future medicine

Introductory Price

SPECIAL FOCUS: The Infertility Conundrum & Kerala’s Best Infertility Centres

November 2012 l `100 $8

www.futuremedicineonline.com RNI 117086 ERENG/2012/44529

THE Talking point: SEX Breathe easy!

Tell your children about sex and sexuality without turning red

INDIA AHEAD IN HIV CARE! DA VINCI ROBOTIC SYSTEM

Dr Anshumala Shukla

third e h t being e highest e t i p s De th th i w y r DS count r of HIV/AI ead h e numb , India is a d s n victim s of care a ent m agem in ter n a m se disea

TRADITIONAL MEDICINE

Chirattai Thailam

WORLD’S HAPPIEST MAN

Dr Matthieu Ricard

EDITOR’S NOTE Life is as good as the Rubik’s Cube

T Volume 1 Issue 5 | November 2012 Editor Ravi Deecee Deputy Editor Sanjeev Neelakantan Assistant Editor Dipin Damodharan Senior Reporter & Research Assistant Sreekanth Ravindran Senior Reporters Lakshmi Narayanan Prashob K P RESPONSE TEAM Coordinating Editor Sumithra Sathyan Reporters Tony William Shalet James Neethu Mohan Design & Layout Kailasnath Anil P John

BUSINESS Head - Business M Kumar ADVT SALES Senior Managers Kainakari Shibu Rajasree Varma Anu P M Biju P Alex K S Syam Kumar Managers Febin K Francis Bipin Kumar VS MARKETING Sr Manager Sabu Varghese Mathew Assistant Managers Priya P A Mobin E Mathew Liju P John Circulation Athul P M Sone Varghese

Business Office - India

DC MEDIA, DC Books Pvt Ltd No 387, Ist Cross, 4th Block, 80 Feet Road Koramangala, Bengaluru – 560034, India

Business Office - International

DC Books, Near Karama Metro Station Trade Centre Road, Dubai, UAE

Editorial Office

DC MEDIA , DC Books Pvt Ltd 234/C, Adjacent to YMCA, Chittoor Road, Cochin – 35, Kerala, India

Contact

Ph: +91 484 3047 405, Fax: +91 484 4021 145 Mail: editorial@dcmedia.in, info@dcmedia.in

www.futuremedicineonline.com Published from DC Books Pvt Ltd, D C Kizhakemuri Edam, Good Shepherd Street, Kottayam – 686001, Kerala, India and printed at Five Star Offset Printers, Nettoor, Cochin – 40 for DC Press Pvt. Ltd., Industrial Development Area, Poovanthuruth, Kottayam – 686012, Kerala, India. Printed, published & owned by Ravi Deecee

DC Media Publication

4 FUTURE MEDICINE I November 2012

he triumvirate of life, sex, and death is as enigmatic as ever before. Sex is the fuel for life, the creative force that guides our evolutionary cycle. A misunderstanding of our sexuality, deficiency in sexual appetite, or incapacity for procreation, or sexual misadventure is enough to steer a human being’s course of life into the jaws of despair, or death incarnate, in very many ways. The dreadful global spectre of HIV/AIDS, the rising incidence of infertility among young couples, and the inherent dangers of sexual promiscuity among the new generation are a few pointers to the faultlines in our rapidly changing lifestyles and adaptation of risky behaviour that make the journey into the future a tightrope walk.

Answers to the lifestyle crises lie in comprehension of our own basic instincts in relation to the very purpose of existence. For that to happen, we need to tend to the roots (the childhood years). An adolescent who knows the power of love, sexuality, and disciplined living acts in a responsible manner in adulthood. And that’s what brings about a difference in the quality of life.

On one hand, we get to learn about the procreative potential of sex. On the other hand, parents, mostly well-educated, find it difficult to strike up a conversation about sex and sexuality with their children. The idea is not to stuff loads of information about the dangers of sexual perversion, abuse, or unprotected sex, into their minds, but to make them understand the basics of life in such a way that they start respecting life and nature the way they aesthetically should be. That would set a beginning point for a healthy lifestyle.

What’s the urgency of such a conversation between parents and children? Well, more than 30 million people across the world are victims of human immunodeficiency virus/acquired immunodeficiency syndrome (2010 data). And there’s no sign yet of breaking free from this dreadful disease. Statistics show an improvement in HIV care and management, particularly in India. But that’s not enough.

In this edition, Future Medicine has taken stock of the HIV/AIDS scenario in India in its cover story, touched upon the importance of sex education, and focussed on treatments that can help couples escape from the misfortune of infertility.

CONTENTS

16

COVER STORY India’s Ahead in HIV Care There has been considerable improvement in HIV/ AIDS strategies and treatments across the world over the past three decades, particularly in India.

Despite ranking three in HIV numbers, because of its affordable anti-HIV drugs, India plays a great saviour globally by preventing deaths and ameliorating the sufferings of millions of HIV+ victims, much more than the original inventors of these drugs, says Dr I S Gilada, the President of AIDS Society of India

25

DA VINCI ROBOT SYSTEM Dr Anshumala Shukla

Sex Education What to tell your children?

52 78

TRADITIONAL MEDICINE The healing potential of Chirattai Thailam

SCIENTIFIC MOTIVATION Paralytic moves Robotic arm

42

Why do parents feel embarrassed when it comes to answering their children’s queries on sex and sexuality? Dr Rajan Bhonsle, Head of the Department of Sexual Medicine, K E M Hospital, Mumbai, says there are many ways to inform children about issues concerning sex

58

Absolute bliss World’s Happiest Man

Renowned Buddhist and Frenchman Dr Matthieu Ricard is the world’s happiest man, according to studies conducted by researchers of University of Wisconsin, US. The energy produced by his brain has added a new dimension to neuroscience literature 6 FUTURE MEDICINE I November 2012

P33-41 & P62-71

Infertility Conundrum Kerala’s best infertility hospitals

Cases of infertility among young couples across the world are on the rise. There are plenty of reasons leading to this reproductive inability. Our special package looks into the causes, symptoms, and possible deficiencies in the reproductive system and lists a select group of healthcare institutions in Kerala that can help couples overcome the problem of infertility through affordable treatments

14

Laser Hair Removal

28

Good, Bad Cholestrol

32

Drug Pricing

46

Sexual Health

50

Nucleoplasty

61

Dental Implants

Dr Divya Ramkumar

Dr A G Unnikrishnan

Dr Jitendar Kumar Sharma

Dr A Chakravarthy

Dr Ram Kumar Menon

Dr Ravi R Hebballi

November 2012 I FUTURE MEDICINE 7

MEDICAL DIGEST

India’s 2014 polio target NEW DELHI: Having made

unprecedented progress in polio eradication, India hopes to be polio free by 2014 by guarding itself against import of the polio virus from neighbouring countries and boosting routine immunisation. Earlier this year, the World Health Organisation had removed India from the list of polio-endemic countries.

If no fresh case is reported till 2014, the country will be declared polio free. “However, the risk of polio persists as

long as polio virus transmission continues anywhere in the world,” said Dr Ajay Khera, Deputy Commissioner at the Union Ministry of Health and Family Welfare. He pointed out that among the remaining polioendemic countries - Pakistan, Afghanistan, and Nigeria - two have close proximity to India.

Regular immunisation is being carried out at five border points along the Indo-Pak border, at Baramulla and Poonch in J&K, Attari and Wagah in Punjab, and Munabao in Rajasthan.

Improving HIV diagnosis LONDON: Scientists have come up with a test for the virus causing AIDS that is ten times more sensitive and a fraction of the cost of existing methods, offering the promise of better diagnosis and treatment in the developing world.

The test uses nanotechnology to give a result that can be seen with the naked eye by turning a sample red or blue, according to research studies conducted by scientists from London-based Imperial College. The findings have

Uganda battles Hemorrhagic Fever KAMPALA: Uganda is struggling with the spread of the deadly Marburg virus, just weeks after an outbreak of Ebola killed at least 16 people.

Last month, health officials declared an outbreak of the rare and deadly Marburg virus, a type of hemorrhagic fever similar to Ebola.

Five people have died so far, six have been placed in isolation, and over 150 more are being monitored for symptoms. One of the cases 8 FUTURE MEDICINE I November 2012

is being treated in the capital, Kampala.

The outbreak comes just two weeks after Uganda was declared free of Ebola. At least 16 people died of Ebola, a virus which in the past has killed hundreds.

The cases of Marburg have all come from the southwestern district of Kabale, a heavily forested area where the vectors for the disease, monkeys and bats, are most commonly found.

been published in the journal Nature Nanotechnology. “Our approach affords for improved sensitivity, does not require sophisticated instrumentation, and it is ten times cheaper,” said Molly Stevens, head of the research team.

Simple and quick HIV tests that analyse saliva already exist, but they can only pick up the virus when it reaches relatively high concentrations in the body. The test could be reconfigured to detect Sepsis, Leishmaniasis, Tuberculosis, and Malaria as well.

e t r o f r u o s i y t d i e . u r . . n u d e s Ing ity is as arallele l p a n u u Q ice is Serv GB D’Care-546

GB-325

25 Parameters & 3-Part Diff Automated Hematology Analiser

GB-235

A Versatile Clinical Chemistry Analyser

An Automated Glycated Hemoglobin (HbA1c) Analyser

GBLISA-W

A rapid Microplate ELISA Washer

UROGB

A Series of Compact Automated Urine Analysers

GBLYTE

A Range of Automated (ISE) electrolyte Analyser

Corporate Office:

No.13, Dhandapani Street, Radha Nagar, Chrompet Chennai-600 044, Ph: 044 - 4989, Telefax: 044 - 4557 4291.

Works:

No.87, Gandhi Salai, Alapakkam, Chennai - 600 063.

www.genuinebiosystem.com

MEDICAL CONFERENCE

Meet on rural health at Panaji in December

PANAJI: The XVIIIth International Congress of Rural Health and Medicine will be held at Kala Academy in Panaji, Goa, from December10-12 this year. Organised by the International Association of Rural Health and Medicine (IARM), Japan, in association with the Association of Agricultural Medicine and Rural Health in India, Pravara Medical Trust, Maharashtra, and the Goa State Law Commission, the theme of the conference is “Challenges for Rural Medicine in Global Village”. To highlight and foster opportunities for innovative, comprehensive, participatory rural health models that can be replicated, the main objective of the conference is to promote dialogue among rural health workers, governments, NGOs, UN agencies, national and international funding agencies, and other stakeholders for finding solutions on global rural health issues and attainment of the Millennium Development Goals.

Mumbai to host obstetrics and gynaecology conference MUMBAI: The 56th All India Congress of Obstetrics and Gynaecology (AICOG) will be held from January 16 to 20 next year in Mumbai’s Bandra Kurla Complex. Since it is the most important annual event on the academic calendar of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), each year, FOGSI assigns the grand responsibility of organising AICOG to one of its 218 constituent member societies. The Mumbai Obstetric and Gynaecological Society (MOGS) has been selected to organise the 56th AICOG. Expecting a record number of over 10,000 delegates at this academic event and social gathering, MOGS, with a dedicated Conference Organising Committee, is determined to set benchmarks for AICOG. The conference will have an interesting mix of lectures, symposia, social events, panel discussions, and paper presentations by experts from across the world.

Strategy on TORCH, Chlamydia trachomatis, HPV treatments The International Conference of the National Strategies for kompleksa TORCH, Chlamydia trachomatis, and human papillomavirus will be held in Kiev, Ukraine, from November 15-16 this year. The conference will help develop national strategies for early detection, control, and treatment of kompleksa TORCH, Chlamydia trachomatis, and human papillomavirus. The conference is being organised in cooperation with the Ukrainian Association of Clinical Chemistry and Laboratory Medicine, and the Latvian Society of Laboratory Specialists. The conference will address the latest clinical diagnostic, economic, and scientific achievements to meet the needs and interests of immunologists, allergists, laboratory specialists, gynaecologists, dermatovenereologists, infectology, microbiologists, and health professionals.

10 FUTURE MEDICINE I November 2012

VOICES

“The government is moving towards Universal Healthcare. We have launched the Janani Shishu Suraksha Karyakram to provide free care to pregnant women and neonates. Now, we intend to provide free essential medicines in all public health facilities” Ghulam Nabi Azad, Union Health and Family Welfare Minister

“Health is an area where there is high potential for application of e-Governance initiatives. If assessed and applied in right areas, it will bring high benefits to the common man” Praveen Prakash, Commissioner of Health and Family Welfare, Government of Andhra Pradesh

“We have taken a turn for the worse with Obama Care, with its high taxes and vastly expanded federal control over our lives. I believe the better course is to empower the states to determine their own healthcare futures” Mitt Romney, Republican Party’s nominee for US Presidency

“What really matters is that the NHS is always going to be a free service, free at the point of need, and is also a service that has a genuine compassion and will continue to look after the most vulnerable patient groups ” Dan Poulter, British Health Services Minister

“India should routinely start screening diabetics for TB and TB patients for high blood sugar. It is important for countries like India where numbers of both the diseases are enormous” Dr Anoop Misra, Chairman, Fortis Centre for Diabetes, Metabolic Diseases, and Endocrinology

12 FUTURE MEDICINE I November 2012

LASER HAIR REMOVAL

Dr Divya Ramkumar Dermatologist & cosmetologist

No more hair-raising U

horrors

nwanted hair has been traditionally removed by various techniques like shaving, plucking, waxing, bleaching, depilator use, electrolysis etc.

All these techniques are tedious, slow, inconvenient, and painful.

Out of this, only electrolysis offers permanent hair removal, but it is again slow, painful, and impractical for treating large number of hairs.

Electrolysis can be used to remove 100 per cent of the hair from an area and is effective on hair of all colours if used at an adequate power level with proper technique.

Laser therapy (diode, long pulsed Nd-Yag, ruby and alexandrite), IPL (intensed pulsed light) therapy, LHE (light and heat energy), and the newer ELOS (electro-optical surgical system) are the available permanent hair reduction systems. They have been in use since 1997 and have been approved for “permanent hair reduction” by the US Food and Drug Administration. “Permanent” hair reduction is the long-term, stable reduction in the number of hairs regrowing after a treatment regime.

Laser technology was developed to efficiently remove unwanted facial and body hair over large areas

14 FUTURE MEDICINE I November 2012

of skin with as few complications as possible. Although it is more expensive than electrolysis, it is faster and arguably less painful.

Darker skin types are more difficult to treat with lasers. This method can lead to permanent removal of some hairs, along with marked delay in growth of others. It is rightly called permanent hair reduction.

These techniques remove hair through the principle of selective photothermolysis of melanin-rich structures, allowing light energy absorption primarily in hair follicles and minimal absorption by surrounding tissues. When melanin in the hair follicle absorbs light, the follicle is heated and destroyed, preventing its ability to produce new hair, while leaving other structures unharmed. This system is most successful for dark, coarse hair with decreased or almost no efficacy for white or grey hair. The ideal patient would be one with light skin and dark hair. Indian skin varies in colour from the very fair to dark. Since dark skinned patients (Fitzpatrick 4, 5, and 6) have more competing melanin in the surrounding structures, they are prone to experience more

The laser treatment is not to be done on anybody less than 15 years of age, an uncooperative patient, or one with unrealistic expectations. Other contraindications are associated photoaggravated diseases, or on drugs causing photosensitivity, if treatment area has active infections, or any cuts, or wounds

effects and in them, the long wavelength lasers, particularly the long pulsed Nd Yag and diode, are the lasers of choice.

IPL therapy is more useful for finer hairs, though more number of sittings may be required. But it can be safely used on most skin types. The number of sessions depends on various parameters, including the area of the body being treated, skin colour, coarseness of hair, reason for hair growth, gender, etc. Multiple sessions, ranging from four to eight or more, are required since the laser light is absorbed only by the anagen hairs present in a particular area. Usually, treatments are spaced four to eight weeks apart depending on the body area and the hair cycle length for that area.

The laser treatment is not to be done on anybody less than 15 years of age, an uncooperative patient, or one with unrealistic expectations. Other contraindications are associated photo-aggravated diseases, or on drugs causing photosensitivity, if treatment area has active infections, or any cuts, or wounds. Caution should be exercised in patients with keloids and keloidal tendencies and in patients with psoriasis and vitiligo (for risk of koebnerisation). Previous history of herpes simplex is a relative contraindication since risk of precipitation of active lesions exist.

A detailed consent form is needed. Patients should be provided with adequate information through brochures, photographs, and personal consultation. Female patients must be evaluated properly to rule out the underlying cause for hair growth. If necessary, a gynaecologist or endocrinologist’s opinion should be sought.

Patient should be instructed not to pluck, thread, or wax treatment areas. The hair is usually shaved, or trimmed, before the session. Protective eye goggles are used and the skin is cooled before and after the laser shot is given. Following treatment, patients are instructed about strict sun protection. Side effects vary from the simple post-procedure pain, erythema, and edema to transient pigmentary changes, and sometimes to the more severe vesiculation and crust formation. Compensatory hypertrichosis (new hair growth in vicinity of laser-treated area) is rare but is the side effect which causes anxiety to the patient. This may also need to be treated with lasers.

Careful patient selection, proper evaluation of individual cases, application of proper technique with appropriate machine settings, and good pre, intra, and post-operative care are all essential parts of this therapy to get satisfactory cosmetic results.

Dr Divya Ramkumar, MD, works with Sun Medical and Research Centre & Carewell Clinical Centre in Thrissur, Kerala November 2012 I FUTURE MEDICINE 15

COVER STORY India Ahead In HIV Care

HIV/AIDS:

Taking

stock

The global AIDS epidemic has completed 30 years of its devastating presence. HIV Care in India has completed 25 years. Yet, all is not hunkydory in HIV management.

Future Medicine takes a look at the spectre of human immunodeficiency virus/ acquired immunodeficiency syndrome with an insightful introductory piece by an eminent doctor, Dr Ishwar S Gilada, who is known as the ‘Indian machine gun against AIDS’. For those who know little about HIV/AIDS, the story has informative fact boxes

I

Dr Ishwar S Gilada is Secretary General of Peoples Health Organisation (India), President of AIDS Society of India, and Chairman of Unison Medicare & Research Centre (India’s first private sector comprehensive HIV care centre since 1994)

n the run-up to the World AIDS Day, several success stories from every nook and corner of the country are turning it into a “Celebration Day” from its earlier status of a “Mourning Day” just a decade ago. Peoples Health Organisation (PHO), the country’s first NGO in the crusade against AIDS since 1985, had established in 2004 that HIV was leveling off in Mumbai, as it had seen a downward trend among sex workers and flattened graphs among general population. Any change, upward 16 FUTURE MEDICINE I November 2012

or downward, in rates of HIV, or Sexually Transmitted Diseases, happens in high-risk population, is subsequently followed by a similar trend in general population with a gap of five to seven years.

The global AIDS epidemic has completed 30 years of its devastating presence. HIV care in India has completed 25 years.

Yet, all is not hunky-dory in HIV management. AIDS has always been maddening. The virus moves more slowly than any infective organisms that ride sneezes, or coughs, or rats, or mosquitoes.

HIV permits years of symptomfree infectivity and only kills, like a sluggish-torturer, at leisure.

Despite ranking three in HIV numbers, because of its affordable anti-HIV drugs, India plays a great saviour globally by preventing deaths and ameliorating the sufferings of millions of HIV+ people, much more than the original inventors of these drugs.

Just imagine the world without India vis-Ă -vis AIDS? Ironically, we save millions globally but lose thousands to HIV nationally.

Initially, HIV was found mainly in sex workers, professional blood donors, and among their clients/ buyers. But now, the disease has already entered the third phase of the epidemic. We have numerous housewives and children infected with HIV. It has gone from urban to rural areas, crossed from high risk to low risk and from sex workers to housewives. In India, there is a massive single malemigration to industrialised cities/ towns, and sex with multiple and often unknown partners is an established behaviour in males between 20 and 45 years of age.

There are persons travelling for their business and having good time just for fun, including sex indiscreetly.

HIV infection is truly a PREVENTABLE infection. Both the monetary and human costs for prevention are far less when

compared with costs of treatment.

The cost of HIV management in India is far less than in Western countries. Yet, most of us have come across stories about doctors, or hospitals, neglecting HIV patients, which brought disrepute to the entire profession and challenged the Hippocratic Oath we had taken on joining this noble profession. Though it is a new disease for many of us, we have to manage this efficiently with whatever resources we have, using the scientific information on HIV disease spectrum.

Death is generally not due to HIV infection itself, but the opportunistic infections (OIs) that occur when the immune system can no longer protect the body against agents normally found in the environment, or the secondary cancers. The appearance of any one of more than 25 different OIs, along with a CD4 count less than 200 cells per c/mm of blood, provides the clinical diagnosis of AIDS in HIV-infected individuals.

The most common OI seen in HIV is TB in India and Pneumocystis Carinii Pneumonia (PCP) in the Western countries. Bacterial pneumonia and PCP, caused by the fungus Pneumocystis Jiroveci, are also commonly associated.

In the late phase, Miliary TB, Extra-pulmonary TB, and bacterial infection by Mycobacterium Avium can cause fever, weight loss, anemia, and constipation alternating with diarrhea.

Bacterial infections of the GIT commonly cause diarrhea, weight loss, anorexia, and fever. The most common diarrhea is caused by Cryptosporidia, Microspora, and Isospora Belli organisms, giving rise to frequent watery stools.

During advanced stage, diseases caused by protozoal parasites, especially toxoplasmosis, and fungus, especially cryptococcosis of the brain, are common. In addition, people with AIDS often develop other fungal infections.

Thrush, an infection of the mouth

One of the most famous posters, this was inspired by the experience of Ryan White, a 13-year-old hemophiliac with AIDS who was barred from school in 1985 and became a symbol of the intolerance that is inflicted on AIDS victims

Freddie Mercury, lead singer of the British rock band Queen, died of bronchopneumonia brought on by AIDS in 1991. There are many other celebrities who have fallen victim to AIDS, including yesteryear US basketball sensation Magic Johnson, American actors Rock Hudson and Anthony Perkins, and American pianist and vocalist Liberace

November 2012 I FUTURE MEDICINE 17

COVER STORY India Ahead In HIV Care

by the fungus Candida Albicans, is most common from the early phase.

A ghastly devastating disease of early 1990s, it has become a chronic manageable disorder now. People infected with HIV can survive up to 30 years now – 10-15 years without ART (anti-retroviral treatment) and another 15 years on ART. But the patients should be in safe medical hands and have to follow a healthy lifestyle protocol, regular treatment, and meticulous followups. Alcohol, recreational drugs, smoking and tobacco use hasten

disease progression and hamper the recovering process. Treatment for only richer countries and the rich in poorer countries has become affordable.

India is at crossroads vis-à-vis HIV, making it imperative to look back in the recent past, take stock of what has been achieved, and what has been amiss in order to decide upon a future plan for a better tomorrow. The saving grace for a larger Indian population from HIV is the Indian culture, the responsiveness of its youth, efforts of voluntary NGOs and medical caregivers, and yeomen

contribution of our pharma lobby. We certainly have reasons to rejoice and project India as a powerful (not a poor, gullible third rate) country – at least in relation to HIV/AIDS.

Treasure India’s asset

India’s clinically oriented, conservative, comprehensive and holistic care has earned accolades.

It’s wait-n-watch approach in starting ART is indeed a blessing in disguise for HIV patients (as against the ‘Hit-Early, Hit-Hard’ approach of the West). It improves the quality of life, increases survival, reduces cost, and spares

How HIV is transmitted?

What is the risk?

HIV is spread through the exchange of bodily fluids, primarily semen, vaginal secretions, blood, and blood products.

It cannot be transmitted through casual contact. There are four main modes of transmission: Sexual, Parenteral, Perinatal, and Accidental. The primary mode of infection in India is through sexual transmission, mainly heterosexual. The basics of each mode of transmission are outlined here:

Occupational Needle-prick Per-cutaneous 0.3% Mucous membrane 0.09% Sexual transmission (single contact) 0.018% to 3% Mother to child (in natural course) 25% Infected blood/ blood products 95%

18 FUTURE MEDICINE I November 2012

Ishwar Gilada is a medical doctor specialised in Skin and Sexually Transmitted Diseases with special training in HIV management; Managing Director and Consultant on HIV/AIDS at Unison Medicare & Research Centre, India’s first private sector comprehensive HIV care clinic; President of AIDS Society of India (ASI), a professional organisation of physicians in HIV care; Secretary General of Peoples Health Org. (India).

He was Secretary General of ASI from 2005-2011 and the Joint Secretary of National AIDS Committee, Govt of India (1995-97). He was the first to raise alarm against AIDS in 1985, is known for bringing India on AIDS control map, had started India’s first AIDS clinic in 1986, and has expertise in HIV care in resource-poor settings. He has trained several doctors, nurses, and social workers; He was the Editor-Publisher of AIDS ASIA from 1993 to 2008. He initiated, managed, supervised, evaluated over 40 HIV/AIDS projects in India, addressed over 3,700 public meetings and training programmes in India and abroad, has submitted 235 scientific papers at conferences, written chapters in books on AIDS/STDs. He was consultant for the American Foundation for AIDS Research (AmFAR), World Vision, USAID, has more than 60 awards to his credit, including the Outstanding Young Person of the World Award, Glasgow, in 1995, and Annemarie Madison Award, Germany, in 1999, where he earned the moniker ‘the Indian machine gun against AIDS’.

them of impending drug resistance and adverse effects for years. The Indian culture of joint families and lasting marriages, with integrity in women folks, have been an asset in providing psycho-social support and reduced transmission. The age at first sex is higher in India than the West, or Africa. Kama Sutra, an Indian art and science of lovemaking, has a lot to offer. It adds sensuality to sexuality and reduces HIV transmission with its prescription ‘Many positions with one, better than one with many!’

The “One Tablet A Day Keeps HIV at Bay!” treatment, invented in India, made ART cheaper, safer, and easier.

The West copied India! Ironically, the

lauded for saving millions.

What is amiss?

About 18,000 children get HIV from 65,000 HIV+ mothers annually in India, while there are strategies to prevent each of them. HIV+ women received only single-dose Nevirapine in an outdated strategy meant for Africa. The National AIDS Control Organisation (NACO) is responsible for this gross neglect, yet doesn’t change strategy. Shamefully enough, less than 15 per cent of the pregnant women received Prevention of Parent to Children Transmission (PPTCT); only 60 per cent of sex workers are reached with the HIV prevention programme and 40 per cent of them

MODES OF TRANSMISSION: SEXUAL: (a) Ano-genital; (b) Vaginal; (c) Oral-genital (rarely)

PARENTERAL: (a) Infusion of blood and blood products; (b) Organ transplants; (c) Intra-venous Drug Use; (d) Artificial Insemination

PERINATAL: (a) During pregnancy; (b) During child birth; (c) Breast-feeding

ACCIDENTAL: (a) Occupational (eg. needle prick); (b) Exposure of non-intact skin/mucous membrane to internal body fluids MNCs made a big hue and cry, calling Indian Generics copy-cats! When the ‘West copies the East’, why apply different yardsticks? Indian pharma took the lead and risk of inviting litigations, circumvented patents by producing generic copies using reverse engineering, and brought down the prices to one per cent, with 100 per cent bio-equivalence (quality). The yearly cost of threein-one cheapest first-line combo has come down from $11,452 per patient to $69. Indian Pharma must be

identify correct ways of prevention methods. Only 30 per cent of the infections are recorded at NACO, due to the inherent flaws in the reporting system. Half of the infected people do not know their HIV status. Our efforts to make the risk-takers understand their vulnerability have been inadequate nationally. Initially, most of the national energy and funds were wastefully spent on ‘surveillance’ without ‘interventions’; Only a third of adults with advanced HIV infection are receiving ART (up from six per November 2012 I FUTURE MEDICINE 19

COVER STORY India Ahead In HIV Care

cent in 2005), while 20 per cent patients at NACO’s free roll out are dead, and 12.5 per cent have failed to follow up, or stopped ART in two years.

Thanks to the Supreme Court order of December 16, 2010, there is universal access to even second-line ART that includes patients treated by private practitioners with initial regimen, and because of its previous order in 1998, India’s total blood supply is HIV screened and safe.

What India needs to learn?

We must critically evaluate the state-run and NGO programmes, replicate best practices, and shun the unsuccessful ones. We should provide three-tiered (not free for all) ART with 20 FUTURE MEDICINE I November 2012

quality care and move from ‘donor dependence’ to ‘selfreliance’. We should focus on reducing vulnerability of women and children and make PPTCT a national emergency with 100 per cent coverage. There should be a strong focus on youth and de-addiction as more than 50 per cent new infections are among those below 30. We should not run our AIDS programme on clutches of foreign aid. If Bill Gates contributed millions of dollars for India, where is the matching response from Indian giants? High ‘political will’ is needed to contain HIV beyond lip-service.

We are facing an extremely challenging situation with Multi-Drug Resistant and Extremely Drug Resistant (MDR/ XDR) Tuberculosis and HIV, and Immune Reconstitution Inflammatory Syndrome (IRIS) – a serious disease situation caused by regaining the lost immunity following successful ART, marriages/alliances among HIV+ people, jobs for recovered people, and medical insurance for them. What is not yet discovered is an effective vaccine for HIV prevention among risktakers and Vaginal Microbicide to prevent its transmission among women.

No other disease has triggered such a fast and quality research in a short span of time.

We know enough on the pathogenesis and epidemiology front. Knowledge on AIDS is fast evolving and that necessitates timely update of doctors providing HIV care. United Nations Secretary-General Ban Ki-moon suggested a strategy of the “three zeros” - zero new HIV infections, zero discrimination, and zero AIDS-related deaths. Let us pledge to work together to realise this vision. India’s strategy of working on vulnerable groups at highest risk of contracting HIV is now paying off dividends and is projected to avert three million infections.

India’s success deserves praise, but there is no room for complacency.

DOs & DON’Ts in THE FAMILY OF THE INFECTED PERSON

by Dr I S Gilada The bottom line in Do’s and Don’ts is that you must treat an infected person the same way you would expect others to treat you had you been infected with HIV. Make all possible efforts to reduce the pain and agony in the infected person, increase his/ her life span in a productive and meaningful way, and provide him/her the honour and dignity he/she deserves until death.

DOs:

1. Do sympathise and empathise with the infected person 2. Do provide family and social support 3. Do allow the infected person to be a part of the family in the true sense, as he/she was prior to HIV detection 4. Do allow the infected person to get back to job/business as soon as he/she is physically fit. Remember HIV infection doesn’t require special rest as many people may be thinking so irrationally 5. Do keep him/her engaged in some activity, as ‘an empty mind is a devil’s workshop’ 6. Do provide good nutrition with protein-high vitamin diet 7. Do provide clean potable water at home or outside (boiled water or zeroed water) 8. Do allow the infected person to join any selfhelp group, if the person so desires 9. Do register the infected person with an appropriate healthcare facility for regular checks and follow-ups 10. Do dispose of blood-stained tampons/bandages properly, either by flush or after disinfecting with detergent 11. Do forgive the infected person for his infection as that helps in coping up 12. Do prevent TB in the infected person with proper medical guidance 13. Do care for the children of the infected person or the HIV orphans 14. Do fight against discrimination of the infected person by hospitals, doctors, and workplaces. It is your right to fight!

15. Do ask the infected person to practice safe sex

16.

17.

18.

19.

20.

21.

22.

23.

24.

25.

(condom) with his sex partner, even if he is undergoing Anti-Retroviral Treatment Do seek a psychiatrist or counsellor’s intervention if the infected people develop any suicidal tendency or irrational behaviour Do seek the help of a ‘Semen Bank’ or a ‘Cryo Bank’ if pregnancy is desired in an uninfected female partner Do provide complete information on AntiRetroviral Treatment and start the same at an appropriate time Do follow-ups regularly with appropriate tests like CD4/CD8 etc, irrespective of AntiRetroviral Treatment Do encourage the infected person to exercise and meditate. It can prolong the life span Do make efforts to reduce the stress of the infected person Do make efforts to ensure that the infected person sleeps peacefully Do make efforts to stop all addictions in the infected person, such as tobacco use, smoking, consumption of alcohol, or other psychotropic, or recreational drugs Do help the infected person to prepare a ‘will’ at an appropriate time Do grant permission to die to a terminally ill infected person and share their responsibility

November 2012 I FUTURE MEDICINE 21

COVER STORY India Ahead In HIV Care

DON’Ts: 1. Don’t be judgmental and/or moralistic towards the infected person 2. Don’t demoralise the infected person by blaming him for getting infected. It doesn’t help.

3. Don’t try to probe as to when, how, where, and from whom the person was infected 4. Don’t blame god, fate, and luck for the infection 5. Don’t make the infected person feel guilty 6. Don’t isolate the person in family, or society, or at the workplace 7. Don’t separate/divorce the infected person from the spouse. In fact, spouse is the best support and companion for the infected person 8. Don’t keep the infected person away from his/her children. It is better to provide an opportunity for more parenting hours so that children can express their love for the person 9. Don’t use gloves while feeding the infected person or wiping off his saliva, sweat, nasal secretions and tears 10. Don’t share razors, toothbrush, and other sharp objects with the infected person, or with anybody else 11. Don’t use blood from the infected person for transfusion 12. Don’t wash the clothes of the infected person separately, as it is not desirable.

13. Don’t disclose the HIV positive status of the infected person to the relatives, neighbours, friends, employer, community leaders, or insurance company 14. Don’t insist on pregnancy in an infected woman because of desperation, emotional blackmail, or superstitions 15. Don’t insist an infected male member to impregnate his uninfected wife 16. Don’t humiliate the infected person and/or his/ her spouse, children 17. Don’t scare the infected person with news of imminent death or of possible suffering. Prepare him/her for a smooth journey to death during the terminal illness, when medicines stop working 18. Don’t irritate the infected person 19. Don’t get trapped in fake cures or fake claims 20. Don’t fall a prey to witch-hunters, faith healers 21. Don’t make trips or travels to people who have claimed cures, and wait for the declaration of a

22 FUTURE MEDICINE I November 2012

Nobel Prize for a real cure 22. Don’t make the infected person a guinea pig for irrational trials of drugs 23. Don’t spend the entire available money in the first bout of illness; it may be the first of such illnesses in the pipeline. Make a proper planning of your spending and capability 24. Don’t start ART haphazardly or on advise of a doctor inexperienced in doing so 25. Don’t stop or change ART or skip dosage or take drug-holiday without proper expert guidance

FIGHT FOR IDENTITY

s a h i k l a K , e

d e v i r ar

Kalki Subramaniam

m o s r Fo

By Neethu Mohan What were the gender issues you faced during your childhood and how did you come to terms with your own identity?

Until the age of 12, I was like any other child. The problem started in my adolescent years. I was confused when my body began to change.

I was transforming into a man, which was unacceptable for me.

I went through a tough phase of mental trauma. The future seemed bleak, and I couldn’t concentrate on my academics. Against the bodily changes akin to manhood, my feminine body language only made me an easy victim of bullies and teachers in my school. At the age of 15, I made up my mind as to who I really wanted to be. I wanted to be a complete woman. I started taking hormone therapy. There was no help from anybody. There were no qualified doctors, psychiatrists, or counsellors to help me. My family loved me, but didn’t know how to help me. I had a very disturbed childhood.

The one common thing that anyone strives for is creation of a firm identity in society. The fight for an identity goes way beyond the essence of womanhood and gender parity, quite literally. The very mention of the word ‘transgender’ can morph our thoughts into an unending list of misconceptions and misplaced apprehensions.

Who are they? What makes them different? Here’s a chance to learn more about the psychological trauma of this ostracised section of our community from Kalki Subramaniam, a transgender rights activist and Founder of Sahodari Foundation, an organisation working for the social, economic, and political empowerment of the transgender community in India

What are the misconceptions regarding a transgender in our society today?

There are many misconceptions about a transgender person. Many people think that transgenders are sexual perverts, that we have extreme sexual desire for young men, that we kidnap children and turn them into transgenders, that we either have both genitals, or no genitals at all. Actually, we are very ordinary people. We need food, love, and care as much as any other normal person. We also cry November 2012 I FUTURE MEDICINE 23

FIGHT FOR IDENTITY Kalki Subramaniam

People have a fear psychosis when it comes to dealing with those from the transgender community. Is it a misplaced apprehension?

Transgenders are always hated, misused, and harassed. So, there’s an angst over deprivation of identity and equality in society. That makes some transgenders volatile. Some of them have also been using the fear factor to their advantage as a survival tactic. Never fear them. Be friendly. You will only earn a new friend.

How empowered is the transgender community in respect of entitlements to the basic rights of living?

and laugh. We are also human beings. We need to break these misconceptions and give transgenders the dignity they deserve.

You are a role model for a section of people faced with a social stigma. Have your achievements ever inspired any person sharing your predicament?

I think my life, the things I have done in the past, and my current work have inspired people not only in India, but also transgenders across the world. Many transgenders from Sri Lanka and Canada keep writing to me, saying that they find a role model in me. I am happy that I am a source of hope and inspiration for many people.

Who is your target audience when it comes to writing and acting?

Everybody is part of my target audience.

But I want to strike a chord with youngsters in particular since they are the ones who will shape the future of this nation.

How have you contributed to the transgender community’s upliftment?

I have given them hope and courage. I have been working with the Tamil Nadu government for educational upliftment of transgenders. I am also working with the United Nation’s Development Programme, the National Legal Service Authority, and the Planning Commission. At the grassroots level, I have been helping transgenders acquire training in media education through scholarships.

I have also been encouraging them to take up entrepreneurship. There have been many failures, but the success stories keep me going.

24 FUTURE MEDICINE I November 2012

Ninety-five per cent of transgenders do not have the basic facilities to survive. Today, the biggest challenge in front of people like me is the rehabilitation of transgenders. The government and some private institutions are providing educational and employment opportunities to transgenders.

But the fact remains that they are not qualified enough. Most of them are unable to complete even their basic education. Apart from the struggle for daily bread, they too have housing and medical needs. We are trying our best to empower them so that they too can lead a dignified life.

Has there been any improvement in the status of transgenders in terms of jobs, social mobility, and government support?

Certainly, there have been improvements in the case of healthcare. The government is giving them ample support. But when it comes to basic living facilities, the situation is still the same.

Both the Central and state governments should be pro-active. They should have a vision plan for empowerment of the transgender community.

Speaking of transgender issues, how openminded is our society when compared with the West?

India is much better than the West. Our people are good at heart, but the ignorance that prevails in our society makes people discriminate against transgenders. Their fears lead to ostracisation and marginalisation of the transgender community.

What all needs to be done for the welfare of the transgender community?

There is a lot to be done. We have to rehabilitate transgenders trapped in beggary and flesh trade. We need to provide them proper medical care. We need to care for the ageing transgenders. They should be given monthly pensions. The next generation of our community should be really happy. I dream of a day when transgenders will be a part of the mainstream.

NEW TRENDS Robotic Surgery

Introducing the

da Vinci Robotic system

What are the processes involved in a Robotic surgery and is its use limited to specialty care?

The da Vinci Robotic system is essentially a computer assisted surgery system. It uses technology to give the benefits of open surgery through 1-2 cm small incisions. The Robot consists of a surgeon console which offers the surgeon a three-dimensional view of the operative field with 12 times magnification, making surgery more precise and safe. The Robotic arms are at the patient’s side, holding the Robotic instruments operating on the patient. The Robotic arms are controlled by masters held by surgeon at the console. The Robotic instruments have wrist-like motion with flexibility. This enables fine hand-like movements in confined

Dr Anshumala Shukla-Kulkarni, MD (O&G) (Bom), DGO, FCPS, is a Consultant Gynaecological Laparoscopy Surgeon, Robotic Surgeon, and Urogynaecologist.

She had done Clinical Fellowship in Advanced Gynaecological Laparoscopic Surgery from Sydney Women’s Endosurgery Centre and St George Hospital, Sydney, Australia. She then obtained Clinical Fellowship in Minimally Invasive Surgery from K K Women’s and Children’s Hospital, Singapore. She currently works at the Kokilaben Dhirubhai Ambani Hospital in Mumbai, which introduced a Robotic surgery programme earlier this year. In an interview with Future Medicine, Dr Anshumala talks about the surgical procedures involving a robotic system

By Prashob K P

November 2012 I FUTURE MEDICINE 25

NEW TRENDS Robotic Surgery

spaces like the pelvis. The Robot allows a surgeon’s hand movements to be filtered and translated into precise micro movements of tiny instruments.

It is important to know that surgery with da Vinci does not place a robot at the controls; the surgeon is controlling every aspect of the surgery with the assistance of the da Vinci Robotic platform. The da vinci offers minimally invasive approach to complex surgeries as it overcomes limitations of both open and laparoscopic surgeries. It has multispeciality applications and is used for multi-organ surgeries.

What kind of Robotic medical procedures are undertaken at Kokilaben Dhirubhai Ambani Hospital?

We started the Robotic programme on May 28, 2012, and have the distinction of having completed the fastest 50 surgeries in 70 days. We are performing all routine gynaecology procedures like hysterectomy (removal of uterus), myomectomy (removal of fibroid) as well as complex surgeries such as prolapse repair called sacrocolpopexy and endometriosis surgery. Gynaecological cancers of uterus and cervix are treated with Robotic surgery. In urology, cancer surgery for prostate, kidney and bladder have been done, with first Robotic adrenalectomy (adrenal gland tumour), Robotic anterior exenteration (urinary bladder cancer in females), Robotic radical cystectomy (urinary bladder, creating a new bladder in same position), video endoscopic inguinal lymphadenectomy (lymph 26 FUTURE MEDICINE I November 2012

nodes removal from groin in case of penile cancer). In thoracic cancer, we have done lobectomies and oesophagectomies.

We will be starting head and neck surgeries with thyroidectomies and base of tongue surgeries.

How can such sophisticated procedures be extended to patients from humble backgrounds? Tell us about the costs involved.

The da Vinci Robotic instruments go through extensive checks and are recommended for use only 10 times. In fact, the Robot does not accept the instrument after that. This limited usage and the basic cost of the machine means that Robotic surgery comes with a price. The additional cost of the instruments works out to approximately Rs 1,00,000 more than laparoscopy. At present, the da Vinci are few and far between in India.

Given the availability of more Robots and larger volumes of Robotic surgery, the price of the disposable instruments can be brought down, making it available to all categories of patients.

How safe is Robotic surgery?

Extremely safe!! At no point does the Robot move on its own. Each millimeter of movement is as per the direction of the surgeon. There are numerous inbuilt checks and safety steps in the machine itself which does not allow inadvertent mistakes. Studies on cases of Robotic surgery, as compared to laparoscopic surgery, have proved that it has fewer complications.

How has Robotic surgery helped you overcome the challenges generally encountered in traditional modes of treatment?

A Robot allows me to do more complex surgery with the minimally invasive technique. It has less blood loss and faster recovery time. The wristed movements of Robotic instruments make suturing in narrow, confined spaces like pelvis easier. It makes suturing faster, especially in cases of large fibroids.

Are you conducting research through robotic surgeries in collaboration with international medical organisations?

We are connected to the Intuitive Surgery Site which keeps an account of the number of cases and success rates. We are independently collecting and comparing data for Robotic vs laparoscopic methods of surgery.

Tell us about the da Vinci system.

The da Vinci has essentially four components: One, Surgeon’s Console: Using the da Vinci Surgical System, the surgeon operates seated comfortably at a console while viewing a high definition 3D image inside the patient’s body. The surgeon’s fingers grasp the master controls below the display with hands and wrists naturally positioned relative to his/her eyes.

The system seamlessly translates the surgeon’s hand, wrist, and finger movements into precise, real-time movements of Robotic instruments.

Two, Patient Cart: The patient side cart is where the patient is positioned during surgery. It includes either three or four Robotic arms that carry out the surgeon’s commands. The Robotic arms move around fixed pivot points which reduces trauma to the patient, improves the cosmetic outcome, and increases overall precision. The system requires that every surgical manoeuvre be under the direct control of the surgeon. Repeated safety checks prevent any independent movement of the instruments or Robotic arms.

Three, EndoWrist Instruments: A full range of EndoWrist instruments is available to the surgeon while operating. The instruments are designed with

seven degrees of motion - a range of motion even greater than the human wrist. Each instrument has a specific surgical mission such as clamping, suturing, and tissue manipulation. Quick-release levers speed instrument changes during surgery.

Four, Vision System: The vision system is equipped with a high-definition 3D endoscope (flexible tube with a camera and light at the tip) and image processing equipment that provides true-tolife images of the patient’s anatomy. A view of the operating field is available to the entire OR team on a large viewing monitor (vision cart). This widescreen view provides the surgical assistant at the patient’s side with a broader perspective and visualisation of the procedure.

Are there any policy bottlenecks hindering you from broadbasing treatments, or research?

Like anything new, adaptation of the Robot technology is just the beginning and taking its time.

Large-scale awareness is lacking, especially among insurance companies, which need to be educated about the need for such technology in surgeries.

Aren’t Indian healthcare institutions far behind their foreign counterparts in introduction of innovative treatment methodologies?

We are certainly far behind the USA, which has over 1500 Robots. Robotic technology is now adopted for most abdominal surgeries. Cost effectiveness of the equipment is a limiting factor.

Shortage of trained surgeons is hampering growth.

Better training centres, dedicated surgeons, and subsidy to use the method for patients should help.

Is there a need for mass awareness of the efficacy of Robotic surgery?

Most definitely. Laparoscopic surgery took over the open method in the last two decades, and presently, patient awareness has forced every surgeon to build up the skill sets in laparoscopy.

Better awareness among patients will create a demand for Robotic surgery and increased adoption for the same.

November 2012 I FUTURE MEDICINE 27

CHOLESTROL CHECK

Dr A G Unnikrishnan

Of mysterious oranges and good cholesterol

Something’s Gotta Give: Remember to care for the heart!

T

he story begins in the year 1959, at Tangier Island, USA. A little boy had opened his mouth and his parents were surprised to see two orange swellings within. They rushed him to the surgeon, and the surgeon noted that the tonsils were replaced by large orange-coloured structures. Immediately, a surgery was done. Sensing something unusual, the biopsy samples were sent by the surgeon to a well-known pathology institute. The reason for the magnificent

28 FUTURE MEDICINE I November 2012

colour of the orange tonsil was soon diagnosed.

The tonsillar cells were completely swollen with cholesterol droplets, which had given them the orange colour! Later, a well-known team of scientists found that both the boy and his sister had zero levels of cholesterol called “HDL cholesterol. The disease was named “Tangier Disease”, and its description eventually helped us understand the benefits of HDL cholesterol, also called

“good cholesterol”. HDL, or high density lipoprotein, cholesterol is a good form of cholesterol, which helps the body get rid of its excess cholesterol. In the absence of HDL, fat droplets accumulate in the body’s tissues, and this excess cholesterol in the tonsils was the reason for the swollen, orange tonsils.

Cholesterol is a waxy particle, and high levels in the blood are generally bad for the heart.

However, there is a caveat.

Cholesterol does not move alone in the blood - it is usually tagged to a protein. This combination of cholesterol and protein is called lipoprotein. Depending on the amount of cholesterol and the type of protein, cholesterol moves around in the body as various lipoporoteins of different sizes. There are different types of lipoproteins, depending on the size, and density of each of these.

They are high density lipoprotein (HDL), low density lipoprotein (LDL) and so on. What is the importance of knowing all this? The importance is that some lipoproteins, like HDL, are actually good for the body, helping it get rid of the excess fat. Other lipoproteins, like LDL, are bad for the body, and contribute to heart disease by causing cholesterol-rich materials to block important blood vessels. And when the blood vessels to the heart are blocked, it may result in heart attacks.

HDL, or the good cholesterol,

is important in disposal of the excess fat of the body. It carries all the excess, dangerous fat to the liver, where the liver destroys the fat and throws it out of the body, partly through feces. And when the HDL level is inadequate, cholesterol accumulates, as it cannot be disposed of. Cholesterol accumulating in blood vessels may lead to heart attacks. Therefore, in order to reduce chances of heart attacks, one must reduce the bad cholesterols and increase the good cholesterol.

How can we increase the good cholesterol? Well, studies have shown that there are only some simple ways - exercise, red wine, and reducing dietary fat intake, or by shifting to heart-friendly oil, such as olive oil. Except for exercise, all the other techniques offer only modest effect.

What about medications to improve the good cholesterol levels? While most cholesterol controlling medicines (a well-known example is the group of medications called “statins”) can lower the bad cholesterol levels, they generally do not increase the good cholesterol levels. However, two medications may increase the good cholesterol levels. The first is called a “fibrate”.

Through a series of complex processes, it increases the good cholesterol and reduces levels of triglycerides (like LDL, this is a bad

Some lipoproteins, like HDL, are actually good for the body, helping it get rid of the excess fat. Other lipoproteins, like LDL, are bad for the body, and contribute to heart disease by causing cholesterolrich materials to block important blood vessels. And when the blood vessels to the heart are blocked, it may result in heart attacks

particle). The other medication is called “Niacin”. Niacin too can reduce triglycerides and increase the HDL. So, dear reader, whenever you check your cholesterol levels, please ask for a complete lipid profile test - as only this can tell you whether the good cholesterol is low and bad cholesterol is high. And meet your physician, or cardiologist, with the report, as they will be able to advise you about treatment.

Dr A G Unnikrishnan, MD, DM, DNB, MNAMS, is a Professor at the Department of Endocrinology at Amrita Institute of Medical Sciences, Cochin, Kerala November 2012 I FUTURE MEDICINE 29

MRITA SANJIVANI Kidney Transplantation Programme

Seeking your help in donor hunt Mrita Sanjivani is an antidote that can revive the dead, according to Hindu mythologies. Inspired by this, the Kidney Federation of India, in association with the Kerala government, has launched a novel initiative named after the antidote to create a database of over ten lakh kidney donors across the country Fr Davis Chiramel, Chairman, Kidney Federation of India

D

o you know that the number of people in Sri Lanka who have pledged their eyes for donorship after death is the highest in the world? That’s a touching gesture indeed.

The success in giving vision to the blind and those with eye disorders can be attributed to strong organ donation campaigns and awareness classes in the island nation. Back in India, an organisation is trying to replicate this success in the field of kidney donation.

‘Mrita Sanjivani’ is a programme initiated by the Kidney Federation of India under the chairmanship of Fr Davis Chiramel, a Keralabased priest who had donated one of his kidneys in 2009 to save a patient. “The number of people suffering from kidney failures is increasing in our country. Every year, lakhs of Indians need kidney transplantation. Annually, Kerala alone needs 5,000 transplantations. Availability of kidney is a great problem here. In such a scenario, we have to consider the fact that India has been witnessing a rise in the number of brain deaths due to accidents... If we can use the organs of these brain dead victims after pronouncement of their death, there will be sufficient amount of organs for transplantation. Such a move can also curb malpractices in organ transplantation and donorship. This (end to malpractices) is the motto of the Mrita Sanjivani project, which aims to collect 10 lakh promissory notes from willing donors,” Fr Davis tells Future Medicine.

The first phase of Mrita Sanjivani project, initiated in Kerala in September 2012 with support from the state and Central governments, got a favourable feedback. Within two months, four lakh donors associated themselves with 30 FUTURE MEDICINE I November 2012

By Lakshmi Narayanan Mrita Sanjivani. Now, the Kidney Federation of India, along with the Kerala government, plans to conduct the second and third phases of the project in Delhi and Mumbai. In the coming months, Fr Davis will spearhead awareness and promissory note campaigns in the UK, Germany, the USA, and many other countries.

The Core Committee for Cadaver Transplantation (CCCT), the legal wing of the Kidney Federation of India, will assist donors in registration with hospitals, organ allocation, and organ transplantation. CCCT shall act as the appropriate authority under the Transplantation of Human Organs Act 1994. Besides, all activities under Mrita Sanjivani are to be coordinated and monitored by Kerala Network for Organ Sharing (KNOS), a non-profitable charity organisation under the Kerala government that provides services to donors, recipients, hospitals, and the general public.

“The Kidney Federation of India’s next plan is to start a demand bank and a donor bank. While the demand bank will provide all types of organs, including kidney, heart, liver, pancreas, eyes, and bone marrow, the donor bank will preserve the organs,” says Fr Davis.

Many Keralites from various walks of life, including celebrities from the fields of politics, film, and culture, have already joined the network. Well, life doesn’t have to end with death.

One can live on by donating his organs for use by the needy after death. The vital organs of one donor can give a new lease of life to at least eight people. So, Fr Davis and his panel of experts, including transplantation surgeons, are spreading awareness on the ethics behind organ donation.

AFFORDABLE CARE

Dr Jitendar Kumar Sharma Member, Faculty of Health Sciences at University of Adelaide, Australia

The dual battle of drug pricing and dispensing Policy change

The Government of India is set to undertake measures to control prices of essential medicines in India. This covers 348 drugs – all listed in the National List of Essential Medicines. The decision comes in the wake of the pressing agenda of delivering quality affordable care to citizens as well as recent research, especially those undertaken by experts from Public Health Foundation of India, confirming that a substantial part of out-of-pocket (OOP) expenditure (almost 80 per cent) is due to purchase of drugs - about 70-80 per cent takes place in OPD settings, leading to purchase of both prescription drugs as well as over-the-counter drugs.

The state governments in Rajasthan and Tamil Nadu laid an example by officiating generic prescription and dispensing in the respective states, following which the possibility of a similar policy on a national domain could be conceptualised. The policy, expected to be ready by November 2012, would bring in a pharmaceutical system with three distinct features: a) generic prescription; b) generic dispensing; and c) price cap on all drugs from the National List of Essential Medicines.

The Problem

The proposed policy would apparently try to achieve the goals of greater healthcare reach as well as reduction in expenditures made on healthcare.

However, since this reduction is being carved out of the market share, essentially in the sale/profit per unit of drug consumption, the market runners would try to make for this by volume of consumption. In simple terms, the decline in profit per unit of sale could only be compensated in volumes of sale.

The lurking devil of over-prescription, irrational dispensing in thousands of chemist shops across the country, and improper consumption of over-thecounter drugs by uninformed patients, stands. With drug resistance emerging as a threat to evidencebased medicine and the greatest miracle of modern medicine, the magic Antibiotics, fighting a battle for 32 FUTURE MEDICINE I November 2012

existence, an overconsumption of any and all forms of drugs could bring a stop to this lifeline.

The path to health protection

A supplemental support to the policy of generic drug pricing needs to come forth. The support obviously needs to be firmly embedded in the policy itself rather than as an external method. A support/ adjunct policy inclusive of the following components would help the proposed pharmaceutical policy achieve the overall goals of health protection: • Bringing all antibiotics under strict ‘on prescription’ sale only • Popularisation of clinical standard treatment guidelines among clinicians, chemists, and pharmacists, considering the fact that an extremely large number of people would continue to buy medicines straight from shops • Popularisation of drug intake effects and side effects for all common ailments with clear instructions on overconsumption side effects • Strengthening Pharmacovigilance Programme of India (PvPI), with more PV cells in hospitals and health centres to tap reports of adverse drug reactions • National monitoring for increase in sale of all forms of drugs under proposed price control The goals of a good pharmaceutical policy can only be achieved by incorporating the qualitative components discussed above into the policy domain to conserve health and promote true health protection.

Dr Jitendar Kumar Sharma has served as Hospital Administrator for a number of years at Sri Sathya Sai Institute. Later, he served as a consultant to the World Bank and the World Health Organisation in the division of medical devices. He is part of the Faculty of Health Sciences at University of Adelaide, Australia, and Advisor to Health Technology Innovation Centre of the Indian Institute of Technology, Madras. He has authored many research papers and two books.

Special Package:

Disease Preparedness

Overcoming The Infertility The more we know about the most common diseases prevalent in today’s world, the more prepared we can be.

So, Future Medicine has decided to start a series to disseminate useful information on common ailments and diseases and the best treatment methods available in the country’s stateof-the-art hospitals.

In this edition, we have focussed on the infertility conundrum of young couples.

To make this special package reader-friendly, instead of jamming your mind with reams of data at one go, we decided to intersperse news features, interviews, and columns on infertility between equally interesting and informative stories on healthy living, only to give you and the package a breathing space.

27

November 2012 I FUTURE MEDICINE 33

INFERTILITY SPECIAL An internal, external probe

Stillborn dreams?

Don’t

worry!

More than 10 per cent of couples worldwide are infertile. For many of them, this is a great disappointment, and for some, this causes lifelong psychological trauma. Medicine has had limited opportunities to help these individuals in the past. Today, the situation is entirely different!

By Sreekanth Ravindran

T

he statement given above is part of the citation issued by the Swedish Nobel Committee in 2010 for its award in Physiology to Robert G Edwards, a pioneer in reproductive medicine and InVitro Fertilisation. In this edition, Future Medicine looks into the infertility conundrum, right from its causes to treatments and sociopsychological implications.

Infertility is a reproductive inability that robs a couple of the joy of child conception. It can affect anyone irrespective of the vitality of the immune system.

This reproduction problem is taking a heavy toll on scores of couples indulging in a risky lifestyle, affecting the social and psychological profile of the affected parties. The joy of giving birth and raising a child can’t be compensated in anyway. Yet, desperate couples are trying to rewrite their fate by taking

34 FUTURE MEDICINE I November 2012

recourse to effective treatments that can improve fertility or the alternative option of In-Vitro Fertilisation (IVF). However, in a majority of cases, the conjugal life, especially sexual union, takes a hit because of the after-effects of heavy medications, or the social pressures over the failure to conceive. Though there’s no cure for certain problems causing infertility, a majority of the conditions are treatable.

There are a number of things that can go wrong in the female and male reproductive systems, resulting in infertility. Dr K K Gopinathan, Executive Director of the Kochi-based Centre for Infertility Management and Assisted Reproduction (CIMAR), says: “Generally, when we talk about infertility, we mean primary infertility, in which a woman partner has not become pregnant after engaging in at least one year of unprotected sex. The first thing

any couple, who have failed to conceive after trying hard for a period of one year, should do is to seek the professional opinion of a fertility doctor to find out which of the two is having an issue and whether there is a way to correct it. There are also a lot of other options that are available to help couples who cannot have a baby of their own.”

Issues related to male infertility

There are many factors causing male infertility. There are even some cases where men have become infertile due to some childhood illness or injury. The most common causes of infertility are as follows: Low Sperm Count: Most men have a very low sperm count fewer than 20,000,000 sperms in each ml of semen. The reasons for low sperm count could be many, and sometimes, it is very hard for doctors to find a definitive cause.

This can be very hard on a man, making him feel frustrated and inadequate. “One common reason why men have low sperm count is because of a condition called “Varicocele”, which simply means the presence of Varicose Veins in the testicles. This type of swelling in the vein often causes the testicular temperature to rise. As a result, the sperm mobility and production are significantly decreased,” says Dr Gopinathan.

Low Quality of Sperm: The presence of abnormally shaped or slow-moving sperm indicate low sperm quality. It can make conception very difficult as the sperm does not reach the woman’s egg during the time of fertilisation. Most of the time, this happens as a result of poor lifestyles, or use of certain medications. Umpteen research studies suggest that some substances, including marijuana, nicotine, pesticides, and certain medical prescriptions, can lower the quality of sperm as well as sperm count. Hence these substances should be avoided at all costs.

Female Fertility Issues

Women have much more complex reproductive systems than men. So, it stands to reason that there are a number of complications that could occur, causing a woman to become infertile. However, many more treatments and alternatives are available to women than men.

Therefore, female infertility seems to be a lot easier to treat or correct. Some of the following factors of infertility are common among women: Hormone Imbalances: One of the major reasons for infertility among women, hormonal imbalances hinder ovulation. Some hormonal imbalances could be so severe that a woman may stop ovulating altogether. Dr Gopinath explains, “The good news is that there are a number of different synthetic hormones which can be given to women in order to even out their hormone levels and help things go back to normal within their bodies. Some of these hormone therapies take a little while before they work and some of them are effective almost immediately. It depends a lot on the severity of the hormone imbalance on a woman’s body.”

Medical Conditions: There are many medical conditions that could lead to infertility among women. The main reason is the complex and abstruse nature of the female tract. Some of the most common medical conditions include: Fibroids: Uterine fibroids are non-cancerous tumours found among women aged between 30 and 45. The growths, which may appear

singly or in groups, vary from the size of a bean to the size of a grapefruit. They may either be confined to the uterine wall, or grow outward.

Fibroids usually cause no symptoms, unless they grow large enough to press painfully on other organs, or even distort the shape of the abdomen. Large fibroids may narrow the uterine cavity and lead to miscarriage, or infertility.

Fibroids can impact fertility if they grow inside of the uterus. They change the environment of the uterus by interfering with embryo implantation, or predisposing a woman to have early miscarriages. Fibroids have a tendency to grow during pregnancy and could also cause deformities in the arms and legs of the baby if they press on the foetus.

Endometriosis: Endometriosis, one of the leading causes of female infertility, is a common disorder affecting the cells that lines the uterus, resulting in a growth outside the uterine cavity.

The tissue (group of cells) gets attached to the reproductive, or abdominal organs, and swells with blood during menstruation. Because this blood is trapped within the tissue and cannot be shed through the vagina, blood blisters form and may develop into cysts, scar tissue, or certain

November 2012 I FUTURE MEDICINE 35

INFERTILITY SPECIAL An internal, external probe

adhesions. It affects the ability of a woman to achieve pregnancy by scarring and blocking of the fallopian tubes.

Ovarian Cysts: Ovarian cysts are fluidfilled sacs formed in the ovary that disrupt the normal ovulation process, or the fertilisation process.

Polycystic Ovarian Syndrome (PCOS): PCOS is characterised by infrequent menstrual cycles, obesity, Hirsutism, and hormonal dysfunctions. In many cases, PCOS is associated with other endocrine gland problems, including the adrenal gland

be the result of previous surgeries within the area. They could be the result of a ruptured appendix with abscess formation, or endometriosis, as well. Pelvic adhesions impact fertility by interfering with the ability of the fallopian tube to pick up the oocyte at the time of ovulation.

Decreased Ovarian Reserve (DOR): DOR is a normal physiological condition that commonly happens during the pre-menopausal years. It can affect patients after the age of 36, although it is more common after the age of 40. Occasionally, patients in the late 20s and

and thyroid gland. PCOS impacts fertility by decreasing the number of ovulation throughout a women’s lifetime. In addition to these, patients have a tendency to have heavy menstrual periods that could develop endometrial polyps and other changes at the endometrial lining level, making it difficult for embryo implantation.

Pelvic Adhesions: Pelvic adhesions are scars, or fibrotic tissue, that develop around the tubes, ovaries, bowel, and the uterus.

Usually, this happens due to previous pelvic inflammatory diseases, or venereal diseases like Chlamydia, Gonorrhoea. This could also

early 30s have this condition. It is also seen in patients who have had surgery on the ovaries for ovarian cyst treatment, or removal of endometriosis.

Age and Lifestyle: Poor lifestyle choices can contribute to infertility. Excessive drug, or alcohol use, smoking, stress, and poor health habits are inadvisable. Smoking has been associated with an increase in chances for an ectopic (tubal) pregnancy, stillbirth, miscarriage, and even cervical cancer. It is also a fact that women, as they age, gradually lose their ability to become pregnant. This is because the amount of healthy eggs they

36 FUTURE MEDICINE I November 2012

Laptop can affect male infertility

A

study by State University of New York has proved that laptops damage the fertility potential of a person.

The study revealed that laptops reached internal operating temperatures of over 70 degrees Celsius. The user sits with his thighs close together to balance the machine, trapping the scrotum between the thighs.

The researchers recorded the temperature changes to the scrotum caused by laptop use among 29 healthy male volunteers aged between 21 and 35 and found that just sitting with the thighs together, caused scrotal temperatures to rise by 2.1 degrees Celsius.

T

Infertility and libido

hough there is a popular belief that a man suffering from low sperm count will automatically have a low libido, the reality is different. No medical evidence is, however, available to prove that every man with low sperm count, or lack of quality sperm, will automatically have reduced sexual desire. Males have been found to ejaculate two to three times a day despite having low quality of semen. Males being treated by infertility specialists seldom complain of low libido.

release each month decrease significantly with each year that passes after the age of 35.

Dr Parasuram Gopinath, Scientific Director, CIMAR, observes, “It is possible to prevent some potential kinds of infertility by bringing about certain changes to one’s day-to-day lifestyle. For instance, smoking can be directly linked to low sperm counts and sluggish sperm movement in men, and an increase in miscarriage in women.

Alcoholism affects the fertility of both men and women trying to conceive either naturally, or through infertility treatments.

Alcohol reduces sperm counts, can interfere with sexual performance, disrupt hormone balances, and increase the risk of miscarriage.

Striving for a weight loss could also lead to infertility. Weight loss should be gradual

Vitamins and infertility

W

hile Vitamin E is a powerful anti-oxidant, which improves egg quality by preventing egg damage during the process of maturation, Vitamin C improve the chances of implantation of the egg in the uterus. Vitamin B-9, or Folic acid, another important prenatal vitamin, prevents the incidence of birth defects in the foetus. It is essential to produce genetic material in every cell of the human body.

and accompanied by a balanced diet and moderate exercise. Studies have revealed that women following strict diet controls and engaging in strenuous activities have decreased ovulation and increased menstrual disturbances. In men, heavy exercise leads to a decrease in the sperm count due to an increase in the testicular temperature, impairing sperm production.

Since consumption of too much tea, or coffee, in a day can affect bodily functions, it is also directly linked to increased risk of miscarriages.”

Treating infertility

Dr Sathy M Pillai, Director, Samad IVF Hospital, Thiruvananthapuram, is an infertility specialist with more than two decades’ experience. She says, “Though infertility is a serious issue, the worldwide November 2012 I FUTURE MEDICINE 37

INFERTILITY SPECIAL An internal, external probe

success rate (in treating infertility) stands at 30 per cent. This is quite promising.”

Today, there are several methods to treat male infertility. Varicoceles can be repaired by blocking off the abnormal veins through surgery. Hormonal abnormalities, along with obstructions in sperm transport, can also be treated through surgery and using proper medicines.

Assisted Reproductive Techniques Assisted Reproductive Technology (ART) refers to the technical application of laboratory, or clinical technology, to gametes (human egg or sperm) and/or embryos for the purpose of reproduction. According to Dr Sathy, ARTs are the new powerful options. The methods used in ART treatments are: Intrauterine insemination (IUI): IUI is a technique that involves placement of male sperm inside a woman’s uterus to facilitate fertilisation. At the time of ovulation, sperms are injected directly into the uterus. Medicines are usually given to the woman first to increase the number of eggs she releases.

In-vitro fertilisation (IVF): Sperms are mixed with multiple eggs collected from the woman in a test tube. Fertilised eggs are then placed in the uterus. This method, that has emerged as one of the most successful methods to treat infertility across the world, has been proving helpful in overcoming both male and female infertility.

Intracytoplasmic sperm injection (ICSI):

38 FUTURE MEDICINE I November 2012

A single sperm is injected through a tiny needle into an egg. The fertilised egg is then implanted in the uterus. ICSI can be performed when sperm counts are extremely low, or abnormal.

Apart from these techniques, there are drugs that could boost egg growth and help the ovaries release more eggs. Many disorders, including Endometriosis, Fibroids, and other defects in the uterus, can be cured through surgery.

Infertility and psychological implications Since parenthood is one of the most important transitions any adult would desire for, the emotional pressure of the non-fulfilment of a wish for a child could lead to mental depression and a feeling of worthlessness. Partners may become more anxious to conceive, ironically increasing sexual dysfunction and social isolation. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Couples experience stigma, sense of loss, and diminished selfesteem in the setting of their infertility.

Dr Ajay K Keshavan, a clinical psychologist at Samad IVF Hospital, Thiruvananthapuram, says that infertility could bring down sexual desire among couples. “A disturbed mind and worries can disrupt proper sexual interaction as sex is a complex synthesis of fantasy and fiction developed in a social framework,” says Dr Keshavan.

INFERTILITY SPECIAL

Dr N P Vijayalakshmy Chief Medical Officer of Vijaya Institute of Medical Sciences

Conception issues?

What’s bothering you?

I

nfertility is the inability to achieve pregnancy even after one year of unprotected sexual contact. One needs a healthy egg, a healthy sperm, a good environment for them to meet, such as a patent fallopian tube and a healthy environment for implantation, namely uterine cavity and good uterine blood flow for optional growth.

Women can have disorders of ovulation, menstruation, blocked fallopian tubes, and space occupying lesins, such as “Fibroids”, in the uterine cavity, which prevent implantation and sometimes cause abortion.

A simple blood test can confirm the type of ovulatory disorder; a pelvic scan confirms normalcy of uterus and ovaries; and a sonosalpingography reveals patent tubes. If abnormalities are detected, they can be treated medically, or surgically, yielding good results.

The two common disorders seen here are Polycystic Ovarian Disease (PCOD) and Endometriosis. PCOD causes ovulatory disorder, menstrual disorder, and sometimes abortions.

Blood hormone evaluation and pelvic scan confirm this disorder.

Generally referred as a “lifestyle disorder”, it can be treated by making the woman reduce her weight, if obese, regularising food

habits, and exercise.

If blood test reveals hyper insulinaemia and insulin resistance, treatment with insulin sensitiser - metformin tablets – can enable return of regular menstruation and ovulation in a good percentage of women. Laparoscopic surgery in the form selective follicular puncture in both ovaries help in getting regular periods and ovulation.

Endometriosis is another common disorder causing infertility in this part of the Kerala. The inner layer of uterus, called “Endometrium”, is seen in other parts of pelvis like ovaries, back of uterus, causing adhesions and severe dysmenorrhea. Endometrioma, which is a cyst in the ovary, is dealt with laproscopically. The cyst is removed, adhesions are lysed, and pelvic anatomy is made normal.

There have been good results, with a high percentage of women getting relieved of pain and conceiving naturally.

Tubal block can be corrected by hysteroscopic cannulation.

In the above cause, if pregnancy does not follow naturally within a stimulated period, the patient has to go for an assisted reproductive technique, called ART. Usually In-vitro fertilisation is the line of management.

Men can have erectile dysfunction, or ejaculatory disorder.

This can be corrected by proper counselling and medication by an andrologist. A simple semenogram, done after 72 hours of abstinence,

can give a clue to the cause for male infertility.

Clinics and laboratories follow their own criteria to call a semenogram normal. If the sperm concentration is very much less than the normal, we call it “oligozoo spermia”. If the sperm mobility is very much reduced, it is called “asthenozoo spermia”, and a high percentage of abnormal sperms are called “terrato spermia”.

If the count and mobility are slightly low, and the female partner is normal, one can attempt sperm wash and intrauterine insemination.

This gives about 20 per cent success rate.

Intra cytoplasmic sperm injection and the embryo transfer are another form of ART. In all these, hormone injections are given to the female partner and the follicles are aspirated for eggs under anesthesia.

The eggs are either inseminated with sperms, or one sperm is injected into the egg in accordance with the procedure.

PESA is the procedure where percutaneous epididymal aspiration of sperm is done and injected into the egg. This is done in the case of azoospermia due to the congenital absence of vas deferens (the duct that conveys sperm from the testicle to the urethra).

Dr N P Vijayalakshmy MD, DGO, is the Chief Medical Officer of Vijaya Institute of Medical Sciences, Kadavanthra, Cochin, Kerala November 2012 I FUTURE MEDICINE 39

INFERTILITY SPECIAL Bourn Hall Clinic

World’s best

IVF centre now in Kochi Cambridge-based Bourn Hall Clinic is the world’s best IVF centre. It has two clinics in India – in Gurgaon, Haryana, and Kochi, Kerala. The clinic’s sole aim is to provide moral, emotional, ethical, and advanced technical support to couples troubled by the problem of infertility

By Sumithra Sathyan

T

wo years after achieving the first success through IVF, with the muchawaited birth of Louise Brown in 1978, Dr Patrick Steptoe and Professor Robert Edwards achieved another first – a new clinic that made IVF treatment available to couples with difficulties conceiving. The result has been many children who otherwise would never have been born, and the birth of a whole new area of medicine undertaken at Bourn Hall Clinic over the last three decades.

What drove Steptoe and Edwards was life – both the lives of the patients themselves, and the possibility of making their dream of a family a reality. Bourn Hall Clinic was conceived as a calm, supportive environment where patients receive the best possible treatment and care. In an interview with Future Medicine, Dr Pravin Kini, the CEO of Bourn Hall Clinic (India operations), speaks about India’s potential to become an important location for infertility treatment.

What are the new trends in infertility treatment?

•

Clean room-based IVF Lab: All IVF labs that come up in the future would have to be ISO 5/6 clean rooms. This is as per the EU Tissue Directive. Every upcoming lab in the West is conforming to this standard.

40 FUTURE MEDICINE I November 2012

• •

Blastocyst Culture: In order to ensure that embryos reach this level, we need to grow them in a clean room of ISO 5/6.

Elective Oocyte Cryopreservation (EOC): This enables young women to keep the option of using them in case they fail to get pregnant after 38 years of age.

What are the major causes and curable aspects of infertility ?

Younger women in India: Blocked tubes because of TB and pelvic inflammation; Males: Having no sperms (Azoospermia); Older women: Endometriosis and poor quality of eggs because of Premature Ovarian Failure (early menopause) Curable aspects: • Tubes blocked – IVF • No sperms – take it from the testis using micro TESE (possible in 70 per cent of cases) • Endometriosis – IVF • Poor egg quality: One needs to have children early. If not possible, then EOC is to be done

Does our changing lifestyle affect infertility?

Bad lifestyle and junk food cause higher diabetes, leading to high insulin levels – this in turn leads to PCOD and infertility. They

can be easily treated with drugs and change of lifestyle.

Usage of cosmetics and face powders can lead to early menopause.

How can we detect infertility on time?

A semen test can be done to rule out serious male factor problems. Check for egg quality by doing simple blood tests.

Finally, if after one year of trying, no pregnancy takes place, then test whether the tubes are open or not. With these three tests, one can clearly say if the person has serious infertility or not.

What are the food items and other factors which may cause infertility?

Junk food, high in simple carbohydrates, are to be avoided.

Exercise daily. Men should not wear tight undergarments.

Have children early. If that’s not possible, go for EOC.

What’s your message to the common man?

Eighty-five per cent of all married couples conceive without any problems within a year of marriage. Of the balance 15 per cent, 12 per cent get pregnant with simple treatments. Tubes have to be normal. More than 50L actively moving sperms have to be there in one ml of semen. And not more than three intrauterine inseminations (IUI) have to be done. If any of the above conditions are there, then do an IVF. Only three per cent require IVF at Bourn Hall Clinic; Eight out of 10 couples who come to us become pregnant over a period of time. For those who do not have any eggs because of premature menopause, Bourn Hall Clinic offers donor eggs, which ensures that 70 per cent of couples become pregnant at the end of one IVF cycle.

For those who do not have a good uterus, Bourn Hall offers a surrogacy programme.

Dr Pravin Kini, the Chief Executive Officer of Bourn Hall Clinic (India operations), is an infertility specialist and obstetrics and gynaecology physician. He has rich experience in the field spanning more than two decades. He has pioneered many start-up ventures in the fields of medical information technology, rural hospitals etc. Notable among them are Iscapesciences, iMed, and SA Hospitals.

November 2012 I FUTURE MEDICINE 41

SEX EDUCATION What parents should tell their children?

Answer

your

child’s queries

on sex, sexuality

The very mention of the word ‘Sex’ before children of an impressionable age causes a deep sense of embarrassment among parents today. This intellectual and moral incapacity to educate children about sex and their sexuality often leads them on a path of self-discovery that involves the highly objectionable idiot box, internet, cheap publications bordering on sleaze and skin shows, and inane or immature group banter on human experiences involving the reproductive organs. So, is there an effective way to reach out to the children and tell them about the basics of sex, sexuality, and the dangers of voyeurism, abuse, and perversion, without inviting embarrassment? Certainly! Here it is…

T

here are certain issues which even the most courageous people choose to avoid discussing, and society keeps suffering the repercussions of such an attitude. Sex education is one such issue.

Parents as well as teachers hesitate to provide sex education to children; while they are being pounded with sexual messages everywhere they look; from newspapers, magazines, television, films to toilet walls. The information, both forbidden and desired, is available to them freely and it is practically impossible for parents to really monitor and control all their activities. The exposure is immense,

42 FUTURE MEDICINE I November 2012

the dangers enormous, and the price that could be paid, huge. Their young minds are more vulnerable to these corrupt messages as they are rarely prepared with healthy and legitimate information about sex and sexuality.

This undoubtedly interferes with their development towards matured and healthy adulthood.

Sex education does not mean merely providing information on genitalcentered sex; it is about transferring correct values, balanced attitudes, and sound perceptions. It is important that we build adults who will use their sexuality in mature and responsible ways. It is our responsibility to keep

Dr Rajan B Bhonsle, M.D. (Bom) Consultant in Sexual Medicine and Counsellor, Hon. Professor and Head of the Department of Sexual Medicine at K.E.M. Hospital and Seth G.S. Medical College, Mumbai, and Diplomate, American Board of Sexology and The American College of Sexologists

the young generation adequately informed, so that the correct scientific knowledge may lead to building healthy attitudes towards sex, high standards of conduct, responsible behaviour, and wholesome personalities.

Researches have shown that over 90 per cent of the children get their information on sex from immature friends, pornographic literature, films, television and videos and less than 10 per cent from parents and teachers. The youth, therefore, are misinformed through unhealthy sources, rather than informed in a legitimate way, through the family and school.

The influence of misinformed peer groups has set the trend of exploring relationships with a new kind of freedom. Their approach to sex is more reactionary.

This is because our society has always been prohibitive and repressive in matters of sex. The result is a paradox in their young minds. They are either found feeling guilty for their natural sexual instinct, or they are found indulging in risky sexual experiments.

Sex is not a grimy secret between two ashamed individuals but a divine impulse of life and love. Like all the other instincts, sexual instinct also carries with it certain responsibilities, and the only way to prepare the young generation for sharing these is through sex education.

The question today is no more whether sex education should be given or not, but it is a question of how best to give this education, what exactly is to be taught, when, at what age, and how to impart it, and finally, who should give it. These questions need our serious consideration and attention to help meet the changing generation in changing times. Giving children a realistic and practical outlook on sex is as important as giving them food, shelter, security, and loving care. It is easier to answer their questions today, but difficult to solve their problems tomorrow.

What Should I Tell My Kids about Sex?

Answering kids’ questions about sex is one of the responsibilities many parents dread most. Otherwise confident parents often feel tongue-tied and awkward when it comes to sex. Childhood is a period of complete innocence, but for adults, sex is not so innocent an activity. Majority of parents go to almost absurd lengths to keep anything remotely connected with sex as far away from children as possible.

In the course of bringing up our children, there emerges a broad variety of actions and behaviours that we do not want our children to indulge in. A child’s innocent delight in his/her own natural nudity is one of the first such activities that make us uneasy. A child’s curious discovery of his/her own body is the second.

Any attention that a child devotes to exploring different body parts we consider ‘private’, often invites a harsh admonishment. This does not mean that we should allow the child to romp around naked all the time, or not teach him/her correct etiquettes. This is simply to say that a parent must restrain the immediate tone of outrage and taboo that they tend to adopt.

Kids learn an enormous amount about bodies,

When exactly do children start becoming curious about sex?

Children are human beings and, therefore, sexual beings. From the very infancy, children have curiosity about their own bodies, which is healthy and normal. It is hard for parents to acknowledge this, just as it is hard for children to think of their parents as sexually active. relationships, affection, and communication from their first year of life. It is important to help them feel good about their sexuality from the very beginning. This will make it easier for them to ask questions about sex throughout their lives. As they grow, we can give them useful information to help them make responsible, healthy decisions about their sexuality.

When’s the best time to start?

It is best to start as soon as children begin getting sexual messages. And they start getting them as soon as they are born. But do not worry if you have not started November 2012 I FUTURE MEDICINE 43

SEX EDUCATION What parents should tell their children?

The Myth of “Good Touch and Bad Touch” Experts caution against using the “good touch-bad touch” explanation because young children tend to think of a “bad touch” as one that causes physical pain or involves hitting. Many types of sexual contact are not painful, do not cause injury, and may even “feel good” to the child. So instead, tell your child exactly what an “OK” touch might be - a pat on the back, a rub on the head, a high five, and so on.

Ask your child to name some touches and let them know whether they are OK. yet. It is never too late. Just do not try to “catch up” all at once. The most important thing is to be open and available whenever a child wants to talk.

Children’s queries related to their own body and sex are utterly out of curiosity and a pure sense of wonder. They have not yet learnt to attach any sense of ‘secrecy’ and ‘privacy’ to these matters.

Toddlers will often touch themselves when they are naked. At this stage of development, they have no ‘modesty’. Their parent’s reaction will tell them whether their actions are acceptable. As a rule, toddlers should not be scolded or made to feel ashamed of being interested in their bodies. It is natural for children to be interested in their own bodies. Some parents may choose to casually ignore self-touching. Others may want to acknowledge that, while they know it feels good, it is a private matter.

Parents can make it clear that they expect the child to keep that activity private.

By the time a child is three years of age, parents may choose to use the correct anatomical words.

They may sound clinical, but there is no reason why the proper label should not be used when the child 44 FUTURE MEDICINE I November 2012

is capable of saying it. These words - penis, vagina - should be stated matter-of-factly, with no implied silliness. That way, the child learns to use them in a direct manner, without embarrassment.

Children between three to six years of age are most trusting of their parents. They hero-worship their fathers and adore their mothers. Their parent’s word is ‘law’ for them. Most of the times, what kids want most is to know that they are “normal”. We can help them understand that it is “normal” for everyone to be different. In fact, the most important lesson we can share with our kids is just that: Being different is normal.

By the time they are five, it is necessary to tell them that their body is their own and that they have the right to privacy. No one should touch them if he/she doesn’t like it or want it. Tell them that if anyone ever touches them in a way that feels strange and unusual, he/she should tell that person to stop it and then tell you about it, even if the person is a close relative, neighbour or even teacher.

Parents are often concerned that telling their children too much too soon will harm them in

Where do babies come from?

Depending on the child’s age, you can say that a baby grows from an egg in the mother’s womb and comes out of a special place, called the vagina. You can say that when a man and a woman love each other, they like to be close to one another. Tell them that the man’s sperm joins the woman’s egg and then the baby begins to grow. Most children under the age of six will accept this answer.

What to say on Masturbation?

Masturbation is a harmless activity.

It is considered abnormal only in the following situations: • If it is done in front of others • If proper hygiene is not maintained during and after the act • If it is done in a manner that can cause injury to the organ • If it is chosen over intercourse in married couples • If it becomes an “obsession” and affects any or all aspects of life

some way, or will encourage their kids to become sexually active. Information and education do not encourage young people to be sexually active. In fact, kids make better decisions about sex when they have all the information they need and when there are no taboos on what they can talk about at home. Studies on the effects of sex education in schools show that it actually encourages children to delay their sexual activity and to practice safer sex, once they are active. This is contrary to the belief that teaching children about sex and contraception encourages sexual experimentation.

Learning about sex should not occur in one all-or-nothing session. Questions should be answered as they arise.

Pre-teens (8 to 12) need all the facts about menstruation, wet dreams, and other signs of maturing. They often worry a lot about whether they are “normal”. Boys worry about their penis size. Girls worry about their breast size. Reassure them that no two people are the same.

Most 12-year-olds are ready to know about sex and reproduction. They want to know about sexual and social relationships. They need to know about sexually transmitted infections, birth control, and the consequences of teen pregnancy.

And they need to know how all of this can affect their lives.

Teens (13 to 19) must learn how to say “no” and understand what “safer sex” is. “Safer sex” activities lower the risk of spreading sexually transmitted infections. They must know how to have relationships without getting hurt and without hurting other people. And they must know they are responsible for their choices.

Masturbation is very common during this time.

It is necessary that we actively educate children about masturbation.

What to say about the ‘possibility of pregnancy’ at puberty?

During puberty, most girls start having periods. Most boys start having wet dreams. And girls and boys begin having a lot more thoughts and feelings about sex. Sometimes they get really turned on. Important changes happen inside the body at this point of time. These changes mean that the reproductive system is maturing. As boys mature, they begin producing sperms. Sperms are the male reproductive cells. As girls mature, the eggs (ova) in their ovaries begin to ripen.

Ova are the female reproductive cells. Pregnancy can happen if only one sperm joins with an egg (ovum). So, a girl or woman can get pregnant if a boy or man puts his penis in or near her vagina.

The sperm from his penis can swim up her vagina to join with her ovum. Often our reproductive systems grow up faster than we do. That is why girls can get pregnant and boys can cause pregnancy before they finish growing up.

November 2012 I FUTURE MEDICINE 45

SEXUAL HEALTH

Dr A CHAKRAVARTHY Consultant In Reproductive and Sexual Medicine

Simply being

sex-positive I

f we do not concentrate on the positive faces of sexuality, we will be missing out on a way of life that can make our sexual health promotion messages more attractive and believable for the youth. Young people know that sex isn’t just about effects and they dismiss adults if that’s all we talk about. Equilibrating our sexual health publicity attempts to include an accent on the positive aspects is important.

Being sex-positive means: • • • • • •

having a complete definition of sexuality regarding sexual health as a basic human right focussing on the life-heightening aspects of sexuality as well as paying attention to the negative aspects being non-judgmental about thought-provoking narrow social concepts (e.g. the myth that sex = intercourse) using inclusive language rather than value-loaded language making claim based on sexual orientation, or gender separates assisting individuals to be aware of the choices involved in sexual decisions (e.g. whether or not to be sexual and exactly what being sexual can mean)

Role of sexual problems in marital disharmony

“Marriages are made in heaven” is just an age old saying. Marriages are made to be weathered, withstood, and lived by the teamwork of the couple involved. While the success of a marriage is the sum total of mutual understanding and cooperation at all levels, marriage is often rocked by rough times. Sexual problems are the unfitness of one or both spouses to realise each other sexually, to make some essential changes, and then 46 FUTURE MEDICINE I November 2012

work with, or adjust to each other’s disputes.

Sexual mutual exclusiveness is one of most common reasons why couples drift apart and eventually break up. Though all couples want physical intimacy from their partners, the exact form and frequency of sexual desire may differ from one person to another. If such a situation remains for long, it might even lead to the collapse of a marital relationship. However, you can manage sexual inconsistency. Here are a few ways to go about it. Understanding the source of conflict between you and your partner will help you take the right steps in dealing with the situation.

Introduction to Sexual Medicine

Sexual Medicine is the specialty of modern medicine (Allopathy) that covers the study identifying the cause and nature of treatment of sexual health concerns of men and women.

Sexual Medicine gives Patient Care, Education, and Research in the field of human sexuality.

Sexual Medicine attempts to improve sexual health through the Prevention, Diagnosis, Treatment, and Therapeutic Rehabilitation of conditions or diseases that involve sexual function.

Sexual Medicine handles the effect of health on sexuality. Some of the common medical problems which affect sexuality include high blood pressure, coronary heart disease, diabetes, hormonal problems, neurological disorders, bladder, prostate gland and gynaecological problems, depressive disorder, and anxiety. Medicinal drug treatments, surgery, radiotherapy, and chemotherapy might also impact sexuality.

Sexual Medicine also covers the consequence of sexuality on health. For instance, people who have had a coronary heart failure, stroke or intervention for cancer are often concerned that summarising sexual activity might not be good for them. The Sexual Physician can leave a complete judgment of risk and offer evidentialbased advice on these subjects.

Dr A Chakravarthy, MBBS; MBA (Hospital Management); MHSc (Reproductive & Sexual Medicine) is a Consultant in Reproductive & Sexual Medicine based in Thiruvananthapuram, Kerala

Sahrudaya Hospital is one of Alleppey’s most trusted health care providers over the last 45 years.

Managed by the Archdiocese of Changanacherry.

Endeavours to provide the most reliable technology, backed by well-brained highly qualified medical professionals.

Premium yet cost-effective medical services across all specialties.

SAHRUDAYA HOSPITAL (Unit of Social Welfare Society Thathampally, Kerala) Thathampally P.O, Alappuzha-688 013 Kerala. Ph: 0477 2252269, Fax: 0477 2263658 E-mail: sahrudayahospital@gmail.com

General Medicine Paediatrics Gynaecology & Obstetrics General Surgery Ortho Ophthalmology ENT Dental & Maxillo Facial Surgery Cardiology Pulmonary Medicine Dermatology & Venereology Psychiatry Clinical Psychology Anaesthesiology

HEALTHY FOOD What to eat, What not to eat

A healthy, balanced diet keeps you active What’s the best diet to stay healthy? Do you need to focus on the calorie intake, or the nutritional value of various food items? Or is it the right mix of both calorie as well as nutritional food intake? Be easy on yourself and just follow the simple plan given below

M

By Shalet James

aintenance of a healthy balanced diet does not mean ban or omission of any food or food groups. It just requires a balance in consumption of a variety of foods from each food group in the right proportion.

The value of a good diet • Fruits and vegetables

These should make up about a third of your daily diet and can be eaten as part of every meal. Given their assured value of nutrients and plant compounds, they can even be the first choice for a snack.

You should eat at least five portions of fruits and vegetables each day. Various studies suggest that such a habit can shield you against cancer, obesity, and various chronic diseases of the heart and other vital organs.

• Bread, rice, potatoes and pasta This food group should make up about a third of your diet since it contains the starchy carbohydrates, the body’s main source of energy.

While selecting products from this food group, choose unrefined carbohydrates over those that have been

48 FUTURE MEDICINE I November 2012

refined, as they will contain the whole of the grain. Wholegrain foods are rich in fibre and other nutrients, posing lesser risk of certain cancers, diabetes, and coronary heart disease.

• Milk and dairy foods These should be eaten in moderation because of their high saturated fat content.

Being an important source of calcium, they are essential for healthy bones and teeth. Choose low-fat products.

• Meat, fish, eggs and beans This food group includes both animal and plant sources of protein, a major functional and structural component of all cells. Protein provides the body 10 to 15 per cent of its dietary energy, vital for growth and repair.

• Foods, drinks high in fat/sugar

This group should make up the smallest section in a dietary plan since it contains high levels of unhealthy components such as saturated fat, trans fatty acids, sugar, and salt. Treat yourself with these occasionally.

Sopanam Multispeciality

Ayurvedic Hospital S

opanam Multispeciality Ayurvedic Hospital beckons you to regain the physical robustness and mental tranquility you enjoyed in your youth, in an atmosphere of joy and peace of mind. Sopanam is a multispeciality hospital with Green Leaf accreditation from the Department of Tourism, Government of Kerala.

Sopanam Multispeciality Ayurvedic Hospital is situated in the cultural district of Thrissur in Kerala at Nadavarambu in Irinjalakuda, with three ancient temples with great architectural splendor and religious importance, viz., Koodal Manikyam Temple, Kodungallur Temple and Mukundapuram Temple on its three sides. Divine blessings for your wholesome wellness flow in from all around you. Besides, it is set amidst an expanse of lush greenery where pristine nature fills you with rejuvenating freshness.

There are sufficient and spacious treatment rooms, separate for ladies and gents, to save you the trouble of standing in long queues. All the treatment rooms are furnished in traditional elegance, taking care of every minute detail that goes into a perfect setting for the various treatments and creature comfort.

Special treatment programs in Sopanam Multispeciality Ayurvedic Hospital are • • • •

Spine Care Program (14-21 days) Slimming Program (14-21 days) Beauty Care Program (7 days) Rheumatoid Arthritis Treatment (21-28 days) • Rejuvenation Program (14-21 days) • Panchakarma Therapy, Abhyanga, Patra Potali Sweda, Choorna Pinda Sweda, Shashtika Shali Pinda Sweda, Kaya Seka, Sirodhara, Nasyam, Kativasthi, Sirovasthi, Urovasti, Akshi Tarpanam, Vasti, Traditional Ayurvedic Massages, etc.

For more information: Sopanam Multispeciality Ayurvedic Hospital, Nadavarambu, Irinjalakuda, Thrissur - 680 661, Kerala, India.

Ph: +91 480 2821636, 95678 61550, 98952 06019 , Fax: +91 480 2822758, Email: info@sopanamayurvedic.com Web: www.sopanamayurvedic.com

HERNIATED DISCS

Nucleoplasty is extremely

precise

T

raditionally, patients with contained disc herniations have been treated conservatively with rest, pain relieving medications, injections, and physical therapy.

Typical signs of a contained disc herniation are primary pain radiating down the leg, or arm, accompanied by some back pain. Some of these patients will merit surgery, depending on the severity of herniated disc.

While not effective against ruptured discs, or other degenerative disc disorders, the procedure is an option to traditional openback surgery in limited disc herniations.

This is because nucleoplasty is extremely precise and requires very little post-operative recovery. The determination whether a patient is a candidate for this procedure requires a physical examination and the use of medical imagery such as CT or MRI Scan to ensure that the protruded disc is not a result of an underlying problem such as Arthritis, or other chronic disease.

It is imperative to know that this procedure is only effective for treating certain bulging

50 FUTURE MEDICINE I November 2012

Dr Ram Kumar Menon Consultant neurosurgeon

back discs, or enclosed herniated discs, and not discs that have already ruptured. Under this technique, a patented plasma device is inserted through the needle into the disc, where excess tissue is removed. The removal of nucleus tissue relieves pressure on the protective ring around the disc, or annulus, which permits the bulge to recede, so that the disc no longer irritates the nearby nerve root. Normally, the entire procedure takes less than an hour, and the patient can leave the medical facility one to two hours later, with no requirement of overnight hospital stay. It permits limited and controlled removal of tissues, thereby limiting the possibility of excess tissue removal, or removal of tissues beyond a limited area, which can lead to premature disc degeneration. There is a level 1C recommendation, strongly supporting the therapeutic efficacy of this procedure.

The procedure is done in the posterolateral approach with the patient awake. After administering local anaesthesia to the patient, a needle is inserted and probe positioned into the bulging disc space. A catheter is then inserted into the disc space, the tip of which generates a plasma field. This disintegrates the disc, allowing it to shrink.

It may be used to compliment an Endoscopic Disc Decompression and Foraminoplasty (remodelling of the outlet of the nerve at the spine) at an adjacent level, or as a primary procedure in early stage degeneration.

Nucleoplasty can successfully decompress the spinal disc, reduce pain scores, and eliminate narcotic usage.

(Dr Ram Kumar Menon, MS, DNB, MCh, has settled down in Thrissur, Kerala, where he works with Elite Mission Hospital and Care Well Clinical Centre as a consultant neurosurgeon. He pursued subspecialty training at the university hospital in Slovenia in central skull base surgery under world renowned neurosurgeon Prof Dolenc, and then at Barrow Neurological Institute at Phoenix, USA, under another eminent figure, Dr Spetzler)

Share your royal experience with us...

KUNNATHUR MANA AYURVEDA HERITAGE Ayurveda Heritage & Laxurious Resort

Punnayurkulam, Guruvayur, Thrissur-679 561, ph: 0487-2547552/2547553, Fax: 0487 2547554, Web: www.kmaheritage.com, E-mail: mail@kmaheritage.com

TRADITIONAL MEDICINE Chirattai Thailam

Skin care from the good old

Are you suffering from plantar warts, warts, corns, or other painful skin diseases? Instead of opting for a surgical removal of such abnormal growths, try a simple, effective method of healing prescribed under Siddha, a branch of the traditional medicine system that is based on the theory of ‘Ashtamahasiddhi’, which was developed during the ancient times. Siddha practitioners say that ‘Chirattai Thailam’, made out of pure coconut shells, can cure eczema, ringworm infections, plantar warts, warts, and corns

coconut S

By Lakshmi Narayanan

iddha is a branch of the traditional medicine system developed and practiced by the ancient Dravidians. Its origin can be traced to Tamil Nadu, from where it spread to various parts of South India.

Today, Siddha is still popular in the northeastern parts of Tamil Nadu.

Siddha is considered to be one of the oldest medicine systems in the world. It is said that Siddha came into practice during the Kumarikandam period, much before the continental drift. Since time immemorial, mankind has strived to make best use of the bounties of nature. It is here that Siddha has much relevance. The theories of Siddha say that a healthy lifestyle is possible only when man lives in harmony with nature.

Siddha, a dependable system of healing for a host of rare diseases, is often mistaken to

52 FUTURE MEDICINE I November 2012

be a part of Ayurveda. Experts on ancient texts of Siddha say that other than the fact that it is based on the concept of natural healing, it has no relation with Ayurveda. It has both “external” as well as “internal” medicines.

Unlike the liquid medical formulations under Ayurveda, such as ‘kashayam’ and ‘arishtam’, powdered medicine (‘churnam’) is prescribed under Siddha.

Chirattai Thailam offers the best cure

Lost in the din of a hectic life in a polluting environment of the metros, people have taken to a hazardous lifestyle with scant regard to nutrition, fitness, and body care. As a result, skin diseases and allergies are on an alarming rise. Those living in untidy conditions fall an easy victim to ringworm infections and scabies. Then there are people who have black and white warts on the

face and other vital parts of the body. Short-cut treatments may involve creams, or surgical removals. For those who are looking for a quick cure from such skin ailments, Siddha is the best remedy.

“According to the Siddha system of medicine, one of the most important external medicines is Chirattai Thailam (coconut shell oil), easily obtainable in South India.

Coconut shells are the only ‘drug content’ used in the preparation of Chirattai Thailam. It is a very effective medicine for eczema, ringworm infections, plantar warts, warts, and various other skin diseases. In fact, warts, corns, and ringworm infections can be easily healed by a few drops of Chirattai Thailam in a few days’ time,” Dr Reshmi Chandran, a Siddha practitioner at Santhigiri Siddhasramam, Kottayam, tells Future Medicine.

TRADITIONAL MEDICINE Chirattai Thailam

Best remedy for • • • • • •

Corns Plantar warts Warts Scabies & rashes Eczema Ringworm infections

Preparation of Chirattai Thailam

This medicine is prepared through the ‘Kuzhi Thalika’ method. Under this method, thin wires are inserted into a clay pot through small circular holes. These thin wires are pulled out of holes on the bottom of the pot and tied into a knot so that it holds firm. After that, the upper ends of the pot are filled with pure, well-dried coconut shell pieces.

Once the pot is sealed, the sides and top of the pot are covered by cow dung cakes, which are then burnt. The resultant heat produces medicinal oil from the coconut shell pieces inside the pot. Expert pharmacists of Siddha medicine then collect the oil through the ‘destructive distillation method’ by placing a vessel below the pot’s bottom hole.

The oil extracted through this method may not seem to be in proportion with the number of coconut shells placed in the pot. But then, remember, it’s quality that matters, not quantity.

“This is one of the rare medicines in Siddha that offers an effective remedy for eczema, ringworm infections, plantar warts, warts, and various other skin diseases, many of which are incurable by Allopathy, Homoeopathy, or other modern medical methods,” says Dr Reshmi Chandran.

According to Siddha texts, the preparation of Chirattai Thailam is a delicate task. The heat applied on the pot, the cow dung cakes, and the coconut shells has to be in the right measure. Extra care is required in each step of the preparation.

Siddha practitioners in Tamil Nadu are experts when it comes to preparation of Chirattai Thailam.

However, the production of Chirattai Thailam has never been undertaken on a large-scale, given 54 FUTURE MEDICINE I November 2012

According to the Siddha system of medicine, one of the most important external medicines is Chirattai Thailam (coconut shell oil), easily obtainable in South India. Coconut shells are the only ‘drug content’ used in the preparation of Chirattai Thailam.

It is a very effective medicine for eczema, ringworm infections, plantar warts, warts, and various other skin diseases. In fact, warts, corns, and ringworm infections can be easily healed by a few drops of Chirattai Thailam in a few days’ time

Dr Reshmi Chandran, Siddha practitioner, Santhigiri Siddhasramam

the ignorance and lack of knowledge among the general public about this special treatment.

How to apply Chirattai Thailam?

It is applied on the skin for treatment of fungal infections and planter warts, or warts. As it may cause mild corrosion, this oil is mixed with an equal quantity of coconut oil before application on the skin. It is best suited for corns on the foot. In the case of corns, Chirattai Thailam is applied with Croton seed and three to four drops of coconut oil.

For best results, it is better to use at night. Apply the oil on the affected area at night and wrap it with a cotton cloth. Remove the cloth only in the morning. If the treatment is followed for three consecutive days, one can be completely cured of warts, corns, and other skin problems. As this oil is corrosive, it should not be applied near the eyes.

HEALTHY PRACTICES Regulatory checks

Throwing the

tax net on ‘gifted’ doctors

H

ere’s some bad news for unscrupulous doctors making windfall gains in the guise of gifts. The Central Income Tax Department has been entrusted with the task of putting an end to the unhealthy practice of gifts to doctors from pharma companies in exchange for promotion of their drugs. It is well-known that many doctors receive a lot of gifts and freebies from pharma companies for promotion of their drugs through prescriptions irrespective of efficacy in treatment.

For long, health activists have been campaigning against this malpractice, saying that pharma companies are paying doctors in kind to push their respective drugs under the guise of marketing. It is in recognition of these protests that the Central government has decided to put an end to such malpractices. New rules against this malpractice were planned in August and circulated in October. According to sources, the Central Income Tax Department has received a set of guidelines on the ways and means to keep track of gifts being given to doctors. According to estimates, drugmakers spend nearly five per cent of their revenue on expensive gifts, like LCD TVs and overseas vacations, to doctors in exchange for promotion of their drugs. In India, the cumulative budget of pharma companies for such freebies is massive. According to an estimate, the top 20 pharma firms in India spend about $600 million a year on freebies for doctors. “This kind of practice is crucial to sales. A doctor is not going to prescribe something he or she has never heard of, and

The Central Income Tax Department has been given the power to check malpractices within the medical profession by keeping track of the dubious gifts being given to doctors by pharma companies for promotion of their drugs

By Dipin Damodharan

it’s the medical representative’s job to force doctors into prescribing our products,” a Calicut-based medical representative tells Future Medicine.

“Pharma companies often send doctors and their families on overseas junkets in the garb of ‘continued medical education programme’.

Doctors attend these conferences only for a day, and spend the rest of their vacation with their families in tourist spots at the cost of a pharma company,” says a Kochi-based doctor on condition of anonymity.

So far, the pharma companies have been projecting these costs as “marketing expenses” on their balancesheets. Now, the IT Department intends to end this marketing game by making doctors and pharma companies more accountable. Here’s how the IT hawks will track unscrupulous doctors: In case a doctor is heading for a 10-day conference, the Income Tax Department will calculate the per day cost of the trip and tax him accordingly for the expenses made beyond the ambit of the conference.

Until recently, pharma companies have been sending gifts in the name of doctors. But the trend is changing because of new rules and controversies. “Now, medical representatives send requests to the pharma headquarters for huge freebies and expensive gifts. The gifts are then sent in the name of the respective medical representative, who makes arrangements for a veiled handover of the freebies to doctors,” says a Calicut-based medical representative.

November 2012 I FUTURE MEDICINE 55

PHARMA ROUNDUP Industry Updates

Sun Pharma to fund new telecom JV with Telenor

I

Patheon inks pact with Vion

P

atheon Inc., a leading provider of contract development and manufacturing services to the global pharmaceutical industry, has entered into a definitive agreement with the Netherlands-based foodstuffs and ingredients manufacturer Vion N V to acquire Banner Pharmacaps (Banner), a specialty pharmaceutical business dedicated to the research, development and manufacturing of unique gelatin-based dosage forms. Banner is the world’s second largest pharmaceutical business focussed on delivering proprietary softgel formulations for over-the-counter, prescription, and nutritional consumer products, with four manufacturing facilities, significant proprietary technologies and products, and leading positions in some of the industry’s fastest-growing product categories.

Banner is headquartered in High Point, North Carolina, with additional research labs and manufacturing facilities in the Netherlands, Canada, and Mexico.

56 FUTURE MEDICINE I November 2012

ndia’s fifth largest pharma company by market size, Sun Pharma could be readying itself to fund its Executive Director Sudhir Valia’s private investment in the Norwegian telecom firm Telenor, says a report by InGovern Research Services, a consultancy firm that advises investors on corporate governance and proxy voting. Telenor announced that its subsidiary, Telewings Communication, has signed a joint venture agreement with Valia’s Lakshdeep Investments, which would help the company bid in the upcoming spectrum auction. Valia has picked up 26 per cent stake in the company. Sun Pharma could be readying itself for a possible indirect financial support to Lakshdeep.

Sagent Pharma launches leucovorin calcium for injection

S

agent Pharmaceuticals, Inc. has launched Leucovorin Calcium for injection, a folic acid derivative, and an adjuvant in antineoplastic agent therapy, in four latexfree and preservative-free vial presentations.

According to IMS Health, a leading provider of information, services, and technology for the healthcare industry, for the 12 months ending June 2012, the US market for Leucovorin Calcium for injection approximated $14 million.

As with all products in Sagent’s portfolio, Leucovorin features the company’s PreventIV MeasuresSM packaging and labelling, designed to help reduce medication errors. “Leucovorin, which has consistently been on both the American Society of Health System Pharmacists and the Food and Drug Administration lists of drug shortages, is one of the first products which we will launch from our supply agreement with Zydus Cadila,” said Jeffrey Yordon, President, Chief Executive Officer and Chairman of the Board of Sagent. “We are excited to provide this important product to our customers.”

DC Media Publication

The whole world speaks in one voice “I am Malala! Shame on you Taliban” ALSO READ EXCLUSIVE INTERVIEW Dr Nandini Sundar

BRAINWAVE Sunit Tandon

SPECIAL STORY Child Education

INDIAN CAMPUS NIT Calicut

November 2012 I FUTURE MEDICINE 57

HEALTHY LIVING Dr Matthieu Ricard

Oh Man! Here’s the

happiest man!

Dr Matthieu Ricard, who lives at Shechen Tennyi Dargyeling Monastery in Nepal, is the happiest man in the world going by the studies of researchers from University of Wisconsin, US. How? In what measure? Gamma waves produced by this renowned Frenchman and Buddhist monk’s brain, during intense sessions of meditation, have given sureshot indications of his merger with higher levels of consciousness, attention, and learning, a first in neuroscience

“

You can unleash the power within you through mediation...

When our mind transcends limitations, we find ourselves in a wonderful world of happiness,” according to Patanjali, a philosophersaint of ancient India. Biochemistturned-Buddhist monk and Frenchman Dr Matthieu Ricard would, perhaps, concur with him.

Today, the world calls Dr Matthieu “the happiest man in the world”.

This molecular geneticist and confidant of the Dalai Lama says anyone can be happy if they train the brain. “Mind training is based on the idea that two opposite mental factors cannot happen at the same time. You could go from love to hate.

But you cannot, at the same time — toward the same object, the same person — want to harm and want to do good,” says Dr Matthieu.

Dr Matthieu puts forward the point that meditation is not just about being in absolute bliss under a mango tree. It completely changes you and your brain.

According to media reports, neuroscientist Dr Richard Davidson wired up Dr Matthieu’s skull with 256 sensors at University of Wisconsin four years ago, as

58 FUTURE MEDICINE I November 2012

part of a research on hundreds of advanced practitioners of meditation. The scans revealed that Dr Matthieu’s brain produces a level of gamma waves - those linked to consciousness, attention, learning, and memory – “never reported before in the neuroscience literature”. The scans also showed excessive activity in his brain’s left prefrontal cortex as compared to its right counterpart, giving him an abnormally large capacity for happiness and a reduced propensity towards negativity, researchers believe.

Born on February 15, 1946, to renowned French philosopher JeanFrançois Revel and abstract water colour painter Yahne Le Toumelin in Aix-les-Bains, Savoie, France, Dr Matthieu is one of the famous Buddhist monks in the world.

After acquiring a PhD in molecular genetics at Pasteur Institute, Paris, Dr Matthieu had left his scientific career for practice of Tibetan Buddhism. He then lived in the Himalayas, studying with the Kangyur Rinpoche and some other great masters of that tradition. That’s when he became a close student and attendant of Dilgo Khyentse

Rinpoche until his death in 1991.

After that, Dr Matthieu has been striving hard to fulfill Khyentse Rinpoche’s vision.

Dr Matthieu Ricard A book containing a dialogue between him and his father, ‘The Monk and the Philosopher’, was one of the best sellers in Europe. The book was translated into 21 languages.

Another book, ‘The Quantum and the Lotus’ (co-authored with Trinh Xuan Thuan), reflects his long-standing interest in science and Buddhism.

His 2003 book, ‘Plaidoyer pour le bonheur’ (published in English in 2006 as ‘Happiness: A Guide to Developing Life’s Most Important Skill’), explores the meaning and fulfillment of happiness.

Dr Matthieu also co-authored a study on the brains of long-term meditators, including himself, who had undergone a minimum of three years’ retreat.

FOCUS Nice Neotech Medical Systems Pvt Ltd

Established in 1997, Nice Neotech Medical Systems Pvt Ltd is a Chennai-based manufacturer known for an innovative range of neonatal products. Certified for Quality Management System QMS ISO 9001:2008 and ISO 13485:2003, the company has 26 products approved and certified by CE, a testimony of its commitment to quality Transport incubator

Baby incubator

Promising neonatal care T he medical equipment of Nice Neotech Medical Systems reflect the innovative, pioneering spirit to meet the everchanging complex needs of the healthcare industry with simple, durable solutions. Technology is the transformational force leading to advancement in neonatal care.

Understanding the demands of end users, the company has been carrying out pragmatic changes in design in its entire spectrum of medical equipment to facilitate a user-friendly medical culture.

The product range includes infant incubators, transport incubators, infant resuscitators, transilluminators, infant open care systems, infant radiant warmers, phototherapy units, pulse oximeters, infant trolleys, NICU (neonatal intensive care unit) accessories, baby weighing scales, oxygen hoods, and infant CPAP (continuous positive airway pressure). “We have an excellent team to constantly upgrade our manufacturing systems through research and development. That’s how we engineer innovative applications for modern medical treatment systems,” says Suresh Madhavan, General Manager (Marketing) of Nice Neotech Medical Systems Pvt Ltd. “The company had registered a turnover of around Rs 8 crore in the last financial year. The dynamism of our marketing team and introduction of new hi-tech products are guiding us into a new chapter of growth. This year, we hope that our turnover will cross Rs 12 crore,” adds Suresh Madhavan.

‘Nice’ stands for ‘Neonatal Intensive Care Equipment’, which

amplifies the objectives of the organisation. Currently, the company is also investing heavily into research and development programmes for production of third generation infusion pumps, syringe pumps, humidifiers (neonatal and adults), neonatal CPAP, and ventilators. Nice Neotech’s R&D teams are driven by a group of qualified engineers specialised in relevant fields. Nice Neotech enjoys the good will and confidence of innumerous customers all over India since it has kept the promise of delivering qualitative products intact. The products of Nice Neotech are exported to Malaysia, Thailand, Sri Lanka, and Bangladesh as of today. Now, the company plans to enter Europe and the Middle East. Absolute thoroughness at all levels, close cooperation with medical organisations, continual monitoring and updation of technology have been the strengths of Nice Neotech.

Nice Neotech, which supplies 23 models of warmers and three models of incubators, has two full-fledged modern manufacturing units in Krishna Industrial Estate in Chennai. With 16 international and 26 domestic dealers, Nice Neotech has a commendable marketing network. To ensure perfect care to new borns, Nice Neotech is committed to delivering effective medical equipment and accessories that can consistently meet customer and regulatory requirements and serve the healthcare needs with the highest integrity and cost efficiency.

Protection during the critical neonatal stage is crucial. Talking of reliance, Nice Neotech products comply with the national and international regulatory standards.

November 2012 I FUTURE MEDICINE 59

FOCUS Oceans Machine Supply India Private Limited

Delivering

accuracy, precision Would you like to procure the best medical system for your healthcare institution? Turn to Ocean Machine Supply India Private Limited, a global sourcing and distribution company dealing in industrial spare parts, machines, medical equipment, and heavy machinery

C

hennai-based Oceans Machine Supply (OMS) India Private Limited is a global sourcing and distribution company dealing in industrial spare parts, machines, medical equipment, and heavy machinery. The company has a corporate office as well as a global sourcing office in Chile, South America.

OMS primarily focusses on sourcing and supply of all industrial machines, medical equipment and systems, industrial parts as well as indirect requirements of MNCs and superspecialty hospitals. The sourcing and supply capabilities of OMS are vast like an ocean and can address all the purchase requirements from a single point of contact.

Supplying all imported furnishing items for hospital, OMS also assists and guides hospitals in procuring latest equipment from across the globe, such as Robotic surgery systems (da Vinci Surgical System) and other advanced cutting edge equipment.

With special focus on hospital products, OMS provides a wide range of products, from CCTV cameras to

Deepu Nair, Managing Director, Oceans Machine Supply India Pvt Ltd

We assist the purchase, production, and engineering teams of our clients by sourcing, quoting, and supplying all their requirements on time re-furbished high value equipment related to CT/MRI scans, Endoscopy etc and customised, special surgical equipment like LED, non-shadow lights and robots, which are used for complicated surgeries demanding accuracy and precision. “We assist the purchase, production, and engineering teams of our clients by sourcing, quoting, and supplying all their requirements on time. Through our widespread global sourcing network, we are capable of getting the lowest possible cost for your requirements, thereby helping you save thousands of dollars,� says Deepu Nair, Managing Director of Oceans Machine Supply.

The widespread global sourcing network of OMS enables it to offer perfect assistance to purchase, design, and planning teams of clients by sourcing, quoting, and supplying all their requirements on time. By merging robust supplier relationships with best available logistics networks, OMS provides quality services within the best time spans, saving money and resources.

DENTAL IMPLANTS

Dr Ravi R Hebballi Consultant Oral & Maxillofacial Surgeon

A solution for your

missing teeth

H

ave you not been smiling these days because of missing teeth? Missing teeth can make you lose your confidence, cause discomfort in eating, and make you appear older than you are. If you want that confidence, smile, and good health back in your life, then dental implants are just what you need!

Dental implants are an affordable solution for all your missing teeth problems. Dental implants look and feel so natural - you may forget you ever lost a tooth!

A dental implant is an artificial tooth root that an Implantologist places into your jaw to hold an artificial tooth, or a bridge. It is an ideal option for people with good oral health who have lost a tooth, or teeth, due to a gum disease, an injury, or some other reason. The other advantage is that dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on adjacent teeth for support.

Dental implants are a solution to: • Replace one, or more teeth, without affecting adjacent teeth • Provide support for a denture, making it more stable, secure, and comfortable to the patient • Support a bridge and avoid the need for a removable partial denture Advantages of dental implants • Dental implants look and feel like natural teeth.

Since they integrate into the bone, they prevent bone loss and gum recession.

• Dental implants don’t sacrifice the quality of your adjacent teeth, and the neighbouring teeth are untouched, thereby ensuring a long lasting oral health.

• Dental implants will make sure you speak and eat with comfort and confidence.

• These days with advanced technology, the success rate of dental implants is highly predictable.

They are considered an excellent option for missing teeth.

Dental implant: Is it ideal for you?

The ideal candidate for a dental implant is the one who maintains a good oral health. The Implantologist will assess if there is adequate bone (to support the implant) in your jaw and the key to implant success is maintenance of a good oral hygiene by you.

Treatment procedure

The implant treatment is a multistage procedure.

The first stage is placing the dental implant in the jaw bone. It is a minor surgical procedure done under local anesthesia. Once the implant fuses with the bone, eight to 12 weeks later, the second stage involves exposing the implant through the gum.

Following this, impressions are made, and the artificial tooth is fitted onto the implant. In some cases, immediate implant placement is also possible after an extraction. The Implantologist is the best judge to decide.

What next after the implant treatment?

Similar to natural teeth, dental implants will require care and regular checkups. It is very important to maintain a good oral hygiene and also prudent to keep your implant clean and free from plaque. Regular brushing of teeth, flossing, and use of prescribed mouth rinses will ensure the implant lasts longer.

Implants, if placed under proper conditions by an experienced and qualified Implantologist and with diligent patient care, can last a lifetime.

Dr Ravi R Hebballi is a Consultant Oral & Maxillofacial Surgeon based in Bengaluru, Karnataka November 2012 I FUTURE MEDICINE 61

KERALA’S INFERTILITY HOSPITALS Centre for Infertility Management & Assisted Reproduction (CIMAR)

Baby boomers in safe hands

With a blend of the traditional modes of treatment and the latest techniques, such as In-Vitro Maturation and Intracytoplasmic Morphologically Selected Sperm Injection, Cochin-based Centre for Infertility Management & Assisted Reproduction (CIMAR) is making and saving babies at the same time at a safer, better pace than others in the field. Its success is not just limited to ensuring healthy pregnancies.

Unlike the business-minded treatment centres, which make couples jump into costly treatments, CIMAR places a high degree of importance on careful diagnosis, genesis of a problem, and counselling

By Tony William

Dr K K Gopinathan, Director, CIMAR, with his wife, Chitra Gopinathan, Managing Director, CIMAR 62 FUTURE MEDICINE I November 2012

T

he dark corridors, acerbic smell of medicines, and nerve-wracking sight of patients and nurses can easily sap the confidence of a positive man, forget about the faint-hearted. On the other hand, a conventional model of healthcare can perk you up. The beautifully designed building, spacious ambience, well-lit interiors, and care-assuring faces of nurses and support staff at Cochin-based CIMAR (Centre for Infertility Management & Assisted Reproduction) may make you wonder whether you are in a star hotel. Well, if the child in you is feeling secure enough to hear more about it, let’s get down to the specialties of CIMAR, led by renowned infertility specialist and Managing Director Dr K K Gopinathan.

Dedicated to the mission of “making and saving babies together”, CIMAR, the first In-Vitro

Fertilisation (IVF) centre of Northern Kerala, launched in September 1996 as a project of Edappal Hospitals (P) Ltd, is equipped with top notch infrastructure, state-of-theart technology, highly experienced and qualified team of professionals and matches the best international clinical practices. Dr K K Gopinathan, one of the first laparoscopic surgeons in Kerala State Health Service, has supervised more than 100,000 deliveries so far. He is the man behind the first Intra Cycloplasmic Sperm Injection (ICSI) baby of North Kerala and the first recombinant Follicle Stimulating Hormone (FSH) baby of India.

Even while such experts are there, many infertility treatment clinics and hospitals

with dubious credentials are mushrooming everywhere as of today. “You can’t have 100 per cent success in this field of healthcare.

It (the success) always depends on the patients themselves. So, anybody claiming a 100 per cent success rate is actually cheating. The success lies in prescribing and carrying out the right treatment at the right time,” says Dr Parasuram Gopinath, Consultant and Scientific Director of CIMAR. At the same time, it’s the highly educated people who do not have the right knowledge about infertility, says Dr K K Gopinathan.

In an interview with Future Medicine, Dr Gopinathan talks about infertility treatments in India.

What are the main reasons for November 2012 I FUTURE MEDICINE 63

KERALA’S INFERTILITY HOSPITALS Centre for Infertility Management & Assisted Reproduction (CIMAR)

that out of 100 couples, 10 per cent are infertile. Of this 10 per cent, one per cent needs advanced treatment. We believe that it is an offence to give a couple an unhealthy baby after making them go through all the required medical processes. We have a Feto Maternal Unit, which is probably the first and the only unit in South India that combines the expertise of fetal medicine and Dr Parasuram Gopinath, Consultant Gokul Gopinath, refinement of high risk pregnancy & Scientific Director, CIMAR CEO, CIMAR management. We have much experience in this field because of infertility? which we are far ahead of others.

Basically, they (the reasons) are part of a Are infertility treatments in India at par social lifestyle. In the olden days, people used with international standards? to get married during their adolescence, which We are almost at par with international only enhanced the chances of pregnancy. In standards. At CIMAR itself, we have new contrast, today, the greatest challenge before techniques like In-Vitro Maturation (IVM) us (in infertility treatment) is the age of and Intracytoplasmic Morphologically women. The mindset and priorities of the new Selected Sperm Injection (IMSI). Future age couples have undergone a sea change. advancement could be in the field of cloning.

Today, couples want to get educated, enjoy But unfortunately, there are social and legal life, and then get married. Even after marriage, limitations pertaining to cloning in India and they postpone conception for a while, which various parts of the world. further increases the complexities associated with pregnancy. Shockingly, most couples Do you think any governmental measures who come here for treatment have not stayed can make this treatment cost-effective? together for at least a month after marriage.

The main problem with IVF treatment On a scale of 100, only 25 per cent married is that a lot of co-ordination is required in women get pregnant and are in a good all aspects of treatment, which involves condition. This alarming drop in the pregnancy the doctors, support staff, technicians, and rate could be due to low sperm quality, technology. That’s why the government is lifestyle changes, change in sexual habits etc. unable to bring down the costs. Another To have good sperm quality, normal sexual unfortunate thing is that the insurance life is necessary. It is like using a machine. companies have not identified infertility as If you don’t use it for a long time, you can’t a disease. So, an insurance coverage is out guarantee the results later. Sexual harmony of question. But things are changing. In the is the stimulation which ensures good sperm West, some companies have begun covering quality. Regular sexual life is an integral part infertility treatment as well. We hope that of any infertility treatment. There should be a insurance companies in India would soon “normal trying time” for pregnancy to happen. follow suit.

What are the specialties at CIMAR?

Out of the 100 couples who come to CIMAR, only 20 per cent require treatment.

A counselling, to make couples understand the right method of procreation, is the only requirement in most cases. Unlike a few others in this field, we do not start or recommend treatment to a couple as soon as they enter the hospital. We are keen to educate them about the right methods. At CIMAR, we are more concerned about delivering healthy babies. Statistics on infertility in India show 64 FUTURE MEDICINE I November 2012

How much does IVF treatment cost at CIMAR?

At CIMAR, IVF treatment costs around Rs 1.5 lakh. Out of this, Rs 75,000 is charged for the drugs, while the rest is the hospital fee.

There are no hidden charges other than this.

What are your expansion plans?

CIMAR had opened a big facility in Coimbatore, Tamil Nadu, this year. We are planning to launch a facility in the Middle East soon.

KERALA’S INFERTILITY HOSPITALS Asian Reproductive Medicine Centre (ARMC), Kozhikode

Kerala’s first

day

care IVF centre

Founded in June 2009, Asian Reproductive Medicine Centre (ARMC) is the first day care IVF centre in Kerala. IVF-ICSI has been a part of the services provided by this centre since its conception.

Situated at Puthiyara in Kozhikode district, ARMC started its reproductive healthcare programme in association with Moulana IVF at Perinthalmanna in Malappuram district. Driven by the sole aim of helping couples who have difficulty conceiving, ARMC is one of the state’s most renowned infertility clinics known for its professional expertise. As the Medical Head of both ARMC and the Assisted Conception Unit at Moulana Hospital, Dr K U Kunjimoideen leads a team of doctors, scientists, nurses, and administrative staff that is dedicated to the noble cause of delivering the progeny of the future. With doctors having expertise in advance treatments, ARMC offers a wide range of treatment options, including Intrauterine Insemination (IUI), In-Vitro Fertilisation (IVF), and Intra Cytoplasmic Sperm Injection (ICSI) programmes, as well as a 3D and 4D scanning facility. With branches in Kozhikode, Malappuram, Thrissur, and Dubai, ARMC is helping traumatised couples by rekindling their innate desire for a child with therapies that not only assure them of a healthy extension of their family but also provide them the comfort, care, and advise required for the smooth transition into parenthood. In an interview with Future Medicine, Dr Kunjimoideen speaks on various issues concerning fertility treatment

Dr K U Kunjimoideen, Medical Head, ARMC

Infertility and infertility treatments: The present day scenario

Infertility can be defined as the failure to have babies. It is a condition of the reproductive system, often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages. Infertility can be broken down into (i) male factor (50 per cent); (ii) female factor (50 per cent); and (iii) combination of the two, or unexplained infertility

November 2012 I FUTURE MEDICINE 65

KERALA’S INFERTILITY HOSPITALS Asian Reproductive Medicine Centre (ARMC), Kozhikode

(20 per cent). Infertility is tested, diagnosed, and treated like any other disease. In some cases, it can be prevented; in others, it cannot be. According to a recent survey, infertility is seen among one in five newlymarried couples. It is really difficult to achieve a 100 per cent result through treatments. The maximum achievable result is 40 to 50 per cent and that too is possible only if the couple, especially women, are in the age group of 20 to 30.

Reasons for increase in infertility rates

Stress and hectic life are major factors causing infertility worldwide. Besides, changing lifestyles of job-oriented men and women, late marriages, lack of timely family planning, medical termination of pregnancy, use of intrauterine device etc, are some other reasons. There are other factors as well, such as the effect of pesticides, male factor, Polycystic Ovarian Syndrome, Premature Ovarian Failure and genetic disorders.

The process of In-Vitro Fertilisation

In cases of blocked, or absent, fallopian tubes, or low sperm count, IVF offers couples the opportunity of biological parenthood. During IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish (“in vitro” is Latin for “in glass”). After about 40 hours, the eggs are examined to see if they have become fertilised by the sperm and are dividing into cells. These fertilised eggs (embryos) are then placed in the women’s uterus, bypassing the fallopian tubes.

66 FUTURE MEDICINE I November 2012

About IVF treatment at ARMC

The concept of a day care infertility centre itself makes ARMC different from others. We provide the best possible chance of having a baby, with the best possible care and support. Our team of accredited fertility specialists, nurses, and counsellors provide a full range of infertility investigations and treatments — from diagnosis and advice to a range of IVF and other infertility treatments.

Recourse to IVF

This kind of treatment is highly individualised. It depends on a lot of things, including patient age and diagnosis. In general, for patients who have unexplained infertility, IVF is a last resort option, not a first resort option. Depending on the kind of male factor infertility (sperm count/ mobility), we offer Intrauterine Insemination before IVF.

About donor programmes

We do not do any donor programmes for sperm, egg, or embryo if we have both the husband’s sperm and wife’s egg. Otherwise, we will lose our transparency in the long run. Malpractices are rampant in many hospitals. Patients are being cheated with the use of donors. In some hospitals, donor programmes have turned into a business.

Cost of IVF treatment at ARMC

We charge Rs 1.5 lakh for IVF, including the charges for medicines. We provide a total package for IVF treatment. IVF treatment in a hospital atmosphere could be more expensive.

FUTURE MEDICINE I August 2012

23

KERALA’S INFERTILITY HOSPITALS Kinder Women’s Hospital & Fertility Centre, Alappuzha

Kind, Kinder, Kindest

Focussing on the goal of liberation from reproduction-related problems instead of the inability to conceive in itself is a head start of sorts. The desperation, despondency, and negativity of couples faced with infertility problems dissipate as soon as they enter a realm of positivism, the Kinder Women’s Hospital and Fertility Centre at Cherthala in Alappuzha district of Kerala. A venture of Kinder Medical Group, Singapore, Kinder Women’s Hospital and Fertility Centre aims at heralding a new era of comprehensive care for expectant and new mothers

K

inder specialists from Singapore make themselves available online roundthe-clock for consultations and observations on each and every aspect of a treatment. Equipped with modern birth bed facilities, which monitors the physical conditions of a pregnant woman, Kinder Women’s Hospital and Fertility Centre has a proven record of handling complicated births and delivering the best child care. When it comes to access and affordability, even the poor can avail of qualitative treatment of international standards.

Kinder is at the forefront in the fertility treatment segment as of today, offering low-cost treatment

68 FUTURE MEDICINE I November 2012

By Tony William for patients from humble backgrounds. Kinder, which has presence in Mangalore in Karnataka, plans to open facilities in Chennai and Bengaluru in the near future. For now, Kinder is focussing on its foray into Punjab through a facility in Jalandhar

by November this year. Expertise from Singapore, Australia, and India enables the 100-bedded Kinder facility to provide superlative care. The hospital has advance clinical facilities like Labour Delivery Suite with neonatal resuscitation, highly equipped Operation Suite with laminar OTs, Fertility Suite of international standard, Obstetric ICU with latest equipment and ventilators, and Advanced Level

III Neonatal ICU facilitated with High Frequency Oscillating Neonatal Ventilators and Neonatal Transportation.

In an interview with Future Medicine, Praveen Kumar A, Director and CEO of Kinder India operations, talks about fertility treatment and donor programmes in India.

What is the current scenario in infertility treatment?

First of all, we like it to call it fertility treatment, not infertility treatment. Success rates quoted in international literature range from 35 to 50 per cent per cycle. This success is the ‘clinical pregnancy rate’. It is far different from ‘live birth rate’, which is calculated by

Dr Ravin Selvadurai, Chairman, Kinder

Dr Pradeep Kumar, Chairman, Kinder

taking into account the birth of live healthy baby per every IVF cycle initiated. This success is also different from a ‘cumulative pregnancy rate’, which takes into account the result of two or three successive IVF cycles performed on the same patient, usually with the help of frozen embryos. It is advisable for a patient to be realistic about success rates and expect about 40-50 per cent clinical pregnancy rate per cycle and 60-80 per cent cumulative pregnancy rate after three attempts in an IVF centre having a well-maintained laboratory performing standardised practices by qualified personnel. We take pride in having success rates at par with some of the reputed IVF centres worldwide.

Are unethical practices on the rise?

The importance of observing ethical practices, preferably in accordance with a guiding body like the Indian Council of Medical Research, cannot be overestimated. This, in the absence of a regulatory body in India like the HFEA in the UK and the lack of a legal ART bill, makes the issue of ethical practice all the more imperative.

What is Kinder’s policy on donor programmes?

Kinder has already treated a number of couples with donor gametes and embryos. Kinder strictly follows international protocols (Singaporean and Australian models) on donor programmes. Each case is properly documented and

Praveen Kumar, Director & CEO, Kinder

The delivery package that we have from two months of pregnancy up to the normal delivery of a baby costs Rs 22,000, inclusive of medicines, room rent, delivery, and diagnostic services

monitored from Singapore with the help of a special software.

Donor gametes (either sperm or egg) are offered based on the individual case scenario and after proper psychological counselling.

We understand the sensitivity of using donor gametes and the doctors at Kinder address this issue with particular care. The couple is made aware of the reason why using a donor sperm/ egg is necessary, the options available, the possible legal, social, psychological, and familial consequences of such a treatment, and finally, what to expect in terms of a successful outcome.

Proper care is taken to ensure that the consent form is thoroughly understood and duly signed by the couple. The options offered do not end with donor gametes and embryos. Kinder also offers the option of ‘surrogate pregnancy’, in which the embryos generated are transferred into the womb of a surrogate woman, who then, on behalf of the commissioning couple, carries the pregnancy for the entire duration of nine months, and after delivery, the baby is handed over to the couple.

This form of treatment is a blessing to those couples among whom the woman is not able to bear a successful pregnancy on her own, when there is a problem with her uterus (womb).

What makes Kinder unique in fertility treatment?

Despite having guidance from centres in Australia and Singapore, Kinder is firmly rooted with the Indian psyche. That is why we understand and feel a strong need

today for an IVF centre in India that can deliver quality care, good success rates, and affordable services with a human touch. This is precisely what Kinder offers.

Kinder hospital is not built like other hospitals. With beautiful gardens and luxurious interiors, Kinder hospital has a refreshing and rejuvenating touch. Combine this with personal care by our nurses, a soothing ambience, and quality medical services.

Kinder’s vision is to give quality world class care at affordable rates. For example, the delivery package that we have from two months of pregnancy up to the normal delivery of a baby costs Rs 22,000, inclusive of medicines, room rent, delivery, and diagnostic services. This novel philanthropic approach comes from the visionaries who have pioneered Kinder and it aims at revolutionising medical care, especially women and child care in India. The positive sentiments generated by us have led to a continuous stream of appreciation from successive patients, and a steep rise in patients.

In what all areas does Kinder offer service?

Kinder is focussed on providing comprehensive healthcare to women. Other than providing state-of-the-art IVF services, Kinder offers services in obstetrics and gynaecology, neonatal diseases, including a full-fledged NICU, and cosmetic surgery, as in body contouring procedures, aesthetic breast surgery, and cosmetic surgery of the face.

November 2012 I FUTURE MEDICINE 69

KERALA’S INFERTILITY HOSPITALS Samad IVF Hospital

They helped a

62-year-old

conceive!

Have you heard of Bhavaniamma, a retired school teacher from Kerala and, perhaps, one of the oldest women to conceive for the first time through in-vitro fertilisation (IVF) and embryo transfer at the age of 62? She had conceived with the assistance of specialists at Samad IVF Hospital, a well-known infertility centre in Kerala founded 23 years ago. Located in Thiruvananthapuram, SAMAD IVF Hospital is India’s first NABH-accredited, ISO 9001-2008 certified IVF hospital in Kerala. Apart from the recognition from the National Accreditation Board for Hospitals and Healthcare Providers (NABH), this IVF hospital has received accreditation from the Indian Society for Assisted Reproduction (ISAR) for quality management. It is a training centre of the Federation of Obstetric and Gynaecological Societies of India (FOGSI) for infertility and Ultra Sound Specialists

B

Dr K G Madhavan Pillai, MD, Samad IVF Hospitals 70 FUTURE MEDICINE I November 2012

Dr Sathy M Pillai, Chief IVF Specialist, Samad IVF Hospitals

y strictly adhering to the motto of providing the best “reproductive technology with care”, Samad IVF Hospital ensures quality, transparency, and accuracy in each and every treatment methodology. Led by leading infertility specialist Dr Sathy M Pillai and Dr K G Madhavan Pillai, Samad IVF Hospital has a team of dedicated professionals.

The hospital is known for its proactive corporate social responsibility initiatives. While the government is still planning to earmark two per cent of the total budget for corporate social responsibility (CSR) programmes, this hospital has been following such a model for several years. Recently, it has organised two pre-marital

counselling and medical examination programmes for newly-engaged and newly-married couples at the SAMAD IVF Hospital, Thiruvananthapuram, and Mitraniketan People’s College in Vellanad, Thiruvananthapuram. These programmes are sponsored for one year by Kerala State Council for Science Technology and Environment and two more further programmes are planned in November 2012 and January 2013. The hospital has four branches in Kerala – at Thiruvananthapuram, Kollam, Kochi, and Attingal respectively.

In an interview with Future Medicine, Dr K G Madhavan Pillai, Managing Director, Samad IVF Hospital Group, talks about the need for more emphasis on quality research and scientific enquires in the field of reproductive medicine as well as governmental support for such initiatives.

What are the problems in India when it comes to infertility treatment?

India is found to be lacking in terms of critical research and scientific enquiries in the field of infertility treatment. We have to depend on American, or the European medical organisations for the scientific protocol support. But this does not mean that Indian infertility treatments are not at par with international standards. Our doctors and embryologists constantly update themselves and can match global standards of excellence. On the technology front also, Indian healthcare institutions have the wherewithal (modern machines) to provide quality care. However, India is lagging behind in the area of hospital administration in terms of quality and safety.

The absence of specific laws with regard to infertility treatment is affecting transparency. India is lagging behind, especially in the field of test tube baby procedures. The existing laws on sex, marriage and inheritance are to be amended for family building in the light of altered parenthood by IVF/ART. Today, we get to read a lot about unethical practices being carried out in the name of IVF treatment, particularly in Kerala. Reports on such practices have damaged the reputation of even good hospitals. The media should guard against unwarranted generalisation while reporting such things.

There is an urgency for updation of laws, as is the case with technology. Appropriate laws can put a stop to many unethical practices and media hypes.

What is Samad IVF Hospital’s super-specialty?

Genetics is our super-specialty. Some diseases

or deficiencies in infertility may be due to genetic problems. We can know, predict, and circumvent embryonic problems through the use of genetics.

Though disease correction through genetics is not possible as of today, it still gives us hope.

The future of healthcare lies in individual medicine, or personalised medicine. It is a kind of customised medicine designed for a certain person in accordance with his/her genetic make-up.

What are your future plans?

Samad IVF Hospital ventured into telemedicine recently. Since 2008, it is a treatment point in the ISRO national satellite telemedicine network. SAMAD IVF Hospital has its own private telemedicine facilities at Kochi and Thiruvananthapuram under the global connectivity network. But the project did not take off the way we expected. Even the West is yet to tap into the full potential of telemedicine. We are early birds in this field, and we expect the project will become popular in due course of time. SAMAD IVF Hospital is also planning a holistic health programme for girls through the CSR initiative in 2014, titled “Healthy Adolescent Female”.

What about your donor programmes in infertility?

Donor programme, surrogacy, and adoption are all items coming under the category of third party reproduction in ART. The current scenario in our society suggests that even the educated are not ready to become donors. But such programmes will certainly gain popularity in future. In the West, they have strict provisions for donor selection. There are accepted protocols in the West for selection of donors or surrogates which can be suitably modified. Such provisions can be used for a sensible formulation of donor/surrogate programmes in India.

What are your suggestions on the Assisted Reproductive Technology (ART) Bill?

It is stated in the ICMR guidelines and the ART draft law, which are followed for guidance in IVF treatment, that the semen bank and other third party reproduction facilities must be separated from the IVF/ART clinic. We feel that a semen bank must be part of an ART clinic. Both semen banks and ART clinics serve the same purpose. So, it will be convenient if both are under the same roof.

One person may be the ovum donor as well as the surrogate mother. If embryo donation and adoption are acceptable, any form of surrogacy should also be acceptable to society.

November 2012 I FUTURE MEDICINE 71

FOCUS Sopaanam Multi-Speciality Ayurvedic Hospital, Thrissur

In rhythm

with nature P K Lonappan, Director, Sopaanam Multi-Specialty Ayurvedic Hospital

If music from the heaven flows uninterrupted at the divine triangle of Thrissur, comprising the Koodalmanikyam Temple, Kodungalloor Temple, and Mukundapuram Temple, the holistic treatment methodologies of Sopaanam Multi-Speciality Ayurvedic Hospital in Nadavarambu only underscore the significance of the healing power of mother nature

E

quipped with synchronised in-patients and out-patient departments, this hospital helps patients overcome their health disorders and regain mental tranquility. It re-establishes the patients’ connection with nature through Ayurvedic healing methods and erasure of the very mental and physical imbalances that cause illnesses. The soothing green ambience of this hospital relegates the compulsions of a pressure-laden life to the background and motivates patients to be in harmony with nature.

Guided by the motto of providing qualitative service to its patients, Sopaanam Ayurvedic Hospital prescribes the best medicines from recognised manufacturers.

Special Ayurvedic extracts are also formulated at the hospital. The treatments are carried out under the supervision of well-qualified personnel. Optimal patient care is not just limited to treatments. Each and every patient is given sound 72 FUTURE MEDICINE I November 2012

medical advice and counselling in accordance with the nature of each case.

The main objective of the hospital is to ensure restoration of the patients’ physical, mental, and spiritual harmony through each service and treatment. Among the special treatments offered at this hospital are the Spine Care Programme, Slimming Programme, Rheumatoid Arthritis Treatment, and Rejuvenation Programme.

Traditional Ayurvedic treatments, such as Abhyangam, Udwarthanam, Elakizhi, Talapothichil, Navarakizhi, Kati Vasthi, Swedana, and Panchakarma treatments, including Snehapana, are also offered here.

“Established in July 2007, Sopaanam Welcare Centre Pvt Ltd comprises nine directors from various parts of Kerala. We never had to resort to any advertisement campaign to popularise our treatments. Our patients are our ambassadors. They have been the

yardstick of our success. Now, the centre is receiving more patients from the European countries, Oman, Saudi Arabia, and other Middle Eastern countries. This (international recognition) is an honour for us,” says P K Lonappan, Director of Sopaanam Multi-Speciality Ayurvedic Hospital.

The hospital’s speciality departments include Gynaecology, Paediatrics, ENT and Eye Care, General Medicine, and Dermatology.

Yoga and meditation occupy a special place in the healing initiatives undertaken at this hospital. There are good remedies for patients suffering from migraine, headache, and back pain as well.

The 32-room hospital provides luxurious as well as ordinary facilities at its male and female wards. Well-known for its expertise in Gynaecology, Paediatric, and Skin Care, the hospital has received the ‘Green Leaf’ accreditation from the Department of Tourism, Government of Kerala.

FOCUS Shanthi Ayurvedic Psoriasis Speciality Hospital, Malappuram

‘Shanthi mantra’ on psoriasis Founded by Jojo Thomas, an expert administrator, with a specialised team of doctors, Shanthi Ayurvedic Psoriasis Speciality Hospital at Pullikkal in Malappuram district of Kerala receives patients from various parts of India and the Middle East and assures them of speedy recovery from this irritable skin disease with the aid of effective Ayurvedic formulations. Recipient of the Nehru Peace Foundation Award and the Sri Chithira Thirunal Award, this hospital has extended its specialty care to skin disorders like eczema, scleroderma, and pemphigus over the years. Treatments are carried out under the supervision of expert Ayurvedic physicians Dr Sangeetha B, COO, (BAMS), Dr V Jayaanandhan (DAM), retired medical officer, and Dr K P N Namboothiri DAM (SMO). In an interview with Future Medicine, Dr Sangeetha, the Medical Director of Shanthi Ayurvedic Psoriasis Speciality Hospital, talks about various procedures of psoriasis treatment What are the specialties of Shanthi Ayurvedic Psoriasis Speciality Hospital?

We specialise in psoriasis treatment, using Ayurvedic medicines like ‘kashayam’, ‘churnas’, and oil prepared as per our specifications. We have formulated these medicines on the basis of intensive research and development initiatives. Our medicines have been made in accordance with the requirement of patients. They are available for the general public at our counters.

We have even treated patients with acute psoriasis who had tried Allopathic medicines for 20-30 years.

Besides psoriasis, we treat skin disorders like eczema, scleroderma, and pemphigus.

What is the main difference between Allopathic and Ayurvedic treatment for psoriasis?

With steroids and antibiotics, doctors are able to contain the disease for a limited time period. But a complete cure is a distant dream since the disease relapses. At our hospital, we use pure Ayurvedic medicines. Though they don’t produce quick results, complete cure can be assured to patients who are ready to follow a diet as instructed by the doctor. Our treatment focusses on helping a patient develop immunity against this disease.

From where all do patients come to you?

The majority of the patients are from Maharashtra, Madhya Pradesh, Orissa, Uttar Pradesh, and the Gulf.

What’s the mental make-up of the patients suffering from psoriasis?

Psoriasis can cause several physical discomforts and public embarrassment. But in most cases, patients would have taken recourse to Ayurveda after repeated failure in Allopathy. Psoriasis is a serious disease. If not treated properly, it can spread to the joints as well as the inner parts of the fingernails. One may also lose his/her nails in the longer run. New skin cells generate at a much faster rate than dead cells. The excess in skin cells then accumulate to form thick patches. Psoriasis can be caused by an infection, injury, or stress. The use of certain drugs, such as anti-depressants, antihypertensive drugs, beta blockers, and anti-malarial drugs, can produce psoriasis in certain cases.

What are the challenges in production of Ayurvedic medicines for this disease?

New laws have placed certain restrictions on production of medicines. Availability of raw materials has also become problematic. Though new laws are good in several ways, they make the situation of small scale medicine developers like us worse.

What precautions can be taken against psoriasis?

Ayurveda has identified a few food items (‘virudhahara’) that cannot be consumed simultaneously. Strict adherence to this disciplinary practice is the first step (of avoidance). Patients must not take non-vegetarian food items during the course of the treatment.

November 2012 I FUTURE MEDICINE 73

FOCUS Prashanthi Ayurveda Hospital, Calicut

Specialised centre for

Osteo Arthritis

P

rashanthi Ayurveda Hospital has formulated a unique method called “POAM” (Preventive Osteo Arthritis (OA) Management), which is centred on the youth and those who are involved in rigorous exercises, like sportspersons. This treatment ensures that OA is detected and controlled at the earliest stages itself. The hospital has also launched a Knee School to spread mass awareness about OA. In an interview with Future Medicine, Dr P Hebeeb, Medical Director of Prashanthi Ayurveda Hospital, tells why and how Ayurvedic treatment is dependable for treatment of OA.

How is the treatment for OA in Ayurveda different from modern medicine?

Conventional medicine has limitations in terms of offering relief for those suffering from this disease.

Modern medicine can, however, produce better results than just symptomatic relief. The disease emanates from the architectural failure of a joint. So, only something that can maintain a biomechanical stability protocol can succeed.

The main causes for this disease 74 FUTURE MEDICINE I November 2012

Founded in 2000, Prashanthi Ayurveda Hospital at Kondotty in Malapurram district of Kerala is a leading Ayurvedic treatment centre specialised in Osteo Arthritis (OA). Owing to the successful treatment of about 13,500 patients over the past nine years, the hospital has been receiving a heavy rush of patients at its Kondotty, Calicut, and Dubai facilities. Driven by extensive researches and case studies, this hospital chain has a unique method of predicting the results even before commencement of the treatment. This is the only Ayurvedic hospital which has secured a cent per cent success rate in treatment results through the Radio Isotopic Bone Scanning Procedure are ageing, injuries, or hormonal deficiencies. If the first signs of this disease are ignored, the joints’ compression absorption ability would be lost after some time.

This leads to mechanical stability problems.

What are the major problems associated with OA treatment?

These days, doctors give more importance to lessening of pain in patients, instead of maintenance of the joint structural stability. OA doesn’t make pain on its own. Undue pressures, or undue strains, cause pain. Any treatment which advises rest during OA treatment would give only short time relief. But that’s not a lasting solution. We follow Ayurvedic medicines formulated by us. Though they are Ayurvedic, these medicines are a little advanced and produce quick results. Our medicines do not contain heavy metal toxicity, or painkillers. They are made from pure herbal extracts.

Our thorough research with 13,500 OA patients over the past nine years has only supported us in making considerable headway.

Even doctors are prone to

mistakes when it comes to treatment of OA. First of all, they may fail to identify it as a structural problem, but go ahead with the diagnosis and treatment.

Other than Dr P Hebeeb, Medical Director, Prashanthi that, 95 per Ayurveda Hospital cent of doctors take an x-ray while the patient lies down. The knee would be in resting mode during the process. You can’t tell an engine problem only by watching the dysfunctional part of the car.

You need to see it running so as to identify its problem. Similarly, you need to take an x-ray in standing mode, or a wheel baring model x-ray. The advantage of doing so is that we can detect and correct three stages of deformity, like Genu Varus Deformity, Genu Vulgam Deformity, and Complex Deformity, which appears later. Full rest is not advisable for any joint. Movements ensure maximum health to joints.

FOCUS Kunnathur Mana Ayurveda Heritage and Luxurious Resorts, Guruvayoor

Extending a healing vacation

Mythological legends can teach you the values of a disciplined life in harmony with nature. The image of the four-armed Lord Guruvayoorappan holding a basil garland in one of his hands only exemplies the age old relevance and significance of Ayurveda, the traditional science of holistic healing and good living. Guruvayoor, the earthly abode of Lord Vishnu, is a small town in Thrissur district of Kerala, where a divine, tranquil atmosphere will tease your inner craving for a life of peace, calmness, and resoluteness. If you happen to visit this pilgrim town, try and make some space for relaxation and rejuvenation at a historic Brahmin household-turned-Ayurveda resort, known as Kunnathur Mana Ayurveda Heritage and Luxurious Resorts. It will be the beginning of a life-long culture steeped in practices of healthy living

By Tony William November 2012 I FUTURE MEDICINE 75

FOCUS Kunnathur Mana Ayurveda Heritage and Luxurious Resorts, Guruvayoor

K

unnathur Mana is one of the prominent Brahmin households in Thrissur district of Kerala. Kerala’s prominent poet and writer late Kamala Das had spent a few childhood years at this Mana, and some of her belongings are still preserved here. Today, this Mana has been turned into an Ayurvedic resort, christened “Kunnathur Mana Ayurveda Heritage and Luxurious Resorts”.

Spread over five acres, this resort is far away from the hustle and bustle of the pilgrim town. The traditional façade of the Mana is still intact. The traditional ‘Nadumuttam’ (inner courtyard) and a pond within the Mana premises remind you the culture of a bygone era.

In an interview with Future Medicine, P K Shelly, the Chairman of Kunnathur Mana Ayurveda Heritage and Luxurious Resorts, tells us how the resort can help preserve a slice of history and culture, and propagate the traditional Ayurvedic methods of healing.

What inspired you to buy a Mana and turn it into an Ayurvedic resort?

I have always had this liking for antiquity.

That’s how the idea of making this Mana a part of my personal history came into my mind. After acquiring it, we wanted to preserve as well as put this historic Mana to good use. So, we associated it with an Ayurveda resort. I believe there is immense scope for a healthy combination of heritage, Ayurveda, and holidays. It may be an expensive proposition for some, but customers will not back out of a good wellness holiday plan if they are assured of utmost satisfaction. That has been our experience.

Is a heritage-Ayurveda-resort model viable?

I personally believe that it will flourish. We are losing our cultural traits fast enough. But some things, such as the beauty, rarity, and uniqueness of our culture and personal emotional connections, make people revisit their roots.

How has the initial customer response been so far?

The initial response has been very good. The resort has been very well appreciated by people who have undertaken Ayurvedic treatment here during their stay. We have had visitors from Mumbai, Hyderabad, and other metros. Among the famous personalities who have visited our resort are Chhagan Bhujbal, the Deputy Chief Minister of Maharastra, and Vivek Goenka, the Chairman and Managing Director of The Indian Express Group.

They still get in touch with us whenever they plan a pilgrimage to Guruvayoor. We offer a temple 76 FUTURE MEDICINE I November 2012

People at the helm Nisha Shelly is the Managing Director of Kunnathur Mana Ayurveda Heritage and Luxurious Resorts.

Aakash Shelly and Arjun Shelly, sons of Chairman P K Shelly and Nisha Shelly, actively support their parents in each business endeavour.

Nisha Shelly

P K Shelly

package, making the pilgrimage to Guruvayoor hassle-free in every way.

What are the specialities of the Ayurveda resort?

Apart from accommodation in “royal club” nonair-conditioned, or deluxe, or presidential suites, featuring the most modern amenities and interiors, our multi-cuisine restaurant, Akathalam, is famous.

We have a sea food restaurant, named Nikumbhila.

For those interested in holding conferences, we have a spacious conference hall, Koothambalam.

We offer seven-to-21-day Ayurveda packages in anti-obesity, stress management, rejuvenate and detox, panchakarma, beauty care, eye, skin care, back pain, slip disk and spondylitis, migraine and sinusitis, and pre- and post-natal health. For foreigners, we hold special Kathakali shows and yoga classes.

Our specialist Ayurveda doctors include Dr Dharmadas Erath, who had been in government service for a while, and Dr Sleeba Dheeraj, BAMS, who conducts routine check-ups.

In future, we intend to associate ourselves with various initiatives of the Department of AYUSH of the Government of India and the Department of Tourism.

What are your future plans?

We are planning to modify the pond in the Mana premises, while we also have a modern pool adjacent to it. We will launch a spa centre soon.

Given our interest in beach resort tourism, we have an annexe that will be gradually upgraded with three star facilities.

FOCUS Sahrudaya Hospital, Alappuzha

Sahrudaya Hospital is known for specialty departments in General Medicine, Gynaecology, General Surgery, Paediatrics, Ophthalmology, Orthopaedic, ENT, Dental & Maxillo Facial Surgery, Pulmonary Medicine, Dermatology, Psychiatry, Clinical Psychology, and Anaesthesiology.

Managed by the Archdiocese of Changanacherry, the hospital is striving hard to emerge as one of the best healthcare providers in India with affordable medical solutions

Of noble hearts

By Shalet James

E

stablished in 1967

by Social Welfare Society Thathampally, Sahrudaya Hospital at Thathampally in Alleppey town, Kerala, is Fr Thomas Maliakel, a 100-bedded Executive Director, hospital Sahrudaya Hospital managed by the Archdiocese of Changanacherry.

Offering outstanding diagnostic services like High Frequency X-Ray, Tread Mill Test, ECG, 2D Echo, Colour Doppler, Sahrudaya Hospital has a well-equipped labour room and fully-equipped ICU and MICU. Initially started as a dispensary under the name ‘Health Centrecum-Hospital’, the hospital subsequently changed its name to ‘Sahrudaya Hospital’. It was with financial assistance from Caritas India, Helpage India, Helpage UK, Indo-German Social Service Society, Rotary Club of Alleppy, Lions Club of Alleppy, Round Table Club, and MISEREOR that Social Welfare

Society Thathampally could give shape to the hospital expansion plans. Today, more than 85 per cent of the Society’s building is being used by Sahrudaya Hospital.

“With a good reputation in the healthcare sector for 45 years and a special touch to humanity and charity, we are now heading towards a new era of modernisation at par with international standards. We are trying our best to emerge as one of the specialist hospitals in India,” says Fr Thomas Maliakel, Executive Director of Sahrudaya Hospital.

Taken over by the Archdiocese of Changanacherry last January, the hospital still maintains its ties with the Society. It is now vying for recognition from the National Accreditation Board for Hospitals and Healthcare Providers. With an aim to offer the best cardiac care to the general public at affordable rates, the hospital is setting up a modern, full-fledged Cathlab with an investment of more than Rs 1.5 crore. “We are also planning to start an affordable dialysis centre. The poor will be given 100 per cent free service,” says Fr Thomas Maliakel.

He adds, “As of today, there are no

avenues for paramedical studies in Alappuzha town. We plan to start paramedical courses in affiliation with recognised universities and support from well-experienced faculty members.”

Sahrudaya Hospital, which has collaboration with Chethipuzha Hospital, is trying to achieve quality certification for its laboratories from Christian Medical College, Vellore.

The management is planning to tap into the potential for medical and dental tourism. To fulfill expansion plans, the hospital has acquired land in Punnapara and Kaithavana.

With the expertise of consultants in all specialties and 24-hour emergency services, Sahrudaya has a day care surgery centre, cardiac ambulance service, a geriatric ward, an ICCU, two operation theatres, a clinical laboratory, and X-ray/ ultra sound scanning facilities. It is known for specialty departments in General Medicine, Gynaecology, General Surgery, Paediatrics, Ophthalmology, Orthopaedic, ENT, Dental and Maxillofacial Surgery, Pulmonary Medicine, Dermatology, Psychiatry, Clinical Psychology, and Anaesthesiology.

November 2012 I FUTURE MEDICINE 77

SCIENTIFIC MOTIVATION

Paralytic moves Robotic arm

A

team of scientists at Institute for Brain Science, Brown University, in Providence, Rhode Island, US, has invented a mind-controlled robotic arm that could reduce the dependence of patients paralysed by stroke, who otherwise, completely rely on others for each of their daily needs.

The device, called BrainGate, bypasses the nerve circuits broken by the brainstem stroke and replaces them with wires that run outside the patient’s body. The implanted sensor, which is about the size of a baby aspirin, is linked to a Robotic limb that enables the patient to reach and grasp objects and perform activities.

“You can go from the brain, which seems to be working quite well, directly to a device like a computer or a Robotic arm,” John Donoghue, Director of Institute for Brain Science, was quoted as saying in foreign dailies. “This can help restore independence to a person who had been completely reliant on other people for every activity, whether it’s brushing their teeth, eating their dinner, or taking a drink,” adds Donoghue.

“Having control over your life restores

78 FUTURE MEDICINE I November 2012

an e to h fiv olled g i h r a cont t ives fer g otic arm tic patien f a h c b y S l o r a e Kati imental es, a par r expe m Hemm i T y b

dignity,” said Donoghue. For most people, reaching and grasping are effortless.

But the simple movement is guided by a complex pattern of brain activity, according to Donoghue.

In a similar research, a team from University of Pittsburgh, Pennsylvania, US, had developed a thought-controlled Robotic arm, with which a paralytic patient could reach out and touch his girlfriend’s hand.

According to researchers at Pittsburgh University, “The Robotic arm is considered the most human-like bionic arm to date - even the fingers bend like real ones. It’s controlled by electrical signals from tiny brain electrodes implanted into the brain.”

“We really are at a tipping point now with this technology,” said CBS News, quoting Michael McLoughlin of Johns Hopkins University Applied Physics Laboratory (APL). Earlier, APL had developed the human-like arm in a $100-million project for DARPA, Pentagon’s research agency.

Though all these researches are heading in the right direction, it will take a few years more for regulatory clearances to these robotic applications for use in daily life.

www.ramadacochin.com