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”

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

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

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

 

How we grow

By Zubeida Mustafa

IS the world really waking up to the population crisis that received a lot of international publicity at the London Summit on Family Planning last week? One wishes it were. But all the noise seems to be emanating from the developed states which have managed their own demographic affairs very well while generously supporting the Third World countries’ population programmes. Their success is to be attributed mainly to their strategy of working honestly within a holistic socioeconomic framework.

Unfortunately, developing countries, which are the biggest contributors to the galloping global population growth and that have restricted resources, have shown a poor record. According to the UN, the current world population stands at 7.6 billion and is expected to be 8.6bn by 2030 and 9.8bn in 2050. The world has roughly 83 million new mouths to feed every year. Continue reading “How we grow”

No child’s play

By Zubeida Mustafa

FOUZIA is 13 and is employed by a working mother of two children. Fouzia is the victim of oppression on three counts. She performs the duties of an adult woman, which would be classified as child labour. She is not attending school as is compulsory for children from five to 16 years of age under Article 25-A of the Constitution.

Above all, she will soon be another example of early marriage as she is said to be engaged. The wedding will take place as soon as she has earned enough for her dowry. In the process, Fouzia has been robbed of her childhood and an education.

These deprivations do not bother this young girl’s family. Their sociocultural norms and, according to many, poverty have landed her in this ugly situation. According to Unesco, from 1987 to 2005, early marriage was the fate of nearly 32 per cent of all children in Pakistan. Continue reading “No child’s play”

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