The secret behind strange obsessions

Published in SouthAsia (May 2009)

Autism Spectrum Disorder is the fastest growing neurobiological condition in the world and on the rise in countries in the South Asian region. There is still little awareness and help available for autistic children in these countries, observes Ayesha Hoda

“Hello. Allow me to introduce myself to you. My name is autism. Perhaps you know me or know of me. I am a condition, “disorder” that affects many people. I strike at will, when and where I want. Unlike Downs Syndrome or other birth “defects,” I leave no marks on those I strike. In fact, I pride myself on the ability to infiltrate a child’s life, while leaving him or her strikingly handsome. Many people may not even know I am there. They blame the child for what I cause him or her to do. I am autism and I do as I please.” (My Name is Autism, Author: Anonymous)

I came across this poem while randomly reading about health and human psychology on the internet. This led to the discovery of the hidden world of autism and the various autism awareness campaigns that have only recently gained prominence in our part of the world.

Autism Spectrum Disorder (ASD) is a developmental disability affecting 1 in 100 individuals, according to recent world estimates. ASD is on the rise in India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan and the Maldives. It is the world’s fastest growing neurobiological condition.

ASD was first described in 1943 by Johns Hopkins psychiatrist, Leo Kanner, and then by Austrian pediatrician, Hans Asperger in 1944. Kanner used it to refer to children who were socially withdrawn, struggled to acquire spoken language and could become so preoccupied with one thing that they would be completely indifferent to everything else in their environment.

Asperger named it the “Asperger syndrome.” He identified a pattern of behaviour and abilities in four boys, which he called “autistic psychopathy,” meaning autism (self) and psychopathy (personality disease). This pattern included “a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements.”

Asperger used the term to describe children who developed strange obsessions and were socially awkward, yet highly verbal and seemingly quite bright.

To understand the condition better, I approached a remedial therapist in Karachi, Fathma Naqvi, who explained, “Autism can be mild or severe. Symptoms generally appear before the child has turned three and include extreme difficultly in communicating and interacting with others, and repetition of any action or word. An autistic child prefers to play alone and does not make eye contact.

Some children with ASD are gifted with certain unique talents. For instance, they may be able to perform complex calculations which their peers are unable to or solve a complex puzzle which no one else can as the child has outstanding visual-spatial abilities. However, not all autistic children are extraordinarily bright.”

Some autistic children also have certain abilities to learn languages or artistic abilities. Further questioning and research revealed that the debate on causes of autism is still going on. Most experts insist that it runs in families and is genetic while others are of the view that children are not born autistic but become that way when their parents, especially mothers, are cold and uncaring. Dr. Eric Hollander, director of the Seaver and New York Autism Center of Excellence, while answering questions for CNN, said, “In fact, of all neuropsychiatric disorders, there’s a stronger genetic predisposition for autism. It’s also clear that early environmental experiences can play an important role in modifying how these genes develop.”

Autism Awareness

Autistic characters have been depicted in western, particularly American, literature, films and television serials. For instance, Arnie Grape, (played by Leonardo DiCaprio) in the film What’s Eating Gilbert Grape?, and Seth Garin, in Stephen King‘s book The Regulators, are two fictional characters with autism. However, in fiction, the focus is usually on the extraordinary capabilities that autistic individuals have which fascinate the audience or readers.

Michael Fitzgerald, of the Department of Child Psychiatry at Trinity College in Dublin, has speculated about historical figures with autism in his numerous journal papers and books. He includes famous figures like painter Vincent Van Gogh, philosopher Immanuel Kant, writer George Orwell and German dictator Adolf Hitler, amongst others, in his lists. Other academics, journalists and autism professionals have also made similar interesting speculations.

Looking at the rising number of children with ASD, the United Nations General Assembly passed a resolution designating 2nd April as World Autism Awareness Day, starting in 2008. US President Barack Obama and First Lady Michelle Obama were sent a CD copy by UK Autism Foundation of the Autism Song, Open Every Door to mark World Autism Awareness Day 2009.

Japanese artist and widow of John Lennon, Yoko Ono auctioned her new work for an autism charity on the day at the UN lobby in New York. Her seven-foot mural, entitled Promise depicted fluffy white clouds against a clear blue sky and was made up of 67 jigsaw-like pieces.

These pieces in the installation were broken down, signed by the artist and auctioned off. Ono expressed the hope that all 67 pieces would be reunited once a cure for autism was discovered.

In South Asia, we have some examples of awareness campaigns related to ASD. For instance, Ivan and Charika Corea, parents of an autistic child, have launched a massive Autism Awareness Campaign in Sri Lanka. There are 30,000 autistic people in Sri Lanka, according to international experts and there will be a massive increase in 5 years time, in Sri Lanka and all over the South Asian region.

The World Autism Awareness Day 2009 was also celebrated in India, Pakistan, Sri Lanka, Bangladesh, etc. A week-long campaign was organized in India to create awareness. Focus was also on helping families from an educational, medical and legal standpoint.


According to the Autism Society of America, there is no single known cause or cure for autism but it is treatable. Children do not outgrow autism but studies have revealed that early diagnosis and intervention can lead to significant improvement. People with autism can live full, healthy and meaningful lives with the right services and support.

People such as Krishna Narayannan from India have broken free from autism. In Narayannan’s case, ayurveda brought a breakthrough, apart from education and music. He co-authored a book with his mother, entitled Wasted Talent, an account of how he overcame all the hurdles to finally open his mind to his parents. They also included advice on therapies and techniques. “The title reflects ultimately my belief that the talent of an autistic is wasted away if it is not nurtured,” he stated when the book was published.

The toughest part perhaps is for parents to accept that their child is different from others. They need to take a proactive approach to learning about the condition and its treatment while working closely with others involved in their child’s care. Parent and family education has been shown to reduce family stress and improve a child’s functioning.

Perhaps more awareness campaigns in developing countries, especially through the mainstream media, will enable people to know and understand ASD better. These may eventually lead to the establishment of more support organizations and introduction of special techniques in educational institutions. This is extremely important, as Narayannan opines, “No challenge is greater than the challenge to educate the autistic because they are restless and their rigidity and rituals interfere with learning. They can neither write nor talk.”

People should identify and appreciate the diverse abilities that autistic children have. As Diane Bubel has said, “By raising our voices together, we are creating a world that celebrates children for their abilities.”

It’s time to promote a positive perception and greater social understanding of the mysterious world of autism.

And the World Changed

And the World Changed – Contemporary Stories by Pakistani Women

Book Review published in SouthAsia (June 2007)

And the world has changed! Not only in Sabyn Javeri-Jillani’s post-partition Karachi or in Humera Afridi’s post 9/11 New York City, but also for creative writing by Pakistani women.

There is no vast Pakistani English literature by women, to comment on. Republished in Pakistan in 2006, after its launch by Women Unlimited (New Delhi) in 2005, this anthology exhibits the kind of work that Pakistani women are doing in South Asian literature.

Nonconformity and an unconventional style seem to be the current trend. Though there is still a long way to go in terms of meeting the literary standards of world classics, the stories of this collection do represent myriad perspectives on a number of issues, especially those concerning women.

There is no single theme that the book follows. You cannot label it as ‘feminist’ prose, despite the fact that all texts are by women.

Twenty-four women, belonging to different literary backgrounds, have contributed. These include known names such as Fahmida Riaz (a political and human rights activist), Bapsi Sidhwa (whose novels revolve around the Zoroastrian community in Pakistan) and Kamila Shamsie (of Salt and Saffron fame). Some of the stories are excerpts from novels.

One is bound to notice a few similarities between the authors. All of them have lived in Pakistan as well as in the west, or still do. They write about the Pakistani people and multiculturalism is sometimes an underlying theme:

“Santa Maria, the Black Madonna, Holy Mother of Christ, Jesus, Jesus, Ya Ali! Ya Ali! Ya Hussain, Ya Hussain…” (Bloody Monday by Fawzia Afzal Khan.

Stories focus on problems as serious as rape of the mentally challenged (The Daughters of Aai by Fahmida Riaz), forced marriages (The Optimist by Bina Shah) or on lighter subjects such as the initial experiences of city life ( Look, But With Love by Uzma Aslam Khan) and The Arsonist (an excerpt from Bapsi Sidhwa’s The Crow Eaters). They provide us with a taste of present-day reality and capture the ethos of our society – such as Shahrukh Husain’s Rubies for a Dog, which comments on gender discrimination:

“Isn’t it ironic that I have to dress like a man in order to discover my potential?”

Meeting your future in-laws in a pair of jeans can be calamitous even if you are living in the west, “under the sway of western fashion and, by extension, its moral values” (A Pair of Jeans by Qaisra Shahraz).

Even young and amateur writers show sensitivity towards some social issues (that are often ignored) and provide us with some very original stories, such as Clay Fissures by Nayyara Rahman:

“It was 1953 and patriotism was still a young, strong spirit in Pakistan. People were proud of being Pakistanis. They were proud of being Muslim. They were proud of their own brown skin, which reflected wheat – the lifeblood of Pakistan. And here was I: Pradeep Sehgal, the adopted albino son of a Hindu merchant and a Eurasian seamstress.”

Muneeza Shamsie (the editor and short story writer), has previously edited A Dragonfly in the Sun: An Anthology of Pakistani Writing in English and Leaving Home: A Collection of English Prose by Pakistani Writers. She also contributes to local newspapers and magazines. In this book, she has provided us with a brief but absorbing introduction on the history of creative writing by Pakistani women (or the lack of it). She has eulogized the efforts of those women who have contributed to this form of writing (despite the lack of monetary benefits and inspiring examples), acquainted us with each contributor and has also thrown light on the impact that political upheaval in the country has had on this medium of expression.

It is interesting to note the kind of diversity that exists in our writing as well as our society. We see a close affinity with contemporary writing by Indian women (Shobha De` etc.).

These writers also lead us to new avenues (sometimes ‘experimental’)and provide ideas that can form the basis of future work in fiction. Social critique still largely seems to be the ultimate aim of writing, as mentioned in the introduction: ‘the prescriptive dictum that their work must have an extra-literary purpose, namely to “serve society”.’

– By Ayesha Hoda

A Climate Friendly Future?

Published in SouthAsia (July 2007)

Climate change or global warming is endangering the road to sustainable development in South Asia: a region that adds only a fraction to global emissions. Is it possible to pursue economic prosperity and address environmental concerns, simultaneously, inquires Ayesha Hoda

Global warming is often referred to as climate change as this signifies noticeable changing patterns in measurements such as temperature, precipitation, or wind , etc.; changes which last for decades or even longer periods.

The concept of global warming goes as far as 1824. It came to the forefront as a result of Joseph Fourier’s calculations, which led to the conclusion that without ‘atmosphere’, the Earth would be a much colder place.

The greenhouse effect is what makes this planet habitable for human beings, plants and animals; the atmosphere comprises certain gases, which confine heat like the glass panels of a greenhouse.

The factors responsible for bringing about such drastic alterations in the climate include natural factors (changes in the sun’s intensity or gradual changes in the Earth’s orbit around the sun), natural processes within the climate system (e.g. variations in ocean circulation) and human activities.

In 1895, Svante Arrhenius, a Swedish chemist, discovered that humans could enhance the greenhouse effect by making carbon dioxide, which is a greenhouse gas. Anthropogenic degradation of the environment, which causes changes in the atmosphere’s composition, is brought about by burning fossil fuels, deforestation, desertification, urbanisation , etc.
Global warming is different from the Ice Ages and long periods of warmth experienced centuries ago. There have been rapid changes in the climate since the Industrial Revolution, causing perhaps some irreversible damages to the environment.

The earth’s temperature has been rising; the three warmest years have been witnessed in the past five years only. In recent times, we have been frequently witnessing several negative impacts of climate change.

These include increase in the average level of temperature, rise in the sea level, melting glaciers, disappearance of entire islands, increase in the number and types of tropical diseases, lengthening/shortening of growing seasons, extinction of some species of animals, many adverse effects on ecosystems, etc.

South Asian countries are more vulnerable to climate change. Economic losses in the region, due to environmental degradation, are estimated to be five or six percent of GDP. Food shortage is expected in South Asia, according to the predictions of a recent World Bank report. Bangladesh is expected to be hit by persistent typhoons in the future, which will make it inhabitable and cause massive immigration to countries like India, which have to cope with their own environmental crisis.

According to recent projections, land populated by 80 million people is at risk of flooding. Around 60% of this land is in the South Asian countries of Pakistan, India, Sri Lanka, Bangladesh and Burma, with the very existence of the Maldives Islands under threat.
Sir Nicholas Stern, former Vice President and Chief Economist of the World Bank, commenting on the issue of climate change in South Asia, recently said:

“I think people understand the rising water stress, and how vulnerable they are to melting glaciers and snows from the Himalayas…Precipitation comes and it’s held there. That’s how you get water in the rivers. That effect will not be there if the glaciers and snow are not there. Which means you’ll get torrents during the wet season and dry rivers in the dry season. So you’ll get a combination of flood and drought.”

This reveals that, apart from other things, agricultural produce will be significantly affected. Several South Asian countries like India and Pakistan are largely agrarian economies and farm produce represents a large part of their national output. Even short run fluctuations in the climate can have drastic effects on productivity. Crop yield may fall by as much as thirty percent, around the middle of the century. Average crop yield is estimated to drop down to 50% in Pakistan.

Decrease in yield may be attributed to lack of access to an adequate amount of water, a shorter growth period and vernalization. Also, the countries will have to deal with flooding in some areas and drought in others, simultaneously.

Looking at the options open for defence, there are just two approaches that can be taken to combat global warming. These are mitigation and adaptation.

Mitigation refers to diminishing the extent of global warming whereas adaptation refers to lessening the impact.

Adaptation methods include development of stronger defences from flood (storm drainage systems), water management systems (that can handle water extraction plus irrigation efficiently) and changing patterns of land use (avoiding vulnerable areas for housing). There is a need to develop crop varieties with greater drought tolerance.

For mitigation of global warming, governments need to plan and shift from their present energy policy and modes of investment planning. However, since South Asian nations are still developing, they cannot reduce emissions much because of industrial development.
Individual choices can also affect the global warming scenario. Methods for mitigation for individuals and businesses include support to renewable energy resources, reduction of energy use per person, carbon capture and storage and birth control to lessen demand for resources.
However, to bring about substantial change in global warming, global effort is a prerequisite, since South Asia is not even the biggest contributor to increasing climate risks.

To address this issue, the US government has established a policy to slow the growth of emissions, strengthen science and technology and enhance international co-operation.

However, despite being the largest greenhouse gas emitter, the United States has refused to abide by the Kyoto Protocol. This is the most significant international agreement on combating climate change and came into force on 16 February 2005. It encompasses 160 countries and controls 55% of greenhouse gas emissions.

The US has rejected it since there are no emission targets for Asian countries; despite the fact that an average Indian produces only a 10th of the greenhouse gas emissions of Europeans and a 20th of the average American.

The Kyoto Protocol is an important step taken, but mitigation efforts, as compared to daily threats posed by climate change, have been modest on a global scale. So unless countries like the US, Australia and Kazakhstan co-operate, perhaps not much can be achieved.

Moreover, for technology, research and resources, the South Asian countries need the help and aid of the developed nations. Only then is the development and application of renewable technologies throughout the region (which range from large-scale hydro projects with proper environmental protection and small-scale renewables with social safeguards), possible.

It may be concluded that there is no question now of ignoring this environmental crisis, in pursuance of wealth. Economic prosperity now needs to take into account the depletion of natural resources and the negative effects of industrialisation, on the environment. However, the responsibility does not lie with South Asia only.

To counter the dramatic impacts of global warming, the only viable option seems to be for all countries to work together and make a difference, by adopting the various measures mentioned above.

In the words of Former President World Bank, Paul Wolfowitz:

“We have an opportunity today, to think outside the box and find new ways, practical solutions, to promote the generation and diffusion of low carbon technologies and the integration of climate concerns in development strategies. Let’s work together for a climate friendly future.”

Accepting the Third Gender

Published in SouthAsia (September 2007)Original Link

We see them everyday. We think they are unclean. We might not even acknowledge them, let alone accept them. Such is the plight of the hijras, who are no less human than us, perhaps even more, writes Ayesha Hoda

Hermaphroditism or birth of an intersex child is the result of several biological factors. According to estimates, one person in 150,000 to 250,000, belongs to this third gender.

Hermaphrodites or hijras, as they are generally called, are part of one of the most neglected groups of our society. Our reactions to their presence vary. Some of us fear them, others mock or laugh at them, some abhor and abuse them, others merely ignore them and none of us really thinks of them as human beings, capable of feelings and worthy of respect.

The only characteristic understood and used to define them is that they are “neither men nor women.” Beyond this, nobody comprehends what these ‘eunuchs’ are and what they have to face throughout their lives. Our ancestors and forefathers, however, seemed to have a better understanding and a more tolerant attitude towards the third gender.

The Indian subcontinent saw hermaphrodites in the role of advisors in households of the nobility. Many of them guarded sacred or important places, and acted as a medium of communication between men and women. They were given a place in the rulers’ courts during the reign of the Mughals and often had high positions during this era. This is reflected from not only historical sources and references but also when we see them as characters in literary works of or about that period.

They have been acknowledged in ancient Hindu scriptures. They were linked to Sufi saints and shrines and due to Judea-Christian-Islamic influences, were thought to have special powers of blessing as well as cursing others; they were then treated with reverence, especially in Muslim-dominated areas. Some of them, a minority though, were engaged in prostitution and/or providing entertainment at social events.

Ironically, it was the ‘modern’ British system and western way of thinking that was mainly responsible for ostracizing them. Their new status of social outcasts deprived them of their rights to live as normal citizens and earn their living in an honourable manner.

Today, the only career paths open to them are begging, singing and dancing at social events such as weddings, birth ceremonies, etc. and becoming sex workers. Even educated hermaphrodites, from well-bred families in South India, claim to have been thrown out by their families and find it difficult to find employment in careers of their choice.

Generally, it is perhaps hard for the masses to learn to respect beggars, especially when they are these androgynous individuals dressed in a vulgar fashion, who clap hands in a peculiar manner, make other obscene gestures and sometimes pass rude comments, which has actually become part of the hijra tradition.

The silver screen is also responsible for making us see them as objects of ridicule. They are sometimes introduced in movies as side characters, brought in to make the audience laugh. This is not only true of movies produced in the South Asian region but also of western cinema with its plethora of homophobic and heterosexist jokes.

Lack of respect and sympathy is also a result of the fact that many men these days become transvestites (those who cross-dress) for moneymaking purposes, even though they are neither born as hermaphrodites nor are they transsexuals (those who identify themselves with the opposite sex rather than their own).

In the past few years, there have been some social movements conducted by hermaphrodites to procure their rights in society and to voice their opinions. In this regard, perhaps the most progress has been achieved in India. In 2005, the Indian government updated its passport application forms, incorporating the third gender (E for eunuch). The efforts of people like M. Nikkila, a beautician and therapist in Chennai, must be applauded.

A few years back, Nikkila started training eunuchs or the aruvani of Tamil Nadu, to give beauty therapy. Using her strong network of clients, she thus provided them with an alternate profession and also taught them how to dress properly, carry themselves and adopt a self-respecting attitude.

Indian politics also has an established presence of hermaphrodites. They were given voting rights in 1994. However, Kamla Jaan, who was mayor of Katni (Madhya Pradesh) from 2000 to 2003, lost her job when a judgement was passed regarding her gender status.

Shabnam Mausi was India’s first eunuch MLA in Madhya Pradesh. She was an elected member of the State Legislative Assembly there from 1998 to 2003. During this period, she tried to enter the Congress Party but did not receive support. She says, “I have grown up being called a hijra. That word was like a thorn, which kept piercing me. But now, people respect me.” Her life has also been depicted in an Indian film.

More recently, in Patna (Bihar), policemen turned eunuchs into tax collectors, to benefit from the general feeling of fear that their presence generates amongst the masses and their persuasive manner to procure cash.

In Pakistan, a hermaphrodite Mohammed Aslam was allowed to contest in some local election in Abbottabad, back in 1990. In Multan, in December last year, around 370 hermaphrodites and their gurus (heads) from 40 cities of the country held a convention and demanded quotas in assemblies. During this convention, an All-Pakistan Eunuch Association was also formed.

The condition of hermaphrodites in Bangladesh is even worse than of those in India and Pakistan. Most people there do not believe that the transgender has any special powers. They thus have meagre incomes, are homeless and don’t even earn enough to have medical checkups. They do not have voting rights and the state is not doing anything to check sexual harassment or social discrimination.

Some NGOs in India, Bangladesh, etc. are now working for the benefit of the third gender but they concentrate on this segment of the population as a high-risk community for AIDS, raising awareness about this rather than striving to improve the social status of hermaphrodites and procreate employment opportunities, which will definitely reduce the number of sex workers and incidence of AIDS through homosexuality.

The cause of the strength and visibility of the hijra culture may be attributed to the mistreatment they receive from society. Hermaphrodites become aloof and mysterious. They live together and form their own family networks, as their real families disown them. In the South Asian region, they even have a separate language they use to communicate amongst themselves, called ‘Gupti or Ulti Vhasa’ in Bangladesh.

There is thus, a need to acknowledge the third gender and give these people the status of humans, equal to that of males and females. The government of each country needs to eliminate social and political discrimination against them and to provide a quota for jobs in government offices, as there are for the other two genders. They should be included in the census (as they represent quite a large minority) and should also be part of the suffrage, allowed to vote and to contest seats. Due to their performance in politics in the past, some people in India are actually in favour of having hermaphrodites lead them as they get the work done.

The attitude of the western world in this case should be shunned. Despite transgender or so-called ‘queer’ studies (which, however, concentrate on medicine), it is a practice in North America to hide any sexual ambiguity, especially when surgery for sexual assignment is not possible. We should also reject the local superstitions surrounding the third gender, with regard to the supernatural powers that they possess.

There is a need to integrate the subculture of hermaphrodites with the culture of society. Efforts should be made to help them get rid of the peculiarities they have adopted, to rebel as a result of being involuntary outcasts. The custom of gurus and chelas (older hijras with their protégés) should be abolished.

Many are ready to adapt and change their ways if society gives them the opportunity to prove themselves, without association to social stigmas. They need to have proper educational, housing and medical facilities, at least as much as the other classes have in the third world. There should not be a necessity to register themselves as either men or women. Instead, the third sex should be recognized.

We should learn to look for the unique personalities overshadowed by their asexual definition!

The Organ Bazaars of South Asia

Published in SouthAsia (August 2007)

Nothing substantial has so far been attempted to check rampant illegal organ trafficking in South Asia or to provide systematic treatment for organ failures and ailments, writes Ayesha Hoda

The bazaars of human organs are bustling with activity in South Asia. The underdeveloped world seems to be more privileged than the developed world, at least in one aspect: it has a large population of live donors, with organs for sale at cheap rates!

Peasants, bonded labourers, slum-dwellers and other poverty-stricken people with large families to support, are more than eager to offer their organs, especially kidneys, for meagre amounts of compensation.

In 2005, Shefali Begum, a penniless mother in Bangladesh, offered one of her eyes for sale through a newspaper advertisement. This resulted in a massive outcry from the public and the international press. So did a number of organ-rejection cases in Britain recently, concerning twenty Scots who had unofficially bought kidneys in Pakistan. But this is just a small glimpse of the horrendous world of organ trafficking.

In the village of Eranavour, Tamil Nadu (India), one hundred and fifty Tsunami survivors have been left on the streets sans compensation, after having their kidneys removed at very posh hospitals in Chennai. Sadly, the merciless organ mafia was their last hope when the Indian government failed to provide them with any protection or means of survival.

The question is, who has made the entire process of illegal inter-human allotransplant so easy and successful? The black market in the region is full of internationally-affiliated organ brokers, with government officials as accomplices. The former may be outlawed surgeons or medical technicians operating underground laboratories or anyone interested in making skyrocketing profits quickly.

“Pakistan has become a factory for regional transplant tourism,” says, Dr. Syed Adibul Hasan Rizvi, founder and director, Sindh Institute of Urology and Transplantation. “Recipients travel to Pakistan, where the temptation for money and greed is great.”

The gap between the number of recipients and the number of donations is widening. There is a higher incidence of kidney and renal failures. Most people, especially in South Asian societies, do not like to give away organs of their deceased loved ones. There is a serious lack of data and no systematic way to bring recipients and willing donors into contact. Hence, there are fewer deceased or cadaveric donations.

According to the World Health Organisation (WHO), around 200,000 people around the globe are on waiting lists. Patients with kidney failure, registered on these official lists, often die waiting to receive organs or looking for the perfect match. Some have no proper access to transplantation or dialysis. In such cases, an argument is often forwarded by some that the human body only needs a small percentage of one kidney to survive. Therefore, with donations, two people can live instead of just one.

However, others such as medical anthropologist Nancy Scheper-Hughes, firmly declare this practice as unethical:

“The ultimate fetish is the idea of ‘life’ itself as an object of manipulation. This fetishization of life – to be preserved, prolonged and enhanced at almost any cost – erases any possibility of a social ethic.”

This also leads to the issue of forced donations. Very few donations are altruistic or Good Samaritan (donating willingly to a relatively unknown recipient, without acquiring any benefits in return).

The lower classes have been exploited for a very long time, in every way imaginable, and this is one common example. Mostly, donating kidneys is not even the end of the story. Such people are ignorant of some adverse consequences and complications that may result from the operation. They are left without any post-surgical advice, care or treatment. Medication is unaffordable.

In view of all this, laws have been formulated in different countries pertaining to the legitimacy organ trade. In 2006, Iran became the only country in the world to legalise the sale of kidneys to unrelated recipients, at market prices of $2000 to $4000! However, some may argue that countries like India, which actually have laws against this practice, have rather booming markets for organs.

The Human Organs Transplant Act was passed in 1994 in India. This set down rules and regulations for organ transplant and banned organ sale, with high penalty for any parties involved. It only allowed organ donation out of affection, that is, only to recipients well-known to the donor. In the case of family members, there is no requirement for a government clearance. However, there have been numerous cases of transplantation marriages in India, where poor girls are forced to tie the knot, donate their kidneys and are then divorced.

Even in Nepal, the Organ Transplant Committee, formed by the government to check the smuggling of kidneys from the country, only allows donations to relatives. However, fake relationships are established on paper to combat this rule.

In Pakistan, a few years back, Dr. S.A. Jaffar Naqvi, CEO, Kidney Foundation, introduced the Bill for Organ Transplant in the Senate and obtained a fatwa from Justice Tanzeel ur Rahman (the then Chairman of the Council of Islamic Ideology), which declared organ transplant to be legal in Islam. However, there was no further development for a proper donation system, which would have been beneficial for all.

More recently, however, and after much deliberation and hindrances, the federal cabinet has approved the Transplantation of Human Organ and Tissues Ordinance 2007. But there are many apprehensions about this law, as it does not provide a transparent system for promoting a positive organ donation culture and disrupting trading activities in the black market. Some analysts are of the opinion that there are certain clauses within the ordinance, which actually legalise rather than curb or criminalize unofficial and coercive organ sale.

Trading organs, irrespective of whether the donor is living or deceased, is illegal in Bangladesh. However, as with all the other countries mentioned above, the implementation of this law is rather questionable.

Organ trade is growing day by day. It is not only a cause for concern for social scientists or bio-medical ethicists. It is a very serious problem pertaining to the violation of basic human rights (Articles 3 and 4 of the Universal Declaration of Human Rights). In accordance with this, payment to live unrelated donors is also forbidden under the WHO Guiding Principles.

There is then a need for the WHO to overview, along with its promotion of health systems and altruistic donations, the negative impact that such publicity might unintentionally have had and it should suggest and formulate ways to counter this.

On the medicinal front, people should have cognisance of the possibility of transplant failures, due to rejection of foreign organs by the body’s immune system. Requirements of thorough check-ups before transplantation will lead to a lower death rate due to organ-rejection. Also, the introduction of more preventive drugs and medical care will check the rise in diseases, such as diabetes, which may lead to organ failure.

There should be awareness programmes to promote and encourage donations after demise as well as about factors causing damage to organs. Governments of South Asian countries should improve access to donors by collecting relevant data and building more kidney care and research centres.

Repressed Souls of South Asia

Published in SouthAsia (June 2007)

South Asian women repress anger. They are always expected to maintain a semblance of propriety. Anger is only to be expressed by their male counterparts, or so dictate our social norms. Ayesha Hoda psycho-analyzes this pandemic and tries to unweave the threads of cultural oppression and subjugation in the Indian Sub-continent.

Women’s issues have gained centre stage in South Asia these days. Empowerment and independence are amongst the goals chalked out in discussions on television, in magazines and by NGOs working for the benefit of women.

There are often debates on issues of rape, domestic violence, the violation of basic rights for women, honour killing, prostitution, sexuality, divorce, male-domination, eve-teasing and so on. But what we do not always consider is that inherent in all these issues is the practice of our women, of bottling up their feelings and reactions, even in situations where outbursts might be necessary.

A Global Practice:
Globally, any expression of anger is associated with men. While no eyebrows are raised when boys, even at a young age, take an aggressive approach to project their fury, girls are often advised to stay away and adopt a problem-solving approach. In most cases, this may, in fact, be nothing else but repression of anger, leading to long-term resentment.

Commenting on this social reality, Sandra Thomas, psychologist and director of the nursing doctoral program at the University of Tennessee (Knoxvillle), aptly says: “Both men and women have been poorly served by the gender socialization they have received. Men have been encouraged to be more overt with their anger. If boys have a conflict on the playground, they act it out with their fists. Girls have been encouraged to keep their anger down.”

It thus appears that this is a global trend; even western societies have a patriarchal system and are male-dominated, following the rules set by men. However, one may also safely generalize that this practice has grown rather chronic in our part of the world, that is, South Asia.

Before considering the consequences of this passive approach to anger taken by women, let us first try to investigate the causes of the development of such a habit. Why is the expression of fury considered ‘manly’ and more uncivilized for our women, as compared to men?

Repression of anger by women was not always such a dominating characteristic of South Asian society, if we analyze our cultural history. One can only infer that this is a result of some Arab creed, or the influence of the concept of agni pariksha (test by fire) of Hindu women or a Christ-like submission taught to Christian wives, or perhaps a combination of all these factors. Not speaking up or tolerating injustice is equated with being good, especially for women and the practice is reinforced from one generation to the next.

It is also about who decides what is right and what is wrong. Our society is not only androcentric but follows a patri-local system (brides relocate to live with their husbands’ families). This may often decrease the kind of influence that women may yield in their household, as compared to a matri-local system. The concept of a nuclear family is still largely alien in the region, so equality is a distant dream.

South Asia also has one of the worst gender divides (greater than the Sub-Saharan countries), with Pakistan being in an even worse position than India. There is discrimination in wages, provision of basic needs (such as health needs and literacy), etc.

Within households, there are specific roles defined for males and females, which they are expected to follow religiously. Several families still give preference to the male child (based on the idea that the boy will be the future breadwinner and the pride of the family). The girls, on the other hand, can only expect to uphold the family reputation by being ‘good’ (which equals submissiveness).

Going further, we see that women are often also discouraged from higher learning (even where finance is not an issue) or from pursuing a profession (such as archaeology or sports) which is thought to be a man’s domain. They are not always encouraged to take up a job because the work environment is expected to lack decorum. There are several organizations, which do not appoint women at all, as per their policy.

With rising consciousness of the importance of higher education, it is rather frustrating for women who are not allowed to have their way due to a mindset. Match-fixing or arranged marriages (with or without consent) also  keep women distracted and produce the urge for financial independence which they expect will give them more control of their lives.

These factors cause frustration. However, due to social conditioning, with mothers and other women in the household as role models, women adopt an uncomplaining attitude. Even if they do express their anger, at certain points, they themselves tend to think that it is not something socially acceptable. To save face, they avoid reacting in this manner in front of people other than their family members.

According to Sigmund Freud, repression is an unconscious function of the ego, which controls a person’s desires, wishes, memories, etc., which are part of the id. As a child, one learns what is right and what is wrong. As one grows up, one’s ethical standards become the repressing forces that help lead a civilized life.

Repression is a normal psychological process, important for personality development. However, when an emotion as natural as anger is subdued constantly, there may be acute problems in the long run.

The most obvious problem for an individual may be infrequent but unpredictable and untimely outbursts of anger, which are often also misdirected. Locally, the lack of psychological therapeutic techniques or anger management exercises leaves women without any solution or outlet. Women are not even conscious of practices as simple as meditation, relaxation, looking at nature, painting and so on, which are often healing.

An example may be quoted here. An educated woman (who chooses to remain unnamed), belonging to the middle class, had problems in her marriage; she was battered and verbally abused by her husband. She become more capable of dealing with the situation, when on a psychologist’s advice, she started voicing her thoughts in front of different people. Whatever her listeners may have said about her being so loquacious about matters so personal, she gradually learnt how to handle the problem and was able to give vent to her fury.

Other than this, anger has an alarmingly close relation with depression. The inability to express negative feelings tends to build up a depressive tendency. With psychological treatment still considered taboo by many and the easy availability of medicines without the prerequisite of a prescription, women often opt for self-medication.

They may dwell in self-pity. Even though they follow what the society deems as acceptable behaviour, they experience a feeling of worthlessness, because of the lack of power to make any difference to their own lives. In extreme cases, women may engage in self-destructive activities and substance abuse and have frequent nightmares and unpleasant thoughts. There are also physical symptoms of repressed anger, such as ulcers, panic attacks, headaches, hypertension and hysteria.

Apart from these impacts, which affect an individual and her relationships, passive anger can lead to destructive gossip, putting people down and provoking aggression without being directly involved in the act. South Asian women, then, cannot be expected to be strong role models for anyone or address the issues that affect them.

In order to move towards gender equality and make the search for self-identity fruitful, one should first become conscious of problems such as these. Anger is an emotion, which is far from subtle. Though it is modern practice to find other ways of releasing anger, this should be applicable to people regardless of gender and in context of the situation.