Why Pakistan is struggling to heal young heart patients
The paediatric cardiology ward in one Lahore's biggest public hospitals is so crowded that some women have crouched on the floor with their small sick children on their laps.
It looks and smells like it hasn't been cleaned for a while.
Mothers, aunts and grandmothers are taking turns pumping oxygen manually into tubes stuck to babies' noses because there are no ventilators in the ward.
There are at least two babies to each cot because there is nowhere else to put them. Some mothers have used waiting benches as makeshift hospital beds.
This is where critical cardiac cases come and wait for urgent treatment or surgery.
Pakistan has one of the highest rates of children with congenital heart disease in the world: each year, between 40-50,000 children are born with heart defects.
Professor Masood Sadiq, a leading heart surgeon, says it's mainly due to lack of maternal healthcare.
"Diabetes is rampant in mothers so that increases the risk," he says.
"We're still not vaccinating the mothers, so something like congenital rubella predisposes those children to congenital heart disease."
Pakistan's public health system is overwhelmed with cases and severely underfunded.
"We live in a country where only 0.9% of the budget is spent on the public health sector and 3% if you add the private sector," Prof Sadiq says. "In a country with that kind of budget spent on health, where would paediatric cardiology fall?"
He adds that it's not just the faltering infrastructure that makes it difficult to care for these children, but also the lack of investment in human resources.
"Doctors need to be paid," he says. "I work two shifts. I work in this institution and then I have a private practice that's how I look after my family.
"If, at this level, I have to do this, what would a junior doctor do?"
'Some will die waiting'
Many trained surgeons prefer to leave for parts of the Middle East, like the oil-rich Gulf, where there's a better pay and quality of life for doctors and their families.
This leaves Pakistan short of much-needed skilled doctors.
In a country of nearly 200m people, there are only eight paediatric heart surgeons and 21 paediatric cardiologists.
In this Lahore government hospital alone, doctors say 8,000 children are waiting for surgery.
"Some of these children will die waiting," says Salman Shah, one of the senior paediatric heart surgeons.
"Of the children born with congenital heart disease, about 25,000 need surgery every year.
"Only 3-4,000 get it. That leaves a huge backlog of children added to a pool of already existing patients," he adds.
"It becomes very frustrating when you know a kid needs an operation, you know you can do it but there's no infrastructure or you're held back because they just can't pay for it," Dr Shah says.
A charity called the Pakistan Children's Heart Foundation is trying to help children from poor families by funding surgeries through donations.
They've teamed up with a number of private and public heart centres across the country to provide funds, space and adequate medical care for the children.
The charity's founder, Farhan Ahmed, started the charity for personal reasons.
"My daughter was born with congenital heart defect and we went through a terrible time," he says. "It was very difficult for us to find the right doctor.
"It took us three weeks to find out she had a congenital heart defect."
Farhan's daughter did have the surgery but she died after that of other complications.
Mr Ahmed said it was his daughter's memory that gave him the incentive to start the initiative.
One of the children the charity is helping is 16-month-old Muskan Wali.
She was born with a hole in her heart and suffers obstruction of blood flow to the lungs.
Muskan and her family are from North Waziristan and were displaced after the military operation against the Taliban started there.
"It was already a very difficult life," her father Saud Wali says. "After we were displaced, Muskan's condition worsened.
"Her nails would go blue and so would her eyelids. She would scream and then faint.
"I'm jobless now and we couldn't afford an operation anyway. Then we found out about this charity in Lahore. We came here with little hope. But they have offered to help us."
After waiting for a year, Muskan is now one of the few children who'll undergo heart surgery and get adequate health care at a private facility.
An operation in a private hospital costs between $3-4,000, which is a hefty sum for most families.
The other option is to rely on government hospitals and keep waiting.
Prof Sadiq says one of the most difficult aspects of his job is deciding which child to help on any given day, knowing that many children may never get the help they need.
"The prioritisation of patients is what hurts the most," he says.
"It's mental torture - you fight with your conscience every day."