THE QUESTION OF WHODUNIT

 https://www.pakistantoday.com.pk/2021/10/16/the-question-of-whodunit/

Forensic medicine, which is the application of medical science to criminal investigation, is a fascinating field, and one of its most vital aspects is employing DNA to identify those involved in crime, particularly in cases of assault and death. It is a technology that has been in use since 1986, and then, in that first case it was responsible for proving that someone had not committed a murder.

The first time DNA evidence led to a conviction was in 1987 in the UK, and in the USA In 1992 two other DNA analyses led to a conviction and an exoneration. This technology is now used throughout the world, and some countries have set up databases so that when a crime is committed the DNA samples recovered from the scene can be compared with samples belonging to known offenders existing on the database, while a search is conducted for other persons potentially involved.

The rules, such as those of sanitization surrounding the collection of these samples are vital, and stringent.  In other words, success greatly depends upon the care with which this technology is used. The same applies to many other things. It can be dangerous for example to eat food or medicines that have been improperly stored, and plants sicken or die if housed under inappropriate conditions, as do animals and humans. There have been innumerable cases where surgery has gone badly wrong because of ineptitude, carelessness, or inattention to hygiene. We still have surgery, despite this, because if it provides the only chance of recovery, not having it would greatly increase the odds against survival.

So, coming back to Pakistan and the use of DNA as evidence here, the case of gang-rape at the Mazar-e-Quaid immediately comes to mind. In this re-trial of the case registered in 2008, the judge in his verdict stated that: ‘the evidentiary value of a DNA test is not acceptable in a case falling under the penal provisions of zina punishable under the Hudood laws, which had its own “standard of proof.”

In short, DNA evidence was not accepted in this re-trial of the three accused men accused of the crime.

It is important to reiterate that The Hudood Ordinance does not accept DNA evidence, while Pakistan’s other legal stream, the PPC (Pakistan Penal Code), which is a colonial legacy, does accept such evidence.

An observation made in the verdict in this case was most interesting. It said that ‘The court pointed out that the clothes of the victim produced in court as evidence were not sealed.’

And that is probably one of the crucial points when assessing whether or not DNA evidence should be taken into account in Pakistan.

While DNA evidence is invaluable in determining responsibility in criminal cases, it can only be so when and if such evidence is obtained and stored in conformity with the guidelines. Even when the guidelines are followed it can still point, in a few cases, towards the wrong person. If those guidelines are not adhered to, that evidence would definitely be unacceptable.

This is the reason why some people wonder if using the Pfizer covid vaccine in Pakistan is a desirable option, given its stringent storage requirements of extremely low temperatures, since it is an unfortunate tendency in this country to ignore guidelines, a tendency fostered by ignorance, and in the case of storage requirements by Pakistan’s regular power breakdowns.

In the case of the evidence produced in this Mazar case, the clothes the victim wore at the time the incident took place were produced in court in a bag that was not sealed. Which means, that even if DNA samples were taken at the time, they stood a great chance of being contaminated by conditions if the bag was not sealed to make it impervious to them. It also means that these samples– clothes, with or without DNA evidence, could easily have been tampered with at any stage. So, even without the stipulations made by the Hudood Ordinance which were legally binding on the judge, it is worth considering whether or not to accept such evidence.

Science is an invaluable asset. It is also worth understanding that certain guidelines that were gifted to us are powerful reminders of the principles behind matters involved, so they should not and do not forbid better and newer methods. However, if there is a great chance that the methods are implemented incorrectly, as they very often are in Pakistan, should such methods be admissible? Or should we first ensure that attitudes towards guidelines first undergo a sea change?

WHEN THE ONLINE EXPERIENCE REPLACES REALITY

 https://www.pakistantoday.com.pk/2021/10/10/when-the-online-experience-replaces-reality/

When something gains such a massive presence in people’s lives as Facebook, WhatsApp and Instagram have— as the entire being on-line experience has— it’s a good idea to be a bit wary and examine the phenomenon a bit more closely to see what effect it is having on us.

Instagram is one of the fastest growing social platforms with a billion users at a time when WhatsApp had two billion users, and Facebook two and a half billion and rising. So, few people would not know that these media platforms had a bad week recently, that not only did they shut down across the world, but that when they did come back, it took a while for them to run smoothly again. It seems in fact that even some Facebook employees were shut out of their offices, since their security cards would not function.

Even those who are not on one or all of these platforms would have heard about the outage from friends and family, and what they heard would have sounded as though they had been deprived of food and water, so important have these platforms become. If you’re addicted to Facebook for example, it is no relief to be forced to spend that time with anything else, not Tumblr, not Tik Tok, not Twitter. They’re no replacement.

For many people social media means entertainment alone, but for as many it stands for the ability to connect with friends and family, and view them and their lives in far-away places, in an age where friends and family are spread out all over the world. And now, during the pandemic, it means the ability to shop online since isolation has become a way of life for those who are able to keep themselves isolated. For businesses it has become a lifeline, particular now that fewer people are visiting shops and malls and other places of business.

But what lies in the online experience for children, who we see glued to the screen even more than adults?

It’s not just Facebook we are talking about, or Whatsapp or Instagram, it’s the entire online experience. Children these days go online for the fun of being there, for the ability to have someone to ‘play’ with without having to coax them to do so first.

Entertainment is available online for the asking so long as someone can access a screen. All those games where you shoot someone, run a race, almost anything you like. It is the place to be, also because online is where the adults are, and children have been copycats ever since humans were born.

Yet being glued to the screen for long periods for children is even worse than it is for adults, since it means that not only could they access all the wrong content, they are giving up active time to sit on a couch, necks bent, staring at something presented by someone else. No physical exercise, no imagination required, no creativity. It leads to obesity, eye strain, and problems with sleep.

One hears it all the time, but it’s a valid concern: there was a time when children played, using their hands and feet and the rest of their bodies, outside, in the fresh air. They jumped, and chased, and fell. They made stuff with their hands, and went camping and climbed trees. None of that is the case anymore. And the result is not good.

There are non-physical problems too.

Children who spend too much time in front of the screen are less able to handle reality, less able to handle social interaction, since their one aim when any human interaction takes place is to get back in front of that screen as soon as possible. They miss out on the give and take and become increasingly less able to pick up social cues. They are likely to become impatient, because they are used to instant solutions, and might be subject to depression when forced to spend time with other humans.

The onus now is on the parents to find a solution. Governments need to butt out of this matter. No amount of ‘banning’ and controlling as our authorities try to do, will prevent those who want to access something from accessing it. Our world is no longer a tiny, isolated space that can be controlled. It is parents who need to place curbs on how much time their children spend in front of the screen, parents who must provide their children with interests when they are not in front of it.

Children need attractive alternatives, activities and other creative things to compete with being online. Unless this is provided, we are set to be a nation of zombies, glued to a shining rectangle, and in the case of a predominantly illiterate nation a set of people with the ability to click but not to understand. The recent downtime for FB et al and the reaction to it should serve as a warning for what the consequences can be.

Social media and being online for work and play is here to stay. There is no way it can be pushed back into the box. The most we can do is regulate the amount of time we give it at home, and this must be done.

A DIRE NEED FOR PALLIATIVE CARE

 https://www.pakistantoday.com.pk/2021/10/02/the-dire-need-for-palliative-care/

It is time morphine was made available in hospitals for pain relief

“All of medicine, not just cadaver dissection, trespasses into sacred spheres. Doctors invade the body in every way imaginable. They see people at their most vulnerable, their most scared, their most private.”

Paul Kallanithi

Hospitals in Pakistan cater to most fields of medicine, cardiology, oncology, rheumatology, gastroenterology, but the crucial field of palliative care is sorely neglected, in fact it barely exists. It is said that the ratio of palliative services to population in Pakistan is 1:90 million, which is a staggeringly woeful picture.

What is palliative care?

Palliative care is the help offered to a patient when his or her disease no longer responds to curative treatment, in other words at a ‘terminal’ stage, where the disease is considered likely to lead to death. That is when palliative care and hospices are required.

Of all other fields of medicine, palliative care is the one that caters most holistically to a patient.

Palliative care includes non-medical care for the dying person, it caters to a person’s physical as well as emotional needs, such as providing religious facilities where required, addressing the patient and his family’s questions and concerns, and generally making that period of life as easy as possible.

Palliative care takes into account a person’s quality of life, and works towards making death as peaceful, as dignified and as painless as possible.

At a certain stage, such care is ideally provided in the patient’s home, when the role of the family takes on even greater importance, but that depends on the individual situation. In a poverty-stricken country like Pakistan this might not always be possible, therefore adequate facilities must be available in hospitals, and professional training, equipment, and personnel provided.

There are the usual set of people who say that death is not the concern of hospitals and medical professionals. Those are generally the people who also say that since it is God who determines the manner of death, everyone else should stay out of the matter. Again, these are generally the same people who fail to rationalize religion, who in fact imagine that reason contradicts faith.

God is certainly the one who determines the manner of death. However, if humans must stay out of that matter, then we should all also stop taking medications and going in for surgery, since ‘all of medicine trespasses into sacred spheres,’ yet no one expects this.

There are other misconceptions.

Palliative care is sometimes confused with euthanasia, when in fact these are two very different things. Euthanasia is the practice of actively ending a person’s life to minimize suffering. Palliative care does not end life, it strives to make the living easier and the ending – when it comes, less difficult.

Paul Kalanithi, an American neurosurgeon who opted to work in palliative care until he himself died of metastatic lung cancer, was 37 at the time of his death. His book on this subject, When Breath Becomes Air, is worth a read. Obviously, after a certain point Paul was unable to write himself, and then the tale was taken up by his wife. One of the most remarkable features of the book is her description of the way Paul dies. The quote at the head of this piece is taken from this book.

One of the most important requirements of palliative care is morphine, which is used to minimize pain and help the dying person move forward with the least possible suffering. Unfortunately, that is another misconception, that allowing morphine into mainstream medical care is the same as encouraging drug addiction. That is highly incorrect. To equate the two is like equating breathing polluted air with suicide. You need to prevent pollution, which would minimize deaths related to it. In the same way, the manner in which morphine is dispensed needs to be controlled, to prevent it from falling into the wrong hands.

Morphine, a crucial narcotic, is not available in Pakistan. At least not legally, not even in hospitals.

Morphine is an extract derived from the opium plant. Also made from the opium plant is heroin, which is used as an addictive substance.

It is time morphine was made available in hospitals for pain relief.

Afghanistan is the world’s largest producer of opium. Its opium harvest accounts for 80 percent of the world supply. So now, instead of simply batting our eyes at the new Taliban leadership, authorities in Pakistan should look at importing opium, the most abundant and useful commodity produced in their country, instead of importing the Taliban brand of religion. And then to use this opium to make morphine, to help all who need this narcotic in this country.

Palliative care is probably a difficult concept for our authorities to understand, the fact of making death easy for its people, when they seem to find it so difficult to make it easy for them to live, but it is well to remember that we all have to experience death, which is an integral aspect of life, and not all of us can be airlifted to another country and treated in foreign hospitals when the time comes.