Author: AbdulMajeed Abid

Farewell, Houston

I arrived in Houston because of an email. I had just gotten done with my USMLE step one in July 2016 and was furiously emailing people in the U.S. for possible observer-ship opportunities. I did not get a lot of replies. Almost a week after I had started this process, I got an email from a famous pathologist at M.D. Anderson Cancer Center (MDA) in Houston. It was brief and to the point. He wrote that he can accommodate me next year in April. I was over the moon. Prior to this episode, I had never been to Houston or known anyone from the city, except a professor of history at Rice University.

I arrived in Houston in April 2017 after spending some time doing observer-ships and studying for USMLE step two, in West Virginia and Miami. It wasn’t as hot as I had expected it to be and in my initial encounters, I found people to be generally friendly and warm. Houston wasn’t culturally impenetrable as Miami or as distant as West Virginia. It was a city teeming with people who looked like me, with huge hospitals and endless roadways. I had booked an Airbnb for my first two weeks of stay and then moved to a private room I had rented from a very interesting character named Gustavo (Gus). I met Gus through a random mutual friend on Facebook, a Pakistan-American girl who had added me as a friend after some of my work on environmental issues in Pakistan. She was renting from Gus at a different location and got me in contact with him. I spent two months at MDA, left for three weeks to visit Pakistan, and returned to the Houston area. While I was at MDA, I met a resident from the University of Texas Medical Branch in Galveston who got me intrigued about the program and I met the Chair of the program who was welcoming. Afterward, I was in Galveston for the next three years, firstly to do research or get observer-ship at the medical school there (didn’t get either) and later, for residency training at the same medical school. Two years into my residency (total of four years), we moved to the clear lake/NASA suburb of Houston, and another two years afterward, out of Houston for good, for my fellowship.

It was a tough decision to leave but after a lot of brainstorming and weighing options, I felt it best to leave the area. There were many things that I like in Houston and a lot more that I disliked. Following is a brief discussion of both.

Things I will miss about Houston/Texas

Food/”Shef”/Diversity

Houston has been ranked as the fourth most diverse city in the United States. According to some data that I’ve seen, there are more Pakistanis living in Houston metro area than anywhere else in the US. A lot of Vietnamese refugees during the 1970s settled there and the Hispanic community has always had a foothold in the city. I remember once interacting with people from nine nationalities in a single day while I was at MD Anderson. As with other diverse places, I didn’t find many regional/national ghettos in the metro area. However, there are places with more people of one ethnicity than another; with an abundance of Desis in Sugarland, same in the Chinatown area but you can find different ethnicities almost everywhere in the city.

Mahatma Gandhi district/Hillcroft Avenue offers some of the best Indian/Pakistani restaurants in the country. I will certainly miss the Halwa puri, chaat options, and Indian vegetarian food available in the area. A year or so ago, I found out about a food service where you can order home-cooked food from local chefs, called “Shef”. I availed myself of that service every week and had some delicious food without having to cook it myself. Shef is available only in a few cities in the U.S. (NYC, San Francisco, L.A, Houston, and D.C. as far as I’ve checked) and I will sorely miss the time it saved me and the variety of Indian food that I could taste at a great cost.

There were also many “fusion” foods that chefs created because of diverse cultures. Halal southern hot chicken sandwiches and Texan-Vietnamese tacos were just two examples. 

Another example of diversity was a halal grocery store in the same shopping plaza as “battle rifle company”. 

Organized medicine 

One of my friends in Miami told me before I arrive in Houston that Texas is a great place for doctors to live and work. I did not know what she meant and didn’t press her to explain why. Many years later, I understand what she meant. It was not just about average salaries or jobs, both of which are plentiful in Texas. It has to do with tort reform in the state that was enacted in the early 2000s after long-term advocacy by Texas physicians. I had the unique opportunity to interact and work with some of the people who worked behind the scenes at the time advocating for tort reform.

I got my first taste of organized medicine through the Texas Society of Pathologists (TSP). I started off as a liaison from TSP to my program and eventually ended up being Chair of a committee and being on other committees. TSP is the oldest pathology society in the US (established 1921) and is also the most active state society in the field. TSP works under the umbrella of the Texas Medical Association (TMA). TMA has more than 55000 members including medical students, trainees, and licensed physicians. TMA was responsible for getting tort reform enacted in the state because residents were leaving the state after training in droves because of high liability insurance rates in the late 1990s and early 2000s.

TMA is a behemoth with millions of dollars in assets, lobbyists in Austin, a liability insurance trust, and a foundation that gives away millions of dollars to deserving medical students across the state. TMA also gives out educational loans to medical students and residents at very low-interest rates. I was part of the Resident-Fellow section and served on the board of the TMA foundation for a year, followed by a year of the TMA board of trustees. During my time on the board of trustees, physicians in Texas faced unprecedented challenges such as Texas laws S.B. 6 and S.B.8 and a national dispute over the “No Surprises Act” for which TMA sued the HHS.

The house of medicine is under assault from many sides. Right-wing assault on reproductive care, private equity eating up hospitals, encroachment from extender services like physician assistants and nurse practitioners (called “scope of practice”), and Medicare cuts are some of the highlights. TMA is involved in fighting all of these, on a state and national level.

Things I will NOT miss about Houston/Texas

The weather 

Before I arrived in Galveston, my professor friend from Rice had warned me about hurricanes. Galveston Island was decimated by “The Great Storm” of 1900 and the whole city had to be rebuilt. Since then, other hurricanes have affected Galveston, the most recent being “Ike” whose storm surge flooded the island, at some points reaching six feet in height. My friend’s prophecy almost came true in August 2017 with Hurricane Harvey, but instead of Galveston, it caused massive flooding in Houston. Since then, I became an amateur meteorologist between June 1st and late October (hurricane season) every year, trying to discern which tropical disturbance could affect us when. We had some near misses in the last few years until there was a snow storm in February 2021, which caused blackouts, reminding me of Pakistan.

Even besides the hurricane season, Houston’s weather was frustrating at best. On January 1st, 2022, it was 80 degrees in the afternoon, dropping to 35 degrees at midnight. Houston weather resembled Lahore weather quite a lot, with humidity as the cherry on top. It could be 80 degrees with a real feel of 103 because of humidity. Even A.Cs don’t work above a certain temperature. Last year, between July and September, our central A.C. couldn’t cool off during the last few hours of the day and we were stuck between 73 and 78 degrees until late at night. The temperature started soaring in late May and days would be hot and humid till December. And it is only getting worse with climate change. A friend recently posted on Facebook that “Texas is that feeling when you open the oven to check on your cookies and you burn your face. Only there are no cookies and you can’t shut the oven door”. Just as I was writing this, saw this headline: “Extreme heat pushes highs over 110 in Texas as power grid nears brink”.

Urban Sprawl 

Harris County, with Houston as its main city, has a larger population than more than 30 states in the U.S. Houston is second only to Dallas in terms of cars per household in the U.S. as well. Combine these two facts with the never-ending expressways and you have a city in which you have to drive at least 30 minutes to go anywhere. I remember carpooling with a guy once who drove from his house in the Northern part of Houston to Galveston (almost a two-hour journey) starting at 4:30 am. He would leave Galveston in the late afternoon to get home by 6:30 pm. This is not a typical drive in the area but many people I knew (including myself) had long commutes every day. Texas is mostly flat so all you get along your drive are strip malls and gas stations. As a result, greenhouse gases generated on Texas roads account for 0.5 percent of total worldwide carbon dioxide emissions, even as the state accounts for 0.38 percent of the world’s population. The only good thing about roads in Houston are the feeder roads, so if you miss an exit, you can take the next one and turn around.

For anyone more interested in reading about Houston’s infrastructure issues and history, Stephen Klineberg’s book “Prophetic City: Houston on the cusp of change in America” is an excellent read.

An imaginative take on Texas roadways in the Texas Observer: https://www.texasobserver.org/the-road-home/

Politics

Texas is second only to California in terms of residents. As the saying goes, everything is big in Texas. That includes the disregard that politicians have for their constituents. The late great Molly Ivins, one of my favorite Texans of all time, once wrote this about the Texas legislature: “As they say around the Texas Legislature, “If you can’t drink their whiskey, screw their women, take their money, and vote against ’em anyway, you don’t belong in office”. A friend of mine from Lahore once called and asked how Texas treated people. He was intrigued because he had read in the news that a lot of businesses were moving their HQs to Texas. I told him that if you are not a straight, white, Christian man with a small business in the state of Texas, the state government doesn’t care if you live or die.

Texas lags behind on all key indicators of education, healthcare (despite it being so good for doctors), nutrition, and income inequality compared to other big states in the union. There are more uninsured people in the state than anywhere else because Texas politicians refuse to expand Medicaid and impose work requirements on the poorest people. Maternal mortality rates are even lower than the national average. Texas’s power grid is not connected to the national grid, which makes a great advertisement for “doing it all alone” but is a terrible idea in a state so prone to natural disasters. The level of corruption in Texas has been phenomenal over the years, regardless of which party was in power (another one of my all-time favorites, LBJ was an emblem of that). Because of constant gerrymandering, one party has been permanently in power for the last two decades and will be, for the foreseeable future. Even Beto (who has his faults) couldn’t defeat one of the most hated men in the country in Texas. While moving away from a place that has different politics than yours is not always possible or beneficial, I found the political climate to be smothering.

I could live with the monster trucks with “Infowars” stickers at our local grocery stores or people I played pickleball with wearing NRA shirts or our one-time neigAbdulhbors who stopped interacting with us as soon as they saw the color of my skin but I couldn’t live with S.B. 8 (the vigilante law) or the Billboards along highways congratulating Texas with a picture of multiple babies as soon as Roe was repealed or when a bigwig in TMA boasted about hosting Greg Abbot at their house for a fundraiser.

For a good review of Texas’s political history and impending future, Lawrence Wright’s “God Save Texas: A journey into the soul of the lone star state” is highly recommended.

Will I ever go back to Texas?

I have been asked this question by friends and acquaintances many times since I decided to leave. As of now, my answer is a firm “No”. I may visit occasionally for a conference or to visit my residency program but I don’t see why I would want to live in Texas if I have the choice. My life was changed completely while I was there and I am thankful for many things that happened when I was there, friends that I made and spent time with, meals that I cherished but also, heartbreak and forgettable memories.

P.S: The astronauts originally said: Houston we have had a problem.

(A few additional comments added on 02/21/21)

COVID-19 is still a menace that is affecting thousands of people every day across the globe. However, vaccination and palliative therapies indicate that there is less of it ahead of us than behind us. I am training in pathology at a hospital in Texas and do not have the required qualifications to talk about the nitty gritty of COVID virus and its structure. However, I was involved in management of patients with COVID who were in intensive care and before that, in procuring convalescent plasma for COVID patients. I want to write about the policy and public health side of managing COVID and not the clinical perspective, which is not my primary specialty. This piece was inspired by two articles in the New Yorker, the first is a long-read from Lawrence Wright (here) and the second is from Charles Duhigg (here).

When news about COVID started trickling at the end of December 2019, I was not alarmed. I thought of SARS, Swine flu, Ebola and MERS, which were mostly containable viral diseases and their human impact was not global. I was at a conference in Dallas at the end of January, where a presentation was on memories of dealing with the first Ebola case in the US. I remember sitting in the back row of the auditorium and listening to the lengths that a particular hospital in Dallas went, to quarantine the said Ebola patient. By February, there was news of how Chinese state was hiding things about the mysterious viral infection and whistleblowers were shedding more light on the disease. It was in late January-early February that first cases of the mystery virus were discovered in Seattle suburbs and suppression of data/news about COVID started in the US (the Trump administration). I was at another conference in Los Angeles at the end of February and saw the news that cases of COVID had been diagnosed near San Francisco.

Upon my return to work in the first week of March, I was required by the hospital to report travel to the employee health clinic, which I did. Prior to arrival of COVID, I was going to travel to Ohio for an elective rotation and to New York to present at a conference. With COVID, all plans had to be cancelled. Since March of last year, COVID has affected millions of people across the globe and disrupted life as it used to be. One of my friends refers to any year before 2020 as “X years B.C.” (before COVID).  Moving from my personal story to a bird’s eye view, what can we learn from COVID moving forward? I have tried to distill my thoughts about the pandemic, pandemic response and best practices.

Based on what we know now, here are a few things about COVID response, with relevant exceptions:

1. Island nations have generally done better, with exception of Britain and to an extent, Vietnam. At the start of the pandemic, there were fears that autocratic governments will prevail better because dictators don’t have to worry about human rights, laws or courts. That fear has not come true, generally. Australia, New Zealand, Taiwan, Sri Lanka or Vietnam are mostly democratic nations.

2. Things have been better when scientists and public health officials have been allowed to be at the forefront, except in the case of Sweden, where the top epidemiologist wanted to test his “herd immunity” theory.  The New Yorker story from Charles Duhigg that I mention above, refers to a significant difference in COVID cases and deaths between New York, where politicians were at the forefront of COVID response, versus Washington state, where public health officials made the rules.

3. African nations have done better at managing COVID than most ‘first-world’ countries, in my opinion, due to their experience in dealing with Ebola, MERS and similar viral illnesses. There has been a recent second wave and a South-African variant that is more resistance to the mRNA vaccines than the OG COVID-19 or the UK variant. There was a recent story in the BBC about the second wave (here) and earlier, about the low rates of infection and mortality in the African continent (here).

4. It is incredibly hard to restrict what constitutes “daily life” even in the face of a deadly pandemic. Human beings are social animals and severing that connection from others, whether in form of closing offices or bars and restaurants, cannot be reliably depended on for long periods. Travel has become another necessity in this day and age, for business or pleasure. Airlines and the hospitality industry as a whole will be running losses for years to come. I traveled three times during the last year, twice domestically and once on an international route. I tried to be cautious and got tested before/after each of these journeys, which, admittedly is not a perfect way of being safe from COVID. There were multiple studies about spread of COVID on airplanes and I was constantly in fear of contracting it while flying, despite all precautionary measures.

I do not frequent bars/clubs in general so i didn’t miss them much. However, I did miss spending time at the library and our nearby Barnes and Noble.  If one were to look at the graphs of cases and deaths in the US, there are peaks around memorial day, 4th of July, Labor day, Halloween, Thanksgiving, Christmas and New Year. Around Christmas, close to a million people were flying every day in the U.S. Graphics from the Washington Post tracker.

5. China, not completely culpable but deserves blame for its early missteps and obfuscation (a la Great leap forward) when it comes to COVID. We still don’t know if COVID transmission started at a wet market or somewhere else. Wuhan is back to pre-COVID times while the rest of world keeps suffering. Chinese authorities have tried to strong arm the WHO and any outside effort to investigate the origin of transmission of COVID. I do not subscribe to the conspiracy theory that COVID is a “China virus” or that it was manufactured in a Chinese laboratory.

6. Vaccines. I consider the development of COVID vaccines a modern day miracle. The fastest that a vaccine had been previously prepared was close to three years. The severity of disease, mounting death rate and irresponsible behavior by the general public, made the timeline for introduction of a vaccine shorter than ever. Fortunately, the mRNA type platform vaccines had been in development for years and this was the right moment for them. The journey started in January 2020, when COVID genome was first shared by Chinese scientists and culminated in November/December 2020, when two major candidate vaccines was ready to be administered. Since mid-December, more than 73 million doses of either of these vaccines has been distributed in the US. This is a graphic from the Washington Post tracking vaccine distribution in the US:

I got vaccinated in January and feel fortunate to have that immunity. However,  the mRNA vaccines have a 66% response to the South-African variant (versus 90-95% against the OG COVID).  The AstraZeneca vaccine has a 23% immune response to the South African variant. There is very little good data on vaccines developed by Russia, China and India. From what we know about their mechanisms of action, Russian vaccine is similar in mechanism to the AstraZeneca vaccine (uses inactivated Adenovirus), while the Chinese vaccine is based on inactivated virus and the Indian (serum institute version) uses live attenuated virus. Graphic from NEJM.

7.  Viruses don’t care about state or national boundaries. The Sturgis motorcycle rally in South Dakota in August led to increased cases in neighboring Minnesota (here). A single conference in Boston in Feb 2020 lead to almost 300,000 cases (here). COVID has reached Antarctica, the last bastion of human presence without infection (here).

8. Disinformation spreads faster than the truth. The famous line that “A lie can travel halfway around the world before the truth can get its boots on” was truer during the COVID pandemic than any other modern peacetime event. Since I have a medical degree and had some exposure to COVID response, I was asked by many family members and friends from across the globe about various conspiracy theories circulating regarding COVID. The top hits included COVID vaccine altering your DNA, different cocktails for treating COVID (the whole hydroxychloroquine debacle), herd immunity, exaggerated vaccine side effects, masks, Vitamin D, COVID vs Flu, PCR vs rapid testing and their predictive values, various miracle cures etc. Many of these lies and misinformed views were spearheaded by medical personnel (doctors, nurses, nurse practitioners etc) which made it incredibly hard for a layperson to know what was the truth and what was just a fanciful conspiracy theory. To top it all off, many people initially (and still) refuse to believe that COVID is real.

9. Masks work but not all masks are the same. This is related to point 4 from earlier (human nature cannot be suppressed for long). It is hard to wear a mask all the time. I work at the hospital and that being a high-risk area, everyone has to be masked almost all the time. But, due to strict masking requirement, infection rate of workers (both medical and non-medical) at our hospital stayed less than 1% even when the infection rate was close to 10% in the community that we serve. N95s which should be worn by individuals who are at the highest risk of getting COVID provide better protection than a regular surgical mask (efficacy close to 65%), which is better than a regular cloth mask (efficacy less than 50% and needs to be washed regularly). I have seen innumerable number of people wearing their masks incorrectly (i.e. nose not covered) but I think that at least they are wearing a mask. One reason that east asian nations did better at controlling the pandemic is because mask-wearing is normalized at a larger societal level, compared to “freedom from tyranny” type attitudes seen in the US. According to estimates, if 90% people in the US had worn masks at the beginning of COVID, we could have averted millions of cases and thousands of deaths.

In Arizona, there were dramatic improvements in case numbers once mask mandates were enforced. (paper from CDC here).

10. The curious case of Pakistan and India. Early in the pandemic, while COVID was running rampant through most of Europe, North America and South America, India and Pakistan had very few cases compared to their populations. While India has caught up with the rest of the world lately, Pakistan is still reporting less cases than any major city in the US per day. What is causing this divergence? There are many theories and until it is studied methodically, I don’t have a clear answer. Even people who got COVID in Pakistan, got a mild disease. Many people pointed to BCG vaccination as being semi-protective against COVID. Some commentators proposed immunity due to earlier sub-clinical viral infections. Are there genetic factors causing this? My hypothesis is that Pakistan is not as exposed to the outside world as lets say the United States is. Secondly, testing in Pakistan is at a much lower level than anywhere else. At one point last year, the state of Punjab, with a population larger than Germany, was doing close to 15,000 COVID tests a day. If you don’t test, you can’t diagnose. Cases in Pakistan and India, graphs from the Johns Hopkins dashboard.

11.Personal Responsibility. The mantra of personal responsibility has been used throughout the pandemic by mostly right-wing politicians, trying to avert blame from themselves, resulting in a terrible failure. Anyone who has ever worked in customer relations can tell you that most people don’t really care about other people (knowingly or unknowingly). Public health does not work that way. One can argue that even economics doesn’t work that way either, but that is a separate debate.

12. One heard the phrase “how many lives can you save by closing the economy” or variations of it since the early days of the pandemic. The lives versus economy rubric was debated over and over, without much evidence. Countries in the EU and Australia/NZ paid people to stay home. That approach is paying them off in the long run. In a paper titled “COVID-19 and global income equality” (here), Angus Deaton showed that saving lives has a positive impact on long-term economic outlook of a country.

13. Is the “office space” dead? Are we going to have a different economy after the pandemic? Would there be mass migration from major cities towards smaller towns and suburbs? I don’t have these answers as I am not an economist or a public planner. But these questions interest me and I am always trying to read about them.

14. Lastly, I cannot predict what is going to happen with COVID. When the pandemic started, my hope was that it would die down within six months. With a sharp decline in case numbers and increase in vaccinated individuals, I have hope that COVID would be under control by the end of the year. Would new variants disrupt this timeline and everyone will have to get a booster vaccine at some point in time? It is quite likely.

Comments and suggestions welcome!

I could have been in Junaid Hafeez’s place. He was born in a small town in Punjab and was ‘foolish’ enough to leave a career in medicine to pursue the arts. He got a Fulbright scholarship and studied literature, photography, and theatre at Jackson State University in Mississipi before returning to Pakistan and working as a guest lecturer at Multan’s Bahauddin Zakariya University. In 2013, he was arrested on charges of blasphemy. In 2014, his lawyer, Rashid Rahman, was killed in broad daylight, and some lawyers in Multan celebrated that killing. According to witnesses, when Rahman’s body was being bathed before being buried, someone was beating the dhol (signifying happiness) outside their house.  This month, Junaid Hafeez was sentenced to death (link from BBC). He has been kept in solitary confinement for years, for his own protection. What was Junaid Hafeez’s fault?

He chose to say (or just think) things that are not supposed to be said or thunk in Pakistan. He could have chosen to return to the United States or to another country where his life was not in constant danger and where he would not be held in solitary confinement for his own sake. He also chose to teach younger generations and give back to the country, which is also a grave sin in the land of pure. (Read my friend Komail’s experience in his recent piece here).

Sometime during medical school, I myself got disillusioned with medicine and thought about alternative careers. It took me a few years to figure that out and in the meanwhile, I graduated from medical school and completed the necessary medical training. I also got a scholarship to visit the United States and was writing for blogs and newspapers during that interim period. I got sick and tired of sitting at home and applied to be an instrutor in Anatomy (never my favourite subject but that was the only job open at the time) at a private medical school in my hometown. I had never formally taught a class, much less a class of fresh faced medical students on their first day. I did my best effort to hide my nervousness (using my experience as an actor during med school) and hopefully succeeded. There is not a lot of ‘concept-based’ teaching in Anatomy which made my life hard and the fact that in Pakistan, most med schools spend an inordinate amount of time teaching anatomy that students will never use (2-3 months on upper limb!!). I tried to mix things in, just because i wanted them to pay attention. Some of my first lectures would include a mention of the theory of evolution and anatomic signs of that alongside the scientific method. I once started a presentation with a small biography of Karl Marx that I had written for an urdu newspaper, as the day was Marx’s birthday. I tried to not bring up religion or politics in class (other than that one Marx episode, and I wasn’t even a Marxist!) because i wasn’t teaching them social sciences and didn’t want to get into trouble. I was however once asked what an atheist is, to which i gave a very diplomatic answer. The place was run by a political family, who had bought the land for that med school when one of their members was a local nazim under in the Musharraf era. They ran the school like a traditional patriarchy. Female students were prohibited from openly mingling with their male classmates. They eventually started giving ‘tickets’ to such micreant girls and started calling their fathers when they were ‘found’ talking or sitting with a male. I taught at that place for about a year and then moved to Lahore to start my residency.

During residency, we were supposed to oversee students during their labs but there were very few opportunities to actually engage them in a conversation. I took a break from residency after ten months to study for USMLE exams and got a teaching job at another med school in Lahore. That place was the worst of my three experiences mostly because it was a diploma mill. It was also a hybrid campus, so med students would attend classes alongside pharmacy, physical therapy and social sciences students. The social sciences segment was a net-negative for the med school since there was a lot of reactionary views (Orya Maqbool was a frequent guest at their events) going on. One day, I was studying in the lab (the only reason I went to campus every day) when a media student came in and asked if he could do a mock interview for his project to which I agreed. He wanted to ask generic questions so I fed him generic answers without delving too much into specifics. Otherwise, that place was quite toxic. The lab staff (high school graduates and diploma holders) treated female teachers (all of them doctors) as their equivalent and misbehaved with them. One of the lab staff tried to sell the annual exam questions to the highest bidders and was caught on tape (thanks to WhatsApp). Before anything could be done against him, he had fled. I felt sorry for the students and their parents who spent millions of rupees on their offsprings’ education.

No wonder the best and the brightest (not including myself) don’t bother coming back to Pakistan.

I am an aspiring stand up comic (‘aspiring’ the operative word here). I was attracted to quick-witted, slapstick comedy while I was at an all-male boarding school in Pakistan. Since I was not physically strong enough to compete with the big boys, I had to use my tongue as an asset/weapon. I grew up watching mild-mannered comedies in Urdu on Pakistani television. It wasn’t until the late 2000s that I discovered ‘Seinfeld’ as a syndicated show on an Indian TV Channel. I had started watching ‘The Daily Show ‘ with Jon Stewart almost at the same time, through pirated websites (broadband internet was a late arrival in our household). There was no broader culture of stand up comedy in Pakistan, except a few souls with western education who were briefly on the scene in the early-to-mid 2000s (Sami Shah, Saad Haroon, etc.), mostly clustered in Karachi (which was as culturally far away for me as New York City). I used whatever avenues I could to write humor. I wrote parodies and mockeries in Urdu, first in boarding school, then in med school. Urdu has produced some great humorists (Ibne-Insha, Patras Bokhari, Khalid Akhtar, to name a few), but written humor is different than performative comedy. The only parallel I could find was in stage dramas that were mostly, if not entirely, produced in Punjab and consisted of varying degrees of ‘jugat baazi,’ which is pure slapstick comedy. It can consist of monologues or a back and forth between two men (and it is almost always men) who take turns to insult each other. While it is quite entertaining, it is most often misogynistic and hinges upon common tropes.

The TV show ‘Hasb-e-Haal’ ushered in a new era of political comedy in Pakistan. Before that, there was ‘Hum Sab Umeed Se Hain’ (literal meaning: we are all hopeful; a double entendre since ‘umeed se hain’  can mean hopeful or pregnant), which consisted of parodies of major political figures. Hasb-e-Haal had regular news and humorous analysis of that news by Azizi, a character played by veteran stage actor, Suhail Ahmed. The show was competing against completely serious political shows and shot to popularity in the late 2000s/early 2010s. Soon after that, there was a deluge of TV shows offering political comedy, in varying degrees of success. There was no ‘Saturday Night Live’ analog that poked irreverent fun at every possible institution in the society. Noone could criticize the judiciary, the military (and its proxies), or the ‘Two-Nation Theory’ (TNT).  I remember watching a stage show that was quite popular in 2013-14, written by Anwar Maqsood (famous playwright), in Lahore. It was a miniature, middle-class, sanitized version of the nightly news shows. The state of humor in Pakistan was bleak, a nation taking itself too seriously and too afraid to laugh at ourselves. I actually wrote a parody show that was educational at the same time as it was humorous, in 2012, which was filmed by a friend but did not make it to the screen, partially because it was my first experience writing in that format.

Recently, there have been some positive developments like Aurat Naak, an all-female comedy troupe, and satire sections in newspapers (dearly-departed/banned Khabaristan Times and The Dependant, both of which I contributed to). However, satire in English newspapers and blogs has its limitations: Very few people in Pakistan read English papers regularly. A few years ago, Nadeem Farooq Paracha (cultural critic for Dawn and one of my early heroes) wrote a blog for Dawn.com that portrayed Malala Yousafzai as a polish agent planted in Pakistan (there were enough hints in the piece for it being a satire column/blog). The article was soon shared by people who took is as gospel truth, and some local newspapers even published Urdu translation of that piece as evidence that it was proof of Malala being a fake (a common enough conspiracy theory in Pakistan). Dawn had to label the piece as Satire at the front and bottom of the page as a response. A year or two later, when I submitted a satire piece to Dawn, I was told to ‘tone it down a bit’ in light of the Malala story. In Pakistan, there is a very fine line between humor and absurd reality, and as a writer, I was often treading that line, veering from one side to another.

It is not as if Pakistan does not have people who are funny and can poke fun at the ‘holy cows.’ I know dozens of people who do that in private frequently but cannot, for their safety, say those things in public. There is no First Amendment guaranteeing free speech rights in Pakistan. ,’ 19 of the constitution explicitly identifies the holy cows (military, judiciary, TNT) and prohibits speech against that. Adding to this fuel is the firepower possessed by Pakistan’s right-wing media and loudspeaker power wielded by molvis who can commandeer people to form a mob against anyone at the drop of a hat. A few years ago, a fellow journalist and friend wrote an article about the ‘homosexual question’ in Islam on a popular Urdu website. A week later, Orya Maqbool Jan, former civil servant, and lifelong windbag dedicated a whole TV show to that one article and targetted that Urdu website. A case of hate speech was filed against him with Pakistan’s Electronic Media Regulatory Authority (PEMRA). For his hearing, Orya brought a bunch of goon (including lawyers, molvis and other members of a for-hire mob) and disrupted the hearing. Nothing ever came out of that hate speech case.

When I moved to the US in 2017, I had the opportunity to see stand up comedy myself. I went to a place in Miami that had bi-monthly comedy shows and to a place in Fort Lauderdale that had an open-mic. I wrote some material myself, which I performed in front of a group of friends but never on stage. In Houston, I went to an open-mic and was going to perform my set, but I was supposed to be on stage around 11 pm, which is way past my bed time, and I had friends in the audience who had to go to work the next day. In Washington DC, I went to a show titled ‘Black Side of the Moon’ in December 2016. It was a combination of monologues and sketch comedy by an all-black cast. The most memorable moment in the show was when a white volunteer who came on stage was given the ‘Full African American Experience’, including being sold at a slave market, denial of place in a sports team despite his qualifications, and being shot dead by a black policeman. It was probably my first exposure to live, politically conscious comedy. A Pakistani version would have Ahmadis or Baloch people mocking the majority Sunni population or Punjabi elite. That show is not going to happen any time soon.

Sadly, the only Pakistani import to the US in terms of stand up comedy (Kumail Nanjiani) is a good actor but a subpar stand up comic. His film ‘The Big Sick’ was an amalgamation of stereotypes and some mildly emotional scenes. He does quite well in the HBO TV show ‘Silicon Valley’ and was admittedly quite good in the movie ‘Stuber’. Many of his Karachi acquintances are on the record saying how he fabricated things about his life in Pakistan (you can google that).

I was in Chicago recently and saw a show at the famed Second City theatre titled ‘Do you believe in Madness?’. It was a powerful sketch show with a diverse cast and ranging in topics from Abortion to Impeachment, global warming , Brexit and including a song with names of all the people who have left the current white house (sung to the tune of Billy Joel’s ‘We didn’t start the fire’). It was like watching SNL but better. This is my long-winded way to say that the satte of comedy in the US, is strong, and long may it continue!

(In 2017-18, an Indian friend wanted to collect essays from Pakistanis on how they view MK Gandhi across the border. I wrote this short letter to Mr. Gandhi that I recently saw in my collection. Sharing it with the BP community. )

Mohandas Karamchand Gandhi
Birla House,
New Delhi.

Dear Mr. Gandhi,

My name is Abdul Majeed and I am writing to you from the city of Lahore, Pakistan. I have been asked to write about you by an Indian friend of mine and I accepted his proposition. I feel ambivalent writing about you since I have thought about you in myriad ways over the course of my life. I grew up in a conservative Muslim household in a small Punjabi town called Sialkot and first learned about you in the ‘Social Studies’ textbooks taught to schoolchildren. My first impression of you as a person was quite negative since the role assigned to you by virtue of ‘Two Nation Theory’ (or TNT, as I now call it) was that of a Hindu politician who opposed the formation of Pakistan and probably hated Muslims. Like many schoolboys of my age, I idolized Mr. Jinnah, your arch-nemesis and a founding father of Pakistan. For us, Jinnah was the David to your Goliath, a defender of minority rights against all odds, an impeccably dressed man who stood up to the might of Hindus and saved Muslims of India from a cultural annihilation. In our imagination, he was everything you were not. We used to make fun of your attire and your persona. I grew up in a society where violence was the channel through which you expressed your masculinity and thus we thought your non-violent methods were signs of cowardice. I learned that All India Congress, a party you led for many years, did not support the idea of an Independent Pakistan (or a divided India, depending on whom you ask) and refused to believe in Partition even after two separate countries had been established.

My outlook towards history and towards your personality changed when I went to boarding schools in the northern part of the country. While the basic ideological framework remained in place, facts added up through the years. At one point in time, I could recite the whole ‘Pakistan Studies’ book by heart in two hours, including names of the books written by Sir Syed Ahmad Khan, a Muslim educationist and reformer in Nineteenth-century, charter of demands presented by the Shimla deputation to Viceroy of India in 1905, consequences of Bengal’s partition in 1905, Minto-Marley reforms of 1909, Fourteen points of Mr. Jinnah (a proposal for constitutional reform in British India) and the Islamic clauses in Pakistan’s three constitutions. You might be astonished to know that history books in our schools start the story from the Nineteenth century as if nothing happened in this land before. The boarding schools I went to, were located near Mansehra (containing artifacts from two thousand years ago) and Taxila (where the oldest University in the world was once present) respectively, sites containing artifacts from a past I never had. I knew you as a wily politician who duped Muslims during the Khilafat Movement. The word ‘Mahatma’ was used as a prejudicial slur towards anyone ‘Indian’. I often got called by this name because I was a vegetarian.

Years later, I ended up seeing you in a different light. I was roaming the streets of New York City in the immediate aftermath of Hurricane Sandy when I chanced upon a statue of you in Greenwich village. A week after that, I saw another one of your statues at the MLK memorial in Atlanta. I learned about your influence on Martin Luther King Jr. and the strategy of non-violence resistance. It was around this time that I read Arundhati Roy’s foreword to ‘Annihilation of Caste’ and ‘The South African Gandhi: Stretcher-bearer of Empire’. As I grew up, I came around to the idea that human beings contain multitudes and having contradictions is partly what makes us human. On one hand, you paid lip service to the idea of caste in Indian society, on the other, you made public displays of spending time with the untouchable community. You accelerated the fusion of religion and politics in India during the late 1910s and the Khilafat movement and you also held fast when Pakistan was not paid money it was due after partition. You used elements of Hinduism in your political and social message and were eventually gunned down by a Hindu nationalist. You didn’t subscribe to the Two nation theory but the last century proved you wrong. India and Pakistan have grown and keep growing apart as a Sunni state and a Hindu state. Some of your ideas were as controversial then as they are now. You were in favor of treating Nazis with peace and non-violence and you lived to see how that turned out. In Pakistan during the 2000s, some people wanted to talk to the Pakistani Taliban (TTP) and that didn’t go as planned either. The question then is, how does one deal with groups whose founding ideology is based on violence? With this, I’ll leave you in peace in your forever abode.

Greetings from Lahore,

Abdul Majeed Abid

I recently read an article in The Economist about Jair Bolsonaro and one of his prominenet supporters  (a UChicago economist) and it remineded me of the damage done by such ‘luminaries’ to other third world countries such as Pakistan.

“In July, at a convention of his small and inaptly named Social Liberal Party, Jair Bolsonaro unveiled his star hire. Paulo Guedes, a free-market economist from the University of Chicago, has done much to persuade Brazil’s business people that Mr Bolsonaro can be trusted with the country’s future, despite his insults to women, blacks and gays, his rhetorical fondness for dictatorship and the suddenness of his professed conversion to liberal economics. At the convention Mr Guedes praised Mr Bolsonaro as representing order and the preservation of life and property. His own entry into the campaign, he added, means “the union of order and progress”.”

Further in the article,we learn more about the adventure of ‘Chicago Boys’

“[Chile’s dictator from 1973-90, Augusto] Pinochet sensed, rightly, that corporatism would require him to share power with his military colleagues. Instead, he called on a group of civilian economists, dubbed the “Chicago boys” because several had studied at the University of Chicago, where the libertarian economics of Friedrich Hayek and Milton Friedman held sway.

The Chicago boys applied these principles in Chile, whose economy had been wrecked by the irresponsibility of Salvador Allende, a democratic socialist overthrown by Pinochet. Their programme would eventually lay the foundations for Chile to become Latin America’s most dynamic economy at the turn of the century. But it was akin to a major operation by trial and error and without anaesthetic. They slashed import tariffs and the fiscal deficit, which fell from 25% of GDP in 1973 to 1% in 1975. They privatised hundreds of companies, with no regard for competition or regulation. Worried that inflation was slow to fall, they established a fixed and overvalued exchange rate. The result of all this was that the economy came to be dominated by a few conglomerates, heavily indebted in dollars and centred on the private banks.

In 1982, after a rise in interest rates in the United States, Chile defaulted on its debts and the economy slumped. Poverty engulfed 45% of the population and the unemployment rate rose to 30%. Pinochet eventually dumped the Chicago boys and turned to more pragmatic economists, whose policies contributed to Chile’s post-dictatorship prosperity.”

Pakistan was one of the countries that was ‘advised’ by economists from Harvard during the 1950s and 60s.

M. Ziauddin, veteran Pakistani journalist, wrote about the influence of Harvard and UChicago on Pakistan’s economy in his piece titled: Way Out of Deepening Inequality.

Some critique of the Harvard Advisory Group’s (HAG) broader actions can be found in a paper (found here and without paywall here) by Nadeem ul Haque and Mahmood Hasan Khan (Haque obtained a PhD from UChicago and Khan from a Dutch University).

“The HAG vision was flawed in three respects and sowed the seeds of the distorted development of the economics profession in these three respects.

First, it did not attempt to develop an economics profession that was rooted in the country. They left the universities and colleges in a state of neglect attracting resources to these new non-academic, semi-bureaucratic institutions and attempted to give them the lead in the profession. Without the seed of the pure profession being nurtured and jealously guarded in academia, the profession was bound to have a distorted growth.

Second, the HAG trained economists were very different from the economists of the time. The HAG training was very development oriented and specific to Pakistan. They were not encouraged to do any theoretical or pioneering research. Third, given the importance of HAG and the new institutions and the symbiotic relationship between these institutions and the bureaucratic and political setup of the time, these HAG trained economists acquired a large and visible role in the economy. These visible economists not only played an important role in Pakistan’s history but also distorted the country’s perception of an economist, the economics profession and economic policy.”

” By design, the HAG group was interventionist, plan and budget allocation oriented. They mistrusted the market and had the arrogance of having more information than the market and the rest of society. Interestingly enough, the HAG training of development economics was collapsing on itself. Because these people had no behavioral relationships in mind and no faith in markets, they did not merely push policy levers and study response lags and dynamics. Instead, they developed lengthy plans or wish lists and used the bureaucratic structures to control the environment to make these plans happen. This control-oriented and market-mistrusting civil service loved this new intellectual force given to their view.

A second element in the thinking of the HAG economist was the concern with inequality. Haq and Baqai (1986), two important economists of the HAG era, note with concern that “early writing on economics in Pakistan surprisingly did not contain much reference to poverty related themes.” It is very interesting that most of the early econometric or behavioral research is done mainly by the HAG advisor, whereas the work on measuring poverty, productivity (the ratio calculation work) is done by the Pakistani economist. Before anything about the economy was understood, poverty indices, regional inequality indices, and declines in real wages (when hard wage data was hardly available) were the main areas of concern.

The manner in which these economists were trained itself created a certain perception of economists in the country which lasts till today. These economists were trained to be policy-oriented development economists. A sharp distinction was made between such economists and those who studied more theoretical and academic economics. The erroneous impression was unintendedly cultivated that the study of theory or more rigorous economics is of limited use to the country. Such a pursuit was considered a luxury that the country could ill-afford. This view has persisted and developed over time and reinforced the perception that to be a good economist for Pakistan a grounding in economic theory is not only not required but perhaps may even be a hindrance. The result is that there is a tremendous disrespect for academic and theoretical economics. The term “ivory tower” intellectual was used to describe anyone who attempted to read and keep abreast of academic economics. Instead, an amalgam of general knowledge and mild development verbiage has been established as sound Pakistani development economics.’ Fragmentation of the Profession”.