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Outbreak of ‘Brain-eating Amoeba’ in Karachi – Information and Prevention FAQ

 

Health Alert!

Outbreak of ‘Brain-eating Amoeba’ in Karachi

 

This is in response to queries regarding the recent Out break of Neagleria fowleri also known as ‘Brain-eating amoeba‘ in Karachi. Following information is provided for your health and safety:

What is Naegleria?

Naegleria is an amoeba (single-celled living organism) commonly found in warm freshwater (for example, lakes, rivers, and hot springs) and soil. Only one species (type) of Naegleria infects people: Naegleria fowleri.

 

How does infection with Naegleria fowleri occur?

Naegleria fowleri infects people when water containing the amoeba enters the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. The Naegleria fowleri amoeba then travels up the nose to the brain where it destroys the brain tissue. You cannot be infected with Naegleria fowleri by drinking contaminated water.

Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water and contaminated tap water) enters the nose, for example when people submerge their heads or cleanse during religious practices (wuzu), and when people irrigate their sinuses (nose) using contaminated tap water.

 

In what water temperature does Naegleria fowleri cause infection?

Naegleria fowleri is a heat-loving (thermophilic) microbe. It grows best at higher temperatures up to 115°F (46°C) and can survive for short periods at higher temperatures.

 

Can I get a Naegleria fowleri infection from a disinfected swimming pool?

No. You cannot get a Naegleria fowleri infection from a properly cleaned, maintained, and disinfected swimming pool.

 

When do Naegleria fowleri infections most commonly occur?

While infections with Naegleria fowleri are very rare, they occur mainly during the summer months of July, August, and September.

 

Can infection be spread from one person to another?

No. Naegleria fowleri infection cannot be spread from one person to another.

What are the symptoms of Naegleria fowleri infection?

Naegleria fowleri causes the disease primary amebic meningoencephalitis (PAM), a brain infection that leads to the destruction of brain tissue. In its early stages, symptoms of PAM may be similar to symptoms of bacterial meningitis.

Initial symptoms of PAM start about 5 days (range 1 to 7 days) after infection. The initial symptoms may include headache, fever, nausea, or vomiting. Later symptoms can include stiff neck, confusion, lack of attention to people and surroundings, loss of balance, seizures, and hallucinations. After the start of symptoms, the disease progresses rapidly and usually causes death within about 5 days (range 1 to 12 days).

 

What is the actual mechanism of death from Naegleria fowleri infection?

The infection destroys brain tissue causing brain swelling and death.

 

What is the fatality rate for an infected person who begins to show signs and symptoms?

The fatality rate is over 99%.

Is there effective treatment for infection with Naegleria fowleri?

It is not clear. Several drugs are effective against Naegleria fowleri in the laboratory. However, their effectiveness is unclear since almost all infections have been fatal, even when people were treated with similar drug combinations.

What should I do if I have been swimming or playing in freshwater and now think I have symptoms associated with Naegleria fowleri?

People should seek medical care immediately whenever they develop a sudden onset of fever, headache, stiff neck, and vomiting, particularly if they have been in warm freshwater recently.

 

What swimming behaviors have been associated with Naegleria fowleri infection?

Behaviors associated with the infection include diving or jumping into the water, submerging the head under water or engaging in other water-related activities that cause water to go up the nose.

 

How can I reduce the risk of infection with Naegleria fowleri?

Swimming-related risk

  • Use chlorinated and boiled water.
  • Hold your nose shut, use nose clips, or keep your head above water when taking part in water-related activities in bodies of warm freshwater.
  • Avoid water-related activities in warm freshwater during periods of high water temperature and low water levels.
  • Avoid swimming in waters where you suspect poor hygiene and insufficient chlorination.

Non-swimming-related risk

If you are irrigating, flushing, or rinsing your sinuses (for example, Wuzu), use water that has been:

  • previously boiled for 1 minute and left to cool or
  • filtered, using a filter with an absolute pore size of 1 micron or smaller or
  • purchased with a label specifying that it contains distilled or sterile water.

 

Courtesy:
Dr. Kamran Dawood
Consultant Microbiologist and
Head of Microbiology and Infection Control Department
Patel Hospital

Further Reference: http://www.cdc.gov/parasites/naegleria/general.html

 

Medical Disclaimer: This is general information provided for educational and awareness purposes. This information is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

Cosa Nostra in Karachi

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A Cross Post by Majyd Aziz

“This is a moment of choice for everybody, for politicians, and for people right the way down through every part of the community.” Peter Hain (British MP from Wales)

Although Hain was talking about the situation in Ireland, the fact of the matter is that if Hain was a MNA from Karachi, he would be expressing the same sentiments about his metropolitan city. At this time, it is the month of Ramadan, whenMA-LAUGH-1 the faithful perform their ordained religious obligations of fasting, praying, and distributing charity and Zakat. This is the month when retailers and suppliers rake in most of their yearly profits and reduce their held up inventory. This is the month when social welfare organizations bombard citizens with pleas for donations and contributions. This is the month where children look forward to new clothes, new shoes, and new gifts on the occasion of Eid-ul-Fitr, the Muslim day of feast.

Come Ramadan 2011 and Karachi has been transformed into a city where streets have become rivers of blood, where the candles of happiness have been extinguished in hundreds of households, where the citizens, no matter how brave, walk or drive to their places of worship in fear and apprehension, and where there are no signs of security or sanity. This is the city where, instead of religious sermons and religious poetry heard from loudspeakers, one hears the rat-a-tat of gunfire by snipers and even desperadoes brazenly roaming around the city streets and lanes.

There is talk of thousands of policemen, Rangers, and other para-military forces devotedly performing their assigned tasks of maintaining peace and providing security to citizens. This claim is assiduously proclaimed by President Zardari’s Interior Minister Rehman “Baba” Malik as well as by newcomer Sindh Home Minister Manzoor Wassan. Unfortunately, one is a publicity-freak who ensures that he comes up with a new weekly theory, however preposterous, while the other professes to have “dreams” on every subject except how to usher in peace.

The main causes for this bloodshed, for this deteriorating law and order, for this breakdown in Karachi are not something that arose overnight. These are the outcome of the past decade of buildup of brutal power, manipulation, and control by new and old political and religious organizations. Bagh-e-Qassim at Sea View Clifton in Mid-Night...

In USA, especially in New York City, there was a time when five Families of Italian-American origin made life hell for the people and the government. In everyday terms they were known as The Mafia. Among themselves, their operations were known as Cosa Nostra, which meant “Our Thing”. They were also referred to as The National Crime Syndicate and today they have an informal set up known as The Commission. The five main Mafia Families are known as the Gambino, Lucchese, Genovese, Bonanno and Colombo Families. They are all independent but nationwide coordination is thru The Commission consisting of the heads of each Family.

These Families have branched out into various legal and illegal activities but one fact still remains. They are hoodlums and they have a penchant for muscle power. They are ethnic based, they deal in drugs, they deal in land grabbing, they deal in extortion, and they have learnt how to influence the political environment. As Mario Puzo’s Godfather Don Corleone would say, “Make an offer you can’t refuse”. The five Families have faced legal challenges and a lot of laws were used to break them but inspite of all social and governmental pressure, the Mafia is still strong, powerful, and can create havoc.

The Karachi of today is also under the control of five Families. They are also primarily ethnic-based, have well-trained militants, display and use arms openly, have been accused of extortion, murders, bombings, and political muscle. Some are major players in drugs supply, land grabbing and encroachments, extortion, and can even make or break the democratically elected government. These five Families are Pakistan People’s Party, Muttahida Quami Movement, Awami National Party, Sunni Tehrik, and Tehrik-e-Taliban Pakistan.

The sad fact is that gradually over the past many years all these Families have enhanced their influence over the city and have carved out their own turfs. Three of these Families are basically political parties while the last two are more oriented towards their religious manifestations. They masquerade as religious entities but in effect they too indulge in many illegal operations such as extortion, taking over of mosques, bank robberies, etc. The PPP uses the paraphernalia of a Lyari-based radical organization, euphemistically known as Amn Committee (Peace Committee). This organization has been propped up with official backing of PPP leadership to counter the influence of MQM. The Amn Committee indulges in blatant extortion, gang-wars, drugs, and protection rackets.

The business community is faced with constant threats and demands from all those forces that are on the warpath against one another. The leaders of various markets in Karachi have devised a system where they collect a fixed amount from every shop in a particular market and the money is divided between various extortionists. The government announced the disbandment of the Amn Committee but that was just for public consumption. The Amn Committee is very much active and the chits for extortion are routinely sent to businessmen. The market gossip is that an erstwhile Sindh Home Minister who has a penchant for verbal diarrhea wants to be the Don of Karachi thru this Amn Committee.

The business community has to become strong and fight back. Enough is enough. The task is difficult but when push comes to shove then drastic steps must be taken. The businessmen are tired of being coddled by Rehman Malik. He comes up with his reassuring statements and gets live coverage on the electronic media courtesy the Chamber or the Associations. As always, his bombastic proclamations turn out to be nothing but hot air. Even the police do not take him seriously. One micro example: Few days ago at SITE Association of Industry, the industrialists questioned the procedure of parading alleged criminals by making them wear a hood so that their faces are not seen. Malik assured the meeting that this would be ended immediately. As always, the police hierarchy is all deaf-ears and the old system continues. It is time the business leaders refrain from inviting him at business forums. Business organizations do not need this grotesque publicity.

Businessmen must now have their own armed militia a la the notorious Blackwater of Eric Prince. They should not demand guns for themselves because this is not a doable or advisable step as the soldiers of some of the Families have, according to Malik, latest Israeli guns. Instead, they should obtain the services of counter-terrorism experts who have retired from Pakistan Army to train an elite force. In the short term, retired Army personnel should be hired as mercenaries. Karachi businesses need atleast 300 such commandos. The modus operandi would be that whenever a market or a company receives the demand for extortion, the militia hotline would be informed. The collector would be asked to come and receive the money at a mutually agreed time, and on his arrival he would be caught, hanged upside down, and submitted to third degree torture to extract information from him. Then, gasoline would be poured over him and he should be burned to death. The CD of the whole event would be dispatched to the media, the Supreme Court, and to the Family that sent the collector. This is the pragmatic approach rather than succumbing to pressure from the extortionists and also rather than handing over the collector to the police. All that is needed are four or five such actions and the extortionists would flee the city. The ludicrous step taken by the Sindh government and Malik to “mildly warn” the extortionists to leave the city is proof positive that they have no desire to control this menace.

The other steps that businessmen should take are to compel Karachi Chamber to organize a non-violent, non-cooperation protest where all members would stop depositing their taxes and utilities bills and instead would submit these with pay orders to KCCI so that the government is forced to listen to the cries of the Karachi citizens. At the same time, KCCI must get the top hierarchy of the five Families to come to KCCI where an ultimatum would be issued to all of them to stop their nefarious activities and allow the City to flourish and live in peace. They should also be given a warning to desist from calling protest days and strikes. They should also be told in no uncertain terms that these Families should voluntarily surrender their illegal arms and ammunition, not to the police but to the Pakistan Army. They should also be categorically warned that land grabbing and drugs supplies should end immediately and all such persons within their organizations should be expelled from membership and not provided any political support.

Yes, this is a tall order and as always, the Families will not pay heed. Thus it would then be a desperate call to GHQ and Supreme Court to honor their obligations under the Constitution and help save Pakistan by purging Karachi, the City of Lights, from roguish elements.

As my friend Anwar-ul-Haq, a senior officer of Federal Board of Revenue writes:

In Bastion Ke Baasi Khudaya Teray Supurd

Toofan Uth Rahe Hain Kinaron Ke Saaath Saath

Dono Ki Ik Misaal Hai, Dono Hain Khokhlay

Insan Phat Rahe Hain Gubaaro Ke Saath Saath

Majyd Aziz is a Karachi based Entrepreneur and a senior leader of the business community. He is a former Chairman of SITE Association of Industry, former President of Karachi Chamber of Commerce & Industry, and has held posts on the board various public organizations and companies.


Businessmen’s Silence is Deafening

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MA-LAUGH-1A Guest Post by Majyd Aziz

PAKISTAN is fortunate to have a formidable number of experienced, visionary, and dedicated entrepreneurs who have carved out a name for themselves in trade, in industry, in social activities, and at global forums. Inspite of monumental odds and roadblocks, whether in the domestic environment or in international markets, Pakistani businessmen and industrialists have persevered and succeeded. Over the years, they also formed Chambers, Associations, Forums, and Groups to protect, promote, and project their views, their endeavors, and their organizations.

"Our lives begin to end the day we become silent about things that matter." Martin Luther King, Jr.

The trade and industry community has also boldly taken stands whenever the need arose. In 1990, under the aegis of SITE Association of Industry and APTMA, a forum SICORLO was formed to protest the deteriorating law and order situation. At that time, SICORLO issued advertisement on a daily basis making fervent appeals for the restoration of law and order. Millions of rupees were spent, and this campaign proved so effective that the government had to step in, literally pleading that this “sob-story” was giving a notorious reputation to the country and that it could turn out to be counter-productive in the long run. Things did improve for a short time thereafter and then the country was back to square one mainly due to juvenile politicians.

In 1986, under the dynamic leadership of a brave business leader, the late Ejaz Shaffi, the SITE Association of Industry led the campaign against the enforcement of a draconian system in Excise Duty that the mandarins in the erstwhile Central Board of Revenue had tried to introduce by camouflaging it as “simplification procedures”. This was a hectic nine-day protest, where five to six hundred industrialists would gather daily at SITE, keeping their factories shut, and listening to the motivational oratory of Ejaz Shaffi and other leaders. After nine days, Premier Junejo had to fly to Karachi, and at a meeting with the industrialists at the Sindh Governor House, declared that this draconian exercise planned by the egoistic CBR officers would be ended immediately. All this happened during the martial law tenure of General Zia.

The above events are narrated because I was fully involved in both. These brought me into limelight and established by bona fides as a representative of trade and industry.

In recent times, businessmen have had their protests but these have been few and ineffective. Once even FPCCI went on strike during the tenure of Benazir Bhutto but she got the better of it. Recently, a self-styled leader of small traders called a strike against extortion and law and order. Initially, the Karachi Chamber President agreed to support it but Interior Minister Rehman Malik and the Sindh Governor prevailed upon the KCCI leadership to cool down. Resultantly, the strike fizzled out and the small traders’ leader got, what Andy Warhol once said, his fifteen minutes of fame. He was a hot item for a couple of days on the media but then the party was over.

The reason I am presenting these examples is that today, when Pakistan needs to sort out its various problems, the role of the business community is zilch because it is at a crossroads. It has this feeling that policies and events in this country are working against businessmen and their very survivability is at stake. The businessmen have this feeling that they have lost whatever ground they had achieved in the last some years. A situation has developed where it seems that the businessmen are damned if they do anything and damned even if they do not do anything.

The leaders of the business community generally tend to play it safe when it comes to dealing with the ruling party, even in these days of democracy and freedom of expression. The present economic scenario and the recessionary trends in the country along with cost increases, utilities shortages and high rates, coupled with low demand, volatile business conditions, uncertainty of the rupee-dollar parity, and the deteriorating law and order situation, not to mention the upsurge in strike calls, have brought businessmen into a frenzy. Their long-term planning has gone to the dogs while in the short run the capital crunch is proving disastrous. The stock exchange is going down like a roller coaster and the media is showing the mess in vivid colors. It seems that in Islamabad the economy is on the lower strata of the government’s agenda, and the Finance Minister is spending more time in the corridors of IMF and World Bank rather than interacting with the businessmen. In his absence, the FBR fudges figures and the Finance Ministry gets pie in the face. All budgetary calculations are based on what loans and aid Pakistan will or can receive rather than endeavoring to expand the tax base at home.

Pakistan faces on-going violence in Karachi, resulting from political grievances which have been enormously magnified by extremism and lawlessness. It is a shame that the law-enforcers are so impotent that they are not able to control the city. There have been reports that they tend to become silent spectators rather than assiduously performing their obligations. Moreover, if there were no Edhi, Aman, or Chhippa ambulances, how would the injured and dead be transported to the hospitals or the morgue? And the less said about KESC, the better.

The political impasse has been putting a heavy toll not only on Karachi’s economic picture, but also on the nation’s economic progress. At the same time, the effect on foreign investment in Karachi is also being felt. The head of a multi-national stated bluntly that “foreign businessmen are now becoming reluctant to invest under the prevailing circumstances and the only option left for them is to check out other countries.” Another declared in clear terms that the US investors have lost interest in funding projects due to civil strife in Karachi. His colleague added “although foreign investment is not a panacea of all ills, yet the influx of foreign investment in power generation, infra-structure development, and other sectors could help solve crucial issues.” A Japanese representative of a trading company stated that the Karachi problem has discouraged Japanese investors from coming here and that there “is a general feeling among the foreign investors that Karachi is no longer safe to invest.” Another Japanese moaned the circular debt when requested to invest in an upcoming coal-based power project. Ominous words that further erode the image of this city.

The beef against the business leadership is that matters are taken in stride and, if need arises, a press release is issued condemning this or that. That’s it. There is apathy even when rates of utilities are increased multifold. There are murmurs but no conviction in statements or actions. Extortion by vested interests is a daily occurrence but there is acquiescence within the business leadership. Market leaders collect funds on a shop-basis and then distribute them to various extortionists and political elements. Quite easily done. No hassles.

There is no better time than now for the business leadership to catch the bull by its horns. There have been no overtures made to the political parties or to the government or even to the armed forces and judiciary. There has not been a unified stance by businessmen to play a prominent and purposeful role to handle the crisis. The silence is truly deafening. Silence is not golden in this case. The FPCCI President with the support of business leaders like Tariq Sayeed, Siraj Teli, S M Muneer, Aqil Karim Dhedhi, and Asad Umar must initiate the dialog and must energize everyone towards the resolution of the crisis. Hope is there if businessmen mediate and if businessmen put some sense in the ranks of politicians. The FPCCI President is also a Senator and thus is better placed to carry on the task.

So, what it boils down to is that circumstances could look favorable for a solution to the political and economic imbroglio that Karachi is facing. The process should begin. All it needs is a pragmatic, resolute, and sincere push from the businessmen. From Asif Ali Zardari, Altaf Hussein, and the twenty million residents who want their City to become once again a peaceful, secure, and bustling city, this is the message. Peace and prosperity soon!

"There are a million ways to lose a work day, but not even a single way to get one back."

Tom De Marco and Timothy Lister

 

Majyd Aziz is a Karachi based Entrepreneur and a senior leader of the business community. He is a former Chairman of SITE Association of Industry, former President of Karachi Chamber of Commerce & Industry, and has held posts on the board various public organizations and companies.


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