The Express Tribune hi five - September 7

Ms SEPTEMBER 7, 2014

ISSUE NO. 116

Summer Romance

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page

Sexual Ambiguity

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inside lifestyle —

Unusual professions

domestic goddess —

Homemade egg pudding

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Section In-Charge: Sarah Munir Sub-Editor: Nisma Chauhan

The passionate footballer Afshan Altaf

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Ms

the buzz

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

Who

am I?

Patients with sexual ambiguity struggle with the trauma of not knowing their identity

Expecting a newborn is one of the most anticipated moments in any couple’s life. It was not any different for Shan and Maimoona* who spent the entire pregnancy preparing for every tiny detail so things would go smoothly once the little one arrives. While they welcomed the idea of having a son or a daughter equally, like most parents, they were eager to know which one it would be.

What the couple, however, was not prepared for was Disorder of Sex Development (DSD) — a rare condition where a child is born as neither a male nor female. “We were so ashamed,” admits Shan, “and we were afraid whether our community would accept our child as one of them.” The baby was delivered by a midwife in a village near Muzaffarabad, where both the parents worked as domestic staff. Not knowing what to do, they decided to name

For patients with sexual ambiguity, facing society can be a lot more painful than their condition

by Ans Khurram

their baby Danish and raised him as a boy based on the physical appearance. Things seemed well until Danish hit puberty and started showing signs of a female anatomy.

The troubled parents decided to seek help from their employer, who adviced them to take medical help from Shifa International Hospital in Islamabad, where Danish was diagnosed with Congenital Adrenal Hyperplasia (CAH) — a type of DSD. It’s not a disease According to Mayo Clinic Organisation (MCO), sexual ambiguity has various causes which differ for both male and female genitalia. It is crucial to understand that this is not a disease but a condition that affects sexual development.

In scientific terms, a baby’s genetic sex is established at conception. The mother’s egg contains the X chromosome while the father’s sperm contains either the X or the Y chromosome. A baby who inherits the X chromosome from the father is a genetic female while a baby who inherits the Y chromosome is a genetic male. A disruption of the steps can result in a mismatch between

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THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

The social stigma For patients with DSD, facing society can be a lot more painful than their condition. According to Management of children with DSD: A retrospective analysis — a study carried out by a team of Pakistani doctors — children with sexual ambiguity are often diagnosed as late as puberty. The report attributes this late diagnosis to ‘a lack of awareness, poverty and a tendency of hiding sexual issues’. However the biggest issue the report states are the ‘cultural taboos considering genital ambiguity a social stigma’.

DSD patients and their families are subjected to immense scrutiny and discrimination, beginning at the child’s birth.

Hence, a baby born with sexual ambiguity is usually hidden away by the family due to fear of shame, scorn or pity. “You have no idea how tough it is to deal with the snide comments passed by people, especially for the child,” says Maimoona.

People’s comments are not usually limited to the child, but even the mother is often blamed for the condition, she adds.

Meanwhile, dealing with the condition as late as puberty

the external genitals and the internal sex organs or the chromosomal sex (XX or XY).

Thus, if there is a lack or deficiency of male hormones in a genetic male foetus it can cause the baby to have ambiguous genitalia, while exposure to male hormones during developments in a genetic female can also lead to the same condition.

CAH, the condition that Danish is suffering from is defined by MCO as a condition associated with an increase in the level of male sex hormones. According to, Dr Muhammad Afzal Sheikh, a pediatric surgeon who runs the Lahore Cleft Centre, CAH can be a life-threatening condition in some cases, if not treated immediately.

“It may lead to acute adrenal crisis and in some children may cause hypertension.

The patient is usually a female child and the defect lies at enzymatic level due to a genetic deficiency.” Although the abnormal genitalia can be seen only after birth, the diagnosis for this condition can be made prenatally as well.

The child [who] is brought up as a male or female according to their appearance can find it very difficult to adjust to a different gender so late in life Dealing with the unknown Lack of awareness plays a huge part in perpetuating the stigma associated with DSD patients and also gives rise to a lot of myths relating to the issue. “Parents of CAH affected children believe that the child will not be able to give birth after the gender

also leads to many serious psychological problems, according to Sheikh. “The child [who] is brought up as a male or female according to their appearance can find it very difficult to adjust to a different gender so late in life,” he says referring to patients who opt for a gender change surgery later on. “A few patients have also refused conversion based on both age and social pressures,” adds Shiekh.

The lack of medical expertise about DSD in the country is also a huge obstacle in tackling the condition. At the International DSD Symposium in Glasgow 2013, Dr Syed Jamal Raza from the National Institute of Chile Health described the facilities for DSD care in Pakistan as “scarce and non-existent.” “Various concerns and constraints have been identified during our 15 year experience of treating DSD patients,” summarises Raza.

“These range from religious, cultural, social, and financial to limited facilities available for investigations and treatment.”

According to the report, Pakistan has only three pediatric endocrinologist and 20 adult endocrinologists at the moment.

change,” explains Sheikh. “When, in fact, they have normal internal female organs and shall have normal fertility after surgery and treatment.” Another common mistake is to confuse a patient suffering from DSD with being a homosexual or a transgender.

Most patients of DSD think of themselves as being either male or female as opposed to a transgender — who feels that he or she are trapped in the wrong body (i.e. a person with male anatomy wishes to be a woman).

In Danish’s case, an extensive treatment plan has been devised to deal with his CAH which consists of crisis management, maintenance of body steroid levels and then continuous monitoring of those steroid levels. “Along with medical treatment for correcting underlying deficiencies and providing symptomatic relief, reconstructive surgical procedures have been successful in providing physical and emotional relief to the patients and their families,” says Sheikh. The final step is a gender-change surgery, which is advised universally for all CAH patients who are of the same age as Danish is.

Shan and Maimoona are already worried about how Danish will adjust to his new lifestyle and if he will accept the gender change. “Our doctors have recommended a psychologist to help Danish with the transition,” says Shan.

Danish’s case might be rare, but it would be foolish to turn a blind eye to such patients.

According to the Pakistan Journal of Medical Sciences, 61 patients were diagnosed with the same condition in 2011. The sooner we accept that such conditions exist, the better chances we will have of saving hundreds of children from a life of confusion and shame. *Names have been changed to protect privacy.

Ms

en vogue

Summer

Glam

4

Sheep’s latest collection is a perfect mix of pastel colours and embroidery.

Coordination: Umer Mushtaq Hair, Makeup & Grooming: Saba Ansari at Sabs Label: Sheep Photography: Jaffar Hassan Models: Fia Khan and Omer Shahzad

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

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lifestyle

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

Taking on a new role Pakistani women venture into fields that were previously considered to be a ‘man’s domain’ by Wishaal Khalid

Revolutions are, by their inherent nature, loud and fearless. But in Pakistan, a silent revolution is slowly and noticeably reshaping the structure of society – redefining pre-existing attitudes towards gender roles. Women, who were once expected to be seen and not heard, are now stepping outside the comfort of conventional or safe career paths, such as teaching and nursing, to cement their role in professions they were once alien to.

Experimenting with science When it comes to women in science, the West has always stood out with prominent names such as Madam Curie, a pioneer in conducting radioactivity research. While Pakistan may not top the list, according to the Pakistan Bureau of Statistics’ ‘Employment Trends 2011’ report only 24.4% of women in the country are classified as working women, it is making headway in this field.

Standing against all odds, Dr Mariam Sultana, who is the first Pakistani woman to earn a PhD in astrophysics, is now a lecturer at the mathematical sciences department of the Federal Urdu University of Arts, Science and Technology. “Gender inequality is a primitive concept in the cities now. It may still be prevalent in rural areas where women [continue to] face many challenges, but there is no such thing in Karachi,” she says assuredly. Although Sultana’s challenges did not stem from deep gender biases, she faced a great deal of disapproval from her students and their parents, who confused astronomy with astrology and declared the subject ‘haram’.

While engineering is another perceived no-go area for women,

the classroom dynamics are now changing with more and more female students filling the seats at engineering universities across Pakistan. Nida Farid, who studied aerospace engineering from Massachusetts Institute of Technology in United States, is now a renewable energy consultant, specialising in wind energy, in Pakistan. She even played an active part in the construction of electro-structural components for the Airbus project in Switzerland and continues to shrug off filial and social pressures to switch to a more conventional job.

Driving through barriers Pakistani women have taken to the roads as well and are making headway in the transportation sector. Many women from Lyari, Karachi, in a bid to lead independent lives, have taken up driving to earn an income. Forty-year-old Shabana Parveen, from Surjani Town, Karachi, who has been in the pick-and-drop business for primary students for the past 10 years, says that although she’s always been passionate about driving, she only recently took up the profession. After marrying a low-wage factory worker, she had to contribute to the family income to make ends meet. “I took a taxi on rent to support my family,” she says.

Stories of women taking charge of the wheel are plenty.

Wajeeha, a 12-year-old from Charsadda, Khyber Pakhtunkhwa, has been riding a rickshaw since 2010 after her father, a soldier, was severely wounded in a clash with the Taliban and was no longer able to financially support his family. She also never let her work get in the way of her education and simultaneously completed her schooling.

Dodging the bullet A surprising number of Pakistani women have also joined the military and police forces since 2006 and Ayesha Farooq became Pakistan’s first female fighter pilot in 2013. Along with defending the country, Pakistani women have entered the field of security to claim their right at equal employment opportunities. Shahnaz, heading the female wing of a private security service, is currently employed as a security head at the Karachi University. She arrives daily before students to make sure no outsider enters the premises without prior permission. “I did not want to get married and that made survival [in society] quite [difficult],” she says, adding that she took up the job so she could be independent.

Rebranding the word ‘woman’ While women across the world have proven to be convincing in sales, Pakistani women have only recently realised their potential in the field. With a number of boutiques and supermarkets springing up in city centres, women have taken up the opportunity to earn a steady income by selling wares and assisting customers. Sumaira, who runs her shop for ready-to-wear clothes in Hyderi market, Karachi, is an ideal example of women who’ve excelled in the field. “It is a constant struggle to ignore comments and focus on your work,” she says, adding that despite the negativity she hasn’t stopped going to work.

While Pakistan may still be light years away from complete gender equality, its women have surely set out on the right foot.

Their relentless efforts are not only bridging the gender gap but also motivating others to follow suit.

domestic goddess 7

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

Recipe

Egg Pudding

A delicious dessert that will make you come back for more.

Maheen Ibrahim indulges in her passion for cooking, in between raising three kids, running the household and catching up on her reading.

Method • Cover the pot and let the water boil.

• Boil the milk in a saucepan and let it cool.

• Once the milk has cooled down, add sugar and stir.

• Take another pudding pan and cover the bottom of the pan with sugar. Melt the sugar until it is golden brown to make caramel.

• Set the caramel aside to cool.

• In a large mixing bowl, add the eggs and whisk thoroughly.

• Put the egg mixture in the milk using a strainer.

• Add a pinch of orange food colour and whisk again.

• Pour the mixture in a pudding pan and place it in the boiler with the pudding pan covered. Place something heavy on top so it is airtight and cook for 35 minutes.

• Once cooked, place the pudding in the fridge.

• Remove from the pan and serve chilled.

Ingredient:

Eggs 12 (large size)

Milk 1 litre

Sugar 24 tbsp

Food colouring a pinch

Sugar enough to coat the bottom of the pan (for the caramel)

woman of the week 8

THE EXPRESS TRIBUNE, SEPTEMBER 7, 2014

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