Bioethics Links Volume 8 Issue 1 June 2012 Centre of Biomedical Ethics and Culture What can I say about visiting CBEC every other year to teach research ethics? Each time a constant has been the challenge of overcoming tedious bureaucratic requirements for visas, travelling all the way from Trivandrum to Dubai and back-tracking to Karachi and so on, all this to experience the exhilaration of a truly rewarding teaching experience. When Indians write about their experiences in Pakistan the tone is either political or rooted in shared socio-cultural ethos, one not possible for me to do. Having strived for precision in expression all my life, I cannot label my experiences as being that of Pakistan; mine are unique - to Karachi in general and to CBEC's environs specifically. When I first came to CBEC in 2008 as a team with colleagues Dr. Amar Jesani and Dr. Richard Cash to teach in the Public Health and Research Ethics module, little did I know what I was getting myself into. I knew Dr. Aamir Jafarey for years, a fellow like me from the Harvard School of Public Health, a friend with whom a shared camaraderie has transcended to a familial relationship. I met Dr. Moazam, revered and respected in the subcontinent, and had the opportunity to watch her and learn that greatness is a product of continuous engagement with all matters, great and small, not overlooking any detail however trivial it may seem. Her guidance for CBEC training programs, the planning, selection of readings, sequencing of sessions is reminiscent of how she must be in the surgical theater. The ease with which past students engage with the faculty on an ongoing basis is a hallmark of CBEC. CBEC takes into its fold trainees and alumni, welcomes other disciplinary orientations into bioethics discussions, and this helps to build a strong team of foot soldiers for the discipline. The confidence with which Dr. Bushra Shirazi and Ms. Anika Khan, MBE alumni, assume academic responsibilities in CBEC is both a mark of the quality of their Continued on page 7 Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 1 Engaging days and nights: Ethics education in CBEC-SIUT ghazal Mala Ramanathan* Dr. Mala Ramanathan with PGD (2012) and MBE (2013) students in a session during the April 2012 Research Ethics Module Pakistan cbec SIUT *Additional Professor, Achutha Menon Centre for Health Science Studies, SCTIMST, Thiruvanthapuram, India F r. The Editor or this issue of we invited our international teaching faculty (Dr. Ramanathan, India) and students (Dr. Bukusi, Kenya; Dr. Kolambage, Sri Lanka) to write about their impressions of CBEC programs and being in Karachi. Also included are commentaries by Dr. Khan (AKU, Karachi) and Dr. Ismatullah (International Islamic University, Islamabad) who audited our Research Ethics module, an essay by PGD student Dr. Faheem, and reports about bioethics activities in Peshawa Bioethics Links
Transcript
Bioethics Links
Volume 8 Issue 1 June 2012
Centre of Biomedical Ethics and Culture
What can I say about visiting CBEC everyother year to teach research ethics? Each timea constant has been the challenge ofo v e r c o m i n g t e d i o u s b u r e a u c r a t i crequirements for visas, travelling all the wayfrom Trivandrum to Dubai and back-trackingto Karachi and so on, all this to experience theexhilaration of a truly rewarding teachingexperience. When Indians write about theirexperiences in Pakistan the tone is eitherpolitical or rooted in shared socio-culturalethos, one not possible for me to do. Havingstrived for precision in expression all my life, Icannot label my experiences as being that ofPakistan; mine are unique - to Karachi ingeneral and to CBEC's environs specifically.
When I first came to CBEC in 2008 as ateam with colleagues Dr. Amar Jesani and Dr.Richard Cash to teach in the Public Health andResearch Ethics module, little did I know whatI was getting myself into. I knew Dr. AamirJafarey for years, a fellow like me from theHarvard School of Public Health, a friend withwhom a shared camaraderie has transcendedto a familial relationship. I met Dr. Moazam,revered and respected in the subcontinent,and had the opportunity to watch her and learnthat greatness is a product of continuousengagement with all matters, great and small,
not overlooking any detail however trivial itmay seem. Her guidance for CBEC trainingprograms, the planning, selection of readings,sequencing of sessions is reminiscent of howshe must be in the surgical theater.
The ease with which past students engagewith the faculty on an ongoing basis is ahallmark of CBEC. CBEC takes into its foldtrainees and alumni, welcomes otherdisciplinary orientations into bioethicsdiscussions, and this helps to build a strongteam of foot soldiers for the discipline. Theconfidence with which Dr. Bushra Shirazi andMs. Anika Khan, MBE alumni, assumeacademic responsibilities in CBEC is both amark of the quality of their Continued on page 7
Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 1
Engaging days and nights: Ethics education in CBEC-SIUTghazalMala Ramanathan*
Dr. Mala Ramanathan with PGD (2012) and MBE (2013)
students in a session during the April 2012
Research Ethics Module
Pakistan
cbecSIUT
*Additional Professor, Achutha Menon Centre for Health Science Studies,
SCTIMST, Thiruvanthapuram, India
F
r. The Editor
or this issue of we invited our international teaching faculty (Dr. Ramanathan, India) and students
(Dr. Bukusi, Kenya; Dr. Kolambage, Sri Lanka) to write about their impressions of CBEC programs and being in
Karachi. Also included are commentaries by Dr. Khan (AKU, Karachi) and Dr. Ismatullah (International Islamic
University, Islamabad) who audited our Research Ethics module, an essay by PGD student Dr. Faheem, and reports
about bioethics activities in Peshawa
Bioethics Links
Memoirs of the first international MBE student at CBECElizabeth A. Bukusi*
I have the privilege of being the firstforeign student to be accepted in theMaster in Bioethics (MBE) program inCBEC. My welcome to Karachi for the firstmodule in January was a bit of a shocker intwo ways. One, I was the only African onthe flight. Two, on arrival, the man at thehealth desk took one look at me (I assumewhat he saw was a relatively rare “visitor”)and decided I was his dinner ticket. He firstsaid that my yellow fever vaccination wasout of date, and when I pointed out thevaccination entry which was valid, hegrimaced and promptly pointed out that mycholera and typhoid pages were blank. Ismiled and informed him politely that thePakistan High Commission in Nairobi hadnot advised me to get these when applyingfor the visa. He then said that he would helpme if I would help him, or I could spend thenext six days in quarantine. It was clear tome that the “help” he was referring to wasmoney. I responded that I did not have anyPakistani money, to which he promptlyreplied that I could give him any money. Itold him I had a card but did not admit tohaving American dollars and Swiss francs(talk about starting an ethics course withethical questions - should I have told thetruth? Should I have simply said I would notgive him money and that I knew very wellthat what he was asking for was not arequirement?).
He asked me to stand aside and Iwatched as the queues for immigrationgrew longer and longer. Eventually, wheneveryone else had passed through I saidthat I was being met by someone from SIUTand perhaps he should speak to them andexplain the problem. Finally, seeing hopesfor his dinner dwindling by the moment, hegot tired and let me go. The rest went
smoothly. My luggage was waiting for me,as was the doctor sent to “meet and greet”me who took me to the set of flats forstudents from out of Karachi.
My room was self-contained, and Ishared a kitchen and a sitting roomequipped with a TV (loads of Bollywoodmovies, news in Urdu, and of course CNN)with three other ladies. Three male studentswere housed in another flat. A van with achaperon came to pick us up in the morningfor CBEC and dropped us back in theevening. (I have not yet figured out the needfor a chaperon.) I noted that women andmen do not sit together in public transport,and we too adopted a similar code with thewomen sitting in front of the van and themen in the back.
The classes are interactive and verybusy. Students are evaluated onparticipation in addition to writtenassignments. I have struggled to keep upwith the reading and keeping the subjectsfrom getting jumbled up, while myclassmates seem to easily quote sentencesfrom the readings and authors. That part ofmy brain seems to have fossilized; I havebeen living on deduction Continued on page 6
MBE Class of 2013 and faculty engrossed in a
seminar on public health ethics
*Researcher / Deputy Director, KEMRI, Nairobi, MBE student Class of 2013
Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 2
Different ways of thinkingS. H. Kolambage*
When I thought of doing a study onethical issues in relation to organtransplantation in Sri Lanka, my professorDr. Chula Goonasekera told me about theCenter of Biomedical Ethics and Culture,SIUT and handed me a copy of theirnewsletter. I never thought that I would bewriting for this newsletter a few monthslater.
Just three months later, I could notbelieve my eyes when I received aninvitation to participate in a CBEC moduleon research ethics in April. When I landed atthe M. A. Jinnah International Airport inKarachi it was the first time that I hadstepped on foreign soil, but CBEC had madearrangements for me to be picked up andtaken to my accommodation. What a relieffor an anxious first-time traveller!
The module began with a meeting of theKarachi Bioethics Group. It was aninteresting occasion in which healthcareprofessional colleagues critically analysedethical issues they had come across in themedia or their places of work, and took bolddecisions independently to act on them. Iwas so glad I was amongst a like-mindedgroup of people thinking parallel to me.
The module itself was a novelexperience for me due to the different way ofteaching. Each day classes began with adiscussion on a newspaper article oradvertisement violating the limits of ethics.The group was presented with differentways of analysing ethical dilemmas. Duringteaching sessions, lectures became moreand more interactive, and questions weredealt with on the spot. Besides CBEC staff,lecturers from different institutions ofPakistan, India, and USA were there toshare their experiences with us. A variety of
people including MBE and PGD students,invited auditors, and the faculty participatedin round table discussions. This was adifferent approach which actively helpedstudents understand the concerns that mayarise during the ethical review of a researchproject. Cases were used to understand howvulnerable groups of people around the worldmay be affected by research. For some whowere members of ethical review committees,these sessions were an eye opener.
During this period of continuous (butinteresting) hard work we were lucky enoughto also enjoy a lovely, traditional Pakistanimusical show in the SIUT auditoriumorganised for workshop participants andothers. I was also able to participate in the“Organ Donation Day” organized by SIUT toeducate the public on brain death anddeceased organ donation. My time in CBECmade me realise that there are many peoplearound the world, many more than Iexpected, geared to serve humanity andsafeguard moral values irrespective of theircolour, cast or creed.
*Physician, Intensive Care Unit, General Hospital, Kaluthara, Sri Lanka
The “CBEC-SIUT bridge:” National and international faculty
Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 4
The advancement of medical scienceshas produced new challenges to the thinking,training and actions of those involved inhealthcare delivery. In this background, I findthose involved in the training of medicalprofessionals facing these challenges andplaying key roles. At CBEC-SIUT, Dr. FarhatMoazam and her team are involved inimparting medical ethics education in theoverall training of health professionals. Thisarea has, by and large, been neglected bymedical institutions in Pakistan.
While auditing the April module I realizedthat, in addition to including medicalprofessionals in this educational venture,CBEC also opens the doors of its programs tonon-medical people, including students ofShari'a like myself. In reality, workshopssuch as these in which Shari'a experts caninteract with medical experts in deliberationsabout emerging ethical challenges can helpprovide direction to the thinking of Muslimcommunities.
Connecting Shari'a with emergingethical issues
Ismatullah*
*Head, Fiqh and Law Unit, International Islamic University, Islamabad
Some life experiences prove to beunique and have an unexpected impact onour inner selves. As a busy surgeon withthree decades of patient care, I believed Ihad lived up to the Hippocratic Oath torelieve living beings of suffering and pain.However, I had not considered that well-intended exercises to reduce humansuffering may have unseen elements ofharm.
As chair of the Ethics ReviewCommittee of my institution, I wasprivileged to audit CBEC's Public Healthand Research Ethics Module in April. As Iglanced through the program, I preparedmyself for daylong sessions of talks,didactic lectures, and discussions. Thereality was quite the contrary! Almost allthe sessions involved active learning bymodule participants themselves. Mostimportantly, the medium was notexclusively text, but visual too. Theenvironment was unique with openness ofdiscussions facilitating the process of self-discovery. It led to recognition ofknowledge that had always been therewithin oneself but never verbalized, and anunderstanding that many actions we mayhave considered to be altruistic wereactually more self-directed.
I figure that there is a need for all of us -not just those in the medical profession - torediscover our inner selves, and learn howto fulfil our responsibilities to the rest ofsociety. Perhaps we can make a beginningby being empathetic and learning to look atissues from different perspectives, not justour own.
Unique learning environment in
CBEC's teaching moduleShaista Khan*
*Professor of Surgery, Aga Khan University Hospital, KarachiWindow-cleaning Pakistani style: Raju, CBEC
cleaner and all purpose man, in action
Makkah Clock Tower: “ ”Meray liye mitti ka haram aur bana doFaheem Khan*
The Makkah Clock Tower, the world'stallest hotel with a clock face bigger than thatof Big Ben in London is in the immediatevicinity of the Kaaba in . Thisskyscraper is built in the city of Makkah, oncethe gracious but humble abode of ProphetIbrahim (AS) and Prophet Muhammad(SAW). The simplicity and humility thatcharacterize the ritual of Hajj were part of thecity's character. Now this city will be knownfor exactly the opposite.
Some will see this construction as asymbol of Muslim progress, an alternative tothe Greenwich Mean Time (GMT), or anotherbuilding adding to the beauty of this holy city.My feelings are opposite to this: On seeing thisphotograph I see hard concrete walls, marbleand glass, an ostentatious display of wealthfinding flamboyant expression in architecture.I see this as human striving to elevate oneselffrom the ground but in a mechanical ratherthan a spiritual way, a shift from sanctity tomere sanctimony.
The construction of this building raises aquestion. Who is more eligible to live in suchclose proximity to - the personwho is rich and a believer, or the one who is abeliever but not rich? Prohibitive expenses willmake the hotel inaccessible to poor Muslimswho will only be able to yearn and say
(praise to God). Furthermore, uniqueand historical buildings are being demolishedto make space for these skyscrapers. In myopinion, spending money on sky-reachinghotels which benefit rich entrepreneurs is nota fulfilment of religious duties of Muslimstates in current times. These billions wouldbe better spent to alleviate the sorry state ofpoverty in Muslim countries.
Making an alternative to GMT is not theMuslim most urgent need in today'sworld. What we require instead is just oneuniversity that rivals Harvard, Yale, or Oxford.Providing basic human rights to citizens on theground is more important than raising oneself601 meters above it. I believe that imprintingthe name of Allah in the sky has no spiritualbenefits; rather it is imprinting this in the innercore of a believer's heart which is needed.
I end with sadness, wondering whetherthese thoughts will ever strike Muslim royalsand policy makers. My own feelings relate toAllama Iqbal's poetic yearning:
Haram Shareef
Haram Shareef
Subhan-Allah
umma's
“Main nakhush-o-bezar hun marmar ke silon se,
Mere liye mitti ka haram aur bana do”
(Weary of columned marbles, sickened is my sight
Raise for me another temple, build it with mud,)
*Psychiatrist, AKU, PGD Student Class of 2012
The Clock Tower looms over the Kaaba in
seen in the foreground
Haram Shareef
Student and Alumni Voices: This new section will periodically feature brief writings by CBEC students and alumni
for . The inaugural essay is written by Faheem Khan, from the Department of Psychiatry in AKUH
Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 5
for the last fifteen odd years. In class we areprovided with food throughout the day -breakfast, teas, lunch - and there are lots ofspicy Pakistani snacks during the day.Given that we get to class at 8.00 am and onmany days leave at 6.30 pm, it is no wonderwe can pack so much into a day.
The streets in Karachi look like anydeveloping country - a picture of the modernand the old, dusty and clean. The onlydifference is people, both men and women,in traditional “ ” suits. Mostwomen are veiled or cover part of theirheads when they go out in public; it makeslife easier and they are unnoticed. The veils Iam told represent modesty. Surprisinglyfor me, wearing of the full is notcommon in the streets I pass on my way toCBEC.
I was nostalgic as I left following the
second module in April. Pakistan is growingto be a home away from home. I will miss theinteraction with classmates, the rich learningenvironment, the history, examples of ethicaldilemmas, and learning how to take areasoned position. The best thing about thisprogram is not that it gives you knowledge,but that it changes you from the inside. Youstart to question your knowledge, yourreasoning and your opinions about variousissues which are largely a construct of yourupbringing. I feel so privileged to have hadthis opportunity to be part of this learningcommunity. I am sure that it will continue tochange me in more ways than I can imagine.I hope that the change in me will also result inchange in others. Each drop of water adds toa mighty ocean. I hope I will add to the dropsthat will change the face of bioethics in thedeveloping world.
shalwar kameez
burka
“Memoirs of the first international MBE student” from page 2
The Peshawar Bioethics Group (PBG)
was inaugurated in December 2011 with
guidance from CBEC-SIUT and Aga Khan
University. Its purpose is to provide a
platform for discussion of bioethical issues
relevant to Pakistan and to create general
awareness of bioethical issues among
healthcare professionals. PBG has held three
meetings so far to formulate its terms of
reference, aims and objectives, and to
discuss scientific and Islamic perspectives in
the teaching of medical ethics.*Research Registrar / Secretary IRB, Postgraduate Medical Institute, Peshawar
On 28 April, 2012, in an elegantceremony, the University of Zurich,Switzerland, recognised eight individuals indifferent fields by awarding them HonoraryDoctorates. Dr. Moazam, Chairperson,Centre of Biomedical Ethics and Culture,SIUT, Karachi, the only woman among theeight, was awarded the Honorary Doctoratein Medicine in recognition of her contributionsto ethics and organ transplantation inPakistan. She is seen here with the UniversityRector and other awardees.
Peshawar Bioethics Group (PBG)Dr. Mumtaz Muhammad*
Centre of Biomedical Ethics and Culture, SIUT, Pakistan Page 6
learning experience, and remarkable withinhierarchied societies that characterize thesub-continent.
Meanwhile, Mr. Aamir Shehzad and Ms.Michelle Fernandes ensure that bowls ofcrunchy snacks are kept filled and hot waterfor tea/coffee is always available toguarantee that hunger pangs do not interruptteaching sessions. It may seem banal tomention food and beverages when writingabout bioethics, but believe me there is arationale for this. While discussingcontentious issues deeply troubling to theconscience it is essential that issues ofphysical discomfort do not troubleparticipants!
Long and tiring sessions sometimesextend into evenings, and discussions cancontinue over dinner in restaurants, andduring shopping trips for things I amexpected to fetch for family and friends backhome. Evening social events - arecital, an Urdu play, or an amazing musicsession with a doyen of Sufi music - involveparticipants who express enthusiasm andunrestraint, a characteristic among manyothers shared by Indians and Pakistanis.
There are many “political” reasons forcitizens of India and Pakistan to exchangevisits, participate in activities, and buildcamaraderie. I am not much of a politicalcreature in this sense, and do not claim noblereasons for coming to Karachi when invitedto teach in CBEC, although my time inKarachi with friends and colleagues may helpto reduce hostilities within a very small circleof people in India. My reasons are largelypersonal. Every teacher needs renewal ofskills and spirits; CBEC offers me such anopportunity and I leave a better teacher than Iwas before. Teaching in CBEC is a form ofcleansing for me. Often when I run bioethicstraining modules a few participants are eithernot there voluntarily or if they are, are unsurewhat they are doing in a workshop on
bioethics. In contrast, almost all CBECstudents are there because they have chosento be there, and a careful selection processensures that they are aware of programrequirements. This results in a uniform senseof purpose amongst participants who areprimed to challenge, debate, and discussissues in a spirit of learning through a processof active engagement. Teaching in this settinghelps hone a trainer's skills and improvesthem phenomenally as compared to programsin which participants are not primed to engagein this way.
My experience in CBEC is challenging andenriching. In teaching sessions you cannotexpect the polite silence and vagueness thatoften greets pronouncements by a facilitatorin other settings. You have to make sure thatyour thoughts are coherent, sentences youuse to convey these are lucid, and that yourargument is consistent. This is because mostparticipants have thought about the issue,grappled with the dilemmas on a personalbasis, and are trying to seek answers.Therefore discussions are not clichéd andrepresent a broad spectrum of possiblearguments based on varying experiences.Dealing with different voices in these debatesleaves you a better teacher than you werebefore.
One can also not discount the comfortingexperience of ' ' (hospitality)that is uniquely Pakistani! Starting fromyoung residents who come to the airport toshepherd us through customs andimmigration to waiters at our hotel, the senseis one of warmth and caring. It is somethingthat I can never match or reciprocate equallywhen my Karachi friends visit me in India butone that I deeply appreciate every time I visit. Iwish these visits could happen morefrequently from both sides and without themulti-pronged efforts required for visas tomake these possible.
