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Rapid Responses: Rapid Responses published:
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The Unpardonable Hypocrisy
- Balaji Ravichandran (11 November 2005)
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In Pakistan's earthquake zone global relief has so far failed its test
- Tayyeb Tahir (14 November 2005)
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Re: The Unpardonable Hypocrisy
- Tayyeb Tahir (14 November 2005)
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Conduct of doctors during Earthquake
- Prasanta Raghab Mohapatra (14 November 2005)
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Free journals access for Pakistan.
- Omer Ashraf (15 November 2005)
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Moved by the agony of others
- Margaret Allen (15 November 2005)
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Every cloud has a silver lining
- MOHAMMAD T MASOUD (16 November 2005)
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Free access to bmj.com for Pakistan
- Kamran Abbasi (16 November 2005)
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Earthquake Management
- Dr NADER KHANDANPOUR (1 December 2005)
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Global relief needed for Pakistan’s earthquake zone
- Melanie Amna Abas (16 December 2005)
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Balaji Ravichandran, Medical Student, HIV/AIDS campaigner, AI Member Madras Medical College, Chennai, India
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Dr. Groves was right when she said 'the world seems to have shrunk this year' a couple of weeks earlier [1]. She also raised the question, 'Is the richer world more genuinely interested now?'. If the question wasn't condescending enough, she went on to say, 'It should be, and not only for humanitarian reasons: these events and the responses to them can inform and improve policy decisions in our own countries'. In case of the Pakistani earthquake, even the selfish motive did not manifest into a decent response to the disaster. 'Interested', Dr. Groves? It is my humble opinion that it is an imperative moral responsibility of the monetarily rich countries (given the response of these countries, I cannot hold them rich on humanitarian or altruistic grounds anymore) to provide genuine help to the poor nations, which always seem to bear the brunt of great natural disasters. Over a hundred thousand people might have well died in the Pakistani earthquake now... And what has the so-called rich nations done? Even 'dismal' is too light a sentence, in the wake of the unabashed hypocrisy we, in poor nations, witness. General Musharraf has, probably for the first time, taken the bold step to tell the BBC that the response was 'woefully inadequate' [2]; and that the richer nations were more generous in their aid with the Tsunami because a large number of foreign tourists had given their lives to the killer wave. He believes the response to be partisan. I would agree with him. I witnessed the response to the Tsunami first hand. I also saw how great the world responded to the crises in Darfur, in Niger and in Malawi (how many richer countries are even aware of them?). I also saw the response to hurricane Katrina - outgoing messages in Yahoo still carry a 'Donate to Katrina' link; Yahoo even has a separate 'Yahoo Groups Directory' for the victims of hurricane Katrina; Google public service-ads are no exception either. (Is the USA poorer than the African nations, I wonder.) I have yet to see a donation link for the Pakistani earthquake on these websites. No, the richer world hasn't been genuine in their response, inadequate though it surely is. No, the richer world is not genuinely 'interested'! While the UN seems content with donors' conferences and acquiring pledges that never materialise, it has become a comfortable excuse for the richer nations to blame the corruption of the governments; and in the current situation for citizens of such nations to blame President Musharraf for spending more money on the military than on infrastructure. How irrational is it to lament about the lack of infrastructure when people are already dying every minute? Disasters have been happening one after the other, and will continue to occur. And as the richer nations continue with this unpardonable hypocrisy, the world will continue to shrink forever, and humanity would have lost its meaning. REFERENCES (1) Groves, T. Better Decisions. BMJ 2005;331 (22 October), doi:10.1136/bmj.331.7522.0-f (2) http://news.bbc.co.uk/2/hi/south_asia/4363418.stm [Accessed November 11, 2005] Competing interests: None declared |
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Tayyeb Tahir, SpR Psychiatry Whitchurch Hospital
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Dear Mr Villar I hope your views on this earthquake would raise further awareness for the need to do more. Life has changed after the earthquake for every citizen of Pakistan. It is different while you are watching it on T.V and totally different when you are there on the ground. This is an unfortunate and a unique event to happen. Perhaps, and hopefully, we would never see such scale of devastation again in our life time. Sadly the response from the world has not been strong enough. Pakistani doctors in the NHS feel particularly strongly at this time to act in some manner. They feel that along with monetary support, a lot more can be done. Many feel a great need to participate by using their skills and training to deal with the physical and psychological impact. It is in the best interest of the NHS to initiate a programme for these people to participate or contribute to the effort. Tayyeb Tahir Competing interests: None declared |
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Tayyeb Tahir, SpR Psychiatry Whitchcurch Hospital, Cardiff, CF14 4XN
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Relief work after earthquake is severely affected by an extremely rugged terrain and extreme winter conditions with some of the world’s highest peaks located in this vicinity. Victims of earthquake are hence at the risk of dying from hunger, being without shelter, cold weather and disease. The devastation of the tsunami was spread over 13 countries mainly Indonesia, Sri Lanka, India, Thailand, Malaysia, Myanmar and the Maldives. The number of people displaced and left without shelter in the last few weeks is three times as many as in the tsunami. In the aftermath of the earthquake many in Pakistan and the Islamic region will be able to quantify their lack of worth and importance in the world with the benchmark of giving for Tsunami. In this time of tension between the West and Islamic countries the UK has an opportunity to win the hearts and minds of Muslims in general and Pakistanis in particular by leading the efforts from rest of the world for the relief efforts. While Disaster Emergency Committee hopes that the people in UK will overcome donation fatigue, government in UK need to do far more than what it has done till now. Pakistan needs your support in the short term as well as for the long term rehabilitation of this earthquake hit area. Tayyeb Tahir Competing interests: None declared |
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Prasanta Raghab Mohapatra, Senior Lecturer, Department of Tuberculosis and Respiratory Medicine Govt. Medical College, Chandigarh, India
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It was 9.22 AM (IST) of October 8, 2005, whole northern India and Pakistan experienced an earthquake magnitude of 7.4 on Richter scale at its epicentre. Doctors along with medical and paramedical colleagues were involved in active patient care at that time. The problem was worsened by disruption of power supply. This did happen in some outpatient department, wards and even in intensive care unit. The conduct of doctors during this natural calamity raised several ethical and potentially medico legal issues. The reflex responses of everybody including doctors were to quit for a safer place. These raise the question whether professional like doctors and paramedical staffs can seek safety for themselves leaving the patient unattended. At the outset, it appears that morally doctors should not leave the patients for their own safety, but in a situation like earthquake where even the multistoried buildings crumble in seconds; would staying by the side of patient be of any help endangering life of doctors and other paramedical staffs? Also running outside during a quake is also risky as falling debris is a major danger during and shortly after an earthquake. Particularly in a disaster like earthquake it appears impossible in any setting to evacuate all the patients within seconds. It may still be possible in case of fire outbreak which spreads from one part of building to other giving some time for the evacuation. I am not aware of any guidelines which provides the role of doctors during (not after) the earthquake. I hope this need to be debated at international level or some opinions from the editors and readers of BMJ. Competing interests: None declared |
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Omer Ashraf, Doctor Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
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Over time the one thing that has unified man across all regions of the globe has been knowledge. Despite all the differences of political, religious or ethnic region over ages, the pursuit and sharing of knowledge has been the one distinction that, on many occasions, separated our species from the rest. Even though art and science both are requisites for the human form, it has been the global spread and appreciation of scientific disciplines that has truly made the man stand out from ages of dark, into light. Of sciences, health science or medicine is the one generally considered by many as the noblest. Indeed it is the one discipline that owes its evolution most to the synergy of the knowledge acquired by its pioneers. Medicine is the kind of script that evolves and strives from sharing. Access to it has to be universal, for the noblest of reasons. For denial of its free access compromises not the designing of budding nuclear reactors, but often the waste of the most precious commodity, the human life. The advent of copyright and streamlining of information internationally has been a relief in many ways. It has contributed greatly to the maintenance of integrity of scientific work. This, though, has also meant embarkation of pricing on medical knowledge globally. Journals of medicine the world over today are marketed. Profits contribute towards running of these publications and maintenance of their standards of scientific work. Whilst the abovementioned practice is logical and indeed appropriate, there are certain ‘limitations’. Health today faces many different challenges across the globe. The distribution of disease is diverse. Where developed world faces a different burden of disease, plights of the poorer nations differ. The lag in economic capabilities results in a marked underdevelopment of the health systems of the developing world. This adversely affects their ability to control their disease patterns. Very often the standards of health education and practice suffer for similar reasons. Indigenous research work lacks quality and regional publications lack international appraisal and impact. For these developing countries, that generate the majority of world’s population below the standards of global health, access to quality research work is paramount. However, since most of the international medical journals of major standing require monetary subscription, access is often subject to financial capacity that is already limited in these nations with the lowest per capita incomes in the world. For this reason their right to provide their populace with the best health care is correlated with their fiscal limitations. Considering this premise it has been particularly heartening to observe the move by a number of publishing groups to introduce free access to their journals to the developing world. Included amongst these are the low-income countries as designated by reputed global bodies. BMJ Publishing Group is one of these. It has entitled free access to its journals to low income and low-middle income countries. Apart from this it in indeed welcoming to see the recent inclusion of countries devastated by the tsunami: India, Indonesia, Malaysia, Sri Lanka, and Thailand. Along with tsunami, recent times have seen another natural disaster of comparable destruction. This refers to the 7.6 magnitude earthquake that struck the northern areas of Pakistan on Oct 8th, 2005. To date nearly 75000 deaths have been confirmed, with a level of destruction that is believed to take upto a decade to repair (1). Apart from being a huge burden on Pakistan’s weak economic reserves, the earthquake has posed enormous challenges for the country’s under equipped health system. Even as it is welcoming to see the aid and concern of international community, the effect of this disaster on this nation’s health reserves is likely to take years to wean off. As physicians in Pakistan we are rallying all our efforts to combat the calamitous effect of the tragedy. Whilst it is indeed welcoming to see help coming from all quarters, mostly from global medical community, it would be a nice initiative if another step were taken. This refers to the inclusion of Pakistan in the list of countries having the free access. It might come as a gesture of understanding for many of our health community members, and indeed boost their future research as well as overall medical aspirations. BMJ is a journal with wide international readership. It is hoped that publication of this message in this journal would encourage other publishing groups to follow the suit and grant free access to the readers to this country, which already has its share of enormous health sufferings and challenges for the next decade. References 1. Overview: Quake aftermath. [monograph on the Internet]. BBC News UK Edition [cited 2005, Nov 14]. Available from: http://news.bbc.co.uk/1/hi/world/south_asia/4322624.stm Competing interests: None declared |
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Margaret Allen, Physician Assistant East Palo Alto, California, USA
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Richard Villar's account of his time in Pakistan recently is unbearably moving, and I am so sorry for his deep feelings of impotence and grief. I have just returned from a medical mission to the Mississippi Gulf Coast where, two months after the Katrina hurricane, many thousands of people are living in dire and derelict conditions. I heard over and over again from the recently- homeless that they had "lost everything, but" - and here's the surprise - their loss was "nothing like what had happened to people in Pakistan". Perhaps it is only when we are personally affected by a disaster of our own, that those of us in the West can relate. My mother who experienced the Blitz as a nurse at St. Thomas's Hospital is so much more deeply moved by the agony of others than her grandchildren who have seldom encountered pain. Sadly, without a frame of reference, many of us just shake our heads and move reluctantly on. I'm not sure how we can change this. Competing interests: None declared |
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MOHAMMAD T MASOUD, SENIOR HOUSE OFFICER, OPHTHALMOLOGY STIRLING ROYAL INFIRMARY, STIRLING. UK. FK8 1LU
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I was deeply touched by Mr Richard Villar's article on the earthquake in Pakistan. He has very correctly described the human misery caused by this event. As a Pakistani doctor from the northern city of Abbottabad, I have personally been affected by this calamity. My city Abbottabad, and in fact my own house has been damaged by the earthquake. Although the situation in the earthquake hit northern areas is very grim, there are numerous stories of hope, strenghth, bravery and goodwill. It is widely believed that the Pakistani nation has never been so dedicated and united in its entire history as it is now. Everyone is trying to help the affected people in all possible ways. Students, doctors, nurses, engineers and ordinary people from all major cities, especially Karachi, Lahore and Islamabad have volunteered to work in the earthquake hit areas of the country. Millions of ruppees, clothes and food has been donated. The Pakistani community living and working abroad has also contributed tremendously towards relief work. Many doctors from the United Kingdom and the US have gone to Pakistan to help their people. The role played by the International Community and the UN has also been commendable. Many International relief teams arrived in Pakistan within the first few days and helped in rescue and relief work. In my home city of Abbottabad, many emergency medical camps from Korea, Japan, the UK and Cuba were set up at the Ayub Teaching Hospital, which is the major surviving tertiary hospital in the North West Frontier Province. Many governments and ordinary people from all over the world have shared in our grief and have donated very generously towards the relief and aid work. The Pakistani nation is very grateful for all this help. It is true that this calamity is of great proportions. The relief work in the valleys and mountains is particularly difficult and the winter weather is making things worse. This is the reason Jan Egeland, the Chief UN Relief Co-ordinator, has called this calamity worse than the Tsunami (1). According to President Musharraf, the earthquake relief and rehabilitation will cost the country more than $5 billions(2). Experience has shown us that the aid pledged by donating countries is rarely met(3). However we hope that through our hard work, strength and dedication and with the help of the International Community, we will be able to successfully pass through this difficult stage of our nation's history. REFERENCES: 1. Quake is ‘UN’s worst nightmare’. http://news.bbc.co.uk/2/south_asia/4358902.stml (accessed 16th Nov 2005). 2. Quake costs to exceed $5bn: Musharraf. Jang Group Online Editions 26th Oct 2005. www.jang.com.pk/thenews/index.html. (Accessed 16th Nov 2005). 3. Walker P, Wisner B, Leaning J, Minear L. Smoke and mirrors: deficiencies in disaster funding. BMJ 2005;330:247-50 Competing interests: None declared |
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Kamran Abbasi, Former acting editor, BMJ London EC3A
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I support the call for free access to bmj.com for Pakistan. I was disappointed by the BMJ Publishing Group's decision last year to end free access to bmj.com for the world's poorest hundred or so countries. Instead the BMJPG chose to allow free access to a list of countries agreed by HINARI, which conveniently--for the sake of publishers' profits--excluded several countries with many millions of poor people, including China, India, and Pakistan. The BMJPG then freed up access (for 2005 only) to countries affected by last year's Tsunami. Pakistan's and India's earthquake deserves a similar gesture. Indeed, why doesn't the BMJPG go back to its old policy--a policy based on equity not profits--of free access to bmj.com for the hundred or so poorest countries. As a journal that has long supported preventative measures wouldn't it better to do just that than have to react each time there is a natural disaster? Competing interests: I was born in Lahore and I support free access to the scientific literature |
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Dr NADER KHANDANPOUR, Clinical Fellow Addenbrookes Hospital, Surgery Ward, Hills Road, Cambridge, CB2 2QQ
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Natural disasters, from earthquakes and floods to fires and hurricanes have claimed many lives. Obviously, they are not restricted to a nation or a specific time. Looking at history we see that surprisingly the number of casualties starts increasing dramatically days after the disaster. Although I agree that there have been pitfalls in the response to the Pakistani tragedy, one should not ignore that there are many other ways to help. When I compare the Pakistan earthquake with the Bam disaster, Iran, where I myself saw the scene from the first day, I find that the common problems are common! After the disaster people become panicked and chaos ensues. Many people would like to help but do not know what to do. I believe that tackling the problem could be done at different levels. First level is the “people of the area”. They have rapid access to the field and strong motivation to help. So, it could be a good idea if we train all the general public to have the generic skills and knowledge of tackling the problem effectively. If they work in organized way it could be more useful and can save more lives. In national curriculum of many countries there is not even a single session for this. Ironically, media have many “Accident & Disaster News”, but rare “Accident & Disaster Management” programmes. What is more, “the local and national authorities” could have some integrative programs for helping people as soon as possible. To this end a specific and reasonable budget is needed to be allocated for rescue programmes. It is too late to start thinking how to fund the rescue operation while many humans are alive under the rubble! The third level could be “International Help”. Although it comes as the 3rd level yet, no one can ignore its important role. I believe we need to divide its role into two parts: Informing the world of what has happened and then utilizing international help in the best way. Actually this needs a good communication between nations. Disasters have always been with human beings. Every now and then, there are conditions where humans are in need, ranging from food disasters in Africa, earthquakes in Asia to hurricane in Jamaica. So a preplanned help to disaster stricken nations could be more effective than an on-off reactive one. In the final analysis, I believe that the ideal way to tackle the problem perhaps would be a blending approach with both individuals, national and international authorities work continuously and effectively together. Competing interests: None declared |
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Melanie Amna Abas, trust grade consultant psychiatrist/honorary senior lecturer South London and Maudsley NHS Trust/Section of Epidemiology,Institute of Psychiatry, London, SE5 8AF
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The rapid publication of Richard Villar’s (1) deeply moving personal view shortly after the earthquake was commendable. Since then there has been virtual silence from the BMJ, synchronous with most of the British media. Yet the toll is 86,000 deaths, 8,000 schools destroyed, 2,000 clinics and hospitals destroyed, 3.3 million homeless, more than 100,000 injured people, 20,000 children disabled and vast loss of crops and livestock. At a conference I asked if the experiences of British health professionals who have been over to support the relief effort might be used to ‘bring home’ to British people the dire conditions in Kashmir, as a way of increasing international awareness and fundraising. Many British- Pakistani doctors wrote to me with their accounts. We offered them to the BMA News Review. Their response was disappointing - ‘we covered that story two weeks ago”. The Sunday Times however published a small percentage in a powerful and affecting article on Dec 4th (www.timesonline.co.uk/newspaper/0,,176-1902716,00.html) . Alongside the outstanding work of the large charities within the Disasters Emergency Committee (DEC, www.dec.org.uk/), such as Merlin (www.merlin.org.uk/), many initiatives from ‘ordinary’ health professionals have come together in the UK and US. These include Earthquake Trauma Relief Initative (www.bppauk.com), Emergency Aid (www.aidinemergency.org) and Operation Heartbeat to name but three. On Monday December 19th the Institute of Psychiatry at the Maudsley, Kings College London, will host ‘Pakistan in Need’ - an open invitation event to raise awareness of what is needed to assist with rebuilding lives and communities (www.iop.kcl.ac.uk/international/). Speakers will be from DEC charities, other organisations and individuals committed to supporting local capacity and extending the relief effort. We highly value the participation of the media. imh@iop.kcl.ac.uk 1. Villar R, In Pakistan’s earthquake zone global relief has so far failed its test. BMJ Vol. 331, 12 Nov, p.1151 Competing interests: None declared |
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