Aman Foundation launches second health initiative.

KARACHI: At least 40% of deaths in Pakistan are preventable, said the chief executive officer for Aman Foundation, Ahsan Jamil at the launch of the organisation’s latest initiative Aman Telehealth. “Most of these deaths occur due to three major factors – lack of transport to a healthcare facility, affordability and lack of decision makers being present at time of the emergency.”

In a previously conducted study, Dr Sadiqua N Jafery concluded that the most common of the three reasons was the lack of decision maker ie husband, mother-in-law, father or mother being present. according to Jamil, the launch of a system whereby you can receive an initial diagnosis and prescription for non-chronic symptoms on the telephone is therefore most opportune. the telehealth project has been in the works for several months now with ongoing training for the 26-strong staff to attend to a caller’s medical queries. the service will be in operation 24 hours, seven days a week on 111-113-737.

“At present we have the capacity to attend to 1,000 to 1,200 calls a day, with 10 attendants in the morning, 10 in the evening and six overnight,” said Dr Zahid Ali Faheem who is heading Aman Telehealth.

The call is answered by a registration officer who notes the caller’s name, address, gender and age. the call is then transferred to a health advice officer ie nurse or doctor where a list of your symptoms are noted in a system. if the programme is unable to generate a suitable response the call is then passed on to a medical officer who further questions the caller about their symptoms.

In case of emergency, the call is routed to the ambulance service.

According to Faheem, among other objectives they hope to achieve greater empowerment for women, early-stage intervention and reduce incidence of medical emergency through this initiative. “In three to five years we hope to increase our attendants to 150.” but the process of increasing staff as well as advertising the service needs to be gradual for a sustainable setup cautions executive director for Aman Health Dr Junaid Razzak.

“The most important thing is to fill the void of missed opportunity,” Razzak said. the most difficult part for a medical professional is not the medical life saving procedures they give but delivering the news to loved ones of the patient’s condition or demise, he added. “It is with the hope to decrease these conversations by early intervention and diagnosis that Aman Telehealth has been launched.”

The service also provides a medical directory to hospitals, laboratories and other medical facilities in the city. While the service is available to people calling from all over the country the medical directory has thus far only been compiled for Karachi.

Published in the Express Tribune, January 2nd,  2012.

“Don’t you worry about a thing, ’cause every little thing is going to be all right.” -Bob Marley

“Mom says to tell you that now I have the most expensive hair in the house,” my daughter, Coco, tells me over the phone from our home in Georgia. Coco called me as soon as my wife, Margaret, brought her back from the salon where Coco apparently got a major, life-changing, going-back-to-school, radical cut and dye job. For the last 10 days, Coco and Margaret have waited patiently for me to get back from my latest trip to my parents’ place in Delaware to help my mother take care of my father who is living with dementia from a brain injury he suffered last year. but Coco starts her sophomore year in high school in three days, Margaret starts teaching middle school part time the same week, the carpet in my mother-in-law’s room in our house needs to be shampooed, the dog needs to go to the groomer, new furniture needs to be assembled (yes, the same furniture I mentioned in my last post — the one about procrastination), the yard’s a mess, and they needed me back home yesterday.

I tell Coco that I thought her long blond hair looked great already. I ask her what it looks like now, but she won’t say. “OK, then are you even more beautiful than you were before?” I ask her.

“What? I don’t know. It’s cool, though. but I’m not telling you anything about it until you get back and see for yourself,” Coco says. “And Mom isn’t telling you either!” she yells to my wife who’s with her in our living room. Coco’s 15 years old and, like me, has attention deficit hyperactivity disorder (ADD/ADHD) and a bit of a problem with her temper.

“Watch your tone, sweetie,” I say over the phone from my parent’s house in Delaware. I’ve got the phone cradled on my shoulder as I clear dinner dishes from their dining room table.

“I’m just kidding around, Dad,” Coco says.

My 87-year-old father glares at me as I take away his dinner plate. I smile back at him. He shakes his head and looks away. He’s been even more confused and irritable lately. My mother thinks the recurring pain from yet another fall he took recently has intensified his spells of dementia. whatever the cause, all we can do at this point is stay as cheerful and calm as possible so that he doesn’t get more agitated and hurt himself again.

“OK,” I say to Coco. “But still that’s your mother you’re talk–…”

The cell phone begins to slip away from my ear, and I press my shoulder and head together harder to keep it from falling as I head to the kitchen with the dirty dishes. For some reason this causes my lower back, which I strained this afternoon pulling weeds in my parents’ yard, to spasm.

“Dad?” Coco asks. “Are you OK?”

“I’m fine, honey,” I tell her.

“For God’s sake!” my father yells. “Stop all this, right now!” He tries to lurch up from the dining room table but he’s stuck halfway, one hand on the table and the other on his wheeled walker.

“Darling, sit back down,” my mother says from the kitchen, where she’s getting ice cream. “Just for a second, OK?”

“No, damn it, it’s not OK at all! why won’t you listen?” my father yells, his voice straining. And ignoring her and me, as he ignores everyone these days, he continues struggling to stand, bending over, teetering dangerously on unsteady legs. 

I know none of this is my father’s fault. He’s suffered a traumatic brain injury, and as a result, he has recurring headaches and back pain, has bouts of dementia and depression, and copes by drinking. but a rush of irrational anger surges through me. I know I’m in an ADD/ADHD overload. I can feel my heart racing and my breath quickening, but I don’t care. I should take a minute, do my deep-breathing exercises, and let the storm settle in my brain. but I don’t want it to settle. though part of me fights to stay calm, the truth is, I want to explode. My cell phone squeezed between my ear and my shoulder, the dirty plates and silver rattling in my hands, I snap. “Stop acting up,” I yell at my father. "And sit back down!”

My mother looks over at me, startled. The only bright spot in all of this is that my 89-year-old mother, who continues to be strong and lucid, seems determined to plow on with good cheer through her 90s. but doing what? being a permanent caretaker for this irritable, demanding man who, lost in his own pain and confusion, lashes out at those, especially my mother, who just want to try to help? why does she let herself be used like this? It’s a terrible, dark, heartbreaking trap that I suddenly have no patience for, and here I am taking it out on my defenseless father.

Over the phone, real concern in her voice, Coco asks, “What’s going on, Dad?” And I realize, as I told Coco a minute ago, that I had better watch my tone. I tell Coco everything’s fine and that I’ll call her right back. I let the phone fall to the carpet, place the plates back on the table, and help my dad get up. but my mother is quickly by me. “It’s all right,” she says with a pat on my shoulder. “Talk to Coco. I’ve got him.” as she holds out a steadying hand for Dad, she tells him, “You should listen to your son, you know. He’s trying to help you.” “Nonsense,” my father says.

I pick up the phone and take the dishes into the kitchen. After the kitchen’s clean, dishwasher cycling, and Mom’s got Dad in his chair peacefully eating mocha java ice cream with a martini on the side, I go to the guest bedroom and call Coco back. I assure her that everybody’s fine in Delaware and that I’ll be getting on the plane home tomorrow.

“I can’t wait for you to come home,” Coco says. “There’s a centipede in the garage you’ve got to get rid of and a huge dead cockroach in the living room behind the couch. And oh yeah, my new bed was delivered. You’re going to put it together as soon as you’re back, right?”

I tell Coco I’ll take care of all that. I tell her I love her, that I’ll see her tomorrow, and to put her mother on. I lie down on the bed. as Margaret and I talk, my breathing and heart rate slow, my back spasm eases, and I feel calmer and a little more human. Margaret says she knows how much my mother and father have needed me. They’re OK now, I tell her; things have settled down. She says she’s sorry to put more pressure on me, I tell her she isn’t.  She’s sorry that they need me so much at home too. “Thank God you do,” I tell her.  as Margaret and I talk, joking and comforting each other, I realize how much I treasure the sound of her voice. And suddenly I understand that my mother isn’t being used. She knows she’s needed by her husband, a man she loves and vowed to have and hold in sickness and in health over 60 years ago, and that means the world to her. Then my anger at my father and the pain his injury and disease have brought us begins to ebb under the influence of my mother, my daughter, and my wife’s gentle voice. 

As I fly home to Georgia the next day, I begin to see that family is a messy proposition, full of conflicting needs, and maybe an ADD/ADHD family is a little messier and more conflicted than most, I don’t know. but I do know that the world can be a dangerous and uncaring place. And I know that to need those you love, and to be needed by them in return, is a profound gift. when you have that, you have proof that no matter how tough the times, every little thing will be all right.

When I walk into the house from the airport, Coco runs down the stairs and jumps into my arms nearly knocking me over and wraps me in a hug. Then she steps back and says, “What do you think?”

Her hair is a little shorter. And deep black. And in the middle front, a purple stripe down each side. It’s not what I would have picked out as a look for her. It’s not anything really that I could imagine. I miss her blond hair. but as she stands there smiling expectantly at me, I can see that she loves it and that when you give it a chance, the black frames her face dramatically and the purple brings out the sparkling blue in her eyes.

“It’s gorgeous,” I say.

By Dr YLM

MY mother-in-law was diagnosed with lung cancer. She was devastated, but the doctor persuaded her to go for radiotherapy. what is radiotherapy?

Radiotherapy has nothing to do with radio waves. the “radio” here means “radiation”. It’s actually short for radiation therapy, which uses high-energy radiation targeted at the area where the cancer is. These waves will then shrink or kill the tumour cells.

Radiotherapy may be used alone or in combination with surgery, chemotherapy, or both. These days, the thinking is to attack the cancer as aggressively as possible so that you can kill the tumour cells with one mighty blow as fast as possible. this is to prevent recurrence.

Very likely, even when the cancer is at an early stage, radiotherapy is likely to be used in combination with surgery and a dose of chemotherapy and targeted therapies.

Radiotherapy is also given even when the cancer is incurable. Here, it is to relieve the symptoms and suffering at the final stages, as in allowing the patient to breathe properly, eat and drink, or to relieve pain.

What type of radiation waves are used? is it something like a microwave?

The waves used are x-rays, gamma rays, and charged particles. These are delivered by a machine which can be placed outside your body, or through radioactive material placed inside your body near the cancer cells.

The type of radiotherapy placed outside the body is called external-beam radiation therapy.

The one involving the radioactive material placed inside your body is called internal radiation therapy or brachytherapy. the radioactive isotope material is planted as a “seed” through a needle or catheter in a surgically created hole near the tumour. the isotope decays naturally, no longer giving radiation when it is spent, and will cause no harm if left in the body.

There is also systemic radiation therapy where radioactive substances such as radioactive iodine is injected in your blood or given orally, where they travel to the organ where the cancer is to kill the cancer cells.

An example of this treatment involves thyroid cancer. the radioactive iodine will go directly to the thyroid cells, and be naturally taken up.

I don’t understand how radiation can kill cancer cells.

Radiation can kill a whole lot more living cells other than cancer cells! Radiation damages the DNA of the cancer cells, or creates charged particles called free radicals within them, which in turn damages the DNA of the cancer cells.

The cancer cells with the damaged DNA then cannot divide properly, and they stop reproducing themselves, so to speak. the cancer shrinks and the dead cells are broken down and eliminated by our own body’s metabolism, just like it is done for our normal dead cells.

How does radiotherapy kill only the cancer cells and avoid our normal cells?

Most radiotherapy don’t. There are sophisticated machines such as the Cyberknife, which attempts to deliver the radiation waves as close to the cancer margins as possible without destroying normal tissue around it. but by and large, the normal tissue areas around the area of cancer treatment may be affected.

The normal cells that may be affected during the course of treatment is taken into account while planning for the radiotherapy. Normal cells can receive a certain amount of radiation safely. There is also such a thing as a safe lifetime dose, which means a certain part of your body can only receive a certain amount of radiation safely for your entire life!

Radiation doses are in units called Gray (Gy), which is a measure of the amount of radiation absorbed by 1kg of human tissue. different doses of radiation are needed to kill different types of cancer.

Of our normal tissues that are most easily damaged by radiation, our reproductive organs (ovaries, testicles) are the foremost.

My mother-in-law was told by her oncologist that she will get radiation therapy and chemotherapy before surgery. is this normal?

This is called neo-adjuvant therapy. it is given to shrink the tumour so it can be removed easier by surgery and be less likely to return after surgery.

Sometimes, radiation therapy is given during the surgery.

Okay, let’s talk about the thing most people are afraid of when they hear about radiotherapy: side effects. what sort of side effects can my mother-in-law expect?

There are early and late side effects. During radiotherapy, the rapidly dividing normal cells around the area being treated are affected.

These include your skin, hair, salivary glands, and bladder. So you may experience skin irritation or damage to your salivary glands, hair loss, or even urinary problems, depending on the area being irradiated, of course.

These side effects disappear when the treatment ends. There are drugs, however, that protect the normal tissues from being harmed, called radioprotectors.

You may also experience nausea and vomiting if your gut is being irradiated, and fatigue.

Later side effects include scarring, damage to your bowels, infertility, memory loss, but very rarely, a second cancer caused by exposure to radiation.

The oncologist will tell you the benefits and the risks, and you can decide for yourself.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health advice, computers and entertainment. the information contained in this column is for general educational purposes only. Neither the Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. the Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.