foundation’s current projects are centered on flood recovery and response, particularly on Water, Sanitation, and Hygiene (WASH).

“The Sphere technical standards of WASH & Hygiene, have been particularly informative for me. After the training, I conducted a session on WASH technical standards, for my team of community mobilisers & hygiene promoters. We are now referring to the Water Supply Standard 2.1 (Access and Water Quantity), Excreta Management Standard 3.2 (Access to and use of toilets) and Hygiene Promotion Standard 1.2 (Identification, access to and use of hygiene items). Our teams are using these indicators while designing toilets for communities.”

Harris has also helped his team update the organisation’s Safe Programming Matrix document, incorporating protection principles, gender sensitivity, operational context, and environmental impact, all in line with Sphere guidelines.

Although ARTS Foundation has not yet initiated the Sphere or Core Humanitarian Standards (CHS) accreditation process, they are keen to build their staff’s capacity on Sphere standards and integrate the Sphere approach into their grassroots community work.

Furthermore, participants acquired an understanding of accountability mechanisms, such as feedback and complaint systems, to promote transparency and community involvement. They also learned strategies to enhance coordination and collaboration with other humanitarian actors, thereby improving the overall effectiveness of emergency response efforts.

CWSA remains committed to supporting local NGOs and civil society in strengthening their knowledge and capacity on Sphere, to enhance the overall effectiveness of humanitarian and development responses.

[1] Interviewee: Engineer Haris Najeeb, Advocacy, Research, Training and Services (ARTS) Foundation, Sindh, artsf.haris@gmail,com, (03343317352)

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Life has taken a harsh turn for Lachhman, a 26-year-old father of two in a small village in Union Council Faqeer Abdullah of District Umerkot, Sindh. His family of five—two young daughters aged eight and seven, his wife, and his mother—depend entirely on agriculture as their primary source of income. On their five acres of rain-fed land, they once grew crops such as cluster beans, moth beans, and millet, which thrived in good rainfall seasons. This brought a yearly income of around PKR 70,000 to 80,000 (approximately 288 USD).

However, for the past five years, irregular and increasingly unreliable rainfall has made this a once-stable source of income precarious. The crop yield from their land has fallen by 50%, and rising inflation has made survival incredibly difficult for the family. Their total household expenditure, almost PKR 10,000 to 12,000 (approximately 44 USD), has become nearly impossible to meet for the couple. As a result,  the children cannot attend school—not just due to financial constraints but also because there is no school available in their village.

Recognising the challenges faced by agricultural communities like Lachhman’s, Community World Service Asia (CWSA) initiated a humanitarian project titled “Strengthening the Livelihoods and Resilience of Vulnerable Agricultural Communities in Rural Sindh, Pakistan”, supported by Diakonie Katastrophenhilfe (DKH). This initiative is specifically designed to support families whose livelihoods depend heavily on agriculture and have been severely impacted by unpredictable weather patterns and climate change impact, in terms of a significant drop in their income. The project aims to enable these families to adapt and survive in these challenging and evolving conditions.

Lachhman’s family was selected to receive assistance under this project, as their livelihood was 75% reliant on agriculture, and their income had drastically decreased due to poor crop yields. Lachhman received Multipurpose Cash Assistance (MPCA), distributed through mobile cash transfers (Telenor mobile wallet accounts). On October 8, 2024, he received his first installment of PKR 17,000 (approximately 62 USD). A total of five installments of the same amount will be provided, totaling PKR 85,000 (approximately 306 USD), during the project.

This first installment was a lifeline for Lachhman and his family. With the money, he bought new clothes for his children and met other essential needs, such as groceries. The timing of this assistance was important, as his crops were not yet ready for harvesting[1], and the family had no other source of income. Without this support, Lachhman might have had to borrow money, causing further financial difficulties.

For the future, Lachhman is already planning to invest the next installment in a small tuck shop. He requires PKR 15,000 to 20,000 (approx. USD 54 to 72) to fulfill this dream. He hopes this new business will provide his family with a steady daily income of PKR 200 to 300 (approx. USD 1 to 2), while also benefiting other villages, as there is currently only one shop in the area. In the meantime, Lachhman has also started cultivating his land again, planting cluster beans on two acres, moth beans on one acre, and millet on the remaining two acres. He managed to buy the seeds even before he received the financial assistance.

“I am very thankful to the whole team at CWSA for this immense support. If I had to borrow from someone, it would have caused a lot of difficulties going forward,” Lachhman said gratefully.

The selection of participating families in the project began in late August 2024, and CWSA had started providing much-needed financial assistance to those most in need by October. Through these efforts, families can survive the economic hardships brought on by climate change and maintain their livelihoods in the face of unpredictable weather conditions.

This initiative not only addresses immediate financial needs but also helps these vulnerable communities build resilience for the future. It helps reduce their suffering and survive challenging times with dignity. With support like this, families like Lachhman’s have hope for a more stable and prosperous future, despite the continuing challenges they face due to climate change and subsequent economic hardships.

[1] August is typically the harvest time for cluster beans and millet, but these had been severely affected

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Thirty-five-year-old Hasina, from the village of Khuda Bakhsh Dasti in Khairpur, suffered from severe lower abdominal pain, backaches, a burning sensation in her urinary tract, and vaginal itching. Her husband had spent a substantial amount of money taking her to clinics in Hyderabad and Larkana. Despite paying what were described as nominal fees to doctors and purchasing expensive medications from the clinics’ pharmacies, nothing seemed to work, even after multiple visits.

In late February 2024, Community World Service Asia (CWSA) and the Disasters Emergency Committee (DEC) launched their first medical health camp in their village. Dr Tayyaba Iqbal recalls how about two hundred villagers swarmed their vehicle. Although the team had enough time to treat only around 50 patients on the day, Dr Tayyaba and her assistant, Lady Health Visitor Mumtaz Kahlon, managed to attend to 95 people. Many unwell or healthy villagers came out of curiosity to witness the new “hospital in a van”.

Among the patients was Hasina, who had nearly lost faith in doctors. The camp’s doctors guided her to take a urine test that revealed a urinary tract infection (UTI), while an ultrasound ruled out the presence of kidney stones. Hasina was sent home with the appropriate antibiotics, finally on the path to recovery.

Twenty-one days later, Hasina returned to the second health camp in the village to report that the medication had worked perfectly and she was feeling well. However, during her third visit during Ramadan, she complained that she experienced burning again due to fasting regularly.

Dr Tayyaba prescribed oral rehydration salts (ORS) and advised Hasina to drink plenty of water. She also explained that maintaining her health by staying hydrated was important and that missing fasts due to illness was permissible.

Dr Tayyaba noted that the most common ailments in the village were scabies, malaria, asthma, and respiratory tract infections, with the prevalence of scabies and malaria attributed to stagnant water left behind by 2023’s floods. In addition to these recurring diseases, she observed that most patients were anaemic, likely due to iodine deficiency in their diet.

After holding just three medical camps, each lasting a single day with three weeks between them, the number of out-patients had dropped to fewer than 50 per day. This reduction indicated that villagers were more confident accessing regular medical care. More importantly, the effectiveness of the treatment provided by the mobile facility stood in stark contrast to the high-cost private clinics they had previously relied on.

Rukhsar is another woman from the same village, with a similarly challenging story. When the CWSA health camp first visited the village in late February 2024, she struggled to reach the facility, walking with great difficulty while carrying her daughter, who was too young to be left unsupervised. Although Rukhsar said her daughter was eighteen months old, the child appeared no older than six months and was so weak that she couldn’t even sit up on her own.

By late March, Rukhsar was full-term pregnant with her third child and was experiencing severe bleeding. The doctor diagnosed her with vaginal bleeding, leukorrhea, anaemia, malnutrition, and lower abdominal pain. This had been ongoing for over a month, during which her husband, Ghaffar, had sacrificed two days’ wages to take her by motorcycle to a private health facility in Khairpur, a two-and-a-half-hour journey. The doctor charged the couple PKR 1,000 (Approx 3.6 USD) for an ultrasound, PKR 1,000 (Approx 3.6 USD) for her consultation fee, and PKR 1,500 (Approx 5.4 USD) for medication from the clinic’s pharmacy. Additionally, the motorcycle fuel for the journey cost PKR 600 (Approx 2.2 USD).

Strangely, the medication Rukhsar received was prescribed for only three days, and when the dosage ended, she felt no better than before. The couple then tried the government health unit in nearby Thari Mirwah, where she was given medication for five days. Yet again, it had no effect.

The night before this interview, Rukhsar’s discomfort worsened, prompting her and Ghaffar to visit the Thari health unit. Upon arrival, she was kept waiting for over an hour while the doctor tried to determine if her abdominal pain was due to labour. After the wait, they sent her home, informing her that the baby was not yet due.

Having modest means, both Rukhsar and Ghaffar were deeply concerned. If the delivery required a caesarean, despite her first two children being born naturally, they didn’t know how they would arrange such a large sum of money at short notice. Seeking clarity, they returned to Thari the next morning. Rukhsar was given a blood test, which cost PKR 800 (Approx 8.9 USD), only to be told that her haemoglobin level was dangerously low at just nine and that she needed urgent treatment. Speaking in a barely audible voice, Rukhsar expressed her frustration that neither private nor government doctors had ever explained her condition or answered her questions.

When she first visited the CWSA health camp in February 2024, Rukhsar informed the doctor that, despite being eight months pregnant, she felt very weak foetal movements. After a thorough examination, she was given a prescription that stopped both her vaginal bleeding and leukorrhea, and she was also provided with dietary supplements. Upon her return in late March, she reported that all her symptoms had been resolved. A follow-up blood test confirmed that her haemoglobin levels had improved.

As they were preparing to leave, Ghaffar disclosed that their sickly daughter, who looks much younger than her age, had been diagnosed with a heart condition. He did not know the specifics, only that she had “holes in her heart”. A doctor from Thari had advised him to seek help from a primary health care unit in Sukkur, but that visit yielded no results. Ghaffar wonders whether the CWSA health camp can help his daughter, but fears that her condition might be beyond the scope of the facility. 

Although Ghaffar still doesn’t fully understand his daughter’s illness, he feels relieved and optimistic now that his wife, Rukhsar, is doing much better. The improvement in her health has eased his worries. 

As for Hasina, the proper medication and thorough check-up helped her fully recover from her infections and she can once again support her husband in the fields. 

Both families are living examples of how timely, effective medical care can transform lives in communities deprived of such services.

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Pakistan—the fifth most populated country in the world—is extremely vulnerable to climate change and food insecurity. The Global Climate Risk Index ranks Pakistan as one of the most climate-affected countries in the world. With an economy heavily reliant on agriculture (almost 20% of GDP), even minor climactic incidences can have dramatic effects on food security.

To help build seeds of resilience in marginalised communities, CWSA implemented a humanitarian assistance, early recovery, and development (HERD) project, with the support of PWS&D, in highly food-insecure Sindh province.

The project, which supported 23,319 people, provided emergency food assistance during the first stage of intervention. Further stages provided families with seeds and training on climate-smart agriculture. Additionally, 300 women artisans received training to expand their livelihood opportunities.

Watch the Seeds of Resilience video, which documents the changes in the community, and then engage in discussion and dialogue using the provided discussion questions.

**This project received financial support from the Government of Canada through the Canadian Foodgrains Bank.

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Nestled between the irrigation provided by the Nara branch of the Indus on one side and the grey-white sand dunes on the other, Behram Mallah is a village of boatmen from an ancient time when the Nara was the most convenient mode of transport. Their sailboats with their high sabot-shaped prows, once cleaved the waters from its southernmost navigable point to Rohri, where it takes off from the mighty Indus. They transported food, agricultural produce and fruit to the many river ports whose remnants still dot the meandering route of the Nara.

However, as time passed, roads were built and buses began to replace the camels that once plodded along leisurely. The mariners of old were forced to adapt. About eight years ago, Mushtaq’s great-grandfather abandoned his boat to become a small-time farmer. By the time Mushtaq grew up, the small plot of land belonging to senior Mallah had been divided repeatedly and even sold off in parcels to enable his father to educate his three sons up to high school and run a tube well boring and installation service. Today, Mushtaq’s father is landless, except for the house where he lives with his sons.

In 2020, Mushtaq married Nafisa while he worked as a daily wage construction labourer. He did not confine his wife to housework but instead sent her to the nearby middle school, where she studied in grade nine. The couple knew that becoming wealthy was a distant dream, but they aspired to start a family that could one day improve their circumstances.

Three years passed and young Nafisa was still unable to conceive. They knew of a well-known gynaecologist in Khairpur, but getting there by local bus required a six-hour journey, followed by an overnight stay due to the long queue of patients at the clinic. Alternatively, they could hire a taxi for PKR 12,000 (approx. USD 43) for a round trip and return home the same evening after seeing the doctor. The couple opted for this option.

Nafisa shyly recounts her experience. “The doctor’s fee was PKR 800 (approx. USD 2.8) and she prescribed medication that was only available at her clinic’s pharmacy. This cost us PKR 8000 (approx. USD 29). We were told to return after a month.” Although the doctor’s consultation fees were modest the medication cost was substantial.

Mushtaq explains that they did not have ready cash and borrowed money from his father, brothers and uncles to cover these costs. Over nearly a year, the couple made around ten trips each costing them about PKR 22,000 (approx. USD 79). Each time they returned with a bag full of medication costing PKR 8000 (approx. USD 27), all on borrowed money.

Despite the doctor’s assurance, Nafisa did not conceive. The couple was also advised to undergo expensive tests at the doctor’s in-house laboratory.

Mushtaq then heard about a container stationed at the abandoned health centre in Choondko, staffed by a Lady Health Visitor (LHV) Rabia, who was on call 24 hours a day. In March 2023, the couple, unfamiliar with the Disasters Emergency Committee (DEC) and Community World Service Asia (CWSA) and their work, visited the centre. They were advised to return the next day for a consultation with Dr Sabeen. Choondko, just 12 kilometres from their home, was more accessible and affordable than the ardous trip to Khairpur.

Nafisa is unsure about the exact methods employed by Dr Sabeen and Rabia, but after the second visit, and with no medication expense and free ultrasound, she became pregnant. By March 2024, little Ramesha was two months old, bringing immense joy and hope to her parents. Mushtaq recounts that there was only so much his family could lend him, so he had to borrow PKR 80,000 (approx. USD 287) on interest to cover the cost of the trip to Khairpur. Although he has repaid PKR 110,000 (approx. 394), he still owes PKR 30,000 (approx. USD 107).

The final twist in Nafisa and Mushtaq’s story came when, at full-term, the expectant mother was told during her visit to the centre that she needed specialised care due to complications expected during delivery. The Choondko centre recommended a clinic in Sukkur, but the couple opted for the “well-known” doctor in Khairpur, paying an additional PKR 40,000 (approx. USD 143) for the delivery.

As the reputation of the doctors at Choondko and Nara Gate spread, the patient traffic to the “well-known” doctor’s clinic decreased. Even after having her delivery performed by the famous doctor, Nafisa has continued to visit Choondko for check-ups with Dr Sabeen.

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In village Rohiraro, Umerkot, Mauta is a remarkable and outspoken woman. Originally from a village near Chhachro, she was married into Rohiraro, where she and her husband raised six sons. Though she did not receive formal education herself, Mauta was determined to ensure her sons received an education. She sent them through government primary, middle schools and high school, all the way to the twelfth grade. She laughingly admits she thought this was the highest level of education because she had no idea about university degrees. When her eldest completed what she believed was the “ultimate” level of schooling and returned to the village, Mauta set him to work looking after their livestock. With nearly 30 goats, Mauta considered herself well-off and believed her educated son was gainfully employed helping with the animals.

In 2020 when Community World Service Asia (CWSA) began its interventions1 in Rohiraro, Mauta became a very active member of the Village Management Committee set up to ensure community ownership and engagement in the project. She gained a new perspective through her involvement, including the benefits of family planning, which she enthusiastically promoted within the community through door-to-door campaigns, even accompanying women to nearby government facilities to help them plan childbirth.

“It was for the first time I learned that twelve grades of education is no education at all. That there are universities which provide even higher learning,” she says. Determined to send her eldest son to university, she faced opposition from her husband. He is an unskilled labourer with no formal education. He believed that they could not afford the expense of sending their sons to expensive educational institutions. Mauta disagreed, insisting that their livestock could be used to fund her sons’ education. “What is the point of having a large livestock if it could not send our sons to college?” she remarked. She sold some goats to raise PKR 40,000 (approx. USD 144) for her son’s admission to Sindh University in Hyderabad. A year later, she sold more animals to cover his annual fees.

She also enrolled her second son in Sindh University and her third in Allama Iqbal Open University in Umerkot. The younger two are in the intermediate programme post-matriculation and also aspire to attend university. Mauta may not understand what her sons are studying, but she takes pride in the fact that they can speak English and have even taught her to write her name in Sindhi.

“My youngest son is in grade nine and also keen to go to university. He wants me to pay for a private tutor to help him in his studies so that he can make the grade for university,” she says. She shared that traditionally boys in Rohiraro dropped out after matriculation, but Mauta’s decision to send her sons to university has inspired other families to prioritise their sons’ education. According to her, at least 20 other boys from the village are now attending colleges in Umerkot.

“Since my boys started university, everyone began to look at me with awe and reverence,” says Mauta. Although she has no daughter, she insists she would not have held a girl back from education even if it meant selling her livestock. This is very brave of her given she is from a remote village in the Umerkot desert.

To keep her sons in university, Mauta has taken up sewing, using her skills to meet the day-to-day household expenses. In addition to minding her livestock, she sews women’s dresses on order.

What motivated her to take such a bold step after the first few VMC meetings? Mauta credits the visiting social mobilisers whose eloquence impressed her. She wanted her sons to be like them.

When asked about her proudest moment since her sons began higher education, Mauta does not hesitate. She says it was not about her sons but her own growth. At the recent International Education Day celebrations, organised by CWSA and Act for Peace (AFP), in her village, Mauta delivered a speech advocating for education in front of a crowd. The pride she felt came not from the attentive audience but from the applause that followed.

This was the first time she had ever given a speech, and Mauta believes that while her sons’ education has progressed, so has her personal development.

  1. Under the Health-Education Project supported by Act for Peace ↩︎
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