When doctors complain that their academic life is extremely tough, they do not just mean the six years of their medical degree. Doctors who go on to do a postgraduate degree face a number of issues in both the private and the public sector hospitals before they become qualified consultants.

The College of Physicians and Surgeons (CPSP) has designed a course of post graduation, the Fellowship of the College of Physicians and Surgeons (FCPS) degree, which is granted after clearing two examinations with a mandatory four to five-year clinical experience between these.

The CPSP is offering fellowship training in 64 specialties at about 18 accredited public and semi-government hospitals in the city. There are about 39 accredited private hospitals for training postgraduates.

But the lives of doctors in public and private hospitals differ vastly. All hospitals in the public sector are bound by the Sindh government to pay Rs42,500 to each trainee monthly.

In the private sector, however, there is no organisation to regulate and decide the terms of appointment and training of postgraduates – which is why every hospital has its own pay scale. Some private hospitals did not pay postgraduates at all but revised their policies after the CPSP directed that all accredited private institutions will have to give a stipend to trainees. But that is as far as the CPSP can go, as it only deals with its students and has no authority over public and private sector training hospitals.

Doctors working in privately-run hospitals complain that they are paid far less than government-run hospitals.

Liaquat National Hospital pays Rs30,000 to post graduates in the first year and increases this by Rs2,000 every year, said Dr Khurram, who works at the orthopedics department.  The Jinnah Medical and Dental Hospital also pays trainees Rs30,000 per month and postgraduates at the National Institute of Blood Diseases offers Rs 26,000.

But even with higher pay, postgraduates face a number of other issues. There are a slew of problems – politicised appointments, intense workloads and the lack of security at hospitals. The increased stipends aren’t all they are made out to be – there have been payment delays at three tertiary care hospitals.

Hospitals have to pay for the postgraduates’ stipends from their own budget allocated by the Sindh health department. At the Abbasi Shaheed Hospital, residents only received their stipend for November 2011 this April while the stipend for June 2012 was paid early October. Salaries at the Civil and Jinnah hospitals are also delayed.

Budget blues

The hospitals’ management blames this on delays in the release of the budget funds by the Sindh government.  Dr Nadeem Rajput, the medical superintendent of Abbasi Shaheed Hospital, said that they face delays when the Karachi Metropolitan Corporation delays payments.

The Dow University of Health Sciences has to pay Civil hospital’s postgraduates. But Prof. Masood Hameed Khan, the university’s vice chancellor, says they are struggling because their budget has been cut half to Rs350 million, while Rs200 million was spent only on postgraduates.

Prof. Tasnim Ahsan, the executive director of Jinnah hospital, said that the missing stipends are due to the increase in salaries but the hospital did not receive an additional amount for the pay raises. She said that the Sindh government has now, however, matched the budget allocation to the raise in salaries and they are not facing any delays.

Published in The Express Tribune, November 11^th, 2012. 

KARACHI: While some people like to imagine Karachi as an organic entity that is perpetually growing outward, quality patient care unfortunately remains confined to its nucleus.

The hospitals in Malir that line the National Highway near Kala Board are the closest medical facilities for patients coming from Bin Qasim and other localities in Malir and Landhi. The institutes are wedged between an odd assortment of makeshift food, juice and paan stalls, schools and quite amusingly, homeopathy clinics. Some of the more well-known names are Nehal Hospital, Al-Mumtaz Medical Complex, Atia Hospital, Dr Atique Orthopedic and Medical Centre and Hasan General Hospital.

At first glance the hospitals seem like fairly decent places to pop in for treatment – after all, they look quite pristine. But only when you step inside and ask for specialists do you realise that something is amiss: most of the out-patient departments open in the afternoon because the specialists are busy tending to patients in one of the bigger hospitals in the city centre.

Nazia, a resident of Gulshan-e-Hadeed, learnt this the hard way. She wanted to see a chest specialist and made her way to Nehal Hospital. No dice. A family friend, who worked as a physician at the adjacent Al-Mumtaz Medical Complex, said that there were three at his hospital. When she finally made her way down there, she was dismayed to learn that the best physician would arrive five hours later. The hospital’s help desk told her that an appointment couldn’t be booked and that she would have to get in line. “I live very far away so I will have to wait,” she said.

A pulmonary diseases specialist who sits at one of the hospitals said that he sets aside his mornings to practice at an institute in the city centre. There, the number of patients is much higher than that which visit him in Malir the entire day – a mere 25 people on an extremely busy day.

Local expertise?

Most doctors at the hospitals are armed with only local qualifications and do not have much international exposure – far short of the kind that specialists in the city centre have acquired as amply exhibited on their clinic walls. The doctors who sit downtown have the additional advantage of high volume which gives them more practice and makes them better at their job.

One of the hospitals in Malir proudly displays a list of experts at its entrance. But most of them only have an MBBS degree next to their name. There are only a handful of FCPS or Fellows of the College of Physicians and Surgeons, which is a higher qualification. You would be hard-pressed to find a familiar name in the list of specialists.

This would explain perhaps the low fee of Rs350 to see one. This is about 40% lower than what you pay at hospitals in the city centre. There is an obvious trade-off though. You might be paying less, but you have to forgo convenient timings.

Equipment

The good news is that the hospitals do have ventilators, CT scanners and ultrasound machines, labour rooms, incubators. laparoscopic equipment, and offer endoscopies and colonoscopies. But much of the diagnostic burden is shared with the laboratories mushrooming in the area. Most of the hospitals have an operation theatre, but it is hardly ever used. The hospitals do not have any security either. There are very few relief packages for the poor and they hardly report infectious diseases to the government.

Going the distance

The hospital management constantly complains that the turbulent political landscape of the city has had an adverse impact on patient care. “You cannot separate politics from daily life in many parts of the city and Malir is one of them,” said an administrative officer at one of the hospitals. “We don’t want any drama at our place. Some attendants are so intolerant that they start harassing the doctors when they feel that the patient is in danger,” he said. “We usually refer such cases to other medical facilities.”

At yet another hospital, the entrance is narrow. It has intentionally been built that way so that all the people streaming into the building can be scanned. “Last Friday, five gunshot victims came here,” said the officer, counting them on his fingers. It took the hospital hardly half an hour to staunch the bleeding and tend to the wounds. After the basic first aid was performed, however, their relatives took the injured men away to either Jinnah hospital or Civil hospital to see the specialists. This means then that if a patient has come from a far-flung area, they have to travel an additional 17kms after making a pitstop at a Malir hospital if they want to go to a tertiary care centre downtown.

Published in The Express Tribune, November 3^rd, 2012.

“Factors like poor patterns of commuting, social stratification, a lack of parks and public spaces, inadequate housing choices, a large time spent on making the trip to school, uncontrolled traffic, routine breakdowns of urban infrastructure such as electricity, the water supply…  and the poor law and order [conditions] in our country are leading to increased stress,” he said. Stress and depression were the focus of the discussion at the event organised by the Pakistan Association of Mental Health at the Jinnah Medical and Dental Centre on Wednesday.

If we rated stress on a scale of 1 to 100, it turns out that death of a spouse is at the top (95%). Surprisingly retirement does not cause as much stress as the death of a pet. A broken engagement or love affair (57%) is worse than the lack of a son (51%.) Knowledge of your spouse having an affair racks up 80% and marital separation 77%.

While depression is sometimes called the common cold of mental diseases, sometimes it can have long-lasting effects.  Jinnah hospital’s head of psychiatry, Prof. Dr M Iqbal Afridi, shared how depression is linked to other psychiatric and medical conditions from anxiety and substance abuse to cancer, cardiac disease and endocrine disorders. Forty-seven per cent of people with depression can develop cognitive difficulties, mainly due to the shrinking of the hippocampus, the part of the brain related to cognition and memory.  Depression in cardiovascular illness increases mortality three fold. It also affects mortality in other illnesses such as end-stage renal disease, type-II diabetes and myocardial infarction.

Dr Tariq Sohail, the chairman of SM Sohail Trust, gave a critical review of the theories of depression. Depression is a major dysfunction of the brain and the fourth leading contributor to the global burden of disease. The fact that the prevalence of depression is high in all ages is also confusing.

Dr Naim Siddiqi of Aga Khan University Hospital discussed how to identify and deal with a family member with signs of depression.  They become lethargic, let their personal grooming deteriorate, delay manageable work deadlines, are unable to relax, flare up over little provocation, are negative even during good times, and find it difficult to display affection and love. “The proper way to deal with them is to neither compare them with the unfortunate nor tell them what they need to do,” he pointed out.  “That’s because it’s an illness, not a weakness.” They need to be encouraged to see professional help.

Published in The Express Tribune, October 11^th, 2012.

Since July, the organism has killed nine people in Karachi and one in Hyderabad. The latest cases include four patients living in Federal B Area. This fact sent the Karachi Water and Sewerage Board (KWSB) scrambling to test samples of water from supply lines in the locality. The utility supplies Karachi with over 500 million gallons of water per day after cleaning it and adding chlorine at its filtration plants.

The managing director of KWSB, Misbahuddin Fareed, said on Monday that the results showed that the level of chlorine was indeed low – it was 0.15 (parts per million) ppm when it should have been at least 0.5 ppm.

Despite this, the manager refused to believe that the water was contaminated and asked Aga Khan University to conduct research to determine whether the water did indeed carry the organism. “Our water is running water anyway. It does not stagnate and allow germs to multiply.” He said that the organisation checks the quantity of water every three hours.

Yahya Waseem Qureshi, the water board’s chief chemist, said, “Has anyone found this organism in the water? Some experts say that it is in the water, but it is impossible to detect the microorganism in such a large system.” He added that by the time water reaches people’s houses, the concentration of chlorine does indeed dip, but it is still enough to kill bacteria. A greater concentration might be required to eliminate naegleria, but Qureshi said that there “has to be some research to prove that [adding more chlorine] will work.”

At the COD Filtration Plant where 160 million gallons is filtered every day, around 680 kilogrammes of chlorine is added each hour. Gas is pumped from 1,600kg chlorine cylinders into large pools where water coming from Kheenjar Lake is collected.

“We are following the standard procedure. The record is before you,” said Khaliq Siddiqui, a senior engineer at the plant as he refuted allegations that KWSB was saving money by avoiding chlorination. “People living near the plant have been complaining about pungent smell coming from water. That’s because we have raised the chlorine level in recent days. What else can we do?”

Lack of expertise and
facilities

Like other government agencies, the KWSB also lacks the facilities to detect naegleria. “I would have to do it manually by cultivating it in the lab,” said chief chemist Qureshi. “The situation is like the initial outbreak of dengue. When the first few cases surfaced, there was panic and no one knew what was causing it. We had to seek help from foreign experts to contain it.”

The suggestion that people might be dying by intake of water through nostrils during ablution has also raised questions about the subsoil water used at mosques.

“Most of them use underground aquifers,” Qureshi said.

The victims’ families are still wondering where the disease was contracted. “My brother did not go to any other place except for his office at the Institute of Business Administration. He used to pray regularly, but only at his own office or at home,” said a victim’s brother.

Dr Naseem Salahuddin, the head of Indus Hospital’s infectious diseases department, said that there are so many questions that remain unanswered. She clarified that none of the experts claim that the water supplied by KWSB is contaminated, but are seeking its cooperation because if they ensure proper levels of chlorination, then the bugs will not multiply.

Published in The Express Tribune, October 9^th, 2012.

KARACHI: For Sindh’s health sector and doctors, Thursday, was an important day. After it was torn away from the centre last year, the governor and ministers finally decided on a strategy for the next eight years. This plan includes what the health sector intends to do and how it will do it till 2020.

According to the chief of the Health Sector Reforms Support Unit, Kiran Noman, their strategy is to focus on seven main areas, including the district health system, human resources, regulation and financing. Investment in the health sector needs to be increased by Rs318 billion. They plan on increasing the inflow of money towards innovative financing systems to reduce out-of-pocket expenditure by the poor. This will be carried out by harnessing funding from the private sector and international organisations.

In the district health system, special emphasis will be given to under-developed districts and urban Primary Health Care. The under-developed districts will be given Minimum Delivery Service Packages in each taluka as well as Essential Service of Health Packages in district headquarters for secondary care.

In comparison to other parts of the country, Sindh is not doing so well when it comes to infant mortality, maternal mortality, nourishment of children, child and maternal anaemia, food insecurity and utilisation of the government health resources. The rate of infant mortality in Sindh is 81 as compared to 78/100,000 in the rest of the country.

The government also plans on making sure that remote and disadvantaged talukas have access to facilities such as the provision of support and outreach measures like transport vouchers, district-based pilots on nutrition and social development via the Benazir Income Support Programme.

The new health plan will streamline human resources, production and capacity to support priority health needs, including employment of female health staff in rural areas, enhancing coverage and the technical supervision of lady health workers, sending male and female volunteers to districts, filling vacancies of specialists in rural areas and civil hospitals, develop a trained administrative cadre, a hospital pharmacy cadre and strengthening the management of human resource.

In this eight-year plan, special areas of focus will also cover polio through the community based Polio Plus programme, under nutrition health packages, aiming at birth spacing in young couples, controlling non-communicable diseases and establishing links between communicable diseases for integrated control.

They also plan to set up permanent structures at the provincial and district levels for disaster management, have medico-legal units at the provincial level and incorporate an integrated health response to gender-based violence.

One of the other aims is to increase sector-wide access to drugs through improvement in quality assurance, affordability, supply management and description. This will be carried out through enhancing technical and budget support by market surveillance, training pharmacists and creating a central body for pharmacists.

By setting up a regulatory body for licencing, the health sector aims to monitor the extensive private sector, standardisation of care, minimal reporting requirements and address medical negligence. This will increase and provide incentive for self-accreditation and accountability for medical negligence. In the long run, the government also plans to establish a multi-stakeholder provincial health commission on non-communicable diseases along with a framework for the Peoples Primary Healthcare Initiative. They also want to set up hospital autonomy pilots for major tertiary hospitals and improve accountability in service delivery by increasing internal control at district and provincial levels.

The governor hopes that this plan will improve the healthcare for those who need it.

Published in The Express Tribune, October 5^th, 2012.

“I did not take it seriously first,” says Maheen. “My doctor told me it’s a bacterial infection and I used medicines for two-months but to no avail. By the time I went to the fifth eye doctor, my eye was worse, with a greyish white spot in my cornea. That’s when doctors told me that I have lost my eye permanently,” she says.

Fortunately, one doctor gave her a ray of hope when he said there may be a bleak chance that her eye could be saved, but said that she had contracted a fungal keratitis infection, a painful infection of the cornea that can lead to blindness if not treated. Maheen went on an intensive seven-month treatment which involved putting eyedrops every two hours. “The medicine was formulated, so I had to go every third day to the Aga Khan University Hospital to buy it. “I could not go near the stove or look after my two girls,” she says, adding that since the infection had distorted her eye, she was reluctant to meet people.

For this reason, if an ophthalmologist were to define the most dangerous invention for eye care, he would simply say contact lenses, says Dr Jamal Mughal, a consultant eye surgeon.  “It is an extremely misused medical device,” he says, adding that people are now using contacts cosmetically instead of as a necessity. The sale of disposable contact lenses has also increased their accessibility to a greater population, with contacts being  sold at prices that range from Rs150 to Rs4,000.

Dr Qazi Wasiq, the medical director of Pakistan Eyebank Society Hospital, says that the biggest malpractice is that opticians are now prescribing contacts to people instead of ophthalmologists.  “A contact lense is a medical device that is prescribed on certain indications or for very high power vision weaknesses only.”

The perils

Dr Wasiq says that the indiscriminate use of contact lenses can harm the eye, causing problems such as corneal ulcers, corneal abyss, corneal opacity or corneal blindness. If there is an infection on the axis, it may leave a scar even if it heals. If that scar is on the side, vision will not be affected but if it is in the central cornea, vision will be harmed.  Two to five per cent of contact lens users face any one of the above mentioned problems.

Contact lenses cover our cornea, stopping the oxygen supply to it for hours at a stretch. Prolonged use can cause dryness of the cornea and abrasions, small cuts made by the lens that can cause infections resulting in permanent harm, says Dr Mughal. The most common and serious infection is keratitis, an infection of the cornea (the clear, round dome covering the eye’s iris and pupil). In severe cases, it can lead to corneal scarring that impairs vision, and may lead to the need for a cornea transplant. Keratitis can have multiple causes, including herpes (virus), bacteria, fungus and microbes.

He said that the symptoms of contact lens-related infections may include blurry vision, unusual redness of the eye, pain in the eye, tearing or discharge from the eye, increased light sensitivity or the sensation of irritation.  He said that while there is no data in Pakistan about the number of cases, a study conducted in Karachi during 2006 to 2010 and published in 2011, shows that 68 per cent cases of infection due to contact lens result in visual loss.

Do remember to check the following

•  A lens must be properly sterilised and must be made by a recognised and reliable manufacturer.

•  It should be handled with clean hands and the casing must be cleaned and replaced regularly.

•  A user must discontinue use and immediately consult an eye care practitioner if symptoms of pain, blurred vision, redness, increased tearing or photophobia occur.

•  Rub, rinse and disinfect lenses after every use (except in the case of daily disposable lenses, which should be discarded after being worn once).

•  Air-dry the storage case and keep dry when lenses are being worn.

•  Apply your lenses before putting on make-up and before using hairspray and perfume.

•  Lenses should not be used for more than four hours for cosmetic lenses and 10 to 12 hours for extended wear.

Do not

•  Use tap water, saliva or already used disinfecting solution on lenses

•  Sleep with contacts in your eyes

•  Switch the type of solution you use except on the advice of your practitioner

•  Wear lenses if you are swimming or engaging in any water sport, without goggles.

•  Share your contact lenses with anyone

•  Use rose water or betnisol eye drops in case of discomfort as these agents can be extremely dangerous for your eye and may lead to blindness and permanent disability 

The alternative

Doctors say that spectacles are the best solution for weak vision. If not, there is always the option of laser surgery that can cure the defect, says Dr Wasiq.

Published in The Express Tribune, October 2^nd, 2012.

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KARACHI: No detail was too small for Clare Juma, whether it was an unpinned school uniform sash or a leave of absence application handed in without an envelope. This is the stern stuff teachers are made of. And with Mrs Juma’s passing on Thursday, St Joseph’s Convent High School’s matric section mourned one of its best disciplinarians.

Mamma Clare, as she was referred to fondly by close colleagues, worked at the school in Saddar for more than 15 years. She died of chest congestion which developed into pneumonia after she was hospitalized for about a week. “She had a very serous case of Alzheimer’s which got to her very fast,” said her eldest son Khayam Juma. “It was so bad that she could not recognise anyone and could not do anything on her own.”

Clare, a Goan Christian, was born on August 12, 1942, the third of five children, who all went on to careers in teaching. Indeed, her husband and children followed in the same line. Mrs Juma had a rich career before arriving in Karachi as she had taught in places such as Morogoro, Tanzania and Dar-es-Salam.

When Mrs Juma left school in 2010 to go on medical leave, headmistress Sr Julie Pacheco sorely missed her support.”She worked on the academic side on each and every child and would apprise me of each one’s issues and problems,” she said. The school had section for struggling students, and Mrs Juma chose to work with them the most.

Ex-student Tehmina Waleed recalled how she once wrote that she was absent from school over a domestic problem but instead of ignoring it, Mrs Juma and Sr Julie took an interest and actually called her in to the office to find out exactly what had happened.

“Miss Juma was an important part of SJC,” added student Sahar Khalid. “She was a magnificent teacher who cared and understood the girls so well. We were fortunate to have her as our mentor and her strict principles undoubtedly have a positive impact on our lives.”

Indeed, Mrs Juma was just an encouraging at home. “She was unlike other mothers-in-law,” said Audrey Juma, the wife of her youngest son who was the closest to her. “She supported me a lot after my marriage, looked after my children and pushed me to do my PhD.”

Clare’s sisters Rose Correa and Margaret Correa remember her as a loving and devoted sister. “She was full of life and her students liked her a lot for that,” said Rose who also worked with her at SJC. Her son Khayam pointed out how she wielded such authority at home that she never needed to shout; all she had to do was say it and it would be done.

Colleague Mrs Azra Kamal, who was her best friend since college, will miss her cooking. “She would cook innovative dishes like daal with potato,” she remembered. “We used to go together to university and never lost contact after that even when we married and moved to other countries.”

Mrs Juma leaves behind three sisters, Rose, Margaret and Joyce, and brother Leo, her husband, two sons and a daughter. Her funeral, which is scheduled to take place at St Lawrence Church, is on hold till her sister, Sr Joyce Correa, arrives from the Philippines and her daughter Sahifah Indrias flies in from Ireland.

Published in The Express Tribune, September 29^th, 2012.

MQM chief Altaf Hussain addressed the public over the telephone, saying that if appropriate action was not taken, there could be World War III.

Altaf, however, appealed to the people to not stoop to violence. “Attacking the police, consulates and opening fire on our own people is not the way to express anger.”

The party chief urged President Asif Ali Zardari to bring up the issue of the blasphemous film at the next UN meeting.  Supporters of the Muttahida Bainul Muslimeen Forum, including women and children, assembled without sticks or stones and attentively listened to the speeches made by religious scholars. The scholars lashed out at the filmmaker and the US government and praised Muslims, Hindus and Christians for uniting against the movie.

Allama Abbas Kumaili said that the entire Muslim Ummah was united in its love for the Prophet (PBUH). “No one is a Deobandi or a Barelvi today.”

During Kumaili’s address, party volunteers suddenly rushed towards the approaching Pakistan Tehreek-e-Insaaf rally and asked them to wait till MQM’s protest was over.

Christian leaders also came forward to express solidarity with their Muslim counterparts. Bishop Sadiq Daniel said that all the Christian communities in Pakistan condemned the film. “We are in favour of a strict punishment for the filmmaker. May God also punish this man.”

Sindh religious affairs minister, Abdul Haseeb, appreciated the Christians and Hindus for coming out to condemn the movie. He said that Islam preaches discipline and violence was not a part of it.

Muslims respect every prophet, including Moses (RA) and Jesus (RA), said religious scholar, Asad Thanvi. “We demand that others show the same respect as us.” Thanvi called for the UN to adopt a resolution against desecration of religions.

PTI gets its turn

Empress Market was buzzing with energy as the Pakistan Tehreek-e-Insaf supporters lined up to protest against the controversial anti-Islam film after Friday prayers. Their demonstration was also a relatively peaceful one compared to the others that were carried out in the city. The supporters were led by the party’s secretary general Dr Arif Alvi, Sindh president Sardar Nadir Akmal Leghari, and the advisor to the party chairperson, Imran Ismail.

The protesters were told how to remonstrate against the film and the US – but in a civilised manner. With their party’s flag tied on their heads as bandanas, protesters marched on. A few protesters had brought tyres and effigies draped with the American flag to burn but party leaders told them to remain calm. Some of them managed to burn the flag later. After leading the protest to Karachi Press Club, the leaders said that there should be a law to protect the religious sentiment of the Muslims. They added that the government should ask the Organisation of Islamic Council to take action.

Other parties, including the Sunni Tehreek and Majlis Wahdatul Muslimeen, also gathered at Empress Market to protest.

Three killed

Three supporters of PTI were killed and 35 were injured when the police opened fire on them at the Native Jetty bridge, said the party’s spokesperson Faisal Vawda. The workers were on their way to join the party’s rally at Empress Market. Around 50 others were arrested at the Kemari Police Station. Talking to The Express Tribune, Vawda said that the party members were unarmed and were not part of the violent activities. “The government has proven once again that it is being run by criminals,” he said, adding that the PTI is an educated party and its workers are responsible, respectable citizens. “The government did not react when people looted banks and burnt public and private properties but it ordered to kill innocent protesters.”  The leaders visited the families of the victims late Friday night. The namaz-e-janaza of the deceased, Qari Khalid, Ghaffar and Shafiq, will be held at 10 am on Saturday at the KPT Ground.

Published in The Express Tribune, September 22^nd, 2012.

Youm-e-Ishq-e-Rasool (pbuh) [love of Prophet Muhammad (pbuh) Day] was observed throughout Pakistan on Friday on the orders of the Government of Pakistan, condemning the anti-Islam film.

After Friday prayers, protests erupted in several cities across the country which soon turned violent. As the police remained unable to control the protesters, a loss to life and property was reported.

A total of 20 people were killed across the country and more than 200 were wounded during the protests. Cinemas, banks, vehicles and fuel stations were torched, while markets were also vandalised.

Two police officials were also killed during clashes in Karachi.

The central leader of Jamiat Ulema-e-Pakistan (JUI-F) Maulana Fazal Rehman commended the nation over successful protests across the country against the anti-Islam film.

Political parties have called for observing a day of sorrow on Saturday over those killed in Karachi on Friday. Transporters in the city have also announced their decision to keep their vehicles off the roads.

Three PTI supporters killed

Three supporters of Pakistan Tehreek-i-Insaf (PTI) were killed and 35 were injured when the police allegedly opened fire on them at the Native Jetty Bridge as they were making their way to the party’s rally at Empress Market.

Around 50 other PTI protesters were arrested at the Kemari Police Station.

Talking to The Express Tribune, the party’s spokesperson Faisal Vawda condemned the act and said that the supporters were unarmed and were not creating any havoc. He said that the government is to be blamed for this act “as it had instructed the police to open fire at citizens”.

“Once again the government has proved that it’s actually the criminals who are running its machinery,” he said. “The government did not react to the people who looted banks and burnt public and private properties while it ordered to kill innocent protesters.”

He added that the party will define a strategy and fight against the killings. The party leaders visited the families of the deceased late Friday night.

The funeral prayers of the deceased workers, Qari Khalid, Ghaffar and Shafiq, will be held at 10am on Saturday at KPT Ground. The party also plans to lodge an FIR against the government tomorrow against the killings.

End of live updates

9:50pm

At least 15 people have been killed and more than 200 wounded during the protests, including 10 in Karachi and five in Peshawar, hospital officials told AFP.

The combined total of wounded in Karachi, Peshawar and in the capital Islamabad has reached 219.

A doctor at Karachi’s Jinnah hospital told AFP they had received five dead and 65 people with injuries, while the city’s Civil hospital said it had also had five bodies, including that of a police officer, and at least 40 injured.

Hospital doctors in Peshawar gave a combined total of 79 people wounded.

In Islamabad, a doctor at the Services Hospital said 35 people were brought in with injuries, including eight policemen and four civilians with gunshot wounds.

9:29pm

A total of five cinemas have been gutted down in Karachi, including Nishat, Capri and Bambino in Saddar and Gulistan and Nargas in Quaidabad.

9:08pm

Protesters torch a church in the Mardan town of Khyber-Pakhtunkhwa.

8:59pm

Talking to the media in Islamabad, Interior Minister Rehman Malik expressed regret over the suspension of mobile phone services in Pakistan, reported Radio Pakistan.

Malik also expressed sorrow over the loss of lives during riots and asserted that the government had protested at every level against the blasphemous film.

8:33pm

Pakistan Muslim League (PML-N) president Nawaz Sharif has appealed to the protesters to remain peaceful.

7:40pm

The combined total of wounded in Karachi, Peshawar and in the capital Islamabad has reached 195, according to AFP.

Doctor Mohammad Shafqat of Karachi’s Jinnah hospital told AFP that it had received four dead bodies and 65 people with injuries, with more wounded arriving.

Doctor Mohammad Ayub at the Civil hospital, said his medics had received five dead bodies, including that of a police officer, and at least 40 injured.

7:28pm

Muttahida Qaumi Movement (MQM) chief Altaf Hussain appealed to the people that if they love Prophet Muhammad (pbuh), then they should keep the protests peaceful “at all costs”.

Hussain also appealed to the UN and OIC to take immediate notice of the blasphemous film and the cartoons published in France. He said that the world might see the third world war if action was not taken against them.

7:08pm

The US Chargé D’Affaires Ambassador Richard Hoagland was summoned by the Foreign Ministry and a strong protest was lodged with him over the blasphemous video.

He was told that the US government should immediately take measures to remove the sacrilegious video from YouTube and take action against its maker.

Ambassador Hoagland reiterated his government’s position as well that of the US leadership that they strongly condemned the video. He stated that a vast majority of the American people have also condemned it.

6:53pm

Cell phone services have been suspended again in Karachi.

President Asif Ali Zardari and Prime Minister Raja Pervaiz Ashraf have expressed grief over the death of ARY TV worker Muhammad Amir in Peshawar.

In separate messages, they urged the nation to remain peaceful during the protests.

The president and the prime minister said that a peaceful protest was the appropriate way of expressing sentiments.

6:47pm

Death toll in Karachi riots reach 14, reports Express News. More than 80 people are reported to be injured in the city.

6:44pm

Rangers have been summoned in Lahore to disperse the protesters.

Karachi Deputy Commissioner South Mustafa Kazi told the media that around 100 protesters have been arrested by the police so far.

6:27pm

Information Minister Qamar Zaman Kaira criticised the ongoing protests and said that this was not the right way of expressing love for Prophet Muhammad (pbuh). “Pakistan is the only Muslim country in the world which has lodged a protest on a state-level,” he remarked.

Kaira stated that it was the national responsibility to provide security to embassies and consulate in Pakistan. “We have our consulates in the world as well.”

Religious leader Mufti Naeem also disapproved of the violent protests and maintained that the ulema community should make a strong appeal and talk to the people.

“This is our government’s fault. The government provided this opportunity to the people. It should have sent a representative to the US to lodge a protest and should have boycotted the US products instead of declaring a day like this,” he maintained.

6:21pm

Express News is reporting that a blast was heard near the Native Jetty Bridge in Karachi.

6:03pm

Punjab Law Minister Rana Sanaullah, speaking to Express News, expressed support for the protests but maintained that the damage done to property during riots was helping fulfill the “enemies’ ambitions”.

“I have given instructions to the administration to talk to the ulema and the protesters instead of using force,” he said and added that force had to be used in Lahore when some protesters tried to reach the US Consulate. “Otherwise, the protests were kept peaceful with interactions.”

5:57pm

Unidentified men opened fire at Hyderabad Press Club.

Mobile services have also been partially restored in Peshawar.

A cinema located on Toghi Road in Quetta has been set on fire.

5:47pm

Three police vans have been torched outside the Chief Minister House in Karachi.

5:36pm

During riots in Karachi, three police vans, five cars, five cinemas and five banks have been torched so far.

Ten people have died in the protests, including two policemen.

5:16pm

Cellular services in Karachi and Lahore have been partially restored.

5:07pm

A fast-food restaurant in the industrial area of Karachi has been set on fire, while a cinema in the Landhi area has been trashed.

4:55pm

Express News reports that two more cinemas on MA Jinnah Road, other than Nishat Cinema, have been torched by protesters.

4:49pm

Visuals from the Faizabad area of Rawalpindi showed police vehicles on fire.

Protesters have also targeted the fire brigade in Karachi.

4:45pm

Protesters have torched a petrol pump in the Faizabad area of Rawalpindi.

4:41pm

There is no sign of police in the Aabpara area of Rawalpindi.

Two banks have been torched near PIDC in Karachi.

Protesters are reported to be looting shops and businesses near PIDC. The area is close to one of the routes that lead to the US Consulate in Karachi.

4:39pm

According to Geo News, Prince Cinema in Karachi has also been set on fire.

Five police vehicles have been set ablaze in the Faizabad area of Rawalpindi. Protesters and the police have been regularly clashing in the area.

4:37pm

A private bank on GT Road, Peshawar, has also been set on fire.

4:35pm

Express News correspondent Qamar ul Munawar in Islamabad reports that the direction of the wind is towards the police, due to which the tear gas is flowing towards them instead of the protesters.

In Lahore, the protesters are reported to be close to the US Consulate.

PPI reports that cellular services will remain suspended till 6pm.

Islamabad, Rawalpindi, Lahore, Karachi, Quetta, Peshawar, Faisalabad, Jhang, Multan, Khanewal‚ Chakwal‚ Kot Moman‚ Attock‚ Murree and Chakri are currently facing suspended cellular services.

4:32pm

Protesters in Islamabad’s Red Zone reach the last barricade of containers and continue to clash with the police. Express News reported that around 15,000 more protesters have entered the Red Zone.

A bank on MA Jinnah Road in Lahore has been set on fire.

4:27pm

Protesters in Karachi set Nishat Cinema on fire.

4:24pm

Two police officials have been killed so far. The second casualty came after a policeman injured during clashes at Sohrab Goth passed away.

During an ASWJ protest in Karachi, a dog was seen wrapped in the US flag among the protesters.

Protesters and police officials continue to clash in PIDC area of Karachi.

4:03pm

A police official who was injured during the clash at Native Jetty Bridge has passed away.

4:00pm

Protesters in Islamabad are pelting stones at the police in efforts to enter the heavily-guarded diplomatic enclave. The police, in turn, fired tear gas at them.

3:55pm

In Lahore, one police official was injured during a clash with the protesters, who have managed to cross over the containers that were placed to block them. They say that they want to go to the US Consulate to register their protest.

In Karachi, the police resorted to aerial firing at the Native Jetty Bridge to disperse the protesters. Protests have also emerged in the Numaish area of Karachi.

3:48pm

Protesters were successful in removing containers from Shahra-e-Quaid-e-Azam. They are marching towards US Consulate.

3:43pm

Police started aerial firing as an influx of protesters marched towards Shahra-e-Quaid-e-Azam in Lahore.

3:38pm

A youngster in Lahore jumped off a pole during a protest. He was shifted to a nearby hospital where his condition is said to be critical.

3:32pm

Police officials at the Red Zone appear to be helpless in front of the protesters. The protesters have gloves on and are picking up the teargas shells to hurl them back at the police.

Many police personnel have passed out.

3:24pm

A heavy contingent of police has been deployed at Shahra-e-Quaid-e-Azam in Lahore in order to obstruct the movement of a rally proceeding towards the road.

3:18pm

Aerial monitoring of the Red Zone is being done by helicopters.

3:10pm

According to Express News correspondent Qamarul Munawwar, a vigourous clash took place between the police and the protesters at the Red Zone in Islamabad.

Munawwar reported that protesters hurled burning tyres and stones at the police and crossed the barriers placed by the police and have entered the Red Zone.

The police personnel have taken positions to start shelling.

Rangers deployed around Diplomatic Enclave have been alerted.

3:03pm

Protests have sparked in Sohrab Goth, Gurumandar and Khudadad Chowrangi areas of Karachi, while three people have been injured in firing incidents in Steel Town.

Angry protesters blocked National Highway in Karachi.

Death toll in Karachi has reached four.

2:50pm

Police in Islamabad had to resort to aerial firing in order to disperse protesters as they were setting up containers to create cordon points. The protesters, armed with sticks and stones, have been attacking the police and have also destroyed billboards and traffic signals on the route.

Close to 200 protesters from the Jamaat-e-Islami (JI) and Ahle Sunnat wal Jamaat (ASWJ) have gathered at the Qayyumabad Chowrangi in Karachi.

2:40pm

Difa-e-Pakistan Council (DPC) protesters have moved towards the Red Zone in Islamabad. Containers have been placed at all entry and exit points and security personnel are also present.

Gen (retd) Hamid Gul was also seen addressing protesters. It has been reported that Rehman Malik had earlier asked DPC members not to move towards the Red Zone.

Protesters trying to enter Islamabad via the Faizabad Interchange have clashed with the police. Police has resorted to using teargas.

2:30pm

All routes leading to Mall Road have been blocked. Those traveling on foot or on cycles have made it to the area. It has also been reported that an equal number of people are also making their way to the area.

Express News correspondent Talib Faridi has reported that demonstrators have said that they will continue with their “peaceful” protest till action is taken against the film.

Protesters in the area also pelted stones and tried to move containers that have been placed to block routes.

2:25pm

The situation is reported to be tense in parts of Karachi. Rioting has been reported in the Sohrab Goth and Super Highway areas of the city.

2:21pm

Talib Faridi of Express News reported that a huge rally has congregated at Mall Road in Lahore, with participants from Jamaat-e-Islami, Pakistan Muslim League-Nawaz (PML-N), Pakistan Muslim League Quaid (PML-Q), members of the civil society, lawyers and shopkeepers from Mall Road and Anarkali bazaars.

2:12pm

The Interior Ministry has summoned U.S. Charge d’ Affaires Ambassador Richard Hoagland and asked him to get the film removed from YouTube.

1:52pm

Islamabad police confronted protesters near Faizabad Bridge.

An Ishq-e-Rasool Conference is being held at Governor House Punjab in which members of all religious parties have participated.

Three resolutions have been passed during the conference determining steps that will be taken in the future against any blasphemous moves. The resolutions also seek assistance from the Organisation of the Islamic Conference (OIC) and Muslim countries.

1:27pm

The entry and exit points of Islamabad have been sealed.

1:24pm

Chief Minister Punjab Shahbaz Sharif said that the Government of Punjab condemns the anti-Islam film and that the entire nation is protesting against it.

He said that the film is a form of “open terrorism”. Sharif further said that disrespect of Prophet Muhammad (pbuh) cannot be tolerated.

“All the entry and exit points of Karachi are heavily guarded. Helicopters are on stand-by for aerial surveillance,” provincial police chief Fayyaz Laghari told AFP.

“We have deployed our maximum police force to the sensitive parts of the city to ensure security during protest rallies today,” he added.

1:13pm

Newsweek Pakistan, in a message posted on Twitter, reported that a correspondent of ARY News was killed by police bullets in Peshawar. However, Express News reported that a driver named Muhammad Amir, employed by a private TV channel was killed in the incident.

1:02pm

The building of Khyber-Pakhtunkhwa Chamber of Commerce and Industry has been set ablaze by protesters.

1:00pm

Express News correspondent Imran Asghar reported that Islamabad police has ran out of rubber bullets as a result of heavy firing.

He said that when protesters in Rawalpindi ran out of tyres to burn, they broke into tyre shops located at the Pir Widai Road and stole tyres from there.

A control room has been established in the Red Zone in Islamabad on the orders of Chief Commissioner. The control room is tasked to monitor the security situation and keep the Interior Ministry updated.

Different political and religious parties, including Jamaat-e-Islami, Majlis Wahdat-e-Muslimeen, Jamaatud Dawa, Ahle Sunnat wal Jamaat, Jamaatud Dawa, Pakistan Tehreek-e-Insaf, have announced that rallies will be taken out after Friday prayers.

12:43pm

Three police officials in Rawalpindi and one in Peshawar fell unconscious after teargas was fired.

A number of protesters were also injured during firing in Peshawar.

Protesters in Gujranwala burnt effigies of US President Barack Obama during a demonstration.

12:35pm

A 2kg bomb recovered from Bhana Mari area of Peshawar has been defused.

12:33pm

Express News correspondent Naeem Qaiser reported that all the roads leading to the Office of Consul General of US located at Shimla Pahari have been blocked with containers, while Mall Road that leads to US Consulate in Lahore has also been blocked.

Aftab Khan from Karachi reported that Jamaatud Dawa, Jamaat-e-Islami have announced that they will hold rallies after Friday prayers. The rally will march from Guru Mandir to US Consulate.

12:22pm

Roads leading to the US Consulate have been sealed in Karachi.

12:20pm

A contingent of Pakistan Army has been deployed around the US Consulate in Peshawar in order to thwart any possible terror bid.

Interior Minister Rehman Malik has ordered that security in Islamabad be tightened and that no members of banned outfits will be allowed into the city. He said that directives in this regard have been issued to the Inspector General of Police Islamabad.

12:15pm

A demonstration organised by Pakistan Tehreek-e-Insaf (PTI) is being carried out in Quetta.

The protesters in Peshawar said that they will proceed towards the US Consulate after Friday prayers.

12:10pm

Express News correspondent Islamuddin reported that many protesters fainted as a result of the teargas shelled by the police. They have been shifted to Lady Reading Hospital.

He added that an additional contingent of police has been deployed around Firdous Cinema, while the fire brigade has been called to put out the fire. Islamuddin said that cinema’s interior has been completely destroyed by the fire.

12:02pm

Police opened fire and fired teargas shells to disperse the mob in Peshawar.

Section 144 has been imposed in Islamabad.

11:59am

The Ahle Sunnat wal Jamaat (ASWJ) has taken out a rally in Hyderabad in which protesters are burning US flags.

Members of the Sikh Community are also protesting against the sacrilegious film in Nankana Sahib.

11:49am

Protesters in Peshawar set ablaze Firdous Cinema and destroyed shops located nearby.

KARACHI: Sometimes, it takes only two weeks to make one realise that home is where the art is. Artist Naiza Khan discovered that Tehran is not short of thriving artists, but there is no free space for them to unleash their creativity.

During her two-week art residency in the capital of Iran, Khan had to conceal her camera and pose as an idle passerby to be able to document her stay through photographs.

With a hijab covering her hair according to the country’s laws, Khan observed that there was certain anxiety among people due to the restrictions imposed by the government.

A visual artist and curator, Khan spoke to the audience at The Second Floor on Thursday about her pictures and experiences in Tehran. She shared a picture of a board at a pizza joint which said ‘you cannot take off your hijab here’ – a concept which is perhaps alien to most in Karachi since there is no law which makes the practice compulsory for women.

While observing the stark contrasts between Pakistan and Iran, one of the main aspects she noticed was the freedom artists enjoy in the former. Not only does the government have sanctions on the dressing and lifestyle of people, says Khan, it has stringent restrictions for the artist community since the green revolution in 2009.

The ministry of culture and Islamic guidance keeps a tight rein on artists who often cannot teach or produce material that contains nudity, political remarks or is of ‘revolutionary’ nature.

The government’s policy towards arts and culture is quite indomitable, says Khan, so much so that the artists boycott the government.

There are, however, brilliant publications on contemporary photography, along with multiple websites and online journals, says Khan in appreciation of the Persian artists. Such work within confinements has produced “exotic” calligraphy and photography.

“Most of the people, however, have come to terms with these laws and restrictions,” says Khan, adding that she didn’t necessarily agree with what they have to go through.

Khan’s work showcased her journey from the tandoor to all the breads she found in five bakeries on her street, tilted ‘Bread of the People’. “My hosts told me that they boycott bread and milk every Tuesday to protest against the high rates of these two dairy items,” explained Khan. “It exuded a sense of unity and solidarity, not like the divided protests we carry out.”

Published in The Express Tribune, September 21^st, 2012.