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Age of the specialist – Where is the family doctor?

In search of a doctor who treats us as a whole — the one-stop shop for all ailments, both physical or mental

Age of the specialist

We all had that one family doctor. The one who always had time. The one who was always accessible. The one who had given one the first shots as a baby. The one who knew the medical history of the grandparents, the parents, the sons and daughters, and perhaps the grandchildren if the doctor lived through it all. This family doctor was the one stop shop for all ailments, both physical and mental. This doctor treated everything from arthritis to diabetes to heart disease, as well as common complains like the flu or an upset stomach.

This is the doctor who has now disappeared, is missed by many with yearning and nostalgia, and has been replaced by different ‘specialists’ for every part of the body.

The specialists’ option is both more time consuming as well as more expensive, yet it seems this is curveball advancement in healthcare thrown at patients. With more awareness and emergence of newer classifications of illnesses, it seems avoiding specialists is something impossible.

“Going to an ENT specialist for sore throat and to a cardiologist for high blood pressure may feel like getting the best care, and often it is, but the overall health is then overlooked with each specialist focusing only on their area and not the person as a whole. A well-trained family physician is capable of dealing with 90 per cent of common health problems of the individual and his/her family, and appropriately referring to specialist if needed,” says Dr Saniya Sabzwari, Geriatric Specialist at AKU.

Doctors like Dr Mohsin Ali Mustafa agree that the role of the GP is irreplaceable. “Primary care especially in the context of a patient, that is, the role of a family physician is the backbone of a healthy and functioning community. Lack of quality and mistrust of ‘GP Clinics’ in Pakistan has led to people approaching consultants as their first stop for medical needs,” he says. Dr Mustafa is the co-founder of Clinic5.

Clinic5 was established with the aim of reducing the burden of disease by providing primary care in communities, at a cost that the average Pakistani can afford. “A good family physician can treat most common ailments and even some complicated medical cases because they have a good command over not just your medical ailment but also the social and family context. This dual understanding is often missing with a specialist,” he adds.

Yasmin Elahi, a writer, is one of those patients who are not in favour of this trend of reaching out to specialists before the GP. “Doctors these days consider patients not a person but a combination of systems and organs. At 65 plus, I have some chronic health problems. Visiting a dermatologist, ENT, a pulmonologist and a rheumatologist separately, is both time and money-consuming and I often put the less pressing problem in the back seat,” she says, and points to an important and perilous side-effect of this trend: self-medication and seeking over-the-counter advice from pharmacists instead of doctors, which more and more patients have begun opting for, just to avoid the expenses as well as the long wait involved in getting an appointment with specialists.

“Nowadays specialists are not ready to listen to any complaint other than what falls in their own field. Family physicians don’t charge a lot whereas with specialists you have to pay an exorbitant amount.”

A popular career choice these days when it comes to healthcare is being a physician’s assistant (PA), world over. Its popularity is perhaps the outcome of the void being felt by patients due to a sharp recession in the importance and presence of family physicians.

Daniyal Ahmed, a 2nd year student in the US in the PA programme, sheds light on the issue. “The primary care provider (PCP), or general practitioner (GP), is meant to be the first point of contact for a patient. If you are sick, you visit your PCP; if they deem it is beyond their scope of practice, they refer you to a specialist. By eliminating that role, a large gap in patient care has been created — it puts an unreasonable burden on specialists, who are now effectively serving as PCPs in addition to their subspecialty,” he says.

In the US, according to Ahmed, a huge part of the role of PAs is in primary care. “There’s a chronic physician shortage in primary care and family medicine, largely because it doesn’t pay as well as specialties and is a relatively thankless job. PAs and NPs (Nurse Practitioners) are often hired to fill those roles that we don’t have enough physicians for.”

Dr Ambreen Iqbal’s family mostly doesn’t need to see specialists, as she is a family physician who advises them about their basic health problems. “I think family physicians are like gatekeepers who direct one to the right doctor. They have a holistic approach to patient care. Nowadays specialists are not ready to listen to any complaint other than what falls in their own field. Also, family physicians don’t charge a lot whereas with specialists you have to pay an exorbitant amount.”

“In the past, specialists were few and GPS were many. Specialists would come into the picture only when people were referred to them by their GPs; the culture of going on your own to a specialist was simply not there,” says Pervez Muslim, a Chartered Accountant who has observed closely the pros and cons of GPs and specialists as he has been treated by both, in Pakistan as well as abroad. He feels that as more and more doctors started to go abroad for specialisation and began to return to the country to practice, and due to increased awareness, people started to rely more on specialists.

“Affluence in a certain social strata further cultivated the culture of going directly to specialists. Development of better hospitals in the country made it easy for people to go to such hospitals where only specialists practice. Hence, the tide turned,” he says.

Muslim adds that in this day and age, specialisation is the name of the game in every field and profession. “Jacks of all trades are fading with the passage of time.  Their use is now restricted to those who cannot afford to pay to specialists. Unfortunately, this has also become a status symbol.”

The sentiments expressed against specialists, then, seem to be a result of two factors: Firstly, treatment from specialists is a pricier option, and often involves a battery of laboratory tests that patients who are used to GPs find hard to grapple with. The second grievance comes in the form of what seems a lack of empathy. The more a specialist is trained to treat a certain genre of illness, the more disconnected he or she seems with the other illnesses.

“I don’t believe it’s necessarily the specialists themselves who lack empathy or understanding of patients; they are meant to deal with very specific health problems,” says Ahmed.

Dr Mustafa feels that the need of the hour is for standardisation of quality at existing GP clinics and an uplift of their infrastructure so that people can trust the care being dispensed at these centres. “This makes both clinical and economic sense.”

While Dr Sabzwari agrees that the specialist mindset has fragmented care of individuals and families, she adds that it is unavoidable. “The need for specialists will always remain for complicated problems, difficult diagnoses and ailments requiring complex management.”

Thus, varied opinions notwithstanding, and much as patients may resist to the idea, it seems specialists are here to stay.

http://tns.thenews.com.pk/age-specialist/#.W3Uym-gzbIU

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One against twenty – The only differently-abled candidate in Elections 2018

Differently-abled Raza Shah is contesting elections from PS-103, and probably he is the only such candidate

One against twenty
He dreams of climbing the K-2 one day. But contesting against 20 heavyweight contestants in Karachi’s thickly populated and ethnically diverse constituency PS-103 is possibly tougher than climbing a mountain, especially if one is an independent candidate who does not have the backing of the affluent.

For Raza Shah, the fact that he is one of the few, or possibly Pakistan’s only differently-abled contestant for the upcoming general elections 2018, his being a polio survivor is not his biggest limitation. “We live in a world where political parties politicise everything to win the elections. If there were other differently-abled contestants, they would have been highlighted by the big parties by now for sure,” says 36-years-old Shah.

For everyone in their lives, there is one moment of epiphany. So it was for Shah who, witnessing the issues people like him faced and the fact that they had no one to solve the problems, realised he must step up. “For every problem, one had to either contact political bigwigs through networks and contacts, or through giving money. The people who were our points of contact knew nothing about our problems. I thought to myself ‘why can’t I be that point of contact?’.”

From 8am to 3am, Shah and his core group of supporters knock door to door in their constituency for the Sindh Assembly seat PS-103. Gradually, people are getting convinced, and the response is very positive, according to Shah, because he is one of them. But it hasn’t been easy. “Har party ke hissay kee gaaliyan bhi mein ne khayi hain (I have been hearing abuses in place of the other political parties),” he laughs and says, because when he goes to convince people, they ask what can he do if those political giants could do nothing, only to be convinced that here is a man who actually has the will to fight the odds and help his community. And the will is perhaps all it takes.

Campaigning has taught him a lot, as interacting one-on-one teaches what hours on the podium giving speeches doesn’t. “I have also learnt that our people are very hospitable and make sure you take chai or cold drinks, but there are no public toilets in Karachi,” he says, pointing out a legitimate issue in the garb of humour.

While newspapers proudly sported the headline given by Election Commission of Pakistan (ECP) that disabled people are being facilitated and are allowed to vote through postal ballot, where is that much-awaited headline that says that differently-abled people are contesting elections? Yes there are reserved seats for them but is that enough? For Shah, his contesting the elections is also about making a point about social inclusion. Parties like Pakistan Tehreek-e-Insaf (PTI) and Pakistan People’s Party (PPP) have sections in their manifesto talking about ensuring rights of the differently-abled.

Campaigning has taught him a lot, as interacting one-on-one teaches what hours on the podium giving speeches doesn’t.

Other major political parties have not even bothered to do that. However, Shah feels that this is all good to the extent of manifestos only, but Pakistan’s differently-abled need more than just job quotas. They need their voices heard. “Practically, no one has fielded differently-abled candidates from their parties, have they?” says Shah who contracted polio at the age of one and a half. “Every day is a fight, living with this [disability]. If I can fight this, I can do more.”

An optimist, Shah feels that more and more independent candidates will come up in elections over time. “Voters will also understand over time that those who spend crores on election campaigns will obviously invest that much to earn it all and more back after the elections. It is independent candidates who are focused on solving people’s problems because they are in it to serve their communities,” he adds. His election symbol is brick. “It is a symbol of constructing something. It reflects the ideology of progress.”

Shah also does not see his disability as his claim to fame. “I tell people that if I can contest elections with limitations like being an independent candidate, putting up a fight against representatives of Pakistan’s biggest political parties, and on top of it being differently-abled, then so can you. I am a reality. I am part of the equation, even though I have limitations. Unless citizens like me stand up for themselves, and gain the strength to help their communities, no one is going to help us.”

http://tns.thenews.com.pk/one-twenty/#.W3Uw2ugzbIU

Ralli-ing together

A traditional art form has become an unlikely symbol of women empowerment and inter-generational love

Ralli-ing together
Ralli-making (also known as Rilli) comes from the word “ral” which means to mingle. This traditional art form provides women an activity that transforms their homes into women-friendly spaces where women gather and sew bits and pieces of fabric into a quilt. It is a test of creativity, turning whatever pieces life has left them into a thing of beauty and utility – from nothing into something. Even today, if you go to interior Sindh, the lady of the house will spread out her best Ralli on the charpoy and motion you to make yourself comfortable.

The art of quilt-making is, thus, metaphorical in many ways. Women create homes out of small and big things gathered and assembled together as a labour of love. It requires accuracy, patience and hard work. Making a quilt is similar.

When Samiah Ahsan Zia and Samina Qureshi co-founded a group for women in 2008 with a passion for quilting, little did they know that more than a dozen passionate quilters would join hands with them. “The Piecemakers’ Guild”, as the group is named, recently held its 4th exhibition in Karachi. With quilts on display and on sale, the work of these women is nothing short of art.

The love for quilting took time to grow on Zeba Rehman, one of the group’s earliest members. Her eye-catching quilt with shades of white and indigo is on display. “I now spend days sitting near the window in the sunlight, sewing each piece carefully, with my glasses on. When I am working on a quilt, I can go on working non-stop for hours,” adds Rehman.

“We are 16 members, all very committed, who meet every fortnight. Senior quilters train new quilters. We use varied techniques,” says Samina Qureshi. Her piece was the winner of the Mughal Art Challenge this year, in which she has used many mediums like applique, block-printing, sequence and thread embroidery, and even printing. “I find quilt-making therapeutic; it has a calming effect,” adds Qureshi.

Samiah Ahsan Zia echoes Qureshi’s sentiment. “It keeps the mind and hands busy and offers an avenue to express one’s creativity. Patchwork and quilting has been practiced world over since time immemorial. Modern tools have added new dimensions to it,” she says.

The art of quilt-making is metaphorical in many ways. Women create homes out of small and big things gathered and assembled together as a labour of love.

For Nida Huq, another member of the Guild, the inspiration came from her mother who has passed away. “It was my way of remembering my mother as she used to sew,” she says. Huq finds the activity very effective for stress management. For her, the most rewarding piece has been the raffle quilt which has been completed by the team to fund-raise for a good cause.

“The money from the raffle quilt will be donated to the Child Aid Association which operates from the National Institute of Child Health and treats children suffering from cancer. We treat quilting not just as a hobby but try to use it for social activism for causes close to our hearts,” says Zia.

The group was also invited to participate in the Karachi Biennale 2017, and challenged to convert a discarded electric cable reel into an art installation. “Our reel, titled ‘Heroines not victims’ was designed to be a tribute to Pakistani women and their resilient spirit, highlighting their achievements despite immense socioeconomic challenges and rampant misogyny,” says Zia. The group has also intermittently worked with groups of women from interior Sindh to help hone the skills of rural women in the art of ralli-making. “We hope that while staying true to their age-old craft, their work would become more contemporary and hence more marketable.”

For Rehman, a mother of two sons, the aim is “to leave one quilt each for my two future daughters-in-law as a personalized family heirloom”.

http://tns.thenews.com.pk/ralli-ing-together/#.W3UvjegzbIV

 

The population challenge

 http://tns.thenews.com.pk/population-challenge/#.WqJhJuhubIV

Rising population poses a serious threat to Pakistan’s progress. Here are a few suggestions by experts to stem the crisis

The population challenge
 The biggest issues facing Pakistan are the booming population growth and the lack of awareness across the board regarding how big a threat this poses to the country’s progress. Simply put, the country has too many people and not matching resources in the spheres of food, health, education, and employment systems. Conferences are held and experts join their heads in exasperation to think of policies and projects that can manage this unbridled growth. Yet, the most basic of problems is often overlooked — raising awareness.

If enough efforts are not made to slow down Pakistan’s population growth rate, the population will likely increase from the current 189 million people to 310 million by 2050 (UN DESA, 2015). But this is a conservative estimate. According to President Population Association of Pakistan and Chairman Punjab Higher Education Commission Dr Nizamuddin, the country’s population would cross the 395 million mark by 2047. He said this at the recently held Eighteenth Annual Population Research Conference, Population Growth and Investing in Human Resource Development, in collaboration with Government College University Lahore. With just three years left to achieve its FP 2020 targets, Pakistan’s high growth rate of 2.4 per cent depicted in Population Census of 2017 asks for serious efforts.

Speakers at the conference gave different and relevant solutions to how the challenge can be met. Dr Aziz Rab of Greenstar Marketing emphasised on a number of ideas, all aimed at raising general awareness among people regarding family planning, like a toll free number where people can get guidance regarding FP, as well as free air time for the purpose. However, all of this would need political will and support from the government.

If enough efforts are not made to slow down Pakistan’s population growth rate, the population will likely increase from the current 189 million people to 310 million by 2050 (UN DESA, 2015). But this is a conservative estimate.

Dr Attiya Inayatullah, Chairperson Rahnuma Group of Pakistan, pressed upon the need for public-private partnerships to achieve the desired targets. She expressed the need to bring the private sector on board in all FP efforts, as well as leveraging men to become allies in this endeavour. Stalwarts of the field like Dr Mehtab S. Karim, Executive Director, Centre for Studies in Population & Health, Dr. Zeba A. Sathar, Country Director, Population Council, and Dr. Farid Midhet, Vice President, Population Association of Pakistan & Country Director, Jhpiego Pakistan, participated in the conference.

A panel discussion on Pakistan’s 6th population census results, organised by Jhpiego and the Population Association of Pakistan, had experts debating the methodology of the population census 2017. Journalist Zofeen Ebrahim who was invited as a panelist at the session, said that now that Pakistan has a fair idea of the numbers “we need to focus on planning for the people in earnest instead of quibbling over the methodology of the census”.

As Dr Inayatullah pointed out, Pakistan has the know-how and can achieve the targets. What it needs right now is a reality check, she said. “There are two gaps: Implementation is key for which we must get down to the grass roots. And secondly, where do we find a political leader who will speak out boldly in an upfront manner about this?”

A possible solution

While moots like the aforementioned conference give the much needed impetus to the issue at the top of the pyramid, doctors working at grassroots level like obstetrician Dr Halima Yasmeen at the Jinnah Postgraduate Medical Centre (JPMC) Karachi, feel that growth rate cannot be slowed down till awareness is raised. For this, dedicated counselors who can talk to women and convince them to use contraceptives can play a core role.

“It is an evidence-based fact that introducing a cadre of FP counselors shows better results when it comes to use of contraceptives. These counselors should be there at hospitals 24/7, just like nursing and janitorial staff is there round the clock. And their job should be only to talk to people,” she said, emphasising the importance of convincing people to use contraceptives.

“Our doctors are fulfilling their own dreams, and are on autopilot mode. What they are not doing is fulfilling the needs of this country as a whole,” said Dr Azra Ahsan, gynaecologist and consultant at the National Committee for Maternal and Neonatal Health (NCMNH). Dr Ahsan, while talking to The News on Sunday, expressed that the key to solving this problem lies in sensitising healthcare practitioners. “Every healthcare provider should know about providing family planning (FP) services. But they are not taught how to do it properly even in medical colleges. They don’t even know how to manage post-partum hemorrhage, because there is no glamour in this kind of healthcare service,” she says.

With mobility restrictions and traditional barriers, women don’t readily come to hospitals and clinics. However, the rates of women opting for deliveries in hospitals or healthcare units has gone up considerably, and this allows a great opportunity to convince them for post-partum contraception. “Most women do not come back for follow ups, which means that they will not get contraception-related advice in time,” says Dr Ahsan, commenting on golden opportunities that keep slipping through the net.

A project of NCMNH involved stationing two to three dedicated FP counselors in selected hospitals in Karachi, and this strategic placement multiplied the number of women opting for contraceptives like Intra-Uterine Devices (IUDs). “The day the counselors didn’t come, we saw that no women opted for contraceptives,” says Dr Ahsan.

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)

Day 8, Day 9 & Day 10 #Ramadan #Quran #Verseoftheday #Paradise #Charity #AngerManagement #Forgive #Chastity

– Day 8, Day 9 & Day 10
Forgive and be Forgiven  

And hasten to forgiveness from your Lord and a garden as wide as the heavens and earth, prepared for the righteous.

Those who spend [in the cause of Allah] during ease and hardship and who restrain anger and who pardon the people – and Allah loves the doers of good.

3_135

And those who, when they commit immorality or wrong themselves, remember Allah and seek forgiveness for their sins – and who can forgive sins except Allah? and (who) do not persist in what they have done knowingly.

How beautiful is Islam, full of hope, for the door to forgiveness is always open till the last breath.

These verses from Surah Aal-e-Imran have multiple inter-related themes. Here I am, marveling at each verse and each word and each letter that is meaningful beyond comprehension. With gentle love and care, our Merciful Rabb shows us the path towards salvation, guiding us each step of the way, motivating us, telling us what to do.

The surface of the key subjects in these 3 verses can be at best barely touched upon as under:

  • Verse 133: Allah (swt) is using the word “Saa-ri-‘oo” – rush, hasten, run, compete towards Allah’s forgiveness. The word implies that we must not delay, for each moment is precious. Allah’s forgiveness is the only thing that can lead us to the unimaginable Paradise that He has lovingly prepared for the God-conscious. What fascinates me is the fact that the Quran recognizes that even the God-conscious or “Muttaqeen” who may eventually end up in Jannah with His Mercy, will make mistakes, but with effort and sincere intention to improve, they may attract Allah’s forgiveness. The people of Jannah are not perfect. But they accept their faults and strive to improve, and do good deeds that may wash away their sins. #Hope
  • Verse 134: SPEND – One of the sure shot ways to wash away your mistakes. And spending not conditionally only when you have lots to give, but spending in times of difficulty and financial restrain. Spending what we love. Spending even when we do not have a lot of “extra” to spend. Spend on those who live on earth, and He will forgive you and shower blessings on you from the heavens.
  • Verse 134: CONTROL ANGER – Anger in all its forms. Both inner and outer. Outer anger manifests itself as abuse, violence, taunts, sarcasm and harming the other. Inner anger manifests as grudges and ill feelings. The word “kaazimeen” is so apt – to suppress. Meaning the anger IS there, and in all probability is justified, and the person we are angry with may have hurt us or wronged us. Yet, true strength lies in controlling this negative emotion.
  • Verse 134: FORGIVE: Wow! So if we want Allah (swt) to forgive us, we have to forgive those who have harmed us. So many times, even if we are somehow able to suppress anger, the seething pain and the grudges towards those who have hurt us remain. They do not harm that person, mostly. These ill feelings damage the heart that is housing these ill feelings. Allah (swt) is telling us to let go of whatever it was. After all, if it is Allah (swt) on whom we have tawakkul (reliance), we have to trust that He Knows who hurt us and harmed us and scarred us. If we want to heal, this is the only path – forgetting may not be possible but forgiving (with a lot of hard work) is a possibility. So let go of that anger…..forgive…for inner peace. For Paradise will be home to those who have found inner peace 🙂
  • Verse 135: BEGGING FOR FORGIVENESS: Yes, even those who will eventually, InshaAllah, enter Paradise, make major mistakes and commit major sins….sins that come under immorality, indecency, and go against the command to guard their chastity. When they do so, they have wronged no one but themselves. The inner impressions such sins leave harm our soul, bit by bit. The verse addresses those who have harmed themselves. Recognizing that one has erred and accepting that it is we who harm ourselves is the first step towards forgiveness. When they ask Allah (swt) for forgiveness, Allah (swt) showers His forgiveness on His slaves. But the one condition this verse puts forth is this: Do not insist on repeating a sin when you realize it is a mistake. Strive and aim to ward it off, and ask Allah (swt) for the strength to be able to resist the temptations. And its beautiful when the verse says who can forgive but Allah (swt)? The piles and mountains of our sins can only find forgiveness in our Rabb, the Magnanimous and ever Merciful.

As the beautiful Hadeeth-e-Qudsi says:

On the authority of Anas, who said: I heard the messenger of Allah say:Allah the Almighty has said: “O son of Adam, so long as you call upon Me and ask of Me, I shall forgive you for what you have done, and I shall not mind. O son of Adam, were your sins to reach the clouds of the sky and were you then to ask forgiveness of Me, I would forgive you. O son of Adam, were you to come to Me with sins nearly as great as the earth and were you then to face Me, ascribing no partner to Me, I would bring you forgiveness nearly as great as its.” (Tirmidhi)

In this most special of months, let us forgive and beg Allah for forgiveness.

Love in War – The love story of a Syrian refugee

Published: December 20, 2015
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http://tribune.com.pk/story/1011087/love-in-war/
Tracey and Ahmed are waiting to begin a new life in Sweden once Ahmed gets legal residency in the country. PHOTOSCOURTESY: TRACEY SHELTON

Tracey and Ahmed are waiting to begin a new life in Sweden once Ahmed gets legal residency in the country. PHOTOSCOURTESY: TRACEY SHELTON

He is thousands of miles away from his home in Aleppo, Syria, in a refugee camp in Bastad, Sweden. The Nordic winter is bitterly harsh here in December. The journey as a refugee has been long and winding. “We travelled mostly on foot; it was dangerous,” says Ahmad Al Haj, one of the more than four million Syrian refugees who have had to leave home in quest of safety. But Ahmad says it was all worth it in the end, as in the midst of war and displacement he found the love of his life.

For Tracey Shelton, now Ahmad’s wife, the wait for her husband to get legal residency in Sweden is not easy. “It has been really tough being forced to stay apart for so long, but hopefully it will be coming to an end soon. His asylum has been approved; we are now undergoing what seems like an endless wait for them to issue his papers,” says the Australian journalist and photographer who has spent years covering conflict in volatile regions, including Iraq, Libya, Syria and Lebanon. She is presently living in Istanbul, Turkey, in what she calls a “limbo”, waiting to move to Sweden to start a new life with Ahmad.

Families grieving outside a hospital in Aleppo province after identifying the bodies of their loved ones following a government airstrike that killed civilians.

Images of those affected by the Syria crisis and painful headlines about the spillover effects of it tell much about the situation on ground, but millions of stories behind the images and headlines remain untold. Ahmad and Tracey’s love story is one of them.“Her work and her understanding of the situation in my region,” is one of the things Ahmad mentions when asked what drew him to her. By reporting on conflict and internal displacement, mostly within the Middle East, an affinity with Ahmad came naturally to Tracey. “After six years of working largely on frontlines and with Arab families, it’s hard for me to fit back into life in a Western country,” says Tracey.

The couple met socially when Tracey was living in Syria. “We met through a mutual friend. Ahmad and I got along really well from the beginning and became close friends. Things developed from there,” explains Tracey, adding that one of the reasons Ahmad took the trip to Europe was so that they could establish a life together.

Getting married was another obstacle for the two of them. Here were two people wanting to start a life together, and the proverbial man-made laws restricting them from doing so. “In Turkey it is illegal for a Sheikh (Muslim clergyman) to perform a nikaah (religious marriage) without a legal marriage so we couldn’t find anyone to do it there,” says Tracey. “Although in Islam, marriage between a Christian woman and a Muslim man is permitted, the Sheikhs did not want to accept the responsibility. We eventually found someone (to perform the nikaah) in Sweden, but we are still waiting for our marriage to be registered.” After trying for six months, the couple got married in June this year.

Protest against the Syrian government during a rally in Syria.

The couple has been living apart since Ahmad left Turkey for Europe earlier this year; they only get to meet sporadically when Tracey visits him. “Since he’s been in the camp, it’s harder for me to visit.”

While Ahmad has dreams of a secure future with Tracey, the ordeal has been traumatic. “Life was normal in Syria before the revolution. I never thought I’d be a refugee one day. I was still studying at the time and thought I’d go on to develop my career in IT,” reminisces Ahmad, son of a civil engineer and businessman and the eldest among three brothers and a sister. “The fighting in our area turned intense. It became hopeless to stay there. It was difficult to even get food and medicine. Our entire family left Syria together,” he recalls.

The Al Haj family, today, is spread all over, and none of them have yet acquired asylum anywhere. Ahmad’s father returned to Syria to try to sell some of his property, while his mother, brothers and sister are in Southern Turkey. “The displacement affected us in every way possible. I don’t have any legal status anywhere. On paper, technically, I didn’t exist. You have no rights, no identity, no work, and no way to study again,” says Ahmad, who now spends most of his time in the camp fixing everyone’s phones and laptops.

A boy holds up a piece of shrapnel during a protest in the town of Kureen in Syria.

Despite the situational difficulties and a mostly long distance relationship, the two of them lighten up when asked about each other. “He is intelligent, funny, cool, sweet and charming. He cares about me and looks after me in a way I never dreamt of. He is also excellent with languages. He speaks three languages expertly,” says Tracey. Ahmad’s easygoing charm worked on her, as he was easy to talk to, she shares. “He has a lot of knowledge and a deep understanding of things. I love talking with him and listening to his ideas.” For Ahmad, what attracted him to her was “how she treats people. Her personality. And her beautiful eyes”.Tracey recalls when she met him twice en route to Greece and Serbia. “The soles of his feet were just two huge blisters from walking, just cushions of liquid. I don’t know how he managed to walk on them. But from there they had to keep walking through to Hungary.”

According to Sweden’s migration agency Migrationsverket, the applications for asylum received by Sweden in January 2015 were 4,896. By November 2015, the number rose to 36,741, and more than 25,000 of these are males. So far this year, more than 120,000 people have applied for asylum in Sweden.

While the future looks bleak for Syrian refugees, they have certain advantages, according to Tania Karas, an Athens-based journalist covering migration and refugee issues. “Syrians in particular tend to be middle-class, educated and technologically literate,” she says, adding that while this may be a slight generalisation, it does mean that Syrians, more than other refugees, have an easier time navigating their journeys and assimilating into European society. “Another advantage is that Syrians are considered ‘prima facie’ refugees because there’s an active war going on in their country so they are highly likely to be granted refugee status,” says Karas, who has been actively working with Syrian refugees in the Greek island of Lesbos. More than half of the refugees and migrants who have reached Greece this year have landed at Lesbos. Some 3,460 lives have been lost crossing the Mediterranean, reveals data provided by the United Nations Refugee Agency (UNHCR).

The number of Syrians arriving in Europe seeking international protection continues to increase. However, according to the UNHCR, it remains low compared to Syria’s neighbouring countries, with slightly more than 10% of those who have fled the conflict seeking safety in Europe. Sweden which has had a very relaxed system in the past, where refugees could enter the country unobstructed, is now introducing border checks. The laissez-faire might not be feasible for Sweden any more, considering the very real security threats following the attacks in Paris. The situation, thus, seems poised to make life even tougher for the refugees. And a solution seems nowhere in sight.

An earlier photograph of Syrian rebel fighters praying before launching an anti-government attack near Idlib city.

UN High Commissioner for Refugees António Guterres acknowledges that this is the biggest refugee population from a single conflict in a generation. “It is a population that needs the support of the world but is instead living in dire conditions and sinking deeper into poverty,” Guterres says. According to the UNHCR, Syrians in exile face trials such as living in sub-standard shelters and below the poverty line in countries like Jordan and Lebanon. “Having to leave behind their family and friends and not knowing when they will see them again or whether they will see them alive are the prime difficulties Syrian refugees face,” says Argentina-based correspondent Kamilia Lahrichi. It’s tough for refugees to adapt to a new culture because of cultural barriers, she adds.While Ahmad appreciates European countries opening their gates for the refugees, and acknowledges that they try their best to help refugees and keep them comfortable, he is very clear when asked what he sees as a solution to the Syria crisis. “All of the outside countries — USA, Russia, Iran, Saudi Arabia — need to back off and let us solve our own problems. Foreign powers have made Syria their playground, trying to prove their strength,” he says. Tracey echoes the sentiment and expresses dismay at what started as a revolution has escalated into a regional proxy war. “Everything in Syria has become so complicated with too many players. I honestly don’t know what the solution is anymore.”

But for Ahmad, “the most difficult thing is being apart from Tracey” at the moment. “Until Ahmad’s final residency decision, everything is up in the air. Once it’s finalised Ahmad can start working here in Sweden and I can join him. We hope to start a family too,” says Tracey. Till then, love must wait.

Farahnaz Zahidi works as a senior subeditor at The Express Tribune. She tweets @FarahnazZahidi

Published in The Express Tribune, Sunday Magazine, December 20th, 2015.