Altaf Hussain ‘Hali’ was an important literary figure that bridged the nineteenth century and the beginning of the twentieth century. Hali was a literary historian, critic and an Urdu poet of the first order.

Hali is arguably most famous for his long poem about the rise and fall of the Muslims called Musaddas-e-Hali. He evidently wrote this after a suggestion to do so by Sir Syed Ahmed Khan. For most people in my generation one of the things we did among others as a part of growing up was to read the Musaddas by the time we hit about ten years of age. So did I.

For all these years I remember the message but not much of the verses in it except for the opening lines. The opening lines sort of stuck in there since I went on to become a physician myself. Basically Hali in these verses compares the Muslims to a patient that ignores the advice of his physician.

I will take a stab at translating the opening six lines (Musaddas). "Somebody once asked Hippocrates what diseases he thought of as incurable. Hippocrates replied that there were no maladies for which God had created no cure except those that the patient considered insignificant and ignored the advice of the physician as nonsense".

The reason why I am thinking of Hali and his above verses is because as time goes on I have started to believe that humanity is not imperiled by some natural cataclysm but rather by our innate inability to accept sane advice. In the field of medicine three things are happening that bring Hali’s complaints about patients and physicians to mind. And I have written about them all in these pages over the last couple of years.

The first is the excessive and inappropriate use of antibiotics, often without prescriptions that is creating new super bugs that are increasingly resistant to usual antibiotics. The rise of such a Typhoid bug in Sindh was reported recently.

The second problem is that of the ‘antivaxxers’ who are refusing to let their children get vaccinated. These come in two major variations. The first are the so called well educated people that have decided that somehow vaccinations are causing an epidemic of ‘autism’ and other childhood problems. A lot of ‘pseudo-science’ is floating around on the Internet which is being used as an excuse to oppose routine lifesaving vaccinations.

The second category of the antivaxxers is those that oppose vaccination on religious grounds. Here also there are no established religious beliefs that oppose vaccination but even so there was a recent outbreak of measles among children of some conservative Jews in New York City. More than a hundred children were reportedly infected.

In our part of the world, medical teams vaccinating children against polio have been attacked by those possessed by an excess of religious zeal and such attacks have even resulted in deaths of the vaccinators. The end result of such religiosity is that polio as a disease will remain active in Pakistan.

If the resistance to vaccination spreads then many diseases that we thought were gone forever will return. Also modern travel has become so fast and widespread that new epidemics can spread very rapidly. Yes we are much better informed than we used to be but there is the problem of ignoring or even defying medical advice that is becoming an important problem.

Now to another medical problem that is in the news. It is the discovery of a cluster of Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome (HIV-AIDS) infected patients in Sindh. A single physician giving ‘injections’ with unsterilized needles is being held responsible for this outbreak. Possible but not highly probable.

The AIDS virus can be transmitted through ‘shared’ needles. But considering the large number of small children infected, it is difficult to give them intra-venous injections so these children might have been infected by their mothers. A proper investigation needs to be conducted to determine how these patients were infected and who or what was the source of the infection.

Almost a year ago in an article about HIV-AIDS in Pakistan I had warned about the coming AIDS epidemic. The discovery of more than a hundred ‘new’ patients in just one town in Sindh suggests that this disease has entered the population ‘at large’ and will start spreading.

Already in Pakistan we have an epidemic of Hepatitis C (Hep C) with an estimated ten percent of the population infected. And a recent statistic suggests that more than a million patients with Hep C urgently need a liver transplant. HIV infection spreads in almost a similar fashion to Hep C and the initial infection is also usually mild and might be missed but the lethal effects of AIDS become apparent many years later.

The spread of this disease in Pakistan will follow in a similar pattern to the spread of Hep C with disease spreading through injections given usually by untrained and unlicensed medical practitioners using improperly sterilised needles.

Then will come unchecked blood transfusions followed by minor surgical and dental procedures performed by roadside dentists and other such practitioners. Then there is the ‘needle sharing’ that goes on between intra-venous drug abusers.

However one way of HIV transmission will be ignored in Pakistan. That is the transmission of the virus through sexual activity. Suffice it to say that in the early years of the AIDS epidemic in the United States before the virus was identified, the disease was often referred to as the ‘Gay Plague’.

It is not my intention to give a sermon about sexual morality. However the point I will make is that the spread of HIV-AIDS among the gay population was eventually controlled by the use of ‘safe sex’ practices, primarily the use of condoms during sex. Already the advice about the use of condoms has been floating around in Pakistan in the context of ‘family planning’ but with little effect.

Here again ignoring advice from physicians is likely to play a role in the spread of HIV-AIDS in Pakistan and if it spreads like Hep C, that could create a major healthcare crisis in Pakistan over the coming years. Fortunately HIV infection can now be effectively controlled through medicines but first we have to identify that infection.

As important as all these problems that I have mentioned above are, the future of the human race on this planet depends to a great degree on the effects of climate change. Here again advice from ‘doctors’ (original meaning of the word being wise and learned men and women) about the effects of climate change is being ignored.

As an optimist I do believe that scientific progress will mitigate some of these problems. New antibiotics will be discovered and already medicines can now control Hep C as well as HIV-AIDS.

About global warming I am not sure. Sadly most of my generation that still runs much of the world will be gone by the time global warming evolves from a problem to a universal catastrophe. Those that run the world today don’t really care about it, or do they? We will find that out over the next few years.