panwar
iPandering to everyone's palate for paan
Considering the huge market for paans in Karachi, the popular green leaf serves as a source of livelihood for thousands of workers in the city. 'Imran' is one of them.
By Fasahat Mohiuddin
There is a multi-million rupee industry in Karachi with close to 3,000 little shops dotted around the city's landscape. All it requires is a few leaves, a series of powders, and a handful of nuts. It is responsible for the livelihood of thousands of workers in the city and is hugely popular among more than 150,000 other people in Karachi. 

For years, Karachi has been riddled with water and sewage-related problems, and one of the biggest contributing factors to these troubles is the fact that just half of the city's population is believed to be connected to the city's sewerage system while the rest make to with alternate means, if at all.

The Karachi Water and Sewerage Board (KWSB) has been running three waste water treatment plants (TPs) in different parts of the city, but these are not nearly as effective as they should be. All are outdated, and one has clogged to a virtual halt. Estimates suggest that of all the sewage that ends up in the sea, only 40 percent is properly treated.

In order to meet national environmental quality standards (NEQS), industrial units are required to treat their sewage before discharging it. However, Kolachi has learnt that barring the tanneries in the Korangi Industrial Area, no chemical-based wastewater generating unit complies with this law.

"The KWSB supplies 650 million gallons per day (MGD) of water to its consumers," informed Gulzar Memon, KWSB mechanical and electrical engineer. "We have a formula to determine the wastewater to manage in return. About 70 percent of the water supplied to consumers becomes wastewater and drains into the city's sewers."

Memon conceded that there is a huge gap between the wastewater being generated and that being treated. According to official calculations, the city yields approximately 450mgd of sewage, out of which 299mgd is untreated and left to pollute the sea.

Environmentalists say this is a grave violation of the Pakistan Environmental Protection Act 1997. "Not acting as per its own laws, the government is culpable of opting for development at the cost of health and the environment," comments a veteran PCSIR scientist.

Each KWSB plant should theoretically treat 151 MGD of sewage, but the treating capacity of each of these plants has plummeted to a mere 60 MGD. The TP-I, installed in 1959 in SITE area with a designed capacity of 51 MGD, has been treating only 25 MGD, whereas the TP-II, set up at Mehmoodabad the same year, has a capacity of treating 46 MGD. This particular plant was forced to stop functioning in October owing to a series of faults, but when it reopened its performance was below par.

The TP-III is more recent. It was built in Mauripur in 1998 with a designed capacity of 54 MGD, but has been treating only 35 MGD.

Not only do treatment plants fail to treat all the sewage, there are many areas where the majority opts for makeshift channels for dealing with sewage such as disposing it outside their houses in lanes connected to a large pit nearby. Around five to 10 percent the population uses such septic tanks, mostly in illegal housing schemes.

In 1982, the NGO Orangi Pilot Project (OPP) realised the government's failure to deliver the required sanitation system, and proposed the installation of a 'self-financed and self-managed' sewerage system, offering technical support.

The new system proved to be a success. People of the area financed the scheme, building their own sewerage lines and connecting it to their houses at a fraction of the cost. This line in turn was connected to trunk sewers installed by the government. The simplified, low-cost alternative to a government-installed sewage system was in place.

The OPP, along with its Research and Training Institute (RTI), also brought about a radical change in the government's policy attitude towards solving the city's sewage problem. In 1999, the OPP-RTI managed to secure the cancelled US$100 million Korangi Wastewater Management Progamme (KWMP).

The KWMP was known amongst policy makers and town planners as the Greater Karachi Sewerage Plan (S-III), and would have been built through local resources and local expertise. Nearly 70 percent of the expense would have come as loan from the Asian Development Bank (ABD). Originally, the OPP-RTI's proposal for the KWMP was to involve the existing community and the sewerage system by the defunct Karachi Municipal Corporation.

According to architect Arif Hasan, the project would convert drains, which act as units, disposal into box trunks and place a treatment plant just before the point where the sewage enters the Korangi Creek, which rendered the ADB loan unnecessary by dramatically cutting the cost.

Bearing in mind the existing faulty sewage treatment project, the City District Government Karachi launched the S-III in 2007 at an estimated cost of Rs8 billion to maintain the ecological balance of marine life by improving the capacity of its sewage treatment plants. KWSB officials estimated that the S-III project would take four years to be completed.  

According to them, it was approved by the Executive Committee of the National Economic Council, with both the federal and Sindh governments expected to provide funds. KWSB documents suggest that the approved Greater Karachi Sewerage Plan would double the capacity of the existing treatment facility under KWSB's belt.

The utility service also seeks to add another treatment plant in Korangi: TP-4, which has been designed to have a capacity of 200 MGD. "We are having the feasibility study and designing the project S-III," Gulzar Memon told Kolachi. "The entire system will be upgraded, and the capacity of existing sewage treatment plants would be increased to 300 MGD." One can only hope for a cleaner beach and effective disposal of sewage in the years ahead. Till then, one has no choice but to bear the stench with fingers crossed.

When Asiya fell ill, her mother took her to a nearby doctor in F.C. Area, Liaquatabad, who referred her to the National Institute of Child Health (NICH). For four days, Asiya suffered from diarrhoea without any improvement. 

"The doctors administered a drip and an injection three days later, but her condition did not improve," her mother told Kolachi. "Even a drop of milk made her nauseous. When she is administered a drip, she can rest, but when the drip runs out, her condition deteriorates."

Asiya's mother was convinced that her daughter would receive good treatment at the emergency facility at NICH, but her condition shows little improvement. The ward Asiya is admitted in is popularly known as 'diarrhoea ward', and houses many other patients with the same symptoms, including four other girls and four-year-old Osama. Osama is a resident of Bazarta Line, Saddar, and has been suffering from diarrhoea and fever for five days, although according to his mother, his condition improved after he took ORS (Oral Rehydration Salts).

Most of the patients at the hospital are residents of low-income neighbourhoods of Karachi who purchased water through tankers. Hamza Ali is no different. Ali resides in Kala Pul and purchases water through a tanker in Hazara Colony, and for the past few days, his son has been suffering from diarrhoea. Ali complained that no specialist had visited their ward, and that so far, only one medicine was prescribed, which brought little improvement in his son's health.

Nine-year-old Ziaratullah has a similar story. Yet another resident of Hazara Colony, he, too has been admitted for the same reason.  

"We escaped the Taliban war in Bajaur and took shelter in Hazara Colony, where we live in overcrowded rooms," says Ziaratullah's mother when talking about her living conditions. "The water is dirty and there is filth everywhere."

Each year, hundreds of children visit the NICH, and all have the same problems these children have: they are suffering from diarrhoea and other waterborne diseases. According to Dr A.G. Nagi, Director NICH, around 28,000 patients visited the NICH last year, and 20 percent of these were diarrhoea patients.

"There are many waterborne diseases that affect one's digestive system and liver," said Nagi. "Potable water helps reduce the risk of waterborne diseases."

Poor families suffering from waterborne diseases undergo more than just emotional trauma: they are also under a massive financial burden, as the cost of treatment can go as high as five billion rupees a year.

"We do not even have enough money for food. How can we afford mineral water?" questioned a woman whose seven-month-old grandson, Hamza, is yet another diarrhoea patient. To save his life, the family had to give up on food to purchase five bottles of mineral water at Rs30 each, but to no avail. The boy has stopped eating, and his condition has not improved.

According to Nagi, there is a vaccine against diarrhoea, but many cannot afford it. "A vaccine against diarrhoea (Rota virus) requires two doses, each costing Rs4,500 - an unbearable cost for the poor."

To counter deaths in children brought on by high fever, the government has started a vaccination programme. The vaccination, however, costs between Rs1,200 and Rs1,500, and like the diarrhoea vaccine, is unaffordable to much of the population.

Nagi pointed out that although public hospitals provide treatment free of cost, an increasing number of cases of waterborne diseases have placed a heavy burden on the doctors. "There are not enough doctors for the numerous patients that visit each day, and because of overcrowding, most doctors only pay attention to those patients whose cases are very serious."

Many of these cases, however, are serious. Professor Iqbal Memon, a child specialist at Civil Hospital, Karachi told Kolachi that diarrhoea is the leading cause of deaths among children below five years of age. In Pakistan, there are approximately 25 million children in this age bracket. It is estimated that each child has four to six diarrhoea episodes per year, resulting in at least 100 million cases annually. "Out of these, approximately 90,000 children across the country die each year," said Prof Memon.

Memon added that the majority of the patients suffering from diseases caused by contaminated water come from Lyari, Shershah, Banaras, Kharadar, Lea Market, Burns Road, and Ranchore Line.

Diarrhoea, however, is not the only serious illness they are susceptible to. Typhoid, dysentery, and hepatitis A and hepatitis E, all waterborne diseases and all potentially lethal, are rampant in these areas. Typhoid affects children between the ages of two and 10 in particular, and if not fatal, results in the loss of school days. Dysentery, where bacteria enter the blood and multiply, causes malnutrition and in most cases, death. Hepatitis A and E, which damage the liver, can also lead to death.

Despite the seriousness of the situation, there are not enough doctors to attend to every patient. However, Prof Memon believes that the solution lies not in increasing the number of doctors, but in improving the quality of water.

"If you want to reduce child mortality, it is imperative that the state ensures clean, safe water and sanitation conditions," he said. "Washing hands and breastfeeding are cost-effective measures that can ensure a child's survival. Vaccinations and access to health can further reduce the death rate," he concluded.

The spiralling inflation blanketing the country has given birth to a new set of woes to the underprivileged – and in some cases, the not so underprivileged – in Karachi: the rising cost of essential medicines.

The business of many pharmaceutical companies around the city has been thriving as the price of these medicines continues to hike – a trend that has been all too evident over the past few months. There is no coherent government plan to regulate such prices, and a visit to medical stores around the city shows that the cost of several essential medicines usually consumed by the middle and lower income circles of society has registered an increase from a mere three percent up to 67 percent.

Adjacent to the Jinnah Postgraduate Medical Center (JPMC), pharmacies have been selling the Hydralin cough syrup (120 ml) at Rs25 instead of the previous Rs21, a near 20 percent rise over the past two months. Kleen Enema is being sold for Rs32, up from Rs25 (a 28 per cent increase), while Novapressin Cancer medicine, which is commonly labelled a 'life-saving drug' by pharmacists and doctors alike, is being sold for Rs1,480, up from Rs990 - a 49 percent increase.

There is a similar trend in Karimabad, where folic acid tablets are being sold for Rs20, up from Rs12, registering a 67 percent increase. At the same time, Motilium tablets bear a selling price of Rs85, up from Rs70, amounting to a 21 percent increase.

"This is happening because the government does not have an organised plan to regulate and monitor medicine prices," stated Dr Qaiser Sajjad, a former head of the Pakistan Medical Association (PMA). "The profitability of pharmaceutical companies should be monitored and national or multi-national pharmaceutical companies should not be allowed to exploit the masses."

The high costs have meant that many patients are reluctant to purchase all the medicines their doctors prescribe. "With inflation at an all-time high, should the poor buy food or purchase medicines?" questioned Jaffery, the owner of a medical store.

This drop in purchasing power, however, has spelt trouble for medical store owners, many of whom are now having trouble sustaining their small businesses.

"We are giving discounts to the customers to keep them attracted. Our government is doing nothing to support the local industry," complained both Mohammed Irfan and Tassavur Hussain, who jointly own a medical store opposite the Jinnah Hospital. These discounts, they added, were often close to 10 percent.

On the other hand, there are medical practitioners who believe that despite the recent price hike, the cost of medicinal drugs in Pakistan is still relatively cheaper than in other countries. They justify the trend of rising prices by saying that it has happened after eight or nine years.

"The price increase has been gradual," explained Dr Sohail Rangwala, a reputed general physician in North Nazimabad Town. He argued that the price hike is understandable bearing in mind that the cost of the raw materials that pharmaceutical companies import into Pakistan has increased (owing to the rupee's depreciating value against the American dollar).

However, under the law, pharmaceutical companies cannot raise the price without proper government approval. "Pharmaceutical companies cannot increase prices of medicines without prior approval of the 'Price Advisory Committee.' It is against the law," said Sheikh Ansar, an official in the Federal Health Ministry Drugs Control and Registration Department.

But some suggest that despite the presence of such a law it is not difficult for companies to get their proposals approved by exercising their influence on the government.

One proper method to regulate prices, suggests Dr Samrina Hashmi, Secretary PMA, is to allocate the cost of each medicine in accordance with the formulae of the product. "Medicine having the same basic formulae and compounds should be priced within a certain price range that should be strictly implemented by the government."

Both Dr Hashmi and Dr Sajjad pointed towards another disturbing scenario in the pharmaceutical industry. When taking their oath, doctors vow to not accept any gifts or rewards for their service, but Kolachi has learnt that this is not always the case.

"Pharmaceutical companies dole out cash worth millions of rupees, and perks and privileges in various forms to doctors when advertising their products. This includes foreign trips. The trend affects the overall market of medicines," revealed Dr Hashmi.

Since Pakistan is without an industrial infrastructure to manufacture raw material, some doctors have suggested giving incentives to industrialists for establishing the industry to help stabilise the prices of essential medicines. "Pharmaceutical companies never contemplate manufacturing their basic salts and raw materials in Pakistan," Dr Sohail Rangwala said.

"Multinational companies have been establishing plants all over the world. Why would they not want to establish one in Pakistan?" he questioned. He stressed the importance of regulating medicine prices by the government, without which companies would not come forward to invest in the country – and Rangwala is convinced that prices would only fall after companies invest in Pakistan.

There is a reason pharmaceutical firms do not manufacture the required salts and raw material locally. Batool Raza, senior manager at Hilton Pharmaceuticals, explained why: "There is a lack of infrastructure and a trained workforce, including PhD-qualified doctors and pharmacists," she said. "Because of this, drug manufacturers in Pakistan have to import their entire stock of raw material."

Rafiuddin Ahmed of Mectar Pharmaceuticals added that prices of medicines were last revised in 2001, and have remained stagnant while the costs involved in bringing them in has increased. According to him, this can be blamed on not just the currency rate fluctuation, but also on the rise in cost of labour and energy. "Imported raw materials have become twice as expensive," he lamented.

Although the ministry claims to make medicines easily accessible at reasonable rates, Ansar was unable to elaborate if there is a formidable plan in place on how to do so. This shows that the proposals and policy initiatives outlined by doctors, officials of PMA and pharmaceutical companies have not been taken seriously by this government.

Doctors, however, insist that there is just one way forward: that the government reduces duties and taxes on the import of essential antibiotics, life-saving drugs, and on salts and other raw material. These measures, they say, would help ease some of the cost-push at medical stores and bring some uniformity in prices of medicines.

Abdul Waheed Bhatti, 50, is one of many fishermen whose life and work have been affected by the rising pollution around island villages. 

Bhatti has lived on an old Bhit island for decades and can remember a time when there used to be clean water all around. Now, however, many of those fish no longer exist in the area. He can count off dozens local commercial fish that have died out because of the pollution.  

One of the biggest complaints fishermen have is that many drains discharge sewage into the sea near their localities - which are situated in low-lying areas - leaving children vulnerable to deadly diseases. The water around Bhit is the only source of water for this community. 

The pollution, say many, is a relatively new phenomenon. To illustrate just how polluted the waters have become, Bhatti says, "Just 10 to 15 years ago, children swimming under the Native Jetty Bridge would entertain picnickers by tossing coins into the water and watch children dipping down to find it. Now (thanks to the sludge) there is no way of knowing if even a boat sinks under the same bridge."  

A few years ago, fishermen did not have to go far from their homes to make a sizeable catch. With the polluted waters, however, they have no choice but to travel for four to five hours out to the open sea.  

"It is difficult, costly, and risky," adds another fisherman, Mahmood Qasim, 55. "Often boats return without a catch, and in bad weather, fishermen can mistakenly cross sea borders and often get arrested by Indian forces." 

As the livelihood of fishermen and their families depends solely on their catch, this is something they can ill afford. Before the waters were polluted, fishermen would find plenty of fish within 10 to 15 minutes by boat. Activists even report that small whales could be seen near the islands. As a result, fishermen would make a bigger catch and have more for their families, but now they have to sell everything they catch.  

Moreover, not only has the water become too dirty to fish in, but places to anchor fishing boats are also disappearing. Fishermen belonging to Khadda, Lyari, say they can still anchor their boats close by, but in Machhar Colony, Sultanabad, Shireen Jinnah Colony, and the DHA (Defence Housing Authority), such landing sites have been occupied by high-rise buildings and residential colonies.  

In addition, builders have started to occupy the Nehr-e-Khayyam, which carried water from two drains flowing to the sea near Boat Basin. Parts of the drains have now been narrowed or blocked, causing problems during the monsoon season and leading to fears that the area might by flooded if the drains are not fixed.

After residents of the area highlighted the issue at government level, the City District Government Karachi (CDGK) launched a project worth Rs180 million in 2006 and planned to build a 2.8-kilometre storm water drain from the Clifton Bridge to Nehr-e-Khayyam, which would last for a minimum of one hundred years.  

According to reports, a contract for the project was awarded to a Chinese firm, but so far, work on it has not been initiated. When contacted by Kolachi, neither officials from the Karachi Water and Sewerage Board nor the CDGK Executive District Officer Works and Services Department, who were involved with the project, were able to comment on the status of the project.

panwari

There is a multi-million rupee industry in Karachi with close to 3,000 little shops dotted around the city's landscape. All it requires is a few leaves, a series of powders, and a handful of nuts. It is responsible for the livelihood of thousands of workers in the city and is hugely popular among more than 150,000 other people in Karachi. 

Welcome to the paan industry. The non-paan lover would be astonished to learn that in Karachi alone, there are at least 25 different types of paan (betel leaves), and shopkeeper Imran (not his real name) can tick them all off one by one: azre zahoor raja jani, raja jani, mix patte, guru ratan, dabal patti, zahoor zafrani, saunf khusboo, meetha paan, sada elaichi, sada paan, zahoor rajana, zahoor zafrani, dabal patti chuna, malai wala paan, and many more. Each flavour is sold at different rates. The maximum price of a paan goes up to Rs10.

Imran is the proud owner of 'Shandaar Paan House' in Nazimabad and also has a branch in Clifton. Both his shops are forever buzzing with customers, many of whom often call before coming to place an order.   

"If they are in a hurry, they call and say, 'I want 25 paans'," says Imran, and adds, "They like the special taste of my shop." 

There is no denying this, as his customers can be seen making a beeline for their shops. They are none too picky - often they will ask for a specific worker in the shop to prepare their paan. Imran is quick to credit them for their good taste. 

"They always want the same kind of paan," he says. "They understand the magic of paan-making." 

Imran illustrates how a paan is made, which he insists is not something every shopkeeper knows. The cut betel leaf is bedecked with chopped chhalia (betel nut) and coconut powder. The leaf is then folded into a tight triangle, wrapped in plastic, and packed into a piece of paper, ready to be sold. He aquired this skill over several years.

With such meticulous packaging, it can remain intact for hours. Imran says he does not put any drugs in his paans, but acknowledges that many others do.  

"It takes time to train someone to get it right, but trained paan makers are highly paid," says Imran. "They can prepare 20 paans in 20 minutes." 

Considering the huge market for paans, paan makers cannot afford to be untrained or not paid well. Imran estimates that excluding the rent, it takes roughly Rs200, 000 to establish a paan shop. Regardless of such a cost, he believes that tons of paan is sold in Karachi, Hyderabad, Mirpurkhas, and Lahore.

There is no real peak season for the popular green leaf, but sales rise during Ramazan and the wedding season. As the population rises, so does the demand for paan.  

The most popular paan shops are clustered in North Nazimabad, Nazimabad, Clifton, Defence, and Bath Island. At Imran's shops in Clifton, the paan is very popular amongst the wives of diplomats. "But they don't purchase paan openly," says Imran. "They send their servants to get them." 

Popular though the other shops are, Imran does not feel threatened by any of them. He has faith in his customers. "Once a customer develops a taste for one shop, he doesn't go anywhere else," says Imran. He knows his aren't going anywhere.