“Early diagnosis could save lives”

pinktober

To observe Breast Cancer Awareness Month, we speak to Dr. Muhammad Arif about the disease, its symptoms and treatment options, and the very significant importance of early detection

Breast cancer is a pesky interloper that has a cruel habit of cutting lives short in the most unfair of ways. It can sit silently in a person’s body, spreading its tentacles till it eventually strikes with vicious force. It can take over the lives of those in treatment as well as those around them for months, if not years. It can ravage the body and spirit of the patient and leave a permanent scar on the hearts of their loved ones.

But it doesn’t have to.

If detected early, the disease is fairly easy to control with extremely promising chances of survival. But in a country like Pakistan, where awareness levels are low and the healthcare system severely lacking, the outlook is often more grave. By the time most women realize they have the disease, it is already at an advanced stage and far more difficult to manage.

“As a nation, there is a delay in diagnosis and many patients do not survive because by the time they are diagnosed their disease is late-stage,” Dr. Muhammad Arif tells Instep. He is the owner of the Razia Sultana Memorial Cancer and Blood Associates clinic, named in honour of his late mother who also battled the disease.

So what exactly is this nasty malady that seems single-mindedly hell-bent on causing misery? Cancer is basically a group of diseases characterised by the uncontrolled division of cells (which are the basic building blocks of a living being). And what causes this unregulated cell multiplication? “There are a lot of theories,” Dr. Arif replies. “The old theory was that this is genetically determined. But after research into DNA and mutations, we found out that cancer is not necessarily genetic. It is mostly caused by metabolic problems in the body which then trigger cell growth.”

According to the oncologist, about seventy percent of cancers in general are now attributed to lifestyle issues, such as what we consume and how active we are.

Our diet, he says, is one of the fundamental driving forces behind the ailment. “The so-called industrial diet of today, products which are far from natural foods, [damage our bodies],” he explains. He lists the overconsumption of sugar and sweets, bakery products, vegetable oils, chicken and other meats, and Western-styled junk food as contributing factors and explains that we simply are not used to the chemically processed items we are now consuming. “We have evolved millions of years to get to this level, but in the last 100 years or so, our diet has been turned upside down. Things like over-processed oils are a huge factor in this, as are the chemicals and preservatives that are used to enhance the taste and shelf life of food [but that aren’t good for the human body].”

Unhealthy and fatty diets alongside a lack of activity, like exercise and walking, lead inevitably to weight gain. “In breast cancer, one of the highest risk factors is obesity and inactivity,” he says. Stress can also make the disease worse in patients who already have it. And then there are elements that cause a disruption in our internal metabolism but which we can’t easily influence, like our environment, the toxic chemicals that have been sprayed on the vegetables and fruit we consume, fertilizers, pollution, and water supplies contaminated with factory runoffs.

Specific to breast cancer, a woman’s familial history (first degree relatives with breast cancer) as well as reproductive history (early menarche, late menopause, and late first pregnancies) are often cited as risk factors. 

Altogether, these elements play a role in triggering a disease that disrupts the lives of millions of women – and even some men – every year. According to the World Health Organization, in 2020, there were 2.3 million women diagnosed with breast cancer as well as 685,000 deaths globally. While real data about the prevalence of breast cancer in Pakistan is not available, Dr. Arif says that according to estimates, about 1 in 7 or 8 Pakistani women will develop this disease in their lifetime, with Pakistan being among the highest risk countries in the breast cancer category worldwide. 

Detecting the disease in its earliest possible stage is the best way to combat this life-threatening adversary. And awareness of the symptoms certainly helps. “The most common sign of breast cancer is a lump in the breast. Sometimes there is a discharge from the nipple, swelling, or skin discolouration,” the doctor details. If the disease has spread, then it can cause any sign or symptom anywhere in the body, like pain in the back or in a bone (bone metastasis), a cough (if it has spread to the lungs), or swelling in the neck (if there are tumours in the neck nodes). “I think, as a general rule, any symptom that is new and persists beyond a few weeks should be investigated properly by a qualified physician,” he says. 

Thanks to scientific advances, we now have several treatment options for breast cancer. Surgery can remove a tumour; chemotherapy kills cancer cells with medication; radiation therapy sterilizes the area affected by the disease and destroys the cells responsible for the growth; and targeted treatment, like hormone therapy and immunotherapy, attacks specific elements to slow down or eliminate the growth. 

Treatment options are dictated by how advanced the disease is. If diagnosed at an early stage, the treatment is likely to be less taxing and more effective. With metastatic disease, surgery is no longer an option and the symptoms are basically managed with medication and radiation but the intent is generally palliate and no longer curative.

“Stage I breast cancer – where there is a small tumour in the breast which is less than 2 centimetres in size – has an 85 percent rate of survival. In Stage II, the chances of survival go into the 60s and 70s. Once it’s Stage III, it’s not only in the breast but is in the axilla as well, having spread through the lymph nodes, and the survival rate drops to less than 50 percent. When the disease is at Stage IV and has gone beyond the breast region and spread to another organ, then the five year survival is less than 10 percent.”

Dr. Arif strongly suggests that women, especially those who have close relatives – mother, sister, aunt – with breast cancer, pay special attention to any and all changes in their breasts. “In other countries, there is a lot of screening which leads to early detection and people get treated. [The lack of screening here] is a major factor why our mortality rate is very high,” he says. “By Western standards, the recommendation is that any woman who has a strong family history of breast cancer should get a mammogram every year after the age of 50. In the Pakistani context, I think it is not feasible to perform a mammo on every woman every year [because of high costs and lack of facilities]. So I think the most important thing for a woman would be to pay attention to the symptoms, pay attention to any lump they feel in the breast, and get the lumps investigated with an ultrasound and mammogram immediately.”

He also reasserts that special attention should be paid to prevention. “[It is essential] to take care of the lifestyle factors, like a proper diet, weight control, exercise, and stress management. Then there is self-examination; if you notice anything new, any symptoms at all, try to pay attention to it right away so that there is no delay. Early diagnosis could save lives.”

So try your best to take good care of your bodies. And no matter what your age, gender, or lifestyle habits – this disease can affect anyone, irrespective of their risk factors, after all – monitor any changes in your breasts (or elsewhere), get regular clinical examinations, follow the advice of the experts, and encourage your family and friends to do the same. Be vigilant, and spread the message. It could ultimately make a world of difference.

- By Sameen Amer

Instep, The News on Sunday - 30th October, 2022 *

Bringing it home

cover story

As Coke Studio takes its live show to Dubai, Instep asks industry insiders about the issues associated with live events in Pakistan and what can be done to have bigger, better concerts here.

Coke Studio is going live! The country’s biggest music platform is taking its magic from television to stage for an evening filled with song and dance.

It’ll be huge! It’ll be amazing! It’ll be ground-breaking!

It’ll be ... in Dubai.

That sound you just heard … that was our enthusiasm collapsing in on itself to form a giant black hole of disappointment.

Coke Studio Pakistan! Live! In the U.A.E.?!

So, what exactly is going on? Here’s a quick recap. 

Once upon a time – back in the good old days of yore when corona was just that luminescent ring around the Moon and Donald Trump was just that guy from The Apprentice – one Rohail Hayat took the idea of a concert-like platform from Brazil and turned it into the most successful music show in the history of Pakistani television. It was an audience-pleasing, career-making hit from the get-go, combining traditional and classical music with contemporary sounds to create irresistible fusions, with Rohail himself spearheading the production.

Several seasons, and a couple of personnel shuffles, later, the long-running series ended up in the very capable hands of Zulfiqar Jabbar Khan, a.k.a Xulfi, who breathed new life into the by-then tiring franchise. The result was stellar. From the stratospheric success of Ali Sethi and Shae Gill’s ‘Pasoori’ to the infectious charm of Kaifi Khalil, Eva B, and Abdul Wahab Bugti’s ‘Kana Yaari’, the fourteenth season offered plenty of bops and earned well-deserved global attention.

Then came the announcement of a live gig, the first show of its kind, which, unlike those Coke Fests that insisted on putting food and music together, would focus solely on the performances. 

Recruited for the show are the likes of Faisal Kapadia, Hasan Raheem, Karakoram, Young Stunners, and Justin Bibis, as well as the aforementioned Ali Sethi and Shae Gill, stars of the latest season who will perform their hits at the Coca-Cola Arena in Dubai later this month. Spectators will also have the chance to witness the moves of Norwegian hip-hop dance group Quick Style. And we can only assume that a handful of surprises are also in store.

Instead of debuting the event in Pakistan though, Xulfi and his team have opted to go straight to Dubai. So, yeah dude, what gives?

“The Coca-Cola Arena in Dubai is an arena for global events,” the producer tells Instep. “We see Coke Studio as a language we speak to the world, the language of art from our part of the world, from Pakistan. Also, Coke Studio 14 has had a heart-warming global response. So it’s crucial that part of our focus should always include an approach that’s transcending boundaries.”

All fair points, plus you can’t fault him for reaching for the stars. He clearly aims to put on a show of international calibre, and knowing Xulfi, it’s safe to assume he’s crafting something special. “A representation of Pakistan with so many of our artists performing together hasn’t happened on this scale before,” he says. “Think of it as a medium for aspiring musicians from Pakistan to express and perform live in front of the world.”

When Bryan Adams came to town

While it would have been nice to have the Coke Studio artists serenade their local fans, we must concede that it is still all kinds of cool that the show will be abroad and we finally have a bona fide musical export that excites the world. Plus it’s fairly obvious that putting together a massive event in Pakistan comes with many challenges. Just ask Shehzad Roy. The singer – who has not only spent nearly three decades in the music industry but has also made an impact with his philanthropic work – was the driving force behind what remains one of the most memorable concerts in the country’s history: the performance by Canadian musician Bryan Adams (who happens to be Shehzad’s friend; you have our permission to be impressed) in 2006 at Karachi’s Arabian Sea Country Club.

Shehzad remembers the Rock for a Cause gig with fondness. “It was an amazing experience,” he enthuses. “We’ve all grown up listening to the music of Bryan Adams. Singing ‘Summer of ‘69’ and ‘Let’s Make a Night to Remember’ with him – we sang those songs together – was also a terrific experience.”

The event served as a fundraiser for Shehzad’s Zindagi Trust and to aid the victims of the devastating earthquake that had hit the country a few months prior. And although the ‘Saali’ singer and his team pulled off the concert without a hitch, putting together the show was easier said than done. 

“Organizing anything at this scale is very difficult,” he says, citing everything from security concerns to technical issues. But the main problem his team ran into was the lack of a proper venue. “We couldn’t figure out what the venue should be,” he says. They needed a space that could offer a proper concert environment, plus handle everything from ticketing to the technical elements. The right place was hard to find. “We had to set up a whole infrastructure at the eventual venue. So that was a huge issue. There is no infrastructure here for events like that. Plus there are things like security and other considerations. There are venues available in other parts of the world – you go and everything is arranged. But I think venue was the biggest issue for us, because we don’t have places where we can arrange big concerts with the required equipment and all things necessary.”

Local fans of international artists would have hoped that the Canadian singer’s show would be the first of many of its kind, but that was not to be. “[After the Bryan Adams gig], several international artists [expressed interest],” Shehzad reveals. “In fact, I did a show – a fundraiser for our organization – with Guns N’ Roses but in L.A. because it was difficult to do it here and there were multiple other reasons as well. There are several artists I have met that were all willing [to perform here], but this isn’t my job plus it’s very difficult to arrange.”

So what makes it so challenging to arrange a show in Pakistan? “I feel like there’s an issue of uneven growth [here],” Shehzad answers. “You have one of the top hospitals, top buildings in Karachi, and there’s an open gutter nearby and the garbage isn’t being removed. Just like that, when you arrange anything, some things are very organized, while others very disorganized. Especially in concerts, you have things like … the kind of lights and sound system they expect, they then have to bring it themselves. And arranging international concerts is a huge issue.”

The way forward, he thinks, lies in creating a concert culture in the country. “It’s just like movies,” he says. “If your cinemas are being closed, then you won’t get movies. Just like that, if a significant number of concerts aren’t being held, then the system won’t be established. And then doing big concerts all of a sudden will be very difficult.”

Music festivals of the mad decent variety

The other major event that came our way was the Mad Decent Block Party in Islamabad in 2018, an event that was labelled as Pakistan’s first international music festival, and saw the likes of Diplo and Major Lazer Soundsystem performing alongside local artists like Adil Omar and Talal Qureshi.

“When my company, Black Box Sounds, invited Diplo and Major Lazer, two major EDM acts to Pakistan for Mad Decent Block Party, Pakistan was not considered a possible performance destination by any international act,” explains Irshad Ali Khan, the co-founder of the aforementioned company that organized the event. “It took a lot of courage and nerve for us to take on something like this and I am happy that we were able to pull it off successfully.

“There were many challenges, including the perceptions of security in the country, which made it very difficult to convince an international act to visit Pakistan,” he states, expressing gratitude to the artists for committing to visit at a time when the Western media was only running negative stories about the region. “Other challenges from within Pakistan included arranging visas for the artists, scouting for a large enough and secure enough venue, ensuring the right audience, artist insurance, ticket control, security, etcetera. As you know Pakistan did not have the right infrastructure and systems to facilitate such an initiative back then and still there is a lot that needs to be done to make it easier.” 

Irshad also laments the “dearth of good, skilled organizers” and their impact on the overall image. “What we do with a dozen good events gets ruined by one untoward incident at a badly managed event,” he says

Despite everything though, Irshad and his team found the experience very rewarding and cherished the opportunity to create a market for EDM in the country while showcasing Pakistan as a progressive and inclusive society. “I think that tour actually put Pakistan on the map of performance destinations for international acts for the first time. Diplo rightly called it DJ Diplomacy, as with international news outlets such as CNN and BBC covering it, it brought a lot of positive light to Pakistan’s cultural resilience in some of the darkest days for the nation.”

To make bigger events possible, Irshad thinks that we all need to work together. “Make sure that all players involved in the game from artists to organizers to administration and relevant government departments and most importantly the audiences understand that it is important to keep this positive trend of successful events going if we want to bring in more mainstream and well-known artists to Pakistan. We definitely don’t want to be missing out on our place on the global stage. All we need to make this happen is to keep at it, keep trying to do bigger and better events, and never compromise on the essentials that make a good safe entertaining event for all.”

Krewel intentions

As challenging as it may be to arrange massive shows here, music fans have no reason to despair, for there is a lot more on the horizon. Despite any issues, several local platforms – from Lahore Music Meet to Salt Arts – are continuing to put on enjoyable shows. Plus we will see more international acts here as well, like EDM duo Krewella who are all set to tour Pakistan in January next year.

And yes you guy, put down those pitchforks and take a chill pill – Coke Studio Live WILL come to Pakistan. Eventually.

“This is a beginning,” Xulfi says with reference to the show in Dubai. “The vision is that CS Live, at this scale, frequently happens in Pakistan. Not just that, in fact the idea is that the concert space can evolve into an experiential space for the audience. It’s important we do it to ensure the love and interest for a live music experience never wanes.”

And just like that, from the ashes of our disappointment rises the phoenix of hope! All hail the gods of music! Now if someone could help us figure out how many kidneys we’ll need to sell to afford all those darn tickets, that would be a big help, thanks a bunch!

- By Sameen Amer

Instep, The News on Sunday - 9th October, 2022 *

Of global triumphs and cross-cultural rom-coms

talking movies

The last few months have shown that our artists and creatives have the ability to shine at an international level. Films like the upcoming What's Love Got to Do with It? will hopefully help continue that trend.

If you are passionate about Pakistani entertainment and have spent the longest time frustrated with the quality of our output and feeling like you’re stuck in the timeline that’s meant to cause you maximum disappointment, then you’ll be relieved by the recent developments in Pakistani music and cinema. Turns out you were actually in the most rewarding of alternate universes after all, for Pakistan is having a spectacular moment in global entertainment and it’s absolutely glorious.

Within a span of months, we have been blessed with our very first Grammy winner (Arooj Aftab), our first major superhero gracing the Marvel Cinematic Universe (Ms. Marvel), the global recognition of a local song (‘Pasoori’), and the unprecedented success of the film Joyland that has earned critical appreciation at both the Cannes Film Festival and the Toronto International Film Festival.

We are on a roll! And it doesn’t stop here. 

There’s more on the horizon, including a British movie that pays homage to Pakistani culture. Penned by Jemima Khan and starring talent from both Britain and South Asia, the romantic comedy What's Love Got to Do with It? takes a cross-cultural look at love and is all set to arrive in cinemas early next year. 

Its premiere at TIFF was well-received, and we can see why based on the trailer.

The clip introduces us to Lily James’s Zoe, a documentary filmmaker whose efforts to find love on dating apps haven’t yielded the results she would have hoped for, much to the dismay of her mother, Cath (Emma Thompson). When her neighbour, Kaz (Shazad Latif), decides to follow in his Pakistani parents’ footsteps by opting for an arranged marriage, Zoe decides to film his journey, following her childhood friend from London to Lahore to marry a stranger – Sajal Aly’s Zoya – chosen by his parents.

It’s a joy to see Pakistani culture take centre stage in a foreign flick. Jemima Khan has described the project as “a celebration of all things Pakistani, [and] a love letter to my old friend Pakistan”, and given the credentials of its filmmakers, the movie will hopefully take a respectful, insightful look into a very different approach to finding love.

Films like this will hopefully put a positive spotlight on our country and help our talent – both in front of and behind the camera – gain recognition and earn the chance to explore other international projects. 2022 has shown us that we have the ability to shine at a global scale. Here’s to our creatives continuing to impress and making a mark, breaking barriers, and taking our entertainment industry to even greater heights in the months and years to come.

Helmed by Indian director Shekhar Kapur and also starring the likes of Shabana Azmi, Asim Chaudhry, Jeff Mirza, and Mim Shaikh, What's Love Got to Do with It? is a StudioCanal presentation produced by Working Title Films in association with Instinct Productions and will be released in January 2023.

- By Sameen Amer

Instep, The News on Sunday - 2nd October, 2022 *

In the picture: Lou

movie review

It may be formulaic and predictable, but action thriller Lou still makes for a fun watch, thanks in large part to the considerable talents of its leading lady

Lou

Starring: Allison Janney, Jurnee Smollett, Logan Marshall-Green, Ridley Bateman, and Matt Craven

Directed by: Anna Foerster

A young girl is taken. Lucky for her though, her neighbour is Lou, an aging lady who has a very particular set of skills, skills she has acquired over a very long career, skills that make her a nightmare for people like the kidnapper.

Well, sort of.

The new Netflix action flick Lou retreads old ground, venturing onto paths that several thrillers have walked down before. Lucky for us though, the film is in the very capable hands of Allison Janney, a wonderful screen presence who makes her strong, kickass character a delight to watch.

Allison’s gruff loner Lou is, the movie tells us from the very start, a troubled soul. She lives with her dog Jax in a small, isolated island community in 1980s America, and demons from her past are making her want to forego her future. But when Vee (Ridley Bateman), the daughter of her tenant, single mother Hannah (Jurnee Smollett), goes missing, the protagonist immediately springs to action and heads into the woods to go on the trail of the man (Logan Marshall-Green) who has kidnapped the girl.

To make matters worse, a torrential storm has hit the island and is making it even harder for the women to navigate the area’s trying terrain.

But the road is riddled with derivative elements and silly turns and ultimately leads to a fairly foreseeable destination, made all the more predictable by the fact that the movie keeps telling us that everything isn’t quite as it seems and a convoluted revelation is imminent.

The story around the strong central character could have been more convincing, and while the rain makes for a fittingly grim backdrop, the film could have perhaps spend a little more time exploring the survivalist aspect and the harshness of the elements or at least thrown in a couple more adversaries for Lou to defeat.

Still, it is so much fun to watch the wonderful Janney being a total badass and so refreshing to have an older heroine in charge of an action vehicle. Lou gives Janney the opportunity to not only show off her action chops but also display enough emotional depth to keep you invested in the drama. 

All in all, it may be formulaic but if you’re in the mood for a good old fashioned action thriller, then Lou will deliver some escapist fun, even if it doesn’t leave you with much to think about.

Rating: 3 out of 5

- By Sameen Amer

Instep, The News on Sunday - 2nd October, 2022 *