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 Bagrri 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.

Doctors Dealing With COVID-19 in Pakistan: Experiences, Perceptions, Fear, and Responsibility.

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a "tool of a proxy war" and a "plot," without giving agency to anyone for that "plot." Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to "serve humanity," yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government should be doing much more. All expressed confidence in the use of personal protective equipment (PPE), viewing it as an effective buffer against viral contagion. We conclude with a call for further research especially ethnographic studies on dealings of physicians with COVID-19 across Pakistan as frontline care providers.

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

The coronavirus disease 2019 (COVID-19) is still unfolding. Its several implications are visible, yet more of them we have to observe and witness in future. Dealing with these impacts, this rapid-response article aims to situate the COVID-19 pandemic within Pakistan's overall sociocultural and politico-economic context; next to investigate the impacts of COVID-19 particularly the psychological ones on pregnant women in Pakistan via five case. One case history of Haleema (pseudonym) revealed how the pandemic exerted a substantial amount of mental pressure due to "arranging someone to accompany her to the hospital, finding a blood donor for her, and insecurity of convenience to hospital." In this article, we show that Pakistan's geographical division into urban with an appropriate healthcare system, infrastructure and economic status, and more impoverished rural areas may show different impacts on people in general and the pregnant women in particular. This difference of facilities may contribute to disease transmission in the more deprived areas, that also due to cultural norms and mores such as shaking hands, cheek-kissing, and hugging that spread the virus are being overturned and that pregnant women are particularly vulnerable to psychological effects of the pandemic.

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.

Corrigendum: COVID-19 Vaccination: Concerns About Its Accessibility, Affordability, and Acceptability.

[This corrects the article DOI: 10.3389/fmed.2021.647294.].

COVID-19 Vaccination: Concerns About Its Accessibility, Affordability, and Acceptability.

By the mid of June 2021, after an almost 1.5-year-long COVID-19 pandemic that has significantly affected the world in multiple ways, various vaccines against COVID-19 have arrived and started worldwide. Yet, economic, (geo)political, and socio-cultural factors may influence its uptake at individual and country levels. Several issues will (and already have been reported in media) revolve around this vaccination regarding its accessibility, affordability, and acceptability at an individual level and a country level. Given that in this commentary, we provoke a discussion: Who-a country as well as the individuals-would have access to it, and who would economically afford it, and who would accept it? Centering these intriguing questions, we revisit the body of literature that explicates vaccine hesitancy, refusal, and resistance, and we also draw on the current literature and media reports about vaccination against COVID-19. We suggest that these backdrops need essential attention so that everyone can afford, accept, and have access to it. Otherwise, the current risk in the face of a year-old pandemic will continue.

Birthing Between the "Traditional" and the "Modern": DaI 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 DaI in the singular and Dayun 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 Dayun and 11 with mothers, we explore a maternity care system in tension between the past and the present, the DaI and the doctor. We ask, what does the maternity care provided by the Dayun look like during times of normalcy, and how does it differ during COVID-19? We look at the roles the DaI has traditionally performed and how these roles have been changing, both in ordinary and in Covidian circumstances. Presenting the words of the Dayun 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 Dayun, 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 Dayun, we also briefly present local mother's perceptions of the Dayun 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 Dayun and their roles within their communities. Positioning this article within Pakistan's national profile, we propose formally training and institutionalizing the Dayun 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.

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.