| March 16, 2008 | Sunday | Rabi-ul-Awwal 7, 1429 |
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Is Article 58(2)b draconian?
Epilepsy cure: a surprise
Plight of mentally-ill prisoners
Cousin marriages
Import of wheat
Co-benefits of air quality improvements
Achievers’ ratio
War on terror
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 apropos of your editorial, ‘Efficacy of antidepressants’ (March 2). We have very poor awareness of psychiatric illnesses. Even the educated do not understand depression and its symptoms, blaming them on witchcraft etc.
Having a vast experience, both in the UK and in Karachi as a senior consultant, establishing a department in University Hospitals, and now treating poor patients free of charge in Markaz-i-Nafsiyat Trust, I would like to state that depression is of two kinds in lay man’s term. One, due to factors such as the death of a dear one, financial losses and marital conflicts and, therefore, can be sorted out with timely counselling and physical exercise. In most cases such depression can be remedied in six months.
The second type is due to chemical imbalance and usually runs in the family though it is well proved that even a prolonged stress can lead to certain anatomical and chemical changes in the brain and, therefore, in such cases medication is necessary. The devastating effects on the family, children and work of such an individual if not treated could be enormous and irreversible.
In this type, the scenario is very similar to treating insulin dependent diabetes where you cannot expect the patient to recover on his own. It takes much time to convince such individuals to take antidepressants as they continue to believe in effects of evil eye and witchcraft.I am concerned about the kind of editorial written. It could be misleading, discouraging severely depressed individuals to take medication and seek psychiatric help, expecting them to improve on their own and thus leading to serious consequences such as suicide. It is not possible for a patient to judge whether it is a mild, moderate or severe depression and this decision should be left to the psychiatrist.
It is also not true that lifelong dependency can occur on antidepressants. Even when there is a chemical deficiency, we treat patients for at least six months and then try to gradually taper it off. Only in some cases medication may be required for years, especially with strong family history, mulitiple episodes, suicidal ideation, delusions of guilt, though appropriate therapies are also offered. Abrupt withdrawal should be avoided as it can lead to sudden discontinuation symptoms which can cause great discomfort.
Unfortunately people confuse them with tranquillisers which are habit-forming. Benzodiazepines including diazepam, bromazepam, alprazolam, nitrazepam, temazepam, flurazepam, lormetazepam and all hypnotics can cause dependence and make depression worse and must be avoided unless prescribed for a few nights only when an individual is very disturbed.
Depression is the most common psychiatric disorder, and is the most common cause of suicide. Having conducted free camps in our villages, I can say that it is even more common in lower socio-economic groups due to financial stress, injustice and lack of basic amenities, though its expression is by physical complaints such as headache, backache, hyperacidity, abdominal pain for which no organic cause could be found.
No conscientious psychiatrist ever prescribes at the request of a pharmaceutical company and not every patient is prescribed the same medication. We have to look at the symptoms, cause, family history, support system, financial background, etc, before making any decision. Therapies are also offered. It is worth quoting that like all other specialities, there are some dishonest professionals in this field as well.
Since my main interest is to provide free treatment to deserving individuals, including medication from my personal resources and income, I would like to quote that Amitriptyline is still a very effective and economical antidepressant but in individuals with cardiac and some other medical issues should be avoided. There are local inexpensive and effective substitutes of SSRI type of antidepressants widely available.
DR SHAHIN HAYE HUSSAIN
Karachi
FORMER Supreme Court judge Fakhruddin G. Ebrahim (one-time governor of Sindh, Attorney-General of Pakistan and federal law minister in subsequence) says as reported in the Dawn issue of March 10 that Article 58(2)b of the Constitution is a draconian section and must be cast out.
This is disconcerting to one’s mind. In my letter appearing in your issue on March 5, I had elaborated the need for holding on to the said article for some time in view of the chequered performance by our politicians in the past.
When the president, while applying his judicious mind and with good intent, reaches the conclusion that the government is not functioning in accordance with the Constitution and there is evidence of loot and plunder of our national wealth, this article would serve as a subterfuge to dislodge the government. It is for the apex court to determine the good intent of the president or otherwise and give its verdict. Would Mr Ebrahim care to expound on this, as to its noxious effect.
However, this article could only go hand to hand with a truly independent judiciary with the reinstated deposed judges. There have to be checks and balances on the government, otherwise it would be facing once again massive allegations of misrule and corruption. This article would stall mass corruption to a great extent.
It is also felt in many quarters that the office of the president should be occupied by a non-partisan person not affiliated with any political party, with impeccable integrity, most probably a retired judge of the apex court.
I may recall that when Nawaz Sharif’s government was dismissed under this article, the then Supreme Court, headed by chief justice Nasim Hassan Shah, held in a full court reference that the action of the president was not free of malice and, therefore, unwarranted. Thus the government was reinstated. So this article has a nexus with an independent judiciary. With the present judicial dispensation, its outcome could be foreboding.
I would like Mr Fakhruddin Ebrahim to spell out his percipient mind judiciously, keeping in view our politicians’ role in former times.
SAIFUDDIN E. CONTRACTOR
Karachi
My nine-year-old son had a first-ever fit in school about nine months back. On consulting his paediatrician, we were told not to worry as such an episode usually occurred in schoolchildren who go without breakfast and play in the sun. We were relieved.
However, within a week he had another fit while asleep and since then he started getting them two to three times daily. The doctor put him on medications and we were told he has epilepsy. This was conveyed to his school to condone his absence and to our horror we were told to keep the child away at home until he was fully cured.
Our son is on medications since then but with no improvement. We had almost lost hope when last week I read Ardeshir Cowasjee’s article. We visited the National Epilepsy Centre at Jinnah Hospital, though with not much hope. But we were in for a pleasant surprise as we walked into a simple, clean building which had an air of comfort. People were patiently waiting for their turn. Each patient was being given individual attention in a separate consulting room giving them privacy.
The doctor who handled our son’s case took a detailed history for about 30 minutes. We were informed that this was extremely important to diagnose epilepsy and its type. After documenting every minute detail in the file and examining our son, she confirmed the diagnosis of epilepsy.
She explained that though the medicines our son was at present taking controlled most types of fits, these had a worsening effect on the type of fits our son was having. A change of medicines was suggested.
All the fears and questions that haunted my wife and my mind were satisfactorily answered. It’s now four days since the new treatment has started and my son has not had a single fit.
My wife and I thank Mr Cowasjee for making us aware of an institute dedicated to people with epilepsy. We strongly recommend relatives of people having epilepsy to visit this place and benefit from their services. God bless all concerned for doing such a great job.
Hussain Ibrahim
Karachi
AS chairman, Board of Visitors, Sindh, constituted under the Mental Health Ordinance (MHO) 2001, I deeply appreciate the contents of your editorial, ‘Inmates are also humans’ (March 9), highlighting the plight of mentally-ill prisoners due to the absence of a full-fledged psychiatric ward in the Central Prison, as well as in the Landhi Jail.
In our country the psychiatrist-to-population ratio is dismally low. The total number of beds in government mental healthcare facilities is about 2,154 and currently out of 350 psychiatrists available in the country the majority is based in urban centres whereas more than 60 per cent of our population live in rural areas.
This is the reason that mental healthcare scenario in our country is still very pathetic. Therefore, I would request the authorities concerned to please take serious note of the prevailing situation and adopt remedial measures, including framing of rules as mandated by Section 59 of MHO 2001 for its effective implementation, so that the common man is benefited by it.
JUSTICE ( r) DR GHOUS MUHAMMAD
Karachi
APROPOS of the letters ‘Cousin marriage’ (Feb 28) and “Issue of cousin marriages’ (Feb 20), I would like to share a few facts:
· Albert Einstein married his first cousin. And so did Charles Darwin. Both couples had exceptional children.
· No European country prohibits marriage between first cousins. It is also legal throughout Canada and Mexico to marry your cousin.
The USA is the only western country with cousin marriage restrictions.
· A study by the National Society of Genetic Counsellors says that having a child with your first cousin raises the risk of a birth defect from about three to four per cent to about four to seven per cent. In plain terms, first cousins have a 94 per cent chance of having healthy children.
· It is estimated that 20 per cent of all couples worldwide are first cousins. It is also estimated that 80 per cent of all marriages historically have been between first cousins.
KAMRAN PARACHA
Karachi
A SHIP carrying 73,000 tons of ‘C’ class wheat, imported from Canada, has been stuck at good distance due to shallow waters at Gawadar Port, awaiting high tide to unload. Here a question does arise: what is the wheat doing at Gawadar Port whereas it used to disembark at Port Qasim?
Keeping in view the import cost, it is obviously going to raise the wheat price to Rs1,890 per 40kg or may be more. The policymakers sitting in Islamabad have, however, made up their mind not to give the local farmers more than Rs510.
They are certainly not oblivious to the fact that growers have to buy DAP at the rate of Rs2,800 per bag or urea at Rs689 per bag, but they think that it is their problem. They are ‘contented’ with enjoying the subsidy which is shared by importers along with self-conceited financial wizards such as Salman Shah, who have been left behind by Shaukat Aziz.
While the political parties and the president are busy in manipulations, nobody is there to look after the interests of 60 per cent of our unfortunate farmer class. If things persist in the present way and the price of wheat is not increased to Rs650 per 40kg, most probably the growers will not be able to sow another crop with this paltry support price.
This will affect the government finance in a big way as the government, in order to satisfy the consumer, will have to import wheat at thrice the cost of local wheat. At the same time it destroys the farmer.
IMTIAZ ALI SOLANGI
Karachi
IN London, traffic congestion charge was introduced in 2003 to cut traffic and reduce pollution. While the primary aim of the congestion charge was directed towards automobile movement control and reduction in air pollution, an unintended benefit that resulted was that of improvement in health.
Scientists in London calculated that since 2003, 1,888 extra years of life had been saved among the city’s seven million residents. The London transport department described it as a ‘welcome side-effect’ of the charge. The researchers found that policies affecting a larger geographical area and residential population, and which directly aim at reducing vehicle emissions, are likely to have larger public health impacts.
It currently costs a motorist eight pounds to enter the centre of London during working hours, and Transport for London data suggests that car journeys within the charging ‘zone’ have fallen by a quarter. The link between certain types of traffic pollution and health problems, including heart attack and breathing problems in children, are well established, and Transport for London’s own figures estimate that the capital’s poor air quality is responsible for 1,000 premature deaths and 1,000 extra hospital admissions every year.
It recently launched a ‘Low Emissions Zone’ targeting principally high polluting heavy vehicles in a bid to meet London mayor’s target of a 16 per cent improvement in air quality by 2012. Scientists at the London School of Hygiene and Tropical Medicine, and King’s College, London, wanted to examine further if traffic reductions since 2003 could have had a direct impact on health.
They used a computer model to work out changes in air pollution based on the traffic figures, and looked for any relationship between this and death rates in areas in or near to the charging ‘zone’. Within the central charging area itself – where relatively few people actually live – the benefits seemed more significant, with an extra 183 years of life saved for every 100,000 residents. This does not necessarily mean that every resident received an equal but tiny slice of this, as the benefits to certain people, such as those with existing heart or lung problems are likely to be greater.
Outside the congestion charge areas, the benefits were far less, totalling an extra 18 years of life per 100,000 residents. However, because the number of residents there was much higher, this added up to a total of 1,888 years spread across the whole of London. While acknowledging that the benefits were fairly ‘modest’ in size, the researchers said that traffic cutting schemes could still be regarded as potentially health-improving policies.
Across the whole UK, the impact of traffic pollution is far more significant. The UK’s Department for Environment, Food and Rural Affairs has estimated that, in a century, approximately 39 million years of life are lost. A spokesman for Transport for London said that the congestion charge, together with the ‘Low Emission Zone’, should dramatically reduce the number of people living in areas of the capital in which air pollution was a threat to health.
The congestion charge was introduced five years ago primarily to tackle congestion in central London, but has also had some success in reducing CO2 emissions and pollutants harmful to human health. This ground-breaking work in London is expected to have an impact throughout the world as other cities follow London’s example.
This example, or the ‘lesson learnt’, could be applied in Saddar (around Empress Market area), where traffic congestion is high and air quality is poor, to reduce traffic, enhance air quality and improve public health.
(Source: Clean Air Initiative, Asia, ADB, March 2008).
F.H. MUGHAL
Karachi
ACCORDING to a report (Feb 27), 15 students of Pakistan achieved top positions in different subjects in the last Cambridge international examinations. Among these students, six students are from Lahore, eight students from Islamabad and only one student from Karachi.
Comparing the difference in the population of these cities, it speaks of a very sad state of affairs of Karachi in the excellence in education, which needs serious thought.
The intellectuals, educationists and politicians of Karachi should find out the causes of this downfall of Karachi in the field of education. Without achieving excellence in education, our children will not be able to compete in the job market or for scholarships in higher education offered by the Higher Education Commission of Pakistan.
MIRZA SHAHID BARLAS
Karachi
MY son, Maj Faran Mahmood (FF), was killed by enemy action on Feb 14 while serving in the Bajaur Tribal region (Dawn, Feb 15). On his death many civilians and military personnel came to offer their condolences. There are some points which I learnt and wish to share with your readers:
a. Many militants, who were caught by the security forces in the region, could not speak either Pushto or Urdu.
b. Some of the equipment which has been recovered from the militants is as modern and sophisticated as anywhere in the world.
c. There is extensive inflow of money to some influential individuals in the region.
d. Explosives are brought into Pakistan from Afghanistan. This is substantiated by your Bureau’s report and the news published on March 12.
e. Despite the limited and rational use of force, innocent people are also killed in the operational area.
Considering the above events, while there is a strong reason to believe about the involvement of the foreign hands in our present internal security situation, there is an urgent need to redefine the term ‘war on terror’ and review our existing policies.
Terrorist activities have been taking place not only in Afghanistan, Iraq and Pakistan but also in Congo, Kenya and Cambodia, where they do not appear to be linked with religion.
All propaganda against Islam is primarily meant to create hatred against this religion and to exploit the people and resources of Muslim countries.
After reading the letters, ‘Aftermath of proxy war’ and ‘Bitter harvest’ (March 10), I come to the conclusion that in order to stop the war on terror, three steps must be taken urgently.
First, the US and Nato forces must announce a departure plan from Iraq and Afghanistan.
Second, Pakistan security forces should make sure that after apprehending the culprits, the homes of the militants are not destroyed as they also provide shelter to dependents but innocent women and children.
Third, it must be realised by our electronic media and the government that any idea cannot be killed by force. It can only be countered by another more forceful idea or doctrine.
The teaching of the Quran can serve as a guideline: “Anybody who kills a person without three specified reasons kills the whole mankind” — Al Myeda (The Feast).
BRIG (r ) KHALID HASSAN MAHMOOD
Karachi
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