Authorities at the Guru Govind Singh Government Hospital in Jamnagar,Gujarat,India labelled a 25-year-old pregnant woman as ‘HIV positive’ with a sticker on her forehead and paraded her in the hospital in the presence of her six-month-old daughter and mother-in-law, on Saturday June 20, 2009.
Yes, news report of yet another inhuman and cruel discrimination against HIV positive persons. This is depressing reading. I watched the news report in NDTV too and was shocked to see the video clip showing the woman's full face.How can the TV channels be so in-sensitive!!!
I had posted about stigma and discrimination against HIV positive persons before, especially about that I encountered in my clinical practise. Read some of them here.
Why there is Stigma and Discrimination against HIV positive persons?
1. Fear of contagion,ie the irrational fear that going near a 'positive' person will make you 'positive'.
2.HIV/AIDS is still considered by many as a death warrant.
3. Being 'positive' is considered 'immoral' by many people.It is considered to be a result of sins committed or due to Personal irresponsibility and deserve to be punished.
4, Many believe that HIV positive persons are vengeful and try their best to transmit the disease.
Why there should not be any Stigma or discrimination against HIV positive persons?
1. HIV is not transmitted from person to person by social or even intimate contacts. Read here how HIV is not transmitted.
2.HIV/AIDS is not a Death Warrant. It is a chronic manageable disease like Diabetes and Hypertension.
3. HIV/AIDS is just like any other disease.There is nothing immoral about it.More than 70 percent of positive persons in the World are those who never had sex outside marriage and had never abused IV drugs.
4. Discrimination against HIV positive persons will increase the transmission of the virus and epidemic will explode further. Seeing the discrimination in the Society a 'positive' person [who fears he/she is positive but has not tested] will be reluctant to test for HIV. They will continue to transmit the disease. If one knows he/she is 'positive' they will not reveal it, fearing stigma.Thus they will not get counselling and treatment which will reduce transmission. A pregnant 'positive' woman,like the one who was discriminated in Jamnagar should take medicines to prevent transmission of the virus to her child. Stigma will prevent her doing that and she may get a 'positive' child.
I can add on many more points,but the message remains the same.
A society that discriminates against HIV positive persons is fuelling the epidemic in its midst.
Showing posts with label Public Health. Show all posts
Showing posts with label Public Health. Show all posts
Sunday, June 21, 2009
Sunday, November 30, 2008
Questions and answers about HIV transmission
What are the main routes of HIV transmission?
These are the main ways in which someone can become infected with HIV:
1.Unprotected penetrative sex with someone who is infected.
2.Injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected.
3.From a mother who is infected to her baby; this can occur during pregnancy, at birth and through breastfeeding.
4.Sharing unsterilised injection equipment that has previously been used by someone who is infected.
Can I become infected with HIV through normal social contact/activities such as shaking hands/toilet seats/swimming pools/sharing cutlery/kissing/sneezes and coughs?
No. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.
Can I become infected with HIV from needles on movie/cinema seats?
There have been a number of stories circulating via the Internet and e-mail, about people becoming infected from needles left on cinema seats and in coin return slots. These rumours appear to have no factual basis.
For HIV infection to take place in this way the needle would need to contain infected blood with a high level of infectious virus. If a person was then pricked with an infected needle, they could become infected, but there is still only a 0.4% chance of this happening.
Although discarded needles can transfer blood and blood-borne illnesses such as Hepatitis B, Hepatitis C and HIV, the risk of infection taking place in this way is extremely low.
There is a wide spread belief among 'negative' people that HIV positive persons will try deliberately to spread the disease.There is no factual basis for this belief.
Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?
If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. However, people who carry out body piercing or tattooing should follow procedures called 'universal precautions', which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.
When visiting the barbers there is no risk of infection unless the skin is cut and infected blood gets into the wound. Traditional 'cut-throat' razors used by barbers now have disposable blades, which should only be used once, thus eliminating the risk from blood-borne infections such as Hepatitis and HIV.
Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
Transmission of HIV in a healthcare setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and healthcare professionals from the transmission of blood-borne diseases such as Hepatitis B and HIV.
Can I get HIV from a mosquito?
No, it is not possible to get HIV from mosquitoes. When taking blood from someone, mosquitoes do not inject blood from any previous person. The only thing that a mosquito injects is saliva, which acts as a lubricant and enables it to feed more efficiently.
Can I become infected with HIV through biting?
Infection with HIV in this way is unusual. There have only been a couple of documented cases of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.
Can HIV be transmitted outside of the body?
Whilst HIV may live for a short while outside of the body, HIV transmission has not been reported as a result of contact with spillages or small traces of blood, semen or other bodily fluids. This is partly because HIV dies quite quickly once exposed to the air, and also because spilled fluids would have to get into a person's bloodstream to infect them.
Scientists agree that HIV does not survive well in the environment, making the chance of environmental transmission remote. To obtain data on the survival of HIV, laboratory studies usually use artificially high concentrations of laboratory-grown virus. Although these concentrations of HIV can be kept alive for days or even weeks under controlled conditions, studies have shown that drying of these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within a few hours.
Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, the real risk of HIV infection from dried bodily fluids is probably close to zero.
Does circumcision protect against HIV?
There is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Male circumcision probably has little or no preventive benefit for women.
If I am taking antiretroviral drugs and have an 'undetectable' viral load, am I still infectious?
Even if your tests show that you have very low levels of HIV in your blood, the virus will not have been totally eradicated and you will still be capable of infecting others. Some drugs do not penetrate the genitals very well and so do not disable HIV as effectively there as they do in the blood. This means that while you may have little active virus showing up on blood tests, there may still be quite a lot of HIV in your semen or vaginal fluids. Transmission may be less likely when you have a low viral load, but it is still possible so you should always take appropriate precautions.
Courtesy- Avert.org
Click here if you want to know more
These are the main ways in which someone can become infected with HIV:
1.Unprotected penetrative sex with someone who is infected.
2.Injection or transfusion of contaminated blood or blood products, donations of semen (artificial insemination), skin grafts or organ transplants taken from someone who is infected.
3.From a mother who is infected to her baby; this can occur during pregnancy, at birth and through breastfeeding.
4.Sharing unsterilised injection equipment that has previously been used by someone who is infected.
Can I become infected with HIV through normal social contact/activities such as shaking hands/toilet seats/swimming pools/sharing cutlery/kissing/sneezes and coughs?
No. HIV is not an airborne, water-borne or food-borne virus, and does not survive for very long outside the human body. Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.
Can I become infected with HIV from needles on movie/cinema seats?
There have been a number of stories circulating via the Internet and e-mail, about people becoming infected from needles left on cinema seats and in coin return slots. These rumours appear to have no factual basis.
For HIV infection to take place in this way the needle would need to contain infected blood with a high level of infectious virus. If a person was then pricked with an infected needle, they could become infected, but there is still only a 0.4% chance of this happening.
Although discarded needles can transfer blood and blood-borne illnesses such as Hepatitis B, Hepatitis C and HIV, the risk of infection taking place in this way is extremely low.
There is a wide spread belief among 'negative' people that HIV positive persons will try deliberately to spread the disease.There is no factual basis for this belief.
Is there a risk of HIV transmission when having a tattoo, body piercing or visiting the barbers?
If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. However, people who carry out body piercing or tattooing should follow procedures called 'universal precautions', which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.
When visiting the barbers there is no risk of infection unless the skin is cut and infected blood gets into the wound. Traditional 'cut-throat' razors used by barbers now have disposable blades, which should only be used once, thus eliminating the risk from blood-borne infections such as Hepatitis and HIV.
Am I at risk of becoming infected with HIV when visiting the doctor or dentist?
Transmission of HIV in a healthcare setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient. These procedures are called universal precautions for infection control. They are designed to protect both patients and healthcare professionals from the transmission of blood-borne diseases such as Hepatitis B and HIV.
Can I get HIV from a mosquito?
No, it is not possible to get HIV from mosquitoes. When taking blood from someone, mosquitoes do not inject blood from any previous person. The only thing that a mosquito injects is saliva, which acts as a lubricant and enables it to feed more efficiently.
Can I become infected with HIV through biting?
Infection with HIV in this way is unusual. There have only been a couple of documented cases of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.
Can HIV be transmitted outside of the body?
Whilst HIV may live for a short while outside of the body, HIV transmission has not been reported as a result of contact with spillages or small traces of blood, semen or other bodily fluids. This is partly because HIV dies quite quickly once exposed to the air, and also because spilled fluids would have to get into a person's bloodstream to infect them.
Scientists agree that HIV does not survive well in the environment, making the chance of environmental transmission remote. To obtain data on the survival of HIV, laboratory studies usually use artificially high concentrations of laboratory-grown virus. Although these concentrations of HIV can be kept alive for days or even weeks under controlled conditions, studies have shown that drying of these high concentrations of HIV reduces the amount of infectious virus by 90 to 99 percent within a few hours.
Since the HIV concentrations used in laboratory studies are much higher than those actually found in blood or other specimens, the real risk of HIV infection from dried bodily fluids is probably close to zero.
Does circumcision protect against HIV?
There is very strong evidence showing that circumcised men are about half as likely as uncircumcised men to acquire HIV through heterosexual sex. However, circumcision does not make a man immune to HIV infection, it just means that it's less likely to happen. Male circumcision probably has little or no preventive benefit for women.
If I am taking antiretroviral drugs and have an 'undetectable' viral load, am I still infectious?
Even if your tests show that you have very low levels of HIV in your blood, the virus will not have been totally eradicated and you will still be capable of infecting others. Some drugs do not penetrate the genitals very well and so do not disable HIV as effectively there as they do in the blood. This means that while you may have little active virus showing up on blood tests, there may still be quite a lot of HIV in your semen or vaginal fluids. Transmission may be less likely when you have a low viral load, but it is still possible so you should always take appropriate precautions.
Courtesy- Avert.org
Click here if you want to know more
Friday, October 24, 2008
How I got interested in HIV/AIDS?
In the late 1990s, I was working in a small [Government] Taluk Hopsital. HIV 'Positive' persons I saw in my practise were few and I was happy to refer them to higher centres.
Then I got transferred to a busy District Headquarters Hospital in 2001. There I could not escape dealing with 'positive' persons.
Every week the infectious disease ward will see a new 'positive' patient coming to die.
Most of them by then might have spend a fortune on magical remedies. The most infamous among them was the medicines of Fair Pharma from Kochi. For more detailed information about how one Majeed cheated poor patients and build the costliest house in Kerala click here. Now fortunately the 'medicine' is banned in Kerala by the Court after a longstanding legal battle with 'Positive' people and PUCL.
The patients in my hospital were given symptomatic treatment and left to die. Some come and die alone while the more lucky ones have a wife or mother to be with them during their last days.
I was depressed seeing all these deaths.
What can I do for them? I asked myself.
I had no experience in treating HIV/AIDS patients. In the medical college where I studied in early and mid 1990s, 'positive' persons were rarely seen. I knew a lot from the text books but practical knowledge was nil.
Those days the Government was giving lot of training in HIV/AIDS for doctors and other health care workers, but it was only about prevention.
HIV/AIDS is a death sentence. So train yourself and others how not to get it.
This was the message of such trainings. Nobody mentioned treatment. We were not trained to cope with these dying 'positive' patients.
In the developed world by the year 2000, more than 10 drugs were available effective in treating HIV/AIDS. Few were available in India too at that time. They were expensive and somewhat toxic but still they worked. And they were cheaper than the Fake medicines of Fair Pharma.
More over, HIV/AIDS patients need treatment for opportunistic infections that attack them as their immunity is low.
So when a 'positive' patient is sick, first we have to find out which opportunistic organism or organisms have infected him/her. Then give the proper treatment so that he/she becomes better. Later, ART [anti retro viral therapy] was started. Some time in severely sick patient we may have to start both treatments together.
Training myself in HIV/AIDS management, I started treating these patients in earnest. I procured medicines from drug companies directly and thus was able to give it to patients much below market rates. The stigma of buying such medicines from Drug Store was circumvented as I myself provided the medicines.
The results were dramatic. Patients in death bed about to say their final prayers were able to look after themselves with in months. Those who sticked on to the medication schedule for more than a year began working and earn for themselves.
I lost many patients too, but I tried my level best. Some came to me at a very late stage. Many could not continue the medicines because of the high cost of ART. Many by then had become social outcasts and committed suicide.
I urged other Physicians to take up the challenge of HIV. I conducted lectures in the IMA[Indian Medical Association]. I told them that it was ,we the modern medicine doctors, who are making the 'positive' persons go to Quacks like Majeed [Fair Pharma]. As we are not ready to take care of them, they are helpless. Unscrupulous persons squeeze out the last penny from them giving false hopes.
That made some difference. Few of my colleagues started taking up such cases.
By 2003-2004, things started changing in a positive direction for 'positives'. ART drugs became cheaper. India became one of the biggest manufacturer and exporter of cheap generic HIV drugs. Govt of India started giving ART drugs free of cost at selected centres. Kerala Government followed suit.
The emphasis in training of health care workers shifted from prevention to treatment. From a 'death sentence' HIV/AIDS became projected as a chronic manageable disease needing lifelong medication like Diabetes.
Now a 'Positive' person comes to my clinic every other day. Most of them are old patients coming for follow up. A newly detected 'positive' person is seen once or twice a month. Most of them are taking the free ART drugs from Medical Colleges. Some who can afford [and is afraid of perceived stigma at Govt centres] take medicines from me.
Deaths occur but only rarely.
I cherish the sight of happy faces and healthy bodies of all those positive persons. That sight make my life meaningful.
Then I got transferred to a busy District Headquarters Hospital in 2001. There I could not escape dealing with 'positive' persons.
Every week the infectious disease ward will see a new 'positive' patient coming to die.
Most of them by then might have spend a fortune on magical remedies. The most infamous among them was the medicines of Fair Pharma from Kochi. For more detailed information about how one Majeed cheated poor patients and build the costliest house in Kerala click here. Now fortunately the 'medicine' is banned in Kerala by the Court after a longstanding legal battle with 'Positive' people and PUCL.
The patients in my hospital were given symptomatic treatment and left to die. Some come and die alone while the more lucky ones have a wife or mother to be with them during their last days.
I was depressed seeing all these deaths.
What can I do for them? I asked myself.
I had no experience in treating HIV/AIDS patients. In the medical college where I studied in early and mid 1990s, 'positive' persons were rarely seen. I knew a lot from the text books but practical knowledge was nil.
Those days the Government was giving lot of training in HIV/AIDS for doctors and other health care workers, but it was only about prevention.
HIV/AIDS is a death sentence. So train yourself and others how not to get it.
This was the message of such trainings. Nobody mentioned treatment. We were not trained to cope with these dying 'positive' patients.
In the developed world by the year 2000, more than 10 drugs were available effective in treating HIV/AIDS. Few were available in India too at that time. They were expensive and somewhat toxic but still they worked. And they were cheaper than the Fake medicines of Fair Pharma.
More over, HIV/AIDS patients need treatment for opportunistic infections that attack them as their immunity is low.
So when a 'positive' patient is sick, first we have to find out which opportunistic organism or organisms have infected him/her. Then give the proper treatment so that he/she becomes better. Later, ART [anti retro viral therapy] was started. Some time in severely sick patient we may have to start both treatments together.
Training myself in HIV/AIDS management, I started treating these patients in earnest. I procured medicines from drug companies directly and thus was able to give it to patients much below market rates. The stigma of buying such medicines from Drug Store was circumvented as I myself provided the medicines.
The results were dramatic. Patients in death bed about to say their final prayers were able to look after themselves with in months. Those who sticked on to the medication schedule for more than a year began working and earn for themselves.
I lost many patients too, but I tried my level best. Some came to me at a very late stage. Many could not continue the medicines because of the high cost of ART. Many by then had become social outcasts and committed suicide.
I urged other Physicians to take up the challenge of HIV. I conducted lectures in the IMA[Indian Medical Association]. I told them that it was ,we the modern medicine doctors, who are making the 'positive' persons go to Quacks like Majeed [Fair Pharma]. As we are not ready to take care of them, they are helpless. Unscrupulous persons squeeze out the last penny from them giving false hopes.
That made some difference. Few of my colleagues started taking up such cases.
By 2003-2004, things started changing in a positive direction for 'positives'. ART drugs became cheaper. India became one of the biggest manufacturer and exporter of cheap generic HIV drugs. Govt of India started giving ART drugs free of cost at selected centres. Kerala Government followed suit.
The emphasis in training of health care workers shifted from prevention to treatment. From a 'death sentence' HIV/AIDS became projected as a chronic manageable disease needing lifelong medication like Diabetes.
Now a 'Positive' person comes to my clinic every other day. Most of them are old patients coming for follow up. A newly detected 'positive' person is seen once or twice a month. Most of them are taking the free ART drugs from Medical Colleges. Some who can afford [and is afraid of perceived stigma at Govt centres] take medicines from me.
Deaths occur but only rarely.
I cherish the sight of happy faces and healthy bodies of all those positive persons. That sight make my life meaningful.
Friday, October 3, 2008
Smoking banned in public places from today
India on Thursday once again imposed a countrywide ban on smoking in public spaces in its fight against tobacco use, four years after a largely ignored earlier prohibition saw people continue to puff away in restaurants, clubs and bars.The ban, aimed at the country's 120 million smokers, has received a good response from people across the country,Health Minister Anbumani Ramadoss asserted.
"It is a continuous process, ... and the message will go across through repeated awareness campaigns by the government and the media," Ramadoss, a tireless anti-smoking campaigner, told reporters.
The new order bars smoking in hotels, eateries, cafes, pubs, bars, discotheques, offices, airports, railway stations, bus stops, shopping malls and parks. People can continue to smoke in private homes and open spaces.The new ban has directed establishments to appoint anti-smoking officers who will be liable if people smoke.
Britain, France, Ireland and Thailand are among the countries that already have similar bans in place.
The fine for violating India's order is 200 rupees (4.29 dollars), but health authorities said higher fines of up to 25 dollars were being contemplated.
The new Smoking in Public Places Rules 2008 came into force on the anniversary of the birth of Mahatma Gandhi the Father of Nation, who was known for his ascetic habits.
Citing a survey that found that 52 per cent of children took up smoking after watching film stars lighting up on the screen, Ramadoss appealed to Bollywood celebrities not to encourage smoking.
"People look up to celebrities and follow them," the minister said. "Our popular film star Rajnikanth has stopped smoking in movies. Other stars should also set an example."
Besides the police, government officers; inspectors of central excise, sales tax, transport and health departments; and principals of schools have been given powers to fine violators on their respective premises.
Officials acknowledged that enforcement might not be easy.
India is the third-largest tobacco producer and consumer in the world after China and the United States.
According to a Health Ministry release, more than 2,200 Indians die every day from tobacco use. They are at risk from cardiovascular diseases like heart attacks, strokes and cancer.
A recent study by a team of doctors showed that tobacco smoking would kill 1 million people annually beginning in 2010.
Saying India is in the midst of a "catastrophic epidemic of smoking deaths," the doctors warned that nearly 70 per cent of the million deaths would take place among smokers in their prime.
In this large, nationally representative case–control study, it was found that in both rural and urban India, among men between the ages of 30 and 69 years, the rate of death from any medical cause in smokers was 1.7 times that in nonsmokers of similar age, educational level, and alcohol status (use or nonuse). Among female smokers, mortality from any medical cause was double that among their nonsmoking counterparts.
If you are still not convinced about quitting smoking read this and decide.
"It is a continuous process, ... and the message will go across through repeated awareness campaigns by the government and the media," Ramadoss, a tireless anti-smoking campaigner, told reporters.
The new order bars smoking in hotels, eateries, cafes, pubs, bars, discotheques, offices, airports, railway stations, bus stops, shopping malls and parks. People can continue to smoke in private homes and open spaces.The new ban has directed establishments to appoint anti-smoking officers who will be liable if people smoke.
Britain, France, Ireland and Thailand are among the countries that already have similar bans in place.
The fine for violating India's order is 200 rupees (4.29 dollars), but health authorities said higher fines of up to 25 dollars were being contemplated.
The new Smoking in Public Places Rules 2008 came into force on the anniversary of the birth of Mahatma Gandhi the Father of Nation, who was known for his ascetic habits.
Citing a survey that found that 52 per cent of children took up smoking after watching film stars lighting up on the screen, Ramadoss appealed to Bollywood celebrities not to encourage smoking.
"People look up to celebrities and follow them," the minister said. "Our popular film star Rajnikanth has stopped smoking in movies. Other stars should also set an example."
Besides the police, government officers; inspectors of central excise, sales tax, transport and health departments; and principals of schools have been given powers to fine violators on their respective premises.
Officials acknowledged that enforcement might not be easy.
India is the third-largest tobacco producer and consumer in the world after China and the United States.
According to a Health Ministry release, more than 2,200 Indians die every day from tobacco use. They are at risk from cardiovascular diseases like heart attacks, strokes and cancer.
A recent study by a team of doctors showed that tobacco smoking would kill 1 million people annually beginning in 2010.
Saying India is in the midst of a "catastrophic epidemic of smoking deaths," the doctors warned that nearly 70 per cent of the million deaths would take place among smokers in their prime.
In this large, nationally representative case–control study, it was found that in both rural and urban India, among men between the ages of 30 and 69 years, the rate of death from any medical cause in smokers was 1.7 times that in nonsmokers of similar age, educational level, and alcohol status (use or nonuse). Among female smokers, mortality from any medical cause was double that among their nonsmoking counterparts.
If you are still not convinced about quitting smoking read this and decide.
Wednesday, September 24, 2008
What to do if an HIV positive person comes to you for help?
This post is for all health care providers and Social workers in India.
You know an HIV positive person who needs medical help.What to do?
First thing you have to make sure is whether he/she is really 'positive'. Three positive rapid tests detecting antibody is considered confirmatory. These tests are done virtually free of cost at all major Government Hospitals. The person can go directly there to the testing centre and get tested.No need for a doctor to order the test.
If he/she do not want to test in a Government testing centre you can ask him/her to get tested in a good private lab. There the more costly Western Blot test is usually done to confirm the diagnosis.
If the diagnosis is confirmed the most important thing is to reassure the patient that HIV/AIDS is a treatable condition now and the treatment is available free of cost at ART Centres attached to certain major Hospitals. Before starting treatment few other blood tests also have to be done to assess the immune status and overall health of the patient.
It is important to note that all positive persons do not need treatment.If there are no illness and if the person's immunity status is good[meaning the CD4 count is more than 200], treatment is not started immediately.The person needs to follow up regularly to check his immune status.
What do you mean by Immune status?
It is a measure of the ability of the person's body to fight against infections. HIV virus slowly destroys the ability of the body to fight against infections.Such an immune compromised individual can get infections easily.
Why treatment is delayed till the immunity is destroyed?
In early stages of infection especially the first 5 years the body partially win the battle against HIV. Slowly but surely the virus get the upper hand [in most of the positive persons] and the body's immune system gets destroyed. Only at this stage the person becomes ill. We start anti HIV treatment at that time so that we can prevent the person falling ill due to various infections.
Starting treatment before that do not give much benefit.As of now we can only reduce the multiplication of the virus to a minimum.We cannot eradicate the virus. Also the anti HIV medicines have many side effects.There is also chance of drug resistance if the dosages are missed. Considering all this treatment initiation early in the course of HIV infection is not very useful.
It is also important to test the spouse of the person.If the mother is positive the children if any also have to be tested.
If there is a pregnant positive woman, she needs treatment to prevent her child getting infected. This also is provided at ART centres.
Compassion and good advise is what that is needed for a newly detected 'positive' person.
You know an HIV positive person who needs medical help.What to do?
First thing you have to make sure is whether he/she is really 'positive'. Three positive rapid tests detecting antibody is considered confirmatory. These tests are done virtually free of cost at all major Government Hospitals. The person can go directly there to the testing centre and get tested.No need for a doctor to order the test.
If he/she do not want to test in a Government testing centre you can ask him/her to get tested in a good private lab. There the more costly Western Blot test is usually done to confirm the diagnosis.
If the diagnosis is confirmed the most important thing is to reassure the patient that HIV/AIDS is a treatable condition now and the treatment is available free of cost at ART Centres attached to certain major Hospitals. Before starting treatment few other blood tests also have to be done to assess the immune status and overall health of the patient.
It is important to note that all positive persons do not need treatment.If there are no illness and if the person's immunity status is good[meaning the CD4 count is more than 200], treatment is not started immediately.The person needs to follow up regularly to check his immune status.
What do you mean by Immune status?
It is a measure of the ability of the person's body to fight against infections. HIV virus slowly destroys the ability of the body to fight against infections.Such an immune compromised individual can get infections easily.
Why treatment is delayed till the immunity is destroyed?
In early stages of infection especially the first 5 years the body partially win the battle against HIV. Slowly but surely the virus get the upper hand [in most of the positive persons] and the body's immune system gets destroyed. Only at this stage the person becomes ill. We start anti HIV treatment at that time so that we can prevent the person falling ill due to various infections.
Starting treatment before that do not give much benefit.As of now we can only reduce the multiplication of the virus to a minimum.We cannot eradicate the virus. Also the anti HIV medicines have many side effects.There is also chance of drug resistance if the dosages are missed. Considering all this treatment initiation early in the course of HIV infection is not very useful.
It is also important to test the spouse of the person.If the mother is positive the children if any also have to be tested.
If there is a pregnant positive woman, she needs treatment to prevent her child getting infected. This also is provided at ART centres.
Compassion and good advise is what that is needed for a newly detected 'positive' person.
Friday, September 19, 2008
A Study in Contrast
The other day two of my patients were boys who presented so differently.Their stories were a study in contrast.
The first boy came along with his anxious parents.Both of them were school teachers. The boy was around 14 years and appeared healthy.
' What brings you here?' I asked.
' His urine is frothy'.The mother said.Is he having a kidney problem? They were very anxious as a classmate of their son had Kidney disease.
I examined him in detail and could not find anything wrong.Then I asked for a series of tests of urine and Blood and that too were normal.
I reassured the parents and send them off.
The other' boy' came with his father.They were from a village 30kms away. They came with a reference letter from a Local doctor.The ' boy' looked as if he is about 12 years old. When I looked down at the patient file in front of me I was shocked to see the age written as 23.Was it a clerical mistake?I asked the father about the boy's age.Yes it is 23. I read the reference letter.Yes he was referred to me to find a reason for his short stature.
I examined him. His height was 123cm and weight 24 Kilograms. He did not show any features of puberty. He had no hair growth over face, chest, armpits or genitalia.
His penis was small and testicles rudimentary. His voice was like that of a 10 year old child. It seemed as if his body got stuck at 10 years for the last 13 years.
'When did you notice that there is something wrong in your son?' I asked the father.
He told me that once a doctor told him the boy had problems and need many tests to find out the cause,but nothing was done.
Why those tests were not done?
Money was the major problem he said apologetically. 'Also I was sick for several years.So there was nobody to take him to distant City to do the tests.' He added.
He is probably a case of ' Pituitary Dwarfism'. It is an abnormality rarely seen in children.They stop growing early or growth is very much delayed. This is caused by deficiency of Growth hormone . Such children may have deficiency of other hormones also.This may result in lack of sexual maturity as seen in this boy.
Early diagnosis in the childhood is important. Treatment with Growth Hormone Injections usually makes a big difference.But it have to be given before adulthood.By 18 to 20 years the bone plates fuses and further growth is not possible.
Treatment with sex hormones may help this 'boy' to mature.But he will never gain height. He could have gained height if treatment was started when he was around 15 or earlier.
Such contrasting tales I see in my practise regularly. India is full of such contrasts. Over anxious literate and well off parents who know many things and is afraid of all known and unknown diseases attacking their children on the one hand,and the illiterate poor rural folk who accepts everything that is given to them as destiny on the other hand.
India is a land of
Luxury,opulence and high education on one side
and
poverty,illiteracy and ignorance on the other side.
When will this huge divide go away?
The first boy came along with his anxious parents.Both of them were school teachers. The boy was around 14 years and appeared healthy.
' What brings you here?' I asked.
' His urine is frothy'.The mother said.Is he having a kidney problem? They were very anxious as a classmate of their son had Kidney disease.
I examined him in detail and could not find anything wrong.Then I asked for a series of tests of urine and Blood and that too were normal.
I reassured the parents and send them off.
The other' boy' came with his father.They were from a village 30kms away. They came with a reference letter from a Local doctor.The ' boy' looked as if he is about 12 years old. When I looked down at the patient file in front of me I was shocked to see the age written as 23.Was it a clerical mistake?I asked the father about the boy's age.Yes it is 23. I read the reference letter.Yes he was referred to me to find a reason for his short stature.
I examined him. His height was 123cm and weight 24 Kilograms. He did not show any features of puberty. He had no hair growth over face, chest, armpits or genitalia.
His penis was small and testicles rudimentary. His voice was like that of a 10 year old child. It seemed as if his body got stuck at 10 years for the last 13 years.
'When did you notice that there is something wrong in your son?' I asked the father.
He told me that once a doctor told him the boy had problems and need many tests to find out the cause,but nothing was done.
Why those tests were not done?
Money was the major problem he said apologetically. 'Also I was sick for several years.So there was nobody to take him to distant City to do the tests.' He added.
He is probably a case of ' Pituitary Dwarfism'. It is an abnormality rarely seen in children.They stop growing early or growth is very much delayed. This is caused by deficiency of Growth hormone . Such children may have deficiency of other hormones also.This may result in lack of sexual maturity as seen in this boy.
Early diagnosis in the childhood is important. Treatment with Growth Hormone Injections usually makes a big difference.But it have to be given before adulthood.By 18 to 20 years the bone plates fuses and further growth is not possible.
Treatment with sex hormones may help this 'boy' to mature.But he will never gain height. He could have gained height if treatment was started when he was around 15 or earlier.
Such contrasting tales I see in my practise regularly. India is full of such contrasts. Over anxious literate and well off parents who know many things and is afraid of all known and unknown diseases attacking their children on the one hand,and the illiterate poor rural folk who accepts everything that is given to them as destiny on the other hand.
India is a land of
Luxury,opulence and high education on one side
and
poverty,illiteracy and ignorance on the other side.
When will this huge divide go away?
Sunday, August 3, 2008
Unaffordable Health Care
Rapid advances in Medical Science is now giving more and more treatment options to the patient. Whether it is Leukemia, Cancers, Parkinsonism, Rheumatoid Arthritis, Diabetes or many of the other chronic diseases, newer and newer drugs brings hope to the suffering millions, but will their hope of a better life be fulfilled?
The astronomically high costs of newer drugs make sure that only the fortunate few will be able to get the benefit. For the rest it will be pure agony of suffering with the knowledge that treatment is available but is unaffordable. Maybe, they would have been better off if there was no treatment. Then they could have suffered and died peacefully.
Why newer drugs are so costly? Why we cannot share the fruits of scientific research evenly among all human beings of the World? Why a handful of pharmaceutical Giants reap the profit of our scientific advances?
The astronomically high costs of newer drugs make sure that only the fortunate few will be able to get the benefit. For the rest it will be pure agony of suffering with the knowledge that treatment is available but is unaffordable. Maybe, they would have been better off if there was no treatment. Then they could have suffered and died peacefully.
Why newer drugs are so costly? Why we cannot share the fruits of scientific research evenly among all human beings of the World? Why a handful of pharmaceutical Giants reap the profit of our scientific advances?
Wednesday, July 30, 2008
Rain
Though late, the South-West monsoon [the main source of Rain for this area] finally have been kind enough to my native state, Kerala.
Until this week, Newspapers were saying that this was the weakest monsoon in recent memory with a 43 percent deficit in rainfall in the first 7 weeks of the season. Power blackouts started [as the major source of Power here is Hydro-electric projects] and fear of failed crops were looming large.
This week everything changed. The sky started pouring and pouring. Even as I type, I can hear the wonderful sound of rain. Newspapers started talking about flash floods and landslips. Let us hope the monsoon will wipe off the rainfall deficit in quick time.
Rain or no Rain,Chikungunya epidemic continues relentlessly. In some families, almost all members are getting affected. I had an opportunity to visit a small town 15 kms away. I went there on invitation of a local Club. They wanted me to give a health education class about chikungunya fever.
When I reached there, the people were not in a mood to listen to a talk. They wanted prescription for medicines so that they can recover fast. Most of them were manual labourers, and the persistent joint pain and swellings were preventing them from working. Some wanted preventive medicines to protect them from the virus. I was helpless. There is no fast cure.The joint pains may last for weeks to months. During that period, they will have to continue taking anti-inflammatory drugs. Also, there is no preventive medicine or vaccine yet. I asked them to take measures to reduce breeding of Aedes mosquito. I also asked them to isolate the patient inside a mosquito net during the time of fever. At that time, maximum number of viruses are there in patient's blood and mosquito bite can easily spread the illness.
My team saw more than 50 patients. Some free medicines were distributed, but nobody was satisfied. As we drove back, my thoughts were on the enormity of physical and economic damage this virus had brought on the society, especially for the poor.
Until this week, Newspapers were saying that this was the weakest monsoon in recent memory with a 43 percent deficit in rainfall in the first 7 weeks of the season. Power blackouts started [as the major source of Power here is Hydro-electric projects] and fear of failed crops were looming large.
This week everything changed. The sky started pouring and pouring. Even as I type, I can hear the wonderful sound of rain. Newspapers started talking about flash floods and landslips. Let us hope the monsoon will wipe off the rainfall deficit in quick time.
Rain or no Rain,Chikungunya epidemic continues relentlessly. In some families, almost all members are getting affected. I had an opportunity to visit a small town 15 kms away. I went there on invitation of a local Club. They wanted me to give a health education class about chikungunya fever.
When I reached there, the people were not in a mood to listen to a talk. They wanted prescription for medicines so that they can recover fast. Most of them were manual labourers, and the persistent joint pain and swellings were preventing them from working. Some wanted preventive medicines to protect them from the virus. I was helpless. There is no fast cure.The joint pains may last for weeks to months. During that period, they will have to continue taking anti-inflammatory drugs. Also, there is no preventive medicine or vaccine yet. I asked them to take measures to reduce breeding of Aedes mosquito. I also asked them to isolate the patient inside a mosquito net during the time of fever. At that time, maximum number of viruses are there in patient's blood and mosquito bite can easily spread the illness.
My team saw more than 50 patients. Some free medicines were distributed, but nobody was satisfied. As we drove back, my thoughts were on the enormity of physical and economic damage this virus had brought on the society, especially for the poor.
Thursday, July 24, 2008
Acute severe joint pain
She was a 30 year old housewife. She was literally carried in to my consulting room by her husband and her mother. She was writhing with agony at each movement of her joints.
She was perfectly all right in the morning.She walked down to the river[which was about 1/2 kilometre away] to bath, came back and made coffee.At that moment,before she could serve coffee her joint pain started with shivering and she had to be carried from kitchen to bedroom.
She had pain in small joints of fingers, wrist,elbow, shoulders,hip,knee and ankles. All those joints were warm. Her temperature was 101F. Rest of the examination was normal.
Yes, this is the classical onset of Chikungunya fever. I send her out in a wheel chair to get admitted.She was given medicines to reduce fever and inflammation of joints.The next day she was sitting happily ready to go home. Her fever has subsided and joint pains less.She will continue to suffer from joint pains for uncertain number of weeks, and thus may need to continue anti inflammatory drugs.
The fever and joint pains in chikungunya infection start so suddenly that some patients are able to tell the exact minute of onset. I still wonder why the onset is so sudden and unexpected.
She was perfectly all right in the morning.She walked down to the river[which was about 1/2 kilometre away] to bath, came back and made coffee.At that moment,before she could serve coffee her joint pain started with shivering and she had to be carried from kitchen to bedroom.
She had pain in small joints of fingers, wrist,elbow, shoulders,hip,knee and ankles. All those joints were warm. Her temperature was 101F. Rest of the examination was normal.
Yes, this is the classical onset of Chikungunya fever. I send her out in a wheel chair to get admitted.She was given medicines to reduce fever and inflammation of joints.The next day she was sitting happily ready to go home. Her fever has subsided and joint pains less.She will continue to suffer from joint pains for uncertain number of weeks, and thus may need to continue anti inflammatory drugs.
The fever and joint pains in chikungunya infection start so suddenly that some patients are able to tell the exact minute of onset. I still wonder why the onset is so sudden and unexpected.
Monday, July 7, 2008
Health Care in India
India is supposed to be one of the fastest growing economy in the world. How does the growing economy help the poor in India? How it affects the health care situation especially for the poor?
An article bringing light into the true facts regarding the health care situation in rural India is there in The Hindu. The village Dhasai is only 150 kms away from India's commercial capital Mumbai.
Such villages are not an exception but the rule in rural India. Still our Government spends abysmally low amounts for health care, less than 2 percent of GDP.
So much political and media attention is there on the Indo-US nuclear deal.Will our politicians ever look seriously at this question of providing affordable and easily accessible health care facilities for all Indians?
An article bringing light into the true facts regarding the health care situation in rural India is there in The Hindu. The village Dhasai is only 150 kms away from India's commercial capital Mumbai.
Such villages are not an exception but the rule in rural India. Still our Government spends abysmally low amounts for health care, less than 2 percent of GDP.
So much political and media attention is there on the Indo-US nuclear deal.Will our politicians ever look seriously at this question of providing affordable and easily accessible health care facilities for all Indians?
Sunday, July 6, 2008
A happy family
Two days ago a family came to meet me. A 32- year-old husband with his wife and 3 year old son. They came to see me regarding a minor fever for the wife. They seemed to be happy, especially the kid who kept on exploring my consultation room for treasures. My thoughts went back to the time they visited me the first time.
They were referred to me by a Gynecologist when a routine HIV screening on the pregnant woman was found to be 'positive'. They were in tears, the husband and wife. They did not want the baby but it was too late to abort. They wanted to end their lives as the husband also turned out to be 'positive'. I tried to talk to them in a positive way. I assured them that with proper treatment for the mother and the newborn, the baby will be negative. I also told them that HIV/AIDS is now a well treatable condition, and they will be able to continue living with a good quality of life indefinitely. They did not want any of their family members to know. I promised that I wont tell anybody.
Next day itself I started Mother to Child infection prevention medicines. Her pregnancy period was uneventful, and she delivered a normal boy by Cesarean section. In case of a 'positive' mother, it is always better to avoid breast feeding if the parents could afford formula feeding. So the paediatrician while giving the newborn the medicines for prevention of infection asked them not to give breast milk. This advice produced a commotion among women members of the family. The guy (new father)called me frantically warning me that both Grand mothers are coming to me to ask me about breast feeding. He pleaded with me not to say anything about HIV.
Meanwhile I called the Gynecologist and pediatrician and discussed with them what to reveal and what not to reveal. We decided that we will tell a lie as per the wishes of the couple. The Grand-mothers arrived in front of me. I told them that a virus that can cause jaundice is there in the mother's blood. If she breast feed, the newborn will get infected with dire consequences. So, it is better to give formula feeding. If they have any doubt they can ask the other 2 doctors. Some how or other, I was able to convince the two women. Later I learned that they did not go to other 2 doctors.
All was seemingly well for a few days when suddenly I heard that the guy was hospitalised for attempted suicide. The young mother one day told her mother all the truth. On hearing that, the husband not able to bear the thought of stigma tried to kill himself but fortunately was unsuccessful.
After 18 months, the couple came to me with the kid. They were very happy. They just got the result showing that their boy is HIV Negative. I asked them how is it with their families. They told me that both parents know the truth and they are very supportive.
Later last year, I referred the guy to the ART centre as his CD4 count was below 200. Now he is on ART for last 9 months. His last CD4 count showed steady improvement.
All these I remembered as I watched the son happily playing with a paper weight on my table.
Then the mother said, 'He has not been given any shots'.
I was shocked. The 3-year-old child has not been given any vaccines for immunisation. How could it be like that?
She said that when they went to the nearest Govt Health Centre for immunisation, they saw the HIV positive status written on the mother's medical record. The doctor there was confused which all vaccines to be given. So he referred the child to a Higher Centre some distance away, but the couple fearing stigma never went there.
I asked them to get the child vaccinated immediately, told them to take ART regularly, also reminded them about measures to prevent further pregnancy and said goodbye.
It was a pleasantly satisfying interview for me.
They were referred to me by a Gynecologist when a routine HIV screening on the pregnant woman was found to be 'positive'. They were in tears, the husband and wife. They did not want the baby but it was too late to abort. They wanted to end their lives as the husband also turned out to be 'positive'. I tried to talk to them in a positive way. I assured them that with proper treatment for the mother and the newborn, the baby will be negative. I also told them that HIV/AIDS is now a well treatable condition, and they will be able to continue living with a good quality of life indefinitely. They did not want any of their family members to know. I promised that I wont tell anybody.
Next day itself I started Mother to Child infection prevention medicines. Her pregnancy period was uneventful, and she delivered a normal boy by Cesarean section. In case of a 'positive' mother, it is always better to avoid breast feeding if the parents could afford formula feeding. So the paediatrician while giving the newborn the medicines for prevention of infection asked them not to give breast milk. This advice produced a commotion among women members of the family. The guy (new father)called me frantically warning me that both Grand mothers are coming to me to ask me about breast feeding. He pleaded with me not to say anything about HIV.
Meanwhile I called the Gynecologist and pediatrician and discussed with them what to reveal and what not to reveal. We decided that we will tell a lie as per the wishes of the couple. The Grand-mothers arrived in front of me. I told them that a virus that can cause jaundice is there in the mother's blood. If she breast feed, the newborn will get infected with dire consequences. So, it is better to give formula feeding. If they have any doubt they can ask the other 2 doctors. Some how or other, I was able to convince the two women. Later I learned that they did not go to other 2 doctors.
All was seemingly well for a few days when suddenly I heard that the guy was hospitalised for attempted suicide. The young mother one day told her mother all the truth. On hearing that, the husband not able to bear the thought of stigma tried to kill himself but fortunately was unsuccessful.
After 18 months, the couple came to me with the kid. They were very happy. They just got the result showing that their boy is HIV Negative. I asked them how is it with their families. They told me that both parents know the truth and they are very supportive.
Later last year, I referred the guy to the ART centre as his CD4 count was below 200. Now he is on ART for last 9 months. His last CD4 count showed steady improvement.
All these I remembered as I watched the son happily playing with a paper weight on my table.
Then the mother said, 'He has not been given any shots'.
I was shocked. The 3-year-old child has not been given any vaccines for immunisation. How could it be like that?
She said that when they went to the nearest Govt Health Centre for immunisation, they saw the HIV positive status written on the mother's medical record. The doctor there was confused which all vaccines to be given. So he referred the child to a Higher Centre some distance away, but the couple fearing stigma never went there.
I asked them to get the child vaccinated immediately, told them to take ART regularly, also reminded them about measures to prevent further pregnancy and said goodbye.
It was a pleasantly satisfying interview for me.
Thursday, June 26, 2008
Negative thoughts about 'Positives'
Recently I was attending a dinner and having small talk with my doctor friends. A doctor was talking about how lucky he was in finding out one of his patient was HIV positive just in time to refer him to a Government Medical College without causing any 'damage' to his nursing home. He was patting himself in the policy of his Nursing Home to screen all patients for HIV and to refer all patients who were found 'positive'. At the same time he was lamenting that these 'positive brutes' always hide their 'Positive' status.
Why do they hide the 'positive' status?Especially why do they hide in front of that doctor?
None of them hide their 'positive' status from me.Because they knew from their friends or relatives or other doctors that I never discriminate. So why they hide their status elsewhere? Because they fear stigma and discrimination. They know that the moment the 'positive' status is known they will be discriminated and stigmatised.If there is so much stigma and discrimination among medical community what can you expect from common people?
Why do they hide the 'positive' status?Especially why do they hide in front of that doctor?
None of them hide their 'positive' status from me.Because they knew from their friends or relatives or other doctors that I never discriminate. So why they hide their status elsewhere? Because they fear stigma and discrimination. They know that the moment the 'positive' status is known they will be discriminated and stigmatised.If there is so much stigma and discrimination among medical community what can you expect from common people?
Sunday, June 15, 2008
Being positive with 'Positives'
Today I was invited to be with some of the 'Positive' people in my district.I am referring to a meeting organised by the local Network of HIV positive persons.
When I reached there, the meeting had already begun. It was held in a Hall in a house which also houses the office of the network. There were around 50 adults, women almost equalling men. Around 10 kids were also there playing in the next room.Most women were sitting on the floor while men had chairs and few benches to sit. Most of them were poor, some may be in lower middle class. Most are Hindus, some Muslims and a few Christians. They include Manual labourers, Drivers, House wives, Sex workers and many are currently unemployed. The only thing common about them was that they were all 'positive' persons.
Today was their monthly meeting day. They come here to discuss their health, about Stigma and discrimination they face, about the difficulties they face in getting employment and sending their kids to school, and about the ways to get more benefits from the Government etc.
When I came in their faces lit up. I know many of them. I am a regular visitor there. I usually take Health classes for them. I give them hope and so they like me.
Today also I stressed the importance of taking medicines regularly in the correct dosage at the correct time. I told them not to worry about side-effects of medicines. It can be managed. I told them the importance of healthy food and asked them to abstain from tobacco and alcohol.
They listened intently and in the end when I asked if they have any questions, many stood up but they were not asking questions. They wanted to consult me. They wanted solutions for their personal health problems, not a health lecture. Such lectures they are hearing regularly.
I saw some of them. A 10 year old kid taking ART [ anti retro viral therapy] had Scabies. A 45- year- old man's cough was persisting even after completing anti tuberculous therapy. Many had general medical complaints not related to their 'positive' status. They were not keen on relieving their status to other doctors. They also complained that when they reveal their 'positive' status, many doctors ask them to get treatment from the ART Centre [which is 2 hours away]itself.
I did not had time to see all of them as I had planned only a class. The organisers were embarrassed.They started shooing away those crowding around me. I went promising to come again to them another day.
The Government and many NGOs are helping them.Even then their plight is miserable. It is a big fight for them every day to keep their body and soul in good spirits.I try to do my bit by being positive with 'Positives'.
When I reached there, the meeting had already begun. It was held in a Hall in a house which also houses the office of the network. There were around 50 adults, women almost equalling men. Around 10 kids were also there playing in the next room.Most women were sitting on the floor while men had chairs and few benches to sit. Most of them were poor, some may be in lower middle class. Most are Hindus, some Muslims and a few Christians. They include Manual labourers, Drivers, House wives, Sex workers and many are currently unemployed. The only thing common about them was that they were all 'positive' persons.
Today was their monthly meeting day. They come here to discuss their health, about Stigma and discrimination they face, about the difficulties they face in getting employment and sending their kids to school, and about the ways to get more benefits from the Government etc.
When I came in their faces lit up. I know many of them. I am a regular visitor there. I usually take Health classes for them. I give them hope and so they like me.
Today also I stressed the importance of taking medicines regularly in the correct dosage at the correct time. I told them not to worry about side-effects of medicines. It can be managed. I told them the importance of healthy food and asked them to abstain from tobacco and alcohol.
They listened intently and in the end when I asked if they have any questions, many stood up but they were not asking questions. They wanted to consult me. They wanted solutions for their personal health problems, not a health lecture. Such lectures they are hearing regularly.
I saw some of them. A 10 year old kid taking ART [ anti retro viral therapy] had Scabies. A 45- year- old man's cough was persisting even after completing anti tuberculous therapy. Many had general medical complaints not related to their 'positive' status. They were not keen on relieving their status to other doctors. They also complained that when they reveal their 'positive' status, many doctors ask them to get treatment from the ART Centre [which is 2 hours away]itself.
I did not had time to see all of them as I had planned only a class. The organisers were embarrassed.They started shooing away those crowding around me. I went promising to come again to them another day.
The Government and many NGOs are helping them.Even then their plight is miserable. It is a big fight for them every day to keep their body and soul in good spirits.I try to do my bit by being positive with 'Positives'.
Friday, June 13, 2008
Polio eradication
While working in Government service, I took part in the 'Indian Pulse Polio Campaign' [as part of my duty] and had supervised immunisation of thousands of children given Oral Polio vaccine[OPV]. On a single day all the kids below 5 years were given the vaccine. This Campaign continued twice a year for several years. Still it is continuing in India at least in some states. What is the result? India [along with 3 other countries ] still reports many Polio cases. Why the Polio eradication campaign with OPV failed?
Pushpa Bhargava in an interesting article in 'The Hindu' is of the opinion that it was destined to fail. Many of the experts as early as in 1988 were favouring Injectable inactivated Polio Vaccine[IPV] for achieving eradication.
Many investigations show that while in developed countries three doses of IPV or OPV can produce a protection rate of 98 percent, in developing countries it was consistently found that OPV is much less effective than IPV. Two doses of IPV can generate a protection rate of 89 percent, while the protection rate of two doses of OPV is only 72 percent. Three doses of IPV can protect almost 100 percent of the children, while three doses of OPV protect less than 85 percent of the children The reasons for the difference in OPV efficacy in developed and developing countries are not clear. Problems with the cold chain explain only a small part of the difference. The major reason might be the interference of other virus infection, e.g., diarrhea caused by viruses, which hinders the uptake of OPV.
Then why the Government went along with WHO in choosing OPV for eradication?
Pushpa Bhargava in an interesting article in 'The Hindu' is of the opinion that it was destined to fail. Many of the experts as early as in 1988 were favouring Injectable inactivated Polio Vaccine[IPV] for achieving eradication.
Many investigations show that while in developed countries three doses of IPV or OPV can produce a protection rate of 98 percent, in developing countries it was consistently found that OPV is much less effective than IPV. Two doses of IPV can generate a protection rate of 89 percent, while the protection rate of two doses of OPV is only 72 percent. Three doses of IPV can protect almost 100 percent of the children, while three doses of OPV protect less than 85 percent of the children The reasons for the difference in OPV efficacy in developed and developing countries are not clear. Problems with the cold chain explain only a small part of the difference. The major reason might be the interference of other virus infection, e.g., diarrhea caused by viruses, which hinders the uptake of OPV.
Then why the Government went along with WHO in choosing OPV for eradication?
Thursday, June 5, 2008
Medical Tourism in India. A Boon or Curse?
India's annual earnings through Medical Tourism is all set to double to 8000 Crore Rupees [2000 million US dollars] by year 2012 according to a recent study. The main reasons the study claims why medical tourism would flourish in India include much more lower medical costs for various surgical procedures such as bone narrow transparent, coronary bye-pass surgery, knee transplant and liver transplant as compared to western countries and even many of the Asian countries. Very good medical infrastructure not only in large Metros but also in tertiary towns is another reason for medical tourists favouring India.Availability of highly qualified medical professionals and nurses gives them the confidence to do such major procedures here.
How will this affect Indian Health care system?As per World Bank estimates about 80% of all health spending in India is in the private sector.Most of the Posh private hospitals are out of reach of majority of Indians.They are considered as gleaming Islands of excellence surrounded by seas of medical neglect. So a doubling of medical tourism earnings may only make these Islands of excellence more and more inaccessible to common people.Also more and more of the qualified medical professionals may opt out of Govt run Hospitals for highly paid jobs in private sector.This will further weakens Public Health Care
If the Government [which now spends less than 1 percent of its GDP for health sector] can direct some part of the revenue the Health Industry will earn by medical tourism for strengthening the Public health care network the poor Indians may benefit.But that needs considerable amount of Political will and perseverance.
How will this affect Indian Health care system?As per World Bank estimates about 80% of all health spending in India is in the private sector.Most of the Posh private hospitals are out of reach of majority of Indians.They are considered as gleaming Islands of excellence surrounded by seas of medical neglect. So a doubling of medical tourism earnings may only make these Islands of excellence more and more inaccessible to common people.Also more and more of the qualified medical professionals may opt out of Govt run Hospitals for highly paid jobs in private sector.This will further weakens Public Health Care
If the Government [which now spends less than 1 percent of its GDP for health sector] can direct some part of the revenue the Health Industry will earn by medical tourism for strengthening the Public health care network the poor Indians may benefit.But that needs considerable amount of Political will and perseverance.
Wednesday, June 4, 2008
Stay away from this Temple feast
Visit to a Temple [or any other religious place] is always a great experience. It brings peace to our mind and washes away depression and sorrows. We get 'prasadam', which we eat with reverence and gratitude with the belief that it will make us better in body and mind.
When we see frequently devotees getting sick after pilgrimage to a particular Temple, our suspicions are raised. For last few years, I am seeing devotees getting sick within few days of their travel to Mookambika Temple at Kollur, Karnataka. Many had a severe form of typhoid, some had jaundice due to Viral Hepatitis, and most had an acute self-limiting diarrhoeal disease. Almost all my patient devotees had taken the Temple feast. I strongly suspect either there is fecal contamination of the water used for drinking /cooking, or one of the food handler may be a carrier for such disease causing organism. I had informed this to local Public health authorities, but it seems not much action had been taken as the Temple is in a different State. So now it is wiser to stay away from the temple feast there to maintain the health of our body. Or will the Temple authorities of one of the most famous Devi Temples of India wake up and act?
When we see frequently devotees getting sick after pilgrimage to a particular Temple, our suspicions are raised. For last few years, I am seeing devotees getting sick within few days of their travel to Mookambika Temple at Kollur, Karnataka. Many had a severe form of typhoid, some had jaundice due to Viral Hepatitis, and most had an acute self-limiting diarrhoeal disease. Almost all my patient devotees had taken the Temple feast. I strongly suspect either there is fecal contamination of the water used for drinking /cooking, or one of the food handler may be a carrier for such disease causing organism. I had informed this to local Public health authorities, but it seems not much action had been taken as the Temple is in a different State. So now it is wiser to stay away from the temple feast there to maintain the health of our body. Or will the Temple authorities of one of the most famous Devi Temples of India wake up and act?
Monday, June 2, 2008
Are we winning against Tuberculosis?
It is now 2008,more than 40 years after the discovery of Rifampicin, the most potent drug against Tuberculosis.The 3 or 4 drug cocktail that includes Rifampicin almost always work against Tuberculosis.These drugs are available free of cost at Government health units through out India.Still TB is rampant and some say it is increasing.It is estimated that about 1 in 3 of new TB infected patients do not get access to the Govt run TB control programme. Even if they get access it is not properly utilised.
Last week I started anti tuberculous medicines in 5 patients,3 of them on the same day. I offered them reference to Govt TB control facility.I told them that they will get the drugs free of cost and that the drugs are of good quality.But only one, a poorly paid nursing trainee took the offer.Others were not rich but were ready to spend money from their pocket for the medicines.Why?
Their confidence in approaching the Govt run TB control centre was low.One reason is such centres are notorious for lack of efficiency. Patients may have to go there several times before they get the medicines.Timings of such centres are such that the patient will have to sacrifice few of his/her working days.Also there is stigma associated with queuing up in front of the crowded TB centre.When drugs are available in private pharmacies at a reasonable cost [as there is a Govt control on prices] why should one take all the pains to get those medicines free?
Inefficiency,lack of privacy,unsuitable working hours,ignorance of the public etc are some of the reasons behind the lack of success of TB control programme even in a literate and health conscious,Semi-urban State of Kerala.So we can very well imagine the plight of the programme in other States of India.
Last week I started anti tuberculous medicines in 5 patients,3 of them on the same day. I offered them reference to Govt TB control facility.I told them that they will get the drugs free of cost and that the drugs are of good quality.But only one, a poorly paid nursing trainee took the offer.Others were not rich but were ready to spend money from their pocket for the medicines.Why?
Their confidence in approaching the Govt run TB control centre was low.One reason is such centres are notorious for lack of efficiency. Patients may have to go there several times before they get the medicines.Timings of such centres are such that the patient will have to sacrifice few of his/her working days.Also there is stigma associated with queuing up in front of the crowded TB centre.When drugs are available in private pharmacies at a reasonable cost [as there is a Govt control on prices] why should one take all the pains to get those medicines free?
Inefficiency,lack of privacy,unsuitable working hours,ignorance of the public etc are some of the reasons behind the lack of success of TB control programme even in a literate and health conscious,Semi-urban State of Kerala.So we can very well imagine the plight of the programme in other States of India.
Friday, May 23, 2008
Crisis averted?
Doctors working in Government run Hospitals in my native State Kerala has called off their proposed strike yesterday. The working conditions of Doctors in Government sector is so poor that only a hand full of new pass outs from Medical Colleges join it.The demands of Doctors agreed to by the Government may help in persuading those who work in that sector not to leave it.But will it help to attract new recruits?Chances are low as there are much greener pastures waiting them elsewhere. This raises a doubt.Is the current Government really interested in Public Health?
Subscribe to:
Posts (Atom)
