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Childhood Interrupted – Child Marriage in Pakistan

Published: June 14, 2017
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While there is an increased awareness about the concept of child marriage, much needs to be done at grass-root level. PHOTO COURTESY: Haseeb Siddiqui

While there is an increased awareness about the concept of child marriage, much needs to be done at grass-root level. PHOTO COURTESY: Haseeb Siddiqui

KARACHI: When Safiya was married off to a man, some 20 years older than her, she was barely 13. Her body frame was slim. She was still gaining height and had no idea about the physical demands of a marriage or motherhood. Within just three months, this resident of an underprivileged part of Karachi was expecting.

“My brother was married to my husband’s sister. It was a watta satta (exchange marriage). They waited only until the day I started menstruating after which I was married off,” said Safiya.

The birth of her first child, born premature, was an ordeal for Safiya. She received several pints of blood for transfusion as she was anaemic and she barely survived. Today, Safiya is a 16-year-old mother of two. She laughs when anyone asks whether she even prepared for the marriage and for the responsibilities of parenting.

“Does it matter now whether I was prepared for it or not? Girls have to do what they are told to do. In our social strata, this is just how it is. We are like cattle. We are born, married off to bear a child and eventually one day, we die.”

In Pakistan, according to lawyer and gender activist Maliha Zia Lari, the legal marriageable age for girls and boys in Sindh is 18, while it is 18 for boys and 16 for girls in the rest of the country.

“A marriage with a female child under the age of 16 is punishable under Section-498B of the Pakistan Penal Code 1860. In Sindh, punishments extend to girls aged 17 under Sindh Child Marriage Restraint Act,” she continued while shedding light on the legal aspects around child marriage in Pakistan.

Pakistan has recently outlawed child marriage and toughened penalties for those guilty of the crime in an effort to crack down on the practice estimated to affect one in five girls in the country. A minimum five years in prison that may go up to 10 years is the punishment, in addition to a fine of up to Rs1 million. A legislation passed by the National Assembly (NA) in February 2017, also bans forced marriage involving women from minority groups.

For a second time, the NA’s Standing Committee on Religious Affairs in the following month unanimously rejected a draft ‘Child Marriage Restraint Act’ aimed at increasing the minimum legal age for marriage of a girl to 18 years from 16.

Despite the laws and surging criticism, child marriage victims like Safiya continue to endure a cycle of lifelong disadvantages and miseries.

NA panel refuses to raise minimum marriage age for girls

Pakistan is also a member of the South Asia Initiative to End Violence Against Children (SAIEVAC), an inter-governmental body which has adopted a regional action plan to target child marriage. Yet, at the grass-root level, social attitudes remain static.

According to a Unicef report, State of the World’s Children 2016, at least 21 per cent Pakistani girls are married off before they turn 18. Now, this number on the ground is, of course, higher since a significant part of the populace in Pakistan remains unregistered. Therefore, they also do not show up in surveys. Almost 60 million children in Pakistan are not registered at birth – approximately 65 per cent of children in the country – according to Unicef.

Regrettably, the ramifications of underage marriages are also both physical and psychological.

Dr Azra Ahsan, a gynaecologist and consultant at the National Committee for Maternal and Neonatal Health, disagrees with the argument that a girl attains physical maturity at 18.

“All the organs of a woman including the genital tract continue to grow and mature until she is 18. The emotional maturity, however, comes much later. To me, a girl at 18 is still a child,” she stressed and added that marrying a girl at a tender age and then lumbering her with pregnancies and children is taxing her capabilities to the limits.

“Sexual relationship, pregnancy and childbirth are catastrophic for young girls. For them, a sexual relationship becomes a nightmare. Going through a pregnancy is a test of endurance even for grown-up women and one can only imagine what a burden it should be for a child girl,” said Dr Ahsan.

She maintained that when a fully grown baby tries to negotiate its way out through a small immature pelvis of a young mother, it becomes a harrowing experience for that child.

Man accused of child marriage sent into police custody for five days

“This not only results in a horrible agonising pain but can also cause pressure ischemic injuries to her genital tract and the adjoining organs. As a result, holes known as Obstetric Fistula appear between the genital tract and the urinary tract and/or the bowels. She then dribbles urine or stool constantly. The lives of young child mothers are literally nipped in the bud.”

For Samar Minallah Khan, an inspirational documentary filmmaker, a girl is forced to grow overnight into a child marriage.

“Child brides are at a risk of physical and emotional violence, and pregnancy-related complications. Depriving a child of education means perpetuating a cycle of poverty, violence and inequality. The very concept of a girl child as ‘someone else’s property’ prevents parents from investing in her future,” she said.

In Minallah’s experience, child marriages are mostly practised in the garb of culture and traditions. Once a girl child is betrothed, she becomes a property of the family that she is supposed to wed into. “There is no concept of documenting such [child] marriages. There are legal lacunas to determining the age of the child.”

Minallah’s documentaries mainly focus on culturally sanctioned forms of child marriages including ‘pait likhi’, ‘swara’, ‘vani’, ‘sang chatti’, ‘irjaai’, ‘addo baddo’ and ‘watta satta’.

“Not many urban Pakistanis know about the forms of child marriages and which is why more in-depth understanding and research needs to be carried out,” she explained. Minallah underlined that during January 2016 to May 2017; only over 35 cases of swara, vani and sang chatti were reported in the media.

Gender activist Lari wants Pakistanis to start talking more and that too openly about the impacts of child marriages in the society. “We need to emphasise that child marriages are void and not a real nikah. We need to provide economic incentives at community levels for families insisting them not to marry off their girls at a young age.”

Too young to marry: Police thwart child marriage in Khanewal

“Any action taken must be consistent, state-owned and sustainable,” she added while suggesting campaigns at schools and strategic intervention points for adults.

While there is an increased awareness about the concept of child marriage, few voices have also started making a lot of noise against it in Pakistan.

Designer Waqar J Khan and his team started one such campaign that made waves earlier this year with the hashtags #fashionforacause and #againstchildmarriages. The fashion shoot showed three girls dressed as child brides, juxtaposed alongside their photos in sportswear ready to take on the world.

“The purpose of the shoot is to build awareness about child marriage, and promote women in public spaces, especially the sports field,” said Khan.

Younger girls mean long birthing life, which is considered important in our culture. Lari feels that it is still a taboo to talk about women’s sexual and reproductive issues and the hush around the subject means that people do not actually see the human impact.

“The custom [child marriage] is linked to patriarchy, power and control. We hear statements like, older girls get too set on their ways as compared to the younger girls since the younger they are, the more adaptable she is.”

According to the gender activist, women in Pakistan witness several examples around them – their grandmothers and aunts – who were child brides and mothers and so they also think, if they were fine, what is the problem?

“There is a reluctance to see a girl as a child. She is seen as a woman as soon as she reaches puberty and thus must be married off before her sexuality becomes out of control”, complained Lari.

While there in a rising need to bring a change in the overall Pakistani mindset, Minallah thinks that stringent legislation, complemented by strong implementation was also required. Most importantly, supporting girls’ education is one of the single best investments a country can make to help poverty and prevent early marriages, she added.

“A girl who has completed her education is less likely to experience violence after marriage and have children when she herself is a child. Above all, she is more likely to be conscious and healthy,” Minallah concluded.

Preventing child marriage has a significant bearing on women’s education in the country. Therefore, it is important that the state must challenge unfair social norms strengthening child marriage by using legal and advocacy campaigning tools.

 

With additional input by Ali Rahman.

Surah Yusuf – The Best of Stories – Reflections

Surah Yusuf, Chapter 12 of the Quran, is the most engaging, timeless, and complete story ever. It was relevant back then and it is relevant today.

Prophet Yusuf (as), known for his miraculously good looks, was beautiful both inside out. Often people advise pregnant women to recite it to have a beautiful baby. This tradition is not proven by any verse of the Quran or hadith. This is also is certainly not what the Surah is meant to be used for.

The real impact of this Surah is how it helps beautify relationships, and teaches invaluable lessons in times of difficulty and ease.

The Quran itself calls the true story of Prophet (Yusuf) “the best of stories”. It is the story of the life of Yusuf (as). Here are a few reflections on this Surah:

·         There are disadvantages of announcing your plans and showing off blessings – the evil eye (Nazr-e-Bad) and jealousy. Do not share plans till they materialize. For example initial pregnancy, intent to marry someone, the initial job interview that went well. Don’t also announce good dreams. (12:5)

·         Three elements of Sabrun Jameel (beautiful patience): Don’t announce your suffering all the time. Don’t complain to everyone. And don’t imply that you are perfect and free of faults. (12:18)

·         Maturity does not come without having gone through difficult times. Tough times have a way of making us stronger and hopefully wiser. (12:21)

·         The credit goes to Allah if we do something good and are able to ward off a temptation. The biggest temptation is narcissism and vanity. (12:24)

·         People don’t listen to our tableegh if we have not developed a relationship with them. See the example of Yusuf (as). He had developed a bond with the other inmates in jail. That is why they listened to him. Point: Work on relationships with sincerity.

·         Effects of your a’amaal (deeds) reflect on your face – both good and bad. In a world where you have to keep marketing yourself, humility becomes difficult. But it is important for tazkiyah (purification) of the nafs (self) to not announce your achievements all the time. However, undue humility can hamper you getting the deserved position. Therefore, maintain a balance. Tell when necessary & offer your services where needed. Undue modesty will stop you from doing the duty Allah assigned you. Be like Yousuf (as) – humble yet confident, but giving Allah credit for everything good. (Reflection of qualities of Yousuf {as})

·         To be a ‘mohsin’ – one with a beautiful attitude and nature – Sabr (patience) is inevitable. A reactive, inflammable personality cannot be a mohsin. (12:56)

·         In the era of Facebook and Instagram where we share every joy and share every plan with hundreds, we need to remind ourselves that Nazar-e-Bad [evil eye] is a reality. Safeguard yourself against it with prayers, especially the last 2 chapters of the Quran. Also do not announce your plans and every achievement and joy. (12:67)

·         “Do not grieve yourself over what they did” – Beautiful advice Yousuf (as) gave to his brother Bin Yameen. Reminder to self: Stop focusing on the few people who are a test for us and bother/hurt us. Instead, focus on those who are the coolness of your eyes, and are good to you. Ramadan is the best time to let go of this baggage of “I am hurt by him/her”. (12:69)

·         There is someone more knowledgeable than you, always. There is always someone who is better than you even in the things that you are good at. And the most Knowing and Perfect is Allah. So stay humble. You are not the ultimate. Never. (12:76)

·         Allah Knows the reality of people’s intentions and situations. Therefore stop judging people. You do not know their journey. You have not traveled their path. (12:77)

·         A sure shot test of whether you are a “mohsin” or not – check your behaviour with those who are under you or you have power over them. As a parent, as a senior at work, as a ruler, as someone who has house help. How are you with those who don’t have power over you? (12:78)

·         There is patience. And then there is what the Quran calls “Beautiful Patience” – Sabrun Jameel. Another sign of beautiful patience is that you stop assuming things about others and control your habit of judging others and commenting on them. (12:83)

·         Complain of your pain, heartache, and hurt others cause only to Allah. Allah can help. Those whom you gossip to cannot help. (12:86)

·         Give people the benefit of doubt. And at times even if you know they intended to harm you, do not announce in front of them that you know. Sometimes it is wiser to hold your peace. (12:89)

·         If someone hurt you a long time ago – it could even be a parent, a sibling, a friend – don’t think to yourself ‘I can never forget/forgive what he/she did’. Let go! Forgiving is healing for yourself more than anyone else. (12:92)

·         Sometimes grief leads to happiness, and failure leads to success, in the long run. Sometimes the very person that caused you great distress will become the cause of happiness. The situation will get better. Hang in there. (12:96)

·         Your company leads you to become the person you are. Therefore choose your company carefully. Good company in this world will lead us to be in the company of the righteous in the Hereafter. Choose wisely. (12:101)

Corporate culture, humane or not?

Deadlines, pressures, one meeting at the heel of another, unforgiving targets, coupled with the constant need to prove one’s self…Welcome to life in the corporate world.

http://tns.thenews.com.pk/corporate-culture-humane/#.WQ7BI-klE1m

 

Corporate culture, humane or not?

The money is good. The future is promising. But the pressures are incessant. Pakistan’s corporate sector is teeming with newbie 20-somethings who feel once they have entered the big bad corporate world, they have it all figured out and their future is secure.

Yet, the irksome nitty gritty of corporate culture and the price one eventually pays is something they may not have anticipated. Experts and senior management grapple with how to create a healthy workplace culture. Counselling sessions with experts of organisational psychology help.

Yet, in organisations where the silos mentality, red-tapism, closed-door policies and put-me-down attitudes exist, the culture is far from healthy. Life in the corporate world is a tight-rope walk. If you make it to the other side intact, you must have played your cards right or you are plain lucky.

Experts differ on how and if the goal of healthy organisational culture may be achieved.

“When an employer hires someone freshly out of school, the business has to be humane enough to recognise that. We have to understand that the purpose of a business is to improve the quality of life of all stakeholders. So you need to ask your employee ‘what are your dreams and how can we can help you fulfil them’. It’s not about manipulating; it’s about enabling,” says Maqsood Babri, better known as Max, a psychotherapist and clinical hypnotherapist who facilitates healing of individuals and organisations.

Enabling is the opposite of being exploitative, but more often than not, employees fall into the rut of being exploitative due to the number games like Key Performance Indicators (KPI). “Targets are the worst thing; they push a person towards achieving numbers instead of quality,” adds Max. Numbers come at a cost; often, the cost is the well-being of the employee and the organisation.

At the end, there isn’t much in the employees’ control. At the most, what can be mitigated is negativity and interpersonal friction through counselling. “However the counselling need not be mandatory,” says Max, adding that the management needs to work on creating a congenial and inclusive workplace environment – both physical and psycho-social.

“There are people and there are people,” explains Sarfaraz Rehman, in light of his experience both as a former CEO and a present-day consultant and executive coach. Talking of those at the top, he divides them into kinds. “You will always find those who are adept at delegating and so spread the work pressure. Then there are others who are very political and find ways to spread the blame of performance; this is a significant percentage. That is one way of dealing with pressure. There are also those leaders who are bold and iconic. They do not take the pressure of unreal expectations and keep a balance, but also reach for the stars.”

However, the price must be paid. Sometimes one’s inner self, at other times one’s family, and often both suffer at the hands of the demanding work whirlpool. In Sarfaraz Rehman’s opinion, what suffers most is one’s family. “In most CEOs’ case, they are the biggest affectees. Travel is a killer. Years spent at airports and in hotels — it damages health. The children and the spouse take the brunt,” he says.

Known for his leadership skills, Rehman is one for building teams. “I have disliked parts of corporate culture all my life. But I have been blessed with the understanding of people. I know how to make them gel and tick and be inspired and driven. Long ago, I left the need to do things myself, and built teams around me, who, for whatever reason, have been ready to die for a cause I have put in front of them. That has helped in allaying work stress.”

The key, then, lies in the leadership giving employees a sense of ownership, and for that they have to be treated as allies and not target-oriented humanoids who lose their unique abilities. 

Pressed for time all the time is a good way to describe life in the corporate world. The deadlines, pressures, one meeting at the heel of another, and unforgiving targets, coupled with the constant need to prove one’s self, is no mean game.

“The stresses start affecting you once you have a family. Till you are single, the effect doesn’t really kick in. In the corporate world, there are no short cuts. In any good company, it is given that the magnitude of work is a lot, and they will take the work of four people from two,” says Kahkashan Sayied, an HR Consultant with three decades of experience, who describes herself as someone who wants it all, and is willing to work hard for it. Her association with the corporate sector has been worth it she says “because there have been challenges but also rewards”.

The pressure, she explains, increases as you climb up the rungs of the corporate ladder. “People think the involvement is just 9 to 5. It is not.” However, she has made it work. She says that one can balance work life [with personal life], but the key is to be very, very organised and follow a routine at every. “The stations of your life also keep changing with time. You needn’t be regimental, but spontaneity can be afforded only on the weekends, and surprises are not welcome.”

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However, the price must be paid. Sometimes one’s inner self, at other times one’s family, and often both suffer at the hands of the demanding work whirlpool. In Rehman’s opinion, what suffers most is one’s family. “In most CEOs’ case, they are the biggest affectees. Travel is a killer. Years spent at airports and in hotels — it damages health and also takes the edge off living. The children and the spouse take the brunt,” he says.

He adds that this leads to loneliness, which may lead to infidelity. “But executives won’t talk about it. Many are very lonely in travel and this leads to untoward actions in far-off hotel rooms in strange cities. Those who don’t, have learnt to bear this pain and loneliness, and reconcile to a life on the road. It takes a huge toll and it isn’t worth it. Years later, your body in its cry for help will tell you that you have misused it,” he says.

With a lopsided focus on work, the incentive of reward can lead to greed. “If an employee is offered 10 per cent of the salary on their trip, that is what the focus will become. In that process, you miss out on the childhood of your children. It means your spouse has to take care of the home front while you are gone. The freedom that you are gaining is coming at the cost of someone being imprisoned,” says Max.

The quality of life is the time we get for ourselves and our families. It is something one has to be constantly cognisant of. But the plump pay cheque and the buzz of the corporate world that makes one feel indispensable blurs the lines and clouds the vision.

In Max’s opinion, this is one reason why there needs to be more than one breadwinner per family in a country like Pakistan where unemployment is common, so that no one has to do overtime, which consequently affects quality of life.

The impact is not just on the family but also on one’s own well-being. Yumna Usmani, a counsellor and trainer, says that some employees show signs of stress through symptoms like general unhappiness, easy and frequent agitation, bouts of anger, isolation, low energy, and a lack of interest in challenging tasks. In her opinion, the reasons for this “are usually a lack of control over the job, being overly pressed for time, not being able to consult, poor relationship with a colleague, or personal and professional insecurities”.

“The role of a psychologist at such a point is to provide counselling to the overwhelmed individual. Through counselling you can clear the clouded senses, calm the agitation, and revive the energy,” says Usmani.

However, many, over time, learn how to balance the elements. “Pressure in itself is not necessarily bad. It can help us to excel. But being in a constantly stressful situation can be unhealthy and counterproductive,” says Amin Hashwani, businessman, social activist, and author of the visual poetry book Untouched Octaves.

Hashwani feels it is essential to have the ability to step back from a situation to take a 30,000 feet view and to put things in a broader context. “Meditating regularly since early age has helped me tremendously to cope with stressful situations and always view the positive side of life. It prevents me from being reactive or judgemental and help me realise that everything happens for the better.”

Taking out time for one’s self is profoundly important. “During counselling, I highlight the importance of time for self: regular breaks, making friends, breaking of projects into small steps and not withholding seeking help when needed,” says Usmani.

Sayied still finds time for political activism and dog-earing books as avid readers do every night, and advises that one must not forget to focus on one’s own happiness and well-being. “You have to monitor your food pattern, exercise regularly, sleep adequately and stay happy if you want to survive. But by happiness I don’t mean euphoria. I mean contentment.”

Hashwani echoes her sentiment and says, “Sports and exercise help remove the emotional toxicity we normally build up during the course of a day and get the positive chemicals running in our streams”.

The world has begun to wake up to the damages of emotionally and physically burnt-out employees. Thus, newer concepts like flexible hours and agile working have caught up, as has the idea of lesser working hours and a definite two-day weekend at least.

“I don’t see anything wrong with your life revolving around your work. But you have to love your work,” says Saiyed. 

With most people working in the corporate sector spending 12 to 14 hours every day at work, the ambience is extremely important – both physically as well as in terms of the culture and values of the organisation. Jargonised conversation, presentation-after-presentation and incessant meetings may help give a pretentious semblance of a conducive environment, but may actually breed a culture of selfishness where everyone is just watching out for their own interests. These attitudes often trickle down from the top.

Sunlit spaces with ventilation affect efficiency positively. Max even gauges the health of a business environment through what he calls a cliché. “If the toilets in an office are not wonderfully maintained, it means the organisation is not doing well. It shows that you have not been able to educate or motivate your employees enough.”

If walls are broken down, synergies can actually work between individuals and departments. “I laugh a lot deliberately. Many would think it’s frivolous but it’s a defensive wall. It leads me to feel that failure is not that big a deal. So I laugh, I share and I act casual — it makes the world lighter and easier during failure,” says Rehman, explaining how he created a comfortable and positive work environment as a team leader.

“No one thinks I am a Sahib or a big deal. This carefully nurtured image of Sarfaraz Rehman, the humble, laughing, caring friend, helps create ordinariness which in turn reduces expectations and stress,” he concludes.

The question of Quality Education

It’s not just the number of out-of-school children that is worrisome, but also the quality of education they are provided

The question of quality

One day, when in a meeting he was required to answer some questions put by the district officer, his vocal chords gave up. “I couldn’t produce a single sound from my throat. Teaching from 6am to 6pm, all alone, was not easy.”

Decades later, nothing much has changed. Today, there are 55 children studying in his school in Charnor, with only one teacher, his son who took over his father’s job after he retired. “My son is not paid; he is a volunteer. We hope that the Sindh government will actually hire more teachers as is being promised,” says Mal.

A government school officially, it’s made up of three small huts, with neither toilets nor electricity. Foreign philanthropists helped fund a solar water pump, so the school has water, a luxury in Tharparkar. The curriculum is provided by the government. Grades 1, 2 and 3 are taught on one day, and grades 4 and 5 are taught the next, all clumped together in small rooms in the unrelenting Thar Desert heat. With one teacher teaching 55 students of five grades all subjects, and a lack of resources, the quality of education is low down on the list of priorities.

Read also: When the going gets tough

While the Pakistan Education Statistics Report 2015-16 proudly states that the number of out-of-school children (OOSC) in grades 1-12 has reduced by 3 per cent a year from 25.96 million in 2012-13 to 22.64 million in 2015-16, 22 million plus are still OOSC in Pakistan.

What’s worrisome is not just the numbers, but also the quality of education the children going to schools are provided.

“Teachers are not motivated enough to excel in such an environment and perform their duties in a perfunctory manner which is a setback to the learning process of the children,” says Varisha Khalid Nabi, Member, Board of trustees, The Justuju School, Karachi. Schools like Justuju are numbered, but are rays of hope, fighting against the odds.

Pakistan’s educational crisis, in the opinion of Abbas Husain, Director, Teachers’ Development Centre (TDC), is multi-layered. “Our crisis is not just of resources but also of attitude,” he says.

The Justuju School started five years ago in the underprivileged Azam Basti in an attempt to bridge the gap between government and private school education. It began with 30 students; today it is 270 students-strong. The school runs on donations, yet is known for the standard of education and teaching, and the drop-out rate is close to zero. The parents of these children might be poor and uneducated, but have recognised the importance of quality education, which is why they vie for admission here. The key is the emphasis on the teachers’ training. Their academic department is pro-active in equipping teachers with the required skills sets, and has formed alliances with organisations that facilitate trainings and evaluations.

“We started the school to provide education parallel to any good private school. Quality education shouldn’t just be the privilege of the rich but a right of every citizen,” says Varisha.

Pakistan’s educational crisis, in the opinion of Abbas Husain, Director, Teachers’ Development Centre (TDC), is multi-layered. “Our crisis is not just of resources but also of attitude,” he says, adding that the infrastructure is just one of the factors to quality education. In his view, Pakistan’s dilemma is that “the smart child is being taught by the inept teacher. The teacher is no longer the fount of knowledge. The student has access to sources of knowledge that the teacher doesn’t,” he says, and continues that it is unfortunate that many senior teachers refuse to keep up with the times, ignoring the use of tools like the internet.

At senior levels, if schools don’t provide education that keeps up with the times, students may drop-out, and join specialised institutes instead.

Teaching methodologies are important if the bar of the quality of education is to be raised in Pakistan. “A student-oriented approach is used in privileged schools which is non-existent in public schools,” says Asma Munir Salman, teacher and founder of APNA Shelter Home and Learning Centre in Islamabad.

Her experience has been both as a teacher in upper tier schools and also as the person behind APNA, a school providing quality education to underprivileged children. She cites teaching techniques like collaborative learning, group discussions, and use of analytical and reflective approaches. “But in public schools, they’re still using the ‘chalk and talk’ method even in this technological world,” she says. “They feel intimidated by their students if asked questions. They make them cram information without making them understand. I have come across teachers who solve math problems on the board themselves and make their students copy them down and learn them.”

Husain feels that upper tier schools don’t even have the alibi of a lack of resources. They charge exorbitant amounts as fee, yet still lag behind technologically. He says that teachers today are focusing on “professionalism, which is the status of the profession in society, but not on professionality, which is having the required knowledge and skill sets.”

When asked about the makings of a good classroom, he says that the answer lies in three things: “respecting the child’s individual voice, providing a safe space for the child to grow, and accepting all kinds of diversity in the class”.

The onus to not just give quality education but also to keep the children in school, then, largely lies on the teachers, and on their training and growth. “Teaching is a prophetic profession. People should be tested and chosen to become teachers only if they can be as sincere to the students as they are to their own children,” says Mal.

As Husain sums it up, education in its best sense should allow children to have role models in every domain of excellence.

Depression – Career, family life, everything suffers

In a society where mental illness is stigmatised and its treatment is expensive, the harm of not getting treatment for depression can be disastrous

Career, family life, everything suffers

Eventually, you may wander the labyrinth and keep popping pills that sometimes help you sleep and at other times are mood-lifters. By so doing, you become one of the many Pakistanis who pop millions of these “happy” pills to fight a very real and very debilitating illness.

“The total antidepressant market in Pakistan is approximately Rs4 billion, as per annual sales, and is growing at the pace of 16 per cent; the market for tranquilisers or anxiolytics is also around PKR3 billion, with a double digit growth of 10 per cent,” says Nouman Lateef, Director, BU-GI Care, Merck.

“Depression is underdiagnosed and undertreated. People suffer needlessly. On the other hand, some people are misdiagnosed and receive medications they shouldn’t,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital.

However, disagreeing with studies that indicate that between 30-50 per cent of Pakistanis are depressed, he feels the actual figure for patients in need of medical attention is closer to 10 per cent. “That is still very common. Major Depressive Disorder is remarkably common in Pakistan, as it is in the rest of the world.”

The disease chooses its prey without disparity on the basis of economics, and strikes people across the board, whether they are rich or poor. In the opinion of Dr Uroosa Talib, Psychiatrist and Head of Medical Services, Karwan-e-Hayat Hospital, the prevalence rate of mental illness is high. “1 in every 4 persons in Karachi suffers. The reasons are many. Lack of basic amenities like water and electricity, poverty, street crime, terrorism and violence,” she says, talking about the social reasons for depression.

Read also: An overdose of self-medication

Shedding light on the medical causes of depression, Dr Syed says that depression can be the primary illness or frequently also be triggered by other medical problems, such as thyroid disorders or neurological diseases. It can be related to pregnancy or menstruation or even to medications or vitamin deficiency. “All depression is neurological in the sense that it is related to brain abnormality. It is associated with changes in chemicals in the brain, such as serotonin norepinephrine or dopamine. Many neurological disorders can be a reason for depression like stroke, Parkinson’s disease, migraine headaches, dementia, or pain from any cause.”

Treatment of depression can be an expensive prospect, and mental healthcare providers are not readily accessible. “In Karachi, Jinnah Hospital and Civil Hospital have psychiatric facilities. Other public hospitals just have OPDs,” says Dr Talib.

Treatment of depression can be an expensive prospect, and mental healthcare providers are not readily accessible for the underprivileged. “In Karachi, Jinnah Hospital and Civil Hospital have psychiatric facilities. Other public hospitals just have OPDs that prescribe anti-psychotics and that is not enough,” says Dr Talib, adding that treatment requires both talk therapy and medication.

Dr. Syed says the most common medicines used in Pakistan are Escitalopram, Citalopram, Fluoxetine, Paroxetine and Sertraline, sold under various brand names.

Medication to treat depression is a potential lifesaver, but must be prescribed by doctors qualified to prescribe them. “Most of the medicines sold over the counter are anxiolytics like Lexotanil, Xanax and Valium. These are more addictive and people use them as hypnotics,” says Lateef, talking about the popular benzodiazepines class of medicines that are used and abused readily. “Anti-depressants’ effect is not immediate; their impact takes time to show. However, a new class of anti-depressants has a quicker onset of effect.”

“A study shows that 60-65 per cent of the patients visiting primary care physicians are patients of depression and anxiety,” says Dr Talib. However, most of those coming to the general physician don’t even know what they are suffering from. “They complain of chronic symptoms like backache or fatigue, which are actually physical manifestations of depression. We go to the doctor and take medicines for physical symptoms, but not for mental illnesses.”

Females being at least twice as susceptible to depression in Pakistan, Dr Talib feels that this is because females have to carry heavier emotional loads, particularly in lower income groups. “These women are already struggling so much to survive that their stress tolerance is very low. Their families don’t understand what is happening to them. They have no one to talk to. They have no acknowledgment of emotional issues and no means to relax themselves. Multiple childbirths and hormonal fluctuation add to the problem.”

Lateef says that while prescribing an anti-depressant, the age and condition of the patient should be taken into account.

“People should never self-medicate. There are specific medications for specific patient types,” says Dr Syed.

“But instead of psychiatrists who should actually be prescribing them, they are mostly prescribed by cardiologists and general physicians,” says Dr Talib.

She also advises that one should not discontinue these medicines suddenly. “They should be tapered off, but only after the doctor weighs the pros and cons. Relapse of depression is very common so one might need a maintenance dose of the medicine for life.”

The treatment for depression is as complex as the disorder itself. Medication must be coupled with counselling and rehabilitation. Afia Wajahat, therapist, works with Mental and Social Health Advocacy and Literacy (MASHAL), in underprivileged areas of Karachi. It is an initiative linked with the Aman Foundation. Her team goes door-to-door to screen people for mental illnesses, provide them therapy, and help them get a second lease of life through rehabilitation and provision of livelihood to bring them out of the clutches of poverty.

In Wajahat’s experience, rehabilitation is most important in order to avoid a relapse. “For that we have to bring them back towards leading productive lives. We enroll them in vocational trainings, socialise with them as they have to come out of isolation, and counsel them to give them confidence.”

The harm of not getting treatment for depression can be disastrous. “We need to make people understand the consequences of depression. Your career, your family life, everything suffers,” says Dr Talib. It is time Pakistanis understand this.

The battle to save the Bagh

The story of Bagh Ibn-e-Qasim’s slow deterioration — the price Karachi’s green spaces have paid for development

The battle to save the Bagh

The reactions against the idea of the Bagh being taken over were mostly emotional. Yet, few noticed that the park had been dying since the last few years, bit by bit, with every fading tree and plant, and especially with the closing of the main entrance. One year ago, even the battery and UPS of the big clock in the Bagh were stolen. The number of those frequenting it dwindled over the years. Whether Bahria Town takes it over or not, the fact is that Karachiites are paying a price for the ‘development’ in the megacity with the shrinkage of public places.

Worse still is the Karachiites’ aching nostalgia that comes with it. Where once there was Playland, Aquarium, and the main entrance of the Bagh, is now a void.

A resident of this area says that he has seen the so-called development happen overnight as the entire area was well and truly encroached upon. “In the evenings, the Bagh used to be packed with youth, children and families. This park was the most well-lit part of the entire Clifton area. It used to be open almost till midnight,” he says, echoing the memories of many city-dwellers. “The weather would be cool in the evenings close to Karachi’s famous seafront. Standing in the bandstand and looking out at the sea was a fantastic experience,” he reminisces about the evenings spent at the park with his family.

Trees would provide shade to people and encourage them to flock to it even during daytime – the footfall was in the thousands. There was a mosque where visitors could go to pray, and there were foodstalls outside.

“The park had nice horticulture. Plants were shaped as animals. All of that faded. The grass used to be green; now it’s just barren sand over there,” he regrets.

Many public events, such as the centennial celebrations for the renowned poet Faiz Ahmad Faiz in 2011, were held there as the huge park grounds could accommodate large numbers of visitors.

Few noticed that the park had been dying since the last few years, bit by bit, with every fading tree and plant, and especially with the closing of the main entrance. One year ago, even the battery and UPS of the big clock in the Bagh were stolen.

The park has seen better days.

For columnist Nadeem Farooq Paracha, however, this sudden wave of emotions seems too little too late. “Many folks don’t say or do anything about a problem, but suddenly spring to action if that problem is being solved through means they do not agree with.”

He thinks the Bagh has been in doldrums for quite a while now. “Yet, none of the politicos or members of the civil society making such a hue and cry of it being handed over to Malik Riaz did anything whatsoever to better the plight of this once spectacular park”.

Qasim Bagh in the glory days.

Qasim Bagh in the glory days.

The deterioration of the park did not happen overnight. For years, its main entrance was adjacent to where the Bahria Icon Tower looms today. When the construction of the skyscraper began, the main gate of the park became the entrance point for the site office. As a result, the gate was closed down. With the construction of an underpass, the Kothari Parade access points changed as well.

The resident, disgruntled at how the limited accessibility restricted visitors, holds the alteration responsible for changing the traffic flow: “Public transport could no longer collect passengers because the Abdullah Shah Ghazi Mazaar entrance was also changed to the side.”

Karachi - Bagh-e-Ibne Qasim - 055

“Now a majority of the buses pass by the mazaar’s new entrance, which is in the side lanes,” he explains. “Once this happened, the government failed to maintain the park.”

The other entrance to the park is the one which faces the sea. There is very limited public transport on that route and since a vast majority of visitors were ordinary people travelling in buses, the numbers began to drop. Having to walk long distances, and parking problems for those using personal vehicles made it more discouraging.

One of Karachi’s most diehard chroniclers, Ghazi Salahuddin, says he had been observing the deterioration of the Bagh, and feels this was neglect with an agenda. “It’s not just about this Park; it’s about Karachi as a whole. This city’s civic life has been plundered. From public spaces to transport to garbage collection – the government is not performing its civic responsibilities,” says Ghazi, dismayed at the bad condition of places such as Qasim Bagh. “These shared spaces are so precious. Karachi’s cultural life has also been effected by neglecting them,” he says, and adds that whenever he visits Lahore, he feels Karachi is no longer the city of lights, but it is Lahore now.

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Whether this disrepair is because the inflow of visitors decreased or was it done by design is debatable, the resident thinks. “It would be silly to assume that residents of the high-rise would want a view of a park in shambles. When the entrance of the mazaar and park was changed, it warded away ordinary people. Who would want ordinary people around such prime, expensive real estate property?” he asks.

Journalist and tv show host, Zarrar Khuhro feels that Karachi does have precedents of public-private partnerships, and that is not always a bad thing. “An example is how Asim Jofa has used the Do Talwar roundabout for his advertisements, but then he has also maintained that area well and in fact improved it.”

His worry, however, is deeper than just one park. “Public spaces are shrinking in Karachi, especially for the lower and lower-middle class. A city is held together by public spaces.”

Khuhro also says that in Karachi, the rise of gated communities and the disappearance of shared spaces is resulting in social silos. “Playland, Aquarium – that’s all gone. Development should be done, but must be done responsibly, keeping the character of the city in mind.”

He also comments that the stake of Bahria properties in Karachi raises questions, “considering that regulations have been circumvented and even broken to facilitate these properties”.

If Karachiites are getting another chance at utilising this park for the benefit of citizens, then as Paracha suggests, more should be done to maintain Bagh Ibn-e-Qasim while it’s still there.

This is an updated version of the article that was published in The News on Sunday on April 09, 2017

Immunization – Right of children

Unimmunised children continue to pose a challenge to health authorities

Right of children
Awareness needs to be raised among parents.

Like millions of mothers of Pakistan, it did not seem worth it to her to get her children vaccinated as that would make them temporarily sick. “Bacha beemaar ho jata hai; bukhaar charh jaata hai teekay se (The child becomes sick and develops a fever after vaccination).”

However, illiteracy is not the only factor that holds back Pakistani mothers from getting their children vaccinated. A lack of awareness about the importance of Routine Immunization (RI), and an absence of sensitisation regarding facts that dispel myths, seem to be present across the board. Across the road, there are children in upper tier homes in Karachi that have also not been vaccinated, or have not received follow-ups.

Marvi Junaid, a teacher, is an urban mother who, in her own words, is “confused” about vaccination. “I was stopped from getting my sons vaccinated after the initial shots; my husband studied it in detail and was convinced that this could be detrimental to the child’s immunity, and felt it was more of a money-making scheme,” says Marvi. She feels that religious notions also have a role in discouraging people against vaccination. “Even in the upper strata, people believe vaccinations adversely affect children. Once you sense that there is a possible harm of a medicine, you can’t help but stay away from it. I think we need more awareness so that we can make informed decisions.”

Mothers remain the central piece of this jigsaw puzzle, and convincing them of the benefits of immunisation seems to be one of the key factors. Dr Asad Ali, Associate Professor of Paediatric Infectious Diseases at the Aga Khan University, with a research focus on vaccine-preventable infectious diseases and malnutrition, says that the role of mothers in this regard is critically important. “Research shows that many a times, mothers are discouraged by the common side effect of short-time fever and local injection site discomfort after the vaccination of their baby. So they do not complete the series and also don’t get other children vaccinated. What they do not realise is that these transient side effects are a small price to pay for the critical protection their baby will get by receiving the full course of vaccines,” he says.

Dr. Ali adds that awareness needs to be raised among parents that vaccination is a right of their children. “Even if vaccinators are not coming to your house, parents must take their children to local governmental vaccination centers.”

Immunisation of children under the age of one-year against major vaccine-preventable diseases (tuberculosis, diphtheria, pertussis, tetanus, hepatitis B, Haemophilus influenza type B [Hib], poliomyelitis, and measles) is one of the most cost-effective means of reducing infant and child morbidity and mortality. The government of Pakistan initiated the Expanded Program on Immunization (EPI) three decades ago to save Pakistani children from these diseases. All vaccines in the RI schedule are provided free of cost in all public health facilities in Pakistan. Even then, the children are not given the coverage they deserve.

The Pakistan Demographic and Health Survey 2012-2013 sheds important light on some facts regarding the state of RI in Pakistan. Gender preference is seen even in RI. Boys are more likely than girls to be fully immunised — 56 per cent versus 52 per cent. Children’s birth order varies inversely with immunisation coverage — as birth order increases, immunisation coverage generally decreases. 64 per cent of first-born children have been fully immunised, in contrast to 39 per cent of children of birth order six and above.

“When I first became a mom, vaccination was a given; we diligently set reminders for our daughter’s appointments. It seemed as natural as buying diapers. Within the next three years, and with the transition from new mom to an experienced one, I began to read into everything from how the body has a natural mechanism for fighting fever to how to send more probiotics naturally to the gut. With the virals on the rise and doctors liberally prescribing steroids even for a blocked nose, I began to feel that there was too much of unnatural intervention,” says Nida Raza, a working mother of two and a resident of Karachi, who became lax regarding vaccination of her second child. “The anti-vaccination rhetoric on the internet and around didn’t help much and somehow my trust flew out of the window. I have been reading it and discussing it and yet I’m not convinced anymore; I’m confused about its benefits and authenticity.”

Urban-rural differences in immunisation coverage are clear. 66 per cent of children residing in urban areas are more likely to be fully immunised, compared to 48 per cent in rural areas, according to PDHS. There are wide differences in coverage by region. Islamabad has the highest percentage of children who are fully immunised (74 per cent), followed by Punjab (66 per cent) and Khyber-Pakhtunkhwa (53 per cent); immunisation coverage remains lowest in Sindh (29 per cent) and Balochistan (16 per cent), as per PDHS findings.

However, the latter two provinces are seeing a thrust in the efforts for reaching out to children who are not vaccinated. For Sindh, fresh research shows that the numbers of covered children are rising, thanks to efforts of EPI Sindh, yet much remains to be done, and unimmunised children continue to pose a challenge.

EPI Sindh’s Project Director Dr Agha Ashfaq, recently giving an overview of the programme to members of the media, said coverage of RI in Sindh has increased to 45 per cent. In view of the loss of lives of children because of Diarrhea, the Rotavirus vaccine is also being included in the RI in Sindh. Success in Sindh is being seen, for example no stock outs of vaccines were reported in 2015-16 in the province.

Vaccine Logistics Management Information System (VLMIS) is being set up in all districts of Sindh. Polio Eradication Initiative (PEI) and Sindh EPI are working in collaboration. Increased mapping of urban slums is being done. There is also newfound emphasis on the monitoring, evaluation and accountability framework. However, more emphasis is needed in raising awareness among parents, especially mothers, because eventually the decision to get one’s child vaccinated or not remains pre-dominantly with them.

Measles remains one of the key indicators of immunisation programmes in any country. Some 20 million infants missed their measles shots world over in 2015, and an estimated 134,000 children died from the disease. Half of the unvaccinated infants and 75 per cent of the measles deaths are in six countries; Pakistan is one of them. “The frequent outbreaks of measles in our country are a clear reminder that should convince parents about the need for vaccines for their children,” says Dr. Ali.

“Mothers in Tharparkar are very cooperative when it comes to their children’s health but they need to be convinced. We have not reached out enough to create awareness among the mothers,” says Dr. Aziz Kunbhar, former District Health Officer in Tharparkar.

Dr. Ali adds that awareness needs to be raised among parents that vaccination is a right of their children. “Even if vaccinators are not coming to your house, parents must take their children to local governmental vaccination centers.”