My favourite part of Dubai: The ICD and more...

So good to be back home in Montreal! A great experience overall this summer though -nothing more to be said for now. The rest of my time in Dubai was pretty magical, restful, interesting and fun. I'm not really going to go into details about the rest of it. You know what they say about the number of words a picture's worth right... I actually disagree with that most of the time, but well, my last post was the words, this one's the pictures.

Above: Dubai Park across from the Ismaili Centre of Dubai.

Above: inside the Ismaili Centre Dubai (ICD) -that marble fountain was carved out of a single piece of marble, the walls and domes are all built of limestone, the architecture is in the Fatimid style, as I mentioned earlier, the coloured marble tiles in the fountain outside make the water always look like there's a breeze blowing through it even when it's still, the long hall of arches has an architectural special name (axial something?) where there's one "key stone" that if you removed it, all the domes would come crashing down, and that large room with the rectangular windows at the top is the gym for the Early Childhood learning facility inside the ICD.

At the top is Surat-Al-Fatiah which is in the reception of the Centre, the 7-sided star on the floor is the symbol of the ICD and that 7-sided dome is right above it and the only 7-sided dome in the whole world.

Of course, there's much other beauty in Dubai -below are some pics of views of the beach, Madinat Jumeirah, the Burj hotel, city views, etc...

A Tale of Beauty - Dubai: Epinephrine for the Mind and Soul

I arrived here yesterday, and am, suprisingly (for me) completely taken by this place (well, Turkey first, then Dubai -I think I'm in love with the Middle East, quite frankly). It is absolutely, utterly, stunningly, floor-me beautiful. The gulf is blue blue. And smack in the middle of a sandy brown desert, lies one of the most architecturally breathtaking cities in the world. It is very very clean, and the sun shines very hot, palm trees line the spacious, beautifully paved streets, with creamy, artfully-fused traditional-modern villas on both sides. The skyline is so perfectly unique to anything I have ever seen. Sure, the economic slow-down has made its mark here -most sky scrapers actually have cranes hanging in suspension, all work suddenly halted as money ran out and people ran away... there is also not a lot of traffic here these days and the streets are rather empty, even for these early holy month of Ramadan days.

Aunty N and Uncle S picked me up from the airport, and on the way to their home in Jumeira, I was pointed out the many gorgeous sanctuaries -the essence of beauty, kind of like seeing the thoughts and ideas that usually just result in something that is beautiful -that were the mosques on every other corner, the businesses, the villas, hotels, restaurants, office buildings, social centres, learning centres, shopping centres. I saw the Burj tower -currently, the tallest building in the world -from afar, and the Burj hotel from relatively close. This is not a land where people dream -this is a land where dreams and creative thought forms can become actual physical masterpieces.

Now I had thought that Dubai was just a ridiculously ostentatious place full of overwhelming materialism, a superficial aristocracy that mistreated and enslaved the lower classes to do their bidding... a place devoid of soul and of anything that could be truly beautiful in that existential, real kind of way. I was right about the materialism, the aristocracy, the social injustice, but utterly misguided about the beauty and soul. It's no Utopia -nowhere is, there's always room for a society to improve and grow, you know, reach its 'full potential'. But do not underestimate the value of a place where dreams become things, where human-made structures, gardens, finely cared for beaches, streets and homes and shrubs are so very beautiful that you feel the power and majesty of God, or the Universe or the Human Spirit, or whatever you believe. If you are atuned to it -this can be a surprisingly spiritually uplifting place. And it was just the kind of 'injection' I needed after the life- and self-changing traumas in Karachi.

I learned a lot in Karachi -and those experiences were absolutely invaluable. But remember how I said that these people in the squatter settlements and urban slums have these existential disturbances -addiction to suffering, inability to really reason and think about thinking, inability to love because they have never been loved. If only they saw any beauty in their physical world though, it would change their whole life. If they could see Dubai -if anyone could really, really, really see what Dubai means -then places like the villages in Thatta and Rehri Goth, Bin Qasim, could just not even exist. That's the trouble though. I think that people who are completely seduced and hypnotized by all the material excess in Dubai don't actually see that deeper, philosophical, existential beauty that is the ideas and thoughts and powerful force of action that these buildings, fountains, silky tents and gardens (thought beautiful) merely represent. And those who feel it's all fake, built on injustice and the misery of others, well, the beauty escapes them too. It doesn't mean nothing should be done about the injustice. Of course something must be done about it. But if you could see and understand the beauty, why not draw inspiration from all that, to drive positive social action? Am I wrong? There's no right and wrong. But you must come here one day.

Now I will tell you about what I've done and seen here so far. The Ismaili Centre Dubai must be the most beautiful building in the world -it was designed by an Egyptian architect couple, in the Fatimid style, built almost entirely of limestone, with marble fountains, Moroccan hand-crafted lantern-chandeliers, a 7-sided dome (heptagon) -the only one in the whole world, sky-lights in many metres-high domes made of brick and limestone, onyx engraved spiritual words that allow only the sunrise's light to bathe a small prayer room, a lovely fusion of beautiful Islamic architectural tradition and modern technology into one seamless whole that took about 25 years to achieve from the time the land was gifted to the Aga Khan to being fully built and functional.

I ran into not-too old friends from Boston who now work here after traveling and working elsewhere, as well as met with almost-long-forgotten (but evidently, not at all forgotten!) acquaintances and kindred spirits who shaped many a childhood memory and lesson.

I visited the Dubai Museum, sailed a short distance to the other side of the Dubai Creek in an abra, bought some colourful dark chocolate that I had been told was to-die-for, some dried rosebuds to add to my tea, a couple of postcards and small gifts, and a set of silvery-rose coloured Japanese pearls (yes... the adamant anti-shopper apparently did some serious kind of shopping... but I mean, this is Dubai afterall, so if I was going to do it anywhere, might as well be here... also this pearl-set is probably my first ever real 'set', and I love it and love it more because I bargained so hard for it and probably have the economic crisis to thank for my sweet deal and lovely buy!). We went to Gold Suk for that, then after coming home for a delicious lunch (cannot eat publicly here during Ramadan unless you're looking for trouble), made a little trip out to Emirates Mall, which is a mall that has a ski slope inside of it. Like a real one, kind of big, with skiing and luge. And it's -3-4 degrees Celsius in there for reals! Who would have thought you could go skiing in the freakin' cold in the heart of an Arabian desert!

Then tonight a dear friend from my childhood picked me up and took me to the Palace Hotel for the first Iftar (breaking of the fast feasting) of this holy month, where we met up with a bunch of his friends and had quite the merry and delicious time, sitting in the most luxurious place I have ever been to in my life, architecturally and comfort-wise, with intricate coloured lanterns, antique-style furniture, excellent service, fresh and tender lamb chops, tasty barbeque charred tiger shrimp, tabouleh, eggplant, red pepper and string bean Middle Eastern 'sides', mutton biryani, varieties of olives and ball-cheese, potato and meat fried kibeh-like things, smoked salmon and seasoned fish with mixed greens in a spicey salad, yummy Middle Eastern brown-noodle rice with veggies in a creamy sauce and fish in another kind of creamy sauce, and some kind of lamb or mutton curry-like thing... a lovely, gluttonous time indeed (I know, ironic, if we think about the real purpose of all this 'fasting' -well, what to do)! And then for dessert: rasberry Turkish delight, 3 varieties of baklava, a creamy cheese cake with exotic fruit on top, a dark chocolate covered date, and the best one: Um-Ali (which is a traditional dish here, apparently Hazrat Ali's favourite sweet that his mother used to make or something like that) which is kind of puddingy, but not really, creamy and delicious... a piece of Heaven in your mouth. And then ended it all nicely with a silver pot of Moroccan tea (one of the best teas in the world and it's been such a long time since I've had it!).

Then we left the comfort of AC and sat by a lovely blue blue pool, surrounded with palm trees, inside a white chiffony, silky tent, with comfy seating and strong-supportive-yet-soft cushions to hang out and relax / digest. This meant everyone ordered their own shisha -apple-apple, mint-apple, mint-mint -to wile away a couple of hours, except of course, knowing the harms of smoking any form of tobacco, and having satisfied my curiosity by trying it out a couple of years ago in Turkey, and discovering that I could enjoy just the smell of other people smoking it anyway, I opted for some lemon-water, as I listened to the stories of these mostly-new people I had just met. I was particularly taken with one character -and by 'taken', I don't mean anything silly like crushes or even flirtations (there is nothing wrong with either of these, just I was not going there...), but 'taken' as in I have decided to make one of the characters of my novel be this guy because he is that darn interesting. He's a tall, fair, handsome, wispy-dark haired Kashmiri guy, born in Kashmir but had to leave with the civil war in '89, moved and grew up in Singapore with his family, spent some time in India before moving to London for university and then now working in Dubai. But like many natives of a particular land who don't actually live and grow up there he's fully of a marvellous hopeful idealism about the free Kashmiri, blogging and writing about the necessity of free private economic enterprise in an independent Kashmir, to empower people and promote development and it all sounds like a mad man's talk to everyone else, except that it's most likely true. Not easy, but true. In his life and work, perhaps he's a realist, down-to-Earth kind of man -I wouldn't really know. And yet he talks about the beauty of the Earth of a home that was left inhabited too soon and has become a well of longing.

Then I watched the fountains and light show outside the Dubai Mall right from behind this outdoor swimming pool and tent area. And it was amazing. Like watching fireworks in water, with accompanying music and everything, and jets of misty water shooting up so high, it looked almost like it went half-way up the height of the Burj tower, and right in front of it -spectacular indeed!

But really, I would love to go to Kashmir one day, and to the Northern areas of Pakistan, in the Himalayas. There's a lot of work to be done in this world, but its beauty is infinite, and if we're blessed -which we all are, it's just up to you to see it that way (or for the non-religious, just replace 'blessed' with 'lucky' -luck is about hard work and self-perception and a positive attitude anyway) -then I think we're meant to experience the magic and beauty in our lives and in this world too.

I'm in love with all of it.

Pakistan Zindabad Day...

Yesterday was Pakistan's Independence Day -kinda crazy day in this country. The fireworks happen both the night before and the night of, the flag vendors make their money, all the kids go to school for the 'raising of the flag' and then go home and eat halva-puri, and even AKU had a flag raising ceremony followed by free brunch for anyone who wants to come and get it (you can imagine the massive numbers of families that come to AKU on this day!)... of course, there are also random gun firings (I don't think they realize that what goes up must come down... so just firing randomly in the air can actually kill someone... apparently this happens even when they do this at weddings -guests have been known to get hit by the bullet on its way down and sometimes get killed... OIP! OIP is my newly invented abbrev: Only In Pakistan -I enjoy the fact that it can be exclaimed "oyp!" and so is more subtle in its 'hidden' meaning, you see)

I, on the other hand, woke up yesterday morning with massive cramping and had to start a second round of Cipro+Entamizole... back on the dry toast and tea diet and missing out on delicious tastes in my mouth... my hunch is that it's Giardia, and probably the same Giardia from before that just never got fully cleared or I got reinfected after the last round of antibiotics which annihilated all the 'good' intestinal flora, making me more susceptible to reinfection...

I just want to say this: I am soooooooo ready to go home. I want to go home now. My family in Montreal is going up to Tremblant later today and will watch some of the August meteor shower from there at night, and I want nothing more than to be there with them... but I guess, I am here, so I am here. But I am ready to go back to wearing whatever I want, whenever I want and wherever I want -the same goes for eating. The only silver lining to my multiple Karachi-belly infections has been some weight loss (everyone keeps saying "oh! you lost sooooo much weight! so much weight!" -you'd think I weighed a ton before, even though my BMI was still in the healthy range, but hey, I'll take the compliments), which actually is good since I haven't really been able to exercise here as much as I had originally thought, and so otherwise, would not have had my usual pleasant spell of summertime body-goes-back-to-healthier-weight/shape pattern...

When I go home, I want to eat salad and mummy's home cooking. I want to eat lots of cheese. I want to go for Chinese food, and steak, and sushi and try that place, M-burger... of course, I will keep my quantities reasonable so I don't put back on all the weight I suffered so much to lose, but I look forward to having those tastes back in my mouth =)

Sigh. I feel so extremely happy just thinking about all this... really I almost wonder how much it would cost to change my ticket so I can fly home early. Although then I wouldn't get to see Dubai. And I really, really did want to see the Ismaili Center in Dubai, which looks absolutely breathtakingly beautiful in all those photos and film clips, and of course, the family I have there. So... well. Inshallah, this week will go by quickly -there are quite a few fun things planned for the rest of the week (most involve eating delicious food though, so hopefully my stomach will be up for it... like really, if you don't understand what a tragedy it is for me to not be able to eat all this delicious, but obviously contaminated, food, then clearly you don't know me well at all -I live first to eat, and then to love -in fact, I don't think I could love anyone who didn't love to eat because we would not have enough in common)

Also, I must remember that I have some excellent new ideas for my novel, which were inspired by some conversation with interesting people yesterday: ancient books hidden in the pillars of old buildings in exotic places, legend-like faith of one man on a journey by foot from far away lands to visit his beloved, spontaneous large-scale sacred meetings amidst rocks and rivers... it's all like a fairy-tale, which is perfect for my fairy-tale...

I send you my love and hugs and oh, i have so had enough of these stomach bugs... (now visualizing being able to happily eat that delicious chocolate tart and drink that mint lemonade planned for Wednesday -Inshallah, these drugs will have worked their magic by then!)

I Love Medicine -a little heroism is nice. And... back in the field.

So what I said in my last post about not being able to do OB/GYN all the time -yeah, I take that back. I totally take it back. Yesterday was one of my best days in Pakistan, and one of my best days in Medicine so far. I arrived late in the Labour Room (and so unfortunately missed experiencing Rounds) for which I have my lovely stomach to thank. But anyway, more interesting complex cases, I watched 4 deliveries (2 of them were happening in the same room at the same time, which was a bit nutso, but amazing) -also I loved watching the Head Resident stitch -after watching a total of 6 episiotomies, I know I'm no expert, but she does a really beautiful Matrice stitch -so clean and precise sewing up of the internal and external perineum -it's an Art. Also, it was wonderful getting to know the other residents, and meeting some of the consultants and attending physicians -this made such a big difference in the pleasantness of the experience. Loved it. Love it. One of the residents was actually telling me that here, most of the physicians in surgery are really humble, nice and of course, knowledgable. I was blown away, because as we all know, back home, surgeons have a pretty solid reputation of arrogance. Also so many of these young women physicians are already married and stuff, and they're my age (it's like the European system here where all doctors do "pre-med" straight from A-levels).

But I learned about PIH -pregnancy induced hypertension, which is caused by the release of vasoactive factors from the placenta + the effects of placental estrogen and progesterone. They actually simultaneously treat the labour pains and the PIH with Antinox, i.e. laughing gas (nitrous oxide)... Also, some mothers in labour are howling away in agony, and then others are perfectly quiet (just moaning a bit, saying "Ow, Ow...", I mean, that's pretty good for labour, right?)... we saw some more comlicated cases -one mother who was at gestation 40 weeks with an E. coli infection and in a lot of pain, but because her blood was infected, the originally planned epidural became relatively contraindicated (risk of spreading the infection from the blood to the CSF, resulting in meningitis), however, neither the nitrous oxide nor the narcotics (Kinz, which is nalbuphane... don't know if that's the Pakistani Dilotid equivalent or what) she was already on were alleviating her pains (and she wasn't even giving birth yet)... I don't know what they ended up doing... Then there was an epileptic woman who had just had a petit mal the morning before being admitted... and this morning I thought I'd pop in just for Rounds before going back to CHS, but apparently last night's Call had been pretty bad, with a PTL (pre-term labour), gestation of 26 weeks for a mother pregnant with twins and another woman in labour who was admitted with pancreatitis...

So, yes. Of course, some days are heaven and you're a hero, and other days, all hell breaks loose (forgive the cliche, but it is apt) and the head of OB beats down on everyone under her, and there's no time for Rounds. But it's still so exciting and I'm so looking forward to being more a part of all that. For better or for worse. It's a stronger feeling than a marriage vow I think (although, not being married, I guess I wouldn't really know...).

When I went back to CHS this morning, I was warmly welcomed back after my absence (since Friday technically because I had gone to Thatta and had not even seen my supervisor that day). However, I was quickly sent off to Bin Qasim for field work (the worst slum in Karachi). It was miserably hot, that sulfur-y sewage water smell mixed with the smell of burning garbage as we drove over in the AKU van (no AC). They seriously burn garbage everywhere.

It was hard to take today -I may have reached my limit for dealing with all this now -it's a lot and there's only so much of it one can handle before you need a serious break / must leave and get trained-up so that the next time you're in this kind of situation you're actually doing something BIG about it (even if it starts with just practicing medicine here...). But I didn't crack -I'm still here. There were lots of cattle on the road today, and of course, the token mother carrying her naked infant in one arm while juggling 2 paans in the other, and frankly handling those with more care than the kid. Makes you want to be sick, really. Most of the kids are running around everywhere barefoot (perfect for getting those worms that penetrate the skin that we learned about in Immunology). We visited 3 different villages in Bin Qasim -Lalabad (3 visits, 1 of which was not home... the person there though only spoke in Pashto so the AKU driver had to translate what the Dr was trying to ask, which was kind of interesting... apparently you really get a mix of non-Urdu languages in these poor areas... which makes the whole Town seem kind of like a mecca for poor-people-from-all-over-the-country or something), Chsma Goth (nobody home at the only visit there), and Rehri Goth (the worst off village which I had already visited).

My favourite part though was going back to baby Fatma though (whose photo you have seen in a previous blog post) who though recovered from her previous infection, was currently fighting another one (that's how it goes with these kids unfortunately)... lovely to see her much better though =) Otherwise, the stink of rotting fish and burning garbage and sewage, and the fly infestation of these parts was not at all pleasant... I'd say mind-numbing and exhausting, even the drive back through Korangi (another poor area... it's really like most of Karachi is actually poor...) and back to AKU. Like I said, how much of this can a person take without returning home with PTSD. I hope my feeling like I need to stop going into the field for now is not a sign of weakness... I just really need to take stalk, and think, and talk and learn everything I can so that I can be more helpful next time.

So ready to go back home... shopping last night was pretty good though, loving this Coke Studio music I bought (Pakistani musicians / poets /artists sing together and do a kind of 'fusion' of styles... the CDs are the songs from the music TV show here, which is very popular I believe...), as well as the Shafqat Amanat Ali CD (love his voice. love it, love it).

Well, time to go watch some 'House' and forget about my day... love you.

Oh, Babies (and moms, residents and nurses)!

Changed it up a little today. You see, I've been doing all this field work, and presentation stuff... the hands-on, but still research side of early childhood and maternal health. But I am actually going to be a doctor one of these days (inshallah), so my desire for a little in-the-hospital clinical exposure was not unwarranted. Last week's determination to find an OB/GYN doctor at AKU who would somehow get me in the Delivery Room for a couple of days finally paid off today (and I will be there again tomorrow).

Such an amazing experience! Started at 10 a.m. and pretty much shadowed the Chief Resident, Dr. A, all day. First patient I visited with her was a pregnant woman who had to be induced because she was at 41 weeks, but was also taking Metformin for PCOS throughout the pregnancy (so I did some Uptodate.com reading on this and found that women with PCOS who take Metformin have higher fertility rates than those who don't, and also lower risk of miscarriage during pregnancy!) -I watched as Dr. A drained the patient's bladder with a catheter, then stuck her gloved hand inside to do a membrane sweep (part of inducing labour, aside from IV oxytocin, etc), as well as gauge how dilated the cervix was (so cool that just by sticking a hand in there, with a little experience, you can tell whether it's 3 cm or 4 cm!). Then, checked in on a few patients with 'false contractions'... the morning was not that hectic overall, though.

However, after watching the residents share a bowl of Nihari with some naan (I had eaten already) for lunch (I really appreciated this commaradery despite the obvious medical hierarchy of things), and getting to know Dr. A a bit better (she got married in her second year of med school and had a baby in her early residency years!), things began to get a bit crazy (in a very good way, mostly!). I watched 2 babies get delivered in quick succession around 3 p.m. -for both the mothers, it was their first pregnancy, so of course they screamed, moaned, etc in all their pain (but nothing quite so dramatic as portrayed on TV and in movies in the West), and both required episiotomies (which I learned about right in the moment... I don't recall ever learning about this in Unit 3, but surely we must have... then again, Unit 3 was a big botch, so I wouldn't be surprised if we didn't!). An episiotomy is an incision made in the perineum posterior to the vulva to make the vaginal opening a bit bigger to facilitate birthing, which is then sutured up again, or 'reconstructed', immediately post-delivery (so it was cool to watch a little mini-surgery, even though no C-sections were involved).

It is absolutely amazing to see that baby's head come out of the womb, though -really one of those moments where you wonder how a whole other person just came out of a person (I know this is so cheesy and cliche, but until you've seen it, you can't pretend to really know anything about it -I thought I could before today, yet actually witnessing it is very special). And contrary to the complicated motions described in Unit 3 (first the head comes out, then the shoulders rotate, blablabla), what happened in both was once the head was out, the rest pretty much slid right out, with all the white goop and blood, etc. Then the nurse takes the little thing (South Asian babies really are smaller than White babies) and does all that rubbing, and warming, and oxygenating, and making sure none of the meconium is aspirated, etc, while the docs wait for the placenta to be expelled and suture up the episiotomy. At this time, I was surprised and grateful that Dr. A treated me like a real med student on a rotation by asking me a couple of questions -good to get a taste of what it will be like to be put on the spot all the time, except relieving that it doesn't mean anything for now.

The first questions was, "Do you know what this procedure is called?" No, I didn't, and that's how I learned what an episiotomy was, and looked it up further on Wikipedia (easier to decipher than Uptodate.com and still pretty accurate I'd say). The second question was "What are the signs of placental separation?" I hesitated, and then came my ingenius response, "The placenta comes out of the vagina?" Yup, that's what I said. Was not trying to be a smartass, but it was all that came to mind and I didn't want to seem like a total idiot (still not sure whether I had prevented this at all with that response though...). But Dr. A and the other resident just laughed good-naturedly and commented, "Oh, that's a smart answer!" (hard to tell whether they were sarcastic, or pleasantly teasing... I'll just assume it was the latter...). And then they told me what the signs were. And then I looked them up online to make sure I'd remember, and as it turns out, the Four Signs of Placental Separation are:

1. Apparent lengthening of the visible portion of the umbilical cord.

2. Increased bleeding from the vagina.

3. Change in shape of the uterus from flat (discoid) to round (globular).

4. The placenta being expelled from the vagina.

SNAP! Look who was actually right (about one of them at least!)... but anyway, I'm sure I won't forget about the increased bleeding and the lengthening of the umbilical cord (it's not actually lengthening, it's just all starting to make its way out, so you're seeing more of it -I don't think this is a difficult concept to grasp -calling it "lengthening" is just confusing, if you ask me)...

Anyway, at some point an auditor came and gave a couple of residents heck for some minor issue about one of the patient files (they apparently like to waltz in all importantly and make a big deal out of nothing... clearly, it has to be done, but it's perceived as an annoyance by the department, to be perfectly honest). And as I was told to go home for the day, Dr. A was dealing with a case of a pregnant mother (34 weeks) with an acute abdomen (most likely appendicitis or cholicystitis... which I further verified on Uptodate.com of course), and which is apparently surgically treatable without having to deliver the baby so prematurely, except of course a bit risky since surgery can induce contractions... I guess I'll find out what happened there, tomorrow!

But what a nice change today. I thoroughly enjoyed it (although I don't know if I would enjoy doing this all day, everyday for the rest of my life... I think I'd get bored without variety... this is the trend I notice when reflecting on my shadowing experiences in the NICU and Neurology as well... maybe family medicine? or pediatrics? or a general internist? But right now, I don't feel that specializing is really my scene...) and am looking forward to Day 2 in the Labour Room, tomorrow. At the very least, beats the nightmares of cruelty, rape and torture that I've been having for the last 3 nights, since my visit to Thatta. Someone today told me that I "didn't look fresh"... you try staying up for a couple hours, in the middle of the night, for a few nights in a row and then tell me how fresh you're feeling (this was not supposed to sound so bitter -it was a nice person who said it, I like her, and she means well).

Well, that's it for now!

Amidst Ancient Ruins, the Poorest of the Poor, and a Foreigner's Haven!

Yesterday was probably the 'fullest' day that I have had since my arrival in Karachi. I had wanted to blog about it last night, but I was way too exhausted, so instead, I find myself writing to you between loads of laundry, as I listen to 80's pop classics ("Wake Me Up Before You Go-Go" at the moment...) on the following afternoon.

Thatta: First-Half -a "Mega-slum"

So if I had thought Rehri Goth (in Bin Qasim town, Karachi) was in a pretty bad mess and it couldn't possibly be worse anywhere else, well, I was quite wrong. Early in the morning, one of my friends (who also works at CHS) and I left with two of the main researchers (one is working on the Maternal-Newborn Health Registry (MNH) project, and the other, on an infant Brain development study) for Thatta, which is in the interior of Sindh, near the Indus River, before it meets the Arabian Sea, about 2 hours drive from AKU.

Our purpose was to get an exposure to some of CHS' work in this very old, historic, and extremely poor part of Pakistan -apparently, there are over 400 NGO's who claim to be working in Thatta, but actually, just about none of them really do anything at all -it looks good for the NGO to say they are working in Thatta (that's how bad-off Thatta is), but since it's logistically challenging (bad roads / no roads, far enough to be a pain to commute daily from any major city, unsafe enough -gunshots, and other violence all audible and visible in this area -to actually maintain a base there...), the situation in Thatta has not changed much over the last 20 years.

We made visits in 4 different villages for the MNH project -the people here speak Sindhi, which is different from Urdu, and I loved hearing it at the first home we visited (hated it later... you know, whether or not a language makes a good impression on you really has a lot to do with who's talking... if the person speaking makes you sick, well, it's difficult to enjoying their drawling, lifeless tongue). But the first mother was warm, friendly, lively -her baby was born healthy, she was healthy, of course, she already had a bjillion kids and they lived in something that looked a lot like what we had seen in Rehri Goth -1 room made out of concrete / bricks / plaster, albeit falling apart, dirty, fly-infested (but nothing compared to what we saw afterwards)... then we visited some straw huts, huge buffalo, lazing about everywhere, massive piles of animal dung everywhere you turned, cess pools in the middle of paths, scrawny cats picking their way around, bony dogs with diarrhea, sewage water along the sides of all paths with big still ponds popping out every few meters, everyone walking around barefoot, firecracker shots, open gunshots (not at people, but just for kicks, shot up into the air), and of course more multiparity mothers, some old man raving about his spiritual intutions about rain from the overcast skies, etc...

Not far from these villages, there are vacant factories of all kinds -sugar, textiles, etc... there's a forlorn government hospital too, but women can't go there, and with the monsoons, all the flooding made the hospital pretty much inaccessible anyway... quality of care, also likely dubious... One of the homes we visited, I noticed that the mother sat on the bed, her baby was bound tightly in a piece of cloth (likely causing some rash or skin infection unbeknownst to mum) and there not far from the baby's head, a handgun lay innocently too.

The saddest of all though, was when we went to visit a mother who had a botched abortion after being pregnant for 10 months and refusing a C-section because she didn't want a surgery to come between her and her responsibilities to her zillion other kids... 5 days later, she is still bleeding and essentially refuses to see a doctor. The glazed eyes surrounded me there. The flies were very bad here. But there was one little boy, maybe 4 years-old, with flaky dry skin from head to toe, red rashes and brown and purple discolourations from infection and the flies were eating him, clung to his clothing, his skin, on his eyes, in his known, all over his mouth, as he torturously sucked on some dark brown freezie, moaning, and trying to swat at some of the flies every now and then. We asked the mother and older children if he had seen a doctor. They said he was born with skin like that (probably some genetic defect... maybe epidermolysis bullosa, or maybe some kind of skin-collagen defect, or maybe an autoimmune condition... bad eczema or psoriasis with pustules, or God-knows what -I'm not a dermatologist) and they won't take him to a doctor because they would rather use that money to feed the rest of the family. He came close and opened his mouth and began screaming, crying, his head thrown back, his arms hanging limply at his sides, tears streaming down his cheeks between the flies, the flies were in his mouth, a bunch of his teeth had already fallen out, the rest had black roots and were deformed, and his gums were obviously also affected by whatever conditioned his family refused to get treated. The pain in that cry was heartbreaking. He held his tummy and his older sister made him lie down on the woven-cot frame. He had a stomach bug too, which was also going untreated. The family seemed annoyed... short of throwing him out of their house, they seemed to almost leave him for dead. I thought they must wish him dead, and there's no way he's going to make it. He's going to die a painful, miserable death, most likely, and no one will hug or kiss or coddle him between now and those last breaths, if they ever did. When I put my shoes back on after leaving the house, I noticed little flakes of red paan inside them.

And then I suddenly understood something else, in the midst of a flare of internal rage. Maybe these mothers didn't want to not care for their children properly, but what if they didn't know how to care for them? Imagine you're a little girl born into these dirty straw slums, your mother's 9th child. No one kisses and hugs and coddles you. No one makes you feel like you're special. And while your male twin, at the age of 5 roams the streets, playing in dirty sewage water, or is told stories by your grandfather as they sit on a street curb somewhere, you're already changing diapers of your 2 younger siblings. If you were never shown tenderness and love, then how can you be expected to know what love is, what affection is when you start having your own children? And especially if you'll start having your own children when you're only 15 years-old?

Futile tears I did not cry -like I said, even my tear-ducts know that it's futile. I felt numb and I felt pain that I had to try not to feel anymore because what good would that do? I passed tissues and hand-sanitizer to my friend instead, wondering what happened to my own gentle heart... an addiction to suffering AND an inability to show love and affection, or really understand them... just glassy eyes, glazed eyes, unconscious-living in misery, filth, disease... no education (the local goons also see to it that the villagers don't get educated so that they can keep their power so the schools become barns for animals) and virtually no access to any kind of healthcare. They believe in rituals, they put charms on each other for 'protection' and they'll tell you "it's all in Allah's hands". You just want to tell them, "Allah gave you a brain so that you could use it, so please let's leave God out of this" -but there's no use. How do you reason with people who don't understand reason? You can't reason medically, you can't even reason with religious arguments? You can't reason at all, and the worst part is being at a loss to reason and explain it all even to yourself.

Thatta: Second Half (good eats and historic sites)

We had lunch at the AKU CHS offices in the main Thatta town -the chai was delicious, the fried potato slices with spices and scrambled eggs with peppers, masala and tomatoes (reminded me a bit of Turkish menemen), one tiny piece of mutton curry and a manni (Sindhi and Gujarati word for roti). It was the AKU chef who cooked everything so it was quite safe, and I only ate a little bit (and 24 hours later, I am fine ok, so don't freak out that I ate in Thatta -it wasn't street food).

Before heading back to Karachi, we made a stop at the Makli ka Khabrastan (Makli Cemetary / Historical Tomb ruins from the 14-18th centuries AD, also known as 'The Great Necropolis of Makli", which is a World Heritage Site)... although Thatta is a centre of poverty, it's also one of the big cultural / historical sites, and there are lots of ruins like these of previous rulers / dynasties in the Indian Subcontinent... they were really breathtaking -reminded me very much of when I visited the Ephesus ruins in Turkey, and sure enough the main big building was for a King who was a Turk. Although we did take photos with my friend's camera, since I don't have them yet, for now, I found some photos online that are actually similar to some of the ones we took, so you can enjoy these 2 photo collages instead ;).

The architecture is really beautiful -classic Islamic-style geometric shapes woven together into stunning archways, domes and ceilings. Tombs covered in different Qu'ran ayats, Ayat al-Kursi and the Kalima over doorways. Turquoise and Lapiz Lazuli tiling and painted designs here and there (reminds me so much of Turkish Isnik tiles... surely those must have been imported designs...).

It's nice that this beautiful little sanctuary exists in the heart of this poor area -but the sanctuary even is a symbol of the royal, the excess, the wealth even in its own time. I wonder if the people of Thatta feel that they own it, or that it belongs to them in some way. The only indication of anything would be the paan spittles on these architectural beauties. Perhaps it's fitting, but people are people. It's too bad they don't have anything -no land, no home, no nothing... nothing to be proud of, nothing that inspires love, thought, dreams, nothing that's really theirs. Maybe someone should start by showing them the beauty in this world -that belongs to them as much as it does to anyone else... I don't know. How does one light that spark? Any work here will take time and a massive committment -the reason why AKU is even allowed to intervene even in the little way we have begun to is because it has been in Karachi for 25 years, and in Thatta, acting in some form over the last 11 years... but the message is clear: We are here to stay, we want to work with you, we want to help you help yourselves; we will respect your traditions and beliefs, but we will not abandon you. That is something in which no other NGO in Thatta has succeeded -they don't act, and they can't stick it out. Trust does take forever to build though, it seems.

Friday Night in Karachi

We managed to make it back to Karachi in time for khane (just went to Noorabad Jamatkhana near AKU). Afterwards, a bunch of us piled into 2 cars and headed to the Chatterbox Cafe (with a delicious bakery called "Pie in the Sky") on Zamzama (an up-scale street in Clifton / Defence... kind of like the Karachi's Rue Laurier (Montreal), or Newbury St (Boston)...), for a farewell dinner for one of my friends who is leaving Karachi this coming week after having spent 9 months here (the same one who also works in CHS). They basically have more of a North America / European standard food (pristinely clean, salads, appetizers, a variety of main dishes and scrumptious desserts!) and prices (well, still cheap by our standards, but expensive by local standards), and atmosphere (granted the music is probably a couple years old, but still standard pop / hip-hop, etc...). It was my first time going into a place like this in the 5 weeks I have been here and it FELT SOOOOOOOOOO GOOD!!!! Especially after the day we had in Thatta. You just feel like you need to escape, pretend you're back home, pretend we don't live in a world, where I can pay 700 Rs for a nice dinner and a family of 15 has to live on probably less than $1 per day), a world where human life has no value unless it's a moneyed life...

I shared a Thai Red Curry with Prawns (also again, I am still fine today -and I ate 2 prawns so take a chill if you're freaking out that I ate seafood) and rice with another friend, had the most yummy fresh mint lemonade (made with mineral water because I'm still OCD-careful in comparison to everyone else), and a Banofee cup for dessert (this is a very sweet British thing, made with caramel toffee, bananas, graham cookies or something similar, the version I had also had chocolate syrup and an icing-y cream... pretty good, although next time I will have the chocolate tart with fudge sauce and vanilla ice cream because I had a taste, and that must have fallen out of Paradise...)

Came home around 12:30 a.m., watched one of my friends climb her favourite tree in front of Women's Residences (things like this can only be done when there aren't a lot of people around, if you're a woman)... and well, there you have it: her 'fullest' day!

P.S. Piece of Trivia: Etiquette in Pakistan
Women never shake hands with men here, women only shake hands with women (no hugging etc, most of the time unless they're your best bud), men stare all the time all the time, and women do too... when people go on dates in public here, forget PDA -even hand-holding is scandalous (physical contact between the sexes is basically a no-no); if your head is uncovered it means you're single and 'available' (if you're a woman); a lot of the prostitutes here are covered from head to toe in burkhas; and note the power of the dupata (the scarf-shawl thing that all the women wear with all their clothes): you can be wearing the skimpiest, clingiest piece of see-through material, but you're socially acceptably dressed if you've got a duputa hanging from your neck; wear jeans and a baggy T-shirt and the stares you'll get will make you wonder whether you walked out of the house naked! Also, when you're out and about, don't smile. Don't take a rickshaw alone if you're a girl. You cannot visit a cemetary if you are a girl. You cannot go to the Sunni Masjid (mosque) for prayers if you're a girl. If a woman gets raped, she can only take it to court and have it recognized as such with (maybe) consequences for the perpetrator of the crime -get this -if there are 4 male witnesses willing to testify. As Munna Halwai might say in The White Tiger, Rights? "What a f*#$ing joke!" Women, heaven forbid if you live at all, here.

Uh, let me correct myself... and Circadian Fruits of Labours Past.

So yeah, we got that World Bank funding... but having to write the official announcement for our department today, I realized that although our proposed budget was $150,000, the maximum funding we could win in the grant competition would be $40,000... still awesome of course, but just thought I'd correct myself there. This was the announcement:

AKU CHS World Bank Grant Award Announcement

On August 5, 2009, the Aga Khan University’s Community Health Science department was awarded one of 21 grants from the World Bank’s South Asia Region Development Marketplace (SARDM) fund pool of US $840,000, in Dhaka, Bangladesh.

Earlier this year, SARDM announced the 2009 competitive grant program, entitled “Family and Community Approaches to Improve Infant and Young Children Nutrition”, whose goal was to identify innovative proposals from civil society organizations across South Asia that addressed malnutrition in infants and pregnant women. SARDM considered proposals that demonstrated cooperation between families, local communities and grassroots organizations to:

• Empower women and account for socio-cultural determinants of malnutrition,
• Increase access to micronutrient-rich foods (and/or supplements),
• Develop sustainable ways of changing household behaviours to address malnutrition, despite financial constraints,
• Show and measure the impact of community-based interventions, in terms of growth monitoring and promotion, improved quality of child care, hygiene, water sanitation and the physical and social environments in which children live.

Almost 1,000 applications were submitted from Afghanistan, Bangladesh, Maldives, India, Nepal, Pakistan and Sri Lanka. The AKU CHS proposal, “A randomized controlled trial of a comprehensive community-based intervention to improve linear growth velocity amongst children aged 6-18 months in urban squatter settlements in Karachi”, was then shortlisted by a jury of nutrition and development experts as one of 60 finalists to exhibit their nutritional innovation in Dhaka.

The AKU CHS proposal, which details a plan to introduce chicken liver into the diets of babies at 6 months of age to complement breastfeeding, was one of only two Pakistani projects awarded a grant, following Bangladesh and Nepal, each with four grants, and India, with nine. Sri Lanka and Afghanistan each had one winning proposal. All projects were eligible to receive up to US $40,000 for implementation during an 18-month period.

SARDM 2009 was sponsored by UNICEF, World Food Programme, PepsiCo, the Micronutrient Initiative (MI), GTZ (Germany), and the Global Alliance for Improved Nutrition (GAIN). The SARDM regional competition is part of the larger Development Marketplace (DM), which identifies and funds innovative, early stage projects with great potential for impact on development that can be replicated. DM is administered by the World Bank and funded by many partnering organizations, awarding over US $54 million to novel development interventions since 1998 via country, regional and global competitions.

And in other news, remember when I used to be a clinical research assistant at Harvard Medical School in Sleep Med? It was a blind-women cancer study to see if blind women had a lower risk of developing breast cancer than sighted women, and if it had anything to do with melatonin levels or other hormonal patterns too? Well, 2 papers have finally just been published on our study (my name is in the Acknowledgments at the end ;). If you are curious about the first one, you may look up:

"Total visual blindness is protective against breast cancer" by Erin Flynn-Evans et al in Cancer Causes Control, published August 1, 2009 online. Or you can read the abstract of the paper posted below:

Abstract: Objective Observational data, though sparse and based on small studies with limited ability to control for known breast cancer risk factors, support a lower risk of breast cancer in blind women compared to sighted women. Mechanisms influenced by ocular light perception, such as melatonin or circadian synchronization, are thought to account for this lower risk. Methods To evaluate whether blind women with no perception of light (NPL) have a lower prevalence of breast cancer compared to blind women with light perception (LP), we surveyed a cohort of 1,392 blind women living in North America (66 breast cancer cases). Results In multivariate-logistic regression models controlling for breast cancer risk factors, women with NPL had a significantly lower prevalence of breast cancer than women with LP (odds ratio, 0.43; 95% confidence interval, 0.21–0.85). We observed little difference in these associations when restricting to postmenopausal women, non-shift workers or when excluding women diagnosed withbreast cancer within 2 or 4 years of onset of blindness. Blind women with NPL appear to have a lower risk of breast cancer, compared to blind women with LP. More research is needed to elucidate the impact of LP on circadian coordination and melatonin production in the blind
and how these factors may relate to breast cancer risk.

Well, peace out, log (which is Urdu for 'people'... the 'o' is long though, like 'low'...).

Good News! And more 'Field Experience'... and More Happy Tidings

Remember that nutritional intervention I was telling you about for which one of my supervisors was applying for World Bank funding, and for which I had worked so hard on the presentation? Well, she e-mailed my other supervisor a few hours ago from Dhaka and WE GOT THE FUNDING! 150 US Gs. Wild eh.

I am sooooooooooooo pleased. This is not "oh we can run some gels now" -it's "we can save babies' lives now". Not that there's anything wrong with running gels -basic science is of course very important (and I know, indirectly, can save plenty of lives), but as any honest researcher out there will admit, there are 2 kinds of basic research: the ones with the actual innovative questions that mean something for something else (probably account for 50% or less of the research out there), but then there's the "me too" research -let's isolate this part of this protein (which has been done already, but we'll phrase it differently and give it a different name from that other guy)... But anyway, I'm thrilled for those babies -the intervention will provide nutrition for 300 infants in a Karachi squatter slum that they might have a chance at developing a proper body and brain.

Tonight we ordered in: Pakistani Nandos, and it was pretty delicious (especially those spicey wedge fries), and just chilled in the res (me and 3 other girls... yes we are an ex-pat crowd, but you know, there's no use hating on ex-pats just because they're ex-pats because firstly, I'm one of them, and secondly, they are really sweet girls and we have a lot of fun together, and we all need an outlet for our otherwise hidden frustrations -i.e. wearing a shalwar kameez every day, the power of the dupata, the constant oggling, and the generally relatively suppressive social norms for women in this country, I'm not going to lie).

Yesterday, I visited 2 of the 'civic' / government hospitals in Karachi:

1. the Sobhraj Maternity Hospital (founded 1928 in Saddar, with rusty railings and bars on all the windows, the standard crowds of people waiting outside in the heat amidst paan-sewage puddles and dust, and crowds inside... yet they have a path lab, x-ray lab, delivery room, ante- and post-natal care rooms -I got a peak at all of them... the kicker is the seal of government corruption though -you walk into the Medical Superintendent's office -a well-greased looking man -and his secretary is this dude who types very slowly with 1 finger of his right hand... yeah, in this glorious technological hub that is South Asia, the dude that doesn't know how to type gets hired as the MS' 'secretary'. Ha. Ha. Ha.)
2. Qatar Hospital (funded by the government of Qatar obviously, and it's much better than Sobhraj, though still rather run-down and ill-kept, and is in the heart of one of the poorer towns, Orangi Town...)

You feel like you're in the Third World when you see these hospitals. Now we understand better why families try to leverage taking part in our study to get some medical care from AKUH -good for them! Except we don't provide it... so ultimately, kinda sucks for them, because then they don't get food for baby and they won't get quality care regardless. Yes, I take issue with the fact that we don't take care of the baby's healthcare expenses while they're enrolled in our study, but what to do: T.I.P. Hey you bioethics people, what's your take on this one? I really want to know.

Tomorrow morning off to one of the more complex slums -Orangi Town -and then Friday, a macro-slum: Thatta (which is a 2-hr drive away from Karachi, in the interior of Sindh)...

Anyway, I hate to say it, but I'm not really into blogging today. Maybe it's because I started watching Season 1 of "House", which is really great -though not as juicy as Grey's, definitely way more medically accurate, and I can actually understand what they are talking about post-Med-1... so it's a bit of a review / "refresher" before I begin Med-2... well, better get to bed. A couple of hectic days lie ahead (for which I am of course grateful, but I need my rest if I'm to survive them!)...

I thought I'd resist saying anything here, but well, I'm human too and if I brought you here, then you're a friend... in the spirit of good news, I found out a few weeks ago that a creative-reflective piece I wrote sometime over the last few months has just been accepted for publishing, and it was the first time in my life that I actually began crying spontaneously (the cliche "tears sprung into her eyes" was totally applicable) -you know why. Writing is my passion. It's how I share my Truth with the world, so... well, it's exciting to know you get to share it with more people right, and that maybe they will fall more in love with themselves and with others because of it. Isn't it always about love?

Tales of the Bottom 5%: How do you treat an Addiction to Suffering?

I just ranted and raved about the hells I discovered today, working on what was originally just to be a simple task of correcting the English of a stack of adverse event, termination / withdrawal from the study, and protocol violation reports.

Just so I don't bring you entirely there with me, I first want you to know 2 things: 1) for all the frustrating, angering crap I'm about to share with you, know that the Karachi CF site has had an immensely successful 95% participant retention rate, so all of this is telling you what happened to the other 5%; 2) my questions at the end of reflecting, spewing, and crying tears on fire with anger (I have never cried out of anger before) are the following -dear God and dear Medicine, please teach me what is behind this behaviour, teach me all about addiction, teach me about how deep the abyss of trauma plummets down, and how one treats an addiction to suffering.

I think part of the shock was that it was just so unexpected. I mean, I wasn't going out into the field, I was sitting at a freakin' desk all day, and the task was to correct the English syntax, vocab, verb conjugation, etc of a bunch of forms that had been filled out by the Field Coordinators months ago.

So you start, and see one after another "mother doesn't agree to have her child in the study because child doesn't like the taste of study food and vomits when you try to feed it". And you recognize a series of lies / excuses:

1. First, let's not kid ourselves, it's not the mother who didn't agree -it's the father and the grandmother
2. Since when did it matter whether or not the kid likes the taste of the food? Any other Brown people out there? You know what happened to us when we didn't "like the taste" of certain eggplant curries at the age of 4 or 5? We ate it or mum spanked us with gusto. And that was in "the West". When I joked about this with my supervisors they laughed with familiarity.
3. Oh, and absolutely. If the child vomits, it must be the fortified cereal or lypholized meat. Poor hygiene? Eating inappropriate spicey curries as a complementary food as a baby? Cat infestations passing around a good bout of toxoplasmosis (a feline-transmitted parasite)? No way! It must be the cereal (okay of course, there's always the odd chance that it actually is the cereal, but you get my point).

But you know, fine, I could deal with that. Then. Boom. First serious adverse event (which was not related to the study because it took place before the intervention began) I read about: you think it was the severe diarrhea (endless pages of that), or meningitis? Hell, no. It was a baby who started with some quack-treated (thus, untreated) abdominal infection, passed lots of bloody stools, and then nothing at all, and then wound up needing a laproscopy, where damaged mucosal and serosal tisse were found in the ileo-colon, with perforations of all kinds (including appendix obviously), further requiring resection of pretty much the whole bowel (meaning, they just removed a whole bunch of it). To what avail? She died of vaginal hemorrhage despite it all. A painful, miserable death.

And you won't believe the quackery here. I hated them passionately, all those quacks (fake-doctors with no qualifications) that chill out and rob the poor in these squatter settlements and know diddly-squat about medicine. A friend of mine in the department who worked on CF for the greater part of this year was telling me about a case (unrelated to our project) of a pregnant woman in these urban slums who was hemorrhaging, but couldn't leave her house because her husband wouldn't let her without him, so a quack came and paid a home visit. You know what he gave her? Aspirin. Now, if you're not medically inclined, you know this is just plain stupid. But if you do, you know that not only would it not help, but actually makes the hemorrhage worse (thins your blood). So sure enough, by the time her hubby found out and came home, she was a goner.

But okay, it's okay to hate the quacks right? What self-respecting health care professional wouldn't? Except I the contempt and anger that made me cry was not towards them, it was much worse.

Remember how despite breaking my heart over that poor baby girl a few blog entries ago, I still found it possible to show compassion to those poor desperate drug-addict parents, in my future-doctor heart? Today, I wanted blood. Those same parents. If they would have been in front of me, I would have done it myself. How dare they.

It was about another baby who stubbed her toe and it bled for 3 days. Coagulation factor disorder right. Maybe von Willebrand's... something involving the extrinsic pathway that we learned about in heme. So the docs on our team go and explain to the mother that this condition can be medically treated after initial clotting tests are run. A few years before, the mother had an older child who fell and hit her head and went unconscious, and instead of rushing her to a hospital (and despite the dire poverty, there are government hospitals which are free for these kind of emergencies okay, don't kid yourself), the mother just made her daughter lie down to rest. The girl hemorrhaged internally and went brain dead. Now in fear of seeing this trauma happen all over again, what does the mother do? Let the doctors advise and prescribe right? Wrong. No matter how many times the team went to explain how important it was for the child to get treated, precisely to prevent this from happening again, she went into a full out denial, and decided to have the child treated by the community quack, and denied the child further testing and medical care.

At home, you know what would have happened? The state would have taken that child from the mother and saved it's life. It's not just negligence here, it's not lack of education... it's not wanting to know, not wanting to learn, it's what looks like running away from your fears, but is really just feeding an addiction to suffering. And the cost is that baby's life. Not a shitty life. A slain life.

It was all I could do, but go to my supervisors and plead that we try to go back to this 'closed case' 2 months later, and check what happened since then -maybe the mother finally broke and the child can still be saved? She may be in denial, she may have given up, but we, we who know, we who got involved, we cannot just stand by and watch -we cannot be accomplices to this crime. We have to go back. We cannot give up on that baby.

And you know... there's my heart again... we cannot give up on that mother neither.

So teach me. Teach me about trauma and what it's done to this mother's brain and behaviour. Tell me about addiction. And please, I beg you with all of my being, teach me how to treat the addiction to suffering.

A Focus on 3 Senses: Thought, Sight (with more thought), Taste!

First, she Philosophizes...

Well, last night, I finished The Fountainhead -and usually, if you know me well, I don't like to part with my books, but I gave it to someone for whom I know (or hope, at least) it will be tremendously meaningful, and so gave it with love and joy. Fabulous novel. And I think a part of me likes it just as much at Atlas Shrugged (more in some ways, less in others). The more part is that since Ayn Rand's philosophy of Objectivism is not yet completely crystallized in this one, she's a lot more forgiving with her characters, and so, I find them to be more 'real'... anyway, I think my favourite part was at the back of the book where there are excerpts from her journals and research when she was writing the novel -nothing like getting novel-writing tips from a master! I think the insights into her method will be helpful for my own novel...

Now, I will begin Samarkand by Amin Maalouf, which is meant to be really good.

Yesterday I tried on the clothes I had tailored for me by a woman who makes really exquisite outfits for a very exclusive clientele... and I could feel it. I don't think I've ever been in love with an article of clothing as much as I am with this one. Pathetically materialistic of me, especially in light of all my experiences here in the slums, I know, but look, I'm okay with myself and my life, and can still feel moved by the life stories -mysterious, murderous, horrifying, romantic or otherwise -of others. There's no contradiction there for me. One ought not to apologize for what they may have achieved or having had good fortune with regard to opportunities for education and potential success -I am grateful for them and more fully recognize what a blessing they were, and what a blessing that I had the social support and material comforts that enabled me to work very hard for anything I have done. So, no, I make no apologies, and would rather aim for productive, long-term action that I might enjoy seeing others attain their own potential for achievement. This will make the world 'a better place' not in the superficial, altruistic cliche, but actually. It will be better for me, and you, and them and everyone. Win-win. No such thing as zero-sum.

What have I been smoking? Read The Fountainhead. See? Don't you feel like right now, I could be excellent at marketing? I could have been great at anything I ever wanted to do. If I wanted to be a musician, or a painter, or even an engineer. If you read this book, you'll see the Light, I swear. You'll touch the tangible and the ethereal simultaneously and fall hopelessly in love with yourself, even if only for a moment (this is not conceit, it's the Truth, and Truth being Truth, and thus all-encompassing... kind of like God, if you believe in God, but see it exists in an atheistic world too -means that it's true of anyone -yes, you too).

She explores more sights and re-visits others... they take her away to some Romantic (in the Byronic sense of the word) place...

Last night I drove with Aunty, first past Tekri (which means 'hill', and is the only 'hill' in Karachi -the birth place of Aga Khan III Shah Sultan Muhammad Shah -the current Aga Khan's grandfather, and the 48th Imam of the Nizari Ismaili Muslims), and Gul Masjid, and then by the beach again (and that part of the Indian Ocean is actually the Arabian Sea), and it's stunning. All the little lights of vendors selling their fruit, kababs, drinks, rolling their carts through the white sand, families packed tight in vans and trucks to make their picnic outings here and the nearby park, camels, horses trotting about. And the waves that come at you from Infinity, and expanding infinitely in latitude too. The sea is misty and grey and so is the sky, so you don't really know when clouds end and water begins, but then they are actually one and the same anyway, so you're just seeing Truth again in Nature. Only the waves are white like thin slices of a glacier gliding towards you. And even if you only step out for a minute, you can taste the salt on your lips, the same salt that corrodes all the builidings immediately behind the beach. 'Twas a Majestic Truth to witness, indeed.

She Eats! Oh, how she eats (false actually, not about the eating, but about the quantities implied... she eats fairly modestly, but oh what she eats)!

But you know what I just realized? I have been shameless this whole time in hogging all culinary experiences more or less to myself (granted, I didn't have any of note in the last week, which likely accounts for my losing approx 6-8 lbs), but today and yesterday I ate again (in the real pleasure of eating that we all know I have -no worries, no gluttony). Last night, it was chicken keema (ground chicken with various spices / masala), and binda (okra with various spices / masala) and 2 small chappatis. And some sweet, yellow rice, made with saffron, cardamom and sugar (kinda like a delicious rice pudding without the pudding). I also tried a coastal fruit, known in English as a mud-apple (and to be quite honest, that is exactly what it tastes like... a soft, brown, mealy apple) -probably one of the first things I've tried here that I have not liked.

Then this afternoon, for lunch, I had Nihari (which comes from nihar, meaning 'morning' because this savoury food is actually traditionally an early morning, pre-sunrise, dish here), and it is very Pakistani. It was delicious (beats AKU caf nihari too, which may or may not have made me sick in the first palce, but then, of course home-cooked food beats caf food -who woulda' thunk it, right! ;). Basically, it's a spicey stew made with beef shank (very tender meat, in a very spicey sauce, and with a bit of marrow... kind of like paya, but a bit less marrow-y). And then it's garnished with fresh ginger, corriander and you squeeze some lemon juice on top, before digging in with some hot naan. And for dessert, there was a yummy, creamy sev kheer (sweet vermicelli in a cream sauce / pudding-ish, which normally also has cardamom and saffron, but I don't know if this one did) with fresh mango pulp, which probably beats all desserts you ever had (do not worry, I only had 4 teaspoonfulls because I know that my stomach is still getting used to eating normal food again, let alone heavier, richer foods, and especially dairy...).

Well, that's it for now -will probably try to go khane this evening -it's been over a week since I went, and really, for someone who appreciates the spiritual experience so much, I should be going more often! Much love and hugs--