For the past two weeks, average temperature in Islamabad and Rawalpindi has been between 36 to 40 degrees Celsius, with dry and hot weather expected to continue next week with no chances of rain, said Pakistan Meteorological Department (PMD) Director General (DG) Arif Mehmood while talking to The Express Tribune.

He said the heat intensity will increase from 2-3 degree Celsius during next week, however, the two cities will experience normal summer temperature in the coming months as last year.

Meanwhile, according to Pakistan Institute of Medical Sciences (Pims) spokesman, Dr Waseem Khawaja, the emergency department of the hospital receives over 150 cases of gastroenteritis daily. Spokesman Polyclinic Hospital, Dr Sharif Astori, put daily gastroenteritis patients at 20-25.

Moreover, in the last few days, Rawalpindi’s Holy Family Hospital (HFH), Benazir Bhutto Hospital (BBH) and District Headquarters Hospital (DHQ) have received around 150 cases of gastroenteritis.

Talking to The Express Tribune, a senior physician at HFH, wishing not to be named, said, “Every summer hospitals are flooded with patients suffering from various forms of stomach diseases but unfortunately the concerned departments do not pay any heed to this.”

He highlighted that the majority of patients are daily wage labourers who work long hours under the open sky without access to clean water and shade for rest. “Just by ensuring the provision of clean drinking water the government can decrease the number of gastrointestinal patients to a great extent,” he said.

“For poor people like us, two meals and water is a blessing regardless of its quality,” said Mohammad Aleem, an attendant of a labourer brought to Pims for food poisoning.

Published in The Express Tribune, May 19^th, 2013.

The Lancet, a leading medical journal published weekly from London, on Friday launched a major series on health transitions in Pakistan. The report, analysing past and present performance of the sector, calls for a unified vision for universal and equitable health access across the country.

High numbers of diseases

According to the series, an estimated 8-9 million people are infected with hepatitis-C virus, 620,000 people have tuberculosis and every year 410,000 people are infected while 59,000 die from the disease. It further revealed that 500,000 cases of malaria are detected annually and 5,000 people die of rabies every year. Poliomyelitis remains endemic despite an intense global focus on eradicating the disease.

Poor family planning and child mortality rate

Pakistan has a dismal record of reducing fertility rate although it has fallen from six births per women in 1990 to 3.6 in 2012, which is still higher compared to other South Asian countries. With nearly one million women seeking unsafe abortions annually, family planning is the most neglected component of women health issues. The most large-scale public health crisis is the child mortality rate with about 423,000 children under five dying annually, nearly half of whom are new born babies. This is compounded by the deaths of 12,000 mothers. Pakistan has the third highest number of maternal, fetal and child mortality deaths with 57 per cent of neonatal deaths occurring in the first 72 hours after birth. “A governance crisis and poor political ownership of maternal and child health have retarded progress in women and children’s health in Pakistan because no political parties have considered it a priority,” said Professor Zulfiqar Bhutta of Agha Khan University, who is a co-author of this series.

Bleak healthcare system

Public spending on health is at $9.31 per person, much less than the internationally recommended $60 per person whereas 78.08 per cent of the population pays from their pockets for healthcare. Presently 121,374 doctors are registered in Pakistan while the doctor-to-population ratio of 1:1127 is fewer than the World Health Organisation (WHO) recommended 1:1000.

Cost of non-communicable diseases

Nearly four million people aged 30 – 69 are predicted to die from cardiovascular disease, cancers, and chronic respiratory disease by 2025, with tobacco use as the prime factor behind it. Quoting surveys, the journal indicated that nearly 29 per cent of men in Pakistan smoke, as do four per cent of women. High blood pressure is also a leading risk factor for these illnesses, with an estimated 35 per cent of adults in 2008 thought to possess high blood pressure.

If unaddressed, this disease burden is predicted to cost Pakistan $296 million by 2025, with a cumulative loss of productivity due to premature death in workers amounting to $3.5 billion in the same period.

Government investment in health was recommended to increase to at least five per cent of the Gross Domestic Product (GDP) by 2025.

Dr Sania Nishtar, founder of Heartfile, and non-profit health think tank, and author of the series said, “The abolition of Ministry of Health after the 18th Amendment was clearly a setback, as we need a unified institutional framework”.

The launching ceremony of the Lancet Series was organised by Heartfile in collaboration with Agha Khan University and held at COMSTECH auditorium, Islamabad.

Published in The Express Tribune, May 18^th, 2013.

The main emergency ward at Pakistan Institute of Medical Sciences (Pims), currently lacks simple surgical instruments used in operation theatre (OT). In this critical ward there is only one Electrocardiogram (ECG) machine, according to a senior doctor who wished not to be named.

The doctor stated that patients have to wait for hours as there is only one OT at the emergency ward whereas some life saving drugs are either unavailable or spurious. He informed further that more than a 1,000 patients come to the emergency department from Islamabad and far-flung areas in Kashmir, K-P, G-B on a daily basis and have to suffer due to shortage of medical equipment. “They are being referred to other hospitals,” lamented the doctor.

Lack of facility main cause of death

Poverty stricken Muzzafar Hussain, a resident of Nai Abadi, Bhara Kahu was brought to the Pims emergency ward on the eve of May 16 after being referred from Polyclinic Hospital. He was suffering from chest pain and was vomiting blood.

“When we went to Pims the doctors said the medical equipment required for treatment is unavailable and out of order and the patient should be taken to Holy Family Hospital (HFH) Rawalpindi,” claims Hussain’s attendant Khan Mohammad.

After initial treatment, around midnight the staff at the emergency ward told Khan to go to HFH as they had run out of oxygen in the cylinders. “He was in critical condition and we barely managed to gather money for transportation to Rawalpindi,” he said.

Around 2am Hussain suffered from a heart attack and was pronounced dead an hour later at HFH.

Hussain by profession was a daily wage labourer and his second son was born only last week. “Now who is going to look after this poor family, who should be blamed for his death? Poverty or the government officials who have deprived poor people from their basic right to health,” asked a grieving Mohammad.

Pims Administrator Prof Dr Iqbal Memon said through international grant the hospital will soon get new medical equipment and 17 beds will be added to the emergency department.

Published in The Express Tribune, May 17^th, 2013.

According to the Weekly Epidemiological Bulletin – Disease early warning system and response (DEWS) in Pakistan, jointly published by the National Institute of Health and World Health Organisation (WHO), 131 measles cases were reported between April 14 and 20, while 412 were reported between April 21 and 27.

A senior official at the Expanded Programme on Immunisation told The Express Tribune it was unfortunate that the staggering increase in the number of measles cases had occurred at a time when the world was observing Immunisation Week under the theme ‘Stop Measles Now.’

He was of the view that disease prevention campaigns had slowed down considerably due to pre-election activities.

“I hope the incoming government takes this matter seriously and addresses issues which are hindering the immunisation of all children from nine months to 10 years of age,” said the official.

DEWS Senior Surveillance Officer Dr Musa Rahim played down the recent outbreaks, saying there had been an overall decline in the number of cases in the country this year.

He said pre-election campaigning had made it difficult to tackle fresh outbreaks of the disease, adding that children did not have access to hospitals, due to which some cases remained unreported.

Around 10,020 measles cases have been reported across the country in 2013. Of this, 4,070 cases were reported in Punjab, 3,106 in Sindh, 1,116 in Balochistan, 1,178 in Khyber-Pakhtunkhwa, and 97 in the Islamabad Capital Territory. Sindh reported the highest number of deaths from the disease with 141 out of a total 246 across the country, according to the Weekly Epidemiology Bulletin.

Published in The Express Tribune, May 16^th, 2013.

Civil society representatives who observed elections from a disability perspective told The Express Tribune that before the general election 2013 the ECP had assured them that all polling stations would be made accessible to PWDs under its strategic goal number 14, “Marginalised Groups including Women, Minorities and Persons with Disabilities” aimed to ensure their participation in the electoral process.

They said the majority of polling booths lacked facilities such as wheelchairs, ramps and staff to assist persons with sight or hearing impairment.

Zulqarnain Asghar, advocacy and communications manager at Initiative for Raising Awareness, Development and Assimilation of the Handicapped said a polling booth was established on the first floor of Asif Public School, Rawalpindi in NA-52 which was inaccessible for PWDs.

Another polling booth set up in Aisha Lasani Model School Rawalpindi had no ramp and a polling station set in Asir Public School was located in a very congested place where it was difficult to move about in a wheelchair.

Sharing his experience, he said the returning officer at Asif Public School was not aware of the special computerised national identity cards for PWDs. “Some PWDs who were first-time voters were deprived of their right due to lack of facilities,” he said.

Special Talent Exchange Programme (STEP) President Atif Sheikh said his team visited polling booths established in some areas of G-Sector and observed that they were all inaccessible to PWDs.

He said STEP in collaboration with other NGOs formed a team of 80 people who all were suffering with various forms of disabilities and observed the election process at 139 polling stations from a disability prospective in 15 districts.

Society for Special Persons President Zahida Qureshi, who is based in Multan, said, “We utilised our own resources and made model polling stations for the disabled. We built ramps and brought wheelchairs to assist persons with physical disabilities.” She said none of the polling booth she and her team visited were disabled-friendly.

Published in The Express Tribune, May 15^th, 2013.

The Cervical Cancer Free Coalition launched the crisis card on Friday ahead of Mother’s Day which will be observed on May 12.

In Pakistan, the deaths caused by cervical cancer are 12 per 100,000 people. The coalition collects data about the disease, across the globe, from official reports of the World Health Organisation (WHO), the United Nations, the World Bank and International Agency for Research on Cancer (IARC) and Globocan.

“It is really shocking that over 7,000 women die of this disease every year. The upcoming government must ensure that a comprehensive prevention programme is in place to tackle the disease,” said Federal Minister for Science and Information Technology Sania Nishtar.

“Availability of vaccines, screening and treatment for all women and girls must be ensured,” she added.

Nishtar said that huge progress had been made across the globe in terms of fighting the disease, but in Pakistan much more was needed to be done to save and improve lives of millions of women.

Talking to The Express Tribune Director of Health Awareness Society Dr Samia Babar said that anti-cervical cancer vaccine was available in Pakistan but due to its high cost and lack of awareness about its importance, it was not used much. She said that in a country like Pakistan cervical cancer was considered a taboo as it was linked to sexual transmission and taking an unmarried girl to a gynaecologist was also considered a stigma.

“Not only a gynaecologist but also a paediatrician can vaccinate a girl against cervical cancer. It is important for each and every girl before getting married to be vaccinated against this disease,” she said.

Dr Babar said that if the anti-cervical cancer was included in the Expanded Programme on Immunisation by the government, it may help save lives of thousands of women.

She also suggested that all gynaecologists should advise their patients to vaccinate their daughters against cervical cancer and provide them information.

Published in The Express Tribune, May 11^th, 2013.

The GEM Mission has deployed 15 international and 50 national observers to ascertain women’s participation in the upcoming elections.

“I do like and want to observe general elections in Balochistan but our domestic observers have advised us against it because of security concerns,” said Sabra Bano, head of the Mission and director of the Gender Concerns International (GCI) while talking to The Express Tribune.

Bano said that in Balochistan women face multiple forms of discrimination in terms of politics or as voters and this region should not be ignored.

“The GEM Mission has worked in conflict zones across the globe and monitoring polls in Balochistan should not be a problem for it,” she said.

“For us all women in Pakistan are equal and we want to empower them by highlighting their issues they face either while contesting elections or casting votes. If the region was ignored just because of the security fear it would be injustice with the women there,” she said.

“As compare to 80s and 90s there has been an improvement in women’s participation in elections, which is a good sign,” she said

Bano believes that upcoming elections were a ray of hope for every Pakistani despite fragile law and order situation in the country.

International Trainer, GEM Mission, Caecilia J van Peski said that it was for the first time that she had come to Pakistan to train local female observers to monitor elections from the gender perspective.

“Despite security and other issues, all these females are passionate about visiting polling stations in their respective areas which reflect that Pakistani women are strong and brave enough to face all sort of challenges,” she said.

Published in The Express Tribune, May 10^th, 2013.

ISLAMABAD: Every time before the elections, political leaders make tall claims of carrying out development work in their constituencies, soon after they are no where to be seen. Same has been true in Bhara Kahu, according to the locals, for the last many elections.

A locality of over 0.1 million people on the very outskirt of the capital, the area still lacks all basic amenities such as natural gas, roads, clean drinking water, garbage disposal and decent public transport facilities.

The locality, which is only 15-minute drive from the Parliament House and also hometown of Chairman Senate Nayyar Hussain Bukhari, is in the quagmire of issues.

“Everyday my daughters have to fetch water from a nearby well and during summers it becomes even worse. Before elections, candidates from all political parties make tall claims of laying water pipelines for the purpose, but soon they forget everything,” said Shakira Bibi, a resident of Chaudhriyon ka Muhalla.

Kaleemullah, who has been living in Shah Pur for the last 15 years, said that the area residents had been facing water scarcity for the last 10 years and there was no let-up in their woes.

He said that there was not a single water filtration plant in the entire locality.

Shah Hussain Shahid and Samina Gul, residents of Sheri Chowk and PTV Colony respectively, lamented the non-availability of gas in their areas which forces them to fight the biting cold, especially in winters.

“We do not have gas but our neighbour has it because he is a jiyala (PPP supporter),” Shahid claimed.

Meanwhile, other area residents complained about lack of proper garbage collection system, parking facilities and encroachments which often create traffic jams.

“There is an urgent need to construct a pedestrian bridge at Uthal Chowk,” said Mohammad Ali, a shopkeeper.

Bhara Kahu falls in NA-49 and candidates contesting from the constituency have their own tale to tell.

Pakistan Muslim League-Nawaz candidate for NA-49, Dr Tariq Fazal Chaudhry, who was elected from the constituency last time, blamed the absence of a local body system for the woes facing the residents of rural areas.

A PPP candidate for NA-49, Mustafa Nawaz Khokar, said that, his party did a lot of developmental work in Bhara Kahu in the last five years. Pakistan Tehreek-e-Insaf for NA-49, Chaudhry Ilyas Mehrban, said that his party leader Imran Khan has already announced to hold local body elections soon after they were voted to power. “Once the local government system is in place, funds will trickle down to the grassroots level to address the issues of rural areas,” he said.

Published in The Express Tribune, May 9^th, 2013.

DHS had set an initial target of vaccinating 221,000 children aged nine months to 10 years against measles across Islamabad during a 15-day campaign, said an official source.

However, DHS has gotten approval for funds amounting to US$125,000 from the Global Alliance for Vaccines and Immunisation (GAVI) to vaccinate only children aged nine months to five years.

“DHS needs around US$100,000 to immunise children aged five to 10 years but is struggling to find a provider,” said the source. To compound the problem, the DHS has a meagre 13 permanent vaccinators on duty, scarcely enough to successfully carry out the anti-measles drive.

“DHS requires 70 to 80 full-time vaccinators who can spend enough time in the field. To overcome the shortage, around 200 to 250 vaccinators have been hired on a voluntary basis,” said the source.

A major issue for vaccinators, each of which has been tasked with inoculating 200 children per day, is the lack of adequate transport. The motorbikes they currently have are mostly are non-functional.

“A lack of political commitment is the main reason for the shortage of funds and lack of personnel. Billions of rupees are being spent on election campaigns while millions of children are suffering from measles across the country,” said the source.

DHS Director Dr Hasan Urooj called on the administrations of the CDA, Pakistan Institute of Medical Sciences and Polyclinic Hospital to provide staff members to help cover the current shortage.

Urooj said the DHS had mobilised its available resources to help with measles cases as and when they were reported.

Published in The Express Tribune, May 7^th, 2013.

This time, too, an analysis of the political manifestos reveals that almost all the major parties have illustrated their full commitment, on paper, to the improvement of the healthcare system.  However, not one among them could provide a roadmap to show how they intend to achieve the proposed targets.

Health budget

Assertions to raise the health budget and equip institutes with modern technology have been made, but just how this will be done, given the financial situation, remains to be seen.

In its manifesto, Pakistan Muslim League-Nawaz (PML-N) said it would raise the health budget to at least 2% of the GDP by 2018. In this manner, it would also achieve a three-fold increase in the overall expenditure on health. These points are in line with UN recommendations.

In a similar vein, Pakistan Tehreek-e-Insaf (PTI) claimed to ‘progressively double state spending on health’, while the Muttahida Qaumi Movement (MQM) promised to increased expenditure  from 0.6% to 5% of the GDP, all in a span of five years.

Furthermore, the Awami National Party (ANP) expressed its intention to allocate at least 6% of the GDP for health, while the Pakistan Peoples Party (PPP) also proposed an increase in health spending to 5% of consolidated government spending.

Somewhat controversially, both PML-N and PTI mentioned plans to make all government hospitals autonomous. This would make hospitals responsible for generating their own funds, thus depriving poor patients of free healthcare services, and depriving employees of their rights as government workers.

Tackling preventable epidemics

PML-N, PTI, MQM and the PPP all claimed they would ensure 100% immunisation of children against preventable diseases. Although such a claim is admirable in theory, the 100% figure implies that every single child in the country will be vaccinated. Keeping in mind the conflict zones and the inaccessible terrains, this is an impossible endeavour. Current statistics tend to support this view.

In the North and South Waziristan tribal agencies, 260,000 children have yet to be vaccinated, owing to the ban on polio vaccination in place since 2012. Moreover, during the first national anti-polio campaign of 2013, over 1.4 million children missed the vaccinations because of the law and order situation.

Infant mortality and malnutrition

The mainstream parties also promised to reduce the maternal and infant mortality rate, which is another major health issue. However, it will be a real challenge for the next government to achieve this target, because there are multiple hurdles that need to be addressed, including social taboos, cultural norms, absence of the basic healthcare system in remote areas, untrained midwives, poor communication, and illiteracy.

The same problems will have to be dealt with in reducing population growth, another aim the parties listed.

On the other hand, almost all manifestos ignored the malnutrition issue, one of the root causes of maternal and infant mortality. In Pakistan, almost half the children under the age of five are chronically malnourished.

Should we be optimistic?

The healthcare situation can be improved by building on the primary healthcare services. In this vein, all political parties pledged to upgrade basic healthcare units (BHUs) and rural healthcare centre.

However, considering PML-N’s performance in Punjab during its five year tenure, it remains to be seen how it will live up to the tall claims made in its manifesto.

Currently, 98 BHUs in the Rawalpindi districts are facing an acute shortage of medicines. Major public hospitals in the city have stopped providing treatment to the hepatitis patients due to non-availability of interferon injections. More jarringly still, the coverage of routine immunisation in Punjab is around 56%, one of the major reasons behind the recent measles outbreak that claimed over 54 lives in the province. Similarly, the PPP also promised to improve the sector, but it did very little during its term.

With such past examples, it is difficult to be optimistic, despite the enthusiastic manifestos.  Today, Pakistan greatly lags behind on 25 Millennium Development Goals. Even after the devolution of the health ministry to the provinces, under the 18th Amendment, the sector is suffering.

Published in The Express Tribune, May 5^th, 2013.