Negligence by healthcare professionals in Pakistan is common knowledge. Even then it is not taken seriously by the authorities. The debate on this issue surfaces every time a serious case is picked up by the media, but often these short-lived discussions fails to get the attention of health authorities.

The issue is again in focus after the allegedly 'preventable' death of a young man at a leading public hospital in Lahore. This case, like many others, might have gone unreported if the family of the victim had not pursued it seriously. This is a distressing fact as no public or private organisation keeps record of the cases of doctors' negligence or improper care of patients at both public and private hospitals. There are 'death review committees' and 'ethical committees' in all public hospitals but according to Dr Zahid Pervaiz, Medical Superintendent (MS) Jinnah Hospital Lahore, these are merely ceremonial bodies and there is no proper system of incident reporting in public hospitals in Pakistan.

Experts believe there is no proper mechanism for doctors' accountability on account of negligence. "There is no specified authority or body or laws to address the issue," says senior health journalist Wasif Nagi. "It is because either majority of people in Pakistan do not have confidence in the current legal system or they are not aware that such negligence may result in the death of their near and dear ones."

People think in most cases patients suffer because senior doctors leave their patients at the mercy of junior-most doctors (residency doctors). In public hospitals, emergencies are handled by junior doctors. According to Nagi, most of the doctors and hospitals do not keep track of the outcomes of procedures performed by them. "There is no formal review of mistakes and adverse outcome of the treatment given to patients, both in government and private hospitals."

Dr Shershah Syed, representative Pakistan Medical and Dental Council (PMDC) Sindh, thinks that one should take into account the ground realities as well. "Doctors in Pakistan are overworked and under-paid and they do not have proper facilities. Doctors are not the only ones to be blamed for all kinds of negligence or malpractices; nurses and paramedical staff can also be equally or solely responsible, but people always accuse the doctors."

Syed suggests that ethical and disciplinary committees should be made functional in order to fix responsibility. He tells TNS there is a disciplinary committee of PMDC that looks into the matters of doctors' negligence.

But Dr Zahid Pervaiz thinks the role of doctors is very dominant in our system. "That is why people usually blame them. Doctors should allow nurses and paramedics to play their due role and you will see the difference." He admits that gross negligence on the part of doctors is common in hospitals. "Doctors do not see their patients for hours even on regular requests from the relatives of the patients." He thinks senior doctors should take the responsibility and train juniors on "how to treat patients."

In his research paper titled 'Reforms for Safe Medical Practice', M. H. Shiwani of University of Sheffield writes that in Pakistan, there is no league system of the doctors or hospitals to identify excellent performers. There are no insurance companies who can keep check and balance on the adverse outcome of a physician's wrong practice, as in United States. "There is no system of incident reporting. The radical reforms in the health care system in United Kingdom, after the highly publicised scandal of the 'Harold Shipman' case, is an example to be followed from, in the last few years. This case refers to a single doctor's malpractice and killing of a few patients which resulted in radical reforms in the health care proviso of the country. Under the reforms, which builds on 'Good Doctors, Safer Patients', doctors will have their skills and competence checked every five years. Doctors who fail the revalidation process will be expected to take further training."

According to the paper, who protects the public if it suffers from unsafe or dangerous practices in Pakistan? Apparently, the medical council in any country serves as a link between the public and medical professionals. "The statutory purpose of the council is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine and to ensure that patients have confidence in doctors". Unfortunately it is not the prime objective of the Pakistan Medical and Dental Council (PMDC), which is the doctors' regulatory body in Pakistan. It is a statutory autonomous organisation constituted under the Pakistan Medical and Dental Council Ordinance, 1962.

"The objective is to establish a uniform minimum standard of the basic and higher education in medicine..."

It has also devised a code of ethics for the doctors but this code of ethics or any other part of PMDC's constitution does not have anything about the accountability of doctors.

It is true that the PMDC has formed a Disciplinary Committee under the section 33 of the PMDC Ordinance 1962, headed by the nominee of the Chief Justice of Pakistan who is generally a judge or eligible to be a judge of the High Court while the senior doctors help him. But it cannot initiate disciplinary action against a doctor unless a complaint is received from the accuser, blaming him of professional negligence or misconduct. The complainants and doctors are given full opportunity to present their cases either personally or through the lawyer. The maximum punishment of health care professionals' malpractice, according to PMDC rules and regulations, is suspension of registration.

But according to Islamabad-based former secretary PMDC, Dr Sohail Karim Hashmi, the Council has no mechanism to check whether the health practitioner whose registration was suspended still practices or not. He says, in majority of cases, the aggrieved parties failed to prove their cases in front of disciplinary committee because hospital authorities denied them documents or record of the case while on the other hand accused parties -- doctors -- have complete access to the record. According to Hashmi, the last high profile doctor who was penalised by PMDC was Professor Majid of Lahore in 2006. "His registration was suspended for two years by the disciplinary committee. Later, he also went to the court against the decision but did not get relief because there were enough proofs against him."

Legal experts thinks there are no specific laws in Pakistan to deal with doctors' negligence. "Such cases are treated under the law of torts for getting compensation, while if a patient is killed by a doctor, a case is registered under section 319 of PPC (Pakistan Penal Code) that deals with murder due to negligence," says Shamim Ur Rehman, advocate Lahore High Court, while talking to TNS. According to him this is ironic since the same clause deals with registration of case against a driver who kills a person.

Dr Sohail says that PMDC has held the disciplinary committee meetings in Lahore, Karachi and Islamabad last month after a gap of two years. "It exposes PMDC's claim of ensuring quality medical service to the people."

Secretary PMDC, Dr Nadeem Akbar, admits it took two years to hold disciplinary committee meetings, "but it was due to some legal problems that we could not hold the meeting earlier. I am hopeful that, in future, meetings of disciplinary committee will be held every six months," he tells TNS.

Cases of negligence and malpractices are equally rampant in private medical institutions. "They are not even being monitored because there is no law in place to regulate private hospitals. Current PMDC laws can only take some kind of action against individuals i.e. doctors, and not hospitals. Unless there are proper rules and regulations in place to monitor performance of doctors as well as hospitals, both public and private, it will be difficult to make the erring doctors, or the institutions they work in, face legal action," says a senior doctor on condition of anonymity.

PMDC officials are well aware of the situation and admit there is no proper mechanism of accountability of doctors' negligence in place, but they blame the government. According to them, PMDC is still being governed by PMDC Ordinance 1962 which was amended later in 1973 by the parliament. "After not a single amendment was made in this ordinance. We have suggested amendments to the ministry of health more than once, but they show least interest," says an official of PMDC on condition of anonymity. According to him, the last draft of amendments unanimously approved by PMDC was given to the health ministry in 2001 but, so far, it has not been presented in the parliament for approval.

The legal section of PMDC does not have complete data about the total complaints lodged against doctors and the number of doctors penalised so far. According to an official of PMDC, legal branch, in the last meetings of disciplinary committee in Lahore, Karachi and Islamabad (which were held after two years), only two doctors were given warnings. "A total of 59 complaints (26 from Lahore, 16 from Karachi and 17 from Islamabad) against malpractices of doctors have been lodged with the PMDC in the last two years, majority of which have been adjourned by the disciplinary committee due to lack of proofs," he tells TNS. "The ratio of those actually penalised has always remained almost the same."

When it was first heard that the Tehrik-e-Niswan was to perform an Urdu adaptation of Samuel Beckett's timeless tragicomedy, Waiting For Godot, there surely would have been more than a few cringing faces. Intrigue would have come with a healthy serving of pessimism and a side of judgement before trial.

Understandably so. Executing a play such as Waiting For Godot is extremely difficult. There are only five characters, one set, and two long scenes. There are no drastic changes in the plot, no dramatic turns to keep the audience engrossed. Then there is the unmatchable aura of the play, which is often called the greatest play of the twentieth century, creating towering expectations.

If not performed correctly, it can make for an absolutely painful spectacle. In fact, it would not be far-fetched to say that doing an average job would be an achievement in itself. Couple that with Tehrik-e-Niswan's ambition to perform an Urdu version of the play, and you have a potential disaster on your hands.

That's not the extent of the task: Tehrik-e-Niswan strived to perform the play (Insha Ka Intizar) in a single act – making it even more difficult in many ways.

Secondly, given the nature and structure of Waiting For Godot, it comes down purely to the ability and execution of actors, and, of course, the skill of the director to get them ready.

In this play, more so than others, there is no escape for actors, nothing to distract the audience and nothing for the actors to hide behind. An actor's smallest, most inconspicuous weakness can be found out and brutally highlighted.

Therefore, any venture to perform the play, especially an adaptation, would need a fair share of courage. Now, courage alone does not make a good play; the execution also has to be as close to perfect as possible.

When the auditoriums were filling up to watch Insha Ka Intizar, many, even if only in their minds, would have not ruled out an absolute debacle – despite the quality of the actors and the director.

Well, quite frankly, they hit it out of the park. The performance was spectacular; the idea to execute it in one act was a smashing success. Packed auditoriums, for three straight shows, were kept absolutely absorbed. There was not a moment of monotony (which, let's be honest, is there even in the original).

Anwer Jafri did a fantastic job writing/translating and directing the Urdu adaptation, lacing it with local socio-political humour - that too to great effect.

Despite it being translated, Waiting For Godot remained intact despite the huge linguistic and cultural leap. Remember that Beckett wrote the play to be about European conditions, yet, so well was it adapted and performed that Insha Ka Intizar could very well have passed off as a locally-conceived play.

The execution and success of the play not only shattered the linguistic barrier, but bridged and highlighted the commonalities between East and West, which were previously been better known for their differences rather than similarities. It produced a sort of universal concept of dejection and the humorous side of helplessness.

The poignancy of the thrust (which Beckett always maintained was for the audience to decipher using their own perception) is not only sustained but, in fact, is emphasised bearing in mind that the local audience was able to relate to it more given its smartly-incorporated domestic flavour.

Another change form the original, is that the male duo of Estragon and Vladimir are replaced by a male-female combo of 'Karmu' and 'Zulekha', which ended up working out better than expected, possibly because the Zulekha was played by Sheema Kirmani, who, it seems, can do no wrong when on stage.

Salim Mehraj partners up well with Kirmani, playing the role of Karmu expertly. The play was given fantastic impetus by the character of Mansha-ullah ('Pozo' in the original), which was played marvellously by Hafeez Ali. His boisterous portrayal of Pozo went very well with the dreaminess and existential nature of the protagonists – giving the play the sort of balance it needed to be a successful performance.

The highlight of the play, however, it has to be said, was the hilariously written and absolutely beautifully performed rant by Naseeban ('Lucky' in the original), played by Shama Askari. It got a raring response from the audience.

Young Maha Shahid also made an appearance as a 'girl'. Steady and composed the new-entrant came in at a critical time of the play (towards the end) and was able to seamlessly merge into the performance.

Over all, a fantastic show; two thumbs up. A must-watch.

Neo miniature continues to establish its foothold on the contemporary art scene in Pakistan as well as in international circuits. It is even acclaimed as one of the only new art developments to have come out of Pakistan in recent times. On the one hand, it has been criticised for propagating cultural stereotypes, thereby perpetuating false or misconceived notions of the self. On the other hand, its relevance cannot be denied because of its engagement with the socio-political scenario and the politics of global aggression.

However, since it exists as an art form that is changing rapidly and seems to be in a state of continuous transformation, there is enough room to explore, to expose and to critique the diversity that it offers. The fact that it is sought after by foreign auction houses and has opened inroads to more prestigious galleries abroad could work in its favour and, at the same time, put it at the risk of being commoditised into another exotic art form. For once, though, it is not placed under the banner of 'Indian Art', as it is home-grown in Pakistan.

Having said that, it is still predominantly seen as an art form that explicitly draws its inspiration from the aesthetics of the miniature, even if it sometimes subverts that link. This duality is consistent with questions that confront artists and writers today of how and where we stand in our relationship to our past and how we interpret or reconnect with it? Also, why is there the need to do so? Can the past stagnate or constrict the creative process or does it enrich the same? Does being rooted necessarily imply that art has to have a certain 'look' that is easily identifiable with a certain time back in history? What are the notions of beauty that we respond to, culturally?

These questions and many others will continue to be addressed as we see a growing number of artists working in this genre. There is the unavoidable situation of students and younger artists being influenced by their mentors. How far that influence travels and to what extent it keeps its hold is a tricky question. Many works on wasli, for example, seem to be copies or versions of Imran Qureshi, the patriarch of neo miniature. The formation of clouds, the rain drops, the flora and fauna are often cleverly adopted by other miniaturists (and not surprisingly by non miniaturists, too) because it increases the market value of the artist. Tried and tested imagery is always a better option, than having to explore and risk the use of new metaphors. However, artists who mimic the more successful do not realise that the 'tried' is easily interchangeable with 'tired'. Because it is devoid of meaning and context, it does not go very far in breaking new creative grounds or in relating content to context.

Marium Irfan's new works in a two-person show at Chawkandi Art, Karachi, brings some of these issues to the fore. The artist's last show in the city revealed her strong link with the work of her mentor, Aisha Khalid. Marium used the shamiyanah in a similar way that Aisha used the purdah in her earlier work, even if it was at a subconscious level.

However close, there was also a new conversation in Marium's narrative that separated her from Aisha's. The crow as a metaphor and the divisions of space opened up interesting routes to something different. Marium's new body of work is structured along the same framework. The shamiyanah is restructured into new divisions of space, acting as a framing device, or a recurring element that signifies division and separation. The recurring crow, however, becomes an unnecessary embellishment, even if the artist plays with its form. When it is stylised into a repetitive form, its appeal comes close to poster quality, with the result that whatever else happening on the picture plane is negated. One of the works with table cloths and napkins again is synonymous to Aisha's approach and could have easily been used as a reference, but not as a subject.

There is enough that Marium is exploring in terms of the landscape, the horizon and the elements of the city, so that there is really no need to project another's voice through her work.

Atif Khan's non miniature, mixed media works, included in the same show, added relief and expanded on a more experimental approach. Seen here in relationship to the miniature, it almost teased the very presence of the more traditional approach. Atif's narrative in block and digital prints and glass seemed to create new relationships of image with space. His overall division of space reminded one of the works of the miniaturist Tazeen Qayuum. The picture plane drew out towards the viewer, with a subtle relationship between the inside and the outside. A pun on image-making itself, it used the popular ones, such as the rose and the gun. It would be interesting to see how much the artist would rely on his framed boxes in future, as it seemed that there were many more possibilities that could take the work into a more 3-D direction, or even the digital.

Similarly, as many miniaturists have come out of the picture frame, one wonders if and when the work ceases to be a miniature and becomes just a work, so that even if it borrows from the miniature, it is something new, something in the present. For that it is necessary that miniature is not used as a crutch, for decorative purposes.

One of the major difficulties a 'scholar' of music has to face is that there is no primary source that can be referred to. All information and, then, the analyses based on it have been drawn from secondary sources. Music only existed in time. Being an intangible art form it existed for as long as it was performed and played. All our knowledge about the music of the past has been constructed around secondary sources and on what the musicologists or historians ever wrote about music. But the prime source - music itself - could not be retrieved, recreated, sung or performed as it existed in the past.

The recording technology has liberated the study and analyses of music from secondary sources, but it is only about a century old whereas our music goes back thousands of years. It is possible to understand and analyse the music of, for instance, Gohar Jan but it is only a calculated guess as to what the music of Taan Rus Khan might have been. It is just not possible to reconstruct the music of Tansen. Similarly, the music of Amir Khusro falls in the realm of wild conjecture. Anything that was performed earlier is 'pure fantasy'.

We end up in a quagmire trying to make sense of the gram, morchanna, shruti system documented to be the basis of the system. But the musical system that followed or gradually evolved during the second millennium, with massive influence from Persian and Central Asian sources, remains just as inscrutable. Our entire understanding is, then, based on a reconstruction of the present -- it is really a throwback of the current system that is retrospectively imposed on the older system to make it relevant to our times and the contemporary world.

Earlier, the only way to document music was to pass it on to the next generation. Naturally, a very complex system of oral transmission of musical knowledge evolved over the centuries. As one generation succeeded another, the musical trove was preserved but not in its pristine form. Every succeeding generation - the great ustads and gurus - made substantial changes in music that were incorporated and passed on as part of the tradition. The change in music crept on silently and imperceptibly to become substantial only in hindsight.

And then there have been other problems and limitations. Only the grand tradition of music has been documented in written form as the effort was the result of awareness of its importance with the resources that were available. The two centres of musical patronage, the court and the temple, had preserved and documented music, the former as a record of the proceedings of the court and the latter as a vital form of religious practice.

What has really been neglected are the folk forms. The patronage extended to these forms has generally been in the shape of minor institutions operating more at the local and village levels. In Pakistan, since musical forms developed after independence, folk genres have been more popular and in great demand. The classical forms have suffered because of the absence of an institutionalised system of patronage. The older system of patronage collapsed with the decline and disappearance of the princely states and the post-colonial state did not move in to fill the vacuum. But the folk forms have thrived through varying levels of patronage. Ironically, nothing has been done to preserve and document these popular forms in the country.

The classical tradition has dwindled in Pakistan because it has never been considered significant enough, outside of the circle of experts and connoisseurs. It has been attacked as originating from a source that is not Islamic, as nostalgia, as the sensuous pursuit of the leisurely classes, as being too formalistic and as being antithetical to change. The ruling classes that support traditions that are classical have not evolved in the 60-odd years due to tectonic social and economic upheavals.

Even the musical forms that have been patronised due to popular appeal like the ghazal and qawwali do not have any literature that could place them within the social context and offer an analytical comprehension of the significant changes made in the forms.

Besides, there are a lot of regional, local and folk traditions that have continued to inspire singers/musicians and have attracted large audiences. At least these days, unlike the olden times, there is the consolation that the primary form stays intact in recorded form.

But the general attitude has not changed because in singing the primacy was granted to what was sung and the magic rested in it being performed rather than in critical examination of the text in the cold of a studio.

Usually, music surveys are conducted to know more and with a degree of exactness of the music being sung and played in a certain region. Some years ago, a music survey in Pakistan was initiated by Lok Virsa that identified a very small area as its pilot study. It was conducted without any major delays or hiccups but the pilot project could not blossom into a full-fledged music mapping of the country. One does not know the reason for either the delay, the postponement or the cancellation of the project, but it can be easily surmised that it was either because of a lack of expertise, a shortage of funds, an absence of will or the combination of all three in varying degrees.

All said and done, it is imperative that a proper understanding and knowledge and the extent of musical activity is documented before any credible body of work can be produced. All the work done till now appears to be patchy, where a predetermined frameworks have mutilated the available material.

Intizar Hussain in his short story 'Zard Kutta' (the orange dog) narrates an anecdote: There was a time in Baghdad when poetry had become such a 'popular' pursuit that everyone seemed to indulge it (writing verses). This irked a famous poet -- Ahmad Hajri -- who quit the literary circles, in 'protest', and started selling liquor on a donkey cart. One day he tried to push the beast on the path but it wouldn't move. Instead, the donkey started uttering verses, 'Ahmad pushes for steps, whereas Ahad (God) pushes to stop'. After listening to this, the great bard abandoned his animal, left the city and took refuge in wilderness -- away from men and poets.

The reaction of Ahmad is understandable, because if everybody is following the same trend, then there is no point in carrying on. One has to renounce the 'popular' avenues to explore new ones, even if these are difficult and may lead to conflicts.

The same response (and responsibility) of an artist is illustrated by Octavio Paz as he quotes Andre Gide: "The writer must know how to swim against the tide."

Seeing the miniatures of Ayaz Jokhio from that angle makes them look more than just an exercise in formal matters. These 'small' works can be truly deciphered if viewed in the context of the present art, particularly the unprecedented rise of miniature painting in Pakistan. Since the last decade, miniature has been recognised as the genuine and ethnic art form emerging from this land. It has been acknowledged by collectors both in the country and abroad. Quick and easy success of miniature painting in the local and international market/art world prompted many practitioners to take up this genre and make their name and money by experimenting with it -- using the label (or pretext) of contemporising it. Thus, the art world is crowded, if not suffocated, with the miniatures made in all mediums (watercolours, gouache, acrylic and collage) and with all sorts of visuals and techniques (abstract surfaces, minimal imagery or textures created by cutting and incising the paper).

So, what one comes across under the title of 'miniature painting' today are only works on paper with diverse formal concerns and pictorial solutions. The situation is, hence, comparable to that of the abundance of poets in Ahmad's Baghdad.

In addition, the demand for miniature painting rests on other factors such as traditions, heritage and craftsmanship -- the source/symbols of our identity. Given this background, the miniatures of Ayaz Jokhio came as a surprise to many, especially those who have been practitioners and connoisseurs of the art itself. Because we have but a limited idea of miniature painting, a majority of miniatures produced meet only the 'given' definitions/restrictions. Most works (of miniature paintings) are prepared on a particular size (close to A4 sheet) and follow a general fashion. Their content is either political (the face of a king being a favourite motif) or it focuses on a perspective, besides adopting characters and situations from the present age (but stylised in the classical/Mughal miniature mode).

Jokhio makes fun of all of these 'sacred' ideas and recipes for success. In fact, his work could be read as a critique on the contemporary practice and perception of miniature in our part of the world.

The first shock is about the scale. Jokhio's miniatures -- exhibited from Oct 23 through 31 at Rohats 2, Lahore -- were unexpectedly small, rather tiny. Each work was a one inch square and contained in the real gold frame. The minimum size was significant because one hardly gets to see works of this dimension in our art galleries today. By introducing this scale, Jokhio expanded the definition as well as the possibilities of miniature painting, while remaining faithful to the term 'miniature'.

The 'little pieces', captured in frames that were cast in pure gold, seemed to make a comment on the understanding and evaluation of miniature painting being a precious item/entity.

Jokhio's imagery was another pleasant surprise for the audiences. Contrary to one's expectations, the subjects of Jokhio's paintings seemed to have little or no importance. The outline of a painter's head (from the back), the rendering of an insect and its shadow, a pregnant woman, an atomic explosion, a section of the globe as seen from the space, and the two figures inspired from the American artist Robert Longo, might appear simple or ordinary, they conveyed a message/meaning profounder than what was visible.

Presumably, the lack of profound or serious subject (which may have annoyed many miniaturists and other painters) can be perceived as a means to defy the custom of loading miniatures (and other forms of art) with complex and politically charged topics, regardless of the suitability of those themes for that specific imagery or artist.