For A Green Pakistan

Pakistan is loaded with billboards reading a very loud green slogan: Keep your city clean, keep your city green. Now I wanted to work some strategies out for a greener perspective. Since green means more, better and cheaper perhaps much like how to go green. The 3 R’s of environmental protection; Reduce, Reuse and Recycle are to be advocated. Development of ecological intelligence for understanding of how nature sustains life may help us practice sustainable living, which in these times should be of growing interest.

In order to go green, you need to think green; probably greener. Here are a few steps towards the color of new life:

The 3 R’s:                        

Can Pakistan reduce its impact on the environment? I’m thinking deodorants, beef, clothes and gadgets. Reduce waste, for example, reduction in paper consumption. Partners in green are advised to print less, email more and change margins on the word document to reduce paper usage by 5%.  Reduce energy consumption and Reuse. Living in dorms for 4 years has landed me a doctorate in Green Studies. My mother called me the queen of clutter bearing witness to my colossal collection of plastics and various paper goods. Also in the running is Recycling soul. Oprah Winfrey preached how to choose smart off the shelves and recycle goods as much as we can. Some simple ways can help our environment and prevent global warming by convenient implementation without any expense.

Act Green:

Acting green would mean increasing awareness of environmental issues that affect the future of the planet. Spread Green, join a Green program or hold one to educate the community.  Because schools are ideal places to cultivate these Green capacities, ecological education in these settings is very important and more effective. Many Green companies aid schools, communities and other non-profit organizations to educate and empower citizens to make a difference to their environment. Read “Story of the Bottled Water” and “The Story of the Stuff” to channel some ecological inspiration and sense to acknowledge the human impact.

Eat Green:

Eat lower on the food chain; move down a few links and become more of a herbivore and less of a carnivore. A number of chemicals created for industrial use like PCBs and DDT for instance, end up in larger animals. Mercury found in tuna is a classic example of this concern. Consider options by including lots of fruits, vegetables, legumes and grains in your diet. However, organic products are generally more expensive than their conventional counterparts. The organic food supply is limited as compared to the demand.  As for food security, global food production is more than enough to feed the global population; the problem is getting it to the people who need it. Thereby, take only as much as you can eat. Can we change trends at parties and weddings? Go for a seated dinner instead of a buffet arrangement which generates a lot of waste. The caterer always makes more food than will be consumed so it never runs out.

Do Green:

One example to easily employ this strategy is by making it easier for the trash officials by separating plastic goods and paper from the rest of the trash. Therefore, you don’t aim to act green, but also impart green. Also avoid taking away goods. Not only they are more greatly wrapped but surplus packaging wastes resources which contribute to the overflowing landfills. Restaurants and various food joints now practice reusable ceramic plates; cups and silver ware and replacing paper with cloth napkins. Thereby, wash and reuse plastic kits, or consider regular cutlery or portable metal sets. Have your preferred beverage in one of your own ceramic cup instead of plastic/paper cups while travelling. Various campaigns initiated reflect the importance of recycling at the end of a product’s life.

Re-thinking the environmental impact of our decisions and taking into account our plant’s limited resources is an important part of the green education and implementation the Green policy. The strategy can be improvised through the audio/visual networks and newspapers. Turning off lights and appliances when not in use, adopting the use of fans instead of air conditioner in the summers and lowering the thermostat are a few ways towards enlightenment.

Urging the local government to increase sidewalks and bike lanes could prove a positive impact both on the population and the government revenues. Public transportation can cut down on traffic congestion and may lead to improved and more efficient services. Instructing the masses of the benefits of walking and riding which aims to save both money and time could recover health and environment.

Don’t buy. Borrow instead. Being a medical student, I have a made a fortune out of my modest learning by acquiring from used text books as they were stamped with marginal notes and references from previous owners. I passed my legacy to fresh candidates equipped with highlighted segments and additional material. Also, share power tools, appliances and invest in high quality products. They may cost more initially; however, may turn efficient in the long run and require less frequent replacement, consequently less waste. Such thrifty habits won’t cut into your quality of life.

The tap water is treated for safe drinking purposes. Rainwater on the other hand is relatively pure. Therefore, collect rainwater which maybe wholesome choice for non-drinking uses. Supplementing your water needs with rainwater will reduce utility bills and drainage. These attempts may suspend the costly expansion of water treatment services as municipal growth may outstrip supply.

Use Green:

With relatively economical compact fluorescent light bulbs (CFLs) available, Pakistan can use smart lighting which are cheaper and use 75% less energy.  Also, harvest the power of daylight as long as possible. Wind and solar energy have become utility industry’s adoption for the environment’s source of power complimented by countries over the world. Pakistan is currently building solar power plants in Kashmir, Punjab, Sindh and Baluchistan.

Most of the 15 billion batteries manufactured each year are discarded after their span, most of which are alkaline batteries. These batteries have a major share in groundwater leakage when disposed of to landfills. In this electronic era, it makes environmental and financial sense to switch to rechargeable Nickel Metal Hydride (NiMH) or Lithium Ion (Li-Ion) batteries.

Bottled water generates a large amount of waste. Not only it’s expensive, but also verified cancerous with repeated use. Thereby, consider a friendlier approach to drinking by using aluminum instead of plastic bottles while travelling or at work. Also, use a water filter to purify tap water instead of repeated purchase on bottled water.

2 out of 5 of the world population already faces water shortages, and 1.1 billion people in the developing world do not have access to a minimal amount of clean water. So turn the tap off while polishing those pearls. You can save up to 20,000 gallons of water a year, enough to fill a swimming pool!

Avoid using disposable bags. Buy a canvas bag to store purchased items instead of plastic bags. My grandmother always saved and re-used. She carried a large sack which she recovered from flour and rice packaging to the wholesale market. The craftsmanship of an over-sized bag is very captivating coupled with zero stigma attached to its dimensions. So ladies can stash purchases and still manage to look chic.

Expat.com is a renowned Saudi website for practically everything. It offers variety of furniture among other second hand goods. Craglist and Freesharing are a few of the popular spots for hunting down electronics, furniture, books, and other items. One can enjoy almost half of the original price on goodies. Various items casted off from the richer states might hold value to the developing nations and so consumer tendencies of the first class world have created surplus second hand goods. My mother is nature’s best friend. Although she doesn’t realize that she’s taking pounds off earth, she has made useful things out of the useless things.

Think before choosing and the impact of your decision on the planet’s resources. I think the humanitarian efforts would no longer be just a drop in the ocean.

The Social Contract

In Pakistan, medicine is one of the most sought after profession. Admission to medical college is highly competitive like in other parts of the world. Back in the days, a lot of material had yet to be deciphered. Hooray, we wished that it would remain unexplored until we’re out of school, so we wouldn’t have to study that too. It was the same with Fermat’s last theorem and the Riemann hypothesis in Mathematics, cloning animals in biology, and lots of stuff in physics and chemistry were yet to be discovered when I was in school.

 However, it was too late for some things like the structure of the DNA, it had already been revealed, the secret of the nuclear bomb cracked. We had to study the former, but luckily, it was an anti-national or anti-something to teach young students how to make a bomb, the latter was not on the curriculum. A good student got a 63% and a brilliant one scored 72. Anyone who pushed more than that either had his papers re-checked or was immediately made full professor.

 And everyone was guaranteed college admission.  My nostalgia was provoked by a decision by the education committee where the cut off mark for admission was 98%. If you finished your schooling with less than a perfect score, you need not apply. Either we have been creating geniuses in the years since I left school, or high school students have been taking a test designed for nursery school kids. For example, what letter follows ‘C’ in the alphabet?

 I took up the contract along with many students aspiring to become doctors and sat in a Medical Colleges Admission Test (MCAT). Students who failed to qualify for public medical colleges settled for admission in private settings.  Once admitted, we followed a detailed curriculum over the next 5 years appearing for yearly/semester university examination. Success in the final examination granted a degree of MBBS and following registration with Pakistan Medical and Dental Council (PMDC), the graduates were eligible to practice Medicine in Pakistan.

The race began with trying to ensure that wherever the students spend their 5 years of education at either government or private sector; the final product of the dyads is essentially the same. Another argument lies on the student population entering medical school with backgrounds of Pakistani education system (HSC), British (A-Level) and a combination of both with performances in medical college examinations in various years.

Now what leads to an idealistic interest in public service? The heterogeneous foundation of this anticipation ranges from to living the family legacies, intimate contact with the suffering, to set them apart from the common run, or simply, going with the flow. Doctor is one of the most common career choices yet a small percentage enters medical school. Some students abandon medicine because they are told they lack talent; others because they cannot endure the panorama of seven to nine years of education. There are more of others, because they are lured in to multiple academic interests and still others-a significant group – ‘I don’t think I am among them’.

In the course of the social contract, the medical student is less likely to be aware of his own feelings. A decrease in empathic concern including feeling less humanistic and balancing personal life with professional is my personal experience and concern as well. Thereby, despite the potentially serious consequences of a burnout, few interventions exist to combat this problem. Assuming a more partial authority, confronting various aspects of the human condition daily, experiencing substantial vagueness to prevent errors, difficulties in fitting in with the social norms and expectations of the dominant culture of a medical school etc. are only a few glitches a student is challenged with.

Just when our attempts to retain human sensitivity in the modern world weren’t ample, the abuse rooted in medical education took its toll. Despite numerous declarations by the academics, it has shown little amelioration. Therefore, both personal and professional factors appear to contribute to student burnout. Seen from this point of view, this fact should be a subject of research and recognition by medical schools, so they can channel their energies and practice in order to prepare the student for the psychological and physical hazards of his vocation in effort to strengthen students’ sensitivity and social responsibility.

Young students who readily embrace “The Social Contract” experience high levels of pressure during education and training years. The pressure ranges from the large body of clinical knowledge to master and absenteeism, increased competition and demands, inadequate support of health professionals and professional misconduct, financial indebtedness, cultural and minority issues, scarcity of leisure time, poor-self-care etc. This may leave students feeling emotionally exhausted and contemptuous.
So the next Nobel should go to the genius who can perform this crucial housekeeping of our brains – removing the totally useless so there’s room for totally useful; the Medical Schools. Medical schools must train aspiring students to evaluate their personal health and determine its influence on their practice. Another important assessment is support groups for students challenged with personal or professional life events and increase in the humanistic approach in the work force.

Furthermore, medicine’s Social Contract is the profession which receives a variety of public support; thereby schools now encourage their students to complete service work either voluntary or elective. Nevertheless, such a reflective practice may make this kind of learning more fruitful and stable. Thereby, the schools have double function aiming at technical competence and strengthening mental performance.

I think the weighing of the centuries (and the burden of the world) is not upon the old and the ageing. Not if you are a Pakistani Medical Student!

iDoctor

Are you ready to clean up your system? Refresh the nerves, look up your dreams and insert…insert what? Seems that a technophobe student like myself have run out of computer language to continue on my health perspective. In this digital age, I was subscribing to classics like The House of God on my iPhone, casting no less than a 100 songs on my playlist, placing an order at eBay, making online reservations and responding to emails.

From seminar to webinar, episode to webisode, editorial to webitorial and now even webcitations, everyone and anyone can now access the reality of the virtually unreal world from kids to mums and now Doctors. This avenue can take up two paths and I have my reasons to approve and disapprove the use of social media to promote healthcare.

iSupport:

Education and Awareness:

Initially, the primary sources of health information were the doctors. However, using a familiar easy to use interface, patients can have expansive access to quality information; acquiring complete control of their health and lifestyle. Closed communities, as well as open like Twitter and other more public communities, can serve as discussion avenues and learning opportunities. Visitors and registered patients can have full access to the corresponding website and consulting doctor’s portal in order to seek additional information, update health status and follow up in order to ensure privacy and limit misuse of information and identity. Numerous hospitals and famous doctors e.g. Dr Mehmet Oz and the famous reality TV series – The Doctors are experimenting on how to build trust and promote participation in online platforms. Patients can disclose their stories on YouTube and write testimonials on discussion forums to benefit audiences from both parties.

Web-based communication tools will likely enhance e-patient and e-student/doctor education and promote involvement in ways that alter traditional health care interaction and teaching. A variety of complicated surgical procedures and medical interventions previously reputed as “hard to digest” are now easily available as a step-by-step outline stocked with audio/visual enhancements thereby students and young doctors find it easier to adopt and apply to their own practices, leading to enhanced levels of participatory medicine. Doctors can also update regarding details on hospitals/clinics, special cases, drug/instrument retail, educational and exam kits etc. Similarly, webinars, are now being conducted for e-patients and welcome aspiring students and young medical graduates which can be paid/free and are popularized via social marketing for maximum exposure.

The HIVE (Health Innovation Exchange) has been developed as a way to encourage uptake of social media tools by students to support their education at the University of Auckland, New Zealand. A similar interpretation, “mEducator” project is an EU funded initiative of 14 organizations that attempts to establish “best practice” towards the sharing of medical educational.

Communication and Discussion:
Establishment of doctor to patient and doctor to doctor communication via social networking can open doors to new advancements and alleviate some existing problems. Doctors value their relationship with their patients, however are limited by a variety of factors. Non availability, inaccessibly, lack of self-care and education, fragmented follow ups or even consent. Doctors can send instant messages and allow video chats with patients as much as possible. They also can be made available on Facebook/twitter owing to their popularity and a large number of registered users. The synchronous activity can increase availability and access, share information, enable immediate diagnosis and prompt treatment. This facilitates patient empowerment and establishes a friendly relationship with the health care professionals.

Also, the doctors can communicate and share knowledge among themselves in online discussion platforms and the transfer of information can take the shape of any interactive web-based media; especially online videos. Patients can also share and access personalized medical information among themselves and family/peers challenged with similar health problems can benefit from experienced patients via ratings thereby reducing health literacy difficulties.

Feedback, Personal Establishment and Healthcare Marketing:
Web-enabled media require additional research to assess their impact. Social media applications provide convenient web-based interactive communication tools that may promote dialogue between health educators and e-patients. Portals such as Facebook, twitter, LinkedIn, Google Buzz and Foursquare are some of the most followed and sponsored.

The founder of an interactive feedback tool – eyecareScore, Dr. Krefman, is a survey tool known to measure, understand and improve patient feedback. Blogs are a web-based, text-heavy format. Typical blog content on the websites contains health communication messages from medical experts and personal stories from patients. Another hit series are Mobile applications which support health information and messages in a wireless format available through mobile devices like smartphone like iPhone/HTC/Samsung series and web-based tablets such as the iPad/HP/Samsung. Applications include exercises, symptom checkers including Blood Pressure and sugar monitoring, Diet charts, quick drug information, Emergency Dos and Don’ts etc.

Hospitals and doctors may use social media for marketing and public relations attracting both the targets – new patients and recruit physicians. Social media is the most cost effective way to promote a message. It can provide a unique opportunity to position and market brand, add value, differentiate practice from the competitors and benefit health programs. For e.g. Social marketing initiated to de-stigmatize addictions, breast cancer awareness campaigns, eating disorders, health problems of Pakistan like Polio Eradication scheme, Family Planning strategies and Malaria vector control programs were good starters for Pakistan.

iObject:

With several forces converging in the health market to include more digital media, my problems with the social setting are the Privacy Issues, the notion of Consent and Medical Etiquette.

Doctors with bad social media etiquette can indulge in inappropriate patient communication online. Ethics may prevent many physicians from engaging their own patients directly; but they can still serve as teachers to offer assistance. In some hospitals, doctors are being cautioned to avoid interacting with patients on social media; they might try to “friend” you so we suggest you don’t “accept”.  Perhaps they can interact in a professional context and avoid doing so on personal social-media sites; or still they can set up separate professional and private accounts. Later, conveniently, we will be hunted down for another doctor dilemma of handling passwords. “How it’s easier to remember a silly jingle from a commercial and beauty products from childhood but have to go through an entire set of complicated calculations to arrive at a password!”

Technology can threaten patients’ privacy and even their own pocketbooks. A new breed of doctors are identifying medical cases, chasing disease drifts, advertising health campaigns and assessing screening methods via web-generated medical tools. Some doctors are entitled to answer medical questions and voice their opinions via social media, triggering privacy concerns since online anonymity is never guaranteed. Many individuals are not open to talk about their personal sufferings to which accidental revelation might threaten their social and personal lives. For example, breast cancer, HIV, Hepatitis, Legitimacy affairs, or other embarrassing skin diseases. Online interaction undoubtedly limits doctor’s access to important information. Thereby personal questions should still be handled through doctor’s office visits or phone calls; aiming at restoring patients’ values and subjectivities. Patients connect well with the physician; more satisfied with the care and are more likely to follow the doctor’s advice. So, there is a reason why doctors flash lights into your eyes and listen to your breath during an office visit.
Protecting patient confidentiality is important and the standards of behavior and respect for e-patients which are expected from doctors should be observed online; that can’t be on LinkedIn and Facebooked for patient privacy reasons! Consent to publish/share patient information like laboratory tests, photographs and other online confessions can meet public regard thereby defeating the purpose of security and respect. Why are public lashes, medical sufferings and grim images of war of the worlds receiving widespread “likes”?

The open nature that makes social media appealing increases concerns for healthcare organizations.  Social media guidelines application should be made more universal supplemented with stiff penalties. American Medical Association recently released guidance to physicians using social media in their document “Professionalism in the Use of Social Media”

I wonder at times, whether the generated revenue conveniently be spent on a loaf of bread, or an hour of internet…That being said, I think there’s a need for me to be at the hospital!

Juxtaposition : The Neighbouring Broadcasts

Here's my overview of the virtual media approach and their respective impacts and comparisons thereof.

Body mists and colognes
Indian adds focus more on how the locals can curb their odour and reach work pain free. One dad constantly spraying himself after baby sitting is one thing people could relate to rather than a teacher powdering herself and luring the school children into sensing her feminist statement.
Though both sides have the same mind set but the chunky humour pouring from the Indian adds is to die for. If Kitkat talcum powder was taken over by our neighbours, I bet I too could have given in; too classy for competition!

Domestic paints
A beautiful model clad in an evening crepe walking past purple matt walls of virtually strange world opposed to real inhabitants of a home working bits and pieces for a meaningful transformation. The idea of how simple enamel can change your life jolts the consumer mood to get in touch with colour that instant.  Indian ads display weather changes, envious neighbours and friendly spaces. Also, their painted homes include real people, real furniture and real paint too!

Online merchandise
The online shopping ads are perhaps the best broadcasts. They range from couples having a cute feud over furniture, secretly browsing  jewellery and real life situations over exchange polices and returns. The virtual home decor not only offers a wide range of articles but also the ease of access screaming out in every advertisement. A delivery man hands out a recite post delivery to the happy customers and the recipient wife elbows her hubby for a quite gesture out of the pocket; that's when the delivery man quotes "please, save it". The whole point of the exchange was that delivery had absolutely no strings attached! It really set me free...

Fairness frenzy
I have seen very inspiring commercials on Indian telly. Let's begin with a simple soap. A dusky young women, out in the fields, dressed in army shorts and tank top humming an empowering melody. That soap was to wash you free of dirt; perhaps what all kinda soaps do. Moreover in this other fairness commercial, a young girl was shown travelling around the world and not just talking selfies and running into her old flames but doing charitable work, planting trees amid scorching heat and delivering to the masses on a common ground. The fairness cream was embodied under the slogan "for a glowing skin and attitude". So Im guessing she's not worried about her "Rishtas" at this point! I do agree with sharing the same values, however the Indian audience often advance to empower their dusky feminists.


Beverage Rage, Crackers and Sweet Indulgence
Apart from crass lingua, the seemingly sovereign adolescents enter into a dream world of endless possibilities like air walking, wind surfing, and of course, the wings... Indian challengers target real girls and boys in real circumstances. A young desi gal carrying a back pack stresses out on a missed train and ends up in a long cue of ticketing. She finds a masala lemonade and drinks her heart out however, it doesn't put her out of her misery, just puts an end to her thirst on a hot day! Simple and solacing. Adding sexism to  fruit juice or milkshake is absolutely demeaning and could prove damaging to our kids opening their lunch boxes. Most chocolate and other savoury broadcasts rotate around beautiful models clad in red carpet attire, at the edge of their apartment space secretly indulging in the dark confection, dawdling the day away. However we came up with a rusty relationship put to fire with a touch of chocolate in one of the recent adds; it was sweet and romantic. Also, I would rather prefer crackers tossed around amid a group of individuals on a beach than a girl liking the crinkle crisp out of them!

Motor Vehicles
The vehicular traffic is a huge attraction in India, especially the mini scooties and bikes. Scooties though not a thing yet in Pakistan; but all advertisements are very edgy and autonomous for the bold and the beautiful flaunting risks, challenges and opportunities for women. The cars on the other hand apparently serve as a medium towards school, a fun gathering on the beach, a routine visit to the doctor's and forever nursing grandma. Despite all motor adds being monotonous, on the Pakistani tube, "mein te honda hi laisan" which has years of wisdom is cultural in itself and I like it.

Protein shakes and Young World
A local brand advocating butter as a healthy part of a growing child and iron deficits are sure to top the list. The neighbours have stepped ahead with a story of ingenuity waiting to unfold where a mum assists her child in sport activities; to empower him further, she swims and races with him. This advertisement limned great zeal and parent involvement in juvenile years.Then are the biscuits - does a pack of lip smacking snacks illuminate your dancing skills? Get two individuals happily married? or Fuel energy into a boring feast? Don't even get me started over cooking oils and molanas in it!

Internet and Services
Indian tele-networking adds are by far the most humorous, showing young generation making use of the Internet to the best of their interests. We all might use the connection the same way, however the ideas and future models that Indian telly delineates is absolutely out of the box. Lads opening up restaurants, girls setting up small scale businesses, the unfortunate masses educating themselves and senior citizens working their way ahead all twisted with a bit of humour. Since Internet is faster than the speed of light and sound these days, it's very important how we shape the virtual world for our future generation. Sadly, our crust maintains it on a prolonged talk time  and did I mention talk time?

Des Sports
Advertisements get a whole lot cheesier during periodic match months with both neighbouring countries airing colourful patriotism throughout. Incorporation of sodas, special services, eatables and even dishwashers highlight seasonal fever which catch much attention and provoke actions. Get-togethers involving all age groups and endorsing athletic kings ignites our dormant culture and values. Formerly, both the countries have come up with slightly racy broadcasts however, by the end of the inferno, there are always winners and losers.


Sent from my iPad

Biomedical Weaponry - A Medical Faux Pas

Just as a “disasters are an opportunity for development”, the Second World War is known to give birth to “huge advances in medical knowledge and surgical techniques”. This article would provide you with the highlights in history of the friendly use of medicine out of which some good and bad has resulted. If I poisoned your fields with bio-agents as an answer to your attempt to poison mine; it can be dually regarded as good and bad. Biological warfare is a deliberate use of various agents to spread disease amongst plants, animals, humans and everything and anything.

Some of the most common, deadly agents known to have wiped out populations are as follows: Among bacteria are Anthrax, Plague, Tularemia, Brucellosis, Q Fever. Among viruses are Smallpox, Viral Equine Encephalitis and those responsible for Hemorrhagic Fever (Filo/Flavi Viruses); and toxins include Ricin, Botulinum, Mycotoxins and Saxitoxin.

Wars forced companies to develop highly effective medicine and techniques on an industrial scale. Pre-war penicillin discovery by Sir Alexander Fleming increased the chances of survival of appalling casualties and henceforth the treatment. In addition to pioneering the work on skin grafts and blood transfusion, refining in the war years were preventive medicine for malaria, tetanus, gangrene, pneumonia and gonorrhoea.

Poor man’s atom bomb: The Romans attempted the first ever use of biological weapons (BW) by poisoning water supply of the enemies using battered animals. Later, this thought was elaborated by the Mongols in 1346 who used corpses infected with plague instead of animals to stretch a bigger picture. In 1710, the Russians defeated Swede enemies by plague-infected corpses. The British didn’t lag behind who in 1767 aided the Indians with blankets initially used to protect smallpox victims.

 A popular weapon, Anthrax was first used by the Germans in 1916. They also used Glanders, which is an infectious disease cause by Bacterium Burkholderia Mallei to infect equestrians and feed to allied forces. Romanian sheep, Argentinean mules and American horses, all had been used to feed the human agenda.

The Japanese stepped in to poison Soviet water supply with intestinal typhoid at the former Mongolian Border in 1937. Ever since, Japan began its Offensive program in to which at least 10,000 prisoners have given their lives to. Japanese plague-fans dropped rice and wheat mixed with plague carrying fleas over China and Manchuria.

In 1942, the US began their Biological Offense program. Various tests were conducted henceforth in San Francisco and New York. Germans too tasted the use of offense in 1945 followed by Iraq which embarked to develop a biological offensive program which included toxins like botulium toxin, aflatoxin and anthrax.

In 2001, the anthrax attacks in the United States, also known as Amerithrax, occurred over the course of several weeks beginning on Tuesday, September 18, 2001, one week after the September 11 attacks. The Daschle Letter contained 2gm powder in an envelope, containing 100 billion – 1 trillion spores (10 (11) – 10 (12) cfu) were mailed to several media offices and two Democratic U.S Senators, killing 5 people and infecting 17 others.

Several reasons may advocate bioterrorism. A biological agent self-replicates within the victim, has relatively low costs of production, requires a small dose (1gm of toxin could kill over 1 million people), appropriate particle size and stability in aerosol, ease of dissemination, insidious symptoms, prolonged incubation period and difficult detection. Owing to multiple feasibility features, a biological attack could be planned and placed on a moving or stationary position. Also, the ease of modes (frozen/dried) and methods of delivery (bomblets) have also been described.

 BW still depends upon the susceptibility of the aggressors and Mother Nature; temperature and sunlight, environment persistence of some agents like anthrax, relatively longer incubation period, advanced and specialized infrastructure for development among others maybe limiting parameters. Not only are a wide variety of biological agents genetically being modified to withstand antibiotics and other treatment regimens, but also mocking sensitive detection systems. I find it extra-ordinary to have SARS, MERS and other challenging diseases with resistance patterns escalating regions. Some difficult whereas some easy to grow; incapacitating agents like VEE, Bacillus Anthrax, Plaque, Yersinia and various forms that cause Hemorrhagic fever have high fatality rates once established in a non-immune host.

Viruses are quite attractive weapons from a both engineering/harvesting technique which is a rather effortless and treatment complexity. If you sense an unusual disease entity, large numbers of civilian and military casualties, aerosol route, morbidity limited to the localized geographical area, multiple dead animals; run for your lives! The unusual pattern of victims showing at a health site and vague clinical features should raise suspicion for a covert biological poisoning. Accessible laboratory screening should be implemented immediately and common bio-agents should be cultured by standard methods until specifications can be made available.

 More specific methods include Mass spectrometry for toxins, antibody and antigen tests, DNA probes and Detection of metabolic products. Vaccines, anti-virals, antibiotics and other antidotes should be available en masse to avoid overwhelming supplies. Common sources like food and water should be protected, vector control measures, indoor movement, issuing Personal Protective Equipment may all be temporary measures.

 Conventional decontamination methods like chemical, heat or UV may also be utilized. Such detention tactics are deemed impractical and reason for terrorists to continue to implement attacking strategies. Development of the public health systems, public education and programs (workshops/drills), governmental incentives for research and development into biological attack and countermeasures since biological weapons are now being engineered; all have been undertaken to forbid the use of biological weapons.

 The strategies have been targeted to enhance disaster preparedness and response capacity, when initiatives should strictly be taken to promote preventive tactics, interdicting arsenal, registering/documenting purchases, imposing strict penalties and regular screening and inspection of suspected regions. Disaster management should come into action when a biological intervention is suspected. Disaster Management should be an Integrated System of Hospital Management.

 Dr.RezwanNaseer, General Director of Punjab Emergency Service (Rescue 1122) proposed a Disaster Preparedness program. Dr.Naseer anticipated a safety community development program through injury prevention research, school safety program, community safety officers and teams etc. The program is to expand to other provinces of Pakistan; in KPK, AJK, GB and Baluchistan.

Dr.SherazAfridi, Accident and Emergency – Khyber Teaching Hospital, introduced a MIMS course, Major Incident Medical Management Support. The aim of such a service was to provide the knowledge and skills needed to effectively manage the scene of a major casualty incident supported by a “Methane Message” for better understanding.

M: My call/sign/name. Major incident STANDBY or DECLARED.

E: Exact Location.

T: Type of Incident.

H: Hazards, present and potential.

A: Access and egress.

N: Number of severity of casualties.

E: Emergency services – present and required.

 Certain systems which have been developed to detect biological attack are: SMART (Sensitive Membrane Antigen Rapid Test) JBPDS (Joint Biological Point Detection System) BIDS (Biological Integrated Detection System) IBAD (Interim Biological Agent Detector) and The Tactical Biological Standoff Detection System. Bio-terrorism Outlawing Washington Conference (1921–1922), the Geneva Conference (1923–1925), and the World Disarmament Conference (1933) forbade the use of BW.

However, The Geneva Protocol did not prohibit the development, production and stockpiling of biological weaponry. Failure to decommission the arsenal is perhaps best illustrated by the super powers. There are several events in history of a seemingly incidental or offense free warfare, while pushing agendas for peace, sponsoring and staging attacks and establishing grounds for hostile purposes. When our great doctors, health workers, activists and freedom fighters rising to the challenge of the civilian war magnificently are being shut out from raising their voice, who am I write this peace on warfare when the global voices are now silent?

 There remains no time to ponder anxiety, panic or psychological effects among the civilians in attempt to train them against a possible biological attack, applying to both attacking and attacked nations. Rampant bio-agent use for a personal crusade has indoctrinated the methods and availability of sophisticated techniques without considering the consequences. For instance, product tampering (Tylenol tampering cases of the 1980s); attacks on specific ethnic population; sabotage of specific food item (the lacing with cyanide of Chilean grapes in March 1989); attacks directed at one of a country’s agencies or departments (anthrax mailings in 2001). Whether you call it an arms trade or a defense fair, weapons regardless of their kind will continue to be sold to the dictators, which would follow military intervention and a flow of protesters wrapped in an anti-intrusion agenda; giving rise to nothing but massacre; an exhausting merry-go-round.

The Government Luncheonette

My practical venture, ideally the taste of reality began when I stepped out as a fresh graduate embarking on a journey to minus insult to injury, joining a government hospital as per PMDC requirements for a stretch of 12 months. A new graduate sticks out like a sore thumb and so did I. After braving the series of delays in the entrance exam, I was finally handed out my choices for the year. 

Ideas of lending a helping hand to help fill the void and several other encouraging designs were running through my veins. At the time, I felt like a ninja, perhaps a doctor without a border. With most of the government vainness out in the open, how vulnerable was I? Highlighting a series of events and outcomes, I have divided the government setting into 8 subcategories, each with its own surprises.

 The Parfait Healthcare Delivery System:Hospital and hygiene go hand in hand. The sanitary situation in every department lacks even the generic rules of waste disposal method. Beginning from basic techniques, there lacks a concept of waste segregation.

 The containers are not color coded differentiating them from sharps and other forms of risk waste which burdens the waste management plan. The risk waste like pharmaceutical, genotoxic and chemical waste fall into the same bin which is mishandled thereby adding to the health risk. The ambulating services within the hospital responsible for moving patients from one unit to another don’t meet the standards as quite.

 The vain chain to making a request via land line towards the main office to the arrival of the ambulance is enveloped in endless delays pushing caretakers to take charge and conduct the patients to the desired destination. Often, there were several intensive care patients within the unit required shifting with oxygen; sadly, both the nursing attendants and oxygen showed no avail. Patients referred from the main emergency to the corresponding department are seen stretching across the hospital, braving the heat and confusion.

 The blood bank and laboratory are perhaps the only operating units with order. However, collection units servicing the admitted patients in every department had been closed a year ago due to which all samples are directed to the main laboratory by the patient/patient’s attendants, even an arterial blood gas sample dipped in ice-cold water. According to a local perspective, the laundry and food services have little to offer too.

The Individual Unit: A doctor too is a human being you know, and hence a potential candidate entitled to safety, security, privacy and well-being. Through the course of my rotations in the major departments, there were no private rooms assigned for interns, let alone for boys. We either shared a room with the members of the opposite sex or didn’t have a room at all and therefore took shelter in the nursing staff’s shack where we were not welcomed.In the brighter cases where we had a place to settle down after prolong duty hours, the restrooms were devoid of a necessity called water (I didn’t complain of the hygiene at all at this point). Moreover, the rooms often became flooded with the senior on call duty doctors with the juniors compromising their happy hour or adding to the pile. Attacks on personal lockers and unrestrained theft were next that rocked my world.

The Nursing Posse: Here I would like to speak of “some and not all” nursing staff who fail to deliver nursing care and indulge in illegal practices of selling off the healthcare goods to make a handsome living. Every department is allotted a budget that covers certain departmental expenses. Some turn over their departments into a new system, others drive the budget into their pockets. Mostly, I was requested to return used voiles and document disposables consumed at a duty the next morning to a senior staff member. The staff member at various events refused to handout important healthcare materials deemed necessary for post-operative patients and insisted they be ordered by the attendants of the hour. Ruckuses were often sparked following an ample spending on their behalf which was totally justified. On the flip side, some staff members remained true to their responsibilities and did more than their capability to offer help.

The O.T Blues: The sketch of an operation theatre felt like a blue area, highly disinfected, with limited personnel and a protocol that followed. If you should know everything, the theatres were often crowded with interns more than desired. Moreover the practice of proper theatre specific attire including a foot and head gear, scrubbing details and bringing unauthorized personal articles were far from supervision. The advent of disposable gowning and draping is a dream which is yet to come true. Given the resources, I believe the hospital still makes the most of it. However, the smallest details of observing proper measures before, during and after a procedure need a reality check. In the unlikely event of an instrument/machinery running out of order is only followed by a feud and the blame game. Also, patient privacy is still misunderstood and incompletely sought after and the concept of medical ethics in the OT has a supporting role to play.

 The E.R Bloom: The emergency from a distance gave me the chills. It’s been updated into a new building, with central conditioning system instated, separate areas of major trauma departments including a resuscitation room, emergency serial reporting and a theatre. I believe the ER should be a place with absolutely no shortcomings. To begin with, the patients and scores of attendants scramble and split to locate stretchers to put them out of their misery. In case you require wheelchair, you would have to ambulate at least 10 times to find the right person to reason with. Once in, the patients meet their amateur interns and are treated in accordance with the emergency decrees and senior reporting.

 In the morning when most seniors and head staff report to duty, things maintain order. However, as the sun dusks, the ER becomes an independent entity which has rendered the ER helpless and in-efficient. The freedom proceedings range from disappearing from duty hours, making medical supplies in need unavailable, illegal medico-legal practices, misguiding the patients in terms of remote access and pharmaceutical crimes. Not to mention the security of the healthcare workers which often falls into great danger when important personnel, drunkards or criminals arrive for healthcare delivery in the wrath of night. The security officials allocated for their purpose are found napping and sipping in their booths. Obviously, surveillance and profiling hasn’t worked.

The Secret Society: This society only comes to being in events of an emergency. By that I mean foreigners touring for funds/donation, senior accountability, employment/sacking, greetings from highlife, and… can’t think of anything else.The patient welfare fund doesn’t approve of your poverty unless the secret society authorizes. Serology, MRI, thyroid/bone scanning and others forms of expensive reporting harbor bad news to the unfortunate masses. Also, in the event of a mass/multiple casualty when reporters gather around for scoop, the personnel arrive for a routine visit touching only the outskirts of the area. To my surprise, there were more than single units reserved for mass emergencies. These rooms were equipped with automatic monitoring systems, in-built laboratory, quick serial assessment structures and restrooms. I discovered this mode of personalized care when it played host to an official who presented with a low blood-sugar level.

 Us: Speaking so much of the bitter truth, I have thought of nothing positive except the doctors. Because doctors do not discriminate, healthcare belongs to everyone!

An Ode To The Wheels Within

It was just another rough day at the hospital when my friend invited me to a cycling endeavor on the streets of Karachi. I thought to myself, “cycling, in Karachi? Why would someone pursue cycling had they been on good terms with the gym? Or risk their lives to flaunt their recreational mood on a good day? Could it be safe keeping in mind the safety concerns and political unrest for the past few years? What do medical professionals do in their idol space? I sat behind a desk flooded with in-patient files broadening my perspective on harmless fun in Karachi. Being an adventure aficionado, I left behind a lot of memories of creative writing and favourite sports which began their slow decline as I entered the realm of medicine.

Taking the sage advice, we decided to ride solo because my friend feared I will unleash my wilderness on to the streets. However I kept my cool and didn’t hit the roads and limited my edition to parking spaces and sea front. After much decent practice, we departed succeeding morning prayers and embarked on different routes decided prior to departure. Over the weekends, mums and their little duckling joined the ride and suddenly, I felt I was riding into another dimension. Cycling re-defined life in Karachi and the peloton I cycled with totally had me re-imagine its limits. Every Sunday, over 100 cyclists joined and rode into different parts of Karachi; of course the line of travel were carefully selected in accordance with the safety concerns. The group also announced competitions by the kilometer and planned trips to slightly remote islands, beaches and highway.

During one of my rides, I met a woman who owned a 1000c.c motor bike and professed her lifestyle and the taboos attached to it. Her rousing story moved me when she disclosed how she performed daily chores including going to work on her motor bike. Graduating from foot to cycle empowered me with my right to move around freely. When deepika defined her choice to arrive late from work, I thought why not ride to work? I found it difficult initially as people cooled their eyes off, followed me briefly, mouthed obscenities, and mistook me for a daughter of anarchy; nonetheless, the chauvinists failed to throw me off my pedal. Using cycle as means of transportation to work gained me a space in the parking lot though it did prompt an ongoing war between the motor lads and I. people en route became accustomed to my standard routine and I was praised by my fellow colleagues who drove my confidence over. 

The government perhaps could join in hands to promote this two-wheeled action and act upon building a network of segregated lanes for bikers for a safer journey and prevent danger posed by trucks and construction roads. However, one of the paradox elements of cycling in Karachi is that it's not as safe as people might think. Female riders suffer disproportionately as drivers are impatient against their slower average speed. We need to polarise all the fractious groups into a united front to get these basic facilities take form. Perhaps, with the advent of metro bus facility which apparently in shambles, and lack of divided lanes for heavy and long vehicles; cycling network is eagerly awaited by the connoisseurs of the pedalling platoons.

My story is perhaps another women empowerment story on wheels, defeating the conventional notions of female domesticity. However this story only implies to me and perhaps people like me. Just like how deepika’s movement implied to her only. Where women’s participation in variously areas of workforce is debated, this could hopefully abrogate the poison from reflection over several issues associated with women and their right to move freely. Defying the repressive tradition, women should use this mode of transportation to reach schools and offices, healthcare facility and other workplaces.  I’m content with the activity as it keeps me fit and healthy, mentally empowering and physically forward. Perhaps a hashtag trend could spell out which way the masses pedal!