Category Archives: Health

Psychosocial Dynamics of the Khorwah Medical Camp – an Overview


paddy fields near Khorwah

There are instances when theory doesn’t exactly translate into practice – rather as I call it, it undergoes a transduction process. Each fragmented element, becoming whole through subjective perception. Let’s just say that the Khorwah medical camp held on 31st July 2011, barely a day before Ramadan, was another of such instances. A brainchild of the 4×4 Offroaders Club, this was my first experience with this group in their medical camp and their dedication to the cause is appreciable.

Khorwah, is located in the north east of Karachi and it took us almost 4 hours to reach there by bus. The land may be fertile for paddy fields but it is a hard life for the locals who have a hand-to-mouth living at best. The main profession in the area is hiring oneself out as farm labourers and its secondary adjunct is grazing cattle. A few luckier ones, according to the local definition of ‘luck’, are ironsmiths or carpet weavers, basket weavers and tradesmen who do not have to undergo the hardship of toiling in the hot climate.

While a quick online search shows that there are apparently two schools in the vicinity for boys and girls, not one of the children we came across has ever attended a school there and several of the elders shook their heads when asked about the existence of a school. Another ‘ghost school’ perhaps? From a psychological perspective the absence of a school makes the task of psychologists harder for the assessment of children. How does one gather data for any child’s achievement level when there is no available baseline? Simon – Binet and Wechsler, the fathers of intellectual testing, take the backseat in the face of pastoral and cultural dynamics. For my part, I found that I could easily add in a number of intelligences to Gardener’s Theory of Multiple Intelligence while assessing intellectual ability based on performance in Khorwah.

Towards Sujawal and beyond

The harsh climate, the financial hardships, the lack of knowledge, the focus on medicine only as the cure-all, and the disinterest in prevention over symptomatic treatment are definite barriers to creating awareness of diseases and disorders. There is also a tendency to label all mental issues as ‘pagalpan’ or madness – no matter what the age of the person under speculation. The language and dialect barrier is also hard to overcome. A slightly different inflection of the voice even if close to the original Sindhi word, was very difficult for the people, especially the womenfolk to understand. However, all is not as bleak as it looks. There is a definite interest in learning new ways and in the fact that for once there is a ‘different kind of doctor’ – someone who cares, wants to help and is ready to listen and, with no disrespect on my part, is not ‘just a journalist who will listen, go back and write or publish photos and not offer any concrete suggestions for our ailments’. Children with behavioural, intellectual and emotional issues were curious, and eager to try out new exercises yet too afraid of the doctor label to be able to open up and relax.

Most of the prevalent diseases are a result of poor health awareness and future programmes can be chalked out to include large scale group therapy with at least one translator available per group. This time we initiated a focus group venture but it did not succeed too well due to the low voice of the translator and addressing partial groups in the audience, neglecting those seated at a distance. It also didn’t help that the translator had her own views regarding what would help the women and what would not and most of the sentences spoken had to undergo negotiation before they were translated. Some of the women who had partially understood the sentence followed the negotiation ball as in a tennis match with frustration writ large on their faces.

A group of local women with the volunteer doctors

Among the common issues faced by the villagers that would require preventive awareness programmes, skin diseases are almost at the top of the list, and poor hygiene conditions make it very difficult to say that these will be eradicated anytime soon. The villagers walk barefoot in the fields in all weather and deformed calluses caused by incessant scratching and its resultant sores that may get infected, are very common. Again the issue is greater in women than in the men, who being seen as the main breadwinners, are less likely to go barefoot. Hand washing is a luxury and whether scratching sores, or tending to cattle or cleaning up their own or their children’s faecal matter with stones and leaves or hands, just a quick sieving of the fingers through sand or a nearby muddy pond is considered enough to cleanse the hands. The same hands then return to their own body, to the food they cook and the utensils in which they eat and drink. Clothes are not washed more than once in two weeks if there is time left over from working in the fields. Cotton cloth is tied round, washed after a day and reused in times of menstruation. Several women believe that having a bath during menstruation is bad for health and here the case was no different. I witnessed many garments soiled and stained with blood that are not washed at all and are kept aside only to be worn during the time of menstruation on a monthly basis. There is dire need of awareness and presentation of cost effective, easy alternatives to deal with the hygienic aspects of preventive health care in the region. Abdominal aches due to intestinal worms and other genitourinary problems

Another issue is of oral and dental health care. Many women are addicted to various substances used by their husbands and chewing hard betel nuts coupled with calcium deficiency along with other forms of nutritional deficits, leads to brittle teeth, swollen gums and cavities.  There is hardly any concept of brushing or even the traditional ‘miswak’ or ‘tooth stick’ use and dry twigs are used if anything gets stuck in between the teeth. The use of salt as a cleansing agent was advocated in front of quite a few women as a cheaper alternative to fill Dentonic bottles once they would get empty. Children were especially eager to show off shiny teeth and this factor can always be used to motivate them on future occasions.

PNS Shifa hospital affords us psychologists at the Institute of Professional Psychology, a cushioned existence. It has taken us a while to build up our reputation and most doctors here at PNS Shifa now know what we do, we have interlinks and they many refer cases easily.  With the medical camp we went back to basics. I was all the while strongly reminded of the words of our colleagues working in remote areas and in other parts of interior Sindh. It took awhile to tell people at the camp a number of things. Firstly that psychologists do take a long while to diagnose and treat but depending on the type of test or clinical interview, diagnosis can be a quicker deal especially in cases of psychosis and neurological issues, secondly the fact that therapy and counselling does take a number of sessions but there are a number of techniques that can be taught in a shorter time and thirdly the idea for the patients that psychologists are not journalists and they ask questions to diagnose, not write only and that medicines are not a cure-all, there are times when medicines are just not needed.  In this entire process I hope we have re-educated more than just the visitors.  It was heartening to see many men come forward to discuss their wives genitourinary issues after they had been silently observing us from a distance and felt that they could get some assistance from this ‘different’ method of treatment and develop some understanding about how to deal with such issues. I was extremely glad to see one patient in particular who approached us on his own after watching us from a distance. He was worried about his wife’s growing weakness and low mood and a complete clinical interview revealed that she had been suffering from post partum depression since the past one year. He went back encouraged to know the dynamics of the disorder and a few pointers to help her deal with this period of stress.

The Medical Camp site sans tables and chairs that were earlier lined up with numbers assigned for each doctor's table. Beautifully organized.

In a hospital setting such as the one in which we are based, we take it for granted that in case of any illness – terminal or otherwise, the caregivers will need to be counselled about the mode of care, their issues of anger or treatment follow up and prevention but in Khorwah, out in the open it hit us hard that there are people out there who need to understand that still. Similarly, many patients with chronic chest conditions were referred to us directly and we asked them to first see the general practitioner and then approach us on their way out.

Clinical Psychologists who are interested in the types of psychological issues faced at this remote area and the interventions we used for them would find it interesting that we went far off the beaten track with generally good results. Neurological problems were at the forefront of most cases seen and neurological screeners were applied for evaluation along with intakes. The rush at the camp made many children nervous, cranky and prone to tantrums which made this test very difficult and reinforcement in the form of biscuits generally helped in soothing more than one terrified child. Children also kept thinking that they were going to receive an injection as soon as they closed their eyes for a few subtests and refused outright to close their eyes even for a few seconds. It would be idealistic and demanding to expect a secluded spot for such testing in a medical camp but we improvised by taking a few patients slightly away from the camp for relaxation and guided imagery in the case of anxiety disorders as well as the motor subtests of the neurological screeners. Some patients were referred to hospitals in Karachi for further medical treatment. They were also provided with guidance about occupational therapy and its correlates and demonstrations were given to each patient individually about the simple exercises they could do at home to help improve the gait or eye-hand coordination.

another view of the Medical Camp site

Complete diagnosis and treatment for many patients with psychotic features could not be initiated at the camp but initial diagnoses revealed Schizophrenia with prominent visual and auditory hallucinations and they were again given detailed directions for seeking psychiatric help in Karachi. Most of the patients earlier had no idea what to do about this condition of madness and had been at the mercy of faith healers who were fleecing them. Their caregivers were guided about their conditions, expectations, possible prognosis and types of treatment along with modes of care, and do’s and don’ts.

Suicidal ideation, suicidal attempts, self mutilating behaviour and depressive features with melancholic states were observed in a number of women. Considering the financial state and the early marriages, childbirth issues, and other problems these women face this does not come as a surprise. A number of Conversion disorder and Somatisation cases that had been labelled as various pain issues gradually floated over to the Psychologists’ table after getting a negative from other doctors present. Far more had been noticed when conversing with the women during the group therapy initiative. Contrary to what some doctors feel, it is important to state here that Conversion and Somatisation are distinct from Malingering and just because there is no physical evidence for the patient’s condition, it does not always mean that he is indulging in attention seeking behaviour or wishes to gain some material benefits. The managers of the estates will as a rule complain about the labourers not working properly and defining a patient as alright and having no pain just because nothing comes up during the course of the physical examination does not mean that from now on the patient will be fine. Conversion symptoms are like the flow of a river. You can barricade the pressure, but temporarily. Eventually, the course may change, the walls of the patient’s self may tumble down or he may experience other similar symptoms incorrectly labelled by many novices as Hypochondriasis. A better alternative is to refer such a case to a psychologist who can then deal with the entire etiological presentation of the case.

While there are successes, there are stark facts of unforgiving and harsh circumstances in many cases. A few really saddened us and I still think of the old man who was caught in a catch-22 situation. An ironsmith by profession, he showed initial signs of Parkinsonism, was well aware of the changes in his body and yet he had been abandoned to his current state by his six sons who considered this trade a demeaning one, did not help him financially and he was still looking after his two daughters. Only one son helped him from time to time and he too rebuked him and had been distancing himself from his father. In another case, a man who was the sole breadwinner suffered from severe congestion and asthmatic symptoms each time he was involved in threshing procedures. He had no idea about safety procedures and used no form of protection whatsoever. He was counselled briefly regarding safety procedures and provided with suitable alternatives.

The entire initiative on the part of the 4×4 Offroaders was well executed and very well organized in terms of crowd control from start to finish and I’m sure it is not the last one! The whole team deserves to be congratulated and I’ll refrain from taking any one person’s name in particular as each and every member was immensely dedicated. There is always room for improvement and I’m looking forward to the next trip already. Let’s see how many suggestions can be utilized and how far it is possible to correctly identify patients at source or educate each other about our respective roles so that maximum benefits can be derived from everyone’s contributions.

 N.B. All the photos were taken by me after the camp was almost over and during the camp there was no time to take photographs. Hence there are no photographs of the doctors or the patients undergoing treatment. A safe estimate, however is that nearly 800 – 1000 patients visited the camp that day and were given free medicines, free treatment and physical and mental examinations.

 

Growing together…


I still remember the first time I saw a pea sprout. Out came the root just as the teacher had predicted and the cotton wad on which it had been placed was handed around gingerly to all one by one to see and marvel at. Much of that innocent wonder has been lost to most of us today. A garden is pretty and the flowers … yes, prettier. And that is it.

As life rushes by, daily we race with the clock, never pausing for an instant to look around us. Sadly enough most of what we Pakistani city dwellers do see around is not calming in itself. The eyes see rows after rows of residential areas or shops. Green strips are rare and for the apartment dwellers, the odd plant or two in the balcony is considered ornamental enough. Still rarer is the concept of
working in ones own garden and thus we see maalis bearing the brunt of the equation. Additional work, you think? Maybe yes. But then again, it may be just what the doctor ordered…

The benefits of gardening are so diverse that in several parts of the world, horticulture therapy has been inculcated into clinical practice where it provides relief and hope to patients with all kinds of problems ranging from low mood to the omniscient stress and worry that punctuates most modern lifestyles. More than anything, gardening is what you make it.

Researchers agree that physically the effects of gardening are quite obvious. Forget about paying extra for the gym, as gardening provides one of the best aerobic exercises that give strength and flexibility to the bones and the muscles alike as well as the cardiovascular and respiratory systems. However, care should be taken with regard to posture while lifting heavy objects.

Psychologically speaking, the effects are slower, yet they run deep. In the long run, sleep and appetite can be regulated pretty well by a regular dose of gardening. A routine can be structured around the watering and weeding process that can stimulate the appetite as desired depending on the amount of work done and gift ease in sleeping to the sleepless. The natural rhythm is in more than one way, fine tuned.

A thing of beauty is a joy forever wrote Keats and these oft quoted lines bring every planted bulb to life. Whether it is a lonely heart, a sad one or a merely pensive one, the sight of flora and fauna is soothing to the senses. Poetic sentiment isn’t the only plus point here. The physical work associated with caring for an entire garden is said to release endorphins that in turn alleviate stress. Apart from working in a garden, simply being in one also works wonders for the mood and  stress levels. This effect can be heightened through a water garden that ideally has gently flowing water or at least includes some source of water whether a basin or a pond. The sound of water such as that in water features like fountains and imitation waterfalls stimulates the mental capacities and reduces tension inside a person. Visually too, the same effects are felt but over a longer time duration.

The process can be meditative as well. The sense of here and now it exudes, quietens the ever critical conscious mind as the individual can finally allow himself to simply… be. The innocent wonder comes surging back at the tiniest instances: a new shoot, the sight of bees around the first flower of the season, or even butterflies twirling merrily round the flowerbeds.

Exotic garden in Karachi

Creative potential can be explored too as a constructive outlook can allow the
individual to experiment with various landscapes, lighting conditions and
embellishments. The sense of achievement this brings also builds confidence and
provides on the whole a very healthy outlet for pent up emotions.

Still, a garden or even nature is far from being picture perfect all the time. Buds wilt, plants die, and entire gardens are destroyed by pests, stray animals, heavy
rain or the burning sun. The farsighted gardener often recycles dead leaves and
plants as compost in the gardening sphere and life goes on. Gardening then, for
the regulars acts as a microcosmic world, analogous to the one outside but far
safer. The temperament of a gardener in the long run becomes peaceful and
positive – from one season to the next, as the mind tends to dwell more on what
will grow, while enjoying the present and respecting the past.

Horticulture therapy has been in practice for quite a few decades now but its beginnings can be traced back to the time of the ancient Greek physician Asclepius who prescribed rest near streams and shady woods as treatment for most illnesses. Dr Benjamin Rush, the Father of American Psychiatry, in the 19th century called gardens curative for people who were emotionally disturbed. Yet, it was the rehabilitation centres emerging in the 1950s that made horticulture therapy popular. In Pakistan, its practice is not yet structured, nor indeed is it known by this name, but individuals have made efforts on their own to involve the elderly, the emotionally disturbed and the mentally challenged in ‘activities’ involving gardening. In its essence, horticulture therapy involves guiding individuals with various emotional issues in their lives towards a better future by empowering them in all phases of the horticulture process from propagation to selling products as a form of satisfaction. This may be internal, allowing for enjoyment of the produce by the person and his family or external through monetary benefits.

Different emotional states require different kinds of stimulation and at different
levels. For those feeling low, sitting in a garden without flowers may be
beneficial to some extent, but not as beneficial as sitting in one with flowers. For the mentally challenged or for those with sensory disabilities, especially children who are intended to work with plants, it is essential that plants are planted for their variations of texture or colour or fragrance rather than the price tag that comes with them. Variations provide a richness of experience unparalleled by mere human toys. Using the bare hands to plant, weed or dig in, provides a sense of purpose and fulfilment when small goals are met and merge into larger ones.

For those with motor disabilities gardening can be made easier by raising the beds at least two feet from the ground and making paths between them broader so that manoeuvring becomes easier.

On an individual level, each of us is as responsible for our own emotional health as for that of our families. Living in and loving a garden, whether it is spread over acres or is restricted to a balcony, has its rewards that can not be judged lightly. With the alarming rate of emotional disturbance amongst many issues that is spreading rapidly in our country, a healthy, constructive activity acts as a
panacea and in the long run, helps us grow… together.

Rehabilitative mental health care in Karachi – A case study of a single psychiatric set up.


It is 9:00 A.M. The wide green lawn ensconsed in the quadrangle of the double storey building  is bathed in mellow hues. Soon enough, they start emerging from their rooms, wearing fresh clothes after their morning showers. Single file, they are guided downstairs to begin the daily morning excercise session. A variety of expressions meets the eyes. Some look bored, a few seem indifferent, while others are quite enthusiastic – smiles lighting up their features. No, these are not children from a boarding school. They are mentally ill patients and residents of Karwan-e-Hayat PCRC (Psychiatric Care and Rehabilitation Centre) located in Keamari, in Karachi, Pakistan.

People have varied and often gross misperceptions about mental health institutions and their resident patients. A rehabilitation centre is often thought to be at par with an assylum with violent, drooling, dishevelled and possibly jumpy patients sitting in dark, narrow cells restrained by chains and administered electric shocks daily. These impressions belie the image of a rehabilitation centre like Karwan-e-Hayat PCRC. Though the entrance hall is flanked by burly security guards and has strong grills in order to prevent the patients from escaping, the rest of the Centre is bright, airy, clean and built on the model of Western rehabilitation centres. There are separate dining halls, activity rooms that are lined with the patient’s own creations and indoor game rooms for male and female patients. Two buildings adjacent to each other within the same compound house the male and female residential wards, semi private rooms and airconditioned private rooms. Presently it has 65 beds but in future there are plans to increase the number to 100 beds which is the Centre’s actual capacity. In short, it epitomizes the modern residential and Day Care facility for the mentally ill.

Karwan-e-Hayat started out as an NGO in 1983 committed to caring for the underprivileged  mentally ill patients. It got off to a good start with names such as Begum Ra’ana Liaquat Ali Khan, Cardinal Joseph Cordeiro, Ms. Anita Ghulam Ali, Prof. Dr. Zaki Hasan, and Dr Zafar Quraishi, who is currently the President of the NGO, as its founding members. In a city like Karachi where mental illness had a great deal of stigma associated with it they made the correct move – that of  organizing awareness camps. The target? Again, smartly enough – katchi abadi and slum dwellers who stood in utmost danger of being fleeced by miracle workers and fake pirs. In a simultaneous move, seminars were arranged in high profile schools like St. Joseph’s Convent and Karachi Grammar School. Since then, the NGO has come a long way. The Consultant Psychiatrist of Karwan-e-Hayat PCRC, Dr S. Ajmal Kazmi, met with Dr. Zafar Qureshi in 1995, then the Director of Karwan-e-Hayat. This interaction led to the concept of a rehabilitation centre in Karachi. The next few months brought on a search for a suitable location. KPT (Karachi Port Trust) were the owners of this premises in Keamari and after spending around Rs. 80 lacs for renovation, it became fully functional in 2004. As it is primarily a charity organization, 90% of the patients are treated free of cost thanks to various donors like Rotary Club Karachi and Infaq Foundation.

Theoretically, Karwan-e-Hayat combines two concepts – a rehabilitation program and a crisis  house. As such it provides services like medical examination and assistance, rehabilitation counselling and occupational training opportunities found in rehabilitation programs. As a crisis house in a community setting it is based on the model of rehabilitation and accordingly is staffed by mental health care professionals. The relatively little research that exists on such centres has not only found that they are very acceptable to their residents, but also suggests that they may be able to offer an alternative to inpatient care for about a quarter of the patients admitted to hospital, and that they may be more cost-effective in the long run than inpatient care since most patients are eventually assimilated back into society!

Karwan e Hayat follows a  multidimensional approach for treatment of adult patients between the ages of 18 years to 65 years. Drug addicts were earlier not treated here due to the vast differences in treatment methodology and other complexities. However, drug addicts suffering from psychoses are now admitted and treated.

Occupational therapy activities

Generally, firstly an RMO (Resident Medical Officer) medically examines the patient in the OPD and takes his history. Next he is sent to a Psychiatrist for consultation where, if needed, he is prescribed medication or admitted as an inpatient. The Centre offers admission to some patients who need inpatient care because of acute and severe mental health conditions like Schizophrenia, Bipolar Disorder etc. The patient may also be referred to the Clinical Psychologists for psychological testing and psychotherapy to resolve his inner conflicts. Inpatients are divided into three main categories for individual psychotherapy which takes place twice a week: 1. Obsessive Compulsive Disorder and Depression, 2. Schizophrenia, and 3. Personality disorders. Testing material worth Rs. 3.5 lacs has been acquired by the Centre to facilitate psychological diagnosis. Occupational Therapists attend to the patient in the Centre’s Day Care. They give the patient something  purposeful to do in the Activity Rooms with the intention of improving his general sense of self. Sessions for improving the patients’ awareness about their illness are also conducted frequently with a view towards helping them manage their self care. Various organizations such as the Institute of Professional Psychology and the Aga Khan Hospital send their students to the centre for internships and community service.

All these professionals work together to firstly diagnose and then help a chronically ill patient ease into society or at the very least sustain daily functioning ability. There are plans to include a Social Worker in the team this year as in other Western countries, but Dr Kazmi laments that the training provided in Pakistan at Masters level in Sociology or Social Work is far off the mark.

Karwan e Hayat ward

A typical day at the Centre starts with the ward boy waking up those in the Inpatient facility and encouraging them to wash themselves and take a shower. Some of the long term stable patients are encouraged to lead the morning Excercise Session. The patients then return to their wards or rooms for the morning round by the mental health professionals. Any decisions taken during this round are noted and the team then divides in two groups for better management of the not so stable inpatients and the Day Care activities. The Day Care group session includes both male and female patients who are stable enough to take part in discussions on basic topics such as “The importance of cleanliness”, “Ways to control anger” or “Hobbies”. The objective of such discussions is to draw the patients out of their fantasy world towards practical life and develop their interests.

All other activities apart from the group session are carried out in a segregated environment under supervision. During occupational therapy the patients are encouraged to make arts and craft items as per their interest. Many simply colour in drawing books and often the colours they pick or their manner of colouring is quite suggestive of their inner emotional states. Computers in the activity room are a relatively recent acquisition and selected patients are even taught programs like Microsoft Word by others. Evenings bring with them time for indoor games like table tennis, cards, carrom board and sometimes cricket. While it is encouraging to see the careful supervision of various activities, it is surprising that the patients are exposed to several cable channels and can watch movies – blood, gore and dances included, without a bat of an eyelid by the supervisors, in the activity room. Major activities at the Centre culminate with the Day Care closing at around 4:00 P.M. There is a skeleton staff for night duty to prevent possible mishaps.

Overall, it is creditable that Karwan-e-Hayat has not only managed to live up to its mission objectives by establishing centres such as its outpatient clinic on Khayaban e Jami and PCRC at Keamari during the past 24 years, but has fostered healthy links between psychiatrists, psychologists and occupational therapists – bringing them all under one roof at PCRC. Job satisfaction appears to be moderate amongst the staff members which is saying something, since the Centre is located at quite a distance from their homes. Yet many psychologists are sceptical about the level of therapeutic care being provided at the Centre as psychiatrists take centre stage in the proceedings.

There are several other rehabilitation centres – for drug addicts or psychotic patients etc located in the city but an impromptu survey taken from mental health professionals and patients revealed that most are not as spacious or as well organized. Moreover, there were complaints regarding the quality of meals provided elsewhere and the level of hygience maintained in the kitchens. Similar complaints of boredom, lack of good and comfort come from patients at this centre as well but they seem to be fewer in comparison.

The seemingly eternal rivalry between psychiatrists and psychologists has also proved to be a bone of contention in many cases with each faction wanting to show their supremacy over the other in terms of treatment efficacy. Dr. Kazmi’s rejoinder is interesting to note: ” Team work should always be there. If you work alone you can never do as well.  I’m lucky to be working with an honest and hardworking team. If someone is at the forefront, it is because there are several unnamed people at his back.”

Mental Health Professionals and policy makers would do well to take a leaf out of Karwan-e-Hayat’s book. With Schizophrenia at 11% and Depression at 15% world over, the demand for mental health facilities is bound to increase with the rise in population. Already, a figure of 1.5 million mentally ill people is estimated for Karachi. Karwan-e-Hayat’s PCRC is but a drop in the ocean. True, it is one of the few fairly good centres and is providing free treatment to poor patients but it is definitely too far from the city and has a limited capacity. There is dire need for many more centres, not only in Karachi but in the whole country.

N.B. This article was published in 2009 in Expose’ magazine, Karachi.

Photos courtesy: Karwan e Hayat website

Pilates


Pilates is the brainchild of Joseph Pilates, who despite being a sickly child suffering from rickets and asthma, lived to be an octogenarian. His in-depth study of gymnastics, bodybuilding, diving and skiing led to his devising a series of exercises. Today his disciples have made variations of the original, while the Pilates exercises themselves have undergone quite a few changes based on scientific grounds for added safety.

Pilates is a form of exercise, which focuses on

–       Realigning the spine in its natural ‘S’ bend or neutral ‘S’ – more suited for fluidity of movement and less wear and tear of discs. Our sedentary lifestyle encourages the spine to move out of the natural ‘S’ shape which can lead to rounded shoulders or back pain.

–       Strengthening and toning the back, abdominal and pelvic muscles

–       Improving overall body posture.

–       Giving the body a complete workout and helping you gain an insight into the specific strength and structure of your body, so that mind and body are harmonized.

Pilates is based on 8 principles, namely:

Pilates Positions
  1. Relaxation
  2. Alignment
  3. Control
  4. Precision
  5. Routine
  6. Breathing
  7. Centring
  8. Flowing movement

You can do Pilates with a class as a general activity or you may find one-to-one training,  called Personal Pilates, more to your liking based on your needs. Classes vary from 4 sessions in a week to 1 session per week depending on your schedule. A single session usually lasts for an hour.

Pilates is suitable for almost everyone irrespective of fitness level. Contrary to popular belief, it is not just the domain of dancers, gymnasts and athletes but a variety of people ranging from those wishing to tone their thighs, get a flat stomach, reduce their bulk or simply remain fit.  However, special considerations include:

–       Pregnancy: Pilates is suitable for prenatal or postnatal women as it is a gentle, low impact form of exercise. However, pregnant women should attend a class designed to meet their needs rather than the general Pilates class or go for Personal Pilates.

–       Osteoporosis: Such patients need to work on a one to one basis with their instructor rather than attend mat work classes.

–       Disc herniation (slipped disc, prolapsed disc, bulging disc): Such individuals may attend a mat work class only after more than a year has passed since their problem.

Image courtesy : http://www.google.com.pk/imgres?imgurl=http://www.easyvigour.net.nz/pilates/pPilates3.gif&imgrefurl=http://www.easyvigour.net.nz/pilates/h_pilates3.htm&usg=__G8Ow4fRmZYMeAA5AymsQh0P7zLw=&h=715&w=315&sz=12&hl=en&start=22&zoom=1&tbnid=cm9C6pOt5pZEvM:&tbnh=157&tbnw=69&ei=xkLOTdD1GJDWtQP0nfSzCw&prev=/search%3Fq%3Dpilates%2Bimages%26hl%3Den%26sa%3DX%26rlz%3D1T4GGHP_enPK418PK418%26biw%3D1093%26bih%3D466%26tbm%3Disch%26prmd%3Divns0%2C790&itbs=1&iact=hc&vpx=807&vpy=166&dur=2400&hovh=210&hovw=92&tx=95&ty=96&page=3&ndsp=10&ved=1t:429,r:8,s:22&biw=1093&bih=466

The Dried Apricot


The tangy dried apricot

Apricots (prunus armeniaca) belong to a large family of fruits including cherries, peaches and plums. While the fruit is native to China, it is cultivated in cool, dry, and temperate climes in most parts of Asia, Southern Europe, North  Africa and certain regions of  America. The American Pomological Society lists 11 main varieties of the fruit such as Riland, Tiltand, Blenheim, Royal and Chinese.

Come summer, and one can see the fruit and its cousins lining the pushcarts of any fruit seller in Pakistan as Apricots proliferate in the northern coller climes of the country.  However, apricots can be used all the year round if preserved by canning, by using  in jams, or even by drying them out. It is this latter aspect that carries various medicinal properties.

Considering that water content of the body diminishes rapidly during Ramadan, taking with it, important nutrients in our diet, which can make one feel light-headed and dizzy, dried apricots can be beneficial in more than one respect. They are important sources of iron, calcium, potassium, vitamin A and are high in natural sugar which is  metabolized easily and is not harmful like artificial sugar. Moreover, they reduce feelings of thirst during the daytime when consumed at Sehri during Ramadan along with adequate amounts of water. The   potassium in the fruit can help reduce electrolyte imbalance and ward off strokes

Local Hakeems prescribe the fruit to minister to the symptoms of constipation and for killing harmful bacteria in the stomach. People with acidity, piles or stomach ulcers may also find it helpful to have the fruit early in the morning they say. It is also prescribed to those who have fever. However, it is important that the dried apricots are sweet rather than sour as the sour variety may cause gases and consequently, a hard,  swollen  stomach.

Kernels of the fruit can be eaten raw or roasted. Make sure that they are sweet in taste
before consuming them, for a few varieties yield bitter kernels, which can be mildly poisonous until roasted. It is beneficial to eat no more than 8 – 10 kernels at a time.

In general, apricots are good for those on a diet, with 1 apricot containing approximately
17 calories. The fibre content is an added bonus.

Dried apricots also produce a wholesome and highly nutritious jam or halwa especially when put together with roasted kernels of the same.

* Box feature published in Daily DAWN Newspaper. Karachi, Pakistan.

Reiki at home


Reiki is one alternative medicine that has gathered many followers in this part of the world
over the past few decades. Though I have gained exposure to some of its mental and material benefits with reference to the human body, I was unaware of another benefit till recently – namely its effect on inanimate objects and household appliances.

A focussed discussion with Pakistani Reiki Healers and Masters in different cities of Pakistan
revealed some interesting facets. While Reiki may not exactly bring my crashed hard drive back to life or fix the broken manholes lining the roads I pass by, it promises to store positive  healing energy in objects of daily use increasing their efficiency. This action can be seen more as a preventive measure than a completely curative one.

An attuned Reiki healer can direct the Universal energy through his Crown chakra or Third Eye chakra towards his hands or feet and then on towards either people or objects. The
premise behind this is that everything in the Universe resonates with ‘life’. While Reiki doesn’t subtract anything from the attuned healer, he acts as a medium for the positive life force and in the process corrects any internal imbalances in both his own self and in the intended person or object.

A closer look at the main Reiki principles confirms the belief in doing good in the world and
reducing negative thoughts and feelings which attract similar negative energy as in like to like. Honouring one’s elders, refraining from anger and worry, being grateful for life’s bounties and earning an honest living are part and parcel of Reiki. Attitude towards Reiki plays a major role in treatment whether for one’s own self or for an object.

While attunement is carried out by the Reiki Master drawing symbols – figuratively – over the body of the person being attuned, other symbols form an important part in the learning of Reiki. The Power Symbol Cho-Ku-Rei can be used by Level II Healers as a mantra to clear negative energy from rooms by flowing into the walls and being stored there. It can also energise crystals, food and water.

Thus Reiki can be successfully used to open jammed locks, start up cars giving trouble during
winters or otherwise and as a Reiki practitioner friend tells me, through his personal experience, also help in fixing troublesome computers where even computer experts have failed to offer any advice except reformatting!

*Published as a box feature in DAWN newspaper, Karachi, Pakistan.