| May 30, 2007 | Wednesday | Jamadi-ul-Awwal 13, 1428 |
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Compressed oxygen in hospitals
Problem of Palestinian sovereignty
Opting for better options
Smuggling is a great mess
Primary healthcare initiative
Steroid in toothpaste
Lal Masjid
Rise in swara
Indian onslaught
Readers are requested to restrict their comments to a maximum of 400 words. We reserve the right to edit letters for reasons of clarity and space. Letters, including those by e-mail, should carry the complete postal address of the sender. The views expressed in these columns do not necessarily reflect the views of the newspaper.—Editor
THIS is in reference to the news items appearing in the national press about two young persons from Punjab who have been labelled as the ‘she-couple’, and the sensational way in which the events, especially involving Raj, are being portrayed.
I write in my capacity as a physician who has taken care of many individuals born with medical conditions that fit within the broad category of gender ambiguity or transgender disorders. These are conditions over which the affected individuals have no control and which can lead to tragic consequences for them and their families.
I am, therefore, appalled and horrified at the insensitivity and ignorance with which this couple is being dealt with.
Whether one develops the identity of a ‘she’ or a ‘he’ in life depends on a combination of factors that include the chromosomal structure which will determine whether testis or ovaries will form in the foetus, the external appearance of the genitalia at birth, and the gender in which the parents raise the child in the first two to three years of life. The majority of us are fortunate that at birth all these factors ‘match’ and thus there is no unclarity in our gender.
However, there are well-known, well-reported medical conditions in which a child is born with various mixtures of the above three factors, leading to gender ambiguity at birth. The vast majority of our physicians are unfamiliar with these conditions and such children often remain undiagnosed at birth.
I have managed many children raised as ‘girls’ who were brought to me at puberty because they had begun to sprout facial hair and undergo a change in their voice.
Psychological assessment revealed many to be clinically depressed and sometimes even suicidal.
The issue of gender ambiguity is complex and requires specialised medical and psychological experts for diagnosis and management. Raj is said to have been examined by a ‘panel of doctors’ and determined to be a ‘she’. From the news reports available it is unclear on what basis this opinion was formed and what was the background and expertise of the doctors involved in this assessment.
What is evident, however, even to a ‘non-medical’ eye is that Raj’s photographs appearing in the newspapers reveal a normal male facial hair distribution and a normal male body physique.
One of the most regrettable parts of the story is the insufficient attention being paid to the social context within which the two young people took this step. Shahzina Tariq has reported (Dawn, May 21 and May 23) that she was being forced by her father and uncle to marry against her wishes, and that her father had threatened to kill her if she refused.
This case raises not only troubling questions about our lack of understanding of a complex medical and psychological condition by dismissing it merely as a ‘sex change’, but also profound concerns about our lack of compassion as a society and our strange notions of what constitutes justice.
DR FARHAT MOAZAM
Sindh Institute of Urology and Transplantation,
Karachi
EVERYBODY is sensationalising the plight of the couple from Faisalabad, who if they thought had done anything wrong would not have approached the court to provide them security, as they were being harassed by their relatives, who allegedly wanted to trade the girl to settle a debt.
Do we not remember the same press giving headline to news like ‘Vehari ki Mussarat Khalid ban gayee’, well I do, with pictures of the proud parents claiming they always wanted a son (well who doesn't in the Islamic Republic). There were quite a few reported cases which are just the tip of the iceberg, as most are kept as secrets keeping in view our ‘tolerant’ society.
Well anyway where do you think are those ‘men’? I am sure living among us, trying to lead as normal lives as possible, and why not, it wasn’t their fault that they were born as one sex, while their apparent sex was otherwise. Who are we to ostracise them because we are fortunate to be normal.
We know of some cases where the marriages have been arranged by the families with both the parties aware of everything and they are living normally for years.
So please let us be civilised for a change, and stop giving fatwas on each and every matter, by considering it to be influenced by the distorted values of the West. I am also surprised by the doctors’ panel who did not go beyond the physical findings.
Let us live and let live.
DR S AHMAD
Lahore
I WOULD like to draw your attention to an important issue of unprecedented price hike of ‘liquid’ and ‘compressed’ oxygen to hospitals by the suppliers. Oxygen is one of the most important and highly demanded of the medical gases in hospitals.
This is delivered by the suppliers mainly in ‘compressed’ and/or ‘liquid’ forms. In the former case, cylinders are used for the delivery while the latter is delivered through tankers to specially-designed storage tanks in hospital premises.
There are only a couple of suppliers of this item and thus they enjoy a monopoly in the market. Due to a poor regulatory control of the government and rampant corruption, these suppliers are in the habit of unannounced price revisions as and when needed. The customers under the potential threat of non-availability have to succumb to their demands.
In 2007 the price of ‘liquid oxygen’ has registered a rise of 70 per cent in five months. Last year it was delivered at the rate of Rs35 per cubic metre and now it is being delivered at a rate of Rs60 per cubic metre.
Similarly, the rates of ‘compressed oxygen’ have been increased by 40 per cent in the last five months. Previously it was delivered at a rate of Rs25 per cubic metre and now the rate is Rs35 per cubic metre.
As you are aware, oxygen is needed as a life support in most of the critical as well as normal settings. On average a patient consumes four to five cubic metres of oxygen in 24 hours.
The number of such patients are very high in intensive care units, coronary care units, accident and emergency departments, operation theatre complexes, labour room complexes, general wards and private rooms.
In a tertiary care hospital setting of 500 beds with full occupancy, there are around 150 to 200 patients who need this support.
Average per patient per day cost under the present rates comes around Rs250 to Rs300. Thus hospital has to spend around Rs35,000 to Rs50,000 a day to meet this demand.
In a poor country like Pakistan where hospitals in the private sector depend upon philanthropist support and in the government sector on revenues collected through taxes this posses a huge financial burden and ultimate sufferers are the poor patients.
The health regulatory authorities should look into the issue and devise stringent policies to exercise a price control of this precious commodity, alleviating the sufferings of the common man.
Moreover, the government should exempt liquid and compressed oxygen from general sales tax, which at present is at an exorbitant rate of 15 per cent.
DR SYED K . J. MAHMOOD
Lahore
“FOUR Palestinians militants were killed in a car in a new Israeli air raid in Gaza and it threatened to hit Hamas leaders unless rocket fire stops” (May 22). This cannot deter the people fighting against the foreign military occupation. Let us look into the background of the present scenario.
To start with, during the last 60 years, Israeli army hasinvaded Palestine hundreds of times, for as many reasons, has killed boys and girls in their school premises, patients in hospitals, women standing in their verandah and the like, on different occasions.
How come? In the opinion of many the Palestinian problem was architecturally rooted as such by the master builder. Read:
— In 1947, the UN passed a single resolution for the establishment of the states of Palestine and Israel: It gave birth to Israel in 1948 but refused the other twin to see the light. Why? The part implementation of a resolution was unique in the history of the UN and remains so till date.
— In fact, the present bad time for Palestine started when the UN decided for the establishment of the state of Palestine when it was already in existence for centuries. It is beyond one’s comprehension as to why the UN has not, then, simply handed over the lands it had already carved for Israel, to it.
— To further confuse and complicate the Palestinian problem, the UN passed 600 more resolutions about it (Dawn, April 26, 2002).Which were all against it.
— The worst can be as to why the UN has involved Israel, with almost having a veto power, for the establishment of an independent Palestinian state when it did not involve the other way? The UN should undo it forthwith, otherwise Israel won’t stop what it is doing to secure political, strategic and extra territorial gains.
Z.A. KAZMI
Karachi
MR President, we have been ardent admirers of your policies and had the hope that you had the commitment and vision to take Pakistan ahead. We defended you in political discussions, notwithstanding the fact that there is enormous opposition to your wearing the uniform. We felt that, as good work was being done, this was a tolerable infraction to be accepted temporarily.
We decided to stand by you, despite opposition to military rule. This is because the period before you took over was replete with examples of bad governance and conflict with the organs of the state. Attempts were also being made to gain absolute power, albeit, in civilian clothes. The economy was a shambles and there was overall despondency. We had aspirations and we had expectations.
However, the series of actions taken, March onwards, have created instability and that is not constructive for the nation. Unrestrained street fighting between different political groups has to be questioned, to put it mildly. This could happen in Ethiopia or racist South Africa but not in Pakistan.
The situation can be retrieved. The people want justice and economic security. Moderation and a sense of proportion in all policies and actions are desperately clamoured for. They want relief when their rights are being trampled. The people do not want the executive to be arrogant. They feel that the parliamentarians should not be disconnected from the stakeholders, the people, and be available to resolve their problems. The judiciary, the bureaucracy, the agencies and the executive must be more people-friendly and helpful.
The problems facing the country now can be considered in the light of “better options and solutions” for strengthening “all organs of the state”.
SHAMS ZAHEER ABBAS
Lahore
ACCORDING to a news item, the Central Board of Revenue has finally decided to do something about underinvoicing and misdeclaration in the next budget. Of course, this should have been done long ago, but better late than never.
However, why is nothing being done to curb smuggling, which is the real menace to the country? Is it because smuggling, along with drug trafficking, is the main activity in the two troubled provinces where fundamentalists dominate everyone? Or is it because smugglers have friends and relatives in high places?
If the authorities really want to know how much smugglers are earning, they should go to Karkhano Bazaar outside Peshawar where millions of rupees’ worth of smuggled items are sold every day in 25,000 shops. And despite this clear evidence, if they are still reluctant to do anything about smuggling, it is suggested that they should exempt local manufacturers from custom duty and sales tax, so that thousands of industries are saved from closure.
WAJEEHA KARIM
Karachi
Thanks ever so much for noticing the existence of the president’s Primary Healthcare Initiative (PHI). Your editorial, ‘For better healthcare’ (May 21) is one of the few pleasant surprises of our brief life. Alongside the expression of gratitude, we wish to draw attention to some assertions in para one of the editorial.
What is said about perquisites for the staff, massive funding, financial viability, sustainability, pilot districts, etc., creates an impression that may be less accurate than what Dawn normally carries. Please allow us to add the following to complete the picture for your readers:
First, this is no pilot. It has been in 12 districts of Punjab since March 2003. The president desired its upscaling to the national level in September 2005. We wish we had been asked what was happening all these months since September 2005. Answers to such questions would provide some real education.
Second, our work in Punjab has been a rare experience for the poor. We invite anyone to come and see for himself what our work has come to mean to the rural poor in the 12 districts of Punjab. It shall be great if we are questioned about what remain unaccomplished.
Third, our work is only starting out in seven districts of Sindh, 16 districts of Balochistan, nine districts of the NWFP and two districts of the Northern Areas. It takes our work many months to get off the ground -- another matter on which we wait to be questioned.
Our assignment, from the president, is to take our work to all the districts of the country by a specified date. And an equally important task given to us is to exit by a certain date and leave the services to a reformed and re-engineered district health management.
This is to ensure that the life infused by the PHI, into the decaying system, is sustained and strengthened by the successor management.
Fourth, it is our conviction, acquired from experience, that money is the least of the problems. Our work in the 12 districts of Punjab has proved this over the last four years. The need for ‘massive funds’ is highlighted only by those who do not wish to deal with the real problems or do not care to know these.
The most important requirement for resuscitating primary healthcare services in the rural Pakistan is vigorous and spirited facilitation -- some will call that plain good management. That is what sets the PHI apart from every other intervention in the social services sector.
The second para of the editorial lists what are articles of faith for our work. These are the tenets that regulate our work. God bless you for highlighting these. Help us by coming out to see the PHI at work and witness all that we are doing and all that obstructs us. When you do, we are sure that you will also know how to help us.
FAROOQ HAROON
Lahore
I WISH to draw the attention of all to a potentially serious health hazard posed by some toothpaste brands. A few of them even claim to ‘cure’ all diseases of teeth and gums without even listing the active therapeutic ingredients on the label.
And all this has been going on right under our noses. Why? Because toothpastes are not included in the list of items under compulsory monitoring by the Pakistan Standard and Quality Control Authority.
There had been anecdotal reports previously that perhaps the unusual popularity of some medicated toothpastes could be due to presence of steroid in it. Corticosteroids have a very limited use in the routine management of dental disease.
At best, they are indicated in conditions not amenable to other measures and drugs.
Steroids are known for their ‘masking effects’ and their abuse is documented in a previous study in the country.
There is no justification for incorporating steroids in over-the-counter dentifrices/toothpastes because of potential hazards inherent in side-effects of this drug.
Eight out of 20 brand samples tested positive for the presence of steroid (cortisone). Some of these brands are supposedly more popular than any other regular toothpaste.
All those concerned are urged to take a serious note of this problem. It goes without saying that absence of any regulation/legislation led to this exploitative, unscrupulous and highly unethical practice/marketing.
Can we hope that something could be done about it now?
WAJEEHA KARIM
Karachi
THERE can be no justification for creating a state within a state, nor is anyone entitled to give calls for jihad or impose any laws.
The mullahs must realise that the only way they can come to power is the constitutional way, through elections. Otherwise there is no shortcut to attaining power.
WAHEEDUD DEEN
Islamabad
CAN anyone help me and provide the reference from the Quran or Sunnah regarding the issue of holding hostage in Islam as a way to register one’s protest?
I would like this information so that I can look forward to holding someone hostage. After all I too want to be a true Muslim.
ASIF A. R. KHAN MAHAR
Rohri, Sukkur
THIS has reference to a report on the rise of incidents of swara in Sindh since the suspension of the Chief Justice (May 24). The women of Sindh are the most persecuted creatures on earth. They are fighting not only for equality but also against old traditions like karo-kari and swara.
Over the last few years the press has started a commendable fight against those evils and that movement got legal support when the suspended CJ took suo motu actions against these incidents.
The report rightly mentions that crimes like swara are increasing, particularly in the north-western districts of Sindh.
A few weeks ago a similar kind of incident happened in the district of the acting CJP Rana Bhagwandas, when the sitting nazim and his son gave away as compensation two infant sisters, aged three and four, against the will of relatives.
The local media reported on this for a few days in the hope that Justice Bhagwandas will take note of this but due to the present tussle between the judiciary and the government, the poor people of this country are suffering.
The Supreme Court is requested to give relief to that poor family and save the lives of poor people as the decision is made by influential persons who are also part of the government.
ALI KHAN CHLOYANI
Shahdadkot
THIS has reference to the letter on Indian culture (May 24). In this age of advance media devices, the only way to stop this onslaught is to produce interesting and good quality movies which are watched not only at home but also in India.
Sometime down in the future, perhaps Indian children may ask their parents about how the marriage ceremony ended without having taken the bride’s consent three times and when the “nuqal and chohara" would be showered on the guests.
These are however, trivial matters. The prime responsibility of the parents should be to teach their children as how to boldly say no to injustice.
ABUZAR RAYEES
Plano, Texas USA
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