Candle of hope

Dr Ruth Pfau: Photo by Dr Salamat Kamal

By Zubeida Mustafa

WHEN you start to despair — and we have too many occasions for that — go get the light of hope from someone who holds the candle. So I went to see Dr Ruth Pfau, who has been an inspiration for many, especially the most stigmatised of segments — her leprosy patients.

Even in her poor state of health in her hospital bed, Dr Pfau continues to be the candle of hope she has epitomised. She was hospitalised recently but is now in her own apartment in her neat and prim clinic. Of course, she is happy to be back home, she told me.

As I held her hand I could feel the “enrichment flow from her into me” to use her words. That is the role she has been playing since she arrived as a young woman of 31 in Karachi from Germany in 1960 and made Pakistan her home. It was chance that took her to the Lepers’ Colony behind the commercial offices on McLeod Road (now I.I. Chundrigar Road). The squalor and subhuman conditions did not deter her. Within three years, she had set up a proper leprosy clinic, now an eight-storey hospital on Shahrah-i-Liaquat, and the hub of 157 leprosy centres all over the country. There followed an arduous journey of over five decades devoted to “serving the unserved”. At no stage has her commitment slackened. Continue reading “Candle of hope”

Where the ill lies

By Zubeida Mustafa

“THERE has been an enormous overproduction of uneducated and ill-trained medical practitioners … due to the existence of a very large number of commercial (medical) schools … which are profitable business.”

Does the above refer to Pakistan? It doesn’t but it could as it is an apt description of the conditions prevailing in the country. The words above are from Abraham Flexner’s 1910 report on the state of medical education in North America. It led to the closing down of 124 of the 155 medical schools operating in the US and Canada at the time. Continue reading “Where the ill lies”

The magic crop

By Zubeida Mustafa

THE existential threat that Pakistan faces today is the insidious devastation of our human resources. It is a silent crisis, yet to be recognised, as an entire generation of children faces a slow death by malnutrition.

Denied basic nutrients — especially protein — essential for their physical and cognitive growth in the critical first 1,000 days of life, the majority of children never enjoy the same health and mental growth as that of a normal well-fed child. Paediatricians tell us that the damage done during this window of life — from conception till the second birthday — cannot be reversed. We have been warned, but nothing stirs us out of our complacency.

According to the Pakistan Demographic and Health Survey 2013-14, 45 per cent of children under five in Pakistan are stunted while 30pc are underweight. That means many of our children are denied the capacity to realise fully their learning and growth potential. Malnutrition also affects their mothers who give birth to them.


New solutions are needed to provide nutrition to children.


This is the real food insecurity that Pakistan faces. Its grim implications are not reported by the media because we do not have too many deaths by famine. But, silently, the minds of our children are dying. It is an irony that we cannot feed the little ones when nature has blessed Pakistan with an abundance of wheat. Poverty and the unaffordable price of wheat mean that children are being starved of nutrition. The decline in official subsidies over the years and the rising cost of inputs has put food beyond the reach of the common man.

It is time to think of new solutions, especially in terms of providing nourishment to children. The Food and Agriculture Organisation has the answer in quinoa, which has been dubbed as the miracle grain, the magic food and, above all, the complete protein possessing all the nine essential amino acids needed to build the body and brain of a growing child.

Another major advantage it offers is its low cost of production and its natural adaptability to diverse climatic conditions. FAO, a vocal advocate, declared 2013 as the International Year of the Quinoa.

The grain, it is claimed, has many nutritional properties and is also cheap to grow. Dr Shahzad Basra, professor of agronomy at the Faisalabad Agriculture University, is an ardent supporter of the quinoa and has been doing research on the seed since 2009 when he imported some germplasm from the US Department of Agriculture to test it in Pakistani conditions.

According to him quinoa is gluten-free, rich in protein (15-19 pc), has many minerals such as zinc, magnesium, manganese, etc and a low glycemic index. Wheat, our staple grain, has only 13pc protein. Dr Basra also points out that quinoa is a resilient crop that is not affected by unfavourable weather, thrives in saline soil — clayey or sandy — and is drought resistant. The yield per acre is 800 kilograms. This is much lower than that of wheat. But I presume the yield of quinoa will grow with more research and cultivation.

What I find strange is that given these advantages, why is quinoa not being promoted in a big way in Pakistan? According to Dr Basra’s information, quinoa is cultivated on 800 acres (a little over 300 hectares) or so which means a production of 640,000kg a year, most of which is exported. It is true that a culinary taste for quinoa has yet to be developed. That calls for a public campaign in a land of wheat eaters.

This is worth it as quinoa has done well as the staple food of the Andean region in South America where the indigenous populations have preserved the crop carefully with their traditional knowledge and practices.

From what I understand, the government has not tried to promote quinoa at all. Those who have, including some resea­rchers and cultivators, have focused on its rich potential as an export item. As prices have risen in the world market, local production has increased somewhat in the last three years. As a result, the price of quinoa, Dr Shahzad tells me, has declined in Pakistan from Rs3,500 to Rs400-600 per kilo.

It is time we thought of our children. The government needs to draw up child-centred nutrition programmes focused on quinoa. This is possible if a policy is adopted to indigenise the grain and devise ideal agricultural practices to maximise its production. It need not displace wheat. Given its easy-to-grow properties, tillers could grow it on land that is not fit for wheat cultivation. Why not distribute the ‘barren’ land among small farmers and show them how to grow the magic crop?

Sensible pricing and export policies could ensure affordable prices with export being allowed only above specified ceilings after local nutritional needs have been met. Small entrepreneurs should step forward to produce cereal and baby food.

Source: Dawn

 

 

Physician let a colleague treat you

By Zeba Hisam

TODAY I am writing this while waiting for my turn for physiotherapy for my right hand carpal tunnel syndrome. I had been having severe pain that became worst on twisting movements and pulling or bearing weight on this hand. First I took a painkiller regularly without any benefit then kept on complaining about pain and was scolded by my mother and elder sister to consult a doctor and not to treat myself. I got all my lab investigations done which came out to be normal ( CP, ESR, CRP, uric acid, RA factor and T3, T4, TSH and the x-ray of my wrist). I was convinced that it was carpal tunnel syndrome as I previously got a persistent parasthesia on my right hand so I got an appointment with my teacher, Professor of neurology, Dr. Abdullah, who endorsed my diagnosis and sent me to this amazing physiotherapy Center named “Neurology & Falij care Center”! He advised me to get my physiotherapy done by the specific lady physiotherapist. So it’s my third session today and I do the exercises advised by her regularly at home multiple times. I hope and pray that improvement will come soon. 

I am writing this because I want to warn and advice all doctors who are even specialist in their own specific fields, to please consult a doctor if you have any complaint and do not let yourself be treated by yourself considering yourself as a self sufficient doctor! As we take the history of a patient then we examine the patient physically in a proper set up of our clinics to make a diagnosis so like that, we also need to be examined in the same manner by another professional doctor and trusting that doctor and following the advice given!

I give an example of my doctor friend who got fever with sore throat. She followed her own advice by assuming a viral infection so didn’t take any medicine and neither got any tests done. After a few days she was sick enough to not come out of bed. She mentioned this to another doctor who met her by chance. That doctor said that her husband had the same sickness and he got well by a five day course of tablet Levofloxacin. On her advice, she took that medicine and deteriorated further. I also met her by chance and found her unable to talk and walk. She was in need to be on a hospital couch to be examined by me or any other doctor. Her super spirits kept her working and she told me that everyday her fever settles with panadol tablets and she comes to work! It was beyond my comprehension! She consulted me on her way by standing in the corridor and asked me for some appropriate medicine? How could I answer that without even taking her proper history and physical examination? This I am telling you about a specialist doctor’s behaviour on illness and not of a layperson! 

One of a colleague gynaecologist working in the same hospital,  came to me one day with complaints of dizziness and feeling of doom. I checked her vitals and found her blood pressure to be 200/120 mmHg. I advised her to get admitted and get her tests done but she said there is no history of hypertension and lately she had a few episodes otherwise she was fine and was not taking any medicine. Although every time she had this episode she used to go to the emergency department to lie down on a bed with a sub lingual Capoten tablet given by emergency duty RMO and after half an hour, she would return to her  OPD for examining her patients! (How could she ignore her patients)! She never checked her blood sugar level or lipid profile or electrolytes or urea and creatinine! She was so oblivious of hypertension’s complications! So at times we can give only a sincere advice and let the doctor decide what he has/she to do! 

So doctors! Take a break if you are sick and consult another doctor to help you by examining and treating you with an appropriate diagnosis!

The writer is a Consultant Physician at the Zubaida Medical Center, Karachi

Sent from my iPhone

Click here to Reply

Right vs wrong

IN a society as morally perverse and corrupt as ours, does a centre of ethics have any relevance? A cynic’s answer would be a resounding ‘none whatsoever’. The idealist/reformer would say, ‘all the more’. That is a dilemma that faces all activists in this country seeking to light the spark of change.

In this context, the SIUT’s Centre for Biomedical Ethics and Culture (CBEC) faces a daunting challenge. It has been struggling for the last 13 years to introduce an ethical perspective not just in healthcare but also in the non-medical sector. Its endeavours became meaningful and received international recognition when last week WHO declared the CBEC a Collaborating Centre for Bioethics — one of the eight to receive that prestigious status worldwide. Continue reading “Right vs wrong”

Blame rests on ….

By Zubeida Mustafa

IN August, Pakistan will be celebrating the 70th anniversary of its independence. This has understandably spawned a spate of soul searching. It was in abundance at the Karachi Literature Festival. The session titled “Pakistan: a fragile state or resilient nation” focused entirely on the state and didn’t address the issue of resilience at all. The state was held responsible for all the evils that have befallen us.

Unsurprisingly, the speakers concentrated on identifying the villain of the piece that was said to be the ‘state’ — an abstract term. As the discussion proceeded, the state became the “invisible state” and then the “deep state”. The audience clearly understood that these terms referred to the army which has played a central role in determining Pakistan’s destiny. Continue reading “Blame rests on ….”

The secret of success

By Zubeida Mustafa

Why is the SIUT a success story when other health institutions in the public sector in Pakistan have failed? This question is frequently asked by people who are wonderstruck by the SIUT’s performance. Few can believe that this immaculate  hospital that sprawls before them is in the public sector. It has taken it 40 years to reach its present greatness. And it is still growing.

The only feature that betrays its ownership is the over-crowding you see there. Being in the public sector, this tertiary healthcare institution attracts all and sundry. Moreover it is a hospital that is affordable and actually works, where people are treated and recover from their illness.  Continue reading “The secret of success”

Message of hope?

 

By Zubeida Mustafa

IN these times of despair, even the dead can give us hope and inspiration. That is the powerful message that emerged from the Orangi Pilot Project-Research and Training Institute’s forum on Jan 22. It was organised to commemorate the birthday of Perween Rahman who was shot fatally in March 2013.

Why was Perween killed? It might sound bizarre but the fact is that there are vested interests in our society who feel threatened by people who work for the poor. That was confirmed by SP Akhtar Farooqi who said on the occasion that the murder was not motivated by personal enmity but by economic factors. Continue reading “Message of hope?”

Loss of dignity

By Zubeida Mustafa

A FRIEND sent me his greetings on New Year with this verse: “Apnay haathon say dastar sumbhaloon kaisay/ Donon haathon mein kashkol pakar rakha hai.” (How should I hold up my turban when I hold the begging bowl with both my hands?)

The truth of this verse hit me when a news item in this paper reported the proceedings of the Senate recently. The government had come under fire from a PTI member for piling up external and domestic debts to such proportions that servicing them was becoming impossible.

One should not dismiss this as political gimmickry to embarrass the ruling party. After all, which party in Pakistan has even attempted to be self-reliant by adopting austerity as a policy to reduce the government’s dependency on loans? With few parties remaining in office for too long, every ruler spends money with abandon knowing that the chickens will come home to roost when he will not be around to cope with the problem. Continue reading “Loss of dignity”

A hill station in decay

The snow covered Thandiani mountaintop in the background  can no more be seen from a point of one's choice due to buildings like this one.
The snow covered Thandiani mountaintop in the background can no more be seen from a point of one’s choice due to buildings like this one.

By: Nasser Yousaf

guest-contributorAbbottabad. The name sounds romantic. But romantic it is no more. The small hill station, named after its first district administrator, is not even a shadow of its former glory. Sir James Abbott had been so greatly enamoured by the pristine beauty of his place of posting and temporary abode that he wrote an emotional poem in its praise. Continue reading “A hill station in decay”