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roots strategy Terrorism
vs good governance health The
‘Big’ problem The
roots of violence project Transport
troubles
Education woes A peep into history to know what was the educational philosophy of the fathers of Pakistan, what principles they wanted our educational institutions to be based on and how they wanted it to be organised By Yaqoob Khan Bangash A few days ago,
the Pakistan Tehreek-e-Insaf government in Khyber Pakhtunkhwa announced
that it was going to introduce a common curriculum in all institutions,
public and private, in the province from the next academic year. As we
await the details of such a revolutionary development, my mind turned to
ascertain the roots of education policy in Pakistan. I wanted to know what
was the educational philosophy of the fathers of Pakistan, what principles
they wanted our educational institutions to be based on and how they
wanted it to be organised. Our current education
system is quite simply in crisis. We do not have an adequate number of
schools, resources, developed curricula, and teachers. The 18th Amendment
to the constitution made education a fundamental right under Article 25A,
but even after the passage of a couple of years, proper legislation and
processes have still to be formulated to realise this right. But getting
students to properly equipped schools is just the beginning of the
educational process. Our system is fraught with the problem that our
students never learn one language adequately: they mostly cannot read or
write their mother tongue, are conversant in Urdu but cannot handle it at
a higher level, and a large majority is simply unable to string together a
grammatical sentence in English. So at the end of school (or even
university) Pakistani students are hardly proficient in even one language.
Therefore, I dug up the
speeches of our first education minister, Fazlur Rahman, to determine what
were the issues he was dealing with at the inception of the country. What
I found was really interesting, and in a way, astonishing, and to a large
extent reflected the problems we are grappling with today. At the creation of the
country, education did not get an independent minister, but was given as
an additional department to the interior minister, Fazlur Rahman, whose
role as interior minister gave greater gravity to his comments on
education. One of the primary
concerns of Fazlur Rahman was that he wanted to create a ‘new’
educational system. This notion was predicated in the eagerness of the
government to provide a ‘third way’ as Prime Minister Liaquat Ali Khan
argued. For us now it might seem like a distant memory, but in the late
1940s, with the advent of the Cold War, the global battle between
Communism and Capitalism was a crucial concern for almost everyone.
Therefore, Rahman noted, at the meeting of the Advisory Board of Education
in 1949, ‘...my mind is appalled by the extent to which, as a result of
the conflict in political faiths, the world has been divided into hostile
camps. There is on the one side the old order based on Capitalism and on
the other hand a new order based on Communism, with its uncompromising
denial of God and the right of private property...Unless we offer to the
world an ideology that will provide an effective answer to both Communism
and Capitalism, we may not be able to keep at bay the influences that
emanate from them. It is my faith and conviction that Islam supplies the
ideology we are looking.’ The eagerness to find
another option, coupled by a romantic notion of the golden age of Islam,
it seems, was the main driving force behind these ministers believing that
they had something new, unique and fulfilling to offer to the world. This
reminds me of the writings of Saadat Hassan Manto, the famed Urdu writer,
where he once noted that when he tried to bribe someone for a ticket he
was strictly told: ‘This is not done in Pakistan!’ This sense of being
at the threshold of a new age inspired many novel initiatives. In his speeches, Fazul
Rahman speaks of the complete transformation of the educational outlook of
the country, strictly on ‘Islamic ideology.’ This again is rather
interesting since most people in Pakistan believe that the words
‘Islamic ideology’ and its official application are later concepts.
However, at the first All-Pakistan Education Conference in November 1947,
the education minister had already stated: ‘It is, therefore, a matter
of profound satisfaction to me, as it must be to you, that we have now
before us the opportunity of reorienting our entire educational policy to
correspond closely with the needs of the times and to reflect the ideas
for which Pakistan as an Islamic state stands.’ He again emphasised in
February 1949: ‘But mere lip-service to Islamic ideology will be as
foolish a gesture as Canute’s order to the waves of the sea. We must see
to it that every aspect of our national activity is animated by this
ideology, and since education is the basic activity of the State, I
realised that a start had to be made there.’ Rahman clearly knew what
this change meant — it was not a mere realignment but a radical
transformation. Rahman noted at the Academic Council of Dacca University
in 1948: ‘What is wanted is a complete transformation of the spirit and
content of education, and unless the spirit reflects the higher
conceptions of Islam, our education will be a counterfeit and a sham.’ These statements, most
of which were made during the lifetime of Jinnah, should make us wonder if
the often repeated claim that Jinnah wanted to create a ‘secular’
Pakistan is indeed true. Could a minister appointed by Jinnah himself
publicly declare that the educational philosophy of the country would now
be based on ‘Islamic ideology,’ if the founder of the nation wanted a
secular republic? Perhaps we mistakenly lambast General Zia ul Haq and his
Islamisation since he was merely following through the wishes of the
founding fathers of Pakistan? The education minister
was also clear to the extent to which Islamic ideology should form the
basis of education in Pakistan. Elucidating his views on teacher training,
he stated that teachers should unmistakably formulate their teaching
philosophy on Islamic ideology. Speaking at the third
meeting of the Advisory Board of Education in Dacca in December 1949, he
noted: ‘What I mean is that they (the teachers) should study the
fundamental principles of Islam on which we have based our educational
ideology...I would, therefore, suggest for your consideration that there
should be a compulsory paper in the teachers’ training course on the
contents of Islamic ideology...Teachers so trained should be asked to
prepare definite projects on the basis of the chief characteristics of
Islamic ideology so that students in their charge may seek to embody these
characteristics...’ Therefore
not only should teachers be taught and tested on this ‘Islamic
ideology’ they should also ensure that this ideology is lived by their
students. Since Pakistan was a new
country, and its founding fathers had a great zeal for giving something
new to the world, several new (and novel) ideas were also in circulation
at that time. For example, the education minister and a number of others
were strongly in support for adopting the Arabic script for all the
languages in Pakistan. In a speech at the
second Advisory Board of Education, Fazlur Rahman went through all the
scripts of the languages in Pakistan and concluded that ‘...on practical
as well as educational grounds...it (Arabic) is the most suitable for
adoption as the common script of Pakistan.’ He later gave several more
reasons for the adoption of a common Arabic script and noted: ‘...the
adoption of the Arabic script will be a potent means of promoting cultural
homogeneity and unity of national outlook...’ He therefore concluded:
‘We must, therefore, take immediate steps to introduce this script on a
nation-wide basis...’ What the honourable
education minister failed to note here is that changing the script of all
languages in the country, where a number might use an adapted form of the
Arabic script, will fuel linguistic nationalism, since any self respecting
people will see such moves as degrading their language and culture. Since
Arabic has had no real and direct connection with South Asia (except
through its influence on Persian), such an imposition would be surely seen
as alien as the imposition of any other foreign script. These tendencies, as
well as, continuous efforts at trying to enforce the abandonment of the
Bengali script by the East Pakistanis, led to increased tensions between
the two wings of the country, ultimately ending in the vivisection of the
country in 1971. The minister was also
very adamant that this ‘transformation’ must be state-led and involve
a strong control of curriculum and textbooks. Obviously, if education were
to impart one ‘ideology’ and develop a common outlook, a strict
control of what students are taught is essential. As a result the minister
exclaimed at the first All Pakistan Educational Conference: ‘I am,
therefore, strongly of opinion that there should be special governmental
organisations to undertake the preparation of text-books. This will not
only ensure the observance of approved educational principles on which
textbooks are to be based, but will also bring together talent of
sufficient width and diversity...’ The ultimate aim, the
minister crystallised in his address to the Inter-University Board in June
1948, was that universities and other institutions ‘...have to undertake
the immediate revision of their syllabuses and curricula with a view to
their conformity with the spirit of that (Islamic) ideology.’ This state
control of textbooks and their content has been a major hindrance in the
development of education in this country since its inception. Quite
simply, any ideological based educational system has to teach one sided
versions and undermine other views. After reading speech
after speech by the first education minister, one thing is amply clear to
me: that the fathers of the country were clear about their aim of
transforming the educational foundation of the country from a secular
outlook to a firm Islamic viewpoint. The minister clearly noted this in
his preface to this compilation: ‘The theme of Islamic ideology...is
recurrent through almost all the speeches.’ Therefore, when certain
quarters of the country lament the fact that Pakistan began as a
‘secular’ state under Jinnah, and was later taken over by the
religious right, they probably need to rethink their proposition. Fazlur Rahman was very
clear that he wanted to change the system in the country and root it in
what he called ‘Islamic ideology’. He noted: ‘...our educational
system was not based on any ideology and did not provide for the
satisfaction of the spiritual and moral needs of the community.’
However, what this ‘Islamic ideology’ meant always remained vague in
his speeches and its fundamentals were only referred to as ‘universal
brotherhood, tolerance and social justice,’ which being more of less
universal values, do not indicate how ‘Islamic’ this new system was
supposed to be. Clearly, once it was settled that ‘Islamic ideology’
set the rules, what the rules actually were could be elucidated according
to the will of the lawmaker — be they Islamic in spirit or not. In February 1835,
Macaulay in his most famous ‘Minute’ on Indian education stated that
the aim of education in India should be to create ‘a class of persons
Indian in blood and colour, but English in tastes, in opinions, in morals
and in intellect.’ This minute which was based on Macaulay’s
understanding that there was not much to learn in the Orient, and that the
Oriental languages were not developed enough to be used for modern
scientific teaching, created the oft-repeated educational confusion which
I have referred to above — that our students are not proficient in any
language by the end of even university education, and that even culturally
and intellectually they are torn between their local culture, Muslim
culture (in Pakistan), or Western inspired culture. I do not know what shape
the education policy of the Khyber Pakhtunkhwa government is going to
take, or for that matter, what policies governments of other provinces or
the federation will develop, but let me, at least, argue for
non-ideological and ‘liberal’ education. By liberal I mean a broad
based system of education which does not pre-decide what the students
should believe and follow, but an education which develops one’s
intellect to think independently and decide rationally. As one scholar put
it, liberal education is: ‘..at once the most enduring and changeable of
academic traditions.’ Liberal education, therefore, is something which
is not static, exclusionary, or ideological, but literally ‘frees’ the
individual to purse the ‘good life’ Aristotle talked about. Only with
such a liberal education can a ‘Naya Pakistan’ or any Pakistan
develop. The writer is the
Chairperson of the Department of History, Forman Christian College, and
tweets at @BangashYK. capion “Islam supplies the
ideology we are looking for,” Pakistan’s first Education Minister
Fazlur Rahman.
strategy With the
swearing in ministers, at the national as well as at the provincial level,
the process of transition from one civilian government to another has
almost been completed. Elections for the Presidency will be held when the
incumbent completes his tenure in September, this year. Pakistan’s first ever
orderly completion of the democratic process, foiling designs of vested
interests to derail democracy, marks an important milestone in the
country’s chequered political history. This first transition, under the
auspices of a civilian government, has been widely acclaimed both within
the country and abroad. The vested interests, it
may be recalled, had fielded an articulate religious scholar as their
opening batsman to pave the way for the formation of a non-democratic
government comprising technocrats, at least for three years to begin with.
But, the masses did not lend support to those elements, paving the way for
the May 11 general elections and transition to a new civilian government
in keeping with the provisions of the Constitution. In messages of
congratulations to the newly-elected prime minister, the world community
has hailed the democratic transition and extended hand of cooperation to
the new democratic set-up. The UN Secretary General Ban Ki-moon has
expressed the confidence that under the leadership of Mian Nawaz Sharif,
Pakistan would build up on its democratic achievements. Mian Nawaz Sharif, in
his maiden speech after election as the country’s prime minister, asked
the MNAs to make the National Assembly “the fortress to safeguard the
democratic order.” Listing some of the
major challenges, including power shortfall, economic meltdown and
precarious law and order situation, the PM said, he would not portray any
rosy picture to the people, but he won’t disappoint them either,
pledging to sincerely put in efforts for the resolution of these lingering
issues. He visualised a prosperous Pakistan in days ahead and announced
zero tolerance for corruption and pledged to make all appointments purely
on merit. Giving broad contours of
the PML-N’s plan for the first 100 days in office, Nawaz Sharif said
that they would assign priority to rebuilding basic infrastructure with
focus on boosting agriculture and industrial sectors, while work on
overcoming the energy crisis has already been put in motion. While the
country faced an acute energy shortfall, two stalwarts of the previous PPP
regime — Law Minister Babar Awan and Law Secretary Masood Chishti —
during their tenure allegedly delayed approval for the shifting of
Nandipur and Chicho Ki Malian power plants’ machinery from the Karachi
port to the site. Law Ministry’s Senior
Joint Secretary, Dr. Riaz Mehmood, made the startling disclosure before
the Supreme Court on June 10, 2013. How unfortunate – rather criminal
– that state minions whose job should have been to facilitate
installation of new power houses have been creating obstacles even during
times when the country was experiencing a deepening shortfall of energy,
impelling some industrialists to relocate their factories to other
countries? This brings to the fore
the need for curtailing the role of the bureaucracy to the minimum as far
as new investment in the country is concerned. Without taking drastic
steps, it might not be possible to curtail the scourge of corruption. Referring to his meeting
with the Chinese PM, Nawaz said they had planned to lay a rail track from
Kashgar to Gawadar and Karachi. He said that his party was doing the
politics of values and that was why they respected the PTI mandate to form
the government in Khyber Pakhtunkhwa (KP). In the same spirit, he said,
for the first time in the country, a majority party has doled out the
slots of CM and Governor to its smaller partners in Balochistan. The citizens are
confident that, under Nawaz Sharif, Pakistan would not only come out of
the present economic morass, the country would also start making economic
progress, once again. In support, one may refer to the signs of turnaround
in the crippled and debt-trapped economy of Pakistan immediately after the
PML-N’s electoral victory. The five key economic indicators — stock
market, real estate, foreign exchange reserves, dollar-rupee parity and
inflow of foreign investment — are showing signs of recovery. According
to analysts, these five factors are the foremost economic indicators that
show immediate response to economic change: If the economy progresses
these indicators rise and if the case is otherwise they start regressing. The Karachi Stock
Exchange benchmark-100 index is setting new records every week. It surged
to a record high mark of 22,358.96 points on June 7, 2013 when market
capitalisation ballooned to 5.39 trillion rupees from 4.75 trillion rupees
in early May, indicating an increase of over 650 billion rupees. Analysts
described it as a good omen for the economic revival. While before
elections, people were talking about default and economic failure, after
the PML-N’s electoral victory they are now talking about economic
revival and growth. They cite the inflow of foreign investment as one of
the key indicators of economic growth. After stock exchange,
real estate is the second key indicator that immediately reacts to the
economic turnaround. In the last two months, the real estate prices, in
posh areas, have increased by 10-25 per cent, depending on the
property’s location. Similarly, the foreign exchange reserves that were
constantly showing downslide before elections have started registering
improvement beginning in the third week of May, 2013. On May 17, the State
Bank of Pakistan reported a slight decline in foreign exchange reserves,
from US$11.60 billion to US$11.43 billion. However, the situation changed
by May 24, 2013, when the SBP reported reserves at US$11.62 billion, from
11.43 billion dollars of the preceding week, showing US$190 million growth
despite US$390 million payment to the IMF as loan installment. Since the flight of
capital has stopped and inflow of foreign investment has started
increasing, this trend would strengthen the foreign exchange reserves and
the value of Pakistani currency against major currencies of the world.
Dollar-rupee parity that had crossed 100 rupee mark before elections has
reversed to below 100 and it is now hovering around 98.50 to 99 rupees. It
is believed that improvement in investment and reserves would further
squeeze the value of dollar against the rupee in the coming weeks. Meanwhile, the
country’s new leaders, it seems, have started proceeding on a course of
austerity. To begin with, the PM has trimmed the size of the cabinet of
ministers. Against six dozen ministers in the cabinet of the outgoing PPP
government, Nawaz has constituted a cabinet of 25, including 16 ministers
and nine ministers of state. In addition, he has appointed three advisors
and two special assistants to the prime minister. A ministerial slot, on
an average, costs about 12 million rupees annually. This means a saving of
about 500 million rupees. Furthermore, the number of ministries has also
been slashed, which would result in considerable savings. To curtail
administrative expenditure, the new PM has also directed a reduction of 30
per cent in the staff of the PM’s office. On June 10, he advised the
members of his cabinet to reduce all non-development expenditure by at
least 30 per cent. Furthermore,
corresponding to every ministry, there are committees both in the Senate
and the National Assembly. A reduction in the number of ministries would
automatically result in the curtailment of the number of parliamentary
committees and their chairmen, who enjoy perks and privileges equal to
that of a minister of state. In addition, there is a parliamentary
secretary for every ministry and reduction in the size of the ministries
would mean corresponding decrease in the number of parliamentary
secretaries. As the number of
ministers, federal ministries, committee chairmen and parliamentary
secretaries decrease, so would the need for providing them limousines. The
cumulative effect of rightsizing the cabinet, the parliamentary
committees, committee chairmen, parliamentary secretaries and various
ministries/departments would result in savings of billions of rupees. Only
a popularly elected leader could have taken such bold and drastic steps! Taking a cue from the
helmsman, leaders at the federal and provincial level have also announced
to adopt austerity. The PML-N government has reportedly decided to abolish
the multi-billion rupee discretionary development funds for the prime
minister and also impose ban on the import of luxury Mercedes cars in the
budget for 2013-14. The PM’s discretionary
development fund had swollen to a whopping Rs42 billion under ex-PM Raja
Pervaiz Ashraf. Federal Information Minister Pervez Rasheed, Chief
Minister KP Pervez Khattak and Chief Minister Balochistan Dr. Abdul Malik
have expressed their determination not to use secret funds at the initial
stages of their new tenures. Interior Minister Ch. Nisar Ali Khan has
announced not to use the official car, the official helicopter or aircraft
of the Interior Ministry. These austerity measures
are bound to show results, in the shape of accelerated growth, in due
course of time. The writer is a
freelance columnist based at Islamabad. alauddinmasood@gmail.com
Imran Khan’s
Pakistan Tehreek-e-Insaf’s (PTI) first-ever government has started
working in the Khyber Pakhtunkhwa (KP) province as the cabinet portfolios
have been allocated after much delay. Irrespective of which party or
individual gets what ministry, it would be the overall performance of the
government that would be a barometer to gauge the tall claims Khan has
been making for many years. As the PTI has failed to
win majority in the National Assembly and is not part of the government in
any other province, its government in the KP would also be critical for
the future of the party and perhaps democracy in Pakistan keeping in view
the party’s slogan of ‘change’ on which it got the second highest
number of votes across Pakistan. The KP is both
simultaneously fortunate and unfortunate to have the PTI-led government
because the party has a non-traditional political programme, which the
province needs the most to sort out its myriad issues. Although the entire
Pakistan needs change, the KP needs it the most as the decadent political
and economic institutions have almost collapsed due to multifarious
factors while the society is experiencing large-scale changes and is in a
state of transition. In this situation there ought to be a political force
which could not only bring change but also manage change. The KP, as a society and
administrative entity, has had some very critical and peculiar issues and
problems. The province is extensively affected by the direct and indirect
effects of the unprecedented insurgency-cum-terrorism of the Tehreek-e-Taliban
Pakistan (TTP) and the 30-year-long international conflict plus civil war
in the neighbouring Afghanistan. It is important to note that the KP for
decades hosted two-third of the 3.5-4.0 million Afghan refugees, the
biggest refugee population anywhere in the world, which migrated to
Pakistan due to the Soviet-Afghan War and lived there for decades. A large number of these
refugees are still living in the KP. On the other hand, the KP in recent
years also experienced one of the biggest internal human displacement in
modern world history when due to the TTP insurgency and consequent
military offensive around three million residents of Swat-Malakand had to
leave their homes to get refuge in rest of the province. Apart from that,
presently around a million IDPs from the Fata displaced due to Taliban
insurgency are also living in the adjoining districts of the KP. Terrorism, international
conflict and insurgency of such big magnitude and intensity have left the
KP government institutions extremely weakened, has significantly eroded
the state writ and lacerated the social fabric of the province or more
aptly Pakhtoon society. Against this backdrop, what is required is
reconstruction and development effort of a gargantuan proportion. It is
also a dilemma of the government that it has to reconstruct and develop
the province simultaneously. The incoming government
must understand that terrorism in the name of Islam in Pakistan,
particularly in the KP, has many causal factors, many of which, like
underdevelopment and society’s ultra-conservativeness, have roots in
political vacuum and resultant bad policies and governance. Thus terrorism
could only be countered through good governance and pro-social change. For
this, the province needs a government that is composed of able, educated
and erudite people and has cognition of not only the problems but most
importantly their solution. The KP has a strange
fate as it has got a government led by a party, which does not have any
experience of governance. However, such argument in no way can take the
right of governance from the party as it has been given the mandate to
rule by the majority people of the KP. At least, the newly-elected Chief
Minister of the province, Pervez Khattak, is an extremely experienced and
educated man, who has the potential to overcome these challenges and
reconstruct the province and put it on the path of development. Khattak, in his maiden
speech to the provincial assembly after election, said that his government
has come with full preparation to rule and had ready policies and won’t
waste time to think what it had to do. This sounded music to the ears.
Because once vision is clear, priorities get straight, policy formulation
become rational and their implementation mechanical. During the same
speech, one could feel that Khattak as a nominee of Imran Khan had
realisation of the situation as he himself said everything in the province
had crumbled. “Is there anything in shape,” he questioned. Apart from the chief
minister, there are also quite experienced and educated men in the cabinet
like the seasoned campaigner Shaukat Yousafzai, Atif Khan and Sirajul Haq
(JI). Here are some important
points, which if taken into consideration, could greatly help the new
government to overcome challenges and ensure good governance. The PTI leadership and
everyone else are grossly mistaken when it states that terrorism is the
biggest challenge of or in the KP; it is neither. Firstly, it is beyond
the capacity of the KP government to address the phenomenon of terrorism
in the name of Islam. Secondly, the terrorists have their bases in the
tribal areas, a federal territory. Thirdly, the phenomenon of religious
terrorism has been the result of decades-old state policies and
international intervention in the region and Pakistan. The KP has not been the
mainspring of terrorism but only has been the victim of these forces and
policies. So the KP government cannot be expected to resolve these issues
unless there is a fundamental change in the state policies and withdrawal
of foreign forces from Afghanistan. If the provincial government would
attempt to eliminate terrorism and bases of its perpetrators by force it
would be a grave mistake which the previous provincial government of the
Awami National Party (ANP) committed. However, the KP government could
mitigate the effects of terrorism. The only way of this is to ensure good
governance. Desire for having good
governance was the very reason which motivated most of the people to vote
for the PTI in the province because the party, claims notwithstanding,
does not have any coherent political ideology. Taliban have got most of
their supporters and fighters among the extremely poor and unemployed
youth. Thus poverty and unemployment along with structural
underdevelopment and, above all, profound social-psychological
conservativeness in the KP have been some, not all, of the main
contributing causes to the phenomenon of religious extremism and
terrorism. Therefore, if the provincial government come up with such
policies that could address these critical issues then it would do its
part to counter terrorism in the province. Thus the challenges
which the new government of the PTI in the KP have to face, including
effects of terrorism and economic meltdown, are huge but they can be
adroitly managed provided the government has the vision, comprehension and
solution. With the popularly-elected, experienced and dedicated government
of the PML-N at the centre and the PTI-led government in the KP, hopefully
the country would see qualitative improvement in governance. caption Only good governance can
save the party.
Heart-to-heart A guidebook for all with heart complications By Syed Mansoor Hussain At almost every
dinner I attend, when people find out about my area of expertise in
medicine, whether I like it or not, I often have to spend much of the
evening talking about heart disease especially blockages of heart
arteries. And the reason is that there is always somebody around who has
had treatment for blockages of these arteries. First, a quick primer on
disease of the heart arteries (coronary artery disease-CAD) is in order.
As anybody who read ‘biology’ in high school knows, the heart is an
organ made up of muscle. It receives ‘impure’ blood from the body
through ‘veins’, pushes it into the lungs to be ‘purified’ and
then gets it back and pumps or pushes it into the rest of the body through
blood vessels called arteries. But, the heart also has to supply itself
and this is done through the coronary arteries. Almost all arteries in
the body can develop narrowing or blockages and so can those that supply
the heart. Once the arteries of the heart start developing blockages
(CAD), problems occur. The heart, after all, is an organ that cannot rest
and must keep on beating about seventy times a minute for as long as a
person is alive. And has to beat harder during exercise or any form of
physical exertion. So if the heart arteries are narrowed, during exercise,
parts of the heart muscle might not get enough blood producing heart pain
also called angina. Most often the first time a person seeks medical help
for CAD is after developing angina. If, however, a heart artery gets
completely blocked it can lead to damage of the heart muscle supplied by
that artery. This is called a heart attack or a myocardial infarction
(MI). The ‘risk factors’
for developing CAD include inherited tendencies, high blood fat
concentration, presence of other medical problems like Diabetes (high
blood sugar), and high blood pressure and then there are life style
choices like high fat diet, lack of exercise, smoking and putting on
excess weight. The important thing to remember is that not all patients
with the risk factors mentioned above will develop CAD and that some
patients without any known risk factors will go on to develop serious
blockages. However, an important part of cardiac medicine is devoted to
controlling and minimising risk factors, but that is a topic for another
time. Today, I just want to mention what treatments are available for
those that have actually developed CAD and have developed problems due to
it. Before any actual
treatment is initiated, the first step is to establish that the problem is
really due to arterial blockages. An electro-cardio gram (ECG) is often
the first test. This shows the electrical heart action and can help
determine if a person has had a heart attack in the past or is having one
at the time of the test. Other than that, it has limited use. Most tests
used to establish the presence of CAD depend on some sort of exercise or
medicines that increase heart function during which time either an ECG is
performed (stress test) or special medicines are injected and pictures of
the heart are taken to see if the heart is getting enough blood during
increased activity. The ultimate tests
remains the ‘angiogram’ where a thin tube (catheter) is passed up
through an artery in the arm or the leg into the heart, placed in the
coronary arteries and a special ‘dye’ is injected and X-Ray pictures
are taken. This shows the actual arteries and confirms the presence of
blockages. An alternative test that is being used frequently is called a
‘CT angiogram’ where a special dye is injected in a vein and then a
multiple rapid X-Ray images of the heart are made and a computer generates
a three dimensional picture of the heart and its arteries. Once it is determined
that problems are due to significant blockages of heart arteries, two
types of treatment are possible. First are medicines that decrease the
activity of the heart so that it can function with less blood that is
available. This is referred to as medical treatment. The other option
especially in patients at increased risk of developing a heart attack is
to increase the amount of blood that is passing through the heart
arteries. This can be done by two methods. First and the older treatment
is called a bypass operation in which arteries or veins taken from other
parts of the body are attached to the heart arteries beyond the blockages
so as to ‘bypass’ the blockages. This is a major operation and carries
some risk and possibility of complications. An alternative that is
more frequently being used now is opening up the blockages from the
inside. This is called angioplasty and ‘stenting’. Angioplasty is
performed during an angiography mentioned above. Once a catheter has been
placed in the obstructed artery, then under X-Ray control a thin wire is
threaded through the catheter and is passed through the obstruction in the
artery. Once this wire is across the obstruction another catheter with a
balloon attached to its tip is passed over this wire, the balloon is
placed at the site of the obstruction and distended to open up the
obstruction. However, angioplasty is rarely done by itself anymore and
almost always once the obstruction is opened up, a small tubular metal
mesh is placed at the obstruction site to keep the artery open. This metal
mesh is called a stent. Newer types of stents
have the metal coated with special medicines that decrease the chance of
the obstruction from recurring. The stents without such medicine are
called ‘bare metal stents’ (BMS) and the ones with the medicines are
called ‘drug eluting stents (DES). Once these ‘stents’ have been
placed, a lifetime regimen of ‘blood thinners’ is often necessary to
improve the chance that these stents will stay open. The modern term used
for all catheter based treatment of coronary blockages and associated
conditions is “Percutaneous Catheter Intervention’ (PCI). Finally, to the extreme
form of artery blockage that produces a heart attack. Complete blockages
of heart arteries are usually due to a blood clot at the site of a partial
obstruction. If the victims of a heart attack reach a well equipped
hospital with a few hours of developing a heart attack, they will often be
given a medicine into the blood stream to dissolve the clot. The medicine
most often used in Pakistan is called Streptokinase (SK). However, over
the last decade or so, a PCI or a catheter based opening of the blockage
combined with medicines to dissolve the clot are becoming the preferred
method of treatment for appropriate patients. All the descriptions
mentioned above are for information rather than as recommendations for any
type of treatment. The writer is former
professor and Chairman Department of Cardiac Surgery, KEMU/Mayo Hospital,
Lahore: smhmbbs70@yahoo.com
The ‘Big’ problem Being with
family, especially with kids, always make people cheerful. But this does
not happen to Bizwar Khan. After being displaced from Bara tehsil of
Khyber Agency against the backdrop of consecutive military operations, his
large family, comprising 22children (12 girls and 10 boys) and three
wives, witnessed a division — 10 of his family members shifted to
Jalozai camp established for internally-displaced persons while the
remaining 16 still reside in Bara. His displaced family is
braving scorching heat while sitting in a makeshift tent after the mercury
jumped to 42 Celsius at Jalozai camp. The camp, situated in Nowshera
district, has accommodated tens of thousands of tribespersons uprooted
from various tribal agencies of the Federally-Administered Tribal Areas
(Fata). “I cannot bring all of
my children to the camp because the ration given at the camp is not
sufficient enough to meet the requirement of such a large family. At the
same time, owing to the law and order situation, I am worried about the
safety of my family which I left in Bara,” Bizwar Khan, 40, tells TNS. “I strive hard”, he
adds, “to make both the ends meet but it has become increasingly
difficult for me due to ever-surging prices of daily-use items.” The family of Bizwar is
one of the many in Pakistan who are faced with many problems due to their
large families. Experts say that population explosion has its own dynamics
essentially embedded in ignorance, lack of social vision and the
complications and consequences caused by population overgrowth. There are three views on
population and economic development — Pessimistic View, Optimistic View
and Neutralist View. The Pessimistic theory says that population growth
has negative impact on economic growth while the optimistic theory states
that population growth promotes economic activity while the neutralist
theorists are of the opinion that population growth is independent of
economic growth. Whatever the optimistic
theorists state about the benefits of the population growth, it is an
ascertained fact that it has negative effects on economic growth,
education, health, food and environment. It also increases poverty and in
certain cases triggers international migration. With limited resources
in hand, fewer opportunities to earn and living a hand-to-mouth life
further worsen the already deteriorated plight of the children. Since its inception, the
population of Pakistan increased with a remarkable pace and from around 33
million in 1947 it has reached, according to a rough estimate, to 180
million in 2012. Currently, Pakistan is the sixth largest country of the
world and also one of the poorest as well. With the same pace of growth,
Pakistan’s population is expected to touch the mark of 210 million by
2020. According to recently
issued World Development Indicators by World Bank, 60 per cent of
Pakistanis are living below the poverty line. The international poverty
line is two dollars a day or an income of Rs 200 per day. The report tells
that 21 per cent of Pakistan’s population lives below $1.25 a day. It further states that
30.9 per cent of the children under the age of five are suffering from
malnutrition and underweight while mortality rate under five is 72 per
1,000 birthrate and maternal mortality ratio is 260 per 100,000 births. The population growth
rate in Pakistan is 2.03, the highest in South Asia, while the fertility
rate is 3.4. The contraceptive prevalence ratio is 27 per cent and if the
trend continues Pakistan’s population will double by 2046. This huge burden of
population has adversely affected almost every sector of the country, be
it education, health, infrastructure, environment, energy, sanitation,
sewage, unemployment, transport, to name a few. Education is getting
expensive with every passing day; the increased number of children limits
the access of these children even to primary level let alone higher
levels. It results into increase of uneducated mass which has its own
detrimental complication for the society at large. The healthcare of such
huge families has also been compromised. Immunization becomes patchy which
results in an alarming increase in infant mortality. Children of large
families are also prone to communicable diseases. The public sector health
outlets are overburdened and cannot cater to the needs of the public which
results in dependency on private sector and puts immense financial
pressure on people like Bizwar Khan who has to cater for 22 children. The burgeoning trend of
child labour in the country is also attributed to the rapidly growing
population. Besides, awareness about
the basic facts and consequences of population growth is severely lacking
and has been replaced by myths of obscurantism. “The basic duty of the
society and the government is to create awareness through print and
electronic media and community participation,” says Tahirullah, an
official of the Rahnuma Family Planning Association of Pakistan. caption The burden of large
family.
Zia Ur Rehman’s book “Karachi in Turmoil” is a telltale of social and economic motives behind unceasing violence By Ali Arqam The unceasing
violence in Karachi has many facets. It has been, for the last few years,
in the headlines for periodic waves of violence due to varying reasons.
Sometimes, a political assassination has flared up the turbulence or a
fiery political statement has led to violent responses resulting in losses
of innocent lives, torching of vehicles and devastation of valuable
properties. Amidst all the political
antics of making and breaking alliances, joining or quitting coalitions,
calling on the supporters for strikes, protests and days of mourning,
accusations and allegations of foul play, the unremitting saga of killings
of political workers from all the political parties continued without a
break. The story of these
turbulent years, different players who have contributed to the turmoil,
political, social and economic motives behind this and the repercussions
and implications of this are paraphrased well in the book by the
Karachi-based journalist and researcher, Zia Ur Rehman, in his book,
“Karachi in Turmoil” published by the Narratives Islamabad. In the beginning,
violence was attributed to the ethnic tensions between Urdu speaking
community represented by Muttahida Qaumi Movement (MQM) and Pashtuns whose
support was divided proportionally among different secular and religio-political
parties. But in the 2008 general elections, Awami National Party (ANP)
projected itself as the representative party of the Pashtuns by winning
from two provincial constituencies. For decades, Karachi has
been a centre of gravity for the labourers from all the provinces due to
its commercial and industrial importance. War, insurgency and military
offensives against the militants have escalated the process of migration
towards Karachi. Outskirts of the city have seen a rapid growth, many of
the goths around were included in the city to meet the growing demands of
lands for residential purposes. The author has provided
statistics showing trends of migration during these decades since
partition till the recent years, and highlighted how these migrations have
changed the demographics of the city and have greater implications over
the politics in the coming years. During these years, new
forces have joined the rumble. The infamous gangs of Lyari have gained
notoriety by engaging in more barbarous and ferocious acts of brutalities
against their rivals and political opponents. Lyari is the oldest locality
of Karachi and home to indigenous Baloch and Sindhi people who have
consistently voted for the PPP. A larger group of Lyari gangs put on a
political avatar of People’s Aman Committee (PAC) and served as a
subsidiary of the PPP initially. After violent clashes with the MQM and
targeting of members of Katchi community, mostly the PPP supporters,
realisation in the PPP ranks led to a ban on the PAC. Furious over the
developments, the PAC looked around by making contacts with other
political parties including the PML-N and later formed Karachi City
Alliance with Pakistan Awami Tehreek, Jamat-e-Islami and other groups. The
author has painstakingly collected informations over the inception of the
PAC and provided a detailed profile of the notorious outfit. It will be interesting
to note that apart from all the criminal activities, criminal gangs in
Lyari are intolerant of and against the influence of Baloch nationalists
groups. Mir Sohaib Mengal, international representative of BSO (Azad), has
stated that Uzair Jan Baloch-led faction has been involved in repressing
the activists of Baloch nationalists groups. With the emersion of
anti-Shia outfit Sipah-e-Sahaba Pakistan as Ahle Sunnat Wal Jamaat (ASWJ),
violence against members of Shia community too escalated. Scores of Shia
professionals have been killed while ASWJ too has faced reprisal attacks. The author has gathered
views and opinions on different aspects of anti-Shia violence. He also
referred to the popular perception of Saudi-Iran proxy war behind these
killings, though one can hardly find any substantiated argument supporting
these claims. Tehreek-e-Taliban
Pakistan too has left its mark in the city. Most of the outskirts of
Karachi are virtually under the control of the TTP. The TTP has been using
Karachi as its financial jugular by resorting to land grabbing,
kidnappings for ransom and collecting extortion money. The author has shed
light on these criminal practices utilised by all the political and
religious groups at different levels. At the end, Zia Ur
Rehman has made it very convenient for the students of politics, those
interested in the city’s tumultuous politics and researchers who want to
understand the roots of chronic violence in the city.
project Mega projects
serve the public good and also serve as monuments, as instruments for
self-serving rulers wanting to immortalise themselves. The obsession for
such mega projects was quite rampant during the medieval ages, when kings
sometimes conceived projects as large as a full-fledged city, as the
engineer King Shah Jahan did by building Shahjahanabad, on the outskirts
of Delhi, to perpetuate his own memory. Similarly, the primary
motivation to build the Taj Mahal might have stemmed from Shah Jahan’s
proverbial love for his queen Arjumand Bano, commonly known as Mumtaz
Mahal, but his hankering to have that monumental mausoleum built must have
also been designed to help the King transcend the confines of mortality.
Thus, these practices were the bequest of an autocratic and monarchical
dispensation where the persona of the King was held sacrosanct. The ruler, as a person,
held precedence over institutions — indeed it would not be unfair to say
that the all-powerful ruler embodied all sorts of institutions. This
essentially medieval trait has sustained itself to this day, when the
collective will of the people is supposed to prevail, but in most cases
does not. Instead, the idiosyncratic fantasies of elected rulers refuse to
usher themselves into the era of modernism. Their conceptions of mega
projects, which they want to flag as monuments, such as metro buses or
bullet trains, in a third world country hobbled by resource constraint, is
a reflection of misplaced priorities. Now is the time our political elite
should think far beyond such shenanigans, beyond the distribution of
favours just to win elections. Going back to the
theoretical aspect of mega projects, attention should be turned to
projects far larger than those mentioned above, which were planned and
executed in the modern era, projects with a very different aim and spirit
behind them. One cannot credit any one person from among the British
administration for the canal network which, to many scholars, is no less
than a miracle. The same can be said about the railway network, the
settlement process in the trans Ravi Punjab and the methods of revenue
documentation and its collection. Such feats came about as a result of
institutionalised practices, performed to ensure effective governance. One Viceroy, during
British rule, would initiate a certain policy which would then be carried
on as a legacy by his successors. Continuity in the policy invigorated the
administrative structure under the British. That was how it
(administrative structure) endured even to this day, although in a
deformed and mutilated way. It is, however, quite obvious that the
imperial interests were latent in all such undertakings. Here the point
worth pondering is as to why our rulers have not embraced that British
legacy. What we can learn from
the successful democracies is a pressing need to strengthen our state
institutions, which is the only way to achieve political stability and
economic viability. Personalised rule erodes the institutions and
unleashes anarchy. The over-exuberance demonstrated with impunity in
administering the Punjab has proved counter-productive. Let the heads
(read bureaucrats if you like) of government departments handle affairs in
the way they think is proper. Meaningful reform in the administrative
structure is a commendable and essential undertaking. It requires soul
searching and introspection by those conversant with the nitty-gritty of
various systems working in different countries with the same historical
experience as has Pakistan. However, instead of taking that route, the
iron man of the Punjab juggles officers around at will, which has proven
and will continue to prove perilous. One cannot expect effective
governance and efficiency in an ambience plagued with uncertainty. It is,
therefore, imperative that the one holding the reins of power builds
confidence among officers. Efficiency and personal integrity ought to be
the criterion, rather than personal likes or dislikes. What is of utmost
importance is the shifting of the focus from the development by building
road and bridges to the human resources, so that social capital can be
generated. It is the social capital that forms the core of any society. In
order to do that the mediocrity that is pervasive to an alarming extent in
our institutions for education and healthcare will have to be tackled at
the earliest. Any clear vision regarding education or health is
conspicuously missing from the agenda of the government. Several
universities are finding it difficult to fill the professorial positions
which does not bode well for the future of higher education. Similarly, the public
school system is in a shambles and no one seems to be mindful of that
dereliction. Now that education is a provincial subject, it should figure
among the top priorities of the government. Some task force needs to be
instituted and the ailments afflicting the education and healthcare should
be identified and subsequently addressed. Public schooling of
Finland and national health service of the United Kingdom may impart us
some lessons in this regard. Surely enough nations sustain and thrive
because of the social capital which comes about through investing in
education and health services instead of ostentatious projects conceived
and built on the shifting sands of time. Our leadership must come out of
the fantasies of medieval ages to confront the challenges of the modern
age.
Transport
troubles The Sindh Chief
Minister announced the revival of Karachi Circular Railways at the
humungous cost of $2.6 billion during a high level meeting in Karachi on
June 07, 2013. With assistance from Japanese agencies at various levels of
its planning and development, the project has already seen several bouts
of cost escalation. Experts say that the
operation of KCR will have an in-built subsidy — as income from
passenger fares shall not be enough to shoulder the running of the train
service even for a day! At a time when the Sindh and federal governments
are both cash-strapped, the investment in a system with an in-built need
of a cash injection every year may not be a wise option. So what is the
answer? The Sindh Chief
Secretary, during the same presentation, gave some revealing figures. The
city transport comprises 47.3 per cent motor cycles, 36.5 per cent private
vehicles, 4.5 per cent public transport, 9.9 per cent para-transit and 1.7
per cent contract carriages. Ironically, 4.5 per cent public vehicles
carry 42 per cent passengers while 36.5 per cent private vehicles carry
only 21 per cent commuters. It is a common
observation that rising number of private vehicles is the key reason of
transport system inefficiencies in the city. Excess consumption of
subsidised CNG fuel option; high occupancy of operational road shoulders;
formidable utilisation of road space/vacant lots for parking; pressure on
city administration to facilitate fast movement through de-signalisation
and grade separated crossings; swift usurpation of pedestrian spaces and
sidewalks and spiraling atmospheric pollution are some of the common
problems generated by exponentially increasing private vehicles. The rising statistics
for fatal accidents and other damages to human life are other mentions
that impact our urban living due to rising number of private vehicles.
While a rational support to domestic automobile industry is a good policy,
the decision to allow import of motor cars is neither solving transport
problems nor helping employment rise beyond the conventional limits. When the need-demand
combine is suppressed beyond logical limits, it bursts at its seams to
evolve rather unique solutions. The swarming rise of the three-wheeler
vehicles operating on busy Karachi roads is an unavoidable phenomenon.
Qingqi, CNG rickshaws and other improvised vehicles of the same range
constitute this category of popular transport. It is capable to carry as
many as 5-12 passengers on board at a time depending upon the make or
seating capacity design. A study conducted by
Nabeel Ajaz of NED University in Karachi on urban planning revealed that
easy availability, opportunity to sit and travel in relative comfort,
prevention from thugs and thieves (who now hold up bus and mini bus
passengers on a routine basis), low fares and uninterrupted operations
during political strikes are some of the comparative advantages that have
made Qingqi a very popular mode of transport. Housewives, school children,
college and university students, white collar workers, labourers and a
host of other categories of people use this transport. Women find it a more
comfortable mode due to limited or no chances of lecherous treatment by
operator. However, there are many disadvantages also. A sizable number of
drivers/operators are under-aged and have no proper driving licence. The
vehicle design is also inappropriate for broken roads with potholes. These
instances lead to road accidents causing injuries to riders. The
relatively low velocities and unavailability of dedicated lanes impact
their optimum performance. However, it may be taken into account that
these tri-wheelers, like other modes of public informal transport, are
entirely financed by the operators themselves. No bank loans or subsidies
are available to them, a small proportion of loans from micro finance
institutions notwithstanding. On an average, a three
wheeler costs Rs 200,000 as against Rs 4.5 million for a public bus. This
enormous advantage in terms of starting cost of the transport business is
a core factor behind the phenomenal rise of tri-wheelers. Besides the
safety factor during riots and unrest is another consideration. Dozens of
buses and mini-buses have been routinely torched during the previous years
under political, ethnic and sectarian strife in the city. It is important to
revisit the wisdom behind the development of signal free corridors by the
erstwhile City Government of Karachi. Among the various benefits that were
highlighted for going ahead with the multi-billion rupee projects was the
relative efficiency that was ensured for buses, mini-buses and wagons. The KCR option must be
examined minimising its cost factor by intelligent and smart options of
investment through private sector. Similarly, a mini bus and bus system
that augments the KCR routes may be contemplated. An integrated transport
system is the one which optimises efficiencies by collaborating linkages
with multiple modes of transport. As Karachi has grown as
a consequence of urban sprawl, there will remain ample business potential
for multiple modes of transport. And announcement and focus on one project
alone cannot solve commuting problems of a city of Karachi’s magnitude.
Critical analysis, appropriate planning, efficient implementation and
dispassionate monitoring and evaluation of transport approaches can
formulate logical answers to complex problems that the city is grappling
with.
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