Mind where you eat

As one drives through the trimmed roads of Rawalpindi; the capital’s twin city, the gleaming lights, aroma of the frizzling chapli and seekh kebabs, and the buzzing crowd magnetize the senses. The city roads are trimmed by dhabas or khokas (makeshift shops), rehris (pushcarts) and small hotels. For a common Pakistani theyare a source of wide-ranging scrumptious desi food. Ranging from qulfi, paratha roll, dahi baray and jalebi to mouth-watering full meals like nehari and paaye; it is hard to classify what street food really is.

Despite Pakistan’s unstable economic and security conditions, the trend of eating out does not seem to lessen. The culture of eating out is not only a major source of delectable food but also facilitates people to sit together and talk their hearts out. Regardless of the unappealing ambiance, people from all walks of life are enthralled by the unique flavor of street vended food because it is affordable and convenient. Nevertheless, road side eating is not just a trend but an important part of our popular culture.

But with the growing number of diverse street side food sellers, their lack of understanding of critical food safety issues, people’s unawareness about health risks and negligence on part of the concerned local authorities have made street side food eating a public health concern.

According to Dr Farzana Shafqat, a gastroenterologist at Shifa International Hospital Islamabad, contaminated food causes diseases like typhoid, hepatitis, diarrhea and various infections including food poisoning. “Up to 20 percent patients visiting the hospital come with complaints because of eating out”.

Unhygienic conditions and food handling coupled with cheap low quality ingredients cause these health problems. According to Moti Khan, a nutritionist at Aga Khan Hospital Karachi, most of the food sellers at such places keep their food uncovered, reuse water to wash utensils, and have inappropriate storage and cooking method. “They use substandard oil and impure color, herbs and spices that have sand and chemicals added to them which increase health risks”.

The Shifa News International (SNI) team visited Murree Road, one of the busiest roads in Rawalpindi, to observe the condition of street side food sellers. It was noticed that majority food sellers prepare and sell food in inappropriate conditions. Some cook food at their open stalls that are exposed to dust, smoke, flies and other insects. Those who sell home-cooked food prepare it overnight, which is then kept at ambient temperature and reheated till sold. Prepared foods are likely to putrefy if not kept in appropriate temperature especially during summers. “Storing food for long periods and reheating it over and again causes bacteria to develop”, explains Moti.

Some food stalls were even located near open gutters and others next to puddles filled with rain water and mud. Due to lack of facilities for waste disposal many food vendors dump the waste in nearby gutters and streets which become breeding places for flies and rats. A cook of a restaurant (name kept confidential) when inquired about the uncovered bowl of chutney remained mum and busy with his work. He was least bothered about the flies bustling over it. Also, a nearby vendor was seen cutting vegetables that were uncovered and exposed to flies. A number of food vendors when asked where they buy the meat from gave vague answers.

Another frying parathas on a full-sized pan was asked about the oil he used. “I have no idea which oil it is. It is just oil”, said the middle aged man. He confessed reusing the same oil but could not remember how many times it was reused. The kitchen of the same restaurant, whose name is also kept confidential, was not properly lit and the cleanliness of the cooking utensils was not satisfactory. The purity of water used for drinking, washing utensils and cooking was also doubtful. Due to scarcity of water at several places, some food vendors were seen re-using the water for washing utensils. “Contaminated water is the most common cause of diarrhea”, says Dr Farzana.

There is a legal framework that expresses certain provisions for those involved in food production, storage, distribution, and consumption etc. All provinces have adopted The Pure Food Ordinance, 1960, with certain amendments, to ensure public health and safety. The law regulates production and sale of food and ensures purity of food being supplied. But who is following the law and where are the law enforcers?

Town Municipal Administration is the authority responsible for such issues. According to Dr Ansar Ishaq, District Health Officer (DHO) of Rawal Town Rawalpindi food stalls and restaurant’s are regularly visited to ensure food safety.  “Food inspectors collect food samples, issue and cancel licenses and charge fine. All those involved in food handling and selling are medically checked and it is ensured that they do not have any communicable disease. The premises are also visited before issuing the license”.

Well, the reality is a bit different. Anwar, a food vendor on Murree Road working for the past 16 years told SNI he has “never gone through any medical checkup”. According to him the inspection team visits twice or thrice in a year. “I once forgot to renew my license and they charged me fine worth Rs30, 000. I did not pay it. If you have a reference you can be exempted that is not a problem”.

Another food seller, Aziz, on the other hand said the inspection team visits every week. The condition of the hotel however negated his claim. The washing area was filthy and the oil was being re-used for frying. The food vendors said they had heard inspectors charging fine but not cancelling licenses.

The local authorities responsible for ensuring food and health safety of the public perhaps need to revisit the food safety legislation. Monitoring of the food inspectors’ is not satisfactory.

Apart from the carelessness of the food vendors and the local authority a major dilemma is the careless attitude of people towards the cleanliness of the food they eat. Many people are aware about things going around yet seem to ignore and neglect the fact that contaminated food is a serious threat to their health and wellbeing.

Sajjad, a frequent visitor of a specific restaurant in Rawal Town is aware that “unhygienic food can lead to food poisoning”. He was not even sure whether he is satisfied with the quality of food. Yet he often stops over at the restaurant. Unlike Sajjad, many other visitors had no clue how it can affect their health.

It is not possible to completely stop eating out. But Dr Farzana suggests becoming choosy when doing so. “Avoid eating things like salad and chutney. The least you can do is prefer well-cooked foods”.

Informed people can help effective enforcement of laws especially in the matters directly affecting their health. The food safety legislation clearly states that the public has all the rights to monitor the implementation of food safety laws, register complaints regarding “false warranty, misbranded foods, and incomplete labeling”. Moreover, public can request information concerning consumer safety from the concerned government department. It is just that people need to be made aware of their rights. Media can indeed play a vital role in educating people.

The point to think over is what is it that makes us take such hasty decisions about the food we eat. Why are we ready to put the most precious thing we have, our health, at stake? Is it carelessness or unawareness? The answer is both!

Kill drugs before they kill you

While talking to a 23 year old drug addict, being treated at a well known addiction and attitudinal healing facility in Islamabad, I was amazed at the spur in his eyes and the keenness in his words. Harris, resident of the capital city who belongs to a good reputed family started taking drugs a year ago. After getting his bachelor’s degree he applied for commission in the Pakistan Armed Forces and unfortunately was rejected. Hopeless and distressed about his shattered dreams, the young man started taking drugs with two other friends. Harris was lucky that his father, after coming to know about his son’s addiction, decided to send him to a rehab. Harris is now fully encouraged and wants to get back to life. After his treatment, he wishes to get a masters degree and become a pilot.

Most of us are ignorant of the dilemma of drug addiction whereas the World Health Organization has declared drug addiction as a chronic disease. The evil of drug abuse has not only become a health issue but is damaging the whole society. Pakistan, given illegal narcotic production is at the core of the problem. Afghanistan however is the world’s largest drug producing country. The border between Pakistan and Afghanistan is porous and thus Pakistan is highly vulnerable to drug trafficking and drug abuse. According to United Nations Office of Drug and Crime (UNODC), Pakistan is accountable for 84 % of the total drugs exported around the world.  Moreover, according to the Ministry of Narcotics Control (MONC), drug abuse has doubled in the past five years. “Every year 600,000 people get involved in drug addiction”, says Dr Tallat H. Abid, project director and founder of Nishan Foundation. With each passing day sale and use of chars, garda, heroin and hashish is increasing.

Disappointment, stressful life, easy availability of drugs or lawlessness; whatever the reason might be, truth is that the rapid increase in drug addiction is affecting everybody in urban and rural Pakistan. Currently, use of narcotics is spreading among all social classes including the so-called elite, middle and the lower class. Generally we believe it is the oppressed and needy that opt for drugs. However research shows that 60 per cent of drug addicts belong to the educated class, most of them being university students.

Although Pakistan is a Muslim country, use of drugs is still common. Islam prohibits the use of all kinds of non-medical drugs because of their intoxicative effects and harm to the human body. The Quran clearly forbids the use of substances that change the state of consciousness. Allah (SWT) states in the Holy Quran, “And make not your own hands contribute to your destruction.” Surah, Al-Baqara, 2: 195. Ibn-e-Umar reported that the Messenger of Allah (Peace Be Upon Him) said, “Every intoxicant is khamr (wine) and every intoxicant is haraam (unlawful). Whosoever drinks wine in this world and dies whilst consumed in it and does not repent will not drink it in the next world”. (Muslim)

Drug abuse among women has also increased alarmingly and exists in all sections of the society. However the major prevalence of female drug addicts is in higher socio-economic class and the lower economic class. According to the Ministry of Narcotics Control 47 per cent of women drug addicts have acquired university or college education and 21 per cent have either primary or matric education. 43 per cent of female drug addicts get drugs from friends and 15.6 per cent get them from neighbours. Some of the reasons for rise of drug abuse in women are: enjoyment and pleasure, stress related physical and emotional pain and domestic violence. Some are even forced by their husbands.

Some people start taking drugs because of the influence of peers, neighbours, friends, siblings or other family members’ use of drugs. Some get addicted to drugs to get rid of stressful family and social life and to overcome frustrations, depression and tragedies. A lot of people also start taking drugs as “pain medication” and gradually get addicted to them. Some may also take drugs simply for pleasure or out of curiosity.

Reasons for rise of drug abuse in Pakistan:

Availability of drugs at cheap prices

Rapidly changing social demands and norms

Unemployment and economic disappointment

Carelessness of parents

Lack of interest in education

Lack of awareness of drug abuse at home and in educational institutions

Lack of concern on part of the community leaders

Media also plays a role in the rise of drug abuse. Many times media represents drug addicts as heroes. “A lot of people are inspired by celebrities who take drugs in real life: fans try to imitate them in every way”, says Dr Tallat. He added that schools and colleges are breeding grounds of drug abuse. Almost half of the drugs smuggled through Pakistan are stopped in the country and therefore are consumed within Pakistan. Excessive prevalence of drugs needs to be tackled with on war footing.

According to the Anti-Narcotics Force (ANF) the average age of initiation of drug use is 18 years and chars (cannabis) is the most commonly used substance followed by heroine and other opiates. Ecstasy and cocaine are expensive and so are common among the higher socio-economic group. However inhalant abuse (inhalants are volatile substances that produce chemical vapours that can be inhaled to provoke a psychoactive, or mind-altering effect) is common among street children.

“Drug addiction is a disease not only for the patient, but the entire family”, states Dr Tallat. It destroys the health and happiness of the individual, the family and the society at large.

The individual becomes socially isolated due to poor health and loss of income. Drug addiction is seen as a stigma in our society and so the drug addict is looked down upon by the people around him.

A lot of drug addicts in Mohalla Raja Sultan, Rawalpindi, when interviewed were not able to answer questions regarding their source of income. A person who spends most of his day on the piles of junk and trash or on the brink of a nullah spends roughly around Rs500 on himself every day. He obviously does not earn and is likely to resort to petty crimes to support his addiction expenses. These addicts thus pose a serious threat to the society.

Drug abuse also puts people in danger of getting HIV/AIDS and other sexually transmitted diseases (STD’s). That is because when a person is high on drugs he cannot think clearly. He might have unprotected sex ultimately getting HIV/AIDS or other diseases. HIV/AIDS and other deadly diseases are also transferred by sharing a needle for injectable drugs with someone who is already infected.

Of all the people who come to Nishan Foundation, 80 per cent are treated the first time. 16 per cent relapse and come back to the rehab once or twice. However the remaining 4 per cent come back to rehab 3-4 times before they are successfully treated. “We cannot claim that drug addiction is 100 per cent curable but yes it is 100 per cent manageable”, says Dr Tallat.

Almost all the addicts at Mohalla Raja Sultan, Rawalpindi, told Shifa News that they want to get rid of the evil of drug addiction. They have the will to get rid of drugs but in most cases because of negative association and lack of financial support these people relapse back to drugs.

In the presence of Shifa News’ team, a representative of a local NGO, nai zindagi, came where the addicts were lying at the banks of a nullah. He collected the old injections and gave them new ones. Mr Ghazanfar Imam Rizvi, program director, nai zindagi, told Shifa News that the NGO is working for HIV prevention, harm reduction, care and support, detoxification and skills training for people affected by drug abuse.

Since we have limited rehab resources, we provide street based treatment to the addicts. The problem of drug addiction is on rise, whereas the donor support has considerably decreased over the past few years. It is government’s responsibility to take serious steps to curb down drug abuse, says Mr Ghazanfar.