Saturday, February 10, 2018
By Anna Almendrala
“It’s all in your head” is a common refrain.
The first time Mary H. realized something was wrong with her body was the first time she had sex. She was 22, living in New Jersey, and with the high school boyfriend she had been dating since she was 16 years old. During their first intercourse, she felt a sharp pain at the entrance of her vagina that was so intense that they didn’t complete the act. She continued to feel the pain during subsequent attempts.
Over the years, she tried to bring up the pain with different health care providers, but was rebuffed. They advised her to drink some wine, relax, and watch movies. One clinic suggested her boyfriend may be coercing her into having rough sex. Another clinician said it could have something to do with her anxiety disorder.
After eight years, the pain was so bad that on the rare occasions that she and her now-husband would have sex, Mary would end up crying in the shower afterward. After every climax, she said that cramping was so intense that it felt as if someone had moved her organs around inside her body.
“I felt like I was being a bad wife. I felt like I wasn’t a woman,” Mary recalled. “What was I doing wrong?”
For women like Mary who experience chronic, debilitating pain during sex, there can be few places to turn for help. If doctors learn about female sexual symptoms at all during medical school or residency, they are advised to prescribe ways to “relax” patients, like drinking alcohol. But sexual dysfunction symptoms are more common among people with chronic ailments like diabetes, psoriasis, depression or cardiovascular disease, and they can also be one of the first signs that something may be seriously wrong with a woman’s reproductive organs. When a doctor dismisses a woman’s concerns about sexual dysfunction, he or she could miss an opportunity to diagnose diseases where sexual dysfunction may be their first or only symptom.
‘It’s all in your head’
The definition of female sexual dysfunction is slippery because it depends on an individual woman’s own perspective on her symptoms. For instance, female sexual dysfunction is an umbrella term that covers symptoms like pain during sex, low libido, and difficulty with arousal or orgasm. But if a woman experiences these things and is not distressed about them, or if she is satisfied with the quality of her sex life, then she doesn’t have female sexual dysfunction. Women can also experience seasons of female sexual dysfunction that come and go, depending on other factors in her life like postpartum recovery, serious illness or the beginning of menopause.
That may be why it’s so difficult to measure how common female sexual dysfunction is in the U.S. One nationally representative survey from 1999 estimates that 43 percent of American women ages 18 to 59 experience sexual dysfunction, on the basis that they said they had experienced, for a period of several months or more, a lack of interest in sex, inability to have an orgasm, pain during sex, lack of pleasure during sex, anxiety before sex or an inability to self-lubricate in the past 12 months. But this number doesn’t reveal whether any of these symptoms caused women distress, or whether some of these issues could be related to the woman’s sex partner.
Doctors in medical school and residency are typically not trained to approach sexual concerns this way, said Dr. Leah Millheiser, founder of the Female Sexual Medicine program at Stanford Hospital.
“As a resident, I learned that it’s all in a woman’s head,” Millheiser said. “She should go home and drink a glass of wine.”
As a consequence, women like Mary are not treated for serious medical problems, and can go from doctor to doctor feeling dismissed about issues that are having severe effects on their health, self-esteem and relationships.
Dr. Lauren Streicher, founder of the Center for Sexual Medicine and Menopause at the Northwestern Memorial Hospital, said that she is often the fourth or fifth doctor a woman has seen for a sexual health symptom. And while the causes of sexual dysfunction can be complex, they can also be symptoms of screenable diseases like thyroid problems, endometriosis or ovarian cancer — all things that can cause lack of libido or pain during sex and shouldn’t require multiple doctors’ visits to find.
Streicher recalled a recent patient, a young woman whose problems were so severe that she hadn’t been able to consummate her new marriage. She’d visited 14 other doctors about the pain she experienced during intercourse and was being pushed toward talk therapy as a solution.
But once Streicher performed a simple physical examination, she discovered an obvious explanation for the woman’s problems: a vaginal septum, a rare condition in which a wall of flesh divides the vagina into two chambers. Every time she had tried to have sex, her partner’s penis was crashing into the septum, causing her intense pain. Streicher was able to fix the problem with a simple surgery, but said she still referred the patient to talk therapy because the length of time it had taken to get the correct diagnosis had strained her relationship with her husband. Like Streicher’s patient, some women may have a singular medical cause for their sexual symptoms. However, it’s most likely that a complex mix of factors — both psychological and physical — could be contributing to sexual dysfunction. Additionally, one sexual concern could snowball into several other problems.
That’s why an integrative approach to this issue is so crucial, said Millheiser. It’s her job to “triage” a patient’s symptoms, getting to the root of when the problem started, exploring factors in her life and relationship that may be contributing to the dysfunction, while also doing full physical workups to look for potential medical reasons for sexual symptoms.
“You can’t discount a sexual concern as ‘just psychological,’ because then a woman might become upset or offended,” she said. “She doesn’t want to be told this is all in her head.”
For most women, comprehensive care is out of reach There are no accredited fellowships that allow doctors to specialize in sexual health for either men or women, but this hasn’t stopped a handful of doctors from crafting their own training programs and opening medical practices in academic centers. Their goal: to take women at their word about sexual symptoms, which sometimes involves approaching problems as potential medical conditions. After cobbling together their own training on female sexual health, they take a multidisciplinary medical approach to female sexuality instead of simply shunting patients off to talk therapy.
Centers that approach female sexual dysfunction from this perspective are rare, but growing. In addition to Streicher’s program at Northwestern and Millheiser’s at Stanford, academic medical centers at UCLA, UCSF, Indiana University Bloomington, Loyola University in Chicago, the University of Kansas, Boston Medical Center and Beth Israel Deaconess Medical Center approach female sexual health in a multidisciplinary way. But Streicher said that most American women don’t have access to this kind of comprehensive treatment for sexual health.
“For the overwhelming majority of women, it’s a very specialized thing,” Streicher said. “It doesn’t exist.”
Making up for lost time
By 2015, Mary was 29 and living in Maryland with her husband. She had seen three different doctors and even a reiki healer for the pain she experienced during sex. Her menstrual cramps were also getting worse, to the point that she was falling over from the pain or vomiting during her period.
The one day, a friend of hers who was teaching a class on human sexuality came across a small blurb in her textbook on endometriosis, a condition in which the uterine lining that usually grows inside the uterus begins to grow outside the organ, rooting itself onto ovaries, fallopian tubes, the colon, and other surfaces in the pelvic region. Then, during a woman’s menstrual cycle, the lining begins to shed, causing severe cramping and pain.
She passed the blurb on to Mary, who immediately started doing more research on the disease. Armed with a list of endometriosis symptoms she had — including painful intercourse — she went to a new OB/GYN doctor who congratulated Mary on diagnosing herself.
“She said, ‘You should do this for a living, I can’t believe you figured it out,’” Mary recalled.
After the initial clinical diagnosis, Mary went on to have laparoscopic surgery to confirm the presence of endometriosis and to remove the lining from other parts of her body. The surgeon told her he removed endometriosis from 80 percent of her pelvic region, as it was affecting her bladder, appendix, ovaries, pelvic wall and the area near her rectum. The lining had also created an endometrioma, or large cyst, on Mary’s right ovary, pinning it to her pelvic wall.
That wasn’t the end of her story. Because she had been enduring pelvic pain for so long, she had developed vaginismus, an involuntary clamping down of the pelvic floor muscles that made penetration difficult or painful. After the surgery, it took another eight months of pelvic floor therapy to help her ease back into sex with her husband. By then, she was 30 years old.
“It was kind of like losing my virginity all over again, but in a much better way,” she said. “Now I see what all the fuss is about.”
Stories like Mary’s are exactly what Millheiser hopes to avoid with her approach. While she isn’t Mary’s doctor, listening to some of the facts of her case align with other patients she has seen. Millheiser said there’s no doubt that “years and years of painful intercourse” would go on to cause more problems down the road. Specifically, that vaginismus is a very common result of untreated endometriosis. ″Vaginismus is an involuntary contraction of the pelvic floor muscles, often as a result of fear of pain,” Millheiser said. “Her body was protecting her from pain.”
Mary still lives with a small measure of pain — something she describes as “completely tolerable,” and avoids sex on days when she might have to do something else that might cause her pain to spike, like a long car ride that can jostle her body. But she cries thinking about the years of pain that affected her relationship with her husband.
“Now that I am sexually active, there’s an added layer of guilt, where [I think], ‘Wow, if he rejected me nearly as many times as I did then, I would be crushed,’” she said.
The shutting down of a US-funded Pashto-language radio station has raised concern over Pakistani authorities clamping down on free speech and Western media outlets in the country. Shah Meer Baloch reports.
Many journalists, politicians and activists view the move as a crackdown on free speech and the Western media in Pakistan.
Launched in 2010, Radio Mashaal is the local name of the US Congress-funded Radio Free Europe/Radio Liberty's (RFE/RL) Pashto-language service in Pakistan. It was introduced as a public service to counter the extremist narrative of the Taliban in Pakistan's mountainous regions that border Afghanistan. Foreign media rarely gain access to these areas.
ISI alleged that Radio Mashaal's programs portrayed Pakistan as a hub of terrorism and a safe haven for militant groups, propagated an image of Pakistan as a failed state in terms of providing security to its minorities and Pashtuns, showed the Pashtun population of Khyber Pakhtunkhwa (KPK), Federally Administered Tribal Areas (FATA) and Baluchistan as being disenchanted with the state, and distorted facts to incite people against the state and its institutions.
An essential source of information?
Insisting that Radio Mashaal serves no intelligence agency or government, RFE/RL President Tom Kent clarified that it is an essential source of reliable, balanced information for its Pakistani audience.
"Our reporters are Pakistani citizens who are dedicated to their country and live and raise families in the villages in which they report. We demand that their safety be ensured, and that they be permitted to resume their work without fear or delay." Mir Mohammad Ali Talpur, a Pakistani activist and columnist, told DW that this is another attempt by the Pakistani state to curb free expression of opinion that does not coincide with the official narrative.
"It is indeed a crackdown not only against the Western media; all opinions counter to the Pakistani narrative will be punished," he said. Talpur and Mohammad Taqi, a Pakistani-American columnist, were stopped from writing for the Daily Times in November 2015 because their writing was considered "anti-state" for exposing injustices in KPK and Baluchistan.
Clampdown on Western media
Taha Siddiqui, a journalist and France24 correspondent in Pakistan, says that the crackdown on Western media has intensified since 2013, when a former New York Times Islamabad bureau chief, Declan Walsh, was deported from Pakistan without sound reason. Siddiqui himself escaped an abduction attempt by unidentified armed men on January 10, 2018, in Islamabad.
The government's move came after relations soured between Pakistan and the United States, which suspended nearly $2 billion (€1.63 billion) in military assistance after accusing Islamabad of supporting Taliban militants causing chaos in neighboring Afghanistan.
The US State Department has "expressed concern" over Radio Mashaal's suspension and has "demanded that the transmission be restored immediately." Siddiqui explained that the government is helpless against the deep state, namely the ISI, which wants to control the Western media as it does local news agencies. "But it cannot because the Western media have their own values such as free speech and objective and impartial reporting that challenge the state's narrative. So they have started this propaganda against the Western media and their correspondents, trying to make them suspicious in the eyes of the Pakistani public that they are Western agents and involved in anti-state activities."
Speaking to DW on condition of anonymity, a Radio Mashaal reporter insisted that they are not anti-state. "We are proud Pakistanis, but we do impartial reporting in a country where many journalists .
A matter of formality, not censorship
Senator Afrasiab Khattak, a senior leader of the Awami National Party, has said that controlling the media and restricting free speech is detrimental to democracy. "We can't become a democratic state until we promote free speech," he told DW. Yet, experts believe that the state controls much of the Pakistani media via financial restrictions and other means, but resorts to propaganda and clampdowns when dealing with foreign media. Meanwhile, Yasir Shakil, the interior ministry's public relations officer, said the suspension was due to the 7-year-old service's failure to fulfil licensing formalities.
"It has not received approval from the Pakistan Telecommunication Authority (PTA), nor has it gotten clearance from the Pakistani intelligence agencies to operate within Pakistan. It has also not followed Standard Operating Procedures (SOPs) and was involved in reporting against our national interests. Therefore, on the recommendations of ISI, we suspended its services," he told DW, while refusing to comment on whether this was a crackdown.
However, RFE/RL has been documenting increased threats against Mashaal journalists over the past two years. Freedom House, a US-funded watchdog, has designated Pakistan as "not free," while the Committee to Protect Journalists ranks Pakistan as the fifth-deadliest country, and the most dangerous country in South Asia for the media and journalists.
It is feared that if a fair trial is not ensured this time round, Hafeez may end up spending another 5-10 years in prison.
Hafeez’s trial has been dragging on for several years due to frequent transfers of presiding judges, absence of prosecution witnesses, and other reasons beyond the defendant’s control.
For example, in May 2014, Rashid Rehman, a regional coordinator for HRCP and the lawyer representing Hafeez, was gunned down inside his office in Multan.
Subsequently, finding a legal representative proved extremely difficult for Hafeez’s family. The current turn in the case has therefore made Hafeez’s situation untenable.
The transfer of Hafeez’s case to a new judge when the defence has already tested the prosecution’s account – and the trial is near conclusion – seriously undermines the defendant's right to a fair trial.
A new judge at this stage will fail to understand the nuances of cross-examination because it was conducted before another judge. It will certainly lead to an inordinate delay in the disposal of the case and add to the suffering of the accused Hafeez has a legitimate expectation that the judge who heard the case through cross-examination of the prosecution's witnesses and challenges to its evidence preside over the concluding stages of the trial.
The situation is made worse by the fact that Hafeez has been detained in solitary confinement since May 2014 in a high security prison in Multan. Jail authorities claim this is so because he faces a threat to his life even inside the prison.
Furthermore, Hafeez’s lawyer has been denied an opportunity to meet him in private in prison.
Hafeez’s right to a fair hearing within a reasonable time, an essential component of the right to a fair trial, is enshrined in article 10A of the Constitution of Pakistan and laid down in international human rights instruments.
HRCP therefore condemns the transfer of Hafeez’s case, in the strongest possible terms, and reiterates that Pakistan’s national and international human rights obligations do not support such vehement and uncalled for disregard of the human rights of any of its citizens.
Pakistan stands today as a country where young men go off to university and never come back. Where they risk being gunned down not by terrorists. But their fellow classmates. And where religious parties protest the convictions of those with blood on their hands. It’s also a country were swift justice is often preferred over the long-drawn out version.
This explains why many have seemingly accepted the verdict in the Mashal Khan murder case. An anti-terrorism court (ATC) this week sentenced the man who pulled the trigger on the journalism student well known for his progressive views and independence of thought. Indeed, one month or so after the incident, Imran Sultan Mohammed told the BBC — as he sat in Mardan Central Jail along with the more than 50 other suspects involved in the prolonged and brutal lynching — that he didn’t regret any of his actions that day. Five more have been sentenced to life; with 25 facing just three-years in prison. And, perhaps, most shocking of all: 26 have been acquitted due to insubstantial evidence.
We, for our part, don’t believe justice has been fully served. Which is why we wholeheartedly support Iqbal Khan’s pledge to approach the higher judiciary to appeal these exculpations to ‘honour’ his son. For as one rights activist has accurately pointed out: the 26 who have been let off scot-free are in no way innocent. Not when they have been seen celebrating their release by glorifying and encouraging violence; while vowing to do the same all over again. The only positive development is that the KP government is now planning to contest the acquittals.
For true justice to be delivered there has to be collective responsibility; and one which goes beyond holding the university administration and police to account, though this is also vitally important. The Chairman of the Journalism and Mass Communications department in the immediate aftermath of Mashal’s brutal murder — when asked who should be held to account over students holding such extremist views that made them think it acceptable to violently take the life of another — admitted the failure was on the part of the Abdul Wali Khan University Mardan (AWKUM) as well as the entire Pakistani education, social and political systems. In this, at least, he is right. For as long as our schools are filled with hate material there will be no respite. Similarly, as long as mainstream (religious) political parties like Jamiat Ulema-e-Islam-Fazal (JUI-F), insist that blasphemy was committed (regardless of police findings) and say that this is suffice to warrant ‘murder’ the cycle of bigotry will forever repeat itself.
Indeed, the JUI-F and other likeminded parties that today plan to hold a rally protesting the ATC convictions need to ask themselves this: whether their utter disregard for the law and due process is, in reality, compatible with their participation in the electoral process. We don’t think that it is. And we would urge the Election Commission to arrive at the same conclusion.
Video - Chairman #PPP @BBhuttoZardari is addressing at International Luncheon where 1200 dignitaries, all Ambassadors based in Washington D.C.
Chairman #PPP @BBhuttoZardari is addressing at International Luncheon where 1200 dignitaries, all Ambassadors based in Washington D.C. were present. Before Chairman's speech they showed #SMBB documentary as a tribute on her 10th martyrdom anniversary. pic.twitter.com/EtkWmeNnFj— BilawalBhuttoBenazir (@BBhuttoBenazir) February 10, 2018
Chinese and Pakistani scientists have teamed up to try to assess the threat to an infrastructure project where geopolitics meets tectonics. It has been more than 70 years since the last big earthquake shook the Makran Trench off the south coast of Pakistan but if and when the next catastrophic one happens, it could disturb more than the landscape.
The trench is the meeting point for two tectonic plates and is close to the Pakistani deep-sea port of Gwadar, where geopolitics, oil and diplomacy intersect.
The facility has been leased to China for 40 years and any potential disaster in the area could undermine Beijing’s ambitions to revive trade from China through Asia to Africa and Europe.
That is why scientists from China and Pakistan have teamed up to survey the trench and assess the dangers lurking in the deep. The trench is a seismically active zone in the Arabian Sea where one plate is inching beneath the other in a “subduction zone”. The last major earthquake was a magnitude 8.1 quake in 1945, which triggered a tsunami that battered Iran, Pakistan, Oman and India, and killed around 4,000 people. And last year a 6.3-magnitude quake hit the area.
Despite the damage, not much is known about the zone.
Seismologist Yang Hongfeng, from Chinese University of Hong Kong, said scientific expeditions in this part of the ocean were quite rare. “A lot of important scientific questions remain unanswered,” Yang said. “The results will definitely advance our understanding … [while] providing critical data to reduce the risk in the region.”
The quest is to get a better understanding of the subduction zone, which scientists say is unusual in part because it has a deposit of soft sediment several kilometres thick.
To find answers, roughly 40 researchers from the two countries boarded the Experimental 3 vessel for the trench last month, lowering instruments into the waters to do a “CT scan” of the Earth’s structure. The expedition was a joint effort by the South China Sea Institute of Oceanology in Guangzhou and the National Institute of Oceanography in Pakistan. It was funded largely by the Chinese government-funded Chinese Academy of Sciences, according to Asif Inam, NIO director general.
“The information and data being collected during the expedition would make a significant contribution to … coastal developers and planners,” Inam said.
The threat of an earthquake near the port is a big concern for both countries. The facility gives China access to waterways through which about 40 per cent of the world’s oil passes and is the centrepiece of the US$62 billion China-Pakistan Economic Corridor linking Gwadar to Xinjiang in China.
The corridor is also part of Beijing’s sprawling “Belt and Road Initiative”, a vast infrastructure and trade programme to project China’s influence abroad.
“There’s a whole lot at stake,” Michael Kugelman, a senior associate for South Asia at the US-based think tank Wilson Centre, said. “The port, if fully developed and operationalised, can be a critical asset for Pakistan, and there’s no nation that Pakistan would be more comfortable entrusting it to than its close friend China.” But Kugelman said the destructive impact that an earthquake or tsunami could have on the operations of the port should not be overstated, given that actual operations were still limited.
“Still, given issues of proximity and general vulnerability – Pakistan doesn’t cope or respond well to natural disasters, given a lack of resources and incapacity – there’s certainly reason to believe that intense earthquake activity would pose a clear and present danger to Gwadar,” he said.
Developments at the port have caused unease in neighbouring India, especially with reports that Gwadar will be the site for Beijing’s second overseas military base.
“China, India, and Pakistan are on a collision course,” Kugelman said. “This isn’t to say we’re about to see conflict, but escalations in tensions are highly likely as China steps up its activities in the region, and particularly in Pakistan.”
If China built a naval base in Gwadar, as reports had suggested, it could trigger even greater tensions with India, he said. But Zhang Jiadong, director of South Asian studies at Fudan University in Shanghai, said China’s focus should not be on India, but on solidifying its relationship with Pakistan and ensuring the success of their joint projects.
“India feels that all countries in South Asia need to listen to India,” Zhang said. “If China worries about India, it will not be able to do anything.”
By DIAA HADID
I recently hunched over my desk lunch and typed: How to get a cat from Israel to Pakistan.
This is not a question that Google easily answers. There are no holiday packages from Israel to Pakistan — no direct flights, and no diplomatic relations.
But here I was, asking the Internet weird questions at NPR's Washington, D.C., headquarters in June. I was being trained there before I was to be dispatched as their Islamabad-based correspondent. Most of my worldly possessions — and my cat — were in Israel and the Palestinian Territories, where I was previously based as a Mideast correspondent for The New York Times.
Foreign correspondents are famous for adopting cats. It's a quixotic proclivity, because of how frequently we travel. But no other correspondent I've heard of had tried something like this. And I asked all the cat-loving correspondents I could find.
Finally, through the company Animal Airways, I reached Eytan Kreiner, an Israeli veterinarian. I explained the pickle I was in.
"Don't worry. We are experts in taking animals to enemy countries," he said in a thick Israeli accent. I imagined an aged Mossad operative.
"We just took a dog to Iran," he said. "We have an underground network of vets who help us. Everybody is sympathetic to animals. Even enemies."
Kreiner said he could fly my cat from Israel to a third country. They would change his papers and then fly him to Pakistan. I dutifully paid $350 to start the process.
My cat Shawareb — Arabic for "mustache" — was an accidental acquisition.
In 2015, I lived in the Palestinian city of Ramallah in the West Bank. There, one of my roommates brought him home: a stray, mewing, gray-striped fur ball with enormous green eyes. I liked him but I wanted nothing to do with him.
I grew up with countless cats in the yard of my parent's home in Canberra, Australia. In the late 1980s, my father, a postman, went broke and the cats became a luxury. Instead of cat food, we gave them scraps of meat from the sheep that Dad slaughtered for halal meat. The cats were a burden. Dad abandoned a few at the local dump, but let two or three stay. I think he saw how much they meant to me. I didn't have many friends, and I spent my school lunchtimes in the library reading books. At home, the cats were reliable company. But I developed nasty allergies as a teenager. Cat hair triggered violent sneezing. My eyes watered and my skin itched. My parents gave the last cats away. I didn't touch another feline for two decades.
Then I moved to Ramallah. It's a fun place, with hipster bars and country outings, but I had few friends. I was lonely. My old childhood yearning for a friendly cat welled up inside. My roommate lost interest in the kitten and soon I was letting him sit on my desk as I wrote. I took two or three antihistamines a day to breathe. He slept curled into a ball near my shoulder. I took more pills. I took to calling him "Shawareb" for his funny kitten mustache.
I knew he was mine when he got sick — a tooth infection left him a smelly, mangy mess. I drove him to Jerusalem to see a vet. He removed most of Shawareb's teeth and charged me $400. When we went for a follow-up, demonstrations had broken out through the West Bank. The main Israeli military checkpoint was closed as soldiers fired tear gas and rubber bullets at masked youths hurling rocks and flaming bottles. I tried to leave through another checkpoint. Masked young men burning tires on the road stopped me.
"The road is closed, auntie," one of them announced. He glanced into my car and I grimaced.
Most Palestinian residents of the West Bank can only enter Jerusalem with hard-to-obtain Israeli military permits. Here I was, cavorting about with a cat, no less, for a follow-up at the vet. I felt silly. It wasn't lost on me that my Ramallah street cat may have more freedom of movement than the area's human residents.
I called the vet in Jerusalem. "I'm late. There's a few problems on the road."
"Where are you?" he asked. "Ramallah," I answered. "Oy vey," he responded.
Over the next 18 months, I moved five more times — it was a procession of bad-luck apartments, from Ramallah to Jerusalem. Shawareb came with me.
He grew into a friendly thing, always seeking out a lap to sit on. He meowed endlessly for attention. He left mauled birds under my bed. My cat allergy disappeared.
In November 2016, I decided to leave The New York Times — and Jerusalem. I packed my things into boxes. But Shawareb?
I got in touch with an old friend, Amit. He lived on a communal farm known as a kibbutz on the Israel-Lebanon border. He promised to care for Shawareb until I could take him. Last February, I drove six hours across the country to deliver Shawareb to Amit in Kibbutz Misgav-Am. Shawareb settled into Amit's tiny apartment. I thought about my life that had taken me across these enemy lands — for me a patchwork region of the Middle East that I loved deeply. Covering its conflict and suffering left me tired and broken hearted. The sun set into a gorgeous sky of pink and orange, and I said goodbye. I left Jerusalem in March.
Then during my visit to Washington last June, I began thinking: Could I find a way to move Shawareb to Islamabad?
For weeks, I plotted how to ship him to Islamabad with Ahava Cohen, who works with Kreiner, the Israeli vet. We needed a third country that had direct flights to Tel Aviv and Islamabad. We had three options: London, Istanbul and Bangkok. The airline had to be cat-friendly. The third-country airport had to process Shawareb quickly. We settled on Bangkok. Cohen cheerfully informed me that the company would do the move for $3,335 — over double the yearly wage of a cook in Islamabad. That's immoral, I thought. If I did it myself, it would be about half the cost.
There was a glitch: I had just moved to Pakistan, but I only had a single-entry visa. If I left the country, I couldn't re-enter.
I asked on a reporters' Facebook group in Jerusalem if somebody could take the cat to Bangkok — I'd pay — causing a pileup of journalists cheerfully volunteering for the flight. But the problem was Pakistan: Getting a visa here is hard, and I feared problems for anybody coming from Tel Aviv.
Then Amit called with some pressing news. He moved apartments and his new landlord didn't want pets. Shawareb had to go. I begged for more time.
I finally received my Pakistani multi-entry visa in October. I arranged for a week off in January.
But those days were planned for another big day: my wedding in Australia. I eyed the dates. If I cut short our honeymoon, I could fly to Bangkok and pick up the cat. I know. Suddenly I was spending money furiously on Shawareb's big move. I paid for my flight, which included agreeing to pay $25 for every kilogram of Shawareb. He's 8 kilos — 17 pounds.
I paid for Amit's trip to Bangkok. Friends in Bangkok directed me to a cat-friendly hotel while we sorted his papers. Amit arrived in Bangkok with Shawareb. I arrived at 3 a.m. to the cat-friendly hotel. Shawareb meowed when I open the door. I curled up with the cat on the couch and slept.
The next morning, I handed Shawareb over to a travel company with the dubious job of transforming him: from a Palestinian cat with Israeli papers into a Thai cat heading to Pakistan. They only needed a few hours, they said, and they'd drop Shawareb off at the airport. With a few hours before my flight, Amit and I caught up. He talked me through Shawareb's epilepsy medicine, and gave me a tincture for his anxiety. We lost track of time. I raced to a taxi.
I sat on my suitcase at Gate 4 as hundreds of people poured in through sliding doors. Shawareb soon emerged on a luggage trolley, pushed by a representative of the Thai travel company. In Suvarnabhumi Airport, traveling with a cat is like presenting a baby. Shawareb was smiled at and treated gently, even when he was put through a scanning machine. The representative gave me two envelopes: one with all Shawareb's Israeli documentation, another with his new Thai papers.
Nearly a year after I drove Shawareb to a kibbutz on the Israel-Lebanon border, my little Palestinian cat made it home. Amid the crowds and chaos of Islamabad's Benazir Bhutto International Airport, a luggage handler left Shawareb's carrier near the baggage claim. A Pakistani man on my flight carried him over to me. Nobody asked for Shawareb's papers. There seemed to be some security alert. Airport staff were busy screening all the suitcases coming off the flights.
Shawareb is still adapting. He hisses at Doodh, the elderly Siamese cat that I'm taking care of for a friend. He wants constant belly rubs. When I video call my husband, he sits in front of the screen. He shredded the black foam of the recording studio. And when he jumps on my desk, crunching the keyboard with his paws and deleting my work, I cuddle him and bury my face in his fur. I'm so happy he's here. I hope we make it together, to our next destination.