The minimal role of the medical professionals in preventive medicine in Pakistan

By Zubeida Mustafa

 A recent report issued by the British Heart Foundation said, “More than 20 million people in the UK are physically inactive. Inactivity increases the risk of heart disease and costs the NHS around £1.2bn each year.”1

Seventeen years ago in 2005, the British Medical Association and the Irish Medical Organisation had warned in a public statement that a million British children accounted for a third of the cases of obesity seen in children in the European Union countries. The BMA called for strong action by member governments and the EU health commissioner to stem the rising epidemic of obesity in under-16s.2

This was followed by a report in July 2015 in which the BMA  called on the government to impose a tax of 20 per cent on sugar sweetened drinks to pay for subsidies on fruits and vegetables in an effort to slow down  the “obesity epidemic”.3

The BMA also demanded a clamp down on the marketing of unhealthy food and drinks to children and even a ban on clusters of fast food outlets.

This persistent campaign by the BMA has produced results. It has created enough public pressure and the British parliament is now set to adopt the Sugar in Food and Drinks (Targets, Labelling and Advertising) Bill 2016-17.4

Can we ever expect the medical profession to take  a stand on similar issues  in Pakistan and then sustain the pressure to produce results?

The fact is that the health professionals in this country focus too heavily on curative medicine. They are inclined to treat the person who falls ill with the aim of curing him rather than pre-empt his illness by preventive means. Doctors are trained to perceive their responsibility to ease an ill person’s pain and provide him relief while regarding it the civic authorities’ responsibility to work for preventive medicine.

Physicians and surgeons have launched campaigns on some issues that have serious implications for public health. For instance it was the collective efforts of the SIUT and the Transplantation Society that the Transplantation of Human Organs and Tissues Ordinance5 was promulgated and the illegal organ trade was brought into the limelight. While this proved beyond doubt that our professionals have the capacity and skill to launch public campaigns, this was not what one would call a preventive health issue. It was a public evil, a heinous crime that also had to be curbed.

It is not that Pakistan never had a programme of preventive health. True it was the municipality that undertook this function but the health professionals were also concerned about its success.

What would qualify as measures of preventive health? In a nutshell it would be anything that prevented the outbreak of a disease and ensured that people generally remained healthy.

Preventive health would include immunisation programmes, sanitation, anti-TB measures, eradication of malaria by destroying the breeding grounds of mosquitos, nutrition projects, screening and monitoring drives and the supply of potable water.

True the main work will have to be undertaken by civic authorities but the medical professionals’ bodies could always pitch in to put pressure on the government to undertake the above listed measures that prevent disease and ensure the well-being of people. That is the role the BMA has played.

Health professionals have yet another function to perform. They have to act as the advocates of the health rights of the people. If doctors were to demand vocally clean drinking water for the people it would have a powerful impact. Besides they are in a better position to make a convincing case supported by facts and figures.

The PMA at times makes demands of this nature. A few months ago it had invited a sanitation expert for a talk and called on the authorities to lift the garbage from Karachi’s streets. But this was a call from the blue and not a campaign.

Unfortunately we do not have a strong tradition of health education. With such a weak education sector, it has not been possible to create health awareness in the public through schools and textbooks. Even in a limited way most physicians and surgeons have failed to teach individually their patients the basic principles of remaining healthy. With most doctors giving only a few minutes to their patients, they tend to skip out the preventive side. With the doctors’ waiting rooms chock-a-block it is a pity that the professionals do not avail of this opportunity to pass on the message of the good practices of preventive health. Many doctors have televisions fitted in their waiting halls to keep patients entertained.

One can understand that given the heavy load of work, it is not physically possible for the doctor to play the teacher’s role as well.  But it is not clear why doctors cannot with a bit of effort get social workers and health workers trained to talk to the patients in waiting rooms and tell them about basic health principles. There are measures individuals can adopt and reduce illness in the family such as boil drinking water, use mosquito nets and so on. This effort on the part of health professionals would certainly help in reducing the burden of disease. This apathy on their part is unforgivable.

The government’s indifference to preventive medicine is underlined by the health plans. I looked up the section on Dengue Fever in the Pakistan Economic Survey of 2011-2012.6 Titled Dengue Epidemic and Control Programme, it lists 13 measures ranging from sending delegations abroad, research, setting up task forces and cells to online surveillance of cases. There are only two points which can be considered as truly preventive measures. One is called environmental measure which includes proper disposal of waste water, desilting operations, timely repair of leaks in plumbing and cleanliness drive in eateries. The second point speaks of vector control without elucidating it. We do not know how much was actually spent on each item. We do know that Dengue Fever is now a common disease — perhaps as common as malaria.

This is certain that preventive medicine incurs less expenditure than curative medicine which is very expensive. And its impact is greater.

References

1. More than 20 million Britons ‘physically inactive’. BBC Health News. Cited on 9 April 2017. Available from URL: http://www.bbc.com/news/health-39457993.

2. Lorraine Heller. More than 20 million Britons ‘physically inactive. Newsletter Food Navigator. Cited on 9 April 2017. Available from URL: http://www.foodnavigator.com/Policy/Doctors-call-for-EU-wide-approach-to-obesity.

3. James Gallagher. Tax sugary drinks by 20%, say doctors”. BBC News, 13th July, 2015. Cited on 9 April 2017. Available from URL:   http://www.bbc.com/news/health-33479118.

4. BMA. Doctors leaders welcome sugar tax. BMA news, March 2017. Cited on 9 April 2017. Available from URL: www.services.parliament.uk/bills/2016-17/sugarinfoodanddrinkstargetslabellingandadvertising.html/.

5. The transplant of human Organs and Tissues, Pakistan, March 2010. Cited on 9th April, 2017. Available from URL: https://academic.oup.com/ckj/article/1/2/128/565238/Organ-transplantation-law-in-Pakistan-to-curb.

6. Health and nutrition- Ministry of Finance, Chapter 12,  Pakistan Economic Survey 2011-2012. Cited on 9 April 2017. Available from URL: https://www.google.com/search?q=Pakistan+ economic+surver+1995-1996+health+chapter&ie=utf-8&oe=utf-8.

Source: Journal of the Journal of the Pakistan Medical Association, October 2017

Continue reading “The minimal role of the medical professionals in preventive medicine in Pakistan”

New horizons

NEARLY 60 years ago, an epic Partition novel was published in India. It became an instant hit. Jhutha Sach narrated poignantly the epochal events of the time. Its author, Yashpal, a communist revolutionary who had spent many years in British jails, also captured the disappointment of the masses at their failed expectations. They had been promised much more than what they received.

This powerful book, written in Hindi, received a second lease of life after 50 years. The author’s son Anand translated the book into English. This is not that Dawn, the English title, has certainly introduced Yashpal to a new generation of international readership. In this journey, involving the crossing of borders that Jhutha Sach has undertaken, lies the importance of translation of literature. It is increasing as the book trade goes global. Though in the world market only 4.5 per cent of the books sold are translated works, in different non-English speaking countries the ratio is significantly higher. Thus a third of the books published in France are translations from other languages. In the Netherlands, this ratio is 45pc.

Though translations have helped popularise authors, this genre is one of the most challenging but least appreciated. I spoke to Anand, who is a literary translator and is fluent in English and Hindi, about how he feels about his work. He shot to fame after the publication of his elegant translation of his father’s book in 2010. He lives in Montreal and has just finished translating Alice Munro’s Runaway into Hindi which is in the press now.

Anand says that his ultimate goal is “the comprehensibility of the final text”. In other words, a translation should be so natural that the reader should not feel that what he is reading is a product of the process of transmission from one language to another. “I try to get into the author’s mind,” he remarks.

Why do we not have more translations in Pakistan?

That can be tricky, he admits, because every language has its own syntax and rhythm, and to impose those of the source language on to the target language seldom works. Many translators may not agree with that. But no one would question Anand’s assertion that the translator must have equal mastery over the two languages involved. It also means that the translator must be familiar with the culture, geography and history of the place where the story is set. Anand has an advantage in this respect as he lives in Canada and visits India every winter.

Personally I feel that the translation is best when the translator identifies himself with the author. In the case of Jhutha Sach, Anand had a ringside view of the writing process. He was a teenager in the late 1950s when the book was being written. He says, “I saw it being written. I knew some of the people who shared their experiences of Partition with my father.”

The book was first serialised in a magazine and hundreds of letters poured in. Anand helped his father by responding to them. He felt close to the book and it became a part of his being.

But most important is Anand’s statement, “I agree with what my father writes about post-independence India failing to deliver the expected sort of egalitarian society that was promised during the freedom struggle. The promises made about social and economic freedom, women’s rights and empowerment, were either sabotaged or inexcusably delayed by hidebound reactionaries.”

This is precisely what Yashpal captures in his book. When two minds think alike the result will inevitably be powerful.

This has left me wondering why we do not have more translations in Pakistan. We have a number of good translators, no doubt. Yet Ameena Saiyid, the MD of OUP, once told me that the translations they published do not sell. Is there such a chasm between the English-speaking elite classes and the non-English speaking masses? Conversely, are the Urdu readers rejecting English so conclusively that they do not want to read even the translated work of English writers? Or is it simply that the mindset and literary tastes of our society have diverged so sharply that there is no meeting of minds between them?

I have noticed this in the media of the two languages. Their worldviews are poles apart. Their social, cultural values do not meet at any point, nor do their literary tastes.

This alienation is a product of our social inequity. Language barriers have been erected to keep the poor beyond the pale. Or is it simply a case of our education system failing to inculcate the book-reading habit? If people don’t like to read books, translations will not sell either. Take Iran as an example. Iranians are avid readers and translations are also popular. Khaled Hosseini’s The Kite Runner has 16 different versions of Farsi translations available in Iran. They must be selling.

Source: Dawn

Dr Pfau’s leprosy miracle

By Zubeida Mustafa

Haleema Khan (a name used in this story to preserve her anonymity) is a health management expert who is head of the secretariat in a prestigious hospital in Karachi, Pakistan’s biggest city. Efficient, professional and confident, one would never guess that Khan reached the heights of success by starting from the lowest rung of the ladder.

Khan grew up in a shanty town in the backwaters of Karachi, where she was born to parents who suffered from leprosy. This concentration of humble dwellings was home to the outcasts of society, and Khan, who had never contracted the disease herself, inherited a lowly status by virtue of her parentage. The stigma attached to leprosy has haunted her all her life (and is why she was reluctant to reveal her identity for this story). Read on

Source: Truthdig

Running where?

By Zubeida Mustafa

IN the introduction to Pakistan at the Crossroad, Christophe Jaffrelot labels Pakistan as a “client state” and a “pivotal state”. For long, we had been dubbed an ideological state and a security state.

None of these titles are too flattering, but they are not inaccurate. The status of being a client and a pivot stems from Jaffrelot’s observation about Pakistan’s “ability to navigate at the interface of domestic and external dynamics”. Continue reading “Running where?”

Whatever lies ahead

By Rifaat Hamid Ghani

WHATEVER lies ahead or went before, the IJIC inclusion of Nawaz Sharif’s family’s offshore assets as revealed in the PanamaLeaks, at a fortuitous but blessed moment for the political opposition, has culminated in his local political disqualification.
Diligent digital research yielded other Panama-originated leaks featuring sundry plutocrats – in drips as it were. Indeed an international basket of politicians has been highlighted by the ICIJ, so it doesn’t seem as if Nawaz Sharif was being targeted or a country prioritized for scrutiny by extra-territorial watchdogs. The leak was, however, a veritable tsunami of good luck for Imran Khan who had not been able to achieve his declared and entirely altruistic end of getting the ‘corrupt’ Nawaz to go despite a fiercely sustained battery of charges of election-rigging; state brutality; to say nothing of dharnas, lockdowns, jalsas, rallies and vehicular marches. Continue reading “Whatever lies ahead”

Time to heal

Voices of Partition, Mumbai 6 Aug 2017

By Zubeida Mustafa

THIS year an alternative discourse dominated the weeks leading up to the middle of August, when, 70 years ago, Pakistan and India became independent. Marking a shift in focus, the public narratives moved away from the traditional recounting of the politics of the leaders in the 1940s to the experiences of the common man whose fate was decided.

This, to me, is a significant development. This people-to-people interaction at the grass roots can eventually pave the way for peace in the region. It may also change the public perception of the events of 1947. Until now, the people of the two countries have been exposed to one-sided accounts of their leaders’ political ‘achievements’ and the ‘deceit’ of the ‘other side’. The new narrative can be termed the ‘people’s history’. It is oral so that more people can be accessed in South Asia. And these are untold stories. Continue reading “Time to heal”

Women are at the heart of development in Pakistan

The Garage School founder Shabina Mustafa at her desk in the educational center in Karachi, Pakistan. (The Garage School)

By Zubeida Mustafa

Three years ago, when Truthdig invited me to write an article on “How the women of Pakistan cope” for its newly launched Global Voices Project, it was a challenge for me. I wished to show the readers a face of Pakistani women that does not generally figure in the global media. They are the women who do not in the normal course create a sensation. But in their quiet way they are the change-makers.

The relaunch of Truthdig offers me the opportunity to take another look at the situation of women in Pakistan. Has it changed?

First, let us redefine the dichotomy in the women’s situation in Pakistan in terms of their achievements. The two classes I spoke about in my earlier article still exist: We still have a small, privileged class of the haves, and there is also the huge, underprivileged class of the have-nots. The world fails to recognise Pakistani women through this perspective. Read on

Source:Truthdig

Taking to the streets

PTI street power

By Rifaat Hamid Ghani

There is a difference between grass roots and street power.

To start with the MQM. It had the kind of street power that could both empty and fill the streets to considerable effect: Its leverage worked; but it was not admired. The MQM as factionalized –- imploded and exploded –- no longer commands that kind of street power.

Yet, alongside of its waning street power, its grass root political strength is more clearly perceived. Besides its thugs (I choose that word for its wider etymological ethnic resonances) it evidently has a broad constituency that remains loyal to cadres of a well-organized party whose workers stayed in touch with and served and protected the people they represented. The party leadership presently is amorphous even though the founder is unambiguously self-destructed, but the constituency remains. Continue reading “Taking to the streets”

What ASER says

By Zubeida Mustafa

ANY country which values education provides for an independent mechanism to test the learning levels of its students. That is the only way a state can assess objectively the strength and weaknesses of the system that it has in place to educate its children.

In Pakistan, the Annual State of Education Report (Aser) has been doing precisely that since 2008 when its first annual survey was held. It is like an audit and should be valued for the database it collects — mainly in the relatively inaccessible rural areas. Policies made on the basis of this wealth of information should make learning tools more effective. Continue reading “What ASER says”

Syed Adibul Hasan Rizvi: Book Review

By Zeenat Hisam

THE reading habit needs to start being cultivated in early childhood through stories of fantasy, fairy tales and folk sagas as these ignite the imagination and the curiosity of children. Every culture and every language has its own heritage of such stories. And so does Urdu. However, what was missing was biographies of renowned people written for younger readers in Urdu.

The Oxford University Press is now filling in this gap by bringing out a few series devoted to the genre. Under the series Azeem Pakistani and Tasveeri Kahani Silsila, biographies of notable figures highlighting their contributions to the country have been published. Roshni kay Meenar is the third series focusing on biographies of prominent personalities of Sindh who have made valuable contributions either before Partition or since. The three biographies published earlier under this series presented the lives and works of Mirza Qaleech Baig, Hasan Ali Effendi and Ruth Pfau.

The biography of Dr. Adibul Hasan Rizvi is the fourth supplementary reader under Roshni kay Meenar. Targeted at children of 10 years and above — students of classes six to eight — this 50-page reader is divided into seven chapters. The first five chapters shed light on his childhood, education and career as a medical professional, as a family man, and how he started the Sindh Institute of Urology and Transplantation (SIUT), and what went into making it such an outstanding success. The sixth chapter tells the stories of two young patients, Aymen Khan, whose life was changed after treatment at the SIUT, and Naveed Anwar, Pakistan’s first deceased organ donor. The last chapter tells the young reader about Dr. Adib’s success and the national and global fame and honours he has received.

Zubeida Mustafa, an accomplished senior journalist and writer, has brought out key aspects of Dr. Adib’s personality — his humility, integrity, commitment and compassion – in simple and fluent language. She talks of how he transformed an eight-bed burns ward at Civil Hospital, Karachi, into a full-fledged, state-of-the-art medical institution, the SIUT, predominantly serving the marginalised sections of society, free of cost, with dignity and compassion.

However, the booklet is visually disappointing, even though it contains many photographs. It has not been packaged in a format that will attract children. These minor quibbles aside, this is a much-needed addition to our store of knowledge.

Source: Newsline, July 2017