I am torn. I am drowning in an ocean of emotions and thoughts. At times my mind and my heart are in conflict with each other but at times they are in sync.

I do not remember the moment when I left Karachi for Canada. I was too young to remember my thoughts and emotions at that time. Even as I got older in Canada, I felt as if my life in Karachi was from another lifetime…a previous lifetime…or maybe it was a fairytale. Sure certain tastes and smells would jog my memory about Karachi but it was never the whole picture. Bits and pieces of memories would sweep me away. It was as if I was imagining everything…nothing was real yet it was only because I was told it was so by my parents. I had always imagined what my life was like while in Karachi…my birth place.

Now that I have lived in Pakistan for almost 8 months, I cannot bring myself to leave this place. Of course I am excited to see my family and friends back in Canada but my heart will not let me leave this place. I am all too aware of my emotions and thoughts now. This is not a fairytale anymore. This is my life. I now feel the bond and connection I have with my country and with my countrymen and women. I feel their pain and their joy. I laugh and cry with them. I pray and work with them. Yes I am my own person, unique in my thoughts, emotions, principles, morals and ethics but I share a great deal with my people. I am cut from the same cloth….

I Love, with a capital L, the people and the culture. I enjoy the multiplicity of ethnicities. I enjoy the presence of different languages, religions (Muslims, Hindus, Christians) and practices--the ground work for pluralism. Too bad some individuals are too concerned with speculating what divides them rather than what unites them. Sure I do not agree with the government and some of the nuances I have encountered, but my goal should be to work with the system. Pakistanis and Pakistan as a country has so much to offer to the world. This land is full of resources. Its people are wise with extraordinary talents. I am not saying this out of bias but from sheer conviction. If only the world would realize this. If only Pakistanis themselves could realize this…

Often in Canada I would proudly proclaim that I am a ‘Pakistani.’ No wait...a Pakistani Canadian. But who was I kidding? I did not know anything about Pakistan or what a ‘Pakistani’ actually means. I was already struggling to find my identity. I was struggling to fit in with a new crowd and a new culture in a new country. I found my self becoming too engrossed into the ‘Canadian culture” that I had forgotten about my roots. It took a while for me to assimilate with the rest of my Canadian brothers and sisters while being true to my own principles, morals and ethics. With all tests come great lessons. The struggle continues to this day.

And now I wonder, what does it mean to be a Canadian? What does it mean to be a Pakistani? Who defines this and by what criteria? Is it based on how one acts? Or how one thinks or feels? Just because I hold a Canadian Citizen Passport or a Pakistani National Identity Card does that define who I am? Are we merely labeling ourselves for our own convenience? Are we not all Global Citizens as we have a responsibility to all of mankind?

A friend of mine made a comment recently, which has left me deep in my thoughts. “Identity is not a single thing. It has dimensions….good dimensions are those which care for human beings, the bad are those which undermine human dignity.” So true are his words. With that in mind, my last few weeks will be spent reflecting on those dimensions. Yes I am a Global Citizen, which includes being a Canadian Pakistani. This is not based on which cards I hold, but on the dimensions I decide to adopt and act upon. Action towards those who are less fortunate lead better lives while respecting their autonomy and dignity. This I know will require time and patience…

I leave Pakistan knowing what I need to do next. What I need to do for this country. It took me more than 20 years to return to my birth place. I only pray that it does not take me more than 20 years this time around. The memories of Pakistan, in all its shape, size and form, will remain etched in my Heart, Mind and Soul. Until next time….

As today is my last day in Pakistan, I am recalling the wonderful moments I have experienced here as well as the lessons I have learned. This has truly been a life changing experience, and this is no cliche. For years and years my dream was to come back to Pakistan and work in AKU. I can proudly say that my dream has come true. I will let you in on a secret. While thinking about pursuing nursing as a career, I had talked to Shams Kassam Lakha, President of AKU at that time, about the possibility of me pursuing nursing at AKU. He humbly advised me to finish my program in Canada and then come back to Pakistan to work. Well, I didn't really work as a nurse while here but I was definitely blessed with a wonderful opportunity.

I apologize if this is long but the following is a recap of my experiences while in Karachi. These have been moments of joy for me and each of them has been a blessing. I wish to share these with you, my dear friends...



- Re-connected with my birth place and my childhood.
- Visited the our home in karimabad that we left Canada from. I then realized the hardships my
mom and father had gone through to raise and take care of us. My parents left Pakistan with
the belief that us children will receive a better a education. To be back in Pakistan
after acquiring my BScN was truly a humbling moment and one filled with many thanks.
- Experienced genuine Love and Spiritual Ecstasy. My Soul lifted on several occasions and
strengthened my bond with the Divine.
- Made amazing and lifelong friends. People who I had met for the first time but felt as if I had
known them forever…Maybe in a different lifetime…
- Experienced a life outside my own narrow world and loved every single moment of it
- Experienced first-hand how others live and struggle in life and how they do so with joy and
laughter.
- Learned a multitude of life’s lessons through people I had never met. Compassion, gratitude,
and sympathy amongst many others.
- Witnessed both the sadness and joy in the eyes of many
- Experienced poverty and destitution, hunger, environmental degradation, lack of political will,
lack of enterprise, illiteracy, frustration and anger, terrorism, and violence.
- Witnessed strangers lending a helping hand regardless of age, race, gender, class, ethnicity, and
religion. People are wrong....civil society does exist in Pakistan, but to a different degree.
- Experienced the power of language but also the power of human connection without the use of
any words

- Achieved my goal of having more questions when leaving this country
- I see my goal, my focus, my path and my destination. I now know what I need to do
- Through my many field visits, I saw how people live together, eat together, and pray together
- Wore many hats as an intern: learner, educator, event planner, administrator, leader, clinician,
and many more. All these roles came with lessons and challenges but all very rewarding!
- Learned a great deal about health and health care systems, primary health care, government
and non-government health care structures, maternal and child health, and the list can go on
and on…
- Had the wonderful opportunity to be taught by intellectuals and visionaries. Such amazing
people here! So much brain power!
- Given the opportunity to visit various NGOs: AKU itself, Urban Health Programme and
HANDS
- Had my dreams fulfilled of working for AKU and AKHSP (trip to Northern Areas and
volunteering at Noorabad Health Center).

- Spending time with family. Meeting those family members whom I had never met before or
was too young to remember
- Blew up my kitchen the first day of moving into the women’s residence.
- Experienced intense security and safety issues, with a case in particular.
- Rode on a camel twice at sea view. However, while mounting the camel the second time I
ripped my pants… Yes the noise of the tear was loud. Yes it was a pretty bad tear. Yes it was
extremely difficult to mount off without giving every one a show.
- Re-discovered my love for climbing trees. In love with on particular tree outside my residence.
I love the way it makes me feel – liberating.
- Realized I had Michael Jackson’s blood running through my veins – My moonwalks and other
‘dances’ in public spaces.
- Had my first and only Hen/bachelorette party in Karachi thrown by my wonderful girlfriends.
This involved walking around the city and malls with a veil and flowers over my head, asking
random people for random marriage advice and singing marriage songs to random people.
- Rode my first quad bike at Go-Aish. Accelerated without knowing how to steer or brake,
crashed into the wall, got thrown off the bike, and landed on my head on the cement. Alive to
talk and joke about it!
- Driving for two hours to find Dream World. Once around the vicinity, taking one more hour to
find it. Wondering if this place is actually a dream, like ‘never never land.’ Once there, enjoyed
the water slides, archery, horse back riding and rodeo.
- Faced my fear of swimming by teaching myself how to swim. However, because I still do not
know how to swim properly and keep my eyes closed, I crashed into the wall and hit my head
pretty hard. I had the biggest bump on my head and two days of headaches.
- Faced my fear of Chipkalis (lizards). I am not completely over this fear but I feel I have made
pretty good progress.
- Had ‘stomach issues’ for four months, including an episode of traveler’s diarrhea (sorry for the
details). I refused to take antibiotics until I was cornered. Also had three chest infections. I
blame the pollution!
- Travelled to the Northern Areas of Pakistan: learned about the health care system, enjoyed
the company of wonderful people and re-connected with nature and culture.
- Attended my first outside rock concert (‘Call’) and the ‘after party’ after the party!
- Attended my first outdoor soccer game-Manchester United and Barcelona Finals
- Attended my first cricket final (even though if it was inside in an auditorium). Experienced the
joy of Pakistan’s win with my fellow brothers and sisters. Falling in love with Afridi. The only
girls dancing on the stage after the win, which created a fight.
- Developed a love for bargaining at various bazaars and markets. Enjoyed joking around with
the merchants in order for them to cut me a deal. My favorite tag line: “Mein apki favorite
customer hoon” which means “I am your favorite customer.” Shopping was always great fun
with a multitude of colors, fabrics, and designs. Pleasure to the eyes.
- Learned how to buy fabrics and get outfits made at tailors. This was not an easy task at first-in
fact it was very tedious and time-consuming. However, I think I have gotten the hang of this!
- Developed a love for riding in rickshaws and sticking my head out to see what the world has to
offer.
- Re-connected with my fellow HDPians on route to Pakistan and while in Karachi and Gilgit.
- Re-experienced the joys of my childhood favorites: Gola Ganda, Halwa puri, Kheer puri,
biryani, Nihari, Haleem, Guban, Kulfi on a stick, faluda and so much more!
- Discovered new local dishes like handi and Afghani pilau. Shawaras at Guru mandir, Thai food
at Bhan Thai, and Chinese at Peeking, My ultimate favorite restaurant: Chatterbox! Food,
food and more food!!!
- Experienced the joys of late nights with great friends and good food. Drinking chai and the
infamous ‘plain cake’ at AKU cafeteria. Sunday breakfast with the girls.
- Enjoyed street food, even though the after affects were not so pleasant. Ice off the street.
Sugar cane juice from sketchy vendors. Bun kabab that led to food poisoning. I heart street
food!
- Experienced monsoon season in Karachi. This resulted in spending the night at a friend’s house
as road conditions were too dangerous to go back to residence.
- Tolerated +40 degrees Celsius- of dry and arid heat. Sweating buckets and smelling of body
odor. The talcum powder, body sprays and multiple cold showers in a day became my best
friends.
- Enjoyed a variety of delicious and sweet fruits at every season. My favorites: falsa (similiar to
cranberries), mangos and Guava.
- Enjoyed some Jamat Khana hopping and visited many Ismaili colonies.
- Developed a crush on Dr. S and Dr. Z. Oh so wise and caring! Lets not forget good looking too,
especially Dr. S!
- Sunday Bazaar, Sadaar, High tea, cafeteria food, chilling at sea view, the memories go and on...

Shukar Shukar Shukar!!!

Last night was a historic for me. I celebrated Paksitan's independence day in Pakistan! I purposely delayed my flight back to Canada by a few days just so I can celebrate this day with my fellow brothers and sisters. What a night it was! After dinning at Lal Qila (a restaurant thats a Mughal-inspired castle) we headed to the streets. I had my Pakistan flag wrapped around me and celebrated like the rest of the Pakistanis. Celebrations were occuring in all parts of Karachi but the area we went to was surrounded by thousands and THOUSANDS of people! Never have i seen so many! However, it seemed to be more of an MQM (a political party) rally than anything else. There were more MQM flags than Pakistani flags. People were chanting and singing and really making the most of the day. Flags were everywhere-on motorcycles, cars, and bicycles. Little children were also proudly waving their flags. Men had their flags wrapped around their heads. Many were dancing on the streets while blarring loud Pakistani music. Merriment was in the air. With all my years in Canada, independence day celebrations in Pakistan has got to be the best I have ever experienced!

However, a question, actually many questions, were disturbing me. Even though we are celebrating Pakistan's independence, are we really independent? With all the outside influence, do we really have autonomy? Would the founder of Pakistan really be proud of the state Pakistan is right now? Is this what he had imagined Pakistan to be. I dont know...I feel that Qaed-e-Azam would not be happy right now if he were alive. Sure we have come along way, but we have even longer to go. So sure I am celebrating Pakistan's independence but my spirit is not there and it wont be there until we really earn our independence.....

Yesterday we made a field visit to Thatta located in interior Sindh province of Pakistan. As part of the Maternal and Newborn Health Registry in Thatta, the purpose of this visit was to visit households in various villages to conduct post-partum follow up assessments and monitoring adverse events. This also entails health education and health promotion.

No difference is made between urban and rural parts of Thatta as both are considered to be slums. Sure you can notice some differences with regards to health and socio-economic factors, but these differences are minimal. What I saw yesterday and what I see in almost every field visit since I have been here should seriously be considered a public health emergency. Disease-infested sewage water (the remains of recent torrential rains) almost anywhere you look. Piles of garbage scattered all along the streets. Swarms of flies and other disease-carrying vectors trying to get a piece of you. Poor literacy rates. Stray cats and dogs, also carrying God knows what, roaming freely around in search for some human blood and flesh. Below poverty line. Traditions and beliefs interfering with health and well-being. Complete lack of awareness. Ignorance. I can go on...I really can...

All this makes providing health care such a challenge! Villages are located so far away in isolated areas that health care workers have to travel afar just to conduct health assessments. Roads are poorly constructed, requiring health care workers to travel by foot for hours. Monsoon seasons make it impossible to travel, leaving villagers with health concerns stranded for days, even weeks. Government-run Basic Health Care units and Hospitals are so poorly equipped with inadequate human resources and supplies that they do more harm than good. From the 400 NGOs that are currently working in Thatta, only a few are actually serving people rather than themselves. This has been proven by poor health indicators which have not improved for years. To top it all off, it is difficult to provide health education to individuals who refuse to believe that one has some form of control over their own health and well-being. Sure God is Omnipotent and Ever-Powerful but human beings have also been given an intellect. That is why God has created human beings at a higher status than animals, because of our ability to use our intellect. So what is the purpose of this blessing when we leave our faith to jinn or some other supernatural power. This is definitely a complex matter with multiple factors involved. Families through generations and generations have accepted this way of thinking and passed it along to their children. We should not tell them that their way of thinking is wrong but work with them and use the "yes...but" approach.

I would like to end with an experience at one of the home visits. The mother has three surviving children and two that have passed away. The baby that recently passed away (5-7 days ago) was actually doing well right after birth but later that night, the baby passed away after experiencing seizures. It is believed that the child may have received a BCG immunization a few hours after birth, resulting in a fever right after. It is being speculated that the child may have experienced a febrile seizure. This child was in the womb for more than 9 months, in fact 10 months. The doctor had suggested a Cesarean section to the woman but she refused as she was deeply concerned about her remaining children and who would take care of them. Also, it is a known fact that surgery is much more expensive than a natural birth by a Dai (which is also not the safest in this part of the world). Therefore, the mother was induced into pregnancy via Oxytocin. One of the three surviving children of this woman was in severe health condition. I will never forget her face. I will never forget her eyes. Nor will I every forget her cries. Imagine a young girl with a severe skin infection from the time of her birth. Her skin has peeled away with ulcers throughout her body. Her fingernails and toenails are completely gone. She only has patches of hair on her head. More than half of her teeth are gone, exposing her raw gums. Ulcers are also located inside her mouth. It appears that she has not taken a shower in years and the clothes on her back have not been changed. Dirt has accumulated from head to toe. She has dirt caked on to her feet. She is surrounded by flees. They all are attracted to her and sticking to every inch of her body. They are entering her mouth, hovering around her eyes and on the sticky, brown 'Popsicle" she is sucking on. These flees are basically eating her up. She cries as she holds on to her stomach. We ask what is the matter. The mother says she has a "stomach ache" which is fairly common for her. We ask if she has seen the doctor but mother says she has no money. If she takes her to the doctor, then the rest of her children will suffer. The child cries...but there is something unusual in her cries. This is not merely a cry of pain..but a cry of despair. A cry begging us to "save her." This was the most heart-breaking experience. I wish I could just take her in my hands and cuddle her and tell her that everything will be ok....but her eyes say something else. She knows everything is not going to be ok...she herself has given up hope. How easy would it be to just take her to the hospital myself but her family wont let me. If we offer free health services and transportation to the family, the family will not take it for reasons unbeknownst to me. This has happened several times before. If this was the case in any other part of the world, I am sure that social services would have stepped in by now. But what right do we have to take this child away from her mother. I will not dare claim that this mother is neglecting her children as her hands too are tied. She is part of the vicious cycle where the poorest are neglected and the family members show love in the only way they know how. She has her family to feed and the rest of her extended family depend on her as well. She too is fighting an infection for days and for that she is not seeking health care as that too is expensive. This situation all too common here...

Oh how I wish I could do something! How horrible this feeling of knowing that I can do something but not being able to. However, I will not lose hope...I will not despair...

“There are those …who enter the world in such poverty that they are deprived of both the means and the motivation to improve their lot. Unless they can be touched with the spark which ignites the spirit of individual enterprise and determination, they will only sink back into renewed apathy, degradation and despair. It is for us, who are more fortunate, to provide that
spark.” - Aga Khan, India 1983

More than 2000 families migrate to Karachi daily. However, the ones who migrate are already so poor that it is difficult for them to find any permanent residence. They are unable to find jobs and neither can they find housing. So, what happens? They live on the streets without a roof over their heads. Nothing to call their own...

Now you ask, "Well, can't anybody help them?" Who is going to help them? Even though the government has tons of money, they are not allocating resources appropriately to the people who actually need them. They are not able to respond to socio-economic needs of the poor in both urban and especially rural settlements. Sure the government has developed squatter settlements like Korangi and Landhi in Karachi but these settlements are not conducive to the needs of the poor. There is no power, no clean water, no safe housing, no sewerage system, no nothing!! What are these people suppose to do with just free land?? Lets turn to private institutions. Sure many have great initiatives for the poor with regards to health centers and water and drainage system but most are for profit only. They make their big bucks and leave the people they claim they are serving. And then there are land mafias who will give the poor everything they need, but a big price. This price endangers their safety as well as that of their family members. One is indebted to them and are required to follow their every command.

Civil society is composed of totally voluntary and social organizations. Community members recognize their own needs and work together to solve their problems. Individuals who are poor take their lives into their own hands to change their present and the future. Community members are empowered and mobilized into action. Khuda Ki Basti is such an example. This is the name given to the colonies located not only in Karachi but Hyderabad and Lahore as well. It literally translates into "God's own land." This housing scheme won the Aga Khan Award of Architecture in 1995. The AKAA jury felt that this model proved to be a successful effort to create affordable housing for the poor and that this model can be replicated elsewhere. This field trip proved to be inspiring and thought-provoking. If you would like to see pictures, go on facebook.

Khuda ki Basti (KKB) is an incremental housing development scheme, located in the slums of Karachi and Lahore. The KKB was actually developed first in Hyderabad and is a joint initiative between the NGO Saiban and Malir District Authority. We visited the Taseer site in Karachi, however. This project is actually a prime example of what civil society should be.

Saiban has purchased plots from the Malir Development Authority, which they distribute to poor families based on their income and family size. This allows individuals and families to settle on land and own a place which they themselves can call 'home' at a price they can afford. The development of the scheme is incremental while the internal services are limited to the basics. At the start only communal water supply and public transportation to the city center are provided however, services such as internal water supply, sewerage, road, electricity and gas are provided as the allotte pay their monthly installments. Speed and standard of development thus depends on installments. The total price of a fully, furnished 80 sq yds plot is Rs 37,500 with Rs 8,000 as the down payment and the rest is paid in installments of 300/month. Once the full price is paid off, the land belongs to the family. With this regard, the project is self-financing without any subsidy from the government or anyone else for that matter. Individual dignity is preserved and their ability to help themselves encouraged.

The great thing is that the families get to design and construct their home with any material or style they can afford. Usually, the first house is made from cheap, raw materials like wood or cardboard. Once families take up permanent residence and generate some income, materials such as brick or cement block is used. These materials are locally available and not bought it from an outside source.


Khuda-ki-Basti is also provided with education and health facilities, both private and public. Families are also privided with affordable transport service. However, I was too happy with the Baqai Hospital (sponsored by another NGO). Sure its nice to offer free services but this is not sustainable. A small amount of user fee can go a long way. Aren't we then undermining individual dignity by giving them charity? Now this hospital gets its funding from profits made by international institutions like Bill and Melinda Gates Foundation. However, what happens when these institutions decide to opt out. Where will the people of Khuda Ki Basti go then?

Either way, this scheme is changing the concept of "katchi abadis" -those living in shanty towns/slums who have no means nor motivation to help themselves.

"Even when governments are fragile, or even nearly paralyzed in their functioning, strong civil society organizations can advance the social and economic order as they have done in Kenya and Bangladesh. Civil society is a complex matrix of influences, but its impact can be enormous, especially in rural environments." - Speech by His Highness Aga Khan at the Graduation Ceremony at University of Alberta, June 2009.

Rumi has a way of speaking to me through his poetry. He speaks to my Soul-my very essence. In fact, his words tend to describe perfectly what I am feeling and my thoughts. I can never articulate the way he does.

And so, I present a poem by Rumi....

Seeking the Source

a voice out of this world
calls on our souls
not to wait any more
get ready to move
to the original home

your real home
your real birth place
is up here with the heavens
let your soul take a flight
like a happy phoenix

you've been tied up
your feet in the mud
your body roped to a log
break loose your ties
get ready for the final flight

make your last journey
from this strange world
soar for the heights
where there is no more
separation of you and your home

God has created
your wings not to be dormant
as long as you are alive
you must try more and more
to use your wings to show you're alive

these wings of yours
are filled with quests and hopes
if they are not used
they will wither away
they will soon decay

you may not like
what i'm going to tell you
you are stuck
now you must seek
nothing but the source

- Rumi

I have to get used to the fact that I will always be seen as a foreigner in Pakistan. Lets be frank, my Urdu is not the greatest. Even though I can communicate with others but how I speak sets me apart from everyone else. I have been laughed at, in fact I have been asked if I am a 'pathan' because of how I speak. Pathans are referred to as ethnic Afghans or Pashtuns and are often distinguished by the way they speak Urdu, which is not always clear.

When I go to field visits and introduce myself as someone from Canada who has come to Pakistan to learn at AKU, I am automatically bombarded with several questions. Some personal and others general. Even when I do not introduce myself and just open my mouth, the questions start. Initially I found this to be uncomfortable as some would ask really personal questions. Questions that are 'normally' not asked during the first encounter. I say 'normally' because the definition varies from culture to culture and person to person. A question that I would always get asked and that would make me most uncomfortable is "Are you married?" If not then, "Are you engaged." "How did you meet him?" "Is it love?" Now just imagine how I felt. Blushing. Shy. Shifting my weight. Looking down. Giving one word answers.

I have now realized a few things now. First, many of the individuals I have met thus far have had no interaction with the outside world. They have stayed in the same country, the same city, and the same village all their lives. They interact with the same neighbours, the same 'sabzi wala' (vegetable man) and the same 'doodh wala' (milk man) all their lives. Some to do not even own a T.V to at least be updated as to what is going on in the world. There is a sense of isolation. So it is no wonder that as soon an individual from another country enters their premises, their curiosity would peak. They want to know what it is like 'over there?' What do I do? What do I do for enjoyment? In a way I am seen as their only connection with the outside world. Sure I am still uncomfortable when I am bombarded with questions (I guess its my personal nature) but I am more understanding now. So why not share with them what I can for knowledge that is to benefit all is to be shared. Also, this type of sharing is a form of human connection that goes beyond all boundaries and territories. Not to worry, I try not to reveal too much information as I know some (not all) can use this to harm me and those around me.

Second, the concept of love is always a great mystery especially in a country where arranged marriages is the norm. Individuals are not permitted to choose who they will marry as it is a decision made by the family, for the family. They make this decision by weighing the benefits verses the risks. However, some decisions are made only to benefit some and not others but that is a topic in it self! Regardless, interest and curiosity becomes heightened at the thought of some one's marriage being a love marriage. This is something new. Something different. Something exciting. Sure love marriages are now becoming popular even here in Karachi but the norm is still arrange marriages. So when I am talking to the female family members about my "love life" I feel like we are school girls indulging in our secrets. I do not feel uncomfortable anymore. Instead, I feel like I am a part of their family.

I have been invited to quite a few weddings here by my work colleagues and I enjoyed every single one of them! Each wedding provided to be quite an experience. I love to attend weddings because I am such a hopeless romantic and I love to see the excitement and the anticipation in the couples' eyes.

Let me give you a quick cultural lesson on wedding's in Pakistan.

Mayoon = celebrated at the bride's house, where all her friends and close relatives gather and celebrate with dancing and singing. Drum music is usually accompanied. Henna is usually put on the women's hands as well.

Mayun = a custom of the bride entering into the state of seclusion for eight to fifteen days before the wedding. The bride is free of all chores and errands as the beautification rituals being.

Ubtan (a paste made from turmeric, sandalwood power, herbs and aromatic oils) is prepared for the bride by the groom's mother, which is then applied to the bride's hands and face. It is applied to the bride's skin each day leading up to her wedding.

Dholki = a ceremony where the girl's family (immediate and extended) sing traditional wedding songs as well as popular songs accompanied by a Dholki (drum). I had a great time when I attended my friend's sister's dholki. We were entertained with dancing and singing and not to forget great food!

Mehndi/Rasm-e-Henna = a ceremony held separately for the bride and the groom where henna is placed on the couple's hands. The groom's friends and family bring along sweets and henna for the bride, and the bride's family does the same for the groom. The bride and the groom cannot attend the other's ceremony.

Baraat = is a procession of family, relatives, and friends of the groom that accompany the groom to either the bride’s home or a reception hall for the official wedding ceremony. The groom makes his way to the bride's home on a richly decked horse or in a car and the “baraat” follows in different vehicles. Groom is given warm welcome by the bride’s family with flower garlands and rose petals.

Nikah = an Islamic official wedding ceremony that takes place either at the bride’s home, a reception hall or a Mosque. It is attended by close family members, relatives, and friends of the groom and the bride. Usually, the men and women are made to sit separately, in different rooms, or have a purdah, or curtain, separating them. Verses of the Holy Qur'an is recited-the verses highlighting the significance of a marriage. Nikah-naama is a document of marriage contract, which is registered during the Nikah ceremony. The Nikahnaama contains several terms and conditions that are to be respected by both parties (bride & groom). Both the bride and the groom have to verbally approve of the conditions by saying "Kabool kya" which means "I accept." I guess this is similar to saying ' I do.'

Shaadi = A reception held after the Nikkah. Usually this event takes place in large wedding tents set up in a garden or an open lot. The bride's family is responsible for the reception and arrangements on this day. I will talk more about this a little later..

Rukhsati = An event that takes place after the shaadi when the groom and his family leave together with the bride. The Qur'an is usually held over the bride''s head as she walks from the stage to the exit in order to bless her. Since this event symbolizes the departure of the bride from her parent's home, it is usually a somber occasion. Hence, it becomes a very emotional scene as the bride bids her family goodbye in order to start a new married life with her husband and his family.

I have found that weddings play a big part in the lives of people here. Families save up all their lives only to spend their entire life's savings on the most exquisite weddings. This becomes especially hard on the girl's side as they have to host the Shaadi (reception). The whole of Karachi has everything you need for a wedding. If you drive around the streets of Karachi, you will find HUNDREDS of marriage lawns and tents pitched up especially for this occasion. One block has up to 10 wedding lawns. I wish it could be this easy in Canada. Just find an open space and pitch a tent! No need for renting halls and all the administrative and legal stuff that accompanies it. There are SEVERAL markets and bazaars where one can purchase what ever they need for a wedding. Everything from clothes, shoes, and purses to decorations and gifts.

During these weddings, families pay so much such to put a 'show' on for others. This is true for pretty much all cultures. The bridal and groom party wear the most exquisite outfits and are drowning in gold (not the men, of course). They spend a lot on the most finest cuisine (usually biryani and pillau). And lets not forget gifts for either side of the family. Weddings do not start until late in the night-say 10:30 or 11. Hence, dinner is served REALLY late! Most guest come late and leave right after food is served.

The brides look beautiful but they too have to go through a great ordeal. They have to wear the most heaviest and shiniest outfits with the finest designs and embroidery. They are covered with jewelry from head to toe. They have to wear big earrings on their nose, which makes it difficult for them to eat. It takes 4 hours to get their hair done and 4 hours for their make up. They are told to not smile nor laugh but 'act' shy. Their heads are always kept down, looking at the ground. They are to talk only when spoken to. For two of the weddings I had attended, I could see that the brides really wanted to laugh but couldn't. I felt like tickling them so they could just laugh! Don't worry, I didn't as that is a big no-no.

In every culture, weddings and marriages play a big part in people's lives. This is accompanied by various 'rasams' (traditions). However, it has more so to do with families than the actual couple getting married. Culturally, it is all about the families and the communities rather than the individual. Hence, to make the family happy certain traditions are followed and restrictions obeyed regardless if you understand any of these traditions or not. Even after the wedding when the couple starts their married life together, families continue to play a big part.

Individuals are never an entitity in and of itself. He or she is continously interacting with the environment through a symbiotic relationship.

Some thoughts on my mind...

Why is Urdu the only language that uses the same word for 'yesterday' and 'tomorrow'- 'Kal'? Is there a deeper, philosophical rational behind this or is it purely coincidental? While reflecting, I thought that maybe Pakistanis worry less about the past and the future but focus more on the present. But I soon realized that this reasoning is ignorant, simplistic and completely flaud. And so I continue with my search.....

Why is it that every time in Karachi I complement someone, they think I am "makhan mareing"-which means to 'butter someone up.' The assumption is that someone butters someone up only when they need something. I asked someone this and they informed me that people in Pakistan do not easily complement people-it is not part of the culture. I firmly believe in recognizing and appreciating work well done. It serves to motivate, encourage and inspire others. And if you are looking at this from a business point of view, then it leads to productive employees. A friend mentioned that she has noticed the same while being here and was recently shocked when a fellow colleague complemented her work.

I wonder why people here hate it when I say "thank you" and "please"? Is it part of the culture? I have noticed that people are much less formal here. Which is different for me because I always try to be as polite as I can be. This is appreciated in any western or European country but not here. I guess they see no reason to be so formal when you are amongst family and your own people. I mean, we are not this formal with our close family members so why be so formal with those that consider you as their own? This type of informalness is referred to as "bhai-chagh"-which means brotherhood. So how do you explain the fact that I always hold doors for people but hardly anyone holds the door for me? Well, again I was told that people are not used to this opening door business. One cannot and shouldn't even dare to make the judgement that people here are not civilized or respectful because that is completely flaud (I have heard these comments here before). What it means to be civilized here does not mean the same in another part of the world. And I have seen some pretty civilized and respectful folks here. Culturally appropriate behaviour is defined by that culture alone-not by an outside influence.

I was recently informed that The Economist ranked Karachi fourth least livable city amongst the 132 cities surveyed and Business Week ranked it 175 out of 215 in livability in 2007, down from 170 in 2006. So why am I deeply attached to this country and do not want to leave?! Is it because of my birth attachment or am I attached to the people and the culture? What is it about Karachi that I love while others consider it the least livable?

How do people here stay awake so late yet still have the strength to wake up early and concentrate on their daily activities? I need to sleep early and wake up early in order to function properly during the day. This could be because I am used to this and it has been my habit. However, since being here in Karachi, this habit is slowly changing...Even at 2-3am in the morning, one can see local karachities just chilling over a cup of chai at a local chai shop or on top of their cars. These same people wake up as early as 6am to start their day's work. How do they do this?! Karachi is a city that never sleeps-no matter what time of the night (or morning) you go out, you will always run into traffic jams and crowds of people on the streets. I guess when you need to make a buck, you will do whatever it takes while not giving up your leisure time.


“Wondering's healthy. Broadens the mind. Opens you up to all sorts of stray thoughts and possibilities.” - Charles de Lint quotes.

“Wonder is the foundation of all philosophy, inquiry the progress, ignorance the end” - Michel de Montaigne quotes

Keep on wondering....

Freedom: The idea of being free. The absence of interference with the sovernity of an individual by the use of coercion or aggression. The condition in which an individual has the ability to act according to his or her own will.

The above are some definitions of 'freedom' I have come across. However, I have been trying to construct my own definition of freedom ever since I have been here in Karachi.


It was initially really hard for me to get into the groove of things when I arrived in Karachi. I felt constricted and restricted. There were many things I could not do that I could do freely in Canada. For example, I had to think twice-three times before going to Jamat Khana (place of worship) or getting groceries. I would need to really think about the 'how, when, where, whom' over and over again before I even stepped out of my residence and campus. This was mostly due to safety and security issues, especially since I am a female in a male-dominated society. I couldn't, and still, cant go to most places without a companion or proper transportation. This was frustrating for me because I could easily go out in Canada at any time of the day, where ever I pleased. I felt as if my rights and freedom have been taken away from me. That I had to do what others told me to do - I was being coerced and forced against my will...

Here, women's mobility in the public sphere is severely restricted...for several reasons mind you. These vary from security and safety issues, culture and even tradition. So what about their 'freedom?' Freedom to go where they please and do what they desire without any interference?

Even while living in Canada I may have enjoyed a certain degree of freedom-more so than here in Karachi-but I do not think I was ever completely free in Canada. I too had to follow societal and familial rules and restrictions. For example, a new driver cannot drive at certain times of the night. I can only cross the road in areas where there are designated pedestrian crosswalks otherwise I run the risk of getting heavily fined. These 'rules' do not exist in Karachi. Rules and restrictions serve to maintain a functional society and prevent chaos. However, these restrictions can only be valid if and when they are for every one's benefit, instead for a selected few. Both in Pakistan and Canada, I have seen some regulations benefiting some and not others. So sure I may be "more free" in Canada but only with a lot of restrictions.

Looking back, I think I had become individualistic. I was merely thinking about my rights and my freedoms. I had failed to realize that I was living in a communal society, where my actions affect not only myself but those around me as well. The culture here revolves a lot around families (immediate and extended) and on the community as a whole. Every decision and every action is taken while keeping the wider community in mind.

And so I wonder.... is freedom given to us or do we have to acquire it? Is one considered privileged to be born with a certain degree of freedom? Or does it depend on luck of the draw? What about those who were not born privileged enough ? Do their rights matter or are they just tossed aside? If we are "free" then what are we free from and whom? Are we ever completely "free"?


"The shepherd drives the wolf from the sheep's throat, for which the sheep thanks the shepherd as his liberator, while the wolf denounces him for the same act, as the destroyer of liberty. Plainly the sheep and the wolf are not agreed upon a definition of the word liberty; and precisely the same difference prevails today among human creatures." - Abraham Lincoln

"You can only protect your liberties in this world by protecting the other man's freedom. You can only be free if I am free" - Clarence Darrow

Even though I have been here in Karachi for almost 7 months now, I am still not used to the idea of having maids, house cleaners, cooks and drivers. In Canada, I would see cleaning staff in office buildings and grocery stores but never in homes. Here in Karachi, almost every house has a "massi" (maid) to clean the house or cook. However, you do have to make fairly good income to hire one. Some households have up to 4 maids/housekeepers. Even at the women's residency, every week (or however often you call) housekeeping comes in to clean your room...and I mean the entire room. From dusting to sweeping to mopping. This makes me uncomfortable because I have always cleaned my own house-never have I needed anyone to do this task for me. In fact, I have always enjoyed performing these household responsibilities. I find cleaning, as well as cooking, very peaceful.


I understand that everyone needs to work in some form or the other to bring income and support their families. If there were no jobs created for housecleaning and cooking then how can these individuals and their families survive, especially since many have not receieved any formal schooling and are unable to read or write. But I cannot help but feel an overwhelming sense of compassion for them. Every day since I have been here, I see these individuals working really hard around the clock to make a buck. They do tasks that you and I would never dream of doing. My heart really goes out to them. I try to offer my assistance but they always refuse saying, "No Memsaheb, this is our duty." And what I find to be most inspiring is that they never complain. They work hard and they work hard with a smile..no matter the issues they may be dealing with at home.

Something else I have discovered is that these workers always sit on the ground while the rest sit on sofas or chairs. Every time I ask them to sit beside me or if I sit down with them, they look down and say, "no." I guess they have been so used to this that anything else does not work for them anymore. I do not know if their employers have asked them to sit on the ground or that is just what they prefer. I really dont know. Either way, I do not like it when someone is not at the same level as me-whether it be higher or lower. It creates a feeling of superiority/inferirorty, even if it is unintentional. In my opinion, only God All Mighty is superior to all. I prefer to be at the same level as all my brothers and sisters-I am from them and they are from me...

What else bothers me is that some employers treat their workers with out any respect. They are rude and get upset at the smallest things (I have witnessed this). We are all human beings and because of this status, as exhalted as it is, we are not perfect and are prone to make mistakes.

All that I have mentioned above merely creates the "other." We segregate ourselves based on class and social status. Those that do not belong to the same social class as us are seen as "the other." Those whose job descriptions are not the same as ours are seen as "the other." With this, we forget that we are all one and the same. We fail to understand and appreciate each others' thoughts, opinions and desires because we have become too engrossed in our own.
Reality check: We do not live in isolation-we are part and parcel of our environment.

I leave you with a quote by Albert Einstein which I feel sums up everything I have said as well as my feelings which I am unable to express.
"A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty."

Let me tell you a true story told by a good friend....

As M (my friend) was riding on the local bus with F (his friend), they encountered a man who had first gotten off the bus but jumped back on when he realized his cell phone was missing (a common occurrence in Pakistan). That man yelled (in Urdu, of course) to everyone on the bus, "No one is getting out of this bus until I find my cell phone! Who has it?!" So M and F suggested to this man that he should try calling the cell phone and wait for it to ring. That man used one of their cell phones and sure enough, his phone started to ring! As everyone on the bus started to look around as to where the 'ring' was coming from, someone noticed a man scrambling to turn of a cell phone. That man was called out right away. Soon enough, that man was getting a beating for the crime he had committed. F had joined in as he too wanted to teach this man a lesson but M never joined in.

Apparently, when someone commits a crime (esp. stealing), local people come together to teach that person a lesson through public violence. They call this, "Haath saaf karne ka" which means to "clean your hands" of something. As my friend was telling me his story, I was reminded of a book I am currently reading by Alice C Hunsberger's The Ruby of Badakshan. Nasir Khusraw mentions that during Fatimid Cairo, the punishment for those caught cheating anyone was to mount on a camel and ride around the city with a bell in his hands while crying out, "I have committed a misdemeanour and am suffering reproach. Whosoever tells a lie is rewarded with public disgrace." This method proved to be successful at that time. I guess what happened on that bus was a form of "public disgrace" to teach that man a lesson about morals. I do not completely agree with this as violence is never the answer. It never "teaches" anyone a lesson and it never gets to the grass root of the problem. But I am assuming this form of public disgrace evolved from culture and how things have always been done.

Anyways, back to the story. After that man was beaten up and the bus ride continued, a couple more men got on that bus. These men approached M and F and asked, "whose idea was it to tell that guy to ring his own cell phone." He sounded as if he himself thought it was a great idea. So F admitted that it was his idea, as he was smiling. Brace yourself as what happened next will shock you. Both M and F received a beating from these guys as they were the friends of the man who had stolen the phone. These guys were upset that because of M and F, their friend was caught and was beaten. Oh and here is something else that you should know...when someone steals anything of yours keep in mind that there is an army full of people behind this one act. No act is performed solo.

As he was telling me this I was shocked because M and F did a good thing by helping this man find his stolen phone. F's involvement in the beating is a different story. So why did they have to pay for it? There is a saying, "Kar Bala, Pakar Ghala" (Do good and they grab your throat-i.e do good and you pay for it). I asked M if he would continue to help others in spite of this incidence and he said YES because that's his "responsibility" as a human being, to help others. I haven't told him this but I was really proud of him at that moment. In fact, he is a source of inspiration for me....


I have seen random acts of kindness being performed here all the time. While we were on the road, an old man's car stopped working so young men came from all over to help this man out. When any one's car gets stalled, random people come over to help push that car. Sure a few people give the rest a bad name but rest assured that most people in Karachi are extremely helpful and are there for you when you need them. I have been a recipient of this kindness every day since I have been here. Yes I have met some individuals who are not the most helpful but you will find this anywhere you go in the world. The message I am trying to get across is that do not be influenced by what the media or what a few people tell you. Listen to the whole story and listen to both sides of that story. Only then will you really be able to understand and appreciate the situation.

NEWS ALERT!

I am frustrated and saddened by the recent news in Karachi. I need to reflect and vent.

Saturday's torrential rains have claimed more than 30 lives and the death toll is still climbing. This has been the worse rainstorm for 36 or so years now. As mentioned in my earlier blog, these deaths have not only occurred on the roads and in villages but also due to fallen power lines. Karachi has a population of millions living in all different parts of the city. So you can imagine that many of these people are not accounted for, neither are they registered in Pakistan's National Registry system. I can very well bet that there are also deaths not accounted for due to the monsoon.

To make matters worse, last night riots had broken out in Karachi as people were protesting against the K.E.S.C (Karachi Electric Supply Company). The power had not returned to most parts of Karachi for more than 24 hrs, creating frustrated and angry people. Cars and tires were burned. Violence had broken out. My poor friend was stuck in the middle of these protests and as result, he was beaten with sticks. He is fine though, thank God! Obviously frustration against the government has been building for years and the best way that these people know how to release this frustration is through violence. However, by burning down their own city they are only harming themselves. Also, we are all in the same boat-everyone is in the same situation. Instead of hurting each other, why can't we just work with each other? I mean what is the point of hurting innocent people, like my friend here. But I can definitely feel their anger and sympathize with them. Wouldn't you be angry too if you haven't had power, gas and water for more than 24 hours while your government is enjoying their generators?!! Wouldn't you be angry too if water was leaking through your roof, or worse yet your roof had collapsed leaving you homeless while your government was relaxing in their palaces?!! I am not making excuses for anyone but merely trying to understand and appreciate the situation. It is like looking at an onion-from the outside you only see one layer but only when you cut the onion in half do you notice a multitude of issues, perspectives and insights encompassing one situation or event.

What other means do these people have to go against their government than to result to violence when their own government officials suppress freedom of speech and crushes anyone that dare raise their voice or try to act on behalf of their countrymen and women. No wonder civil society is not strong in this part of the world. Sad to say but many people have just given up. And those that haven't given up and actually voice their thoughts....well lets just say that is the last you may ever be heard....Oh and lets not forget the one Karachi city mayor who is hated by every government official but loved by the people of Karachi as he is the only one who cares for the people and does not 'eat their money' like the rest. Why else do you think Karachi and Pakistan as a whole has been experiencing 'brain drain' at an unprecedented level? People's potentials, knowledge and expertise are not being respected nor utilized to its maximum. And so people leave their country for better opportunities elsewhere. Come on Pakistan (the government and its people), open your eyes! You have so much potential and so much to give to the world! Do not give up on yourselves...do not give up on your country!

WHO Global Database on Child Growth and Malnutrition
Department of Nutrition for Health and Development

"We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the foundation of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made and his senses are being developed. To him we cannot answer "Tomorrow". His name is "Today"."

- Gabriela Mistral, 1948


I came upon this quote as I was researching on child growth and malnutrition for an assignment. This is a powerful message with truth written all over it. I am not even going to try to explain this one as this message is pretty self-explanatory. It's essence speaks in volumes.

However, I will add that I have witnessed this 'crime' occurring in all parts of the world. The difference is its degree of severity, nature and subtleness in these different parts of the world. Not one nation is free of fault. Not one nation can say that crimes against children do not occur.

Since the downpour had stopped for a couple of hours late yesterday evening, individuals and families left their homes for an outing, including myself. Little did we know, we were in for a surprise...

The downpour started again but it did not stop for a long time and to make matters worse, it was REALLY raining HARD! I had gone to a friend's house to chill with him and his sisters but I ended up spending the night there as the road conditions were horrible and unsafe to travel. The city was flooded and the power had gone out throughout Karachi. Cars had stopped in the middle of the road as water had gotten in-to knee level. Water had collected at the bottom of hills and slopes, so much so that if cars were to go down the hill, you can be rest assured that they weren't coming back up. Power and electric lines had fallen, creating dangerous situations for the people. Individuals were stuck on the road and some had to spend the night in their cars in the middle of nowhere...

Approximately 14 people died in Karachi last night, either on the road or their roofs had collapsed on them. The homes of Katchiabadis (those living in slums) are the most unsafe as their roofs are built from straws and branches (katchi=raw). I really wish the city government or even the government of Pakistan would take preventative measures to build proper homes and roads. I mean floods occur in every part of the world, it is a part of nature. But the government needs to take proper measures to keep their people safe. Monsoon season comes around every year and every year people lose their lives as a result of situations that are preventable.

I am extremely grateful for the fact that I was stuck at my friend's home. I would rather spend the night there than anywhere else...I felt safe and was well taken care of. I was really worried but they were really sweet about it. We had no power, no electricity but we managed to keep ourselves occupied by playing games, talking and eating jalebies (sweet dessert which is apparently THE thing to have on a rainy day). The night was pretty tough for everyone as it wasn't the coolest, even with the windows open...However, we made do with what we had.

In spite of everything, I am grateful and blessed to have wonderful people in my life. There are really good people here with big hearts and beautiful spirits. There is a lot of love in this world...

Last night was a night I will never forget. However, let us also pray for those who lost their lives and for those who may still be stuck somewhere....

As most of you already know, I was really young when I left Karachi for Canada. I was around 6 years old, so no wonder I am not able to recall much. However, while in Canada, there were a few things that jogged my memory. For example, certain tastes and smells would remind me of certain events that occurred while in Pakistan but I couldn't understand whether these events actually happened or if I had dreamt about it a while back. I hope you know what I mean...
I remembered the taste of Halwa puri (sweet breakfast) for 21 years. I remembered the taste of Kulfi (on a stick!) and Gola Ganda (see picture on face book). As you may already know, it rains almost everyday in Vancouver, Canada but there was always a certain smell after the morning rain that would some how remind me of Karachi. It was a wonderful smell...a sweet smell....and it always made me feel at peace, no matter what type of challenges and issues I was dealing with at that time. Oddly, that sweet smell would always make me miss Pakistan but I always wondered, "what am I missing when I cannot even remember much?"

Today I woke up in the morning to thunder storms and rain! This wasn't just any rain...it was a downpour! We had been anticipating rain like this for a while, especially since it had become really humid due to the trapped heat and the grass and trees were getting dry. How can a person sleep then?! So, I walked around the campus and enjoyed the rain, of course. Girls were dancing in the rain at the female hostel. Children were playing. The greenery was breathtaking. The campus looked so beautiful, I had to take pictures! My elders and the wise have always told me that rain is a blessing...I believe it! *It's rainin' Love!*

I then decided to walk to my department to get some work done. Suddenly, I smelled something in the air....something sweet....something peaceful....It was that same smell I had smelled back in Canada. Some feelings and emotions are just indescribable and no amount of words could ever do justice to those feelings. Therefore, I am not going to even try to explain how I felt at that moment. But I will tell you that I became emotional (very) yet I was extremely at peace. I had entered another world and I was loving every moment of it....

Not to disturb any one's peace, but I want to add something here about the rain in Pakistan. More than 80% of families and men use motorcycles as their means for transportation. In one motorcycle, a family of three to five can fit as this is least expensive than cars. Not everyone can afford a car, especially in a country like Pakistan. However, when it rains it is a terrible scene on the roads. Because rain mixes with the oil on the road and motorcycles do not have proper traction, you will see these motorcycles slipping. There are NUMEROUS accidents and deaths because of this. I have witnessed these accidents just a few nights ago when it showered. It is a really sad scene because you see that same family of five (with little children mind you) in serious medical conditions.

I have seen this over and over again that some one's happiness is another person's misfortune. As much as rain is a blessing for all of mankind and nature and as much as I love the rain...I cannot help but worry about these individuals whose lives are at risk.

Please pray for them.....

In 1985, the Community Health Sciences Department at the Aga Khan University in Karachi, initiated the Urban Health Programme (UHP) with the intention of introducing a Primary Health Care model in the various squatter settlements across Karachi. This was accomplished in collaboration with communities, District Health Organizations, Urban Health Organizations, and union councils. Rehri Goth is included as one of the field sites. Each site includes a Community Management Team (CMT), which consists of community leaders (men and women), volunteers, school teachers, religious scholars and local health care providers such as traditional birth attendants. Community participation is encouraged through priority setting exercises with the CMT to identify health and developmental needs of the community that require immediate intervention. This promotes ownership and empowerment of community members. Management and accounting training is also provided to CMTs so as to build their leadership skills and allow these teams to run the project as their own. Community mobilization is then further enhanced through the provision of training and capacity building. Women are selected from the communities to be trained as Community Health Workers (CHWs). These are volunteers who are trained to provide basic preventative, dispensary and referral services.

Health care facilities have been established in these squatter settlements, as identified by CMTs and local government representatives. These facilities provide basic preventative and curative services on a private, free-for-service basis so as to maintain sustainability of the program. Services provided include immunization, antenatal and postnatal care, and family planning as well as those directed towards malnutrition and anemia. A referral system has been established to secondary and tertiary (both non government and government) facilities nearby. As part of health promotion and disease prevention, health education is the hallmark of the Urban Health Programme. Sessions are conducted by UHP staff and trained community volunteers to the community both at the facility and on an outreach level on various health topics. As Primary Health Care also includes rehabilitative services, a rehabilitation center has been established for disabled children at the field sites. Additionally, physiotherapy services are also provided for those with muscular-skeletal disorders.

As community development is inter-related to health and a component of comprehensive Primary Health Care, various developmental programs have been established by the Urban Health Programme so as to improve the quality of life of people living in squatter settlements. For example, adult (especially women) and children literacy programs have been organized with the assistance of CMTs. Other initiatives include micro-credit loan schemes, income-generating activities, and development of an adequate sewage system. For these developmental activities, UHP has been networking with various government and non-government organizations.

This program has recently been a first prize recipient of the Talloires Network MacJannet Prize for Global Citizenship on June 6, 2009 at Talloires, France. "The MacJannet Prize for Global Citizenship recognizes exceptional student civic engagement initiatives based in the Talloires Network member universities around the world and contributes financially to their ongoing public service efforts."

After visiting the Rehri Goth site of the Urban Health Program, my colleagues and I came to the realization that this program has achieved noteworthy milestones, especially since it was initiated from scratch with our a previous foundation to work on. Additionally, the cultural and religious barriers that had to be encountered and solved, with the communities of course, was no easy task. Therefore, it is no wonder that further areas of improvement were identified. For example, the immunization program runs only once a week at the health care clinics and once a week on an outreach level. Additionally, only one worker conducts the immunizations but she too has to travel far distances in order to obtain vaccine supplies. A comprehensive model of Primary Health Care would dictate the implementation of a routine vaccination schedule every day of the week. Due to several material, money and manpower resource restrictions, this is difficult to achieve. Community members need to be mobilized and trained as vaccinators in order to increase the human resource power, especially since the catchment population of only one field site is 40,000. Emergency Obstetric and Neonatal Care (EmONC) is not provided and communities rely on the referral system to secondary and tertiary health facilities for emergency care. These facilities are usually far away and families cannot afford transportation. Therefore, it is imperative that we train traditional birth attendants residing in communities so that they can conduct safe delivers and recognize obstetric danger signs so women can seek health care efficiently and effectively.

The following is a report I had written for my Primary Health Care course after a field visit to Rehri Goth and the Urban Health Program (UHP) that has been set up there by AKU. I will first provide you with some background before talking about the UHP.



With the advent of industrialization and with the global population rising at an unexpected rate, the world has witnessed a rapid urban growth from rural areas. Cities across the globe are rapidly increasing in size and in numbers due to increased opportunities and incentives for its people. However, despite of its obvious benefits, urbanization has been accompanied by negative and devastating consequences, especially for the poor in the developing world. In the developing world, economic growth and development in urban areas are severely inadequate to meet the needs of the growing population. This has resulted in environmental degradation and poverty at an unprecedented rate. Due to poverty and lack of available land, individuals and their families are forced to settle in slums or ‘squatter settlements.’

A squatter settlement is a residential area in an urban locality inhabited by the very poor who have no access to land which they can claim as their own. With the population of Karachi (an urban hub) continuously on the rise, so are the numbers of squatter settlements in this city. One such example is Rehri Goth (remember I talked about this village in one of my earlier blogs), located in the outskirts of Karachi, Pakistan. Rehri Goth is a 400 year old village at the coastal margins of the Arabian Sea with a population of 40,000. As with any other squatter settlement, Rehri Goth has her own share of health and developmental problems. For example, living conditions are extremely crowded and there exists unsafe housing infrastructure. Income generated from the fishing industry is not enough to meet the needs of the people. As a result, poverty is getting worse and worse. To further complicate the matter, literacy levels are very low with only 10% men and 4% women having attended formal schooling. A system for proper waste disposal does not exist within the community and neither is there a functioning sewage system. Additionally, as clean water supply is severely limited, diarrhea and other water-borne illnesses are of major concern. This is further aggravated by limited health education and unhygienic living conditions, leading to severe health complications such as acute respiratory infections and skin infections. Malnutrition is also a major concern within the community, resulting in anemia and poor growth and development. Therefore, crude birth rates, maternal mortality and infant mortality are on the rise and need serious attention.

In order to address the health and developmental needs of squatter settlements, such as Rehri Goth, a Primary Health Care model is needed. Primary health care is a people-centered approach aimed at providing universal coverage for essential health care services based on the principles of equity, accessibility, and affordability. This can only be accomplished through the participation of various stakeholders, especially communities. Other key elements of achieving this goal, as outlined by WHO, includes the reduction of social and economic disparities, organizing health services as per the needs and expectations of the community, and integration of health into all government sectors through public policies and reforms.

A colleague and I were conversing about our future career/education plans while enjoying some delicious samosas and chai (tea). She excitedly mentioned that she plans to either pursue her MA or MPH. However, when the topic changed to our love lives her smile turned into a forced smile. Her fiancee is against her working as well as pursing a higher education. He has made it perfectly clear to her that after marriage she is to stay home. Guess how old she is? 23! Since she is to get married in two years, she hopes she can fulfill her dreams of going back to school within those two years.

With her permission, I inquired further as to why her soon-to-be husband is against her working and going back to school. He feels that it is his 'responsibility' to provide for his family. That she should not be working and to let him be the 'breadwinner' while she rests at home. However, he had also said that he does not want her to work because that would mean she may have to work with male colleagues and this makes him uncomfortable.This may have more to do with cultural differences than trust issues. Additionally, he feels that after completing 14 yrs of education, "there is no need to go further." Apparently to him, 14 years of education is more than enough....

Again, I claimed ignorance and asked her how she feels about all this. Where does her happiness lie? Even though she wants to continue working, she also feels that she needs to make her husband happy.

That is a big sacrifice to give up your goals and dreams for the one you are about to spend the rest of your life with. But why can't couples support each other to pursue their individual and collective dreams? Why does schooling and working have to be only about making money? Why can it not be about passion, desire and happiness? I have seen this in Canada as well. Individuals obtain higher education at the best universities only to land the best job so that they can make the most amount of money. Why can we not do all of the above but do so out of interest and not solely to acquire material gain? Have we become greedy? Unmotivated? or have we surrendered ourselves to societal and cultural norms and expectations?

I am frustrated and stressed. This is why....

1) I made the stupid mistake of not booking a 2-way flight when booking for Karachi from Vancouver. Because of this mistake, I am having a hard time booking a one-way flight to Vancouver. Apparently, people in Pakistan book flights two weeks before their expected departure. Booking in advance, say a month or two, is to be laughed at. That is the reason why I am having a hard time booking my flight back. On top of that, the 4-5 travel agents I am in contact with are each giving me different information and making me run around in circles. I am not used to this. I am used to booking two months in advance via Internet. No travel agents, no middle men, no fuss! Lets not forget the corruption that is involved here either. One travel agent gives me a higher rate for the same flight as compared to another travel agent all to get extra commission. When confronted with this, the other travel agent is accused of being a liar and a fraud. I then looked at flights for the same airline online and lo behold! The rates were 5 times higher than what the travel agents had proposed. Lets also not forget that as soon as they see I have a Canadian passport, they automatically assume that I have money coming out of my rear-end. It is common in Pakistan, as I'm sure in other countries, for foreigners to get ripped off.

2) I keep getting random phone calls on my cell phone and on my land line from random people (men) at odd times of the night (2 am, 4 am, 5 am etc...). This has been happening for months and I am losing my patience...Initially when these men would call I would genuinely think that they called the wrong number by accident and I would try to help them out. I then found out that some men call random numbers, hope that a girl would pick and try to be "friends" with them. I now have 3 numbers stored on my cell phone as, 'Creepy Balouch' (he thinks I am a Balouch and wants to marry me), 'idiot', and 'stalker.' I seriously think these three numbers belong to the same guy...Also, a friend of mine has called one of these numbers and literally yelled at him. He said, "If you do not stop bugging my sister then you will regret it" That sure didn't help....

Anyways, because of these random men, I have found myself becoming rude. When I recieve these random calls now by men asking to be "friends" with me I say "I do not want to be your friend and do not call me ever again!" I am getting annoyed at my recent change in behaviour. But I cannot help but get annoyed by these men! So now I sleep with my phone receiver off the hook and cell phone on silent. I cannot deal with this anymore....

I was talking to a colleague the other day when I realized that he was the only one not eating lunch (we had ordered biryani). Curious me asked him why he wasn't joining the rest of us. His simple and most touching answer: "I am saving my lunch for my kids when I get home. They will love it."

Parents, including mine, sacrifice for their children day in and day out. They spend every single living moment concerning over their children, providing for them, nurturing them, and protecting them from the "world's evils." Knowing this and being the recipient of it, I could not help but feel emotional and sad after hearing my colleagues statement because this is not the first time I have heard this type of statement. In fact, I have witnessed it. Individuals here and in other developing countries are so poor that they are unable to fill their stomachs. I am sure you are familiar with this situation. But my heart goes out to those who sacrifice their health and well-being so that their children can survive, even though the food they receive may not be the healthiest. Imagine wondering every hour of every day as to how you will feed your family. Imagine wondering whether your child will survive or grow up to be a healthy adult. Imagine watching your child waste away before your very eyes. Imagine going to sleep hungry yet content that your child isn't. Most of us cannot imagine this because we have not lived through it and may never need to.

This reminds me of a story about my parents when we were living in Karachi. My mom and dad had cooked a meal with whatever little they had. We were not well off at all. However, they never got to enjoy that meal because my baby brother had well....urinated over the food. I mean he was just a little baby and he didn't know any better. I am sure I might have done something like that as a baby as well. The outcome? Brother was fed but my parents went to sleep hungry that night and who knows how many more nights they went to sleep hungry.

During my Primary Health Care course, I had the opportunity to visit a non-government organization called HANDS (Health and Nutrition Development Society) in Malir (a town in Karachi). Since 1979, HANDs has been promoting health, education and the alleviation of poverty in marginalized communities in Pakistan. This includes, 9.0 million people living in nearly 7000 villages in 15 districts of Sindh and one district of Balochistan. HANDS is certified by USAID.

We visited this particular organization because our course objective was to gain practical and theoretical knowledge about primary health care set up in an area serving marginalized populations. This experience also gave us an idea how both private and non-private organizations can work together in partnership as well as how communities can be mobilized and empowered to take care of their own health and well-being.

Some of the services provided by HANDs include: education programs (for midwives, educators, nurses, community doctors, and volunters), Early Childhood Development, primary school education, micro-credit loans and other financial services, programs aimed at establishing clean and safe drinking water, vocational training, medical services (OBGYN, Lab, OR, EMONC, radiology, vaccination, family planning, etc..)

A distinctive feature about this organization is that it works hand-in-hand with the communities and the people it serves. The communities were consulted before the services and clinics were set up. The people were asked as to what problems and issues they are facing and what type of services they would like in their communities. This concept of community mobilization and participation is of the utmost importance to any health care system in any part of the world. In fact, community participation is one of the principles of the Primary Health Care. It's the community that decides (or should decide) what it needs and how to best solve their problems. Organization can provide technical support to communities but should not force their will. Only this creates sustainable and committed communities.

As part of HANDS, young women are given training in handicraft and sewing, free of charge. We were given the opportunity to see the textile workshop set up by HANDS. So many young women were working on various different designs on various different fabrics taught by their instructor. I talked with a couple of these wonderful ladies because I wanted to see what they thought about this program and what are they personally benefiting (if they were) from this program. One lady said that it is a 3 month training program for women living in marginalized communities across Sindh. This same lady also mentioned that when she is done with the program she will go back to her community and with the skills she has gained, she will open up her own shop and sell her designs. I had asked, "Why are you doing this? What motivates you to do this?" She said, "Because this is my passion. This is what I like to do." Every women in that women said the same thing. So I asked, "What about your family? Do they support this?" Another women answered, "My father encourages me. They want me to do this." I also found out that all the supplies (sewing machine, fabrics, scissors, etc) are all provided free of charge. How wonderful is it that women are empowered to pursue what they love instead of being forced to settle with something they have no interest or passion for. This is community participation.

Historically, women in Pakistan are not allowed to leave their homes without the company of a man. This is true for other patriarchal societies as well. Women's mobility into the public sphere is restricted so much so that they are confined to the four walls of their homes. Not only their mobility, but their behaviour and activities are also dictated only by the men in their lives. Hence, women are responsible for maintaining the family honor by being obedient to the demands placed on them by these men.

During my field visits to the Karachi slums (katchia badis) and rural areas, I continuously hear stories of women not being allowed to leave their homes without their husbands, brothers or fathers. This means that if a women needs to go to a health center for any sort of health care for herself or her child, she cannot unless she is accompanied.

Sadly, this remind me of a story. A women was pregnant with her 9th child. First of all, she did not want to be pregnant anymore and proposed to her husband that she would like to get her tubes tided. Her husband refused, saying that it was "unislamic" to do so as that would "go against Allah's will" since it is "Allah who allows us to have children." Let me just briefly add that there is no mention of this in the Holy Quran and furthermore, Islam is a faith of intellect. These two are inextricably linked, that one relies on the other.

So this women continued to work during her pregnancy as a house cleaner as the family income was not adequate to meet the needs of the entire family. Additionally, she was very weak and malnourished. During my experience, I have learned that short birth spacing is extremely harmful to the health and well-being of the mother as well as her children due to nutrient deficiencies as well as limited psycho-social interaction. Such was the case with this mother. While at work, she started to bleed and needed to go to the hospital immediately. Since her husband was not home, she was not allowed to leave the house. The local people knew this and hence, did not provide her with any assistance. However, a traditional birth attendant recognized the severity of this situation and travelled for 3 hours in order to get the village lady doctor to see this women. Unfortunately, the lady doctor had been relocated. When the birth attendant returned to this women's house, the women had bled to death....

This story bothered me a lot even though I know this is a regular occurrence. Why do we have such little respect for women? If God created us equally, then why are men given more rights then women? I refuse to buy in to the idea that "people are just not educated enough" or "there is a lack of awareness." First of all, what does it really mean to be "educated?" Second, I think this has more to do with behaviours that are deeply engrained and rooted in culture and tradition. Behaviours are hard to change, especially when that is all you have ever known.

When I arrived in Karachi, I was shocked to see men holding hands. I think you know what my initial thought was. However, little did I realize that men hold hands here all the time! It is a symbol of their brotherhood and friendship. Relationships amongst friends is so strong here that people are not afraid to show their affection in public. In the west (taking Canada as an example), when two friends of the same sex express their friendship in public by holding hands, individuals automatically assume the presence of homosexual relationship, just as I did.
We put labels on everything but do not even know why or where these labels originate from. We fail to understand the big picture and instead take the easy way out because society dictates what is normal and what is not. Apparently, society says it is "not normal" for individuals of the same sex to hold hands without an underlying meaning behind it. But what does "normal" really mean and who has the right to define it? My idea of what "normal" means is completely different than yours.

Additionally, I feel that most of the time (East, West, South and North) we are too engrossed in our own lives that we fail to truly love those around us. Our family, friends and even strangers. We rush about trying to fulfill our daily tasks that we forget to express our love and affection to those that matter us the most. We spend hours at work on our desks and with our computers yet our families and friends don't even get one hour with us. To tell you the truth, I am just as guilty of this as the next person.

How can an individual spend time with their family and friends when societal pressures are massive and demanding? Are these pressures man made? Do we really not have time for our loved ones anymore?

Maslow's Hierarchy of needs is depicted as a pyramid consisting of five levels. The lowest level is asssociated with physiological needs (health, food, and sleep), then safety, belonging, Esteem and finally the uppermost level is associated with achieving self-actualization. Why am I telling you something you already know??

Poverty remains to be a problem in most developing countries, including Pakistan, which has resulted in an exceptional slow progress towards development. Without going into the details, poverty also affects a person's physical, professional and psychological advancement.

Many people are so poor that they cannot even meet their very basic physiological needs. They are unable to fill their stomachs, provide a shelter for their families and are at a risk for several diseases. Hence, a person becomes more engrossed in meeting their lower needs that they eventually abandon their higher needs. This makes it difficult for them to advance higher and to recognize their potential, but not impossible.

The situation is further complicated when a country is unable to meet the security needs (physiological and psychosocial in nature) of its people. Not only does there remain an overwhelming sense of food insecurity but one also becomes constantly afraid for their lives. Such is the case in Pakistan. The political and social situation is so volatile that individuals are constrained and suppressed.

Unfortunately, poverty and insecurity can sometimes lead to abandonment of morals and ethics. I am not trying to make excuses but only offering a different perspective. The poverty rate in Pakistan has a positive co-relationship with the crime rate, as with most developing countries. In Karachi alone, 200 mobile phones are stolen each day. When your basic needs for survival are not met one is forced to do whatever it takes to meet those needs, especially when your family depends on you. Now when I look at photos of individuals being caught of theft I feel sad for some reason but my rational mind also starts to kick in. Initially, I used to look at these photos and say, "Good! They deserve to be caught!" Now I look at the same pictures and wonder what might have motivated or influenced them to take such actions. I was always aware that no action or thought is influenced by one single factor, but instead multiple factors. However, I am now living this principle...