| December 3, 2005 | Saturday | Shawwal 30, 1426 |
To send a letter to the Editor
Click here
Glittering India — not really
Vitamin E for heartcare
Extravagant weddings
A holocaust
Plastic bags
Congo virus death
Preventing pollution
Raiwind moot
Language issues
Retired generals
SEVEN weeks after the earthquake, the rescue operation is over, the survivors with serious injuries have been lucky to have received initial treatment and are recuperating. The few unfortunate ones in remote areas are still waiting for help. The second phase of providing shelter, clothing and food has now attained urgency in view of the upcoming winter.
The debate on the future rehabilitation, rebuilding and fund disbursal has started. The army has reacted slowly and monopolized the operation while the civil society has reacted sharply with brimming compassion which has shown the new face of the ordinary Pakistani.
At least 3.3 million who survived have gone through an “experience beyond human endurance” and amply qualify to suffer from post-traumatic stress disorder (PTSD). Trauma of such intensity leaves emotional scars that change the entire personality of a person. PTSD consists of (1) re-experiencing trauma, (2) avoiding stimuli associated with trauma, (3) loss of interest in self, family, job or future and (4) hyperarousal symptoms are hypervigilance, startled response, insomnia, night terror, irritability, anger, persistence of fleeting concentration and anxiety. Depressive disorder may follow.
There are not enough mental health professionals in Pakistan and the task of treating these people is gigantic. This calls for innovation.
Recognizing the quantum of emotional problems in the post-rescue period, the Pakistan Association for Mental Health worked with mental health professionals in Karachi to draw up a plan of action which basically calls for the training of lay volunteers for psychological support (basic skills for individual and group counselling). A manual was prepared and 60 volunteers were trained in Karachi within two weeks of the earthquake.
A team went up to train groups of 15 at Mansehra, Abbottabad and Islamabad, besides conducting group therapy sessions. The PAMH with the help of other institutions has plans to send teams of psychiatrists and psychologists to defined area for the next three months at least. But this is not enough.
Our observation is that the current mental state of a large population in the affected areas is going through an extended period of grief. They are those who may go into more serious PTSD. A majority can be saved by just actively listening to them, ventilation and assurance but with a difference. Our experience in the region is that the entire social support system of a mohallah or city has been destroyed. They have no one to talk to and no one approaches them to listen to them. The goodies handed over to them are not what they want. They are craving to be heard and wish to share their ordeal. In our opinion it is urgently needed that a large number of volunteers, specially women, should visit the area and spend time with a family (in tents). The PAMH, therefore, appeals to the student population of the country to go in batches of 25 or 50, spread out in camps and listen.
“Listening” and “reassurance” in such extraordinary situation is different and need few guidelines. The PAMH has prepared two days workshop manual for serious volunteers and guidelines for the proposed team of young “soother” (volunteers).
With this letter goes a request to the principals of colleges and Vice-chancellors of all universities to swarm the tented city with the “soothers” but only after they have received instructions on “Do and don’t”. PAMH will be glad to conduct a brief workshop for such students. We will soon issue the outlines of instructions about active listening in grief situation.
PROF. S. HAROON AHMED
President, Pakistan Association for Mental Health
Karachi
THIS is in response to Vipul Thakore’s letter of Nov 26. Mr Thakore’s assertions are a figment of his own imagination and are not based on facts. It would be necessary if some “true facts” regarding his own country of over a billion people are shared with readers.
Considering the economic base of India and the areas which now constitute Pakistan in 1947, Pakistan virtually started from scratch. In India, there were quite a few fully operational steel mills, plus other industrial bases at the time of independence whereas Pakistan was deprived of its genuine share of resources. Keeping this in view, Pakistan’s economic and industrial progress has been rapid and commendable. An average Pakistani’s standard of living and other facilities of daily use available to him are far superior to what his Indian counterpart has access to. If India has produced brilliant scientists, mathematicians and engineers from its institutes of technology, what have they done to alleviate the sufferings of such a huge population living in abject poverty? Are there no electricity failures, train accidents, unavailability of water in the country which boasts a 5,000-year old civilization?
It is indeed interesting that indian engineers have not been able to develop a 24-hour uninterrupted water supply system even for the national capital, New Delhi. Except for the Delhi metro, no other noticeable engineering achievement can be claimed by any Indian engineer. In fact, no indian building finds a place in the list of 100 tallest buildings of the world. Their government introduced colour television six years after Pakistan. Up to this day, it has not been able to launch a computerized national identity card or a computerized passport service for its citizens. If India has made strides in software export and other electronic equipment, what is the trickle-down effect to the common man?
The slums of Kolkata and Mumbai do not give the impression of an industrially and economically prosperous country. As far as corruption is concerned, nearly every Indian politician of note has been involved in some kind of scam. The tales of Laloo Prasad, George Fernandes and most recently, Natwar Singh, are a case in point. Can Mr Thakore identify what percentage of members of Bihar’s provincial assembly have a clean record? These are but just a few examples.
Now for terrorism, it is an extremist minority in Pakistan which got trained and started resorting to terrorist acts during the struggle for the Soviet pullout from Afghanistan. Since then, Pakistan’s government has effectively reined in those elements. Pakistan’s contribution towards international war against terrorism is highly praised and is definitely enormous. In India, even a commoner becomes a terrorist when he is involved in the massacres of Sikhs in 1984, or of Muslims in 1992 and 2002.
In the end, I would like to point out that the people of Pakistan are thankful to the $25 million in aid pledged by the Indian government for the earthquake victims. But, objective reality about India should be highlighted by its people. India is not what is depicted in its 300-episode television soap operas, It is in fact synonymous with the nearly 500 million people who live below the poverty line.
UMAR M. MAKHDUMI
Karachi
SOME Americans had asked for Dr Donohue’s input on his reading that users of high doses of vitamin E do not live longer.
Dr Paul G. Donohue answered the query (The Review, Dawn, Nov 24-30) that “it’s been found that people who take 265mg (400 IU) or more of vitamin E are not getting any heart benefit and are at a slightly greater risk of suffering from heart failure. The recommended daily dose of vitamin E for people 19 and older is 15mg (23 IU).”
I have been taking vitamin E 400mg (603 IU) for several years. I stopped taking it, the day after reading Dr Donohue’s opinion. My wife also discontinued its use who was prescribed only a couple of months ago by a doctor, MD(USA).
My purpose of writing this letter is (i) to bring to the notice of the readers who may have missed the said issue of The Review, (ii) to solicit the views, through these columns, of the cardiologists practising in Karachi and other cities, (iii) to know from reputed cardiologists whether or not vitamin E is of any benefit to heart and (iv) it would benefit readers if the cardiologists comment on the opinion of Dr Donohue.
In the end I suggest that the health ministry should make half-yearly or yearly refresher short courses, seminars, etc., mandatory for all specialists as in the US. In Pakistan, such refresher courses can be organized by the College of Physicians and Surgeons but the lecturers for these courses should preferably be from the US, or from the UK.
Refresher courses for the general practitioners (MBBS) according to their level should also be made mandatory. Such courses are necessary for the GPs as after passing their MBBS examination they continue to practice for decades. Their only source of knowledge of new drugs is the medical representative.
Refresher courses for the GPs may be conducted by the general or family medicine specialists (MRCP, MD and FCPS) who have themselves undergone a refresher course conducted by the College of Physicians and Surgeons. Unfortunately, there is no protection to the patient like in the US where doctors take insurance to pay damages in case a patient dies or suffers due to the negligence of the doctor. This aspect also needs serious consideration by the health ministry or any other competent authority.
PRO BONO PUBLICO
Karachi
IT seems we feel no shame or consideration for our country and its deprived people. Thousands of people are dying of hunger, starvation, cold, lack of warm clothes and shelter and in cities like Karachi one can see people planning extravagant weddings.
At such weddings, the bride wears tons of make-up and very expensive clothes and jewellery. The guests in attendance can hardly see the couple since they are surrounded by umpteen photographers and relatives. And when dinner in announced — which does not happen before one or two in the morning — the guests run to the food table as if they haven’t eaten in days.
The justification usually given for spending so much on wedding functions is that these come once in a person’s lifetime. But with the world changing and coming to be what it is today, the once-in-a-lifetime reason can hardly be a handy excuse.
FATIMA FUTEHALLY
Karachi
MY good friend Minoo P. Bhandara has recently written in your paper the following: “No single deed in modern history is more wicked than the Holocaust”. I would submit to Mr Bhandara that more consideration should perhaps be given to tragedy that led to the elimination of the native Indian population of North and South America, in which 16 million were systematically murdered, over some four hundred years ago and for the purpose of grabbing rich lands and gold. Also, what about the kidnapping of Africans and their subjugation into slavery for commercial use? Furthermore, we are today witnessing the abuse of the environment, again for commercial advantage, by rich nations and one day this may prove to be the most wicked deed of our entire history.
SAEED Y. CHINOY
Karachi
I would request the media to launch a campaign against the use of plastic bags. The government must adopt legislation to ban the use of plastic bags for shopping purposes. People need to be educated on the harm that plastic bags do to sanitation and the environment. I remember that when I was young we used to shop using bags made of paper or cotton. We should go back to the same old system.
SHARIQ HILAL
Kuwait
THIS is with reference to your editorial “Congo virus death” (Nov 24). Earlier on also while reporting the outbreak of this disease and the death of a young doctor in Islamabad you had drawn attention to the inadequacies of public hospitals to deal effectively with an infectious disease of this nature (March 7, 2002).
At Karachi, hundreds of doctors now believe Dr Yusra Khalid died of this deadly disease. Some persons have also expressed the possibility of her having contracted the disease in Malaysia.
The incubation period, i.e., the time which elapses between the invasion of the body by the micro organism and the appearance of signs and symptoms in the CCHFF, is only two to nine days. If she returned on Aug 28 from Malaysia, she must have caught the infection in Pakistan. Let there be no doubt about it.
Others have opined about contracting dengue haemoulogic fever which is transmitted by the bite of an infected mosquito called aedes aegypti. It is characterized by blackish colour with white bands on its body. This species of mosquito occurs abundantly in Karachi and its density exceeds that of malaria transmitting mosquito; the anopheles. Let us accept that cases of both Crimean Congo haemorrhagic fever (CCHF) and dengue haemoishagic fever (DHF) have been occurring in Karachi.
Now that the Sindh health minister has constituted a committee of three senior doctors, it should determine as to what exactly afflicted Yusra Khalid (May God bless her soul).
During June-July we carried out a study with the help of medical students to determine the degree of vulnerability of our doctors to infectious diseases and emotional trauma, as a result of the occupational hazards to which they are exposed. The study was carried out in four tertiary care hospitals of the city. Serious lapses have been observed both about the inadequacy of protective equipment, clothing and desired hygienic practices.
The PMA’s plea that there is an urgent need to consider the establishment of laboratories for diagnosing diseases like viral haemorrhagic fevers should be given urgent attention. Sending specimen to NIH and thence to South Africa leads to loss of time and creation of more complications without resolution of the problem.
Mr Arman Sabir has quoted an important person: “We do not take it seriously as the haemorrhagic fever has never spread like an epidemic in the country” (Nov 26). In case of high case fatality rate of CCHF, such ailments should be taken very seriously. We do not have to wake up only when an epidemic has occurred and hundreds have died.
As for the demands of young doctors (Nov 24) I think all reasonable people even outside the medical community will support them. I differ on only one point. A house officer should not hesitate to draw blood, set up drip and canulas. Nurses and paramedical staff are equally important and deserve to be protected like the medical officers.
DR KHALID HASSAN MAHMOOD
Professor of Community Health Sciences,
Sir Syed College of Medical Sciences for Girls, Karachi
THIS has reference to the letter “Preventing pollution at ports” (Nov 27).
The preparedness of the Karachi Port Trust to respond to oil spills is exemplary, complies with the provision of international conventions. This has been noted by almost all international experts who have visited the marine pollution control department of the KPT during the past several years.
The department is adequately equipped and trained to respond to medium-sized oil spills and this resource has been used to address spills not only at the Karachi port but also the 1,000 tonnes oil spill at Fotco terminal at Port Qasim in December 1999.
The oil spill contingency plan of the Karachi port mentioned in the letter is well in place since 1996 and is being updated regularly. Training and exercises on oil spill response have been provided by the KPT to many organizations concerned and the oil industry during the past few years.
As regards books and publications on oil spill response, the KPT has distributed 41 complete sets of these books to the relevant officials of organizations, including the oil industry, which have any role to play in oil spill response.
Fencing of tankers is done at some ports but at heavy cost to tanker owners. This facility is also available at the Karachi port for tankers if they want it.
The marine pollution control department of the KPT conducts a wide variety of activities, besides the oil spill response. The efforts of this department have paid dividends in terms of cleaner harbour and the previously dominant oil patches have almost disappeared from the water surface. The KPT has also acquired a special debris collection boat which has greatly enhanced the capability of the KPT to respond to the heavy ingress of floating garbage in the Karachi harbour from the city.
The influx of pollutants in the Karachi harbour from land-based sources is a major environmental issue and warrants cooperation of the relevant organizations as this can best be handled at source, i.e., prior to discharging in water bodies.
MANAGER
(Pollution control, KPT),
Karachi
THIS is with reference to your report on the Raiwind moot (Nov. 27). I agree that millions of rupees spent on the conference could have been diverted to earthquake relief. But more importantly, the millions who participated in the event could have instead travelled to the quake-affected areas to do some volunteer work.
KHALID A.
London, UK
THIS is with reference to Tahir Aslam’s letter “Language issues” (Nov 28). It is true that one can not deny the importance of the English language in today’s world, and that English has now become the language of science and technology.
However, one can also not deny the importance of national or regional languages. Mr Aslam’s statement that these languages have no role in the development of a country seems to be based on a lack of knowledge of these languages. The fact is that these languages have a profound effect on the nation, playing a key role in the socialization of the Pakistani people.
The rich literature owned by these languages contributes considerably towards enhancing people’s commonly shared values.
SAQIB ALI KHAN
Lahore
RETIRED army officers eye to get a civilian post after retirement from the army and think this to be their legitimate right. Similarly, there seems to be no justification for having a large number of retired and serving military officers working on lucrative contracts in almost all government departments.
In fact, the situation is such that the current job market has become hostage to retired bureaucrats and generals looking for jobs. Those who have played — in most cases a very long — innings should go back to the pavilion gracefully and let others play instead. I would like to know why retired military personnel continue using their military ranks even in civilian jobs?
DR TAHMINA RASHID
Melbourne, Australia
You can also send letters to the Editor
Just send your message to the following address: letters@dawn.com
Make sure you include your full name, postal address, e-mail address, and in the case of Pakistan your day-time telephone number.