Chief Editor : Dr. Aniruddha Malpani, M.D.
Improving Patient & Family Health
July’2012
Pink Revolution of HealtHcaRe in india Let us start a PINK REVOLUTION of HEALTHCARE in INDIA, by investing 10% of GDP in public healthcare by the Govt now, from a shockingly low 1%!. Only 7 countries all round the world, spend less than we do, to look after the health of citizens! 230 Indian mothers die during childbirth, compared to 50 per 1 lakh childbirths in other BRIC countries. 66 Indian children under 5 yrs die in India, compared to 20 in other BRIC countries. Excellent facilities in hospitals, Primary Health Centres, for preventive & curative treatments, in the Government sector can and should be made possible with more funding and support. 400 million poor people need this kind of support badly and immediately. Indians have a RIGHT TO LIFE, and a RIGHT TO HEALTH is a vital part of this constitutional right. It is a duty of the Govt to provide good hospitals and medicines for all citizens now. Remember that we need to help the millions of poor underprivileged citizens of our country, and increasing and upgrading the Govt healthcare system is vital and paramount to this goal. So much suffering of the poor is due to illness, and this needs to be sorted out now. Private healthcare will never be able to do so many of the things the Govt healthcare system does in India, and around the world. The recent plan to increase spending to 2.5% of GDP by 2017 is too little, too late, and totally inadequate. We can and should do much more to help the 400 million Indians who are below the official poverty line of Rs 32/day. Severe or moderate illness episode in the life of these impoverished millions is enough to set them back in life even more & erase their already slim chances of improving their living conditions. And sanitation, clean water, health education, also need to be improved side by side with this also. A toilet in every house, clean drinking water, sewage & electricity connections to each house in India in needed now. Internet based and citizen based monitoring of spending and other controls can be implemented for effective funds utilisation.
Yes, we have to also work towards prevention of corruption in healthcare, as we do have to in other sectors. But it should not stop investment now. Corruption is not an excuse for the measly healthcare allocation that we have tolerated in india for so long. Let us all wake up and help our poor fellow citizens by this awesome step of vastly increased funding & healthcare up gradation by the Govt. Girish.K, Please sign the petition at http://www.avaaz.org/en/petition/Pink_Revolution_of_Healthcare_in_India/?cIelYbb P T N
Dr Prathap Reddy Speaking at the event organized jointly by the Confederation of Indian Industry (CII) and the Centre for Strategic and International Studies (CSIS), Dr Reddy lauded the ongoing efforts in the US to digitize healthcare data through Electronic Medical Records and hoped that such techniques would be brought to India as well. He also acknowledged the tremendous contributions made by research organizations in the US in diagnosis, methodology, innovation, research and technology in the healthcare sector. Applying existing innovations from US, Europe and other parts to countries like India is thus critical, said Dr Reddy who pioneered the concept of corporate hospitals in India in the eighties after returning from the US where he had a very successful practice as a leading heart surgeon. "The three biggest challenges India faces in the healthcare sector are: paucity of hospital beds for people; lack of skilled health human resources; and rise in both infectious and non-communicable diseases," he said. India is facing alarming numbers of cases of heart disease, cancer and diabetes, Dr Reddy said. For example, the number of diabetes cases in India, earlier projected at 36 million by 2020, has already surpassed 75 million. Soon, one out of every five diabetic patient in the world will be Indian. Noting that comparable surgeries in India cost onetenth of the price in the US, he said high quality healthcare and cost benefit is hence a major priority area.
HIV AND WORKPLACE
Q. Is it safe to work with someone infected with HIV? Ans. Yes. Most workers face no risk of getting the virus while doing their work. The virus is mainly transmitted through the transfer of blood or sexual fluids. Since contact with blood or sexual fluids is not part of most people's work, most workers are safe. Q. What about working every day in close physical contact with an infected person? Ans. There are no risks involved. You may share the same telephone with other people in your office or work side by side in a crowded factory with other HIV infected persons, even share the same cup of tea, but this will not expose you to the risk of contracting the infection. Being in contact with dirt and sweat will also not give you the infection. Q. Who is at risk while at work? Ans. Those who are likely to come into contact with blood that contains the virus are at risk. These include healthcare workers - doctors, dentists, nurses, laboratory technicians, and a few others. Such workers must take special care against possible contact with infected blood, as for example by using gloves. Q. If a worker has HIV infection, should he or she be allowed to continue work?
Ans. Workers with HIV infection who are still healthy should be treated in the same way as any other worker. Those with AIDS or AIDS-related illnesses should be treated in the same way as any other worker who is ill. Infection with HIV is not a reason in itself for termination of employment. Q. Does an employee infected with the virus have to tell the employer about it? Ans. Anyone infected, or thought to be infected, must be protected from discrimination by employers, co-workers, unions or clients. Employees should not be required to inform their employer about their infection. If correct information and education about AIDS are available to employees, a climate of understanding may
develop in the workplace protecting the rights of the HIV-infected person. Q. Should an employer test a worker for HIV? Ans. Testing for HIV should not be required of workers. Imagine that you are a worker with HIV infection and are healthy and able to work. As far as your work is concerned, the information about the infection is private. If it is made public, you could be a target for discrimination. If AIDS-related illness makes you unfit for a particular job, you should be treated in the same way as any other employee with a chronic illness. A suitable alternative job can often be arranged by the employer. The employers in different parts of the world are beginning to deal with these problems more humanely. Their associations and workers' unions can be consulted for advice. Q. What if you are already infected with HIV? Can you still travel? Ans. If you are already infected, consult your healthcare provider for guidance well before you plan to travel. Some immigration officials insist on an HIV free certificate. Your travel counsellor will advise you. Q. 'AIDS is mainly a problem of developing countries.' or 'No, AIDS is really a problem of developed countries'. SOURCE – NACO
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The “ Speak Up “ Program in the USA encourages patients to: • Speak up if you have questions or concerns, and if you don’t understand, ask again. It’s your body and you have a right to know. • Pay attention to the care you are receiving. Make sure you’re getting the right treatments and medications by the right healthcare professionals. Don’t assume anything. • Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. • Ask a trusted family member or friend to be your advocate. • Know what medications you take and why you take them. Medication errors are the most common healthcare mistakes. • Participate in all decisions about your treatment. You are the center of the healthcare team. This does not mean that you ask questions just for the sake of asking – after all, doctors are busy people and do have other patients to see. The trick is to be inquisitive – and to do your homework ! The only stupid question is the one you did not ask. Asking appropriate questions about your treatment and medicines will help you to acquire knowledge and will also keep the doctors and hospital staff on their toes ( which is good for them as well !) . The more the questions you ask about your treatment, the more careful they will be about what medicines they are giving you and how they treat you . Never take any medicine without asking : what it is, why it is used and what are its side-effects. Remember, there are lots of patients and your physician sees many everyday. There are chances that the staff may confuse your details with another patient. So , the more involved you are in your treatment, the more protection you
get from unintentional errors. The more knowledge you gain, the more questions you will able to ask, and the more attention you will get! Thanks to the internet, it’s become increasingly easier for patients to find answers to their health-related questions online. Learn to alpani, M.D. niruddha M A r. D use the internet intellictor, Founder Dire n Library for gently, so this will help atio Health Educ you ask smarter quesP) People (HEL tions – and will also save your doctor time, because your routine questions have already been answered ! and you are the captain ! Because Don’t worry if you do not understand time is limited during medical appointeverything on the first reading or in ments, you will feel less rushed if you the first sitting. It takes time to absorb prepare your questions before your this information, and analyse it. The appointment. good news is that there are lots of re- Doctors are not mind-readers , and liable websites to help you with Infor- good doctors want you to ask quesmation Therapy. Even better, there tions, because they know that the are now many expert patients online, more you know about your medical who can help you make sense of care, the happier you are going to be what is happening to you with your treatment. Being well-inA lot of patients are scared to ask formed will help you to have realistic their doctors questions. They are expectations of the treatment, and inworried that the doctor is too busy to crease your satisfaction with the care answer them, and they don’t want to you get. Remember that if you want waste his precious time. They are VIP care from your doctor, you need also secretly worried that the doctor to become a VIP – Very well-Informed may take offense at their questions, patient ! because he may think that they are Here are some useful questions questioning his judgment, and this you can ask. may cause him to get upset and pro- 1. How will the results of this test vide poor medical care. change my treatment options ? Please remember that your health de- 2. What is the natural history of my pends on good communication, and disease ? asking questions and providing infor- 3. Are there any other alternatives I mation to your doctor and other care can explore ? providers can improve your care. 4. Which is the best center in the Talking with your doctor builds trust world for this treatment ? and leads to better results, quality, 5. Can you refer to a website where safety, and satisfaction. can I learn more about my probQuality health care is a team effort lem ?
s ’ r o t i d E Desk
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PNEuMONIA •
Pneumonia is the leading cause of death in children worldwide. • Pneumonia kills an estimated 1.4 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined. • Pneumonia can be caused by viruses, bacteria or fungi. • Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors. • Pneumonia can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need. Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.4 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be preventedwith simple interventions, and treated with low-cost, low-tech medication and care. Causes Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are: • Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children; • Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia; • respiratory syncytial virus is the most common viral cause of pneumonia; • in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia,
responsible for at least one quarter of all pneumonia deaths in HIVinfected infants. Transmission Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.
Symptoms The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. The symptoms of pneumonia include: • rapid or difficult breathing • cough • fever • chills • loss of appetite • wheezing (more common in viral infections). When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions. Risk factors While most healthy children can fight the infection with their natural de-
fences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed. Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia. The following environmental factors also increase a child's susceptibility to pneumonia: • indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung) • living in crowded homes • parental smoking. Treatment Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases. Prevention Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia. Adequate nutrition is key to improving children's natural defences, starting with exclusive breastfeeding for the first six months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill. Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia. In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia. Source –World Health Organization P T N
Frequently Asked Questions on Nutrition 1. Does excessive eating of salt increase blood pressure? Ans: Yes and No Yes in certain individuals who are salt sensitive, while this does not happen in those who are salt insensitive. 2. What are the foods to be avoided by BP patients Ans: (a) Salted snacks e.g. Potato wafers (b) Pickles and papads (c) Ketchups (d) Salted meat / salted sea food (e) Excess of fat 3. Will eating fruits cause cold? Ans: Cold is caused by a virus. Most fruits rich in vitamin C (like oranges), in fact can protect against frequent attacks of cold. Some people may be allergic to certain foods which may include fruits. They should find out by trial and error and try and avoid only those fruits. 4. Is it good to drink water while eating? Will it reduce digestion? Ans: There is no evidence to suggest this. Some feel that it may dilute the digestive enzymes, but this does not occur, because the intestines produce several times more enzymes than what is actually required for digestion. Water intake may however fill the stomach and thereby give a feeling of fullness. This is common
among children. 5. Are artificial sweeteners harmful? Ans: Scientific data does not indicate that either saccharine or aspartame are harmful to humans 6. Which is the best source of calcium? Will calcium tablets prevent fracture? Ans: Best source of calcium is milk. To a certain extent calcium tablets @ 500 mg/day would help. Women
should take calcium well before onset of menopause, as more than 50% of the calcium in the bones is lost during the first 5 years of menopause itself. 7. Which of the cooking oils are good for health? Ans: All oils are good in one way or the other. Groundnut oil, mustard oil are very good. It is always suggested to use a combination of oils either blended or by rotation. e.g. Groundnut oil, soya bean oil, sunflower oil, rice bran oil so that you get the ben-
A popular TV program focus on Unethical practices in medical profession caused discomfort to several medical organizations I only wish that medical organizations had taken the information as a feedback from the community and applied its collective mind to initiate corrective measures to minimize the agony, if not to totally eradicate the menace of exploitation in general. I give further additional feedback that might help in bettering the system. Well, with my close association with the profession, observation and experience I feel the profession should adopt much more transparency in practice: 1. Write the prescription in the way it is taught in medical school: Name with qualification, Reg No, adress, prescriber's contact No, Patient's name, age, sex, Special status like Pregnancy, lactating mother etc, Name of the medicine (in caps), strength, dose and dosage regimen. 2. Prescribe the low priced brand or
efit of all. Sunflower / any single oil alone is not preferred. 8. Which is the best way to lose weight? Ans: A combination of physical activity of atleast a 30 minute walk per day with a moderation in calorie intake would do wonders. Drastic weight loss programs can be rarely sustained. Just avoiding refined sugars, disserts, deep fried foods, dairy and bakery products, aerated bottled drinks itself can cut down a large amount of calories. Consuming at least 400 gms of fruits and vegetables can also avoid the hunger. 9. Will eating tomatoes and palak cause stones in the kidney? Ans: No! These are unfounded fears. Eating tomatoes and palak may be little harmful to those who are prone to the problem of formation of stones in the kidneys. 10. Is alcohol drinking good for the heart? Ans: Alcohol in moderate i.e. 30-60 ml/day has been shown to be beneficial. Red wines in addition has anticancer effects. But if you are not used to drinking, there is no advantage in starting it now. If you are already used to it then limiting to 30-60 ml/day is beneficial and anything beyond has the opposite effects. source-National Institute of NutritionHyderabad P T N
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generics to make treatment more affordable 3. Insist on the manufacturers that their product will be prescribed only if their prices are competitive. 4. Shun the attitude that Doctors are no wrong doers and cannot be questioned. 5.Referal doctor should come to the rescue of the patient or their well-wishers if there is a real medical negligence. 6. There is a check and counter check for every system of activity which is totally absent in medical practice. - Please understand that It is essential for minimizing medication errors. There were days when people were never addressing or talking of the doctors in singular. There is a need to restore the old glory and make the legendary 'VAIDHYO NARAYANO HARI' true. P.S.BHAGWAN Registrar, Karnataka Pharmacy Council, Bangalore
'SATYAMEVA JAYATE
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ARtHIRIts - KNEE PAIN Arthritis means inflammation of the joint, which means there is pain, swelling, tenderness around joint. This simple looking disease arthritis is of many types. It’s important to know which kind of “Arthritis” one is suffering from. This will make you able to nip it in the bud and control this deadly disease easily. The fact that 15 per cent of the Indian population suffers from this crippling disease is alarming and arthritis deserves immediate attention. In India osteoarthritis, i.e. degenerative arthritis, which affects the knee, is more prevalent with every third person above the age of 70 years affected. The incidence of rheumatoid arthritis is little less than in the West. More than 20 crore Indians are suffering from arthritis. Let us talk how to manage osteoarthritis. Since this is degenerative in nature so we should all understand how to prevent it. We can prevent it by followings: 1. Reducing weight – keeping weight in normal limit
according to age, height, sex and frame of body (small, medium, large). 2. Regular physiotherapy – strengthening muscles around knee like quadriceps and hamstrings. 3. Maintaining strong bones by keeping normal Bone Mineral Density (Normal value is T score – 1 and above). Regular walking. 4. Maintaining normal vitamin D 3 levels. A recent survey showed that health personnel are vitamin D 3 deficient to the tune of 65%. This is an eye opener report as we think that medical illness is not meant for us. In spite of all the preventive measures osteoarthritis affects people and the affected person feels the following features: 1. Pain while climbing stairs more on coming down. The person looks for railing to catch hold. 2. Seeking for some support to get up from sitting on ground. 3. Experiences some cracking sound while bending knees. 4. Avoid going to Indian toilet and prefers western commode. 5. Usually feels pain on inner side of knee joints. 6. Stiffness around knee joint. Dr A K Agrawal, MS Ortho, MCH Ortho Orthopedicand Joint replacement Surgeon STMC & Krishna Hospital Kanpur drakagrwak@yahoo.com
DEPRESSION is a serious medical illness that involves the brain. It's more than just a feeling of being "down in the dumps" or "blue" for a few days..Symptoms persist and interfere with your everyday life. Symptoms can include • Sadness • Loss of interest or pleasure in activities you used to enjoy • Change in weight • Difficulty sleeping or oversleeping • Energy loss • Feelings of worthlessness • Thoughts of death or suicide Depression is a disorder of the brain.
There are a variety of causes, including genetic, environmental, psychological, and biochemical factors. Depression usually starts between the ages of 15 and 30, and is much more common in women. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter. Depression is one part of bipolar disorder. There are effective treatments for depression, including antidepressants and talk therapy. Most people do best by using both.
Tb PREVENTION If you test positive for latent TB infection, your doctor may advise you to take medications to reduce your risk of developing active tuberculosis. The only type of tuberculosis that is contagious is the active variety, when it affects the lungs. So if you can prevent your latent tuberculosis from becoming active, you won't transmit tuberculosis to anyone else. Protect your family and friends If you have active TB, keep your germs to yourself. It generally takes a few weeks of treatment with TB medications before you're not contagious anymore. Follow these tips to help keep your friends and family from getting sick: • Stay home. Don't go to work or school or sleep in a room with other people during the first few weeks of treatment for active tuberculosis. • Ventilate the room. Tuberculosis germs spread more easily in small closed spaces where air doesn't move. If it's not too cold outdoors, open the windows and use a fan to blow indoor air outside. • Cover your mouth. Use a tissue to cover your
mouth anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it away. • Wear a mask. Wearing a surgical mask when you're around other people during the first three weeks of treatment may help lessen the risk of transmission. Finish your entire course of medication This is the most important step you can take to protect yourself and others from tuberculosis. When you stop treatment early or skip doses, TB bacteria have a chance to develop mutations that allow them to survive the most potent TB drugs. The resulting drug-resistant strains are much more deadly and difficult to treat. Vaccinations In countries where tuberculosis is more common, infants are vaccinated with bacillus CalmetteGuerin (BCG) vaccine because it can prevent severe tuberculosis in children. The BCG vaccine isn't recommended for general use in the United States because it isn't very effective in adults and it causes a falsepositive result on a TB skin test. Researchers are working on developing a more effective TB vaccine. Source: Mayo Clinic
VAsAVI MEDICAL AND REsEARCH CENtRE (Vasavi Hospital)
#6-1-91, Lakdi-ka-pool, Khairtabad, Hyd. RECOGNISED by AAROGyASRI, CGHS, bSNL, STATE GOVT., ALL INSuRANCE TPA’S
IP-bLOCK
OP-bLOCK Sri. Ganji Rajmouli Gupta Chairman
Vasavi Medical & Research Center is a 200 bed Multi Specialty Hospital, located centrally in Lakdi ka pool, Khairtabad Hyderabad. The hospital strives to provide quality medical care at affordable prices, serving all strata of the society. Special focus is on service to people categorized as BPL, with care, compassion and love. We have 4 operation theaters, C.C.U, PICU. NICU, Step down ICU, Post Operative Wards with high technique equipments 24hrs critical care unit, PICU & NICU with ventilators Round the clock Pediatricians, Pulmonologists and General Medicines The hospital has experienced and renowned Doctors and staff in the following fields: * Critical Care Unit * General Surgery * Dental * Nephrology * Obst.&Gynecology * Diagnostics * Pulmonology * Laparoscopy * Endocrinology * Pediatric * Polytrauma * Neurology * Peadiatric surgery * Orthopedic * Skin & VD * Urology * Cardiology * Psychiatry * Surg.Gastroentrology * Gastroenterology * Plastic Surgery * General physician * PICU * NICU The Institute is geared to grow to greater heights in the near future, with the sole motto of providing quality health care for all at affordable prices. We have performed up to 5 thousand surgeries under Aarogyasri scheme with 99% success rate. Sri.G.Chandraiah Gen.Secretary
Sri.B.Dayanad Treasurer
Sri.K.Jayprakash Ram Convenor
DR. DEVI PRAsAD sHEtty
“The first point that I have on my agenda is health insurance for all the poor people of our country. We have 750 million Indians spending Rs. 150/- per month just to speak on the mobile phone. All we need is Rs. 10/out of this Rs. 150/- to ensure the best health insurance program one can think of. This can be implemented just by minor policy changes by the government and my sincere belief is that our government will definitely be willing to bring about required regulatory changes to make this happen.”
IndIA fAcIng ShorTAgE of 10 lAkh MBBS docTorS: AzAd
Jammu: The country is facing a shortage of 10 lakh MBBS doctors, which is affecting healthcare delivery system in rural areas, Union Health and Family Welfare Minister Ghulam Nabi Azad on Thursday said. “There are seven lakh doctors in the country against a requirement of 17 lakh, leaving a deficit of 10 lakh doctors. This is directly affecting the healthcare delivery system in rural areas,” Azad said. Speaking at a public meeting at Kil- According to the minister, to provide hotran in Gandoh tehsil of Doda dis- better healthcare in rural areas, the trict, Azad said though the Centre syllabus of MBBS doctors is being was providing adequate funds for amended so as to ensure trainee construction of hospitals, there was doctors serve in villages for one year shortage of MBBS doctors. before getting the MBBS degree.
british doctors to face tests every year
London: Doctors in Britain will have to appear in tests every year to ensure they are fit to practise, a media report said on Friday. At present, doctors in the country can go for their entire career without any formal assessment of their competency, the Daily Express reported. But from December, they will be assessed to see if they
are fit to stay on the medical register, according to the General Medical Council. The test would take the form of an annual appraisal. Doctors will be expected to demonstrate they meet clinical standards and have kept up with the latest developments. Appraisals will include feedback from patients and colleagues.
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