A FEATURE common to all regimes in Pakistan — political or military — has been that the people for whom the writing on the wall is intended are the only ones unable to read it. Never was it more true, both of men and institutions, than it is now in the current transition.

The writing on the wall that only Pir Pagara and Altaf Hussain (not a spiritual Pir but no less to his followers) were able to read is, respectively, dreadful confusion throughout the country and bloody strife in Karachi. Not heeding the warning are Asif Zardari and Nawaz Sharif who are merrily sharing power and platitudes to fulfil the pledge made in the Charter of Democracy to pull the country back from the “brink of total disaster” with the help, of all people, of Maulana Fazlur Rehman.

And then they would go on to put the country on a course that would make it “economically sustainable, socially progressive, politically democratic and pluralist, federally cooperative, ideologically tolerant, internationally respectable and regionally peaceful” and what else have you. Escape from harsh reality is thus being sought in idle rhetoric, which the London Charter provides in ample measure.

Quoted above is just a short extract. Here is one quick example where the signatories to the Charter are already seen failing in their commitment. They promised to hold local government elections “within three months of the holding of general elections”. As it happens it might take them longer than that to put together the central and provincial governments.

In contrast to the solemnity of the Charter the reality on the ground, as seen by the tabloid press, is the return of revelry marked by song, dance and booze as the lawmakers (said to be the best paid and most pampered in the region) descend on the sedate, and now also sad, capital.

In the selection of men and women — the prime minister, the speaker, chief ministers and ministers — who are to implement the Charter the guiding principle apparently remains, as it has always been, kinship or cronyism. Punjab is lucky that its designated chief minister Shahbaz Sharif, though falling in the same definition, is a hard working, and for others harder driving, administrator. The other chief ministers placed in a more difficult political environment will be constantly looking up to their party bosses.

Countering insurgency in Balochistan and terrorism in the NWFP have been, and as far as one can see will remain, a primary responsibility of the federation. Governing Sindh may pose insurmountable challenges when the MQM is in hostile opposition and its leader is predicting bloodshed while the PPP’s ally, the PML-N, is all but wiped out in the province.

In the first PPP government (1988-90) neither coalition with the MQM nor confrontation with it made the province easily governable, such was the clash of interests and lack of trust between the two then and so it is now.

It can be even worse this time round because the district governments in Karachi, Hyderabad and in some smaller cities are dominated by the MQM. It is in the urban areas that the money and patronage lies. All politics, as is the axiom, is local and about jobs. Asif Zardari therefore needs to extend his conciliatory zeal to bring the MQM into the provincial government in a spirit of genuine cooperation rather than the mutual deception that marked their coalition of 1988. A particularly praiseworthy feature of the Charter is a promise to revive the old parliamentary tradition under which the leaders of the opposition in the national and provincial assemblies chaired the public accounts committees. Going further, the auditor general should be made answerable to this committee and not to the government.

A regrettable, perhaps deliberate, omission in the Charter is a guarantee to civil servants that their terms and tenures

will be protected against whimsical or vindictive actions. In the last decade’s alternating rule of the parties to the Charter, officials were treated like the servants of the party rather than of the public.

It has been said before and bears repetition that in the Nawaz Sharif government this writer, then a senior secretary, was made OSD after just three months in one ministry and then another three months before retirement. Mian Sahib then considered it was impertinent of a secretary to ask “pray why?” Hopefully he doesn’t this time round.

The rules of business and conduct which are binding on ministers and officials alike were not followed then nor in the Musharraf era and nor, surely, will they be in the upcoming government. Therein lies the root of maladministration, especially in the provinces. The people who must but refuse to see the writing on the wall are all too willing and eager (to employ a similar phrase) to cross the line in the sand, that is go beyond the point that they must not. Doing it at the moment, surprisingly, are not the ministers, legislators and officials but the judges and the lawyers.

Pervez Musharraf indeed acted arbitrarily, and to many unjustly, in retiring the judges. His action whether illegal or unjust or both can now be undone only by the legislators. By boycotting the courts and blocking roads, the lawyers only add to the misery of the litigants and the people at large. After all a million cases, some for a full generation, are awaiting adjudication.

The new government, howsoever exhilarated or confident, has a very short time in which to show the people that it can provide the security of life and employment which the previous government couldn’t. Prices of foodstuff will nevertheless keep rising and the shortage of electricity and gas keep worsening for some years to come.

If the lawyers continue to distract the government and the legislators in turn keep fighting for profitable posts, for cars, escorts, larger allowances and strut around with cronies and hatchet men in train, only the elite and the bootleggers will prosper.

Then it could be months, not even a year, before the people hark back to the good old Musharraf days.

EXHIBITION of military might or bulging muscles is distasteful. Alas, newly independent countries and adolescents are given to such displays of these symbols of power and masculinity that are so often intertwined.

Drive through the decolonised parts of the world — Africa, the Middle East and right here in Pakistan — and one is made aware of symbols of power everywhere. This can be guards carrying lethal weapons, monuments as paeans to military might or road names commemorating the war dead. All these are constant reminders to the public’s psyche that the military is awesome. None of this is arbitrary; those who wish to glorify power install these symbols to brainwash the public.

The frequent installation and rare removal of such symbols of power throws light on the thinking of the ruling elite. We shall consider four such occurrences in Pakistan: two of removal — indication of a change of heart — and two others that show we have some way to go. Detour: let’s touch on similar failings of the West.

The US, for example, has open houses on military bases where the latest high-tech gadgetry and modern killing machines are displayed. Parents with impressionable kids in huge numbers take this all in, returning home thrilled that this wonderful technology will let them maintain leadership of the ‘free world’. Not to worry: the few who die for glory of the land can get an honoured place in Arlington cemetery, an inevitable sacrifice to keep the world a safer place.

Countries in Europe, for example Britain, are more subtle about displaying military prowess. But in these parts hypocrisy parallels subtlety. Here one does not find Yankee ostentation or the crudity of Third World military parades with their display of armoured vehicles, chunky missiles and synchronised marching hunks in spanking uniforms. Scratch below the surface, though, and you find the same rapaciousness when it comes to selling armaments. The recent unprecedented $80bn arms deal with the Saudis is a case in point. Thankfully these dangerous toys will never get used.

I recall the valorisation of the F-86 Sabre fighter plane in 1965. The 17-day war fizzled out as the two pathetic warriors gasped for supplies and licked their wounds, until Uncle Sam asked them to stop the game. Thereafter, old F-86s started being placed in public places around the country as a reminder of our ‘victory’.

When a hideous mini-sub was placed there years ago, a prominent roundabout near Gizri, Karachi, came to be known as Submarine Chowk. About a couple of years ago it disappeared unannounced, just as it had appeared. Having stayed there so long, the name has been imprinted on people’s memory.

Regrettably, what have replaced military vehicles are equally ugly structures, such as the water-fountain arches at the F-10 roundabout, south of Fatima Jinnah Park in Islamabad. (The tackiness of the fountain is a constant reminder of the municipality’s lack of aesthetics.) The current eyesore replaced a replica of the Ghauri missile, ‘developed’ by Kahuta Laboratories. This was in the wake of the 1998 atomic explosion, when it was realised that a big ‘firecracker’ needed a delivery system.

Competition for building a missile system mirrored the development of the atomic weapon. While Dr A.Q. Khan hogged the limelight prior to the explosion, the Pakistan Atomic Energy Commission’s Dr Samar Mubarakmand made it known that it was in fact his organisation that did most of the work, thereby somewhat fading the halo around the great Khan. The two famous Atomic Doctors then proceeded to ‘build’ missiles. In competition with Ghauri, Dr Mubarakmand’s men ‘developed’ the Shaheen missile.

As Dr Khan’s reputation took a nosedive for other reasons, the military command must have asked the CDA to get Ghauri uprooted. No one in the CDA could unilaterally take this decision. Around this time, Shaheen was lauded as the new, better missile and was placed at the north corner of Fatima Jinnah Park. Some weeks ago the CDA suddenly removed the Shaheen missile too, but thankfully has replaced it with rather more tasteful landscaping than at the old Ghauri site. Let’s applaud the removal of two pointy weapons.

These missiles and their expected payload are justified on the diabolical theory of mutually assured destruction that developed during the Cold War. Possession of such expensive weapon systems has misused qualified manpower and made us insecure. They led to the misadventure in Kargil and the infiltration of jihadis across the borders, assured that India would not retaliate strongly for fear of being nuked.

A humongous ugly monument remains, a shapeless fibreglass model of the Chaghai Mountain, which was the first victim of the country’s atomic test. The grotesque model reminds hundreds of thousands commuters daily about our weapon of mass destruction. We occasionally hear from rabid leaders that it is not a toy and that we will use it, if necessary. Surely this obscenity has to disappear. So too must another brainchild of the military mind. This bit of state vandalism can be seen, driving toward the airport, before reaching the Chaghai model.

A vast tract of land south of Shakarparian, almost 120 acres, had its trees cut and levelled last year to prepare it for the Republic Day parade held every March. Why is it important to take up wooded land for something that is totally non-productive? Must the population be subjected to men marching in unison once a year? If brainwashing and the inculcation of false patriotism is the purpose then let’s not destroy the environment. Why can’t this marching take place in cantonments where an open house could make it easy for the interested public to attend? If the army chief, praiseworthy for pulling back military officials from cushy civilian jobs, were to see the wastefulness in this, the land could be returned to nature.

Good sense can sweep in as a pleasant surprise, just as happened when the missiles were removed. Two symbols of man’s destructiveness and waste still mar our landscape. Could this year of change, with the fresh winds of reason and goodwill, blow away the remaining blemishes?

The author is an Islamabad-based physicist with an interest in the environment.

Medicine is a moral enterprise — Ivan Illich

TRANSPLANTATION of kidneys in Pakistan began in the 1980s without the benefit of a national law to regulate transplant practices. In the beginning almost all kidneys were donated by family members to save the life of their kin.

In the last decade this altruistic practice was rapidly converted into a commercial racket in which private hospitals, primarily located in Punjab, and their transplant physicians formed an immoral nexus with willing middlemen. A flourishing business developed, netting millions of rupees annually, in which kidneys of the most disadvantaged became commodities bought for transplantation into the most affluent, including those travelling to Pakistan from the Middle East and as far away as North America.

A patient contemplating the use of one such hospital explained that it was a very “user-friendly” service with access to a “gurda piri” (kidney market) where suitable organs could be procured.

After a collective struggle of almost two decades by concerned members of the public and health care professionals, the national media and NGOs — aided by suo motu notice by the Supreme Court — the government of Pakistan finally promulgated the Human Organs and Tissue Transplantation Ordinance in September 2007. Although weak in some clauses (the details are beyond the scope of this article) such as insufficient protection for female donors, especially wives, and no criteria to ensure the integrity of appointees to oversight mechanisms, the bill was nevertheless felt by many to be the first step in the right direction.

It clearly prohibited donation of kidneys by Pakistanis to non-citizens, and made commercial dealings in organs a crime punishable by fines and imprisonment. It was believed that this would at least stop the immoral international kidney trafficking that was on the rise in the country. This sense of triumph has been short-lived.

It is rapidly becoming clear that the tenacity and resourcefulness of the unethical health care professionals involved in organ trafficking has been underestimated. The lucrative kidney trade is rearing its ugly head again in the hospitals of Punjab. In January of this year, while giving a report in Taipei on Pakistani transplantation to the Asian Task Force on Organ Trafficking, I was approached by Dr Michael Bos, senior scientific adviser to the Health Council of the Netherlands.

He informed me that a private hospital in Lahore had approached his government with an offer, which was refused, to organise a system for kidney transplantation for Dutch citizens. More than three months after the passage of the Ordinance, the Netherlands government was unaware that this was now illegal in Pakistan.

The Netherlands is not an exception in this regard. In February this year, I was contacted by the producer of a major TV station in the United States. While working on a TV special on kidney donation, she had interviewed an American citizen who was planning to travel to Pakistan for a transplant. When I informed her that this was now illegal in the country, the producer wrote back to say that the man had told her that “the hospital he’s going to has ‘special’ clearance from the government to continue organ transplantation involving foreigners.”

It is evident that the passage of the Ordinance has been ineffective in forcing an enterprising organ-trafficking mafia to pull down the shutters. It also appears that relevant authorities have not effectively disseminated news about the Ordinance to other governments.

The latest proof that kidney trafficking continues in Punjab is the horrifying story reported in this paper on March 18. An email received this week from a transplant surgeon in Kuwait gives details of a Kuwaiti patient who received a transplant in the dead of night in Lahore in a facility that was, by his description, “like a large house”.

This particular incident epitomises everything that flies in the face of a long-held but seemingly crumbling ethos that the practice of medicine is a moral enterprise. Not only was this patient almost certainly transplanted with a kidney bought from a destitute individual, he was also operated upon furtively at 3.00 am. He suffered significant complications necessitating his consulting the Kuwaiti surgeon upon return.

The third and perhaps most tragic casualty in this episode is the professional integrity on which medical practice rests. It is through such practices that health care professions, vocations that must remain grounded in ethics, are being converted into commercial transactions divorced from moral sensibilities.

This episode of the Kuwaiti patient (with identifiable doctors) presents an important challenge and opportunity for the government. The health ministry and the federally appointed monitoring authority (HOTA) must demonstrate to Pakistanis, and to the world, that the Ordinance is not a paper tiger but a law that means business and, in its application, is blind to the status and connections of offenders.

Prior to the passage of the Ordinance the government possessed no legal mechanism to stop organ trafficking in the country. But it does now and it must demonstrate zeal and willingness to enforce it. Perhaps this will help wash away our national shame as the kidney bazaar of the world.

The writer is professor and chairperson, Centre of Biomedical Ethics and Culture, SIUT, Karachi.

famoz@mindspring.com