On the campaign trail: Dr Saveera Parkash, a nominee for the Pakistan People’s Party. She is the first Hindu woman to run in Pakistan’s general election Credit: Ashfaq Yusufzai/IPS
PESHAWAR, Jan 18 2024 (IPS) – A woman medical graduate from the Hindu community is making waves, as she is the first minority woman to contest the Pakistan Parliamentary election for a general seat, and she does so in the face of deep-rooted religious traditions and wealthy political opponents.
Dr Saveera Parkash, a nominee of the Pakistan People’s Party (PPP) for the February 8 polls, is sure of her victory despite her religion.
“I have been witnessing the support that I am getting from the Muslim-dominated district of Buner in Khyber Pakhtunkhwa province,” Parkash told IPS in an interview.
“My slogan is addressing issues of pollution, women’s empowerment, gender equality, female representation, and their health issues, in addition to ensuring respect for all religions,” she elaborated.
Born to a Christian mother and Hindu father, she has lived in a Muslim-dominated community; therefore, interfaith harmony is on her wishlist.
“Interfaith harmony is extremely significant because we have seen enmity among different religious sects on flimsy grounds.”
“We have to inculcate a sense of brotherhood among all schools of thought and pave the way for lasting peace in the area. We have to respect our religious places and shun differences, as all religions advocate peace and harmony,” she says.
Candidates in Buner, one of the 36 districts of Khyber Pakhtunkhwa that remained thick with militants from 2007 to 2010, are likely to witness a hard contest as the women and youngsters have shown support for the first-ever minority female candidate.
The Khyber Pakhtunkhwa Assembly, one of Pakistan’s four provinces, has 145 elected members, 115 regular seats, 26 reserved for women, and 4 for non-Muslims.
Pakistan is home to 4.4 million Hindus, which is 2.4 percent of the total population.
Her father, a medical doctor and late leader of the PPP and twice Prime Minister Benazir Bhutto, who was assassinated by militants in December 2007 in the garrison city of Rawalpindi, inspire her, she says.
“While my ideal is Mother Teresa, my main focus will be women’s education. The overall literacy rate is 48 percent, but only 25 percent of females are literate; therefore, I want to spread awareness about the importance of women’s education,” she says.
Additionally, it is very important to end favoritism and nepotism and ensure merit in the appointment of teachers, especially women.
After completing medical education in July 2022, she saw the issues women visiting hospitals faced and decided to enter politics instead of continuing her career as a doctor, as she believed issues needed to be resolved at the policy level.
“We need more women doctors, nurses, and paramedics to encourage female patients to visit hospitals. Currently, the number of female health workers is extremely low, due to which most of the women don’t come to hospitals because they don’t want to be seen by male doctors,” she says.
“My big advantage is that I belong to a middle-class family, and the people will vote for me because I am approachable to my electorate.”
The promotion of women’s rights is her main objective.
“We have to scale up awareness regarding women’s rights to property inheritance and their right to education. I sense victory in the polls, as I know the people listen to me and would reject opponents for their bright future.”
So, how does she feel the run-up to the election is going?
“In our district, 75 percent of voters are under 30, and they are well-informed about the issues they are facing. I may be lacking wisdom and knowledge compared to senior politicians, but my sincerity will lead to my success,” says the 25-year-old, who routinely wears a headscarf.
Because she is trying to reach a young electorate, her campaigning includes the wide use of social media, apart from the traditional approaches of public meetings and house-to-house canvassing.
Highlighting corruption is also part of her election campaign.
At the moment, she is concentrating on a smooth run-up so she can win popular support in her constituency
“Voters in my constituency call me ‘sister’ and ‘daughter,’ which gives me immense strength,” she said.
Parkash said she wanted to follow in the footsteps of her father, Oam Prakash, a retired doctor, and serve the people.
Securing a space for women is vital for development, as they have been suppressed and neglected in all areas.
She said “serving humanity is in my blood” due to her medical background, highlighting that her dream to become an elected legislator stemmed from having experienced poor management and helplessness in government hospitals as a doctor.
Most people in the area endorse her candidacy, regardless of her Hinduism or political affiliation. Voters appreciate her bravery for challenging traditional policies
The Election Commission of Pakistan makes it mandatory for all political parties to award 5 percent of seats to women in general seats.
Political analyst Muhammad Zahir Shah, at the University of Peshawar, said that Parkash has created history by contesting the general election.
“We have been seeing women becoming members of the assembly on reserved seats. They don’t contest elections but are nominated by parties on the basis of the seats they win in the election,” Shah said.
In the past, some women have fought elections, but they were Muslim; therefore, they don’t draw as much media and public attention, but the case of Parkash is unprecedented.
She is well educated and belongs to the Hindu community while standing for vote in an area where 95 percent of the voters are Muslims.
“She is contesting on the PPP’s ticket, which isn’t a popular political party, but it seems that she will make her presence felt during the electioneering,” Shah said. Already, she has hit headlines, and if the election takes place in a fair and transparent manner, there is a greater likelihood that she will emerge victorious,” he said.
Transgender people often entertain at weddings and other events, but they increasingly face violent acts, especially since part of an Act ensuring their rights was recently struck down. Credit: Ashfaq Yusufzai/IPS
By Ashfaq Yusufzai PESHAWAR, Jul 24 2023 (IPS)
“The problems transgender people face start from their homes as their parents, especially fathers and brothers, look them down upon and disrespect them,” says 20-year-old Pari Gul.
Gul, a resident of Charsadda district in Khyber Pakhtunkhwa (KP), left her house at 16 when her mother asked her to or face being killed by her father.
“I was born as a boy, and my name was Abdul Wahid, but when I came to Peshawar and joined a transgender group, I got a female name, Pari Gul. Since then, I have been going to weddings and other festive ceremonies to dance,” she says. “Dance is my passion.”
However, she has often been the brunt of discrimination and violence.
“During my five-year career, people have beaten me more than 20 times. Each time the perpetrators went unpunished,” she told IPS in an interview.
Trans people are often targeted in KP, one of Pakistan’s four provinces.
On March 28, a man shot dead a transgender person in Peshawar. It was the third incident targeting transgender persons in the province in less than a week. Despite the violence, violent attacks on transgender people aren’t considered a major crime.
Khushi Khan, a senior transgender person, says lack of protection is the main problem.
“People have developed a disdain for us. They consider us non-Muslims because we dance at marriages and other ceremonies,” she says.
“We had lodged at least a dozen complaints with police in the past three months when our colleagues were robbed of money, molested and raped but to no avail,” Khan, 30, says.
Last month, clerics in the Khyber district decided they wouldn’t offer funerals to transgender persons and asked people to boycott them.
Rafiq Shah, a social worker, says that people attack the houses of transgender, kill, injure and rob them, but the police remain silent “spectators”.
“We have been protesting against violence frequently, but the situation remains unchanged,” Shah said.
Qamar Naseem, head of Blue Veins, a national NGO working to promote and protect transgender people, isn’t happy over the treatment meted out to the group.
“Security is the main issue of transgender persons. About 84 transgender persons have been killed in Pakistan since 2015 while another 2,000 have faced violence, but no one has been punished so far,” Naseem says.
The lack of action by the police has emboldened the people.
“Health, transportation, livelihoods and employment issues have hit the transgender (community) hard. Most of the time, they remained confined to their homes, located inside the city,” he says.
There are no data regarding the number of transgender in the country because the government doesn’t take them seriously, he says.
In May 2023, the Federal Shariat Court (FSC) dealt a severe blow when it suspended the implementation rules of the Protection of Transgender Persons Protection of Rights Act.
Farzana Jan, president of TransAction Alliance, says that FSC’s declaration that individuals cannot alter their gender at their own discretion, asserting that specific clauses within the Transgender Persons (Protection of Rights) Act, 2018 contradict Islamic law, has disappointed us.
The FSC declared un-Islamic sections 3 and 7 and two sub-sections of Section 2 of the Transgender Persons (Protection of Rights) Act, 2018, five years after the law was passed, the FSC rolled back key provisions granting rights to Pakistan’s transgender community.
Some right-wing political parties had previously voiced concerns over the bill as a promoter of “homosexuality,” leading to “new social problems”.
The Transgender Persons (Protection of Rights) Act, 2018, is against the injunctions of Islam as laid down in the Holy Quran and Sunnah of the Holy Prophet (PBUH) and will cease to have any legal effect immediately, the verdict stated.
Amnesty International said the verdict was a blow to the rights of the already beleaguered group of transgender and gender-diverse people in Pakistan. It said some of the FSC’s observations were based on presumptive scenarios rather than empirical evidence. The denial of essential rights of transgender and gender-diverse persons should not be guided by assumptions rooted in prejudice, fear and discrimination, AI said.
“Any steps taken by the government of Pakistan to deny transgender and gender-diverse people the right to gender identity is in contravention of their obligations under international human rights law, namely the International Covenant on Civil and Political Rights (ICCPR) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) to which they are a state party,” it said.
The government should take immediate steps to stop the reversal of essential protections, without which transgender and gender-diverse people will be even more at risk of harassment, discrimination and violence, AI added.
On July 12, 2023, transgender representatives from all provinces held a press conference at Lahore Press Club, where they vehemently condemned the recent decision by the FSC against the Transgender Persons (Protection of Rights) Act, 2018.
Arzoo Bibi, who was at a press conference, said it was time to stand united for justice and equality.
“Militants don’t threaten us, but our biggest concern is the attitude of the society and police,” said Arzoo.
IPS UN Bureau Report
Experts encourage parents to vaccinate their children against typhoid to ensure that the child has access to clean drinking water. Credit: Zofeen Ebrahim/IPS
By Zofeen Ebrahim KARACHI, Jul 6 2023 (IPS)
The first thing you notice about eight-month-old Manahil Zeeshan is how tiny she looks on the adult-size hospital bed at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi.
Her right foot is taped with a cannula, and she whimpers incessantly. “I have been in and out of the hospital for the last seven days,” said Uzma Mohammad, Zeeshan’s mom, with worry lines on her forehead. “High fever that refused to come down, severe cough for days and breathlessness,” were some of the symptoms Mohammad described. She was convinced someone had “put a spell” on her daughter.
The doctors, however, suspected she had typhoid.
Salmonella Typhi bacteria cause typhoid fever, and Salmonella Paratyphi bacteria cause paratyphoid fever. According to the US-based public health agency, Centers for Disease Control and Prevention, along with a fever that can be as high as 103 to 104°F (39 to 40°C), the sick person can have weakness, stomach pain, headache, diarrhoea or constipation, cough, and loss of appetite. Some people have a rash of flat, rose-coloured spots. Internal bleeding and death can occur but are rare. It affects between 11 and 20 million people each year, leading to 128,000 to 161,000 deaths, according to the World Health Organization (WHO). The highest fatality rates are reported in children under four years of age.
While Zeeshan’s blood culture report had yet to come to ascertain the cause of her sickness, she needed urgent medical care, said Dr Shabita Bai, who had admitted her.
“We could not wait for five days for the blood culture report as she was not doing well. And because she had already been given an antibiotic (a medicine used to kill bacteria) from outside, our chances of finding if the baby had typhoid for sure were slim, and we had to rely on the history,” justified Bai.
Decisions had to be made. Based on her condition, symptoms, and clinical diagnosis, the baby was given Ceftriaxone, an intravenous antibiotic, but she showed no improvement. The doctors then administered the stronger Meropeneme intravenously, a last-resort antibiotic.
Manahil Zeeshan’s foot has a drip in an effort to bring her temperature down and fight suspected typhoid. Credit: Zofeen Ebrahim/IPS
Battling the Superbug
But even if she had typhoid, the bacteria in her body had taken on the form of a superbug — the extensively drug-resistant (XDR) typhoid and the current antimicrobials had become ineffective, said paediatrician Dr Jamal Raza, the executive director of the SICHN.
According to a Lancet study published in 2022, multidrug-resistant (MDR) typhoid has been seen in Pakistan, while typhoid bacteria resistant to the widely-used antibiotic azithromycin have been found in Bangladesh, Nepal and India. “Our analysis revealed a declining trend of MDR typhoid in south Asia, except for Pakistan, where XDR S Typhi emerged in 2016 and rapidly replaced less-resistant strains,” stated the study, which researchers claim is the largest ever examination of the S.Typhi bacterium.
The reason why antibiotics are losing their punch against some types of bacteria, said Raza, was the “indiscriminate use of antibiotics” that health practitioners prescribe to provide immediate relief. Another big problem was self-medication by people. “I know people often use an old prescription by a doctor to get the same medicine if they feel they have the same symptoms, thinking they do not need to visit the doctor.”
But he pointed out viruses, which are also small germs like bacteria, are causing bacteria-like infections, like a cold or the flu.
“Taking an antibiotic for the latter does not treat the disease; it only leads to antibiotic resistance,” said Raza.
A study conducted by researchers from three medical institutions, namely, the Aga Khan University (AKU) in Karachi, the Armed Forces Institute of Pathology (AFIP) in Rawalpindi, and the Shaukat Khanum Memorial Cancer Hospital & Research Center (SKH) in Lahore in 2018, found indiscriminate use of antibiotics to be causing new drug-resistant “superbugs.”
It found a high prevalence of multidrug and fluoroquinolone resistance for both S.Typhi and S. Paratyphi strains of typhoid bacteria. From 20% in 1992, the resistance was found to have increased to around 50% in 2015. The stubborn bacteria were resistant to antibiotics like ampicillin, chloramphenicol (and co-trimoxazole), as well as fluoroquinolone (ciprofloxacin and/or ofloxacin).
“The situation is quite grim,” said Dr Mashal Khan, chairperson of the government-run paediatric medicine department at Karachi’s National Institute of Child Health, referring to the increase in the number of children developing resistance to typhoid drugs. His worry is not that the bacteria has spread; his concern is the bacteria has mutated and become resistant to the drug.
“We’re running out of new antibiotics to treat bacterial infections; Meropeneme is the last one, and a very expensive one too,” he said resignedly, adding: “Although the development of newer antibiotics is the need of the day, I must emphasise the rational use of the ones being used is more urgent.”
Developing new drugs is challenging, and antibiotics more so, as the science is tricky.
“Antibiotics are not the most lucrative drugs to develop for pharmaceuticals as their utility is limited in the future due to the bacteria developing the ability to resist them,” said Infectious Diseases specialist and epidemiologist Dr Faisal Mahmood at the Aga Khan University Hospital in Karachi. “A lot of money goes into developing new drugs, and since most of the funding is from the global north, they prefer to work on infections which concern them directly. Typhoid is unfortunately endemic in the low and middle-income countries in the South, which have poorer water quality and have warmer, more humid climates.”
And that is why the only sure-shot way of reducing the disease burden of typhoid is to vaccinate the children.
In 2019, Pakistan became the first country to get the World Health Organization (WHO)-recommended single-dose typhoid conjugate vaccine (TCV) injected intramuscularly, added to its routine immunisation (RI) regime. This is given to babies at nine months, alongside measles-rubella vaccinations, without impacting either vaccine.
“Childhood vaccination complemented with clean drinking water and improved hygiene practices is the much more cost-effective way of eradicating typhoid than pumping antibiotics in a child,” said Raza. Meropenem costs as much as Rs. 30,000 (USD 105) for a 10-day course, and if hospitalisation is included, it can go up to Rs 100,000 ($349), said the doctor. Being in a government hospital, Zeeshan is treated free of cost.
Eight-month-old Manahil Zeeshan is treated for typhoid at the government-run Sindh Institute of Child Health and Neonatology (SICHN) in Korangi, a neighbourhood in Karachi. Credit: Zofeen Ebrahim/IPS
Typhoid Vaccine Launch Hits a Snag as Covid-19 Surfaces
The 2019 TCV campaign was first launched in the two cities of Sindh – Karachi and Hyderabad (children up to 15 years of age were also given a shot), which reported the highest number of typhoid cases among children. There was a pause when Covid-19 hit the world. But by 2022, TCV had been launched across Pakistan, and 35.5 million children were vaccinated, after which it was added to the government-run Expanded Programme on Immunisation (EPI) programme.
“Many parents do not know that the TCV is a more effective vaccine but only available at government vaccination centres, and not at private clinics and hospitals as Gavi has only given it to the government of Pakistan,” said paediatrician Dr D.S. Akram.
“There is another typhoid vaccine available in the private sector (typhoid polysaccharide vaccine), but it can only be given to children over two years of age, and it needs boosters every three years. My advice to parents is to vaccinate their kids against typhoid bacteria at nine months,” she said.
But it is still a drop in the ocean, and the fight against typhoid and other childhood diseases continues. The WHO places Pakistan among the ten countries that account for almost two-thirds of the world’s unimmunised children.
When Covid-19 hit the country’s already crumbling health system, it also brought the country’s immunisation programme to a halt too. An estimated 1.5 million children across Pakistan missed out on basic vaccines from March to May 2020, according to Gavi.
For Pakistan, which already has low immunisation coverage (the percentage of fully immunised children aged 12-23 months is just 66%), it meant a further dip in coverage which led to an unprecedented rise in the number of zero-dose children (those that have not received any routine vaccine). Add to these were the almost 19,000 new births every day. But when the lockdown eased and vaccinators returned to work, there was less demand for vaccination, having been replaced by fear of the new virus.
While Pakistan has yet to reach the optimal immunisation coverage of 90%, during Covid-19, Pakistan’s EPI received plaudits internationally for taking both vaccine coverage and the number of zero-dose children close to pre-pandemic levels in 2021. “What Pakistan achieved needs to be celebrated. In fact, Pakistan and Chad are used as examples internationally of how to get it right in an emergency,” said Huma Khawar, an immunisation and child health advocate working closely with EPI.
“Despite a year’s delay due to Covid-19, which was unforeseen, I think it is the best thing that the government has done for its country’s children,” said Khawar. She credited the RI programme that bounced back to the pre-pandemic level in 2021.
Clean water, Good Hygiene Key to Preventing typhoid
While immunisation can protect children from getting infected, clean drinking water and improved hygiene practices can reduce the risk of catching the disease to a great extent.
“Vaccines provide immunity when there is exposure to the bacteria,” agreed Dr Jai Das, assistant director at the Institute for Global Health and Development at the Aga Khan University and one of the co-authors of the 2018 report on typhoid, but emphasised the need for improved water and sanitation, a situation that continues to remain dismal and compromised in Pakistan.
The same study not only found a strong correlation between water and sanitation but to literacy levels as well. In addition, it stressed improving the country’s food safety protocols and implementing regulations.
While Mohammad believes that her daughter is under a curse, one reason could be that the unpasteurised cow’s milk she gives her daughter may not be properly boiled at home. “I was unable to breastfeed her,” she said. Further, she confessed to diluting it with unboiled tap water to make it last longer.
Doctors say giving Pakistani babies a lease of life is simple and costs nothing. “Exclusive breastfeeding up to at least six months of age (right now it is only 43%), attaining 90% coverage of RI across Pakistan and improving water and sanitation quality,” according to Dr Akram.
Bacteria Don’t Respect Geographic Borders
The XDR typhoid bacteria propagating in Pakistan has crossed borders and reached as far as the UK, Canada and the US. Earlier this year, a team of Pakistani and US researchers published their findings in the American Journal of Tropical Medicine and Hygiene, stating that with numerous typhoid bacteria variants circulating in Pakistan have also been identified in Southeast Asia and Eastern and Southern Africa and have been introduced into the United Kingdom, Canada, and the United States by travellers.
The Lancet study said strains from South Asia had spread 200 times to other countries since 1990. When these superbugs grow and spread, they can cause infections that are hard to treat. Sometimes they can even spread the resistance to other bacteria they meet.
The future looks frightening. While the need for improving water and sanitation cannot be overemphasised, along with the need for vaccinating children, newer and stronger antibiotics need to be developed and fast as typhoid may surface in deadlier ways than now since very few antibiotics remain effective against the bacteria.
Note: This story was supported by the Sabin Vaccine Institute and Internews
Childhood vaccination, complemented with clean drinking water and improved hygiene practices, are the key to eradication of typhoid XDR, not indiscriminate use of antibiotics, say Pakistan health experts. Source
