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12-1-2009 Reflections on a Visit to Karachi: A Small World, After All Paul A. Lombardo Georgia State University College of Law, [email protected]

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Recommended Citation Paul A. Lombardo, Reflections on a Visit to Karachi: A Small World, After All, Bioethics Links, Dec. 2009, at 1.

This Article is brought to you for free and open access by the Faculty Publications at Reading Room. It has been accepted for inclusion in Faculty Publications By Year by an authorized administrator of Reading Room. For more information, please contact [email protected]. Volume 5 Issue 2 December 2009 cbecSIUT Centre of Biomedical Ethics and Culture Bioethics Links Each year we invite national and international students and faculty to participate in different activities in CBEC. In this issue of Bioethics Links some of our guests, including a visiting faculty member from America, write about their impressions of their visit to CBEC and Karachi. Editor

Reflections on a Visit to Karachi: A Small World, after All Paul A. Lombardo, Ph.D., J.D.*

It was well past midnight when my plane of the old city doctors at SIUT face landed at the Jinnah International Airport in daunting challenges in identifying Karachi and after almost a full day in appropriate donors and navigating the transit, fatigue had dulled my perceptions. medical complexities of transplant surgery But by the time I made the trip through the for those in need of replacement organs. almost empty airport I woke up, and The work of CBEC takes place in this glancing at the McDonalds restaurant in the context, where medical realities define the parking area, remembered that Karachi is a conversation, and where poverty and the place where East and West sometimes social dynamics that play out in families meet. When the driver turned the ignition speak louder than the neatly plotted key, the first sound was the Disneyland tune theories of my academic texts. “It’s a small world, after all.” I felt certain My 2009 trip to Karachi brought this would be another fascinating visit to a me directly to CBEC, where I was returning place that reflects some Western influences to teach a seminar in Law, Medicine while continually reasserting the and Contemporary Bioethics. The students foundations of its own culture. Continued on page 4 My first trip to Karachi in 2004 was an adventure that showed me, in a short week, some of the many faces of Pakistan. I visited the campus of and was also asked to speak at the Institute for Urology and Transplantation (SIUT), where the new Centre for Biomedical Ethics and Culture (CBEC) was being inaugurated. My encounter with downtown Karachi revealed a vibrant, big city that contained a cacophony of sounds and smells, with traffic alternately surging Dr. Paul Lombardo’s Pakistani attire being admired by students in CBEC and freezing with congestion. In the midst * Professor of Law, Georgia State University, Atlanta, Georgia, USA

Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 1 Bioethics Links cbecSIUT Pakistan Volume 5, Issue 2 (December 2009) The Hidden Jewel that is CBEC Humza Aasim Yusuf * In the twilight zone between doing my O Dr. Farhat Moazam, the founding levels examination and waiting for the chairperson of CBEC, who was very result, I applied to the Centre of welcoming and gave me an overview of the Biomedical Ethics and Research (CBEC) goals of CBEC and its activities. of the Sindh Institute of Urology and Over the course of the next two weeks, I Transplantation (SIUT) in Karachi, to be helped with mostly clerical work, such as allowed to work as an intern for two updating and correcting the library weeks. Happily, I was accepted. When I catalogue for both books and videos, helping arrived from Lahore in Karachi on July 09, to clear up and sort the contents of filing I wasn’t entirely sure what I would be doing cabinets and so on. In addition, Dr. Moazam in CBEC, but had heard great things about gave me a variety of literature and research it from several people. CBEC is Pakistan’s Continued on page 6 primary and only centre for Biomedical CBEC Launches Masters in Bioethics (MBE) Program Ethics, a relatively unexplored field in After its successful Postgraduate Diploma Program in Biomedical Pakistan. On arrival in CBEC, I was first Ethics (PGD), CBEC launched the Masters in Bioethics (MBE) program in November 2009. This two year program consists of on greeted by the friendly faces of Mr. Ali Bin campus and distance learning components, and a thesis. The MBE aims at developing academic leadership in bioethics for Pakistan Ayjaz (the Webmaster) and Ms. and the region. Antoinette David (the Administrative Students enrolled in the MBE Class of 2011 are: ! Aamir Jafarey, FRCS Assistant). Centre of Biomedical Ethics and Culture, Karachi I had pictured a boring office with tons ! Anika Khan, BA READyslexics, Karachi of files and people busy at work, seeing as ! Bushra Shirazi, FCPS , Karachi this is the only such centre in Pakistan. In ! Saima Pervaiz Iqbal, FCPS reality, what I discovered was an incredibly Shifa College of Medicine, Islamabad The first on campus “Foundation Module” ran from November friendly place, with smiling, happy people 02-13, 2009, and consisted of five courses: Philosophy and who care deeply about what they are Bioethics, Religion and Bioethics, Humanities and Bioethics, Law and Bioethics, and Introduction to Contemporary Bioethics doing. They seemed imbued with an Teaching Faculty of Foundation Module: ! Dr. Abdul Wahab Suri almost missionary zeal to further the Assistant Professor, Philosophy, Karachi University study of what is right and what is wrong ! Dr. Asif Aslam Farrukhi Writer and Critic, UNICEF, Karachi and how we understand this, not just (as I ! Dr. Farhat Moazam later learned) within the boundaries of Chairperson, CBEC, SIUT ! Dr. Khalid Masud medicine but also within the larger society. Chairman, Council of Islamic Ideology, Islamabad I was introduced to Dr. Aamir Jafarey, ! Dr. Manzoor Ahmed Professor and Chairman of the Board, Usman Institute of an integral member of CBEC who showed Technology, Karachi ! Dr. Mohsin Naqvi me around the department and told me Member, Council of Islamic Ideology, Islamabad what I would be doing a mixture of filing ! Dr. Paul Lombardo Professor of Law, Georgia State University, USA and cataloguing of the teaching material ! Ms. Sharmeen Khan which is used in their educational Director, Legal and General Counsel, Pfizer Pakistan programs. I was also privileged to meet *Student of Aitchison College, Lahore, Pakistan

Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 2 Bioethics Links cbecSIUT Pakistan Volume 5, Issue 2 (December 2009) Finding Hope in Unexpected Places Saamia Noorali *

I came across Dr. Moazam’s book the city. All my conversations seemed to Kidney Transplantation in a Muslim end up about land mafias, load shedding Society: A Study in Bioethics, Culture, and with no electricity for hours, water Religion while standing in line at the shortages, and endless examples they felt University of Virginia (UVA) bookstore. I justified their desire to leave Pakistan and was so intrigued by the subject and its immigrate elsewhere. Unable to find valid author that I immediately went home and counterarguments, I quietly accepted their Googled her. The search results were pessimism as truth. endless, yet after only a few articles I was Therefore I walked into CBEC with a thoroughly mesmerized by all her particular view of the country, and the accomplishments. It did not take long for poverty of the patients I saw seemed to me to send Dr. Moazam an email informing confirm the negative opinions I had formed. her that I was an undergraduate student in On my first day in the clinic, I saw a middle- UVA, and requesting an externship at the aged man bring a five year-old girl in kidney Centre for Biomedical Ethics and Culture failure bloated enough to look as though (CBEC) in the Sindh Institute of Urology she was nine months pregnant. As he and Transplantation (SIUT), in Karachi. spoke to the doctor, the father explained She responded that this would be possible how he had traveled two days just to bring and we agreed on a two week period during his daughter to the hospital. As he was the the summer of 2009. She would arrange sole bread-winner of his family, taking time for me to spend time participating in CBEC off from his job as a mazdoor (laborer) had activities and, due to my interest in a cost him and his family 150 rupees each career in medicine, would also arrange to day. Continued on page 6 have me accompany Dr. Ali, a pediatric PGD Class of 2010 nephrologist, in the clinics and wards of ! Agha Riaz Ahmed, MBBS SIUT. To be honest, I did not know what to Chandka Medical College, ! Ambreen Usmani, MBBS, Mphil expect from the experience but I began Medical and Dental College, Karachi looking forward to what I felt would be a ! Ghulam Murtaza Gondal, FCPS unique summer in Pakistan. Foundation University Medical College, Rawalpindi ! Mariam Hassan, MBBS Although my family is originally from Shaukat Khanum Memorial Cancer Hospital, Lahore ! Pakistan, I have spent most of my life Naveed Mazhar Bhatti, MSc Hamdard College of Medicine and Dentistry, Karachi outside that country. All my perceptions ! Naima Zamir, FCPS about Pakistan have therefore been National Institute of Child Health, Karachi ! Nida Wahid Bashir, FCPS derived from family discussions or news Patel Hospital, Karachi pieces about the country. During my first ! Sarwat Nasreen, FCPS week after arriving in Karachi in July I Ziauddin University, Karachi ! Sirajuddin Soomro, FCPS spoke with many family members about Chandka Medical College, Larkana

*Undergraduate Student of University of Virginia, Charlottesville, Virginia, USA

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Reflections on a Visit, from page 1 were postgraduate diploma candidates, S h armeen Khan to join me in teaching the together with the first cohort of Masters in new MBE students. Bioethics (MBE) students, whose study is Ms. Khan is a lawyer with solid projected for completion in 2011. grounding in the practice mileu of Pakistan. Trying to determine the boundaries of She has written about controversial the law when it intersects with science and bioethical topics such as abortion and is medicine is difficult enough in my own sensitive to international regulatory issues country, where the field of bioethics in the pharmaceutical industry where she developed alongside the growing field of works. Her presence provided an invaluable biomedical law. It would be impossible to perspective from which to explore how replicate the political conditions and social concepts rooted in the Anglo-American factors that brought bioethics in the U.S. legal tradition had many analogues in to its current prominence, and I knew it Pakistani law, and to understand the would be folly for me to try to impose many importance of the differences between concepts of American health law on those two systems as well. students of bioethics in Pakistan. The curriculum for the course was a Dr. Farhat Moazam directs CBEC. She combination of two classes that I have has written that bioethics is an area of taught before in the U.S. One study that must take note of indigenous concentrates on legal issues that arise in circumstances, and the CBEC educational the clinical medical context; the other program embraces this idea. My own focused on famous legal cases that have experience this year, speaking on played an important part in defining our bioethics and watching how the field is understanding of the field of bioethics in applied in places as different as Russia, the past thirty years. Canada, Italy, Germany, Pakistan and the The students came from several clinical U.S., has convinced me that she is right. disciplines; approximately two thirds of Any attempt to export models of bioethics them were women. In this detail the from one country to another with no bioethics program at CBEC was nearly attention to social and cultural differences identical to its counterparts in the U.S. is a recipe for failure. To presume that all where the current majority of students are ethical considerations are universal is to women as well. The class is chosen from devalue moral traditions that differ from applicants with backgrounds in medicine, our own, and dismiss cultural values of dentistry, nursing, biological sciences and other societies. research, and education, and they must So before I decided to make the trip, I have at least five years experience in their asked Dr. Moazam if it was possible to p r im ary discipline. recruit a local lawyer who had experience The legal structures in the U.S. and in the areas of health law and bioethics to Pakistan share some similarities. Because help me with the course. Fortunately, Dr. both countries were once part of the British Moazam had already identified Ms. Empire, they incorporated British legal Continued on page 5

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Reflections on a Visit, from page 4 m o d e l s . B o t h c o u n t r i e s h a v e morality of abortion is perhaps, the most representative bodies that write divisive and controversial issue faced by U.S. legislations (Pakistan’s Parliament and the health lawyers and bioethicists. Yet this U.S. Congress) and both countries have was clearly not the case in Pakistan. Though judicial systems that interpret those laws, the law there regulates the availability of as well as creating a “common law” of abortion, and there is not absolute precedent cases that set new standards in a agreement on how that law should be system of evolving legal rules. As the class interpreted, none of the bitterness and discussed fact situations from actual recrimination that characterizes the medical cases, it was obvious that the way a American debate over this topics was lawyer from the U.S. and a lawyer from evident. Pakistan would approach those cases I was repeatedly struck by the attention of reflected the many commonalities of our students to the relationship between the law training, as well as techniques of analysis and their religious obligations. Time after that can be traced to the similarities in our time students asked for further clarification legal traditions. of the principles imbedded in civil law and Of course, there are many differences as Sharia, and engaged in extensive well. In contrast to the U.S., in which the law discussions probing how best to meet is not explicitly tied to a single religious commitments to their professional roles perspective, Pakistani civil law may not and their faith at the same time. In my conflict with Islamic law, or Sharia. experience, such discussions also happen in Students were particularly fortunate to the U.S. But because among the wide receive instruction in our class from Ms. variety of religious traditions represented Khan, whose early legal studies focused on there no single religion is legally entitled to Sharia law. In other parts of the curriculum privileged status, such discussions usually they also heard from Dr. Muhammad Khalid remain a private, rather than public matter. Masud and Dr. Mohsin Naqvi, scholars with In addition to the course in legal topics, extensive background in Islamic studies and the week’s instruction also included Islamic jurisprudence. They explained to lectures, discussions and student students how Sharia scholars incorporate presentations on matters as diverse as insights from several schools of philosophical influences on bioethics, interpretation to arrive at legal opinions that feminist perspectives on bioethics and the are consistent with Islamic scripture and role of narrative in bioethics. The week was tradition. I noted that this method of capped by a musical performance jurisprudential analysis has analogues in representing a prime example of why both the Scholastic tradition of medieval “culture” is part of CBEC’s name. Christianity and in the ancient Jewish The guest for CBEC's Ethics and Culture Talmudic tradition. Hour was Pakistani singer Tina Sani. Ms. Another point of contrast in our course Sani is famous for her performances, in discussions related to abortion. The Urdu, of the classical poems know as ongoing debate over the legality and Ghazals. On this occasion she sang Allama Continued on page 7

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The Hidden Jewel, from page 2 Finding Hope, from page 3 papers on ethical issues such euthanasia, As he spoke about his fear for his abortion, in vitro fertilization procedures daughter’s health and the loss of income and consequences. After I read them, she from the missed days of work, the man would discuss some of the ethical and broke down and began to sob. He covered moral issues involved. She listened to me his face with his hands, and I bit my lip and patiently, even when I was wrong, and then stared at the ceiling in an attempt to helped me get on the right track. control my own tears. I felt that nothing I appreciated the fact that Dr. Moazam could equal the anguish of a grown man was willing to make time for me when she cry in front of his child. In those few was obviously so busy, and when I thought minutes I experienced the same sorrow my opinions were probably not terribly and disgust for Pakistan that my relatives interesting for her. She encouraged my had been talking about. curiosity and is truly a role model and an It took another week for me to begin to inspiration for all who meet her. Dr. Aamir see how unjust my feelings were. It was not Jafarey also helped me with his ready that there were not many instances of smile and his easy going manner. He hopelessness and misery I saw but my asked me to see several films with ethical dawning realization that I had been only dimensions which we would later discuss. focusing on one small part of a much larger I was impressed by the work CBEC is picture. doing and what the faculty is planning for The more I shadowed Dr. Ali around the future. One of the primary aims is to the hospital, the more I confronted poverty help set up ethics committees in medical at its most extreme. But as the days institutions all over Pakistan. I found both passed, with this I began to find hope Dr. Moazam and Dr. Aamir very proactive, everywhere. I found hope in the parents and willing to push the envelope beyond who regardless of their illiteracy tried their the realm of Biomedical Ethics to delve hardest to learn about their child’s illness into the greater ills of society by reaching and struggled on how best to help them. I out to high school students and to the found hope in the doctors’ convictions that public. This was something I really most of their patients could live admired as people like them are pretty comfortable lives with proper treatment. hard to come by in Pakistan. Not only was Perhaps most touching, I found hope this experience thoroughly enjoyable, it through the constant proof of humanity in was also very educational. It helped me to the doctors who worked tirelessly to treat be able to think more clearly, to be able to their patients, and in an institution that formulate my thoughts, and express them provides all medical care free of cost. in a concise and precise way. At the end of I learned that the doctors in SIUT, like my two weeks at the Centre, I was sad to most other Pakistani doctors who work be leaving but I knew that I would keep on abroad, could have easily found much coming again and again to work in CBEC. higher paying jobs in Pakistan but they chose to practice here willingly. Perhaps Continued on page 7

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Finding Hope, from page 6 there were some who may not have been NA Unanimously Passes Transplant Bill Islamabad, Friday November 13, 2009: The National there of their own accord, but if so, I did Assembly on November 12 unanimously passed a landmark bill to not meet any. All the doctors I met were full regulate transplants of human organs in the country, making their sale and unauthorized transplant punishable with up to 10 years in of zeal and selflessness that I had come to prison. The House suspended some rules to take up the Bill, and believe now existed only among the most adopted it without a debate to honor Pakistan’s iconic kidney naïve individuals in a selfish world. transplant surgeon Dr. Adib Rizvi, who had campaigned for framing such a law. Moreover, unlike the doctors I had come DAWN, Friday November13, 2009 across prior to this externship, the Reflections on a Visit, from page 5 activities of the doctors connected to Iqbal's poems: Shikwa and Jawab e CBEC and SIUT do not end with patient Shikwa. The complaint of a man to the care. They are also struggling to help bring Almighty, and the response that follows, back ethics to the medical system in was a poetic and musical expression of Pakistan which is plagued by corruption. sentiments that resonated with the CBEC organizes seminars, workshops, and overflow audience at CBEC that evening. Ethics Grand Rounds in which ethical To a Western observer, the poem also issues are discussed. shares similarities with the complaint of CBEC faculty are also part of a “Karachi the Biblical Book of Job. For me it was a Bioethics Group,” a group of fitting conclusion for a trip that showed professionals from different institutions me how much the cultures our course in Karachi who meet regularly to discuss tried to bridge had in common. various aspects of biomedical ethics. When I prepared to leave, my friends at Apart from their passion for practicing C B E C p r e s e n t e d m e w i t h a medicine, the doctors I met are driven by commemorative plaque that contained the ethos of the medical profession that scenes found in the ruins of Mohenjodaro, they should help the weakest in our a ancient city that thrived on the Indus society. I found doctors going beyond a River plain north of Karachi from about search to relieve the symptoms of illness in 2600 BCE to 1900 BCE. This memento a patient to a holistic approach in trying to now sits in my office in Atlanta, and I am correct the way medical profession itself is again reminded that the universities I have being negatively transformed. spent so much of my life within had their Physicians I met seem to value the roots in Islamic civilizations that reach thanks and prayers offered to them by their back to the 9th Century, and that the first patients and their families rather than in medical degrees originated in those the number of digits in their paychecks. I civilizations. Even further in the past were am sure those I met during my brief some of the first collections of people - externship in Karachi also have to deal with like the city at Mohenjodaro - we recognize electricity outages and water shortages, as “civilization.” At some level we all but I never heard them utter these derive our social institutions and the way complaints. They are too busy saving lives we govern them from similar sources, and most of us don't even know exist. in this sense it is a small world, after all.

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PGD Class of 2010 and MBE Class of 2011 with Faculty Standing, from left: Naveed Mazhar Bhatti (PGD), Agha Riaz Ahmed (PGD), Ghulam Murtaza Gondal (PGD), Mariam Hassan (PGD). Seated, from left: Naima Zamir (PGD), Sarwat Nasreen (PGD), Farhat Moazam, Paul Lombardo, Rubina Naqvi, Sharmeen Khan. Seated on floor, from left: Bushra Shirazi (MBE), Saima Pervaiz Iqbal (MBE), Anika Khan (MBE), Aamir Jafarey (MBE), Sirajuddin Soomro (PGD), Nida Wahid Bashir (PGD), Ambreen Usmani (PGD)

PGD Alumni Publications The alumni of CBEC’s PGD program have published 24 papers in peer reviewed journals in the past 3 years. The full list can be accessed at our website www.siut.org/bioethics by visiting the alumni page. Following are a few examples of the papers that have been published: !Anwar N. "A Tale of Two Pathologists: Questions on Good Laboratory Practice." Asian Bioethics Review, September 2009, Vol. 1, Issue 3 !Akhtar J. “Induction logic: Historical Background, Al-Ghazali’s Argument, Notion of Causality and Atomism.” Pakistan Journal of Medical Ethics, June 2009, Vol.10 Issue 1 !Naqvi R. "Teaching Bioethics to Medical Technology Students." Journal of Ethics and History of Medicine, May 2009 !Khizar B “Mock ethics consultations for teaching ethics in Pakistan.” Medical Education, May 2009, Vol. 43, Issue 5

Centre of Biomedical Ethics and Culture Full Time Faculty Farhat Moazam Anwar Naqvi Professor and Chairperson Professor and Coordinator Aamir Jafarey Associate Professor Associate Faculty Bushra Shirazi Rubina Naqvi Ziauddin University SIUT Staff

Ali Bin Ayjaz Antoinette David Web Designer Administrative Assistant

5th Floor, Dewan Farooq Medical Complex Sindh Institute of Urology and Transplantation Karachi 74200, Pakistan Welcome Trust School of Bioethics, Mumbai Nov. 29-Dec. 4, 2009. Phone: (92 21) 3272 6338 Fax: (92 21) 3520 6738 This year's theme was “Gender Sex and Ethics.” Dr. Farhat Moazam was an invited speaker while Dr. Jafarey and three CBEC alumni E-mail: [email protected] www.siut.org/bioethics attended the School and a workshop on grantsmanship

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