American drones kill Pakistani children. Pakistani military harbors Osama bin Laden for years. Most Pakistani women are illiterate. Pakistani corruption is rampant. The word from America’s frenemy seems uniformly bleak. The problems run deep.

Perhaps. Yet much of Pakistan comes to the West through the unsatisfactory filter of mass media. The dynamic culture that lies beneath news accounts remains unavailable to Americans, who, for example, know little of Pakistan’s revered poet Faiz Ahmed Faiz or its short-story master Saadat Hasan Manto. Even more hidden from view than Pakistan’s literary icons are the everyday lives of its desperate poor. Some authors from the newly acclaimed generation of fiction writers in English have explored the codependency of the impoverished and elite—Daniyal Mueenuddin is an especially talented example. But now with Our Lady of Alice Bhatti, Mohammed Hanif is the first to devote an entire novel to the downtrodden. In it, grim headlines and social problems give way to an improbable radiance. It’s an enthralling successor to his first novel, A Case of Exploding Mangoes, about the still unsolved 1988 assassination of President Zia ul-Haq.

Hanif has followed that much acclaimed book with a novel that’s a savage chronicle somehow hilarious, a love story entrancingly doomed, and an acerbic free-of-cliché portrait of Pakistan’s largest city. Part of its genius lies in Hanif’s shrewd understanding that what makes the disadvantaged unforgettable is not their crushing predicaments but how they invent ways to cope with them. That insight was common in Manto’s best work. Not surprisingly, Hanif references Manto early in the novel Sister Hina Alvi. One of the nurses at the hospital where the majority of the action takes place is showing the ropes to a new nurse, the Alice Bhatti of the novel’s title, in the psychiatric ward. The sister tells her, “As far as I’m concerned the whole country is a nuthouse. Have you read Topa Tek Singh? ... Manto wrote about the nutters in a charya [Urdu for psychiatric] ward and then ended up in one himself. His own family put him there.”

It makes sense that Manto, who died in 1955, would be on the mind of even the most disadvantaged woman. He’s considered a national treasure and widely read; the mayhem of his work and life encapsulate Pakistan in many ways. In a country where alcohol is illegal, more than a few drink anyway, and Manto’s imbibing was so over the top it landed him in a psych ward. There he wrote the story Sister Hina mentions, one of the most powerful about Partition, in which Pakistan and India arrange for the transfer of Muslim mentally ill inmates in India to Pakistan and Hindi lunatics in Pakistan to India. The comic fable, featuring patients constantly disrobing during the solemn exchange, captures the preposterous essence of Pakistan’s horrific birth. Hanif’s novel is as ribald as Manto; they share a hatred of cant that makes their work raw and alive.

Nowhere is this more obvious than in the case of the novel’s eponymous protagonist Alice Bhatti. She is a 27-year-old member of Pakistan’s minority Christian population, and discrimination leads her to suffer uninvited groping, an unjust prison term for assaulting a surgeon, and sexual assault on duty. Ever defiant, she counters with a razor blade to her attacker’s penis. Where she works is conjured with realism so unvarnished, that Pakistan’s public hospitals, several of which I’ve visited, feel almost supernaturally awful, which they most definitely can be. “The nursing station … is empty and covered in dust,” “the walls have developed a skin rash,” and Alice quickly finds that “she has seen some grotesque things in her life, but a nest the size of a football made of grey human hair with a live rat at its centre is not one of those things.”

At first it seems the repellent extends to the men in her life. Teddy Butt, a weightlifter who plumbs the hospital for corrupt favors, works for the Gentleman’s Squad, an unofficial police unit of sometime rapists, torturers, and sharpshooters that torments and tries to execute a young man for his role in a bombing. Alice’s father, Joseph Bhatti, descends from the chuhra or untouchable caste. He excels in pinpointing tough-to-find sewer blockages. He’s also a mumbo-jumbo “healer” of stomach ulcers. He and Alice live in French Colony, a slum made up mostly of Christians who are often the target of violence. Alice’s mother, who worked as a maid, was raped and killed with impunity by one of her employers.

Yet this necrotic world yields a tender shoot: Teddy, a Muslim, falls for Christian Alice. Some of the book’s most irresistible passages center on his awakening to his love for her. When he first meets her, “he feels he can carry her and walk the earth…He feels he has been allowed back into a school of happiness from which he was expelled a long time ago.” Inarticulate, he hopes “that somehow his midnight yearning for her and his insomnia would walk hand in hand and form a rhyming, soaring declaration of love that would reverberate through the corridors of the hospital.”

When that fails to happen, he reverts to what he knows best, and puts a gun to her head, causing the indefatigable Alice to calmly ask what he wants. “Mixed up couplets about her lips and hair, half-remembered speeches about a life together, names of their children, pledges of undying love, a story about the first time he saw her, what she wore, what she said, a half-sincere eulogy about her professionalism that he wasn’t sure she would appreciate, her shoulder blades, all these things rushed through Teddy Butt’s head.” He finally gets out a few garbled words only to have Alice push by him to help a patient. Rushing outside the hospital in a fit of despair, he fires his gun at nothing in particular, unintentionally causing a farandole of murders, riots, strikes, and sundry doings that shut down Karachi for three days.

Unbelievable? Not really. Karachi can be beset by such pandemonium. In the grip of the worst of it, many stay home and businesses shutter. One week last July, 120 people died and thousands of stores were looted. Such convulsions have myriad causes but are often attributed to mafia-esque rivalry between political groups dividing the city’s ethnically contentious 18 million residents.

Yet the novel’s positing Teddy as the cause shows Hanif at his best. A journalist for the BBC in Karachi, he has mined his country’s seemingly inexplicable news to uncover and deliver to English readers its difficult-to-convey and often uproarious roots. Abroad, his first novel gained recognition—A Case of Exploding Mangoes won the Commonwealth Writers’ Prize for the Best Novel in 2008, was a finalist for the Guardian First Book Award and long-listed for the Booker. Perhaps his second book will bring him wide and much deserved acclaim in the country that knows least about his subject and needs to know so much more.