Malaysia Airlines Flight 17 – Not the first, likely not the last

Malaysia Airlines Flight 17 was shot down last ween while flying over Ukraine on the 17th of July.

Malaysian Airlines Boeing 777-200

Malaysian Airlines Boeing 777-200

The Boeing 777 crashed in rebel held areas, and all 283 passengers and 15 crew members are presumed dead.

There has been widespread outcry over the incident. President Obama termed it an ‘outrage of unspeakable proportions,’ pointing the finger at Russian armed and supported rebels. Mr Putin in turn blames Ukraine, citing that it is the responsibility of every government to ensure the safety of civilian flights in its airspace.

Whoever is to blame, it is indeed a tragedy. All loss of life is tragic.

It is especially tragic when a civilian plane that poses no threat to anyone is shot down by a military.

Unfortunately, Malaysia Airlines Flight 17 is not the first civilian flight to be shot down in this manner. 

There have been several such incidents in the past.

Korean Air 007 Flight Path

Korean Air 007 Flight Path

In september 1983, Korean Airlines Flight 007 from Anchorage to Seoul was shot down by Soviet jet fighters, killing all 269 passengers and crew on board. The Boeing 747 had strayed into Soviet airspace. The incident sparked a new wave of tensions in the Cold War.



In July 1988, Iran Air Flight 655 from Tehran to Dubai was shot down by a US Navy ship in the Persian Gulf, killing all 290 on board. The Airbus A300 had taken off from an airport which was also used as a military base. The US investigation revealed that the plane had been misidentified as an Iran Air Force F14.


There are unfortunately several other such incidents. El Al Fligt 402 was shot down by Bulgarian Migs in 1955. Libyan Airlines Flight 114 was shot down by the Israeli Air Force in 1973. And most recently, Serbian Airlines Flight 1812 was shot down by the Ukrainian forces in 2001! 

International Air Travel is by and large safer today than in years past. In fact, many of these incidents sparked changes in safety standards and technology, leading to improvements that go largely unnoticed till a new tragedy strikes. Of note, in the aftermath of the Korean Airlines incident, the US government made the US military navigation system (now known widely as GPS) available for non military use. 

The debate over Malaysia Airlines Flight 17 is not over. There is plenty of blame to go around. The Russian sponsored rebels who fired the missile. The inability of the Ukraine government to secure its airspace. And the decision by Malaysian Airlines (and several others) to continue to fly over an active war zone. None of this is any consolation to the families of the victims.

I will say this though. Malaysia Airlines Flight 17 was not the first civilian flight to be shot down. And if history is any indicator of the future, it probably won’t be the last either. 


Acute Transfusion Reactions

Acute transfusion reactions need to be diagnosed and managed immediately.

This presentation offers a basic overview of common transfusion reactions, their symptoms and initial management.





Pakistan – No Honor in ‘Honor Killing’

Two weeks ago I had a serious argument with a few American and Canadian friends.

The subject of the argument was women’s rights in Pakistan.

These people were convinced that women lead miserable lives in Pakistan.

They were adamant that women are not allowed education and other basic human rights in Pakistan.

This is not a new argument for Pakistanis to have.

Any Pakistani who travels abroad often comes across well meaning but pointed questions about the state of the country.

Questions about the security situation. Questions about education and democracy. About the rights of minorities and the rights of women.

Over time, I have found myself repeating the same few lines in response to all these questions.

When people ask about women’s rights, I point out that we have had a woman prime minister and a woman foreign minister. I talk about women fighter pilots and women army generals.

When people talk about minority rights, I talk about Justice Bhagwan Daas, the prominent Hindu member of the supreme court bench.

My favorite thing to say is that the media likes to highlight the negative. What you see on CNN is not reflective of the whole country.

I am pretty good at these arguments. And I won this argument a couple of weeks ago. I managed to convince my foreign friends that Pakistan is indeed a country that values life, education and civil liberties. I had them convinced that minorities can and do prosper in Pakistan. And after a lot of effort, I managed to convince them that all of Pakistan is not like the tribal areas.


And then this week happened.

Dr QamarFirst , a few zealots took it upon themselves to rid the world of Dr Mehdi Ali Qamar, a member of the Ahmadi sect. He was shot multiple times in front of his family. Shot because he didn’t share the beliefs of the shooters. Shot, because the shooters truly believe that they are doing God’s work, and anyone who doesn’t share their beliefs deserves to die.





Farzana's husband with her bodyThen, a young pregnant woman was killed by a mob in Lahore. The mob was led by her father and brothers. Killed because she had married the man of her choosing. Killed mere 50 yards from the High Court. The police called it an ‘honor killing.’

Apparently Farzana had been engaged to be married to one of her cousins. She had defied her family’s wishes and chosen to marry another man. This, in the minds of her family, warranted an ‘honor killing.’ Otherwise known as murder.


It seems to me that every now and then the people of Pakistan reach for a new low. 

Whether it is shooting a girl for wanting to go to school, or shooting a journalist for speaking his mind.

There is always an excuse for this behavior.All manner of sin is explained away in the guise of conspiracy theories and ‘real stories.’

And these ‘real stories’ are accompanied by vicious aggression reserved for the victim. It’s always the victim’s fault. Why did she have to write about going to school. Why did he come to Pakistan. Why didn’t she just marry her cousin. She’d still be alive.

Us Pakistanis, we are not kind to our own.

But there is no ‘real story’ here. This is the story.

A man was shot for his beliefs.

A woman was stoned for her choice of a husband.

There is no honor in ‘honor killing.’

And as much as I love Pakistan, I can’t bring myself to defend Pakistan.

Not this week.




Samina Baig – A Hero for Pakistan

Pakistan is a difficult country for anyone to thrive in. Much more so for a young girl from a mountain village in a remote part of the country.

But Samina Baig is no ordinary young girl. She grew up surrounded by mountains, so it was only natural for her to start climbing!

And a year ago today, at just 21 years of age, accompanied by her brother and mentor Mirza Ali, Samina became the first Pakistani woman to climb Mount Everest.

Watch the video and see Samina Baig talk about her experience.

You can also visit Mirza Ali’s blog here.

Pakistan has many heroes, but for some reason we don’t celebrate them and recognize them as much as we ought to.

Samina Baig is one hero that all Pakistanis, men and women, can be proud of.

Here’s to a true hero for Pakistan.

‘You must do the things you think you cannot do.’ Eleanor Roosevelt

A wish for Pakistan

My dear Pakistan.
I love you so much.
I love your resilience.
I love your passion.
I love your ‘never give up’ attitude.

I love your emotion.





You don’t have to make sense.
You don’t have to excel.
You don’t have to be the best place in the world to live.

You are my home, and I love you unconditionally.
But if I may, I would like to make a wish for you.

It is a well meaning wish.

A wish out of love and concern.

It is not a wish for self respect, for we can muster that any time emotion strikes.
It is not a wish for self reliance, for that ship sailed long ago.
And it is not a wish for better leaders. We get the leaders we deserve.
My dear Pakistan, my one wish for you is a wish for clarity.

That’s it.
Nothing too big or fancy.
Just clarity.

A brief moment in the sun, to see things as they are, and not as they are imagined.

Clarity of purpose – to define the state you wish to be. It is not enough to be against something. You have to stand for something. 

Pakistan Army (پاک فوج) Pakistani Armed Forces Troops Soldier helping tribal Operation Rah-e-Nijat South Waziristan Administered Tribal Areas War in North-West Black Thunderstorm fata people  (4)







Clarity of conscience – to provide your citizens, all of them, the security and opportunity they deserve.



Clarity of thought – to recognize the enemy. Perhaps the enemy is within. 



A brief moment of clarity.
A brief moment in the sun.
Devoid of emotion and conspiracy theories.
Free of politics and grand standing.




World Cancer Day

Cancer is an ominous word. A scary word. Unfortunately, it is also a very common word. Virtually everyone knows someone who has cancer. Virtually everyone has lost someone to it. Cancer is the second leading cause of death in Pakistan, surpassed only by heart disease.
February 4th was World Cancer Day.  It is a good opportunity to  day to talk about cancer and the havoc it causes in so many lives. According to data from the Punjab Cancer Registry, cancer of the breast is the most common type of cancer in Pakistan. It is important to make women aware of the risk of breast cancer, and the importance of detecting it early.
Here are some important facts about breast cancer:

1. You Don’t Need Many Risk Factors
Unlike lung cancer and smoking, there is no one overwhelming risk factor for breast cancer. In fact, the biggest risk factor for developing breast cancer is simply being a woman! No, I have not lost my mind. It is true. While men can develop breast caner, it is about 100 times more common in women. In fact, studies suggest that one in eight women will develop breast cancer in her lifetime. And most of those women who do develop breast cancer do not have any family history of breast cancer.
That is why it is important to know that any woman can get breast cancer. You don’t have to be a certain age or belong to a certain family to get it.
2. Early Detection is Key
It is sad whenever a woman loses her battle against breast cancer. It is sadder still when the battle could have been won, if only she had spoken up about the mass she felt in her breast. Many women don’t want to draw attention to themselves and their medical needs. The reasons vary; some are shy to talk about their illness, while others don’t want to put a burdon on the family’s resources. Unfortunately, when the mass doesn’t go away and these women finally do visit the doctor, it is often very late. Cancer which might have been curable a few months earlier has by then spread beyond the breast.
It is important to do away with the taboo of talking about breast cancer. It is important for women to come forward as soon as they feel a lump in the breast.
3. There is Life After Cancer
A diagnosis of cancer is not the end of the story. Not anymore. There have been many significant advances made in the treatment of cancer. There are all sorts of treatment options that doctors can use to fight breast cancer. From surgery to radiation therapy, and from hormonal manipulation to targeted gene therapy, there are a host of treatment options.

Do you know someone who has cancer? How did they cope? What are some suggestions you can give to people fighting cancer?

Frozen Section – Diagnosis in a hurry!

‘It is negative. All margins are clear.’ These were the very words the surgeon wanted to hear.

‘Thank you,’ he said. ‘Please let me know when the final report is ready.’
This was the exchange between myself and a surgeon whose patient was still under anaesthesia. Now, knowing that the entire tumor had been removed, the surgeon was going to close the patient.
This is how a frozen section works. The surgeon removes a piece of tissue (biopsy specimen) and sends it to the pathologist. The pathologist quite literally freezes the tissue, then cuts thin slices (sections) of the specimen which are put on a slide and stained. Once the slide is ready, the pathologist examines the tissue under the microscope  to render a diagnosis. The surgeon’s next move, whether to continue removing more tissue or stop and close the patient, depends entirely on the frozen section diagnosis.
The pathologist’s job during a frozen section is rife with stress. While routine processing of a biopsy specimen is performed overnight, a frozen section specimen is proceseed within minutes. The pathology lab can perform a large number of special stains to assist in making the right diagnosis, but these are of no use during a frozen section – there simply isn’t enough time! The whole process is a race against the clock. In most cases  a diagnosis has to be given within 20 minutes of receiving the specimen. That is an incredibly small amount of time, but that is all that the pathologist can get, for while he does his thing, the patient is in the hands of the anaesthetist, who keeps the patient ‘under’ just in case more surgery needs to be performed.
While a frozen section is not needed for most surgeries, it is very useful when the surgeon is operating to remove a tumor. Using frozen section, the pathologist can inform the surgeon if the entire tumor has been removed, or if there is tumor present at the margins. In the latter case, the surgeon can remove more tisse from the site in question during the same surgical procedure, saving the patient time, money, and most importatly, the risk of complications that comes with any surgicalprocedure.

The idea of  a frozen section technique was first introduced more than a hundred years ago in the United States. Needless to say the technique has evolved greatly, with many advances coming in the last two decades. My father’s generation of pathologists used to freeze intra-operative specimens in deep freezers, and then cut sections using Treet platinum blades. Today we use solid steel bars and −26 degree chambers which can freeze the specimen in 45 seconds, and then use a precision microtome that can cut sections as thin as 3 micrometers.

Frozen Section slide: This lymph node shows metastatic carcinoma.
All these techniques however don’t make one oune of a difference when you are the pathologist, the slide is under your microscope, and the surgery team is anxious to hear from you. The pressure is immense. It is the ultimate exercise in focus and discipline. Is is benign or malignant? Is the margin clear or not? Is it in situ or invasive? These are serious questions, and the answers are not always simple, especially when the clock is ticking and the phone keeps ringing. It is a lonely moment. There usually isn’t enough time to seek a second opinion. What happens to the patient next depends entirely on what you say.

Of course, nothing beats the feeling you get either, knowing that in this moment, by doing the very best you can do, you are making a real and positive impact in the life of your patient.
And that is why I became a doctor.

Of Course You Had a Heart Attack!

I have an uncle who I love dearly. He is a wonderful person who treats everyone with respect and humility. He likes to make people laugh at his jokes. Everyone enjoys his company. He has two kids; a son and a daughter. The son is doing his O’ levels and the daughter is about to finish her BBA. Whenever we meet I chide him about his one bad habit – chain smoking. Like a broken record I tell him about the increased risk of heart and lung disease. He, of course, in his usual jolly ways, laughs off all my warnings.


Last year on a routine September morning, my uncle had a heart attack.  He had been getting dressed for work when he felt that ominous chest pain. All of a sudden he was breathless and his chest started to feel tight. His wife saw him as he fell to the floor gasping for air. She screamed in panic, and before too long he was being rushed to the hospital. He was fortunate to make it in time. He ended up having bypass surgery, and lived to tell about it.


Many are not so lucky.


I think a lot of people can relate. Virtually everyone knows someone who has heart disease. Just about everyone has lost someone to a heart attack. By some estimates heart disease accounts for almost a third of all deaths in our society. This is an incredibly high toll, and it is entirely within our powers to reduce it.


Women are just as likely to have a heart attack

It is a myth that heart disease affects only old, rich men. The fact of the matter is that heart disease does not discriminate. Women are just as likely as men to have heart disease. Heart disease can and does affect young people. And of course, illness does not care how much money you have in your pocket



The level of awareness about heart disease is a lot higher today than it was just twenty years ago. People are more aware about the risks of a high cholesterol level. They know smoking is not good for them. They know being overweight is a risk factor for diabetes and heart disease. Unfortunately this heightened awareness has not been accompanied by a decline in heart disease. In fact the incidence of heart disease is higher than ever before.

More than awareness and education, I believe it is a matter of attitude. As a society we tend to be cavalier about everything. We like to pretend that we are immune to consequence. Whatever happens to someone else, it won’t happen to us. And whatever we do to our body, it won’t eventually break down. Unfortunately this attitude fuels some of most self-destructive habits.

There’s only so much a heart can take!

This reckless attitude towards smoking led to my uncle’s first heart attack, and I am sad to say that it will cost him his life, for he has not learnt from his painful experience. In fact, instead of finally quitting once and for all, he has resumed smoking! He believes that now that he has ‘new pipes’ supplying the heart, he won’t have another heart attack for a long time to come.

 I don’t even know what to say anymore.

Dengue Fever – Give Govt Credit

There is a low level outbreak of Dengue Fever in Lahore and its outskirts. Over the last few weeks almost a hundred patients have tested positive for the Dengue virus. Every day the media gives the public an updated count of how many patients have been diagnosed with Dengue Fever. Sometimes the media is so dutiful in its duty to inform that the reports include the names of the suspected Dengue patients as well!

Every patient is important. Even one case of Dengue Fever is one too many. Having said that, if we look at the size of the outbreak, it is much, much smaller than had been anticipated by the World Health Organization.

The Government has run a massive public awareness campaign

For the last several months the Government of Punjab has been conducting detailed and exhaustive surveillace for Aedes mosquitoesthat spread the Dengue virus. Survey teams have been looking everywhere in Lahore for any small collection of still water. Almost to the point of harrassment, the government and its operatives have been fixated on making sure that there is no fertile ground for the breeding of  mosquitoes. This effort has been accompanied by a massive public awareness campaign. Countless seminars have been held in schools and colleges. There has been a major drive to educate the public on how to prevent Dengue Fever.

CM Punjab Deserves Credit

This timely focus on prevention of an outbreak seems to be paying dividends. At least for now it appears that the massive outbreak that was expected as a follow up to last year’s epidemic has been curtailed. Who can forget the chaos and panic last year.  Thousands and thousands of patients were suffering from Dengue Fever. Heavy criticism was directed at the government for failing to curb the spread of Dengue Fever.

We are not completely out of the woods yet. The outbreak could flare up still. But if we do manage to make it through the next three weeks without a significant increase in Dengue Fever cases, we will have indeed performed a modern-day miracle. And the credit should go to the relentless efforts of the Government of Punjab.