photo of Zeba Mohammed Rasmussen '76 and son Yousef

'Whom Will You Serve?'

Greetings, or as we would say in Pakistan, As-salamo-alaikum! This is a greeting used throughout the Muslim world which means, peace be upon you. ...

Graduates, here you are, at the threshold of a new stage of life. You have accomplished a great deal, have worked hard to reach this point, and have much to be proud of, as do your families. You have completed one phase of your education, which is, of course, a lifelong process. A distinguished educator, John Taylor Gatto, once said:

“Whatever an education is, it should make you a unique individual, not a conformist; it should furnish you with an original spirit with which to tackle the big challenges; it should allow you to find values which will be your road map through life; it should make you spiritually rich, a person who loves whatever you are doing, wherever you are, whomever you are with; it should teach you what is important; how to live and how to die.”

Ambitious words, but not too ambitious, I think. Many questions are raised by them. How are you unique? Which challenges will you take on in life? What really is important? How should we live, facing the certainty of death? We who are here under this tent have many choices, options, in life. This is our wealth.

Let me describe how I have tried to fulfill the spirit of Gatto’s words.

For more than 10 years, my husband and I have lived half way around the globe in the Northern Areas of Pakistan. Our home is in Gilgit, a town in the spectacular Karakorum Mountains, which include K2, the second highest mountain in the world. Nearby is the Karakorum Highway, a winding road connecting Pakistan with western China, part of Marco Polo’s ancient Silk Route. It is a vertical desert, with cold winters and hot summers. People are poor; subsistence agriculture was the mode of survival for centuries. Until the highway was built 20 years ago, there was hunger and starvation each year when the stores from the previous harvest were exhausted. But change is coming, and rapidly so. Children who never had the chance to be educated are now going to school. In a society where the education of girls was not considered as important as that of boys, girls’ schools are being opened everywhere.

Villagers who eked out a living on small plots of land are now forming village organizations. They work together to build roads and irrigation channels, upgrade agriculture and farming, in order to improve their status. These organizations have managed to collect almost 10 million dollars of savings. Death rates, which were amongst the highest in the world, have dropped dramatically in areas where primary health care services have been made available through illiterate or partially literate community health workers. It used to be that one out of every five babies died before her first birthday, now it is less than 1 in 20; this is still more than double the U.S. rate, however. One old villager said, I know there have been changes, because we have far fewer small graves in our graveyard. It has been most interesting to be witness to such dramatic social change.

Now what is a Bryn Mawr graduate doing in this remote part of the world? And why do Bryn Mawr and, occasionally, Haverford students, come to visit and work there every few years, funded by the Solter fellowship? Let me tell you how we ended up there. Along the way, I’ll touch on lessons learned in high school, at Bryn Mawr, in medical training and, more recently, with marriage and a child.

I spent my first five years in Karachi, Pakistan, one of the world’s megacities with a population of greater than 10 million. After 10 years in Washington D.C., my parents said we were going back to Pakistan. I objected, saying that it would interfere with my being vice-president of the French club at my local high school, not to mention disrupting my baby-sitting practice. My parents wisely did not pay too much attention to these objections. Having grown up in comfortable upper-middle class northwest Washington, the contrasts in Karachi between the rich and poor were striking. The rich had large houses, fancy clothes and cars, telephones, access to good education and health care, and opportunities to travel. They seemed to think they were entitled to their privileges. In contrast, the poor had very little, but seemed more grateful for what they did have. During a war between Pakistan and India in 1971, many refugees fled to Karachi. They lived in makeshift homes of tin and tents. They had no regular water, or medical care. There was much leprosy among the refugees, along with diarrhea, hepatitis, and other infectious diseases. When my high school delivered clothes and toys to the camps, I remember my shock and horror at how some people had to live. It seemed unlivable. These were the days before the Vietnam war was over; the media was full of images of refugees there as well. I came to the conclusion that the needs of those in the world who were poor were so overwhelming, that even if all of us who were privileged made an effort to help them, that it still would not be enough. From this point of view, it made sense to plan to go into medicine, as a means to encourage social change. After all, if all these refugees were sick, they could do nothing to improve their situation. If they were healthy, at least they could do something for themselves. It was a simplistic notion, but it set me on the path of pursuing medical education, with a plan to return to Pakistan.

photo of Zeba and Nancy Vickers

A friend of my parents in Islamabad turned out to be a Bryn Mawr graduate. Wendy Acker Weiss ’64 has no idea how she influenced my life! She supplied the appropriate catalogs, I applied early decision to Bryn Mawr, and was accepted. Wendy was busy taking care of her young children while her husband worked in Pakistan. My father, after reading all the literature about Bryn Mawr, asked, how could one spend all one’s time taking care of children after such an education? I’ll come back to this theme later. Is it a waste of one’s Bryn Mawr education to spend all one’s time raising children? I do not think so. I am myself contemplating stopping work, at least for pay, to do the same! My husband and I have a very active 3-year-old adopted son and are hoping to get him a sibling.

Five Bryn Mawr lessons

Now about the years at Bryn Mawr, I enjoyed them, although of course I felt we all worked too hard! I’ll mention five things I remember most: learning to relax, the honor system, being affirmed as valuable, learning to write, and the focus on quality.

photo of Pakistan's Northern Areas First, we had required sessions on relaxation. We had to lie down on mats in the gym, deliberately relaxing each of our muscles, trying to eliminate all tension from our bodies, to be still and to rest. I have used this technique over the years with good effect. Stress is ubiquitous in our world, the demands on time and energy unending. We need to find ways to rest and relax, to strengthen ourselves for the work which really is important.

Secondly, the honor system is an aspect of life at Bryn Mawr which has stayed with me. I live in a society now where cheating is common. In some universities, examiners are afraid to proctor exams, because their lives are at risk if they confront someone cheating. Indeed, professors have been shot for holding students to account. When I tell people about the honor system at Bryn Mawr, they are amazed that such a system can exist. What is it based upon? The premise that we are honorable, trustworthy people, both individually and as a community.

I think this sense of value was the most important contribution Bryn Mawr College gave to me and my friends. The strong message was that we were valuable and capable women. Whether we chose to pursue science or literature, music or anthropology, we were able to do exceedingly well. Our teachers stretched us, as did our colleagues; we stretched ourselves to our limits. Our expectations of ourselves were high. In a society where depression is not uncommon, this sense of value is key. The estimates are that by the year 2020, depression will be the most common cause of years of productive life lost worldwide due to disability or death. Isn’t it important that we foster, in every way we can, this sense of being valuable, in ourselves and in those around us? Equally important is that we learn to keep our expectations realistic.

At Bryn Mawr we learned to write—this a precious gift. I always regretted missing freshman year English because of having placed out. The opportunity to have one’s work carefully and constructively critiqued is invaluable. I find that much of what I do now, in helping others write research proposals, collect data, analyze and write it up, is just that—to give careful and hopefully, constructive, critique. A general in the Pakistan Army, one of my collaborators in a research project on diarrhoeal disease, once said to me, when I asked him if he had written up his previous work: “Young lady, where wouldn’t I be now if I could write like you!” So keep your writing skills—you will use them well.

Another lesson learned at Bryn Mawr and useful today was: be concerned with quality. Dr. Ernst Berliner, in those seemingly endless organic chemistry labs, would tell us that it was more important to make one gram of a pure compound than hundreds of an impure one, and then smile, saying that it was all in the wrist! I have used that analogy so many times, as I try to encourage those around me to be careful, meticulous, thorough in what they do. Recently we set up a Montessori school in Gilgit, the town’s first such educational institution for children aged 2 to 5 years. People were interested, but mainly because they knew that it would be an institution of quality, observing national and international standards.

From Bryn Mawr, I went on to Harvard Medical School and the Johns Hopkins School of Hygiene and Public Health. Of course the decision about where to go for medical school, and later residency in internal medicine, seemed agonizing at the time. Now I see that it was not worth the fretting. It was not exactly a “potato chip decision,” the sort of decision one makes going down the potato chip aisle at the grocery store about whether to get ruffled or plain, or sour cream chips, but essentially it did not make a lot of difference whether one went to San Francisco, Boston or stayed in Philadelphia. You women and men have many good options to choose between. Be glad you have them and do not worry about it too much.

Redefining ‘success’

There are, however, difficult choices to be made in life. Which challenges to take on? Whether to marry, when and who? When to try to have a family, if at all? Whether to stay home to raise one’s children, or, if not, to whom to entrust them for raising? Whether to try to be a “superwoman” or “supermom”? Can it be done? And at what cost?

We live in a society where women have fought hard to be considered “equal” to men, to have the same opportunities for work at the same pay. Much progress has been made, more remains to be done. And yet I wonder if we have not bought too much into the definition of success as established by men. Working long hours, not feeling satisfied with ourselves if we choose to stay at home to raise children, feeling divided when we work part time, as if we are not really doing anything right. We delay our child-bearing to pursue careers, then we have difficulty conceiving since our bodies are biologically best at having children when we are younger. We invest heavily into infertility treatment; once we have children we often rush back into work. We want it all. But we cannot have it all. We must choose.

Your generation must take on this issue of redefining “success” for women: how to keep opportunities to work, and yet how to create space to have time to enjoy and properly raise children, children who are not hurried and harried, who have a sense of value and who will build the next generations.

I was fortunate to meet my husband when we were both students at Johns Hopkins. He is an American who had grown up in Pakistan, the converse to myself, a Pakistani who grew up in America. We joke that between us we make one Pakistani and one American, but it’s hard to know where the lines are drawn. His Urdu is better than mine; certainly his accent less American. We share the goal of working to build capacity in underserved populations, and to work in Pakistan. It took a while to get the courage to marry someone from such a different background, and we married at the age of 31, seven years after we met. We had both been working at the Aga Khan University and Hospital, a new institution in Karachi.

My husband was then asked to run a primary health care program in the north of the country, based in Gilgit, while I had already planned to do further training in infectious disease at Harvard and the Centers for Disease Control. This resulted in our spending our first year of marriage apart, a high price to pay, but worth the investment. It gave me the chance to later contribute in the field of infectious disease, which includes AIDS, tuberculosis, pneumonia and related problems. Why infectious disease? Around the world, the greatest burden of disease leading to death is primarily from infectious and parasitic conditions. This is mostly in the developing world. It is amazing to contrast where needs are worldwide and where resources are invested. For example, most of the burden of premature mortality, an estimated 93 percent of potential years of life lost, occurs in the developing world. However, health problems in developing countries receive only 5 percent of total research expenditures available, while 95 percent go towards health problems of developed countries.

Why should there be such differences? How will the problems in developing countries be solved? Although all countries have problems, the magnitude of those in developing countries is much greater and the resources much less. You live in a powerful country, which can influence where resources are placed worldwide. Some of you may one day be in policy making positions. Will you know enough about the needs of those with little, and care enough, to change the way resources are allocated? May I suggest that you will, if you spend some time living with, and thinking about the problems of those who have less than you do.

Over the last nine years, we have had six students or graduates from Bryn Mawr and Haverford come to the Northern Areas to work for periods from two to eight months, most with funding from the Solter fellowship. Ariadne Solter was killed in a bike accident while a student at Bryn Mawr. She had wanted to work overseas in medicine or public health. Her family turned this tragedy into an opportunity for learning and good through the creation of the scholarship. The students who have come have worked in the health field. Projects have included immunization status of children, causes of maternal mortality, and improving the use of medicines in illiterate populations. Each of them has come away with a new sense of the breadth of the world and its microenvironments. Each has made friends, seeing the commonality between themselves and others in another place. There is a subtle shift of attitude, I believe, from thinking of people elsewhere as “those people far away” to thinking of them as persons like oneself. Each has come away with a tremendous sense of appreciation of the privileges that they have grown up with here, a new perspective about life and where they fit into the world. Particularly encouraging to me, several have had a desire to make a difference for underserved populations, not necessarily overseas, but even close to home.

And so I would like to challenge you too, to take some time to see another part of the world, even if it is just a few weeks or months. It may be inner city Philadelphia, where I understand groups of Bryn Mawr women have worked with the American Friends’ Service Committee, or a far away place like Gilgit. You do not need to go far to find people in need, who have less than you do. You will come away thankful. It will put your own problems and issues in a new perspective. You will develop greater sensitivity to and compassion for the poor. You may never want to go away from the comforts of home again, but the experience is bound to stretch and teach you. Try it.

I spent my first seven years in Gilgit building up a community based health program, training village women on the recognition and management of diarrhea and pneumonia, the main causes of death in our children. Actually, pneumonia is the main cause of death worldwide. Did you know that the number of children who die of pneumonia daily is the same as if a jumbo jet full of children crashed every 45 minutes? Just imagine the amount of investigation which would go into such a crash, and yet the worldwide attention on pneumonia is remarkably little. The women in our community became very good at educating mothers in their village and our death rate plummeted. One of these women became very special to me; I’d like to tell you about her.

The story of Iqbal Bano

Iqbal Bano is a lovely round-faced, red haired woman in her late 20s. She, like most of her colleagues, had finished 10th grade, the highest level of education in her village, was married about age 16, and had several children quickly. When I met her, she was pregnant with her third, and delivered a beautiful red-haired freckled daughter. Every week she faithfully visited the young children for whom she was responsible in her village. She weighed them monthly, keeping track of their growth on special growth cards. She tied the cards of those who were healthy with blue string, those who she was concerned about with red string, and those in between with blue and red, so all problem children could be identified easily. This was her innovation.

A few years later she had another daughter; when this baby was one and a half years old, she brought her one day saying that she had a fever and something wrong with her arm; she was not moving it quite right. We checked the baby, thought the child had pneumonia as she was breathing fast, and referred her to the district hospital. There the pediatrician did an X-ray but still could not find anything in the arm, and treated the baby for pneumonia. Sure enough, a few days later, the arm swelled up and showed signs of osteomyelitis, an infection deep in the bone. This requires treatment for a long time, usually six weeks. The baby spent the first days in the hospital, which was not a clean or friendly place. Iqbal Bano and her husband decided to take her home to give her the six hourly injections required themselves. Soon this became too difficult, and after another stay at the Gilgit Hospital, they eventually ended up 1200 miles south at the Aga Khan University Hospital where the child received optimal care. Sadly, however, just a few days before the treatment was to be completed, one night the little girl be-came acutely ill, developing a more serious hospital-acquired infection, and died within hours. We were all devastated.

It took a while to recover. Iqbal Bano had been pregnant when her daughter died. It was a difficult pregnancy, and she needed to spend two months in bed, eventually delivering a tiny premature boy weighing less than four pounds. There are no intensive care units for babies in Gilgit. She nursed him every hour, and he became a healthy boy of normal weight. Unfortunately, premature babies have a higher risk of getting pneumonia, and when a viral epidemic came to the village when he was 8 months, he developed severe pneumonia and died of it, despite our best efforts. She grieved his death, too, and after the mourning period was over, returned to work as a community health worker.

The next year my husband and I received, through a miracle, a newborn son whom we adopted at the age of 3 days. Some weeks later, all the community health workers came to my home to celebrate his arrival. Finally, in my late 30s, I had joined them in becoming a mother. That night someone knocked at the door. It was Iqbal Bano’s husband, saying she was out in the car with the body of the beautiful daughter born when I’d first met her, six years before. The child had climbed a tree, as do all children in the villages, to get some mulberries. She had jumped off a low limb, ordinarily not too risky, but had fallen badly and had died instantly. Iqbal Bano would not believe it even though the surgeon at the hospital had pronounced her; would I please examine the child? I had that beautiful child’s body brought into our house and examined her carefully. There was no question that she was dead, and then I confirmed what the doctor had said to her mother and the family. I think it is the hardest thing I have ever done as a doctor.

The grieving period was longer this time. Three major losses in three years. And then—where did she get the strength? She says from God, and from her loving family—she slowly returned to her daily activities as well as her job as a health worker. When the supervisor of the Pakistan Prime Minister’s Program for Lady Health Workers came to visit, they found her, working faithfully in her village, with data she had collected and analyzed; she knew the needs of the people around her and helped them as she could. They were amazed and delighted, encouraged at such faithfulness in obscurity. I am glad to tell you that she has been able to have another son, now over one year old and doing well, so she has three living children.

The courage of my friend—what an example she is—brings to mind a quotation from Reverend Martin Luther King, Jr.:

‘Hew out a stone of hope....’

“Forces that threaten to negate life must be challenged by courage, which is the power of life to affirm itself in spite of life’s ambiguities. This requires the exercise of a creative will that enables us to hew out a stone of hope from a mountain of despair.”

I think of that often, as I look at the high mountains around me in north Pakistan, the need for courage.

Today, however, we are celebrating your accomplishments. We are not in despair, although times of despair are likely to come in all of our lives. Why tell the story of Iqbal Bano? I tell it so that you may see how one woman far away responded in the face of trying times and much grief. She was faithful and loving. And so I too encourage you, to be faithful and loving. Be loving and faithful daughters and sisters, and when the time comes, faithful and loving spouses and mothers. Care about your communities, and the needs of those who have less than you do. And don’t get discouraged. When you are, turn to God, who gives wisdom and encouragement to us all. He is our nourisher and sustainer. He made us and we will return to Him, to account for all we have done with our many privileges. It may not be common, these days, to talk about God on occasions like this. But I cannot refrain. I have seen His power, and His miracles, in my own life and in those around me. I have known His tremendous help. You can as well. The world lies before you today; there are many frontiers to be conquered. There are important ways you can contribute. You too can make a difference in the lives of people, people like Iqbal Bano. What will you choose? Whose problems will you take on? Whom will you serve? These are my questions for you.

I will close now with the greeting we use in Pakistan, Khuda-Hafiz. It means, “May God protect you as you go on your way.” This concept of protection may be more familiar to many of you in the blessing said to be given to the prophet Moses: “May God bless you and keep you; May God make his face shine upon you and be gracious to you; may God turn his face toward you and give you peace.” Thank you. BMC

Zeba spoke to the Bulletin at greater length about changes in her own life.

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