Mathew S. Hull, Government of Paper: The Materiality of Bureaucracy in Urban Pakistan

The civilian bureaucracy has been central to everyday life and the imagination of ordinary citizens in Pakistan in a way that is almost unique in South Asia. Pakistani public discourse and scholarly debates on the country’s politics, internal security, foreign policy, and its overall direction inevitably return to the role of the ‘bureaucracy’ and the ‘establishment’ in charting the course of people’s individual and collective lives. These terms are used in the singular in conversations, indi..

Mathew S. Hull, Government of Paper: The Materiality of Bureaucracy in Urban Pakistan

The civilian bureaucracy has been central to everyday life and the imagination of ordinary citizens in Pakistan in a way that is almost unique in South Asia. Pakistani public discourse and scholarly debates on the country’s politics, internal security, foreign policy, and its overall direction inevitably return to the role of the ‘bureaucracy’ and the ‘establishment’ in charting the course of people’s individual and collective lives. These terms are used in the singular in conversations, indi..

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Anxiety of Development: Megaprojects and the Politics of Place in Gwadar, Pakistan

This working paper explores the social geography of anticipation, desire, exclusion, and control that has emerged as a result of Baloch fishermen’s entanglement with the Pakistani government’s plans to develop a large commercial seaport in the small coastal town of Gwadar. Keeping in mind the centrality of everyday experiences in generating social forms, this paper describes how development, transnationalism, and ethnic identity are (re)configured on the ground. It is based on ethnographic encounters that foreground the lived experiences and imaginations of fishermen from Med kinship group who occupy a subaltern position within the local status hierarchy. On the one hand, the promise of becoming modern citizens of the future mega city incites new desires and longings among those fishermen who facilitate their incorporation into emergent regimes of labor and entrepreneurship. On the other hand, Pakistani security forces have tightened their control over the local population by establishing a cordon sanitaire around Gwadar Port and the town. These mechanisms of control have disrupted local fishermen`s experiences of place and intimate sociality and introduced elements of exclusion, fear, and paranoia. By interrupting the fishermen`s expectations of their rightful place in the city, it compels them to think of alternate ways to confront the state’s development agenda, including peaceful protest and armed struggle