Breast Cancer – Time for an Attitude Shift

It was the summer of 1999. A bunch of us final year medical students were seeing patients in the crowded outpatient department at the Mayo Hospital in Lahore. Our professor called out to us to come see a patient in one of the consultation rooms. The patient was a young woman no more than 35 years of age. She had come to the hospital with a large breast mass. She said she had first felt the mas more than a year ago. After ignoring it for months, she had finally mustered the courage to talk to her husband about it. Together they had visited a local ‘peer saab’ who had given her a ‘taweez.’ When that didn’t help, they had gone to a local ‘hakeem,’ whose medicine hadn’t worked either. And now here she was. A hundred miles from home, at Mayo Hospital, hoping for a cure.

It was too late. It had been too late for several months. She had needed surgery and chemotherapy months earlier. As thins stood, the cancer had spread to her bone marrow and lungs. She died a few weeks later. 

This is a sad story. Unfortunately this is also a common story. Fifteen years after that day at Mayo Hospital, I still see similar patients. Women continue to hide their illness. Out of shyness, they are reluctant to talk about it. In many cases women don’t draw attention to their illness because they don’t want to burdon their family’s limited resources. They only go see a doctor when the pain is too great, or the weakness unbearable. By the time they present to a doctor for diagnosis and management, it is almost invariably too late.

Breast cancer will affect one of every eight women in their lifetime. Punjab Cancer Registry data suggest breast cancer is the most common cancer in Pakistan. Unfortunately it is still taboo to talk about breast cancer. images

Breast cancer can be beaten. The kind of treatment options that exist today were not available even a couple of years ago. Depending on the size and type of cancer, treatment options include surgery, hormone therapy and even targeted gene therapy. These treatments are available in Pakistan. But the golden rule of cancer therapy still applies: early detection leads to successful treatment.

​October is Breast Cancer Awareness Month all over the world. It is time for us to spread the word on the need for early detection. We need to educate women about self examination and the need to see a doctor if they feel a breast lump. This will require more than just a few seminars here and there. This will require a shift in our mindset towards women and their health.

Breast cancer does not affect women only. It devastates entire families. And that is why we need to stop thinking of breast cancer as a women’s health issue, and start looking at it as a national health issue.

Quaid’s Message to Pakistan

My fellow Pakistanis,

Quaid e Azam

Quaid e Azam

It has been nearly 70 years since you were given the gift of freedom.
You have squandered it.

You have managed to lose half the country to secession.

More than half of Pakistanis live in poverty.

Even more are illiterate.

Corruption is rampant.
Religious fanaticism is the norm.
There is unending political intrigue.

This is not what Mr Iqbal and I had in mind.

My message to you today is the same as it was in 1947.

Pakistan is more than just land.
Pakistan is an ideal that every Pakistani must strive for.

Pakistan was forged from the selfless sacrifice of millions.

This sacrifice deserves an equal effort from you.

On this Independence Day, I want you to stop looking to others for leadership. 

Quaid e Azam

Quaid e Azam

I want you to ask yourself what you are doing to make Pakistan better.

I want every Pakistani man, woman and child to ask this question.
Are you making Pakistan better than it was yesterday. Are you making a small difference.

Greatness can be achieved through the small efforts of millions of Pakistanis.

We must realize that only Pakistanis can build Pakistan. No one else can. No one else will.

We have unlimited potential.
We can achieve whatever we set our minds to.

I am disappointed, but I remain hopeful.
For if a nation can rise once to create its future, it can surely rise again to change it.

God has given us a grand opportunity to show our worth as architects of a new State; let it not be said that we did not prove equal to the task.

Pakistan Zindabaad!

The Religion Problem

The world is on fire. There is conflict everywhere. People killing people. Soldiers killing children. Suicide bombs. Entire people displaced. There is war everywhere.

In some places, the cause of the conflict is geo-political. Russia’s adventure in Ukraine is all about expansionism and Mr Putin’s ego. But in most cases, the conflict is firmly rooted in religion. No one religion in particular. Just religion. This is not a new trend. History is rich with examples of wars in the name of religion. In war after war, it is the followers of one religion pitted against the followers of another. Sometimes the motives are truly religious. Sometimes the motives are more geo-political, disguised as religious because a religious war is easier to sell to the people. 

Here are a few examples of today’s wars in the name of religion:

The civilian death toll in Gaza is well above a thousand now. Even the United States is ‘appalled.



By no measure of humanity is this an acceptable situation. But here we are. Hamas refuses to stop setting off fireworks, and Israel refuses to stop bombing Gaza. Israel’s stated position is that no population should live under the constant threat of violence. What that really means is that no Israeli (Jewish) person should live under the constant threat of violence. The lives of the people in Gaza are someone else’s problem.

– The Islamic State (ISIS) continues to wreak havoc in what used to be Iraq and Syria. Christians living in Mosul were given simple choices: convert to Islam, pay a tax for protection, or leave.



A community which had thrived there for 1600 years was uprooted in a matter of weeks. And now ISIS has turned its attention to Shia Muslims. ISIS is composed to Sunni Muslims, and they regard the Shias as non-believers. The shias have been given even simpler choices: convert and join Sunni ranks, or die. ISIS proclaims to be the Islamic State. It’s leader claims to be the Caliph. And this war, now turning its eyes toward Saudi Arabia, is being waged in the name of Islam.

– In Myammar, 135,000 Muslims are living as refugees in their own country. They have lived in their refugee camps for two years now. They live in fear of violence from the Buddhist majority. Followers of the religion that gave the world ‘karma’ are driving people from their homes and burning villages. 

Afghan Mujahideen - 1980's

Afghan Mujahideen – 1980’s

– Of course, no list of modern religious wars is complete without the greatest one of them all.The first American war in Afghanistan. A war against the Soviet Union, sold to the Afghan people as a religious war against communist infidels. That war brought the Soviet Union to its knees.


The problem is not religion itself. No religion condones murder. No religion preaches intolerance.

The problem is with some practitioners of religion. The ones who believe in their God, and their God only. The ones who believe that anyone who does not share their belief is somehow less than human.  It is this mindset that justifies all manner of sin in the name of religion.

Israel, Hamas and Gaza

There is a cease fire in Gaza today. There is hope that it will be extended and hostilities will finally end.

Let both Israel and Hamas claim victory.For both of them have won. And the people of Gaza have lost.

Israel can claim military victory. Iron Dome Missile Defense System

The ‘Iron Dome’ missile defense system has worked spectacularly well. Hamas has fired more than two thousand rockets at Israel, almost all to no avail! The only meaningful impact those rockets have had is the suspension of flights to Tel Aviv airport for two days. An embarresment, but not much more.

The ground invasion of Gaza appears to be meeting its objective as well. The Hamas built ‘terror tunnels’ are being sealed one by one, crippling Hamas’s ability to conduct covert raids for some time to come.

Mr Netanyahu appears to have made the calculation that every Israeli life is worth a thousand Palestinian lives. He appears hell bent on crippling Hamas. But trying to cripple Hamas is messy business, for Hamas lives among the people of Gaza.


Israel’s military victory comes with a truly astounding number of civilian casualties. More than a thousand people have died in Gaza. The deaths of children, reported by citizens and journalists, and amplified massively by social media, have put a human face on this human tragedy.

For decades Israel has presented itself as a nation under siege. A nation whose neighbors want to destroy it. A nation dealing with a senseless violent uprising. This latest episode has changed all that. The tide of world opinion is changing ever so slightly.

Israel may have been the victim once, but that is certainly not the case now. This change in world opinion is what Hamas will claim as a moral victory. By luring Israel into the fight, and by not being annihilated within six days, Hamas will claim that it is the only Palestinian organization with the will and ability to engage Israel militarily. Considering an audience of millions of Palestinians starved for leadership, that is a powerful message. Of course, this moral victory is hollow at best, for it comes at the cost of a thousand Palestinian lives.

While Israel and Hamas may have their claims to victory, it is the people of Gaza who are paying the ultimate price. Trapped on all sides, they can’t run and they can’t hide. There is no escaping this madness. The people of Gaza are the board on which this deadly game of chess is being played. Every time Hamas fires rockets at Israel, rockets come raining down on Gaza. Hamas claims victory. Israel claims victory. And another child dies in Gaza.  

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.