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Accountability cells to be set up at federal govt hospitals
KARACHI, June 30: Taking note of the complaints about the quality of services and alleged inapt behaviour of the hospitals'
staff towards patients, the federal health ministry has ordered constitution of “accountability cells” in all its health care facilities
to ascertain facts and take required action in this regard.
This was stated by the Federal Health Minister Mohammad Naseer Ahmed prior to the National Institute of Cardiovascular
Disease (NICVD) Governing Body's meeting here on Thursday.
Such accountability bodies had already been established at the Pakistan Institute of Medical Sciences (PIMS - Islamabad), he
said adding that the government was committed to provide quality health care to the people.
The federal minister observed that complaints along with suggestions forwarded by the patients as well as people visiting the
health facilities would prove to be a source of guidance to bring about changes in accordance to the actual needs.
This, he further said was extremely essential for making judicious use of massive investments being made by the government
in the health sector and the government medical facilities.
The minister, in this regard mentioned that the federal government had allocated Rs11.8 billion in the health sector for the fiscal
2006-07 as compared to Rs9.5 billion in 2005-06.
“Apart from the annual health budget worth Rs11.8 billion we have also earmarked Rs2.57 billion for hepatitis prevention
programme and another Rs2.75 billion for blindness eradication during 2006- 07,” the federal health minister said.
With regards to the National Institute of Cardiovascular Diseases (NICVD), he said allocation for its running expenditures had
been raised from Rs150 million to Rs240 million during 2006-07.
Appreciating the leadership qualities of NICVD Director Prof Azhar Masood Farooqui, the federal minister said that an
additional amount of Rs600 million was being approved for NICVD for refurbishment of the facility and replenishment of its
equipment.Answering a question, Prof Azhar Masood Farooqui said that half a million people were attended only at the outpatient department of the NICVD, while another 100,000 were provided the required medical support at its emergency unit
annually - 100,000 is the annual load of in-patients.“NICVD shares an annual turn out of 700,000 patients which is the highest
around the world,” the NICVD director said.
The federal minister assured all-out support for the proposed heart house in Karachi, forwarded through the platform of the
Pakistan Cardiology Society and approved by the prime minister.
At the end of the meeting, he said a special package for paediatric surgery would be created at the NICVD and PIMS. He
approved constitution of a committee headed by Prof Azhar Farooqui, to hire and train human resources to help optimum
functioning of paediatric cardiac surgery at the NICVD.—
(Dawn-19, 01/07/2006)
Hepatitis patients in Sindh
THIS refers to the letter by Altaf Hussain Qureshi (June 25) on a recent statement made by the health minister of Sindh.
Although I have not seen the report personally, “5,348 hepatitis patients in the province” is an extremely gross underestimation
of size of the problem. I personally know that the minister is a very sincere, honest and competent politician and, therefore,
suspect that he may have been misquoted. However, it is the duty of his staff to clarify his position and correct any mistakes of
the media in this respect.
It is obvious that one needs to have a very good idea of the size of the problem and also know some basic facts regarding it
before one is making any viable plans to combat it. Hepatitis means inflammation of the liver, and viral infection is perhaps the
commonest cause for it. There are various types of viruses that can cause it and they are named after English alphabets.
Among them the common five are A, B, C, D and E.
Viruses A and E are spread mostly by faeco-oral route and as such contaminated water supply is an important source for their
spread. For this and for various other reasons, Mr Qureshi has very rightly pointed out the importance of providing clean and
safe water to the public. Virus D only causes illness when it occurs with virus B.
Viruses B and C (but not A or E) are responsible for vast majority of chronic liver disease leading often to cirrhosis of liver, and
sometimes to primary liver cancer after several years of acquiring the infection. They both are spread by blood and by bodily
secretions. In a study conducted recently at our teaching hospital, we found that 69 per cent of all patients who tested positive
for having the exposure to hepatitis C virus reported having received injections with used syringes at some stage, and this
remains a major cause of this deadly disease at least in rural Sindh.
Other sources of disease included unscreened blood and blood products transfusions, use of contaminated surgical
instruments in diagnostic and therapeutic procedures, re-use of razor blades at barbers (this is especially prevalent in rural
Pakistan), unprotected and promiscuous sexual practice, etc. This is of course completely preventable. It is the duty of all
sectors of society, including media, medical professionals and their bodies, government and also the public to take measures to
stop such practices. Mass awareness via all sources of the media is urgently needed.
The Pakistan Society of Gastroenterology’s (PSG) guidelines on “Management of Hepatitis B and C” suggest that the
prevalence of hepatitis B in Pakistan is 3-4 per cent and that of hepatitis C is 6 per cent. So nearly 10 per cent of Pakistani
population is exposed to either of these two viruses. However, this varies widely from region to region. A study conducted of
apparently healthy blood donors found that over 17 per cent of them had evidence of exposure to hepatitis C alone. Every
fourth patient admitted to our medical wards has this problem which is also responsible for the death of every third patient in our
medical ICU.
So the scale of the problem seems to be much higher than what has been suggested by the PSG —- at least in rural Sindh.
However, even accepting these figures of PSG, the 31,746,503 population of Sindh (quoted from Pakistan Demographic
Survey 2001) may include an alarming 3,174,650 patients of hepatitis caused by either hepatitis B or C – this is well over the
entire population of Hyderabad city. The problem of course would be even bigger if we also take other causes of hepatitis into
account.
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Treating patients with hepatitis B and C present serious problems. Only about half of our patients can afford the cost of tests.
The government should provide a subsidy for these tests. The treatment is even more expensive and less than 10 per cent of
patients can bear the cost.
Beyond certain stage of the illness, the drug treatment is no more an effective option. For such patients, liver transplant is the
only hope – but this is not available in Pakistan.
Prevention is, therefore, a preferred option. And for this the government, NGOs, medical professional bodies and the public
must work together.
DR S. ZAFAR ABBAS, Mirpurkhas
(Dawn-6, 02/07/2006)
Man back from 19-year coma
NEW YORK, July 4: A man woke up from coma induced by his fall from a pickup truck 19 years ago, says a medical journal
report. Terry Wallis’ ‘resurrection of sorts’ has rekindled hope for such patients’ recovery.
Doctors now, armed with latest brain-imaging technologies, think they may know part of the reason he revived, says the Boston
Globe in which the story appeared first.
Mr Wallis showed few outward signs of consciousness, but his brain was methodically rebuilding white matter, the infrastructure
necessary to interact with the outside world, researchers reported in the Journal of Clinical Investigation on Monday. “It’s a …
very slow self-healing process,” said Henning Voss, lead author of the study and a physicist at Weill Cornell Medical College’s
Citigroup Biomedical Imaging Center.
Mr Wallis emerged from a minimally conscious state in 2003 at the age of 39 and his first word since Ronald W. Reagan was in
the White House was: ‘Mom.’ Since then, the one-time mechanic from Big Flat, Arkansas, has regained the ability to form
sentences and recovered some use of his limbs, though he still cannot walk or feed himself.
In a minimally conscious state, a patient shows intermittent signs of awareness but is generally unable to interact with the
outside world. It is a less severe condition than a persistent vegetative state.
Researchers found that cells in relatively undamaged areas had formed new axons.
(By Maqsood Haider, Dawn-1, 05/07/2006)
Plentiful supply spurs demand for Gutka
KARACHI: Imports of different kinds of Gutka into the country have replaced the ancient tradition of paan chewing with Gutka
chewing. In order to try something ‘new’ consumers have, over the years, turned towards Gutka and today, whether branded or
unbranded, this product is witnessing steep growth in its demand with more and more people getting hooked to it.
Approximately 45,000 kilograms of Gutka is being supplied to the market daily, giving the numerous announcements by the
government of banning the sale and purchase of the product a lie.
Because the revenue Gutka sales generate for the betel nut industry is too great, its import is not prohibited and is easily
accessible at all paan shops. In fact it is registered as an important import item from countries like India and Indonesia.
The industrial and site areas and downtown vicinity of Karachi is where the importers or wholesalers store thousands of packs
of Gutka. Besides, several chemical factories in the city also continue to produce Gutka and so far no action has been taken
against them because these manufacturers represent business interests and are powerful enough to resist such moves.
What tempts one to purchase imported Gutka is its packing that falsely portrays it as being made of hygienic ingredients. Dr
Mahmood Haider, Dental Surgeon at Baqai Hospital, says that more than the import the government should monitor the
marketing of Gutka and its by-products on the electronic media. “With fancy and attractive sachets of imported Gutka and a
variety of catchy names, its consumption is bound to increase and associating celebrities with such products would only add to
its massive sale and consumption.”
Apart from the elderly, the shiny packets of Gutka on display attract youngsters as well who are not only active buyers but also
sellers of Gutka. The betel-sellers usually disregard the age group their customer belongs to; their only target is profit
maximization. Moreover they claim that Gutka selling generates a larger slice of profit than selling other tobacco products like
paan and cigarettes.
Ghulam Sajid has been supplying Gutka at a kiosk in Sachal Goth for the past six years and he sells 7-10 kilograms of Gutka
daily. One sachet of Gutka earns him between 20-30 rupees. Since this is his only source of income, he his reluctant to give up
his trade. “Why should I or any other retailer feel responsible when the government is not doing anything about it? The trade will
eventually stop once it imposes a ‘serious’ ban, meanwhile I can’t stop making a living,” he says.
Furthermore, unlike tobacco, Gutka comes without a health warning and due to lack of awareness in the lower stratum of
society, where the addiction of Gutka largely prevails they tend to be completely ignorant of its grave consequences and impact
on oral health.
In a sample study conducted by the Department of Microbiology, University of Karachi, last year, out of 32 different types of
Gutka 28 were found to have narcotics — a killer for human life. The study also revealed that there were 18 different types of
fungus in Gutka and other forms of betel nuts. It also contained methadone — an opium derivative.
As far as government stance on the issue is concerned, it was only in 2003-04 when betel nut import was prohibited when
laboratory tests proved that it was infected by aflatoxins, a fungus, and was pronounced unfit for human consumption. Tons of
betel nut was confiscated then and orders were passed by the court to destroy the betel nuts that were seized but this could not
be brought into action due to the strong influence of importers. In turn this resulted in an increase in its smuggling.
Importers manage to violate the set rules of inspection at the clearance stage at the port of Karachi by paying graft. They also
develop links at the local level to get their infected betel nut cleared and certified at the customs stage without any check.
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According to a leading importer: “If you pay Rs55,000 per container the customs authorities would not go for a physical
examination of the consignment. An almost equal sum is needed to bypass the group inspection.” During the fiscal year 200405, the country imported around 47,229 tons of betel nut cleared by Karachi’s customs appraisement.
This ascertains the pressure betel nut importers exert on government officials and here one can clearly observe the
irresponsible role of the latter. Steps taken by the Karachi Municipality for Food Control to deal with the issue are also
insufficient.
However some genuine importers also feel that due to the flow of low-priced and inferior quality betel nut into the market, their
trade of high quality betel nuts is being sidelined. But health advocates at Pakistan Dental Association and Pakistan Medical
Association say whether or not the betel nut is of inferior quality, the government should strictly ban all the brands of the
addictive nationwide.
(By Aroosa Masroor Khan, The News-2, 05/07/2006)
Doctor steals kidney from patient
KARACHI, July 6: When a man who went to a private hospital for the removal of his gal bladder found that he was instead
deprived of his right kidney, he had a case registered on Thursday night against the doctors and paramedics he believed were
responsible for the act.
Mohammad Kashif, a shopkeeper and resident of Gulistan-i-Jauhar, felt pain in his abdomen. He went to different doctors and
after medical tests, he came to know that stones had developed in his gal bladder. The doctors advised him to get his gal
bladder removed.
Having consulted different doctors, he decided to get admitted to a private hospital in Block-L, North Nazimabad, where he was
under treatment of Dr Syed Kashif Mateen. The patient and his family were told that the operation would take 90 minutes.
The surgery was performed on Mohammad Kashif on May 7 in the hospital but its duration stretched to four-and-a-half hours.
Kashif’s family was shown a gal bladder containing stones, and after a few days he was discharged from the hospital. Kashif
said he felt pain and went to the doctor again. Being dissatisfied with the treatment, he consulted other doctors and after
medical tests, to his horror, he came to know that he was deprived of his right kidney whereas the affected gal bladder was in
its place.
After it was confirmed by medical reports, he went to the Taimuria police station and got an FIR (280/06) registered under
section 334/406 of the PPC against the relevant surgeon and paramedics.
(By Arman Sabir, Dawn-17, 07/07/2006)
120,000 babies born with congenital heart disease annually
KARACHI: With the Pakistan population at 140 million, there are 120,000 babies born each year in the country with congenital
heart disease. Ninety percent of these either die or are detected so late that they are beyond surgery.
Presently only 1000 operations, mainly palliative procedures, are performed in Pakistan due to lack of either trained staff or
infrastructure. Karachi alone has about 12,000 children born each year with congenital heart disease. Only the parents can
understand the plight of these helpless children, said Dr Muneer Amanullah, Paediatric Cardiac Surgeon at the Aga Khan
Hospital, in a telephonic interview with The News.
Dr Amanullah, who trained over the last seven years at the Freeman Hospital in Newcastle-upon-Tyne, said that Pakistan had
one of the highest incidence of congenital heart disease with eight out of 1000 children suffering from some form of the disorder
or the other.
At present, parents of children with congenital heart disease who need open heart surgery are forced to travel outside Pakistan
for corrective surgery. This is because Pakistan has only a limited number of trained paediatrics cardiac surgeons who can
perform corrective cardiac surgery. This service is offered at the National Institute of Cardio-Vascular Disease in Karachi, the
Children’s Hospital in Lahore, and the Armed Forces Institute of Cardiology in Rawalpindi. These parents must have heaved a
sigh of relief as now the Aga Khan University Hospital (AKUH) in Karachi has started paediatric cardiac surgical programme
using the latest technology and state-of-the-art equipment.
Paediatric cardiac surgery at the AKUH programme was initiated after many months of planning and training of personnel. With
Dr Muneer Amanullah joining the faculty at AKUH paediatric open-heart surgery program was initiated in June 2006. It was
imperative that for the success of the programme, help be sought from more experienced paediatric cardiac centres. AKUH
utilised the expertise of a team from the Freeman Hospital in Newcastle-upon-Tyne in England. The team comprised Dr Asif
Hasan consultant paediatric cardiac surgeon, Dr Kelly Dilworth paediatric cardiac anaesthetist/intensivist, Mr W Watson
paediatric cardiac perfusionist and Mr. T Redhead Specialist Surgeon’s Assistant. This team spent two weeks at the AKUH to
help initiate the programme with the experts at the AKUH, i.e. Dr Muneer Amanullah paediatric cardiac surgeon, Dr Mansoor
Khan paediatric cardiac anaesthetist/intensivist, Mr. Ijaz paediatric cardiac perfusionist, the operating room nurse specialists
along with the team of highly trained, dedicated and motivated nursing staff of the pediatric cardiac intensive care unit.
Speaking exclusively to the News, Dr Muneer Amanullah said that all the surgeries performed so far at AKUH had been
successful. The complexity of surgeries varied from complete repairs of Total Anomalous Pulmonary Veinous Drainage in a 3.5
Kg baby girl, to complete repair of Tetra logy of Fallot in a 4-year-old girl. These encouraging results were achieved due to
proper planning, with induction of specialist, acquiring expert help and opinion, and most importantly everyone working as a
team.
The treatment for congenital heart disease is very expensive, whether in Pakistan or abroad. Cardiac surgery in India costs
more than in Pakistan along with the inconvenience of living in a foreign country. The AKUH now offer corrective surgery to
anyone, affording or non-affording, with the comfort of being in your own country and amongst the people you love, Dr
Ammanullah said.
Finally Dr Muneer Amanullah informed the News that the success of any paediatric cardiac surgery programme depended on
total commitment, dedication and continuing education of the team of experts looking after these very sick children.
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(By Shamim Bano, The News-3, 08/07/2006)
Maternal misfortunes
By Dr Shershah Syed
The maternal death rate can easily be reduced with genuine commitment and efforts from the authorities
IT IS more than 20 years since Professor Fatha Ali of Aswan made a documentary called Why did Mrs X Die. He showed that
women in underdeveloped countries are dying in enormous number because of pregnancy. He told us the story of Egyptian
women who were dying because of delay in getting treatment at home, delay in transportation to hospital and even delay at the
tertiary care centre.
He also showed that Egyptian women are having lots of children from very early adulthood. They are chronically anaemic and
they are living without essential privileges in a society which is male-dominated. The medical causes of maternal death were
bleeding, infection and hypertension in pregnancy. All these conditions are preventable causes of maternal death.
The maternal death rate was very high at that time. More than five hundred women per hundred thousand deliveries were
dying. Egypt had very poor indicators as far as maternal and child care are concern.
But it is a different story right now. The maternal death rate has declined to 63 per 100,000, the neonatal mortality rate is 20 per
1000, the infant mortality is 27 per 1000 and the under five mortality is 41 per 1000. These figures are very impressive for a
country where women are not valued. They have very little representation in political parties, parliament, judiciary, bureaucracy
and the armed forces. The female literacy rate is still low and civil society is still struggling against issues such as female genital
mutilation and abortion rights.
Egyptian society has many contraindications. The women of the Egyptian civilisations thousands of years ago probably had
more rights than the modern ones. There has been an increase in female literacy rate but society as a whole is dominated by
men. Recently, the government appointed the first female judge but it was not the result of the system, rather it was desired by
the First Lady. Male vasectomy as an option for family planning is not acceptable. Few women will go for tubuligation as the
consent from the husband is required, who is usually against these procedures. I was informed that abortion is illegal as far as
the law is concern. Despite the fatwa from Al-Azher University and guidelines from Kuwait Islamic declaration, gynaecologists
are not ready to terminate pregnancies at early stages. In fact it was surprising to note that many obstetricians and
gynaecologists are against family planning.
How Egypt reduced its maternal death rate?
AT present Egypt has 27 administrative divisions called governorate and there are 254 districts in the country. The government
has decided to provide primary healthcare to the poor living in city slums and rural areas. Four thousand and five hundred
primary healthcare (PHC) Units are established throughout the country. These PHCS are well equipped and has proper staff of
doctors, midwives and paramedical staff.
According to the figures given by the Health Department and verified by the World Health Organization (WHO) more than 70
percent women are attending the PHCS. In the year 2005, 56 percent of women had their deliveries at health facilities. The
government has strengthen the emergency obstetrical care at secondary and tertiary healthcare centres. It is available for 24
hours and patients are receiving it without any cost. The government has also strengthen the referral system. All villages have
access to PHC and patients can be transferred immediately to secondary and tertiary healthcare centres. The country is
producing enough numbers of doctors, nurses and paramedical staff. Though they are not well paid, they are playing a major
role in health delivery system.
The country has no DAIE (Traditional Birth Attendant) training programme any more. A trained nurse can get a license to open
a maternity home after six months of extensive on-job training in midwifery and emergency obstetrical care (EmOC). She can
work as community midwives. She is well respected and has a system in which she can refer her patients to centres where
emergency treatment is available without any cost.
With the development of PHC, the government has established 238 neonatal intensive care units where well trained
neonatologists and expert nurses are providing neonatal care to newborns. Two thousand one hundred and seventeen (2117)
incubators are functional with the help of trained paediatrician and nurse at different health centres. According to the Health
Department, a backup service is available for machinery and equipment.
This networking with availability of EmOC has resulted in drastic reduction in maternal death and neonatal mortality rate. This is
only achieved because of political commitment of politicians and government. Each governorate has a powerful safe
motherhood committee which is responsible for the surveillance of EmOC. They have power to act in favour of patients and are
authorised to post, transfer or terminate the health workers’ services.
Each safe motherhood committee produces the annual MMR report and conduct’s confidential enquiry of maternal death. This
powerful committee has access to higher government authorities for the implantation recommendations after confidential
enquiry.
The government is spending four percent of the GNP on health and the director of maternal and child health programme said
that the government is committed to millennium development goals and will be able to bring maternal death rate below 40 per
100,000 till year 2115.
What is happening in Pakistan?
THE government of Pakistan Ministry of Health and the provincial health departments have no political commitment to reduce
maternal death rate in Pakistan. They are experts in slogans and can’t produce results.
The Federal Ministry of Health is busy with other agendas like licensing of drugs, conspiracies against PMDC, so called
investigations against CPSP and useless meetings with national and international non-governmental organisations. The
provincial health departments are busy in establishing medical universities, construction of buildings and promotion of
programmes like liver transplants, etc. Maternal health is not at the top of the health agenda. There is no programme of the
government to provide EmOC and basic obstetrical care at basic health units, rural health centres and Taluka hospitals. The
donors are creating programmes and often facing problems with the government in implementing these programmes. The
National Committee on Maternal Health is not receiving funds to perform its duty with power and authority. The government
even does not listen to their recommendations and advises.
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The prime minister announces that the government is committed to millennium development goals but the ministry has no idea
how to achieve these goals in the given time.
The majority of safe motherhood programmes are donor-driven. The program works till the funds are available. Once the funds
are exhausted, the programmes are over. Without the government’s full support and participation, no programme is a
sustainable programme and no project will produce long term impact.
The Present Federal Health Ministry and Provincial Health Department cannot achieve MDG with the present policies. A small
budget for health and charity from donor agencies will not bring the required change.
Till there is genuine commitment from our rulers to improve the dismal situation, people, especially women, are going to keep
on suffering. end.
(By Dr. Shershah Syed, Dawn-Magazine 5, 09/07/2006)
Doctor in kidney theft row held
KARACHI, July 8: The doctor who has been accused of stealing a kidney from a patient during surgery at a private hospital on
May 7 was arrested on Saturday morning from a place where he was hiding.
Police investigators are yet to determine whether the doctor was associated with some organised organ trade cartel or he
removed the kidney, instead of gall bladder, by mistake or with some motive.
Police said on Saturday that Dr Kashif Mateen was accused of removing a healthy kidney without the consent of the patient
during a surgical operation on May 7. Dr Kashif operated upon the patient, Mohammad Kashif, at the Medi Complex Hospital in
North Nazimabad for removal of his gall bladder which contained stones.
“We have arrested him (Dr Kashif) from the house of his girlfriend where he had taken shelter to escape arrest. Senior
investigating officers interrogated him the whole night and in the morning,” said an investigating officer.
Dr Mateen told the investigators that he got his higher education in the field of medicine and surgery from Ireland and he had
already undertaken more than 1,000 surgical operations.
Dr Kashif, who is married and has one child, is a resident of Block-10, Federal B Area, as he informed the investigators.
He maintained that he had removed the patient’s kidney inadvertently. “It was just a mistake.” he insisted, while admitting that
the patient’s file did show that he was to be operated upon for the removal of gall bladder and not the kidney.
While the investigators declined to divulge anything about the removed kidney, sources in the police department revealed that
the investigators had extracted some information from Dr Mateen about it. They claimed that the investigators had been told
that it was kept at a pathological facility. But they were not sure that the organ was alive and valid to be transplanted.
SSP Investigation Mir Zubair Mehmood, who also holds the charge of DIG Investigation Zone-II, said the police suspected that
Dr Mateen, in connivance with some other doctors or paramedics, was trying to cover up his wrongdoings. Police were also
looking into the veracity of the reports received from certain quarters about similar cases in the history of the same hospital.
He said that the police had sought assistance of an expert doctor for guidance on the technical aspect of the case during the
investigation process.
(By Arman Sabir, Dawn-17, 09/07/2006)
Doctor held for stealing kidney
KARACHI: The Investigation Branch of the Capital City Police Karachi has arrested a doctor, who is accused of stealing one of
the kidneys from a patient during an operation to remove a gall bladder, on Saturday.
A spokesman for the Investigation Branch said that Tamoria police had registered a case against Dr Kashif on complaint of one
Muhammad Kashif, a tailor, who went in for the gall bladder operation and ended up minus one kidney.
Following registration of the case, police have the arrested accused doctor and sought services of expert surgeons so that the
incident could be probed on technical grounds. Dr Kashif had performed surgery of Muhammad Kashif at a private hospital in
North Nazimabad few days back.
Having consulted with other doctors and getting his medical tests conducted after feeling no relief, Kashif had come to know
that he had been deprived of his right kidney. He had lodged an FIR with Taimoria police against the surgeon and other
responsible.
Meanwhile, the New Karachi police have arrested four persons, including two girls and claimed to have recovered a TT pistol, a
bottle of liquor and a motorcycle from their possession on Saturday. The arrested persons were identified as Kashif, Sajid,
Huma and Azma. Kashif was involved in extortion from transporters and had remained in jail.
(The News-4, 09/07/2006)
Lack of burn care facilities major cause of deformities
KARACHI, July 9: Lack of burn care facilities and shortage of related medicine expertise were the major causes behind burn
scars, deformities and contractures in patients in Pakistan.
These views were expressed by visiting plastic and reconstructive surgeon from the US, Dr Michael E Schafer, while talking to
newsmen after conducting a skin grafting on the lower face and neck of a 20-years-old girl from Karachi at the Burns Centre of
Civil Hospital, here on Saturday.
Dr Schafer noted that mostly it were the dearth of specialized knowledge of burn injuries, improper management of burn
patients and absence of physical and occupational therapy that contributed to deformities and contractures.
He remarked that burn deformities cases were in significant number in remote and rural areas as health facilities did not exist,
while on the other hand people were ignorant of the carelessness meted out to burn patients.
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To a question, Dr Schafer said that Pakistani surgeons and nurses were competent enough to handle deformity cases and
visits of foreign experts were surely going to enhance their level of information and expertise.
He said that he had been working in the field of burn scars, deformity and contracture treatment for the last 20 years. My first
exercise outside US was in Philippines and since then I have been visiting countries under philanthropic arrangements to
perform surgeries on post-burns contractures and congenital deformities, he added, saying that such tours, in addition to
performing for aesthetic reasons, also helped sharing information and learning from medical professionals and peoples
suffering injuries in different countries.
Saturday was the third day of plastic surgery workshop at the CHK, where Dr Schafer, along with Dr William Geoff William of
Texas University, performed surgeries on post-burn patients.
In addition to surgeons training programme, a workshop on "enhancing nursing skills" was also being conducted in the
Professional Development Centre of the Dow university.
Ms Lesliee Emmert, an instructor nursing skills from Houston and Ms Hashmat Effendi of House of Charity, Houston Texas,
imparted education to local nurses, mostly from Dow Institute of Nursing.
A coordinator for the surgeries hoped that as per plan the two foreign doctors, along with local surgeons, would perform 30-35
surgeries by July 9, when the special theatre would be wound up. Patients were invited to get registered for treatment, majority
of the patients (15) belonged to Jacobabad.
Depending on the type of scar, different surgical procedures are employed for burn scars/deformities/contractures, which
occurred when a burn scar pulled on the edges of the skin making a tight area, causing functional limitation and could also
affect the muscles, joints and tendons, said an expert.
Dr Feroz Ismail, President of Health and Social Welfare Association, said that foreign experts in burns had been visiting to
Pakistan earlier too, but this time they were operating at the Burns Centre, a 66 bedded burns care facility run under public and
private partnership, for the first time.
He said that his association had arranged the medical mission to operate on post burns and congenital deformities in the Burns
Centre and NICH. The mission is leaving for Lahore on July 10 but will return for treatment of paediatric burns at the NICH.
President of Burns Centre, Mohammad Abdullah Feroz, said that visit and operations by the Houston's doctors was a good
experience and beneficial to burn patients, a majority of whom belonged to poor class.
We are working on a plan under which the mission in question may carry out surgeries after every one or two months, he
added, saying that we have got registered a good number of deformity and contracture patients needing the treatment, which
cost significantly high in the private sector.
The medical superintendent of CHK, Dr Kaleem Butt said that the Burns Centre had got the state-of-the-art facilities operating
in line with the international standards and was providing 100 per cent free treatment and medicines to patients.
The executive director of Burns Centre, Dabirur Rehman, said that 743 patients were admitted for medical and surgical
treatment at the centre from Jan 2005 to June 2006, while 3,187 were attended at the OPD.
(Dawn-18, 10/07/2006)
Hunt on for OT team in kidney-theft case
KARACHI, July 10: Police are looking for the anaesthetist, doctors and paramedics who assisted in the Dr Kashif Mateen, a
surgeon accused of stealing a kidney from a patient at a private hospital in North Nazimabad on May 7.
On Monday, Police took remand of Dr Kashif from a court till July 12 and started proper investigation into the matter on the
complaint of the patient, Mohammad Kashif.
Investigators said they were trying to establish through clinical tests that whether the kidney recovered from a pathological
facility belonged to the same patient or not.
Mr Kashif has lodged an FIR stating that Dr Mateen had removed one of his healthy kidneys while operating upon him for the
removal of his gall bladder.
Police found that a complete gall bladder was also deposited in the pathological facility. A medical officer at the facility said that
as per their record, the gall bladder belonged to Mohammad Kashif and was sent there for post-operation testing. However, the
post-operation radiological investigations established that Mr Kashif still possessed the gall bladder with stones.
Investigators are now trying to locate the patient to whom the deposited gall bladder belongs.
The investigators are also trying to verify the credentials of Dr Mateen from the institutions concerned.
Mr Zubair Mehmood, acting DIG Investigation Zone-II, said: “We have to prove in court that the kidney belongs to Kashif for
which we are going through the process of medical tests as advised by doctors.” He said that an expert doctor to provide police
technical assistance in the process of investigation would hopefully join in the process on Tuesday.
Besides, the investigators have also located nine patients who were operated upon by Dr Kashif Mateen. Most of the patients
had gall bladder-related problems. While eight of them made no complaint of a mishap during treatment, one told the
investigators that he would have to check whether he had both the kidneys in place. Police were trying to contact all the
patients operated by Dr Kashif Mateen.
During investigations, Dr Mateen insisted that he had not removed the kidney deliberately. However, medical experts said that
the incision, beneath ribs, showed that it was carried out for removal of gall bladder though the mark of incision should not be
as lengthy in size as it was on the patient in such cases.
According to them a kidney cannot be removed unintentionally because of the ‘peritoneum layer’ that exists between gall
bladder and kidney and a surgeon cannot see the kidney unless the layer is cut apart. They argued that if the operation was
meant to remove gall bladder and kidney was removed by mistake, then why the gall bladder also was not removed.
(By Arman Sabir, Dawn-17, 11/07/2006)
6
‘Kidney-stealing’ doctor remanded in police custody till 12th
KARACHI: Dr Syed Kashif Mateen, who is alleged to have removed the kidney of a patient, was produced before Judicial
Magistrate, Muhammad Aamir Awan on Monday, who allowed police remand till July 12.
The Investigating Office (from the Tamooria Police Station) who produced the accused prayed to the court to allow him to
posses the custody of the accused for another three days so he could complete necessary investigations. The court allowed the
plea. However, the counsel for the accused, Advocate Waqar Shah, who moved the bail application on behalf of the accused
prayed that he deserved to be released on bail. The court entertaining this application issued notice to the prosecutor
concerned and fixed July 11 to hear the bail plea. The complainant in the case, Kashif, has taken the plea that he was cheated
and instead of going through a minor operation, the accused surgeon operated and removed his kidney on May 7, 2006.
Dr Syed Kashif Mateen while talking to the journalists (outside the court room) said he was implicated falsely in the case, as it
was not possible to survive without a kidney after the lapse of three months as the complainant had claimed. He claimed he
had been receiving “threats” from unidentified people from last several months.
Replying to a question, the accused said after completing his education from the US, when he turned up and decided to set up
a clinic, some of his competitors had resisted and warned him not to practise in Pakistan, but he did not care and finally had to
face this “concocted” charge.
Nishtar Park Blast: The Inquiry Tribunal, headed by Justice Rehmat Hussain Jaffery, could not conduct its hearing on Monday
and fixed July 11 (Tuesday) as the next date of hearing. Earlier, since Chief Justice of Sindh High Court Justice Sabihuddin
Ahmed left for the US, a Senior Pausine Judge, Justice Ghulam Rabbani took the oath of Acting Chief Justice and almost all
the judges of Sindh High Court attended the oath taking ceremony.
(The News-4, 11/07/2006)
Doctors’ negligence
WHILE suspicions of foul play are growing by the day in the case of the doctor arrested in Karachi on charges of removing a
patient’s kidney instead of his gall bladder, there is no definitive evidence as yet to prove an ulterior motive behind his actions.
Until fears of his involvement in the growing phenomenon of illegal kidney sales are substantiated, it would be more appropriate
to treat it as a case of medical negligence at the private clinic where the surgery was performed. But regardless of whether the
doctor’s actions were deliberate or a mistake, the fact is that the patient in question faces risks to his health in addition to
footing heavy medical bills.
Unfortunately, this sort of medical negligence — if this indeed was the case — is prevalent across the country. Earlier this year,
two cases were reported of a pair of forceps being left in a patient’s abdomen, resulting in the death of one woman. When such
cases are highlighted by the media, the higher medical authorities do initiate an investigation into the actions of the doctors
responsible, but the affair is hardly ever followed up. In fact, so far only a handful of doctors have been penalised for medical
negligence, and most hospital administrations and doctors manage to evade responsibility. Emboldened by the absence of
checks, they continue to indulge in medical malpractices. This is not only true of government hospitals, notorious for their poor
level of health services, but also for private medical institutions that, unfortunately, are not being monitored, although the
government has promised to introduce laws to regulate them. Unless this is done, it will be difficult to make erring doctors, or
the institutions they work in, face legal action. In the absence of the latter, doctors will carry on flouting all norms of proper
patient care.
(Dawn-7, 12/07/2006)
Sindh govt approves Rs500m grants for Civil Hospital
KARACHI: The Sindh Planning and Development Department has approved Rs200 million additional grants for the Civil
Hospital (CHK), while Sindh Finance Department has also approved Rs50 million for the uplift schemes of the CHK and Lyari
General Hospital (LGH), a high-level meeting was told here on Wednesday.
The meeting was held at the Governor’s House to review the management system for the state-run hospitals of the province,
with Sindh Governor Dr Ishratul Ebad Khan in the chair.
The meeting was told that Rs511 million had been tagged from 30 different projects for the CHK and had been included in the
annual development program (ADP).
It was told that facelift of the CHK had already been started, while a 500-kva generator was being installed in it. Work was also
in progress to upgrade and renovate the casualty department of the CHK, besides setting up a medical ICU and pathological
laboratory.
Regarding the Civil Hospital Hyderabad and Jamshoro, the meeting was told that two eight-bed ICUs funded by the federal
government would be completed by Augusts, while Angio Cath Laboratory and Cardiac Surgery Department would also be
completed next month.
Moreover, 11 different projects, costing Rs 18 million had been included in the ADP. These projects include setting up of new
operation theaters, pathology laboratory and blood bank, trauma centre, kidney transplantation centre and bio-medical
laboratory.
The meeting reviewed the progress of management boards in civil hospitals of Karachi and Hyderabad. Chairmen of both
boards, Abu Shamim Arif and Roshan Zameer briefed the meeting on various steps taken in their hospitals and their future
plans.
Addressing the meeting, the governor said that hospital management boards had already been established in the civil hospitals
of Karachi and Hyderabad, while it this system would be extended to the whole province in various phases. He hoped that after
the introduction of this system, the government hospitals would be made healthcare delivery centres for patients, as it would
further improve their utility and efficiency.
7
The governor hoped that these hospitals would be modernised due to the efforts of the government and private sector experts,
running their management boards. He asked for urgent steps to improve general cleanliness in their hospitals. He said that
patients should be provided a peaceful environment in these hospitals. He said that the government hospitals had been
provided with medicine and modern equipment and the supply of medicines had been raised four times.
Sindh Health Minister Shabbir Ahmed Qaimkhani, Sindh Chief Secretary Fazalur Rehman, Vice Chancellor of Dow University of
Health Sciences Prof Dr Masood Hameed, Vice Chancellor of Liaquat Medical University Prof Dr Jan Muhammad Memon and
others were also present on the occasion.
Ordinance promulgated: Sindh Governor Dr Ishratul Ebad has promulgated an ordinance for establishment of public
procurement regulatory authority to regulate procurement of goods, services and works in the public sector.
The ordinance called Sindh Public Procurement Ordinance 2006, extends to whole of the province and shall come into force
with immediate effect, said an official handout released here on Wednesday.
(The News, 13/07/2006)
Girl suffering from ‘Congo fever’
PESHAWAR, July 15: A patient was suspected of suffering from Crimean-Congo haemorrhagic infection in Abbottabad, officials
said. According to officials of the provincial directorate-general of health, the executive district officer (EDO), health, Abbottabad
had sent a letter on July 13 to the director-general health services, saying that a young girl Saleema, a resident of Balakot,
Mansehra district, had come to the Abbottabad Teaching Hospital with symptoms like Crimean-Congo haemorrhagic fever
infection. The letter said that the girl had developed a fever which lasted a month, adding that she also suffered abdominal pain
and defused body aches.
Then one day, the letter said, she started bleeding from eyes, nose and mouth. The patient, it said, had recovered after being
hospitalised for three days. The girl, the letter said, was unmarried and had no history of addiction and all six members in her
family are healthy. It said she had not travelled before the past two months.
(Dawn-5, 16/07/2006)
Testing for thalassaemia
IT pays to be careful, and even though the incidence of HIV/Aids in Pakistan is low at the moment, the government has done
well to announce plans for a voluntary programme aimed at encouraging couples to have themselves tested for the disease
before marriage. Unless precautionary measures are taken before and after birth, the virus can be transmitted from an infected
woman to her child. But while one appreciates this move, it is puzzling why the government does not seem as concerned about
thalassaemia, a common genetic disorder of the red blood cells that, in its less virulent form, afflicts some 10 million people in
the country. The greater danger is thalassaemia major. Frequent blood transfusions are needed in this condition, and patients
are exposed to increased risks of contracting other blood-borne diseases.
Given the high figures for thalassaemic patients, there have been suggestions that the best way to bring down its incidence is
to prevent the birth of children with that condition. This is where pre-marital blood testing comes in so that couples can make an
informed choice when it comes to having children. True, there are sensitivities involved as more than 30 per cent of marriages
in Pakistan are between first cousins who may both carry the recessive gene, thus compounding the chances of producing a
thalassaemic child. But there are countries with cultural norms similar to ours — like Iran — that have made such testing
mandatory and are dealing successfully with the problem. Cultural traditions can be diluted and made more flexible by
disseminating greater information about thalassaemia and its potentially fatal effects. After all, it is a question of saving our
children from a life of misery and spending much of their time in a protected environment.
(Dawn-7, 16/07/2006)
1,500 posts of doctors lying vacant in Sindh
KARACHI, July 17: About 1,500 posts of doctors and health specialists are lying vacant at various government health facilities
throughout the province, say sources in the provincial health department.
The worst sufferers are the patients in rural areas, who have been left dependant on the ill-equipped primary level healthcare
facilities. A number of basic health units, dispensaries and mother and child health centres have almost ceased to function due
to non-availability of doctors, which could be attributed to the ban prevailing for long on recruitment, it is learnt.
Sources said that unmanaged and under-utilisation of rural health facilities, severe shortage of staff and the menace of
absenteeism had been the sources of concern among the high-ups.
As such, they added, there was likelihood that the basic health units in some districts, including Tharparkar, Dadu, Larkana,
Sukkur, Mirpurkhas, Badin, Jacobabad, would be outsourced in future.
It was in February last that the Sindh government had decided to recruit 1,300 doctors and health specialists against the vacant
posts in grades 17 and 18 in the health department on contract basis.
The posts included about 760 those against which a procedure for appointment on regular basis was undertaken by the Sindh
Public Service Commission. However, it was stopped later on the directives of the chief minister, who in the first week of
February had declared the results of written tests of candidates null and void, citing reports of "large scale irregularities and
manipulations" in the tests.
In view of the fact that cases pertaining to invalidation of the SPSC test results are before the courts of law, the health
department has now decided to request the chief minister to accord approval for appointment of doctors on contract basis
against the posts, which were not subjudice.
Sindh Health Secretary Dr Naushad A. Sheikh confirmed that his department was considering appointments of doctors on
contract basis.
He told Dawn that there were about 465 posts of doctors in Grade 17 and 280 posts of specialists in Grade 18, which were not
in litigation and awaited appointments for long. In view of the crisis, he said, immediate appointments were required.
8
The health secretary expressed hope that the chief minister would accord his permission for the purpose.
He said that the department also intended to appoint candidates against another 36 posts which were vacant for the time being
as doctors had gone on long leave or were out of country on deputation.
Naushad A. Sheikh said that the new appointments would be hospital or district specified in order to retain the doctors at rural
health units and dispensaries for a longer period.
The appointment period under the contract system would be one year with the possibility of an extension over a period of three
years in the light of reports from nazims or DCOs and EDO Health concerned through constant evaluation, he said.
Besides, he mentioned that the persons who would be appointed against the 36 posts would be relieved as soon as the doctors
on long leave and those out of country on deputation returned and rejoined the department.
(By Mukhtar Alam, Dawn-17, 18/07/2006)
11 hepatitis centres to start work this month: Rs2.58bn programme
KARACHI, July 18: As many as 11 designated centres, including one at Karachi, will start giving treatment during this month to
hepatitis patients in Sindh under the Prime Minister’s Programme for Prevention and Control of Hepatitis, according to health
officials.
The programme, launched in August last year, has an estimated cost of Rs2.58 billion to be spent over a period of five years.
Sindh has been promised treatment resources, including Interferon injection, for 1,740 Hepatitis-C patients in the first phase of
the programme which is supposed to continue up to June 2006.
The programme also envisages measures for safe blood transfusion, use of sterilised medical equipment at government and
private hospitals and prohibition of the reuse of syringes.
The quarters concerned, mainly the patients already registered by the federal health ministry for treatment, have eagerly been
waiting for the centres going operational. “We apprehend that the traditional lethargy of the bureaucracy, lack of capacity at the
selected centres and poor publicity of the facility are the factors which can jeopardise the targets set by the planner,” said a
keen observer, suggesting that efficient monitoring and evaluation of the centres’ working is a must.
Though there is no sound scientific study about the number of hepatitis patients in the country, it is established that Sindh has
the highest rate of unsafe injection, which also contribute, among others, to the rise in Hepatitis-C cases.
According to Sindh health officials, an estimate evolved by the ministry of health suggests that about 3.6 per cent of the
population in Sindh is affected with Hepatitis B virus, while 5.4 per cent of the population suffers Hepatitis C. As far as Hepatitis
A (a self-limiting disease) is concerned, nearly 97 per cent population has at least one episode before the age of 15.
Holding the PM’s initiatives in a high steam, a health care facilitator noted that the programme needed to be publicised further
so that a big majority of the affected people which could not afford proper treatment, could approach the government
organisations and centres for a timely relief.
It is learnt that a majority of the centres being established in Sindh lacks basic facilities, proper accommodation and medicine
storage facilities. A number of centres are yet to set up the committee with the task of verifying and recommending patients
deserving free medicine.
When contacted by Dawn for details of the PM’s programme for Prevention and Control of Hepatitis, Deputy Programme
Manager Dr Rana Mohammad Safdar from Islamabad said that the programme was now out of the initial days’ organisational
hang-ups.
Against our initial target of 50 centres to be set up in the first year of the programme (2005-2006), we have established 60
centres at different teaching hospitals and district headquarter hospitals throughout the country, which would be made
functional in a week or so. He said that every centre would comprise pathological laboratory, diagnostic facilities, physicians
and vaccines for scanning and confirmation of hepatitis cases, and delivery of the required medical treatment.
“At the headquarters, Islamabad, we have received about 300 letters from Hepatitis-C patients, including about 100 from Sindh,
seeking treatment,” Dr Safdar stated, adding that approval letters had also been sent to selected patients who would now
contact their designated cure centre and would be able get medicines free of cost.
He said that there was a commitment to provide treatment to 14,000 Hepatitis-C patients in the first phase in the country, while
Sindh would be provided with medicines meant for 1,740 patients. “We are also working for providing treatment for another 500
hepatitis patients in Sindh,” he added.
In reply to a question, he said that in Karachi another hepatitis centre would be established at the Civil Hospital Karachi during
2006-07.
The hospitals where such centres have been established for extension of PM’s programme in Sindh are: Jinnah Postgraduate
Medical Centre, Karachi; Civil Hospital Badin; Civil Hospital Sukkur; Civil Hospital Mithi (Tharparkar); Civil Hospital Mirpurkhas;
Civil Hospital Dadu; Civil Hospital Jacobabad; Civil Hospital Khairpur; People’s Medical College Hospital, Nawabshah; Chandka
Medical College, Larkana; and District Headquarter Hospital, Jamshoro (taluka headquarter Kotri).
The provincial coordinator for PM’s programme, Dr Zulfikar Ali Gorar told Dawn that these hospitals were required to form a
committee for provision of drugs. A person from OPD will report to the physician who will refer the case for laboratory tests after
the confirmation of lab tests; physician will take the case to a designated committee and get the concurrence.
If the committee agrees, the case will be sent to the provincial coordinator for arrangements of Interferon and Ribavirin through
the DG Health Services, Sindh. Mr Gorar further stated that the committees were being formed at different centres. He said that
Sindh had already received about 33 per cent of the total requirement of medicines for 1,740 patients from Islamabad.
He said that about 97 cases had been referred to Sindh by the federal unit of the programme and the same would now be
considered and examined. Replying to a question, he said that there was some problem regarding scientific storage of the
costly medicines, but within 10 days or so, all centres would start handling such patients.
According to experts, Hepatitis-C is a liver disease. The infection spreads when blood or bodily fluids from an infected person
enters the body of an unaffected person.
9
Because symptoms like tiredness, loss of appetite, stomach pain, nausea and vomiting, develop slowly most people with
chronic HCV infection do not know they are infected and can unknowingly transmit the virus to others.
The HCV is not spread by casual contact such as hugging, kissing, sneezing, coughing, eating/drinking and using an infected
person’s utensils, but it may be transmitted if needles, syringes or other utensils of drug use are shared with an infected patient.
Hepatitis may take two to three decades for serious liver damage to occur, experts say, stressing that early detection of HCV is
very important as treatment at the early stage proves effective.
(By Mukhtar Alam, Dawn-17, 19/07/2006)
Nurses’ grievances
THAT there is one nurse for every 35 patients in the country highlights just how pitiful the public healthcare facilities are.
Nowhere does this seem more pronounced than in the NWFP where, according to a recent report, the doctor-nurse ratio is five
to one whereas the World Health Organisation rules require it to be one to four. This discrepancy must be removed — and soon
as the nurses in the Frontier have threatened to go on strike. If that happens, as it did once before earlier this year, it will have
serious consequences for the already beleaguered patients who have no choice but to go to public hospitals. It is a testament
to their profession that these nurses called off their strike in March because they were assured by the government that their
grievances would be addressed but it is disturbing that it has not done so. This apathetic attitude points to the low priority given
to healthcare. Nurses are the backbone of any healthcare system and their problems should be promptly tackled as there is a
dire shortage of them — there are reportedly only 2,000 nurses in the NWFP. Instead of focusing on strategies on how to induct
new nurses or building more nursing colleges to fill the vacuum, the government must attend to the problem at hand.
It is disturbing that unlike their counterparts in other provinces who receive a stipend of Rs 4,100, student nurses in the NWFP
get only Rs 1,275. This anomaly must be removed immediately. It is no wonder that no one is willing to consider nursing as a
good career option. Not only are their working conditions abysmal, nurses are routinely harassed. Much more emphasis needs
to be placed on improving their working conditions as well as training more nurses to fill the gaps in this sector.
(Dawn-7, 19/07/2006)
Diet for health
By Dr Aftab Ahmed Khan
Healthy eating habits can prevent cancer in human beings
Dietary habits can play an important role in preventing or minimizing the risk factors of colon and other cancers.
For many years, scientists have studied the countries where a typical diet is higher in fiber and lower in fat than in the United
States. People in these countries have a lower incidence of heart disease and certain cancers. One such cancer is colorectal
cancer. As dietary fiber bulks up the stool and speeds elimination of waste from the body, common sense led researchers to
explore the link between fiber and a lower risk of colon cancer. In 1811, British physician J. Howard proposed that constipation
was an important factor in cancer risk.
To test this theory about fiber and colon cancer, scientists have often extracted large amounts of fiber from food and fed it to
people as a supplement to their diets. But the idea that fiber alone prevents colon cancer did not hold up.
In 1997, an international panel of 16 scientists, acting on behalf of the American Institute for Cancer Research (AICR), reviewed
all the existing research on fiber and colon cancer. They found only weak evidence for a link between fiber supplements and
reduced risk of colorectal cancer. Since that time, two more studies have been published that find no link at all.
But what about eating whole foods that are rich in fiber? The majority of evidence suggests that fiber-rich foods can help
prevent colorectal cancer.
That AICR panel of experts also reviewed 26 studies on the linkage between vegetables, which are rich in fiber, and colorectal
cancer. Twenty-one of them showed a positive relationship. After carefully weighing all the available research, these scientists
concluded, “Evidence that diets rich in vegetables protects against cancers of the colon and rectum is convincing.”
This conclusion is not surprising. In addition to fiber, vegetables offer vitamins, minerals and phytochemicals , naturally
occurring “plant chemicals” that work to lower cancer risk in many ways. Scientists believe the anti-cancer power of fiber
working with these substances is much greater than any one of them acting alone.
Recently, two new studies that disputed the link between vegetables and the prevention of colon cancer were published. They
received a lot of publicity. It is significant, however, that in both studies, most participants failed to eat the recommended five or
more servings of vegetables and fruits a day. Eating a salad or even an apple a day may not be enough to influence cancer
risk, but AICR researchers believe that eating five or more servings of vegetables and fruits will do so. Therefore leave the fiber
supplements on the shelf, and enjoy a variety of fiber-rich foods for lower cancer risk.
Eating more fiber-rich foods may protect you from some forms of cancer and significantly reduce your risk of heart disease,
diabetes and obesity. Getting enough fiber also helps many common conditions related to colon function, including
constipation, hemorrhoids and diverticulosis
Foods that come from plants, including vegetables fruits, whole grains and beans are the best sources of dietary fiber, Animal
products, such as cheese and eggs, do not contain any fiber. Some people, because of age or illness, are unable to digest
high-fiber foods easily. If this is the case with you, then speak with your physician or a registered dietitian about alternatives.
Nutrition experts suggest eating between 20 and 35 grams. However, there is no need to count, if you eat minimum five
servings of fruits and vegetables each day, as well as seven servings of whole grains and beans, then you will be getting
enough fiber. And it’s not as difficult as you might think.
A serving of fruits and vegetables is equal to just one apple or peach, one-half cup of pineapple chunks, one-half cup of
chopped broccoli or one quarter cup of raisins. Servings of grains and beans add up even faster, the two slices of bread on a
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sandwich equal two servings, as does a cup of rice or pasta. A cup of beans equals two servings, and you can wrap them in a
whole wheat tortilla for one more, your morning bowl of cereal probably contains two or more servings.
If you find that you need more fiber in your diet, cut back on pastries and choose fruit for desert and snacks. Cut back on meat
servings and add more vegetables, fruit, whole grains and beans to every meal.
Fiber alone may not prevent cancer, but eating a fiber-filled diet has many advantages for health:
• Dietary fiber slows the absorption of food by the body.
It helps to keep the level of blood sugar and insulin steady and appetites satisfied longer.
• By lowering cholesterol absorption from food and reducing cholesterol production by the body, dietary fiber may help protect
the cardiovascular system.
• As the colon tries to digest fiber, substances are produced that regulate the growth of cells lining the colon. A regular pattern
of cell growth is healthy, cancerous cells grow unchecked, out of control.
• By collecting and holding damaging bile acids, fiber protects the lining of the colon.
• By increasing stool bulk and weight, fiber dilutes harmful substances and speeds up their elimination from the body. This
action also helps prevent constipation.
Eating very large amounts of fiber (60 grams or more) may pose unwanted side effects. A person may experience more gas
than usual. Eating a very high fiber diet and not drinking enough water may leave the stool very hard and difficult to eliminate.
The recommended daily intake of dietary fiber is from 20 to 35 grams. At this level, you will experience only the beneficial
effects of dietary fiber. It is a good idea, however, to increase fiber gradually and drink at least eight ounce glasses of water (or
other uncaffeinated beverages) a day. This will help your body to adjust to the change.
Look at your dinner plate. Are you eating to protect your body against cancer? Form the habit of filling at least two - thirds (or
more) of your plate with vegetables, fruits, whole grains and beans especially vegetables and fruits - and one-third (or less) with
lean meat and dairy.
This kind of diet is naturally low in fat and calories and high in vitamins, minerals, phytochemicals and dietary fiber. Eating these
nutritious foods can help you reduce your cancer risk, increase your energy and enjoy better health at the same time.
1. Choose a diet rich in a variety of plant-based foods.
2. Eat plenty of vegetables and fruits
3. Maintain a healthy weight and be physically active.
4. Select foods low in fat and salt
5. Prepare and store food safely.
Food
Serving size
Amount of fiber (in grams)
Potato, baked with skin
1 medium
5
Acorn squash, baked
½ cup
5
Mixed vegetables, frozen
½ cup
4
Carrots
½ cup
3
Broccoli
½ cup
2
Corn kernels
½ cup
2
Spinach, raw
1 cup
1
Apple, with skin
1 medium
4
Blueberries
½ cup
4
Apricots, dried
½ cup
3
Banana
1 medium
3
Orange
1 medium
3
Strawberries
½ cup
2
Vegetables
Fruit
11
Grapefruit
½ large
2
Lentils
½ cup, cooked
8
Split peas
½ cup, cooked
8
Kidney beans, black beans
½ cup, cooked
7
Hummus
½ cup,
6
Bulgur
½ cup, cooked
4
Whole wheat spaghetti
½ cup, cooked
3
Barley
½ cup, cooked
3
Whole wheat pita
½ pita (6 ½)
3
Brown rice
½ cup, cooked
2
Whole wheat bread
1 Slice
2
Enriched spaghetti
½ cup, cooked
1
Bagel, plain
½ bagel (3 ½)
1
White rice, instant
½ cup, cooked
1
Legumes
Grains/Breads
long-grain
White bread
1
(By Dr. Aftab Ahmed Khan, Dawn-The Magazine-5, 23/07/2006)
Hypertension on rise among urban, rural populace
KARACHI: "Affecting 21.5 percent adults in urban and 6.2 percent in rural areas, hypertension is certainly one of the latest
health scares for our society", said Dr. Zahid Jamal, a senior cardiologist and Associate Professor at the National Institute of
Cardio-Vascular Diseases (NICVD) while addressing a seminar on hypertension organised by the Pakistan Medical Association
(PMA).
"The definition of hypertension is changing everyday, since the amount of stimulants for hypertension an individual comes
across everyday in our society is variable. We are still trying to establish what the normal blood pressure is, because normal
blood pressure differs in different kinds of patients."
"There is a strong relationship between hypertension and cardio-vascular disease. Ninety percent of people develop both of
them after 55 years of age. The best way to prevent them from occurring is to exercise regularly, eat low salt diet, avoiding
greasy foods, and complying with your physicians advice strictly", he added.
The speaker also shed light on the kind of medication suitable under different conditions and on different patient types. He
emphasised that every physician upon initiating treatment must always take the patient's history and must look for clues of
diseases like cardio-vascular disease, diabetes since this directly affects the treatment structure that follows diagnosis.
The cardiologist added that potassium supplements becomes necessary for hypertension patients. However the best option for
them remains regular exercise, which not only cures the disease but also helps prevent the related diseases as well.
At the end of the seminar, Dr. Sher Shah Syed added briefly that the entire physicians' community condemns the act of the
doctor who stole the kidney of one his patients. He urged the authorities that medical ethics be introduced as part of the
medicine curriculum, the absence of which is greatly responsible for such incidents.
(The News-5, 23/07/2006)
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Kidney removal case continues to mystify
KARACHI: Surgeon Dr Syed Kashif Mateen of the Medi-Complex Hospital (MCH), after confessing to a ‘mistake’ on television
and in custody, now denies the kidney theft charge, saying that he is innocent and all this was being done to blackmail him into
paying money to the victim and could be engineered by certain ‘envious’ elements.
He says that if Kashif’s kidney was removed, he should have had the relevant post-operative symptoms, which he did not. He
maintains that he possessed a prestigious qualification and could never commit such a heinous crime or mistake.
The surgeon’s bail application moved before the Additional District and Sessions Court, Central, was rejected on Saturday. The
Health Department committee assigned to probe the matter by the Sindh Health Minister, Shabbir A. Qaimkhani, has initiated
its investigation. The three-member committee comprises Dr Ashfaque Hussain Memon, the Additional Secretary (Technical) of
the department as the Chairman, Dr Aisha Saleem and Dr Humayun Zafar of Sindh Government Qatar Hospital.
The retrieved kidney has been ‘retrieved’ from a morgue, claims Farrukh Mateen, Dr Kashif’s brother. Even the doctor who is
reported to have been consulted for the second opinion seems to be fake since he has not appeared in court or seen anywhere
even once.
Dr Kashif was arrested and is being questioned after he allegedly removed Mohammad Kashif’s kidney instead of the gall
bladder for which he was operated upon. The kidney, according to police, has been recovered from Dr Essa’s Laboratory on Dr
Kashif Mateen’s indication. It was submitted to the SIUT for Cross-matching by HLA (human leucocyte antegen) to establish
whether it belonged to the complainant or not but has been returned after initial approval of SIUT stating that the facility is not
available there, according to Ejaz, investigation officer.
Police have also traced Anesthetist Dr Inam and OT Technician Abid who recorded their statements in the court of judicial
magistrate, Central, Amir Awan’s court, denying that they saw Dr Kashif Mateen ‘steal’ the kidney.
Investigation officer Aijaz said that the use of the word ‘theft’ is being done to divert attention from the spirit of the Section 334,
which is removal of an organ. Mohammad Kashif, 30, resident of Gulshan-e-Maymar, had reportedly presented to Dr Kashif
Mateen, a Dow graduate having double FRCS (England and Ireland), FICS (USA) and MRSH (England), with abdominal pain
and was diagnosed with Cholelithiasis. He was operated upon on May 7, 2006, for cholecystectomy.
When after remaining under Dr Mateen’s treatment till June 30, the symptoms of gall stones continued to aggravate, he
consulted another doctor, Afzaal who had his ultrasound repeated, revealing that the gall bladder was still there and instead,
the right kidney was absent.
According to patient Kashif, he brought the matter to the notice of Dr Mateen who initially advised him to get admitted for a reoperation but when his attention was drawn towards the missing kidney, he told Kashif that the matter could be ‘settled’.
Mohammad Kashif initially lodged a complaint in the Taimuria Police Station on the afternoon of July 7, but when Dr Mateen
failed to turn up despite several calls from the police, an FIR (280/06) was registered under PPC article 334 and 406 by night
and Dr. Kashif Mateen was later arrested.
According to Dr Kashif’s lawyer, Advocate Waqar Shah, certain professionals are protected by law for errors they commit,
which include law enforcement agencies as well as doctors. Even if Dr Kashif committed the mistake, it is not a crime. In
contrast, Dr Kashif is categorically denying that any such error was committed.
Meanwhile, conflicting evidence and logic-defying circumstances have made the case considerably complex. If at all the kidney
was removed, as evident from circumstantial evidence, the nature and exact circumstances of the procedural error remain
unclear. The routine technique for cholecystectomy nowadays is by laproscopic surgery. The MCH also displays a board on its
building to promote laproscopic surgery. However, this technique was not employed to operate on Mohammad Kashif.
Even for an open surgery to remove the gall bladder, according to senior surgeons, the incision was longer than that usually
made. Moreover, the gall bladder lies anteriorly to a sheet of tissue called peritonium whereas kidneys lie behind it and hence
the latter cannot be accessed unintentionally. Also, it is rare for a partial cholecystectomy to extend over four hours.
Even after the removal of the kidney by mistake, the removed organ can be visually identified. Interestingly, according to police,
the first sample of tissue received by Dr Essa’s Lab was in fact a kidney which was labeled gall bladder. Upon contacting Dr
Mateen, he replaced the kidney with a gall bladder. Also, Dr Kashif Mateen’s post-op note of performing a partial
cholecystectomy conflicts with the lab report of a complete gall Bladder. According to police, Dr Mateen has admitted that the
organ belonged to another patient and not Mohammad Kashif.
Surgeons’ opinions are that the circumstantial evidence indicates that the kidney was removed intentionally but raise the
question that even if it was so, why did Dr Kashif not perform the gall bladder surgery so as to relieve his symptoms.
Importantly, upon realisation of the mistake, the doctor could have re-operated the patient later to remove the offending organ,
since the symptoms persisted. Other opinions include that the gall bladder was not removed because after removal of a
normally functioning kidney and four hours under general anesthesia, the patient’s condition might have turned unstable due to
which the doctors might have hurriedly closed the abdomen without removing the gall bladder. This opinion is complemented by
the fact that the patient was kept in the ICU till the following day.
Surgeons have also raised the question of the role of the OT technicians and the anaesthetists involved, stating that the whole
team is well aware of whatever is happening on the operating table and could have pointed out if any step was being done
‘mistakenly’. The Pakistan Medical and Dental Council (PMDC), when contacted, said that it cannot act on such cases of
malpractice unless there is a formal complaint lodged with the council.
(By Shamim Bano, The News-2, 25/07/2006)
High Court forbids dumping of toxic waste
KARACHI: A divisional bench of the Sindh High Court comprising Justice Mushir Alam and Justice Nadeem Azher Siddiqui on
Wednesday ordered that no industrial waste dumping will take place on plot numbers F-620 and F-621 in the Sindh Industrial
Trading Estate (SITE).
It may be recalled that dumping of toxic waste by unscrupulous elements in March this year on the above-mentioned plots
claimed the life of one child besides seriously injuring as many as 20 others.
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Faisal Siddiqi, an eminent lawyer is pursuing the case against the dumping of toxic waste on the above-mentioned industrial
plots on behalf of an “Action Committee” formed by the affectees of toxic waste.
The Advocate for Gharibsons (Pvt), Limited, whose owner was arrested by police for allegedly dumping toxic waste on these
plots and later released also filed his Vakalatnama. The divisional bench adjourned haring till a date to be fixed by the office of
the court.
The dumping of toxic waste on the above mentioned plots claimed the life of a Iftikhar, nine, while another child, Shiraz, has
been disabled for life because he got his legs amputated as a result of being affected by the industrial waste.
It has been submitted that the aforementioned death and injuries were a direct result of the presence of industrial chemical toxic
waste on the above-mentioned Plot F-620, SITE Town, Karachi, and Plot No. F-621, SITE Town, Karachi, which were being
used for the dumping of industrial chemical toxic waste, the petition said.
The petitioners Nawab Ali, Noor-u-Rehman, Janzada, Muhammad Majeed, Abdul Shakoor and Gul Nazeer are members of a
voluntary association known as “Action Committee for the affectees of the tragedy of SITE.” (Action Committee Barae
Mutasareen Saneha SITE).
Some of the petitioners are parents of children who sustained injuries as a result of the unauthorised waste dumping and all the
petitioners are part of the Action Committee which has been formed after the tragic incident that made headlines in the print
and electronic media recently. The purpose of the Action Committee is not only the removal of the industrial chemical waste on
the above- mentioned plots but also to stop dumping of hazardous material anywhere in SITE area.
The petition pointed out that not only was the industrial toxic waste still present on the above-mentioned plots but further
dumping of the industrial chemical toxic waste was also taking place.
Probably this is for the first time in the chequered history of Pakistan that activists hailing from the poorest strata of the society
have come up to fight the powerful mafia that openly violates the national environmental quality standards and thereby play
havoc with the lives of innocent people. The 20 children badly burnt by the toxic chemicals were playing in the abovementioned plots, oblivious to the activities of the unscrupulous elements who had dumped toxic waste in those plots, and
became victims of the callousness of the cruel but powerful mafia.
(By Shahid Hussain, The News-2, 27/07/2006)
Citizens call for spray against mosquitoes
KARACHI, July 28: Karachiittes have urged the city government to start aerial spray to save them from the attack of mosquitoes
and flies.
Citizens of Karachi said despite the announcement by the city government one month ago that it will conduct a spray, an aerial
or ground spray is still awaited in most of the residential areas.
They said flies attack during the day while mosquitoes do not permit them to sleep peacefully in the night.
Mrs Bukhsh, a resident of Block 13-D Gulshan-i-Iqbal, told APP that mosquitoes and flies have swarmed their apartment
building.
A physician Dr Haleem Siddiqui of Block 5, Gulshan-i-Iqbal said he was receiving so many cases of malaria.
Most of them are children who come to his clinic in high fever, he noted.
Another physician Dr Asif, having clinic in Sindhi Hotel area in North Karachi, said cases of seasonal fever were on the rise.
An official of CDGK said a spray was conducted in some areas.
(Dawn, 29/07/2006)
Neglect ruins health centres in Orangi
KARACHI, July 30: For a population of over two million spread over different sectors of Orangi Town, the provincial government
has established only nine dispensaries which are being run by the city government following introduction of the local
government system. Almost all the health facilities are in a pathetic condition and need immediate attention.
Shortage of medicines, water and furniture, besides lack of maintenance, are the common problems of these dispensaries.
Ironically, the Shaeed-i-Millat dispensary located in UC 5 near Block L, has been functioning in a small room originally built for
watchman as the seven-room building on a hilltop is crumbling and the staff has, therefore, vacated the same.
Conditions at this health unit appeared to be worst among the nine. Water is not available and the furniture has got broken to
the extent of being unusable. Its main gate, doors, ventilators and windowpanes have been removed and the building is fully
exposed to intruders and drug addicts. Many addicts have already occupied portions of the structure as their safe heaven. The
doctor on duty told Dawn that even in this single room, he attends up to 20 patients a day. A social worker, Anwar Hussein,
stressed the need for rebuilding the structure immediately to give it a shape of a dispensary with all facilities, including
medicines, being available to patients as per their needs.
The most important health facility in Orangi is, perhaps, the Orangi Maternity Home, which needs immediate attention.
Surprisingly, it has none of the essential facilities of water, power and gas. It is functioning only because the electricity has been
drawn through a hook (kunda).
It transpired during a visit to the hospital that until three years back, it had two ambulances at its disposal, but at present it has
none. The hospital does not have life-saving drugs and doctors have to refer emergency cases to some other hospitals.
Due to the non-availability of water, medicines, surgery instruments and other related utensils, the doctors could not perform
surgeries. Basic diagnostic equipment like ultrasound, x-ray and weighing machine are also not available. A laboratory is there
but without necessary equipment and articles for tests.
The number of nursing staff has been decreased from eight to four. There is only one medical officer (MO) and in her absence,
the hospital has to be run by the nursing staff. The number of patients visiting the OPD daily is stated to be about 70.
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The building has already got its sewerage system damaged and the gutters within its compound are overflowing only to block
one of the two main gates with filth and stinking water. The windowpanes are broken and there is no planning for its renovation,
whitewash and replacement of the faulty lights and fans. The hospital’s boundary wall is not high enough to prevent thieves
from climbing it. They have already taken away the ceiling fans and other valuables and the staff members had to purchase the
same on their own.
People of the locality dump garbage right at the hospital’s main gate which not only presents an ugly look, but the foul smell
emanating out of it makes the atmosphere in the whole locality intolerable. The hospital staff told this reporter that despite their
efforts, the dumping site was not being removed, adding that they had to request every time to the authorities concerned for
removal of the garbage.
Cracks have appeared in the building structure, they indicated, adding that they were at all time risk while remaining inside.
Adjacent to the maternity home is an urban health centre (UHC), with one medical officer, which receives about 50 patients a
day. The dispensary doesn’t have water and electricity and its building has also developed wide cracks. The staff complained of
shortage of medicines.
The urban health centre (UHC), Aligarh, located in a congested lane, is little known to the people of the area. The medical
officer said that the number of patients visiting it was increasing and at present, the OPD receives 150 to 200 patients a day.
Al-Razi dispensary is another healthcare unit in Orangi. Located in UC 3, it is also in a dire need of water, furniture, electricity,
sufficient medicines and power meter. About 50 patients visit the hospital daily. The entire water pipeline at the building needs
to be replaced. There is no proper furniture even for the staff and the doors are also broken. The lavatories and wash basins
are in bad condition and the accessories in the washrooms are damaged. Cracks in walls are clearly visible. Garbage is seen
scattered everywhere around the hospital and there is no arrangement for its removal.
Ibne Sina dispensary, located in the UC 4 area, where have arranged furniture, fans, etc, on their own, also lacks water facility.
The windowpanes and doors are broken. The daily general OPD at of the dispensary is done for up to 25 patients. The staff
complained of shortage of medicines. The interesting scene at the dispensary was that its doctor was not present and the
patients were being treated by a person who introduced himself as a ‘cook’. He claimed to have gained a good experience of
nine years now and was competent enough to handle the job. Due to the non-availability of beds, patients were seen lying on
wooden benches. The conditions at the basic health unit, Baloch Goth, in UC 13 is also almost the same.
The localities of Raja Tanveer Colony, Tori Bangash Colony and Raees Amrohvi Colony have no healthcare centres as the
local residents’ repeated calls in this regard had so far remained unheeded. People of these localities have been demanding
establishment of a hospital which could also cater to the needs of adjacent areas, Ittehand Town and Mohammad Khan Colony.
It is learnt that three other dispensaries, one each in Mansoor Nagar, Bejli Nagar and Haryana Colony, are under construction.
(By Ali Hazrat Bacha, Dawn-14, 31/07/2006)
AUGUST
Kidney theft victim seeks compensation
KARACHI, July 31: Mohammed Kashif, 30, a tailor and the father of two minor sons, who was operated upon by Dr Kashif
Mateen and was allegedly deprived of his kidney, has demanded payment of compensation.
Dr Kashif had operated the man for removal of his diseased gall bladder on May 7, but pathological reports later suggested that
instead of gall blader, his normal kidney had been removed.
As the matter still remains a mystery, a criminal case has been lodged against the surgeon at the Taimuria Police Station for
stealing the kidney.
Dr Kashif has been remanded to the judicial custody after remaining in the police custody for interrogation for five days.
The victim patient, who is still suffering from pain in his gall bladder, and needs proper treatment, and surgical operation.
“I am now restricted to very limited physical activities and has to live a cautious life, unlike my previous natual life”, he stated.
Kashif has also appealed to the President and the Prime Minister for a justice.
“I must also be substantially compensated for the loss of my perfectly healthy and vital body organ and for the pain and agony
that my family will have to undergo for the rest of his life”, he added. While talking to Dawn, the elder brother of the victim
expressed concern over the investigation of the case.
Mohammed Shamim also said his brother was not being given proper medical treatment as promised.“Additional health
secretary Dr. Ashfaq Hussain Memon had assured us of treatment of my brother, who has been suffering from severe pains,
but, so far, nothing has been done”, he deplored. He said Dr Memon had referred Kashif to Dr Tariq Mehmood of the Abbasi
Shaheed Hospital on July 21.
“My brother was admitted to the hospital where he was to be operated upon for his gall bladder on July 24”, he said. However,
Mr Shamim said, the hospital administration told him that Kashif could not be operated upon on the given date. “My brother was
given a room on the third floor where construction work was being carried out. We were told that Kashif might be operated upon
on July 26”.
He said in view of these circumstances, the family moved the ailing Kashif to home.
“Our first priority is to get Kashif properly treated and for this we need an approval from the authorities”, he said.
“Secondly, we want a thorough probe against Dr Kashif Mateen,” he added.
Mr Shamim also demanded that a thorough investigation be conducted to ascertain whether the kidney recovered actually
belonged to his brother and demanded the DNA test of the kidney be conducted.
The police had referred to the SIUT for cross-matching of the recovered kidney with the blood sample of Mohammad Kashif .
However, the SIUT informed the police that the tissue sampling and cross-matching at the SIUT is related to transplantation
between interfamilial donors, and blood samples for such tests are taken for cross-matching between the donor and the
recipient.
The police were also informed that the SIUT does not perform solid tissue matching as it is not necessary for transplantation.
According to SIUT, for solid tissue sample i.e. kidney in formalin is required which is not SIUT’s domain of activity.
(Dawn-18, 01/08/2006)
15
Beneficiaries of family planning
By Zubeida Mustafa
POPULATION control — or population welfare, if you want to be genteel — is the buzzword today. The focus has been on the
economic impact of a rapidly growing population and its implications for employment.
Some scholars have been concerned with the religious dimension since the general impression is that Islamic leaders are
opposed to contraception on religious grounds, and so people are reluctant to limit their family size.
But the reality is far from this. If this had been the case, we would not have had a big unmet need of 34 per cent among women
which is much larger than the percentage of users (23 per cent). This means that nearly a third of married women in the
reproductive age group want to prevent a birth but cannot do so. Most say that opposition from their husbands deters them from
using contraceptives. Others believe that the unavailability of the required services hampers them.
Why should many husbands want large families? It is not so much the family size as the gender factor that is the crucial
determinant of the number of children desired by the parents. In the patriarchal set-up that exists today, no family is generally
considered to be complete without a son — preferably two sons. Family planning workers have observed that women with a
number of daughters continue to give birth to children until the desired number of sons have been born. Men are even known to
abandon their wives and marry another woman in the hope that she will give birth to a son.
This perception is confirmed by the ratio of men to women in Pakistan. Here males have always outnumbered the females,
although in societies where unnatural phenomena like wars/epidemics do not upset the biological growth rate, women
constitute the bigger segment of the population. Today, Pakistan is estimated to have 72.6 million women as against 78.8
million men. This ratio reflects the higher mortality rate in women who do not receive the same healthcare and nutrition as the
men. Daughters are still discriminated against compared to their brothers.
It is the low status of women that determines social attitudes towards the girl child. Mercifully, opinion is now changing and a
daughter is not always rejected as she was before. Nevertheless, she cannot take the place of a boy when it comes to carrying
on the family name, protecting the family property/business and providing support to the parents in old age. So the aims of the
family planning advocates are defeated if the first-born is not a boy.
What has not received enough emphasis is the role of birth control in the reproductive health of women. Given the unreliable
statistical base we have, one cannot be too certain about some of the data given. When it comes to women, even the more
optimistic figures are really not so rosy, especially when we remember that we are low down on the list. For instance, 500
women per 100,000 births die of pregnancy related causes while infant mortality is a high 74 per 1,000 live births, the highest in
South Asia.
One major cause of the high mortality rate is not simply lack of pre-natal healthcare which leads to many women becoming
victims of tetanus or haemorrhaging to death because iron deficiency has made them anaemic. Multiple pregnancies also
weaken many women as well as their infants. Even a child, who survives when his mother dies, has relatively few chances of
living very long. The men who insist on their wives bearing more children in spite of the risks frequent pregnancies incur for
many women betray an uncaring attitude towards their spouses. Of course, poverty compounds the situation.
Unfortunately, the government’s population welfare programme also reflects this bias and apathy although it should be in the
lead in setting a direction for the small family norm and a pro-woman approach. In the public-private partnership scheme of
things, it has been left to the NGOs to carry on the job — which many of them are doing excellently — but within the limits of
their meagre resources. As has been the trend in other social sectors the government has gradually been disengaging itself
from the field of population welfare. The public sector does not have much to show by way of performance. As a result, the
Pakistan Economic Survey, 2005-06 does not even record any statistics to show the categories and quantity of contraceptives
dispensed as was the practice several years ago.
Only the institutions have been listed and they do not inspire much hope. The number of family welfare centres, supposedly the
linchpin of the programme, have increased from 1,777 in December 2003 to 2,206 in March 2006 which works out to an
increase of 24 per cent in three years. The reproductive health A centres, which perform sterilisation procedures, have gone up
from 108 to 204 in the same period which is a more impressive increase of 88 per cent. But the number of the mobile service
units declined from 146 to 118 in 2003-2006 (a decrease of 19 per cent).
As for the funds allocated for the programme, they have consistently been on the decline. Population welfare is essentially a
provincial subject and managed by the provincial governments. While the Sindh budget for 2006-07 shows the amount
allocated under this head as nil, the NWFP has given it five million rupees, Balochistan gives it Rs 11.8 million and Punjab has
earmarked Rs 18.5 million. The federal budget shows a bigger sum for the population sector — Rs 172 million for 2006-07.
What is surprising is that the development budget for the current year runs into billions for the federal programme (Rs 4.3
billion) and Punjab (Rs 1.7 billion). Sindh and Balochistan show a more hefty sum for the development expenditure on
population compared to the revenue budget. In the NWFP, the ADP for population is Rs 47 million and Rs 6.8 million for the
current expenditure. How are the development funds to be used? How will a meagre revenue budget sustain a massive project
presumably envisaged by the annual development programme?
There are 264 NGOs with 479 outlets reporting to the National Trust for Population Welfare playing an “innovative” — to use
the government’s words — role in this field. But their resources are limited and the flow of funds from NATPOW is not always
steady and assured. The 58,000 outlets of social marketing projects make contraceptive services available at a subsidised rate.
Instead of transparency what we have is a clouded picture of the population programme making it difficult to assess the
strategy that has been adopted. This ambiguity militates against the success of the programme. This hardly promotes the
women’s cause. Dr Akhter Hameed Khan, the great social activist and founder of the Orangi Pilot Project, once said in an
interview in 1986, “Actually economic forces have undermined the traditional perception of Islam. Inflation, urbanisation (which
has led to the breakup of the joint family system) and the compulsion for female employment have brought about changes in
attitudes. Now women with many children feel distressed ... The official programme is in no way responsible for this change in
attitude... Family planning is closely related to the emancipation of women. But the government does not see it that way.”
Neither do many others.
(By Zubaida Mustafa, Dawn-7, 02/08/2006)
16
Rs27bn plan for mother, neonatal health care
ISLAMABAD, Aug 1: The government on Tuesday decided to launch a Rs27 billion mother and neonatal health project. The
decision was taken at a meeting arranged by the Population Council of Pakistan, which discussed the USAID funded Pakistan
Initiative for Mothers and Newborns (PAIMAN) and shared the findings of a recently conducted household survey, quality and
health services assessment in ten selected districts of the country.
Secretary Health Anwar Mehmood stressed the need for skilled birth attendants, as the survey suggested that more birth
attendants should be made available to the needy population.
He stressed that female medical students should opt for medical practice to improve MCH, and highlighted the need for
strategising and implementing quality health services in addition to the public awareness.
Dr Donya Aziz, Parliamentary Secretary Population Welfare, pointed out that basic health facilities needed prime attention. The
world over the focus is shifting towards the provision of basic health facilities and the number of basic health providers is also
increasing compared to specialists.
Dr Nabeela Ali, chief of PAIMAN, told the meeting that information from field had revealed that majority of population did not
have access to media and, therefore, there was a need to shift focus from media campaigns to interpersonal communications.
Dr Jonathan Addleton, director USAID, expressed his appreciation on a recent research conducted by the population council
and said the upcoming programme should act like an umbrella activity that would house numerous sub-components focused at
the MNH problem.
Meanwhile, in a meeting of the Pakistan Country Coordinating Mechanism, a national consensus group was established in
response to requirements and recommendations of the global funds to fight AIDS, tuberculosis and malaria.
The meeting discussed a new five-year proposal to be submitted to the Global Fund for Round-6 funding.
The round-6 focuses on the global fund support for efforts to combat AIDS, TB, malaria by implementing new treatment and
prevention strategies for saving lives, raising awareness among vulnerable population and preventing further infections.
(Dawn-2, 02/08/2006)
Cases of waterborne diseases on the rise
KARACHI, Aug 3: Fearing an outbreak of waterborne and food borne diseases in the wake of the ongoing spell of monsoon
rains in the city, experts have called for keeping an eye on the quality of water and edibles citizens consume nowadays.
“Since our surroundings are dirty and water and sanitation systems are unpredictable there is a fair possibility of rise in the
number of waterborne diseases in the city and as such people should not take fever, headache, gastrointestinal discomforts,
vomiting and diarrhea lightly,” said an expert at a private hospital.
A survey of some government and private hospitals revealed that cases of gastroenteritis, including adults and children, had
been brought to hospitals during the last couple of days from different localities, including Lyari, Macchar Colony, New Karachi,
Korangi, Federal B Area and Orangi Town.
The health EDO of the city government, Khalid Shaikh, said that so far the situation at medical centers and hospitals in his
jurisdiction was under control, but staffs had been told there to stay alert to handle any untoward situation. Very shortly, we will
start fumigation and spray activities as well, he informed.
An official at the Abbasi Shaheed Hospital said that 41 patients with history of vomiting and loose motions were brought to the
hospital on Wednesday, of which adults were released after initial aids while a majority of the minors were kept under
observation.
Based on the number of cases reported till Thursday noon it can be speculated that Thursday would receive waterborne cases
more as compared to Wednesday, said the official located at the medical superintendent office of the hospital.
A doctor from the NICH’s emergency section told Dawn in the afternoon that so far he had received 30 children with gastrointestine problems from various parts of the city, 70 per cent of whom had been detained for further treatment.
People coming along the children said that they had been receiving turbid water after rains in their residential areas, he replied
to a question.
Doctors at the JMPC casualty said that they had received patients with the history of fever, respiratory problems,
stomachaches, but the situation was not very alarming, they claimed. The gastro cases are still within the trend, said a senior
doctor, asking people to consume boiled water and well cooked food to avert any health adversity in the wake of the monsoon
showers.
However, Dr Zaheer Hussain, chief medical officer at the Lyari General Hospital, said that the number of gastro patients was on
the rise in his hospital. Today, like Wednesday, we have received so far (around 2.30pm) 50 patients, in addition to 50 children
who were handled at the child unit of the hospital, mostly coming from Lyari and Macchar Colony, and affected due to the
consumption of turbid water, he added quoting the attendants.
Dr Kaleem Butt, medical officer of the Civil Hospital Karachi, said that the hospital too had started receiving patients with
symptoms of waterborne diseases after the beginning of rains, but he felt that there was nothing to worry.
Our doctors are already alert while medicines are at the disposal of the emergency and medical wards’ staff as the number of
gastro patients may further increase in the days to come, he added.
Health experts said waterborne diseases might be endemic to the city and there was a need to remain watchful about
gastroenteritis, hepatitis, typhoid, amebiosis, a form of diarrhoea, and cholera, which were among the main waterborne
diseases.
A doctor said that diarrhoea, high fever, typhoid, and jaundice were the feature of the monsoon, which could be attributed to
insects, bacteria and viruses that thrived in monsoon environment or attracted to water bodies and shattered sanitation.
17
Dr Qamrul Arifeen of the Liaquat National Hospital said that reporting of the gastro cases at his hospital was marginal. He
advised the citizens to consume only boiled water otherwise it would be a serious health risk.
Referring to the turbidity factor in river and dam water that the city receives for drinking purposes, he remarked that in addition
to that the chances of contaminations in drinking water was also high as sewer and water supply ends were open in many
cases. To survive, we need proper monitoring of both the sewer discharge and water supply system for the city, he added,
advising people to ensure proper treatment of water before consumption.
Doctors in general were of the view that cases of gastroenteritis took place only when people turned indifferent to water and
food they consumed. They said that children should also be refrained from swimming or dipping in the stagnant water or
puddles as it was tantamount to inviting waterborne diseases.
According to an expert, turbidity is included in some of the most obvious water problems which were also the easiest to solve.
Turbidity affects the look and taste of the water, and may cause it to be undrinkable by some people's standards, he further
noted.
Several methods to treat turbid water included use of an activated carbon filter which are designed to remove solid particles
from the water. Most taste and odor problems can be reduced with the use of such filters.
The most cost-effective method of reducing the haziness of turbid water is treating alum. If one can afford, he or she should first
get the water filtered through equipments available from the market, then boil it and again pass it through thin fabric to withhold
the precipitated matters, concluded a senior doctor.
(By Mukhtar Alam, Dawn-17, 04/08/2006)
Registration of case against LNH staff ordered
KARACHI, Aug 4: The additional district and session judge, Karachi East, on Friday ordered SHO New Town police station to
register FIR against doctors, administration and paramedics of Liaquat National Hospital.
Mohammad Kabeer, a local journalist, alleged that her wife Surraya and their newborn baby died on Nov 30, 2005 due to
deliberate negligence of the hospital’s staff.
His counsel Tariq Hamza Khan submitted that police refused to register case.
He told the court that inquiry report, prepared by medical experts of Dow University of Health Sciences, also reflected gross
negligence by doctors, administration and paramedics of Liaquat National Hospital.
The applicant prayed court to order registration of FIR against Dr Quratul Arfeen, Dr Inayat, Dr Shagufta, Dr Farah, Dr Erum, Dr
Aimen, Dr Sumita, Dr Waliullah, Dr S.M. Nadeem, Dr Azmat Ali Abedi, Medical Director Prof Salman Fareedi and Director
Finance Samiullah Baig.
(Dawn-19, 05/08/2006)
Congo virus patient recovering at CHK
KARACHI, Aug 7: A woman, who according to doctors is a confirmed Congo virus positive case, has started showing signs of
improvement at the Civil Hospital Karachi.
The medical superintendent of the CHK, Dr Kaleem Butt, said that the patient, who was brought to the hospital for the first time
on Saturday evening, was responding to treatment and her blood platelets count, which had decreased drastically at home due
to viral infection, was found increasing. We have administered her so far two mega platelets units, after which her counts are
around 93,000 now, added Dr Butt.
According to doctors, Sumaira, 22, a resident of Arab Muhalla, Baldia Town, suffered a high grade fever over 12 days back.
After keeping her under treatment of a doctor in her area, her husband and other family members took her to a nearby private
hospital as she was not responding to the treatment at home.
At the private hospital, the doctors keeping in view her history of fever and blood vomits decided to conduct some blood test as
well. One of the sample tested at a major private hospital confirmed that she was affected with Congo Crimean viral
hemorrhagic virus.
At the Civil Hospital, doctors at the emergency ward examined the patient and on the basis of the private hospital’s report of a
confirmed Congo fever case and patient’s history and symptoms, doctors, including those from medical ward-5 of the CHK,
decided to shift Sumaira in the isolation ward of the hospital.
Dr Butt said the patient was under high observation and as per an assessment made on Monday afternoon, he could say that
patient’s overall condition had improved now and she was also responding to antiviral treatment.
Her liver and kidneys and other organs are functioning normally, he added.
It was further learnt that blood samples of the patient in question had also been sent to the NIH Islamabad for reconfirmation of
Congo. A two- month son of Sumaira is also suffering fever, who will be brought for a check-up at the CHK on Tuesday, said a
source at the hospital.
Humans can suffer CCHF or Congo fever as it is more commonly referred to, if they acquire infection from infected tick or from
contact with fresh, infected blood and tissues of livestock or humans.
According to doctors, the patient presents with flu-like symptoms, headache, fever, muscle pain, especially lower back pain,
cold shivers and hot sweats. Nausea, vomiting, diarrhoea and abdominal pain may also be noted.
The patient can bleed from any organ, from the bowel leading to the vomiting of blood, or the passing of stools containing fresh
or dark altered blood, bleeding from the nose or gums, or bruising of skin, bleeding into muscles, or oozing from injection sites.
(Dawn-18, 08/08/2006)
18
Congo virus patient dies
KARACHI: A patient at the Liaquat National Hospital died on Monday afternoon reportedly of Congo Virus, informed sources
said. The deceased was a research scholar and a lecturer at a government college.
The authorities of the LNH when approached for confirmation of the news did not offer any cooperation in this regard. The
doctor on duty inside the medical ICU on Monday refused to comment on the incident.
The media relations department at the hospital also never came into contact despite numerous attempts. Cases of
haemorrhagic fever are increasingly being reported at major hospitals in Karachi however, none of the hospitals have admitted
to having received any such cases.
Earlier, last week, a woman was brought to the Civil Hospital Karachi with symptoms of haemorrhagic fever, and the results of
her tests confirmed her positive for Congo Virus. Her condition is reported to have improved since the day she was admitted.
Her vomiting had traces of bloods in it.
Haemorrhagic fever, particularly Dengue Virus Fever, is a common incident in Pakistan at this time of year. High temperatures
are an ideal condition for the virus to attack. The symptoms are high grade fever, followed by signs of haemorrhage from
orifices. The disease is highly infectious in nature and claims a huge number of deaths almost every year in the country.
(The News-2, 08/08/2006)
Number of gastro cases on the rise
KARACHI, Aug 9: A surge is registered in the cases of gastro along with other waterborne diseases at major healthcare
facilities, including the Lyari General Hospital, National Institute of Child Health and the Civil Hospital - Karachi.
Concerned professionals, mentioning that it was an expected scenario following the recent showers in city, said immediate
referral and medical intervention was particularly required in the context of under-five children suffering from the
ailment.“Malnourishment, a largely common phenomenon in our children below five enhances their vulnerability to
complications linked to dehydration,” Prof Ayesha Mehnaz, head of Pediatrics, Civil Hospital, said here on Wednesday.
In specific context of Lyari, she said comparatively older children (coming in the bracket of 10 years plus) were also reporting
with hepatitis A and E.
Fearing an outbreak of cholera in the area, she said stagnant water witnessed at almost every nook and corner of the town had
exposed children as well as adults to high risk of getting inflicted with varied infections and illnesses.
Answering a question, she said immunizable diseases including typhoid were also expected to increase in local children. This
was said to be besides the fact that children with measles, chicken pox and tuberculosis had been reporting frequently even
before the monsoons.
“Tuberculosis is contracted by children from an adult patient suffering from the disease,” the paediatrician said.
Dr Afshan, associated with the NICH, said a three-fold increase had been noticed in the number of children reporting at the
facility with gastro enteritis. She said there might be rise in the cases of oral-fecal infections.
With regard to the NICH, the doctor said most of the people were coming with the complaint of diarrhoea and vomiting and/or
with severe cramps. A majority of them was released after required medication, but those reporting severe dehydration have to
be admitted and provided with required assistance including intravenous and oral therapy.
There was said to be no shortage of necessary medicines at the NICH and the CHK. However, in context of the Lyari General
Hospital it was found that the availability of even essential medication was an issue and the doctors concerned had to arrange
these with the support of local philanthropists.
Dr Khalid Shaikh, EDO for health, city government, told APP that special health units had been established in the CDGK's
identified health facilities in all 18 towns and they were not only adequately manned but had no shortage of medicines and
relevant supplies.
All doctors were of the unanimous opinion that parents and care-takers had to ensure consumption of only adequately boiled
water by children as well as adults.
Mothers were particularly advised to see that their offspring did not purchase and eat edibles prepared and/or sold by street
vendors under poor hygienic conditions.
“They must under all conditions see that food prepared or cooked at homes is taken and that it must be necessarily prepared
with due care for cleanliness of their hands as well as utensils,” they elaborated, urging mothers to also ensure proper handwashing of children before and after meals.
(Dawn-19, 10/08/2006)
PMA annoyed over hurdles in patients movement
KARACHI, Aug 9: The Pakistan Medical Association has expressed its concern over the frequent traffic jams registered in
different parts of the city which also affect the movement of ambulances carrying patients in need of early assistance.
General Secretary of the PMA-Karachi Dr Qaiser Sajjad, in a statement here on Wednesday, said the frequency in the
instances of traffic jams had particularly increased after the recent showers.
“The situation is not only a major hurdle in transportation of people requiring urgent medical support and exposing them to risks,
but is also causing stress to general commuters,” he said.
Dr Sajjad said this otherwise ignored pressure was affecting health conditions of the people which was increasingly manifested
through high blood pressure, headache and provocation on the slightest pretext.
(Dawn-19, 10/08/2006)
19
Paramedics go unprotected against infection
KARACHI: None of the major government-run hospitals in the city have acted on an earlier demand of medical staff to build
isolation wards for victims of highly infectious diseases like Congo Crimean Hemorrhagic Virus despite the passage of almost a
year.
In the wake of resurgence in cases this year, medical staff have expressed fears for their safety in dealing with such patients.
Last year, after the death of a doctor at the Civil Hospital, medical staff had demanded that adequate protection measures be
put in place so that they could treat such patients.
It may be mentioned that two people have lost their lives during a recent outbreak of hemorrhagic fever in the city, which was
initially reported as Dengue Hemorrhagic Fever.
However, both the patient who lost their lives proved positive with Congo Crimean Hemorrhagic Virus, a much rarer
hemorrhagic condition.
According to a senior pathologist at the JPMC, Dengue Hemorrhagic Fever is a common occurrence during high temperatures
in Pakistan, because it spreads due to the bite of a particular mosquito.
But Congo Crimean Hemorrhagic Fever (CCHF) is more lethal and calls for better protection for medical staff who are treating
the patient. However, despite calls by medical staff for measures to protect them from infection, this has not happened.
During the last outbreak of CCHF in November 2005, the house officers at the Civil Hospital staged a week long strike,
demanding isolated wards for such patients and provision of proper prevention facilities like adequate supply of masks, gowns
and gloves to the paramedics tending to the infected people.
However the demands are to date unmet by the authorities of the hospital as well as the health ministry, disclosed a doctor on
house job at the Civil Hospital Karachi.
The doctors at the Civil Hospital Karachi have urged the authorities to facilitate the hospitals with proper isolated wards.
Members of the College of Family Medicine Pakistan have demanded that the Ministry of Health create awareness and give
proper guidelines not only for Viral Hemorrhagic Fever but also regarding other diseases that occur as an aftermath of rain and
improper sanitary conditions that are prevalent in the city round the year.
Doctors warn that the CCHF is not a common disease. This is not even airborne. It can only be contracted through a normal
person’s bloodstream coming into contact with infected CCHF’ blood through an injury or bruise.
Patients with any kind of hemorrhagic fever cannot be kept with other patients, due to the highly infectious nature of their
disease. For them, there must be isolated wards, which, according to international standards, should have partitioned beds, airfilters that clean the air leaving the room and incineration chambers, which are needed to burn the clothing, bed linen and other
things used by the patients.
Some ten patients have been reported with hemorrhagic fever conditions at different hospitals in the city during the past few
weeks.
(By Asra Pasha, The News-2, 10/08/2006)
Safe drinking water to help control diseases’
KARACHI: President General Pervez Musharraf has said that upto 60 per cent diseases in the country are water-borne and
there would be a tremendous amount of saving in monetary terms if safe drinking water is made available to the people.
“This would help control almost 60 per cent of diseases in the country,” he said, adding that it would also help ease load on
hospitals, basic health centres and rural health centres.
He was speaking during a briefing on safe drinking water at the Chief Minister’s House here on Wednesday.
The president asked the Senators, MNAs, MPAs, as well as Nazims to emphasise this very point and urged that filtration plants
should be installed in accordance with the requirement to combat contamination in respective areas.
Musharraf directed that filters at the plants should be replaced timely to make these plants work effectively. He further
instructed that the private sector should also be involved in the installation of filtration plants.
(The News-2, 10/08/2006)
17 suffer from food poisoning
KARACHI, Aug 10: Seventeen persons were brought to the Jinnah Hospital for suffering from food poisoning, some of them in
an unconscious state, on Thursday night. Six of the patients were children.
Hospital sources said the patients were brought from the Cantonment station area, mostly residing in the huts along the railway
tracks.
The six children were referred to the National Institute of Child Health, where some of them were stated to be unconscious.
Eleven adults were admitted and given treatment at the emergency ward of the Jinnah Hospital.
Hospital sources said the patients had consumed lassi which apparently caused the food poisoning.
However, it was not clear if someone else had offered them the lassi or they themselves had prepared the drink, police said.
STRANGULATED: A seven year old girl was killed by unknown persons in Orangi Town on Thursday morning.
Saba had gone for her madressah at 6am in Sector 12. However, the strangulated body of the girl was found after an hour near
a nallah.
The incident created resentment among area people. Police shifted the body to Abbasi Shaheed Hospital for postmortem.
KILLED: A young man, Waseem Ahmed, was shot dead by unknown persons in North Karachi on Thursday. His bullet riddled
body was found in Ali Mohammad Goth early morning, police said.
Police shifted the body to Abbasi Shaheed Hospital for postmortem; hospital sources said that victim had suffered multiple
bullet wounds.
20
DIES: Body of an unknown man was recovered from beneath the Natives Jetty Bridge on Thursday.
Police said that 45-year-old unidentified man had reportedly jumped off the bridge to commit suicide some time early Thursday
morning.
Fishermen fished out the body and the police shifted it to Civil Hospital.
(Dawn-17, 11/08/2006)
Equipment at skin hospital lying idle
KARACHI, Aug 10: Various machines procured by the Institute of Skin Disease Sindh (ISDS) two and a half months ago, are
still not being used due to a financial dispute between the Accountant-General Sindh and the contractors hired by the hospital
management for the procurement of the machines.
Sources in the hospital told Online that the machines in question costing Rs5.4 million were procured in the last budget but their
bills were still pending due to the lethargic attitude of the officials concerned.
According to sources, due to the non-issuance of the contractors' bills, all the machines are lying in the corridors of the hospital.
Sources said that all the bills had already been cleared by the AG Sindh, however, due to reasons best known to the authority
concerned, the bills were not being issued to the contractors.
The contractors had threatened the hospital administration that if the bills were not issued within the next few days, they would
have no other option but to take the machines back.
The sources said that the Sindh government had allocated special funds to the tune of Rs5.4 million in the last fiscal for the only
public-sector skin hospital in Sindh.
(Dawn-18, 11/08/2006)
All about spurious injections hitting the market
The World Health Organisation declared that 390 drugs are well enough to fulfil the requirements of patients in any country but
interestingly it was noted that almost 589 manufacturing units are functioning within Pakistan.
The confusion raised in the public mind pertains to the outcome from these units. As the general public are not satisfied with the
quality and especially with the price they paid for such drugs.
India, China, Russia, and Mexico are reported as the best hideouts for counterfeit and sub-standard drugs. Unfortunately
Pakistan also figures in the list. These countries are reportedly being considered for blacklisting after failing to safeguard the
interests of their people.
Third generation antibiotic injection costing at least Rs400 was found with very improper packing and the picture clearly
indicates a piece of glass in side the bottle, actually it was a result of careless maintenance and unsuitable packing of the
product and the manufactures are solely responsible for the misfortune which might risk the people life.
Interestingly, this injection hardly cost Rs40 at the time of its finishing (completeness) but the commission for the licensing
bodies, who allow the sale of these products, medical stores, who keep such products in their stores for maximum profit,
governmental departments which never check the samples and the license of such manufactures and a small number of
doctors who are involved in the unethical practices by prescribing such medicines to their patients, leads the price up to Rs400
per unit and unfortunately only patients have to pay all the amount.
Some main lessons learnt from the experience are that these manufactures use low quality salt and the other essential
elements in their products, mainly to avoid the heavy expenses as the price of superior salts is higher than the ordinary one
they use in their products and secondly the involvement of Muk Mukka (kick-backs) mafia in the business.
It is also learnt that the manufacturers are not afraid of the concerned authorities as somehow the latter are not strong enough
too handle the case, mainly on account of the delay in the process of hearing and re-sampling and the other complications in
the basic laws of drugs.
Do patients have the right to purchase original and pure medicines? This is the question mostly asked by the poor, affected
people, who are totally ignored by the authorities.
If they have to purchase such products then who would be the responsible for their lives, the manufactures or the chemists?
One could only imagine that the law of one year in prison and fine of around Rs50,000 would really help the law enforcing
agencies to curb the unethical business.
On the other hand, if these activities cannot be stopped now then it would be difficult to save the lives of innocent people who
are being held hostage.
(By Muhammad Zeeshan Azmat, The News-4, 13/08/2006)
Health sector grabbed by mafia, says expert
KARACHI, Aug 12: The health sector has been taken over by a ‘mafia’ that sells hospitals on the pattern of police stations to
the highest bidders.
This was observed by Prof Tipu Sultan, a leading medical practitioner, while speaking on ‘Health For All’ at the Karachi
Secretariat of the Pakistan People’s Party on Saturday.
Prof Sultan said that high allocations were made for purchasing sophisticated equipment in the name of providing modern
healthcare facilities, but the price paid for such equipment appeared to be 8-10 times higher than their rates in the open market.
Nobody would raise a finger, he wondered.
There has been a mushroom growth of medical colleges and universities where students are charged astronomical fees but the
conditions are deplorable and the faculty non-existent. He alleged that corruption was rampant even in the controlling
authorities like the Pakistan Medical and Dental Council.
There is an urgent need to break the hold of this ‘mafia’ and set the priorities correctly.
21
Prof Sultan said that while the government was spending a mere 0.6 per cent of the GDP on health sector, 97.5 per cent of this
meager allocation never reached the patient as it was embezzled on the way down. He pointed out that the countries, like Sri
Lanka, which had long been embroiled in a civil war were spending six per cent of their GDP on this sector and were providing
excellent health services to their citizens.
Giving a long list of national indexes in the social sector, he drew a scary picture of high rate of infant mortality and deaths
during childbirth, non-availability of safe drinking water, complete absence of hygienic sewage systems even in urban areas,
epidemic-like spread of contagious diseases, very low rate of child vaccination, almost 10,000 unemployed doctors, thousands
of unattended health units (specially in the rural areas), 600, 000 quacks playing havoc with the health of citizens, high birth
rate, growing poverty and unemployment, low literacy, and other such factors.
He said that even in the public sector hospitals, the fundamental right of free treatment was not available to citizens. Patients
have to buy medicines and philanthropists and charity organisations have to arrange for food for patients.
All this could be set right with better management, efficient use of resources, eradication of corruption and, above all, the
political will of the government to provide citizens with their basic needs.
Prof Sultan stressed the need for paying maximum attention to primary health care, preventive measures, as well as promotion
of awareness of adopting hygienic and healthy practices. He said that if these aspects were effectively looked after, the load of
providing expensive tertiary level healthcare would greatly reduce and all health indicators might show great improvement.
Nawab Yousuf Talpur, who presided over the seminar, claimed that there was an organised attempt by the government to
hoodwink the nation in the budget session where fake figures of poverty, unemployment and growth of population were
presented. These had been contradicted not only by different government departments but also by the World Bank, which had
put the figure of people living below the poverty line at 32 per cent and assessed that another 50 per cent were at the brink of
poverty.
(Dawn-19, 13/08/2006)
Steps urged to check Dengue fever
KARACHI, Aug 12: Dengue hemorrhagic fever, which has emerged to be an epidemic and a common feature in Karachi for
around a year, is currently registering a surge due to filth and pools of stagnant water witnessed across the city.
Healthcare professionals in the given situation have strictly advised the people to ensure that their water sources remain clean
and none of their stored water is left open or inadequately covered, as mosquitoes causing Dengue breed in clean water.
They have also stressed the need for immediate removal of garbage and filth scattered around and clogged sewers properly
cleaned to ensure water do not remain stagnant in any part of the city.
Karachiites in general have also been strongly advised to keep their surroundings clean and finding water standing in front of
their homes must spray on it either kerosene or even mobil oil -- eliminating breeding spots for insects.
The president, Infectious Diseases Society of Pakistan, Dr Naseem Salahuddin, told the APP news agency on Saturday that
Dengue fever, one of the varied types of viral hemorrhagic fevers (VHF) is largely self-limiting.
This, however, can be fatal if the affected person experiences Dengue Shock Syndrome, the senior professional said advising
doctors to ensure timely diagnosis and proper investigation preventing unnecessary medication.
“Diagnosis should be made on the basis of history and blood count through a simple test,” she elaborated urging her coprofessionals that it should not be confused with malaria or any other infection.
Decline in blood platelet, high fever that persists for three to five years, non-specific pain, body ache, rashes, occasional
bleeding as from gums but most importantly discharge of blood from stomach as through stools are some of the manifestations
of Dengue fever.
Fortunately, the expert reiterated that patients inflicted with the condition had registered complete recovery in 99 per cent
cases, but there did remain risk of Dengue Sock Syndrome.
She in this context advised doctors to understand that most of the Dengue fever patients did not need blood transfusion for the
sake of platelet.
In case of constant bleeding and falling blood pressure, the patient must be admitted to the hospital and provided with fluids, Dr
Salahuddin said urging doctors to hydrate their Dengue fever patients well as this ensured better chances of recovery.
Doctors serving other hospitals including both private and public sectors said Dengue fever had emerged to be `Pan Karachi’
and cases from all localities ranging from Lyari, Orangi, Korangi, Malir to Clifton, Defence, Gulshan-i-Iqbal and Federal B Area
were equally reporting the disease.
The IDSP president confirmed the scenario and mentioned that contrary to previous years when Dengue fever was reported
from low-lying areas it was now prevalent in all parts of the city.
(Dawn-17, 13/08/2006)
Dispensaries in pitiable condition in Baldia
KARACHI, Aug 15: The existing three dispensaries and one rural health centre (RHC) of Baldia town cannot cater to the needs
of 601,922 people of the town.
Shortage of medicines, non-availability of water, furniture and diagnostic equipment, like ultrasound and weighing machines are
common problems in all the health centers. It is ironic that even after the passage of 10 to 14 years the government has so far
not approved the statement of new expenditures (SNE) of the dispensaries, which are situated at Sajjan Colony, Saeedabad
and Rasheedabad. The RHC is, comparatively, playing an active role, while the rest of three dispensaries are in dire need of
prompt attention of the officials concerned to improve their function.
The dispensary at Saeedabad in union council No 5 limits which started functioning in 1991 is now in a dilapidated condition as
the building structure has developed cracks and the staff members are not feeling themselves safe while inside the building.
Termites have destroyed wooden doors, windows and the decade-old furniture.
22
The rooms of this spacious building are now giving a look of a century-old historical construction and the rain water has further
exposed its weak position.
The building needs proper checking from the officials of the concerned department, which has endangered lives of the people.
During a visit to the dispensary it was observed that the staff present there was just watching at the dispensary’s gate, but no
patient was visible, perhaps due to the obstructions created by the stagnant water in front of the main gate.
Though water is available to the local population around the dispensary, but it has no such facility due to the obsolete pipelines.
It was learnt that the water facility could be made available only after the replacement of pipelines, repair of motor, and
cleansing of the overhead water tank. It has no X-ray, ultrasound and laboratory, and the medicines being provided to it are
also stated to be insufficient.
At least 50 to 60 patients get treatment through the outpatient department (OPD) daily, the doctor informed. One may believe or
not but it is a fact that the only stethoscope available in the dispensary was also out of order. It had lost both the ends that a
doctor put them in ears, while examining a patient. It was informed that the dispensary had been renovated once during the last
14 years and that is all. The doctor suggested that the dispensary needed to be upgraded in accordance with the increasing
population at least up to the level of a rural health centre (RHC) or basic health unit (BHU).
The condition of a dispensary in Rasheedabad Colony (union council No 8) which started functioning in 1992 is also not very
different from the rest of urban health centers (UHCs) of Baldia town.
It was observed that during the monsoon rains the situation in and out of the hospital was the same. The water trickling from the
roof had made lives of the staff very miserable. The wet walls had got electric current and the naked electric wiring has also
posed a threat to the lives of the people.
The staff itself has to repair the furniture, which was visible from the wooden benches and chairs. The number of patients
coming to the OPD on daily basis was stated to be from 25 to 50. The medicines’ quota being given to the dispensary is
reportedly not meeting the needs of the patients.
The Urban Health Centre (UHC) of Sajjan Colony is situated in UC 3 which too speaks of the government apathy.
During a visit to the dispensary it was observed that only two of the Class-IV employees were present and a woman with her
ailing child was waiting for the doctor at about 10.15 am. It was said that the doctor also had to attend a rain-emergency relief
camp.
An employee of the dispensary told this correspondent that water had earlier been supplied to the dispensary, but the
surrounding population had no such facility and in retaliation an angry mob forcefully entered the dispensary and demolished
the hospital’s water tank, adding that the mob had also tried to break pillars of the building in order to lodge their protest against
non availability of water. The upper portion of the UHC, he said, had been changed into the offices of the nazim union council
No 3. A lady doctor is available in the dispensary and the upper portion, which consists of four rooms could be made as
maternity home, he suggested.
The dispensary is not given annual budget since its opening in 1994 to meet its expenditures and the medicines being provided
to the patients from the UHC have to be arranged by the Town Health Office (THO) office on its own.
It is best known to the authorities concerned as to why the SNE of the UHC has so far not been approved. Almost 30-35
patients visit the OPD daily. The dispensary’s building is situated at a distance of about 500 square yard from the metalled road
and the people have to walk in a playground to reach its main gate. During the rains the people have to scramble in the water
without shoes. The hospital has a vast courtyard, but wild plants have grown up which are giving a bad look.
In the entire Baldai town, there is only one rural health centre (RHC) at Patni area, which is catering to maximum of the
patients’ problems, where approximately one hundred patients get medical treatment daily. The staff complained of lack of
water and poor sewerage system.
The RHC needs furniture, repair of the sewerage system, wash basins and windows. It was learnt that a hospital of its kind
needed at least 10 doctors, while at present it has only six. The facilities of laboratories, ultrasound, X-ray, etc are not available
in the health centers.
A patient Israruddin pointed out that there was no maternity home in the town and the people had to rush their patients to the
civil or Jinnah hospitals, which are at distance from the area, saying some time patients breathe their last even on way to
hospitals.
A resident of the area, Pir Mohammad, said that the people had lost their confidence in the government dispensaries owing to
non-availability of proper facilities, and absence of the doctors.
The THO was not available for comments. The DTHO of Baldia town, Dr Imtiaz, avoided giving details. However, to a question
he said construction work on a 50-bed hospital along the RHC was in progress and maximum of the patients’ problems would
be solved with the establishment of the hospital. He said the authorities of the health department were well aware of the
problems of the health centers and trying to resolve them at the earliest.
(By Ali Hazrat Bacha, Dawn-18, 16/08/2006)
Dengue fever alert
DENGUE fever is back in the news again with around 15 of the 40 cases of haemorrhagic fever having been reported in
Karachi in the last three months. Unlike another haemorrhagic fever, the Congo virus which is caused by the bite of a tick found
on cattle, Dengue fever is caused by a mosquito bite; both have been found in Pakistan and both are curable if diagnosed in
time. However, this does not mean that the health authorities should take it easy or wait for the number of cases to go up
before taking any action. Nor should they adopt their usual stance of denying there is a problem and therefore not informing the
people about the viruses. Precautions are important given that of the 40 cases detected so far, five were diagnosed as Congo
virus while the remaining ones could not be identified. The health department must ensure that its hospitals and staff are
adequately equipped to deal with any outbreak.
Given that after the rains Karachi is dotted with stagnant pools of water and filth which are a breeding ground for mosquitorelated diseases, it is imperative that the local government carry out extensive fumigation in all parts of the city. This should be
done throughout the year as most people living in Karachi are surrounded by the most unsanitary of conditions. It is equally vital
23
to educate doctors on how to identify the diseases in question as many of them may be unfamiliar with the symptoms or the
treatment required. Of paramount importance is to spread awareness about the two diseases through the media so that people
know when and where to seek medical help. There must be a clear realisation that timely action alone can prevent suffering
and loss of life.
(Dawn-7, 16/08/2006)
CHK to have orthopaedic trauma centre soon
KARACHI, Aug 16: The establishment of orthopaedic trauma centre (accident and emergency centre) in Civil Hospital Karachi
with a cost of Rs1.4 billion has been approved and its construction will start soon.
This was stated by Naib Nazim Nasreen Jalil at a rehabilitation camp set up for handicapped at the Civil Hospital, on
Wednesday. She said that the federal and provincial governments would jointly fund the project.
The camp was arranged by the Ortho Rehab Society in collaboration with the Feroza Hashim Foundation.
On the occasion, Ms Jalil announced bearing expenses of artificial limbs for eight patients under ‘adopt a patient’ scheme
proposed during the ceremony while Feroza Hashim Foundation provided artificial appendage to 80 patients free of cost.
The naib nazim called upon philanthropists to join hands with the government, individuals and organisations engaged in
providing healthcare facilities to people, as government alone could not do the job.
She said the city government was strengthening its departments and laying special emphasis on health sector, citing example
of Abbasi Shaheed Hospital which, she claimed, had been made the best hospital of the city.
Dow University of Health Sciences Vice-Chancellor Prof Masood Hameed, Civil Hospital MS Dr Kalim Butt, Abu Shamim Arif,
Prof Younus Soomro, Hashim Sheikh and others were also present on the occasion.
(Dawn-18, 17/08/2006)
Marie Adelaide Centre’s scope to widen
KARACHI, Aug 16: The Marie Adelaide Leprosy Centre (MALC) is now planning to integrate leprosy care with the general
health care system so that patients could get the facility of diagnosis and treatment close to their homes.
This was stated by Honorary Adviser, federal ministry of health and a former MALC chief, Dr Ruth Pfau, who along with the
Federal Adviser on Leprosy and MALC chief Dr Capt Ashfaq Ali Khan, was speaking at a press conference at the Karachi
Press Club here on Wednesday in connection with the 50th anniversary of the centre.
They said that the MALC would soon start giving trainings to the doctors and other paramedical staff to enable them identify
any leprosy patient and provide treatment to them promptly and perfectly. With the early diagnosis, the disease could be
controlled early, they added.
They also urged the family and the society to accept the cured leprosy patient so that such a person could be fully rehabilitated
to lead a normal life.
They said that the leprosy control work was started by a young Mexican, Nun Sr Berenice Vargas, and her fellow nuns from the
beggars’ colony behind McLeod Road on Aug 16, 1956. Sr Vargas died last year at the age of 76.Dr Pfau joined the MALC in
1960 and with the help and dedication of the MALC staff working at over 150 centres, leprosy was brought under control in
1996. As the leprosy prevalence in the country is less than one active case in a population of 10,000, the disease has ceased
to be a public health problem.
They said that though the disease had been controlled in 1996, it had a long and variable incubation period ranging from two
years to 40 years. Therefore, there was a need for vigilance against it. However, as the main goal had been achieved, the
MALC has also taken on other health problems like the TB and blindness control in the leprosy affected areas.
They said that they were carrying out community awareness programmes in these areas so that the diseases were identified at
early stage to contain morbidity or mortality.
They said that in the MALC’s expanded leprosy control programme, 90 per cent of all registered leprosy patients would be
comprehensively rehabilitated, the same percentage of TB patients would be cured, and the same number of persons in a
danger of turning blind would be plotted on care cards.
Giving some data, they said that there were over 52,450 registered leprosy patients in the country and last year, only 551 new
cases were detected. Some 8,155 patients were being monitored for sight threatening conditions and about 5,817 (72 per cent)
had been successfully treated. Over 3,500 cataract surgeries, with a success rate of over 87 per cent, had been performed.
More than 94,300 TB patients had been registered and the cure completion rate among them had remained above 90 per cent.
They said that about 65 per cent of the MALC annual budget of Rs120 million came from overseas donors while the rest was
generated from local philanthropists and local corporate sector. They said that as the leprosy had been controlled in the
country, the TB and eye diseases would also be brought under control soon with the efforts being made by the dedicated MALC
staff.
(Dawn-19, 17/08/2006)
Chest hospital in Kotri without specialists
DADU, Aug 20: The Institute of Chest Diseases in Kotri is working without chest specialists, radiologists, general surgeons,
physicians and anaesthetists since 1995.
Due to failure of the government to post specialists chest diseases patients in Sindh have been deprived of medical facilities.
The institute, formerly known as the TB sanatorium, was established in 1954 on the hills of Soan Wallahar of Kotri taluka.
Spread over 54 acres, the hospital caters to the need of patients of tuberculosis and other chest diseases in Sindh, adjacent
area of Balochistan and southern Punjab.
The 204-beded hospital (TB sanatorium) was upgraded and made Institute of Chest Diseases in 1995 by the then chief minister
Syed Abdullah Shah.
Hospital working under the provincial government has two female, four male and children wards.
24
Approximately 212 patients are admitted to the hospital belonging to different districts from Jacobabad to Umerkot.
Some patients, belonging to lower Punjab and adjacent area of Balochistan, were also admitted to the hospital.
The OPD is being looked after by a senior medical officer who is working on the seat of chest specialist. At least 20 quarters
initially constructed for the residence of patients were in deteriorated condition and no patient was living in these quarters.
Conditions of at least 86 staff quarters and four bungalows were deteriorating.
Dr Liaquat Rajput, additional director of the Institute of Chest Diseases, told Dawn that 212 patients were admitted to six wards
and being treated for the disease since the last six months.
He said that the hospital was spending Rs2,000 per patient every month on medicines and diet.
Senior medical officer Dr Shoukat Shaikh said that 150 to 200 patients daily attend the OPD.
Dr Fazalur Rehman Soomro said that the number of TB patients was increasing every year.
He said the hilly belt from Jacobabad to Jamshoro was most affected and most of the cases were reported from Kohistan and
Kachho belts of the districts.
He said that most of the patients from ranging between the age of 10 to 20 years were admitted to this hospital.
He said that due to poor nutrition and poverty, TB was gripping the population fast.
The director of the institute, Dr Jamil Shaikh, said that at least six chest specialists, four general surgeons, two radiologists, two
physicians and two anaesthetists were required at the hospital.
He said that 16 doctors including lady doctors of the hospital were working at other hospitals on deputation which had affected
the working of the hospital.
He said that they were providing a complete treatment to the patients. He demanded that the postgraduate centre should be
established in the hospital and the hospital should be handed over to the Liaquat University of Medical and Health Sciences for
it better performance.
(By Qurban Ali Khashik, Dawn-2, 21/08/2006)
Congo virus or what?
ON Aug 7 a young research scholar and a scientist of repute, Imran Ali Siddiqui, died mysteriously. Incidentally the young
scientist was to be married on that fateful day. His family circles initially said Mr Siddiqui died of Congo virus and high-grade
fever within 48 hours.
Authorities at Liaquat National Hospital, Karachi, have not clearly mentioned the exact causes of Mr Siddiqui’s death. The press
information department of the hospital and doctors there have also kept mum about the death of this young scientist who had
more than 100 research publications to his credit at such a young age.
It is a usual practice that we deny the presence of calamity until we are severely affected by it. Be it an epidemic, a natural
disaster or even a war, our habit of saying ‘all is well’ does not see any bounds.
The authorities in the city and provincial and federal governments should inform the general public about the spread of
contagious viruses and epidemics and the hospital authorities should also inform the general public about the precautionary
measures and arrange for the treatment rather than isolating and letting die a patient in the ICU.
I hope that the authorities at the Liaquat National Hospital, Karachi, would come forward to give a plausible explanation
regarding the death of Mr Imran Ali Siddiqui. The Pakistan Medical Association too should investigate the breakout of Congo
virus infection in the city and suggest the necessary precautionary measures. This will be in the fairness of medical ethics also.
ARIF-UZ-ZAMAN, Karachi
(Dawn-6, 23/08/2006)
Free laser-treatment deptt at Spencer’s
KARACHI, Aug 22: Diabetic eye patients will now get free of charge treatment by laser at the Spencer’s Eye Hospital with the
establishment of a new department where all modern facilities will be made available.
The opening ceremony of the new facility was performed by City Nazim Syed Mustafa Kamal at a function held in the hospital’s
premises which was attended by the senior doctors and city government officials here on Tuesday.
The hospital was known for the provision of best eye care services not only in Pakistan but also abroad and once it was pioneer
of corneal graft surgery in Pakistan but for various reasons this service was not available to the poor patients for the last many
years.
Named Khursheed Begum Diabetic Eye Disease and Laser Treatment Department, established at a cost of Rs13 million, the
city nazim termed it a leap forward and said that it would provide better eye care services to the poor patients of Balochistan
and interior Sindh besides citizens of Karachi.
In his inaugural speech, Mustafa Kamal recalled his first surprise visit to the hospital four months back when he was shocked to
witness that there was no staffer in the hospital except a nursing staff and there were no patients in the wards.
Thereafter, he appointed a new medical superintendent of the hospital and directed him to take all necessary steps to improve
its services and boost its image as an excellence center.
He lauded the efforts of the new administration for taking effective measures to improve the services of the hospital and
expressed hope that it would soon become a prestigious institute for provision of excellent eye care services in the country.
Mustafa Kamal said the city government did not believe in mere slogans, but a strong supporter of realism and pragmatism,
hoping that the hospital’s staff would continue to work with the same zeal and commitment to gain respect and dignity.
“We want to serve the poor regardless of the fact whether they had voted us not,” he said. He said that he was not the
representative of the 14 towns, but the nazim of the people of Karachi, adding that the city government was giving special
attention to the development of backward areas, including Lyari, which were hitherto neglected.
On this occasion, Mustafa Kamal also announced free of charge lenses to the poor patients.
25
At the same time, he also announced that free service of corneal graft surgery, which ceased to function some years back,
would be revived. The supply of cornea donations from Sri Lanka was stopped many years back, he said adding that after a
series of negotiations the supply was restored. Now, he said, the handling charges and other expenses would be born by the
city government. The facility would be made available to one patient every week, he added.He announced that a diabetic
specialist would be available at the hospital round the clock and all facilities would also be provided free of cost to patients.
“With the help of hospital’s dedicated team we would make it a model institution,” he remarked.
The chairman of city government health committee, Dr Waqar Kazmi, said that up to 95 per cent blindness due to diabetic
retinopathy was treatable and avoidable by timely laser photocoagulation. He said that an OPD section for diabetic patients was
also being established in the hospital to provide them diagnose facility.
Earlier, Spencer’s Eye Hospital Medical Superintendent Dr Mashood-uz-Zafar Farooq welcomed the chief guest, saying that all
possible steps would be taken for the welfare of the patients as it was our duty to cater to the needs of the poor patients. He
thanked the nazim for his support and said that gigantic task for upgrading the hospital could not be accomplished without his
active support.
On the occasion, Naib Nazim Nasreen Jalil announced to provide an ambulance to the hospital. She appreciated the
performance of the management in rehabilitation of the hospital and assured them of all possible help in solving their problems.
The ceremony was also attended by Provincial Minister for Housing and Town Planning Shoaib Bukhari and MPAs Muneer
Sheikh and Aziz Bantwa.
(By Latif Baloch, Dawn-18, 23/08/2006)
Ibad increases doctors’ remuneration
KARACHI, Aug 22: Sindh Governor Dr Ishratul Ibad Khan has underlined the need for the establishment of an authority to bring
private hospitals and their medical facilities under some regulation and called for an early legislation for this purpose.
He also issued a directive for increasing the remuneration of doctors, having done a major diploma from the College of
Physicians and Surgeons and now under training at provincial hospitals, from Rs6,000 to Rs10,000.
He was presiding over a high-level meeting held at the Governor’s House here on Tuesday in which matters concerning the
medical universities and medical education in the public sector were considered.
The meeting was attended by Health Minister Shabbir Ahmed Qaimkhani, Labour Minister Mohammed Adil Siddiqi, Nazim of
Karachi Mustafa Kamal, Principal Secretary Saleem Khan, Secretary for Health Dr Naushad Shaikh, Secretary for Finance
Malik Israr Hussain, Vice-Chancellors Prof Dr Jan Mohammed Memon and Masood Hameed and other officials.
The governor directed the payment of basic science teaching allowance to teachers of medical universities whereby a professor
would get Rs15,000, an associate professor Rs10,000 and an assistant professor Rs7000.
The meeting decided in principle the transfer of TB sanatorium of Kotri from the health department to the Liaquat Medical
University.
Since the graduating medical students used to wait for six month for a house job, the governor directed that students doing
MBBS and BDS should be provided house job from the very first month.
The employees of the Dow Medical University were allowed to avail medical facilities at the Services Hospital.
Taking stock of financial matters, both Dow and Liaquat medical universities were directed to take comprehensive steps to
attain autarky and in the meantime financial assistance from the provincial government and the Higher Education Commission
will continue. In this regard it was decided to further strengthen the cooperation of their respective alumni.
The governor directed that necessary steps be initiated to get the buildings of the Dow Medical University from the Evacuee
Property Trust permanently.
DELEGATION: A delegation of the Pakhtoon Action Committee (Loya Jirga), led by its chairman Shahi Syed, called on the
Sindh governor in the Governor’s House on Tuesday.
The governor exchanged views with the delegation members on a 13-point list regarding problems presented by the committee
and issued directives for taking practical steps for the resolution of transport-related problems, says a press release issued here
on Tuesday.
The governor directed the Sindh chief secretary to arrange a meeting with transporters belonging to the committee on Aug 28
at his office. Political secretary of governor Salim Khan would arrange a meeting Aug 30 at the Governor's House for the
resolution of problems related to katchi abadis, enlistment of voters and the devastation caused by rainwater.
During the meeting, Sindh Transport Minister Mohammad Adil Siddiqi vowed to have a meeting with the federal communication
minister to resolve issues related to the Motorway and National Highway.
The delegation comprised Syed Mahmood Afridi, Al-Haj Malik Ahmed Khan, Haji Mir Zaman Mahsood, Haji Akram Ali, Gul
Mohammad Afridi, Haji Khan Jadoon, Abdul Rauf Khan, Hakeem Khan Mandokhel, Taj Khan Bangash and Amir Nawab Khan.
(Dawn-17, 23/08/2006)
Dr AQ Khan has cancer
ISLAMABAD: Nuclear scientist Dr Abdul Qadeer Khan, known as AQ Khan, has prostate cancer, the government said on
Tuesday. Officials said the disease was not at an advanced stage.
Signs of the disease were detected during a routine test in early August and confirmed by a detailed ultrasound examination at
the Khan Research Laboratory hospital near Islamabad, a government statement said.
The results of the tests were analysed by at least two leading histopathologists, said an official spokesman here on Tuesday.
“The results have unfortunately indicated adino-carcinoma (cancer) of prostate. Further investigations are being conducted by a
board of doctors,” the statement said.
“Since the state of health of Dr AQ Khan is of public interest, the government of Pakistan would like to hold out an assurance
that the best specialist medical care is being provided to Dr AQ Khan in consultation with his family and personal doctors.” The
public will be kept informed from time to time whenever necessary.
26
A government source told AFP: “He is fine, the disease is not at a threatening stage.” Dr AQ Khan is revered as a hero in
Pakistan as the father of the Islamic world’s first atomic bomb. A family friend of Dr AQ Khan said the scientist should be
allowed to go abroad for treatment despite the restrictions on him.
Pakistan’s medical facilities are generally poor. “He used to feel problems but it has developed suddenly,” said the friend, who
did not want to be identified. “If he needs to be sent abroad he should be sent abroad. It is very disturbing news for the whole of
the nation and Muslim Ummah. “He is the icon of our power as a nation.”
In June 2005, Dr AQ Khan was taken to hospital suffering from chest pains but was given the all-clear after undergoing a
procedure to check arteries for blockages. Extra plainclothes security officers were posted outside Dr AQ Khan’s plush villa in
Islamabad where he has been under virtual house arrest.
Friends and associates were quick to wish a speedy recovery for the scientist, who also suffered a minor cardiac problem in
June 2005. Officials said he had been discharged from hospital on Monday.
“We had apprehensions about his health. He had regular checkups. He was suffering from things you get in depression but we
have never heard of his cancer. This is very sudden,’’ said Hussam-ul Haq, who is the brother of Khan’s former secretary.
Foreign Ministry spokeswoman Tasnim Aslam said Khan would be provided “the best medical care” in Pakistan and would not
go abroad for treatment.
Pakistan launched a formal investigation into Dr AQ Khan’s dealings in 2003 after the International Atomic Energy Agency, the
UN nuclear watchdog, wrote a letter to Pakistan saying that Khan was operating a black market in weapons technology and
know-how.
Pakistan’s government maintains it was not aware of his dealings, but has repeatedly refused to allow the IAEA to question
him. Aslam said that would not change. “We have conducted our investigation. We have shared the results with the IAEA and
third countries. If any questions come up, they should be given to the government of Pakistan and we would investigate and
provide a response,” she said.
Patrick Cronin, director of studies at the International Institute of Strategic Studies in London, said Khan’s condition would lead
to renewed calls for access to the scientist that Pakistan would be highly unlikely to allow.
“In terms of critical information that would be lost forever once he goes, that’s something that’s going to be of considerable
concern for security officials around the world who are going to press Islamabad again for further access to Dr AQ Khan,’’ he
said in a phone interview.
“It’s highly unlikely they (Pakistan) are going to open up more than they have. I think Khan’s dealings were so inter-threaded
with senior military leaders inside Pakistan and the Pakistani intelligence community, they would be very reluctant (to grant
access).’’
(The News-1, 23/08/2006)
Emergency declared at Fatmid
KARACHI: Three thalassaemia patients at Fatmid Foundation have died due to non-availability of blood, Dr Saghir, head of the
blood department, told this reporter.
Two of them were children as young as 14, namely Mohammed Nawaz and Amir, while another aged patient of hemophilia,
Abdul Hakim, died of blood disorder.
As a matter of fact, the current monsoon spell which devastated the entire infrastructure of the city, with all civic agencies at a
total loss, had badly affected the children of thalassaemia who were not provided with blood on time due to its shortage at the
foundation.
Sabir Dar, Coordinator of Fatmid Foundation, also disclosed that a patient named Saad is in critical condition. While he needs
four platelets of blood every day, he is receiving only two. This is a life-threatening situation.
Dr Saghir said that Fatmid Foundation had always collected blood through some private donations and organising roadside
camps but due to stagnant water on streets, these camps could not be set-up.
Besides, he said, the blood donated by some private organizations could not be collected due to thin attendance of staff at
these institutions.
On an average, a thalassaemia patient needs blood every fortnight failing which the proportion of hemoglobin reduces to risk
level resulting in the death of the patient, the doctor said.
Around 70 to 80 children, who need blood on a regular basis, could not be provided with enough of it due to the torrential
rainfall, he said.
An emergency has been declared at the foundation, according FF coordinator Sabir Dar. People have been requested to
donate blood at FF to save the lives of hundreds of children suffering from blood cancer and thalassaemia.
(The News-4, 24/08/2006)
Regular treatment at KIHD begins
KARACHI, Aug 26: City Nazim Syed Mustafa Kamal on Saturday inaugurated regular treatment facilities at the second largest
state-run heart diseases hospital in the metropolis, the Karachi Institute of Heart Diseases.
He said that he believed in concrete work and not in just publicity-oriented steps. He said that the hospital during the last three
months had carried out angiography of 830 patients. He said that modern machinery worth Rs100 million had been purchased
for the hospital and 340 staff had been appointed.
The nazim announced to run the 120-bed hospital in three shifts. He said that the city government would pay all expenditures of
this modern hospital, which had already stock of medicine for one year use.
He said that the first vital injection for heart patients costing Rs5,000 would be provided free to patients at this hospital. He said
that angiography cost Rs30,000 in other city hospitals, but the KIHD would charge just Rs3,000 for it. He said that angioplasty
costing Rs175,000 in other hospitals would be provided here for just Rs35,000.
(Dawn-17, 27/08/2006)
27
SEPTEMBER
Spread of gastroenteritis
WATERBORNE diseases, particularly gastroenteritis, are cutting a swathe of misery across Sindh, with children and the elderly
being the worst affected. Since the onset of the monsoon, over 30,000 cases of gastroenteritis have been reported in the
province and at least 14 patients admitted to government and private hospitals have died from the disease. Estimates of those
affected in remote areas are unavailable. However, given the debilitating nature of the ailment, coupled with the constraints of
poverty, it can be assumed that some villages remain without any kind of medical help. Of the cases on record, the majority are
being reported from districts Nawabshah, Khairpur, Mirpurkhas, Larkana, Naushero Feroze and Sukkur. Hyderabad is also
affected, while government hospitals in Karachi are receiving an estimated 150 gastroenteritis cases a day.
The need now is to mobilise teams of healthcare professionals who can travel to remote villages and provide treatment.
Wherever possible, these mobile units must carry emergency supplies of clean water for the most critically affected. Provision
of chlorine tablets, along with guidelines for safe use, is another option. Since such measures are sustainable only in the short
term, it is imperative that efforts be made to raise awareness of the dangers of contaminated water and the ways by which they
can be overcome. A concerted campaign is required in both rural and urban areas to highlight the need to vigorously boil
drinking water prior to consumption. In the longer term, the drainage and sewerage systems should be overhauled to ensure
that rainwater and household and factory discharges do not seep into water lines and underground tanks. Water treatment
plants also need to be upgraded and professionally managed. In the rural areas, plans to bore bacteria- and arsenic-free ‘deep
wells’ must be pursued with sincerity of purpose. All this is possible. Just doing the doable will suffice.
(Dawn-7, 02/09/2006)
Hospitals getting filthy water
KARACHI, Sept 3: Contaminated water is being supplied to all major hospitals of the city increasing the possibilities of
outbreaks of viral infections among the patients and hospital staff.
A survey revealed that there was no water treatment plant in any of the government hospitals and the underground and on
surface water reservoirs of all these hospitals had not been cleaned for years.
The recent monsoon showers have further aggravated the situation as sewage-mixed rainwater that remained accumulated at
these hospitals for many days, got mixed up with the underground water reservoirs, apparently resulting in further
contamination of the water, which is to be supplied to the hospitals.
A doctor at the Civil Hospital Karachi said that the underground and overhead water tanks of the hospital had not been cleaned
for over a decade. He revealed that the hospital's underground tank was cleaned 10 years ago when a dog had fallen into it.
The doctor said that although some small filter units had been installed in the water coolers but those were not sufficient
enough.
The situation in the other major hospital of the city, the Jinnah Postgraduate Medical Centre (JPMC) is not different from the
Civil Hospital, where the water reservoirs had not been cleaned for many years and contaminated rainwater had mixed up with
the underground reservoirs.
A doctor told Online that he had been working with the hospital for the last eight years and during the entire period the
administration did not conducted a single cleaning operation of the facility’s water reservoirs.
There were no filter units in the hospital and the doctors, paramedical staff and patients either have to bring boiled water from
their home or to buy mineral water from medical stores, he said.
He said that the poor patients, who could not afford to purchase mineral water, were compelled to use the unfit and polluted
water being supplied from the tanks. He deplored that the supply of unfit water was not the only problem at the JPMC, but even
substandard food was being provided at the hospitals' canteen.
(Dawn-13, 04/09/2006)
Right to know
PRETENDING that something doesn’t exist will make it go away or so is believed by our health officials. Last year when Dr
Yusra died due to dengue haemorrhagic fever (DHF), the resulting headlines at least brought to light a viral threat that had
existed routinely before but which our health officials had chosen to ignore entirely.
No government statistics can prove otherwise because I know that although I am a pretty well read person, before Yusra’s
death I, along with the rest of the public of Karachi, had no clue that DHF existed in epidemic proportions in our city.
An interesting denial by a health official was published in Dawn Review Aug 24-30 issue where a statement goes on to say that
“Dr Zia and Dr Yusra’s blood samples were sent as far as South Africa and it was confirmed that neither had dengue nor
Congo.”
The fact is that Dr Yusra’s blood samples were tested by the Aga Khan Hospital and were confirmed positive for DHF. If
government hospitals look the other way every time one of their doctors dies, then it is sadly their heartless choice and not
because evidence does not exist.
The statement also went on to label the ‘hype’ created by the media last year as ‘extremely unfortunate’. As a grieved family,
we believed and still believe that the public has a right to know even if this awareness is labelled extremely unfortunate by
those in charge. I’m sure the Dawn Review’s heading ‘The Dengue virus has arrived’ has also given our health officials a few
turns in their cosy beds and fresh ideas are forming in their minds as how to wish away the whole thing.
When are health officials going to wake up to the fact that if a viral threat is present, then precautionary measures are the only
deterrent? But as long as we don’t admit we have a problem, we will sadly never have a cure.
Conditions remain unchanged at government hospitals. No proper precautionary measures in effect, no masks, no gloves, no
disinfectants. All subjecting medical personnel, as well as naive medical students, to perilous hazards.
True that dengue fever and Congo fever spread by vector mosquitoes and tick-borne virus, respectively, but direct unprotected
contact of say a doctor with an actively bleeding patient will also result in the doctor getting infected.
28
Every day the brightest of our children go to medical colleges and work there facing not occupational hazards but occupational
suicide. Is there some one responsible bothered?
MRS ALMAS SHAHZAD
Family member of Dr Yusra, Karachi
(Dawn-6, 05/09/2006)
Trauma of a man who helped visually impaired
KARACHI: Forty-seven year-old social worker, Shaikh Nasir Ali, who had been effectively working for the rights of the visually
impaired for 22 years, is now confined to his home after facing severe emotional and physical torture.
Ali alleges that police tortured him for almost a year under pressure from some individuals who, he says, repeatedly lodged
false FIRs against him in order to take over his assets. Despite winning the case in Sindh High Court and reconciliation with
these people Nasir Ali says that his family continues to receive threatening phone calls.
Disclosing the scandalous acts of the perpetrators, Nasir’s wife Sakina told The News that her husband and brother, Irtiza
Khan, initially refused to fulfill the demands of one Shiraz for which they were subjected to brutal torture for several months. At
a press conference in July, Sakina said that her husband is being targeted by a vicious group of criminals.
According to his statement, Nasir was introduced to Shiraz by his acquaintance, Mohsin Khan, in February 2005. Mohsin told
Nasir that Shiraz was impressed with his (Nasir’s) work and wished to assist him in community service.
Having learnt sign language, Nasir Ali had been voluntarily teaching acting to the visually impaired since 1984. He has also
staged various commercial programmes to help these special people, who are otherwise deemed a useless segment of society,
become independent.
Shiraz told Nasir that he would assist him with Rs200,000 which Nasir needed for his upcoming programme. Initially unaware of
his intentions, Nasir agreed to make Shiraz a part of his team.
However, he later suspected Shiraz’s motives and decided to call off the deal. When Shiraz learnt this, he told Nasir of his real
objective which was to take over his funds worth millions of rupees that Nasir had earned through his work.
Sakina says that upon refusal, Shiraz continued to harass Nasir and his family. Sakina also said that during a visit to Nasir’s
sister’s residence in July last year, Shiraz illegally entered the house to search for Nasir’s money and physically attacked him. It
was at this point that Nasir decided to file a case against Shiraz.
Nasir was oblivious of Shiraz’s influence and in October 2005 he was arrested by the Sindh Police’s Anti-Violent Crime Cell
(AVCC). During his three-day detention, he was handcuffed and blindfolded.
Nasir mentioned in his statement later that while he was in custody, he was attacked with a sharp weapon. Later in court, he
was falsely accused of attempting suicide. He was then sent to Jinnah Hospital for treatment and a temporary bail was granted
to him. Shortly afterwards, an FIR was lodged against Sakina’s 20-year-old brother, Irtiza, who had absolutely nothing to do
with the case. He had shifted to Karachi after his house in Kashmir was destroyed due to the earthquake.
Eventually Nasir and Irtiza were arrested. They were beaten up in separate cells of the police department for several weeks.
Apart from putting up with repeated episodes of mental and physical torture, the poor conditions of the prison added to their
misery.
Nasir also revealed that the policemen used to hit his feet several times a day until he was unable to walk. His constant denial
to comply, led to the enraged policemen to shift him to a mental ward in the prison where he was frequently given psychiatric
medication. While Nasir and Irtiza were suffering at the hands of the police, their family remained clueless about their
whereabouts.
However, Sakina and her family were keen on challenging the false FIR in court but their hearings were being postponed.
Meanwhile they had also appealed to the Home Minister for support but in vain.
In their next hearing, however, their fortunes changed when the SHC judge after witnessing the wounds realized the agony
Nasir and Irtiza were subjected to. Their immediate release was ordered.
However, things continued to get bad. When Nasir and Irtiza were heading home from the court, their car was stopped by 8-10
people who forcibly pushed them into a van. Their valuables were taken away and they were blindfolded and handcuffed.
The family says that they were shifted from the van to another vehicle and after their journey, which lasted a few hours, the men
told them that under the orders of Shiraz and Faisal, they had the authority to kill them if Nasir refused to pay them Rs3 million
as previously demanded.
Fearing death, Irtiza forced Nasir to comply. Nasir added that after his family had agreed to meet their demands, the next day
Shiraz appeared in front of them and confessed to his crime. He also apologized for the torture he had subjected them to in the
past but threatened to kill them if they pursued the case. Nasir and Irtiza were then set free. Shiraz then sent them to their
residence in Karachi through a taxi, whose fare was paid by him.
Meanwhile in Karachi, Sakina had filed an FIR against Shiraz and other police officials for kidnapping but no serious action was
taken until Sakina called a press conference on July 01, 2006. The Sessions Court then ordered the filing of the FIR in the City
Court. But before the investigation could proceed, Shiraz lodged another false FIR in which he accused Nasir and Sakina of
threatening to kill him on the premises of the court.
Sakina added that the case was then transferred to AVCC by the City Court who have failed to produce the perpetrators in
court. “It has been more than ten days now and the culprits are still absconding,” said Sakina.
She said her husband and brother feel unsafe staying in the city and have not been able to continue with their lives. Fearing
that he might be kidnapped again, Irtiza chose to leave the country. He is unable to pursue his studies and has been
emotionally disturbed after the incident.
“I have relevant proof to support my case and the police are well aware of the truth even then no action is being taken. They
say they are investigating through a special ‘channel.’ I fail to understand their channel of operation.
29
Sakina reiterated that the case be investigated in an impartial manner and pressure from Shiraz, Faisal and their accomplices
should be resisted and they should be convicted in court for harassing innocent citizens. “The state should realize its duties in
safeguarding vulnerable members of the society,” she said.
(The News-3, 05/09/2006)
50pc cola drinks not fit for consumption
LAHORE, Sept 5: Some 50 per cent of cola drinks being sold in the city fail basic laboratory test conducted to assess their
fitness for human consumption.
Health department’s public analyst Qamar Shaheen told participants in a Civic Forum meeting on Tuesday that the bottled
colas either had contaminated water or contained particles besides the proportionate of ingredients was not found according to
standards. “At present, we have no facilities to check things other than the particles, especially the micro-organisms, that is an
advanced stage,” she said.
The state of affairs regarding loose pack tea was not different as 50 per cent of the commodity available for sale was spurious.
Lahore District Quality Control Board secretary Dastgeer Ahmad Bhatti said on the directive of the Supreme Court, medicines
of three companies were got tested and 23 were found spurious and as many substandard.
He said spurious medicines did not at all contain actual ingredients, while the substandard drugs had not the standard quantity
of materials. He said the federal government decided drugs quality, while the provincial authorities monitored the provision of
the medicines according to the standards.
Health department deputy secretary Dr Naseer Ahmad Raja said presently there were two food-testing laboratories in Lahore
and Multan. He said four posts of food inspectors had been lying vacant in Lahore for the past many years, but now the city had
eight inspectors. Half were already working, while a notification for another four had been issued. “The recently notified are exofficio food inspectors, and are qualified to collect samples for testing,” he said.
Mobile food testing laboratories were being set up in the province, while committees had also been constituted at tehsil level to
check the quality of drugs in rural areas.
The government was also actively contemplating to revise the pure food rules. Half of the rules had been vetted after at least a
five-hour discussion on every item, involving the manufacturers, especially multinationals, besides law, industries department
officers and other stakeholders.
(Dawn-13, 06/09/2006)
Radioactive iodine safe for thyroid cancer: experts
KARACHI, Sep 6: Enough evidence exists that an appropriate use of radioactive iodine turns negligible the future risk of
malignancy without impairing fertility or casting serious side effects on patients inflicted with thyroid cancers.
Prof Najamul Islam from the Aga Khan University Hospital, who presented his series of cases of thyroid cancers during the
National Symposium on “Advancing the Frontiers of Endocrinology in Pakistan”, organised by the Pakistan Endocrine Society,
identified papillary as the most common cancer.
He also mentioned that more than 100 patients with thyroid cancers were brought to him in a short span of time, reemphasising presence of a palpable thyroid nodule which requires evaluation.
The most cost-effective diagnostic modality, he said was to introduce a needle biopsy in the nodule to establish the diagnosis.
“This technique which is locally available also has a very high safety profile,” he said.
Dr Lubna Zubairi, Consultant Endocrinologist, discussing the local diagnostic and treatment strategies on hyperthyroidism,
suggested use of drugs, iodine ablation and surgery as the treatment options for people with high activity of thyroid disease.
“Anybody with palpable thyroid gland should immediately consult his doctor in order to find out whether their thyroid gland is
overactive and requires treatment,” Dr Lubna said.
Dr Khurram Shahid from the Liaquat National Hospital and Dr Abid Jamal, Consultant Surgeon with interest in Endocrine
Surgery, presented data on hyper-parathyroidism, a gland responsible for the control of calcium.
The relevant patients might present with bone pains, renal stones, however, 75 to 80 per cent hold vague feature of
hypertension, weakness, psychological problems, they said, adding that if remained undiagnosed, they may suffer from a risk
on high incidence of cardiovascular disease.
According to Dr Abid, an experienced surgeon can salvage 95 per cent of the previously failed operation. He also highlighted
the need for a minimally invasive surgery in these patients and showed his data of 11 such patients in which the surgery was
performed and majority had a normal calcium following surgery.
Dr Khalid Imam from the LNH presented his paper on frequency on metabolic syndrome in patients with type-II diabetes.
Dr Yaqoob also presented his data on the metabolic syndrome in the Pakistani population, and commented that with the
introduction of fast food chains in Pakistan, the incidence of metabolic syndrome had greatly increased, turning people
increasingly vulnerable to diabetes, hypertension and cardiovascular problems.
It was stressed that healthy eating habits had to be induced from early childhood to prevent outbreak of any epidemic
condition.By treating obesity, we can reduce diabetes in up to 50 per cent of our affected population, the researchers said.
Prof Abdul Jabbar, President of the Pakistan Endocrine Society and a senior diabetologist associated with the Aga Khan
University, in his presentation on “New Modalities of Diabetes Mellitus” said that Pakistan was exposed to dramatic increase in
the prevalence of type-II diabetes among its people.
He said there was a large number of newer drugs to help control the ailment. Newer compounds, including Rimonabant, has
led to a significant decline in HbA1c and a better control of diabetes.
The drug was said to be particularly suitable for patients with metabolic syndrome and central obesity.
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There are a number of gut peptide (GLP-1) which have now been found to have a beneficial role in the control of diabetes, the
speaker said.
A synthetic analogue is now available which is likely to improve control in patients with difficult diabetes and might spare the
use of insulin in some of these patients.
President of the Society’s India chapter Dr Abdul Hameed Zargar of Srinagar presented his data on the “Gestational Diabetes”.
The overall prevalence rate is 3.8 per cent in all women in South Asia, mainly India and Pakistan, he said, regretting that the
two countries seemed to be one of the major culprit as increased weight with increased body mass index and a family history
often result in diabetes during pregnancy.
Sixty per cent of these women require assistance, he said, mentioning that 95 per cent of the women who developed
gestational diabetes had more than one risk factor.
It is essential that along with the treatment, most of these women should do moderate exercise to control their diabetes and
protect themselves from related complications.
(Dawn-18, 07/09/2006)
Doctors remove forceps left in woman’s abdomen
KARACHI: A woman has had a pair of forceps removed from her abdomen a year and a half after they were left there during a
caesarean operation, a doctor said on Thursday. The mother of four was admitted to a hospital in Karachi last week
complaining of severe abdominal pain. Surgeons removed the forceps on Wednesday. “We have removed the forceps but they
caused some damage to her intestines,” said Shaukat Rajput, a doctor at the Liaquat Hospital. “We will carry out another
operation to do repair work. But she is doing well now and should be okay,” he said. The 30-year-old woman lost her child
during the caesarean at another private hospital 18 months ago. The woman’s husband said he was planning legal action.
(The News-3, 08/09/2006)
Dr AQ Khan’s surgery successful
KARACHI: The father of Pakistan’s nuclear programme, Dr Abdul Qadeer Khan, who is suffering from prostate cancer,
underwent a successful surgery at the Aga Khan University Hospital (AKUH) on Saturday, hospital sources confirmed.
According to the sources the operation started about midday and continued for about four hours. Dr AQ Khan, 70, was
conducted to the operation theatre amid tight security. He was accompanied by his wife and daughters and personal physician
Lt-Gen (retd) Riaz Ahmed Chowhan. He was shifted from Islamabad to Karachi on Thursday.
The nuclear scientist was admitted to the hospital late on Thursday night and had various laboratory tests on Saturday before
leading surgeon Dr Farhat Abbas, along with a team of expert doctors, conducted the surgery.
According to the sources, Dr AQ Khan is out of danger after the surgery and he has been shifted to his room. After doctors
diagnosed Dr AQ Kahn with cancer, the government immediately made an announcement about his ailment, which shocked the
entire nation. The prostate cancer was at a preliminary stage and could be treated for which he underwent a surgery on
Saturday.
According to a press release issued by the Inter-Services Public Relations (ISPR), leading surgeon Farhat Abbas termed the
operation successful. The prostate cancer surgery on Dr AQ Khan “was a delicate operation,” the statement quoted Farhat
Abbas as saying.
The team of doctors and nurses were able to perform the operation successfully without any complication, the press release
said. It said the operation is likely to control further spread of the disease. He is expected to remain in the hospital for some
time for post-operative care, it added.
Nobody except family members were allowed to see Dr AQ Khan. A number of other close relatives of the scientist have met
him regularly since his arrival in Karachi. The hospital sources said none of the staff, other than those who were conducting the
surgery, was informed about his health.
Dr AQ Khan has been under house arrest since 2004 after he admitted in a televised speech leaking nuclear technology to
Iran, Libya and North Korea. The process of diagnosis that started in early August found slightly raised level of serum prostate
specific aitegen (PSA).
Dr AQ Khan’s tests were mainly conducted at Kahuta Research Laboratories and military hospitals. This was the first time that
his tests were held at a civilian medical institute in Islamabad on September 1 as the institute had best MIR facilities.
Later, a detailed examination, which included ultrasound and guided biopsy indicated adino carcinoma (cancer) of prostate.
Online adds: Prime Minister Shaukat Aziz has sent a bouquet to Dr AQ Khan after the good news of his successful operation of
the prostate cancer. According to sources at the PM House, Shaukat Aziz has also expressed his best and heartiest wishes for
the speedy recovery of the scientist.
(By Shamim Bano, The News-1, 10/09/2006)
Pakistan lags behind in clinical research
KARACHI, Sept 9: Experts at a two-day workshop on Good Clinical Practices (GCP) and Biostatistics, that concluded here on
Saturday, urged clinical researchers in Pakistan to gain knowledge of the GCP concepts and principles as it was customary for
them to get their research papers published in international journals.
The workshop at Liaquat National Hospital was an extension of the recently held Health Asia Congress 2006.
The speakers informed that at present clinical research was a $60 billion industry globally and realising its potential the Indian
health sector had heavily invested in this area attracting an annual business of more than $300 million from other countries.On
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the contrary, the number of clinical researchers in Pakistan was alarmingly low and one could not even find a WHO-approved
lab facility where bioequivalence and bioavailability studies and research on drugs could be carried out.
Speakers and trainers at the workshop included Dr Pedro Lopez Saura, Director, Center for Genetic Engineering and
Biotechnology, Cuba, who is on an extensive visit to Pakistan to evaluate clinical trials on Hepatitis-B vaccines and Hepatitis-C
interferon produced by his centre and to liaise with leading healthcare institutions of the country. Dr Saura's session during the
workshop included a presentation titled “Statistical principles applied in clinical trials”.
The chairman of the Department of Biotechnology, University of Karachi, Dr Mustafa Kamal, in his presentation titled “How do
drugs come into market?” elaborated upon the various stages of drug discovery.
Dr Kamal informed that a highly sophisticated process of identifying a molecule carrying medicinal properties and developing it
into a marketable drug may take around 10 to 12 years and a budget of several million dollars.
On an average 10,000 different molecules are screened initially, out of which 250 enter the pre-clinical testing phase carried out
on animals subsequently allowing five molecules to reach the clinical trial testing requiring human volunteers and only one of
which is approved by the drug regulatory authorities, he informed.
Dr Zakiuddin Ahmed gave a presentation on the “Role of a clinical research associate”. He said that in order to opt for a career
as a CRA one should have a degree in life sciences such as pharmacology, pharmacy, biochemistry, biotechnology,
physiology, microbiology, etc.The typical work activities of a CRA, he explained, included identifying and briefing doctors or
consultants as investigators to conduct trials; setting up study centres, ensuring each centre had the trial materials and
checking that the investigator knew exactly what had to be done; monitoring the trial throughout its duration which involved
checking the patient data in the case report forms (CRFs) and sort out any problems which may arise; validating and collecting
CRFS; discussing results with the statisticians, etc.
In his presentation on “Understanding the basic need for GCP”, Dr Asghar Naqvi said that the term Good Clinical Practices was
a misnomer and a widely misunderstood concept in Pakistan. He was of the view that it should be rephrased as Good Clinical
Research Practices. He explained that GCP was a quality standard for the design, conduct, performance, monitoring, auditing,
recording, analyzing and reporting of clinical trials that provided assurance that the data and reported results were credible and
accurate and that the rights, integrity and confidentiality of the subjects were protected.
Dr Syed Tajamul Hussain elaborated upon the issues of GCP compliance for clinical research and highlighted the ethical
protocols required for the same. Around 40 senior consultants and physicians attended the workshop.
(Dawn-19, 10/09/2006)
Youngest bone marrow patient
KARACHI, Sept 14: A two-year-old boy became the youngest bone marrow transplant patient at the Aga Khan University
Hospital. The boy was suffering from Thalassemia Major, a disease that previously required the affected patient to have a blood
transfusion every month. The family came to Karachi from Kuwait, especially for the treatment and were delighted that a
matching donor was found in the person of his three-year-old sister.
Five to six per cent of the population are estimated to be carriers of thalassemia gene, and around 5,000 babies born in
Pakistan carry the gene. The only curative treatment for this disorder is Bone Marrow Transplant (BMT).
The Bone Marrow Transplant unit at the Aga Khan University Hospital, inaugurated in 2004, has modern equipment and over
40 bone marrow transplantations have been successfully carried out.
The bone marrow transplantation team has expressed its satisfaction over the young patient's progress, saying that no
significant complication has been seen at any time in the pre to post-operation period.
(Dawn-18, 15/09/2006)
Smoking cause of over 30 serious diseases
KARACHI, Sept 17: Experts at a seminar held here on Sunday highlighted issues relating to heart diseases and called for an
increased awareness of the problem. The public awareness seminar, besides the Health Mela, was organised by the Aga Khan
University’s Cardiology section in connection with the World Heart Day, according to an AKU news release.
Speaking at the seminar, head of the Cardiology section Prof Sajid Dhakam, highlighted importance of the day and gave an
overview of the simple preventive measures required to prevent heart diseases.
He also highlighted the role of AKU in arranging seminars on a wide range of health-related issues in Pakistan and abroad.
Prof Javaid Khan, Consultant Chest Physician at the AKU, said that tobacco use was the most important among the risk factors
leading to heart attack or stroke, as well as at least 30 other serious diseases, including lung cancer.
Quoting a research carried out in 52 countries and published recently in a leading medical journal, he pointed out that use of
tobacco in all its forms, including paan and gutka, was extremely dangerous for heart and lungs.
Prof Khan said smoking was responsible for the one-fifth cases of cardiovascular diseases worldwide and if the trend
continued, the diseases caused by smoking might claim lives of 10 million people by 2030, 70 per cent of such fatalities could
occur in the developing countries.
Dr Aamir Hameed, Consultant Cardiologist, said environmental factors, genetic make-up, and habits form a milieu exposed
people to conditions leading to heart attacks.
Prof Salma Halal Badruddin, Department of Community Health Sciences, discussed the importance of diet and exercise from
an early age for prevention of heart diseases.
The Health Mela, arranged alongside the seminar, was organised to increase awareness in public by offering free tests and
advices for a healthy lifestyle.
The World Heart Day this year is being observed on Sept 24 for which the theme is “How young is your heart”.
(Dawn-14, 18/09/2006)
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36-bed trauma centre at Abbasi Shaheed ready
KARACHI: A sophisticated 36-bed “Trauma Centre” built at a cost of Rs55 million at the Abbasi Shaheed Hospital is to open
soon and cater to low- and middle-income segments of society. This centrally air-conditioned facility is equipped with three
operation theatres to carry out major surgeries.
“This trauma centre will provide services to patients free of cost,” Dr Feroze Mansoor, senior cardiologist at the Abbasi
Shaheed Hospital, told The News on Monday. The centre is tentatively billed to open its doors to patients on September 20 with
Sindh Governor Dr Ishratul Ebad likely performing the ceremony.
He said the patients will not be required to purchase medicine from outside. The centre, he said, has become a reality “due to
the untiring efforts of city Nazim Mustafa Kamal”. This is a unit where consultants and senior doctors will be on hand round-theclock. Its operation theatres are fitted with special lights to allow surgeons to have perfect view of the patients from whichever
angle they desired.
The cardiologist said that air-conditioning system at the trauma centre is the first ever among such facilities in any public-sector
hospital, designed to keep the air in the theatre clean and minimize chances of infection spreading in the vicinity.
The centre is also equipped with cardiopulmonary resuscitation equipment, ventilators, ECG, and other equipment necessary to
deal with any kind of medical emergency or trauma. The facility will take good care of the critically ill and the severely injured,
Dr Feroze said.
Glazed tiles all over the place give a neat, tidy look — so necessary for the patients’ care. A separate cardiac centre has also
been established at the upper floor of the centre. Three beds have been designated exclusively for 24-hour monitoring of heart,
pulse, and body saturation rates of in-patients. Separate ventilation room and recovery areas are among the features of this
state-of-the-art facility.
Dr Feroze said the main emphasis of city Nazim was to provide best medical facilities free of charge to low-income people,
which should in no way be inferior to those provided at a high cost to the well-heeled by major private hospitals.
He said not a single patient will be turned away simply because he lacked means. The service will be provided without
discrimination, he emphasized. The centre also has an X-ray department, blood bank, portable X-ray machines and a
laboratory to carry out various tests.
He recalled that Abbasi Shaheed, an 850-bed hospital located in Liaquatabad Town and run by the CDGK, had been neglected
for more than a decade with the result its health-care services deteriorated in terms of quality. Citizens often advised their near
and dear ones against going to the ASH and stressed on visiting private hospitals, even though expensive.
The hospital’s laboratory and X-ray facilities lie in neglect. The poor maintenance of the building has created a dirty and untidy
atmosphere which pervades all corners of the premises. Shortage of staff, non-availability of medicines and surgical supplies
are all too common. Not only this. Highly discourteous attitude of medical and paramedical staff further adds to the sufferings of
patients there.
In early 90s, the Trauma Centre of Abbasi Shaheed was one of the best in Pakistan. The hospital used to run at full capacity,
and long queues were witnessed at its out-patient department (OPD). Unfortunately, its standard services deteriorated overtime
and nobody cared to stop the rot.
A measure of its under-utilization can be had in the fact that bed occupancy only topped 250 on an average — less than onethird of its total 850 beds.
Sindh Governor Dr Ishratul Ebad visited the hospital in October last year and found the situation pretty bad. He issued orders
on the spot to revamp the hospital. When Mustafa Kamal took reins of the city government in 2005, he constituted a committee
for the revamp and took personal interest in seeing that the hospital was back to its former best. The trauma centre is being
seen as part of that effort.
PMA Karachi chapter’s secretary-general Dr Qaiser Sajjad said that a visit to the health facility revealed that ventilators, crucial
to saving lives, are in such large numbers there as are not to be found in any public-sector hospital. He said the expensive
equipment installed at the centre will make a real difference in health-care delivery.
(By Fasahat Mohiuddin, The News-2, 19/09/2006)
SC orders strict implementation of smoking ban law
ISLAMABAD: A three-member bench of the Supreme Court directed the Health Ministry on Monday to take all steps for strict
implementation of Smoking Prohibition Ordinance 2003 and hold meetings with inspector-generals and chief secretaries of all
the four provinces in this regard.
The bench, comprising Chief Justice Iftikhar Muhammad Chaudhry, Justice Abdul Hameed Dogar and Justice Saiyed Saeed
Ash’had, heard the point of view of the Health Ministry regarding implementation of the ordinance, which was promulgated on
June 30, 2003.
The case was adjourned for four weeks and would be taken up in the third week of October. It was taken up by the bench as
suo moto notice on the application submitted by Chest Physician of Agha Khan Hospital Karachi, Professor Dr Javed Khan,
along with facts and figures about the dangers of smoking and the diseases it develops.
The applicant has sent complete data about the percentage of people suffering from various diseases due to smoking,
especially the youth and death ratio etc with a request for implementation of the Smoking Prohibition Ordinance. An official from
the health ministry, Abdul Sattar Chaudhry appeared before the court and accepted various administrative lacunas regarding
the implementation of the Ordinance in letter and spirit.
Deputy Attorney General Pakistan, Nasir Saeed Sheikh also appeared before the court on notice and represented the
Federation and the ministry. The bench directed the ministry to submit comments before the Court about steps taken or being
taken for the implementation of the Ordinance.
The bench appreciated the steps taken by the ministry regarding prohibition of cigarette advertisements on electronic and print
media. It also directed the health ministry to delegate powers to the provinces for implementing the Ordinance in its complete
spirit.
(The News-5, 19/09/2006)
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Recycled syringes major cause of hepatitis
ATTOCK, Sept 19: The use of the recycled syringes has become major source of fast spreading hepatitis B and C in the
country. This was stated by District Monitoring Officer Health Attock district, Dr Muhammad Afzal Mirza while talking to a forum
of Central Union of Journalists here on Tuesday evening. The forum was held to discuss the root causes and preventive
measure to control the fast spreading deadly disease of ‘Hepatitis B.
Dr Afzal said that the used disposable items like syringes, catheters, NG tubes, gloves used in operations, drips and swabs
could not be disposed of and the companies reused these items as raw material for the preparation of new ones.
Health department has installed incinerators for the disposal of used items mostly in the main hospitals, but despite the
presence of these incinerators, most of the times these risky items reached the hands of scavengers who sold them to the
traders of these items from where they reached to the companies through the hands of the businessmen who used them again
in the making of these items, he observed.
It was the state responsibility to impose the existing laws regarding the matter and rid the people of the menace, while NGOs,
health organizations and other stakeholders should launch awareness programmes at their own levels about the causes and
prevention measures of this silent killer disease among the masses, he urged.
About Hepatitis B, he said that the disease was hundred percent curable. “It targets the human liver directly and can give rise to
many serious complications like cirrhosis and liver cancer,” he added.
Dr Afzal showed deep concern over the Hepatitis B and C patients’ attitude about avoiding edibles, which were otherwise
beneficial for health and strengthening their immune system.
He said it was observed through various health surveys and reports that the ratio of Hepatitis B and C is being increased at
alarming proportion every year in the country due to such careless attitude of the people and other stakeholders,” he claimed.
Moreover, the lack of diagnostic facilities had rendered many persons unable to know that they were suffering from hepatitis B
and transmitted the disease to others unknowingly, he added.
(Dawn-2, 20/09/2006)
Trauma Centre at Abbasi Shaheed Hospital inaugurated
KARACHI: Sindh Governor, Dr Ishratul Ebad Khan, has underlined the imperative need for making the health sector more
functional in view of ever increasing population in the city.
In this regard, he said, a website be developed in every town of Karachi, providing details of performance of health sector,
statistics, availability of facilities and also how people could benefit from the facilities of the Abbasi Shaheed Hospital for
medical tests. He was speaking at the inauguration of Trauma Centre of Abbasi Shaheed Hospital equipped with modern
facilities on Wednesday.
He directed the city government to set up medical satellite units, attached with Abbasi Shaheed Hospital, in all the 18 towns so
that all such patients, who wish to get admission to hospital, are provided better medical facilities. The governor said that in the
past the condition of this hospital had turned miserable and no one would wish to admit there for treatment.
But now, City Nazim Syed Mustafa Kamal and his team have given a state-of-the-art shape to this hospital where previously
neither medicines nor doctors used to be available, he observed. From management point of view, Ebad pointed out, the
hospital had been in a state of total disarray and would give more a scene of jail than a hospital. He said the provision of most
modern facilities at Abbasi Shaheed Hospital today is a grand example of public-private partnership.
Today, the hospital is providing best possible medical service to people with up gradation of wards achieved through day and
night efforts by doctors and now it will be expanded very soon under an expansion plan to be implemented with the federal and
provincial government’s cooperation.
The governor said that now the hospital has all the capacity to fulfil the requirements of Karachi Medical and Dental College,
which will be upgraded to university level. He recalled that in the past, this hospital used to provide the house job facility, which
was done away with due to non-availability of required facilities.
However, the city’s elected leadership has transformed Abbasi Shaheed an ideal hospital, equipped with medical facilities of
international standard, for house job.
Later, the governor went round various sections and departments and appreciated their up gradation and standard.
The city Nazim briefed the governor about availability of medical facilities and management performance. Mustafa Kamal said
that this is the biggest Trauma Centre of Sindh constructed at a cost of Rs218 million. It has 25 beds, 14 ventilator machines,
and three operation theatres.
(The News-3, 21/09/2006)
City govt told to set up 18 link clinics of ASH: Trauma centre opened
KARACHI, Sept 20: Sindh Governor Ishratul Ibad has underlined the imperative need for making the healthcare facilities more
efficient and easily accessible to public in view of ever increasing population congestion in Karachi.
He stated this while speaking at the inauguration of trauma centre of Abbasi Shaheed Hospital equipped with modern facilities
on Wednesday. The newly established trauma centre at the hospital is the biggest in Sindh. It has been established at a cost of
Rs218 million. The trauma centre has 25 beds, 14 ventilators and three operation theatres.
The governor said that websites would be developed for every town of the metropolis providing details of performance of the
health sector and availability of medical facilities in each town.
He directed the city government to set up medical satellite units attached with Abbasi Shaheed Hospital in all 18 towns so that
all such patients who wished to get admission in the hospital could be provided with timely information and better medical
facilities.
He said that the condition of the hospital turned miserable in the past where neither medicines nor doctors used to be available.
34
He pointed out that the hospital from management point of view had been in a state of disarray.
However, he said, City Nazim Mustafa Kamal and his team gave a state-of-the-art shape to this hospital. He further said that
the provision of most modern facilities at Abbasi Shaheed Hospital at present was a great example of public-private
partnership.
Ishratul Ibad said that the hospital was providing best possible medical service to people with upgraded wards achieved
through day and night efforts by doctors and it would be expanded very soon under a comprehensive plan to be implemented
with the cooperation of federal and provincial governments.
He recalled that the hospital used to provide house-job facility to the students of Karachi Medical and Dental College, which
was done away with due to non-availability of required facilities at the hospital. However, he said that the hospital had been
upgraded with all the capacity to fulfil the requirements of KMDC, which would soon be upgraded to university level.
Later, the governor went round various sections and departments of the hospital and appreciated their standard. City Nazim
Mustafa Kamal conducted the visit of the governor through all departments and briefed him about the availability of medical
facilities and management performance.
The governor was informed that attendance of medical and paramedical staff on paper had been discontinued with the
installation of palm impression machine. The nazim told the governor that now the arrival and departure of all the employees
would be noted through the palm impression machine and their salaries would be paid accordingly.
He was informed that the record of patients had also been computerised. Through MIS technology, complete medical history of
patients along with medical examination and prescription of medicines by doctors was being recorded.
Besides, the governor was informed that with the cooperation of pharmaceutical companies, drugs were supplied to hospital in
specific coloured packing which had helped in checking their leakage and misappropriation, making their sale in market
impossible.
The inaugural ceremony was attended, among others, by Provincial Planning and Development Minister Shoaib Bukhari, Local
Government Adviser Waseem Akhtar, Naib Naim Karachi Nasreen Jalil, MNAs, MPAs, Liaquatabad Town Nazim Osama Qadri,
other nazims, industrialists and businessmen.
The governor congratulated the city nazim and his team for modernizing the Abbasi Shaheed Hospital.
(Dawn-17, 21/09/2006)
Senior citizens
Cultures like ours, unlike those in western countries, are supposed to give considerable respect to elders and senior citizens. It
is said with pride that there are no old people's homes here and families and younger generations are known to maintain close
links with their grandparents. Unfortunately, this culture of respect for the old and aging does not seem to rub off as far as
governments here are concerned. Successive governments have often promised much in terms of concessions and benefits to
senior citizens but the ground realities are quite different. One example that comes to mind immediately is how concessions
given by the state-owned airline, PIA, to senior citizens under a previous government were quietly, without much
announcement, taken back. This background needs to be kept in mind when considering any government announcement on
providing benefits and concessions to senior citizens. On Sept 19, the minister for health told the second international
conference on "productive ageing in Pakistan" that the government wanted to promote "healthy ageing". He also said that
senior citizens would be given free treatment in government hospitals, receive free counselling and nutritional supplements, and
that a primary healthcare system geared towards meeting the needs of senior citizens would be set up.
Now all of this sounds very good and well-intentioned, but shouldn't the ministry of health be more concerned about putting in
place a healthcare system that can provide affordable and reliable healthcare to all Pakistanis, regardless of age? Also, several
recommendations came out of the first conference on 'productive ageing' and none were really implemented, so what's to
prevent a repeat of the same inaction? The country has an estimate eight million people who are over the age of 60 and as time
goes by this number is only going to increase (the proportion of those over 60 should increase as well, as birth rates and fertility
rates decline). Government initiatives to help senior citizens are most welcome and in fact morally necessary because earning
members of society need to give back to those in the generation above them. However, these initiatives need to be realistic or
else they will not be implemented, and that will lower the government's own credibility.
Certain measures that could make life easier for senior citizens are completely practical and involve little or no cost. Foremost
among them is the setting up of separate counters for senior citizens at all government departments which have heavy public
dealing, such as the passport or NADRA identity card office, in the paying of bills or even at airports and train and bus stations.
Also, all savings centres and post offices need to be streamlined to prevent lengthy delays for senior citizens who often visit
them. We tend to criticise those living in the west because they don't value and respect their elders and desert them in old
people's homes. But we forget the fact that countries in the industrialised world have a system which looks after the needs of
the elderly. The aim here should be to have a mechanism of our own which is able to address as much as is possible, given the
country's limited resources, the demands of senior citizens.
(The News-7, 22/09/2006)
Dangers of used syringes
IT IS hardly surprising to know that recycled syringes are a major cause of hepatitis B and C. That only a few hospitals have
incinerators that can safely dispose of hospital waste should serve as a reminder to the government of how much more needs
to be done if it is serious about containing diseases. The hospitals that do have incinerators seem not to have an effective
monitoring system in place to ensure that needles and other equipment are properly destroyed. How else does one explain
scavengers getting their hands on used needles outside hospital premises which they sell to traders? It is a vicious cycle that is
putting peoples’ lives and health in jeopardy. In March it was noted that that the use of recycled syringes was responsible for 90
per cent of hepatitis B and C cases in the country, yet nothing seems to have been done to tackle the problem. The most
immediate step the health authorities can take is to install incinerators in as many public hospitals as possible. They should also
consider installing incinerators that can be shared by several smaller hospitals as this is likely to prevent used syringes falling
into the wrong hands. At the same time, health inspectors must strictly monitor the safe disposal of hospital waste. Those who
do not follow the rules need to be taken to task. Anyone caught stealing or selling used syringes should be proceeded against.
35
The bigger issue is one of raising awareness about diseases like Hepatitis B and C and HIV/Aids whose prevalence is growing.
Educating the people on safe blood transfusions is critical and such awareness campaigns should be carried on throughout the
year, rather than doing so through sporadic ones.
(Dawn-7, 22/09/2006)
Effective control on drug prices demanded: SIUT’s oncology unit opens
KARACHI, Sept 22: The director of Sindh Institute of Urology and Transplantation, Dr Adibul Hasan Rizvi, has stressed the
need to make efforts for bringing down the exorbitant prices of drugs.
He said that the cost of drugs in the country was beyond the reach of common man, which was a major hindrance to proper
management of diseases and as such it was high time to end the human greed that had made the life saving drugs dearer.
The prices of certain drugs available in Pakistan were many times higher than that of the neighboring countries, he pointed out
declaring that the SIUT had planned to launch a movement to bring down the exorbitant prices of drugs.
In this regard, he said, a seminar would be arranged in November.Dr Rizvi was speaking at the inaugural ceremony of Hanifa
Suleman Dawood Urology and Transplant Oncology Centre, which has been raised through the donations by Suleman Dawood
family.
Mrs Hanifa Suleman Dawood along with her family members was also present at the ceremony. The family had also helped in
establishing a dialysis centre at the SIUT in 2000, he said.
Recalling the services of the family and its donations towards fulfillment of two major projects at the SIUT, Dr Rizvi said that the
family had contributed largely to the oncology project both in terms of equipments and endowment.
Without disclosing the amount contributed for the project, Prof Adib said, “We prepared our plan and they financed it and we
never had any problem later”. However, while presenting his vote of thanks at the end of the ceremony, Dr Anwar Naqvi said
that the donation by the Suleman family was the single largest donation by a family towards medical care in Pakistan.
The 150-bed new complex, which has been linked to Deewan Farooq Complex across the street through overhead bridges,
had more than 100,000 square feet covered area. He said that the new centre had all the latest technologies for the treatment
of cancer patients.
Dr Adib Rizvi also mentioned about the support of local government and government agencies in the acquisition of land for the
project and said that the oncology centre was badly needed for treatment of thousands of cancer patients.
He pointed out that the SIUT was working on a plan for the establishment of an institute of transplant sciences for which a 100
acre land was available, while financial supports were needed.
Replying to the questions of newsmen after the ceremony, Dr Adib Rizvi agreed that mere completion of a building was not all,
but there was need to meet out the recurring expenditures of the new oncology centre and that was why he usually urged the
philanthropists and other well-offs individuals and organizations to come up with donations and endowments.
“It is the generosity of the donors that have been supporting the SIUT to keep dreaming and standing by its motto that it will not
let anyone die because he or she cannot afford to live,” he added.
He said that another factor that played the basic role in the survival of patients was drugs, which had been made costlier in the
country without any rationale by the pharmaceutical companies.
“We have now planned to hold a series of seminars and campaign aiming at bringing the end-users, media, industries and
government together to address the crucial issue of survival of the ailing human fellows,” he added.
Earlier, as a mark of respect and appreciation the SIUT faculty members presented bouquets to the donor family members who
were led by Mrs Suleman Dawood. Other family members present at the ceremony were Bashir Dawood, who extended the
financial support, Kulsoom Dawood, Farah Dawood and Razzaq Dawood, who were presented the SIUT mementoes by some
children treated at the SIUT.
Speaking on behalf of the family, Razzaq Dawood said that the oncology centre was a glowing example of public-private
partnership. Expressing trust in the SIUT and its leadership, Mr Dawood said: “Giving is important but it is equally important to
know the quality of recipients”. He said that there was need to give hope of survival to many who were living below the poverty
line.
(By Mukhtar Alam, Dawn-17, 23/09/2006)
SIUT’s six-storeyed oncology unit opens
KARACHI: A fully-equipped six-storey new oncology unit of the Sindh Institute of Urology and Transplant (SIUT), having 150
beds and linear accelerator and equipment for radio and chemotherapies, has started working after its inauguration on Friday.
The Hanifa Suleman Dawood Urology and Transplantation Oncology Centre is a memorial to the late Suleman Dawood’s wife
Mrs. Hanifa Dawood. The attractive building is located just opposite the Dewan Farooq Medical Complex behind the Civil
Hospital. The centre is complete with ideal housing facilities for patients with urological cancer.
The Linear Accelerator is a unique advancement in cancer treatment which is very rare globally. The machine is to arrive at the
centre soon making it the only centre in the region with this facility. Another unique feature is that the building is connected to
Dewan Farooq Medical Complex with two wide bridges. This is the first instance of its kind in the country. These bridges have
been put up to avoid the heavy traffic of the Yaqoob Khan Road which passes in between.
Dr. Adeeb Rizvi of the SIUT expressed gratitude to the benefactors of the centre, the Dawood Family, for their contribution to
the noble cause. He said the facility will be sustained through Zakat and other charity, as is the case with SIUT. He stressed
that “the Dawoods have already put in enough for us to start working”.
Dr Rizvi said: “The management of cancer treatment is not just surgery but includes chemotherapy, radiation and a combination
36
of multiple modalities. The future is very bright with the breakthrough in gene therapy and stem cell research. Advanced
medical management and proper screening facilities will play a vital role in timely diagnosis which is pivotal to complete cure.”
He said that human greed has made the drugs, particularly anti-cancer medicines, very costly and a stark contrast between the
prices in Pakistan and its neighbouring countries could be made out easily. He urged the government to take notice of this
situation immediately.
The centre is likely to bring a breakthrough in the treatment of urological cancers and transplant-related malignancies for the
SIUT. It is currently headed by Dr Altaf Hashim, a surgeon, and Dr Nargis Muzaffar, an oncologist.
Urological malignancies are on the rise not only in Pakistan but across the globe. Early diagnosis, however, leads to complete
cure. Kidney cancers are also frequently encountered and are treatable through surgery and chemotherapy.
SIUT is a charitable organization and all the units associated with it are also working on the same lines. The new centre is also
open to everyone for treatment as well as medication facilities.
(The News-3, 23/09/2006)
The Good Samaritans nobody knows
KARACHI: Government hospitals have long been criticised for providing inadequate services to the needy. Jinnah PostGraduate Medical Centre (JPMC) is one such institution that is unable to provide quality health service to its patients due to its
meagre resources and the increasing number of patients visiting the hospital every day. To lessen this burden, the Patients Aid
Foundation (PAF), an NGO, has been operating in the hospital.
The PAF has been offering pro bono services for the deserving patients covering their medicinal and surgical costs. Operating
within the premises of the hospital since 1991, the foundation only dispenses medicines if the prescription is stamped by the
relevant ward to ensure that there is no misuse-which is one of the reasons patients are rarely informed about its existence.
In its 15 years of service, the PAF has covered the cost of millions of deserving patients from all over Pakistan by providing
them free medical treatment. Speaking to The News, Shaheen Suleman, Secretary-General PAF, explained that the social
service department was set up to alleviate the burden of patients at the JPMC.
Extending a helping hand in the service are some concerned citizens and doctors. “Initially some medical students were a part
of this non-profit organisation too but they gradually started serving their political interests instead of working for humanity. As
such, fearing politicization, we do not encourage many students,” she disclosed.
Meeting the entire blood requirement at the hospital, the PAF today provides about 120 pints of blood daily for free which is
later screened for HIV, Hepatitis B (HBS) and Hepatitis C (HCV). Their blood camps are frequently set up in the city including
Civil Hospital throughout the year to supplement the stock.
Moreover, they introduced a blood fraction service in 1995 with the help of which blood can be broken down into its
components. “In this way only those components are transfused to the patients that are required,” said Ms. Suleman. Similarly
they have also been offering their services in other departments and have provided the much-needed medical equipment to the
hospital to enhance diagnostic facilities. Artificial limbs and braces are also arranged by the foundation for the disabled patients.
It also funds M.R.I and C.T Scan tests for deserving patients. A free shuttle service also runs in the hospital.
Various other construction projects have also been undertaken by the organisation like the construction of a Surgical Intensive
Care Unit in 1994, upgrading of the Eye Department and the construction of a Diagnostic Outpatient Department in 1996 where
patients undergo a thorough diagnosis in order to determine further course of treatment. The building of a new Tuberculosis
Ward is also one of their recent successful projects.
Shaheen added that the increased premises of the Obstetrics and Gynaecology Ward at JPMC, where approximately 7,000
deliveries take place annually, was also a value addition service offered by PAF. “The department provides service to 24
women at a given time,” she said.
Their upcoming projects include the expansion of the Surgical ICU and the Accident and Emergency Ward to accommodate as
many as 40 patients.
(By Aroosa Masroor Khan, The News-3, 25/09/2006)
Health sector to have website
KARACHI: A presentation was held on Tuesday regarding the introduction of health officials and the projects being undertaken
by them.
Senior Provincial Minister for Health and Coordination, Syed Sardar Ahmed, was briefed by Secretary Health, Dr Naushad
Sheikh through the presentation.
According to the ministry sources, the minister suggested that the health department should have a website where information
and all the necessary details about medical projects, health institutes, medical colleges and basic health units could be found.
He said that the health department claims a high budget every year, but the unavailability of health facility to the common man
is a general complain.
Unhygienic conditions prevail in all pubic hospitals which also add to the miseries of the patients.
The health minister pointed out that due to overcrowding of patients at hospitals, doctors are unable to give them proper
attention, and ultimately the patients have to turn to private hospitals.
These hospitals provide better facilities, but are beyond majority’s fiscal powers.
Sardar added that the department must strive to resolve these complaints through putting in hard work and making stronger
relationships between the different units within the department. He said that rural health units must work effectively so that the
public may feel the change.
(The News-3, 27/09/2006)
37
Steep decline in polio cases but target still elusive
KARACHI: The common perception that the nationwide drive to eradicate the crippling disease of polio has not achieved much
faces a challenge from cold and hard statistics.
In percentage terms, the cases of polio in Pakistan have decreased from nearly 27.7 per cent in 2000 to 1.4 per cent in 2006 to
date. Given this phenomenal fall in the disease incidence, it is contextually incorrect to term the campaign a failure. However,
the desired results are still elusive, and not being met by these efforts mainly because of public insensitivity towards the cause,
according to Dr. M. Azmoudeh, Medical Officer for Polio Eradication Program at the WHO Sindh.
The WHO resolved to launch the eradication program in 1988, when wild polio virus was endemic in 125 countries across the
world. At the outset, the program was billed to end in 2000, but some 22 countries still actively carried the wild polio-virus of
which Pakistan was one. In 2002, they shrunk to 10, and in 2005, they tapered off to four, but Pakistan remained an area of
deep all along as there were still 17 cases showing permanent paralysis.
Dr. Azmoudeh said that the key to eradicating such diseases from their roots is to educate the general public about the
consequences of not following the preventive measures as advised by experts.
Polio is an infectious disease, which mainly spreads due to unhygienic conditions, contaminated drinking water, and improper
disposal of excreta. Even though polio has almost vanished from many countries of the world, it is still endemic in those
housing these problems. The incidence of polio virus in Sindh as against the entire country is relatively low, but the problems
that keep the figures of incidence stable are unmotivated community leaders, unhygienic conditions and inadequate
coordination among the districts during the campaign.
Last year there were only two paralysis cases in the province, one in Sukkur and the other in Karachi.
There are three strategies used in any eradication program: Routine vaccination, surveillance system and campaign strategy.
The first one has absolutely failed in Pakistan. A majority of the population doesn’t bother to have their children vaccinated
against the most basic and deadly diseases, one of which is Poliomyelitis.
“It is a distressing fact that so many children are being affected, even dying of a disease that is preventable through an easy
remedy: routine vaccination on time. But the public is not to be blamed for this because mostly they are not educated about the
early vaccination program, which takes place in the first four months of life. The only way they could learn about the vaccine
being given is through advertisements by the government which also do not carry the vaccination schedule,” said Azmoudeh.
In order to get rid of the virus, what needs to be done is to enforce the routine vaccination culture immediately, which shall
continue as long as it is necessary. Firstly, people do not take the precaution, and secondly, even during the campaign, most of
the people do not let their kids be treated because of the misconception floating in society about the imported vaccine having
traces of family planning drugs.
“We even have a Fatwah from eminent scholars (Ulema) confirming that the vaccine is free of any such contamination,” said
Dr. Azmoudeh, adding that there are people who are the enemies of their children otherwise who would want to see their
children die a miserable death or live an even more miserable life with paralysis. He said that such elements of society must be
reprimanded duly.
The hygienic conditions matter a lot in this regard, as due to sewerage line choking, the refuse is scattered everywhere in the
open, and the disease, when endemic, is transmitted through faeces. Another potent contributor to the disease incidence are
the unclean public toilets.
But still the prevention through vaccination remains effective if they are administered on time, that is, all parents follow the
advised schedule during the first four months of their child’s life and also continue doing so during the campaign every time it is
launched until the child is over five years of age.
“We try our utmost that every child who is under five years of age is given the vaccine, but when our teams reach the houses,
several of them lie about not having children. Some even don’t open their doors. This is all due to the prevalent fallacies about
the campaign,” the doctor said.
He also said that volunteers could play a pivotal role in helping us meet our goals of the campaign. He said that due to security
concerns most of the apartment buildings in Karachi do not allow the polio teams to enter which means a lot of children go
without being administered the polio drops.
He said that if educated ladies in those buildings take up the task of making people aware of the ongoing campaign and
motivate people to take their children outside the building at a nearby spot, a lot of children could be saved from being left out.
“This is where the responsibility of media could be questioned. It is a pity that media never strives to disseminate any
knowledge in this regard.
Advertising requires a lot of money, but if the widely read newspapers start printing the routine vaccination schedule at least
during the campaign days, it will ease our task by heaps!,” he said.
He also said that the missing part of the private sector could make a huge difference as they can fiscally support the
dissemination of education on this cause.
“The government shall not be blamed for everything. Community has an important role to play in such matters. Mosques could
be excellent teaching spots for a start. Nobody cares to do their part here. Individuals who are privileged and better educated
should take the initiative of reaching out to the less privileged classes in society and motivate them towards taking part in the
campaign and making it successful. If nobody stands up to do that, the virus will keep returning despite all this effort,” he said.
He mentioned the example of Bangladesh where the virus has recurred five years after the campaign. Until the virus is existent
anywhere in the world, all the countries are at an equal risk of seeing its return. It is only once it is uprooted that people shall
stop vaccinating against it or stop giving it a thought.
The same thing happened when the 2004 floods struck the interior parts of Sindh. The virus was present in the Badin district
and when the population in that district was displaced due to floods, they transported the virus to different areas and the figures
rose to 52.8 per cent from a small 28.2 per cent the previous year.
There is a strong need to introduce the culture of keeping record cards of vaccination. This way it is easier for the volunteers to
find out if the child has received a part of routine vaccine as well as to keep a record all the same.
“If preventable diseases like poliomyelitis are eradicated from the world, a budget of $ 1 billion will be spared which could be put
to other uses like alleviating poverty or giving education,” Dr.Azmoudeh said.
(By Asra Pasha & Muhammad Zeeshan Azmat, The News-3, 28/09/2006)
38
OCTOBER
Dengue fever is back
DENGUE fever has hit Karachi yet again. Also called breakbone fever for the excruciating skeletal pain associated with the
disease, dengue fever is caused by a virus transmitted by infected Aedes mosquitoes and is fairly common in tropical and
subtropical countries. Classic and mild dengue fever pose only a passing threat. Recovery is complete and symptoms — fever,
joint aches, severe headaches and skin rashes — last no more than a week though weakness and depression can linger on for
much longer. Severe forms of the illness can be fatal, however, as seen recently in Karachi where at least two patients died.
Dengue haemorrhagic fever (DHF) and the associated shock syndrome present additional symptoms such as coughing,
vomiting and severe abdominal pain, and can lead to blood clotting, internal bleeding, skin haemorrhage, bleeding from the
nose or gums, convulsions and organ failure. Classic dengue and DHF cannot be spread from person to person, though
medical and paramedical staff are advised to exercise extreme caution.
Karachi saw a major DHF outbreak in November 2005, followed by more cases this year before and during the monsoon. Over
the last few days, hospitals in the city have reported over a dozen DHF cases, a clear sign that the dengue virus is making a
major comeback. The health authorities must immediately launch a media campaign to raise awareness of the disease among
ordinary citizens as well as doctors so as to enable them to make timely, life-saving diagnoses. The civic authorities need to
ensure that the stagnant water still standing in various parts of the city is first fumigated and then removed as quickly as
possible. Citizens should protect themselves by using mosquito repellents or nets and need to take extra care in the early
morning and late afternoon prior to sunset. Unlike some other mosquitoes, Aedes bites during the day.
(Dawn-7, 01/10/2006)
Anti-smoking law
The Islamabad traffic police’s (ITP) implementation of a widely unnoticed law is a welcome first step in safeguarding the rights
of non-smokers. Upon a complaint from a passenger, the traffic police booked the driver of a public transport vehicle under a
2003 ordinance that prohibits smoking in enclosed places. However, a lot more still needs to be done. The conduct of the
driver, who reportedly refused to put out his cigarette after the passenger complained, is reflective of that of most smokers in
the country, who frankly couldn’t care less about the harm they cause to their own and others’ health. The problem lies in a
general unawareness of such laws – primarily because of the government’s failure to inform the public of the existence of such
laws – and in a lack of political and administrative ill to effectively enforce them. Often it is seen that those reporting the
violation or lodging a complaint are made to feel silly and the official looks at them with a mixture of surprise and amusement.
However, smoking is no laughing matter. The harmful effects of second-hand smoke are medically proven and hence a law that
seeks to restrict smoking in public places, especially in closed areas such as those found inside buildings or moving vehicles,
must be enforced. Let’s hope more offenders will be taken to task under this ordinance.
(The News-7, 02/10/2006)
Dealing with rabies
ONE hopes that the city government will adopt a sensible approach when dealing with an alarming increase in dog bite cases in
Karachi. The National Institute of Child Health said on Thursday that it received as many as 40 dog bite cases a week. If figures
from other hospitals were added to it, it is clear that the numbers would be pretty high. The matter is made worse by the fact
that many hospitals are lacking in anti-rabies vaccines which, if administered in time, can prevent many health complications.
People have been known to die after being bitten by a stray dog because they were unable to get the proper treatment. The
situation is indeed a cause for concern and calls for well thought-out strategies to deal with the problems of rabies without
endangering the lives of dogs.
First and foremost, hospitals should be adequately equipped with anti-rabies vaccines. This is especially true for hospitals in
localities where reports of dog bite cases are high. As for stray dogs themselves, shooting them on sight or poisoning them
have never worked. Earlier this year, the naib nazim suggested exporting stray dogs to Korea, ostensibly for culinary purposes,
but without realising that dog meat is banned in that country. Clearly, the situation calls for a saner approach. Local animal
rights groups have been pleading for employing an animal birth control programme which has been successfully tried in various
countries in dealing with rabies. It is cost-effective and humane. These animal rights groups have held meetings with the city
administration and the time has come for their points of view to be heeded.
(Dawn-7, 03/10/2006)
Haemorrhagic fever claims child’s life
KARACHI: Another case of haemorrhagic fever succumbed to late diagnosis and improper treatment at a major private
hospital.
Birjees Mohammad Idrees, 14, died at the hospital after suffering from fever for four days. According to her family, she had
returned home from school with traces of slight fever on Thursday (Sept 14).
The family doctor recommended regular medication against the fever. However, she continued with her routine task. When her
fever did not give way even after two days the family physician again recommended antibiotic medication. Upon taking these,
she complained of severe burning in her food intake tract. The family doctor called it acidity.
On Monday she began to vomit incessantly even on fluid intake. She was rushed to the hospital, and admitted there with 100
degree fever. She was administered a few drips following which she complained of feeling very hot and consumed a little fluid
but vomited soon after. The site where the drip had been inserted had started to bleed. Until then the doctor at the hospital kept
treating her for trauma, acidity and even for rising blood sugar levels.
“They kept insisting that she must have a history of blood sugar in your family because she is showing very high sugar levels
and that’s why her condition is deteriorating constantly,” said one of her aunts.
39
“But I said that she is a perfectly normal child and is in a hospital for this long since after her birth for the first time. But they
were not convinced,” she added. The child kept bleeding and also developed an itch at the same time so severe that rash
appeared on her skin. “She was also having difficulty in breathing at which the hospital authorities asked our permission to put
her on a ventilator. She breathed her last on the machine in ICU on Thursday (Sept 21),” said her aunt.
She said that until they witnessed severe haemorrhagic condition the doctors could not make out if it was the deadly
haemorrhagic fever. The haemorrhagic fever has claimed more than a dozen lives in recent past. Reports of its incidence had
suddenly re-emerged during the past two weeks but the health department has not taken adequate measures to remedy the
situation.
(By Asra Pasha, The News-3, 03/10/2006)
Man dies of viral fever at JPMC: Fumigation drive urged
KARACHI, Oct 2: One of the six patients of suspected haemorrhagic fever admitted to the Jinnah Postgraduate Medical Centre
died on Monday morning, said sources in the hospital.
It was learnt that a man in his forties suffering from high fever and nose bleeding was brought to the hospital in the early hours
from Akhtar Colony. However within hours after his entry to the hospital, while the doctors were yet diagnosing the disease, the
patient expired, said a source adding that the case may be not different from the haemorrhagic viral fever.
Health experts are of the view that though the situation pertaining to viral fever was not an epidemic one but the number of such
patients brought to the city hospitals had increased and relatively higher than the figure of last year when cases were reported
from the entire city.
They said that the number of suspected viral haemorrhagic fever cases received at two government hospitals and a couple of
private hospitals indicated the prevailing poor hygienic condition of the city, particularly after the monsoon showers.
According to the health experts, dengue fever or other similar problems were results of mosquito-borne infection. The only way
to prevent dengue was to eliminate mosquitoes, they stressed, suggesting that the world health body and the federal health
ministry should also probe into the problem of viral infections, which mostly had hit youngsters belonging to lower income group
of the society.
Talking to Dawn, JPMC Executive Director Prof Mashoor Alam said that during the last 10-15 days about 12 patients were
brought to the hospital with history of high and prolonged fever, bleeding profusely from nose, mouth and gums. Blood samples
of the patients have been sent to the National Institute of Health, Islamabad for tests of dengue fever or Congo, he added,
saying that some of the patients after treatment had also been discharged.
To a question, Prof Alam said that at present five patients were admitted to the isolation ward of the JMPC, including one from
Hyderabad while the remaining from Karachi including one from Chanesar Goth area.
An official from Abbasi Shaheed hospital said that one suspected haemorrhagic fever patient died last week at the hospital.
We have no separate ward for patients suffering from viral infections but keep them in TB isolation ward, which remains
normally under utilised, added the official from the MS office.
The medical superintendent of Civil Hospital Karachi, Dr Kaleem Butt, said that his hospital had admitted about ten patients
suspected of haemorrhagic fever since September 23. The latest one, Farzana, 22, a house wife, was admitted to some other
wards of the hospital some days back, was shifted to the isolation ward of on Monday.
Her blood samples were being sent to the NIH Islamabad. We have already sent samples of other patients to Islamabad from
where a good number of the admitted patients had been found Congo negative, while dengue confirmation or rejection is still
awaited, he informed.
To a question, Dr Butt said that the CHK had established an isolation ward last year to handle separately such high fever
patients last year and all measures were being taken to prevent doctors and paramedics from contracting any infection. We
have got medicines to deal with any emergent or epidemic situation related to viral haemorrhagic fever, he added.
Dr Butt said that an inventory of the patients was being duly sent to the WHO representative in Pakistan, federal health ministry,
provincial health department, executive district officer, Karachi from time to time. During the month of September, the CHK
received as many as 26 cases of suspected haemorrhagic fever, out of which 17 have been found dengue negative, while two
were positive, and discharged after treatment, he informed.
The patients admitted at the CHK are A. Malik, 32, a jewellery worker from Pathan Colony, M. Ibrahim, 18, a labourer from
Liaquatabad, A. Razzaq, 19, a student from New Karachi, Iqbal Ahmed, 31, a salesman from Gulistan-i-Jauher, Reham Begum,
18, a housewife from Landhi, Anwar, 22, from Karachi, M. Ismail, 27, an embroidery worker from Manzoor colony, and D. Iqbal,
20, another embroidery worker from New Karachi.
Such cases are not only restricted to any particular area or segment of the society, it was also learnt that big private hospitals-where normally patients from well-off families were brought for treatment--were housing 30-40 cases with history of high and
prolonged fever and bleeding from nose and skin.
In view of the cases reported from almost all parts of the city, experts feel that the authorities, including the international bodies
should look into the matter seriously and ensure inspection of the residential places and surrounding areas as well to assess
the root cause of the cases.
The locality of the patients and their living and working conditions, income, health facilities available to them and the overall
environment and hygiene conditions around their houses and schools, needed to be known, said a senior doctor.
It was further said that the city government should also rise to the occasion and ensure an extensive cleanliness campaign with
effective aerial and ground spray to eliminate mosquitoes so as to avoid any epidemic.
(By Mukhtar Alam, Dawn-17, 03/10/2006)
40
Our profit-driven drug industry
By Zubeida Mustafa
AT the inauguration of the Hanifa Suleman Dawood Centre of Oncology, the director of SIUT, Dr Adib Rizvi, promised to launch
a movement against the spiralling prices of drugs. His concern at what can be described as the anti-social strategies of
pharmaceutical manufacturers is quite valid.
The Sindh Institute of Urology and Transplantation in Karachi, prescribing to the maxim ‘health is the birthright of every man’,
provides free medical treatment to every patient who enters its portal.
Since the bulk of SIUT’s budget comes from public donations and it is always looking around for funds, it has to be extra
mindful of its spending. It is, therefore, worrying for it that 38 per cent of its budget goes towards financing the cost of medicines
alone. This trend is nothing unusual. The Pakistan Association of Mental Health, which runs a free clinic for indigent patients
and provides drugs free of charge to quite a substantial number of patients, spends 25 per cent of its budget on medicines. It
may be noted that PAMH’s formulary includes only the lower-priced items.
This phenomenon of high drug prices, which amounts to the pharmaceutical industry capitalising on the distress of an ill person
in desperate need of medicines, is nothing new for Pakistan. The country never went in for the manufacture of basic drugs and
has always depended on the pharmaceutical multinationals importing their products at transfer prices. When combined with the
corruption in the health sector, especially in the regulatory bodies that fix prices, give licences and inspect the quality of the
drugs produced and marketed, the fortunes of the manufacturers have never flourished as much as they have today in
Pakistan.
The Drug Regulatory Authority that has been on the cards for over two years has yet to see the light of day. The process might
be expedited somewhat now that the prime minister has given his approval for the DRA Act which will be introduced in the
National Assembly. But how the DRA will perform will be known only after it starts functioning.
Seen against the backdrop of the world pharmaceutical industry that had a hefty turnover of $550 billion in 2004 and has been
growing at the rate of seven per cent per annum, the drug manufacturers — both indigenous and multinational — have fared
well. Considering that this is a third world country with nearly a third of the population living below the poverty level and the
public sector gradually disengaging from the health delivery system, can Pakistan afford to turn a blind eye to the waywardness
of the drug manufacturers?
The pharmaceutical industry differs from other manufacturers in a basic way. The decision to use any of its products is not
made primarily by the user. It is basically the health practitioner who makes the choice. That would explain why manufacturers
cannot advertise their products in the media. Their advertising is directed only at the health professionals. In a way it has made
the manufacturers’ job a tougher one. They have to employ an army of medical representatives to carry their samples to the
physicians and persuade them to give their drugs a try. They cannot take the easier way out and place an advertisement in the
newspaper or on television. The Drug Act 1976 does not allow it for sound reasons. How can a patient who is a layperson
decide which medicine is best to treat his condition?
Hence the drugs manufacturers can only advertise in medical journals/papers that are read by doctors and surgeons. They
have now found the easy way out. They try to buy over the health professionals in a bid to influence them into prescribing their
brands of medicines to create a seller’s market for the pharmaceutical company. Many of the marketing tactics the
manufacturers have employed have been unethical and unscrupulous.
A leading Pakistani psychiatrist, Dr Murad Moosa Khan, writes about a multinational pharmaceutical company that launched a
drug for dementia in Pakistan and flew 70 Pakistani doctors to Bangkok for a three-night all-expenses-paid trip estimating to
have cost the sponsor seven million rupees. Other promotional practices include sponsoring attendance at conferences,
underwriting symposia, free drug samples and expensive gifts such as cars, air conditioners, laptops, etc. for writing 200
prescriptions for a medicine.
The manufacturers easily recover the cost of their marketing strategy by jacking up the price of their drugs. In Pakistan, since
minimal basic manufacturing is done, multinationals import their own products and by employing the technique of transfer
pricing keep the prices pitched high.
Another grave problem the country faces — and that too is linked to the price issue — is in respect of the quality of drugs. It is
estimated that 50 to 70 per cent of the medicines in the market are spurious or fake. They are referred to as “dou number” (#2)
and cost less. They do not cure a patient as effectively as the genuine ones are supposed to.
Given all these malpractices in which a number of physicians and manufacturers are involved, and the wrong policies adopted
in the drug sector, it is not surprising that medicines are so expensive in this country. In neighbouring India the same drugs are
much cheaper than what they are here. The following prices are eye-opening.
Ranitadine for acidity costs Rs2 per tablet in India as compared to Rs10 in Pakistan. Ciprofloxacin for pneumonia is Rs1.5 per
tablet in India and is Rs20 in Pakistan. Alfazosin for hypertension is Rs10 per tablet in India and is Rs100 in Pakistan. Injection
Amphotericin B, an antibiotic, costs Rs150 in India and is Rs300 in Pakistan. Bicalutamide, used for treating prostate cancer, is
Rs35 per tablet in India compared to Rs450 per tablet in Pakistan. Lipitor, for lowering cholesterol, costs Rs8 in India and Rs60
in Pakistan.
In the absence of basic manufacturing, Pakistan is at the mercy of the drug multinationals. As a result, even after the patent of
a drug has expired, not many companies other than the original manufacturers feasibly manufacture generic drugs at a lower
price. India has done this successfully and thus brought down its drug prices. If the SIUT’s campaign is to succeed, Pakistan
will have to promote the manufacture of generic drugs and at the same time defeat the ulterior motives of the multinationals
who would not want the generic drugs to sell. It is here that the medical profession should refuse to be bought over by the drug
manufacturers. Can one be hopeful? After all Z.A. Bhutto’s health policy that introduced the generic scheme failed to popularise
it.
Under Trips (Agreement on Trade-Related Aspects of Intellectual Property Rights) of the WTO, a patented medicine cannot be
manufactured by another company until the patent expires. But Trips contains a clause which allows their generic manufacture
in case of an emergency. That is how South African manufacturers could get away without being penalised for making antiretrovirals, used in the treatment of Aids. Why are Pakistani drug manufacturers not more inclined towards social justice? Why
are profit motives allowed to determine their policies?
(By Zubeida Mustafa, Dawn-7, 04/10/2006)
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52 cases of dog-bite reported at hospitals
KARACHI, Oct 3: Four government hospitals in the city on Tuesday received as many as 52 patients bitten by stray dogs in
different localities of the city. The victims belonged to all age groups.
Senior doctors at the hospitals said that on average they were seeing 10-12 dog-bite victims a day. The menace should be
checked at the earliest, and local governments should also launch a public awareness campaign on the issue.
Dr Seemin Jamali, in-charge of Accidents and Emergency Department, Jinnah Postgraduate Medical Centre, said that as many
as 20 new cases of dog-bite patients were brought to hospitals from different towns on Tuesday.
We have been receiving 20-25 cases of dog-bite per day for the last couple of weeks, she added, saying that the JPMC has got
a rabies control centre where patients are provided free of cost treatment, which included immunoglobulin, an injectable soluble
meant for category 2 and 3 bite patients.
She was of the view that people should give importance to the dog bite cases, while doctors in different localities should also
refer the cases promptly to the JPMC for proper treatment in order to avoid complexities. Patients in question received at the
JPMC on Tuesday belonged to all age groups from toddlers to aged people living in Korangi, Landhi, Shah Faisal, Malir and
Mehmoodabad areas, she informed.
Dr Sheikh Zahiruddin, assistant medical superintendent at the Lyari General Hospital said that nine dog-bite cases were
brought to the hospital till 1pm on Tuesday. On Monday, in all eleven new cases of dog-bite were brought from different areas
of Lyari and peripheral localities.
The cases reported to the LGH on Tuesday were: Halim Mohammad Dur (16 years), Ghulam Mohammad (30), Ramesh (35),
Zakir (4), Naim (5), M. Iqbal (35), Mohammad Ali (30), Imran (10) and Riaz (13). Excluding some severe cases, patients are
normally sent back after dressing and medications.
Dr Zaheer said that the flow of dog-bite cases in the hospital had been a source of concern and that was why the medical
superintendent was already in correspondence with the provincial health department and executive district officer health of the
city government. We have recently sent a letter to EDO health, requesting him to take measures for elimination of dogs, he
added.
Dr Khalid Ibrahim, in-charge of Rabies Control Cell of Civil Hospital Karachi said that his hospital was receiving on average 1012 new cases per day. An official from Abbasi Shaheed Hospital said that the hospital had been receiving 8-10 dog patients
every day.
Doctors said that a dog-bite victim should immediately refer a doctor. The patients should report to rabies immunization units,
which met WHO criteria for the administration of anti-rabies vaccines, at the earliest, irrespective of the depth of the wounds,
they further said.
Experts say that 95 per cent of animal-bites cases involve stray dogs; therefore, it is imperative that a campaign is launched to
control the growing population of street dogs. As precaution, children should not be left alone with a cat or dog and people
should avoid making any attempt to intervene in a fight between animals or come close to sick animals, the doctors
suggest.Senior citizens blamed that dog-bite cases had assumed an alarming proportion due to the failure of town
administrations in carrying out sustained campaign against stray dogs. We hesitate to send our wards to nearby parks and
playgrounds as dogs roamed there even during the day time, said a parent in Federal B area.
The executive district officer (health), Dr A. D. Sajnani, while acknowledging the increase in dog-bite cases, said that the towns
should undertake campaigns against stray dogs in their respective jurisdictions.
We do extend support from district by providing them Strychnine HCL in the shape of capsules for use in eatables for dogs
leading to their deaths. The towns are once again being asked for elimination of dogs, he remarked.
(By Mukhtar Alam, Dawn-17, 04/10/2006)
Cabinet bans sale, production of gutka
KARACHI, Oct 3: The Sindh Cabinet on Tuesday decided to ban sale and manufacture of gutka throughout the province.
A meeting of the Sindh cabinet, held here with Sindh chief minister Dr Arbab Ghulam Rahim in the chair, was informed that
these hazardous things were spreading diseases.
Giving a briefing after the meeting, Dr Arbab said the Sindh government in public interest had decided to ban manufacture and
sale of gutka and mainpuri throughout the province.
He said the meeting was told that prices of daily-use items have not only been controlled, but slashed by 10 per cent.
He said that substandard goods were being sold in the market and consumers were not satisfied. He said quality goods should
be sold to the people.
He said that the Sindh government would purchase fire-fighting equipment and provide them to all major towns.
He said that the Sindh government would pay a compensation of Rs 0.3 million to the heirs of those firemen of the province
who were martyred in earthquake in Islamabad and northern areas.
He said their heirs would be given jobs on 'martyred quota'.
He said that the cabinet had decided to post 700 doctors in various hospitals of the province, besides recruiting 1200 more
doctors in hospitals of their areas.
To a question regarding stagnant rainwater in Hyderabad and Latifabad, he said he had directed the Hyderabad district nazim
to improve drainage system on a priority basis.
Regarding purchase price of sugarcane, he said the purchase price of Rs67 per 40 kg was final and it would not changed.
He said he would not talk to the mills. He said now sugar mills would have to talk to the administration.
He said that the sugar mills would have to run their mills at the earliest.
Regarding new highway from Karachi, he said the road would begin from Malir and people of Thatta, Tando Mohammad Khan,
Badin and Mirpurkhas would be benefited from it.
He said this road would develop a vast area which was presently barren.
(Dawn-17, 04/10/2006)
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Enforcing ban on ‘gutka’
WEDNESDAY’S decision by the Sindh government to ban the production and sale of ‘gutka’ is likely to be met with scepticism.
It is not the first time that a decision meant for the benefit of people’s health has been taken but none of the earlier ones have
been enforced in the right spirit, including previous attempts at banning gutka. After all, the ban on smoking in public places, to
cite just one example, was prescribed for the reason that smoking is injurious to health, yet it is widely flouted. The same is true
of the motorcycle helmet law, which was strictly enforced for the first few weeks before the police lost interest. Those involved
in the production and sale of gutka too are likely to remain unaffected by the ban for they will find ingenious ways to sidestep
the prohibition. This must not be allowed to happen. And for that, the government will have to remain alert and watchful and
ensure that its prohibition is strictly followed and enforced. Those found violating the ban — or abetting the violators — should
be strictly dealt with. Unless this is done, no one will take the ban seriously.
The point is that the prohibition will prove ineffective if it is not supported by wide public awareness campaigns on the hazards
of consuming gutka. People must be made aware of how gutka can cause serious illnesses, including oral cancers. These
campaigns must be aggressively pursued at schools, which is where many youngsters first start indulging in bad habits like
smoking. Parents too need to play a responsible role in ensuring that their children are not buying gutka and chhaliyan. TV
campaigns must be a round-the-year process to ensure that the message is effectively heard.
(Dawn-7, 05/10/2006)
Mega-unit platelet for VHF patients urged
KARACHI, Oct 4: Blood banks in Karachi urgently need to ensure easy availability of “mega-unit platelet” which is needed to be
transfused to the increasing number of patients reaching local hospitals with suspected haemorrhage fever - low blood count
and profuse bleeding being its major manifestations.
Dr Kaleem Butt, Medical Superintendent, Civil Hospital - Karachi said here on Tuesday that only one blood bank in Karachi
“Hussaini Blood Bank” was found to have the required facilities to arrange for mega-unit platelet for 28 patients brought to his
institution as suspected cases of viral haemorrhagic fever (VHF) since September.
“However, at times when we had at one single point of time, eight to ten patients with the condition they too were found to be
experiencing shortage of kits to provide for the extremely essential support needed to be provided immediately to the patients
concerned,” he said mentioning that all suspected cases have to be put on asymptomatic treatment.
Elaborating significance of mega-unit platelet, the senior medical professional mentioned that nine packets of small units of
blood platelet was equivalent to one mega unit.
Dr Butt said that along with extremely essential platelet transfusion all suspected patients reported with extensive bleeding from
oral cavities - nasal bleeding , bleeding from respiratory tract or gastro intestinal tract respectively coupled with constant high
fever and rashes on body were also put on latest and strong antibiotics as well as on an anti-viral drug.
The medical superintendent said there was no shortage of drugs and apart from patients all health care professionals attending
them were also administered required anti viral drug.
To a question, he said fumigation and spray of all wards, departments and premises of the CHK had been made a weekly affair
with due provision for proper cleanliness.
(Dawn-18, 05/10/2006)
Patient at JPMC attacked by his visitors
KARACHI, Oct 5: A patient who was admitted to the Jinnah Hospital for the treatment of his bullet injuries was shot by unknown
persons who had come to visit him on Thursday.
Police said Imdad Lakho was brought from Gothki about two weeks back with bullet injuries.
DSP Saddar Salman told Dawn that Imdad Lakho was wounded in a dispute with some persons in his village, Haji Lakho.
He had suffered a bullet wound in his back, two days before Ramazan. He was admitted to Surgical Ward 17 where he had
been under treatment since.
However, on Thursday evening two persons came to visit him. They talked with him before fleeing after shooting him, police
said. The victim suffered two bullet wounds in the abdomen. He was shifted to the emergency operation theatre.
Quoting hospital sources, DSP Saddar said the victim had been operated upon and was stated to be in a stable condition.
“Lakho has identified the suspects who shot him in the hospital, saying that they are the same persons who had shot him back
in Gotkhi.”
(Dawn-17, 06/10/2006)
Family goes from two to seven overnight
KARACHI: Imagine the surprise of 28-year-old Parveen Abbas, a resident of a lower income locality in Gulshan-e-Iqbal when
she was told that she had given birth to quintuplets on Wednesday. Medical reports had revealed only three.
The babies were through caesarian procedure at the Kharadar General Hospital and Parveen says that she was not aware
about her five fetuses “until they were born.” Talking to The News the day after, she said that while celebrating the joy of two
girls and three boys, “I knew I was carrying more than two babies but didn’t know they were five in number because
sonographic reports of different hospitals revealed a different number.”
Parveen had found out about her multiple fetuses when she was four months pregnant but except for one hospital’s ultrasound
report, the others revealed that she was pregnant with three babies.
Ghulam Abbas, the proud father now has another challenge on his hands. Working as a clerk on a salary of Rs2,200 per month
—which is below the minimum pay, he now has to support a family of seven from a family of two earlier.
43
The babies, who were born prematurely, are being kept under strict medical observation. “Instead of 36 weeks, the babies were
born in 30 weeks after Parveen underwent normal labour pains. Their condition is critical because they were born prematurely
and have to be kept in an incubator,” disclosed Dr. Atia-ur-Rehman a postgraduate student at the hospital who is assisting
Parveen’s case.
She said that the babies weigh between 1.2 to 1.5 kilograms. “They are all are quite underweight which eventually decreases
the chances of their survival.” One of the girl child is known to be very critical.
Although denied by Parveen, it was learnt that she is suffering from Hepatitis-C. The doctors at the hospital said that chances of
the disease being transmitted to the babies are only five per cent and that too only through breast-feeding.
Unable to afford the expenses, Parveen and her husband contacted an NGO Ansar Burney Trust who bore the entire expenses
of her operation.
A representative of the NGO, Mehnaz, told The News that the couple had contacted them two months back. “We are thankful to
the trust for making specific arrangements at the hospital, sponsoring the operation and looking after my daughter who had little
hope of a safe delivery due to her meager resources,” said Parveen’s mother.
The father whose happiness knows no bounds says “I’m rejoicing the fatherhood of five babies at the moment and before
anything else, I have to think of naming them.”
(By Aroosa Masroor Khan, The News-2, 06/10/2006)
UK to give £90m for women, child health
ISLAMABAD, Oct 5: The United Kingdom on Wednesday announced £90 million (Rs10 billion approximately) to help address
pregnancy related complications in Pakistan.
According to an estimate, 25,000 to 30,000 women lose their life during pregnancy and 160,000 babies die in their first month
of life every year.
“Today is an extremely important and exciting day for Pakistan because this contribution will have tremendous effect on
government’s maternal and child health policy,” Health Minister Mohammad Nasir Khan told reporters at the ministry.
Gareth Thomas, UK Minister for International Development, who is visiting Pakistan ahead of the first anniversary of the
October 8 earthquake, said the British people were great friends of Pakistan and this contribution would make them proud.
Thomas said the contribution would mainly be spent in the DFID (department for international development) focal provinces of
the Punjab and NWFP.
Women of reproductive age and their children, especially the poor, will benefit most from the programme, he said, adding: “A
woman in Pakistan is 120 times more likely to die a maternal death than a woman in the UK.”
The total size of the project is Rs26.869 billion, of which Rs19.2 billion (71 per cent) will be shared by the government of
Pakistan.
It is estimated that between 2006 and 2011, this national programme will save the lives of at least 30,000 women and 100,000
babies besides preventing serious ill health and disability of 3.5 million women. These improvements to the health system will
transform the health and quality of life of 10 million families and will also avert deaths and ill health well beyond 2011.
The health minister said the project would be placed in the next CDWP (Central Development Working Party) meeting on
October 21 and is likely to commence from November.
The programme will help Pakistan address the huge burden of preventable deaths and morbidity among women and children
and make progress towards the Millennium Development Goals (MDGs) that require reducing mother and child mortality by
three quarters between 1990 and 2015.
Under the programme, community-based midwives will be trained and all the district headquarters hospitals will be equipped
with better family planning services and skilled staff to safely deliver babies in emergency. The programme will also help
women and their families improve their knowledge and take healthy action for a safe pregnancy.
It is expected that the project will help train 10,000 community skilled birth attendants and provide a comprehensive emergency
obstetric, neonatal care services in 275 hospitals and 550 health facilities. It also has provisions of referral services in all the
tehsil headquarters hospitals and district headquarter hospitals. The project also include evidence-based programme
management and capacity building, improved access to high quality MCH and family planning services in all health outlets.
(Dawn-2, 06/10/2006)
Unhealthy medical practices
THE report that hospitals in the NWFP have been using un-sterilised equipment when treating patients is hardly surprising
given the fact that many medical centres in the country do not observe even the basic rules of hygiene. This can be attributed
not only to the absence of proper sterilisation facilities and equipment coupled with poor knowledge of hospital waste disposal,
but also to sheer neglect on the part of doctors and other members of the medical staff. Single-use items such as syringes,
transfusion bags and catheters are routinely reused — sometimes even sold to the recycling industry — while other medical
devices such as surgical items are not cleaned or disinfected in the proper manner. This mans that those undergoing treatment
are constantly exposed to serious illnesses such as Hepatitis B and C as there is no guarantee that the medical instruments
they come into contact with have been thoroughly cleaned and sterilised. No wonder, studies carried out in two districts of the
NWFP — where many in the remote areas resort to the services of quacks — show that a third of all hepatitis cases are
attributable to the use of contaminated syringes and other equipment.
It is a pity that there is no effective monitoring system that can ensure that hospitals and clinics would maintain satisfactory
standards of hygiene to lessen the risk of patients contracting serious diseases. With no plans to revamp the health sector or to
hold health units accountable for negligence, it is only an enlightened and vocal public that can make doctors and hospitals see
the error of their ways.
(Dawn-7, 06/10/2006)
44
Number of suspected Dengue cases rising: 12 admitted to JPMC
KARACHI, Oct 5: While four of the in-house patients at a government hospital were confirmed to have been suffering from
Dengue fever, a private hospital admitted another 12 patients with high grade fever, a dengue symptom, on Thursday.
Executive Director of JPMC Prof Mashoor Alam told Dawn on Thursday that four of the eight patients admitted to the hospital
last week were tested for mosquito-borne viral illness and the clinical findings showed them Dengue positive.
Blood samples of two of the four were sent to the National Institute of Health Sciences, Islamabad, while samples of two other
patients were sent to the Aga Khan University Hospital.
No such patient was admitted to the JPMC on Thursday while blood test reports of the remaining four patients of viral
haemorrhagic fever are awaited. Prof Alam said that all the eight patients were showing signs of improvement.
In reply to a question, he said that keeping in view the residential locations of about 19 patients brought to the JMPC over the
past 15-20 days, it could be said that they did not belong to any posh area. What we need to carry out is fogging of drugs to kill
the mosquitoes in residential areas on a priority basis, the JPMC chief stressed.
Assistant medical officer of the Liaquat National Hospital Dr Shaukat Ali Rajput said that as many as 12 new patients suspected
of VHF were admitted to the hospital on Thursday. The number of in-house patients suspected of Dengue fever has now
reached 16, whose blood tests are being conducted at a private hospital, which has the only pathological lab for the purpose
and takes at least four days to give the reports.
The patients, both male and female of all age group, were brought with the history of high grade fever and bleeding from gums
and nose and came from different areas, including PIB Colony, North Nazimabad, Orangi Town, Gulistan-i-Jauhar, Malir, Latif
Town, Cattle Colony, Shah Faisal Colony, Federal B Area, Sakhi Hasan, Liaquatabad, Model Colony and Jehangir Road.
Dr Rajput said that about 200 such cases had been brought at the LNH since April last and four of them had expired. The latest
death was of a male which took place last month.The in-charge of the Isolation Ward of the Civil Hospital said that no new case
of the suspected VHF was brought on Thursday. AT present, there are six patients at the hospital whose blood samples have
been sent to the NIH Islamabad. They are getting treatment and showing improvement, he added.
A senior media relation executive of AKUH stated that since June 14, 2006, the hospital admitted 59 patients suspected of
having viral hemorrhagic fever. Of them, 26 were found Dengue positive while three were Congo positive. In all, six patients
died and 53 were discharged.
Referring to the figure pertaining to patients, independent quarters observed that details were not being notified by hospitals
and health authorities in an organised manner despite the fact that both the government and health practitioners were under
obligation to notify the communicable disease without any delay with all clarity.
Reports suggest that Dengue prevalence issue holds gravity but the health officials both at government and district level are
failing to address it properly. They should move fast and realise now that VHF and Dengue are spreading across the city.
Underplaying the gravity of the situation may lead to an outbreak of mosquito-borne diseases, said a senior citizen, recalling
that an outbreak of Dengue fever was reported in November last as well.
It was further pointed out that cattle pans and stables existed on some amenity plots and the lands along nullahs in many parts
of the city. This appeared to be a potential threat to public health because of their being breeding grounds for mosquitoes, said
Mr Akhtar, a resident of Federal B Area.
While emphasising on creating public awareness of Dengue fever, Prof Saleem Kharal of JPMC said that every day, new cases
were being reported to various hospitals hinting that the infection did exist in all parts of the city.
He stressed the need for immediately controlling the infection before it was too late. This, he said, was possible only through a
major campaign aimed at removal of heaps of garbage and clearing of pools of sewage.
He said that mosquitoes were considered the major cause of Dengue fever and various areas of the city were identified as the
major source of mosquitoes breeding. The best way to prevent Dengue fever from spreading further was to take special
measures to eliminate mosquitoes, he added, and emphasised the need for capacity building of hospitals and other related
bodies with regard to timely management of cases and bring down morbidity and mortality rate.
Dr Kharal said that the classical Dengue fever lasted six to seven days with a smaller peak of fever at the trailing end of the
fever.
About treatment, he said that the infection was usually self-limited illness for which only supportive care was required.
Paracetamol may be used to treat patients with symptomatic fever, while oral intake, especially of fluid, in care of shock
supplementation with intravenous fluids, may be necessary to prevent dehydration and significant haemo-concentration. He
said that a platelet transfusion was indicated if the platelet level dropped significantly.
(By Mukhtar Alam, Dawn-17, 06/10/2006)
Dengue fever claims 14 lives in four months:
Effective fumigation stressed
KARACHI, Oct 6: The dengue fever has so far claimed 13 lives in Karachi during the last four months, and according to
statistics, out of 315 VHF suspected patients, 13 died during the last four months.
This was stated at a meeting on dengue fever, attended by the health experts, at the Sindh Secretariat building.
As the meeting reviewed situation relating to Degue fever cases, a 33-years-old woman died of suspected viral haemorrhagic
viral fever on Friday at a private hospital, raising the number of deaths to 14.
According to sources at the Civil Hospital, Karachi, four patients of suspected VHF were admitted to the hospital on Friday.
The meeting noted with concern the increasing number of cases and suggested measures to overcome the menace of
mosquitoes. Moreover, during tests, 115 patients were found dengue positive.
The meeting, convened by the Sindh health department and attended by health officials from Islamabad, provincial health
department, WHO, and representative officials of private hospitals, was chaired by Sindh health minister Syed Sardar Ahmed at
the Sindh Secretariat building.
45
The experts were of the view that the data and information about viral haemorrhagic fever and dengue fever, whatsoever was
available with them, gave to understand that the dengue infection was here to stay in the city and as such there was a need to
take effective measures to eliminate the mosquitoes’ breeding places on priority basis. About the ongoing fumigation campaign
in various towns of the city, it was stated that would not help eliminate mosquitoes which transmitted the dengue virus.
After hearing the point of view from the participants, the Sindh health minister said over and above it could be said that the
situation pertaining to dengue was all not alarming, but there was a need to get rid of the menace at the earliest as it disturbed
very much the families affected by the viral diseases.
He said doctors and health workers should ensure that the patients suspected of viral haemorrhagic fever should be brought to
the medical care centres and hospitals before it was a lost case.
“I have been briefed that of the 315 VHF suspected patients, 13 died during the last four months, which is serious and needs
attention of all the stakeholders.
“We should work for the elimination of mosquitoes in our neighbourhoods, otherwise things could get worse”, Syed Sardar
Ahmad, who is also senior minister in the Sindh cabinet, said adding he would write to the city nazim on the issue of flaws in the
ongoing fumigation or fogging exercise to avoid the menace and threat of mosquito-borne diseases in the city.
The health minister issued directives for setting up a dengue fever cell at the health department, which should remain in touch
with all tertiary care hospitals and others concerned and come up with strategies to overcome the fever problem.
He also stressed on sharing of information between organisations and updating of data for a better mechanism.
The minister said as part of the health education programme, the provincial health department would also start publication of
advertisements in national dailies soon.
“We should explain dengue and other communicable diseases and preventive measures, through clear and precise messages
and advertisements from time to time for the awareness and education of public.”
Dr Qutubuddin Kakar of WHO Islamabad said following an outbreak of dengue in Karachi last year, a team from Islamabad had
conducted a detailed survey of hospitals and residences and residential areas of patients and in its reports had predicted that
another worse outbreak could reoccur in April, 2006 and later, if proper steps were not taken by the provincial and district
governments.
He said there was a need for strengthening surveillance activities, development of epidemic contingency plans, community
oriented awareness raising programme and vector controlling.
Dr Kakar said irregular supply of water to residence or water crisis like situation some times compels citizens to store drinking
water for long in drums and home utensils not fully protected, which was a reason behind the breeding of vector within the
houses.
He further said since Karachi was a large and expanding city, people here had to go for jobs and business to distant places
every day, which might be a probable reason behind the transmission of vector from one area to the other.
The secretary of the health department, Prof Noshad A. Shaikh, informed the audience about different steps his department
had taken or intended to take in future at provincial and district government levels for better management of VHF and dengue.
He said the department had collected data from five hospitals -- the Aga Khan University, Liaquat National Hospital, Ziauddin
Hospital, Jinnah Postgraduate Medical Centre and Civil Hospital Karachi -- recently, according to which as many as 315
patients suspected of VHF were brought to them, out of which 115 were found dengue positive, while another four were
Crimean Congo Haemorrhagic fever positive.
Dr Mohammad Mukhtar, Deputy Director, Malaria Control Programme, Ministry of Health Islamabad, said relapse of the dengue
fever in Karachi was a serious matter and all the stakeholders, including the federal government should try to find out the
reasons behind the disease.
Like some other speakers, he too criticised the system of fumigation in Karachi and observed that the broad day fogging of
drugs or fumigation was incorrect and was tantamount to waste of the resources.
“We need to destroy the breeding of the mosquitoes causing dengue or other viral fever in the city by carrying out fumigation
one hour before sunrise or sunset, when the mosquitoes get active and bite human beings,” he added.
Others who also spoke at the meeting were Capt (retd) Abdul Majid, additional secretary of Sindh Health department, Dr
Seemin Jamali of the JPMC, Dr Nasim Salahuddin, Dr Afiya Zafar, Dr Fareen Ali, Dr Jamal Nasir, Dr Najib Durrani of the
National Institute of Health Islamabad, Dr Jamal Nasir, Dr Qazi Mujtaba Kamal and Dr Ejaz Vohra.
(By Mukhtar Alam, Dawn-17, 07/10/2006)
Hospital waste
KARACHI, Oct 6: Sindh minister for environment Dr Saghir Ahmed has urged the hospitals and clinics to dispose of their waste
in a proper manner. He took notice that such waste is thrown near apartments, quarters and lanes which cause environmental
pollution as well as various ailments. The minister was talking to representatives of NGOs on Friday.
(Dawn-17, 07/10/2006)
Dawn and dusk biters at large
KARACHI: With over 300 cases of different kinds of viral hemorrhagic fever reported during the past three months, fever has
become a major reason of concern to everyone. However, few know what distinguishes hemorrhagic fever from the usual
malaria, both spread from mosquito bite.
Dr Rafiq Khanani, President of the Infectious Disease Control Society, gave a few guidelines in this regard while talking to The
News. “The basic difference between the agents of transmission is that the malarial mosquito is Anopheles, which breeds in
filthy water only and works at night while the mosquito of the lethal Dengue, Aedes Aegypti, breeds in clean water, and is active
early morning and at dusk, when it is difficult to sense if one has been bitten,” he said.
46
Apart from that, it takes 15 days for an Anopheles to develop malaria in its bite to transmit it again, while Aedes Aegypti can
transmit dengue actively with every single bite.
Its breeding in clean waters makes it all the more difficult to curb its population.
The symptoms of dengue are the same as malaria, that is, fever which may be low grade initially and turn into high grade, with
severe body ache. Associated conditions may also be evident like, nausea, vomiting, etc.
The major problem arises when it comes to diagnosing the infection. Dengue, in most cases, is confused with malaria because
of the similarity of symptoms of both. The anti-malarial medication only helps to worsen the condition of the patient and
decreases the WBC (white blood cell) and platelet count very fast, which helps dengue virus to take its tolls easily.
Hemorrhage is the only condition which sets Dengue apart from malaria. Red eyes, subcutaneous hemorrhage, nasal bleeding,
and bleeding from all orifices, are the common condition once the virus has worked its way. Incubation period is six days
normally, but mostly patients lose consciousness earlier than that.
Dengue comes in three clinical representations: Dengue fever, Dengue hemorrhagic and Dengue shock syndrome or DSS. The
tests for Dengue are available at private labs but they are either too expensive or not properly carried out which is a big barrier
to its timely diagnosis.
“The only remedy for Dengue is to employ every possible step to avoid mosquito population form breeding. The mortality rate is
1-5 per cent. The virus has more or less taken the shape of an epidemic. Serious move form the health ministry and the City
Government is a must in this scenario,” he said.
Dengue fever: situation in Karachi not alarming, says EDO.
Meanwhile, the newspapers are trying to create panic among the citizens over Dengue fever, but there is no alarming situation
as only 13 such cases have so far been confirmed in Karachi.
This was stated by EDO Health City Government Dr A D Sajnani when asked by this scribe as what measures are being taken
to prevent Dengue fever. He said spray was being conducted in each and very town as per daily schedule.
When asked as to whether any death was reported among these 13 cases, he replied in negative, however, he could not tell
what was the ratio of male and female among these 13 confirmed cases.
These cases were reported at Aga Khan Hospital, JPMC and Liaquat National Hospital, he said and added that no such patient
reported at Abbasi Shaheed Hospital.
Dr Sajnani said such cases were often reported after the rainfall and it would not be true to say that this disease was confined
to poor localities, adding that such cases have also been reported from posh localities.
“We are constantly in touch with World Health Organization and as per their advice spray is being conducted in different
localities before and after sunset,” he said and added there was no alarming situation at the moment in Karachi.
The areas were being sprayed with Melathirin and Permithirin and not insecticide, he added.
In this regard EDO Health sought the cooperation of the media so that undue panic and scare was not created among the
citizens. He advised the people living in the areas having acute water shortage to store water in covered pots.
Replying to a question Dr Sajnani said that the virus was detected from a plant pot in Defence, adding, “it can be at any place
any where now”. “We are providing a complete guideline to the citizens through newspapers with regard to prevention from
Dengue fever,” he said.
Earlier, speaking at the opening ceremony of a road in North Karachi, City Nazim Syed Mustafa Kamal had said that there was
no alarming situation and the health department was alert in this regard.
However, there exists great scare among the citizens and they have been asking the city government to take preventive
measures before it goes out of hand.
Meanwhile, Secretary General of Pakistan Medical Association, Karachi, Dr Qaiser Sajjad said that the PMA was closely
monitoring the situation and would also educate the citizens in this regard.
He told The News that in Karachi there was no facility to detect this virus except Aga Khan Hospital, whereas there was only
one such institute in Islamabad i.e. National Institute of Health and Sciences. He said such cases from Karachi were sent to
Islamabad following which specific treatment was provided to the patients. When asked about the symptoms of Dengue fever,
he said one gets a high degree fever and it was due to a peculiar mosquito bite.
“It is a lethal disease wherein the patient suffers aches in the whole body, besides vomiting and nausea,” he said. He claimed
that Dengue fever claimed four lives within a week and that too at reputed hospitals like Aga Khan and Liaquat National.
Dr Qaiser Sajjad said a letter in this regard has also been sent to City Nazim, requesting him to ensure effective spraying in the
metropolis. He said the PMA had earlier raised voice in this regard, adding that the association would now educate the people
against this lethal disease.
(The News-3, 08/10/2006)
Traffic pollution playing havoc with Karachiites’ health
KARACHI: Karachiites are the most unfortunate people in a sense that the moment they step on the road they have to confront
multiple problems like air, noise and dust pollution, traffic mess and shortage of transport, while footpaths have been
encroached upon only to make pedestrians walk on the roads.
City Nazim Syed Mustafa Kamal seems to have turned his back from all these pressing civic matters which bear vital
significance for the citizens, while he remains busy trumpeting his ambitious plans that the citizens would soon see a big
positive change in the metropolitan city.
As Nazim of the city he has never uttered a single word over the pathetic environment condition that was posing severe health
hazards to the citizens.
According to Secretary General PMA (Karachi) and ENT Surgeon Dr Qaiser Sajjad, this environmental condition of the city
daily brings hundreds of people to hospitals with serious ailments like asthma, whopping cough, breath congestion and various
other diseases.
47
The city Nazim never pondered over this serious atmosphere issue, which is making citizens loose temper and indulge in
heated arguments as altercation over petty matters has become a common sight in the city. “You often observe that people
speak loudly and this is because the ear drums of 50 per cent of the people have been badly affected due to noise pollution,” Dr
Qaiser commented.
The innocent citizens have no choice but to bear all these problems daily and cursing the city government or the concerned
authorities. People often see that ministers and VVIPs speedily pass through the main arteries of the city under security cover,
therefore, they never come across the problems confronting a common man.
Since assuming his office 10 months ago, the city Nazim has kept announcing that CNG buses would be imported by this or
that month which never comes, while the citizens daily pass through thick clouds of smoke emitted by the old and obsolete
buses plying on the roads.
Whenever the city Nazim is asked as to when will the auto-rickshaws would be phased out from this city as they are the biggest
source of noise and air pollution, he just comes up with a stereotype reply that plans are under way which would be
implemented at an appropriate time.
Besides, the biggest problem confronting to this city is the occupation of all footpaths by small eateries, shopkeepers and
vendors, while the helpless pedestrians are forced to walk on the roads at the risk of their lives.
For a long time the City Nazim had been claiming that all encroachments would be removed from the footpaths but now it
appears that owing to some explicit reasons he is unable to take practical action in this regard.
(The News-5, 08/10/2006)
SC acts against protesting doctors
ISLAMABAD, Oct 9: The Supreme Court on Monday gave marching orders to the entire team of doctors of the District
Headquarters Hospital of Chakwal for protesting the arrest of a colleague on charges of medical negligence.
Police had arrested Dr Mohammad Amir after the Supreme Court took suo motu notice of reports that three children died
because of the alleged negligence.
“How could government doctors can go on strike,” observed Chief Justice of Pakistan Iftikhar Mohammad Chaudhry
commenting on the three-day strike by the Chakwal doctors which left their patients at the mercy of God and reportedly caused
some deaths. Their three-day strike and protest demonstrations amounted to defying the orders of the apex court, he said.
Justice Chaudhry and Justice Mohammad Nawaz who form the bench hearing the case then ordered the Punjab government to
transfer all the doctors of the District Hospital “and appoint in their place a new staff other than from Chakwal”.
The Supreme Court also annulled the orders of the Chakwal Civil Judge Tahir Khan to constitute a medical board to determine
the allegations of medical negligence.
Dr Tauqir Minhas, Medical Superintendent of the Chakwal District Hospital, was directed by the bench to prepare a list of the
doctors who went on strike.
While adjourning further proceedings in the case to the first week of November, the bench summoned the Punjab health
secretary to appear in person and explain why he failed to check complaints of mismanagement in the hospitals in Chakwal.
It looked strange to the chief justice that the secretary took no action against the doctors who went on strike for three days.
Advocate Babar Awan, appearing as amicus curiae (friends of the court), presented a document to the court to show that the
Punjab Medical and Health Institutions Act 2003 and certain rules framed by the provincial government contradicted each other.
On the one hand the act put a ban on private practice by government doctors since June 2006 but the rules allow them to
inquire from patients whether they wanted treatment on public facility or to see them privately.
Babar Awan said since the government itself did not adhere to the laws it framed, the result was that doctors persuade the
patients coming to government hospitals to visit them in their private clinics instead.
Even diagnostic equipment, like X-Rays etc, were “deliberately rendered non-functional” to force the patients to go to private
laboratories, mostly owned by them.
The same is the position in pathology laboratories, he said adding that one out of every three hospital in Rawalpindi had nonfunctional diagnostic equipment.
Chief Justice Chaudhry deplored the practice, observing that doctors were bound to give proper advice to patients but here they
were misguided for private profit.
During the hearing Dr Shaharyar told the court that he had tendered his resignation after witnessing what he called the
negligent attitude of MS Dr Tauqir Minhas, DMS Dr Sayadat Ali and Dr Mohammad Amir.
Consequently these doctors were also summoned by the court while the secretary health was asked to say whether Dr
Shaharyar’s resignation has been accepted or not.
Meanwhile the district police officer (DPO) informed the court that there was some discrepancy in the first information report
(FIR) against Dr Amir but the same had been rectified and investigations were on.
(By Nasir Iqbal, Dawn-2, 10/10/2006)
Irresistible lure of Gutka
KARACHI: Despite a ban placed on its sale and production by a cabinet meeting chaired by Chief Minister Dr Arbab Ghulam
Rahim last week, gutka continues to circulate unchecked in the market. The announcement of the general order, looking to
protect public health interests, has been largely ignored by both consumers and retailers.
It was reported that a body had been pondering laws on the sale and production of the gutka and manpuri in the province. The
cabinet decision to ban the two items was taken in the best of public interest but the move was still waiting for the best of
outcomes.
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Numerous bans have been enforced on the sale of gutka in the last few years but to no avail, with sales eventually continuing in
various parts of the city due to a lack of monitoring and spot-checks in order to curtail the supply and sale of the banned items.
Gutka is a powered tobacco with intoxicating and strongly addictive ingredients. There are two types of gutkas: Powdered
gutka, available in the form of packets, is mostly dried up with the help of chemicals and catechu is not used in it. In the other
type, catechu is the basic ingredient. The main difference between gutka and manpuri is the use of catechu (Kattha) in gutka.
Manpuri only consists of betel-nuts, lime and tobacco.
Muhammad Saqib, a shop owner, said that the ban has forced people to take up alternative options such as, “GM” and “one 2
one” (powdered gutka). He also said that a negotiation meeting was held on Friday to review the matter. “There is a possibility
that after some days this ban will be lifted without any notice, but even in this case the prices of these gutkas will rise from
Rs2.50 to Rs3.50 or Rs4.00.”
Saqib, who runs his business in Gulistan-e-Jauhar, said that these items were sold at Rs1.50 per pack before the first ever ban
on them, after which prices were always on the rise, especially whenever a prohibition was announced.
According to him, as a result of this latest ban, the supply would be affected and hence prices increased from Rs120 to Rs180
per container-bag. There are usually 80 to 100 gutka packets in each container-bag but of varying quantity. Ajay, a teenage
resident of Bhattaibad, a locality of Gulistan-e-Jauhar, said that though he generally consumes about 7 to 10 gutka packets per
day, the last couple of days have seen him use hardly 2-3 packets owing to the items being out of stock in his area. Also, he
was now using GM as an alternative but was unhappy with it and looked forward to consuming his old brand of gutka.
A junk-dealer, who was not interested in giving his name, said that after using gutka for the last few years he now could not
work efficiently without it and was searching eagerly after Iftar, but without success.
In many areas, paan-shop owners now sell their own brand of gutka, which is usually made at home or, in some cases, at
makeshift workshops.
Gabool, owner of a paan shop located in Gulshan-e-Iqbal, said that he was now selling home-made gutka prepared by his
family members — something that most of his relatives in the business were also doing. Home-made gutkas are also slightly
cheaper in cost and are sold at around Rs2.0 per packet.
Another interesting fact learnt from a market survey is that the consumers of gutka include not only the labour class, but also
young children and females.
Saleem Arif, a coach conductor, says that his job description demands him to attract the public using his voice and believes that
gutka helps him in this regard. It also makes long, hectic routes and traffic jams bearable for him.
A paan shop owner who runs his business in front of DJ College said that the demand for gutka has increased after the ban. He
was now selling his home-made product on a trial basis and upon a positive response he said he would definitely increase
production quantity to sell at his shop.
Abdul Rehman, shop owner at M A Jinnah Road, near Urdu Bazaar, said that the ban should remain enforced and authorities
should impose huge fines on the sale of these items.
He added that the government should also take particularly serious action against dry gutka as it was more dangerous
compared to liquid base gutkas. He also showed The News a new type of imported Niswar, which, according to him, was yet
another dangerous class.
Abdul Rehman further said that dry gutkas, such as City and Panparag, were causing oral and mouth cancer by and large. If a
person was addicted then the size of his mouth became gradually chock and that person would not be able to eat a piece of
slice as the normal people.
He also said that the chemicals used in these dry gutkas were of such erosive nature that if mixed in a glass of water, they
could easily melt an immersed shaving blade.
The reason for using gutka might vary from person to person, but most of the people use it because it is cheaper and longerlasting compared to paan and other tobacco-based items, he told this correspondent.
Another shopkeeper at Burns Road informed The News that the bags of gutka that were previously placed on display at the
front of the shop were now kept away from view, close to their feet on the floor of the cabins. They only supplied gutkas to their
oldest or regular customers. He said that he would simply refuse selling it to a new customer as there was a fear of raids.
Saleem, Golden, Shahi, Azizabadi, City, Diamond, John Jani are some interesting names of liquid gutkas. Ranchore Line,
Liaquatabad, Korangi, Orangi and New Karachi are said to be the biggest manufacturing units of these gutkas.
Nowadays, the constantly growing ranks of those addicted to this drug-like substance, including teenagers. This alarming
situation demands a strict ban which should undoubtedly be severely imposed and enforced in order to stop the flourishing sale
and trade of these hazardous items.
(By Muhammad Zeeshan Azmat, The News-2, 11/10/2006)
Dengue sends 14 more to hospitals: Schoolchildren vulnerable
KARACHI, Oct 12: There has emerged concern among parents of schoolchildren about the poor state of hygiene and
cleanliness at government and private schools in the city, as the number of in-house patients suspected of having viral
hemorrhagic fever in six city hospitals registered a constant rise, touching the mark of 124 on Thursday.
In all, 14 new patients suspected VHF cases were admitted to four government and private hospitals on Thursday, Capt Dr
Abdul Majid, the Additional Secretary Health and focal person for the dengue fever in Sindh, said, adding that the AKU had
resumed providing data to the health department.
The number of in-house patients at different hospitals on Thursday was as follows: The Aga Khan University Hospital = 33,
Liaquat National Hospital = 35, Civil Hospital Karachi = 09, Dr Ziauddin Hospital = 25, Jinnah Postgraduate Medical Centre =
19 and Bismillah Taqi Hospital = 03.
49
Parents are of the view that schools do not bother for any fumigation or fogging of drugs for killing of mosquitoes within their
premises, including classrooms, and this leaves students prone to the threats of such viruses.
Parents of a student of a private school in Federal B Area said that since there was no way to tell if a mosquito was carrying the
dengue virus or not, schools must take appropriate measures to protect its students from mosquitoes. A mother from North
Nazimabad said that her daughter, studying in kindergarten class at a private school, would return home with marks of
mosquito bites more than often these days, particularly on Mondays, when classes resumed after weekend holidays. She said
that school administration should ensure fumigation of spray in classrooms and corridors to eliminate mosquitoes.
Very recent Interviews of government officials and surveys of some schools give to understand that government schools are not
in a position to undertake any fumigation activity on a regular or casual basis whereas in the case of private schools, the
situation was not very much different, with some exceptions.
According to experts in disease, dengue spreads through the bite of an infected Aedes Aegypti mosquito and the first
symptoms of the disease occur about 5-7 days after the bite.
The mosquito rests in closets and other dark places indoors and in cool and shaded sites outdoors. The female mosquito lays
her eggs in water containers, ponds etc in and around homes, schools, hospitals and other areas. The eggs turn mature in 10
days.
Dengue mosquitoes breed in stored and exposed water collection systems. The favourable breeding grounds are barrels,
drums, jars, pots, buckets, flower vases, plant saucers, tanks, discarded bottles and tires, water coolers and a lot more places
where rainwater collects or is stored.
It is learnt that schools in general do not have any perfect system of cleanliness while many of the places favourable for
mosquitoes to breed and rest are overlooked by heads, as well as the administration, of the schools, mainly because it requires
extra funds and efforts.
In a situation where about 30-40 per cent of the posts of sweepers are lying vacant, what one can expect from them about other
aspects of hygiene, environment and viral diseases.
DO of the Secondary and Higher Secondary School Education Fakhar Karim and DDO (Male) Nazimuddin Siddiqui, said that
schools were not provided with any separate fund for fumigation, but they could seek support in this regard from the city
government or town health officers from time to time.
In reply to a question, the officers said that fumigation or spray activities were very rare in the case of government schools,
which could be attributed to school-heads and education supervisors who lacked the initiatives for the purpose.
A town municipal officer confirmed that schools were not included in the ongoing fumigation campaign conducted under the
arrangements of the city government. He said that two or three machines for fumigation are provided to towns after some
intervals under a schedule, which did not help get rid of mosquitoes and flies at all.
He said that sprayer-mounted vehicles could be used only where the vehicle could move easily, like roads, streets, parks,
playgrounds and big hospitals with wide entry/exit points etc while the narrow streets and the buildings with narrow entrance
would left out. As such, any up to the mark success in anti-mosquitoes campaign could not be claimed, he added.
However, a medical practitioner said that students should protect themselves from dengue-virus carrier mosquitoes during
daytime by wearing clothes that covered most parts of the body and by using mosquito repellents.
Dr Nasim Salahuddin of the Liaquat National Hospital said that schools failing to carry out fumigation or fogging could at least
have ensured that the water containers on their premises were kept covered all time, while stagnant water anywhere around did
not become breeding grounds for mosquitoes.
(By Mukhtar Alam, 13/10/2006)
124 patients admitted to city hospitals
KARACHI: The health department on Thursday said that presently there are at least 124 in-house hemorrhage fever patients at
different private and public hospitals in the metropolis.
As per the break up provided by the Sindh government, the suspected cases of dengue fever at the Aga Khan Hospital (AKUH)
are 33, Liaquat National Hospital, 35, Civil Hospital, nine, Ziauddin Medical University Hospital, 25, Jinnah Postgraduate
Medical Centre, 19 and Bismillah Taqee Hospital, Gulshan-e-Iqbal, three.
Captain Dr Abdul Majid, commenting on the latest strategy of the Health Department to counter the situation said, “We are only
responsible for coordination, monitoring and policy making which are forwarded to the city government for further consideration
and implementation.”
He also said that the Health Department is to advertise an area-wise schedule in different newspapers for fogging and spraying
of insecticides.
Abdul Majid pointed out that the department is also running a continuous awareness campaign against dengue fever through
different media, whereas the isolation wards at the Civil Hospital and Jinnah Postgraduate Medical Centre are working perfectly
well.
(The News-3, 13/10/2006)
Ignorance weakens fight against Dengue fever
KARACHI: In the battle against the spread of the Dengue virus in Karachi, the biggest barrier seems to be misinformation as
well as ignorance, doctors told The News. A visit to a busy blood bank in the city belied claims that blood banks were going dry
because of multiplication in demand for certain blood groups during the past few weeks.
The same was witnessed at other blood banks that were visited on Friday. Other misconceptions and fallacies which have been
propagated during the spread of the virus include claims that paramedics were contracting the disease while treating patients
and that there was an absence of appropriate diagnostic tests in Karachi.
50
When contacted, a senior doctor expressed disapproval about confining certain labs to conduct tests for the virus. He said,
“The claim of the National Institute of Health, Islamabad, that not all labs can carry out the diagnostic tests for Dengue is totally
false and the kit does not need the Bio-safety-level-3 protocol.”
However, owing to the confusion created by medical circles, several private labs are charging thousands of rupees for these
tests, while they hardly cost around Rs500-800 at the mainstream diagnostic centers. Private hospital labs are said to be
charging around Rs3,000 for the same tests.
Dr. Rafiq Khanani, Associate Professor and Senior Pathologist at the Sindh Medical College and Dow University of Health
Sciences (DUHS), told The News that the disease “is not transmitted from person to person. It is only spread through mosquito
bite.” He added that at many hospitals, patients are being kept in isolation wards with the staff treating hem wearing masks and
gloves which is also unnecessary.
“Only maintaining hygienic conditions where they are kept is important so as to ensure there are no mosquitoes around,” he
added.
About the blood transfusions, he said that not all patients need to be given blood and platelets. It is only when a patient’s count
has fallen to a certain level which is life threatening that this is done. Mostly patients don’t reach that stage if on the onset of the
disease it is diagnosed.
Generally GPs in the city start treating fever with anti-malarial or anti-biotic medicines, while in an epidemic situation, all
treatments should be followed by pre-testing to rule out the possibility of contracting the disease that is spreading.
But this is usually not done and in some cases this negligence proves fatal.
At the same time, the anti-biotics and anti-malarial drugs bear a serious toxic effect on bone marrow. This impairs the
production of white blood cells (WBCs) and platelets.
What is interesting is that the Dengue virus also acts in the same manner by killing WBCs and platelets. The combination of the
two greatly worsens the condition.
Doctors also say that it is important to understand that the Dengue mosquito has certain peculiar characteristics, which have
serious implications on Dengue Hemorrhagic Fever (DHF) control.
Firstly, it has a patched body which slightly different in appearance from the ordinary malarial mosquito, and secondly, it can
transmit the disease with every bite unlike the other which undergoes a 15-day cycle of maturing before making its bite lethal
again.
What is worrisome is that the Aedes aegypti mosquito is a dawn-and-dusk-biter when it is difficult to sense the bite. While
window screening and bed netting may help until dawn, but mostly people in Karachi are outdoors at dusk.
Another problem is that since it tends to breed inside closets, and in water containers that are cool and covered, they are likely
to find opportune breeding ground inside water storage tanks of houses as well as in institutions like prisons, hostels, hospitals,
and schools. That is why clustering of cases is witnessed and it spreads like wild fire.
“It is wise to cover the body properly with clothing and apply mosquito repellants adequately on the exposed skin surface. An
ingredient in the repellants DEET actually works to keep these biters away because with its peculiar odor.
Mustard oil for its strong smell also serves the same purpose,” said Dr. Khanani.
Doctors are unanimous in their call for a massive awareness campaign to train health care providers and general physicians
(GPs) about the disease protocol of viral hemorrhagic fevers particularly Dengue. They have also demanded a campaign to
make people aware of not only the dangers of this disease but also signs to recognize it and take immediate action.
Commenting on the management of the current outbreak, doctors say that the DHF is curable with a few exceptions, is not as
contagious as Congo Crimean Fever because it is not airborne nor is contracted through social contact or by working together,
nor does every patient need blood transfusion or the normal drip administration.
The myths surrounding the reality of this disease are making it all the more difficult to deal with it, contend medical practitioners.
“Internationally, the mortality rate of DHF is hardly 2% while our data shows an alarmingly high 5-10% only because of improper
disease management,” Dr Khanani warned.
(By Asra Pasha, The News-2, 14/10/2006)
Karachi’s new fear — the dengue fever
IT is truly baffling to realize the ways and the number of times that one can be scared in Karachi. When one says scared, there
is in mind, for example, the fear of street crime; the anxiety of power failures; the agitated state of mind that water shortages
brings; the panic that traffic chaos generates; the scared feeling that comes from realizing that one has to visit a government
dealing department; or how afraid women can be when they are unescorted and have to go out and confront strangers.
I can imagine that with the worst of summer and monsoon season past us and with an autumn-less October here, people of this
city would get a sense of relief and the holy month of Ramazan would get undivided attention rather than this mosquito fear that
has shaken the confidence of citizens. As one colleague remarked, “It takes so little to upset the equilibrium of the city, so
little...” He smiled to say that mosquitoes had done it now.
And if one looks at the grim scary situation that the dengue fever stories have been generating, the most obvious thought that
comes to the most dimwitted amongst us relates to the absence of preventive measures that should have been taken after the
rains in August -- the havoc they brought being well known.
The rainwater that Karachi’s authorities (varied platforms) failed to clear on time would get sprayed for mosquitoes and other
infections that comes an obvious consequence. Karachiites believed that the spraying on the stagnant stinking water would be
normal and natural, and the health departments of the city and the provincial governments would be proactive in this direction.
We have not seen any real evidence of this desperately needed fumigation despite the alarm bells that have been ringing. Look
at what a spokesman of the provincial health department has been quoted as saying that the authorities are going to advertise
51
an area-wise schedule in different newspapers for fogging and spraying of insecticides. It is very clear that swift action and
emergency measures have not been put in place as they should have. One disgusted citizen observed that it is only being
planned at this stage.
As I write this on Friday evening and stories related to dengue fever spread in the city, there has just been telecast on a private
TV channel an interview with a university professor, who had warned seven years ago that dengue fever could spread in
Karachi.
Prof Jamil Hasan Kazmi said that after his return from the USA where he had gone on a Fulbright scholarship he had focused
on this aspect with reference to Karachi. Even in a developed place like Singapore there were 5,000 cases of dengue fever
reported in 2003, he underlined.
The university professor said that this mosquito breeds on fresh water and also sewerage water, and when these are
unavailable in October they shift to the overhead water tanks. He, however, didn’t believe that that the dengue fever had
assumed yet the nature of an epidemic.
This television news report said that there were 450 people with high fever who had reported to local hospitals. One prays that
this does not spread any further and that it is contained and fully controlled in this city.
More than somewhat disturbing and enigmatic is a news report published on Oct 13th that City Nazim Mustafa Kamal has said:
“No dengue fever cases have been reported in the last 10 days.” The very same newspaper reports that at least 124 patients
with hemorrhage fever were admitted in various private and public hospitals in the city. And while giving details of how many
admitted in various hospitals, a spokesman of the health department Capt Abdul Majid said, “We are only responsible for the
coordination, monitoring and policy making which are forwarded to the city government for further consideration and
implementation.” Citizens do not understand what to make of this kind of cold comfort that comes from such official statements!!
There is not the slightest doubt that citizens are worried and in varying degrees. The ordinary mosquito that the Karachiite has
learnt to live with and whose buzzing and humming sound is a threat and nuisance that the city has often reconciled to is now a
dreaded prospect. The state of the city after the rains with sewerage and rainwater still a challenge (even in Clifton) raises
many questions. One is reminded here of the state of garbage collection and garbage heaps that dot the city. That is an all time
story that we live with!
As we are in a state of dengue fever fear that has landed on the city in the month of Ramazan, it is particularly pertinent to
mention here the high vulnerability of school children, given the inadequate state of hygiene and cleanliness. This is one area
that needs the highest priority, stress parents, as we are familiar with the indifference with which most private and government
schools treat the crucial subject of hygiene. One parents took a philosophic view and said that this dengue fever and other
instances of malaria that have been reported reflect the poor levels of health and hygiene that we have in this society.
This viral hemorrhage fever has been in town since sometime last month and experts warn that it can assume alarming
proportions. There are calls for donating blood and reports underline that blood banks are running out of kits. There are eight or
nine days to go before the Eid moon is sighted and according to some news reports blood transfusion experts fear a difficult
fortnight ahead as they are running out of kits to provide platelets to patients suffering from the fatal dengue fever that had
inundated hospitals.
In brief, there is a desperate call for blood donations in the city right now – at least 200 donors a day are needed at this stage of
the canvass of the dengue fever spread. That is the context of Eidul Fitr this year. The question that Karachiites are asking
each other is whether this situation could have been avoided had the city district government and the Sindh health department
been better prepared with a vision after the heavy monsoon rain this year.
Look what one simpleton remarked, “The rains got the sewerage systems to collapse, and then came the dengue fever.” No
laughing matter, dear citizens.
(By Nusrat Nasarullah, Dawn-17, 15/10/2006)
Another viral haemorrhagic fever patient dies
KARACHI: Another patient of Dengue fever died at a private hospital on Saturday.
The patient was suspected of the Dengue fever, having all the symptoms of the epidemic, died before the case could be
diagnosed as he was admitted to the hospital a few hours before his death.
“The situation at all hospitals, where dengue fever patients are admitted, is under control and no blood bank is run short of
blood supply,” a health department official claimed.
Additional Secretary Health, Captain Dr Abdul Majid said that Bismillah Taqee and Hussaini Blood Banks have sufficient blood
storage, each having 150 kits against the daily consumption of 15 to 20 kits.
Officials from Health Ministry and different public and private hospitals held a meeting here on Saturday to discuss the situation
arising from the epidemic.
The meeting was told that Bismillah Taqee Hospital and Ziauddin Medical University Hospital have already announced to
charge Rs600 for the diagnostic tests.
Health Minister Syed Sardar Ahmed chaired the meeting, which was attended by Dr Noshad Sheikh, Secretary Health; Dr
Abdul Majid, Additional Secretary Health; EDO Health Dr AD Sanjani; Prof Dr Masood Hamid of DUHS; Dr Asim Hussain of
Baqaee University; Dr Shamsi of Bismillah Taqee; Dr Afia of Ziauddin; representatives from Fatimid Foundation; Hussaini Blood
Bank and JPMC blood banks.
The latest breakup provided by the Dengue Fever Monitoring Cell is at 123 to 154. Out of these, 40 have been admitted at Aga
Khan University Hospital (AKUH); 36 at Liaquat National Hospital (LNH); 20 at Civil Hospital Karachi (CHK); 28 at Ziauddin
Medical University; 25 at Jinnah Postgraduate Medical Center (JPMC); four at Bismillah Taqee Hospital and one at Hamid
Medical Centre, Qaidabad.
Meanwhile, the CDGK has announced a subsidy of 50 per cent on mega platelet kits, which costs Rs7000 per administration,
while the dengue fever patient would have to pay only Rs3500.
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The city government has decided to conduct spray and fumigation at all towns and government-run schools from Sunday
(today) and for this purposes three fumigation machines have also been given to the education department.
The CDGK has also announced to give a subsidy of 50 per cent on all diagnostic tests for all VHF patients admitted to public
and private sector hospitals.
(The News-2, 15/10/2006)
Dengue fever case detected in Islamabad
ISLAMABAD, Oct 14: A case of dengue fever has been detected in a capital hospital though health professionals dismiss any
imminent outbreak similar to the one in Karachi. An official source told Dawn on Saturday that a sample sent to the National
Institute of Health (NIH) from the KRL Hospital, Islamabad, was tested positive.
A duty doctor at the KRL Hospital confirmed the report and identified the patient as 22-year-old Rais-i-Azam, a student from
Gujranwala who was staying in a hostel in the capital with some friends.
The doctor said the patient was referred to the hospital by Nescom Hospital on October 6 with the complaints of high fever and
DIC (disseminated intravascular coagulation) and very low platelets count.
The doctor said the patient left the hospital against medical advice on October 12, although his condition was stable. He was
asked to report back to the Nescom Hospital for further treatment.
However, when contacted, chief of public health at the NIH Dr Birjees M. Kazi said he was not aware of any sample received
from the KRL Hospital.
Meanwhile, four samples from the Bilal Hospital Rawalpindi have shown negative results. NIH has also received one sample
from the Shifa International Hospital which was still under process.
The NIH has also received 24 other samples from different hospitals of Karachi, out of which 22 tested positive.
Dengue fever is caused by a specific type of mosquito that bites only during daytime, especially during sunrise and sunset. The
breeding takes place only in containers, drums and buckets of clean water.
Dengue fever is one of the major health risks in South and South-east Asia, he said but admitted that extreme climatic
conditions in the northern part of this part of the world including Pakistan acted as a natural defence against the spread of the
disease. The more humid and warm the climate the more will be the chance of the spread of diseases, he explained. However,
he admitted that outbreak of diseases in the southern part like Karachi reflected a sorry state of affairs of the city governments
and their civic agencies.
Referring to the situation in Karachi, a spokesman for NIH said the record of five major hospitals had showed 371 cases of viral
haemorrhagic fever (VHF) and 16 deaths in the current spell disease with the fatality rate of 4.3 per cent.
This time, the disease was not limited to the poverty-stricken areas of Landhi and Malir as was observed last year (November
2005-December 2006), but rather it spread to different parts of the city, involving even the posh localities like Defence Housing
Authority.
Recently, the ministry of health deputed a joint team comprising experts from NIH, Directorate of Malaria Control Programme
and the World Health Organisation to assess the situation and carry out epidemiological investigations.
The team visited Liaquat National Hospital, Civil Hospital, Ziauddin Hospital and the Aga Khan University Hospital to gather
information about the cases admitted and determine the disease trend and its geographical distribution.
A central focal point has also been established in the office of the secretary health, Sindh, for monitoring and surveillance of
dengue fever cases.
All the five hospitals have also been recommended to work as sentinel sites to generate and disseminate DHF data to the
health department at the focal point on a daily basis for onward transmission to NIH for monitoring the situation. Training
sessions have also been conducted at three places for the senior health managers of the province.
Meanwhile, the team of experts deputed to Karachi hospitals in their recommendation said the breeding sites should be
removed by keeping the clean water containers, buckets, pitchers, saucers and flower and money plant holding inside the
houses instead of keeping them in the open.
(By Nasir Iqbal, Dawn-2, 15/10/2006)
Millions at risk: PMA
KARACHI, Oct 14: The Pakistan Medical Association, Karachi chapter, has urged the city government to take special
preventive measures to save millions of Karachiites from the fatal dengue fever by launching an effective fumigation campaign,
especially at schools, besides providing free of cost blood transfusion kits and other necessary medicines to the concerned
organisations.
Dr Qaiser Sajjad, General Secretary of the PMA Karachi, talking to the PPI on Saturday, expressed serious concern over the
rising number of dengue cases and fatalities in the metropolis.
Stressing on the launching of a vigorous fumigation drive to cover every nook and corner of the city, he noted that parents of a
huge number of children infected and those vulnerable to the diseases appeared worried about their wards.
Considering the fact that the mosquitoes responsible for dengue fever spread bite at around sunrise and sunset, the parents’
worry is justifiable, their wards happen to be outdoors at sunrise (on way to schools) and sunset (playing outdoors either in the
streets or playgrounds), according to Dr Sajjad.
He pointed out that due to a lack of modern diagnostic labs, results of blood test reports were hitting delays in many cases. The
results take three to four hours if the test is conducted through machines and six to seven hours if it is done manually.
He urged the city government to arrange for an increased number of such diagnostic labs in the city.
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Dr Sajjad also appealed to citizens and volunteers for blood donation, and also noted that some blood banks were providing
blood only in exchange of donation in the same quantity.
The PMA leader also appreciated the spirit and generosity of volunteers and general public which had been helping health
providers to cope with the situation amid a constant rise in the number of VHF cases in the city.
(Dawn-17, 15/10/2006)
Dispensaries in SITE reflect govt apathy
KARACHI, Oct 15: Though there are many dispensaries in SITE Town, which on the papers are called healthcare centres, they
practically ceased to function in the prevailing circumstances.
These dispensaries are running under the aegis of the city and provincial governments, which spend a lot of funds every month
on the staff salaries, purchase of medicines and maintenance of infrastructure, but the output seems to be nothing. The
dispensaries are lacking even the life saving drugs and diagnostic equipment. In case of emergency, taking patients to these
so-called healthcare centres is nothing but wastage of time and money.
The health department authorities have failed to improve the dispensaries, which could help provide relief to the ailing people
and reduce burden on hospitals.
During visits to the dispensaries in SITE Town, it was observed that almost all the dispensaries had been constructed on
spacious plots. Some of the plots are so vast that they could be utilised for addition of new departments besides residential
purposes.
SITE Town with a 692,908 population has no big hospital and the patients are shifted to Abbasi Shaheed and Qatar hospitals,
which are already overburdened.
It was learnt that these dispensaries were playing the role of rural health centres and basic health units, where hundreds of
patients were getting medical treatment daily in the past. But the number of patients started decreasing due to deteriorating
conditions at the dispensaries and now people have even forgotten their location.
The health department officials are well aware of the fact that how a building without water, electricity, diagnostic equipments
and life saving drugs can function as a healthcare centre. It is also a fact that every year millions of rupees are allocated for the
purchase and maintenance of diagnostic equipments and medicines, but the situation is getting worse.
Doctors also criticised the role of public works department for its failure to repair the buildings, and sewerage lines saying that
some of the buildings were near to collapse, which had endangered lives of the people.
During visit to the dispensaries in the town, a nine-room structure was found in the use of drug addicts. The building, once a
dispensary located in the centre of Bawani Challi, is now known for the business of heroin and hashish. Doors, windows, steel
spikes, water taps, electrical fittings and other accessories have been stolen and only the building structure is standing.
Area people told Dawn that it was a reasonable healthcare centre in the past but fell prey to the official negligence. They
expressed their apprehension that if the government did not take notice of the situation, land grabbers might get hold of the
land.
A local notable, Gul Rung Shah, emphasised upon the health department authorities to reconstruct it as mostly inhabitants of
the area were the poor labourers and could not afford to visit big hospitals for treatment. The presence of drug addicts in the
area was also threatening the future of youngsters, he said.
Situated in the old Golimar, the dispensary of Rexer Lane has developed wide cracks and is about to collapse.
A staff member disclosed that a tender for its repair had been approved. However, he said that repair was not the only solution
to the problem as the entire building needed reconstruction. The officials of a foreign donor agency had also objected to the
poor condition of its building, he said.
The number of patients in the general OPD is reported about 25. The dispensary has no sewerage line. Its ground level is very
low and in case of rainfall water flows into the building.
The Aban Shaheed dispensary is situated near the Metroville graveyard, where an average number of patients in the daily
outpatient department were reported from 30 to 50.
The staff told that there was no permanent sweeper in the dispensary, adding that a sweeper from another dispensary had to
come there only three days a week. Five fans and two water motors have been stolen and now there is no arrangement for
water supply to the overhead tank. The furniture has also got broken.
In the absence of medical officer, a lady health visitor was examining the patients. The staff demanded supply of gas and
permanent residential facility for the watchman in the premises. When asked, the staff rejected public complaints about nonavailability of medicines at the dispensary.
Another healthcare centre, Ismail Shaheed dispensary is located in Pathan Colony, where the average number of patients in
the daily OPD is reported 15. The water and toilet facilities are not available and the post of sweeper has been vacant since
long. Fans and windows have been stolen. The boundary wall has collapsed and the sewerage line is completely chocked.
Four of its seven rooms had been used by the UC nazim for his office. Though he has vacated the rooms now, the rooms are
yet to be handed over to the dispensary staff. The sewage of the nearby houses is flowing towards the dispensary building,
which is a constant problem for the staff and patients as well.
In the absence of medical officer who was reportedly on a three-day leave, a store in charge was treating the patients, who
claimed to have enough experience to diagnose the diseases and prescribe the medicines.
The Manghopir Maternity Home is situated on the main Manghopir Road near the Golimar Park. This 20-bed maternity home
too has no resident medical officer. The sitting doctor is a consultant, who has been deputed here from the schools health
services. Besides, there are six nurses, four midwives, and a lady health visitor to serve patients.
A maternity home means to provide the facilities on 24 hour basis, but due to non-availability of the RMO it does not function
round-the-clock. Due to lack of facilities and medicines, the number of patients in the general OPD is 15 to 25 only. One of the
two ambulances here is out of order and needs repair.
54
Renovation of the building was started, but stopped for unknown reasons. The healthcare centre has no proper supply of water
and its sewerage system has also completely collapsed. Overflowing sewage in the corridors could cause serious health
hazardous, the staff said.
They also complained of power fluctuations owing to which the diagnostic facilities ceased to function. It was told that MPA
Farida Baloch had allocated Rs300,000 for installation of a PMT. The MPA also helped arranging X-ray and ultrasound
machines, two incubators, which would be installed once power supply was properly restored, they added.
The Rashid Minhas Shaheed Dispensary, situated in Frontier Colony, is in pathetic condition. All the damaged furniture has
been dumped in the main hall. Area people use the premises for dumping garbage. The leaking sewerage line needs to be
repaired. The pumping motor has been stolen and a staff member brought another motor. The overhead water tank has
developed cracks. The medical officer was not available for comments.
Another 15-beded maternity home in the town is located at Hasrat Mohani Colony, which too has no diagnostic facility. The
water supply has been disconnected and the pumping motor is also not available. Electricity has been drawn through an illegal
hook.
The doctor at the maternity home told Dawn that in the past it had an ambulance, but now there was no such vehicle available.
The ultrasound and weight machines have been out of order since long. It has no incubator and X-ray facilities. Termites have
destroyed the doors, windows and furniture.
The posts of lady health visitor, three nurses and a female servant have been lying vacant since long, while its watchman is
performing duties somewhere else without officially intimating the in charge of the maternity home. The sweeper is also said to
be very irregular in her duties.
When asked about the repairs, the doctor said that maintenance funds were not provided and she had to make it from her own
pocket. The number of outdoor patients is said to be between 30 and 40 per day.
The Hasrat Mohani Medical Complex is situated along the maternity home, which also has no water supply arrangement and its
overhead water tank is open to dust. The ultrasound machine has been out of order for the last about four years. The complex
has a laboratory technician, but there is an acute shortage of X-ray films. New furniture has not been provided since 1988. Six
of the ceiling fans are said to be out of order. The doors of almost all the rooms have been hollowed by termites and need
repairs. Two posts of sweepers are vacant.
Two doctors are posted at the complex. The male doctor takes TB cases and the lady doctor performs her duties here three
days a week as she also works at the Manghopir Maternity Home. About 37 TB patients are taking regular treatment at
complex.
The Sindh Govt Dispensary, located at Qasba Colony UC-8, has been functioning in a rented building since its inception about
eight years back.
It is the only healthcare centre in the colony having a population of 70,000. During a visit to the dispensary it was observed that
a staffer, who identified himself as supervisor was examining the patients and the doctor was reportedly on another official duty.
The dispensary has neither electricity nor water and toilet facilities while the number of patients in the daily outpatient
department is reported around 200.
Similar situation was witnessed at the Wilayatabad Dispensary, which has been dislocated thrice since its inception.
(By Ali Hazrat Bacha, Dawn-14, 16/10/2006)
82 suspected VHF cases admitted to hospitals:
Four-month tally swells to 837
KARACHI, Oct 16: Amid city government’s claims of having intensified the fumigation and sanitation drive across the city,
patients with febrile illness continued to land in various city hospitals.
The number of such patients visiting major hospitals of the city over the last four months has now risen to 837.
As many as 82 fresh cases of suspected Viral Haemorrhagic Fever (VHF) were reported at six government and private
hospitals during the 48 hours till 2pm on Monday.
Since June 14, about 27 per cent (227) of the patients admitted to hospitals have been diagnosed dengue-positive, while the
number of those succumbing to the VHF remained at 18.
Talking to Dawn, Additional Secretary Health, Sindh, Capt (r) Abdul Majid, who is also focal person for the Dengue Fever Cell,
said on Monday that the last death of a suspected VHF patient had occurred on October 10 at a government hospital. He did
not confirm the report about the death on Sunday of a prisoner, brought to the Civil Hospital on Saturday night, from the VHF,
maintaining that he had no information confirming that the deceased was a VHF or dengue patient.
Giving details of the 18 recorded fatalities, he said six of the VHF/dengue patient died at the Aga Khan University Hospital, five
at the Liaquat National Hospital, four at the Jinnah Postgraduate Medical Centre, two at the Dr Ziauddin Hospital and one at the
Civil Hospital.
He further stated that 110 out of 308 patients were tested dengue-positive at the LNH, followed by 55 out of 159 at the AKUH,
16 out of 75 at the CHK, nine out of 134 at ZH, nine out of 84 at the JPMC, 19 out of 40 at the Bismillah Taqi Hospital and
seven out of 35 at the Hamid Hospital.
The National Institute of Child Health has one dengue-positive case. Lab test reports of a large number of patients are yet to be
received by the hospitals concerned.
Dr Majid said that in all, 180 patients with suspected VHF were still getting treatment at nine hospitals of the city. In order to
provide laboratory test facility to these in-house patients, the Sindh Services Hospital at Karachi will also start collecting blood
samples from October 17. A laboratory has been set up for the purpose and will be managed by Sindh Blood Transfusion
Authority.
In reply to a question, he said that the number of patients with mosquito-borne diseases had increased after the recent
monsoon rains, but keeping in view the figure of 837 admitted to hospitals since June 2006, one could say that the situation
55
was not so alarming. Nevertheless, preventive measures were needed to be taken. He noted that women and children
appeared less affected by these diseases so far.
With the arrival of new patients at different hospitals between Saturday afternoon and Monday evening, the number of in-house
patients is as under: AKUH: 44 (15 new), CHK: 15 (two new), JPMC: 27 (13 new), LNH: 49 (33 new), ZH: 32 (12 new), BTH:
seven (all new), Hamid Hospital: 1 (no new), NICH: 1 (no new) and Abbasi Shaheed Hospital: 5 (no new).
A source in the provincial health department said that the provincial health minister had impressed upon the EDOs of Health
and Education to submit fogging/fumigation reports to the Viral Haemorrhagic/Dengue Cell on a daily basis.
In a communication on Monday evening, the AKU said that 42 patients with suspect VHF were admitted, most of them during
the last two weeks, to the hospital. The patients had symptoms ranging from bleeding, diarrhoea, vomiting, abdominal pain, etc.
EDO Health Dr A. D. Sajnani said that fumigation through spray machine-mounted vehicles continued on Monday covering
Korangi and Malir areas in the morning and Jamshed Town areas in the evening. In addition, fumigation in about 227 schools of
three towns, including Lyari Town, was carried out.
He said that the patients diagnosed VHF/dengue positive could approach the Bismillah Taqi Hospital, Hussaini Blood Bank or
Fatimid Foundation for getting mega packs of platelets at a subsidised rate. The city government has already undertaken to
bear half the cost, the full cost of a mega pack being Rs7,000.
(By Mukhtar Alam, Dawn-17, 17/10/2006)
Number of suspected Dengue fever cases touches 181
KARACHI: The numbers of suspected Dengue fever cases have risen to 181 from around 150 on Friday. Eighty-two fresh
cases have been reported between Saturday evening and Sunday night in different hospitals of the city, while 103 have been
discharged during the past week.
The break-up as per the health department report provided on Monday is: Aga khan University Hospital, 44; Liaquat National
Hospital, 49; Civil Hospital Karachi, 15; Ziauddin University Hospital, 32; Jinnah Postgraduate Medical Centre, 27; Bismillah
Taqeee Hospital, 7; National Institute of Child Health, 1; Abbasi Shaheed Hospital, 5; and Hamid Medical Centre, 1 patient.
The health department has announced that all hospitalised patients could get their tests done at the Sindh Services Hospital,
Blood Transfusion Centre free-of-cost. The tests are only for the patients hospitalised at any of the private or public hospitals
only.
The health minister has also instructed the EDOs of Education and Health to issue daily press releases as well as reports to the
ministry on the fumigation drive. He has strictly ordered to take special care to fumigate schools and hospitals.
According to the Medical Superintendent of the Civil Hospital, Karachi, two deaths have occurred at the CHK out of the total 64
patients suspected of having Dengue fever brought to the hospital over the past two and half months. Eleven patients out of
these were Dengue-positive.
(The News-2, 17/10/2006)
Schools are more vulnerable to viral haemorrhagic fever
KARACHI: The cases of Dengue fever in the metropolis have caused much concern among the public that is adopting
preventive measures to avoid contacting the deadly disease. But schools, in most of the cases, are oblivious to the hazards of
the disease and its effects on students.
The News contacted many schools on Monday to find out the preventive measures taken by them in various localities against
the ailment that is one of the most feared one and approaching epidemic level.
Shamim Javed, Principal of Shaheen Public School in Gulistan-e-Jauhar, acknowledged the seriousness of the matter, but said
that to date there was no fumigation or fogging by the school or the City District Government Karachi (CDGK).
The school administrator, according to her, was in touch with the CDGK to arrange fumigation. But she was confident that her
school had least chances of the viral attack as it was open, airy and received lots of sunray. The bathrooms and other spots
where water could be stagnant were kept clean to check the breeding of mosquitoes in the school.
The Metropolitan School in Block-18, Federal B Area, had also not taken any preventive measures in this regard. The News
talked to a lady whose four children were registered in the school. She was very much concerned about the fact that school had
not done anything to save the children from Dengue virus attack.
“There is no spray, no cleaning - they are more concerned in minting money than to provide proper hygienic care to their
students”, she said on the condition of anonymity. Government SM Public School in Block-III, Nazimabad was found
unprepared for any eventuality as there was no fumigation and even the students were not warned about the danger looming in
the city. Parents, on the other hand, were more aware and in constant watch to avoid the fever.
Mother of a female student was adamant that no special steps were taken to keep the school free from mosquitoes especially
when the school was very near to the under construction Nazimabad bypass that had stagnant water - a breeding den for
mosquitoes. While Usman Public School in Gulberg was an exception as all the preventive measures, including fumigation,
were taken by the administration. The school was immaculately clean.
Dr Qaiser Sajjad, General-Secretary of Pakistan Medical Association (PMA), said that children in private schools were more
prone to contact the Dengue fever virus as the schools were a 2-3 room affairs, established in flats in congested areas with less
sunlight and fresh air. He urged the private school owners to get their schools fumigated.
Nausea, vomiting and high fever are general symptoms of the Dengue Viral Fever and in such cases children should be taken
to the hospital. The general physicians and other doctors have been advised not to administer antibiotics in such conditions as
the drugs debilitate the immunity system of the body.
All the relevant tests should be performed to ascertain about the nature of the fever. The EDO (Health) Dr AD Sanjnani
informed that the CDGK had started fumigation at public places and schools before the sunrise and sunset, the two times when
the mosquitoes hatch their eggs.
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Dr Seemi Jamali, at JPMC said that children could become victim to the lethal disease if proper care was not taken in schools.
The Dengue fever mosquito stings at day time when children are at schools. Indoor plants should be removed and all the stored
water, even in underground tanks, should be covered properly.
Aedes aegypti, commonly known as the Yellow Fever Mosquito, is a breed that can host the dengue fever, Chikungunya and
yellow fever virus. Although it may feed at anytime, the mosquito’s periods of peak biting activity are few hours after dawn and
in the late afternoon until a few hours after dark.
The mosquito’s preferred breeding areas are in areas of stagnant water, such as flower vases, uncovered barrels, buckets, and
discarded tires, but the most dangerous areas are wet shower floors and toilet bowls, as they allow the mosquitoes to breed
right in the residence.
Dengue is a debilitating infection of comparatively short duration with a high attack rate but a low fatality rate. The so-called
‘classical’ Dengue Fever (DF) form usually affects older children and adults with fever, violent headache, and severe pains in
the muscles and joints following an incubation period of five to eight days, and lasts about four to seven days; recovery is
generally complete although convalescence may be long.
A more severe form, Dengue Haemorrhagic Fever (DHF), involves internal bleeding and is sometimes associated with severe
shock (the Dengue Shock Syndrome (DSS) and occurs most frequently in infants and young children. In a related development,
Khalid Shah, President, All-Private Schools Management Association, Sindh, has directed all schools to arrange for the
fumigation at the earliest.
(By Perwez Abdullah, The News-2, 17/10/2006)
Blood banks feel the pressure
KARACHI: Blood banks are finding it hard to put up with the demand for blood transfusions across the city since the outbreak of
Dengue fever. The blood bank officials are of the view that the situation has occurred due to irrational and increased use and
transfusion of blood.
Since the recent wave of Dengue fever in the city, blood transfusion has increased phenomenally but experts believe that
doctors along with the government body need to formulate certain guidelines to define the clinical management of the disease,
the critical level of platelets count in a patient and the correct time to transfuse platelets.
When contacted, the blood bank in-charge at the JPMC, Dr Syed Abdul Majeeb said every time the disease has its spell on a
large population, such hype is created by the media and other related agencies but nothing is actually done to avoid such a
situation in the long term, which is an obvious explanation of why these epidemics keep recurring. Besides, the absence of any
proper research into the probable factors responsible for an outbreak leaves us every time in the dark until the next time it
occurs.
“I stress upon research, because without proper studies the disease management costs 10 times more. As regards the current
fever wave, it has not been exactly established as to how many cases were actually proved Dengue fever-positive. The
newspapers are printing the soaring figures of patients being admitted to hospitals. Calling anyone suspected does not mean
that he could be made part of statistics of a disease. There are hundreds of diseases with similar symptoms,” he said.
Doubting if the vigorous fumigation actually addresses the problem, he said that Dengue fever and Viral Hemorrhagic Fever
(VHF) have totally different clinical explanations and definitions while they are being used by the media as if they are
interchangeable.
“Blood has a brief shelf life of four to five days maximum. All banks are sufficient enough to meet the demand. But the demand
on ordinary days is only from oncology patients mostly. However, this time round uncalled for demand has badly affected the
supply and finding it difficult to cater to the regular patients.”
In this regard he has urged the government to ensure that the platelets manufacturing equipment is maximised, which is only
limited to some four machines in the city at the moment, and also to promote voluntary blood donation.
“We are particularly short of donors at the moment partly due to Ramazan as blood is not taken when the donor is fasting and
also because we haven’t witnessed any remarkable rise in the number of volunteers since the outbreak. Instead of spreading
scare of the disease what should be done is to promote blood donations by the public,” he reiterated.
He also urged the government to ensure that not only did the blood banks have a steady coordination among themselves, but
instead of a patient’s attendants running from pillar to post to get blood of the right kind, the coordination should be maintained
between the blood banks and the health unit directly. Also the handling and transportation of blood should not be left to lay
people but the City Government must ensure that it is being done by the right people so as to save the loss of resources in this
crucial time.
Dengue fever is of course caused by the Aedes mosquito bite, but the hygienic conditions of the city are exactly the same as
they were before, but no one has actually bothered to find out why the Aedes mosquito population has invaded the city this year
in particular because earlier the disease was only reported in the interior of the province.
“Actually all diseases have an occurrence pattern which helps determine their control strategies. So is it with VHFs and Dengue
as they also affect a certain fixed population which is exposed to it environmentally. And we are all the more helpless because
there is no way to determine a strategy of control unless thorough studies are conducted.
(The News-2, 18/10/2006)
Dengue kills two children raising death toll to 20:
42 more rushed to hospitals
KARACHI, Oct 18: The death toll of Dengue Hemorrhagic Fever rose to 20 with two more patients succumbing to the disease
during the last 24 hours.
Ali Raza, 11, of Baldia Town, and Lal Bibi, 8, of Memon Goth, Malir, are the latest victims of mosquito-borne dengue fever who
died at the National Institute of Child Health (NICH).
The last fatality attributed to any suspected Viral Hemorrhagic Fever (VHF) had occurred on October 10 when a 22-year-old
youth had succumbed while receiving treatment at the Jinnah Postgraduate Medical Centre (JPMC).
The total number of suspected VHF patients under treatment at different hospitals has also risen to 186.
57
According to official sources, a total of 55 such in-house patients are under treatment at the Liaquat National Hospital (LNH).
During the past 24 hours, till 2pm Wednesday, as many as 42 patients with the history of high-grade fever, chill, rigors, rashes,
vomiting, abdominal pain and bleeding were brought to seven government and private hospitals for admission.
Giving details of the deaths at the NICH, its director Dr Afroze Sherali told Dawn on Wednesday that Ali Raza, who had been
under treatment at the Civil Hospital Karachi (CHK), was admitted to her hospital on October 12 with a history of rashes,
bleeding and fever. Similarly, Lal Bibi, who had been receiving treatment at some private hospital, was brought to the NICH on
October 13 with a history of fever, bleeding and fits.
While efforts were under way to save their life, Ali Raza expired on October 15 and Lal Bibi the next day, while reports of their
blood tests from a Karachi-based laboratory were awaited, she said, adding that some delay in notifying the deaths did occur
because the NICH was waiting for the reports to determine whether the victims were confirmed dengue patients or not.
She said that until Wednesday, the institute had received 10 suspected VHF cases out of whom, two expired, two were
discharged and the remaining ones were admitted for treatment. They all belonged to low-income group families living in
Khokhrapar, Orangi, Malir and Landhi.
She advised parents not to take risk by delaying the treatment of their wards, adding that and upon noticing the symptoms
linked to the dengue fever, they must rush the patient to some big hospital having relevant facilities, instead of reporting at illequipped and small hospitals or consulting local doctors. The timely diagnosis and intervention could help save the patient, she
said.
Patients with suspected VHF fever continued to be taken to various hospitals in the city from DHA, Gulshan-i-Iqbal, Garden
East, M. A. Jinnah Road, PECHS, North Karachi, Malir, Nazimabad, Clifton, F B Area, Arambagh, North Nazimabad,
Zamzama, Metroville, Dalmia, Gulistan-i-Jauhar, Qasimabad, University Road, Aliyabad and Landhi on Wednesday.
Dr Abdul Majid, Additional Secretary Health, Sindh said that with the confirmation of another 24 dengue-positive cases on
Wednesday, the Tuesday tally of 248 had risen to 272. The number of suspected dengue patients during June-October period
has swelled to 971.
The present position at various hospitals is as under: AKU: 40 (07 new), LNH: 55 (10 new), CHK-08 (no new), JPMC: 27 (09
new), Dr Ziauddin Hospital: 27 (08 new), Bismillah Taqi Hospital: 05 (02 new), Hamid Hospital: 01 (no new), NICH-13 (04 new),
Abbasi Shaheed Hospital: 05 (no new), and BUH: 05 (02 new).
(By Mukhtar Alam, Dawn-17, 19/10/2006)
New surgical ward at CHK inaugurated
KARACHI: The new Surgical Ward-6 at the Civil Hospital, Karachi (CHK) was inaugurated by the Provincial Minister for Health,
Syed Sardar Ahmed, in the presence of the CHK Medical Superintendent and Dr Adeebul Hassan Rizvi, head of the Sindh
Institute of Urology and Transplantation (SIUT) on Wednesday.
The ward has been established with the cooperation of the Mirza Naqi Family, who have a background of philanthropy,
particularly in the health sector. The minister urged the staff of the hospital to improve their performance. He also stressed that
the sanitary conditions inside the Lyari General Hospital and the Civil Hospital were far from satisfactory. The issue, he said,
was not the availability of funds but their judicious exploitation.
“Civil engineers on a permanent basis are being hired for maintenance and repairs of these hospital buildings,” he said, adding
that 750 doctors were being commissioned while 450 doctors are to be employed on an ad hoc basis, Five-hundred specialist
cadre officers are also to be hired. To address the security of both these hospitals, Rangers have been posted on the premises.
(The News-3, 19/10/2006)
VHF makes inroads into all 18 towns
KARACHI, Oct 19: Continued arrival of patients in large numbers with Viral Hemorrhagic Fever, including dengue, at various
public and private health care units in the city suggests that the VHF/dengue has made inroads into almost all localities of the
city. Samples of such patients’ blood being tested at various laboratories have confirmed another 31 cases dengue-positive,
while the average of fresh admissions per day shows a 40 per cent increase.
On Thursday, 56 patients were admitted to different hospitals while the number of patients with suspected VHF reporting at
certain hospitals crossed the mark of 1,000. Since June 2006, as many as 1,062 patients have been admitted to 10 government
and private hospitals in the city, the official data updated at 2pm on Thursday indicated.
Of the 167 in-house patients, 23 are under treatment at the Aga Khan University Hospital while the same number of patients
was admitted to this hospital alone on Thursday. The Liaquat National Hospital has 11 patients, Jinnah Postgraduate Medical
Centre has seven, Dr Ziauddin Hospital has six, and the Civil Hospital Karachi and the Baqai Hospital have three patients each.
In all, 78 patients, including 28 who were admitted to the LNH, were discharged on Thursday.
On the other hand, the data shows an increase by 11.39 per cent in the cases found dengue-positive. Till Wednesday, their
number stood at 272. The tally of dengue positive patients swelled to 303 on Thursday, which was 28.53 per cent of the total
suspected VHF cases. Six patients were found dengue-positive at the JPMC while another five at the Ziauddin Hospital, three
at the Aga Khan University Hospital and five at the National Institute of Child Health.
According to Dr Abdul Majid, the focal person for the Dengue Fever Cell, in addition to Karachi cases, three persons with
dengue fever symptoms died in the interior of Sindh during the last couple of days.
The patients reporting at hospitals for dengue treatment came from Saddar, Quaidabad, Bahadurabad, Gulistan-i-Jauhar,
Gulshan-i-Iqbal, Nazimabad, Orangi, Federal B Area, Clifton, Defence, Korangi, Baldia, North Karachi, North Nazimabad, Malir,
New Karachi, Manghopir, Landhi, Shah Faisal Colony, University Road, Garden East, PECHS, Liaquatabad, Zamzama, etc.
EDO Education, Karachi, has said that the fumigation by the city government in schools across the city had been completed by
its health department. It had been carried out in all primary and secondary schools of the 18 towns, she said, adding that
reports in this regard had also been sent to the authorities concerned. However, residents of various areas said they were yet
to see any fumigation on a massive scale.
(Dawn-17, 20/10/2006)
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Free dengue tests at city govt hospitals from today
KARACHI, Oct 20: City Nazim Syed Mustafa Kamal said on Friday that all possible resources are being utilized to contain the
spread of dengue virus in the city.
The laboratories at the city government-run hospitals would start diagnostic tests for dengue virus by Oct 21, he announced
while talking to newsmen on Thursday night.
He pointed out that earlier IgM test used to be carried out in city's private hospitals, but the city government had now provided
the facility of IgG test along with other tests.
The lab test kits are being purchased from the same company which was providing it to the National Institute of Health
Sciences, Islamabad, he said.
Today, for the first time in the history of Karachi, both tests of IgM. and IgG are being undertaken free of cost, he added.
He hoped that this would help diagnose the disease and its treatment could also be started at the earliest.
He said the test of IgM was being carried in Karachi, but they had also started tests of IgG at the same time, adding collection
of blood samples at all points would be started by Oct 21.
Mustafa Kamal said fumigation drives were being conducted across the city since two months on regular basis. He pointed out
that the virus of dengue fever in Karachi was found positive some two years back and its maximum cases were reported last
year.
We have finalized all preventive measures in the metropolis. There were only four spray machines in 2005 for 17.5 million
population of Karachi. We increased the number of spray machines to 54, while six extra machines were also being given from
Friday,” he added. He further said that fumigation drives were being restarted after completion of first phase, adding this was
being done under a special campaign that would be continued.
Meanwhile, the city government has launched fumigation drive in surrounding areas of Nullahs in Karachi to stop spread of
virus of dengue fever. In this regard, 450 malaria staff had been put on duties at nullahs and rivers to eliminate mosquitoes.
The sprays were conducted in areas of Shireen Jinnah Colony, Rasool Bux Colony, Boat Basin and other areas. It also issued
new schedule of fumigation drives in the city.
As per new schedule, fumigation drive would be launched in Landhi Town on Oct 21; Gulshan-i-Iabal Town Oct 26; Saddar
Town Oct 27; Liaquatabad Town Oct 28; Jamshed Town Oct 29; Lyari Town Oct 30; Malir Town Oct 31; Gulberg Town Nov 1;
Shah Faisal Town Nov 2; Gadap Town Nov 3; Bin Qasim Town Nov 4; North Nazimabad Town Nov 5; Korangi Town Nov 6;
SITE Town Nov 7; Baldia Town Nov 8 and Keamari Town on Nov 9 at 5pm.
In Gulshan-i-Iqbal fumigation drive has started in its union councils to stop spread of dengue fever.
Besides, a special chemical has been provided to the union councils to kill mosquitoes in ponds and stagnant water. This
chemical will be mixed in water.
Town Nazim Wasay Jalil held a meeting to discuss the precautionary steps taken against virus.
Dr Imdadullah said that people must be made aware of dengue fever and in this connection programmes would be held in all
UCs to inform people its symptoms and precautions.
He advised people to use anti-mosquito spray, keep the water covered and wear full sleeve shirt as precautionary step.
(Dawn-18, 21/10/2006)
91pc doctors, paramedics avoid washing hands
LAHORE, Oct 21: In the absence of basic facilities for hand washing in most public hospitals, some 91 per cent doctors and
paramedics are not observing this practice after examining patients, reveals a study of the Pakistan Medical Research Council
(PMRC).
“Hand washing is one of the most vital procedures for preventing Nosocomial Infection in hospitals. It prevents potentially fatal
spread of infection from patient to patient and from patient to health care workers in a health care setting,” the study says.
The study has been conducted to determine the knowledge, attitude and practice patterns of hand washing in several public
sector hospitals of the country.
Two doctors, a head nurse, a junior/student nurse and a dispenser/dresser/trainee technician were interviewed in each of the
selected hospitals. Pro forma was used to collect the information; besides an observational form was also filled to see the
actual facilities available and the practice pattern of the staff. A total of 386 individuals, including 191 doctors, were interviewed.
It has been noted that the facility for hand washing is available at only 17 per cent units but only nine per cent doctors and
paramedics of them bother to use it.
“Around 48 per cent doctors and 70 per cent paramedics stated that they were practicing hand washing after examining every
patient but when observed only nine per cent were doing so. A majority of them used toilet soap, which they had purchased by
themselves and 33 per cent were of the view that hand washing practice with soap and water was not adequate to prevent
infection. Most of them (58 per cent) said that if the facility was provided they would perform hand washing regularly”, the study
says.
It says that water was not available for hand washing at 66 per cent places. There was no washbasin at 61 per cent units and
detergent was not available at 68 per cent places. At some places these facilities were available to senior doctors only while
junior doctors and other staff were not allowed to use it, it says and adds that gloves were not available at 71 per cent units.
General cleanliness of the hospitals recorded 22 per cent as bad, 51 per cent adequate and only 27 per cent as good.
The results of the PMRC study show that at most places basic facilities for hand washing are not available. A majority of
doctors and paramedical staff is not practicing hand washing after examining patients, therefore, it is recommended that hand
washing facilities should be provided at all places of hospitals where patients are examined.
“Health education should be provided regularly through print and electronic media and workshops to create awareness about
hand washing benefits. Senior doctors should make sure that they adhere to this practice and also keep a check on their juniors
in this regard,” the study recommends.
(By Zulqernain Tahir, Dawn-13, 22/10/2006)
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‘Irrelevant drugs cause of dengue turning worse’
KARACHI, Oct 22: A majority of dengue fever patients admitted to various hospitals in the city had already used antibiotics or
anti-malaria drugs before their admission to hospitals which complicated their case as these medicines had served to reduce
platelet counts further”, said Dr Irfan Ahmed Khan about the 116 dengue patients brought to the Ziauddin Hospital over the past
few weeks.
He presented his study at the multi-faculty presentation on “Causes, Signs, Symptoms and Measures for Prevention of Dengue
Fever” held at the Ziauddin Hospital, North Nazimabad Campus, in collaboration with the Infection Control Society of Pakistan.
He said his patients had a common history of fever, nausea, vomiting and abdominal pain and some of them complained of
cough, diarrhoea and severe headache. Facial flushing, erythema and lymphadenopathy were also common in most of these
cases.
The mosquito responsible for dengue fever breeds on the surface of clean water and is a household insect which may infect all
family members present around with a mild to severe form of the disease.
Dr Khan stressed the need for the formation of a regional authority to maintain a data and analyse the situation, pointing out
that all the guidelines issued by the WHO were based on the studies performed in other countries of Southeast Asia.
Dr Naseem Salahuddin, In-charge of the Infection Control Disease Department of the Liaquat National Hospital said that
although the data collected at the LNH was not completely analysed, it came with the same facts and figures. She appreciated
the efforts put in by private hospitals in spearheading a campaign against this epidemic.
She stressed on strengthening surveillance, preparing a contingency plan, creating awareness in community, launching vector
control campaigns and combining resources to combat this deadly epidemic successfully.
Dr Faisal Mehmood of the SIUT said that dengue had first been diagnosed in 1944 while the first case in Asia had been
reported in 1980. The first dengue case in Pakistan was reported in 1994 and at present, such cases are in the category of
serotype 1 and 2 infections.
Dengue hemorrhagic fever causes leaking of blood vessels and ultimate bleeding from nose, mouth gums etc.
The speakers on the occasion suggested preventive measures, such as using nets and mosquito repellents, avoiding use of
open flowerpots and earthenware water containers, spraying insecticide in and around houses, keeping water storage tanks
and pots properly covered, and ensuring no accumulation of water at any place or in any container.
(Dawn-13, 23/10/2006)
Substandard vaccine
THIS is regarding your report about substandard vaccine against hepatitis B. (Sept 26).
It is a matter of concern when billions of rupees are being spent on running a programme. However, it is not known as to who
was the supplier and manufacturer of the vaccine. If the manufacturer was WHO/Unicef-approved, the vaccine could not be
substandard. There was a possibility of improper conditions of transportation or storage of vaccine which led to its deterioration.
What adverse effects were noticed has not been mentioned in the report.
Of many good things which the ministry of health has done, immunisation of all children under five years against hepatitis B is
an important, desirable and effective tool to curtail the morbidity of the disease.
Reports like this, though important, are likely to create an environment of mistrust amongst consumers. Such reports should
preferably be followed up so that the facts are known to the affected in its entire perspective.
May I state that an opinion was expressed in these columns in May 2001 that to have a sustainability of the programme, an
indigenous manufacture of vaccine is essential. Earlier in 1998 I had met the director of the NIH who told me that they were
very close to an agreement with a French or Chinese firm for manufacturing the vaccine locally.
This project was subsequently shelved (Dawn, May 1, 2001). On July I requested the present director of the NIH to provide
some information on this issue. All what he told me was that even when all formalities were completed, it should take minimum
of two years before any production could be made.
As stated earlier, I reiterate that to cut the overall cost of the programme and to be more self-reliant, we should urgently
consider the manufacture of vaccine indigenously.
DR KHALID HASSAN MAHMOOD Karachi
(Dawn-6, 24/10/2006)
The day my child is discharged will be Eid for me
KARACHI: With the number of suspected Dengue patients increasing by the day, what is worrisome is whether or not such
patients would be given proper attention during the Eid holiday break.
Many look forward to the day their loved one is discharged and they say that such a day will be truly a day of happiness and Eid
for them. While the rest of the city celebrates, the patients and their attendants will possibly suffer as a result of a number of
factors, primarily the absence of proper medical staff during the holidays.
Javed Bashir, a local government servant and father of three children said that his wife, who is seven month pregnant has been
admitted in Civil Hospital Karachi (CHK) for the last 3-4 days and awaits a blood transfusion but to date Javed has not been
successful in arranging for this.
He wears a sorrowful look as he explains: “She is still suffering from high fever, how can I think about Eid celebrations.” Bashir
also said: “Our celebration plans are reduced to one point at the moment ñ how soon will she get better and be discharged?”
Muhammad Sheraz, younger brother and attendant of 34-year-old Muhammad Nasir who is a patient at the same hospital, said
that his brother has been admitted in the hospital for the past one week and as a precautionary measure he has restricted his
children from visiting.
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Sheraz added that Nasir’s four children are quite young which is why only his wife would visit him on the day of Eid. He further
disclosed that Nasir is a mason by profession earning minimal wages. “Like everyone else my brother too had plans to
celebrate Eid with his entire family but his illness only added to his expenses and completely ruined his arrangements
otherwise.” He said that a single bottle of blood may cost Nasir Rs10,000. “Under these circumstances, he was caught in a fix
for he was unable to decide whether to pay for the blood and save his life or save for his family.”
Salma Bano, mother of a 16-year-old patient Muhammad Ayaz who is also at the Civil Hospital said that her husband who is a
carpenter by profession is in Gharo for his job purposes so she has to attend Ayaz in his absence. Ayaz is the eldest child of
the family. She added with worry written all over her face that her 14-year-old daughter is looking after the matters at home
while she is staying with her son at the hospital. “The day my son is discharged from here, will be Eid for me and my family,”
said the mother.
Ishaq Abdul Ghani, 25, was admitted last night. He informed this correspondent that he had plans of outing with his friends but
those are now replaced by “staring at the hospital walls” unless the hospital administration permits him to leave for Eid.
Lal Zaman, another teenage patient at the hospital comes from a lower income locality in Karachi. He said that he was planning
to visit Sea-view and Garden with the family before he was admitted at the hospital.
He further said that he was studying in class eight and for the last one week he was not feeling good and today (Monday) he
was brought to the hospital by his brothers, where he was diagnosed with Dengue fever and subsequently admitted for
treatment.
Many of the patients also feel that the Eid break is robbing them of proper medical care. Other patients complained of lack of
professionalism among the hospital staff. An attendant of one of the patients, who did not wish to be identified, said that one of
the nurses at the hospital refused to take his blood for test saying that it was “past her working hours and he would have to wait
until the next nurse took over his duty.”
He also suggested that the supply of medicine should be enhanced in the isolation ward. It was also learnt by The News that
every single medicine is purchased by the attendants of the patients and none were being provided by the ward staff. Locating
the patients in different wards is also what most complained of.
Dr Farhat, Deputy Medical Superintendent at CHK, said the staff members are trying their best to facilitate the patients but the
attendants sometimes exaggerate to gain attention from the duty staff. “It might be a case of misunderstanding from both ends
and such minor problems occur only when we face a shortage of staff, otherwise our patients are satisfied with the treatment
they are receiving,” she said.
“We are also planning to arrange a small party for the dengue patients, so they would not feel lonely. Our staff members would
bring fruits, flowers and other stuff to entertain them,” said the DMS. The purpose of such an arrangement is to ensure that the
patients do not miss their friends and family.
The 24 bed isolation ward of Civil Hospital is serving as a treatment centre for the dengue fever patients and according to the
hospital administration, they have cent per cent success rate against the disease.
Imran Naseer, elder brother of 21 years old, Rizwan Naseer said that his brother was hospitalised for almost 7 days and during
this period they were pleased with the quality service and the way they attend the patients.
He said “my brother just had high fever but the case was mishandled by a hospital situated in front of PTV station.” He was
admitted for a day in the hospital where he was fed with an anti-Malaria vaccination.
He recovered immediately and the family were delighted with the overnight result but next day were shocked that the illness
resurfaced and the improvement was temporary. “The hospital charged us huge amount for that fake treatment,” recalled Imran
Naseer.
“I my personal opinion, some liabilities should increase on doctors’ shoulder to further improve the working environment and the
administration should also take some series measure to maintain hygiene conditions on the stairs, corridors and especially at
the main entrance,” Imran suggested.
Muhammad Usman, younger brother of Mrs Amna Hanif, said that my sister was admitted in the hospital three days ago, no
treatment was given to her on first night, when she was admitted but on the next day, her check-ups were conducted
thoroughly.
“Everything was fine till today morning, last night a shift in charge doctor advised us to give Platelets (white blood cell) to our
sister as soon as possible, we arranged some bottles in exchange of eight blood bags and Rs700 per bottle but the morning
(today’s) shift in charge said right now there is no need of these bottles, Usman added.
“We are still confused, who was right and who should we listen?” Usman informed this correspondent.
The patients also said that the government should do something about unregistered blood banks.
“Last night’s experience at the blood bank was totally miserable and it happened because that blood bank has the monopoly in
the field, Usman stated angrily.
One of the attendants informed that we tried to arrange a bed in one of the largest community-based hospitals of the city but we
were asked to immediately submit Rs0.25 million but surprisingly they said that the bed would not be available before 48 hours.
At that point we finally decided to come here for treatment.
Talking with this correspondent, Dr Ghulam Mustafa Qazi, a shift in charge said that the isolation ward is only ward to serve the
dengue fever patients and both the male and female ward consist of six beds each, whereas ICU has 12 beds and one more
bed was added to the unit recently.
(By Muhammad Zeeshan Azmat, The News-3, 25/10/2006)
Asian tiger mosquito may be behind fever outbreak
KARACHI: Local health experts find a reason to worry as they feel that another virus with symptoms similar to those of dengue
fever have caused the fever outbreak after realising that more than 60 percent of the suspected Dengue fever cases failed to
prove positive.
Aedes Aegypti, the mosquito that is believed to spread dengue may not be the sole culprit for the present outbreak because
another breed of mosquito called Aedes Albopictus (the Asian tiger mosquito) is also quite abundant in Karachi and is a vector
for Chikungunya Virus or the CHIK Virus (CHIKV), a disease with symptoms similar to those of Dengue viral fever.
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Dr. Rafiq Khanani, Associate Professor of Pathology at the Sindh Medical College, said that there is enough reason for the
health circles to believe the incidence of this new kind of virus in the current epidemic as a large number of cases have not
been established as those of Dengue fever.
“Firstly, the virus typically follows the rainy season and its notorious epidemics are reported during the last quarter of the year,
while Dengue only breeds in very high temperatures, and secondly, India has received more than 1.25 million patients with
CHIKV during February up until October 2006,” he said.
The clinical manifestations of Chikungunya fever have to be distinguished from dengue fever. Co-occurrence of both fevers has
also been observed in Maharashtra state of India. In early illness, the clinical features of CHIK fever can be similar to those of
Dengue and malaria, especially in patients without joint symptoms. Its habitat is also almost the same as Aedes Aegypti’s.
Because no specific drug therapy is available, treatment of CHIK fever is supportive. Chikungunya fever is a self-limiting
condition and is not a life- threatening infection. Symptomatic treatment for mitigating pain and fever using anti-inflammatory
drugs along with rest usually suffices. Prevention is entirely dependent upon taking steps to avoid mosquito bites and
elimination of mosquito breeding sites. Special care should be provided to infected persons as mosquitoes become infected
when they bite people who are sick with Chikungunya.
While recovery from Chikungunya is the expected outcome, convalescence can be prolonged (up to a year or more), and
persistent joint pain may require analgesic (pain medication) and long-term anti-inflammatory therapy. Chloroquine is gaining
ground as a possible treatment for the symptoms associated with Chikungunya and as an anti-viral agent to combat the
Chikungunya virus.
According to scientific reports, most CHIKV infections are symptomatic. “Silent” CHIKV infections (infections without illness) do
occur; but how commonly this happens is not yet known. Human CHIKV infections include a transient, high-titered viremia
(typically detectable during the first two days of illness, ranging up to 6 days after illness onset) that is adequate to infect
feeding mosquitoes. In clinical infections, the incubation period typically is 2-4 days.
Chikungunya is characterized by sudden onset of fever, headache, malaise, arthralgias or arthritis (pain and swelling of joints)
involving the wrist, ankle, knee and small joints of the extremities, myalgias (muscular pain), and low back pain.
Some patients have prolonged fatigue lasting several weeks. The term ‘Chikungunya’ is derived from Swahili dialect which
means ‘that which bends up.’ As due to severe joint pains patient may assume a stooping posture.
Skin rash occurs in approximately half of cases. Although CHIK fever typically lasts 3-7 days and full recovery is the usual
outcome, certain patients experience persistent joint symptoms for weeks or months and occasionally years after illness onset.
Serious complications (e.g., neuro-invasive disease) are rare. Acute Chikungunya fever typically lasts a few days to a couple of
weeks. No deaths, neuro-invasive cases, or hemorrhagic cases related to CHIKV infection have been conclusively documented
in the scientific literature.
The most important differentiating features from Dengue infection is that Chikungunya is a relatively mild condition, joint
involvement is more common, reduction in platelets is less common and less marked, abdominal pain is less common and
patients do not progress to circulatory shock or coma. One attack of CHIKV infection is believed to confer life-long immunity. No
effective vaccine exists.
The CHIK fever was first recognized in epidemic form in East Africa during 1952—1953. Chikungunya virus (CHIKV) which is a
member of the genus Alphavirus, in the family Togaviridae is transmitted by the bite of infected mosquito Aedes Aegypti which
is the primary CHIKV vector in Asia, but Ae. albopictus (the Asian tiger mosquito) may also transmit the virus.
In Asia, CHIKV epidemics involve a human-mosquito cycle, with humans serving as the sole vertebrate amplifying hosts. In
Africa, sylvatic cycles involving nonhuman primates and forest-dwelling Aedes species (e.g., Ae. Furcifer) also occur.
Mosquitoes become infected when they feed on a person infected with CHIKV.
Monkeys, and possibly other wild animals, may also serve as reservoirs of the virus. Most CHIKV epidemics occur during the
tropical rainy season and abate during the dry season. Because CHIK fever epidemics are sustained by human-mosquitohuman transmission, the epidemic cycle is similar to those of Dengue.
(By Asra Pasha, The News-3, 28/10/2006)
Anti-smoking law goes up in smoke
ISLAMABAD, Oct 28: Lack of political will and awareness among public, absence of effective mechanism, loopholes in law
have stalled the efforts to enforce the anti-smoking ordinance in letter and spirit.
The much talked-about plan to strictly implement the ban on smoking in government offices, transport vehicles and other public
places is likely to be delayed as only two provinces have so far come up with strategies to enforce the most crucial healthrelated policy.
An inter-provincial meeting held on October 21 had set a deadline for Oct 28, requiring all the provincial governments to devise
a comprehensive strategy and a plan of action to implement the anti-smoking ordinance.
An official source told Dawn on Saturday that Punjab and Balochistan had submitted their plans of action to the federal
government to strictly implement the Prohibition of Smoking Ordinance 2002, but Sindh and the NWFP were yet to come up
with their respective strategies.
The sources said Punjab and Balochistan had assured the federal government that they intended to interact with all district and
town nazims in addition to arranging awareness programmes in public schools and other institutions against smoking.
Development of health education material to inform the people about the hazards of smoking is also included in the action plan.
The health officials in the provinces and Centre tend to maintain a nonchalant attitude towards such an important matter of
public interest. Therefore, the Supreme Court, on a suo motu notice of an application filed by Prof (Dr) Javed Khan, a
consultant of Aga Khan University, Karachi, has taken up the matter concerning tobacco ‘epidemic’ and violation of the antismoking law in offices, hospitals, parks, educational institutions and public transport. The next hearing in this regard would be
held on Monday.
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In his March 15 letter, Dr Khan had invited the attention of the chief justice of Pakistan towards non-implementation of the antismoking ordinance. He stated that hundreds of people had died due to different smoking-related diseases. Smoking can cause
cancers of lung, oral cavity, oesophagus, larynx, bladder, pancreas, kidney, stomach and blood.
Meanwhile, the health ministry, the source said, had already submitted a compliance report to the Supreme Court, stating that
in line with the court’s directions, the government had delegated punitive powers to provincial governments for strict
implementation of the Prohibition of Smoking Ordinance 2002.
It further stated that as per directions, a meeting of all the four chief secretaries had been called, in which the provincial
governments had made a commitment to expediting efforts to strictly implement the ordinance.
Despite promulgation of anti-smoking ordinance in 2002, the law has had a very little effect in the society which is evident from
the fact that cigarettes are still being sold at a close proximity of education institutions when Section 9 of the ordinance clamps
complete prohibition on the sale of tobacco and tobacco products, especially to minors, within 50 meters of an education
institution. At the last hearing, the apex court had stressed special attention to this particular section.
Even public transport drivers in the capital city can be seen smoking with impunity, causing inconvenience to woman
passengers sitting beside them. The law authorises the wagon drivers as well as the conductors to eject any passenger from
the vehicle for smoking.
“The Islamabad Capital Territory administration has not yet received any guidelines or orders to enforce prohibition of smoking
ordinance,” Deputy Commissioner Islamabad Chaudhry Muhammad Ali said when contacted.
At the last inter-provincial meeting, WHO Representative in Pakistan Dr Khalif Bile had informed the participants that the use of
tobacco was one of the major causes of deaths in the country, claiming over 60,000 lives annually.
On the other hand, the government reportedly earns approximately Rs38.5 billion each year from the tobacco industry alone.
The huge amount does not include the taxes that the provinces are charging on tobacco production.
The law imposed a penalty up to Rs1,000, extendible to Rs100,000 in case of second offence, for smoking in public places.
Punishment, in certain cases, also suggested three months imprisonment.
Any authorised officer like the members of the parliament, local nazim, union council councillors, drivers of the wagons, buses,
trains, cabin crew of PIA, a grade 20 or above government officer, head of institutions like hospitals or schools, colleges or
university or a police officer, not below the rank of sub- inspector, can remove any person from a public place for violating antismoking law, the ordinance said.
It may be recalled here that since the enactment of the law banning smoking at public places in 2002, it was enforced for the
first time on September 4, 2005 when Islamabad traffic police fined a public transport vehicle driver for flouting the ban.
Those accused of violating the ban on smoking at public places have to be taken to the court of a magistrate first where they
could be fined if found guilty. The involvement of courts in the matter has scared away public from filing complaints as it
involves money and time.
The ordinance should be amended further to devise a mechanism for bringing the violators to book forthwith. Smoking in public
transport should be clearly mentioned as a ‘traffic offence’, the statement said.
Total cigarette production in Pakistan is about 71 billion sticks a year, of which the legal production is approximately 77 per
cent. The remaining 23 per cent is illegal production due to which the government suffers a loss of Rs9.2 billion annually.
Another study suggests that 16 per cent children under the age of 17 years in Pakistan are habitual smokers. Fifty two per cent
of juvenile smokers are studying in colleges, while 48 per cent go to school.
(By Nasir Iqbal, Dawn-2, 29/10/2006)
Hospitals not giving VHF data
KARACHI, Oct 28: Many hospitals handling a varied number of the suspected viral haemorrhagic fever cases do not find it
obligatory upon them to report details of such cases to the Dengue Surveillance Cell (DSC) of the provincial health department.
Health circles believe that only a few health care centres in public and private sectors have been keeping the Cell informed of
the cases while several hundred others functioning in the city do handle VHF/dengue cases without providing details to the Cell.
Resultantly, they observe, the health department is unable to bring all VHF/dengue cases to its record.
There are only 15-18 hospitals which have been providing details of haemorrhagic fever patients to the DSC voluntarily on a
regular basis.
A source in the health department said that the provincial Health Minister, Syed Sardar Ahmad, wanted each and every health
care centre to report VHF/dengue cases to the DSC and there were indications that he might take some measures in this
regard shortly.
According to another source, 1,250 such cases had already been reported from October 1 to 27 and 430 of them were found
dengue positive.
When contacted, the Medical Director of Patel Hospital, Gulshan-i-Iqbal, Dr Mohammad Tufail, said that there were 18 in-house
patients at the hospital as of 1pm Saturday and all of them were tested dengue positive. Out of them, six were admitted during
the past 24 hours, he added.
In addition, we have been attending patients with high grade fever and other symptoms of dengue fever in the OPD and 15 of
them were found dengue positive in recent days. However, they were sent back to their homes after the diagnosis and
prescription process because their condition was not serious, said Dr Tufail.
As per the details given by the Sindh health department, the number of patients with suspected VHF/dengue fever swelled to
1,623 till 2pm Saturday while the number of new admissions during the past 24 hours was 39.
Additional Secretary Health Dr Abdul Majid, who is also the focal person for the Dengue Surveillance Cell, said that he could
not give the total number of in-house patients at various hospitals for the treatment of VHF/dengue as the Aga Khan University
Hospital had not provided its data till 4pm.
He said that 499 cases had so far been diagnosed as dengue positive.
Advising all health care centres to provide the Cell with information, including the patient’s name, age, area of residence and
result of the tests on a day to day basis. The Cell’s phone numbers are: 9203108 and 9204203.
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According to the DSC figures, the position of in-house patients at different hospitals in the city as of 2pm Saturday was as
follows:
Liaquat National Hospital: 21 (five new), Civil Hospital: 12 (six new), Ziauddin Hospital: 33 (eight new), Jinnah Hospital: 38 (13
new), Bismillah Taqi Hospital: nine (five new), Hamid Hospital: one, National Institute of Child Health: five, Abbasi Shaheed
Hospital: 10, Baqai Hospital: seven (one new), Zainul Abedin Hospital: three, Patel Hospital: six, Darul Shifa Hospital: five and
Chaniot General Hospital: eight.
(By Mukhtar Alam, Dawn-17, 29/10/2006)
Men and medicine
By Dr Shershah Syed
Not many of our young boys seem to be interested in medicine as a career,
and they have reasons that are not necessarily invalid
AHMED always wanted to be a doctor and used to dream that one day he would get admission to the Aga Khan Medical
College. One of his friend’s older brothers studied there. He always harboured the hope that one day he would get admission to
the prestigious institute.
Once Ahmed went there with his friend’s brother the academic environment of the institute impressed him a lot. Its library,
students’ lobby, benches and academic activities were really good, he thought. The lecture hall was shown to him where a
seminar was going on. He went to have lunch with his friend’s brother and liked the canteen. It was just like a canteen often
shown in some of the Hollywood movies. The kitchen was clean and the food was supplied in a hygienic manner. The dinning
hall was crowded but the environment was clean and pleasant.
Ahmed came to know that there’s a system at the AKU for students through which they would go to selected doctors in different
hospitals of the city for their postings. This way they are exposed to non-AKU hospital environments. Out of curiosity he asked
about the death of a medical student who had died on hostel premises. He was informed that the students who were involved in
the incident had been punished because of their carelessness and some of them were suspended for more than one year.
Ahmed’s second experience of seeing AKU doctors and students came about when his grandfather was admitted to the Aga
Khan Hospital. He was staying with him at the hospital after the grandfather had suddenly collapsed at home. He noticed that
junior and senior doctors and students were at the hospital all the time. He especially liked the junior doctors who were
performing nonstop duties and presenting cases to senior doctors, sometimes as early as 7am. He wanted to work in that
atmosphere, but he did not get admission to the AKU. He passed the entry test, had a very good interview session in front of
the interview board, but somehow his name was not there on the final list. It was a big disappointment. But he understood that
it’s not possible to give admissions to all the students. Ultimately Ahmed got admission to the Dow Medical College.
It was very easy for Ahmed to get admission to the Dow Medical College. He did not want to study there. But his parents
convinced him to go to the oldest medical college of Sindh and see how things turn out.
Ahmed started attending lectures. He was upset to see that out of 352 students in his class there were only 64 boys. He found
out that many of the bright boys from his batch did not join medical colleges. Instead they had left the country to do business, or
study law, accounts and commerce. Many a time he thought to leave the medical college and do something else, but did not.
Ahmed hated the whole system of medical education at the Dow Medical College. He felt that the majority of faculty members
had no interest in students. He was not interested in the Islami Jamiat Talba, the All Pakistan Mohajir Students Organisation or
any other students’ party. He and his friends would attend some lectures and experimental sessions in the laboratory. They
laughed at the childish experiments which were a regular feature at medical colleges. He and his friends were disappointed.
They started playing cricket, volleyball, and football most of the time on college premises and would leave college before 2pm.
There was nothing exciting in college. Outside college they were involved in many things. The only good thing at the DMC was
the Patients’ Welfare Association. He learned and enjoyed a lot working with the association.
Ahmed and his friends passed their exams and found that some of the very bad students had also passed because of their
political connection.
The worst disappointed came when they were posted for their clinical teaching to medical wards. He used to hear stories about
different professors and faculty members. He was amazed to see that wards with 40 or 50 patients had an army of doctors. A
ward usually has the same number of doctors (house officers, RMOs, and postgraduate students) and patients. Some wards
even had more doctors than patients. The teaching hospital had no record keeping system. There was no structured training
programme for house officers and postgraduate students in the majority of departments. Many wards were dirty. There was
always shortage of running water. Clean toilets were not available for most doctors. Doctors used to go to relieve themselves at
different restaurants and laboratories around the Civil Hospital, Karachi. Many professors and faculty members had airconditioned offices and clean toilets for their personnel use only.
Ahmed decided to leave college. Through the Internet he applied at different universities in the USA, the UK and Australia.
Because of his good scores in A and O level exams, he was offered a place at a university in the US.
Ahmed’s parents were very upset about his decision. They tried to persuade him not to leave medical profession. But he had
made up his mind. He did want to continue studies.
The story is different for female medical students. The majority of girl students are there just to get education or for
matchmaking. Some of them want to work part-time any way. Very few female students are ambitious compared to their male
colleagues.
Despite disagreement, Ahmed’s father supported him in financing his studies in Houston. Ahmed worked very hard there. He
was intelligent and hardworking. It is the DMC environment which had made him lazy.
Taking into consideration Ahmed’s performance in the first semester, the university allowed him to do BBA. He also took a
degree course in economics. He was lucky to have rich parents who were ready and eager to pay college fee. In three and a
half years, he did his BBA and graduation in economics.
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Ahmed applied for different jobs and soon was employed at one of the major multinational corporations. He again worked hard
as he wanted to make enough money for his further studies in the UK. He had decided to do law from the UK.
After 18 months of job, Ahmed got admission to a Law School in London with enough dollars in his account to pay for his
studies.
During his recent visit to Karachi prior to his regular classes at the Law School, Ahmed found out that all of his classmates who
were at the AKU Medical College were now working in the US after getting good scores in USMLE. A small number of his male
classmates from the DMC and the SMC were in the UK and the US. The majority of boys had finished their house jobs. Some
of them were working at private hospitals getting a salary between Rs6000 and Rs11000 per month. His classmates with FCPS
Part-I were not happy with the training they were getting at government hospitals. They were also working at different private
hospitals on a part-time basis. A very small number of the boys and girls had joined training posts at the Aga Khan Hospital, the
Liaquat National Hospital and the Sindh Institute of Urology but were not happy because of many problems they had already
faced. But at least they’re hopeful. Whereas many girls were now married to US - or UK-based Pakistani boys.
Why intelligent boys don’t go for medicine
It is clear from the admission pattern that we’ve just discussed that more girls join medical colleges than boys. It is not that girls
are brighter than boys. The fact is that brighter and hardworking boys don’t opt for medicine. Medical profession in Pakistan has
very few role models and the profession itself has lost its charm. It is not that they are afraid of hard work; it is the lack of any
system, any training programme or career structure and the total incapability of the government to understand and deal with the
problem that dissuades them from coming into this field.
Our medical colleges have produced a generation of incompetent, unethical and opportunistic doctors who have no interest in
humanity. Because of the lack of infrastructure in the country and the total lack of vision on the part of the government, things
have gone wrong.
The healthcare system and medical education in Pakistan must be improved. We need to activate our Basic Health Units, Rural
Health Centres and Taluka Hospitals. To achieve this goal, we need an army of doctors and paramedics.
(By Dr. Shershah Syed, Dawn-The Magazine-5, 29/10/2006)
64 contract VHF, 25th victim dies
KARACHI, Oct 30: One more dengue fever patient died at a private hospital here on Monday pushing up the death toll of the
viral haemorrhagic fever, including dengue fever, in the city over the past 18 weeks to 25.
According to the data provided by the Dengue Surveillance Cell of the Sindh Health department, a male patient brought from
Hyderabad expired at the Aga Khan University Hospital on Monday morning. The patient with the symptoms of mosquitoafflicted disease had been admitted to the hospital on October 18 and was tested dengue positive.
The In-charge of the Dengue Surveillance Cell (DFC), Dr Abdul Majid, said the name, age and other details of the patient could
not be known as the hospital concerned did not provide the information.
The latest fatality from VHF/dengue at the AKUH was eighth since June 14 bringing the percentage of such cases at this
hospital to 2.36. It was 3.2 per cent at the National Institute of Child Health, 2.99 per cent at the Jinnah Postgraduate Medical
Centre, 0.96 at the Civil Hospital and 0.72 at the Liaquat National Hospital.
In all, 28 patients of the suspected VHF have died in the province with three deaths occurring in the hospitals located in other
cities.
In the meantime, the total number of patients with mosquito-borne diseases reporting at various hospitals has risen to 1,801
with another 64 patients being brought to 13 government and private hospitals in the city during the past 24 hours ending at
2pm Monday, notwithstanding the fumigation drive in various towns of the city.
The patients came from PECHS, Garden, Gulshan-i-Iqbal, Nazimabad, Malir, Gulistan-i-Jauhar, F B Area, Landhi, Clifton,
Liaquatabad, New Town, Orangi, Model Colony, Buffer Zone, Firdaus Colony, Kalaboard, Memon Goth, Bihar Colony, Lyari,
Mohajir Camp, Site, Banaras, Sharea Faisal and Gadap.
A maximum of 29 fresh cases of suspected VHF was admitted to the AKUH, followed by 13 each at the LNH and JPMC. As
many as 49 patients were discharged from nine hospitals after they recovered during the past 24 hours.
The position of in-house patients at different hospitals in the city on Monday was as follows: AKU: 30 (29 new), LNH: 24 (13
new), JPMC: 40 (13 new), Ziauddin Hospital: 25 (seven new), CHK: 17 (five new), Bismillah Taqi Hospital: 11 (two new), Hamid
Hospital: 2 (both new), NICH: 4 (all new), Abbasi Shaheed Hospital: five (two new), Baqai Hospital: 14 (five new), Zainul Abedin
Hospital: two (no new), Darul Shifa, Malir: seven (four new), Patel Hospital: 11 (five new), Chiniot General Hospital: 17 (two
new) and Midcity Hospital: one (no new).
Meanwhile, a man arrived at the blood-test lab of the Sindh Services Hospital on Monday at around 2.30pm along with his 19year-old son, Abdullah, who was bleeding through his nose and had high grade fever for the last three-four days.
However, the staff at the lab told the man to bring his son next day as they had already wound up for the day.
The desperate father, a resident of Liaquatabad, begged for help apprehending that his son’s condition might turn critical if the
test was delayed. According to him, the lab staff obliged him by taking his son’s blood sample and advising him to collect the
report next day. “We have so far tested about 147 blood samples, out of which 35-40 have been found dengue positive,” one of
the staffers told Dawn.
(By Mukhtar Alam, Dawn-17, 31/10/2006)
Dengue kills one more, raising death toll to 28
KARACHI: Another patient of dengue haemorrhagic fever died on Monday at a private hospital, bringing the deaths toll to 28
since June this year.
The deceased, who hailed from Hyderabad, was admitted to the hospital on October 18. On Monday 65 new suspected viral
hemorrhagic fever patients were admitted to different hospital, bringing the number to 216, with 49 discharges the same day
after complete recovery.
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A total of 1,818 people were registered with suspected viral hemorrhagic fever during last five months, out of whom 563 were
confirmed with dengue hemorrhagic fever positive, the Dengue Surveillance Cell in charge said.
The latest breakdown of dengue patients provided by the Health Department is as follows: The Aga Khan University Hospital
has 30 patients at the moment, with 29 new admissions and 21 discharges during the past 24 hours; Liaquat National Hospital
has 24 patients including 13 new admissions and 4 were discharged; Civil Hospital Karachi has 17 in-house patients with, five
new patients were admitted and four were discharged; Ziauddin University Hospital has 25 patients with seven new admissions
while 12 were discharged; Jinnah Postgraduate Medical Center has 40 cases, 13 are new and 11 were discharged; Bismillah
Taqeee Hospital has 11 with two new patients; National Institute of Child Health has four in-house patients with four new cases
and nine were discharged; Abassi Shaheed Hospital has five cases with two new patients and six were discharged; Hamid
Medical Centre has two cases with two new patients and one was discharged; Baqai University Hospital has 14 cases with five
new admissions and none was discharged; Zainul Abidin Hospital Nazimabad has two patients and none was discharged; Patel
Hospital Gulshan-e-Iqbal has 11 patients, with five new arrivals and none was discharged; Darul Shifa Hospital has seven
patients, with four new cases and none was discharged; Chiniot Hospital has 17 patients with two new arrivals and two were
discharged; Civil Hospital Sukkur has two patients and Liaquat University Hospital Hyderabad has four patients with one new
admission and none discharged during the last 24 hours.
Sources at the Aga Khan University Hospital said that 145 patients were diagnosed to have dengue haemorrhagic fever, out of
whom three patients were diagnosed with Crimean-Congo Haemorrhagic Fever (CCHF), while in rest of the patients, the
special serological tests were either negative or the results are in pending.
Despite the doctors’ warning that another virus Chikungunya (CHIKV) may be rampant along with dengue virus for the last
many days, no arrangement for diagnostic facilities to contain the outbreak of the new virus has been made in the city as well
as at the National Institute of Health (NIH) Islamabad.
(The News-2, 31/10/2006)
NOVEMBER
Dengue: two die, 99 more admitted
KARACHI, Oct 31: As the mosquito menace persisted unabated, deaths of two dengue patients were reported amid flocking of
patients with febrile illness to city hospitals on Tuesday.
The Dengue Fever Cell of the Sindh Health department recorded an all time high, 99, fresh-admissions of patients afflicted with
mosquito-borne diseases at 12 government and private hospitals during the past 24 hours, ending at 2pm on Tuesday.
The reports about fresh admissions and increase in death toll up to 27 in the city are sure to upset the health officials who had
been maintaining that the number of cases would subside significantly by the end of October and things would settle normal in
November, said a couple of doctors at government and private hospitals.
The situation shows that still the authorities in the city government and cantonments boards need to do a lot in terms of fogging
and sanitation in the city. “Unless we eliminate the vector, the Aedes Aegypti mosquito, the dengue menace will continue to
haunt the citizens of Karachi,” said a senior doctor.
As updated by the DFC, since June as many as 30 VHF suspected or dengue fever patients, including three reported from
hospitals outside Karachi, have died. A total of 1960 patients have been admitted for treatment of VHF or dengue fever in the
province, out of which 627 were detected positive for dengue fever. The percentage of dengue positive cases on Tuesday
remained as 31.98, while a good number of in-house patients were yet to be tested for dengue fever.
The focal person for the DFC, Dr Abdul Majid, said that 233 patients were still admitted to 15 city hospitals which had been
giving details to him on a regular basis. As many as 61 patients were discharged after treatment in the past 24 hours, Dr Majid
added.
The patients whose deaths were reported to the DFC on Tuesday were identified as Mansoor Bhatti, 25, a resident of Lyari,
and Ghulam Mustafa, 16, a resident of Gulshan-i-Iqbal. Both the patients were confirmed dengue cases and had been under
treatment at the Liaquat National Hospital.
Giving details of the patients, the assistant medical director of the LNH, Dr Shaukat Ali Rajput, said that they died on Oct 28.
They were brought to hospital in a severe condition and were kept in the ICU, where they remained for two to three days, he
said.
Talking about the admissions of other dengue patients at his hospital, Dr Rajput said that they had been brought from different
parts of the city, mostly congested and marked with poor sanitation condition.
Replying to a question, he said that he understood that the dengue status was in its middle phase and it had yet to attain a
peak. “It is hoped that the dengue cases will start declining in the mid of November when the lower temperature will not prove
conducive to the breeding of the Aedes Aegypti mosquito, which carried the dengue virus,” he added.
The position of in-house patients at different hospitals in the city on Tuesday was LNH — 33 (16 new cases), Aga Khan
University Hopsital — 43 (21 new), Dr Ziauddin Hospital — 22(11), Jinnah Postgraduate Hopsital — 32 (9), Civil Hopsital
Karachi — 13(8), National Institute of Child Health — 15 (11), Baqai Hopsital — 14 (3), Abbasi Shaheed Hopsital — 4 (2),
Zainul Abedin hospital-2 (0), Patel General Hospital- 8 (2),Darul Shafa-18 (12), Chiniot General Hospital — 17(2), Bismillah
Taqi Hospital — 10 (2), Hamid Hospital — 1 and MidCity Hospital — 1.
Giving information about the dengue affected patients, an AKUH press release says that at present 43 patients are hospitalized
with suspected viral haemorrhagic fever; most of them were admitted during the last two weeks.
This reflects a sudden increase in the number of such cases and is a cause of concern, adds the press release, saying that so
far a total of 403 patients with ages ranging between 6 to 82 years were admitted at the AKUH between June 14 and Oct 31,
with viral haemorrhagic fever.
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As many as nine patients died due to the severity of the disease, while 350 recovered and were discharged. The patients
suffered from symptoms ranging from bleeding, diarrhoea, vomiting to abdominal pain, the AKUH further said.
In the meantime, a caller from Bahadur Yar Jang Society on Tuesday night claimed that his residential area as well as adjoining
societies like Al-Hamra and Overseas, situated between the Tipu Sultan and Amir Khusro roads, were awaiting fumigation or
anti-mosquito spray.
The authorities say that fumigation was being carried out religiously in all parts of the city, but he personally inquired about the
much emphasised fumigation from other residents but failed to confirm the exercise so far, the caller noted and urged the
relevant town nazim and other staff to ensure the spray at the earliest.
(By Mukhtar Alam, Dawn-17, 01/11/2006)
Dengue virus could prove more harmful next year, city council told
KARACHI: The EDO Health, City District Government Karachi (CDGK), Uttar Das Sanjanani, has warned that the Dengue virus
would be even more harmful next year and if preventive measures in this regard are not taken on time the situation would prove
fatal.
Uttardas stated this while addressing the City Council session, presided by the City Naib Nazim Nasreen Jalil here on Tuesday.
The EDO Health was called at the session to reply the queries of council members.
He warned that the data of this menace should be analyzed from January to April as the mosquito breeding starts in June and
in the temperature below 23 degrees Centigrade it is not killed.
EDO Health told the house that spray was being carried out in all the towns, however, the opposition members challenged his
claim. Later, Nasren Jalil requested the members to send their complaints in this regard, which would be addressed.
Uttar Das disclosed that so far Dengue virus has affected 25 million people all over the world. According to him, it is a domestic
mosquito that causes virus and it breeds in fresh water or in small pots of water, and that it is not a contagious disease.
The EDO said the CDGK has chalked out a three-pronged strategy to contain the situation from worsening next year, adding
the government was trying to first create awareness among the masses, as prevention is always better than cure.
According to him, the second strategy is to provide relief to the Dengue virus victims and finally carrying out fumigation turn-byturn is each town.
In the meantime, City Naib Nazim displayed a pamphlet issued by Town Nazim Usama, mentioning the preventive measures of
Dengue virus. She said two lac copies of this paper have so far been distributed in the town and asked other town Nazims to
follow suit.
Taking part in the discussion, opposition member Sheikh Mehboob-ur-Rehman said it was the responsibility of the government
to provide proper treatment to the Dengue virus victims as well as creating awareness in this regard.
Terming it a natural calamity, he said Karachi was in dire need of help at this critical time. He alleged that the CDGK was doing
nothing practical in this regard.
Opposition leader Saeed Ghani said the Health Department should be penalized for this lapse and negligence as it miserably
failed to take preventive measures. He said garbage privatization system had collapsed and the piles of garbage became a
fertile ground for mosquito breeding that played havoc with the entire city.
He asked the city government to accept its failure. Similar views were expressed by the opposition member Rafique Ahmed.
The house also offered Fateha for the Bajour seminary victims. The proceedings were later adjourned till Wednesday.
(By Fasahat Mohiuddin, The News-3, 01/11/2006)
City Council tells CDGK to play more active role:
Fumigation to check dengue
KARACHI, Nov 2: The City Council on Thursday urged the City District Government Karachi to launch a massive media
campaign to create public awareness with the help of authentic data pertaining to the haemorrhagic fever and dengue.
A resolution adopted unanimously also suggested that the campaign should be launched on scientific lines.
It stressed the need for conducting a systematic campaign against malaria, dengue and other viral diseases in every town
under the supervision and in consultation with UC nazims.
It also called for anti-malaria staff to be placed at the disposal of union councils and stressed on evolving a proper system for
the distribution of insecticides/germicides.
The resolution lauded the steps taken by the city nazim in combating the virus and condemned the statement given by the
federal health minister on the issue, describing it as “an attempt to absolve himself of the responsibilities by shifting blame on
the city government.”
The council also termed the statement of the federal government spokesman and head of the concerned department “a
deliberate act to provoke people of Karachi.”
It urged the federal government to provide the city and district governments of Sindh with necessary technical and financial
assistance to control the virus effectively.
Earlier, the council resumed the discussion on the issue of dengue spread when it reassembled on Thursday with Naib Nazim
Nasreen Jalil in the chair. A number of councillors from both sides of the divide took part in the debate.
They included Asif Siddique, Abdul Jalil, Syed Waqar Husain Shah, Saeed Ghani, Rafique Ahmed and Sheikh Mehboob
Rehman. The treasury members defended the city government’s efficiency and lauded the timely and effective measures it took
to tackle the situation arising out of the outbreak.
They said that all possible measures had been taken to provide relief to the people affected by the virus and particularly praised
the free of cost tests offered by the government.
They pointed out that besides these facilities, fumigation had been carried out in educational institutions, mosques and other
public places.
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The treasury members also urged the opposition not to resort to criticising the city government for the sake of criticism. Rather,
they advised it to extend full cooperation to the CDGK in this public welfare activity.
They emphasised the need for joint efforts to fight the haemorrhagic virus, saying that being elected representatives, it was also
their responsibility to play their due role in providing relief to their electorates.
The opposition members reciprocated the sentiments by saying that they would support any measures taken by the city
government if they were positive and in the interest of citizens.
In this context, they welcomed the city nazim’s decision about releasing fund to union councils, but complained that some town
nazims were not cooperating with the UC nazims belonging to the opposition parties with regard to the fumigation.
Before winding up the debate, Nasreen Jalil told the house that City Nazim Syed Mustafa Kamal had especially came here to
brief the house about the new strategy adopted by the city government in combating the virus.
Addressing the council, Mr Kamal announced launching of a “Neat and Clean Karachi” campaign soon and, in this regard,
sought all UC nazims’ cooperation and active participation in it.
It was his second address to City Council members in a week.
“Today, Karachi is in the grip of dengue virus and we have to prepare plans right now to protect the metropolis from an alarming
situation.”
Mr Kamal briefed the house about the virus attack, saying that it had been detected in many countries earlier but Karachi was
hit last year. He told the house that no vaccine for the virus had so far been developed. However, he added, there were only
preventive measures that could help control the outbreak.
The nazim said we could only fight dengue and other such viruses by doing better planning and putting in coordinated efforts.
He expressed his strong resolve to make the city neat and clean.
He informed the house that the strategy for fumigation campaign, launched some two months back, had now been changed.
Spelling out the new strategy, the city nazim said fumigation would be carried out in every street to strike hard on each and
every mosquito habitat in order to effectively control the outbreak.
He said that in the new system, to be supervised by him, there would be an active role for all union councils to play. The aim
should be making the fumigation campaign a complete success by running it in an effective and organised manner, he added.
He said a central pool for spray machines had been set up and these machines would be used by the administrations of the
union councils so that they could launch the fumigation in an effective manner.
“Although, the fumigation drive had been undertaken in all towns twice after the monsoon rains, it did not give the desired
results,” he acknowledged.
This prompted the city government to centralise the campaign and let the fumigation carried out by union councils in their
respective jurisdiction, he said, adding: “We will have a fleet of 50 vehicles at our disposal to carry out fumigation in an entire
town at a time.”
According to him, one machine takes 45 minutes to fumigate an assigned area and now, one machine can be used for three
hours continuously.
He hoped that the new strategy would work and the results of fumigation campaign will start showing very soon.
The city nazim also made an impassioned appeal to citizens to make the “Neat and Clean Karachi” campaign a success by
extending full cooperation to the city government and union councils in keeping their localities clean.
(By Latif Baloch, Dawn-17, 03/11/2006)
733 found dengue-positive since June
KARACHI: The number of dengue fever patients in different hospitals of the metropolis rose to 302 on Friday, out of whom 90
were newly admitted within the last 24-hours and some 63 were discharged.
As many as 733 people have been tested positive for dengue virus since June in the metropolis and some of the major public
hospital in the interiors of the province. Most of them were admitted during the last two weeks. This obviously reflects a sudden
increase in the number of such cases and is a cause of concern. So far, a total of 461 patients with ages ranging between six to
82 years were admitted at AKUH between June 14 and Nov 3, with viral haemorrhagic fever (VHF). Out of these, nine patients
expired due to severity of the disease, while 399 recovered and were discharged.
As many as 196 patients were diagnosed to have dengue haemorrhagic fever, three patients suffered from Crimean-Congo
Haemorrhagic Fever (CCHF). A total of 424 patients were received from Karachi and the rest of the patients came from
Larkana, Hyderabad, Thatta, Dadu, Saeedabad, Nawabshah, Gharo, Mirpurkhas, Sujawal, Rahim Yar Khan, Gilgit, Balochistan
and Saudi Arabia.
The Ziauddin University Hospital network (North Nazimabad, Clifton and Keamari campuses), following the directives of the
governor of Sindh and the local Ministry of Health have made the Dengue Serology IgM test free of charge for the dengue
victims.
Pakistan Medical Association (PMA) in collaboration with the Infectious Diseases Society of Pakistan, College of Family
Medicine and various hospitals of the metropolis holding aiming to spread awareness about dengue viral fever.
(The News-3, 04/11/2006)
Ibad calls for legislation to improve facilities: Health, education sectors
KARACHI, Nov 3: Sindh Governor Dr Ishratul Ibad has stressed the need for streamlining medical and education facilities in the
province in line with international standards and emphasised upon necessary legislation in this regard at the earliest so that
modern facilities could reach people without any hindrance.
In a meeting held at the Governor’s House, the authorities concerned apprised the governor about the progress achieved in this
regard so far.
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Taking stock of the federal laws and regulation, Ishratul Ibad called for carrying out required legislation at provincial level. He
pointed out that in bringing the private hospitals and medical centres at all levels into the ambit of rules and regulations under a
system would not only be in their own interest but also bring improvement in their liaison and attitude with the people.
He said that this would also help weed out non-professional activities in some hospitals and quackery.
The governor said that medical was a sacred profession and a basic need of people too and this enjoyed a significant position
in the government’s top priorities.
He said that it was also an imperative process to bring teaching and training in medical profession in commensuration with
qualitative and modern requirements and there was need to make speedy progress in this regard under a clear vision.
Dr Ibad reiterated that legislative work must be completed without any delay for the attainment of desired objectives.
The meeting was attended by Sindh Advocate General Anwar Mansoor Khan, Principal Secretary Mohammed Saleem Khan,
Law Secretary Ghulam Nabbi Shah, Health Secretary Dr Naushad Shaikh, Dr Asim Hussain, Chancellor Dr Ziauddin University,
Vice-Chancellor Dow University Prof Dr Masood Hameed and other officials.Meanwhile, a six-member delegation from the USA
called on the governor and gave presentation on water filtration technology.
The governor told the delegation that the government was determined to provide safe drinking water to every citizen in
compliance to the directive of President Musharraf.
The delegation informed the governor that the technology was first used by astronauts in space and proved to be 99.99 per
cent clean from all bacteria and viruses.
The small unit has the capacity to clean 15 Ltr/minute and each filter can clean 30,000 gallon of water before it requires a
change. The system is portable and can be mounted in a house or put on a vehicle as well.
The delegation said that the technology was successfully working in some of the African and Asian countries, because of its low
cost, cheap maintenance and compatibility.
Ishratul Ibad directed the officers concerned to submit a report on technical viability of the technology as per the local needs
within two days. He told the delegation about government’s concern for providing safe drinking water to every citizen in Sindh
without further delay.
He also briefed the delegation on the working of union councils and said he did not see any hitch in adopting the technology at
all levels if viability was proved.
BAGH IBN-I-QASIM: The governor along with City Nazim Mustafa Kamal visited Bagh Ibn-i-Qasim and Kothari Parade where
he had an appraisal about the ongoing work.
He said that the park being developed on 130 acres along the Clifton coast would be a unique gift not only for the people of
Karachi but of the whole country because of its beauty and individuality. He was informed that the park would be completed
soon.
The governor also inspected the adjoining Kothari Parade which has been renovated in harmony with its historical originality.
With the new constructions keeping in view the old architecture, it was being further expanded on the governor’s directive.
Besides, the shrine of Abdullah Shah Ghazi was also being renovated.
Ishratul Ibad said that with the completion of all these projects, it would become Pakistan’s major attractive complex.
The temple within the precinct of Bagh Ibn-i-Qasim had also been renovated.
On the occasion, the governor especially reviewed the lighting arrangements which gave a beautiful look to the park and
Kothari Parade in the night.
Dr Ishratul Ibad said that the city government worked round-the-clock and completed the park in a record time.
Appreciating the uniqueness of the lighting arrangements in the park, the governor said that with drizzling lights, this park would
be a delightful addition to the city’s humming life.
He said that special arrangements would be made for its maintenance after its completion. In this regard, he said that the nazim
was working out a programme to outsource its maintenance, which would be implemented soon after its completion.
(Dawn-18, 04/11/2006)
Seven areas identified as breeding spots: Dengue fever
ISLAMABAD, Nov 4: The government has spotted seven areas based on demographic data as a major breeding source that
contributed to the outbreak of dengue fever in Karachi though the scourge of mosquito borne fever did not spare affluent
neighbourhoods as well.
"Solid waste and junkyards of used tires, iron containers and similar throwaways were a common feature in these seven
localities, including Landhi, Korangi, Malir and Jamshed Quarters from where a majority of patients came," Federal Minister for
Health Mohammad Nasir Khan told reporters here at the Health Ministry on Saturday.
Prepared by the federal government, in collaboration with the Sindh administration, the data suggested that all kinds of water
holding containers especially those used inside homes where city water supplies are not reliable or junkyards provides ideal
breeding ground for 'Aedes Aegypti' mosquito which lives in dark and cool places, he said but appreciated Governor Sindh
Isharatul Ibad’s initiative to clean the streets of the biggest metropolitan city.
"I also intend to bring a bill before the cabinet for mandatory garbage removal as these are the main source of epidemic in
cities," the minister said.
"Though I do not want to indulge in blame game, respective municipal authorities have to realize and fulfil their responsibility of
cleaning the cities by removing garbage strewn open in our cities," he observed.
With the assistance of the WHO, the health ministry has prepared a protocol that a dengue suspects should expect to get in
hospitals while compact disc (CD) containing guidelines is being dispatched to every hospital of the country especially in the
epidemic hit areas.
The National Institute of Health (NIH) is also constantly monitoring the situation of dengue in the country through an integrated
effort by keeping all the provincial governments on board.
A sustainable six-month national strategy for the control of dengue fever and dengue haemorrhagic fever (DHF) has already
been prepared to attack the vector and create awareness about cleanliness and personal hygiene.
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Larvaciding will be introduced to kill larvae and pupae of the mosquito by using chemicals or toxins. Large permanent
containers will be identified by vector control agencies to treat with insecticides.
It also asks to keep at least three thermal fogging machines in an area having a population of one million besides pesticide
resistance monitoring by vector control agencies be done regularly.Likewise the health education campaign should focus on
improving water storage practices by creating awareness among general population, like frequently changing water held in
small containers.School-based community awareness programmes targeting children and parents to eliminate vector breeding
sites in and around home should also commence while mosques can also be used for enhancing general public awareness.
The strategy also includes case management training of care providers at both public and private sector health facilities to
enhance skills to save lives. Field staff will also be trained in vector control methodologies by expert medical entomologist
(study of insects) through a technically sound agency or institution.
WHO Representative in Pakistan Dr Khalif Bile explained that dengue mosquito was a lazy insect and could not fly more than
100 meters. This means that chances of insect bite would be removed if people maintain hygiene and cleanliness around their
houses.
WHO has also suggested the KPT to fulfil its duty of keeping its surroundings safe for the community as the international health
regulations mandates all airports and sea port management to keep adjacent locality within 400 metres clean.
Regarding statistics, Secretary Health Anwar Mehmood informed the press that as of November 4, 905 cases have been
confirmed out of a total of 2,786 suspects also showing a drop of mortality trend to 0.92 per cent from earlier 1.86 per cent after
the death of 32 people (31 in Karachi, one in Peshawar).
Out of 2,786 suspects, 74 confirm cases are from Islamabad, 73 from Rawalpindi, 17 from Punjab (Chakwal, Khushab and
Lahore), 733 from Sindh (Karachi, Hyderabad, Larkana Umer Kot and Sukker), four from NWFP (Peshawar, Abbotabad,
Khyber Agency) and four from AJK (Kotli).
(By Nasir Iqbal, Dawn-19, 05/11/2006)
What will strike Karachi next?
STANDING at the reception of a large private hospital in Clifton, one overheard a dialogue between a young educated woman
and the cool counter-clerk that revealed that even this well-equipped hospital was running short of test kits that could determine
whether a person was struck by the dreaded dengue fever. She had brought her chowkidar to ascertain whether or not he had
this dengue fever, which has hit Karachi in a manner that has made citizens ask many questions.
Even this hospital was giving its blood tests (complete picture) reports in five days instead of the normal 24 hours. In a way, a
very tiny indicator of the issues that the dengue fever has brought alive. One major question that Karachiites should be asking
is “what next?” How much can they endure? I am saying this in view of the frustrations and humiliation (to say the least) that
Karachi has been exposed to this year, now inching towards its culmination.
Look at the fact that the electricity crisis surfaced very early this year and lasted through Ramazan, and even now there isn’t
much good news for this weary city. The KESC had made it clear that power shortage would be acute and hard-hitting until
October. And that is how it has been.
I do not want to overdo the water crisis, but water shortage has remained a faithful theme when a list of deprivations and
mismanagement in town is drawn up. In fact, I know cynical and skeptical citizens contend that it is stereotyped to talk of water
shortages – and having said this, they drink more of the mineral water!
Then the monsoon rains this year – coupled with the underpasses, bypasses, and overhead bridges – gave to many parts of
the city one of its most unforgettable monsoons ever. That’s a nightmare some residential and commercial areas will never
forget. Once again the unpreparedness of the city for a crisis was underlined, and there is no point in recalling monsoon
mayhem here.
Except that this dengue fever that we battle today, (despite what Islamabad’s bureaucrats have to say) is generally believed to
be an outcome of or linked to the inability of the city to deal with the drainage issues arising out of the heavy rains.
One does not wish to focus unduly on roads that have, in the name of development, been dug up, and forgotten, all over the
city – or the poor quality of work done – and the presumably substandard road building material used. But the streets and roads
being platforms and stages for violent and sudden crime definitely need to be referred to. In fact, street crime, with all kinds of
men wielding weapons and targeting citizens for their cellphones, cars and other valuables, has been a frightening experience.
And this has been stretched to such an extent that we had the Prime Minister, Mr Shaukat Aziz, rushing to Karachi to discuss
with. He had to direct the local administration to bring down the street crime within 15 days (ending Oct 31). Until the time of
writing this column, there is no word in public of what that deadline has meant to citizens, generally speaking.
But the issue that has been the public concern is the dengue fever, and its scare, and the incessant reports of how the
authorities at various levels have (almost by trial and error) tried to cope with it. One citizen who believes that Karachi gets relief
from the torment of summer, which continued until September almost, has failed to get this respite from ordeals, never ending.
As if this wasn’t enough, look at the seasonal virus that has also hit the city, according to the General Secretary of the Pakistan
Medical Association, Karachi chapter, Dr Qaiser Sajjad (also an ENT specialist). This one is the difficult to pronounce and spell
– and is called Rhinopharyngitis. It hits the nose and the throat, and the doctor says that the symptoms of this virus are similar
to that of the dengue fever. In the case of Rhinopharyngitis, the general symptoms include fever, which sometimes turns into
very high grade fever, nasal obstruction, headaches, body aches, runny nose, sore throat and other flue-like symptoms.
Dr Qaiser Sajjad has said that “50 to 60 per cent of the patients with high grade fever at this point of time are most probably
suffering from this virus, and not the dengue virus.” He hopes that once the weather changes further and slides into winter, this
virus will disappear.
And indeed, sooner or later also will vanish the dengue fever threat and reality – both. But besides asking once again that “what
will hit Karachi next?” the question that agitates the mind is whether any lessons have been learnt from the dengue reality.
Have the people in authority learnt lessons?
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These would relate to not just issues that involve keeping the city clean and ensuring that the sewerage and rain water don’t
mix, don’t stagnate in the next monsoon, but also our hospitals will be geared to take on this sort of a medical challenge. And
that the city government will be better and quicker in organising the fumigation and spraying campaigns, which many people
refuse to believe was carried out in most localities. So they used assorted sprays insides their houses, remarked one anxious
housewife.
One also hopes that in the lessons learnt will also be those that relate to the willingness and the efficiency to share promptly the
relevant information, in public interest, of course, rather than make the citizens think that officialdom is downplaying the size of
the issue.
Even this daily carried reports that the health department was not sharing information and not disclosing the number of cases of
people struck by VHF or dengue fever. And, on the other hand, having large billboards on busy roads with congested text in
small font size focusing on the dengue fever is merely a ceremonial exercise.
The dengue fever is a grim growing issue in Karachi and most of the patients with VHF or dengue fever are in this very city. The
City Council on Thursday urged the city government to launch a ‘massive media drive’ to create awareness with the help of
authentic data pertaining to the hemorrhagic fever and dengue.
But let us return to the question that we began with: “what is going to hit us next in this city?” As a friend of mine remarked in
lighter (?) vein: “To survive in Karachi, you have to do tight rope walking!”
(By Nusrat Nasarullah, Dawn-18, 05/11/2006)
85 fresh dengue cases arrive at hospitals
KARACHI: The numbers of suspected patients with dengue virus has come to 2115 in the past five months. At the moment
there are 304 patients admitted to different hospitals of Karachi. Eighty-five were admitted during the past 24 hours, as 134
were discharged and some 866 tested positive with the virus. The death toll has risen and crossed the figure of 30.
A female patient, resident of Nazimabad, succumbed to symptoms similar to those of dengue virus fever on the night of
November 2 at the Aga khan University Hospital (AKUH). However, she never proved positive for the virus. She was brought to
the hospital on October 31.
Different hospitals in Sindh have received 2583 suspected cases of the virus in total. There are 91 new patients and the total
number of patients is 315. 139 have been recently discharged and around 800 patients have tested positive for the virus. A total
of 39 patients have died thus far.
The latest numbers of new arrivals of suspected patients at the local hospitals is: AKU 18; Liaquat National Hospital, 19; Civil
Hospital Karachi, 5; Ziauddin Hospital, 10; Jinnah Post-Graduate Medical Centre, 12; Bismillah Taqee Hospital Karachi, 5;
Abassi Shaheed Hospital Karachi, 3; Baqai Medical Centre, 1; Patel Hospital, 2; Darul Shifa Hospital, 6; Seventh Day Adventist
Hospital, 3; and Kutyana Memon Hospital, 1.
The Liaquat University Hospital in Hyderabad has three and others in Larkana, Sukkur and Umerkot have one suspected
patient each. A walk was held from the Quaid’s Mausoleum up to Nomaish Chowrangi. It was a joint effort on part of Pakistan
Medical Association, Karachi chapter, Infectious Diseases Society of Pakistan, College of Family Medicine, AKUH, Liaquat
National Hospital (LNH) and various hospitals of Karachi aiming to spread awareness about dengue virus fever and to educate
people what preventive measures could be adopted against that.
A headcount of 700-800 people was witnessed there. The participant were doctors as well as people form different walks of life.
The representative of World Health Organisation Dr. Abdul Wahid and Additional Health Secretary Captain Dr. Abdul Majid
were also present and delivered speeches expressing their views on the situation.
Other doctors who addressed the participants on the occasion included Dr. Nasim Salahuddin of LNH, Dr. Rehana from AKU,
Dr. Naseer Baloch, President PMA, Karachi, and Dr. Qaiser Sajjad, General Secretary, PMA, Karachi.
(The News-3, 05/11/2006)
Why we need to think beyond dengue
The explosive outbreak of dengue raises several important policy questions about the long term reform of the health sector
By Dr Sania Nishtar
Dengue is making headlines with widespread public attention and political response. True that dengue and its potentially lethal
complication, dengue hemorrhagic fever, should be a national public health concern. But in order to put into context, however,
we need to know that it is a disease that does not spread from person to person and therefore does not require patient isolation
and barrier nursing. Fortunately, its vector (the mosquito) will not be able to survive and breed in the forthcoming winter season.
On the other hand, many other equally serious infectious diseases (such as Multiple Drug Resistant Tuberculosis) often go
largely unnoticed by the general public and decision makers as they do not produce explosive epidemics.
Notwithstanding all this, the recent mayhem that dengue has caused and the attention that it has generated should provide an
opportunity to put systems in place to address such epidemics in the future. The dengue outbreak and the turmoil created
earlier by the expectation that SARS and Avian Flu would cross Pakistan's territorial borders, underscore some important policy
considerations for long term institutional planning in the health sector.
This article addresses these broad policy issues collectively because all these diseases -- despite their etiological differences -fall within the category of emerging and reemerging infections, for which a unified strategy can be adopted nationally. Under
this category are diseases not previously known, diseases which appear in a new location or in a new epidemic or
epidemiological pattern or outbreak of diseases previously under good control. All these pose a number of challenges:
'reemerging' infections such as dengue need to be grappled with in the absence of vaccines whereas, on the other hand,
control and prevention strategies for newly emerging infections (such as SARS and Avian flu) suffer several limitations because
researchers do not have the opportunity to formulate treatment modalities, vaccines and vector control strategies.
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Pakistan has a number of programmes aimed at controlling existing infectious diseases. these include the national programmes
on HIV/AIDS, Malaria, Tuberculosis and Hepatitis and the National Expanded Programme of Immunization. But the unexpected
emergence of new infectious diseases and the persistent threat of reemerging infections have made it clear that efforts to
control existing diseases need to be accompanied by improved capacity for 'early detection' and 'rapid response' to newly
emergent or re-emergent infections.
Configuring a programme on these lines is not straightforward by any means. Epidemics are unpredictable in time and space;
surveillance efforts are difficult to maintain; sustaining readiness for infections is costly and developing and maintaining vector
and rodent control programmes are difficult. But this is not a justification not to act since human and economic costs of these
epidemics can be enormous. The influenza pandemic, hundreds of years ago, killed millions of people and, even in this day and
age of technological advancement, one of the envisaged SARS outcome scenarios predicted the same number of deaths. The
fact that it fortunately turned out to be otherwise has little to do with man made manoeuvers! In terms of economic costs, the
memory of the economic fall out in the Far East subsequent to Avian influenza and SARS should bear testimony to the
devastation that such diseases can bring in their wake.
The case for enhancing our capacity to address this public health issue on a sustainable basis is, therefore, compelling. The
question is 'how'. It is within this context that three considerations merit careful attention.
First, there is a need to strengthen and consolidate the existing institutional arrangements and clearly define roles and
responsibilities. Currently there is fragmentation in this aspect. Policy making is as much a prerogative of the federal ministry of
health as it is of the provincial health departments -- given that health is constitutionally a provincial subject. Diagnostic and
technical human resource capabilities are supposed to exist within the Epidemic Investigation Cell and the Public Health
Laboratories Division of the National Institute of Health, which is in the federal domain. Here gaps at the resource and capacity
level exist and ambiguities about line reporting (provincial-federal vis-a-vis district-federal) have been noticed in the wake of the
dengue outbreak. Information collection and analysis functions exist at various levels; Within the realm of provincial/district
control, District Health Officers (DHOs) are responsible for locally collating and analysing information but there are serious gaps
at the district level in this respect. This information in turn relays to the central Health Management and Information System
(HMIS), which is in under the ministry of health for central analysis and action. But despite the existence of an elaborate and
potentially brilliant infrastructure to collect information, gaps still abound. For example, there is currently more than a three
month delay before information reaches from the districts to the central HMIS level which is where the analytical capability
exists. This gap can be bridged cost-effectively through the appropriate use of technology. It must be appreciated that
addressing these challenges at the resource, capacity, line responsibility and reporting levels are central to developing a
response capability to emerging and reemerging infections.
The most suitable way of approaching this issue would be to create dedicated institutional responsibility for incident
management as a public health programme priority. Then there is the question of whether this should operate as a silo
mechanism for emerging and re-emerging infections or should this be one that is configured to 'emergency response' within a
broader context. The latter was underscored during and in the aftermath of the October 8, 2005 earthquake as an important
consideration. Public health issues after the floods almost each year would also benefit from such an entity. More recently
concerns about the intentional release of infectious agents, in a deliberate attempt to frighten, harm or kill, should give
additional impetus to this effort. Within this context, several acronyms for an institutional entity have been in circulation within
the ministry of health, the Earthquake Rehabilitation and Reconstruction Authority and UNDAC (United Nations Disaster
Assessment and Coordination). It should be configured as a Health Incident Management System in Pakistan -- a system which
incorporates disaster planning within its realm with a focus on preparedness, response, and recovery. Such an institutional
entity should foster collective responsibility to complex and unique emergencies -- natural or man-made.
Such an agency will have unique normative tasks even out of the 'implementation' mode. For example, it can develop protocols
for different phases of operations in envisaged disasters and procedures for seeking assistance, locally and internationally. It
can also develop mechanisms for ensuring pharmaceutical supply flows and identify potential sources in addition to mapping
health sector infrastructure and human resource. The agency can also plan for hazardous waste disposal, inventorise public
health demands, develop plans for the provision of needed medical equipment and medical supplies and identify potential
sources. The latter can obviate shortages of the kind currently being experienced by DHOs in the field with respect to antimosquito sprays needed to contain the dengue outbreak. Moreover the agency can also ensure regular capacity building of
Communicable Disease Control Officers and Sanitary Patrol Officers on an ongoing basis.
Secondly, at a more technical level and relevant to the emergence and reemergence of infectious diseases per se is the need
to strengthen health information systems or, more specifically, infectious disease surveillance mechanisms so as to gather
evidence needed for an effective response. A lag at this level results in delayed response and increased opportunity for
epidemic spread. Effective surveillance is also particularly important in Pakistan because illnesses with similar initial
manifestations (malaria, influenza, typhoid fever, hepatitis) are common in the country.
Infectious disease surveillance is largely based on acute epidemic reporting from facility sources. Several vertical infectious
disease surveillance systems exist in Pakistan as part of the respective programmes on Polio, Tuberculosis, Malaria, HIV/AIDS.
These involve acute case detection and reporting from several sources including HMIS. The AFP/polio surveillance system in
particular taps all possible sources for information through active surveillance methods and is recognised as being effective. But
this initiative is part of the World Health Organization's global drive to eradicate polio. Other pockets of good practices also exist
in various aspects of surveillance. But, by and large, systems have minimal coordination between vertical programmes and they
usually do not tap into all sectors, thereby reflecting incompleteness. At the district level, there is limited capacity to analyze and
interpret data and utilise it for action, as already mentioned. In addition, these systems have limited capacity to confirm clinically
diagnosed cases of reportable diseases because a functional laboratory system does not exist outside of urban areas. This is
compounded by gaps in legal requirements to report notifiable diseases. On the other hand, HMIS, which serves as the state's
mechanism of collecting data, suffers from several limitations including resource constraints. HMIS does not capture data from
several government hospitals and none of the private sector facilities.
In view of these considerations, a number of gaps need to be bridged. Existing piecemeal epidemic infectious disease
surveillance activities within individual programmes should be strengthened and integrated into a comprehensive public health
surveillance system consisting of peripheral data collection arms linked to a central system. This would mean supporting HMIS,
broadening its base and enhancing data connectivity through the appropriate use of technology, which can bridge the
unacceptable time lags in data transfer. Management information systems in hospitals and private sector should be
developed/standardised and data flows to HMIS established.
In addition surveillance efforts should be backed by a legal system that mandates the notification of priority diseases and
regulates laboratory practice. In this context, a functional laboratory system for infectious disease surveillance should be
72
supported to the extent which a credible cost-effective analysis suggests. Capacity is key to surveillance efforts as ultimately
the purpose is to utilise information for decision making. This is all the more relevant in the post-devolution scenario where
health related decision making is a district prerogative. The recently launched Field Epidemiology and Laboratory Training
Program is an important step in the establishment of a surveillance capacity in the country and should be leveraged for building
capacity at various levels.
Thirdly, and more broadly again, incident management -- as other contemporary considerations in health -- highlights the need
for strengthening health systems rather than coming up with piecemeal solutions. Indeed many of the measures necessary to
address the current challenge are embedded in systems-level solutions. These depend on how the system is governed at
various levels; on how clear the federal-provincial-district roles and responsibilities are in the health sector; on how effective the
state is in harnessing the role of the private sector; on how effective and transparent administration and procurements are and
how effective they are in plugging pilferage and leakages from the system. Moreover, it depends on the capacity of the health
care providers, the health service delivery fabric of the state and its capacity to regulate the delivery of services by the private
sector. This is a long winded way of saying that new institutions can only be effective in well oiled systems. This once again
calls for the need to think strategically about a health reform in the country without which creating regulatory or legal or
institutional interventions will remain a futile exercise.
Some of these broader policy issues related to restructuring the mode of health service delivery in the country are fundamental
to addressing public health threats, which emerge from time to time. There is every reason to believe that a number of factors
will be shaping over the next decade or so the public health landscape very differently from the manner in which it is currently
configured presently. Microbial adaptation, travel, environmental changes such as global warming and changing ecosystems
have implications for spread of disease and its control. Humanitarian crises, conflict and intent-to-harm related public health
challenges are a contemporary reality and there is no guarantee that seismic activity of the kind witnessed last year will not
recur.
In this context, it is important to rely on institutional preparedness rather than ad hoc responses. There can be no argument
against capacity building for incidence management but what is more important is to also focus on systems through which it will
be delivered.
The author is the founder and president of Heartfile -- a health policy thinktank.
(The News-43, 05/11/2006)
7 children receive burn injuries
KARACHI, Nov 5: Seven children suffered burn injuries when chemical dumped on an open plot caught fire in Orangi Town on
Saturday evening, police said.
The children were playing in the dumping area close to a graveyard in Rahimshah Colony in the Mominabad police station
limits when the incident occurred. Police have arrested the driver of the dumping vehicle.
A duty officer at the police station said that the dump caught fire when, according to unconfirmed reports, someone threw a
burning matchstick it.
The children were first taken to the Madina Hospital in Orangi Town but were later shifted to the Jinnah Hospital.
However, later in the night they were referred to the National Institute of Child Health, where the have been admitted and are
undergoing treatment for burns.
The director of the NICH, Dr Afroze Ramazan, told Dawn that the seven children were brought to the NICH on Saturday night
from Orangi Town. Their condition was stable and they had suffered 10 to 20 per cent burns, mostly on the hands and legs,
except one child who suffered burn injuries on his face, Dr Ramazan said.
According to their case histories, they had suffered burns due to some industrial waste being dumped in Orangi Town, the
director remarked. Initial police investigations have revealed that the bags containing chemicals belonged to a multinational
company situated in the Site area.
Police have arrested the driver identified as Naeem who, according to the police, had dumped the chemicals in the Orangi
Town area. An FIR (667/2006) has been registered against the suspect at the Mominabad police station.
Of the injured children, six were identified as Arsalan, 10, Eid Mohammad, 9, Ibrahim, 7, Bilal, 11, Dawood, 10, and Yasir, 10.
Saturday’s incident is similar to an incident that occurred in March 2006 in Site.
At least 20 children had suffered injuries while playing in a toxic waste dump in March 2006.
Iftikhar was so badly burned that he died on April 28. A number of children had lost their legs and hands in amputation
necessitated to save their lives.
(Dawn-13, 06/11/2006)
77 dengue patients admitted
KARACHI, Nov 6: The city is still in the grip of dengue panic as another 77 people from across the city were brought to
hospitals, with the history of rash, high fever, bleeding and abdominal pain.
The death toll due to viral haemorrhagic fever or dengue fever remained unchanged at 29 in Karachi, but death of a woman
was reported to the Dengue Fever Cell of the Sindh health department from Hyderabad on Monday.
A senior official at the cell, Dr Shakil Malik said with the death of a woman of 28 at Liaquat University of Medical and Health
Science, Hyderabad, the overall number of people succumbing to the fever in the province has reached 33, as a woman of 28,
detected positive for dengue fever, died around 11.30am on Monday. Ms Sughra was admitted to the hospital on Oct 31.
The DFC data of patients suspected of VHF or dengue did not include number of fresh admissions from Ziauddin and Chiniot
hospitals as they failed to provide data to the cell. The two hospitals have been receiving dengue patients in good numbers.
With the input from two hospitals, the number of new admissions could have gone high. On Sunday the city hospitals admitted
97 new patients, said a source.
During the last 24 hours, ending 2pm on Monday, a maximum of 26 patients were admitted to Liaquat Hospital. The hospital
admitted about 677 patients of suspected VHF or dengue during the last four and a half months, out of which 128 cases were
detected dengue positive, while seven patients died.
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A maximum of eight deaths, including five those of dengue positive patients and three of VHF suspected cases occurred at Aga
Khan University Hospital since June last, followed by JPMC--seven, National Institute of Child health--three, Civil Hospital--one
and Dr Ziauddin Hospital-- two.
With the fresh arrivals of patients in 10 government and city hospitals the number of patients suspected for VHF since June,
2006 reached 2760, out of which 951 have been detected dengue positive. Thus the percentage of patients identified as
dengue positive comes to 34.45.
According to a DFC press release, patients’ positions in some city hospitals on Monday remained as follows:
AKU--28 (15 new cases), LNH--27 (26), CHK-12 (one new case), JPMC-32 (nine new cases), Bismillah Taqi Hospital-23 (three
new cases), Hamid Hospital--23 with no new case, Abbasi Shaheed-48 (6), Baqai Hospital-13 (one new case), Patel General
Hospital – eight (three new cases), Darul Shafa –15 with no fresh case, Darul Sehat – five with five new cases) and Kutiyana
Hospital --17 with two new cases.
Seeing no letup in the infestation of mosquitoes, Karachiites are now pinning hopes on the onset of winter when average day
temperature will not remain conducive for the day bitters Aedes Aegypti mosquitoes which are seen responsible for
transmissions of dengue virus.A senior citizen and medical practitioner said the ongoing fumigation or fogging drive was not
giving any up to mark relief and can be considered a psychological relief.
However, another expert was of the view that prevention programme, such as elimination of any standing water that could
serve as a breeding site helps reduce adult mosquito population and there was a need to apply pesticides for adult mosquito
control.
Talking to Dawn, Dr Ashfaq Siddiqui, a Pakistani professional having worked outside Pakistan for a longer period, said it
appeared that quarters concerned are yet to carry out a correct fumigation or fogging exercise.
They are required to aim at transmission and control of virus and preventing further breeding of mosquito while knowing their
susceptibility and quality and effectiveness of material being used, he added, saying practical aspects of fumigation also called
for a focal spray and not any unplanned operation under the demands of nazims of union councils and towns, otherwise, use of
insecticides with diesel or kerosene oil could cause harm to the environment as well.
When contacted, the in charge of fumigation of Karachi City District Government, Dr Shaukat Zaman, said a fleet of 50 vehicles
fitted with fog generators had been carrying out fumigation in the city under a new schedule, covering all union councils of two
towns in one day.
Against mosquitoes, at present the main intervention being carried out by the government is fumigation or fogging by machines
using permethrine and deltamethrine (liquid), which was purchased in routine some months back and is considered safe for the
environment and human beings.
To a question, he said fogging was being carried out on turn basis at every town with some gap of time, while the filed staff was
being supervised by union nazims and CDGK’s health supervisors.
We have started fourth round of fumigation with the strategy that at least two towns located side by side and not far distantly
are covered at least thrice in a day, he informed.
(By Mukhtar Alam, Dawn-17, 07/11/2006)
CDGK coins idea of joint fumigation
KARACHI, Nov 6: The growing number of complaints from the areas controlled by cantonment boards (CBs), DHA, KPT and
other land owning agencies has led the city government to suggest for a joint fumigation campaign irrespective of the issue of
jurisdiction across the city to effectively end the dengue menace.
However, the cantonment boards and the DHA officials insist that they have done a great deal in protecting people residing in
their localities from mosquitoes carrying dengue virus.
City Nazim Syed Mustafa Kamal said that the city government had planned to fumigate the areas outside its limits later this
week alongside the respective land owning agencies including DHA, cantonment boards, KPT etc.
“I had extended an open offer to the heads of all the land owning agencies at a recent meeting on fumigation campaign held at
the Governor’s House and got a positive response from them,” Mr Kamal told Dawn. He said that the city government and all
the towns had already fumigated the city twice while half of the towns had done it thrice.
“The remaining towns would complete the third round of fumigation in a day or two and we will be able to start fumigation drive
in the areas owned by other agencies from Wednesday or Thursday,” informed the city nazim.
Mr Kamal said that during that meeting though all the heads of other agencies and cantonment boards had consented to his
offer for a joint fumigation drive irrespective of the fact who owned which locality but a direct official response was still awaited.
The city nazim said that a large number of cases were being reported from Korangi, DHA and other localities, which did not fall
in his jurisdiction but he had in principle decided not to raise an issue of jurisdiction.
“We cannot afford to engage in the issues of jurisdiction because the problem is typical and devoid of boundaries and we all
have to tackle it with joint effort,” the nazim said.
He said that the city government’s dedicated complaint centre was receiving reports of mosquito presence from all over the city
and most of the complaints were being attended to on an emergency basis.
“We have only 34 per cent of Karachi in our control but patients of the viral haemorrhagic fever and dengue fever are being
admitted to hospitals from every locality, we cannot leave those who do not reside in our jurisdiction.”
He said that the city government had not more than five fumigation machines till early this year but now it had equipped itself
better with a total of 70 machines. He said that city government would help the cantonment boards and other land owning
agencies to tackle the crisis and protecting their residents from dengue and other threats.
He said that only a joint campaign by all the agencies could destroy the dangers of dengue and he could not turn a deaf ear to
the appeals of the people of the localities for help who live outside his limits.
Recently, at a high-level meeting chaired by Federal Health Minister Naseer A. Khan, the city government representatives had
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accused the cantonment boards, KPT and the DHA of not taking appropriate and prompt measures to protect the people of
their respective areas from dengue.
Representatives of some cantonment boards said that they were using all available resources for fumigating their respective
areas.
A spokesman for DHA said in a statement that the Clifton Cantonment Board (CCB) had enough resources; capacity and funds
to effectively launch the campaign without the help of any other agency.
He said a number of fog generators, vehicle fitted spraying pumps and fumigation machines were operating round-the-clock to
fight dengue and other deadly viruses. He said that the CCB on the instructions of the DHA administrator had launched a
fumigation campaign since August 2006 in its area of jurisdiction.
A spokesman for the Cantonment Board Karachi said it had started its vector control drive soon after monsoon rains. “All the
areas in our jurisdiction are being sprayed thrice a day. The executive officer has formed a dedicated cell for this purpose,
which has been equipped with adequate manpower and equipments. Similarly, two complaint centers have been established
which are working round-the- clock,” the spokesman informed.
(Dawn-18, 07/11/2006)
Rangers deployed at Lyari Hospital
KARACHI, Nov 6: The Rangers personnel have been deployed at the Lyari General Hospital to improve security in and around
the hospital. On the request of Sindh government, the personnel of Rangers have been posted in the hospital to check the entry
of unauthorised persons in the hospital premises.
Visitors and staff members have always blamed the entry of unauthorised persons as the key factor for disturbing the working
atmosphere in the hospital and demanded that no body should be allowed to enter the premises without a gate pass.
Taking serious note of the situation, the hospital administration brought the matter in the notice of high authorities.
During the recent visit of Sindh Health Minister Syed Sardar Ahmed to the hospital, Medical Superintendent Dr Mukhtiar
Khawaja briefed him about problems like insecurity, water shortage, defective sewerage system and slow pace of renovation
work being carried out by a government agency.
Being concerned over complaints of lawlessness, the minister approached the chief secretary for the deployment of Rangers in
and around the hospital.
The President of Lyari Labour Welfare Centre, Sher Mohammad Raees, who is also vice-president of the Patient Welfare
Society of Lyari General Hospital, appreciated the decision of the Sindh government. He said that the deployment had greatly
improved the security environment of the hospital.
In a letter addressed to the provincial health minister, Mr Raees pointed out the poor condition of medical ward due to slow
pace of repair works. He said the patients were facing a lot of problems because of broken toilets and washrooms. Other
problems he listed were lack of facilities in gynaecology ward, poor lift service and water shortage.
When contacted, Lyari General Hospital MS Mukhtiar Khawaja conceded that water shortage problem existed which called for
early solution, saying that efforts were being made to find out a permanent solution as the issue was linked with the overall
supply situation of the locality.
He said that the administration was working on a two-pronged strategy to improve the general hygienic condition and security
environment at the same time.
For this purpose, all efforts were being made to improve infrastructure of the hospital, he said and added that these objectives
could not be achieved without coordinated efforts of all concerned.
UNIT OPENED: Sindh Chief Secretary Fazalur Rehman on Monday asked the EDO (Health) to set up a dengue fever unit
coupled with dengue fever lab test facilities on emergency basis in the Lyari General Hospital.
(Dawn-18, 07/11/2006)
Dengue virus: Sindh govt, CDGK come under fire
KARACHI: The opposition’s resolution regarding dengue virus was defeated in the Sindh Assembly on Tuesday by majority
votes, as the treasury benches opposed the resolution and the session was adjourned till Wednesday morning.
The city and provincial governments came under fire in the house, with opposition members blaming that neither the Sindh
government nor the City District Government Karachi (CDGK) took preventive measures on time, while the World Health
Organisation (WHO) had informed in advance to both the governments about the spread of dengue virus after heavy rainfall.
PPP’s Shama Arif Mithani, Rafiq Engineer, Dr Mehreen Bhutto and MMA’s Hameedullah Khan and Nasrullah Shaji moved
identical resolutions separately on private members day and requested the treasury benches to support this resolution, as it
was a matter of life and death for the people.
The resolution read: “This Assembly resolves that the dengue virus is spreading very rapidly and may acquire the shape of an
epidemic, therefore, the government should take immediate steps to control the situation by arranging anti-mosquito spray
throughout Sindh.”
Minister for Women Development Dr Saeeda Malik assured the house in the absence of Health Minister Syed Sardar Ahmed
that all preventive and necessary steps have been taken to control the dengue epidemic in Karachi and other parts of the
province. She, however, added that this disease was not new and the same situation persisted in 1999 and 2005.
Winding up the debate Dr. Saeeda Malik made a differentiation between dengue virus and viral haemorrhage and said that the
virus was not new as it was already detected in 1999 and 2005.
She said that 2,797 suspected cases were reported in various hospitals of the province, of which 2,760 were reported in
Karachi alone, adding that 266 patients were admitted in the hospitals. She said 62 more such cases have recently been
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reported, adding that 96 patients have been tested positive, of whom 57 belong to Karachi. She said that 33 people have died
due to Dengue virus throughout the province, of whom 29 belong to Karachi and one each to Hyderabad and Larkana.
The house echoed with the shouts of “shame, shame” when law minister opposed the resolution, saying there was no need to
carry this resolution as the federal government has withdrawn the import and customs duty on the blood test kits, while the
Sindh government has launched awareness campaign and made arrangements for free blood testing in five major city
hospitals. Besides, the city government was carrying out spray in the entire city, particularly in affected areas.
However, the opposition did not agree with these assurances and said that these measures were not sufficient to cope with the
epidemic and warned that the situation could further aggravate if the matter was not taken up seriously.
They demanded that emergency be declared in the province to deal with this situation, and private hospitals should be bound to
help out the people at this critical juncture and provide free treatment, besides compensation be paid for those who died of the
virus, and Zakat fund be provided to all hospitals for free treatment of patients.
They said that the federal government has held the city government responsible for the epidemic, adding that the remarks of
the federal health minister were true that the cleanliness and hygienic condition in the city was not maintained.
Opposition MPA from Badin Dr Sikandar Mundrio, while expressing concern over the situation, said that as per medical
science, the affected patients of this dangerous virus need proper checks and surveillance as the health of such patients
become very weak and they become prone to catching any other disease. He said there was a dire need to mount proper
check and surveillance of such patients as their life remains in danger.
Dr Sikandar Mundrio also warned that the people might face another epidemic in May and June next year if steps were not
taken to curb the dangerous leishmenia disease, which had gripped Dadu district and adjoining areas for the last many years
and it might spread in Karachi.
However, Law Minister and MQM MPA Syed Shakir Ali accused the opposition of exploiting the issue for gaining political
mileage, saying that the government has noted the suggestions of opposition members.
Speaking on the resolution, the movers said that the Sindh government has failed to take preventive measures in controlling the
dengue virus, which has been spreading for the last six months and has acquired the form of epidemic. They said that the
people of Sindh had developed fear as the virus was rapidly spreading in the province. They said that the government’s
campaign against the dengue virus was restricted only to the TV channels, alleging that no groundwork or anti-mosquito spray
was carried out in the interior parts of the province as well as in Karachi.
Rejecting the CDGK’s claim that the spray was carried out in all 18 towns of the metropolis, they termed it a mere eyewash and
said that spray was not carried out in most of the towns.
Queues of dengue virus patients were being witnessed at the government as well as private hospitals but the government
made no proper arrangements to deal with the situation, they said. In interior Sindh 75 percent of basic health units were lying
closed, they said and demanded that mobile service should be started in interior Sindh and facilities should be provided to the
people at all district headquarter hospitals.
Former MQM minister Syed Shakir Ali described the conduct of opposition as regrettable and said that instead of extending
helping hands to ameliorate the lot of the masses, the opposition was trying to politicize the dengue issue by delivering
misleading statements at the floor of the assembly.
It would have been better if the opposition had pinpointed the mistakes of the authorities instead of criticising the Sindh and city
governments, he said and added that the government was utilizing all possible resources in a better way to deal with the
situation.
Earlier, the house again witnessed pandemonium soon after it commenced its proceedings with Speaker Syed Muzaffar
Hussain Shah in the chair. The speaker asked PPP member Rafique Engineer, who was suspended for a day, to leave the
house. Shah had suspended Rafique Engineer for one day (Tuesday) after the latter refused to listen to the repeated warning
of the chair.
After the arguments and counter arguments, PPP MPA offered apology to the house, following which the speaker converted his
suspension order into warning.
The house admitted the adjournment motion of opposition leader Nisar Ahmed Khuhro regarding Buddo and Bundal islands for
debate and the chair fixed two hours for debate on the motion on Friday.
The speaker also referred two privilege motions to the concerned committee to find out whether the privilege of the movers MMA’s Hafiz Naeem and PPP’s Sharf-un-Nisa Leghari - were breached.
(By Tahir Hasan Khan, The News-3, 08/11/2006)
Suicide & mental health
THE Pakistan Association for Mental Health will be looking into various aspects of the problem of suicide when it observes
mental health day belatedly on Sunday. PAMH has been working for decades to create awareness about mental health and
has managed to educate the public somewhat about the common disorders such as depression, schizophrenia, and personality
problems.
But suicide per se has not received the attention it should have, given its growing prevalence. Informed public awareness of this
issue is negligible.
It is strange that the dramatic increase in the incidence of suicides in Pakistan has not alerted policymakers to address this
problem concertedly. The Lawyers for Human Rights and Legal Aid, an NGO working in this field that has set up a helpline, has
reported that suicide led to 3,123 deaths in Pakistan in 2003. Experts estimate that for every suicide there are another 20 or so
cases of attempted suicides that fail. This is a worldwide trend and WHO reported that one million people killed themselves in
the year 2000, which is more than those who lost their lives on account of war or homicide. Worse still, this trend is on the rise.
Take the case of Sindh. In 1985, 105 suicide cases were recorded here. In 2003, this figure had shot up to 1,588.
The lack of understanding of this phenomenon is quite shocking. Conventional wisdom in our society holds that the appalling
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conditions prevailing in the country resulting in joblessness, lack of security, poverty, economic inequities and discordant
interpersonal relations lead to despair and a sense of hopelessness that cause people to take their life. But this is true to an
extent only. Science has now proved conclusively that suicidal tendencies in an individual are a direct result of the chemical
make-up of his brain and his inability to cope with the tension — real or imagined — he is faced with.
Psychiatrists attribute suicide to mental illnesses such as depression, schizophrenia, bipolar disorder, substance abuse and
postpartum depression. Since these are all treatable/manageable, it is a pity that they should lead to suicide. But as Prof
Haroon Ahmed, president of the PAMH, points out a difficult social, family and economic micro-environment can act as a trigger
for a person who is vulnerable. But simply providing a severely suicidal person employment may not really be enough to
preempt his suicide, just as every person who loses his job does not go and kill himself. True, it is not coincidental that the
suicide rate has increased as the conditions in the country have deteriorated. This trend indicates the rise in trigger factors.
Ideally, transforming Pakistan into a Utopia should decrease the stress the citizens face in their daily living. But that would be
like waiting for Godot. Moreover, even in perfect conditions the clinically ill who are predisposed towards suicide would still take
their own life. Hence the more pragmatic approach is to identify the people at risk and reinforce their coping mechanism.
It is this basic fact that needs to be understood by people so that they learn to recognise suicidal tendencies and are not afraid
to seek medical help. While creating this awareness it is also important that a concerted effort is made to reduce the stigma that
is attached to mental illness. The first step would be to change social attitudes because mental health professionals operate in
a socio-cultural milieu and need the community’s cooperation and understanding to provide the mentally ill the socio-medical
support they need.
Suicide, however, poses more complex problems than other disorders. For instance, the stigma is not just social. It is also
religious. This complicates matters for para suicide cases where the patient survives and needs additional support and
treatment. Condemning him as a sinner will detract from the support that is essential in testing times — suicide is a desperate
cry for help. More problematic is the legal aspect. Under the Lunacy Act of 1912 suicide/attempted suicide was treated as a
crime. Mercifully, the Mental Health Ordinance, 2001, (MHO) did away with this ridiculous approach to suicide. But with the
MHO still awaiting implementation it is not at all clear what the legal position on suicide is at present in Pakistan.
With society’s perception of suicide as a mental health problem still so ambiguous, we are now faced with the new
phenomenon of suicide bombers. Given the fact that suicide has never been glorified in our part of the world, as it was for
example in Japan where it was considered honourable to kill oneself to atone for one’s shame, suicide bombing has not been
upheld as an act of heroism. It falls in a different category altogether. The act of the suicide bomber is not directed against
himself alone. He destroys himself with the aim of inflicting maximum damage on others he perceives as his enemies.
A glance at the history of suicide bombings makes it clear that this was first used as a strategic weapon to attack the enemy in
times of war. Starting with the Knights Templars in the Crusades of the 12th century, more recently Japanese Kamikaze pilots
attacked American naval ships in the Second World War. Even closer in time have been the Tamil Tigers in Sri Lanka and the
Palestinians attacking Israelis in desperation. The suicidal attacks launched by Al Qaeda are the latest in the series.
But suicide bombings are now moving away from an act born from despair and hopelessness as the Palestinians’ suicide
attacks symbolised. The suicide bombings we witness in Iraq, Afghanistan and Pakistan today are more in the nature of acts of
vengeance and hatred than anything else. Crazed by these negative emotions, the suicide attackers are willing to go to the
extent of killing themselves — along with others.
How would one describe those who turn to extreme religiosity and freely resort to violence of the most brutal kind? It is said that
the suicide bombers have been heavily indoctrinated and brainwashed into believing that their act of self-destruction is a noble
one that will win them martyrdom and paradise. But one cannot overlook the possibility of socially and emotionally maladjusted
individuals seeking group identity in extremist organisations. Mental health professionals should study this phenomenon from a
scientific point of view and also seek to identify the factors that result in extremism of a mindless kind.
(By Zubeida Mustafa, Dawn-7, 08/11/2006)
Doctors fear outbreak of infectious diseases
KARACHI, Nov 8: Health experts fear that the city could be attacked by more terrible infectious or vector-borne diseases,
leishmaniasis in particular, in the hot weather if the health officials continued to remain idle and take no effective preventive
measures in advance.
“We have no culture of surveillance of infectious diseases or a disease reporting system which could enable us to make our
preparations in advance to cope with any possible outbreak of a dangerous disease in future,” Dr Naseem Salahuddin,
president of the Infectious Diseases Society of Pakistan (IDSP), told Dawn.
She said the authorities had never taken any preventive measures in the past and were not seemingly taking such action at
present to sense and combat with the possible outbreak of any infectious or vector-borne disease, which could send a large
size of population to the hospitals.
Many experts criticise the government’s policy of hiding facts about the incidence of dengue at initial stage. When the number
of victims of suspected viral hemorrhagic fever swelled the authorities were forced to form a surveillance committee in the
provincial health department to inform the public about figures of dengue patients at some major hospitals, she said.
“We had seen many cases of leishmaniasis in Karachi a couple of years ago and it could reemerge and many more infectious
or vector-borne diseases could attack Karachi if we continue to remain in deep slumber,” she added.
Dr Naseem Salahuddin said the Expanded Programme of Immunisation had brought great results earlier but now its functioning
had become ‘faulty and less effective’.
Dr Sikander Mendhro, a doctor by profession and a member of the Sindh Assembly belonging to the PPP, told Dawn that
leishmaniasis’ attacked Dadu district some three years ago and later years saw its spread in other districts of Sindh including
Nawabshah, Khairpur, Jacobabad, Nawabshah and Sukkur. It had mildly attacked Karachi a couple of years ago but its attack
could be more intense if preventive measures were not taken.
Leishmaniasis is a disease caused by parasites that belong to the genus Leishmania and is transmitted by the bite of certain
species of sand fly. The symptoms of leishmaniasis are skin sores which erupt weeks to months after the person affected is
bitten by sand flies. Other consequences, which can become manifest anywhere from a few months to years after infection,
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include fever, damage to the spleen and liver, and anaemia. In the medical field, leishmaniasis is one of the famous causes of a
markedly enlarged spleen, which may become larger even than the liver.
Dr Qaiser Sajjad, secretary of the Pakistan Medical Association Karachi chapter, said it was time for the government to devise
a serious strategy to effectively prevent the infectious and vector-borne diseases. He said that dengue incidence should be
dealt as a forewarning for the outbreak of other dangerous diseases.
According to a recent climate change report, hot temperatures and higher sea levels could devastate Asian economies,
displace millions of people and put millions more at risk from infectious diseases.
(Dawn-18, 09/11/2006)
VHF death toll rises to 34
KARACHI, Nov 11: Another 67 fresh patients suspected of suffering viral haemorrhagic fever were rushed to nine hospitals,
while a woman succumbed to dengue fever at a private hospital during the past 24 hours ending at 4pm on Saturday.
The dengue and VHF has killed 38 people in the province during the last five months out of which eight have been expired
since Nov 2. The total death toll in the wake of dengue in Karachi, as per Dengue Fever Cell of the Sindh health department,
came as 34.
Dr Shakeel A Mullick of the Dengue Fever Cell said that Farhana who was admitted on Oct 13 for treatment of dengue fever
died at the Aga Khan University Hospital on Friday night. Thus the number of deaths due to VHF or dengue at AKU has soared
to 12.
As updated by the DFC on Oct 31, as many as 30 VHF suspected or dengue positive cases, including 27 from Karachi, were
reported dead from all over the province, while the number of patients admitted to hospital at that time was 1960, out of which
627 were detected positive for dengue fever.
According to DFC data, in all 3,335 patients have been admitted to hospitals during the last five months, which included 3275
patients in Karachi. As such about 1375 patients were brought to hospitals in past 11 days, out of which 619 have been tested
as dengue positive, which provides enough reason for our health authorities to check the flaws in the ongoing controlling and
surveillance exercise, said health circles.
A maximum of 12 patients each were brought to the AKU and Dr Ziauddin hospitals during the past 24 hours, followed by nine
at Liaquat National Hospital, eight at Abbasi Shaheed Hospital and seven at Jinnah hospital.
The patient position at different city hospitals on Saturday remained as follows: AKU-26 (12 new), LNH-37 (9 new), CHK-10 (6),
JPMC-43 (7), ZUH-53 (12), NICH-7 (3), ASH-30 (8), Baqai-10 (Zero), Patel hospital-6 (4), Darul Shifa-10 (6), while Bismillah
Taqi, Hamid Hospital and Karachi Adventist Hospital did not report to the DFC on Saturday.
The number of dengue positive patients till Saturday came in Karachi as 1,223.
(Dawn-17, 12/11/2006)
100 suicide attempt cases come to JPMC every month
KARACHI: As Pakistan Association for Mental Health (PAMH) holds an awareness walk today (Sunday) from 90-A, Depot
Lines, at 10am and holds a seminar on “Building Awareness-Reducing Risk: Mental Illness and Suicide” at the Jinnah Medical
and Dental College, at least five cases of attempt to suicide will be reported at Karachi’s premier public sector hospital, the
Jinnah Postgraduate Medical Centre (JPMC) alone.
While existentialist writers like Albert Camus have described suicide as the “fundamental question of philosophy”, psychiatrists
attribute it largely to depression.
“Historically, the causes of suicide have been described variously. Earlier in ancient Egypt dying or committing suicide was not
differentiated because you go from one place to another with all your cherished belongings. Later, the Jewish nomadic
community prohibited suicide because loss of one life in a small community was not desirable. Later, in Christianity and Islam
the prohibition continued,” said President PAMH, Prof. S. Haroon Ahmed while talking to The News.
“In the 18th century sociologist Durkheim divided suicide into various types according to the norms of society: They were
egoistic, altruistic, anomic and fatalistic. More recently, 90 per cent of the people committing suicide were suffering from
depression or drug abuse. The confirmation came that any stress depletes certain chemicals in the brain, leading to various
stages of depression,” he said.
Elaborating, he added: “In major depression, suicide is always contemplated or even executed. So currently it is scientifically
accepted that depression due to life stress depends upon the strength and weaknesses of the individuals and their internal
biochemical mechanisms.”
Dr. Syed Ali Wasif, another leading psychiatrist, says that suicide is a preventable death, especially when it is a result of an
exploitative system of haves and have-nots.
“The World Health Organization (WHO) estimates 1,000,000 (one million) people die of suicide each year i.e. one death in
every 40 seconds,” he said. “About 450 million people worldwide are affected by mental, neurological and behavioural problems
at any time and undiagnosed and untreated mental illness along with the abuse of alcohol and drugs are associated with more
than 90 per cent of all cases of suicide, representing 1.4 per cent of the total global burden of diseases,” he said.
“It’s very strange to note that more people die by suicide each year than are killed by homicide, wars and terrorist attacks
combined and yet suicide is a preventable disease,” he added.
Dr Wasif said family history, genetics and illnesses like depression, schizophrenia and psychological factors like helplessness
and hopelessness play a vital role in suicide.
“Ten per cent of the population needs psychiatric attention and one per cent suffers from severe mental illness,” he said.
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Dr. Abdul Razzak, Medico-legal Officer at JPMC said at least five cases of attempt to suicide are reported at JPMC every day
and most of these attempts are due to domestic problems, indicating the break-up of the social fabric of society.
“We receive 100-150 cases of attempt to suicide every month and 20-30 of them succumb to death,” he said.
Sociologist Durkheim distinguished between the types of suicide according to the relation of the actor to his society. When men
become “detached from society,” when they are thrown upon their own devices and loosen the bonds that previously had tied
them to their fellow, they are prone to egoistic, or individualistic, suicide. When the normative regulations surrounding individual
conduct are relaxed and hence fail to curb and guide human propensities, men are susceptible to succumbing to anomic
suicide. He describes anomie to a state when social regulations break down, the controlling influence of society on individual
propensities is no longer effective and individuals are left to their own devices.
(By Shahid Husain, The News-5, 12/11/2006)
Delving into Niswar’s foothold
KARACHI: While it is believed that efforts by the government of Sindh have dramatically decreased the sale of various types of
Gutka and other chewable tobacco in the city, it is also maintained, on the other hand, that some varieties of tobacco have
vanished because they could not make it into the competitive market. The consumer’s choice of product is dependent on
various factors, especially when confronted with a variety of options.
One such product consumed by a large amount of people in the city is Niswar, which is a sort of tobacco that is collected from
shrubs. It resembles spinach in colour and size but the only difference being that while spinach is planted on the ground,
Niswar bushes are found above the ground level.
It was learned from a survey that the items banned by the government, particularly some imported Niswars, were actually not
being checked by the officials and their supply was discontinued by importers only after a failed response from local
consumers.
A cabin owner at Old Airport informed The News that these imported Niswars were introduced into city markets in mid
Ramazan at which time it was sold at Rs7 per pack. He said that although presented in a beautifully coloured packing, it was
not able to grab the palette of people.
During the said period, sales were negligible and it was thought that consumers might increase following Eid. However, after
that that did not happen. Shopkeepers reduced its price to Rs5, but this, too, was unable to boost sales, he added.
Similar complaints about this imported Niswar were made during a survey of old city area, where cabin owners near Urdu Bazar
confirmed that people were not using this kind of Niswar anymore. They were of the view that though it had attractive
packaging, it did not cater to the tastes of local people.
Another major reason behind the dwindling imports is that local Niswar has more variety whereas imported Niswar had limited
options. In addition, local Niswar was always available in the market while there was no certainty about future supplies of
imported Niswars.
Twenty-six year-old Muhammad Munir, hailing from Azad Kashmir, said that his relatives have been selling local Niswar for
many years now, and he has now come to Karachi to help his brother with the business.
He said that at a given time they have at least five types of Niswar available at their stall, the names of which customers are
mostly familiar with. One can easily identify their favourite Niswar owing to the fact that most of them are slightly different in
colour.
Banu, Harri, Kashmiri and Kali are names of a few common brands of Niswar with the highest quantities of sale. Niswar arrives
from Quetta in powdered form, which is then mixed with limestone. Water is also added in the preparatory process, with the
quantity determining the taste and hardness of the end product.
Abdul Wali, who has run his business for the last 30 years, informed The News that he became involved in this profession,
helping his father in the packing of Niswars, when he was just eight years old.
He said that he mostly dealt exclusively in Niswars and a makeshift set-up under the Saddar pedestrian bridge is his permanent
place for business. He explained that one kilogram of Niswar-powder could yield as many as 38 small packets, but the number
of packets differed from person to person depending on the packer.
He said that the hardest Niswar made using the powder has the least amount of water in it. Banu Niswar, the lightest in taste, is
available in solid form which differentiates it from other classes of Niswars. He also added that Harri and Kali Niswar were
mostly made in Saddar and Keamari respectively.
According to him, aniseed and cardamom are also used to give flavour to these products. Kali Niswar is a speciality of
Peshawar, powdered Harri Niswar belongs to Quetta and the slightly pasted Harri Niswar represented the Kashmiri taste.
Peppermint is also used sometimes to lighten the hardness and give some extra taste. A survey reveals that around 10 to 15
trucks bring powdered Niswar into the city. The retail price of Niswar has risen from Rs1 to Rs2 from the previous rate the basic
reason behind this being the duty amount paid by the vendors.
Muhammad Shafi said that he had been in the business for the last six years and that their shop in main Saddar, managed
along with his father, is one of the oldest dealing in this business, helping him earn around Rs.800 to 1200 per day.
These Niswars are also exported to Dubai, India, Saudi Arabia and some other Middle Eastern countries. Another interesting
fact gathered from the market was that females had their own special brand of Niswar known as Lal (Red) Niswar, which is sold
for Rs.2 and is available in smaller packaging compared to the other brands of Niswar.
(By Muhammad Zeeshan Azmat, The News-2, 14/11/2006)
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A neglected healthcare system
THIS is with reference to the report about a young woman who died from severe case of appendicitis due to a physician’s
negligence (Nov 10). It is physicians like these that have caused a breakdown in the healthcare system. As the rest of the world
moves forward, Pakistan falls further behind in improving its healthcare standards. Just as we think the system is about to be
revived, someone comes in and debases it.
All physicians, at the time of their inauguration into the medical field, take an oath to better serve and protect their patients.
Nowhere in this oath does it say that a physician can leave the patient dying on a stretcher in the hope that he/she will be alive
the following day and can be operated on then.
Physicians need to realise that a patient is not just another ‘body’ that needs to be diagnosed and possibly treated. They need
to treat and save as many lives as possible; they have to provide everyone with adequate healthcare, whether they have
Rs15,000 or nothing at the time of treatment.
A sense of humanity is deteriorating amongst physicians. If they could acquire a tiny amount of compassion and not succumb
to the avarice or power, Pakistan’s healthcare system can improve tremendously.
AMBER KALHORO, Hyderabad
(Dawn-6, 15/11/2006)
Woman dies of dengue fever, death toll hits 37
KARACHI: The Dengue Fever Cell (DFC) has confirmed the death of a woman, who died due to the dengue fever at the
Liaquat National Hospital on Tuesday. The woman was identified as Aneela Awan, 32, a resident of Malir Colony.
The total number of deaths occurring as a result of dengue virus has risen to 37, since June this year.
According to the last report received from the DFC, the total number of suspected cases reported at different public and private
hospitals of the city are 3,543.
At least 271 patients are still under treatment in different hospitals. Some 91 patients were lately admitted, while 50 were
discharged during the same time. Meanwhile, 1,250 persons were confirmed to be dengue positive.
In the interior parts of Sindh, some 3,624 suspected cases were reported till Tuesday out of which 1,299 tested positive for
dengue virus, while the death toll is 41. At least 310 patients are still in hospitals; 94 were lately hospitalised and 50 were
discharged.
The breakup of dengue fever patients at different city hospitals as provided by the health department are: Liaquat National
Hospital has 38 patients, with 9 new entries, while six were discharged and one died; Civil Hospital has 17 patients with 10
fresh cases, while two were discharged; Ziauddin Hospital (three campuses) have 49 patients, of which 17 new patients were
admitted and 11 were discharged; Jinnah Postgraduate Medical Centre has 28 dengue fever cases, with 10 new entries, while
seven were discharged; Bismillah Taqee Hospital has 15 patients with four new cases, while one was discharged; Abbasi
Shaheed Hospital has 45 patients, with 14 new ones, while two were discharged; National Institute of Child Health (NICH) has
11 patients with four fresh dengue cases, while four were discharged after treatment; Baqai Medical Centre admitted 13
patients, of which three were new cases and three were discharged; Darul Shifa Hospital has four dengue virus patients with
one fresh entry, while one was discharged; Hamid Medical Centre has one new patient, while two have been discharged after
treatment.
As per their official report, there are 25 patients at Aga Khan University Hospital (AKUH), currently hospitalised with suspected
viral haemorrhagic fever. Most of them were admitted during the last two weeks.
So far, a total of 618 patients with ages ranging between 6 and 82 years were admitted to AKUH between June 14 and
November 14, with Viral Haemorrhagic Fever. Out of these, 13 patients expired due to severity of disease, while 580 recovered
and were discharged. The patients suffered from symptoms ranging from bleeding, diarrhea and vomiting to abdominal pain.
At least 275 patients were diagnosed to have dengue fever, three patients suffered from Crimean-Congo Haemorrhagic Fever
(CCHF) during the current outbreak, while in the remaining, the special serological tests were either negative or the results are
pending. A total of 590 patients were reported from Karachi.
(The News-3, 15/11/2006)
38,000 vulnerable to HIV in city: study
KARACHI, Nov 19: The geographical mapping carried out in a pilot survey conducted by the National Aids Control Programme
along with HIV/Aids Surveillance Project reveals that an average of 38,000 of high risk people vis-à-vis HIV/Aids are present in
Karachi and the majority of them are living in Saddar Town.
The survey showed 5,078 (13.3 per cent) of the total high-risk people live in Saddar Town followed by Baldia Town 4,967
people (13 per cent) and Lyari 3,866 people (10.1 per cent).
Interestingly, Gadap Town had the lowest prevalence of HRAs (high-risk activities) with only 418 people (1.1 per cent) followed
by Gulberg (613 people; 1.6 per cent) and Korangi (635 people; 1.7 per cent).
Other towns listed in the study are:
Orangi 1,517 people; 4 per cent), Bin Qasim (2,686; 7 per cent), Gulshan (1,587; 4.2 per cent), Jamshed (3,011; 7.9 per cent),
Keamari (1,131; 3 per cent), Landhi (1,034; 2.7 per cent), Liaquatabad (1,623 4.3 per cent), Malir (744; 2.0 per cent), New
Karachi 1,146; 3 per cent), North Nazimabad (1,281; 3.4 per cent), Shah Faisal (1,276; 3.3 per cent) and SITE (2,892; 7.6 per
cent).
Besides, 2,590 high-risk people were reported in DHA which accounted for 6.8 per cent of a total of 38,097 people in Karachi.
The report said the number of high-risk people was on the rise in the city’s peripheral localities too.
It says 12,282 HRAs are injecting drug users (IDUs), 11,546 are female sex workers (FSWs), 8,582 are eunuch sex workers
(ESWs) and 5,687 are male sex workers (MSWs).
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The results of the survey showed that Lyari Town had the highest concentration of all the high-risk groups. In certain towns of
Karachi such as Baldia and Lyari, all types of sex-related activities (FSWs, MSWs and ESWs) were maximally noted. Some
overlapping also appeared between concentrations of IDUs and MSWs; higher concentrations were noted in Saddar Town.
Saddar has the maximum IDUs, 2,463, followed by Lyari (1,197), SITE (1,073), Jamshed (890) and Bin Qasim (889).
Baldia Town has the highest number of FSWs, 2,130, followed by Lyari (1,172), DHA (1,148) and SITE (1,068).
Similarly, Baldia Town has the highest numbers of ESWs (1,910) followed by Bin Qasim (846), Lyari (763) and Jamshed (694).
Saddar Town has the maximum number of MSWs with 1,340 out of a total of 5,687 followed by Lyari (734), Bin Qasim (602),
Baldia (515) and Jamshed (515).
The two high-risk groups, i.e. IDUs and FSWs were further sub-classified into home-based and street-based. It was found that
most of the IDUs in Karachi's top ranking towns were street-based, except Bin Qasim (42 per cent) and SITE town (25 per
cent).
As regards classification of FSWs in Karachi, no particular pattern could be established; Baldia Town had maximum FSWs who
were home-based, compared to those in Lyari Town who were maximally operating from the streets.
All the high-risk groups were mostly between 20-30 years. More than 40 per cent of all these groups were illiterate. FSWs
claimed to be much more frequently married (53-71 per cent) among all the high-risk groups. Between 40-70 per cent of all the
high-risk groups reported to have migrated from other cities; ESWs (66-71 per cent) and IDUs (58-66 per cent) being most
significant among all. Only one third (31 per cent) of IDUs live with their families.
It was noted that most of the high risk groups (HRGs) were poor and socially excluded, though at least more than half of them
were having normal family life; thus poverty and lack of opportunities for improving their quality of life was interwoven and
pushed them into a vicious nexus of poverty-ill health-poverty.
Though no data was collected to find out the determinants of these risky behaviors, it is obvious that there is lack of adequate
social support for reducing vulnerabilities as well as risks associated with their behaviours, the report says.
The report says: The fact still remains that they are part of the general population, having various social networks.
Interestingly, the survey could not actually pick up the aggregate number of the clients of sex workers; rough estimates would
indicate multiples of each of these sex worker. These "clients" mostly, are apparently normal individuals living in the
mainstream without any identification.
It recommended that all those town/cities or any of the major rural areas suspected to be having high risk activities be included
in the future surveillance system, on priority basis and as soon as possible.
(By Hasan Mansoor, Dawn-13, 20/11/2006)
Three more VHF deaths: 43 new cases reported in city
KARACHI, Nov 20: Three more patients of the suspected viral haemorrhagic fever (VHF) died at two hospitals bringing the
death toll since the outbreak in the city about five months back to 42.
While scores of people with mosquito-borne disease continued to report at various hospitals on Monday, the Liaquat National
Hospital confirmed two deaths and the Aga Khan University Hospital reported one during the past 24 hours ending at 2pm
Monday.
According to the data provided by the Dengue Fever Cell of the Sindh Health Department, with the three more deaths in
Karachi, the suspected VHF toll in Sindh had risen to 46 and the number of such cases reported at various hospitals in the
province was touching the mark of 4,000.
The two patients who died at Liaquat National Hospital were Sumaiya, 12, a resident of Suparco Colony, who was admitted on
November 16, and Zubaida Firoz, 52, a resident of Baloch Colony. She had expired on Saturday-Sunday night, said Dr
Tajammul Baig of the DFC.
He said that a resident of North Karachi, Roshan Ara, 53, died at the Aga Khan University Hospital late on Sunday night. She
had been admitted on November 3 with symptoms relating to VHF.
On Monday alone, 43 patients were admitted to just 10 hospitals of Karachi and another four to two hospitals of the interior
Sindh, the DFC data showed.
The city hospital received fresh cases from Nazimabad, Baldia, Jamshed, Federal B Area, North Karachi, Malir, Shah Faisal
Colony, Clifton, Saddar, Lyari, Gulshan-i-Iqbal, Gulistan-i-Jauhar, Korangi, etc., health circle said.
Meanwhile, residents of certain localities in Gulberg, Jamshed, North Karachi and Korangi towns have complained that no
fumigation or fogging had been carried out in their areas as yet. “Perhaps, the authorities are waiting for the cold wave to
eliminate Aedis Agypti mosquitoes,” some people in a locality said, referring to the mosquito species responsible for the
outbreak of viral haemorrhagic fever, including dengue.
A maximum of 10 new patients of suspected VHF were brought to the Ziauddin Hospital whereas the AKUH and LNH received
nine patients each during the past 24 hours.
An AKUH press release put the number of in-house VHF/dengue patients at 21 on Monday, stating that a total of 670 patients
had been admitted to the hospital since June this year. Fifteen of them could not survive, it said, adding that the number of
those tested dengue-positive was 640.
The position of in-house patients at other city hospitals on Monday was as follows: LNH: 67 (9 new), CHK: 7 (2 new), ZUH: 50
(10 new), JPMC: 20 (3 new), BTH: 12 (2 new), NICH: 12 (1 new), ASH: 44 (no new), Baqai Hopsital: 8 (2 new), Patel Hospital:
1 (new), Darul Shifa Hospital: 12 (3 new), Kutiyana Hospital: 5 (no new), Lyari Hospital 2 (no new) and Zainul Abedin Hospital 1
(new).
(Dawn-17, 21/11/2006)
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Dengue fever persists, 64 more in hospitals
KARACHI, Nov 22: The number of dengue fever patients in Karachi on Wednesday swelled to 4,008, which is about 76 per
cent of the total cases reported in the country so far.
According to data provided by the Dengue Fever Cell of the Sindh Health department, 64 more patients afflicted with mosquitoborne diseases were rushed to 10 government and private hospitals in the city during the past 24 hours ending at 2pm on
Wednesday.
The dengue fever has killed 46 persons, including 42 in Karachi, since June 2006, while the number of dengue-positive cases
came as 1,380 in the city. Dr Tajammul Baig of the DFC said that the new patients’ number rose to 64 in the province on
Wednesday against 50 as reported on Tuesday.
Patients were brought to city hospitals with the history of high fever, bleeding, vomiting, pains and rash from various areas,
including Bilal Colony, Shah Faisal Colony, Khokhrapar, Agrataj Colony, Gulsitan-i-Jauher, Nazimabad, Korangi, Saddar, Malir,
Baldia Town, Mauripur, Civil Lines, Chanesar Goth, Karimabad, New Town, Moosa Lane, Rashid Minhas Road and the
Defence Housing Authority.
A maximum of 21 patients were admitted to the Aga Khan University Hospital during the past 24 hours, while 14 more patients
arrived at Dr Ziauddin Hospital and 13 at the Liaquat National Hospital. As many as 208 patients are still admitted to various
city hospitals.
The in-house patients’ position in city hospitals on Wednesday remained as follows: AKU-34 (21 new patients), LNH-26 (13),
CHK-11 (6), ZUH-39 (14), JPMC-20 (3), BTH-5 (2), NICH 10 (no new patient), ASH 44 (0), Baqai Hospital 3 (2), Patel Hospital
2 (1), Darul Shifa Hopsital 6 (1), and Kutiyana Hopsital 3 (1).
In the meantime, Dr Tahir Shamsi, a consultant haematologist and transplant physician at Bismillah Taqi Institute of Health
Science, said the researchers at the institute in collaboration with the dengue branch of the Centre for Diseases Control, USA,
had found out that the prevailing dengue epidemic in Karachi was caused by serotype DEN3.
Ninety-three per cent of the samples drawn from dengue-infected patients at our institute had been confirmed as the DEN3
serotype by the USA centre, Dr Shamsi said, adding that the latest findings wuld surely help in planning to control future
epidemics.
(Dawn-17, 23/11/2006)
34 VHF patients at AKUH
KARACHI: A total of 34 patients suspected with viral haemorrhagic fever are currently hospitalised at the Aga Khan University
Hospital. The figure shows a decline in the number of such cases registered/reported during the last two weeks.
So far, a total of 703 patients with ages between six to 82 years have been admitted to AKUH from June 14 to November 22
with viral haemorrhagic fever.
Out of these, 15 patients expired due to severity of the disease, while 654 recovered and were discharged.
The patients suffered from symptoms ranging from bleeding, diarrhoea, vomiting to abdominal pain.
In all, 294 patients were diagnosed to have dengue haemorrhagic fever, three patients suffered from Crimean-Congo
haemorrhagic fever (CCHF), while in the remaining, the special serological tests were either negative or the results are yet to
be released.
A total of 671 patients were received from Karachi and the remaining patients came from Larkana, Hyderabad, Jamshoro,
Thatta, Dadu, Saeedabad, Nawabshah, Rahim Yar Khan, Gharo, Mirpurkhas, Sujawal, Gilgit, Balochistan and Saudi Arabia.
(The News-4, 23/11/2006)
Dengue patients to get payment
KARACHI, Nov 23: The Jinnah Postgraduate Medical Centre has decided to make payments to its registered dengue patients
against transfusion of platelets, said Dr Mashoor Alam, executive director of the hospital, on Thursday.
He said that in line with a recent announcement made by Federal Health Minister Mohammad Nasir Khan, the administration
had already started process for payment of platelet charges to dengue patients admitted for treatment during the past couple of
months at the JPMC.
Speaking at a press conference, the federal health minister about two weeks back had said that government would bear the
cost of platelet transfusion for patients of VHF/dengue done at federal government hospitals. He had also pledged to refund the
amount what the patients had already paid to blood banks for procurement of platelet packs after completing formalities.
Dr Alam said that as soon as the inventories were prepared in consultation with the hospital wards and blood banks, the federal
government would be approached for allocation of funds for reimbursement. He said he hoped that the process would be
finalised shortly.
Talking about the blood-cell separator service at the JPMC, the director said efforts were under way for the procurement of a
better machine and technical staff needed for making it operational and maintenance of the facility.
At present patients at the JPMC have to pay Rs7,000 to Rs8,000 to blood banks for one mega platelet pack.
In the meantime, another 40 new patients were rushed to various city hospitals in the government and private sectors. A
maximum of 15 new patients suspected to be suffering from VHF or dengue fever were admitted to the Liaquat National
Hospital.
Dr Tajammul Baig of the Dengue Fever Cell of the Sindh Health Department said that the overall number of patients afflicted
with mosquito-borne diseases, who were admitted to hospitals during the past five months or so, had reached 4,048 in Karachi
and 4,151 in the province.
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Of the 1,429 patients confirmed as dengue-positive cases, 1,381 were admitted to city hospitals. During the past 24 hours
ending at 2pm on Thursday, a total of 202 patients were still admitted at 14 hospitals.
The patients’ position at different city hospitals on Thursday was as follows: LNH 33 (15 new patients), CHK 10 (no new), ZUH30 (6), JPMC 18 (10), BTH 6 (3), NICH-9 (no new), ASH 44 (no new), BH 6 (3), Kutiyana Memon Hospital 5 (2), and Lyari
General Hospital 1 (1).
An Aga Khan University Hospital press release said that as many as 29 patients were at present hospitalised with suspect viral
haemorrhagic fever. So far, a total of 710 patients with ages ranging from 6 to 82 had been admitted to the hospital since June
14, out of which 15 patients had died due to severity of the disease, while 666 recovered and were discharged.
(Dawn-17, 24/11/2006)
Illegal organ sales
THE Supreme Court’s instructions to the attorney-general to provide information on whether there was any legislation to curb
the unlawful organ trade in the country have put the spotlight on an issue that deserves immediate attention. The organ sale
racket in Pakistan is reaching dangerous proportions as more and more poverty-stricken people offer their kidneys for sale as a
last-ditch attempt to ease the burden of poverty and debt. Since the laws of their own countries forbid trade in human organs,
many foreign renal patients come to Pakistan, where laws can be easily bypassed, for kidney transplants. Indeed, so lucrative
is the trade for doctors and the middlemen — the actual donor is paid only a fraction of the sum — that an even more nefarious
aspect of the racket is emerging: forcible extraction and by deceit where the kidney of a patient undergoing surgery is
surreptitiously removed.
With poverty acute and widespread in the country, the problem can go on unless legislation on cadaver and voluntary organ
donation is introduced to stem the tide of illegal sales. While our lawmakers mull over the passage of such legislation, it would
be a good idea for our law-enforcers to launch an investigation to identify those hospitals and arrest those doctors and
individuals engaged in such transactions. Such revelations could perhaps expedite the process of enacting a comprehensive
law to curb the trade. What is also needed is an information campaign to educate people on the health risks of kidney donation
and the lifetime medical costs to ensure that the remaining kidney is functioning properly. Without proper checks, illegal kidney
sales in Pakistan will continue, especially as those in need of transplant face problems in finding persons willing to donate one
of their kidneys to save the lives of critically ill patients.
(Dawn-7, 24/11/2006)
SEPA, CDGK to ensure proper hospital waste disposal
KARACHI, Nov 24: The Sindh Environmental Protection Agency and the City District Government of Karachi have joined hands
to check the hospitals responsible for unsafe or careless disposal of hazardous waste.
According to sources in health and environment circles, a majority of the healthcare units neither segregates infectious material
from their waste nor practice environmentally safe methods.
The solid waste management department of city government had served repeated notices to the errant hospitals and clinics
asking them to install their own facilities for safe disposal of hazardous waste or subscribe to the CDGK’s paid facility at
Mewashah to get it done.
A solid waste management official said such notices exerted no impact on the errant hospitals as the CDGK had no powers to
penalise such health institutions. Ironically, none of the hospitals controlled by the CDGK has its own incinerator, neither they
are ready to pay money to the waste management department for safe disposal of hazardous material.
“This shows how hapless we are in netting these institutions,” the official said. He said works and services department that
controls the SWMD had taken up the issue with the health department but the imbroglio was too hard to be dispersed.
The gravity of the situation forced the CDGK to get the Sindh Environmental Protection Agency along for the job. “We have
prepared notices that we will initially send to a few dozens of major hospitals including the ones being run by the CDGK and will
take on the rest later in sequence,” said the official.
The hospitals will be asked to apprise the SEPA of the practice followed by them for the scientific disposal of hazardous waste.
While no confirmed figure of hospitals and clinics functioning in the public and private sectors in the city is available, the
department maintains that only 140 healthcare units have been depositing their waste for collection, transportation and disposal
through the CDGK incineration plants at Mewashah. Only a few hospitals, including two in government sector, maintain their
own incinerators for the purpose of scientific disposal.
According to a conservative estimate, said an official, about 1,250 healthcare centres generate 12-ton waste daily. A little over
two tons is incinerated at different plants. Ten tons waste having 20 per cent infectious material is thrown into the designated or
undesignated sites elsewhere in the city.
For the safe disposal of hospital waste, CDGK’s two incinerators at Mewashah have a capacity of 10 tons per day.
The metropolis generates about 8,000 tons of municipal and about 1,000 tons of commercial/market waste. Around 40 per cent
of the combined quantity is collected and dumped at landfill sites by different agencies.
(By Hasan Mansoor, Dawn-17, 25/11/2006)
41 fresh VHF cases reported
KARACHI, Nov 25: The number of new entry suspected VHF/dengue patients reporting at various city hospitals during the past
24 hours ending at 2 pm Saturday increased slightly.
The Dengue Fever Cell of the Sindh health department recorded 41 new patients, taking to the total tally of dengue or VHF
patients to 4,121 in the city in five months. The number of dengue positive cases reached 1,396.
According to Dr Tajammul Baig of the DFC, as many as 4,226 patients of mosquito virus infection had been reported through
out the province so far, out of which 1,451 were found dengue positive.
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The patients’ position in city hospitals on Saturday remained as following:
AKU-20(2 new cases), LNH-36(2), CHK-9(3), ZUH-37, JPMC-18(6), BTH-15(3), NICH-6(2), ASH-44(No new), BH-5(2), Patel1(1), Kutiyana-8(6) and LGH-1(1).
(Dawn-17, 26/11/2006)
Hazardous waste disposal
IT IS reassuring to know that the Karachi city government is joining hands with the Sindh Environmental Protection Agency to
ensure that hospitals properly dispose of their waste. It is tragic that standards of hygiene are dismally poor at most hospitals
and that instead of trying to improve the disposal system, hospital administrations violate laws and end up contributing to
hazardous situations. This is especially true of the careless manner of used syringe disposal. According to the findings of a
survey conducted in April this year, out of 2,800 medical units in Karachi, only 130 were following proper guidelines for waste
disposal. As things stand, the CDGK runs two incinerators that can take 10 tons of waste per day but few hospitals avail of this
facility, presumably because they do not want to pay for the service. But many of the hospitals do not have their own
incinerators so hospital waste is dumped at various land-filled sites where it is often picked up and then sold by scavengers.
This is a major health hazard, especially since a lot of the disposed waste has infectious material in it. The CDGK says it has
sent several warning notices to hospitals in this regard but because it has no powers to penalise hospitals, their warnings are
often ignored. It has called in SEPA to assist them in enforcing their instructions.
Hospitals will now have to inform SEPA of how they are disposing of their waste and if it is not up to mark, one hopes that
SEPA will take action in accordance with relevant laws. The recycling of used syringes is one of the reasons behind the
increase in blood-borne diseases. Hospital staff must be made aware of their proper disposal. Those who do not follow
guidelines must be taken to task for their irresponsible conduct that puts peoples’ lives at risk.
(Dawn-7, 27/11/2006)
PMA seeks curbs on illegal organ transplants
KARACHI, Nov 27: The Pakistan Medical Association on Monday expressed concern over the flourishing business of unlawful
kidney transplant in the country.
At a press conference, PMA’s former president Dr Syed Tipu Sultan and Karachi chapter’s president Dr Naseer Ahmed Baloch
and Secretary Dr Qaiser Sajjad said approximately Rs1 billion were involved in that racket.
“Kidney market of Pakistan is attracting people even from foreign countries since there is no law banning sale of human organs
in our country and no clearances are needed from Pakistani health authorities in carrying out such illegal transplants,” Dr Sultan
said. He said that taking advantage of the situation; hundreds of Indians were also visiting Pakistan. These trip, he said, were
called kidney tourism.
“Flooding hospitals in Lahore and Rawalpindi are looking for easy way for kidney transplant, since Indian laws prohibit such
trade and transplants,” Dr Sultan said.
According to him, earlier India was leading in the organ sale business but now Pakistan had acquired the same status.
“Pakistan is the only country rather I can say the only Islamic country where absence of such laws have favoured the
commercialisation of human organs, benefiting foreign buyers and other exploiters in the private sector,” said Dr Baloch.
He said organs were being purchased from unrelated donors and 60 per cent beneficiaries were foreigners (mainly from the
Middle East and Europe).
“Poverty is the main culprit behind boost of this racket. Mostly farmers are forced to sell their kidneys cheaply, say $2,500 and
sometimes half of that amount while recipients pay $10,000-12,000. A huge chunk of money goes to the racketeers,” he said.
Dr Sajjad said that two weeks back in Punjab, a woman Nasreen Kausar with her sister, six brothers, five sisters-in-law and two
nephews sold one kidney each.
“Private hospitals, doctors and middle men (agents) are involved in this dirty business. This is purely an unethical and inhuman
activity in the name of saving life and in the name of humanity,” he said.
He said a donor needed constant follow-up checkups to keep their blood pressure and sugar under control so that the
remaining kidney remained safe. “But there is no system of post-operative checkup for donors,” he deplored
Dr Sultan said that in a developing country like Pakistan 73,000 kidneys, 22,000 livers, 20,000 hearts and 7,000 lungs were
needed for transplantation but only 1.6 per cent was available for failing organ replacement.
“In Pakistan there are 120 dialysis centers, majority of them in the private sector. There are 20 transplant centers, 19 of which
are operating on commercial basis”, he informed.
PMA Karachi praised the Supreme Court of Pakistan for its instructions given to the Attorney General of Pakistan to provide
information about the legislation to curb the unlawful organ trade in the country.
The PMA Karachi demanded that the parliament should immediately pass the bill (law for organ donation for transplantation)
which was already pending since many years so that the life of the poor people could be saved.
(Dawn-17, 28/11/2006)
Renal infections cause 10,000 deaths each year in Pakistan
ISLAMABAD, Nov 27: Over 10,000 Pakistanis die every year of renal infections caused by polluted water and some 40 per cent
beds in the country’s hospitals are occupied by patients with water-borne diseases.
This was stated by experts at a seminar on “Public-Private Partnership in Water and Sanitation: Prospects and Challenges”
organised by the Sustainable Policy Development Institute (SDPI) here on Monday.
The speakers highlighted the need for participatory public- private partnerships (PPPs) in the country’s water and sanitation
sector and sought more government investment in this sector, especially in the rural areas.
They said “Clean Drinking Water for All by 2015” was the target of a new initiative of the government, however, in reality, the
government was very far from this goal with only two-thirds of population and half of all inhabitants of rural areas having access
to clean drinking water.
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Wilfried Schlosser from Aga Khan Planning and Building Services, Pakistan, emphasised the involvement of community as a
key factor in the success of any development project. He sought the involvement of local community in the development of
water and sanitation services in the country.
He apprised the participants of Water and Sanitation Extension Programme (WASEP) of Aga Khan Planning and Building
Services, which was successfully providing water and sanitation services to the people where the government alone failed.
Capacity-building for community-based management was the key to this success, he explained. “We build the infrastructure,
ensure water quality, provide trainings, build capacity, monitor the impact and often evaluate the process under the project but
the role of local community remained vital in the whole process,” he added. Red-tape, he said, was the main obstacle to the
provision of sufficient safe drinking water and sanitation to the people of the Northern Areas.
Syed Akbar Zaidi, a development researcher, said that lack of public-private partnerships had brought about failure of the
government’s Social Action Programme (SAP) eight years ago.
(Dawn-2, 28/11/2006)
Malaria and dengue fever
WITH the spotlight on the large number of cases of dengue fever being reported from various parts of Pakistan, one tends to
forget the prevalence of an equally, if not more, lethal vector-borne disease — malaria. According to some estimates, it causes
some 50,000 deaths in the country every year. It is true that several preventive steps being prescribed to ward off dengue fever
are also applicable to curbing the spread of malaria. Sleeping under insecticide-treated nets, the use of mosquito repellents and
wearing protective clothing are all known to lessen exposure to mosquitoes, while regular fumigation of areas with stagnant
pools of water is effective in reducing their breeding potential. Ideally, then, the campaign against dengue fever should also aim
at imparting more information about malaria to drive home the point that guarding against mosquitoes prevents more than one
disease.
Unfortunately, the fact that there is less of an effort to highlight the dangers of malaria may be because it strikes mostly in rural
areas where the level of awareness is low and where there are few opportunities for information and awareness. It has been
pointed out that the rural areas report fewer cases of dengue fever than the cities. But this is because of poor surveillance
methods and the absence of labs equipped to detect the dengue virus in the afflicted areas. In order to record the relevant data
and then act on it to reduce the incidence of both malaria and dengue fever in the rural areas, the health authorities must
improve disease detection methods. Moreover, the campaign against dengue fever in the cities should be broadened to raise
the level of the health delivery system in the rural parts of the country.
(Dawn-7, 28/11/2006)
800 kidney donors to be honoured
KARACHI, Nov 29: About 800 kidney donors will be honoured at a ceremony being organised by the Sindh Institute of Urology
and Transplantation at the Sindh Governor’s House on Thursday. An SIUT spokesman said on Wednesday that the event was
being held to celebrate 20 years of successful transplantation at the institute.
Sindh Governor Dr Ishratul Ibad Khan will be the chief guest at the ceremony. It will be attended, among others, by Dr Luc Noel
of the WHO and Prof Francis Delmonico of the International Transplant Society.
VHF PATIENTS AT AKUH1: The Aga Khan University Hospital stated on Wednesday that 22 patients are currently
hospitalized with suspect viral hemorrhagic fever.
So far, a total of 750 patients with ages ranging between six and 82 years were admitted at AKUH between June 14 and Nov
29 with viral hemorrhagic fever. Of these, 15 patients expired due to severity of the disease, while 713 recovered and were
discharged. A total of 718 patients were received from Karachi.
(Dawn-17, 30/11/2006)
DECEMBER
Quality and low-cost drugs
PRESIDENT Pervez Musharraf’s appeal to the pharmaceutical companies to lower the prices of drugs will evoke a reaction
from many quarters — though not necessarily from the manufacturers to whom it is directed. Those who will take note are the
people, especially those for whom the cost of health care is increasingly beyond their reach. The fact is that the prices of drugs
are so high that in many cases an ill person is forced to make a choice between modern medicine and quackery. What is
intriguing about the president’s appeal is that it is the ministry of health that lays down the prices of most pharmaceutical
products. In fact, it is supposedly looking into many aspects of the drug trade but has not been able to check many of the evils
that afflict it today. The president’s appeal should have also covered the spurious drug manufacturers. They should also be
asked to refrain from their unholy practice which is putting the lives of millions at risk.
The fact is that simply making appeals to the drug companies to be prudent is not going to make much of a difference. There is
need to look into the factors that are contributing to the growing pharmaceutical market in the country, the pricing mechanism,
the huge profits reaped by the MNCs and the unethical practices of some of the manufacturers. It is important to adopt a
rational policy to achieve two major goals. One is to bring down the prices and the other is to improve the quality of drugs while
eliminating the market of spurious drugs altogether. The Drug Regulatory Authority that is on the cards has yet to see the light
of day. Moreover, it is not known how effective the DRA will be in securing these objectives, since its policy board is to be
heavily manned by officials of the health ministry and health departments. The ordinance, which has not been out before the
National Assembly yet, does not specify one of the functions of the DRA to be that of providing for quality drugs. All these
issues will have to be addressed if the government is serious about ensuring good and low-cost drugs for the people.
(Dawn-7, 01/12/2006)
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Girl dies for dengue fever
KARACHI: A young girl died of dengue fever at the Liaquat National Hospital (LNH), taking the death toll to 15 at the LNH over
the last two months.
Nadia, 16, a resident of Afridi Colony, expired on Wednesday as she was found to be dengue positive. She was admitted to the
hospital a couple of days back.
According to the official of the Dengue Fever Cell (DFC), 27 more patients have been admitted to different city hospitals
yesterday, while 36 were discharged. The total number of in-house patients as of Wednesday was 143, while a total of 1,406
patients were tested dengue positive during the past quarter of the year.
According to their official sources, the AKUH has 22 in-house patients currently hospitalised with suspected VHF.
So far, a total of 750 patients with ages ranging from 6 to 82 years were admitted to the AKUH between June 14 and Nov 29,
with viral haemorrhagic fever.
(The News-2, 01/12/2006)
Where do we stand on the AIDS crisis?
KARACHI: Aids in Pakistan is moving rapidly towards the ‘generalised epidemic stage’ because the problem has not been
taken seriously, according to Dr Sharaf Ali Shah, the former chairman of the Sindh Aids Control Programme.
“We were in the ‘low level epidemic’ stage from 1986, when the first case of HIV/AIDS was detected, till 2003, when the first
outbreak was detected amongst IDU (Injecting Drug Users) in Larkana. Instead of taking immediate action, we went into
national denial and wasted one whole year, which pushed the epidemic up to the ‘concentrated level’ by 2004-05,” he said,
adding, “since IDU is a highly efficient mode of HIV transmission, because the drug users share injections and syringes in
groups, there is a serious threat from the rapid spread of this epidemic among other vulnerable populations and even the
general population,” he warned.
In a candid interview with The News, Dr Sharaf Ali Shah, said that the situation of HIV/AIDS in Pakistan is very serious and
requires immediate attention. “HIV prevalence among IDUs is between 10 and 27 per cent in cities like Karachi, Faisalabad,
Quetta, Hyderabad and Sukkur and 7 per cent in other high-risk populations like sex workers and eunuchs,” he said, adding,
“this is a very dangerous picture because it will soon infect the bridging population (the clients of male and female sex workers,
truckers, etc) and then pass onto the general population (including the spouses and children of the bridging population)”, he
explained.
Dr Shah believes that the Government of Pakistan is still in denial and has failed to address the issue, which will soon become
a serious health threat that will be very difficult for a country like Pakistan to handle.
On the other hand, current chairman of Sindh Aids Control Programme, Dr Arshad Mahmood, maintains that the situation is
under control. Rejecting the claim of Dr Shah that Pakistan is facing a threat of “generalised epidemic,” Dr Mahmood believes
that the epidemic would be brought under control in the coming years. “The condition will certainly improve in the coming 5-10
years because we are targeting the bridging population which is still under control,” he said.
Dr Mahmood claims that the government has been able to identify and approach the vulnerable population, which has helped
control the disease. However he was unable to provide any statistics.
“Look, surveillance is an ongoing process, but we have targeted many high-risk groups and are creating awareness amongst
these groups, which will prevent the spread to the bridging population,” he said.
Discussing the positive role of the Sindh Aids Control Programme (SACP), Dr Mahmood said that while it is difficult to address
sex-related issues in Pakistan, they have been able to talk to religious leaders to create awareness through mosques. “We are
creating awareness through the media and any other way which we feel is effective. We have conducted many workshops and
seminars to educate the youth about the disease,” he said.
However, Dr Shah feels that such programmes are neither sufficient nor effective because they target only selected people.
“There is a need for a massive campaign — mainly through television advertisements and programmes”, he commented,
adding “our research suggests that people are still unaware about this disease. Many patients we have contacted did not know
about it till they were diagnosed and informed. Look at India; they are spending so much on educating the masses about the
disease and about the precautions”.
Dr Shah feels that the SACP has failed even to address the gravity of the disease, let alone control its spread. “The programme
has not been implemented properly so whatever little work has been done is not producing the desired results because the
threat continues to loom over our heads”, he stressed.
The reason we do not see any impact is because there are no rehabilitation centres to back up the programme either”, he
added. He rejects the optimism of Dr Mahmood that the disease is under control. “Read the statistics and tell me if it is under
control,” he challenged.
For Dr. Shah, there is an urgent need to increase people’s access to information related to HIV/AIDS prevention, provision of
services to vulnerable people to reduce their susceptibility, including treatment of sexually transmitted infections, and voluntary
counselling and testing, including the antiretroviral treatment on urgent basis to prevent generalised HIV epidemic in the
country. “There are no short cuts and no easy solutions”, he said shrugging his shoulders.
Dr Mahmood who seemed very optimistic was eager to inform that the government is planning to build rehabilitation centres
and very soon there will be visible improvements.
“We are going to make rehab centres to make the programme effective but let me assure you that the disease is under control
and we are trying to reverse it— and we will”, said the optimistic chairman of Sindh Aids Control Programme.
Some ugly facts
* An estimated 38.6 million people worldwide were living with HIV at the end of 2005, and more than 25 million people have
died of AIDS since 1981.
* National reported cases till September 30, 2005, were 3,073 (2,741 HIV symptomatic and 332 full blown AIDS cases).
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* Sindh has reported the highest number of HIV/AIDS cases in the country (1,212 cases out of which 1,109 are HIV positive
and 103 AIDS cases).
* Recent epidemiological trends suggest that perhaps Asia, particularly South Asia, will be the epicentre of the HIV epidemic.
* Blood transfusion is the most efficient mode of HIV transmission but it is the most neglected area in Pakistan. About 2 million
units of blood are transfused annually in both public and private hospitals in Pakistan but only 20 per cent of the total blood
used in transfusions is properly screened for five common pathogens, including HIV, Hepatitis B-C, Syphilis and Malaria.
Globally HIV/AIDS epidemic is divided into three levels:
* Low Level Epidemic: When HIV is not established in any high-risk group but only present in certain pockets.
* Concentrated Epidemic: When it is present in one or more high-risk population group, such as female sex workers, injecting
drug users, male homosexuality, eunuchs and where HIV prevalence is more than five per cent.
* Generalised Epidemic: When the general population gets infected and prevalence exceeds 1 per cent.
(By Husna Ali, The News-2, 01/12/2006)
36 more VHF patients admitted
KARACHI, Dec 1: Thirty-six more people afflicted by mosquito borne diseases were rushed to seven public and private
hospitals in the city during the past 24 hours, with complaints rash and fever.
According to data released by the Dengue Fever Cell (DFC) of the Sindh Health Department, there was an increase by 33 in
the number of new patients, which defied all predictions and claims of experts and health official that the number of cases
would subside significantly by the end of October and things would settle down in November.
An analysis shows that a total of 1,960 patients were admitted till October 31 in the province and the figure rose to 4,399 in the
30 days of November. The increase of about 125 per cent in the number of patients during November demanded that the issue
be given due importance.
Since June as many as 4275 VHF suspected or dengue fever patients were admitted to hospitals in Karachi, out of which 1407
were detected positive for Dengue positive.
Dr Tajammul Baig of DFC said a maximum of nine new patients were brought to Dr Ziauddin Hospital during the last 24 hours,
ending at 2pm Friday.
He said at present there were no patients at the National Institute of Child Health where 151 patients were registered as inhouse patients during the last five months.
The patient position in different hospitals of city on Friday remained as follows:
AKUH-20 (8 new), ZH-28 (nine), LNH-36 (three), JPMC-11 (four), ASH-18 (eight), PH- two (two), Kutiyana Hospital-three (two),
CHK-two(Zero), BH-three (zero) and BTH-two (zero).
Meanwhile, an AKU Hospital press release said 20 patients are currently hospitalised with suspected viral haemorrhagic fever,
which obviously reflected the decrease in the number of cases within the last two weeks.
At AKUH a total of 760 patients have been admitted between June 14 and December 1, with viral haemorrhagic fever. Of these,
15 expired due to severity of the disease, while 725 recovered and were discharged.
The press release said that 303 patients were diagnosed to have dengue fever, three suffered from Crimean-Congo fever and
in the other cases, the special serological tests were either negative or results were pending.
(Dawn-17, 02/12/2006)
Heavy metals causing deadly diseases
KARACHI: Heavy metals are causing lung cancer, hepatitis, ulcer, neuralgia (pain in neurons), diarrhoea and other diseases,
according to Dr Kaneez Fatima Shad, professor of molecular medicine and neuro-physiology at the University of Karachi.
“Studies show that Sindh’s soil is polluted with heavy metals such as cadmium, chromium, copper and nickel that contaminate
vegetables and they become a part of food chain,” she said. “If the presence of cadmium in ladyfinger is to the tune of 0.05ppm
it results in abdominal pain, neuralgia, diarrhoea and vomiting whereas 5.3ppm of chromium in spinach results in lung cancer,
hepatitis and ulcer,” she added.
“An increase in alkyl lead level leads to damage of haemoglobin system, brain damage and abdominal pain,” Prof. Shad, who
earned her PhD from the University of New South Wales, Australia, and a diploma in psychiatry from the University of
Newcastle, said.
“One of the studies showed that human bodies contain 80-100mg of copper due to overuse of copper as fungicides on crops in
Sindh,” she pointed out. “Its residues are found in human blood in more than normal limits and are a major cause of coronary
heart diseases,” she added.
“Copper, when mixed with cholesterol, results in arteriosclerosis or thickening of arteries which leads to heart attacks,” she
explained.
An international study from the United States showed that as many as 600,000 babies may suffer from permanent brain
damage due to their mothers’ exposure to mercury pollution, she said.
Her views are endorsed by a scientific study published in The Lancet medical journal recently that said millions of children
throughout the world have suffered brain damage as a result of industrial pollution. Common pollutants may be causing a “silent
pandemic” of neurodevelopment disorders by impairing the brain development of fetuses and infants, scientists said.
Potential effects of exposure to even tiny amounts of toxic chemicals include lower IQ scores and conditions such as autism,
attention deficit disorder, and cerebral palsy. More than 1,000 chemicals are known to be neurotoxic in animals, and are also
likely to be harmful to humans, especially during the vulnerable phases of development that begin during pregnancy and can
extend as late as the onset of adolescence.
Air pollution in the mega city Karachi as elsewhere in Sindh is mainly caused by fuel consumption and results in production of
carbon dioxide, carbon monoxide, unburnt hydrocarbons, oxides of nitrogen etc. The sources of carbon monoxide are
automobile exhaust whereas carbon dioxide, arsenic, and ozone are considered to be industrial pollution, Prof. Shad said.
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Other industries such as petrochemicals, fertilizers, pharmaceutical and ceramic industries are also the sources of air pollution
in Pakistan, she added.
The normal atmospheric concentration of gases in an unpolluted state which is present in the earth’s atmosphere is nitrogen 78
per cent, oxygen 21 per cent and less than one per cent of organ and other “inner gases” she said.
But if the concentration of nitrogen reaches 1-3 ppm it could be fatal, she warned.
“Toxicity depends upon the formulation and concentration of the compounds and the gases in the atmosphere. If the level of
lead in haemoglobin rises more than 0.08mg per 100ml of blood, the human becomes a victim of lead poisoning,” she said.
She said ozone — a pale blue gas — is located 150km high in the atmosphere whereas its concentration at the ground is 0.012
to 0.03 ppm by volume.
Though several atmospheric constituents such as water vapour and carbon dioxide absorbs short wavelength ultraviolet
radiation but it is the only gas in earth’s atmosphere that absorbs ultraviolet radiation up to 300 nano meter.
“1% depletion of ozone in the atmosphere produces over 20,000 skin cancer cases every year and it is a sad fact that ozone is
constantly depleting,” she said.
“The pollutants are also affecting marine life. About 80 per cent of industrial and domestic water in Karachi is discharged in the
Arabian Sea, untreated, and many creeks and coastal waters are facing eutrophication due to presence of high level of organic
pollutants,” she pointed out.
“If the dissolved oxygen is reduced below 4-5ppm, marine life is affected immensely, leading to scarcity of fish species. And a
further reduction in oxygen results in increased anaerobic bacteria which in turn causes various diseases such as typhoid,
cholera, dysentery and tuberculosis,” she cautioned.
(By Shahid Husain, The News-2, 02/12/2006)
Organ law in the offing?
FOLLOWING a ceremony held recently at the Sindh Governor House to honour kidney donors, lawmakers have once again
been making promises to enact an organ donation bill drafted more than a decade ago. In addition, the Supreme Court has also
taken an interest in the matter and has directed the attorney-general to provide information on the existence of legislation to
restrict illegal organ sales in the country. Coming together, these are positive signs that the bill might be passed soon in the
form of the Human Organs and Tissues Transplant Act. If it is, it will make a big difference to the lives of thousands of renal
patients in the country who otherwise have to put up with the tedious procedure of dialysis as they wait for a donor. The law
would provide legal cover to deceased organ donation as well as encourage voluntary donors. At the same time, it would act as
a deterrent for unscrupulous doctors and middlemen who are currently reaping huge profits from the growing organ racket in
the country. This illegal trade is driven mostly by the poverty-stricken who sell their kidneys in their attempt to escape utter
destitution.
With many Muslim governments adopting similar laws, Pakistani legislators should be able to overcome any resistance posed
by the religious lobby. However, what needs to be actively supported is a culture of voluntary donation, in life and in death.
There is a need to mobilise public opinion on the issue so that people are not averse to the idea of donating an organ after
death and family members keeping good health do not hesitate to donate a kidney to extend the lifespan of a loved one.
Without such a campaign and a regulatory law, the illegal trade will take on other nefarious aspects such as the removal of
organs by force or stealth.
(Dawn-7, 03/12/2006)
Hospitals, private clinics warned
KARACHI, Dec 2: Sindh Environment Minister Dr Saghir Ahmed on Saturday noted that private hospitals and clinics in Karachi
and interior of Sindh were acting irresponsibly by disposing of the hospital waste causing spread of hepatitis and other
infectious diseases.
He said action under environmental laws would be taken against such private hospitals and clinics if they did not make proper
arrangements for disposal of waste in accordance to rules and regulations. “It has been observed that private hospitals and
clinics throw their waste in the nearby streets and apartments creating sanitation problems,” he said sounding note of warning
to them.
“These hospitals have sufficient capacity for safe disposal of waste and I know that the city government had advised private
hospitals to install small incinerators, but so far no such arrangements have been made which show their irresponsible attitude.
Now the Sindh environment department and city government have decided to jointly monitor these hospitals and clinics and
take action against the hospitals for non-compliance of orders,” Dr Saghir said.
(Dawn-18, 03/12/2006)
HIV/AIDS
Where do we stand?
KARACHI: For the last part of The News’ World Aids Day series, Dr Sharaf Ali Shah, the ex-chairman of Sindh Aids Control
Programme, Pakistan, discloses some disturbing ground realities regarding AIDS in Pakistan in an interview with the paper in
Karachi
TN: How successful has the Sindh Aids Control Programme (SACP) been in controlling the spread of HIV/AIDS in Sindh? SAS:
The programme has been a failure because it has only been able to reach 10-20 percent of one of the infected groups —
primarily the IDUs — while the other high risk population, including female sex workers, male homosexuals, prisoners and
eunuchs, remain largely neglected. Unless the programme reaches 80 percent of the population in a group, it cannot be called
successful and unless it reaches all the high-risk population it cannot be effective.
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TN: what are the causes of failure of this programme?
SAS: Funds are not sufficient because the size of the problem is large and the resources available are too little; corruption and
lack of motivation and sincerity to genuinely address this issue. Do you see advertisements on the television? The government
is relying mainly on NGOs, which do not have the capacity to target more groups, so only a few selected groups are
approached and that too only 20-30 percent. We need more man power. There are 60,000 drug users in the country and
approximately 11,780 sex workers and to reach them we need high force. But let me clear one thing here, while we lack
sufficient funds, in some cases, the available funds are not being utilised honestly — provinces like NWFP and Balochistan
have not even started any media programme for awareness. It seems that the government is waiting for people to die before
they will take this epidemic seriously. But if such a stage came, it’s going to be a disaster.
TN: What are some of the challenges to control HIV/AIDS in Pakistan?
SAS: Vulnerable and high-risk population are difficult to approach; illegal status of prostitution; limited education; difficultly to
talk openly about sex and difficulty in allocation of resources for the prevention of HIV/AIDS while there are many other
enormous health problems in the country.
TN: Which is the most at-risk province?
SAS: Sindh is a high-risk province because Karachi is the most popular city in the country for employment. The population of
this city alone is more than 12 million. People from all over the country come here for employment and better diagnostic and
treatment facilities.
TN: What do you suggest should be done to control the spread of this epidemic?
SAS: First of all, every member of the society will have to play a part, but the government will have to provide leadership. It is
due to this lack of leadership and commitment of our politicians that we have not been able to address this issue properly. Look
at Thailand and Nigeria; they are a good model for us to follow.
They have created a Ministry for AIDS, because their leadership is committed. The government will also have to mobilise and
motivate the masses and some groups like the religious leaders will also have to be taken on board along with other stakeholders like print and electronic media to initiate an awareness campaign.
Look, everything will have to be done at a national level, because WHO and UNO won’t solve this problem. There is a need to
change behaviour towards this disease. Let me tell you that even health care professionals have discriminatory behaviour
towards HIV patients.
We have received many complaints that health care professionals refuse to attend patients. While Pakistan is a signatory of the
UN Human Rights Charter, there are no laws in the country to control discrimination against AIDS patients — there is a need to
lobby for such a law.
Mode of Transmission of HIV Positive Cases in Pakistan up to September 30, 2005
Mode of transmission HIV Percentage
Heterosexual
Homosexual/Bisexual
Blood Transfusion
Injecting Drug Users
Mother to Child
Unknown
991 36.72
69 2.52
318 11.60
596 21.74
39 1.42
728 26.56
Total
2741 100
(By Husna Ali, The News-4, 03/12/2006)
Mother-child mortality rate still high
ISLAMABAD, Dec 5: Mother-child mortality rate has seen no reduction during the last four years indicating that maternity health
care has made no improvement.
Since 2002, according to the Economic Survey, the ratio of maternal mortality rate (MMR) is constant at 350 to 400 deaths per
100,000 live births, whereas the infant mortality rate (IMR) is 82-83 per 1,000 births and the death rate among children under
five is 103 per 1,000 live births. For the Millennium Development Goals, Pakistan is obligated to achieve MMR by 140 per
100,000 live births and IMR to 40 per 1,000 births by the year 2015.
“A mother dies of pregnancy related problems after every 20 minutes in the country at the time of giving birth, or forever
become burden on the family due to long term diseases,” Project Director Women Health Programme (WHP) Shaheen Masood
told reporters here on Tuesday.
Lack of timely obstetrics facilities or unskilled birth attendant are the main culprits for these alarming deaths among mothers,
Mrs Masood explained adding Pakistan ranked second after Afghanistan where the situation of MMR and IMR too was not so
encouraging. The other two countries facing identical conditions like Pakistan are the war-ravaged Iraq and Rwanda.
Severe bleeding during pregnancy, infections, anaemia and heart conditions and obstructed labour are also one of the causes
for the high maternal death while wide disparity between rural and urban population, income groups, lack of education, poor
means of communication and demographic factors also features significantly. About half of the women population in the
country, Mrs Masood said, was either malnourished or anaemic besides the untimely death or disability of a woman, a tragedy
in itself, adversely affects the health of her children, household productivity and the national economy, in turn aggravating
poverty.
More than 80 per cent of the deliveries in the country are conducted at home by birth attendants, while emergency obstetric
care is not available to most women especially in the rural areas. Poor health of mothers and lack of health care also have a
negative effect on the health of newborns as about 25 per cent of them are born with low weight. To reduce MMR and IMR by
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improving access to quality of health services, the government had conceived the WHP under social action programme with the
assistance of the Asian Development Bank involving a total cost of $62 million, Mrs Masood said. The project was planned to
be implemented in 20 selected districts, eight in the Punjab and four each in rest of the three provinces.
WHP’s contribution for improvement of women, girls and children could be assessed from the fact that at the federal level the
project recruited 8,000 lady health workers (LHWs) and provided support to the ongoing reproductive health related research
activities at the National Institute of Health (NIH), she said.
The programme was also instrumental in strengthening the recently established Pims Satellite Hospital with top of the line
equipment for mother and child health worth Rs73 million. It also strengthened the existing health facilities at the Rural Health
Centres (RHCs) of the Islamabad Capital Territory (ICT) and the Federal Government Services Hospital (FGSH).
WHP also identified issues hampering quality of nursing care and recommended a comprehensive framework to the
government for improvement for this sector. Moreover, the project arranged permanent campus for the Pakistan Nursing
Council (PNC), a regulatory body for nursing, and strengthened nursing training institutions through supply of latest referral
material and equipments. WHP is also arranging a seminar on women’s issues on Thursday here at a local hotel to bring focus
on those diseases which though common among women and crucial to their health have remained neglected.
Renowned medical experts from the leading hospitals of Rawalpindi and Islamabad will be presenting papers on wide range of
problems including palpitations in women, thalassaemia, rheumatic heart fever, postpartum, hemorrahages, infertility, nonobstetric complications and counselling of adolescents.
(Dawn-2, 06/12/2006)
AIDS prowls our streets
Karachi, Pakistan's largest metropolis is cosmopolitan in every sense of the word – even when it comes to problems. Karachi's
social fabric is layered with many chronic problems. Among these, health issues top the list. Along with the usual suspects
which have now become household names like the Bird Flu, Congo fever and Dengue fever, other lethal ones like the
HIV/AIDS are now slowly making inroads, giving the locals yet more reasons to dread.
On December 1 the World AIDS Day was celebrated in Karachi with, however ironic as it may sound, an unusual festivity.
Banners were hung at nooks and corners, flyers were distributed at workplaces, and public awareness messages blared on FM
stations. Not to be left out, the corporate sector had its say: many corporations had their employees sport the red ribbon on
their bosom. In between all these apparent celebrations, however, one thing became clear: HIV/AIDS is no more a hush hush
affair, and people do not shun discussions relating to HIV. However, despite the catchy slogans and tagline that read: "Baat to
karni ho gee!", "AIDS maut ka dosra naam", one is still left disappointed when it comes to the real awareness of the issue. An
average Karachiite is not adequately information about HIV/AIDS and remains susceptible to the risk of becoming infected with
the disease without indulging in deviant behaviour.
HIV/AIDS is a dreaded disease with a reputation based on fallacies. Poverty, lack of education, wide spread rural-urban
migration along with the stigma and cultural impediments to discussions relating to sex contribute has made the problem even
more acute. Given this grim scenario, it's not hard to imagine a disaster in the offing. But, experts say, that an epidemic can be
prevented if timely measures are taken.
With Pakistan being regarded as a 'low prevalence' country, meaning that the number of cases is still relatively low, one should
not be mislead. The groundwork has been prepared for an epidemic. The biggest barrier to the treatment and prevention of
HIV/AIDS in Pakistan is the stigma associated with it. By allowing myths and discrimination and high risk attitudes to prevail,
scores of people are being exposed to HIV/AIDS. According to UNAIDS estimates, about 85,000 people – or 0.1 per cent – of
the adult population in Pakistan are infected with HIV. Assuming that 10 per cent of the country's population is in Karachi, there
are at least 8,500 HIV positive people in Karachi. However, this number is likely to be an underestimated figure given that
national surveys show that amongst high risk groups e.g. injection drug users (IDUs), Karachi has the highest prevalence of
HIV in the country. The number of drug dependent people in Pakistan is estimated to be about 500,000, of whom an estimated
60,000 inject drugs. Karachi has a large number of drug users with hardcore ones being estimated to be with in the range of
10000–16000. Most of them are IDUs and share needles which pits them at a higher risk of getting the infection.
The general assumption about HIV/AIDS is that affects those indulging in sexual behaviour. However, it is not correct. Very few
people know that most of the HIV/AIDS victims in Karachi were IDUs who shared needles. Dr. Omrana Pasha, Assistant
Professor at the Departments of Community Health Sciences & Family Medicine, Aga Khan University Medical College, says,
"Karachi has an estimated 10,000–16,000 population of drug users most of whom are Intravenous (IV) dependant. According to
a survey done by Family Health Institute (FHI), 24 per cent of drug users have HIV infection and this is alarming. One thing
which needs to be taken in account here is that the estimated population considered here consists of hardcore users, while we
are still unclear about the number of people who use drugs occasionally and may form a larger group." With little data available
on the occasional drug users, Dr. Omrana says that the number of HIV infections amongst the IV drug users could be greater
than what is documented. "The epidemic is unlikely to be confined to Karachi for too long because many of these injectors
move from city to city and a very high proportion of them use non-sterile injecting equipment, leading to a vicious cycle."
She further elaborates on how a drug user may provide a direct route for the transmission of HIV/AIDS to the general
population. "The blood supply in Karachi is not safe, as is the case with the rest of the country. It is estimated that 40 per cent
of the 1.5 million annual blood transfusions in Pakistan are not screened for HIV and about 20 per cent of it comes from paid
donors who usually happen to be drug addicts. If you are using blood from a group that is already 25 per cent HIV positive, you
are increasing the risk factor. It's a direct route, from the drug addict to the general population, without any sexual contact. The
person getting the tainted blood has an almost 100 per cent likelihood of receiving HIV infection for no fault of theirs."
In a society where open discussions on health issues do not feature high on agenda, it is not at al surprising when most people
cringe and look sideways when HIV/AIDS is mentioned. Given this context, HIV/AIDS has become a complex issue for health
care professionals because these double standards are taking their toll on the unsuspecting population of this metropolis.
One of the high risk groups happens to be homosexuals in the city as well as female sex workers. Karachi has a sizeable
population of migrant workers from all over Pakistan, most of who leave behind their families in villages. Away from their homes
for extended periods of time, they may be at increased risk for exposure to HIV if they indulge in sex with female sex workers or
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indulge in homosexual behaviour. The 2004 STI survey found that 4 per cent of men who have sex with men (MSMs) in Karachi
were infected with HIV, as were 2 per cent of the Hijras in the city. Syphillis rates were also high with 38 per cent of MSMs and
60 per cent of Hijras in Karachi infected with the disease. Dr. Farhan Khan, who runs a clinic at Sohrab Goth says, "Most of the
men who come to my clinic and are suffering from sexually transmitted diseases (STDs) have acquired them from prostitutes
and male partners. With homosexuality being a taboo topic, men belonging to the gay community often prefer to stay mum over
the issue due to religious, cultural and social pressures and prefer carrying on with their dual life styles." With many men who
have sex with men do not see themselves as homosexual: they may be married and have children and occasionally have sex
with other men. "These men may not know of the risks they are taking in relation to their own health and that of their families in
terms of HIV/AIDS and other sexually transmitted infections (STIs)," says Dr. Farhan. He further says that prostitutes were also
at a greater risk of getting HIV, "Having unprotected sex is a major risk factor for the transmission of HIV/AIDS. Due to the
number of sexual contacts a sex worker makes, there is an increased likelihood of getting infected by a client if they are not
practising safe sex (i.e. using condoms). In turn they then can pass it on to other clients, their sexual partners and eventually
their children".
Nutalia Aziz, Manager Counselling Services at the Marie Stopes Society, says, "Although now we are talking about AIDS but
there are still a lot of misconceptions that need to be cleared. Since HIV is transmitted predominantly through sexual contact,
and with sexual practices being essentially a private domain, these issues are difficult to address." She further says that a
change in attitude is also needed and would go a long way in helping fight the menace of HIV/AIDS.
As Nutalia Aziz says, "In our country, people are very judgmental. They find it easy to label others. For people affected with
HIV/AIDS, they would say that it is a disease that afflicts people with dubious characters and those involved in immoral
activities. But the fact is that you and I are equally at a risk of acquiring the infection. It's about time that people get out of their
bubble. It's not a disease of "dirty people". In the case of HIV/AIDS, prevention is best thing one can do. Raising awareness is a
must and it should never be limited to just once a year. In fact, it should be an ongoing process where factual information
should be provided. Using public forums is an excellent way to disseminate information regarding the lethal virus. It would be
nice to see the religious scholars coming forward and talk about AIDS in Friday sermons and rather than projecting it as Azabe-Illahi."
(By Sumaira Jajja, The News-41, 10/12/2006)
Shifting of samples from services hospital risky
KARACHI, Dec 10: As the Sindh health minister has ordered dismantling of the Services Hospital, what bothers officials of the
Chemical Examiner’s (CE) office situated on the same premises along M.A. Jinnah Road is shifting of thousands of samples
which they think will lead to all sorts of serious risks.
Insiders in the CE office said the samples on which thousands of criminal cases based could fritter away or be changed during
the shifting that could change the very nature of those cases.
The CE office caters to Sindh and Balochistan, where it is referred to various samples from the courts of the two provinces and
their findings decide the very direction of those cases.
Insiders said this office had been functioning alongside the Services Hospital for many decades and it had a precious record of
thousands of decided, pending and current cases.
“Such a shifting could destroy these samples or some unscrupulous elements could change them, which could decide the
cases against the innocents and render the culprits free,” said a health department official.
Besides, officials at the CE’s office are also worried about their own safety. They said the existing location was in the centre of
the city with crowded surroundings, which ensured them ample security.
“These officials use to be under tremendous pressure from the criminals given the fact that their opinion usually decides the
cases,” said a health departmental official who has received anxious reaction from the CE’s office.
He referred to the concerns in those officials and said the CE’s employees – over 80 in numbers – wanted to remain at the
central location to safeguard themselves and all the samples.
The CE has three major sections. The Narcotic section has two wings: one caters to the samples of heroin and opium while the
other deals with hashish and bhang. The second section examines the samples from viscera etc to detect poison-related cases
while the third checks blood samples on props like cloths, weapons, earth etc.Investigations show the CE office has received
over 500 samples of heroin and opium, around 1,700 samples of hashish and bhang, some 564 samples of poison and 603
blood samples since January to November 30. Besides, the premises reserves tens of thousands of samples it has received
over the past decades.
Provincial health minister Syed Sardar Ahmed has lately ordered the Services Hospital, CE office, Police Surgeon, the Sindh
Blood Transfusion Authority, HIV/AIDS Centre and Central Drug Testing Authority – all located on one premises – to start
packing as the government had decided to pump 1.5 billion rupees received from Islamabad into a project to construct a stateof-the-art trauma centre on that location.
Interestingly, asking these establishments to start packing before December 15 the health ministry has not yet notified any
locations for them to be moved. Similar is the case with the 40-plus families who have quarters in the premises and been asked
to change location.
The health officials referred to the recently-introduced health insurance scheme for the secretariat employees and claimed that
that had made the Services Hospital useless. Investigations show that so far not more than 2,100 employees of the Sindh
Secretariat had been covered with that scheme and that too was much limited.“The insurance scheme only pays 15,000 rupees
to the employee who undergoes C-section and the rest of 10,000 rupees are to be paid by the employee himself/herself,” said
an official.
He said if the Services Hospital Karachi is razed then there would be merely one Services Hospital in Hyderabad, which offered
merely OPD facility.
Recently, the health department has gathered a report that suggested that the Services Hospital is crowded with commercial
and non-commercial buildings and situated on the one-way of M.A. Jinnah Road that means a slightest disturbance, traffic
congestion, law and order situation (invariable under emergency situation) will block not only the entry to hospital, the whole
M.A. Jinnah Road as well and will cease every casualty measure.
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It also points at the security risks to the offices within Services Hospital premises, for example the Civil Surgeon Office (with
very sensitive records) in case of public hostility under emergency.
The government has been suggested to procure the site of Sea Breeze Hospital, which had easy traffic approach. The
multistory building is already constructed for a large hospital.
Other alternatives suggested include the Roti Plant area in front of the Civic Centre, which is an open space and situated at the
virtual centre of the city.
(By Hasan Mansoor, Dawn-13, 11/12/2006)
Talking about Aids
IT is encouraging to know that an association bringing together people afflicted with Aids and HIV has been formed in
Islamabad with plans to establish provincial chapters. The move should help raise awareness about a dreaded disease which,
though not yet rampant in Pakistan, is rarely discussed openly because of the stigma attached to the sexually deviant
behaviour that is the cause of HIV infection. The difference between official and independent statistics on the number of
HIV/Aids cases in the country indicates the extent of under-reporting and the reluctance to talk about the disease openly.
Official figures put the number of HIV/Aids cases at about 3,000, while, according to independent statistics, this number could
be 85,000 or even more. However, as indicated by a report in this newspaper, the number of organisations working for Aids
awareness and prevention are only a handful in the country.
The positive point in the picture is that Pakistan has still not reached the stage where attempts to prevent the spread of the
disease have become an impossible task. But what is worrisome is that a general sense of complacency among health circles
is preventing full implementation of the guidelines for Aids control. Steps to control the deadly infection have been identified
many times. These include regular blood screening of professional sex workers and returning migrants and urging the same for
long-distance truckers who fall into the high-risk group as do prison populations and intravenous drug addicts resorting to the
use of shared needles. Proper screening of blood at blood banks is also necessary so that infected blood donors are kept
away. But these measures alone are not enough. They will be only partially effective — unless accompanied by a vigorous and
sustained campaign to educate the people about the dangers of Aids and the need to disregard the cultural taboos that
discourage its discussion.
(Dawn-7, 11/12/2006)
Hospital mourns humane surgeon’s death
KARACHI: By and large Karachiites who wish to remain anonymous keep the glimmer of hope alive in the dismal milieu of this
metropolis. Dr Masood Ahmed, who died a few weeks ago, was one such Karachiite. He devoted the last years of his life to a
public charity hospital that was conceived by the police.
For the last four years, he distributed his time between practice at Baqai Hospital and voluntary work at the Police Public
Hospital. Since 2002, he performed over 1,200 major operations free. Two years ago when he was admitted in ICU, he chose
to ignore his own health and performed four emergency operations because no other surgeon was available at the philanthropic
hospital where he did volunteer work.
The patients at PPH requiring surgery only had to pay for their medicine as Dr Masood never charged a single paisa for the
operations. He even used to bring a huge tiffin from home so that poor patients did not go hungry.
Operations like removal of gallbladder stones that costs Rs50,000 were done for less than Rs4,000 with medicine. Patients
from as for as Rahim Yar Khan, Larkana, Dadu besides Hyderabad and Hub used to benefit from his efforts.
Dr Masood used to make sure that the hospital was never short of beds. As soon as occupancy exceeded the 25 beds
available, reinforcements were procured, meanwhile the number of daily surgeries performed tripled.
Dr Masood who was an SMC graduate writing his MS thesis on carcinoma of gallbladder, when he met his maker. He had also
served at East Timor treating youngsters most of whom were wounded by machetes. Besides free surgeries Dr Masood Ahmed
had transformed two rat-infested buildings into full fledged schools in slum areas and assisted in expansion of various roads in
Nazimabad and Liaquatabad.
The Police Public Hospital is a good example of what private sector can do to serve public good. One wonders who pays for the
day to day expenses of the setup, well it is mostly the good people of Nazimabad.
The chipped-in to transform portion of the locality’s police station into a 32-bed hospital called Police Public Hospital.
The idea was encouraged by Dr Safdar Hussain and police officers Saud Ahmed and Hussain Asghar, besides many devoted
surgeons, anaesthetists, dentists, eye-specialists and general practitioners who volunteer their time, expertise and even funds.
Many neighbours in the vicinity make it a point to donate zakat and the hide of sacrificial animals to PPH. This money is used to
buy medicines from the wholesale market. A minibus operator donated the computer which is used to maintain a record of
patients, medicines, and donation. Various businessmen donate lamps, plastic sheets and bed sheets. A religious scholar
presented an air-conditioner. Other philanthropists of the area have donated equipment like ventilators, ECG, ultrasound and xray plant etc.
Dr Baqai provided equipment for the general surgery department while Dr Mohammad Ali Shah helped set up the eye
treatment/operation theatre. The local sanitary merchants association which is on main Nazimabad Road less than a kilometre
away gladly supplied the tiles for each theatre.
Some 600 patients benefit daily from PPH and the six clinics set up in slum areas. The main centre provides Rs50,000 worth
free medicines every month. The clinics’ need Rs13,000 each for medicines and other expenses.
After initial treatment, if needed, patients are recommended to Abbasi Shaheed, Baqai or A.O. Clinic. Due to its rapport with
these medical institutes, patients sent by PPH and its satellites are given urgent, exceptional and gratis treatment. Many other
distinguished consultants of the metropolis treat PPH patients free.
The PPH also holds a 25-room eye camp in far-flung locales every fortnight that is attended by thousands where dozens of
surgeries are performed.
(Dawn-14, 11/12/2006)
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SC’s concern over private practice of doctors
ISLAMABAD, Dec 12: The Supreme Court on Tuesday expressed concerns over the trend of private practice by doctors
working for public hospitals and said it seemed to be discriminatory for the patients.
A three-member bench of the apex court -- hearing a complaint about criminal negligence on the part of some doctors of the
Chakwal District Headquarters Hospital -- also directed federal Health Secretary Anwar Mehmood to assist it as to why a
uniform policy should not be formed for the whole country to institutionalise the private practice of doctors.
The court also directed provincial health secretaries and secretary of the Pakistan Medical and Dental Council to submit replies
in this regard by the first week of February next. “Patients at the government hospitals are suffering because of discriminatory
policy of private medical practice by government doctors,” observed Chief Justice Iftikhar Mohammad Chaudhry, adding that
the court would not allow the discriminatory trend to prevail.
At the last hearing, the bench had served contempt of court notices on doctors who had held a three-day strike against orders
of the apex court, which had left patients suffering and reportedly caused some deaths.
The strike was observed when the local police arrested Dr Mohammad Amir after the Supreme Court took up the matter
following deaths of three children -- Hamza Ali, Nauman and Bushra Mubin -- due to alleged negligence of doctors. Punjab’s
additional advocate-general Khadim Hussain Qaiser told the bench that 28 doctors of the Chakwal hospital, accused of staging
the protest against registration of a criminal case against their colleagues, had been transferred to other districts as per
direction of the Supreme Court and criminal cases had also been registered against Dr Tauqeer Minhas, Dr Saadat Ali, Dr Amir
and Dr Mushtaq for committing professional negligence.
A report of the Punjab health department was also presented in the court in which it was stated that the private practice was
allowed only after normal duty hours at government hospitals. However, in different provinces, rules and policies about the
private practice were different. The report was read out by advocate Babar Awan, who is assisting the court as amicus curiae
(friend of the court).
(By Nasir Iqbal, Dawn-1, 13/12/2006)
Dismantling Services Hospital
THE detailed reports ‘Dismantling of hospital to create problems’ and ‘Shifting of samples from Services Hospital risky’
(Metropolitan, Dec 11 and 12) about demolishing Services Hospital, that too within a few months of the sale of famous MidEast Hospital for developing a commercial plaza, have distressed many a conscientious citizen of this medically- starved
metropolis. I have failed to understand why authorities are bent upon dismantling an age-old medical centre which has been
successfully catering to the needs of thousands of provincial government employees since 1948.
I fully agree with the reports that doing away with such a key institution of public sector will severely harm the government’s
programme to provide maximum medical facilities to the people at large. If this undesirable decision is carried out, then there
will be left only one Services Hospital in the whole of the province, i.e. at Hyderabad, with a mere OPD.
Notwithstanding the Services Hospital’s significance, constructing a multi-storeyed complex to house a modern trauma centre
on the city’s busiest road with highest ratio of atmospheric pollution is highly ill-advised. Looking to the congested and jampacked location with same facilities of water, sewerage, electricity, etc., when population of the entire city was 0.350 million
(now more than 10 million) there should have been ban on further multi-storeyed constructions in these areas. Even otherwise
addition of a complex will add to the misery of not only residents of the vicinity but will prove to be antithesis of the purpose for
which a well-established institution is being scarified.
A well-envisaged modern trauma centre not only requires a clean atmosphere but also needs easy approaches so that patients
in severe agony may not die while being carried to the centre on account of road blocks which have now become a daily affair
either owing to VVIP movements or some political or religious events.
I request the authorities not to proceed in haste and reconsider their decision in the interest of the public as it will not only
benefit thousands of middle and lower middle class white-collar provincial government employees but will save the important
records/reports from damage as well as a historical building from destruction.
The suggestions given in the reports for procuring the site of Sea Breeze Hospital or the Roti plant area are quite sensible and
practicable to establish a most viable and modern trauma centre.
MANSOOR-UL-HAQ SOLANGI, Karachi
(Dawn-6, 14/12/2006)
Child mortality 500,000 a year in Pakistan:
Millennium goal to be missed: Unicef
ISLAMABAD, Dec 13: The United Nations Children’s Fund (Unicef) has painted a bleak picture of the state of Pakistani
children, saying some 0.5 million of them die annually before reaching the age of five, mostly from preventable causes.
Unicef’s flagship report entitled “The State of The World’s Children 2007” reveals that Pakistan has made little progress in
terms of reducing the under-five mortality and it is very much likely to miss the Millennium Development Goal of bringing down
the mortality rate among children of five or under to two thirds by 2015.
In Pakistan’s case, this goal could be translated to an under-five mortality rate of 43 per thousand births.
Going by these standards Pakistan would have to scale up the annual rate reduction by 6 to 7 per cent. Pakistan had an underfive mortality rate of 109 per 1000 births in 2001, which has now been reduced to 99, but globally it is still the 47th country with
the highest under-five mortality. Infant mortality rate (under 1) is now 79 per thousand births. This means out of 4,773,000
children born every year in the country, some 473,000 die.
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Poor pre-natal care is the leading reason for children under 5 dying, accounting for almost one-third of all the deaths. Acute
respiratory infections and diarrhoea are the other main killers.
Sixteen per cent of under-5 children annually suffer from pneumonia, 34 per cent of them are never taken to a health care
provider. Similarly, 64 per cent of the children suffering from diarrhoea are not given oral re-hydration and continued feeding.
Unicef’s acting representative in Pakistan, Mr Terje Thodesen, told Dawn that the progress in the country was too slow.
“Pakistan is taking more time than expected.”
The government, he said, would have to attach greater priority to this issue and enhance spending.
One of the other major factors for high mortality rate among children is the high percentage of children born with low weight.
The figure of 19 per cent infants born with low weight has remained static for few years.
Unicef report rated Pakistan’s efforts for improving nutritional status of kids as insufficient.
Reflecting the poor nutritional status of children, the report says 38 per cent of country’s under-5 children are under-weight,
while 37 per cent are stunted and 13 per cent suffer from wasting.
Breastfeeding remains low with 16 per cent of infants less than six months of age exclusively breastfed.
The report says progress has been made in Vitamin A supplementation.
More than 95 per cent of children between the ages of 6 months and 5 years in the country are now protected by twice-yearly
doses of Vitamin A. But, the consumption of iodized salt is very low and only 17 per cent of families use it.
A rare silver-lining for Pakistan is that it has virtually achieved the MDG target on access to water.
The report says 91 per cent of country’s population use improved drinking water sources – 96 per cent in urban areas and 89
per cent in rural areas. In contrast, only 59 per cent have access to sanitation facilities and that is reflective of some very severe
urban-rural disparities.
Immunization coverage is yet another grey area. The coverage rates are on an average 75 per cent, which means some 25 per
cent have no protection at all against different diseases.
(By Baqir Sajjad Syed, Dawn-1, 14/12/2006)
Nine more VHF cases reported
KARACHI, Dec 15: With the arrival of a cold December, cases of suspected viral haemorrhagic fever (VHF) are also declining
as different hospitals of the city admitted nine more such patients during the past 24 hours.
According to the data released by the Dengue Fever Cell of the Sindh health department, of the 4,541 VHF or dengue fever
patients admitted to hospitals since June, 46 died in government or private hospitals in the city, while the other four in interior of
Sindh.
On Friday the number of patients detected positive for dengue fever in Karachi reached 1,502.
Dr Tajammul Baig of the DFC said nine more patients were brought to five city hospitals for dengue fever treatment during the
last 24 hours while six patients were discharged. At present, 36 patients are admitted to eight hospitals. According to the DFC
data, no new dengue patient was admitted to hospitals in the interior of Sindh on Friday.
A maximum of 15 patients were currently admitted with suspected VHF at the Aga Khan University Hospital.
According to an AKUH statement, a total of 796 patients with ages ranging between 6 to 82 years were admitted to the AKUH
during the period from June 14 to December 15 with suspected viral haemorrhagic fever.
Out of these, 17 patients expired due to severity of disease, while 764 recovered and were discharged.
The patients suffered from symptoms ranging from bleeding, diarrhoea, vomiting to abdominal pain.Some 313 patients were
diagnosed to have dengue fever, three patients suffered from Crimean-Congo Haemorrhagic Fever (CCHF), while in the
remaining, the special serological tests were either negative or the results were pending.
A total of 756 patients were received from Karachi and the remaining patients came from Larkana, Hyderabad, Jamshoro,
Thatta, Dadu, Saeedabad, Nawabshah, Rahim Yar Khan, Gharo, Mirpurkhas, Sujawal, Gilgit, Balochistan and Saudi Arabia.
(Dawn-17, 16/12/2006)
Drive against illegal blood banks in the offing
KARACHI, Dec 16: The Sindh Blood Transfusion Authority (SBTA) has reactivated six monitoring teams to launch a vigorous
campaign against unauthorised blood banks in the province to ensure safe blood supplies, well-placed officials told Dawn.
SBTA officials said an amendment to the Safe Blood Act-1997, made some three years ago recommended harsh punishments
for establishments supplying unsafe blood. The punishments suggest a maximum penalty of Rs500,000 and/or imprisonment
up to five years.
“We are going to implement the act in letter and spirit through the fresh campaign against illegal blood banks,” SBTA Secretary
Dr Zahid Ansari said.
In its earlier campaign, launched a couple of years ago, the SBTA had forced more than 100 illegal blood banks in Sindh to
close. However, despite constant check and action, such illegal blood banks were still operating in Sindh. “The fresh drive aim
to eliminate this vicious trade,” he said.
“One focal person in each district of Sindh will guide the teams and supervise the action,” he added.
The SBTA has permitted 57 blood banks to continue business and received 40 applications for registration. Their cases are
likely to be decided later this month.
The concerned officials gave no reason for the mushroom growth of illegal blood banks and their unchecked activities.
However, sources said one reason was ‘pressure’ from influential quarters on SBTA officials. In this context, the sources
recalled that the SBTA had caught the operators of about a dozen illegal blood banks functioning in various districts, including
Larkana, Sukkur and Hyderabad, but all of them were let off.
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This time, the sources said, the provincial authorities had received strict directives from Islamabad to initiate stern action
against such elements and not to yield to pressure.
The SBTA will revive its special committee to liaise with the law department and also acquire the services of a special
magistrate so that punitive action could be taken and FIRs lodged.
(Dawn-17, 17/12/2006)
Herbal drug kills man, wife and mother-in-law
KARACHI, Dec 16: A man, his pregnant wife and mother-in-law died after consuming homemade herbal medicine in Landhi,
late on Friday night.
According to initial police investigations, Ghulam Sarwar, 55, purchased raw herbal medicine from Keamari, got it grounded,
and took it home to Arafat Town, Quaidabad. In the evening, he consumed a dose of the medicine, which was supposed to
treat backache. He offered some of the medicine to his wife, Parveen, 45, and his mother-in-law Sharqa, 80, who also took a
dose. He asked his eldest son who is 10, to take a dose but he declined.
In the night around 11:30pm, Sarwar had fits and was taken to a nearby clinic where he was pronounced dead on arrival.
The SHO Shah Latif police station, Mohammad Ashraf Khan, said the police were informed when Parveen was also taken to a
private hospital in Quaidabad, where she expired. We reached the spot and asked Sarwar’s younger brother to allow postmortems of the deceased but they declined, the SHO said.
When the police learnt that Sharqa had also consumed a dose, they told the family to take her to Jinnah Postgraduate Medical
Centre immediately. She began having fits while being taken to hospital and died during treatment. Her body was also taken
away by her relatives without autopsy.
Ghulam Sarwar and Parveen had seven children, four sons and three daughters. Parveen was expecting and the delivery was
due in a few weeks. Sarwar was a government employee and retired recently availing a golden handshake .
(Dawn-17, 17/12/2006)
Illegal trade of human organs
The Supreme Court's directive to the federal government on Friday for prompt and proper legislation to stop the trade of human
organs in the country should bring about some much delayed action. The apex court's order to the provincial governments for
report on this illegal trade will hopefully also lead to some concerted efforts to address the racket in the trade of human organs.
With the bill on this vital issue pending with the parliament, the directive of the Supreme Court to deputy attorney general Nasir
Saeed Shaikh instructing that if legislation through parliament cannot be procured since the National Assembly is not in
session, a presidential ordinance be promulgated, deserves to be considered. In fact both the president and the prime minister
should personally look into this matter. This would definitely defeat the vested interests which are said to be behind the delay in
the passage of the bill in the National Assembly.
The Supreme Court bench, comprising Chief Justice of Pakistan (CJP) Iftikhar Muhammad Chaudhry, Justice Mian Shakirullah
Jan and Justice Saiyed Saeed Ashhad, was absolutely right in its observation that if Saudi Arabia and India could pass
legislation against this illegal trade, then why should the people of Pakistan suffer at the hands of the mafia. There is no doubt,
illegal trade in human organs and in particular, trade in kidneys, which involves exploitation of poor people and is a flagrant
violation of their human rights, is a black mark against the country. The business of 'organ purchase' in Pakistan has surged
because of legal ambiguities and loopholes which need to be removed through appropriate legislation. The Supreme Court is
right in holding the doctors who perform illegal surgeries equally responsible for this crime. This situation reflects very poorly on
the noble medical profession in the country. It is the duty of doctors who are under oath to defend their profession. They should
influence the government to set-up a core group of medical experts which should be given the mandate of looking into the issue
and suggesting ways of its elimination. The government on its part must also crack down on erring doctors, touts, middlemen,
etc. Moreover, there should be strict screening of records of hospitals that perform organ transplant.
(The News-7, 17/12/2006)
Stopping the kidney trade
THE Supreme Court has once again underscored the urgency of a law to check the growing organ trade in the country. In
stressing the importance of such a law, the court has advocated the promulgation of a presidential ordinance to curb illegal
organ sales if speedy legislation cannot be enacted. For some time now, the kidney trade has been the subject of hot debate as
foreigners come to Pakistan for quick renal transplants that are denied to them in their own countries where strict legislation
forbids sale and purchase of human organs. Patients arrive even from neighbouring India where such transplants are prohibited
by law. Unfortunately, Pakistani lawmakers have not been able to do much beyond drafting an organ donation bill and
promising its passage as the Human Organs and Tissues Transplant Act. Their inaction is a telling comment on the low priority
they attach to the human consequences of a nefarious business that nets thousands of dollars for unscrupulous middlemen and
doctors working for certain hospitals in the country. The greatest sufferers of this trade are the poor, who, in order to escape
their poverty and indebtedness to landlords or employers, are often willing to part with one of their kidneys for a small sum of
money. Many, especially those with a weak constitution, have lived to regret their decision.
If enacted, the law would promote voluntary donation by live donors and through cadaveric transplant. This, in turn, would
weaken the influence of unscrupulous doctors and middlemen who would be liable to severe punishment if found guilty of
engaging in the organ trade. At present, in their haste to make money, many doctors overlook potential health complications for
the recipients, especially if the tissue match is faulty. As long as the lawmakers dillydally with the passage of the bill in question,
matters will continue to worsen, as they already have with kidneys being removed without a patient’s knowledge and
sometimes by force. This is an indication of the growing influence of unscrupulous individuals and doctors who, emboldened by
the absence of a law, are freely practicing their nefarious trade.
(Dawn-7, 18/12/2006)
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16pc schoolgirls use tobacco
KARACHI: The use of tobacco is very common amongst school going girls and about 16 per cent of them were found using
tobacco in some form or the other, a recently conducted survey said.
Prof Javed Khan, Head section Pulmonary and Critical Care Medicine, the Aga Khan University shared the findings of the
survey at a continuing medical education programme titled, ‘Recent Advances in Respiratory Medicines’ held at the AKU on
Sunday.
Prof Khan termed the trend as frightening and said that respiratory diseases were on the rise in Pakistan because of the trend
of smoking particularly amongst the youth of the country.
“Smoking is currently responsible for over 100,000 deaths annually in Pakistan and if the spiralling smoking epidemic is not
checked, it is expected that mortality from tobacco use would mount to over 500,000 per year by 2020,” warned Prof Khan.
He added that over 90 per cent occurrence of the lung cancer could be prevented if smoking is avoided.
Dr Asif Imam, an allergist at the AKU, in his lecture said that 20 per cent of children and 10 per cent adults in the country were
suffering from allergic disorders but most patients were not receiving optimal treatment for this condition.
“Asthma is the most common form of allergic disorder in Pakistan, but with modern treatment almost all asthma patients could
live normal life,” he said.
Dr Muhammad Irfan, Consultant Pulmonologist, gave presentation on management of respiratory failure while Dr Nisar Rao,
Assistant Professor, Ojha Institute of Chest Diseases, spoke on TB.
(The News-3, 18/12/2006)
Body set up to suggest dengue, VHF control
KARACHI, Dec 18: Following the deaths of 50 people due to dengue fever and viral haemorrhagic fever, the Sindh Health
department on Monday constituted a three-member committee to recommend strategies for prevention and control of the
disease in the province.
Sources privy to a review meeting on dengue fever, held with provincial health minister Syed Sardar Ahmad in the chair, said
the committee comprising the health department’s additional secretary (technical), EDO (Health) Karachi and an official of the
National Malaria Control Programme Islamabad, will present recommendations in the third week of January 2007.
Experts and officials were of the view that in Sindh, proper planning and application of preventive and surveillance measures
was a must for the next couple of years where about 4,676 patients reportedly infected with dengue virus were admitted to
various public and private hospitals during the last five and a half months.
It was feared that incidence of dengue could be more severe in nature in the coming year and as such there was dire need of
capacity building for all concerned groups and organisations at different levels. The meeting was told that all the four strains of
dengue and chicken guinea virus were detected in patients admitted to hospitals after the dengue epidemic outbreak since July
2006, said one source.
After the dengue outbreak, 4,541 patients were admitted to Karachi hospitals, another 135 were admitted in hospitals in the
interior of Sindh. Of them 1,564 had tested positive for dengue virus till December 15.
According to a presentation by Syed Shakeel Mullick of Sindh Health Department, the majority of dengue related cases were
reported from Gulsahn-e-Iqbal, Malir, Saddar, Liaquatabad, Orangi. Landhi, Jamshed and North Karachi Towns of Karachi,
while the overall ratio of male and female patients remain 70:30 per hundred, the rate of fatalities remained 1.07 per cent of the
total dengue admissions at hospitals.
At least 2,398 patients were rushed to hospitals in Karachi for treatment of DF or VHF in November, while the number of deaths
during the same period in Karachi was 17. Forty-six deaths were reported in Karachi, of which 27 deaths occured between
June 14 and October 31. The meeting observed that some of the hospitals were not found up to mark as far as supply of DF or
VHF patients’ details by them was concerned.
Representatives of different organisations discussed the possibilities of cooperation and coordination in future for combating
mosquito afflicted diseases, particularly dengue fever and offered their specialised services, if needed. The meeting was told
the dengue virus had almost been suppressed due to the cool weather in Sindh, but there was need to exercise fogging against
mosquitoes from January to April. A relapse of the epidemic was expected around mid April, if preventive measures were not
exercised, said another source privy to the meeting.
Those who spoke at the meeting included Sindh health secretary Dr Noshad Sheikh, Dr Abdul Majid, the additional secretary of
the health department, Dr Abdul Wahid Bhurt of WHO in Sindh, Prof Jan Mohammed, the vice-chancellor of Liaquat University
of Medical and Health Science, Dr Mukhtar Ahmad of National Malaria Control Programme.
Dr Wahid presented the draft of the National Strategy prepared by the federal health ministry and WHO in Islamabad for
prevention and control of dengue fever and viral haemorrhagic fever and maintained that most of the plan could be adopted
with necessary adjustments, if needed, for practical intervention and ensuring effective control and prevention measures
against the diseases in Sindh. He said that there was a need to set up a full time dengue control cell at provincial and sub
provincial levels.
(By Mukhtar Alam, Dawn-17, 19/12/2006)
Eatery manager booked
KARACHI: A manager of Costa Coffee at Zamzama was booked by the Clifton police for misbehaving with the family of Deputy
Inspector General of Police (DIGP) Telecommunication. The police have arrested the guard, while the manager was still at
large. As per details, ASI, Mohammed Ashique of Sindh police reported that he was deputed with the DIGP, T&T, Shahid
Qureshi. Few days ago, he alongwith the family of DIGP went to the Costa Coffee and while he was parking the car, a guard
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Shaukat Iqbal came and told him to remove the car. When he asked the reason, the guard and the manager of the coffee outlet
started misbehaving and abusing them and did not allow them to go inside the Costa Coffee. The police taking notice arrested
the accused guard Iqbal, while the manager escaped from the spot. The police have registered a case 264/06 and were
searching for the accused manager.
(The News-3, 20/12/2006)
26 more blood banks registered
KARACHI, Dec 21: The Sindh Blood Transfusion Authority (SBTA) on Thursday registered 26 more blood banks at its year-end
meeting presided over by the provincial health secretary.
“The meeting decided to register the 26 blood banks as all of them are functioning in accordance with our criteria based on
WHO standards,” Dr Zahid Ansari, Secretary SBTA, told Dawn.
The meeting was attended by senior health department officials, representatives from private labs, pathologists from
Hyderabad, Larkana, Nawabshah and Sukkur and a representative of the Pakistan Blood Banks Association.
With the approval of 26 more blood banks, the total number of registered blood banks has risen to 83.
“We had registered 57 blood banks in the beginning of this year, now their number has risen to 83 which clearly shows that
Sindh is far ahead of other provinces in registering blood banks,” Dr Ansari said.
The newly registered institutions include 10 each from public and private sector whereas the remaining six belong to NGOs.
The number of the registered public sector blood banks now stands at 26 and that of private sector at 37.
Among them, nine are functioning in Karachi (including the one at Lyari General Hospital) and three in Hyderabad. Those being
run by the civil hospitals of Thatta, Badin, Dadu, Sanghar, Jacobabad, Mithi (Tharparkar), Khairpur, Hyderabad, Larkana,
Mirpurkhas and Nawabshah districts and the Taluka Hospital Dighri have also been registered. Besides, one lab each in Badin
and Dadu districts in private sector has been registered.
Dr Ansari said although registered, these blood banks would remain under a constant watch to ensure they did not defy
standards.
(Dawn-17, 22/12/2006)
Four million drug addicts in Pakistan
KARACHI, Dec 21: The number of drug addicts in the country has touched four millionth mark and the victims are mostly
youngsters. This was disclosed at a seminar on ‘Youth awareness on drug abuse’ held at the auditorium at Arts faculty,
University of Karachi on Thursday.
The event was jointly organised by the KU Department of Sociology, United Nations Association of Pakistan (UNAP) and Antinarcotics Force (Sindh) with pro-vice-chancellor Dr Akhlaq Ahmad in the chair.
Speaking on the occasion, Brigadier Faizul Karim Burki said that the menace of drug abuse had strengthened its roots in our
country since 70s mainly due to smuggling from the across the border especially from Afghanistan.
He said the Anti-narcotics Force (ANF) and other law enforcement agencies had been playing vital role to curb the menace by
nabbing drug pushers, but students could also play an effective role in this regard.
Brigadier Burki said that students were more vulnerable to drug abuse and it was duty of the parents, teachers and other elders
to educate them as to how the challenge could be dealt with.
Dr Akhlaq Ahmad in his brief speech said that people mostly from poor countries were found involved in drug smuggling, which
had further complicated problems of their countries.
He said that some were using drugs for medicinal purposes and mental relaxation, which could lead them to a permanent
addiction if not avoided.
Dr Fateh Mohammad highlighted the negative impacts of drugs and asked students to play their role in eradication of the
menace. Dr Rana Saba in her detailed presentation gave examples of use of different kind of drugs, methods, and negative
impacts on human body.
She said that parents could play main roles to protect the youth from drugs and added that parents ought to keep a check on
activities of their kids very seriously.
Dr Akbar Haider Somoro, who is also country chairman of health affairs of the UNAP, in his speech revealed scores of code
words, being used by drug traffickers and addicts for fulfilment of their objectives which, he said had been derived from various
websites.
(Dawn-18, 22/12/2006)
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