From “This Is Enough” to “What Else Is Possible?”: A Girl’s Journey from District Bajaur to Karachi

About the Author:

Asma H. Khan is a Nurse working in Karachi, mainly looking after medical-surgical patients. She holds a diploma in nursing from Murshid College of Nursing. Currently, she is doing her bachelor’s in nursing at Aga Khan University and will be completing her program of study at the end of 2026. Her contributions to extracurricular activities are well note like sports, camps, workshops, and societies, and she enjoys life to the fullest. In her spare time, she likes to write and loves to sleep. 

I was born into a place where a girl’s future could be shaped by circumstances long before she learned to imagine one. As a child, I did not have the language to describe the forces that limit a girl’s opportunity.  I only knew that some doors seemed to open naturally for boys while girls often had to ask for permission to approach them.

I was around seven years, when conflict intensified in my region, educational opportunities for girls were extremely limited. This was just like going to school and coming back quickly and doing nothing.  I noticed that many factors influence this condition including patriarchy distance, poverty, security concerns, availability of teachers, transportation, and sociocultural expectations could all influence whether a girl entered school and more importantly whether she was able to remain there.

This condition was not only about me, but I realised that World bank has shared some data which also reflects similar ideation or experiences. Patriarchy and poor financial conditions make a connection, and the safety of girls become someone else’s decision. Sociocultural beliefs have been identified as important barriers to girls’ education, with rural girls facing particularly significant disadvantages in access and continuation. This is also rooted in socio demographics of our context and impact more than it feels.

With my own experience and after reading all this information, I realised there is a term which clearly explains condition of girls like me and many other. The term is called structural inequality, and I simply understand that the girls around me were leaving school just because of this power-oriented phenomenon. Years later I felt this is not me; this is not the girls; this is not the one person who is doing this; it is a whole system.

When Education Becomes a Privilege

Before my own educational journey began, I witnessed how differently education could be valued for boys and girls. Some girls were not enrolled in school at all. During periods of crisis access to food and other forms of assistance could also influence school attendance. For some families, education was therefore intertwined with survival rather than understood as an unconditional right.

Many girls dreamt of learning, but their education ended after primary school because the next school was too far away transportation was unavailable, or their families believed that further education was unnecessary for a girl. I repeatedly heard a message that would follow me throughout my childhood:

“Bas De! Da Der Day Ta Yawa Jenai ae ...” (translation urdu: buhat hua / ye kafi hai – tum ek larki ho; translation english: this is enough! you are a girl).”

At that age I did not understand why being a girl should determine how far I could study I only knew that I wanted to continue. Looking back through the lens of my nursing education, I now understand that education is much more than academic achievement. It can influence health literacy, confidence, autonomy, economic opportunity, and the ability to make informed decisions. The World Health Organization recognizes education, income, social position, gender, living conditions, and access to resources as important social determinants of health. These conditions influence health long before a person enters a hospital. This realization changed the way I understood my childhood. What I once saw simply as “girls not being allowed to study” was part of a much larger relationship among gender, education, poverty, social power, and patriarchy

The Health Consequences of Being Denied a Voice

The consequences of limited educational opportunities extended beyond the classroom. In the community where I grew up, many women had limited opportunities to become financially independent. Women’s life could be strongly influenced by decisions that are made by their man in charges like fathers, brothers, sons or husbands. This is because of forced and early marriages, or/and limited decision-making power in result of restricted mobility, gender norms, family pressures. This all could leave a woman or girl dependent on others for basic needs, decision making and access to services. Trust me! Even none of us wouldn’t like someone else to do or decide on our behalf. Still, we face alot of difficulties in making it possible.

What else I noticed was forms of violence in my surrounds. It was so normalized rather than openly challenged, in such a way that women couldn’t say anything to their families. In some situations, women appeared to tolerate violence because of financial dependence, social pressure, or fear of losing family support. As a child, I did not have the concepts to understand these experiences. Today, I recognize that gender inequality is not only a social issue it is also a health issue. When I became a nurse and joined one of the prestigious nursing schools in the country and become independent. I learnt through research that gender norms, unequal power, restrictions on mobility, limited financial autonomy, lower literacy, and reduced decision-making power can create barriers to health information and healthcare access and can adversely affect the health of women and girls.

This helped me reinterpret what I had witnessed!!!

Limited educational opportunities may also restrict a woman’s ability to access health information, participate in decisions, and seek care independently. Similarly, restricted mobility can make it difficult to reach healthcare services, while limited knowledge about health can delay recognition of problems and timely care. The connection became clearer to me as I progressed through nursing education. What I had once understood as separate social problems began to appear interconnected: education could influence autonomy, autonomy could influence health decisions, and social and economic circumstances could influence whether healthcare was accessible in the first place.

Healthcare Was Another Silent Crisis

Healthcare access in my community was another challenge. There were few trained female healthcare professionals from the area, and cultural expectations could make it difficult for some women to seek care from male healthcare providers. For women living far from major healthcare facilities, distance and transportation could become critical barriers, particularly during pregnancy and childbirth.  These were not simply stories about hospitals being far away. They were stories about how geography, gender, education, poverty, transportation, and decision-making power could interact to influence whether a woman received timely care. Pakistan’s maternal health situation during the period in which I was growing up provides an important national context. The Pakistan Demographic and Health Survey estimated a maternal mortality ratio of approximately 276 maternal deaths per 100,000 live births, with a substantially higher estimate in rural areas than in urban areas (National Institute of Population Studies [NIPS] & Macro International Inc., 2008). As a child, I could not interpret these experiences statistically. I was able to do when I saw others going through this during my nursing journey or my clinical practice with my teachers in community.

I simply knew that sometimes women needed help and help was far away. Today as a nurse, I understand that health outcomes are often shaped long before a patient reaches a healthcare facility. This is one of the most important lessons my journey has taught me Health does not begin at the hospital door It begins in the home in the school a child is allowed to attend in the road she is able to travel in the information she receives in the resources available to her family, and in whether she has the power to make decisions about her own life.

When Conflict Entered Childhood

Then conflict became part of my childhood I remember fighter jets overhead and explosions that shook the ground. I remember people hiding underground and villages being evacuated. I remember going to a mosque to collect pages of the Quran and seeing blood and human remains scattered across the floor. These are not memories- I learned from a textbook; they are memories I lived. Families were forced to leave their homes, pregnant women gave birth while displaced, babies died, elderly women were carried on people’s shoulders. Some people were left behind because vehicles could not reach them. Eventually my family also had to leave our village. We lived in camps where tents replaced homes and proper sanitation facilities was not available for us.  Where limited food was distributed, making survival a huge issue.  Eventually we moved to Karachi. The geography changed but the fears did not immediately disappear. I carried memories of explosions, blood, displacement, and loss with me. For some time, nightmares continued to bring those experiences back.  Yet something else began to develop alongside the fear and that is hope.

The Question That Would Not Leave Me

 After moving to Karachi, I began seeing girls going to school. They wore clean uniforms. They carried books. They walked confidently toward classrooms. To many people, this was ordinary, to me it was extraordinary I remember watching them and wondering. Why can they go to school when I cannot? That question became personal.

My educational journey was not simply a process of obtaining certificates. It became an act of persistence against expectations that had been placed on me. After matriculation, I was again expected to stop. I continued to insist on my education, secured admission to the eleventh grade, and completed my intermediate education.  Each academic milestone therefore represented more than a grade It represented another barrier crossed. Looking back, I realize that my education changed not only what I knew but also what I believed was possible education gave me language for questions I had carried since childhood.

My Entery into Nursing!

My entry into nursing gave me a new framework for understanding my life and reflect on traumas of my own childhood.  I began to see patterns. I learned that health is influenced not only by disease and treatment but also by the conditions in which people are born, grow, live, work, and age. Who considers these conditions as social determinants of health and emphasizes their role in creating health inequities.  Suddenly, many experiences from my childhood had a different meaning. The girl who could not travel to school was experiencing a problem of access. The woman who could not independently seek healthcare was experiencing a problem of autonomy and gender inequality. The family living far from a hospital was experiencing a problem of geographic access. The child displaced by conflict was experiencing disruption to safety, education, housing, and social support. I began to understand that these were not isolated problems. They were interconnected and now I am ready to conquer them and help others to conquer.

From personal experience to purpose: Now what is next?

 These experiences have taught me that personal experience can become the beginning of scholarly inquiry. However, personal experience alone is not enough, and it requires more connections in others life as well. This will give a perspective and make you stronger in your professional and personal life. As a nurse and emerging scholar, I have learned that observations must be examined critically, supported by evidence, and understood within a broader social and scientific context. Health inequities require more than individual solutions; they require attention to the social and structural conditions that shape people’s opportunities and choices. That is why I have become a strong advocate of gender equality, women and girls’ education, skill building and improving men’s perspectives towards supporting women in my context.

 My childhood therefore does not give me all the answers. It gives me the questions that I want to keep asking. And yes, I will continue to ask, continue to bother and continue to explore.....