Forty-year-old Sitara Burni, who lives in Baghdadi, a lower income locality, is worried sick. Her younger sister, Samreen Shama (25), who is the lady head constable in Sindh Police, is suffering from multiple ailments for the last one year, for which she has been seeking treatment. It all started when Shama received toe injuries during training last year, because of which she started suffering from sepsis. Soon afterwards, Shama was diagnosed with kidney failure. Initially, Sitara, who supports her family, was able to pay Shama's medical bills.

Today, however, Sitara says she has to think twice every time Shama makes a trip to the doctor and comes back with new prescriptions. In fact, Shama has missed two of her visits recently because Sitara did not have the money for the consultation fee and drugs. "Given the inflation, it is difficult to buy medicines," she says, while talking to Kolachi. "Usually, the doctor prescribes medicines for the week but mostly I can purchase only three days worth of medicine because they are so expensive."

Sitara says that she has spent about Rs0.2 million on her sister's treatment and takes Shama to the Sindh Institute of Urology and Transplant (SIUT) twice a week for dialysis. "Previously, I would purchase medicine for Rs300 but now the cost has doubled and is higher than the consultation fee," she explains.

There are many others like Sitara who have been adversely affected by the drug price hike. In fact, most people from low-income groups are forced to make a choice between buying medicines or food. This is hardly surprising considering that over the years, the price of medicines have increased by almost 50 per cent even though pharmaceuticals and officials of the Federal Ministry of Health claim that there has been only a 10 to 25 per cent increase.

A quick survey of the various drugs available in the market revealed that the price of over 240 items have increased by almost 45 per cent, including drugs for Tuberculosis, as well as antibiotics, pain killers, syrups, injections and other life-saving medicines.

Chemists blame the pharmaceutical companies: Kolachi spoke to the President, Wholesale Chemist Council of Pakistan, Atif Billu regarding this, who agreed that prices have increased by more than 50 per cent. "We have not increased prices as we only earn one to two per cent on medicine sales. The rates are decided by the companies," he added.

Local manufacturers justify this increase, saying that the overhead costs, salaries of staff and employees, utility charges, government taxes, etc have increased. "Bills are now in thousands as compared to hundreds in the past," said Chairman, Pakistan Pharmaceutical Manufacturers Association (PPMA), Zahid Saeed.

Even then, he said that 70 per cent of the medicines are cheaper in Pakistan as compared to India and other countries. Local manufacturers here hold 52 per cent of the market share, claimed Saeed.

However, in Pakistan, the Rs8 billion medicine market has an annual growth rate of 12 per cent.

Only 30 to 35 per cent of the population benefits from allopathic treatment. The remaining percentage relies on alternative forms of treatment.

Saeed pointed out that local manufacturers were already selling medicines at cheaper rates than those stipulated by the government at the time of drug registration. "Due to market pressure, we are already selling drugs at lower than approved prices. Now, due to inflation, we have increased our prices but even they don't exceed the official rates," he explained.

When Kolachi contacted Pharma Bureau's (representative body of multinational pharmaceutical manufacturers) Executive Director, Riaz Hussain, in this regard, the latter refused to comment.

Attempts were also made to contact the Chairman Salman Burney but to no avail.

Meanwhile, the Federal Health Minister Ejaz Jakhrani said that the government has allowed a price increase of about 80 items and that too "if absolutely necessary". This means that if the companies are unable to manufacture medicine on previous prices and revision was unavoidable, then the prices can be increased.

But while the blame game goes on, the low-income group continues to suffer who are unable to pay for healthcare and cannot find the medicines they need even at public hospitals. The government claims that health and education are top priority but the ground realities tell a different story. 

Syrups

Lederplex syrup 27 34 20

Citralka syrup 16 28 41

Panadol syrup 20 25 20

Calpol syrup 19 25 22

Lysovit syrup 35 55-65 45

Hydralin syrup 20 25 20

Benadryl syrup 16 20 20

Mucaine syrup 27 34 20

Tablets/Capsules

Cap. Evion 200 170 260 35

Cap. Evion 400 259 440 41

Tab. Mytika 210 225 5

Tab. Augmentin DS 84 100 16

Augmentin 625 99 120 18

Tab. Placel Enzyme 160 188 14

Flogen 50 145 165 12

Herbaser 90 SR 90 105 15

Tab. Stress 72 105 31

Revelol Multi 97 110 12

CaC 1000 48 55 14

Myrin P 43 63 32

Myrin P Forte 48 65 30

Tab. Myvital 17 21 19

Injections

Inj. Klaricid 90 160 45

Inj. Novapressen 990 1400 30

Inj. Tenzo 510 670 24

Inj. Zeftoc 1g 124 162 23

Inj. Meromin 500 826 1070 21

Others

Vicks (balm) 26 30 12

Ventolin inhaler 85 100 15

Gripe water 17 23 25

Ghutti 17 22 22

Naunehal 17 24 30

Arq-e-Shirin 16 25 35

Karachiites spend millions of rupees on allopathic medicines every year, and when they get tired of it, they look for an alternate. Rafay Mahmood explores different forms of alternative treatments available in the city

If you are tired of footing enormous medical bills and disappointed with the lack of concrete results, then no need to worry – there are other options available. Alternative, traditional forms of treatment are readily available in Karachi.  In fact, a research conducted by the final-year MBBS students of Hamdard University on treatment opting behaviour among patients reported at Psychiatric OPD at the Hamdard University Hospital revealed that 54 per cent of the patients suffering from different illnesses had already received treatment from a Hakim, a religious treatment specialist, acupuncturist or any alternative medicine expert. Some of them have been receiving treatment for months, some for years and some even for decades.

Acupuncture is a popular form of alternative treatment for two main reasons. Firstly because it is an old medical science that has been practiced world over for the last 5,000 years. Secondly, the treatment method is unique, that is, insertion of fine metallic needles at specific points in the body. Dr Anwar Ye Binju, who specialises in acupuncture, told Kolachi that "acupuncture cures a wide range of disorders including migraine, toothache and paralysis (in its early stages)." Dr Binju has been running the Pak-China Clinic in the city for the past many years.

He was of the opinion that unlike allopathic medicine, acupuncture has no side effects. Apart from that, the best thing about acupuncture is that the patient is aware of the entire treatment process. He also dispelled the myths surrounding acupuncture – that is, it causes hepatitis and other infectious diseases. "It only happens if the same needle is used again and again which causes infected blood transfusion," explained Dr Binju. "In our case, we either use new needles or sterilised ones." A consultation accompanied with treatment costs around Rs2,000, he added, while those who can't afford it are treated for free.

Another form of popular, alternative medicine widely practiced in Karachi is Greek (Unani) Medicine, better known as Hikmat or herbal medicine. Unani medicine has its basis in various herbs -- all medicine and syrups are made out of ingredients such as cloves, Baadiyan and Saunf. According to the Unani school of medicine, environmental changes cause our body to malfunction and if that change is not neutralised by the body's defense mechanism, it causes disease. To counter such diseases, natural herbs are used because they are more effective. Dr Shahabuddin, the Chairman of Basic Medical Sciences at Hamdard University in Karachi told Kolachi that herbal medicine is "most effective for any type of disease" unlike allopathic medicine, which uses antibiotics that work against any living microorganisms and hence cause side effects. In Hikmat, the medicine prescribed is targeted only towards the infecting micro-organism.

Dr Shahabuddin also said that herbal medicine does not cause sedation but has a relaxing effect on the body. It is most effective when it comes to fever, cold as well as diseases like Typhoid and Hepatitis C, and liver-related ailments.  "As a practitioner of Unani medicine, I must tell you that herbal medicine is not always the solution. We refer patients to allopathy as well, because we aim to cure people and you cannot risk a patient's life if you don't have it," he explained.

The third form of treatment that is closest to allopathic medicine is homeopathy. Dr Jameel Ahmed, a leading city homeopath, while explaining the science, said that the diagnosis is only based on the symptoms shown by the patient.  "Any substance that causes a particular symptom may exhibit the same symptoms when diluted micro-doses of the same thing are given to a healthy person."

A research conducted by the Aga Khan University Hospital on utilisation of services of homeopathy practitioners among patients in Karachi revealed that five main ailments for which homeopaths are consulted are skin diseases, influenza, headache, gastro-intestinal ailments and musco-skeletal problems. So far, the most successful treatment in homeopathy has also been with regard to the same ailments.

Some experts of Western medicine, however, criticise the effectiveness of homeopathic medicine as they believe that the dilution process kills the essence of treatment. Dr Majid Ali Abidi, the head of the Psychiatry Department at the Hamdard University Hospital, who conducted research on the treatment-opting behaviour of patients, said that while all forms of traditional medicine do have some positive effects, one cannot deny the fact that "all allopathic medicines are tested by the Food and Drug Administration (FDA) and are tested for their efficacy and safety before being launched in the market.

This is never the case when it comes to traditional medicine… it is efficient but possibly not safe."

Another problem, he said, is that most people think that allopathic medicine has been imposed on the rest of the world by Western countries. "They think that homeopaths are semi-Western, while herbal treatment is 'Islamic' and traditional," he added. This is not entirely true. For example, homeopathy originated from Germany and "if you buy medicine from a homeopathic medical store in Germany, then you can't claim insurance on that."

However, Dr Abidi admitted, that most allopathic doctors are unable to make the patient feel comfortable.

They just consider the symptoms and give the treatment which makes most patients feel like the doctor is not giving them time or attention.

On the contrary, alternative medicine practitioners give ample time and attention to a patient even if they have a string of people waiting to see them.  

Health awareness is what people lack in Pakistan, said Dr Abidi. "For example, even if ginger provides relief when it comes to liver ailments, it does not mean that people should eat ginger in large doses because it can cause other problems," he explained. It is because people lack basic health awareness that they do not consider the consequences, he added. "One needs to realise that one ingredient in large doses cause several other problems but most people don't understand that," he stressed.

"I have no other option but to get drinking water from toilet taps just the way most other patients and their attendants get it at this hospital," said Haleema, 65, while filling her water bottle from a faucet in the bathroom of the General Surgery Ward II, Jinnah Post Graduate Medical Centre (JPMC), a major public sector hospital in Karachi.

Narrating her ordeal to Kolachi, Haleema said she is lucky because water is supplied through the pipelines in the bathroom she is using. "Patients of the adjoining ward either come to this ward or go outside to fill their bottles," she added.

JPMC one of the biggest public sector hospitals in the country with 26 different wards accommodating around 1,200 beds. Doctors here see about 2,400 patients daily.

According to official sources, around one million out-patient department (OPD) cases are reported in the hospital every year, besides 30,000 minor and major operations. Moreover, the Emergency and Accident Department of the hospital deals with around 0.2 million cases while there are about 12,000 cases related to gynaecology reported here.

Ironically, however, Kolachi's recent visit to the different wards of the hospital revealed that no water coolers are available in any wards or corridors of the hospital. A majority of the ailing people are compelled to fetch water from the faucets of overflowing toilets. The unbearable stench emanating from these bathrooms wafts all the way to the wards, causing distress to the patients.

Khush Mohammed Jamali, an attendant hailing from Shikarpur district whose mother was admitted at the Neuro-Spinal Surgery Ward at JPMC, said that all taps in their ward's bathroom do not work properly so they are compelled to go outside in search of water. There is only one water cooler set up by the Saylani Welfare Trust in front of the main building where water comes twice a day. But it is impossible to stand in queue in the scorching heat for hours. "I get around four to five bottles of mineral water which costs me around Rs25 per bottle," he revealed.

Similarly, Zareena, 45, who has a fractured leg and is being treated in the Orthopedic Ward for the last 15 days, said her nine-year-old daughter looks after her. "I cannot allow my daughter to go outside but she keeps checking the bathroom faucets to see whether or not water is available," she said. Zareena said that she cannot afford to buy bottled water so when water is available in the bathroom "we fill up our water cooler and two other bottles that are enough for 12 hours." 

Meanwhile, a staff nurse on duty said that this is not a recent development. Patients have no option but to get the drinking water from the stinking toilets. "Patients come here to be cured of their illnesses but get more diseases from here," she said. 

Talking to Kolachi, the Executive Director of JPMC, Professor Musarrat Hussain said that the grievances of the patients are genuine but the hospital administration does not have the authority to get the equipment or put up water coolers in wards. "Recently the management of Cantonment Board has agreed to establish a water plant at the hospital. This may change the situation," he said.

Ironically, during a survey conducted by Kolachi, it was revealed that there is no shortage of water for special wards where federal government employees as well those with influence are admitted. Also, a large part of the water supply goes to the residential compounds inside the hospitals.

The management of the JPMC is of the view that cases of theft are on rise on hospital premises and miscreants steal water coolers when made available in the wards.

Dr Sirichand Talib, Deputy Director, Works, JPMC said that because of the lack of funds, water coolers cannot be installed in the wards and corridors of the hospital. The JMPC, he said, in collaboration with some NGOs, had installed coolers in every corridor of the hospital but either the attendants damaged it or they are stolen.

Dr Talib further said that there is lack of awareness among the masses which can be gauged from the fact that taps in several bathrooms are stolen by attendants as well as the people visiting the hospital. He further said that the hospital has no specific budget to purchase equipment or machinery. "The Federal Ministry of Health provides us with everything by awarding tenders," he explained.

Patients, however, have a different story to tell. "We have made complaints regarding the overflowing of lavatories in our ward but no one has paid heed to it. It becomes very difficult for both patients and attendants to stay in a place like this," a patient in the Surgery Ward lamented. In this regard, an officer of the hospital administration, said that there are only two sweepers in the hospital. One works at the residential colony while the other works inside the hospital. "So you can imagine why the problem has not been solved yet," he explained. 

The medical community speaks up

Dr Alam Aara of the Pakistan Medical Professionals, a representative body of professional doctors, said that on one hand there are multiple problems at the hospital while on other, the government has cut down JPMC's budget. 

She said that the Standing Committee of the National Assembly and Senate on health have already expressed their reservation regarding the condition of the hospital. Dr Aara said that the government should take its decision back and enhance the budget of the hospital without delay.

Dr Pardeep Kewalramani, a specialist of infectious diseases, said that water-borne diseases are on the rise in the public hospitals. He said that doctors are required to wash their hands properly before examining another patient because most infections are communicable. Unfortunately, there is shortage of water and the unavailability of disinfectant liquid in wards. "This means that doctors and other medical staff are a major source of infection," he said.

Regarding presence of different infectious organisms in the hospital, Dr Kewalramani said that due to the unhygienic condition prevalent in the bathrooms, organisms such as bacteria, virus, parasites and fungus are found in hospitals.

Dr Kaiser Sajjad, former Secretary General, Pakistan Medical Association (PMA), said providing drinking water in every ward should be the first priority of the hospital administration. He further said that given the soaring temperatures, the consumption of the water is high and patients admitted in the hospital get infected with water borne disease. "Hospitals are supposed to provide medical and surgical treatment but have become centres for spreading diseases," he added.

Meanwhile, Ishtiaq Ahmed Abbasi, Sub-Engineer, Planning, Development and Works Department at Jinnah Hospital said that about 1.5-1.6 million gallons of water are needed inside the hospital on any given day. However, the hospital just gets 800,000 gallons of water. He said that requests have been made to the Health Ministry to increase the budget so that more water pipelines can be laid. – HT

'We come to get better but contract more diseases instead'

A majority of the patients admitted in different wards of the Jinnah Post Graduate Medical Centre (JPMC) have complained about the unhygienic conditions in the hospital, because of which they are exposed to a number of fatal diseases. "We come here to seek treatment for one ailment, but when we go back home, we find that we have contracted something else," they lamented.

"Rats, cockroaches, flies and mosquitoes are a common sight in the wards," they added.

According to medical practitioners, this situation leads to the transmission of infectious diseases and also causes distress to the patients. A House Officer at the Orthopedic Surgery Ward said that those at the helm of the hospital's affairs know very well what is happening but no measures have been taken to redress the situation. In fact, the unhygienic conditions prevalent at the hospital have given rise to allergies among patients as well as visitors. Scabies and other skin ailments are also common, which adds to the woes of the patients and hampers the recovery process of the patients.

A staff nurse working in the night shift at the National Institute of Cardio Vascular Diseases (NIVCD) at the hospital said that "often at night, rats come out of the damaged pipes and disrupt the sleep of the patients," she added.

Meanwhile, medical records show that most complaints have been registered by patients at night. A doctor on duty at the NIVCD said that cardiac patients need a comfortable and relaxing atmosphere but "such conditions cause more anxiety to the patients."

In this regard, Chaudhry Mohammed Akram, Assistant Director (General), told Kolachi that the hospital administration uses insecticides for killing both insects and rodents. "As for cockroaches, we use sulphuric acid to eliminate them from the toilets," he added. He further said that the manholes and sewerage lines of the hospital are very old and damaged, thus allowing for rats to enter the ward. "We have written to the higher authorities to repair the pipes and hopefully, the problem will be solved soon," promised Akram. – HT

Underpasses and flyovers are no longer an unusual sight in the city. What is, however, unusual is the silent force behind their construction. This comprise heavy duty equipment and machines.

Despite being uneducated, the drivers manning these heavy-duty vehicles (commonly known as earth-moving vehicles or excavators) monopolise the market because it is a skill that they pass on to none other than their own generation. Not only are they the driving force behind the construction process, they are also in great demand at the sea port and airport for the loading and unloading of heavy goods. Same is the case at refineries where these drivers are needed to lift heavy equipments.

What is unfortunate is the absence of a training institute for the drivers in this profession, which is why the skill to carry out this mechanical task is limited to a single ethnic group. "Initially, I was trained by my elder brother who used to operate fork lifts. I gradually mastered the art and can now operate any kind of heavy machinery to dig trenches," said Shafiq Baloch, the driver of an earth-moving vehicle.

Baloch, who took a break from his work on a crane in Korangi to talk to Kolachi, said he was a part of the team that was involved in the digging process of all flyovers and bridges in the city as there was a shortage of skilled workers. "We have received training from our forefathers, but there is no formal school where other labourers can get training from. We can only pass this skill on to our next generation," he explained.

Baloch said that most of these drivers from Lyari were formerly sportsmen, but since they did not make enough money, they started driving heavy vehicles and gradually took over the market. They are mostly part-time workers who could usually be found playing daboo (carom) in some part of Lyari, if not at work.

Apart from constructing flyovers, underpasses and buildings, these machines are used to lay water and sewerage lines in the city and remove encroachments as well. Moreover, even the snorkel used by fire tenders (to extinguish fire at a height) is operated by these highly-skilled drivers as they are better trained.

The job, which may otherwise seem simple, actually requires one to remain hundred per cent physically fit, added another driver, Shafiz. The drivers are required to handle six to seven gears at a time. One of the gears helps lift the sand through the bucket and, while the girders and huge pipes are put together by other labourers, this skilled driver is required to lift the huge pipes and place them with the help of his crane.

The entire process, say the drivers, require constant communication which is why they prefer members from their community who would understand their language (Makrani) while the work is in progress. The language of this profession includes words like "Aria! Aria!" (meaning 'bring it down') when the huge pipes are to be laid down they yell: "Hawais! Hawais!" These words are only familiar to the residents of Lyari.

Since they are well-aware that they are the only 'driving' force in An expanding city like Karachi, most of them not only demand extra money from the companies that hire them, but enjoy other privileges like free food and tea (at frequent intervals). "It's a risky job. Plus we work in scorching heat round the year," said Rehman Baloch, who added that this is not a permanent job -- the law and order situation in the city often deprives them of their daily wages.

When dissatisfied with the working conditions, some also do not report to work for days since they know companies cannot hire any other worker, said Baloch, but is quick to explain that they do return if their Ustad asks them to. "When it comes to work, our Ustad is the first person we listen to. The company head comes later," he said.

Kolachi also learnt that as the law-and-order situation in the city deteriorated over the past decade or so, the strength of heavy-vehicle drivers also dwindled as most of them sought jobs in the Middle East, for their better living. The construction industry there promises them good money and better facilities. The cranes in the Middle East, revealed Baloch, have covered air-conditioned cabins and some have a music system as well to keep the drivers entertained as they work.

When asked about their driver's license, he said that heavy-duty vehicle licenses are issued from the traffic police department - but without any tests. "They don't check whether or not we really know how to operate the earth-moving vehicle since they don't have the vehicles or the training to do so."

Contrary to this, in the West, there are separate institutes for drivers of heavy-duty vehicles where training is imparted. These institutes also facilitate the issuance of licenses. Also, at the end of the construction phase, these drivers are given a month off from work so that they are able to rest after the physical exertion. Since this physical labour also requires the driver's presence of mind, it is also one of the highest paid jobs internationally.

Unfortunately in this part of the world, heavy-vehicle drivers barely receive this kind of acknowledgment. This is evident from the fact that while there a number of motor car driving institutes in the city, no such institutes are present to train this silent force, an important agent in the country's development.

In the words of an engineer, Naseem Haider: "We need to do more for them. They are a force without which these construction firms are totally helpless."

Books by Pakistani authors in English often evoke mixed sentiments in readers. 'Where They Dream in Blue' by contemporary author Bina Shah is no exception to this rule. Revolving around the culture shock suffered by an ABCD (American Born Confused Desi) protagonist -- Karim Asfar -- as he lands in Karachi, the book is an outsider's view of Karachi. However, this outsider, unlike the oriental observer, is actually much closer to Karachi then he thinks.

Set in the mid-90s, Where They Dream… attempts to capture the true essence of Karachi -- the Sufi heart -- which lies beneath all superficial brouhaha of terror, class divide and corruption.

The author has tried to bring this to the fore but sadly it appears that Shah has forgotten the heart herself as she gives us glimpses of American collegiate life and long-drawn scenes of the Karachi 'vanity fair', where Karim, the outsider that he, fails to fit in.

Eventually, however, Karim does find a place in the mesh of traffic, tall buildings and corporate culture. He finds love and the direction for social change at a local marine ecology magazine Samandar.

The love story, however, seems forced and unnecessary in a plot which already has a lot to offer. Had the amount of space allotted to the love interest been spent on developing Karim's Sufi inclinations, the book probably would have satisfied more people. Having said that, Nazli (the love interest) does offer an interesting case study of the life of a young, independent working woman in Karachi who is pressured into an engagement owing to her social obligations.

Shah's wry humour is perhaps the high point of the novel, where casual witty exchanges punctuate the otherwise soft tone of the novel. For instance, the reader is left smiling for hours when Karims's best friend -- Akbar -- jokingly reminds him that he's no "Alam Chana", and when Karim says that "girls in Pakistan are too short".

Where They Dream… touches upon the concerns of many immigrants as well as Pakistani citizens as Karim wonders:

"What kind of country was it where people willingly maimed their own children and sent them out to beg on the streets? Where politicians dipped their hands into treasuries and exchequers with no fear of being caught? Where young boys were urged to take up guns and go fight religious wars in far-off countries in order to earn a place in heaven?"

Fortunately, Karim's spiritual compass, Akbar, shows all that the country really has to offer is the love and support of family, beautiful beaches and of course "…girls, slim like reeds, hair long and thick with the kind of heavy promise that long hair inspires only in a Pakistani man."

One of the most intriguing aspects of the novel was the story of the beggar boy Abdullah who is saved by Karim from the life of beggary. Ironically, however, the boy continues to yearn for his old life -- conflict which leads to the eventual climax of the novel.

Another interesting aspect of the book is that unlike most contemporary authors, Shah did not feature as an autobiographical heroine for her novel.

Her protagonist, a young man who is decidedly less interesting than his best friend, is on the verge of becoming a man in his own right and what better place for this transformation for an ABCD than Karachi.

Book:

Where They Dream in Blue

Author:

Bina Shah

Publisher:

Alhamra Publishing

Price: Rs 450