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How Emotional Neglect Is Turning Too Many Of Pakistan’s Boys Into Criminals

While conflict and terror rise alarmingly around the world, it’s time to ask ourselves: could lives be saved if we got better at raising boys?

http://www.buzzfeed.com/farahnazzahidi/the-neglected-sons-of-pakistan#.jlPyOq14p

Rebecca Hendin / BuzzFeed

Editor’s note: Some names have been changed to protect the identity of people interviewed for this story.

When Zafar was young, he wanted to become a professional footballer. Now, at 38, he recruits young men for his brother, who is one of several warlords in Lyari, a densely populated neighbourhood in Karachi, Pakistan. Lyari is as famous for its talented football players and rich culture as it is infamous for gang warfare and targeted killings.

“I am a victim of this system,” Zafar says, referring to his inability to isolate himself from a life crime. “Time in jail can transform innocent people into criminals.”

Zafar describes himself as non-violent. He spends some of his time managing a confectionery shop as a side-business. “I’m not involved in anything wrong,” he insists. His friends, sitting around him, laugh as a rejection of this claim.

We’re sitting inside journalist Saeed Baloch’s house inside the town. As an active member of the community in Lyari, Baloch has seen many young men stray down violent paths, going on to lead lives of crime and imprisonment. “Neglect leads to boys becoming militant,” he explains.

According to Baloch, as many as 3,000 young Lyari men — many of whom had committed crimes — have been killed in encounters by law enforcement agencies between 2013 and 2015.

March, 2014: Lyari residents protest after gang violence killed 16 people. ASIF HASSAN / Getty Images

Between 2003 and 2015, Pakistan has lost more than 20,000 civilians to acts of terrorism alone, according to the South Asia Terrorism Portal (SATP). The average age of men involved in crime and militancy remains dangerously low. According to Saeed, they often start being recruited when they turn 13.

“Young boys see the good life of gang leaders – their money and power leaves even community elders awestruck,” Baloch says. “When boys have no productive activity, they loiter around. Once they get inducted into a gang, they can never leave.”

Baloch’s 17-year-old daughter Muqaddas is a student of Pre-Medical Intermediate. “Boys are generally non-serious about education and seek other outlets,” she chimes in. “For us girls, education itself is the outlet.”

And gangs are only one of several violent paths that attract Pakistan’s boys. Baloch, and several others I spoke to for this story, said that while resources are spent on fixing the problems that come from neglecting these boys – crime, violence against women, terrorism, gang wars — not enough emphasis is placed on finding solutions to the neglect that leads them down those paths to begin with.

While opportunities for acquiring literacy and education may be available to young men, very few initiatives focus on counseling and mentoring them through adolescence.

“We have already lost too many boys due to negligence, too many chances at a good life missed out on,” says Mossarat Qadeem, a peace activist who works to bring back young men from militancy in Pakistan’s north-western province of Khyber-Pakhtunkhwa (K-P).

According to Mossarat, 35% of the population in Federally Administered Tribal Areas (FATA) are between the ages of 15 to 30 — and they don’t have access to a single university.

“We have no institutions that would help channel the energy of youth,” Mossarat adds. “This has left a huge gap and that gap is being filled by the wrong people.”

April, 2012: Plain-clothed police commandos take positions during an operation against gangs in Lyari. ASIF HASSAN / Getty Images

Mossarat’s organization, PAIMAN, reaches out to conflict-prone districts of K-P and FATA, hoping to counter the impacts of radicalisation and extremism. Mossarat and her team have helped rehabilitate some 1,230 boys since the organization first started in 2004. That’s a drop in the ocean.

There’s a correlation between high proportions of 15 to 29-year-olds in a population and a greater incidence of civil conflict, according to a UNFPA study, which means as the proportion of young people in a society increases, so does their likelihood to get in trouble, unless they’re provided with enough access to educations and honest livelihoods.

And nowhere is this need more dire than in South Asia. India has 356 million, the world’s highest number, of people aged between 10 to 24. Pakistan has 59 million and Bangladesh has 48 million.

“This dividend has turned into a demographic disaster,” says Dr. Farid Midhet, a demographer and director of Jhpiego, which focuses on maternal and reproductive health issues and adolescents, for Pakistan. “In coming decades, this problem will become very serious and possibly uncontrollable in the absence of a good education system for the poor urban and rural boys, an extensive system for vocational training including counseling and social training, social support and social security.”

Rebecca Hendin / BuzzFeed

Who’ll talk to the boys?

According to Baloch, most boys in Pakistan do not receive counseling, even from their own parents. “They simply don’t talk to each other,” he says. “Poverty is so all-consuming and keeps the parents so busy that they cannot focus on keeping their interest for education alive.”

Aman Tech, an initiative of Aman Foundation in Pakistan, is addressing this need. In addition to the hard skills and vocational training it gives to young men, it has made “soft skills” a part of its curriculum. This includes not just grooming and image-building exercises but also communication and social skills.

“When they come to us, it is amazing how out-of-touch with themselves these young men are,” says Mahida Baig, the departmental head of Soft Skills at Aman Tech. She says many young men who come there lack self-awareness and do not know how to encash themselves.

“The biggest reason is that they have not emotionally engaged with their parents, especially their fathers,” Baig says. “It’s just something that is not done in our culture.”

Baig says that when Aman Tech identifies a boy as aggressive, they provide one-on-one counseling. Instructors, who are approachable, act as mentors and guide students who confide in them about relationships and life decisions.

But according to Baig, a central challenge in the counseling process is combating the stereotypes of masculinity that South Asian boys grow up around.

In 2002, Promundo, an NGO focusing on promoting gender justice, launched a program called Program H, which primarily targets men between the ages of 15 to 24, and encourages critical reflection about rigid norms related to manhood. Promundo reports that after participating in their Program H activities, positive changes were seen in these young men. With sensitization that made them rethink gender roles, these boys had better attitudes towards relationships and family planning, participation in domestic work, not indulging in sexually harassment, and not perpetrating domestic violence.

Rebecca Hendin / BuzzFeed

A lop-sided focus on girls?

According to the Pakistan Demographic and Health Survey (PDHS) 2012-2013, only 16% of men have completed more than secondary level of education.

Unlike many of the young men, the girls in Lyari are focused and are better students, says Nadeem Ghazi, a peace activist from the area who works on peace-building through education from the forum of his organization Peace Education Welfare Organization(PEWO). “Girls are more motivated to get an education,” he says. “Boys come under a lot of unhealthy outside influence.”

If boys are a problem, they must be engaged as part of the solution, says Rujuta Teredesai, co-founder and executive director of a social enterprise called Equal Community Foundation (ECF) dedicated to engaging men to end violence and discrimination against women.

According to Teredesai, development projects are focusing on girls because girls are not able to access enough opportunities for education and training. “However, if we exclude boys, we are not addressing some of the root causes; we might be creating a bigger problem.”

Experts say that a lack of focus on young men will actually set back the programs that focus on empowering women.

“All of the gains we have made for women and children can be reversed if we don’t pay attention to what is happening, or not happening, to young men,” says Leith Greenslade, vice chair, MDG Health Alliance and Office of the UN Special Envoy for Financing the Health MDGs. Greenslade says rising numbers of young, uneducated men without job prospects can be distracted by violent, anti-woman ideologies. “These ideologies can lead to civil unrest that can destabilize entire societies. Once the level of violence rises to these levels, we see the gains for women and girls unravel quickly.”

Rebecca Hendin / BuzzFeed

Talking solutions

Teredesai says that work with boys should be done in three major areas: Engaging them as allies, providing them with opportunity to learn about these issues, and catering to their needs.

“None of these approaches can work in isolation,” she says.

And according to Mossarat, the answer to how young men can be mitigated from being recruited into violence and radicalization lies in preventive measures taken before the damage is done.

“We need vigilant communities in society. We need the media to play its role to spread awareness. And we need parents to allow their sons to talk to them about everything,” Mossarat says.

“Because once they get inducted into violence, get radicalized and are caught in that web, it is a tumultuous task to bring them back.”

A common man’s obituary: The saviour of Chawkandi tombs

Published: January 21, 2016
http://tribune.com.pk/story/1031397/a-common-mans-obituary-the-saviour-of-chawkandi-tombs/
Ali Dino Mallah wanted to take this photograph against the backdrop of the oil tankers, hoping the authorities would remove them from the vicinity. PHOTOS: EXPRESS

Ali Dino Mallah wanted to take this photograph against the backdrop of the oil tankers, hoping the authorities would remove them from the vicinity. PHOTOS: EXPRESS

KARACHI: “Big money, big tomb. Small money, small tomb. No money no tomb.”

Ali Dino Mallah, the caretaker of the Chawkandi tombs on the outskirts of Karachi, uttered these words in a thick Sindhi accent in an attempt to share the few sentences of English that he had mastered over the decades. I met him in December last year, a week before he died.

Sporting an ajrak wrapped as a turban and an oversized waistcoat worn over a sweater and shalwar kameez, Ali Dino appeared much older than what I remembered of him from our last meeting more than two years ago.

He walked around the ornately carved graves inside the Chawkandi cemetery, shooing away potential vandals with his walking stick. He would stop frequently to catch his breath and take out the tiniest possible water bottle from a gigantic but otherwise empty pocket to take measured sips, a habit he said he had learnt by observing foreigners who visited the cemetery.

“I have a pacemaker in my heart you see,” he explained. “Do you want me to request people to help with your treatment or write about it?” I had asked after he told me that his family had spent thousands on his treatment even at the National Institute of Cardiovascular Diseases (NICVD), a government-run facility that supposedly treats the poor free of charge. “Don’t waste words writing about my illness. I don’t have much time left,” he told me, before urging me to write about what really mattered to him. “Write about these tombs. Please. Maybe someone will read it and expedite the restoration.”

Exploring Sindh: King of the road

Even if his faith in the restoration work was far-fetched, Ali Dino was right when he said he did not have much time left. He died on December 29 on his way to the hospital sitting behind a relative on a motorcycle. “He was the heart of Chawkandi. I have nothing left now,” wept his widow, Rehmat Bibi. The family, comprising his widow and six children, continues to live in the small quarters adjacent to the graveyard and are in need of financial help. “He was like an angel and died an easy death. Like an angel was taken away.”

The old caretaker of the tombs hailed from Khairpur district in Sindh and was a common man. This is a common man’s obituary. And the obituary of a historic, priceless heritage site of the province of Sindh that is crumbling away.

Intricately carved sandstone tombs that are masterpieces of funerary art and rich in symbolism are now mostly half broken. Blocks and bits of these tombs have been stolen by vandals over the years, and now grace the drawing rooms of affluent art collectors in Pakistan and abroad, Ali Dino had shared.

“The commissioner [Shoaib Siddiqui] had promised me that tankers would be removed from this area, security walls would be erected around the graveyard and pickets would be established,” Ali Dino recalled his conversation with the commissioner before he got distracted by the camera. “Listen, take my photo with these oil tankers in the background. And choose an angle smartly. If there is harsh sunlight in the background, the photograph will not come out well,” he said.

After more than 30 years of service as a guide and caretaker of these tombs, Ali Dino had posed with thousands of visitors to know that the play of shadow and light was key to good photography, without ever holding a decent camera in his hands. Many of these visitors were high-ranking government officials and bureaucrats who had given hope to the old man that one day, this spectacular heritage site would get the attention it deserves.  Soon after we met, the commissioner of Karachi was transferred from the post. Perhaps, his replacement will be able to remove the gravel, sand, trucks and tankers, unwanted encroachments, and put a stop to illegal burial in the centuries-old graveyard.

Ali Dino, the man who spent his life trying to safeguard our heritage and tell us tales hidden in the carvings on those tombs, was buried in the same graveyard, among the very tombs he spent his life looking after. The restoration and protection of Chawkandi tombs should be considered a dying man’s last wish. If fulfilled, he will rest in peace.

Published in The Express Tribune, January 21st, 2016.

Waterways choked, Karachi on brink of floods with each rain

Pakistan’s commercial capital Karachi faces the threat of floods each time it rains, due to rampant construction, pollution and encroachments blocking its natural ravines and storm-water drains

Akhtar_Colony_drain

In July this year, Pakistan’s teeming port city Karachi braced itself for disaster after the meteorological department forecast 50-60 mm of rain in a day. With the knowledge that even 20 mm could bring the city of 23 million people to a standstill, officials prepared themselves for a never-seen-before deluge.

“It was the first warning of its kind. The 2013 urban flooding taught us that we must be prepared this time,” said Ajay Kumar, assistant director operations, Provincial Disaster Management Authority (PDMA), in Sindh.

Fortunately, the rains of the 2015 monsoon were less than expected and did not result in casualties and destruction of property and infrastructure as in 2013 when scores were killed in flash floods that paralysed one of the world’s most populated cities.

The crisis was averted this time but it could return with the next heavy rain, fear residents.

In 2013, Kumar recalled, storm-water drains (nallahs) in the country’s commercial capital had overflown following torrential rain, inundating areas like Saadi Town, Gadap Town and Amroha.

While rains are a blessing in other, better-planned cities like the capital Islamabad, in Karachi the story is different. The nuisance value overshadows the joy, owing to overflowing gutters and clogged natural ravines.

“An estimated 60% of Karachi’s population lives in informal settlements, with no access to sewers. People dump sewage into ravines that were for clean water, not for waste,” explained Roland de Souza, executive member of the group Shehri – Citizens For A Better Environment. “So when it rains in Karachi, it overflows.”

“It did not rain as much but at least the warning helped expedite the cleaning of the nallahs by Karachi Metropolitan Corporation (KMC),” added Kumar.

But that’s not really helpful, said architect and urban planner Arif Hasan. While it is a good idea to clean the drains, “it will not really help (check) the flooding if the drain water does not have a passage to go into the sea. Whenever the tide is high, the problem will return.”

Major road and housing projects have been built in Karachi, causing enormous damage to the environment. Mismanaged construction, pollution and encroachments have blocked Karachi’s water passages.

What will happen to a city of Karachi’s size and its choked up drainage system if there are torrential rains? The question remains unanswered.

In Karachi, human greed is destroying life, says ecologist Rafiul Haq. “We have built buildings on water bodies, started using strong detergents excessively and non-biodegradable plastic bags. All this clogs our drains.”

The vein-like network of Karachi’s natural ravines and manmade nallahs as well as the sewerage drains are a confused mess. At the time of Pakistan’s formation in 1947, Karachi had some 400,000 residents but the population exploded in following decades. Inefficient administration, uncontrolled reclamation of land for construction and pollution have resulted in the destruction of natural drainage.

Today, under the pressure of a population of 23 million plus, and a population density of 24,000 people per square kilometre, according to the World Population Review, both the water supply and drainage system of Karachi are less than satisfactory.

Rampant construction

“Rainwater in Karachi used to clear away within 10 minutes once upon a time. But then man came along, over-built, and confused the system,” said de Souza. He cites the example of Gora Qabristan, a graveyard for the Christian community, built on the city’s jugular Sharah-e-Faisal road. Over the last 68 years, the road has been raised by four feet. As a result, the cemetery becomes a pit full of water for days during the rainy season.

“A storm drainage map system is what we need. The building control authorities should check the drainage before approving any construction. A flood in a city is not a natural but a manmade disaster,” de Souza said.

Hasan explained, “There are three main outfalls of drainage to the sea from Karachi.” One of them, the Gizri Creek, has the upscale Phase 7 Defence Housing Authority (DHA), home to the city’s rich and powerful, built on it. “All that we are left with is approximately an 80 feet nallah. When there is high tide, or rain, the water cannot get out. The result is that it gets choked.”

Similarly, the major Mai Kolachi bypass has been built over a drain. “It should have been elevated to avoid problems” and to the west, the Karachi Port Trust colony was built over marshland, Hasan said.

Then there is the Kalri Nallah, near Machhar (mosquito) Colony, the largest of Karachi’s unregulated neighbourhoods, where hundreds of trucks of garbage are dumped every day.

There are several other instances. An 80 feet wide, 4,000 feet long nallah between Akhtar Colony and Defence View Phase 2 has piles of silt, overflowing sewage, mounds of garbage and an entire colony of slum dwellers lining both sides.

Blame game

Commissioner Karachi Shoaib Ahmed Siddiqui, who is also KMC administrator, recently called for the speedy clean-up of the drains. Asked how swiftly this would be done, Syed Muhammad Shakaib, director of planning and development at the Karachi Commissioner Office, admitted that there are serious bottlenecks when it comes to implementation. “Can you tell me names of more nallahs that need cleaning? We can start working on them right away.”

According to experts, the Karachi Water and Sewerage Board (KWSB) should take responsibility. But the blame game continues here too. “Cleaning the freshwater ravines or storm-water drains is not our responsibility. We are just concerned with sewage water. The laws are all there but if people don’t follow them what can we do?” said Nazeer Mateen, KWSB spokesperson.

Mateen admitted that water contamination is not uncommon in Karachi, with some residents stealing water by making holes in pipes and attaching makeshift waterlines to them. “Those sometimes get mixed up with sewage lines KWSB has laid. If we find out, we fix it. What else can we do?”

As the chaos intensifies in the sprawling city, residents remember the old days. “I myself have caught fish from the Lyari river and eaten it,” said a nostalgic Muhammad Moazzam Khan, technical advisor, marine fisheries, WWF-Pakistan. “No one even feels for the loss of natural water bodies. Their absence has affected biodiversity and life itself in Karachi. It has been eaten up by commercialism.”

Dear Karachiites, before you plant trees, think

Published: August 9, 2015

Homeless man rest under trees on a hot summer day in Allahabad. PHOTO: AFP

The heat wave that killed more than 1,300 people in Karachi seems like a long time ago. Concerned citizens, in the heat of the moment, promised to plant trees, but very little has been said regarding when and how this can be done.

As time is passing and cool monsoon winds are blowing away painful memories of the heat wave, the promises seem to be dissipating. Where memories are short lived, long-term efforts to mitigate a recurrence of the same catastrophe seem nowhere in sight.

That is the problem with climate change – the cause and effect, both take place over extended periods of time. In a world of instant gratifications, both individuals and governments seem to have no patience to invest in something that will not show results instantaneously.

Trees are an integral part of the environment, a part sorely missing in mega cities such as Karachi. Trees have a cooling effect as they transpire water from the ground, through the roots and out from their leaves. In addition, trees provide shade. For those who experience Karachi heat on the streets and have compared the temperature in shade and in open air know the difference.

Planting trees in this concrete jungle is the real way we can stop this from happening again. However, few people recognise the impact of planting a tree today that could potentially save lives decades later. Those who are seriously inclined towards it, often end up planting the wrong trees at the wrong places due to a lack of awareness. Other than experts, like the unsung heroes of the ‘Mera Karachi (My Karachi) drives for tree plantation, people may be planting trees in Karachi but are planting them wrong.

First and foremost, not every tree can bear Karachi’s temperament – what to plant should be a primary consideration. In Karachi, one thing to bear in mind is that anything we plant will have to be watered by us, as rains are a rarity and the city is already suffering from water shortage even for human consumption.

As horticulturist and activist, Tofiq Pasha Mooraj says,

“If you plant it, you water it.”

For that, water conservation and recycling is important. However, this should not be the only consideration. The Corynocarpus is hassle free, fast growing, adaptable to even high salt content, economical when it comes to watering, and is the most popular choice of Karachiites since recent years.

Photo: Wikipedia

However, it does not provide shade as it grows almost straight and vertically. There have been studies that point in the direction that Corynocarpus causes allergies in humans who live nearby. Most importantly, its roots, when they grow deep underground in search of water, break or clog Karachi’s sewage and water lines.

In this, it resembles the harm the Eucalyptus trees caused the city earlier. The city realised 25 years later what the Eucalyptus had done. As a result, an unnecessary effort was put into cutting out Eucalyptus trees in the city, and we lost out on the city’s greenery as well. While it has the advantage of providing cheap wood and grows fast, it literally throws toxins at other plants and does not allow other plants and trees to grow close by.

Photo: Reuters

A recent trend is to plant Khujoor (date) trees with full grown tree implants. However, the tree and its fruit are prone to fungal attacks due to the humid weather here. The date tree is therefore a less than ideal choice.

Photo: AFP

The best trees for the city are those that take less water and provide shade. The best example is Neem, a very smart life form, which sucks in water from underground and provides cool shade. Other sensible choices are Gulmohar (Flame of the forest), and Amaltas (Indian Laburnum). These are deciduous trees that shed leaves, which proves to be very useful for Karachi.

Photo: Express Tribune

Photo: Pinterest

Photo: Twitter

Indigenous varieties like Laal Badaam (Indian almond) and Jaamun (Syzygium cumini /jambolan) are also useful fruit-giving trees that give shade. Lignum is also a good option; it looks pretty, and uses less water, but takes time to become a shade giving tree. As it is a mid-sized tree, it is good to plant in areas where there are electricity wires above.

Photo: Wikipedia

Photo: Pinterest

The choice of the tree you plant also depends on where you plant it and the space available. This brings us to the second consideration – where should one plant trees?

For starters, if you are planting in a place other than your lawn, make sure you have permission to do so. Make sure the tree, once it has fully grown, will not interrupt electrical wires or obstruct underground sewage or water lines, or damage any walls. A good place is dividers or the place between your boundary wall and the road. Those living in apartments will have to be more creative, and settle mostly for plants that can be grown in pots on the roof. Yet, the important role green roofs can play must not be undermined.

The ideal planting season for trees is mid-February to mid-March and mid-July to mid-August. Trees can be planted at other times too but extremely hot or cold months should be avoided. This means that it is best not to plant in April, May, June, and October.

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.

demen

“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.

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