Category Archives: Health

Coach Emad

By Zubeida Musrafa

LYARI and Boston. A world separates them. But they have a common connection. Coach Emad. That was the young man of 24 with a passion for football. He passed away in May 2018 leaving his family shattered. He died “of suicide”. That is how his mother, Atia Naqvi, a psychologist, puts it.

Mental illness is on the rise in our society, she tells me. It can lead to suicide. Yet we do not want to talk about it because of the double stigma. Mental illness is “disgraceful” but suicide is worse.

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How we grow

By Zubeida Mustafa

MAHNOOR is 13 years. She studies in the afternoon shift of a school in Neelum Colony. Mahnoor is often late for class because she babysits her six-month-old brother. Her mother is a domestic worker and is away from home the whole day. Mahnoor can go to school only when her nine-year-old sibling returns home from his school to take charge of the baby.

The failure of population planning in Pakistan has robbed many Mahnoors of the joy of childhood and has impacted their education. It has also frustrated our policymakers who have another story to tell. The backlog of 22 million out-of-school children in the country may never be wiped out as 4m new aspirants join the list of admission seekers annually. The government’s capacity to open new schools is limited.

Continue reading How we grow
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Saving mothers

By Zubeida Mustafa

TWENTY years ago, nearly 400 mothers out of 100,000 giving birth in Pakistan died. This phenomenon, referred to as the maternal mortality rate, has come down to 178 per 100,000 today. This is remarkable progress when seen in our own context. One may attribute this to better childbirth practices and immunisation of expectant mothers.

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Joy of giving

By Zubeida Mustafa

PAKISTAN is a bundle of contradictions. We have acquired the latest technologies in medical fields. But we have failed to keep pace with these changes. In fact, socially, we have stagnated if not actually regressed.

Take the case of organ transplantation, which has made great headway in the country thanks to the Sindh Institute of Urology and Transplantation. The institute provides free treatment to nearly 2.6 million patients every year, and performs 350 kidney transplantations from live-related donors. The SIUT also provides free-of-cost, lifelong healthcare to the donors as well as the recipients.

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A dubious solution

By Zubeida Mustafa

THE Pakistan Medical and Dental Council (PMDC) is once again in the limelight, unfortunately for negative reasons. An ordinance signed last week by the president (himself a dentist by profession), who should have understood its implications better, provides for the constitution of a 17-member council to run its affairs. The PMA, the body that represents the doctors, has rejected the ordinance on the grounds that it is ‘undemocratic’.

The document provides for members of the PMDC being nominated by the prime minister, the chief ministers of the four provinces, the College of Physicians and Surgeons Pakistan (CPSP) and the armed forces. Its tenure will be for three years and it will elect its own president. Its composition is diverse with some laypersons also being included to represent the public in addition to the medical professionals. The sceptical response from some quarters is understandable. It is feared that the ordinance will allow some vested interests to monopolise control of the PMDC for their own advantage.

The fact is that the PMDC has had a controversial history from the start. It was introduced by the Ayub regime in 1962 through an ordinance and since then has mostly depended on ordinances for its existence. On some occasions, the government of the day (the PPP in 2012 and the PML-N in 2014) brought the PMDC issue before parliament for enacting a law but that was jettisoned by a subsequent ordinance. The approach has basically been an ad hoc one.

Continue reading A dubious solution

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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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