Nursing the terminally ill

As nurses, every day we come across many types of patients, including the terminally ill who are unable to make decisions for themselves. In such cases, the power to make a decision lies with the family/health care team.

In ICUs, most health care professionals believe that to continue to resuscitate a terminally ill patient whose prognosis is poor is both fruitless and cruel. The family members disagree and want to prolong life, not realizing the patient's status.

To help such families I have some suggestions to help foster trust and communication between the family and the health care teams to pave the way towards shared decision-making.

First, the health care team and the family must trust each other. The nurse can do this by showing concern for the patient and the family. Once trust is achieved, the family will be far more receptive to information that the caregiver would like to give.

Second, the health team should maintain its cool and avoid being judgmental. Sometimes it strongly disagrees with the family decision and gets critical. It should realize the family's stress and allow it to ventilate its feelings.

Third, the family be allowed to have maximum possible contact with the patient to enable it to accept reality. It will also enhance a healthy discussion about what's best for the patient.

Fourth, the caregiver must have enough facts and correct information to share with the family. Wrong information often leads to conflict between the family and the caregiver.

The caregiver should know more about the patient and ask simple questions from the family - for example, who is taking care of the patient since his illness. It is important to identify a responsible family member, so that the caregiver can give all the information and facts related to the patient to the right person.

Fifth, the family be informed about the patient's condition on an ongoing basis. The family's lack of knowledge or misunderstanding about the patient's health status often causes disagreement between the family and the caregiver about the mode of treatment.

It is important to be with the physician when a plan for the care of a patient is being discussed, so that the same information is provided to all the members of the health care team as well as to the family.

Sixth, a patient-care conference be held on a regular basis. This should include physicians, nurses and one or two family members of the patient. It will show the caregiver's concerns toward the patient's prognosis.

I would recommend nurses to practice these strategies to help families to make better decisions for their patient.

MRS SHABANA SALEEM LALJI

Karachi

NFC award and Sindh

This refers to the news item "Punjab, NWFP reject Sindh's demand" (Dawn, May 5). It is ironic that Sindh which generates almost 70 per cent revenues for the country is given 23 per cent in return.

The Punjab's chief minister's pledge that "his government would never concede to the demand of Sindh" is also in bad taste. In today's world, where unlimited factors are considered and compared, sticking to just one factor of population is very unjust and unrealistic.

If population is to remain the prime factor, funds should be allocated district-wise instead of province-wise. This will give the districts financial autonomy. The provincial governments may charge a certain percentage from each district to meet their expenses.

The centre's attitude has been regrettable throughout the episode. Its claim that there is "no quarrel over the funding allocation to the provinces" is also not correct. The provinces have been demanding 50 per cent share for a long time, and whatever the centre has given is already the right of the provinces.

If the provinces are divided over the distribution, the centre should try to resolve the differences. It cannot absolve itself of responsibility by saying that the "centre has nothing to do with it".

TAHIR MAQBUL ZUBERI

Karachi

(2)

This is in reply to the letters appearing under the headline "NFC award and Sindh" by M. Nawaz Khan and Shehram Muzaffar (May 12). Both writers are fully aware that Karachi is the biggest revenue generator, being a major port and the industrial hub of the country, but they have ignored the fact that as a hub port, the city's roads are burdened with heavy vehicles from all over the country.

The Punjab chief minister was quick to impose a ban on the inter-provincial wheat movement without thinking twice about the fact that Karachi and Sindh feed millions of workers from Punjab and their families. The fact is that Punjab has been inefficient in the collection of taxes from industries in Lahore and Faisalabad as well as from the agriculture sector.

If revenue generation is not to be taken into account in dividing resources, then Karachi should be given special funds in lieu of providing employment, residential facilities and utilities to millions of people from other parts of the country.

SYED SAAD MANSOOR

Karachi

Root cause of violence

The mosque blast in Karachi left 15 (the toll has since gone up to 19) people dead and about 96 wounded on May 7. The bombing sparked off widespread violence which left another eight people dead the following day. It seems violence has become endemic in our society.

Such crimes, whatever motivation they may have, are unpardonable. But venting fury on innocent citizens in no way involved in or related such events is equally senseless and unforgivable.

Obviously, the people who come out in the streets to inflict damage on the property of those who in no way are responsible are anti-social elements. Who are they, what forces them to act like this, and what needs to be done to reform them?

We have some prominent and selfless workers in the social field like Maulana Edhi, Mr Jimmy Engineer and Ms Asma Jehangir. While their hands are full with what they are already doing, it may not be unfair to expect them to create social groups to look into the social causes that lead to violent and anti-social behaviour.

M. A. BHURA

Karachi

(2)

This refers to the report "14 die in Karachi mosque bombing" (May 8). Why do tragedies of such horrendous magnitude occur time and again? Such gory killings and murder in the name of religion have become the order of the day. Why? We have to say our Eid prayers under the protection of armed guards. Why?

Islam stands for tolerance and brotherhood. We are taught to accommodate each other's views and to live in peace and harmony among ourselves. The carnage in Hyderi Mosque has done a great harm to the teachings of Islam.

SYED AZIZ AGHA

Karachi

'We don't get it, do we?'

Mr Ayaz Amir, in his article "We don't get it, do we?" (May 14), concludes by saying: "But on one condition: only if the army does its own thing and leaves government and politics alone." How come we have landed in such a situation? The following words of Socrates may answer this question:

"Some sailors think that they know all about steering a ship. Even though they have never been taught, they maintain that it is the sort of thing every man has a talent for and that it cannot be taught.

Each man considers himself fully capable. Those sailors get the captain drunk and they take over the ship. Whoever goes along with their mutiny is rewarded with the honorific title of 'sailor', 'pilot' or 'able seaman'....

"We can see from this parable... that some states have no use for wisdom any more than these sailors see the use of a captain. It is true that philosophy is deemed useless but the fault is not the philosopher's.

The sailors may not realize that they need a navigator, but this not the fault of the navigator. Sick people may think they have no need for doctors, but that is not the fault of doctors.

"In the same way, we may think we have no need of a man who knows how to rule. We may think that is a talent which all men have. The pay-off is that we ourselves must suffer for our delusion.

Thinking that all men have the talent, we choose rulers for all sorts of irrelevant reasons: on the basis of wealth, family or popular appeal. This is as foolish as choosing a doctor because he is tall."

What Socrates said in the fourth century BC is amazingly still relevant. One hopes wisdom will prevail and the ship of the state will be given back to the captain to steer it safely on the right path.

ENGR A. RAHIM

Troy, Michigan, USA

Examination system

All privately-managed schools hold annual examinations of their primary classes at the end of every academic year. The primary examinations of Class V were centralized in 1988, and began to be held at the level of districts, but students of the un- recognized and non-registered private schools were not allowed to appear for them.

From 2002 onwards, a criterion of 'no pass, no fail' as a system of examination was introduced for promotion from Class V to VI and from classes VIII to IX, respectively. It could not carry the day, and was done away with in 2003.

Simultaneously in 2003, the primary and middle standard examinations were declared compulsory for promotion to the next higher classes, and all the students, without any distinction of the 'hue' of their school, were permitted to sit for them, if otherwise eligible.

Similarly, all the other examinations from matriculation up to MA, MSc were, according to inherited practice, to be held after the academic duration of two years each, with a single admission fee.

All was well with this system but one day someone thought of doing otherwise and introduced a new system in which matriculation, FA/FSc and MA/MSc examinations were bifurcated, to be held annually, with double fee for the same examination, while the BA/BSc examinations are still being held as composite examinations against a single admission fee.

The academic duration of the law examination has also been fluctuating from two and three years, and by now it is feared that it may be extended up to four years. Until recently the schedule of examinations of classes IX and X have also not been firmed up as to whether these should be held annually (partwise) or after two years as a combined one.

This is just a glimpse of the muddle we have made of our examination system at great loss to the public.

MIRZA GHULAM HAIDER

Multan

Dealing with aliens in Fata

Today as a result of half a century of criminal neglect and the prejudiced attitude of successive governments towards the NWFP in general and Fata in particular, the government has landed itself in an unenviable situation where it is made to look like a fool led by a few tribal leaders through a maze of violence, ultimatums, ceasefires and yet more violence.

The sorry state of affairs in Fata betrays a lack of vision and fair play on the part of various governments in their dealings with the people of the region.

The fact is that today we are reaping the evil harvest of guns, drugs, extremism and violence that we had sowed in Afghanistan with the help of the Americans. After the expulsion of the Soviets from Afghanistan, jihadis and mujahideen - our erstwhile heroes - suddenly lost their value for the Americans and the West and so they were left to their own devices.

By 9/11, some of our heroes of yesteryear had to some extent settled in the tribal belt in full view of the quarters concerned. Some of the local tribesmen married Arab women.

Likewise quite a few Arabs entered into nuptial bonds with local women. Now one fine morning, all of a sudden, the tribals are told at gunpoint to forsake these foreigners.

Any Pashtoon worth his salt would rather die than hand over someone who is under his protection and who until recently was considered a welcome guest by all and sundry, especially by the state agencies, or else how could you explain the phenomenon of hundreds of Arabs and Central Asians living in Fata for so many years?

What pains me is that the comments that have so far appeared in the context of the Wana operation in the national print media have failed to mention the subhuman conditions prevailing in the tribal region.

Writing from the comfort of their living rooms, very few, if any, columnists have ever set foot in the region. Hence their columns skip some of the glaring harsh realities like the absolutely nonexistent job opportunities, brutal mediaeval laws and lack of civic facilities that the citizens of Islamabad, Peshawar or Lahore take for granted.

Isn't it shameful that in a country where unlimited state resources are being wasted on monuments, extravagant airports and show-piece projects in the most populous province, none is available to construct schools, hospitals and water reservoirs in the tribal region? By being so indifferent to their genuine basic needs for such a long time, we have surely forfeited our right to lecture the tribal people about their responsibilities as citizens of Pakistan. The present government, when it so desires in the larger interest of the country, can make or amend any number of laws.

It is about time it also gave some serious thought to the laws governing the people of Fata so as to bring them into the fold of mainstream Pakistani life.

ALI GOHAR

Peshawar Cantonment

Deportation of Shahbaz

Mian Shahbaz Sharif was deported to Jeddah from Lahore on a special PIA flight by the government when he tried to bring his exile to an end. If Shahbaz Sharif was sent to Saudi Arabia along with his family by General Pervez Musharraf under an agreement with the Saudi government for 10 years, why did the Saudi government allow Shahbaz Sharif to leave the country in the first place?

If Shahbaz Sharif is wanted in a "police encounter" case in which five innocent people lost their lives, why was a person allegedly implicated in a crime who had come to get himself arrested allowed to go back to Saudi Arabia? Are wanted criminals and looters of a country's wealth sent abroad by chartered flights at public expense?

We, the people of Pakistan pay heavy taxes on electricity, telephone and gas bills. Besides, we, the salaried class, also get our income-tax deducted. We don't pay revenue to the government so that it can be spent for the joyride of politicians. What are the courts doing?

M. RAFIQUE ZAKARIA

Karachi

Water scarcity in Balochistan

This has reference to the article "Water resource scarcity In Balochistan"(Dawn, May 10). The centre appears to be trying its utmost to overcome the alarming situation, and the World Bank too is prepared to sanction loan in this regard.

However, the provincial government is not prepared to carry out the scheme, and Balochistan may suffer because of the slow response by the ministry of agriculture. In the current year tenders were floated for a "trickle irrigation farming system" but for lack of support by the people concerned the whole exercise was rendered futile.

Who is accountable for this and how long will it take to streamline a transparent and efficient system so that schemes can be promptly implemented?

SYED WASIF HUSAIN

Karachi

Confession by Rumsfeld

This is with reference to the confession of Donald Rumsfeld that the atrocities and torture committed on innocent Iraqis was in his knowledge. The torture of Iraqis in Abu Ghraib prison is the worst kind of humiliation of mankind.

Although Rumsfeld was apprised about it, he did not take any action. Was this at his behest?

America should remember that those who are being subjected to torture and humiliation are also human beings. Mr Rumsfeld should hand in his resignation immediately.

HAFIZ AHMAD NOUMAN HASAN

Lahore

Living in the Stone Age?

I was shocked to see a news item on page 5 of Dawn (May 5), which says that a tribal malik in Bajam Agency chopped off the hands of his former son-in-law and, to top it all, the levies arrested the culprit and burnt down their 10 houses.

It seems that we are viewing a western or Indian movie where anybody can kill anyone without any fear of the law. Has Pakistan gone back to the Stone Age or have we turned into wild barbarians and junglemen? What would anyone think of Pakistan in the civilized world after reading this news? They already have a very distorted image of Pakistan, which seems to be justified after reading this piece.

For heaven's sake, include the so-called tribal areas into Pakistan and do away with the Frontier Crimes Regulation, so that we can come out of the Dark Ages.

KHAYYAM DURRANI

Karachi

Managing a club

Democracy, whatever be the form and shape, has returned and the politicians and the press have the freedom to express themselves. This is, however, not the case with the clubs managed by the Defence Authority.

These institutions where one can relax and spend some time free of tension and worries, continue to be governed by those who, by virtue of their appointment, self-appoint themselves as members of the executive committee.

When would the people who financially support the clubs by paying huge amounts as entrance fee and monthly subscriptions have the right to have some say in club affairs? Arbitrary decisions are imposed on the members by those who may not even be members of the club.

MEMBERS OF A CLUB

Karachi

Waiting for degrees

It has been about three years since I did my master's in mass communication from Kinnaird College, Lahore, along with many other students. We spent two years of our academic life with the promise of getting our degrees soon, if not right away.

That promise is yet to be fulfilled and we are still waiting for the day we can rightfully call ourselves master's in mass communication. Now it is learnt that batches junior to us have got their degrees. If this is the case if and when we get our degrees, our children will probably be attending our convocation.

I have a request for the Kinnaird College administration to take some action soon and do something for all us ex-KCites and justify the years we spent in that institution with trust in its integrity and professionalism.

ZARA MAQBOOL

Karachi