PINUM providing services to locals

LABORATORY tests have become a prerequisite for any diagnosis, prescription or treatment. However, despite being the third largest city of the country and boasting of a medical college with a teaching hospital having 1,650 beds in the district, Faisalabad does not have a single standard laboratory for conducting tests.

The Pakistan Atomic Energy Commission in view of this situation decided to set up its own centre — the Punjab Institute of Nuclear Medicine (PINUM)— which is one of the 12 medical centres established and run by PAEC.

This project was sanctioned in 1991 at a cost of Rs87.83 million and scheduled to be completed by June 1994. It is spread over 101,088 square feet with a 41,800 square feet covered area. It has six doctors, two scientific doctors, 12 technicians, and 35 other non-technical staff. Although it was claimed that the PINUM became functional in July 1996, it attained full pace of operation on Oct 5, 2001.

This centre was attached with Allied Hospital of Punjab Medical College for providing diagnostic and therapeutic services to the people in and around district Faisalabad.

Over 10,000 patients visit PINUM every year and this number is increasing day by day. In this centre, the patients are provided services of nuclear medicine, nuclear cardiology, exercise tolerance test, ultrasound, radio immunoassay and endoxopy.

Medical students from the Punjab Medical College, FCPS fellows and postgraduate students visit the centre for nuclear medicine orientation in routine as well as for completion of their research. A number of research projects are under way. Review articles and its nuclear physician’s reports are published regularly.

The centre has nuclear medicine section equipped with three Gamma cameras (one planar and two SPECT), two radioiodine uptake systems and a rectilinear scanner. Computerized diagnostic section covers all nuclear medicinal investigations for thyroid, bone, brain, lung, and liver and hepatobility scintigraphy.

MAG, DTPA and DMSA renal scintigraphy is also regularly carried out. Quantitative tests include thyroid uptake, GFR, ERPF, relative renal function, gall bladder ejection fraction, etc. The whole body bone and I”- radioiodine scan and SPECT studies (e.g., bone, liver etc.) are also performed.

Certain rare tests such as parathyroid imaging, mammoscintigraphy, radioiodine MIBG scan, Meckel’s diverticulum study, labelled RBC study, salivary gland scan, venography, (first pass as well as blood pool) lymphoscintigraphy, oesophageal motility and nasolacrimal duct patency studies are also conducted at the institute. Therapeutic portion of Nuclear Medicine covers treatment of patients with radioactive iodine “P” phosphorus. Patients suffering from Grave’s disease, toxic MNG and toxic hot nodule are treated on outdoor basis. Those suffering from differentiated Carcinoma of thyroid seek treatment for thyroid ablation. “P” radioactive phosphorus therapy is given for palliative treatment of bone pains due to metastatic bone disease and polycythemia vera. Four isolation rooms, equipped with eight beds, are available for the patients who need hospitalization.

Likewise, the Nuclear Cardiology Section of PINUM is equipped with Power Jog Treadmill machine, ECG unit and defibrillator. The Stress Room is equipped with all sorts of emergency medicines and instruments. Stress is given using treadmill as well as pharmacological agents, which is a prerequisite in myocardial perfusion scintigraphy and stress multi-gated studies. Routinely performed cardiac tests at PINUM include SPECT myocardial perfusion scintigraphy, gated SPECT myocardial perfusion scintigraphy, myocardial viability studies, stress and rest MUGA, first pass cardiac studies, etc. For perfusion scintigraphy both MIBI and TI-2-1 are used. Stress Room is also being regularly used for performing exercise tolerance test (ETT).

It is said that PINUM is the first institute which started radio immunoassay (RIA) service at Faisalabad. Tests performed in routine include FT4, FT3, TSH, LH, FSH, progesterone, estrogen, prolactin, testosterone, etc. RIA lab section of this centre is also well equipped with latest equipment and experienced staff and producing high quality and reliable results at reasonable rates.

The centre has a most modern ultrasound machine and 500 MeV X-ray unit. Ultrasonography of abdomen, pelvis and thyroid along with ultrasound guided biopsy and aspiration procedures are carried out. X-ray machine is used to perform conventional X-rays as well IVP, barium meal for following through studies. Similarly, the clinical laboratory of PINUM is equipped with automated chemistry and hematology analyzers where clinical tests like complete examination of blood and urine, blood sugar, serum urea, creatinine and uric acid; LFTs, lipid profile, etc are being conducted.

PINUM collaborates with a number of institutions in academic and research fields including Punjab Medical College, Allied Hospital, Divisional Headquarters Hospital, Pakistan Institute of Engineering and Applied Sciences, Islamabad, Punjab Institute of Cardiology, Lahore, and University of Agriculture, Faisalabad.

It also provides postgraduate training in many disciplines. Besides, this centre has a library with computers and internet which ensures good research and academic atmosphere.

The future plan of this centre is setting up new RIA tests facility like tumour markers, establishment of clinical oncology services for conducting PCR based tests in collaboration with local Nuclear Institute for Agriculture Biology and National Institute for Biotechnology and Genetic Engineering (NIBGE) and provision of mammography and clinical tests for breast cancer, addition of another latest Gamma Camera and positron emission tomography procedures.

Working for the weal of the drought-hit

IT was exciting to hear one fine morning that the Larkana district government will shortly begin a survey of the Kohistan area. The very thought that somebody or some authority would be embarking on such an adventure — I mean a mission — compelled me to look back to the time when I had travelled through this area and was confronted with facts of life that had never found their way to the press.

I recalled how our four-wheeler, passing through a desert after Faridabad town, was stuck up in the sand. We pushed and pulled but the jeep refused to budge an inch. As we toiled, we raised loud noises, so much so that these attracted the villagers living around and perhaps busy hunting partridges and rabbits. They came, helped us in pulling out our four-wheeler and we had a sigh of relief.

“You have lost the way,” they (perhaps Rind tribesmen) said and later guided us to Shah Godriyo after an hour’s drive through the desert.

Again, when I went to the Sona Khan Chandio village in the mountainous belt, with a medical team, to collect facts about leishmaniasis, a skin disease spread in the area after the sand-fly bite, it was observed that the pond from which the village women drew water for use at home is also used by buffaloes and dogs, without any let or hindrance. It was a shuddering sight.

“How do you pass your life?” I inquired from the elders. The answer was both blunt and bold, but it was punctuated with an underlying impression of ignorance and bitterness that how the landlords of the area neglect them and how the government has abandoned them to die without butter and bread.

Hence the twinkling in my eye on hearing the news about developing these remote areas where you find the bones of animals that died of starvation and water in the desert and mountains close to Kirthar range of rocks. What a welcome step it is where one should not minimize the efforts of the World Bank and the Asian Development Bank under the programmes of emergency assistance for drought impact mitigation and recovery programme and drought emergency recovery assistance programme.

“We (the district Nazims of Larkana and Dadu) would join hands and formulate a plan for uplift,” says Khursheed Junejo, Nazim of the Larkana district, as the Kachcho falling in the Dadu district has also been included in the programme.

Some regions in Pakistan have been facing a period of extended drought for the past five years. This drought has taken a heavy toll of livestock and reduced agriculture and fruit and rain-fed cereal production. It has resulted in severe economic and financial losses.

The World Bank and the ADB have designed Drought Emergency Relief Assistance (DERA) programme to reduce the impact of current drought by restoring and improving productive capacity and the livelihood and incomes of the people who have been severely affected by the drought, says District Coordination Officer Mohammad Hashim Leghari who would head this DERA programme. Also, it would help reduce the macroeconomic impact of the drought through financing activities for re-establishing productive capacity.

This is a countrywide programme for which, according to sources, the sharing formula has been decided by President Gen Pervez Musharraf himself. According to the breakdown, Sindh and Balochistan would get 30 per cent each and Punjab and the NWFP would receive 25 per cent and 15 per cent, the DCO says and adds:

“We are planning to construct small dams in the arid zone of Larkana. This would be good enough for those who have always been in search of drinking water in these hard areas. Recently, farmers and growers at the tail-ends of Warah branch, Saifullah Magsi branch, Shahdadkot branch and Ratodero branch faced an alarming situation — an eye-opener for the government too.

“Thousands of acres of cultivable land did not even receive a drop of water while the people were forced to migrate to get water for their daily life. It was rather a drought-like situation in these areas,” he says.

“If we have a glimpse of the cultivable command area (CCA) of all the above canals, we can easily estimate the degree of damage and losses. The CCA under the Saifullah Magsi branch, Shahdadkot branch, Ratodero branch and Warah branch is 137,000 acres, 172,000 acres, 70,000 acres and 275,000 acres. This would give us a pretty good idea about how much losses were incurred during the last season alone in the agriculture area. When you have such huge losses in the agrarian belt, what would be the extent of damage in the mountainous belt falling in the Larkana district.

“It needs concrete and far-reaching plans which could have a permanent impact on the population you want to serve and for that the new breed of elected representatives should be taken into confidence. We are planning to accord priority to projects for providing drinking water facilities — also health and education — so as to have unified development of that particular portion,” says Khursheed Junejo.

He says such projects would be designed to provide a systemic thrust to rehabilitate drought-stricken areas through short-, medium- and long-term measures but there would also be durable schemes focusing on mitigation of damage caused by the drought.

The donor agencies under the DERA programme have permitted construction of only five kilometres of new road, costing Rs20 million but it is encouraging that they (donors) have put no bar on the road length if it fulfils the rehabilitation criterion. This provides an opportunity to the local governments of Larkana and Dadu districts to sit together and discuss a feasible plan for undertaking construction of a road running alongside the mountains to connect the two districts, as well as the Indus Highway. This would not only revolutionize this backward area but would also open new channels for tourism.

The introduction of trickle irrigation is the need of the hour for permanent uplift of the area. As the government proposes to construct small dams, it should undertake extensive survey in this regard and opt for the drip or trickle irrigation system.

When you are providing a road network, coupled with drinking water provision and small dams construction, it would be fit to suggest that schools, too, should also be opened there to educate people. The construction of roads would bring in economic activities and help develop the area with the tool of education. The question is, how sincerely will the district government and its officers utilize the funds — to the tune of Rs300 million — being extended by the World Bank and the ADB under the DERA programme? If implemented sincerely, it would bring about revolutionary changes in the area.

A tissue culture lab for Karachi

IMAGINE Karachi with tree-lined boulevards, thick forestation of a few open areas, parks and playgrounds bustling with trees and bushes. Impossible? Not at all! What we are probably missing is a sincere effort by our city and its residents.

Karachi remains an overcrowded city with little vegetation over most of the landscape. Horrifying as it may be, the city threatens to cross 20 million mark for the number of its residents within fifteen years.

Congestion and overpopulation leads to pollution and one of its worst forms remains polluted air. Unfortunately, with all the technological advancement the only filters to tackle air pollution in the world remain trees and plants.

Old Karachi was home to many species of Neem, Rain tree, Laburnum, Cassia, Cheeko, Jack fruit, Ashok, Dessi Coconut palm, Bottle palm, Tamarind, Gul Mohar, Banyan, Gooseberry, Bogunwella, Custard Apple and many other plant varieties. Most of the city’s boulevards and streets were lined with a number of trees.

But then the city was small, effluent and strategically important, for developed specie of humans, exploiting the subcontinent in a planned manner. Fifty years later, the number of people has risen more than 40 times, with survival on day-to- day basis, high on every ones mind in the city.

There seems hardly a collective understanding or long-term planning for improvement of a city’s environment that may have less than four inches of average annual rainfall. No doubt we are short of sweet Indus water as we shamelessly waste almost half the water through leakages that is transported over a distance of more than a hundred kilometres.

On the other hand may it be the diesel guzzling buses, trucks or trailers; lead-rich petrol gulping private vehicles, smoke- emitting industry or its twelve million inhabitants all pollute the city’s air and rest of its environment with total impunity.

For the last fifteen years, the city’s average annual budget for parks and horticulture has been over 300 million rupees. No one seems to know how could that kind of sum of money be lost in manure.

The banks of our natural stormwater drains, barren parks and playgrounds, smoggy roads and boulevards, and garbage dumping grounds need to be planted with suitable plant species especially the native woody ones. A thousand acres of Trans Lyari Sewage farm, also known as Gutter Baghicha, may be the prime candidate for large-scale plantation that could easily serve as a lung for this city. But to achieve that objective we need a massive number of sapplings and a rational use of available water resources.

Unfortunately, at present we have neither the means nor trained personnel to address the gigantic crisis of our deteriorating e