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Karachi Literature Festival: Will the real liberal please stand up?

Published: February 13, 2017

KLF serves as a hub for Pakistan’s beautiful minds that allow critical thinking and are truly progressive. PHOTO: KARACHI LITERATURE FESTIVAL.

http://blogs.tribune.com.pk/story/46117/karachi-literature-festival-will-the-real-liberal-please-stand-up/

The recently held Karachi Literature Festival 2017 was a hub alright. But a hub of what? What it stands for, ideally, is not just celebrating books and authors, but also to serve as a hub for Pakistan’s beautiful minds that allow critical thinking and are truly progressive. Literature and the arts, on such forums, are designed to allow an open inflow and outflow of thoughts and ideas, and an exchange of not just narrative but also counter narrative.

One counterfoil session of the KLF 2017 was introduced as a discussion on conflict-resolution through art and enterprise. One of Pakistan’s well known musicians dared to play a short video as a tribute to the late Pakistani pop icon-turned-evangelist Junaid Jamshed, and went on to talk about how he and Junaid, despite ideological differences, managed to remain lifelong friends, and worked in collaboration on projects pertaining to peace-building. The reaction of a renowned “liberal and progressive” scholar on the panel was perhaps not unexpected but certainly unwarranted. He ridiculed Junaid Jamshed’s long beard and dressing style, and then went on to comment on his alleged misogyny. The comments were not just out of context. They were a giveaway of something that we don’t talk about often enough, which is that when it comes to “liberalism”, Pakistanis seem to have lost the plot.

Most dictionaries define a “liberal” in words as these: Someone who is open to new behaviour or opinions and willing to discard traditional values; lacking moral restraint; tolerant to change; a moderate person or viewpoint that favours a society or social code less restrictive than the current one, and welcomes constructive change in approaches to solving economic, social, and other problems.

The irony of ironies is that the very things liberalism stands against – being judgmental, being inflexible and being rigid – are the very traps we see liberals falling into. Liberal thought is, in essence, the anti-thesis of extremism and fundamentalism. It is the willingness to burst bubbles, push boundaries, and think out of boxes. True liberalism is having the heart to listen open-mindedly to an opposing view point, even though you may disagree vehemently.

Pakistan, today, is in desperate need of truly liberal people who may have their own set of beliefs, yet are willing to hear the other side out, and engage in dialogue. The intelligentsia, as it consists of more evolved people, has on it the responsibility of building bridges. Instead, what we are seeing on both sides is deep intolerance. The religious are seen indulging in feel-good extremism, and write off those who don’t follow religion in exactly the way they interpret it. For that, they get the flack which is perhaps justified. But it is less painful because the right-wingers never really claim to be open-minded. It hits worse when those who claim to be progressive and liberal follow the same patterns. Ironically, many of them, if not all, end up being equally intolerant of dissenting viewpoints, if not more.

Puritanical thinking makes one feel holier-than-thou (and this holds true for both the left and the right, for both the religious and the secular), plugs our ears to voices of those we see as “the others”, and perpetuates a binary world view, leading to the “it is either my way or the high way” attitude.

For cases in point, one should skim through social media websites. The easiest and laziest thing to do is put blanket generalisations on groups of people – something we are becoming very good at. Common assumptions are that a bearded man or a hijabi woman cannot be a human rights activist, a peace-builder or one raising their voice against domestic violence. Equally common are counterpart assumptions that a woman donning a sleeveless shirt or a man who is in the music or showbiz industry lack in faith.

Sneering at the opposite camps might get one some additional readers and followers, or a few guffaws from a chisel-headed audience that wants to enjoy the comfort of collaborative mockery. But what many of our brightest minds end up looking like is eternal teenagers and wandering Peter Pans who imagine the world as a virtual university town where everyone must conform to thinking in a certain way.

This is not to undermine the contributions KLF and similar forums are making. It is just that by default, events that act as magnets to the urban elite seem less welcoming to those who differ socially or ideologically.

We are all living in our ideological silos, comfortable in our respective bubbles with our own sets of designated cheerleaders. No one wants to try understanding another point of view. We sing praises of a word called “empathy” when we have not even arrived at the station of “tolerance”. We spare neither the living, nor the dead. And through it all, we see ourselves as the problem-solvers when we, ourselves, are part of the problem of polarisation. How, then, can any of us claim to be liberal?

If Pakistan truly wants to get rid of extremism, there will have to be more open-minded listening, especially listening to those who are not on the same page as you, without jesting about or being dismissive of the other point of view.

Farahnaz Zahidi

Farahnaz Zahidi

Farahnaz is a writer and editor, and has worked as the Features Editor with The Express Tribune. Her focus is human-centric feature stories. She now writes as a freelancer, and works in the field of corporate communications. She loves literature and traveling. She tweets @FarahnazZahidi. Her work can be seen at chaaidaani.wordpress.com/

The art of storytelling

With dramatic readings, Zambeel is reviving the ancient tradition of ‘dastangoi’

The art of storytelling

Eons ago, people had all the time in the world to nurture the art of listening. Long before the printing press was invented, and later the worldwide web that transmuted into e-books and digital books, narratives were recited and literature was spoken. The Hamzanama, or the Dastan e Ameer Hamza, was one of the many such works of literature that told fantastic tales of the many ventures of Ameer Hamza. Ameer Hamza’s companion Amar Ayyaar (also called Umro Ayyaar) had a bag called a Zambeel that contained all that that is in the world but the Zambeel would never be filled. The magical Zambeel, hence, could produce objects that would be core subjects of many a dastan.

But that was then and this is now. Princess Scherezade could no longer have bartered her life for tales she told as part of her Alif Laila repertoire, for no one has a thousand and one seconds to spare, let alone A Thousand and One Nights. Yet, there is a present day version of the Zambeel that has been successful in its attempts at reviving the tradition of dastangoi, or storytelling as we may call it today. Enter the Zambeel Dramatic Readings, and see a modern day semblance of this ancient art. For even if for a brief period of time, this will take you into a world where Urdu literature is read out to you the way it should be.

Zambeel Dramatic Readings came into being in early 2011 when a group of three friends — Asma Mundrawala, Mahvash Faruqi and Saife Hasan — was requested by a friend to read out a story in a gathering. “We embellished it with music. The response was what made us initiate and realise Zambeel,” says Mundrawala, a visual artist and theatre practitioner who is one of the key people behind this initiative. Zambeel Dramatic Readings was founded with a view to present texts from Urdu literature in a dramatised form to a live audience, and has mainly targeted adult audiences, but has also ventured into readings for children during the last three years.

“We aim to present texts rendered in their dramatised form, to create a dynamic collusion between literature and performance. Referencing traditions of storytelling and the contemporary form of the radio play, our works traverse time and geographical boundaries to interpret and enliven narratives through sound and recitation,” says Mundrawala.

“In an age where the purists were fearful of the fading away of correct pronunciation and nuanced delivery of Urdu, the Zambeel team has bridged the gap between the older generation and younger one by introducing this genre to them.”

Mahvash Faruqi is an educator with a background in theatre, and Saife Hasan is a performing arts practitioner particularly known for his acting.

What begun with writings from Ismat Chughtai’s rich repertoire, the group has since inception presented many projects comprising stories in both English and Urdu by authors that include Quratulain Hyder, Saadat Hasan Manto, Masood Mufti, Afsan Chowdhury, Raihana Hasan, Ashraf Suboohi, Asif Farrukhi, Munshi Premchand, Faiz Ahmed Faiz and Naiyer Masud. Of late, more contemporary writers’ works are also being included into the repertoire, like Asad Muhammad Khan, Ghulam Abbas and Zamiruddin Ahmed.

“Zambeel readings have reintroduced the cultural tradition of dastangoi. The selection and the delivery has the audience in raptures,” says journalist and literature aficionado Afia Salam. “In an age where the purists were fearful of the fading away of correct pronunciation and nuanced delivery of Urdu, the Zambeel team has bridged the gap between the older generation and younger one by introducing this genre to them.”

Mundrawala affirms that while initially the audience mainly comprised only of Urdu literature enthusiasts, over time the younger generation has also begun frequenting the readings. “We now have audiences who have read the stories and also those who have not read the stories. The younger lot may not understand Urdu with facility yet they come.”

Fahad Naveed, a visual artist and long form writer, is one of Zambeel’s young audience members. “I’ve been following Zambeel for a few years now and greatly admire their work. Their readings make Urdu literature approachable and exciting for varied audiences. I’m particularly drawn in by the group’s use of sound; often sitting on a table, they are able to transport the audience with just their dialogue delivery and a few sound effects and audio cues,” he says.

Also reviving the tradition initiated by grandmothers of the region to read out stories to children, Zambeel now also caters to a younger audience, enthralling both parents and children. One such fan of these readings is Saima Harris, an optometrist and mother of a seven-year-old.

“Our experience of Zambeel’s dramatic readings was Tipu aur Jaadu ki Bayl, an Urdu narration of my son’s favorite Jack and the Beanstalk. The audience was predominantly the English-speaking ‘Burger’ primary-schoolers of Karachi (who tend to shy away from the Urdu language), and their very keen parents,” she says, adding the dramatic and interactive Urdu narration, interspersed with toe-tapping melodies, brought a traditional English childhood classic to life. “It is a step aside from the all-important but solitary reading from a book or the mind-numbing watching on a screen. There is immeasurable potential here to both entertain and educate.”

Artist Rumana Husain, who is known for solo readings for children and production of quality Urdu literature for children, says it is rare nowadays to have literary readings in the country read in a dramatic fashion, and is all praise for the initiative.

Zambeel performers imbue texts with a poignant expressive quality and perform narratives that are supported by a soundscape, enriching the aural experience of the audience through sound and recitation, explains Mundrawala. “While we are three core members, we have had many actor friends work with us by lending their voice and acting talents to our projects. Their contributions have enriched our works and we are privileged to have had so many actors, as well as designers, artists, and musicians collaborate with us.”

The team has recently initiated an audio platform of readings once a month on the YouTube channel, Zambeelnaama.

Did Yasra Rizvi deserve to be trolled for her unconventional mehr?

Published: January 7, 2017

Yasra’s unconventional mehr was something many had not heard of. PHOTO: FACEBOOK.

When actress Yasra Rizvi set out to marry Abdul Hadi, little did she know that her claim to fame will be that she married a man 10 years younger and her mehr, which her husband agreed to, is Fajr prayer (obligatory morning prayers for Muslims). The couple was scrutinised harshly through the lens of a magnifying glass, and was trolled on social media for one simple reason – they dared to do something against the norm. And nothing scares us like what we do not understand.

People are still familiar with the older-woman-weds-younger-man scenario, even though they see it as abominable, even those who harp on about how important following the example of the Prophet (pbuh) is, forget that it is also his Sunnah that he married a woman 15 years his senior at the prime of his youth.

But Yasra’s unconventional mehr was something many had not heard of. We, as a nation, have common misconceptions about this Islamic tenet, stemming from a lack of awareness. Yasra, thank you! You taking this step out of the norm may just have triggered a debate that could result in some authentic information regarding the concept of mehr trickling into our collective narrative.

Here are just a few very basic facts about the concept of mehr. While these are just a few pointers, I hope this will encourage us to talk about mehr and help expose some myths:

Mehr (also called haq mehr) is a mandatory payment of tangible assets, currency, property or an intangible, conditional commitment or understanding that both parties agree upon.

Yes, a mehr can be intangible, as is in Yasra Rizvi’s case. The best example of an intangible mehr comes from the Sahabiya Umm Sulaym Bint Milhan al-Ansarriyah (ra) who agreed to marry Abu Talha (ra), and the mehr was him accepting Islam.

Islam has not fixed an upper or lower limit of mehr. It will depend upon the financial standing of both the man and the woman.

While no amount or limit has been prescribed, it shouldn’t be an amount so extravagant that the man cannot afford to pay (and is just fixed to portray financial or social standing). Nor should it be so miniscule that the tenet appears to have been taken lightly. However, once again, no sum or limit has been set, neither upper nor lower.

The amount is to be decided upon after mutual consultation between the man and the woman tying the knot. This is one more reason why the couple entering into the contract read through and understand the clauses of the nikkah nama, and the terms are mutually agreed upon. If elders of the family help with the consultation, it should be made sure that the man and the woman are on the same page and are aware of the agreement.

Mehr is an absolutely obligatory clause of the contract of marriage for Muslims, no matter how big or small the amount.

Mehr is designed as a means of security and protection for the woman. It will be the sole property of the woman and she will have discretion over how and when to spend it. It is therefore a part of the nikkah, and its payment is not conditional with or tied to the incidence of talaaq (divorce). It is therefore strongly recommended that it is paid at the time of the nikkah. However, if there is a genuine reason why it cannot be paid at that time, mawajjal/muakhhar (deferred/promised) rather than mo’ajjal/muqaddam (immediate/prompt), then it should be paid as soon as the man can afford to pay it. Till such time that he pays it to her, it is considered a kind of debt that he owes to his wife. Islam makes clear that if he cannot pay it at that given time, he should intend on paying it at the earliest.

Upon a man’s death, all that he leaves behind as inheritance for his heirs may not be distributed among the inheritors until all payments or debts he owes to anyone are paid off, which includes the mehr.

No man who wishes to marry a woman is exempt from mehr. Thus, the custom of asking the wife to “forgive him the mehr” is not in line with Islamic tenets.

Knowledge gives one the power to make informed decisions. Yasra used that power. Instead of wasting time judging her decision, it’s best to learn more so that we, too, can make informed decisions.

Information shared in this write-up is based on authentic Islamic traditions.

Farahnaz Zahidi

Farahnaz Zahidi

Farahnaz is a writer and editor, and has worked as the Features Editor with The Express Tribune. Her focus is human-centric feature stories. She now writes as a freelancer, and works in the field of marketing and corporate communications. She loves literature and traveling. She tweets on @FarahnazZahidi. Her work can be seen at chaaidaani.wordpress.com/

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

http://blogs.tribune.com.pk/story/44707/did-yasra-rizvi-deserve-to-be-trolled-for-her-unconventional-mehr/

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How Junaid Jamshed used ‘Us Rah Par’ to foreshadow his transformation

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Published: January 4, 2017
Junaid Jamshed on fusion music, Pakistan’s elite and singing naat. PHOTO: AMEER HAMZA

Junaid Jamshed on fusion music, Pakistan’s elite and singing naat. PHOTO: AMEER HAMZA

KARACHI    : For him, the song was never about a beloved. It was always about the Beloved. But he could not have said it then.

The stubble Junaid Jamshed sported in the video was perhaps one of the first times the strikingly handsome singer was seen with some form of a beard. But it was seen as part of the costume for the character of the taxi driver he played in the video, chewing on a match stick while looking intently at a female gypsy singer.

PHOTO COURTESY: PAK FILES

PHOTO COURTESY: PAK FILES

As the nation reeled from the shock of his abrupt death in the airplane crash that took away 47 lives almost a month ago, both his songs and his naat renditions started going viral on social media. It could not have been either/or. It had to be both. Some chose the former part of his singing career – mushy, poignantly phrased and softly rendered ballads and patriotic songs that helped each one of us emote at some phase of our life. Others chose his latter offerings –Islamically inspired renditions in which he sung praises of Allah and the Prophet (pbuh). Then there were those, few in number, who celebrated both phases of the icon’s life – his voice had been with them in moments of both majaazi (of the beloved) and haqeeqi (of the Beloved) Ishq.

Recap: Some of the pop icons we lost to 2016

That was Junaid – a nexus between the two extremes. The song that was shared most by his fans on both ends of the spectrum was the ballad from his solo album in 1999, Us Rah Par. This is deeply ironic; that song represents the transformational phase of this complex, layered and loved icon of Pakistan. It would be unfair to his audiences that what he revealed about this song is not shared with them.

“That song was much deeper than romantic love for me, unlike what the video portrayed,” he had said, while talking to The Express Tribune in 2013. “By 1999, the transition in me had started. Others may not know but I know that for me, that song was about my journey. But at that time, it could not have been shown.”

Against the backdrop of his statement, the lyrics begin to make more sense:

Hum kyun chalein

Uss raah par
Jis raah par
Sab hee chalein
Kyun na chunein
Woh raasta
Jis par nahin
Koi gaya….

Time was to prove that whether people agreed with his choices or not, he did go on to choose a path that few from the entertainment industry would dare to step on. “The song had been conceived metaphorically,” Junaid had shared. While the lyrics were penned by Shoaib Mansoor, Junaid’s interpretation was very different. “I confess that I had no plans of leaving music at that time. But the love of Allah had hit me. I could feel I was changing. I couldn’t run away from it.”

Thousands bid last farewell to JJ

In many interviews and talks he gave later, as part of his work as a muballigh (evangelist), he shared that despite having fame, money and popularity, something in him would not let him rest, as if something was amiss. Investing himself in a material world had begun to seem like a waste of time. “It started with me going to religious people and the mosque for my own spiritual healing. I had everything – fame, money. But something was lacking. I felt incomplete. And being in a masjid made me feel calm. Masjid still has the same effect on me. Masjid, to me, is the place where we discover humanity.”

Junaid found his direction and that led him to discover the peace in himself we all aspire for to be complete within. PHOTO: JUNAID JAMSHED FACEBOOK PAGE Junaid found his direction and that led him to discover the peace in himself we all aspire for to be complete within. PHOTO: JUNAID JAMSHED FACEBOOK PAGE

Dil udaas nazrein udaas

Dilbar nahin gar aas paas
Din raat aah bharna
Aur beqaraar rehna
Yeh khail hee bekaar hai
Kuch bhi nahin angaar hai
Is aag main jalein kyun
Pal pal jiyein marein kyun

Many temptations tugged at his heart all through his life. He never stopped loving music, but eventually he made the choice that felt right to him. “The life of this world and the Hereafter… if you please one, the other will be upset. It’s a choice you have to make,” he had said.

An enduring memory: A conversation with Junaid Jamshed

I remember asking him if he missed his past as a singer. “Naheen yaar. No withdrawal symptoms of my past life. I am not proud but happy that as a singer, I contributed to the spirit of patriotism and my country in a positive way. I lived that part of my life to the fullest. I cherish my time with the Vital Signs,” he had said, adding that he recognised that his voice was a gift from God. “Shoaib’s poetry and my voice touched people’s hearts. They could relate to it. Rohail, Shehzad, Salman, Nusrat, Rizwan, Asad Ahmed, Amir Zaki…they are much better musicians than I ever was. But somehow, I have a voice that people connect to.”

Taimur Junaid recalls the relationship he shared with his father. PHOTO: FACEBOOK @TAIMUR JUNAID

Taimur Junaid recalls the relationship he shared with his father. PHOTO: FACEBOOK @TAIMUR JUNAID

He knew he was a people’s person. “Mein awaami aadmi hoon. The work I am doing now has much more human interaction, compared to the showbiz days. Back then, the stage was in between,” Junaid had said.

Chalo ishq ka kaha maan kar

Apna sanam pehchaan kar

Kisi ese rang rang jaayein

Sab se juda nazar aayein…

Much to the frustration of his fans, who perhaps never forgave him for giving up music, Junaid went ahead and did what he had to. H,e indeed, did become coloured in a colour that made him stand out amongst all. He saw that as the colour of the Divine.

Watch the song here:

Have something to add in the story? Share it in the comments below. 

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Why I shared the #ChaiWala’s picture

Posted on

Published: October 18, 2016

If Pakistanis want to glam up their timelines with the photograph of this stunning young man, so be it. PHOTO: TWITTER/JIAHPHOTOGRAPHY

The piercing blue eyes. The stubble and the moustache. The attractive indifference. Blissfully unaware of the fact that thousands are ogling at him, he has become the hottest (pun intended) topic of debate, and has taken the internet by storm.

Bad start to the blog? I can already hear echoing disapproving remarks in my head that I have been reading on Facebook walls of friends. We over-read and over-intellectualise everything nowadays. I do too. This is why I thought many times before I posted the undeniably handsome chaiwala’s picture. Should I post it? Or not? And why exactly am I posting it? Am I posting it because he is handsome? Or am I posting it because he is handsome and is pouring chai, as chai is my self-claimed weakness? Or (what most people assumed was the case) am I posting it because he is handsome but is a chaiwala from anunderprivileged background?

Just like everything else, there is no single ideologue behind the phenomenon of the chaiwala. People sharing his photograph are not a monolithic entity. There are different reasons each one of us may cite for why we clicked on the share button. My sharing was initially habitual – I share many things that are trending and interesting. But further contemplation also led me to understand that one of my biggest reasons for sharing it, twisted as it may sound, is that if it’s alright to admire women for their beauty and make it the biggest thing about them, why can a man not be subject to the same?

Objectification of both genders is unacceptable. But if it is something that humanity as a race has not been able to fight back yet, then just like the blame of the original sin is shared, let the burden of beauty be shared as well, irrespective of gender. There is a thin line between plain admiration and objectification.

What I would and do have a problem with is the accompanying surprise that he is a chaiwala. That this is a man from an obviously lower income background, and is yet so good looking. Like all things good in life, somewhere the upper tier bourgeois of Pakistan have come to believe that even looks and God-gifted attributes are co-dependent on money and affluence.

On another note, the chaiwala viral trend reinforces another fact: that our ideas of “beauty” remain euro-centric. The blue eyes, the fair complexion, the chiselled jawline. Makes me wonder if a dark complexioned equally stunning man would have garnered the same kind of attention.

An interesting stem of the chaiwala debates is very relevant: when doing street photography, what line of ethics do we follow? Did this young man give permission that he be photographed? For street photography buffs, if someone is in a public space, it’s alright to photograph them. Others fiercely guard a person’s right to forbid a photographer to take their photograph. This particular debate has grey areas; it’s not black or white, because after all we are photographed in shaadis and functions, with videos being made of our plates laden withqorma. Is that acceptable but this is not? Worth a conversation.

If Pakistanis want to glam up their timelines with the photograph of this stunning young man, so be it. Each one of us has different reasons and intent. Let’s not try to be mind-readers and assume that everyone who shared it is fickle or shallow.

As for the chaiwala, already people are offering him modelling assignments and lead roles in TV serials, thus he by now must have an idea that he has caused some kind of a stir. His giddying rise to fame and the media spotlights will blind him for a while, mess with his head, disrupt the comforting status quo of life as he knows it, and give him unrealistic hopes and ambitions. The hashtag #chaiwala would have already started losing the trend by the time the bullet of his fame hits him. We will all move on towards other trends in a matter of minutes or hours. But that’s just how life is.

Nonetheless, what remains irrefutable is this: nothing unites the Pakistani nation like chai does. So here’s to chai, and to the chaiwala, and to the dangerous but alluring power of social media.

http://blogs.tribune.com.pk/story/41981/why-i-shared-the-chaiwalas-picture/

 

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Don’t give up hope – Caring for the elderly

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Farhanaz Zahidi September 11, 2016

http://tns.thenews.com.pk/dont-give-hope/#.V9_ShvkrLIV

 

geriatric-care

As people age, what can we do to improve their quality of life?
“With the bam of a motorcycle I suddenly became the head of the family,” says Junaid Ahmed Qazi. While caring for the elderly is seen primarily as something that women are expected do, Qazi is defying the norms because life left him no choice. As an only child, life changed for him some 20 months ago when his father, a healthy man in his early 70s, became victim of a hit-and-run case.
“Ten days before the accident we had both climbed five flights of stairs together.” What followed was a brain surgery, weeks in the ICU, and a nosocomial (hospital-acquired) infection his father caught, that left him invalid. “We believe he recognises us and has emotions. He wants to talk but cannot,” says Qazi.
For him the sound of his father’s voice is a far-fetched dream. Yet the optimist in him refuses to give up.
Qazi’s troubles are not unusual. The number of elderly people has risen globally with life expectancy having gone up due to advanced medical interventions. So has the corresponding number of their caregivers. The average life expectancy at birth of the global population in 2015 has risen to 71.4 years according to the WHO’s Global Health Observatory (GHO). HelpAge, a global network of organisations working with and for older people, predicts that by 2050 one in five South Asians will be over 60. The network states that South Asia is growing older faster than any other country in the world.
While HelpAge’s Global AgeWatch Index 2015, that ranks countries by how well their older populations are faring, rates Pakistan at 92 out of 96 countries, healthcare professionals and doctors feel the close-knit family structure in Pakistan mitigates cases of neglect and abandonment of the elderly.
“Caregivers are the unsung heroes when it comes to geriatric care. They are also underappreciated. When Parkinson’s disease or Alzheimer’s strikes a patient, the entire family is affected,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital who has been treating elderly people for 25 years. In his experience, if the quality of life of old people in countries like the US and Pakistan is compared, the elderly in Pakistan are much better off, provided their families are taking care of them. “The family is vital for elderly people. Generally, our elderly are not subject to neglect.”
With an increase in urbanisation and more Pakistani women joining the workforce, old homes and healthcare centres for the elderly is a discussion that is expected to come up more and more in the years to come. The need for geriatric medical care and for doctors specialising in the field has also gone up, and related challenges are multilayered.
“There is a lack of awareness and an acknowledgement of geriatrics as a unique specialty with special needs, health issues and care requirements. This exists both at the level of physicians, and at the governmental level. Caregivers often do not understand the needs of their aged family members and the stresses involved in caring for the elderly,” says Dr Saniya Sabzwari who specialises in geriatric care at the Aga Khan University Hospital in Karachi.
“Caregivers are the unsung heroes when it comes to geriatric care. They are also underappreciated. When Parkinson’s disease or Alzheimer’s strikes a patient, the entire family is affected,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital who has been treating elderly people for 25 years.
The patience and endurance of caregivers are put to the test in more than one way and, practically, providing satisfactory healthcare to the elderly is an expensive proposition. “The biggest challenge is financial. Nursing care and attendants at home cost a lot. For those who cannot afford to hire professional healthcare at home, the challenge is even more daunting. It becomes physically difficult to look after an invalid person,” says Asma Nazeer, who requested that her real name not be shared.
Nazeer does not want people to know that she served her mother who had Parkinson’s and related dementia for 10 years, since she feels that it will take away from her award. “I was the only one, as all my siblings are abroad, so they sent help in the form of finances and sporadic visits but basically it was just me for 10 years.”
Nursing care at home for the elderly who suffer from a lack of mobility is expensive. Yet more and more people are opting for it. “The biggest determinant for better geriatric care is affordability — to be able to pay for quality healthcare,” affirms Dr Syed.
Two round-the-clock certified nurses take care of Qazi’s father who, he shares, are pampered by him so that he does not have to go through the process of changing nurses and teaching them the ropes repeatedly. The price of nursing care at home is exorbitant but it still costs him less than the hospital would. His father’s room is now nothing less than the Intensive Care Unit of any hospital emanating the smell of medicines and sterilising liquids. Oxygen cylinders and the feeding tube through which liquefied food is transferred to his father’s stomach, like most elderly patients who are no longer able to eat by mouth due to multiple reasons, are maintained by nurses.
On average, depending on the level of expertise and seriousness of the patient’s illness, a certified nurse for a 12-hour shift costs anywhere between Rs1,200 to 1,800 or more, and are hired through an agency. The monthly cost can run into more than Rs100,000 if two staff nurses and two attendants are hired. “Many nurses are now turning towards attending to bedridden elderly patients at home because it pays well,” says 24-years-old Zaiba Kiran, a staff nurse who has been caring for elderly patients who are mostly bedridden. “We go through agents because it suits both the family of the patient and the nurse in case the nurse needs a day off or either of the parties has any complaints.”
Just like it is tough for caregivers, caring for debilitated elderly patients is not easy for nurses either. “With an elderly patient we have to be extra careful. They are very fragile. They can choke easily. We have to keep a constant watch over their vitals. Anything can happen at any time. It also takes more energy and time to learn how to deal with an elderly patient; they are often impatient like children.”
But perhaps the biggest side effect of seeing your loved parent become a shadow of who they used to be is psychological. “We saw the stages where my mother would hallucinate and there were behavioural changes. But the most painful was the stage when she could not even lift her finger. For the last three years of her life she was fed through a nasal tube,” reminisces Nazeer.
One of the jolts a family may receive is when they are told their loved one is now on what is called palliative or end-of-life care, a concept that is often not fully understood. The term does not mean that these are the final hours or days of the patient’s life. It means that the patient suffers from a terminal disease, and there is no hope of a cure. However the dying process may take years.
“With patients of Alzheimer’s the process may take seven to 12 years,” says Dr Syed. The aim of doctors and family, at this stage, is that the quality of life be improved and the patient be made comfortable. “In Pakistan you get drugs like heroine everywhere but intravenous morphine is not available to a dying patient to help relieve a dying patient’s suffering,” says Dr Syed, explaining the obstacles.
The goal, as Dr Sabzwari explains, is not longevity of life, unlike what families or patients want. “Most important is the quality of life.”
To see a loved one in pain takes its toll. “Till my father had the accident, I was a carefree guy. I can safely say I aged at least 10 years within days. I have lost a lot of hair ever since. I do feel depressed inside at times but I cannot afford the luxury to sit and cry because the responsibility of my family is on me,” says Qazi.
Luckily for him, his supportive wife has been his biggest strength. Even families of the elderly are psychologically impacted. “My six-year-old daughter is affected as well; she can’t understand why dada won’t play with her anymore.” Yet, Qazi refuses to give up on giving the best possible care to his father. “My father didn’t stop caring for me when I was a child and was totally dependent on him. How can I stop taking care of him?”
In Dr Syed’s opinion, one must not give up on the treatment and care of the elderly because a lot can be done to improve their quality of life. “A few years ago dementia was considered incurable and some of the treatments available now were not available then. Now, we can drastically improve the patient’s quality of life as well as slow down the dementia.”
The biggest challenge, then, is to not give up hope.

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Being a mother – How breastfeeding can save lives of Pakistan’s infants

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breastfeeding pic
By Farahnaz Zahidi

August 7, 2016

The myth that just mother’s milk does not suffice has caught on, and this trend is an imminent danger to the lives of Pakistani infants

Her fifth child is due any day. Nazeer Bibi lives in a shanty part of Qayyumabad, Karachi, and has already decided that she will feed her baby formula milk.
“I work in three houses as a domestic help to support my family. I leave at 8 am after dropping my older children to school and return by 4 pm, and the baby will have to be at home. What option do I have? Besides, dabbay ka doodh (formula milk) makes babies healthier. I want my baby to be healthy like the babies in advertisements.”
Nazeer’s baby will be one of the 62 per cent Pakistani infants who are not exclusively breastfed. Only 38 per cent of infants under the age of six months are exclusively breastfed, according to the Pakistan Demographic and Health Survey (PDHS) 2012-13. The rates are the lowest in South Asia.
The myth that just mother’s milk does not suffice has caught on, and this trend is an imminent danger to the lives of Pakistani infants, a danger that is not talked about often enough. As the World Breastfeeding Week is celebrated globally from August 1-7, the conversation around breastfeeding needs to be more audible and frequent in Pakistan. But bringing up the topic inevitably initiates parallel discourse regarding how lives of infants are less safer till formula milk is promoted as a choice. “From tobacco, to sugar, to formula milk, the most vulnerable suffer when commercial interests collide with public health,” says an editorial in medical journal The Lancet.
“Formula milk should only be given when there is a medical reason for it,” says Dr Azra Ahsan, an expert in mother and child health. “The baby gets complete nutrition through breastfeeding. The mother passes on her protective antibodies to prevent common illnesses in the baby. As no water is required to prepare it, unlike how formula milk is prepared, the chances of diarrohea and vomiting are minimised.”
According to the World Health Organisation (WHO), breastfeeding has the potential to prevent about 800,000 under-five deaths per year globally if all children 0-23 months were optimally breastfed. Pakistan has one of the highest infant mortality rates in the region, all the more reason that breastfeeding must be encouraged, especially among the lower income strata.
The PDHS 2012-13 findings also show increase in bottle feeding rates in Pakistan.
“Babies who are born to mothers from the lower income strata are more at danger if they are not exclusively breastfed. The water these mothers use to prepare the formula is unhygienic, and the bottles are not sterilized. Also, formula milk is not cheap. Once they start the baby on it, they start diluting the milk over time so that the formula powder lasts longer; as a result, the baby becomes malnourished,” says Neha Mankani who works as a community health midwife at a hospital in Karachi.
According to the World Health Organisation (WHO), breastfeeding has the potential to prevent about 800,000 under-five deaths per year globally if all children 0-23 months were optimally breastfed.
Once the baby is started off on top feed, the unaffording or unaware mother, over time, starts substituting it with unboiled cow’s milk or low quality tea whitening milk powder which is unsuited for an infant. “We can try and convince the mothers but only till they are in the hospital. Also, Community Health Workers (CHWs) have no access to women who deliver at home,” says Mankani, adding that she and her colleagues try to convince mothers to breastfeed.
However, part of the problem could be that healthcare providers are not doing enough to raise awareness. “Healthcare professionals are the main culprits. Instead of advising new mothers to breastfeed, they help perpetuate the trend of using formula milk. They are given incentives by formula milk companies. Research shows that children delivered in hospitals are more frequently formula fed,” says Dr DS Akram, Founder, Health, Education & Literacy Programme (HELP).
The laws protecting the right of the infant to health and nutrition are there. Lawyer Summaiya Zaidi says that the primary focus of laws like the Protection of Breast-Feeding and Child Nutrition Ordinance 2002 is to protect the nutrition of the child and promote breastfeeding as a primary source of nutrition. After the devolution, each province developed its own Acts for the purpose.
“The Sindh 2013 Act stresses that manufacturing, advertising and sale of alternate sources of child nutrition cannot be promoted as better than mothers’ milk or even compared to it. This stresses the primacy of breast milk as the best source of nutrition for a growing baby, and only when the mother is unable to provide the same to her child should alternatives be made available. It basically controls the manufacture and advertising of child nutrition products by placing certain legal limits on promotion of the same,” says Zaidi.
Yet, the tussle between public health experts and forces of consumerism continue. Companies producing or distributing formula milk refused to give any statement regarding how they justify the tempting advertising campaigns.
At the 69th World Health Assembly earlier this year, a resolution welcomed WHO’s guidance on ending the inappropriate promotion of foods for infants and young children. The guidance states that in order to protect, promote and support breastfeeding, the marketing of “follow-up formula” and “growing-up milks should be regulated. This recommendation is in line with the International Code of Marketing of Breast-milk Substitutes.
“The laws are there, but the implementation is a distant dream. Formula companies continue to particularly tantalise urban markets,” says Dr Akram, adding that the government does not seem interested in this cause. Dr Akram and her team run the Baby-friendly Hospital Initiative (BFHI) of WHO and UNICEF successfully in Pakistan for a few years. “When external funding stopped, the government was not interested in investing in it,” she says, adding that companies that produce formula milk mainly target the urban market to tantalise consumers.
“For the poor population in rural areas, breastfeeding is mostly the only available option. The urban social landscape is more challenging when it comes to breastfeeding. More mothers are working mothers; more options for top feed are available here; more people can afford to buy formula milk. Awareness is needed in both rural and urban areas,” says Dr Sara Salman of WHO Sindh.
According to Mankani, despite trying to raise awareness, most mothers follow popular myths. “They feel the baby is healthier if fed formula, owing to the aggressive marketing of formula milk.”
The biggest challenge for exclusive breastfeeding is the perception that mothers are not producing enough milk and should supplement with formula because the baby cries, says Meredith Jackson-deGraffenried from Helen Keller International. “This perception is driven by the misunderstanding that if the mother is undernourished and poor, she must be incapable of adequately nourishing her baby.”
“We try to teach these women basics about expressing their own milk and how to store it. Mother’s milk stays fine for up to three days in a refrigerator, and up to six hours at room temperature. It’s an economical and healthier option. But myths are hard to fight,” says Mankani.
Despite proven benefits like the mother who breastfeeds return to her pre-pregnancy state much earlier, and the incidence of breast cancer in women who breastfeed being much lower, as Dr Ahsan says, the myths seem to be winning.
“Socially, breastfeeding proves a challenge as well. There are usually no crèche or nursing rooms at work. That’s one reason working mothers stop breastfeeding,” says Dr Ahsan.

Originally published here: http://tns.thenews.com.pk/mother/#.V6hsuPkrLIX

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