Doctors may be prescribing antibiotics for longer than needed



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Most recommended courses last between three and seven days.
Shutterstock

Allen Cheng, Monash University

For most infections, the long-standing advice is to take a full course of antibiotics.

The rationale for not simply stopping antibiotics as soon as you start to feel better is that antibiotics don’t kill the bacteria instantly. If stopped too early, the remaining bacteria, which are exposed to low concentrations of antibiotics, tend to be more resistant. These can then re-grow, causing recurrent infection, or spread to other people.

The recommended length of the course depends on the type of infection, the likely cause, and how effective the antibiotics are at killing the bacterium and penetrating to the site of infection.

For infections commonly seen in general practice, most recommended courses last between three and seven days. For more serious infections requiring hospitalisation, the recommendations are generally a little longer.




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Use them and lose them: finding alternatives to antibiotics to preserve their usefulness


A recent study from the United Kingdom found a substantial proportion of antibiotic prescriptions in general practice were for longer than these recommendations. While for each prescription this may have only been a few days longer, for the UK as a whole this amounted to about 1.3 million days of antibiotics more that would have been necessary.

Researchers are currently investigating how much of a problem this is in Australia.

There’s little evidence to suggest longer courses of antibiotics benefit patients. In fact, even the recommended lengths could be too long for many infections.

Why are courses longer than recommended?

The most important determinant of duration in primary care is probably the size of the pack the antibiotics come in.

But the number of tablets in a pack is rarely the same as the length of a course. One Australian study looked at 32 common prescribing scenarios and found that the pack size only matched the recommended duration of antibiotics in four cases.

Other reasons antibiotics may be prescribed for longer than recommended is when patients are given “repeats” and taking a second course of antibiotics. Often, the doctor isn’t actively prescribing a second course, but their medical prescribing software is printing a “repeat” on their prescription by default.




Read more:
FactCheck: Is Australia’s use of antibiotics in general practice 20% above the OECD average?


In hospitals, clinical uncertainty plays a large role. It is sometimes suggested that antibiotics are used for the benefit of the patient, but at other times to allay the treating doctor’s anxiety.

While the motivation to make sure infections are properly treated is understandable and well-intentioned, particularly in patients who might still be critically unwell for other reasons, continuing antibiotics for too long increases the risk of side effects and antibiotic resistance.

Do we even need a full course?

We may be able to stop antibiotics before we reach the end of our course. The body has the capacity of “mop up” small numbers of bacteria, so at least for milder infections, it may not be necessary to kill them all.

This is important because using antibiotics for too long can be a problem in causing antibiotic resistance. This can occur within individual patients by exposing bacteria elsewhere in the body to antibiotics, but also because antibiotics are eliminated from the body and can contaminate the environment.

We didn’t always standardise the duration of antibiotics. Harry Dowling, one of the pioneers of early antibiotic use, once said

The duration of treatment just evolved. There was no rationale for any single length of time. We saw how long it took for the temperature to come down and gave antibiotics until it did, and then some.

The durations recommended in guidelines often come from arbitrary decisions made in early studies, which have translated into some odd “rules” about antibiotics:

  • prime numbers for durations of up to a week (three, five or seven days)
  • even numbers for more serious infections that take weeks to eradicate (two, four or six weeks)
  • multiples of three for really tenacious infections such as bone infections (three months) or TB (six months).

In writing guidelines for doctors, we often wrestle with whether to set a fixed duration (such as seven days), a range (five to ten days), a minimum (at least five days), a maximum (up to ten days) or wordy qualifications (usually five days, or ten days for severe illness or where there is a slow response).




Read more:
We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?


What about serious infections?

For deep or severe infections, we want to be sure the infection won’t return. Recent research has focused on defining the shortest effective duration of treatments.

A recent trial compared whether seven days or 14 days of antibiotics were required for some types of bloodstream infection, and found outcomes to be similar.

Researchers have also been testing the use of oral antibiotics for two of the most difficult infections to treat – endocarditis (infection of the heart valves) and ostemyelitis (infection of bone) – which have needed intravenous antibiotics for six weeks or longer. These trials have shown a shorter course of intravenous antibiotics with an early switch to oral antibiotics may be adequate.

Shortening the duration of antibiotics is one important way to reduce antibiotic use, the key driver of antibiotic resistance.




Read more:
Health Check: should kids be given antibiotics in their first year?


The Conversation


Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up



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The number of Medicare claims Australians make in a year doubled between 1984 and 2018.
By Sopotnick

Jane Hall, University of Technology Sydney and Kees Van Gool, University of Technology Sydney

This is part of a major series called Advancing Australia, in which leading academics examine the key issues facing Australia in the lead-up to the 2019 federal election and beyond. Read the other pieces in the series here.


Over the last 35 years, Medicare has given Australians access to high-quality health care at a reasonable cost. But, despite our justifiable pride in Medicare, it’s time to reconsider the way we pay for health care.

Australia’s Medicare system is a A$20 billion-a-year program. It subsidises most of our out-of-hospital doctor consultations, blood tests, X-rays and scans, physio appointments, eye tests and many other health services. It’s based on a long list of items and each time an item is provided, Medicare pays a benefit.

But paying doctors and other health providers a set fee for each service they deliver is not delivering optimal value for the health dollar. There are two reasons for this.

First, it encourages a higher volume of services, but not necessarily better-value services.

Second, it constrains doctors into delivering the care based on the items in the schedule, which often don’t meet the needs of complex patients.




Read more:
Explainer: what is Medicare and how does it work?


One promising alternative is “bundled payments”. Rather than paying doctors a “fee for service”, they would be paid a prospective lump sum to care for the patient’s medical problem, over a specified period.

The lump sum would be a pooled payment for all services provided to treat the condition. The provider’s role would be to coordinate the patient’s care across different parts of the health system and work with a range of health professionals to deliver high-quality care.

This would give doctors greater flexibility to manage the care patients need. At the same time, doctors would be held accountable via measurements of the quality of their care.

Importantly, this would give patients greater access to a broader range of services and make it easier to navigate our complicated health system.

Why health costs are rising

Between 1984 and 2018, Australian government spending on services outside of hospitals has increased from A$426 to A$818 per person, after adjusting for inflation.

This increase is almost entirely due to service volume. Back in 1984, the average Australian made 7.25 out-of-hospital Medicare claims a year. By 2018, this had escalated to 15.34; a doubling in the average number of claims.

The biggest growth has been in the number of pathology claims for blood and tissue tests (1.4 in 1984 to 5.2 in 2018), followed by GP consultations (4.2 compared to 6.3) and diagnostic imaging, including X-rays and other types of scans (0.3 versus 1.0).

This is not just the result of population ageing. At every age, we are making more Medicare claims. In 1985, people aged between 75 and 84 made 16.1 Medicare claims per year. In 2018, this number had grown to 44.6 claims per person per year.

Medicare prices have been very steady. For GP consultations, for example, the benefit paid per service has increased by 72% over the 35-year period, and mostly as a direct result of policy initiatives such as the Strengthening Medicare reforms introduced in 2004-05.

In fact, since 2005, the benefit per service has declined by 6% in real terms. This is a result, in part, of the Medicare freeze imposed by government between 2012 and 2018.

So price control is only one part of constraining expenditure growth. The other is the volume of services.




Read more:
FactCheck: has Medicare spending more than doubled in the last decade?


The medical care market has undergone considerable corporatisation. Corporate entities now own around 10% to 15% of all GP practices in Australia.

Corporate entities can own and run primary care practices as well as pathology laboratories, diagnostic imaging services and even pharmacies. This creates more incentive to refer patients to their own businesses for blood tests and imaging to increase the volume of claims, and therefore increase profits.

Greater spending doesn’t mean better care

The second critique of Medicare is that current funding arrangements create disincentives for delivering optimum care over a longer period, particularly for complex patients who require multiple services from multiple providers. They might have cancer, for instance, or multiple chronic diseases such as heart disease and diabetes or dementia.

Currently, Medicare makes a payment for every claim made within what we call an “episode of care” – a set of services to treat a condition, or a procedure. Each provider in that episode has an incentive to increase their own volume of care, but there are virtually no incentives to coordinate or deliver an optimum pathway of care for the patient.

Further, there are too few opportunities and rewards in this system to give doctors flexibility to offer different types of care for patients. This includes care provided by nurses, physiotherapists or dietitians; email or telephone consultations; patient education; and coordination services.

Instead, pay doctors a lump sum

The main feature of a good payment system is that it creates the right incentives for providers and patients to use health care resources effectively, efficiently and equitably.

Bundling payment involves working out the best care pathways for each condition. Cancer, for example, is a complex disease that requires ongoing care from primary, specialist and hospital services.

Under a bundled payment, the patient’s GP clinic would be paid a lump sum to ensure the patient receives all the services they need. This includes consultations, health checks, blood tests, physiotherapy, dietetics, patient education, and so on. The GP would have more control over how each of those services is delivered.

Sometimes will be best cared for by a physiotherapist.
Africa Studio/Shutterstock

If viable, the GP could bring some of these services into their practice, or they could subcontract them to other organisations.

The practice would be held accountable for providing high-quality care through various performance measures. These could range from patient satisfaction measures to objective measures such as timeliness of care or fewer avoidable complications. Payments could, in part, be made conditional on meeting performance targets.

Ultimately, because we are giving the provider more say over how care is delivered, the model of care can be more easily adapted to the needs of the patient.

Health reform must be based on evidence

In the small number of countries where bundled payments have been piloted, they are associated with improved quality, financial savings and increased patient satisfaction.

A bundled payment for hip-fracture patients in England, for example, resulted in more patients receiving surgery within 48 hours after admission and lower death rates.




Read more:
Creating a better health system: lessons from England


Although these studies show promise, the evidence base is still in its infancy.

Successful reform in this area will require careful design of the bundles, the payment levels and patient selection process, as well as how best to monitor quality care. In particular it requires robust evidence to determine:

  • what constitutes an optimal bundle of care for a particular condition
  • the cost of delivering those services
  • how the payment should be adjusted for the specific characteristics of a patient
  • the role performance targets may play in motivating health providers to deliver high-quality care.



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The Conversation


Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney and Kees Van Gool, Health economist, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Christians Suspect Cover-Up in Pastor’s Death in Orissa, India


Police refuse to follow leads pointing to murder.

NEW DELHI, January 21 (CDN) — Relatives of a pastor who was found dead in a secluded area in eastern Orissa state’s Kandhamal district last week have accused local police of a cover-up.

The body of Saul Pradhan, a 45-year-old independent pastor whose house was burned by Hindu extremists two years ago, was found near a pond in Pakala village in Kandhamal’s Raikia Block on Jan. 11 and bore marks of assault, Catholic activist Ajay Singh told Compass.

“I spoke to the widow of the pastor, and she told me that the hands and legs of the deceased looked twisted, and there was blood in his mouth. His pants were also torn,” Singh said by phone from Orissa’s capital, Bhubaneswar. “Why should it not arouse suspicion when Pastor Pradhan was last seen with two Hindu men, Marda Pradhan and Baiju Mallick, who were among the rioters who burned houses of Christians in 2008?”

A local activist with the Evangelical Fellowship of India said he visited the site after the body had been removed and saw blood stains on a stone.

Kandhamal witnessed two of India’s deadliest waves of anti-Christian violence in December 2007 and August-September 2008; the latter killed over 100 people, destroyed thousands of homes and displaced more than 60,000 others after a Hindu nationalist leader was killed by Maoists; Hindu nationalist groups blamed it on local Christians.

Christian residents of Kandhamal say the antagonism toward them by those who engaged in the attacks under the influence of extremist Hindu nationalists remains strong.

Singh said that the two Hindu men who burned houses of Christians in 2008, Marda Pradhan and Mallick, came to Pastor Pradhan’s house the evening of Jan. 10 and asked him to come out.

“The pastor’s wife was about to serve dinner and so asked him to wait,” he said. “But he said he wouldn’t take long.”

When the pastor did not return the next day, his wife went to the house of Marda Pradhan with a few villagers. Marda Pradhan’s wife told them her husband had been in the jungle for three days because of a leg injury, Singh said.

That afternoon, the pastor’s wife and the villagers again went to the house of Marda Pradhan, whose wife claimed he was not there. They could see him inside the house, however, and asked him to take them to the spot in the jungle where he had taken Pastor Pradhan the previous night. After walking for around half an hour, Marda Pradhan ran away, Singh said.

“The villagers got suspicious and began to look around,” he said. “That’s when they found the body lying near a pond.”

Some area residents told the villagers that they had heard loud quarreling the previous night.

Police, however, say they have found little reason to suspect foul play.

“There were no injury marks on the body of the man,” Inspector Ravi Narayan Barik told Compass, refuting the claims of the dead man’s family. “The doctor who performed the autopsy said it was just an unnatural death.”

According to police, Pastor Pradhan and two other men got drunk on the night of Jan. 10. The two others were able to return to their homes, Barik said, while the pastor could not and died in the cold.

“Drinking country-made liquor is normal behavior here,” said Barik, of the Raikia police station. “We called one of the two men who was with the deceased for interrogation but did not find anything suspicious.”

An official autopsy report was still awaited at press time.

Asked what sections of the Indian Penal Code or the Criminal Procedure Code were mentioned in the First Information Report or the formal police complaint, the official said, “None.”

“The family is spreading rumors about murder in hope of receiving compensation from the government, as many victims of the 2008 violence got compensated,” the inspector said.

Activist Singh said when the family went to police to report the suspected murder, officers were unwilling to listen.

“The police scolded them,” Singh said. “They said he must have died from the cold. When the family asked for an autopsy, the police asked them to collect the body, take it to the village and bring it to the police station the following day.”

But after the family insisted, the police asked them to bring the body the same day, he said.

“So the family and friends carried the body on a bicycle and brought it to the police station,” Singh said. Asked why police did not go to collect the body, Singh said, “This is how it happens here.”

Singh also said he heard that some local politicians from the Hindu nationalist Bharatiya Janata Party (BJP) visited the Raikia police station after the death was reported, though he added that he “could not confirm if that actually happened.”

Until March 2009, the BJP was a ruling party in Orissa in coalition with a regional party, the Biju Janata Dal, for 11 years.

Dr. Sajan George of the Global Council of Indian Christians called for an investigation by the Central Bureau of Investigation, the Press Trust of India (PTI) news agency reported on Monday (Jan. 17).

“The killing of Saul [Pradhan] seemed to be an organized crime by a section of people who had threatened him a few months ago, his family members alleged, adding that his house was also torched during the Kandhamal riots in 2008,” George told PTI.

Report from Compass Direct News

Recent Incidents of Persecution


Punjab, India, December 1 (CDN) — Hindu extremists on Nov. 14 beat a Christian in Moti Nagar, Ludhiana, threatening to harm him and his family if they attended Sunday worship. A source told Compass that a Hindu identified only as Munna had argued with a Christian identified only as Bindeshwar, insulting him for being a Christian, and beat him on Nov. 7. Munna then returned with a mob of about 50 Hindu extremists on Nov. 14. Armed with clubs and swords, they dragged Bindeshwar out of his house and severely beat him, claiming that Christians had offered money to Munna to convert. Local Christian leaders reported the matter to the police at Focal Point police station. Officers arrested three Hindu extremists, but under pressure from local Bharatiya Janata Party leaders released them without registering a First Information Report. Police brokered an agreement between the parties on Nov. 18 and vowed they would not allow further attacks on Christians.

Tripura – Hindu extremists attacked a prayer conference on Nov. 6 in Burburi, threatening Christians if they opened their mouths. A local evangelist known only as Hmunsiamliana told Compass that area Christian leaders organized a prayer conference on Nov. 5-7, but extremists ordered the participants not to open their mouth or make any sound. Christian leaders reported the threat to police, and the participants proceeded to pray aloud. On the nights of Nov. 6 and 7, a huge mob of Hindu extremists pelted the Christians with stones, but the participants continued praying. The meeting ended on the evening of Nov. 7 under police protection.

Chhattisgarh – Hindu extremists from the Vishwa Hindu Parishad (VHP or World Hindu Council) disrupted a Christian youth gathering in Raipur on Nov. 6 and accused organizers of forcible conversion. The Evangelical Fellowship of India reported that Vision India had organized the Central India Youth Festival with about 900 in attendance when the extremists stormed in at about 4:30 p.m. and began questioning leaders. The Christian and VHP leaders then held a meeting in the presence of police, with the Christian leaders explaining that it was a normal youth meeting with no forceful conversion taking place. Nevertheless, officers and VHP leaders proceeded to observe the gathering and proceedings, and the Christians were made to submit a list of participants. In this tense atmosphere, the meeting concluded at 10 p.m. under heavy police protection.

Madhya Pradesh – On Oct. 31 in Neemuch, Hindu extremists from the Bajrang Dal barged into a worship meeting shouting Hindu slogans and accused those present of forceful conversion. The Evangelical Fellowship of India (EFI) reported that about 40 extremists rushed into the church building at about 10 a.m. shouting “Jai Shri Ram [Hail Lord Ram].” The Rev. K. Abraham, who was leading the service, pleaded with them to come back later, but the invaders remained and continued shouting. After the service ended, the extremists rushed Abraham and accused the church of paying money to people to convert, as published in newspaper Pupils Samachar. The Christians said the newspaper published the false news because Abraham, principal of United Alpha English School, refused to advertise in it, according to EFI. The extremists grabbed a woman in the congregation who had a bindi (dot) on her forehead, claimed that she had been lured to Christianity and asked her why she was attending the service, according to EFI. “Where were you people when I was demon-possessed?” the woman replied, according to EFI. “You didn’t come to help me, but when I came to the church in God’s presence, these people prayed for me and helped me to get deliverance.”

Karnataka – Police on Oct. 29 detained Christians after Hindu extremists registered a false complaint of forced conversion in Kalammnagar village, Uttara Kannada. The Global Council of Indian Christians (GCIC) reported that at around 8:15 p.m. police accompanied extremists belonging to the Bajrang Dal, who along with members of the media stormed the Blessing Youth Mission Church during a worship service for senior citizens. They dragged out Ayesha Nareth, Hanumanta Unikal,Viru Basha Doddamani, Narayana Unikkal and Pastor Subash Deshrath Nalude, forced them into a police jeep and took them to the Yellapur police station. After interrogation for nearly six hours, the Christians were released without being charged.

Orissa – Hindu extremists refused to allow the burial of a 3-year-old Dalit Christian who died in Jinduguda, Malkangiri. The All India Christian Council (AICC) reported that the daughter of unidentified Christian tribal people fell ill and was taken to a nearby health center on Oct. 27. The doctor advised the parents to take the child to a nearby hospital, and the girl developed complications and died there. When the parents brought the body of the girl back to their village, according to AICC, Hindus refused to allow them to bury her with a Christian ritual. There are only 15 Christian families in the predominantly Hindu village. With the intervention of local Christian leaders, police allowed the burial of the body in a Christian cemetery.

Karnataka – On Oct. 6 in Beridigere, Davanagere, a Christian family that converted from Hinduism was assaulted because of their faith in Christ. The Global Council of Indian Christians (GCIC) reported that the attack appeared to have been orchestrated to appear as if the family provoked it. An elderly woman, Gauri Bai, went to the house of the Christian family and picked a quarrel with them. Bai started shouting and screaming for help, and suddenly about 20 Hindu extremists stormed in and began beating the Christians. They dragged Ramesh Naik out to the street, tied him to a pole, beat him and poured liquor into his mouth and onto his body. His sister, Laititha Naik, managed to escape and called her mother. Later that day, at about 8:30 p.m., the extremists pelted their house with stones, and then about 70 people broke in and began striking them with sickles, stones and clubs. Two brothers, Ramesh Naik and Santhosh Naik, managed to escape with their mother in the darkness, but the Hindu extremists took hold of their sister Lalitha and younger brother Suresh and beat them; they began bleeding and lost consciousness. The attackers continued to vandalize the house, damaging the roof and three doors with large boulders. The unconscious victims received treatment for head injuries and numerous cuts at a government hospital. Police from the Haluvagalu police station arrested 15 persons in connection with the assault.

Report from Compass Direct News

Christian Assaulted in Orissa State, India


Extremists in Kandhamal vowed to kill a Christian around date of Hindu leader’s death.

NEW DELHI, September 9 (CDN) — Suspected Hindu nationalists in an area of Orissa state still tense from 2008 anti-Christian violence beat a Catholic father of seven until he fell unconscious on Aug. 20, the 47-year-old victim said.

Subhash Nayak told Compass that four unidentified men assaulted him as he made his way home to Laburi village from the hamlet of Kapingia in Kandhamal district. Hindu extremists in Kandhamal district killed more than 100 people in several weeks of attacks following the murder of Hindu extremist leader Swami Laxamananda Saraswati.

An 80-year-old monk who for decades spearheaded the anti-conversion movement in Orissa’s tribal-dominated areas, Saraswati was shot dead on Aug. 23, 2008. Area church leaders such as Biswajit Pani of Khurda told Compass that villagers in Laburi have planned to attack at least one Christian around that date every year.

Nayak said the assailants left him for dead.

“I could not see their faces as it was very dark, and they tried to poke my eyes with their sticks,” said Nayak, still in pain. “They stomped on my chest with their feet and hit me relentlessly till I fell unconscious. They left me thinking I was dead.”

Nayak said that he was returning from work at a construction site in Kapingia when, about a kilometer from his home in Laburi, a stone hit him. Four men appeared and began beating him.

The stone struck him in the forehead between 7 and 8 in the evening as he was riding his bicycle, he said.

“As I fell on the road with sharp pain, figuring out who hit me, four people came and started to hit me with wooden sticks,” Nayak said.

Asserting that no one had any personal enmity toward him, Nayak said that Hindu extremists in Kandhamal district have been telling people, “We destroyed and burned their houses and churches, which they have rebuilt, but now we will attack their lives, which they cannot rebuild.”

Pani and another area Christian, retired school teacher Tarsish Nayak, said they also had heard Hindu nationalists spreading this message.

Nayak recalled that a year ago, while returning to his village at night around the anniversary of Saraswati’s murder, he heard someone whispering, “Here he comes … He is coming near,” at which point he fled.

“There were people hiding, seeking to attack me,” he said.

Saraswati, a leader of the Hindu extremist Vishwa Hindu Parishad (World Hindu Council), was assassinated by a Maoist group, but Christians were falsely blamed for it. The ensuing anti-Christian attacks killed more than 100 people and burned 4,640 houses, 252 churches and 13 educational institutions. Violence also erupted in Kandhamal district during Christmas week of 2007, killing at least four Christians and burning 730 houses and 95 churches.

The area where Nayak lives and works was one of the worst-hit in the anti-Christian attacks that took place after Saraswati’s assassination.

After regaining consciousness, Nayak strained to stand up and felt blood dripping down his cheeks, he said. His bicycle was lying at a distance, its front light broken.

Nayak said he was not sure how long he lay unconscious on the road, but it was 11 p.m. by the time he managed to walk home. He said it was only by God’s grace that he “slowly, slowly reached home.”

“‘I am dying,’ were my words as I entered home and fell unconscious again,” Nayak said.

His wife Mamta Nayak, two of his children, his parents and eight villagers carried the unconscious Nayak on a cot three kilometers before getting him into an auto-rickshaw and on to Raikia Government Hospital at 1 a.m.

A doctor was summoned from his home to attend to Nayak, who required stitches on the right side of his forehead. He sustained injuries to his right knee, face, an area near the ribs and chest, and he still has difficulty chewing food, Nayak said.

“I feel nausea and pain in my head as I move my jaw,” he said.

Feeling weak from blood loss, Nayak received a saline solution intravenously for eight days in the hospital. He said he earns very little and had to sacrifice some of his valuables to pay the medical expenses. The doctor advised him to undergo a head scan, which he has eschewed as he cannot afford it, he said.

Pani told Compass that Nayak has refused to file any complaints with police out of fear of retaliation.

Nayak explained, “The police will not take any action, and we have seen in the past that I will be threatening my life by doing so.”

Report from Compass Direct News

Christian Nursing Student Nearly Dies from Assault in Pakistan


She charges Muslim doctors threw her from hospital window after gang-rape.

KARACHI, Pakistan, July 26 (CDN) — A Catholic nurse trainee has regained consciousness after a Muslim doctor allegedly raped her and threw her from a hospital’s fourth-floor window this month.

The student nurse told media and rights groups that on July 13 several Muslim men, led by Dr. Abdul Jabbar Meammon, beat and raped her, and then threw her from the window of Jinnah Postgraduate Medical Center (JPMC) to keep her from revealing the abuse.

Meammon, who had taken over a room in the all-female wing of the hospital, has a history of abusing Christian nurses, a hospital administrator said. Dr. Seemi Jamali, chief of JPMC’s Emergency Department, told Compass that Meammon had been suspended from the hospital seven times for drinking alcohol on the job and other misbehavior, and that he was drunk when he assaulted Ashraf.

A medico-legal officer at the hospital who carried out autopsies, Meammon was forcibly occupying a room in the women-only wing of the doctors’ hostel, Jamali said. She added that Meammon is an influential figure backed by a leading political party in Karachi.

The third-year student nurse, Magdalene Ashraf, was unconscious for 56 hours as surgeons fought for her life at the intensive care unit of JPMC and is still in critical condition. On July 19 she gave a statement to police that has not been released. Later that day she spoke to media and a lawyer from the Christian Lawyers’ Foundation (CLF), saying several men took hold of her at 4:30 p.m. on July 13, and after abusing her for several hours threw her from the window.

Ashraf said that fellow nurse Sajjad Fatima tricked her into going into Meammon’s room by telling Ashraf that he wanted to talk with her about a grade on a class assignment. When she arrived, she told media and the CLF, another doctor and Meammon’s driver were also present, and that Meammon grabbed her.

“When I resisted and tried to escape, nurse Fatima slapped both my cheeks and pushed me into Dr. Jabbar,” Ashraf said. “I cried out but no one arrived there to rescue me. They not only gang-raped me, they also tortured me physically and ruthlessly beat me.”

She dismissed claims by Meammon that she jumped out the window.

“If I had jumped myself, my legs would have been fractured, and I would not have had injuries to my head, brain and shoulders,” she said.

Khalid Gill, head of the All Pakistan Minorities Alliance in Punjab Province, told Compass that Meammon had a history of sexually harassing female Christian students at the teaching hospital.

Gill and the Rev. Azher Kaleem, general secretary of the Christian Lawyers’ Foundation (CLF), said that after Ashraf was thrown out the window, Meammon also jumped down in order to portray himself as innocent, claiming people trying to harm him were pursuing him as well. His hip injury from the jump was treated at the better-equipped Agha Khan Hospital, where he was hand-cuffed and his feet shackled before being transferred to a holding cell to face charges.

The Rev. Khadim Bhutto of advocacy organization Gawahi Mission Trust told Compass that he had the opportunity to speak with Meammon. According to Bhutto, Meammon said that he was relaxing in his room when Magdalene ran in followed by five unidentified men, from whom both of them eventually fled.

Bhutto said that Meammon was grinning about the incident as he told his version, seemingly pleased with what he had done.

The pastor said police have only charged Meammon and his accomplices with attempted murder, but that Christian organizations are urging police to file gang-rape charges. He added that police have also arrested Dr. Ferhat Abbas and another doctor identified only as Tayyab and are holding them at an undisclosed location.

A preliminary medical examination indicated that Ashraf was raped and tortured, said Natasha Riaz, a fourth-year nursing student.

“The swabs taken from her have confirmed that she was raped, and apart from Dr. Meammon, five other men were also involved,” Riaz said.

One of Ashraf’s family members told Compass that they have continued to receive threats from Meammon; the relative also said that Ashraf had complained of being harassed by him.

Dr. Donald Mall, an administrator with Seventh Day Adventist Hospital, told Compass after visiting the victim that there “are hundreds of rape cases of Christian nurses by doctors which go unreported in Pakistan,” and that the Sindh Province Health Department has ignored them.

Police sources told Compass that they are searching for Fatima, the nurse who is an alleged accomplice of the alleged rapists, and Meammon’s driver, identified only as Arshad, both still at large. Police said that when they arrived at the hospital, administrators stalled them long enough for Fatima to escape.

Since the assault, Christians have staged several demonstrations against religiously motivated violence such as the alleged assault on Ashraf and the July 19 murder of the Rev. Rashid Emmanuel and his brother Sajid Emmanuel, who were accused under Pakistan’s “blasphemy” laws. The latest demonstrations took place in Karachi on Saturday (July 24), and in Sargodha and Lahore the next day.

Report from Compass Direct News

Family of 17-Year-Old Somali Girl Abuses Her for Leaving Islam


Young Christian beaten, shackled to tree.

NAIROBI, Kenya, June 15 (CDN) — The Muslim parents of a 17-year-old Somali girl who converted to Christianity severely beat her for leaving Islam and have regularly shackled her to a tree at their home for more than a month, Christian sources said.

Nurta Mohamed Farah of Bardher, Gedo Region in southern Somalia, has been confined to her home since May 10, when her family found out that she had embraced Christianity, said a Christian leader who visited the area.

“When the woman’s family found out that she converted to Christianity, she was beaten badly but insisted on her new-found religion,” said the source on condition of anonymity.

Her parents also took her to a doctor who prescribed medication for a “mental illness,” he said. Alarmed by her determination to keep her faith, her father, Hassan Kafi Ilmi, and mother, Hawo Godane Haf, decided she had gone crazy and forced her to take the prescribed medication, but it had no effect in swaying her from her faith, the source said.

Traditionally, he added, many Somalis believe the Quran cures the sick, especially the mentally ill, so the Islamic scripture is continually recited to her twice a week.

“The girl is very sick and undergoing intense suffering,” he said.

Her suffering began after she declined her family’s offer of forgiveness in exchange for renouncing Christianity, the source said. The confinement began after the medication and punishments failed.

The tiny, shaken Christian community in Gedo Region reports that the girl is shackled to a tree by day and is put in a small, dark room at night, he said.

“There is little the community can do about her condition, which is very bad, but I have advised our community leader to keep monitoring her condition but not to meddle for their own safety,” the source told Compass. “We need prayers and human advocacy for such inhuman acts, and for freedom of religion for the Somali people.”

Somalia’s Transitional Federal Government generally did not enforce protection of religious freedom found in the Transitional Federal Charter, according to the U.S. Department of State’s 2009 International Religious Freedom Report.

“Non-Muslims who practiced their religion openly faced occasional societal harassment,” the report stated. “Conversion from Islam to another religion was considered socially unacceptable. Those suspected of conversion faced harassment or even death from members of their community.”

Report from Compass Direct News

Pakistani Authorities Allegedly Torture Christian Girl, Family


Air Force police illegally detain 14-year-old, relatives after allegations of theft.

ISLAMABAD, Pakistan, April 29 (CDN) — Local authorities on Monday (April 26) recovered a 14-year-old Christian girl from Pakistan Air Force (PAF) police who allegedly tortured her and her family for five days here as Christian “soft targets” over false theft allegations, sources said.

Islamabad police in predominantly Sunni Muslim Pakistan removed Sumera Pervaiz from a PAF hospital, where she was recovering from injuries that a doctor said could cripple her for life. Earlier this month, according to family and police sources, PAF police were said to have illegally detained her and members of her family after PAF Wing Commander Faheem Cheema, who had hired Sumera as a maid, found gold ornaments and other valuables missing from his home in PAF Colony, Islamabad.

Cheema filed a theft complaint with local police without naming any suspects, but without informing local officers the wing commander on April 15 allegedly directed PAF police to detain Sumera and four members of her family – Pervaiz Masih, Sana Bibi, Parveen Masih and Kala Masih – who live in PAF Colony in Islamabad. PAF police allegedly failed to inform local police about detaining the family.

Cheema has denied that he ordered PAF police to detain the girl and her family members.

When District and Session Court Judge Mazhar Hussain Barlas ordered Sumera to appear at a hearing on April 22, she testified that on April 15 three persons who were not in uniform arrived at her house at midnight and detained her, her father Pervaiz Masih and the other family members.

“For many days we remained in the custody of those people, who severely tortured me during their ‘interrogation,’” she said.

When the judge asked her who had brought her to the PAF hospital, she replied that during questioning she had lost consciousness and later found herself in the hospital.

“So I don’t know who brought me there,” she said.

Because of injuries sustained during torture, Sumera is barely able to walk, said Dr. Nusrat Saleem of the PAF hospital.

“Sumera is under treatment, we are trying our best, but unfortunately the reports indicate that she might not be able to walk for the rest of her life,” Saleem told Compass.

The Pervaiz family’s Roman Catholic parish priest, Samuel James, said that the theft accusation, illegal detainment and torture would not have happened to fellow Muslims.

“I am really disturbed to see that this innocent family has been severely tortured by the police,” he said. “They have been targeted because of their faith.”

At the April 22 hearing, Sumera testified that as PAF police were questioning her, she saw her brother Imran Pervaiz also was there. The judge instructed the court to take note that PAF police had also taken her brother into custody.

In denying that he had ordered PAF to detain Sumera and her family members, Cheema reportedly said, “I don’t know anything about the illegal detention of the family, nor have I asked the police to interrogate them. They detained the family and tortured them on their own.”

Inspector Saleem Khan of the PAF police, however, indicated otherwise.

“Faheem’s family expressed their doubts about Sumera and her family, saying they are Christians and don’t belong in PAF Colony,” he said.

Initially police had tried to keep Sumera from testifying, with Station House Officer Mumtaz Sheikh telling the court, “Sumera’s health doesn’t allow her to come in the court, and she was therefore admitted in the PAF Hospital.” 

The family’s attorneys, Jamila Aslam and Shamoona Javid, replied that their client was in the hospital because she had been tortured and requested that the judge direct that she be produced in court. Barlas so ordered, and a few hours later police brought her from the PAF hospital. It was the judge also who ordered that she and her family members be removed from PAF hospital custody on Monday (April 26).

Barlas also directed police to produce Sumera’s brother, Imran Pervaiz, before the court, saying that failure to do so would result in an order for police to file a First Information Report against Cheema based on testimony by Sumera and her father.

The judge also directed police to ensure that Sumera gets a medical exam, with the results to be shown to the court.

Christian organizations including Ephlal Ministry, Peace Pakistan, Protect Foundation, Life for All and others have condemned the incident. Ephlal Ministry Chairman Mehboob Alam has called on other Christian leaders to assist the family, as they have been evicted from their PAF quarters. 

Report from Compass Direct News 

Theology Student Dies in Attack in Madhya Pradesh, India


Hindu extremists raid revival meeting in one area, while others attack gospel event in another.

NEW DELHI, April 27 (CDN) — Hindu extremists raided Christian events in India’s Madhya Pradesh state this month, leaving a visiting theology student dead and several other Christians injured.

The body of 23-year-old Amit Gilbert was recovered from a water well 25 feet from the site of a Christian revival meeting that 15 to 20 Hindu extremists attacked on April 17 in Gram Fallaiya, Post Pathakheda, Betul district. With covered heads and carrying iron rods and bamboo clubs, members of the Hindu extremist Dharam Sena and Bajrang Dal cut electricity at the night-time event and began striking, sending the more than 400 in attendance running, Christian leaders said.

Eyewitnesses said the assailants chased Gilbert, of Gorakhpur in Uttar Pradesh state, and beat him mainly on his legs. Police in the state controlled by the Hindu extremist Bharatiya Janata Party (BJP) said that for the moment they believe Gilbert accidentally fell into the well amid the chaos, but Christians present said that is unlikely.

His body was found with his head and legs submerged in the 1.5-meter deep water of the well, yet he had no water in his lungs or stomach when Christians drew him out, said Pastor Santwan Lal, organizer of the April 15-17 revival event, suggesting that Gilbert was dead before being thrown in. 

“Amit was hit first and then picked up and thrown into the well,” Pastor Lal said. “If he had fallen into the well, he would have had more bruises and at least a broken bone or two, since the well is rocky and narrow. But that was not the case.”

Pastor Lal and others Compass spoke with said they believe the posture of the body leaves no doubt that Gilbert was murdered.

“He sustained an injury on the left side of his face near the ear,” Pastor Lal added.

An autopsy was conducted, but authorities are not disclosing findings, Pastor Lal said. Hindu extremists from the Rashtriya Swayamsevak Sangh and Bajrang Dal are reportedly exerting intense pressure on local authorities.

Betul Assistant Sub-Inspector Santosh Jain told Compass that the results of the autopsy, conducted by a team of doctors, will not be released because they have now become politicized.

Police on April 19 arrested nine people in connection with the incident and charged them with rioting, violence and trespassing, but not murder. Officers also registered Gilbert’s death under the Section 174 of the Code of Criminal Procedure, which pertains to inquiry and report on an incident involving death of a person whether suicide or otherwise.

“We are trying hard, but this case does not seem to be moving forward,” Jain said. “A report has been registered against 10 to 12 [initially] unidentified people, and we have so far arrested nine. All have accepted their involvement in the crime, and all belong to the Bajrang Dal. Not one of them is a local from Betul. Their bails have been rejected at the lower court.”

Arrested were Rakesh Dhurwe, Neeraj Rajput, Radheshyam Sahu, Sonu Rajput, Raju Kahar, Rajesh Oriya, Raju Deshmukh, Arun Thackrey, and Hemrath Bahalavi, he said.

Though police have initially determined that Gilbert fell into the well, they say they are open to the possibility that he was thrown into it.

Pastor Lal added that two women were also injured in the melee.

“As a result of the violence, two ladies attending the meeting were hit, and one of them was admitted in a local hospital for three days,” he said.

Christian leaders said Betul has increasingly witnessed such attacks since the BJP came to power in the state in 2004, with various incidents of Christians being beaten, arrested and intimidated.

The April 17 attack was sudden and without provocation or warning, Pastor Lal said. Soon after the assailants left, the Christians gathered to determine if anyone were missing. An unnamed girl and a nephew of the pastor were missing but later found, and that night Gilbert’s body was found when a Christian shined a flashlight into the well.

Gilbert was visiting as a volunteer to another pastor after having finished his Masters in Divinity degree from Central India Bible College, Itarsi, Madhya Pradesh, in March. He had reportedly insisted on staying to help Pastor Abhishek John in Sallaiya village in order to gain ministry experience.

Sources said April 17 was to have been Gilbert’s last day of volunteer service, as he was planning to return home to Uttar Pradesh the next day.

Rampage in Balaghat

In Balaghat on April 14 and 15, Hindu extremists attacked a three-day gospel meeting with fuel-bombs in spite of the presence of police summoned beforehand to provide security.

Prior to the event attended by 10,000 people in Balaghat’s Mulna stadium, local newspapers carried open threats issued by the Bajrang Dal and BJP workers against the Christian community. On April 14Bajrang Dal members threw two fuel-bombs into the stadium that did not explode.

“They had hurled petrol bombs even in the presence of the police,” Saurabh Panduria, a local Christian doctor, told Compass. “Thankfully it did not explode, or anything could have happened as there were many women, children and sick people in the crowd.”

The next day Bajrang Dal and the BJP workers attacked the event as well as the quarters where people who had come from outside Balaghat to attend the meetings were staying, including Kamla Nehru hall.

Police increased security for the April 15 meeting, but as it was drawing to a close about 150 BJP andBajrang Dal members surrounded the stadium. Some of them tried to storm in, but police repelled them. Hindu extremists responded by pelting them with stones and throwing fuel bombs at police vehicles. They also attempted to destroy stadium property.

Bajrang Dal workers Golu Thakre and Manu Yadav were among those who harassed participants at an afternoon meeting on April 15, said Dr. Amos Singh of Jeevan Jyoti Ministries in Balaghat.

“Darbari and Ganesh from Barai village in Mandla, Madhya Pradesh, and Sunil Jagne from Gondia, Maharashtra, were severely beaten by the Bajrang Dal people, and they were interrogated like they were criminals,” Singh said. “The police arrived later.”

At 5 p.m. extremists caught hold of some Christians and forced them to the BJP local office in Balaghat, where BJP and Bajrang Dal members assaulted at least three of them.

Police arrested nearly 23 Bajrang Dal members, including eight leaders. This prompted BJP Member of Parliament K.D. Deshmukh and Member of Legislative Assembly Ramesh Bhatere to lead a mob that surrounded the police station and protested throughout the night, loudly shouting slogans against the administration and the Christian community.

About 1,000 to 1,500 BJP and Bajrang Dal supporters fanned throughout Balaghat, bunching particularly around a bus stand and railway station and damaging at least three vehicles, including ones belonging to a senior police officer and an ex-Member of Parliament, Ashok Singh Saraswat. The mob attempted to set fire to buses from Maharashtra state transport corporation.

Since most of those attending the meeting were outsiders, the Bajrang Dal members descended on the railway station and bus stand and harassed passengers and broke property, damaging both buses and railway coaches, Singh said. If the extremists found a Bible in the luggage of people at the railway station and bus stand, they attacked them, he said.

“Christians who were returning from the meeting and attempting to get away from Balaghat as soon as possible were attacked and beaten with sticks and pelted with stones,” Singh said. “Women workers of the BJP attacked Christian women staying in Sindhi Dharamshala [hall], and some Christians who had come from Gondia and other places from nearby Maharashtra and Chhattisgarh had to flee for their lives, leaving behind their luggage in the Kamla Nehru hall and other places where they were put up.”

Pastor Kamlesh Nagpure said that he and his family were stuck in the stadium, unable to go to their home outside the city limits of Balaghat.

“People were driven to safety in tractors and private cars following the ruckus, and they were attacked even till early morning, 4 a.m.,” he said. “The attackers used large sticks to rough people up and indulged in brick throwing, which also damaged some vehicles. Some of us who could not get a safe ride outside town limits were forced to stay inside the stadium the whole night. Most of the crowd was composed of women and children.”

Christian leaders reportedly said the mob also damaged a Catholic church in Balaghat and attempted to attack other church buildings and houses belonging to Christian leaders. They threw fuel-bombs at the house of the Rev. Arvind Deep, where several participants had taken refuge that night.

At last the administration was forced to impose a curfew until April 17, even as the BJP declared a total shutdown of market and other activities on April 16 and 17 as part of their protest.

“Targeting participants of the meeting and beating and intimidating them continued till 10 a.m. on April 16,” Singh told Compass. “Many Christians have fled Balaghat out of fear and have gone to live with their relatives.”

Eight people who were arrested on April 15 were reportedly released the next morning.

Report from Compass Direct News 

Recent Incidents of Persecution


Karnataka, India, January 7 (CDN) — Police led by Hindu extremists accused a pastor without basis of forceful conversion, reprimanded him for praying without government permission and stopped the Sunday worship of his India People Ministry church on Dec. 27 in Koppa. The Global Council of Indian Christians reported that police further warned Pastor D.M. Kumar that he would be arrested if he conducted future worship services.

Karnataka – Members of the Hindu extremist Bajrang Dal accused Christian nurses at Pandapura government hospital of forceful conversion for conducting a small Christmas program on Dec. 25 in Mandhya. The Global Council of Indian Christians reported that at about 2 p.m., Sophia Parinamala Rani and two others identified only as Philomina and Bajamma organized a small, customary Christmas meeting for staff members and patients, inviting a guest to speak about Christ. Some 20 Hindu extremists reached the hospital and, manhandling the speaker, accused the nurses of forceful conversion. Pandapura police forcefully obtained an apology letter from the nurses, who received a show-cause notice ordering them to explain the meeting to hospital authorities.

Andhra Pradesh – A Hindu extremist roughed up two Christians at a worship meeting on Dec. 23 in Mahabubnagar. The All India Christian Council reported that a pastor identified only as Prabudas and a doctor identified only as Nehemiah were on their way to a service when a Hindu hardliner and karate master, Satya Narayana, pushed and punched them, threatening to file a case of forceful conversion against them. He threatened them with more violence if they continued Christian activities in the area. Local Christian leaders were taking steps to protect the two men at press time.

New Delhi – Hindu extremists assaulted Christians attending a Christmas program of the Full Gospel Church of God on Dec. 22 at Nagafgarh. A source reported that the Hindu hardliners threatened pastors Benny Stephen, K. Cherian and Stephen Joseph, claiming that the program they were attending aimed to convert people by force, and then attacked them. Pastor Joseph suffered injuries to his left leg and back, Pastor Benny to his back and face and Pastor Cherian to his head. Pastor Joseph told Compass that no police complaint was filed as the Christians forgave the attackers.

Tamil Nadu – Hindu extremists attacked a group of Christians on Dec. 20 in Mangalam, Nagercoil. The Global Council of Indian Christians reported that Hindu extremists objected to a digital sign Christians put up stating details of an impending Christmas celebration and warned them to remove it. When the Christians refused, the extremists beat them, and some of them received hospital treatment for their injuries. A police complaint was filed, but no arrests had been made at press time. 

Andhra Pradesh – Police arrested Pastor P. Benjamin after a Hindu extremist filed a complaint against him of forceful conversion on Dec. 20 in Hyderabad. The Global Council of Indian Christians reported that Pastor Benjamin, of Holy Spirit Church, spoke of Christ with about 200 children at a Christmas program organized by a nearby area’s Christian youth leader. As Pastor Benjamin reached his home, local Christian leaders informed him that police had filed charges of forcible conversion against him under Section 295/A of the Indian Penal Code. Applications for bail were twice rejected. Area Christian leaders were taking an appeal to a higher court, and the pastor’s family was relocated as a security precaution.

Maharashtra – Hindu extremists from the Bajrang Dal on Dec. 20 attacked members of Christian ministry Operation Mobilization in Manchar and took their film equipment. The All India Christian Council (AICC) reported that about 100 extremists attacked the organization’s screening of a Christian film, organized by the area pastor with the permission of the village head. As the movie ended, the Hindu hardliners rushed in, verbally abused the Christians for their faith and took a film projector and DVD player. Moses Vatipalli of the AICC told Compass that area leaders of Hindu extremist groups were planning to meet with Christian leaders to settle the matter.

Andhra Pradesh – Hindu extremists in Karimnagar on Dec. 15 beat 65-year-old Pastor S. Devavaram and other Christians, accusing them of forceful conversion. The Global Council of Indian Christians reported that Pastor Devavaram and five youths were distributing Christmas literature after obtaining permission from the deputy superintendent of police. At about 9 a.m. a mob of 20 Hindu extremists stopped their vehicle, dragged the pastor out and accused him of forceful conversion. They beat the pastor, tied his hands and locked him and the other Christians in a room till 5 p.m. On learning that the pastor and the other five had been abducted, 10 Christians reported it to police. Officers arrived at the site of the assault and took the Christians to the police station, where the extremists filed a complaint of forcible conversion against the pastor and his team. Police took written statements from the Christians and released them without charges at 6 p.m.