Category Archives: Health

No hope is suicide

By Zubeida Mustafa

ACCORDING to the World Health Organisation, suicide is the second leading cause of death among 15- to 29-year-olds worldwide. It has also been reported that the incidence of suicide has been on the rise in Pakistan. WHO put the figure at an estimated 13,337 for all ages in 2012. It would certainly be higher today.

Only recently, this paper reported three students killed themselves in Chitral after receiving their examination results, while another survived. The Human Rights Programme’s chairman reported that 40 to 45 people commit suicide in Chitral (population 447,362) every year. Continue reading No hope is suicide

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To cling or go?

By Zubeida Mustafa

SPEAKING at a seminar, a medical professional once described the changing relationship between patients and physicians. He recalled the time when for centuries, physicians had the upper hand by virtue of their superior knowledge and their ethical standards.

Then the parties achieved a balance in their relationship as public awareness about health issues grew and patients could question the physician’s diagnosis and treatment. They also got more space to decide on the options for treatment available to them. Continue reading To cling or go?

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Inequality kills

By Zubeida Mustafa

OURS is an unequal society. The more unequal we become, the more fiascos will visit us as we have been witnessing lately. How correct was Justice Louis Brandeis of the US Supreme Court when, many decades ago, he famously said words to the effect ‘you can have extreme inequality or you can have democracy — you cannot have both’. We love to delude ourselves with the belief that we have democracy in spite of inequality.

Today, the world’s attention is focused on the issue of inequality which has become a major subject in the global economic discourse. In 2015, the UN Assembly adopted the Sustainable Development Goals, one of which states that by 2030, governments will progressively achieve and sustain the income growth of the bottom 40 per cent of the population at a rate higher than the national average. Continue reading Inequality kills

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Gift of sight

By Zubeida Mustafa

THE exercise in philanthropy about which I write today began 34 years ago. Two successful businessmen who were close friends decided to launch a project in their post-retirement life to serve humanity. Being compassionate, they understood the burden of disease for the poor in terms of financial costs and loss of productivity. Hence they opted for healthcare, which is the most neglected of the services sector in Pakistan. As one of them had lost his vision in one eye, a hospital for eye diseases was their natural choice. Continue reading Gift of sight

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Desperately seeking donors

By Zubeida Mustafa

As the country teeters on the brink, many of the socio-economic and political evils of yesteryears are making a comeback in a big way. One of them is the reprehensible organ trade. Rearing its ugly head at the turn of the century, the sale of kidneys was somewhat suppressed when the Transplantation of Human Organs and Tissues Ordinance was promulgated in 2007. This criminalised the sale of human organs and tissues. Thereafter, the opponents questioned it on several grounds, leading to yet another round of legal struggle.

This ended successfully with Parliament enacting the Transplantation of Human Organs and Tissues Act in 2010, amidst a lot of rejoicing. Its credibility was established when some rogue elements in the medical profession and their accomplice vendors were arrested. Thus, good was deemed to have won over evil. One didn’t realise at the time that this was a case of misplaced hope.

Some recent reports (especially two write-ups by Naziha Syed Ali) in Dawn made it clear that the criminals were back in business. This time they were careful and  avoided media publicity. The papers were not flooded, as they were a few years earlier, with images of rows of people in rural areas photographed with their shirts pulled up displaying the incision marks across their torsos – the tell-tale sign of surgery for kidney harvesting.

Matters came to a head when Dr Adibul Hasan Rizvi, director of the Sindh Institute of Urology and Transplantation (SIUT),   wrote to the Supreme Court and drew its attention to what was happening, mainly in Punjab. In support of his contention, he sent the emails he was receiving from foreign doctors complaining about their patients having travelled to Pakistan  and having been trapped by the organ traders. They had returned home mortally ill.

Under the coordination committee set up by the Supreme Court, the SIUT organised a seminar and workshops last month to formulate recommendations to step up deceased organ donation (DOD). Dr Rizvi believes this  to be necessary to change the pattern of demand and supply of organs and thus the economics that drives the heinous trade. Since human organs are in short supply, they can be sold at fabulous prices to desperately ill, wealthy patients. There is grinding  poverty in some regions of the country, in many cases created by exploitative landlords and brick kiln owners, leading to the compulsion for impoverished people to sell their organs. There are also surgeons whose greed knows no bounds and they have chosen to forget their Hippocratic Oath to serve ailing humanity. These three factors have combined to give rise to   perfect conditions for the commercialisation of organ transplantation in Pakistan.

What is equally appalling is the minimal public awareness about health and illness and the general apathy towards the burden of disease among the people. It is only when a person falls ill that he begins to learn a thing or two from his own experience. With a media that has forgotten its key function of educating the people, it cannot be expected to take too passionately to  health education programmes that have little commercial value. This public ignorance provides the medical profession its huge clientele. The fact is that the burden of disease in Pakistan can be considerably reduced by taking a few preventive measures. Spread more public awareness about healthy living. Provide sanitation and potable water to the people. The healthy environment thus created will cut down the incidence of disease.

That would explain why kidney problems are on the rise in the country. Since the deceased organ programme has not taken off, the demand and supply gap has widened making organ trade  such a lucrative venture.

Will  this exercise of drawing up recommendations produce any fruitful results? It all depends on the will and the capacity of those working for the implementation of the suggested measures.  The transplantation law that was drafted by the late Justice Sabihuddin Ahmad is still believed to be a good law. Changes in the rules could finetune it further. As for putting a halt to the odious  organ trade,  the present law is sufficient for the police to take action and for the courts to act if they want to.  The crime is committed so blatantly, that concerned authorities can crack down on the criminals – even those with powerful connections – if they want to.

The SIUT’s conference and workshops, however, served a useful purpose in another way. They underlined the need to change our social attitudes and culture towards organ donation which Zehra Nigah, our top ranking poet, described as “Tuhfa-e-Hayat-e-Nau” (Gift of a new life) in the poem she recited on the occasion.

There is, undoubtedly, a need to create the infrastructure, train medical professionals in how to handle life-and-death issues, in communicating with the patients and their relatives, and also define, in layman terms, issues like brain death. The recommendations address all these.  Dr Rizvi also brought up the issue of capacity. He pointed out that  the existing number of ICU beds in Pakistan cannot provide sufficient organs – even if consent has been given – to meet the needs of the country. Setting up a centralised registry for donors and patients in need, would facilitate the smooth and efficient working of a transplant programme in Pakistan.  This can be accomplished by the numerous professional medical bodies, working closely together and with the government.

The real challenge is to create public acceptance of deceased organ donation. In this context, the recommendations for the media and for education campaigns to create public awareness and popularise legal organ donation, are most pertinent. Some suggestions for the media, such as integrating the subject of organ donation in TV plays and programmes and including the theme in school textbooks, has the potential to be effective.

The need is to analyse the basic factors that have hampered the awareness of deceased organ donation. Religion is no longer an obstacle. Islamic scholars in Pakistan, and in other Muslim countries, unanimously agree that deceased organ donation  is sanctioned by Shariah.

Superstition, ignorance and the fear of death that have given rise to a negative attitude to deceased organ donation in our society. People need to be told about death and grieving – especially of the need to talk about these phenomena. There is a need to help people see the beauty in the idea of saving lives.

What better strategy can be adopted than what the SIUT itself opted for, when it needed to popularise organ donation by living donors related to each other. Initially, this idea was too radical for people to accept. The battle had to be won if the SIUT’s kidney transplant programme, that was launched in 1985, was to succeed.

After the first few patients and their families had been persuaded to accept this miracle of modern medicial science, it became easy sailing. The patients and their donors became motivators for those who followed. The high rate of recovery of those with transplanted kidneys, along with the care and compassion the patients and their donors received, and the guarantee of life-long free medical cover, proved to be major incentives.

I remember Rasheed, Transplant Patient #1 who came from Azad Kashmir with his brother, who was the donor. They became the agents of change for patients visiting SIUT. There was Rukhsana, the medical student and Transplant  #9, whose sister helped her out. She went on to become a doctor.

Such cases became an inspiration for other patients and their families. There was a lot of interaction among the various patients and donors, but there were also the unfortunate ones who didn’t have a donor. How could their lives be saved?  The answer was:  by  deceased organ donation.

That is what the SIUT’s conference was all about. Pakistan has had five deceased organ donors,  now rightly described as  national heroes by SIUT. The first such donor was Naveed Anwar,  a student who was fatally injured in a  road accident. When he was certified as brain-dead by a team of neurologists, his family – progressive and enlightened – decided to fulfil his oft-expressed wish to be an organ donor if he met such a fate. Dr Razzaq Memon was another and his family also donated his organs in keeping with his will, in spite of some reservations from the biradari.

I mention these two because I have met their families and they have repeatedly endorsed deceased organ donation and their own role in the programme. And so it was that deceased organ donation made a debut in Pakistan. It should be noted that the first three donations were made even before Parliament had passed the law, which certainly helped in promoting the concept.

The inspiration provided by the five heroes, needs to be brought to the fore. The families should lead this campaign. They have experienced the pain of losing a loved one. They have also felt the inner satisfaction and peace that comes from saving a life. Their words will carry weight, just as the SIUT’s presence on a high moral ground in Sindh has kept the organ traders away from this province.

Zubeida Mustafa is a senior journalist. She writes on a variety of subjects but her i

By Zubeida Mustafa

As the country teeters on the brink, many of the socio-economic and political evils of yesteryears are making a comeback in a big way. One of them is the reprehensible organ trade. Rearing its ugly head at the turn of the century, the sale of kidneys was somewhat suppressed when the Transplantation of Human Organs and Tissues Ordinance was promulgated in 2007. This criminalised the sale of human organs and tissues. Thereafter, the opponents questioned it on several grounds, leading to yet another round of legal struggle.

This ended successfully with Parliament enacting the Transplantation of Human Organs and Tissues Act in 2010, amidst a lot of rejoicing. Its credibility was established when some rogue elements in the medical profession and their accomplice vendors were arrested. Thus, good was deemed to have won over evil. One didn’t realise at the time that this was a case of misplaced hope.

Some recent reports (especially two write-ups by Naziha Syed Ali) in Dawn made it clear that the criminals were back in business. This time they were careful and  avoided media publicity. The papers were not flooded, as they were a few years earlier, with images of rows of people in rural areas photographed with their shirts pulled up displaying the incision marks across their torsos – the tell-tale sign of surgery for kidney harvesting.

Matters came to a head when Dr Adibul Hasan Rizvi, director of the Sindh Institute of Urology and Transplantation (SIUT),   wrote to the Supreme Court and drew its attention to what was happening, mainly in Punjab. In support of his contention, he sent the emails he was receiving from foreign doctors complaining about their patients having travelled to Pakistan  and having been trapped by the organ traders. They had returned home mortally ill.

Under the coordination committee set up by the Supreme Court, the SIUT organised a seminar and workshops last month to formulate recommendations to step up deceased organ donation (DOD). Dr Rizvi believes this  to be necessary to change the pattern of demand and supply of organs and thus the economics that drives the heinous trade. Since human organs are in short supply, they can be sold at fabulous prices to desperately ill, wealthy patients. There is grinding  poverty in some regions of the country, in many cases created by exploitative landlords and brick kiln owners, leading to the compulsion for impoverished people to sell their organs. There are also surgeons whose greed knows no bounds and they have chosen to forget their Hippocratic Oath to serve ailing humanity. These three factors have combined to give rise to   perfect conditions for the commercialisation of organ transplantation in Pakistan.

What is equally appalling is the minimal public awareness about health and illness and the general apathy towards the burden of disease among the people. It is only when a person falls ill that he begins to learn a thing or two from his own experience. With a media that has forgotten its key function of educating the people, it cannot be expected to take too passionately to  health education programmes that have little commercial value. This public ignorance provides the medical profession its huge clientele. The fact is that the burden of disease in Pakistan can be considerably reduced by taking a few preventive measures. Spread more public awareness about healthy living. Provide sanitation and potable water to the people. The healthy environment thus created will cut down the incidence of disease.

That would explain why kidney problems are on the rise in the country. Since the deceased organ programme has not taken off, the demand and supply gap has widened making organ trade  such a lucrative venture.

Will  this exercise of drawing up recommendations produce any fruitful results? It all depends on the will and the capacity of those working for the implementation of the suggested measures.  The transplantation law that was drafted by the late Justice Sabihuddin Ahmad is still believed to be a good law. Changes in the rules could finetune it further. As for putting a halt to the odious  organ trade,  the present law is sufficient for the police to take action and for the courts to act if they want to.  The crime is committed so blatantly, that concerned authorities can crack down on the criminals – even those with powerful connections – if they want to.

The SIUT’s conference and workshops, however, served a useful purpose in another way. They underlined the need to change our social attitudes and culture towards organ donation which Zehra Nigah, our top ranking poet, described as “Tuhfa-e-Hayat-e-Nau” (Gift of a new life) in the poem she recited on the occasion.

There is, undoubtedly, a need to create the infrastructure, train medical professionals in how to handle life-and-death issues, in communicating with the patients and their relatives, and also define, in layman terms, issues like brain death. The recommendations address all these.  Dr Rizvi also brought up the issue of capacity. He pointed out that  the existing number of ICU beds in Pakistan cannot provide sufficient organs – even if consent has been given – to meet the needs of the country. Setting up a centralised registry for donors and patients in need, would facilitate the smooth and efficient working of a transplant programme in Pakistan.  This can be accomplished by the numerous professional medical bodies, working closely together and with the government.

The real challenge is to create public acceptance of deceased organ donation. In this context, the recommendations for the media and for education campaigns to create public awareness and popularise legal organ donation, are most pertinent. Some suggestions for the media, such as integrating the subject of organ donation in TV plays and programmes and including the theme in school textbooks, has the potential to be effective.

The need is to analyse the basic factors that have hampered the awareness of deceased organ donation. Religion is no longer an obstacle. Islamic scholars in Pakistan, and in other Muslim countries, unanimously agree that deceased organ donation  is sanctioned by Shariah.

Superstition, ignorance and the fear of death that have given rise to a negative attitude to deceased organ donation in our society. People need to be told about death and grieving – especially of the need to talk about these phenomena. There is a need to help people see the beauty in the idea of saving lives.

What better strategy can be adopted than what the SIUT itself opted for, when it needed to popularise organ donation by living donors related to each other. Initially, this idea was too radical for people to accept. The battle had to be won if the SIUT’s kidney transplant programme, that was launched in 1985, was to succeed.

After the first few patients and their families had been persuaded to accept this miracle of modern medicial science, it became easy sailing. The patients and their donors became motivators for those who followed. The high rate of recovery of those with transplanted kidneys, along with the care and compassion the patients and their donors received, and the guarantee of life-long free medical cover, proved to be major incentives.

I remember Rasheed, Transplant Patient #1 who came from Azad Kashmir with his brother, who was the donor. They became the agents of change for patients visiting SIUT. There was Rukhsana, the medical student and Transplant  #9, whose sister helped her out. She went on to become a doctor.

Such cases became an inspiration for other patients and their families. There was a lot of interaction among the various patients and donors, but there were also the unfortunate ones who didn’t have a donor. How could their lives be saved?  The answer was:  by  deceased organ donation.

That is what the SIUT’s conference was all about. Pakistan has had five deceased organ donors,  now rightly described as  national heroes by SIUT. The first such donor was Naveed Anwar,  a student who was fatally injured in a  road accident. When he was certified as brain-dead by a team of neurologists, his family – progressive and enlightened – decided to fulfil his oft-expressed wish to be an organ donor if he met such a fate. Dr Razzaq Memon was another and his family also donated his organs in keeping with his will, in spite of some reservations from the biradari.

I mention these two because I have met their families and they have repeatedly endorsed deceased organ donation and their own role in the programme. And so it was that deceased organ donation made a debut in Pakistan. It should be noted that the first three donations were made even before Parliament had passed the law, which certainly helped in promoting the concept.

The inspiration provided by the five heroes, needs to be brought to the fore. The families should lead this campaign. They have experienced the pain of losing a loved one. They have also felt the inner satisfaction and peace that comes from saving a life. Their words will carry weight, just as the SIUT’s presence on a high moral ground in Sindh has kept the organ traders away from this province.

Source: Newsline May 2018

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Illusory happiness

By Zubeida Mustafa

THE recently released UN-sponsored World Happiness Report 2018 ranks Pakistan 75th out of 156 countries in terms of how happy their citizens are. That is progress. Last year, we stood at the 80th position. There has been rejoicing at what is seen as Pakistan’s superiority in the ranking table above all its neighbours which includes China and India.

This made me wonder because statistics — objectively compiled one presumes — have a different story to tell. The Sustainable Development Solutions Network, the author of the report, bases its findings on six indicators, namely, income per capita, life expectancy, social support, generosity, freedom and corruption. At least two of these are calculated objectively by many UN agencies (World Bank and UNDP). Continue reading Illusory happiness

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The dilemma of cancer caregivers

By Dr Zeba Hisam

DIAGNOSIS of cancer in any patient is not only stressful to the patient but also the family who looks after the cancer patient. Here in our country the patient and the attendants receive no counselling. When the oncologist suggests the line of treatment — surgery, chemotherapy or radiotherapy depending on the type and stage of the cancer — the  patient and his family have no inkling of the outcome. They are not told about the suffering the patient will undergo or his/her survival rate. Continue reading The dilemma of cancer caregivers

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Integrity above all

ZM with renowne playwright Haseena Moin

By Beena Sarwar

When a pioneering journalist pens her memoirs, you pay attention. Especially when she is Zubeida Mustafa of Pakistan, a long-time feminist and champion of social causes who, from her editorial perch at the daily Dawn, witnessed momentous transitions in the country’s media and political landscapes for over three decades. Beyond being a witness to change, she has also, as she realises with a thrill, “been a part of it, at times driving it and at times being driven by it.”

The narrative in this slim hardcover, My Dawn Years: Exploring Social Issues, is quintessential Zubeida Mustafa: direct, understated, deep, nuanced, thorough — and meticulously indexed. Black and white photos, though somewhat grainy, are well captioned, providing a pictorial reference to many of the events and people mentioned in the book. Continue reading Integrity above all

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Pakistan Has a Health Care Solution Worth Exploring

Patients in a waiting room at the Sindh Institute of Urology and Transplantation in Pakistan. (SIUT)

 

By Zubeida Mustafa

In a Third World country, “health for all” cannot be taken for granted, given the iniquitous provision of welfare and health care, combined with rampant poverty. So it comes as a surprise to me, a citizen of Pakistan, that health care should be the subject of such a fierce debate in the United States, where many of the problems faced by Pakistanis do not exist. This world power, after all, has the resources to provide the best health care for its people, if it wants to.

Yet Truthdig’s search engine brought up 708 results for the last few months when I keyed in the words “health care.” It was eye-opening. It is clear that, despite the heated argument surrounding the Affordable Care Act, or “Obamacare,” that marked the advent of the Trump administration and the president’s failed efforts to repeal it, the controversy has not been laid to rest.

Michael Winship’s article titled “One Nation in Sickness and in Health” very cogently sums up America’s health care problem. “It’s a given that our health care system, one-sixth of our nation’s economy, is a nightmare,” he writes. Winship attributes this “nightmare” to the “stinkers out there so quick to abuse the system and make a quick big fast buck, especially in the pharmaceutical and health insurance industries.” Winship argues that reforms are necessary to attain the ultimate goal of making “universal health care a right for every one of us.”

Ironically, we in Pakistan face somewhat similar problems to the U.S.—albeit on a humongous scale: The factors that have led to a flawed health care system in Pakistan are different. They are mainly scarce resources, an expensive private sector for a handful of elites, no feasible medical insurance and a government that lacks political will and sensitivity to upgrade the existing ramshackle health care system

Health reforms in Pakistan have met equally formidable resistance as in the U.S., where reforms in the health sector have always triggered major political battles. We in Pakistan have done slightly better at creating health care reforms from time to time, some of which were perfect on paper. But alas, these reforms were never implemented, even decades later.

So our quest for a health utopia continues. In an ocean of despondency, ill health and morbidity, we Pakistanis, however, have a few islands of excellence. One institution in particular has the greatest potential when it comes to offering health solutions in universally challenging circumstances: the Sindh Institute of Urology and Transplantation (SIUT). The SIUT, a tertiary care hospital based in Pakistan’s most populous city, Karachi, has been sustained for more than four decades, during which it has grown incrementally in size and reach. The principles that underpin the SIUT’s model of health care could be adapted, adjusted and modified by any country to suit its own circumstances.

As a starter, one needs full commitment to the precept spelled out by the World Health Organization: “Health for all.” Many Americans fight to uphold this concept as a universal right. And health care should be seen as a fundamental right of all human beings and be the ultimate goal of all states. Dr. Adibul Hasan Rizvi, founder and director of the SIUT, labels it the “birthright of every person.” This translates into his institute’s motto: “We will not allow anyone to die because he cannot afford to live.”

Rizvi adds, “We offer health care free with dignity to every one irrespective of colour, creed, caste or religious beliefs.”

Dr. Adibul Hasan Rizvi, founder and director of the SIUT. (SIUT)

And he means it. This is proved by the presence of mammoth crowds that throng the SIUT’s premises in search of succour. All treatment is free, despite the state-of-the-art technology involved, which is expensive. As might be expected, the overwhelming majority of the patients are poor, coming from the 39 percent of Pakistan’s population classified as suffering from multidimensional poverty, who have traditionally been denied adequate health care. At the SIUT, even the most costly laboratory tests or surgical procedures are provided for free, and the ailing are treated with compassion and dignity. “This approach hastens the healing process,” a bladder cancer survivor confided in me after he was pulled out of the jaws of death in this hospital. The SIUT’s Hanifa Suleman Dawood Oncology Centre offers cutting-edge technology for cancer treatment, and last year treated 34,420 patients free of charge.

In 2016, the last year for which consolidated figures are available, 1.1 million people received treatment at the SIUT. Services provided included 8.8 million laboratory tests, 367 renal transplantations and 302,037 dialysis sessions. These can be frightfully expensive, especially transplantation and post-transplant medications, which have to be taken for life. By making its services available and free of charge, the SIUT, with its high success rate, has saved hundreds of thousands of lives. By adopting this approach it has also intervened in the illegal organ trade in Pakistan. The southern province of Sindh, where the SIUT is located, has never experienced the ignominy of hosting an organ bazaar.

How has the SIUT’s miracle worked? The institute is a partnership between the government and the common man. The government facilitates the working of the institute, an autonomous body in the public sector, by partially funding it through budgetary allocations, physical infrastructure where available and project grants. The community’s role is crucial. While the affluent members of the public donate generously, the poor also drop a five-rupee coin in the collection box—such boxes are scattered all over the city. Businesspeople and industrialists have donated buildings and medical equipment worth millions. This combined effort makes it possible for the SIUT to expand—it now has 12 premises under its wings, with three outside Karachi. Donations enable the SIUT to provide free treatment to the community, which reciprocates by showing a sense of ownership toward it.

To instill this confidence in the public, the institution must be seen as delivering on its promises. Any health care system that benefits the underprivileged inspires confidence in the donors and becomes sustainable in due course of time.

People gathered outside the outpatients department of the Sindh Institute of Urology and Transplantation in Pakistan. (SIUT)

No donor wants to feel cheated, which is why wastefulness and profiteering are the biggest enemies of such a relationship. To sustain confidence, expansion at the SIUT is incremental and strictly need-based. It has grown from its initial six beds to 900 beds today. Other health care facilities have tried to emulate the SIUT, but after many adjustments, Rizvi says the viability of the SIUT model is successful because it has been sustained for 42 years, expanding even while the national economy has shrunk. In 1975 the Pakistani rupee was worth almost 10 to a dollar. Today, it is 110.

It is, however a young woman—Aymen Khan, 19—who is the best ambassador for the SIUT. Born with bladder exstrophy, a rare and dangerous bladder condition, Aymen commented, when I first interviewed her five years ago, “To God I owe my birth and to SIUT I owe my health.” Had it not been for the SIUT, Aymen would not have the normal life she leads today as a university student and sports enthusiast. Her family could never have paid her medical bills at a private health care facility.

Source: Truthdig

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Whither feminism?


IS feminism changing in Pakistan? That is the question that should be asked by those who are interested in women’s issues. That is the question that I pondered over at the Women’s Peace Table I attended recently in Karachi.

Organised by Tehrik-e-Niswan (TN) and a few other civil society groups, this gathering was the third in the series that was launched in 2015 on the call of the Peace Women Across the Globe. The idea is to encourage women to be involved in the peace process in regions in the grip of conflict. Continue reading Whither feminism?

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