OmarChughtai.com

World Cancer Day

amber — Tue, 05 Feb 2013 12:51:49 +0000

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!

Omar — Sun, 06 Jan 2013 09:38:29 +0000

‘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!

Omar — Tue, 02 Oct 2012 14:50:07 +0000

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

Omar — Sun, 23 Sep 2012 14:38:12 +0000

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.

The Next New iPhone

Omar — Sun, 16 Sep 2012 12:37:55 +0000

Have you heard yet? iPhone 5 is here, and the world as we know it is about to change! Ok, not the whole word, just the parts of it that lie immediately adjacent to Apple stores. But still, iPhone 5 is here, it’s got 4G and a 4” screen, and Apple would like you to treat it with the same respect and awe as previous generations of the ‘magical’ device. Please!

Tim Cook introduces the iPhone 5

There are of course many naysayers out there. These are the Samsung crowd. They used to be the Android crowd, but they have lately realized that the Android robot is not that cool after all, so they have rebranded themselves as ambassadors of the Korean giant, with the flashy Galaxy SIII their unifying symbol. These people dismiss the ‘5’ as ‘so yesterday!’ They believe the fact that the new iPhone doesn’t have NFC will be a death blow. These are the same people who dismissed the original iPhone for not having 3G. Back then they were called ‘Crackberries.’ Apple has since sold an iPhone to pretty much everyone they know, but they still insist that the iPhone is a passing fad. And to make sure the minions have ample talking points, Samsung Prime has jumped into the fray with a massive ad campaign to showcase how the (allegedly) ripped off Galaxy phones are much, much better than the latest offering from Cupertino.

But lost in the noise of the new iPhone is something more extraordinary. Something which might be the next big thing. Have you taken a moment to look at the new iPod nano!? That little music playing, video taking, radio playing device is everything iPhone, except of course, the phone part. Are you getting my drift?

The cell phone industry is changing faster than anyone ever predicted, and I have a feeling that we are headed to a world with more choices and less ubiquity. And I don’t mean just the choice between an iPhone and a Samsung (Sorry Nokia, try harder,) but also the choice between various screen sizes. Samsung has captured majority market share in the cell phone industry not just by designing one massively popular phone, but also by offering choice of screen size and price point. Apple of course did that with its range of iPods. And now I feel, and hope, Apple will do the same with their iPhone range.

Ladies and Gentlemen, behold the iPhone Nano!

Current iPod Nano – Future iPhone Nano

Why not! Not everyone wants a 4 inch screen on their phone. At lest not all the time. Why not offer the same choice in iPhones that has been offered in iPods for so long. And with Apple’s iCloud finally, ever so slowly gaining traction, why not a world where you have not just one, but two or even three iPhones, all of which seamlessly sync everything from your music to the latest phone calls and tect messages. Just like with iPods and iPads, you carry the one you want that day. Now wouldn’t that would be nice.

Coming Back to Life

Omar — Mon, 13 Aug 2012 08:20:28 +0000

Lahore, June 4, 1947

The air was filled with joy. As he walked through the crowded streets of the walled city, Ahmed could see the excitement on people’s faces. His heart raced with joy at what had been achieved. The Viceroy had just finished his speech on the radio. India was to be divided; Pakistan would no longer be a dream!

Pakistan Movement

The moment of triumph was bittersweet. Mixed with the joy of Pakistan’s creation was the sad memory of those who had laid their lives to make this moment possible. Freedom had not been cheap.

Lost in his thoughts, Ahmed was startled by gunshots behind him. He turned around to see Sikh militants firing randomly into the crowded street. Ahmed started to reach for the pistol he had in his pocket, but it was already too late. His chest was torn open by one and then another bullet. As he dropped to the ground, he saw women and children all around him scrambling for cover. Breathing got harder, and he realized his time had come.

Lahore, July 1, 2010

Data Darbar was crowded tonight. Thursdays tended to be particularly busy at the shrine of Hazrat Data Ganj Baksh. Ali wasn’t bothered by the crowd. He was used to it. He had been coming here every Thursday evening for years. It was a habit he had learnt from his mother as a young boy.

As he made his way through the crowd, Ali thought about his upcoming BA exams. He had been studying hard in the evenings while he worked at the hostel canteen. A friend had told him that he could help him get a job as a clerk in Dubai if he passed his BA exam. He needed to pray for success tonight.

Ali was lost in thought when he heard a scream from a few feet away. He looked over and saw people yelling and screaming frantically as they ran. Through the noise he finally made out one ominous word; ‘Bomb!’ Ali turned around and started to hurry backwards, but he didn’t get very far. The bomb went off in the middle of the crowd.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The emergency ward at Mayo Hospital had been fairly quiet up until an hour ago. And then all hell had broken loose. A bomb had gone off at nearby Data Darbar, and a seemingly endless number of blast victims were being brought in now. Dr Jamal was completely overwhelmed. He had never seen anything like this. It was like a war zone. Everywhere he looked he saw people with severe injuries. He had already declared three patients dead, and more victims were still pouring in. Jamal took a moment to try and recompose himself. He had to do his best. These people needed him. He looked up to see the doors swing open again. This next bomb victim was a young boy with multiple shrapnel wounds in his chest. Jamal got started again. He wasn’t going to lose this one.

——————————————————

Ali felt cold. He hesitated for a moment before he opened his eyes. It was dark. He was lying in a hospital bed. There was a drip hanging on one side. He followed the tube as it ran from the drip to his arm. He saw another tube on his other arm, and this one was red. He tried to look around but he couldn’t make out much beyond the foot of the bed. It was silent except for the regular beeping of a heart monitor. ‘Beep. Beep. Beep.’ As he came to, he remembered the scream. The chaos. And then nothing. He didn’t know what had happened after that. And then he felt the pain. Piercing pain on the right side of his chest. He let out a scream. Where was he? Was he dead?

He heard footsteps in the distance. Ali turned to see a silhouette approaching. From the dark emerged a young man. Dressed in a while shalwar kameez, this man had two large red spots on his chest. But he didn’t seem in pain. He smiled as he said, ‘Hello brother.’

——————————————————-

This was a tough one. The boy had multiple wounds massive bleeding. Dr Jamal asked the nurse to start IV lines and blood transfusion while he tried to stop the bleeding.

——————————————————–

‘Who are you?’ was all Ali could muster.

‘A friend.’

‘A friend? I don’t know you.’

‘Yes you do. Perhaps not by name, but you do know me.’

‘What is your name?’

‘Ahmed.’

‘What is this place?’

Ahmed smiled. ‘It’s a sort of waiting area.’

‘Waiting area for what?’

‘I don’t really know.’

‘How did you get here?’

‘I was shot.’

‘Who shot you?’

‘Some militants. They were not happy about the creation of Pakistan.’

‘The creation of Pakistan?’

‘Yes, the creation of Pakistan. I was a member of the student wing of Muslim League. We were the Quaid’s army.’

‘Muslim League. Creation of Pakistan. Just how long have you been waiting here.’

’65 years.’

‘What! What the hell are you saying man! What is going on!’

‘Calm down!’

‘Calm down!? I am not going to calm down! What is this place!?’

‘Like I said, it’s a waiting area.’

‘Waiting area for what?’

‘Again, I don’t really know. All I know is that I come across a lot of people here. People of all kinds. I always ask them about my Pakistan.’

‘And what do they say? Do they tell you how pathetic our country is? Do they tell you that we have managed to ruin what the Quaid built?’

‘Don’t say that!’

‘Why not? It’s true. It’s a country for the rich. For the connected. Not a country for me.’

‘So you too are planning to leave?’

‘Of course. I need to go where there is opportunity. There is no chance in Pakistan.’

———————————————————-

Dr Jamal had stopped the bleeding from the largest wound, but the boy had lost a lot of blood already. He was running saline and transfusing blood, but would it be too little too late.

————————————————————

Ali was in pain. As he squirmed, he asked ‘How did I get here?’

‘Well, there was a bomb blast. You got wounded badly. Some people are trying to save you.’

‘Where are they?’

‘Who?’

‘The people trying to save me.’

‘You can’t see them.’

‘Why not?’

‘Because we need to talk.’

‘About what?’

‘About our country.’

————————————————————–

As soon as the first blood bag finished, Dr Jamal started infusing a second one. Thankfully there was no shortage of blood. A line of volunteer blood donors had formed outside the emergency unit. It was already a couple of hundred people long!

—————————————————————-

‘Do you know what it took to create Pakistan?’

‘Yes. The Pakistan Movement,’ replied Ali.

‘Of course. But I am not sure you know just how much sacrifice it took to create our homeland.’

‘I know it wasn’t easy.’

‘You are right. It wasn’t easy. Nehru, Gandhi, Mountbatten – they tried their best to keep Pakistan from becoming reality. They tried to trick the Quaid. They tried to negotiate with him and they tried to bribe him. They even tried to question if the Quaid truly represented the Muslims. But our Quaid would not budge. He stood fast. And in the elections of 1945, we showed everyone that Quaid was our one true leader. And Pakistan had to be created.’

‘The Quaid was a great leader. I wish we had leaders like him today.’

‘My friend, that is exactly what I wanted to talk to you about.’

‘What? You are going to tell me that a new leader is coming for Pakistan,’ Ali said with a smirk.

‘No, not one new leader. A million new leaders.’

‘What are you saying?

‘My friend, you don’t have to be governor general to be a leader. Anyone can be a leader.’

‘Sorry man. That is not true. In Pakistan people follow whoever is in power.’

‘That’s where you are mistaken. People want to be led. In the absence of true leadership, they have no choice but to follow the corrupt and inept.’

‘All I know is that I wish Pakistan had a leader like the Quaid today. Our destiny would change.’

‘My friend, the Quaid is gone. He is not coming back. But there is a whole new generation of Pakistanis who are determined and dedicated. They are young and they want to make a difference. You yourself are one of them.’

‘I am sorry. My aims are a little less grand. I don’t want to lead a revolution. All I want to do is live an honest life and feed my family.’

‘I am not talking about a revolution. I am talking about evolution. Millions of young Pakistanis doing the right thing. Doing the honest thing in daily life. Putting Pakistan first. Teaching children, helping the poor, building a future for our country.’

‘That sounds rather boring,’ replied Ali.

‘My friend, Ali, nation building is a long task. It doesn’t happen in a year or a decade. Don’t look at this country for what it isn’t. Look at it for what it can be. As we speak there are hundreds of people lined up outside the Emergency to donate blood. After the floods, Pakistanis donated much more than anyone ever thought possible. The whole nation came together when the earthquake hit. There is immense talent in this country. And immense spirit. You just have to stop being cynical and start doing your part.’

———————————————————–

The senior registrar had already told him to move on to the next victim. There was nothing more that could be done for the boy. But Jamal had promised himself.

————————————————————

‘And what of the corruption at the top? Who is going to stop

them?’

‘Ali, we get the leaders we deserve. We had the Quaid because we knew there was nothing that we wanted more than Pakistan. Once people decide they are going to put Pakistan first and personal gain second, you will see how quickly the halls of power will follow.’

‘So that’s it. Just do the right thing. Be honest. Is it really that simple?’

‘It is simple but it is not easy. You people will have to unlearn what your parents have taught you. You will have to refuse the short cut again and again. It will not be easy. But that is the only way.’

‘You are right, that won’t be easy.’

‘You see Ali, when you want to change the destiny of a nation you have to begin with your own character. Your own actions. Be the example. That is the kind of leadership Pakistan needs.’

‘Do the right thing,’ Ali repeated, as he started to realize the enormity of those simple words.

‘Yes. Do the right thing. Put Pakistan first. When you do it, and your friends do it, and millions of young Pakistanis do it, you will see the change you have started. Don’t lose hope. Don’t lose focus. Build our country a little bit every day.’

————————————————————-

Nobody was watching the young boy now. There were just too many patients, and not enough doctors. But a nurse turned to see what was going on when the patient next to hers let out a cry. She called Dr Jamal, who came running.

‘Take it easy boy. Take it slow. We almost lost you,’ Jamal said with tears in his eyes.

The nurse had never seen someone recover from such injuries. As she looked on in amazement, Dr Jamal said, ‘He is coming back to life.’

Did you need to know the name?

Omar — Thu, 02 Aug 2012 06:37:56 +0000

If you were watching the news yesterday, you probably saw that a patient in Lahore was diagnosed with Dengue Fever. I wish that is all you knew. Unfortunately the media went out of its way to tell you the ethnicity, travel history, local address and even the name of the patient!

Patients have a fundamental right to privacy. They have a right to seek medical attention without running the risk of making their most personal issues public.

In the case of some infectious diseases, the individual’s right to privacy is partially offset by the public’s right to safety. Certain disease conditions such as Dengue Fever are designated ‘Notifiable’ by the Health authorities. Any doctor or diagnostic lab that comes across a patient of Dengue fever is required by law to notify Health Department officials immediately. This is a good idea. It allows Health officials to identify and predict disease trends, and helps them plan fumigation drives.

Unfortunately, there is a down side to this process, and it was on display yesterday. As the news of a Dengue positive patient made its way to various Health Department agencies, someone somewhere leaked it to the media.
Even that would have been fine, for the whole process is for the good of the public at large anyway. But no one needed to know the patient’s name. It did not add anything to the conversation, but it did cause a lot of distress to the patient.

Patient privacy should be everyone’s concern. It is a responsibility of the entire healthcare team, from doctors and nurses to lab personnel and Health Department officials. We must all do our part to make sure that none of our patients are harassed, and that their identities are kept confidential.

I wish whoever shared the information with the news agencies had taken a moment to delete the patient’s name. I wish media outlets had made an editorial decision to not disclose the patient’s name, but I suppose that is too much to ask.

For Nano

Omar — Mon, 09 Jul 2012 19:26:19 +0000

It has been a few days now since my grandmother passed away. And I can’t stop thinking about what just happened.

My Nano lived a full life. She saw good times and bad. She got married when she was young, and saw her husband go off to war just a few days after the wedding. She saw the creation of Pakistan. She lived through the last minute inclusion of Gurdaspur in India, and the sudden helplessness that followed as her husband’s family migrated to Lahore.

My grandfather was an engineer for the military, and at various times served all over Pakistan. Of note were postings in Karachi, Dhaka and Quetta. He and his wife raised a family of four children who grew up and went to school all over Pakistan. With every transfer the young family would gather its belongings, say goodbye to friends, and set off to a new adventure.

One of Nano’s favorite things to do was to teach children. When I was growing up, I would often find myself in a group of three or four, together with a cousin and perhaps two of the maid’s children, being taught English or Maths. She was so fluent in English, even though she rarely spoke it. She also loved teaching children how to read the Quran. And when they didn’t listen or pay attention, she wasn’t known to be particularly patient.

Nano was quite the personality. She could be rude, and she could be quite arrogant at times. At various times she had troubled relationships with each of her children. When my Mom and Dad lived in a small house that belonged to my grandparents, they charged rent – at market rate! My mother often wished that she had a better relationship with her mother. But their egos were about the same size, so that was easier said than done.

Nano was also very charming and well dressed. She loved nice clothes and nice perfumes. Never one to be seen underdressed, she always paid attention to how she looked. And she had quite a social life. For a long time she was the General Secretary of a women’s philanthropic organization. She loved the charitable work they did, and she loved the regular lunch meet ups where she and her friends got to gossip.

Nano’s health deteriorated steadily over the last few years. She started to suffer from dementia, and there came a point when she was unable to remember even the most basic things. She was weak and frail. When her husband of nearly 70 years died in March, her health started to fail. One evening she got rushed to the hospital because of a heart attack. I was there, and I felt there was no hope.

As Nano lay in the ICU fighting for her life, I remember my mother praying to God for time. Praying for an opportunity to talk to her mother. She requested God to not take her yet. Not just yet.

Over the following months I saw my mother’s prayers answered. My Nano recovered beyond belief. She regained her memory. She started to talk again. She started to pray again. She was able to walk once more. It was incredible how quickly she had become her old self. A softer, wiser version of her old self.

Nano with Mariam and Akbar Taaya, who has been with the family for 50 years

In the last two months of her life, Nano reconnected with all of her children. Three of them live in the US, and they all came to visit her. She reconnected with my mother, who was at her side almost constantly. She had moved to my parents’ house, and she would wait for the kids to come home in the evening. Every day she would tell me that I worked too hard. And every evening she would praise my sister for her pursuit of a PhD.

Nano got better, and for a time it was as if this would be the new normal. But it was not to be. The time had come. She left us early morning on the 5th of July. She was 88 years old. She is survived by children, grandchildren and great grandchildren. Perhaps more importantly, she is missed terribly by the many, many lives she touched. And while I am incredibly sad, I can’t help but feel incredibly blessed for these last two months. It’s as if God Himself intervened, and decided that she and her children deserved a little more time together. It was time well spent.

Your child needs Surgery – Come back in 2016!

Omar — Wed, 25 Apr 2012 15:08:06 +0000

Here’s something interesting that happened yesterday. I was going about my routine Tuesday afternoon work when I was interrupted by a lady who walked into my office. She had a cute 4 year old boy by her side. The lady introduced herself, telling me she was the daughter of a maid who used to work at our house a long time ago. As she spoke I could not help but notice the little boy, Rehman was his name, as he had already started fiddling with a pen that had been sitting on my desk. As my attention shifted back to the mother, she handed me a prescription for Rehman. They had been to a hospital just a few hours earlier, and the boy had been diagnosed with an inguinal hernia. The mother was in despair because the people at the hospital had deemed the hernia repair a routine procedure, and had asked his mother to get registered for the waiting list for elective surgeries. Guess how long that waiting list is. Rehman is scheduled for surgery some time in 2016!

Rehman

It troubles me that a child would have to wait four years to get a minor surgical procedure. Rehman’s condition is not an emergency on most days. He is perfectly fine most of the time, but when he runs around and plays with his friends, the hernia starts to hurt. In fact the last time it hurt so much that the little boy nearly passed out.

It is plain for all to see that health care facilities in our society are overwhelmed. As a nation we simply do not make health care a priority. We spend less than 3% of our GDP on health. While the government has set up some excellent facilities and centers of excellence, there is simply not enough capacity in the system to cater to all of our needs. No one should have to wait four years to get a minor procedure. The alternative is for patients to seek health care in private facilities. In fact more than 70% of health care in Pakistan is now provided by the private sector. That however does not mean that all private health care facilities provide good service. In fact, there is a large chunk of private health care facilities that provides very poor quality care. While the child may not have to wait for surgery in such a facility, he may develop infection afterwards.

We could dwell for a long time over the pros and cons of the various healthcare solutions. We could talk about universal healthcare and we would talk about private versus public care. But this post is not about numbers and pointing fingers. This post is about a boy who needs surgery. A small, 15 minute procedure and he will no longer be afraid to run or climb a tree.

I do not have the solution to the larger health care crisis. I don’t know how or when we will be able to provide reasonable care to all who need it. But I do know people, and I can call in a couple of favors. Rehman is scheduled for surgery tomorrow morning. We will figure out the rest later.

Hemophilia Care in Pakistan

Omar — Mon, 16 Apr 2012 14:53:49 +0000

Have you ever met patient of Hemophilia? Have you ever met a young boy in the arms of his father, holding his swollen knee in pain, as he waits for an injection of a factor concentrate that will stop the bleeding? You should see the despair in the father’s eyes, who knows his son is destined for a lifelong battle with a bleeding disorder for which there is no cure. But you should also see the glow in the young boy’s eyes, who knows he will be fine once he gets the Factor. He can’t wait to get back to playing cricket!

Disease does not discriminate between the rich and poor, but in a country like ours, it is not hard to imagine that most patients of Hemophilia cannot afford long term care. According to some estimates, more than 75% of Hemophilia patients in our country do not receive the appropriate care for their illness.

There are, however, a few bright spots in this otherwise gloomy picture. While many patients remain unable to access adequate care, there are also a number of patients who are now getting reasonable Hemophilia care at no cost. Hemophilia Patients Welfare Society of Pakistan is a charitable organization which is responsible for this change for the better. The Society was founded almost 20 years ago by a group of doctors who were caring for Hemophilia patients. Over the years the HPWS has worked to raise awareness about Hemophilia, and directly assist in the care and management of Hemophilia patients.

Today the HPWS has more than 400 Hemophilia patients enrolled in its care program. These patients visit the Society office for free medical consultation, diagnostic and monitoring work up and management through injection of Factor concentrates.

I am honored to say that my father was one of the founding members of the HPWS, and Chughtais Lahore Lab has provided diagnostic and medical consultation services to the HPWS since its inception.

Hemophilia care in Pakistan does not begin and end with my lab or with the HPWS. There are many, many doctors and charitable organizations working to serve Hemophilia patients. For instance the fine people at the National Institute of Blood Disorders in Karachi are doing some excellent research on Hemophilia and Thalassemia, and serve a large number of Hemophilia patients.

World Hemophilia Day is upon us. It is a reason to note the long way we have to go to serve all Hemophilia patients in Pakistan. It is also a day to celebrate the many thousands of patients of hemophilia in Pakistan and across the world, who refuse to let their illness define their lives.