Medical expenditures in Pakistan are too much for the majority of people to bear, and because of this many people prefer to get inexpensive medical care at the hands of the unskilled. The same is the case with pregnant women - even though giving birth may be the most natural of all processes ever, many pregnant women in Pakistan disregard proper medical care and prefer a dai (midwife) or a Traditional Birth Attendant (TBA) as it offers prospects of a low-cost and a much convenient labour at home. However, often this leads to a prolonged and painful labour resulting in the death of both mother and child, especially if the birth attendant is not trained to help them survive the process.

The trust that everyone puts in the skills of a dai sometimes can prove to be fatal for the mother and the baby, or can lead to dangerous complications affecting the chances of future conceiving and can also harm the baby, if the required help is not provided in time.

Take the case of eight-month pregnant Shakeela, an untrained dai was called in, by her in-laws. Hailing from a conventional Pakhtun family in Orangi Town, a poor suburb in Karachi, it was preferred that Shakeela deliver her first child at home instead of a hospital so that her privacy is maintained. As the time of her delivery neared, a birth attendant working in the area for decades was called. She informed the family that there were still a couple of hours for Shakeela to deliver. Those couple of hours, however, stretched over the entire night during which Shakeela was bearing that excruciating pain. It was not until the dai injected her with some pain killer that put an end to her screams and she apparently fell asleep.

In reality, "she and the baby had died hours ago," according to Naureen Naeem, a government trained TBA who also works in the same neighbourhood and was called by Shakeela's panic-stricken husband when he realised that his wife hadn't gone to sleep due to exhaustion or relief, but had died.

Naureen said that when she got there, she found the same dai smoking cigarettes by Shakeela's dead body and insisting that the girl was sleeping under the influence of the pain killer. However, upon a little investigation by Naureen it turned out that Shakeela's pregnancy was a complex one and that the dai failed to tackle it resulting in the dead baby inside mother's womb. Shakeela died because she had been injected by a pain killer that had expired a few months back.

"Even if it wasn't, she wouldn't have survived the poison that had spread in her body after her baby's death. This tragedy might have been prevented if Shakeela was attended by a Skilled Birth Attendant (SBA) from the beginning," explains Naureen Naeem.

With a maternal mortality rate as high as 276 deaths per 100,000 live births (according to Pakistan demographic and health survey 2006-2007), only 39 per cent of the deliveries in Pakistan take place under the presence of a Skilled Birth Attendant, while only 28 per cent of pregnant women can make the recommended four antenatal visits (according to UNICEF Pakistan Annual report 2008).

These two factors together pose a great risk to the lives of both mother and child, especially those who belong from underprivileged factions of society and/or from rural areas where these factors are found more prevalent. Yet, despite having other options available, people continue hiring the services of untrained birth attendants.

Naureen Naeem, trained under government's Sindh Dai Training Project and having worked as SBA in this poverty-stricken neighbourhood of Karachi for two decades, tries to explain the rationale behind this trend followed by people in her area.

"A dai is more convenient to get to since she lives nearby, she is easily accessible." On the other hand to reach even the nearest hospital (Sindh Government Qatar Hospital, the only government hospital in the entire town, in this case) one needs to pay transport fare, not possible for underprivileged class dwelling in Orangi Town specifically.

"Also, a TBA is available round-the-clock which gives her an edge over government-run Urban Health Centres in the area that open only during the first half of the day," she sats.

Naureen Naeem irritably registers that women continue getting delivered at the hands of untrained birth attendants, even if they have unsuccessful deliveries to their credit, only on the basis of acquaintance. "No one can stop these dais from working," she says resentfully that the dai who attended Shakeela's delivery is still thriving even after she literally 'killed' Shakeela due to her sheer negligence and ignorance.

Tasneem Khatoon, a TBA from Baldia Town, another poor locality in Karachi, highlights the fact that getting delivered by a TBA is much cheaper than going to the hospital. Tasneem Khatoon herself charges only Rs. 700 for attending a delivery, which would otherwise cost at least Rs. 7000 if the child is delivered at a private hospital. However, Tasneem Khatoon doesn't mind if the family promises to pay her with the delivery charges of the prospective child next year. "Since I know the families personally, I know they won't go anywhere and will come to me for their next pregnancies, because they trust me," while explaining the reason for accepting such offers.

"It is better for a dai to get some training because pregnancies today are too complicated to be handled properly otherwise," admits Tasneem Khatoon, who has been working as a TBA in Baldia Town for the past four decades but got proper training only recently. Having learned the trade from her mother, Tasneem Khatoon remembers that there were women among her clients who died during or after delivery when she failed to control their high blood pressure or to put a stop to their heavy blood flow.

"I now refer such complicated cases to the government hospital way before the time of delivery." Tasneem Khatoon says that after acquiring training at OPP-Karachi Health and Social Development Association (KHASDA) she is in a position to identify the cases that are beyond her expertise.

Running in Orangi Town since late 1980s, OPP-KHASDA has successfully trained 547 TBAs to acquiring safer and more hygienic methods while attending deliveries. Yet there remain birth attendants in the area who, for instance, continue leaving mother's womb unstitched after delivery or ignore checking the expiry date of the drugs before injecting, thus pushing up maternal and infant mortality rate of Pakistan.

"Normally TBAs are very egoistic and they feel that it is their insult if they take proper training," highlights Naureen. Tasneem Khatoon seconds this, saying that she too never deemed training necessary as she thought her experience in the field was enough and it was just by chance that she decided to go for this 20-day certificate course and realised the importance of being trained.

To overcome this attitude of TBAs Dr. Shamim Zainuddin Khan, Director OPP-Karachi Health and Social Development Association (KHASDA), while talking to You! stresses on the government and the private health sector to provide enough training opportunities to TBAs along with the assurance that they get registered and monitored regularly.

"We can't guarantee they will leave their older practices that threaten human lives, yet we can't deny they need training too," she continues. Naureen Naeem concurs and stresses on the active participation of government and health related NGOs to make TBA training and registration mandatory as "this is the matter of saving lives," she concludes.

History was created when Pakistan's first ever fashion week was held in the first week of November in Karachi. Hats off to the organisers, especially Ayesha Tammy Haq, CEO of Fashion Pakistan Week, Tehmina Khalid and few other resilient souls who were determined to go ahead against all odds. Fashion Pakistan Week was aimed at showing the world that there is more to Pakistan than violence. The four-day fashion week was kicked off amid a lot of tension and turmoil but it turned out be one of its kind event. For the first time Pakistan got a lot of foreign media coverage for all the right reasons. It was for the first time that western media was exposed to the lighter side of our country which was otherwise notorious for bomb threats and terrorism.

Some 32 designers presented an eclectic mix of traditional and western collections. A bevy of gorgeous models including Nadia Hussain, Iraj, Tooba Siddique, Rabya Chaudhry, Rubab and Faiza Ansari sashayed down the ramp for four days, flaunted the latest creations by local fashion designers. Ace designers including Rizwan Beyg, Maheen Khan, Sonya Battla, Faiza Samee, Nomi Ansari, Shamaeel Ansari, Ather Hafiz and Deepak Perwani showcased their assorted collections at the Fashion Pakistan Week.

Sonya Battla's rustic collection - devoid of any embellishments - appealed to the aesthetic sense of fashionistas. Nomi Ansari came up with his all black monochromatic collection with a touch of Goth, which was a refreshing change as the designer is known for his colourful ensembles. Rizwan Beyg's white collection was simply breathtaking, to say the least. It was a blend of fine craftsmanship and creativity. The entire collection was finished with handmade jewellery and the generous use of pearls to add lustre. Maheen Khan presented her collection 'The Woman in You' - an evolution of the Khyber Pass collection recently shown to rave reviews at Milan Fashion Week this year. The collection was fresh, innovative and distinctly Maheen.

Shamaeel's couture collection was an ode to the colourful culture of Pakistan. Ather Hafeez and Sabeen mesmerised the audience by their spectacular collection which depicted the devotional journey of the monks of the orient, the malangs of local shrines and rung festivities. Deepak Perwani showed his colourful ethnic collection which he showed in Milan and it was simply fabulous. Faiza Samee's bridal couture was like feast for the eyes.

Among the new and upcoming designers Rizwanullah, Feeha Jamshed of Teejays and Fahad Hussain showed a lot of potential at the Fashion Pakistan Week. Fahad Hussain's debut collection was essentially western and he showed some interesting outfits. Rizwanullah's collection 'Here After' was an inspiring one. His collection was inspired by the ancient henna art of the sub-continent. Feeha Jamshed followed Teejays design philosophy and showed a collection that was stylish and wearable.

A collection of accessories and assorted bags by Mahin Hussain and Ayesha Tahir Masood of Limited Edition was also shown at the Fashion Pakistan Week. The bags consisted of contemporary shapes, bold colours and textures.

Hair and make up was done by Saba Ansari of Sabs salon and her talented team. The hair and make up gelled well with the over all look of the shows.

One also witnessed a fair number of celebrities attending the show including Adnan Siddiqui, Ayesha Omer, Anoushey Ashraf, VJ Mahira, Amin Gulgee, Freiha Altaf, Cowesjee, Atya Khan, Asad Tareen and Tapu Javeri who was busy capturing the ultimate fashion moments. While the shows in Karachi resembled fashion weeks in other parts of the world, there were no foreign designers or buyers. The organisers decided not to invite them given the precarious security situation. However, after the successful execution of the event, and the kind of foreign media coverage it has got, it is hoped that in future fashion weeks will be packed with foreign buyers and designers!

- Iram Noor Muzaffar

Dear Nadine Khan,

I am a marketing executive by profession. I fell in love with a girl and proposed to her. She accepted my proposal, but after only two days she told me not to call her, and said that she could not marry me. She was just playing with my heart, but I cannot live without her. I really love her, and want to spend my life with her. What should I do?

M. A

Dear M. A,

Since you are a marketing executive, I think I can safely assume that you are a mature person, and smart, too. Please realise that most girls, in our society, are not empowered to take decisions about their marriage. Perhaps that girl also had a soft spot for you and said yes without taking the consequences into account. I cannot speculate on the reasons that compelled her to say no to you, but would advise you to send your proposal through direct channels. In case that, too, is refused, you would be well advised to forget her. My dear, there are plenty of eligible girls in the world and it is not right to mope over someone you cannot have. You can always marry someone else and fall in love with her. Best of luck!

Dear Depressed Aquarian,

First of all, relax! You seem too upset to think straight. Your problems can be solved easily, as they aren't very complicated. All you need is a little tact and some patience to do the trick. My dear, your married life started on the wrong footing. Before setting the wedding date, you should have taken into account your busy schedule.

Settling down in married life is not always easy for girls. But, in your case, the same can be said about your husband. It seems that you neglected him in the initial period. Perhaps the reason was your over-closeness to your own family. My dear, all girls love their parents and siblings, but after marriage they need to give attention to their husband and new home. You need to understand your life partner in that settling down period. If a girl keeps on running to mummy for help, she can hardly adjust into marital life. Instead of spending quality time with your husband in your honeymoon period, you kept on running to your mother and siblings. Naturally, your husband was annoyed. Instead of settling your little disagreements with your husband, you involved your parents. That is never a wise option, unless the problem is too grave. No wonder your husband thinks that you tell everything to your mother! Don't involve anyone if you have a fight with your husband. The good part is that you are now trying to make it up to him and yourself. Do your best to improve your terms with him. Give him undivided attention. If you don't visit your parents in this period, it won't do you any harm. Your parents may have realised this and that is why they are not inviting you so often nowadays.

Annie Mansoor of Allenora is one of the seasoned beauticians of our country. She established her salon in 1988. Recently, Vision Events International and Annie Mansoor of Allenora presented a multi-designer show called 'Montage', featuring Faiza Samee, Asifa Nabeel, Amna Malik, Bareeze, Bushra Aftab, Goal, Imbias, Karma, Lace, Maria.B, Rouge, Sonia Azhar and HSY at PC, Lahore. The event was held to commemorate 20 years of Allenora.

Choreographed by Rezz Ali Shah, the show was an amalgam of colourful eastern dresses and stylish western gowns. Stunning models like Iraj, Nadia, Rubab, Mehreen, Sunita, Neha, Nooray, Rachel, Sofia, Fauzia, Maha, Cybil and Fia, sashayed the ramp flaunting designers' clothes.

Though most designers showcased their eastern collection, some opted to exhibit their western line too. The show opened with Bushra Aftab's spectacular white collection. HSY closed the show with his fabulous bridal collection in red and gold.

It was a well choreographed show. The apt back ground music was also selected by Rezz. Hair and make up was done by Annie Mansoor and her talented team. Since the show was meant to celebrate 20 years of Allenora, special emphasis was given to models' looks - demonstrated creativity and ingenuity.

Annie Mansoor is a woman with multi-dimensional talents and artistic guts. She is passionate about her work. A qualified beautician, she has done several makeup courses and has learnt different techniques in hair and make up. Annie Mansoor loves to experiment with different colours and believes that make up can give you the desired look. With the vast array of soft and dark classy looks Annie Mansoor has developed three different lines of make up, Ethnic/traditional, Colour, and Pastel.

Annie was the first stylist to introduce Gold and Bronze make up and always focus on more photogenic face as well. Besides developing the Colour lines, especially on eyes, followed by Pastel lines, Annie has also developed the Crystal line; for the soft make up look.

Annie Mansoor has worked with many prominent fashion models and designers, and she has been giving that magical touch and adding charm to her clients. This might be the reason that now she has established her well-known name in the list of top stylists of Pakistan.

Annie's signature salon Allenora has branches in Lahore, Karachi, Multan and Bahawalpur. Very soon Annie is going to make her label internationally by opening her salon's branches in Miami and London.

Her salons offer many services. Besides regular services like facials, waxing, manicure, pedicure, one can get all type of hair treatments and protein treatments. The salons also proffer latest hair cuts, hair styles and colouring options. A special section is devoted to 'body spa' with a variety of body treatments, including relaxing full body and head massages, rejuvenating body therapy as well as coin therapy to melt stress and physical fatigue away. Allenora is particularly known for its bridal make up and make-overs. The team of Allenora gets regular training and Annie makes sure that her staff members constantly update their techniques and style.

So the news is that the very talented Saim Ali who is Lahore-based couturier is off to Bosnia... for the Sarajevo Fashion Week. Having a sartorial style that is pretty much his own, this is the third time that Saim has been invited for this annual fashion fiesta in the Bosnian capital. At home too he is hitting all the right gongs and making all the right noises. Hs latest collection has been very well received and even in Isloo, where he is stocking at the very swanky Melange, his creations are selling like hot cakes. So, watch out for this lad....he's destined to be way up there, with the best of the best, very soon.

Now let's welcome the very artistic Bindiya. One of the finest actresses to emerge from PTV, from its halcyon days, this dusky charmer, with oodles of acting talent, left an indelible impression in the minds of televiewers - in the '70s and '80s - with critically acclaimed performances in numerous telly plays like Samandar, Dhoop Jali, Dhook Sayal. No wonder then with such an unmatched talent and selfless devotion towards her acting Bindiya's name is included in the list of most renowned actresses of Pakistani television. But a decade or so back, she gave it all up when she shifted to the US of A, where her son was residing. Now, Bindiya is back, ending her long hiatus when she pleasantly surprised us all by appearing in the eid special of Nadia Khan Show. And it is heartening to see that the years haven't put a damper on her spirits, her looks and hopefully her talent either, as Rubeena Al-Khumash aka Bindiya, is all set to woo us again in a serial titled Sitarey which is being directed by Tariq Mairaj. Next, she is also thinking of getting into direction and production. So no fading to grey for this evergreen diva!

Are you a steak lover? If yes then we have just the right recipe. You can try this out at home without spending a lot of money eating steaks at your favourite steak house. Food maestro Lubna Shariff shares with the readers mouth-watering Texan chicken steak, which is tender, moist and healthy too. Bon Appetite!

Ingredients:

- Chicken breast steak 1 - 2

- Paprika powder 1 teaspoon

- Mustard powder 1 teaspoon

- Garlic clove (crushed) 1

- Olive oil 2 tablespoons

- Black pepper

(freshly ground) 1/2 teaspoon

- Salt 1/2 teaspoon

- Chilli powder 1 teaspoon

- Ground coriander 1/2 teaspoon

- Ground cumin 1/2 teaspoon

METHOD:

- Mix all the ingredients together except for the chicken steaks.

- Now rub this mixture on the chicken steaks and allow it to marinate for 1 - 2 hours.

- After that place the steak on a hot grill or barbeque.

What is diabetes?

Sugar, as it is commonly known, or diabetes mellitus, is a disorder that impairs the body's natural blood glucose or blood sugar regulation process. Diabetes (diabetes mellitus) is classed as a metabolism disorder. Most of what we eat is broken down into glucose (a form of sugar in the blood). When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth, however, glucose cannot enter our cells without insulin being present.

Diabetes is classified into two major categories: Type I and Type II diabetes,

Type I diabetes occurs mostly in children and adolescents and

Type II mostly in adults, research has confirmed that the onset age in both types of diabetes is interchangeable.

World Diabetes Day

14th November has been declared as 'World Diabetes Day' that is celebrated round the globe every year. On this day the eminent research scholar, Frederick Banting was born who made great contribution in the discovery of insulin in 1921. Therefore, with this perspective and recognising his services to the mankind, this day is celebrated, while it also commemorates his birthday.

Unfortunately, the graph of this disease is increasing all around the world. According to an estimate more than 240 million people world wide have diabetes. The disease is a leading cause of blindness, kidney failure, heart attack and stroke. In a number of cases severe infections and un-healing wounds lead to amputation of the affected part of the body. High blood pressure and smoking are some other risk factors of diabetes which may worsen visual impairment.

An estimated 333 million people have diabetes all over the world, and this figure is expected to double over the next 25 years. What is more alarming is that three-fourths of future diabetics will hail from developing countries, like Pakistan, where roughly over 8.8 million (12 per cent of the population) have been affected so far.

About two to five per cent of pregnant women develop high blood sugar during pregnancy, or gestational diabetes. Although the condition usually disappears after the birth of the child, women who have had gestational diabetes are at a high risk of eventually developing Type II diabetes.

"The situation is grim as diabetes has become a world problem and threatens the human, social and economic impact. It has registered an increase by about 6 million new diabetes people each year. If nothing is done to arrest the alarming growth of the diseases this menace could affect over 350 million people within a generation. Unchecked, diabetes threatens to overwhelm health care services in many countries and undermine the gains of economic advancement in the developing world," shares president of the International Diabetes Federation (IDF) professor Pierre Lefebvre.

There is a widely held perception that diabetes is a disease of the affluent but studies show that the economically disadvantaged are at higher risk. Therefore the developing countries are disproportionately affected by the diabetes epidemic. In developed countries, people over the age of 65 are almost 10 times more likely to develop diabetes than people between 25 - 45 years age group. Majority of this figure belongs to poor and the average class of the community.

Awareness campaign

Last week, by chance, I came across one of my old friends, Irfan, whom I hadn't seen for a long time. To my surprise, he was having a beard, not long though but not fashionable either; and instead of greeting me in his typical style like "Hey! What's up?" he welcomed me with a mellow Arabic accent "Assalam-u-Alaikum!" and hugged me tightly as if we were meeting on Eid. Although nothing was wrong with all his changed physical appearance, still I was wondering how a modern IT expert like him turned into a religious zealot; and it was not long before I put a question about this turnaround. "Well (gently rubbing his beard) whenever you find the right path, it's never too late!" Irfan's answer resounded quite predictable. I suggested having some coffee at Gloria Jeans where we will also find some time to refresh some past memories; but he refused politely saying he would prefer to go to some local food spot. Needless to mention that he was clad in a white shalwar kameez with a matching cloth covering his head.

Irfan told me that nowadays his family is looking into some marriage proposals but he himself is quite in a fix and can't decide what to do. "Why it is so?" I asked inquisitively because people like Irfan are usually quite clear headed so it was really surprising for me to find him perplexed on the issue of marriage. "You see," he continued while taking a sip from his cup of tea, "most of the girls do not observe veil so I can't marry any of them..."

"And what about those who do?" I asked intriguingly.

"Ammmm well... about them (thinking for a moment) I can't figure out whether they are attractive enough or not?" Irfan said in a bit of helpless tone.

"But our religion gives right to every man and woman to thoroughly observe each other before marriage and it includes physical appearance as well." I tried to answer Irfan in his jargon of words.

"No", Irfan shook his head with confidence," in our religion, no girl is allowed to unveil her face before any na-mehram not even before her cousins." At this point, it had become quite clear to me that it would be useless to argue with him anymore but still I was interested in continuing the discussion. "If your argument is valid, why millions of Muslim women are not allowed to cover their face while performing Haj with millions of men who are complete strangers? This is, for sure, the biggest mixed gathering of Muslims where your brand of pardah is not observed by any Muslim woman!" I tried to cut the ground from under the feet of Irfan.

"There must be some other reason or order behind it and that I will let you know after talking to my Pir saab!" Irfan seemed to be still unmoved.

"I hope you are not referring to me!" I said jokingly just to make the situation a bit relaxed but it didn't work because Irfan was getting more serious now. "It's a pity that we don't take these things seriously. In my opinion, this is the basis of all our failures, that's why we are in a miserable state everywhere in the world." Irfan concluded with full conviction.

"What precisely is the basis of our failures?" I asked as if I haven't fully understood his point of view.

"We have estranged ourselves from the teachings of God. This obscenity and be-pardgi have ruined us, disgraced us all over the world." Irfan was getting more and more emotional now.

"Well, this sounds surprising," I said "because in my view Muslims are still quite modest nation around the world as compared to other western or American cultures."

My friend gave me a sarcastic look and said, "It looks as if you haven't seen Sania Mirza playing tennis in shorts?"

"Yes I have... and buddy... what a stunning beauty she is!" I replied in somewhat desirous tone which sounded a bit cheap towards the end.

"Here you are," Irfan yelled with a sense of triumph, "this is the reason for our failures. Don't you see her bare legs while she is playing tennis? She has put our religion in danger."

"What?? You mean our religion is in danger because of Sania Mirza's shorts??" I asked having no idea where this argument will lead us.

"I am just saying that due to such obscenity and indecent acts being committed by Muslims, we are rightly being punished by God." Irfan had visibly become distressed by now. Seeing this, I decided to wind up this endless debate and asked him whether he could make a website for me. "Sure, why not? After all I am an IT expert and I am at my best while designing websites." He said proudly.

"Hmmm... I am sure you are!... By the way which software will you use for my website?" I asked.

"What do you mean?" My friend exclaimed, "I am a professional and I know what software to use."

"That's fine... but I want to know whether you will use the pirated software or the original one's?" I rephrased my question.

"Well," a bit confused this time, "I will use the software CDs which are readily available in the market." Irfan's voice was rather unconvincing this time.

"Sorry buddy... then I won't get my website developed from you." I said.

"But why?" He asked in utter surprise.

"Because using pirated software is also a kind of theft and I don't want a religious guy like you to commit a sin by using pirated software for my website."

"But how it can be a sin? I use software CDs which are available in the market after paying their price."

"My dear you just said that you are a professional, so you will be definitely aware of the fact that you pay Rs. 30 for a pirated CD which is otherwise worth more than Rs. 4000-5000. It is quite a paradox that you don't like to have coffee in Gloria Jeans and you think that our religion is in danger because of Sania Mirza; but when it comes to your financial benefit, you use pirated CDs openly and don't even consider it a sin equivalent to theft, punishment of which is well known to you. I salute you for maintaining these self contradictory morality standards."

With this brief "sermon" I shook hands with my friend and left him with a wish that he soon finds a beautiful girl for marriage, preferably "ba-parda."