My child has been diagnosed with ADHD. How do I make a decision about medication and what are the side effects?

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Alison Poulton, University of SydneyIf your child has been diagnosed with attention deficit hyperactivity disorder (ADHD), you might be wondering: what now? And how do I know if medication is warranted?

The answer will depend on circumstances and will change over time. It’s quite OK to leave medication as a last resort — but it can be a very useful last resort.

Here are some questions I typically work through with a parent and child negotiating this issue.

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Five key questions for parents and children with ADHD

1. Is this child underachieving academically in relation to their ability?

Was the child bright as a preschooler but struggled at school for reasons unclear (not, for example, due to vision or hearing problems)? Did they cope OK early in school but didn’t achieve at the level expected when schoolwork got harder?

2. Is this child’s behaviour creating unreasonable levels of stress or disruption at school?

For a child with ADHD to complete a task, it must be sufficiently interesting, short or easy. If a child can’t concentrate in class, they get bored. They might talk in class, create distractions or disrupt class. Obviously, careful judgement is needed to differentiate typical child behaviour from problematic behaviour.

3. Is this child’s behaviour creating unreasonable levels of stress or disruption at home?

At home, is the child able to draw, construct with LEGO, do puzzles or play blocks for longish periods of time? Or do they find the sustained effort needed unachievable? Do they then annoy a sibling to make life more interesting, or constantly ask adults to play with them?

If a child is working on homework for half an hour, how much time is spent concentrating? Are they focused for only ten minutes and the remainder is spent guiding them back on track?

Is the parent tearing their hair out with countless reminders and finding every time they check, the child is distracted again?

Doctors, parents, teachers and the child must work together and regularly ask whether the current approach is actually providing benefit.
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4. Is there a significant effect on peer relationships?

Children with ADHD don’t always have the patience to wait their turn or concentrate on what peers say. They may come across as bossy; they find it easier to focus on what’s happening in their own mind but more challenging to listen and process what others say. Their peers may eventually find someone else to play with.

5. Is there an impact on self esteem?

Is this a smart child who doesn’t think they’re smart because they struggle to concentrate long enough to get work done? Do they speak negatively about themselves? It’s important to take self esteem seriously.

There are also diagnostic criteria that need to be checked.

Support strategies at home and in class

What other supports could help? Is the child sitting at the front of class? Is the teacher giving written instructions? Do they sit next to a good role model?

Has the parent done parenting classes? Have they tried home strategies rewarding good behaviour, or giving appropriate consequences for problematic behaviour?

Having a chart for the morning routine can be helpful. Many such strategies work nicely on children without ADHD. But children with ADHD often find the effort needed to earn a sticker isn’t worth it and may try to negotiate ever greater rewards.

If you’ve got to the end of that road and the child is still having problems, you might consider medication.

The first thing to know is these stimulants wear off reasonably quickly — after about four hours.
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What does medication do?

With ADHD, it’s like your brain is running on a half-charged battery. Your concentration keeps flicking off or winding down. Medication makes it more like your brain is running with a fully charged battery.

The active ingredient in medication is usually a stimulant such as dexamphetamine or methylphenidate. You might know it by the brand name Ritalin.

These stimulants wear off quickly — after about four hours. That may help the child get through the school morning; they may need another dose at lunch and perhaps a third dose if they have after-school activities. There are also capsules that release medication more slowly.

The medication is always wearing off and you are back to square one. On the one hand, that’s a nuisance. On the other, it means you can try medication, then stop and you’ll still have the same child you had at the beginning.

You start low and increase gradually until you find a dose that lasts about four hours. The teacher can help with feedback. The dosage may need to be adjusted as the child grows. These decisions are all made with the support of the clinician.

Generally, you get improvement up to a point where no further benefit is seen. If the dosage is too high, a child may seem aggressive, depressed or “zombie-like”. Nobody wants a dosage that is not leading to a better outcome.

If you decide to use medication, the dosage may need to be adjusted as the child grows.
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What about side effects?

The most significant side effect is appetite suppression, so we monitor weight and height closely. Generally, weight stabilises in the long run.

Rebound hyperactivity as the medication wears off and difficulty sleeping can occur. Sometimes this can be managed by changing the dosage or by not medicating too late in the day.

The decision to give medication is made on a daily basis. If you aren’t happy, you can omit it and see how things go.

This medication improves anyone’s concentration, not just children with ADHD, so it’s also sometimes a drug of abuse (among university students, for example). When used for treating ADHD, the risk of addiction is minimal.

But if you have concentration problems, you have more scope for improvement. A child who is concentrating most of the time cannot experience much improvement.

Reviewing progress

I always ask the child: does the medication work? How do you know? I might find out from a teenager that their concentration has improved from 20% to 80% or 90% of classtime. A younger child who prefers to feel in control of their behaviour may actually remind the parent when the next dose is due.

Often I hear from parents the child is now keen to get homework done, has more friends and feels happier and more confident.

All parents want their child to feel they’re functioning and fulfilling their potential. Most will achieve this without medication. That’s plan A. Plan B is that they are fulfilling their potential and living a great life, helped by medication.

Doesn’t every child, every person, with ADHD deserve a plan B?

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Read more:
ADHD prescriptions are going up, but that doesn’t mean we’re over-medicating

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Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

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

I’ve heard COVID is leading to medicine shortages. What can I do if my medicine is out of stock?

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Nial Wheate, University of Sydney and Elise Schubert, University of Sydney

You’ve just come from your monthly GP appointment with a new script for your ongoing medical condition. But your local pharmacy is out of stock of your usual medicine. Your condition is serious, and without it, your health is likely to suffer. What can you do?

While medicine shortages happen from time to time, researchers and the media report COVID-19 is causing more shortages than normal for many life-saving medicines. In Australia, media reports indicate this includes some medications used to treat hyperthyroidism, high blood pressure, or allergies.

Unfortunately, you’ll only likely find out if this applies to you when you reach the pharmacy. If that happens, there are a few ways you may be able to obtain your prescription.

But if the stock shortage will last for an extended period of time, and you cannot find a supply, your doctor may need to consider prescribing a different medication.

Why are there shortages?

Unfortunately, medicine shortages are an all too common problem of the modern health-care system. When our medicines come from a global supply chain — where raw ingredients are made in one country, processed into medicines in another, then freighted by sea or air to Australia — a single break in the supply chain can result in medicines going out of stock.

So there have been calls for Australia to set up its own medicines manufacturing base. But even if we do, that doesn’t help now during COVID.

Medicines shortages is a growing issue globally. That’s because of increasing demand, higher quality standards and fewer manufacturing sites.

Shortages have also been exacerbated in 2020 due to COVID-19. When workers are locked out of the factory because of a local outbreak, medicines don’t get made. And when we restrict the number of flights into Australia, that prevents medicines from arriving.

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When a manufacturer knows there is likely to be a medicine shortage, for any reason, they are required to inform the Australian Therapeutic Goods Administration (TGA) so pharmacies can make other arrangements, such as stocking up on alternatives or sourcing supply from other companies.

When the medicine shortage is considered to have a critical patient impact, or if it is in the interest of the public to know about the shortage, then the information is added to the TGA’s shortages website, which the public can search.

But this information is only useful at the government and wholesaler level; local GPs and community pharmacists don’t have the time to check the site every day.

Dealing with shortages efficiently is important because their impacts are wide ranging. Shortages result in higher costs to patients when they have to buy branded rather than generic formulations; more drug errors due to the different strengths and brands dispensed; more side-effects and higher death rates because of changes to less appropriate medicines; and more complaints from patients.

There’s not always enough medicine to go round. And shortages can affect a patient’s health.
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What if your local pharmacy is out of stock?

It is best to speak to your pharmacist about your options when your medication is out of stock. There may be other brands still available and appropriate to swap. Alternatively, your pharmacist could dispense a different strength of the same medication. Regulations brought in during the pandemic have allowed pharmacists to do this to help with medicine supply.

If there are no appropriate substitutes, in rare instances a local compounding pharmacy can manufacture certain products in store.

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If none of your local pharmacies stock your medicine, your next option is for an Australian online pharmacy to fill your script. It may be able to ship your medicine from another city or state.

It is not legal or safe for you personally to order prescription medications from online overseas suppliers. This is because they may not have been manufactured to Australian standards, and may be unsafe. But your pharmacist may do so on your behalf, under a special provision called section 19A.

If all else fails, you may need to contact your doctor about changing to a different medication. There are often many alternatives in the same drug class that work in the same, or very similar, way.

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Finally, and especially during COVID-19, for a large number of medicines pharmacists are only allowed to provide a maximum of one month’s supply to each patient.

So if your medicine is actually in stock and you want extra, just in case, then by law they may not be able to dispense it to you. This is to prevent panic buying and to ensure the wider community has steady access to medicine; that is, to prevent further shortages.

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Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of Sydney and Elise Schubert, Pharmacist and PhD Candidate, University of Sydney

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

What time of day should I take my medicine?

Does it matter if you take your medicine morning, noon or night? That depends on a number of factors.
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Nial Wheate, University of Sydney and Andrew Bartlett, University of Sydney

Whether you need to take a drug at a specific time of day depends on the medication and the condition you are treating. For some medicines, it doesn’t matter what time you take it. And for others, the pharmacist may recommend you take it at the same time each day.

But we estimate that for around 30% of all medicines, the time of day you take it does matter. And a recent study shows blood pressure medications are more effective if you take them at night.

So, how do you know if the timing of your medication is critical?

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When timing doesn’t matter

In most cases, it’s not important when you take your medicine. For instance, you can take non-drowsy antihistamines for hay fever, or analgesics for pain when you need them. It doesn’t matter if it is morning, noon or night.

What is more important is the time interval between each dose. For instance, paracetamol needs to be taken at least four hours apart, any closer and you run the risk of taking a toxic dose.

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Even when a medication doesn’t need to be taken at a particular time, the pharmacist may still recommend you take it at the same time every day anyway.

This daily pattern helps remind you to take it. An example is taking the oral contraceptive at the same time each day, simply out of habit.

For the mini pill, taking it at the same time is actually necessary. But the actual time of day can be whatever works best for you.

When does it matter?

It may seem fairly obvious to take some medicines at particular times. For example, it makes sense to taking sleeping medications, such as temazepam, at night before you go to bed.

Some antidepressants, such as amitryptyline or mirtazapine, have drowsy side effects. So it also makes sense to take them at night.

For other medicines, taking them in the morning is more logical. This is true for diuretics, such as furosemide, which helps you get rid of excess fluid via your urine; you don’t want to be getting up in the night for this.

When a medicine needs to be taken at a specific time, this will be indicated on the box.
Author provided

For other medications, it’s not obvious why they have to be taken at a particular time of day. To understand why, we have to understand our circadian rhythm, our own internal body clock. Some systems in our body work at different times of day within that rhythm.

For instance, the enzymes controlling cholesterol production in your liver are most active at night. So there may be some benefit to taking lipid (cholesterol) lowering drugs, such as simvastatin, at night.

Finally, sometimes it’s important to take medications only on particular days. Methotrexate is a medicine used for rheumatoid arthritis and severe psoriasis, and the timing of this medication is critical.

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You should only take it on the same day once a week, and when taken this way it is quite safe. But if you mistakenly take it daily, as happened recently with a patient in Victoria, then it can cause serious illness or even death.

What about blood pressure medicines?

One of the ways the body regulates blood pressure is through a pathway of hormones known as the renin, angiotensin and aldosterone system.

This system responds to various signals, like low blood pressure or stressful events, and controls blood volume and the constriction of blood vessels to regulate your blood pressure.

Importantly, this system is more active while you’re asleep at night. And a recent study, which found blood pressure medication is more effective at night,
may change the way we use medicines to treat high blood pressure.

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Two types of drugs typically prescribed to lower blood pressure are angiotensin converting enzyme (ACE) inhibitors, such as perindopril, and angiotensin receptor blockers (known as ARBs), such as irbesartan. These drugs dilate blood vessels (make them wider) to reduce your blood pressure.

Until now, doctors and pharmacists have often advised patients to take these medications in the morning, assuming it’s good to have a hit of the drugs when you’re up and about.

But this study found taking blood pressure medications at night produced a significant reduction (45%) in heart disease, including fewer strokes, heart attacks and heart failure compared to taking them in the morning.

Taking them at night also meant people’s blood pressure was better controlled and their kidneys were healthier.

So if you take one of these drugs to control your blood pressure and aren’t sure what you should do, talk to your pharmacist or doctor. While evidence is building to support taking them at night, this might not be appropriate for you.

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Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of Sydney and Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of Sydney

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

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

UGANDA: THREATS, EXPULSIONS FOR CHRISTIAN COUPLE

Hostilities evident in Muslim area where missionaries were slain.

NAIROBI, Kenya, June 26 (Compass Direct News) – When a young Muslim woman in northern Uganda heard about Jesus in February 2005 and began having dreams about the cross of Christ, it marked the beginning of a nightmare.

Between the dreams and otherwise sleepless nights, Aleti Samusa of Yumbe district soon converted to Christianity; her family immediately kicked her out of their home.

Economically devastated and deprived of that which is most valued in the communal culture, Samusa sought refuge in a local church in Lotongo village. There she found the man she would marry later that year, David Edema, who was raised a Christian but who began sharing in the sufferings of a convert from Islam by virtue of becoming one flesh with one.

His bride’s family did not attend the couple’s wedding, Edema told Compass, and it wasn’t long before her relatives threatened to break up their marriage. With Samusa’s family threatening to forcibly take her from Edema, the couple fled Lotongo village to Yumbe town. Their troubles had just begun.

“The Muslims started sending people, saying that I am not wanted in Yumbe town and that I should leave the town,” Edema said.

Most houses in Yumbe are owned by Muslims, he said, and since 2006 the couple has been forced to move from one rented house to another without notice.

“The owner just wakes up one morning and gives us marching orders to vacate the house,” the 29-year-old Edema said. “Nowadays, the situation is getting worse. Muslims are openly saying even in their mosques that they plan to take unknown action against my family.”

One potential danger amounts to a death threat against his wife, now 24.

“The Muslims are saying that they are going to send some Jinns [evil spirits] to my wife because she forsook Islam, and that this spirit will kill her,” he said.

Asked what steps he has taken in the face of these threats, Edema was resigned.

“It will be pointless to take this matter to court, because the people who are to hear the case are Muslims,” he said. “I feel no justice will be done.”

Area Violence

Edema said he and his wife are hoping that God will open a door for them to move to another town.

“The sooner the better for us,” he said, “for we do not know what the Muslims are planning to do with us.”

Violence in Yumbe district is not without precedent. On March 18, 2004, seven suspected radical Islamists dressed in military fatigues murdered two African Inland Mission missionaries and a Ugandan student in an attack on a college run by local aid group Here is Life. Warren and Donna Pett, both 49 and agriculture experts from the U.S. state of Wisconsin, were teachers at the Evangelical School of Technology. The slain student was Isaac Juruga.

The murder case was dismissed in February by the state attorney, who claimed lack of evidence. A Here is Life official who requested anonymity, however, said not enough weight was given to evidence that included a mobile phone recovered from one of the suspected assailants.

“We feel that justice was not done in the ruling of the killing of the two missionaries,” he said.

In Yumbe, the administrative arm of the government as well as the judiciary is run by Muslims, said Edema, who added that the district is still not a safe place for Christians.

“Sometimes they even confront me that I should stop converting Muslims to Christianity – this is not true,” Edema said. “It is just a way of wanting to pick a quarrel with me.”

Edema, his wife and two children belong to Pilgrim Church. Christians and converts to Christianity are a tiny minority in the area, but about three kilometers from Yumbe town is the Church of Uganda in Eleke, with a congregation of about 100. This church has recently sounded alarms about Muslims making land-grabs of its property.

A church leader who requested anonymity said area Muslims have seized a substantial portion of the church’s land, but when the matter went to court, the case was dismissed due to lack of a title deed.

In addition, in May Muslim youths beat a female church worker who had taken a photo of a mosque that was under construction 100 meters from the church, he said.

“Rowdy Muslim youths removed the film after destroying the lid of the camera,” he said. “The militant youths started beating up the church worker as they dragged her to the police station in Yumbe, where she was interrogated for three hours before being released.”

Peter Manasseh, vicar of the Eleke Church of Uganda, said the church has filed a complaint with the local governing council, “but we do not expect any fairness to be done because the person handling this case is a Muslim and will be partisan.”

A journalist who works for a Christian radio station, however, decided to look into the case – and was himself beaten. Ronald Oguzu of Voice of Life radio in Arua town went to Yumbe yesterday to investigate, said a senior station official who requested anonymity.

“At the mosque site, the Muslims caught hold of Oguzu, beat him and he had his tooth broken,” the official said. “He was then hospitalized in Yumbe hospital and is still receiving some medication.”

He said a criminal case has been filed, but that chances for justice were not good.

“We know that this case will be thrown out of the window, just like that of the killing of the two missionaries,” he said. “To date no arrests have been made.”

Report from Compass Direct News

CHINA: BOOKSTORE OWNER SENTENCED TO THREE YEARS IN PRISON

Shi Weihan also fined nearly $22,000; ‘illegal business’ printed Bibles for free distribution.

 

LOS ANGELES, June 10

(Compass Direct News) – A Beijing court today found Christian bookstore owner Shi Weihan guilty of “illegal business operation” and sentenced him to three years in prison and a 150,000 yuan (US$21,975) fine.

Sources said Shi’s store operated legally and sold only books for which he had obtained government permission, and that his Holy Spirit Trading Co. printed Bibles and Christian literature without authorization but only for free distribution to local house churches.

The 38-year-old Shi had been released on Jan. 4, 2008 due to insufficient evidence for the same vague charge of “illegal business operation,” but he was arrested again two month later, on March 19, and held virtually incommunicado. Contrary to Chinese law, authorities have denied all but a few visits from his lawyer and family, held him without charges for most of his time in jail, and initially withheld medication for his diabetes.

The court ruling appears to have allowed time that Shi has spent in jail to count toward his sentence, a source said, as his prison term was described as running from Nov. 28, 2007, when he was initially arrested, to Nov. 27, 2010.

Others in a printing company who stood trial with Shi appeared to have received similar sentences. A written judgment is expected within 15 days to allow time for an appeal to be filed, said Ray Sharpe, a friend of Shi.

“Absent an appeal, it is also possible that Shi could be allowed a sort of medical parole, due to his diabetic condition,” Sharpe said. “Hopefully, he could then be allowed to stay in a hospital under a sort of house arrest.”

He said that Shi did not yet know whether he would appeal, adding that the process could take up to a year.

Friends and business acquaintances of Shi have described him as a model citizen of China, saying that he has inspired them to love China by his patriotism and love for his homeland. They said he is known for selfless sacrifice on behalf of poor and disenfranchised rural Christians and minority children.

For much of his incarceration, Shi’s wife Zhang Jing and their two daughters, 12-year-old Shi Jia and 8-year-old Shi En Mei, have not known where he was being held. The family has been under nearly continual surveillance, limiting their ability to make contact with people who could assist them.

Sources said Zhang has worried about her husband’s condition and that she has taken on leadership duties at their church, where Public Security Bureau officials have intimidated the congregation with regular visits. Some members have left the church because of the intimidation, sources said, and Zhang is said to have suffered anxiety and stress that have led to depression.

Their two daughters have been ostracized at school for being the children of a prisoner, sources said.

Shi has lost more than 44 pounds since his second incarceration, they said, dropping to less than 130 pounds. The sources added that he has suffered from blisters because of unsanitary conditions in prison, as well as tinnitus that at times causes his ears to ring so loudly that he cannot sleep.

Chinese officials claim that the Nanjing Amity Printing Co. (Amity Press), the only government-approved Bible publisher, produces enough Bibles to meet the needs of the Chinese church, which various religious freedom organizations dispute. The groups complain that Amity prints a large share of its Bibles for export, and those sold domestically are not available to many Christians.

Report from Compass Direct News

PAKISTAN: SISTERS ABDUCTED, FORCED TO CONVERT TO ISLAM

Repeatedly raped, minor and 18-year-old now face societal rejection.

ISTANBUL, January 19 (Compass Direct News) – The ordeal of two teenage Christian sisters in Pakistan is over after Muslims allegedly abducted and raped them and forced them to convert to Islam, but they fear a future of societal rejection.

Parvisha Masih, 18, and Sanam Masih, 14, said three Muslim men kidnapped them last November, raping them several times during two weeks of captivity.

“We are happy to return to the family, but we are feeling ashamed because there is no respect for us in society now,” Parvisha Masih said. “We don’t want to go back to school and have to face our friends.”

They face a long legal battle that will inevitably bring them into contact with their captors – who have already assaulted their family in court.

“We feel very afraid, and we are still receiving threats,” Parvisha Masih told Compass. “We are worried about our family and about ourselves. I don’t ever want to see those men again.”

On Jan. 2 the sisters recorded statements concerning their alleged abduction, rape and forced conversion to Islam before a local magistrate in Gujranwala. Earlier, they gave statements in Karachi, where they had been taken by their captors some 840 miles to the south. Two First Incident Reports (FIRs) have been filed.

In Gujranwala, Muhammad Irfan, Muhammed Mehboob and Muhammed Rafique, Mehboob’s brother-in-law, are charged with kidnapping.

 

Kidnapped

Irfan and Mehboob, suspected of involvement in a human trafficking ring, at first made contact with Parvisha Masih accidentally.

“Parvisha received a wrong number call and talked to Muhammad Irfan,” said Katherine Karamat, an investigative officer for the Center for Legal Aid Assistance and Settlement (CLAAS). “Some days later, Irfan called again and told her that he had a beauty salon, and if she wanted training he could arrange that for her.”

Eager to earn extra money for the family, Masih convinced her younger sister Sanam to join her in accepting the offer, according to CLAAS.

Irfan arranged to drive them to their first day of work in his car. At 10 a.m. on Nov. 12, Irfan and Mehboob picked the sisters up from their home.

“This is a common practice now,” said Michael Javaid, a Pakistani member of parliament based in Karachi. “They offer poor people from the villages a good job, and the parents are poor so they trust them, but then they bring these girls and sell them to other people.”

According to the sisters’ testimony, Irfan stopped the car after roughly half an hour to buy beverages. He offered them both a bottle of fruit juice that they drank, unaware that he had drugged it.

En route to Karachi, Irfan and Mehboob then drove the sisters to a motel in Mianwali, threatening them at gunpoint and telling them they would be killed if they tried to escape. The sisters reported that the men then raped them.

In the morning they were ushered back into the car and driven to the coastal city of Karachi, where they were held captive at Rafique’s house. Over the next five days, they said, the men raped them repeatedly.

Masih and Sanam then were taken to a madrassa (Islamic school), where a mufti issued certificates stating that the two had become Muslims. Parvisha Masih was renamed Sana, and her sister received the name Tayyaba.

Javaid and lawyers from CLAAS challenged these certificates, asserting that the sisters did not sign them.

“Anyone can get these papers by giving some kind of a bribe; [clerics] feel it is a service to Islam,” said Javaid. “They will issue a certificate without knowing the will of the person, whether this is a forcible conversion or not.”

Following their forced conversion at the madrassa, the Muslims took the sisters to the office of lawyers Nayer Zia-Ul-Din and Kokab Sahab-Ul-Din. Irfan explained to the lawyers that the sisters had converted to Islam and did not wish to return home to their Christian family, but instead wanted to stay at the government-run Dar-Ul-Aman shelter for women. Before leaving, Irfan told Masih and Sanam that they would be freed after the lawyers brought them to court the following day.

The lawyers told the sisters to sign blank sheets of paper, forging testimony from the pair that they planned to use to support their case, according to CLAAS. The attorneys told the sisters that they could stay with their family that night and took Masih and Sanam to their home, but no other family members were present.

After the sisters had fallen asleep, according to CLAAS, Sahab-Ul-Din took Parvisha Masih into a separate room and sexually abused her. Police found medication in Sahab-Ul-Din’s apartment indicating that the sisters were again drugged. Sanam said she woke up when she heard her older sister crying for help.

“I took the mobile of the lawyer and called 15 [the emergency police number in Pakistan],” she told Compass. “One lawyer had left; the other was with Parvisha.” She was able to escape the house and describe her location to authorities.

Police arrived at the scene shortly afterward, immediately referring Parvisha Masih to a hospital and arresting Sahab-Ul-Din, whom they took to the Ferozabad police station. The other lawyer, Zia-Ul-Din, had left but was later arrested at his home.

At the police station, Sanam called her father, Arif Masih, who rushed to Karachi to bring his daughters back home.

 

Assaulted in Court

The following day (Nov. 22), the sisters appeared before a magistrate to give testimony, accompanied by their father and other relatives. Defendants Zia-Ul-Din and Sahab-Ul-Din, both charged with rape, were also present. Upon learning that the sisters’ father was in the room, they located him and began to attack him.

“The magistrate was in his chambers, and so the lawyers attacked the father and relatives, beating them, even the women, there in the courtroom, which never happened before!” said Javaid. “All the police were called, the FHO [court police], the superintendant and deputy superintendant, and they took them to the lock-up for safety.”

Javaid said he plans to take a strong contingent of associates when they next appear in court to protect the sisters and deter another attack.

This is the second known case of its kind in recent months. Saba and Aneela Masih underwent a similar ordeal last July, and although 10-year-old Aneela has been returned to her family, her 13-year-old sister, forced to marry one of the men who kidnapped her, remains with her captors.

Christian girls from poor families make easy targets, and many cases go undocumented, Javaid told Compass. High legal fees often make it impossible for poor families to bring a case to court. Corrupt lawyers, easily swayed by bribes, often create further expense.

On top of this, a biased legal system that favors Muslims over Christians is particularly reluctant to pass judgments that would undermine conversion to Islam.

“Because both [Parvisha and Sanam Masih] are Christian and the accused were Muslim, to save their skin they made [the sisters] embrace Islam forcefully so they can marry them maybe or whatever they want,” said CLAAS lawyer Samson Joseph.

Report from Compass Direct News

INDIA: CHRISTIANS IN ORISSA FEAR VIOLENT CHRISTMAS

Hindu extremists move to stop yuletide celebrations as suffering in Kandhamal continues.

NEW DELHI, December 3 (Compass Direct News) – Christians in Orissa state are anticipating Christmas with fear as Hindu extremists have called for a state-wide bandh, or forced shut-down on all sectors of society, on Dec. 25 – a move that could provide Hindu extremists the pretext for attacking anyone publicly celebrating the birth of Christ.

Last year one of the area’s worst spates of violence came during the Christmas season.

The state’s chief minister has said there should be no such shut-down but stopped short of prohibiting the Hindu extremists’ plan. The federal government has expressed its disapproval of the proposal, but the Hindu extremist umbrella organization Sangh Parivar has vowed to press ahead with the shut-down, reported newspaper Outlook India on Nov. 20.

Though such shut-downs were declared illegal by India’s Supreme Court in 1998, the president of the Laxmanananda Saraswati Condolence Society (SLSSS) sent a threatening notice to the Orissa government on Nov. 15, warning that the Hindu extremist group would impose a bandh on Christmas unless the state government arrested those who murdered Hindu leader Laxmanananda Sararawati on Aug. 23.

A Maoist group on Sept. 1 admitted killing Saraswati and four of his aides, and police on Oct. 6 confirmed that Maoists killed them, but the Hindu extremist Vishwa Hindu Parishad (World Hindu Council or VHP) has continued to blame local Christians for the assassinations, stoking anti-Christian sentiment that led to a wave of violent attacks for more than two months. At least 500 people, mostly Christians, were estimated to have been killed, according to a report by a Communist Party fact-finding team, and at least 4,500 houses and churches in Orissa’s Kandhamal district were destroyed.

Ratnakar Chaini, president of the SLSSS, has demanded the release of Hindu leaders arrested in connection with the killing of Christians in the violence following the assassination of Saraswati.

In a massive rally in Delhi on Nov. 15, Chaini called for the shut-down in order to ensure “a completely peaceful Christmas.”

The general secretary of the Christian Legal Association (CLA) took the Hindu extremist’s comment as sarcasm.

“How can they have a peaceful Christmas if there is a bandh?” Tehmina Arora told Compass. “There can be no celebration, no going out the house also. So there can be no question of peace.”

Inflammatory speeches at the rally by Chaini and other Hindu extremists against Christianity and its leaders in India led Christians to believe the shut-down would serve as the pretext for another spate of violence against those publicly celebrating the holiday.

The Hindu extremists’ rally also included pledges that all Christian converts would be “re-converted” to Hinduism.

“If Hindus decided to take on anyone to protect our religion and culture, then nothing can stop us,” Chaini said. “Unchecked conversions by churches would be opposed with tooth and nail.”

The Sangh Parivar, including the state unit of the VHP, said in a press statement that the government has been shielding those guilty of murdering Saraswati.

 

Prohibition Demanded

Archbishop of Cuttack-Bhubaneswar Raphael Cheenath told Compass that the intention of the Hindu nationalists in calling the shut-down was malicious and done for political advantage – a way of garnering tribal peoples’ support for Hindu nationalist candidates by setting up Christians as disobedient trouble-makers.

“If the government allows the bandh to take place on Christmas Day, it will mean that they are allowing more attacks and violence against the Christians,” said Archbishop Cheenath.

Violence has broken out against Christians on previous shut-downs in Kandhamal district.

“There is a great deal of apprehension, because it was on previous bandhs that there have been attacks against the Christian community,” said Arora of the CLA. “The district collector informed us that they were taking strong steps to ensure that the bandh would not be taking place. Unless the district collector and state administrator take serious steps to see that it is not enforced, it would again be a violent attack against the Christian community.”

Orissa church authorities headed by Archbishop Cheenath met a team of visiting government ministers on Nov. 19. Subsequently Christian leaders delivered a memorandum demanding the proposed shut-down be prohibited as illegal. The memorandum demanded the state punish the people and organizations involved in such activities.

The team of central government ministers visiting riot-hit areas on Nov. 19 advised the state chief minister to ensure that there be no shut-down on Christmas Day. Finding the Kandhamal situation tense and Christians fearful, the team leader, Union Agriculture Minister Sharah Pawar, said they requested Chief Minister Naveen Patnaik to see that the shut-down on Christmas Day does not take place.

“We don’t understand why Christmas was chosen for calling the bandh,” Pawar told Outlook India. “Agitation should not be allowed on major festival days like Diwali [a Hindu festival], Christmas and Chhath [a Muslim festival].”

Stating that the minority community is under tremendous pressure because of such a threat, Pawar reportedly said the need of the hour is to restore normalcy in the riot-affected areas.

“We have requested Chief Minister Naveen Patnaik to make efforts to stop such a bandh on Dec. 25, a major festival day,” Pawar told reporters after meeting with Patnaik.

Patnaik later said, “There should not be a bandh on Dec. 25,” but he made no appeal to the Sangh Parivar to refrain from the Christmas Day shut-down.

Church leaders also requested the ministers pressure the state government to put a halt to Hindu extremists forcing Christians, under threat of death, to convert to Hinduism. Christians are allowed to live in the district only if they became Hindu, they said.

 

Deaths Continue in Orissa

A Christian woman who had fled Hindu extremist violence was killed on Nov. 25 after leaving a relief camp to harvest her paddy.

Lalita Digal, 45, was murdered in Dobali village, Kandhamal district, where she was staying with a friend, reported the Evangelical Fellowship of India (EFI). She had returned to the village on Nov. 21. On Nov. 25 she was allegedly dragged from the house and murdered. No arrest had been made at press time, according to EFI.

The state administration has forced people to leave relief camps even though they have no homes to return to, according to a local Christian body. Representatives of the Kandhamal Christian Jankalyan Samaj (KCJS) said at a press conference this week that threats continue from Hindu nationalists demanding that frightened Christians “re-convert” to Hinduism.

Conditions at the camps remain poor. At Daringbadi camp, Leunsio Digal died on Nov. 24 due to lack of proper medication, EFI reported. He had been suffering a fever for a week without access to medications to alleviate it. Digal had served as catechist for 25 years at Simonbadi parish, in the archdiocese of Cuttack- Bhubaneswar.

On Nov. 22, Orissa police fired at two Christians in Kandhamal’s border village of Kutunniganda, killing one and severely injuring another, according to the Global Council of Indian Christians (GCIC).

Junesh Badaraita died on the spot. The injured Karnel Badaraita later told a television station that they were searching for lost cattle with a flashlight when police fired at them.

Police were combing the area in their hunt for a Naxalite (Maoists or Marxist-Leninist revolutionaries) Training Camp. Under Inspector-in-Charge Narbada Kiro, they reportedly fired at the two Christians from a distance of 350 meters.

Police claimed that the two Christians were Naxalites, though villagers refuted this assertion. In protest, the agitated villagers blocked a public road and kept government officials from arriving at their offices in the area.

At press time, the district administrator promised compensation to the family of the deceased and suspended the squad in charge, said the GCIC.  

Report from Compass Direct News

CHINA: CHRISTIAN BOOKSTORE OWNER AWAITS TRIAL

Family members say Shi Weihan is nearly ‘unrecognizable’ due to weight loss.

DUBLIN, September 5 (Compass Direct News) – Beijing Christian bookstore owner Shi Weihan is awaiting the outcome of an August 19 court appearance and may be back in court within 10 days, according to Compass sources.

Denied proper medication and diet for his diabetes, Shi is almost “unrecognizable” due to severe weight loss, according to family members.

Public Security Bureau (PSB) officers initially arrested Shi on November 28, charging him with “illegal business practices” after he allegedly published Christian literature without authorization for distribution to house churches. Court officials ordered his release on January 4, citing insufficient evidence.

Officers arrested him again on March 19 and reportedly forced him to sign a “confession” convicting him of engaging in the printing and distribution of a large number of illegal publications.

They also forced Shi’s Antioch Eternal Life Church to close in June.

Shi’s bookstore, located near the Olympic Village, continued to operate during the Games.

 

Secretive Legal Process

Initially the Beijing PSB denied having Shi in custody, with officials claiming they did not know his whereabouts.

After Shi’s attorney Zhang Xingshui applied pressure, officers finally admitted having him and allowed a single visit with his attorney. They also labeled Shi a “dangerous religious element.”

Shi’s family and friends expected a trial would take place on June 19, the date that marked the end of three months of detention without charges. Chinese law prohibits the PSB from holding Chinese citizens for more than two months without formal charges, and Shi’s family and friends thought the three-month mark might have been significant. (See Compass Direct News, “Christian Bookstore Owner Still Without Trial,” June 20.)

No trial, however, took place on that day.

Authorities recently moved Shi from the Beijing Municipal Public Security Bureau back to the Haidian District Detention Center where he was held after his first arrest in November 2007.

Shi may have been held virtually “incommunicado” during the Games because of fears that he would use foreign connections to embarrass China during the event, one source who preferred to go unnamed told Compass. Shi has many foreign clients and friends.

“Perhaps the government regarded him as a potential organizer of public dissent, although many who know Shi affirm that he is a peaceful, patriotic and gentle man, not given to drawing attention to himself,” the source added.

Shi’s store operated legally and sold only books for which he had obtained government permission. Under his Holy Spirit Trading Co., however, Shi printed Bibles and Christian literature without authorization for distribution to local house churches, according to Asia Times Online.

Shi’s wife and two daughters are under great strain as a result of his arrest. Sources have asked for prayer that the family’s “strength and faith will not falter.”  

Report from Compass Direct News

My Fight with CFS … Part 1

I have Chronic Fatigue Syndrome (CFS), or as I prefer to call it, Chronic Fatigue Immune Dysfunction Syndrome (CFIDS). It is an extremely misunderstood and debilitating illness. I have read that the average time for a person to be ill with CFS is 18 months. I have had it for 18 years more or less. It has cost me a lot to be suffering from this illness and it impacts on my life on a daily basis. Some days are not too bad, while others are extremely terrible.

My journey with CFS began in the aftermath of the Newcastle earthquake of the 28^th December 1989. In early 1990, while working at Hawkins Masonic Village repairing roofs damaged by the earthquake (it was raining and many roofs were leaking), I began to feel persistently unwell. I decided to see my doctor who put it down as some sort of stomach bug, most likely Gastroenteritis. After two weeks of medication it was becoming clear that I did not have Gastroenteritis and something more sinister was the cause of my intensifying illness.

Within weeks I had begun to develop all of the debilitating symptoms of CFS and what was worse for me they were all intensifying their effects upon me. What was wrong with me was now something of a mystery, but it was clear I was very ill and getting worse.

When I was younger I had Hyperthyroidism and so the doctor assumed that this was what was wrong with me again, despite the fact that blood tests indicated I no longer had an issue with that disorder. I was placed on medication for Hyperthyroidism and monitored. The medication had no effect on my illness and my patience with ‘witch doctoring’ was running out. I pleaded with my doctor to send me to someone else – a specialist. But who would be useful to see?

A friend had recently been diagnosed with CFS by an Immunologist and eventually I prevailed with my doctor to send me to him. Eventually I was able to set up an appointment and so my time with Doctor Sutherland of the Royal Newcastle Hospital Immunology Department had begun.

By this time I was suffering a myriad array of symptoms, with varying degrees of intensity depending on what week I was asked. Among the most debilitating of these symptoms was a persistent headache that no amount of painkilling or other medication had any impact upon. The headache was like a migraine that wouldn’t go away. It would last for an 18 month stretch this first time, bringing with it an intolerance of bright light, noise, etc. These things caused me immense head pain.

I was also suffering numerous nose bleeds (which I often get when I am very ill), fevers and chills, brain fog (a situation where you seem to know what is going on yet you have an inability to act in a logical manner – some times the sense of knowing what is happening disappears altogether), painful eyes, chronic fatigue in the muscles and extreme soreness, tiredness to the point of sleeping at a drop of a hat (I was sleeping for over 18 hours a day with no relief to my tiredness, headaches, etc), loss of strength in my limbs, constant nausea, inability to think or concentrate, etc.

By this time I was already having time away from work, with being away for weeks at a time being the norm – thankfully they were quite understanding of the fact that I was very ill.

At my lowest point during these first two years I was reduced to being bed-ridden, using a cane for stability when walking and at times was unable to walk. I was sleeping above 18 hours a day with no benefit from it.

During this time of extreme illness I was subjected to innumerable blood tests and other tests, which all revealed little at all as to the cause of my illness. A process of careful elimination under the care of Dr. Sutherland brought the diagnosis of CFS, as well as a psychological evaluation.

There was no cure to be found, with the only helpful advice having come from Dr. Sutherland. He told me to try and rest, then to slowly build myself up again. Walk one block for a week, then two blocks the following week, etc. If I overdid it I would be back in a heap again in no time. I needed to be able to read my own situation to know when I should try to rebuild my life. This advice has helped me through the last 18 years.

I struggled with the illness for 18 months or so and I also struggled with the enigma associated with the illness. That I was sick was not believed by all and this has been a constant stereotype I have been confronted with throughout my illness. I often found myself questioning whether I was sick or whether it was some mental thing. It was a relief when a doctor finally gave me a name for the illness and confirmed I was indeed very ill.

There were times (as there has been since) when I thought that dying would be a better alternative than to be as sick as I was, with no life and the prospect of endless years of severe illness. Suicide was something that popped into my head from time to time, but thankfully it didn’t stay there for long.

At times I found myself not knowing what I was doing, where I had been, etc. At one point I waited behind a parked car, waiting for it to turn the corner only to realise ½ an hour or so later that the car was parked. I found myself having gone shopping with a load of groceries I didn’t need and never had used before. It was like having a form of early onset Dementia.

After about 18 months I began to get better – or so I thought. I was well enough to knock back participation in a trial medication experiment for CFS sufferers which would involve a lengthy stay in hospital and a 50% chance I would receive the placebo.  I declined the invitation being concerned I would loose my job as a result of being in hospital for so long.

My health began to improve and I thought I was finally over the illness. During this time I lost contact with Dr. Sutherland who left the hospital because of a dispute with NSW health at the time. Many doctors left the public system at the time.

NEXT: The illness returns