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Book review: Street Smart

Published: June 21, 2015
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http://tribune.com.pk/story/905210/book-review-street-smart/
Rumana Husain’s Street Smart is a photo essay appreciating Karachi’s days of yore.

Rumana Husain’s Street Smart is a photo essay appreciating Karachi’s days of yore.

KARACHI: Over 20 million people in Pakistan warrant 20 million plus stories. In Karachi, the world’s third most populous city, there is never a moment of stagnation. The city grows and evolves as we talk. There is the heritage of the past with nostalgic remains in the form of colonial buildings and tales of simpler, safer times and a futuristic side to the city where buildings are being torn down and electronics replace tender connections. For instance, the quintessential 5:00pm tea with family is being replaced with fast-paced techno music on radio stations as one gets caught in heavy traffic jams during the evening rush hour. Therefore, in her new book Street Smart, Rumana Husain does what a true lover of this city must. She builds a bridge between the Karachi of yesterday and today. And for this, the artist-cum-author uses the lives of 60 people on the streets of the city as her canvas.

In Husain’s signature style, which made her previous offeringKarachiwala a favourite coffee table book among Karachiites, Street Smart is a 160-page long photo essay. The language is simple but the subjects are not. Flipping through the pages of Street Smart is like listening to the untold story of what Karachi has been through. The city has been ravaged by violence, while also facing problems every megacity faces; yet, its beautiful diversity continues to thrive.

The book’s component, which has a touch of romanticism and nostalgia, is the profiles of people in professions that have begun to fade. The roadside ear cleaner, the roaming tinsmith (kalai wala), the handcart puller (haath gari walla), the ferris wheel operator, the typist and the knives sharpener. In the future, our children may not even know they existed. Documentation of the lives of people like Khadija Bai, a poppadum hawker, and Mariam Ahmed, a female potter, is thus invaluable. The book also includes some new professions like a guard and a food delivery man, including peculiar ones like a vendor selling fried liver. However, some new street ‘workers’ have deftly been left out on purpose, such as the mobile snatcher and the stalker.

The most ironic selection would have to be that of a water carrier, also known as bahishti (person of Paradise), who has a newly-found importance in this water-starved city. It is also interesting to note how the book features some very similar, yet different street professions. These include the oil grinder and the masseur, the scavenger and the junk dealer and the peanut hawker and the dried fruit seller. A critical look, however, reveals that some of these come across as repetitive and unnecessarily take up pages. Other professions could have been included instead, such as a gajra seller, children who wash windscreens at signals or even the entertaining and engaging transgender.

Author Rumana Husain

The book’s photography captures the correct sentiments and freezes the right moments. The cover, instead of using the fortune teller with the parrot, could have perhaps featured one of the better photographs in the book, for instance the photograph of a Sindhi cap seller. But the overall impact is nevertheless delightful and moving.

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

Published in The Express Tribune, Sunday Magazine, June 21st, 2015.

Dementia: Still Ammi

Published: May 18, 2015

“So what exactly is wrong with your mother?”

This is a question I kept hearing for seven years. Initially, I would reply, “She has let herself go after my father’s death” or that “she is depressed.” My responses have kept changing over time, as I learnt, unlearnt and relearnt about my mother’s condition, because what she was going through was much more than just melancholy or depression. The shock of my father’s death had triggered the progressive disease called dementia.

My mother showed no symptoms earlier in her life that could have indicated she could be prone to dementia. All I remember is that in her forties, she developed insomnia and began relying on sleeping pills. She often forgot where she had left the keys. There would also be bouts of paranoia wherein she felt she was being watched by someone or that someone was trying to harm her. My family and I shrugged them off, thinking she was overly cautious. Throughout this time, Ammi remained functional, meticulously managing her home, family and relationships.

Her dementia began progressing after an emotional trauma at a later stage in life, in her case the loss of a spouse and so, the deterioration began. Within months, she seemed to have aged by a decade. She was at a loss for words — literally. Having lost one parent already, we — my siblings and I, all adults — felt a double loss. We kept calling on psychiatrists and urging Ammi to stay strong. But today, we understand that she was never weak —  she was just not well.

Since then, her dementia has drastically progressed. While all the medical information one might require is available on the internet, personal details on how you can deal with dementia are sparse. It is amongst the most common ailments of old age but unfortunately goes undiagnosed and misunderstood in our society. While, I know some of my family members will disapprove of me writing about this private family ordeal, someone must speak out to create awareness regarding this debilitating condition. With this, I hope to offer support to patients, family members and caregivers who share what my precious mother and family went through and are going through on a daily basis. Since knowing Ammi, she would have wanted me to share anything that could help others.

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“You say she has dementia but remembers your name?”

How does one explain to an unassuming friend or relative what exactly dementia is. Most people don’t take it seriously unless you call it Alzheimer’s disease. We have all heard about Alzheimer’s so I suppose it rings a bell but in reality, the two conditions are very different. According to the National Institute on Ageing (NIA) USA, dementia is a mental disorder that affects communication and physical performance adversely while Alzheimer’s specifically hampers the parts of the brain responsible for memory, language and thought control.

Memory loss is, nonetheless, one of the main aspects of dementia. It isn’t just the names and faces of people that a patient forgets. For instance, one of the key tests our geriatric specialist (an old age specialist, in layman terms) ran on Ammi involved asking if she remembered which day it was and if she could tell the time on the clock. When she couldn’t, her dementia was confirmed. With one’s thinking affected, basic functions start getting compromised, specially language, vocabulary and communication. A patient knows what an object such as a spoon or a glass is for and uses it as well but has forgotten what it is called. He or she knows if she has a headache but has forgotten to call it a headache. They know what they feel like eating but forget the name of the fruit, vegetable or dish.

But what is truly amazing is that in most cases, the patient’s consciousness does not alter until the very last stages. Even if Ammi struggles with my name, she knows who I am. Social skills remain intact until the advanced stages so even if they don’t recognise visitors, patients generally make normal, pleasant and general conversation. However, they do realise something is not quite right with their memory and try to cover it up with generic responses. Often when someone asks Ammi if she recognises them, she smiles and says “How could I not?” She has forgotten their name but is aware that it is someone she knows and that it would be rude to admit she didn’t recognise them.

In a strange way, it is comforting to know that your loved one still feels the important things in life: a connection with other humans and the Almighty. The ability to laugh, cry and experience pain and joy are blessings that stay with the patient until the dementia progresses beyond limits. 

“I have forgotten how to walk!”

In the advanced stages of dementia, things start getting serious with various symptoms (sometimes irreversible) manifesting themselves. For instance, one morning Ammi stood up and wouldn’t walk forward. “I don’t know how to walk,” she kept repeating while we urged her to take a step, eventually giving up and letting her return to bed. Ironically, the next morning, she was walking again, with support as per normal. The doctors attributed this to a “mini stroke” which admittedly frightened us but we were assured that such episodes are common during old age. Over time, we learned to watch out for sudden changes in Ammi’s personality, behaviour or body language for possible signs of mini strokes and to deal with them accordingly.

A patient suffering from dementia often forgets how to chew and swallow. They can no longer gulp down food and water as normally as they used to. The result can be not eating enough, which may lead to wastage and eventually starvation if nutrition is not given to the body by alternate means. Another complication of this is Aspiration Pneumonia, which happens when food particles enter the lower airways, causing repeated bacterial infection. The patient can also lose bladder control and forget how to exercise basic functions like passing stool or urine, which we take for granted. The result is urinary tract infection, among many other, related problems. 

The caretakers, in this process, learn new concepts, and their vocabulary increases. Words like dignity sheets, silicon catheters, zinc oxide and peg tube are new to us. Before my mother went through this, I did not know who a geriatric doctor was. A more difficult word we learnt is “Palliative care” which is specialised care for serious patients with ongoing illnesses. Some doctors will, when you ask them what it means, say that it means “end of life care”. But that is not so in all cases, and many patients successfully come back from the palliative care stage to rehabilitation. In Pakistan’s urban centres, certain hospitals have begun home based geriatric and palliative care systems so that the patient can get the best care at home.

“But life goes on.” Or does it?

Life does not go on — at least not for the caretaker of someone with a progressive mental illness. Just recently, I texted a friend who has experienced a similar situation with a loved one and although we hadn’t spoken in months, she immediately understood how I felt. I told her that I was breaking and she said, “It does things to you. It alters you in strange ways.”

Truer words have never been spoken. The helplessness of a parent — someone whom you have grown looking up to — is perhaps one of the worst heartaches in the world. Not only must you watch them suffer but the child inside of you dies bit by bit, no matter how old you are.  Accepting that the person who raised you is no longer functional or needs an attendant or a nurse for the most menial of tasks is extremely difficult. Accepting that someone who loved food will never again eat by mouth due to the risk of aspirating and must be fed via a feeding peg in the abdomen is tough. Accepting that they will be bed-bound and catheterised for their remaining days takes a toll on you too.  In the midst of managing nursing staff, memorising sheets of medication and managing doctor appointments, one forgets that life was ever normal.

There is also that unsaid fear when a voice in the head whispers: What if you inherit your mother’s condition too? Over time, you learn to not dwell on the thought, pray to God that that does not happen, and move on.

It took me a while to accept that in so many ways, my mother is exactly like an infant. We make her do exercises and play games with her that will improve her motor skills. We sing her nursery rhymes and songs that she enjoys. Her eyes light up when she sees us. Her needs, now, are very basic, just like a child’s. But through it all, she still is our Ammi.

A few silver linings and things to do 

Here is what you can do to help yourselves and your loved ones through their illnesses: 

•  Balance and manage your work and families well and take care of yourself physically and spiritually, otherwise you end up being of no use to your loved one.

•  Breaks are a must, as is taking turns if there is more than one caretaker. It is at times like these that one thanks God profusely for the family values that help us stick together.

•  Try to spread awareness about dementia and similar disorders among your social orbit. There is still a general lack of knowledge and social attitudes need improving. For starters, tell visitors, politely, that they cannot discuss the patient’s condition in front of them.

•  Choose good doctors who can be reached at any time. Have numbers and contacts of nursing staff ready. Emergency medicines and numbers of ambulances are a must.

•  Try and develop an inclusive culture when it comes to older people in society. They need not be isolated and confined to their room.

•  Spend as much time with them as possible. Company, care and encouragement can result in surprising improvement.

•  Learn to retain the good counsel and support you get from understanding friends and relatives. Ignore patronising attitudes and unsolicited advice. Each patient is different and each family’s situation varies.

•  It helps to stay positive in such a situation and remember the good times. Keep telling yourself that your loved one has, for the most part, led a full life and that their present state doesn’t define who they are or were. Faith and prayer helps you stay strong.

•  Talk to others who have been through the same. You will realise that many other people have gone through this and you are not alone.

•  Cherish this time. It will pass, as will the exhaustion. Enjoy the physical warmth, love and the prayers of your parent.

•  Most importantly, do not give up on someone just because they are old. Even if you cannot cure the disease, there is so much you can do to make them feel comfortable and feel loved.

Understanding dementia 

Dementia is caused when the brain cells fail to communicate with each other. Damaging of nerve cells that may occur in several areas of the brain is why dementia affects people differently, depending on the area that is affected. However, even though the symptoms may vary, some of the common ones include:

Cognitive changes:

– Memory loss

– Difficulty communicating or finding words

– Difficulty with complex tasks

– Difficulty with planning and organising

– Difficulty with coordination and motor functions

– Problems of disorientation

Psychological changes:

– Personality changes

– Inability to reason behaviour

– Inappropriate behaviour

– Paranoia

– Agitation

– Hallucinations

Published in The Express Tribune, Ms T, May 17th, 2015.

http://tribune.com.pk/story/886462/dementia-still-ammi/

Why Lahore is the best get away for a Karachiite

an hour ago

Karachi, for me, is perfect despite its imperfections. Yet, Lahore is not lagging far behind Karachi when I think of my choicest places in Pakistan.

I am a Karachiite to the core. I love my city’s hustle bustle. I adore the variety of culture Karachi offers, especially as it is not a unilingual city. I know its sights and sounds by heart.

Karachi, for me, is perfect despite its imperfections. Yet, Lahore is not lagging far behind Karachi when I think of my choicest places in Pakistan. In fact, in some ways, it even has an edge over Karachi.

Here are five reasons why:

Safety

The traffic at Kalma Chowk is sluggish and heavy. As we get off the Daewoo coach that got us there from Islamabad and head towards the city, Lahore is crowded as ever. I am looking around suspiciously at passers-by on motor bikes from the car’s windows as I take out my phone to text my friend that we have reached. At once Saleem, the driver, friendly in a Lahori way, sees my nervousness and says,

“O baji jee kuch naheen hota. Karo karo aap phone karo,” he reassures.

(Don’t worry, nothing will happen. You can make your call)

For someone who has suffered from attempted mugging twice in that last one month alone, this Karachiite felt relieved. I simultaneously felt a little envious seeing children riding bikes when I visited a friend in the newly populated Defence locality of Lahore. The friend, a diehard Karachiite, has recently moved to Lahore unexpectedly with his entire family. They seemed very at home in Lahore.

“You all have become total Lahoris, haan?” I said.

And they confessed that this was true. Karachiites are flocking towards Islamabad, and more towards Lahore, in search of safer pastures. It’s a better place to bring up your children who will have a less chance of growing up with safety-related phobias. Isolated incidences happen here too, but overall it is definitely a safer bet. Literally.

Trees

It’s a semi-chilly February afternoon. My friend Ayesha, who is one reason why I wish to frequent Lahore, honours my wish to take photographs, and takes me to Aitchison College.

A gurdwara in Aitchison College. Photo: Farahnaz Zahidi

The gurdwara, mandir (temples) and masjid, all are charming beyond words, due to both the red bricks and the feel of pluralism they lend. But perhaps the prettiest thing about Aitchison, and Lahore generally, is the trees.

A mosque in Aitchison College. Photo: Farahnaz Zahidi

Red bricks in Aitchison College. Photo: Farahnaz Zahidi

Lawrence Garden (now Bagh-e-Jinah), alone, has some 150 varieties of trees. Islamabad has more trees and plantation, and the air is crisper and purer. But Lahore’s trees are mostly aged and huggable; they have a certain character. They have seen the world. They are wise. They are the backdrop of the historic buildings that make Lahore what it is.

The tennis courts at Lawrence garden (Bagh-e-Jinah) are a hub for aspiring tennis stars. Photo: Farahnaz Zahidi

In the stables of Aitchison College: Beautiful horse Shehbaz being bathed by his keeper Labba. Photo: Farahnaz Zahidi

Food

The Lebanese food at the renovated Faletti’s Hotel at Lahore reaffirmed this: While Karachi offers everything a foodie can ask for, Lahore is in no way lesser in terms of being a food haven. From the authentic experiences of the Lahori masala fish of Daarul Maahi to themithai (dessert) of Laal Khooh, and from the fancy eateries at M M Alam road to the variousfood streets (the one near Badshahi Masjid is not the only one), it is a foodie’s paradise.

Begum Shahi (Maryam Zamani) mosque. More than 400-years-old- history crumbling away. Photo: Farahnaz Zahidi

A mihraab at the Begum Shahi (Maryam Zamani) mosque. Photo: Farahnaz Zahidi

A carpet at the Begum Shahi (Maryam Zamani) mosque. Photo: Farahnaz Zahidi

A tile motif at the Begum Shahi (Maryam Zamani) mosque. Photo: Farahnaz Zahidi

Organic and healthier food alternatives are also more readily available. But I struggled with my need for a good paan after dinner. Lahore needs to import someone from Karachi to make good paans and perfect its repute of being the ultimate food hub.

It’s happening

Lahoris are zinda dil (lively), truly, as are all Pakistanis. And a safer environment makes that easier. From theatre and grabbing just the right books from “readings” to musicals at Yusuf Salli’s Haveli, it has a lot to offer for those who want to live it up.

Yusuf Salli’s Haveli courtyard. Photo: Farahnaz Zahidi

Yusuf Salli’s Haveli from the outside. Photo: Farahnaz Zahidi

For the wanderers, an added advantage is that places like Islamabad and Nathia Gali are at drivable distance. Some of the best educational institutes, with the most beautiful campuses, are here, as are places of history and culture. And Lahore doesn’t go to sleep early, just like Karachi, which makes it easier for a Karachiite to settle in.

Beautiful vines at Yusuf Salli’s Haveli. Photo: Farahnaz Zahidi

A pictures wall at Yusuf Salli’s Haveli. Photo: Farahnaz Zahidi

The people

At what was supposed to be a nashta (breakfast), I am at the third floor of a thin house in inner Lahore, visiting a family I have not met in decades. Her children, in their teens, are taking selfies with me, while their father is frying stuff for us in the kitchen. From adjacent rooftops, people are waving. On another day, a random person, himself a photographer, agrees to pose for me as I find him an interesting subject for photography. There is a certain openness in Lahore that I love. Lahoris are not afraid of emoting openly.

Photo: Farahnaz Zahidi

They laugh, cry and share readily.

While there are cons to this behaviour, there are definitely many pros. Without stereotyping, I would have to say that I end up making connections in Lahore more readily than any other city. There is a lesser bureaucratic and also a less hurried, guarded and agitated feel toLahore’s people.

Perhaps this is one of the biggest reasons why I love Lahore.

The hands behind the flags

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Karachi – “I am quite old,” he says, contemplating in reply to a question, as his nimble fingers continue working on a huge Pakistani flag of synthetic material. “May be I am 12?” says the podgy child, sitting on a heap of about a hundred flags. “He is ten years old,” yells out his brother from the other side of the huge room where at every turn of the head, all one can see is flags of Pakistan. Mukhtiyar smiles, clicks his tongue non-chalantly, and goes back to work. There is lots of work to be done as Pakistan’s 68th Independence Day is a few days away. Mukhtiyar and his colleagues work in a kaarkhana (factory) in an industrial area of Karachi. He works on almost a 1000 flags a day in peak season.

 

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Just some eight kilometres away, alongside a main road in an affluent part of Karachi, 15 years old Shazia and her younger brother have set-up a stall on a small table. The national flag in cloth and paper of all shapes and sizes, and many other items that help fuel patriotism are on display. “We buy all of this from lighthouse and sell it. We earn about 200 to 300 rupees a day, that’s all. Is dafa dhanda naheen hai (there is not much business this year),” says their mother Shehnaz who works as part-time domestic help in nearby bungalows. She swings by the stall every few hours to see how her children are doing.

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Hoisting flags around the world

Every year, Pakistan is a splash of green and the minimal white. An entire industry springs into action weeks before the 14 August, and goes back into dormancy after the day is over. But for the workers at Pakistan’s only flag-based company, VIP Flags, flags are made all year round and provide livelihood to around 100 workers and their families. The factory is situated in Korangi Industrial Area, Karachi, and the products they churn out have been record-breaking, literally. “We set the world record of the time for the World’s Largest Flag on the occasion of Pakistan’s 57th Independence day in 2004. The flag measured 340ft x 510ft which is 173,400 sq.ft,breaking the previous American Super flag record, which was 255ft x 505ft,” says Asim Nisar Parchamwala, Director, VIP Flags. The record may have been broken but the pride with which he talks is permanent. From ceremonial and table flags to taking export orders of flags in the thousands that they take from all over the world, this is where most flags are made in the country, including the flags for all political parties. While smaller factories and industries make more economical versions of the banner sporting the symbolic star and crescent, most flags used for official purposes are made here. “Prime Minister Nawaz Sharif has commissioned us to make a flag for this year’s Independence Day which will be hoisted on the world’s tallest flag pole in Lahore,” says Parchamwala.

 

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The workers here are mostly young, the oldest ones in their 30s. The volume of work is challenging. The factory is clean and the workers are well looked after. “They get a ten per cent raise in salary every year,” says Parchamwala, talking to The Express Tribune. When asked why he hires such young workers, he replies by saying, “what do you think these children would be doing if they are not hired? They would be running about in the streets or become members of gangs and mafias.”

 

In another room, two young “cutters” are cutting out flags that will later undergo finishing. The weather is hot and humid, but they are not putting on the fan. “Maal urta hai phir (the flags flutter with the wind the fan produces,” says Ghani.

 

Shahid, a 21 years old worker at VIP flags, agrees. “I have been working here for the last three years. My two brothers also work here. Initially I did not know this work, but overtime I have learnt the skill,” he says. Shahid’s salary is a reasonable sum, between 12 to 18 thousand rupees a month. “We make enough to support our family comfortably.”

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A condensed version of this photo feature was published in The Express Tribune here:

http://tribune.com.pk/story/748918/full-mast-the-hands-behind-the-flags/

Worries pile up as waste grows in Pakistan

Pakistan generates about 20 million tonnes of solid waste annually, and its dumps have become a hub for child labour.

 http://www.aljazeera.com/indepth/features/2014/08/solid-waste-pakistan-karachi-2014867512833362.html
Last updated: 11 Aug 2014 

Some four million children, die each year from waste-related diseases in Pakistan [EPA]
Karachi, Pakistan – In the economic hub of Karachi, Ali, an 11-year-old child, awakens at dawn while the rest of his family sleeps next to burners and barrels that will be used to disintegrate metal waste.

The barrels contain acid, and wires and circuits will be burned in the open air, releasing harmful emissions. But Ali’s impoverished family needs whatever money they can get from this dirty business.

Muhammad Ishaq, 12, is another child hostage to the rubbish he collects for a scrap dealer. In return, the scrap-dealer gives his parents fixed Rs 2500 ($25) a month.

“My shed broke in the recent rains. Where will I live now?” is his recurrent concern, as he refers to the shed made also of, ironically, pieces of wood and cardboard he finds in the trash.

These children get food and clothes from NGOs or common people… They eat at charities and bathe in mosques. They are very susceptible to scabies and infected wounds. They suffer from diarrhoea all year round.

– Rana Asif, Founder of Initiator Human Development Foundation

A waste of a nation

Both Ishaq and Ali are among thousands of Pakistani children who work as scavengers, combing through piles of rubbish for a daily pay that maxes out at about $2.

Besides being out of school, these children face severe health hazards from the unsafe handling of waste.

“These children get food and clothes from NGOs or common people… They eat at charities and bathe in mosques. They are very susceptible to scabies and infected wounds. They suffer from diarrhoea all year round,” said Rana Asif, Founder of Initiator Human Development Foundation, that works for the welfare of street children.

Copper remains the most lucrative find for these boys. It is sold at Rs 500 ($5) a kilo, and aluminium at Rs 100 ($1) a kilo, and all of this is found in electronic waste.

These children – 95 percent of whom are male – are often found at Karachi’s biggest markets for e-waste in the Shershah, Lines Area and Regal neighbourhoods.

“We find computer monitors, and buyers buy them from us for a pittance, but sell it for much more. We get nothing,” said Yaargul Khan, 14, older brother of Ishaq.

Even as child labour remains rampant in Pakistan, almost 5.2 million people; including four million children, die each year from waste-related diseases in Pakistan.

A report by Triple Bottom-Line found that globally, many people did not know their old computers and televisions were shipped to countries such as China, India and Pakistan for “recycling”.

Manually dismantling electronic devices comes with a slew of health hazards, including exposure to toxic substances called furans and dioxins.

Burning these materials is even worse: A burning computer releases dioxins, lead, chromium and other toxic substances. Ali has no choice in the matter, and no gear to protect him from the fumes.

Pakistan generates about 20 million tonnes of solid waste annually, according to the country’s Environment Ministry, and that number is growing by about 2.4 percent each year. The waste management methods in Pakistan, however, remain poor.

The country’s most populous city, Karachi, generates an estimated 9,000 tonnes of waste daily, and garbage collectors cannot keep up.


Recycling is not widely practiced, and in many urban areas, dumping and trash burning are daily occurrences.

Asif Farooqi, the CEO of Waste Busters, a Pakistani waste management and recycling firm, says a big part of the problem is improper waste collection.

His team goes door-to-door collecting garbage bags – in Lahore alone, the company services 70,000 homes – and repurposes the contents. From inorganic trash, Waste Busters derives a form of fuel; from organic waste, they create compost.

Sadly, no organised or satisfactory system of solid waste management has been developed till now. The facilities are much too few compared to the waste generated.    

– Shoaib Ahmed Siddiqui ,Commissioner of Karachi

“What we need from people is to stop open dumping and use garbage bags,” Farooqi told Al Jazeera. “And from the government all we need is administrative support. They should at least not create hurdles for us.”

Shifting the blame

While the administrator for the Karachi Metropolitan Corporation (KMC), Rauf Akhtar Farooqui said the solid waste management is the responsibility of the District Municipal Corporations and not of KMC, the Commissioner of Karachi, Shoaib Ahmed Siddiqui told Al Jazeera that it was, in fact, very much the responsibility of KMC.

“Sadly, no organised or satisfactory system of solid waste management has been developed till now,” he told Al Jazeera.

“The facilities are much too few compared to the waste generated.”

Siddiqui expressed hope that things will get better as a result of the recent formation of the Sindh Solid Waste Management Board.

“This applies to e-waste management as well,” he said.

In neighbouring Punjab province, where over half of Pakistan’s population lives, the Environment Protection Department openly acknowledges the shortfalls, stating on its website: “Environmental legislation is still not well developed in Pakistan, especially in comparison to the developed world. For example, there are no National Quality Standards for [solid waste management].”

Still some hope

The situation has created openings for environmental organisations such as Gul Bahao, which literally builds homes out of rubbish, using materials such as bubble wrap and thermocol.

“Attitudes are changing,” Gul Bahao’s Nargis Latif told Al Jazeera.

“Youth have joined hands with us. Students help us collect funds for this. I am very hopeful.”

Even as the south Asian giant struggles to manage its solid waste, its children continue to scavenge trash for petty income at the cost of their childhood, health and education.

Names of some children have been changed to protect their identity.

Follow Farahnaz Zahidi on Twitter: @FarahnazZahidi

International day to end obstetric fistula: ‘Help me stay dry’

Dr Saboohi Mehdi is one of Pakistan’s 38 surgeons who are trained to repair fistulas, but few of these 38 surgeons work in this field. “It pays no money, so most don’t want to pursue this. But I can’t do anything but this.”

Dr Saboohi Mehdi is one of Pakistan’s 38 surgeons who are
trained to repair fistulas, but few of these 38 surgeons work in this
field. “It pays no money, so most don’t want to pursue this. But I
can’t do anything but this.”

KARACHI: 

She wept inconsolably, and the doctors at Koohi Goth Hospital Karachi could not understand why. They had treated this young woman in her 20s already, and they were ready to discharge her so that she could go back to her family near Pakistan’s border with Afghanistan.

A translator was brought in who told them the real problem. “My first born is with the money-lenders as girwi (mortgage). I developed the fistula during his birth. But I was so desperate to be healed of this constant leaking that I took the chance. I needed money to reach here to get treatment.” Doctors at the hospital raised the money and sent her home. One life saved out of the nearly 5,000 women that develop the fistula every year in Pakistan. But thousands await treatment.

For fistulas, precaution is the best cure. And the cure is simple: Women of Pakistan need to deliver babies into trained hands and with basic health care facilities. This cure is still a distant dream.

Snuggled away in the outskirts of busy Karachi, Koohi Goth Hospital is Pakistan’s only hospital exclusively built to end the scourge of this preventable disease. Only, there should be not even one fistula hospital in Pakistan, because fistulas should no longer exist. “The last fistula case in England was in the 1920s. Here we are with 5,000 new cases every year,” says Dr Shershah Syed, founder of this hospital.

“If the labour is prolonged, the baby’s head can get stuck in the birth canal. If it keeps pushing against the thin wall between the bladder or rectum and the wall of the birth canal, thereby causing strain,” says Dr Suboohi Mehdi, one of the surgeons at Koohi Goth Hospital.

Another way a fistula may be formed is if, by mistake of an unskilled surgeon, a cut is caused in the bladder or rectum during surgery. “We are able to treat just 500—600 every year. Lack of awareness and no accessibility to treatment facilities is the reason,” says Dr Sajjad Ahmed, project manager Fistula Project. The project, run by Pakistan National Forum on Women’s Health (PNFWH) and UNFPA, has treated some 3,400 women since it started off in 2006.

Women suffering from fistulas leak urine or stool uncontrollably. Because of this, they are socially ostracised and lead isolated lives. The fear of leaking leads to them starving themselves, which in turn leads to malnourishment-related problems. They miss basic joys like socializing and traveling by public transport.

“I have forgotten what a normal life is. All I have done the last four lives is wash clothes,” says 40-year-old Rihana from interior Sindh. Rihana cries easily; she knows her case is a complicated one. “I don’t know how I will fix her. Sometimes, the cases are so messed up by the time they come to us that there is little we can do,” says Dr Mehdi.

“The first thing we do when a lot of them reach here is give them a shower,” says the dedicated Noor Gul, a senior nurse at the hospital. Gul is now a trainer, helping train young girls who come to the Koohi Goth Midwifery School and Hostel. Once trained, these girls will go back to their communities and be able to help deliver babies safely, so that more women do not develop this disease.

In a message on this day, the President Society of Obstetricians and Gynecologists of Pakistan (SOGP), Dr Tasneem Ashraf correctly points out that doctors must identify high risk patients for fistula development, especially pregnant women below the age of 20 years or above the age of 40 years, women who have given birth to many children, those suffering from obesity or Anemia, or having larger than normal babies.

Husbands on Board

Naz Bibi is tiny in stature but gives a resolute smile. Suffering from a fistula since the last nine years, this woman in her 40s has come to Karachi all the way from Goth Dera Bugti. She lies on a plastic sheet spread out under her, and can’t wait for the day when she will be dry once more. “Every one left me. Family, friends. I smelled all the time. I leaked non-stop. Yet, my husband was the only one in my life. He brought me here,” she says.

Naz Bibi from Dera Bugti, Balochistan, has been suffering from the condition for nine years. “Everyone left me but my husband. On way to Karachi, travelling was tough in the bus because fellow passengers were disgusted with my stench. I hope that will be over soon.”

Naz Bibi from Dera Bugti, Balochistan, has been suffering from
the condition for nine years. “Everyone left me but my husband. On way
to Karachi, travelling was tough in the bus because fellow passengers
were disgusted with my stench. I hope that will be over soon.”

“We are seeing a definite positive change in the trend. More and more husbands now support their wives through the ordeal,” says Dr Ahmed.

“My husband brought me here all the way from Sialkot,” says Fozia, who developed a fistula during the birth of her first child. “I am so excited! Once I heal, I will be able to say my namaz. I have not been able to pray for the last seven years”.

Facts in numbers

Fistula is a poor women’s disease, and the patients are 99 per cent poor women who cannot afford to get their child delivered under proper medical care.

Every year, Pakistan has 4,500—5,000 new cases of fistula. Out of these, only 500—600 reach doctors for treatment.

Pakistan has an estimated 38 surgeons who can perform fistula repair surgeries, but because this is not a lucrative line of medicine, only an estimated 15 are regularly working in this field.

Life saving info:

For information, call 0800-76200

Pakistan National Forum on Women Health

PMA House, Sir Aga Khan III Road, Karachi.

Office number: 021-32231534

Karachi:

Dr Sher Shah Syed

Koohi Goth Hospital

0315-8230856

0333-3026437

Islamabad:

Maternal and Child Care Centre (Professor Dr Ghazala Mehmood, Dr Kausar Tasneem Bangash)

Pakistan Institute of Medical Sciences (PIMS)

Phone: 051-9260450   Mobile: 0300-5510525

Lahore:

Professor Yasmeen Rashid, Dr Tayyaba Majeed

Gynecology ward, Lady Willingdon Hospital

Mobile: 0300-9487305

Multan:

Dr Rafeeq Anjum

Urology Ward

Mobile: 0300-6303574

Peshawar:

Professor Nasreen Ruby and Dr Tanveer Shafqat

Gynecology ward, Lady Reading Hospital

Phone: 091-5810779  Mobile: 0300-6303574

Quetta:

Dr Sadrak Jalal

Christian Hospital, Mission Road.

Mobile: 0300-8381724

Professor Saadat Khan, Dr Haq Nawaz, Dr Masha Khan

Sandeman Civil Hospital.

Mobile: 0321-8198024

Larkana:

Professor Rafi Baloch, Dr Shaista Abro

Gynecology ward, Shaikh Zayed Women Hospital

Chandka Medical College

Mobile: 0300-3415322

Fistula relief centres

Karachi:

Professor Dr Nargis Soomro, Civil Hospital

Dr Azra Jameel, Sindh Government Qatar Hospital

Orangi Town, Karachi.

Hyderabad:

Professor Dr Pushpa Sri Chand

Isra University Hospital

Dr Nabeela Hassan

Liaquat University of Medical Health Sciences

Abbottabad:

Dr Rahat Ansa

Benazir Bhutto Shaheed Women and Children Health Centre

Nawabshah:

Dr Razia Bahadur

Peoples Medical College, Civil Hospital

0345-2750470; 0300-2162392

Published in The Express Tribune, May 24th, 2014.

http://tribune.com.pk/story/712365/international-day-to-end-obstetric-fistula-help-me-stay-dry/

Slide show: http://tribune.com.pk/multimedia/slideshows/712507/

Help me stay dry – Stories of hope in pictures (Photo credits: Faisal Sayani)

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