I do believe angels exist

I love to talk when I'm in the mood. And the best thing to get me into mood is to set up a good conversation. Last Monday proved one such day when I was having a conversation with a junior budding physician from Kolkata Medical College. We talked on various topics and soon it turned to society and our perspective of it. I have to admit although of my being bit of a pessimistic person in this matter but the conversation tickled many grey cells and later I received an email from his side detailing one of his many experiences as a trainee. I present it here with his due permission:

"He spake well who said that graveyards are the footprints of angels" - H. W. Longfellow

What’s the relevance of this quote with my status update??? 

Oh yes, there is. In these 6 long years of my life as a 'junior' doctor, I have witnessed the fate of several patients. Some have been cured; some have died while some others have survived only to lead a mere future life of hopelessness. Many of these souls have become too closely attached to me. And one of them is undoubtedly that small boy of our very own Paediatrics Department...the one I have always talked about: the HIV infected youngest friend of mine about whom I had written almost a year back. 

My last day out with this little friend of mine was 8 months back when he came to our hospital with the same old complaint of fever and diarrhea and got admitted. But since then there has been an uncanny silence from his end and I got no trace of him through calls or letters. The ice was finally broken when I enquired about his whereabouts from the nurses of our Medical ward where he was last admitted. And what did I come to know was that he is no more. He left this world 5 months back! He went into a deep slumber from which he will never wake up. 

I went silent for a moment. I looked down at the envelope in my hand in which I had brought the money to give him so that he could have a great time in the festive season. But all was a waste.

What's the use of the money now...

I feel helpless and hopeless at times when I lose someone close to my heart. I ask myself, ‘who are we? Next to God or next to nothing? We take pride in making new drug discoveries or when we heal a patient physically. But can we heal him from within? Can we help him adapt to this filthy society and live the life with dignity?’ 

The answer that creeps up every time is a big ‘No’.

We don’t in most cases. But surely we can. Curing someone isn’t merely restricted to healing of a bed-sore or relieving Acute Kidney Injury through Hemodialysis or prolonging the life of a cancer patient by 5 years. To heal someone means to heal with the power of love. Even if medical therapy fails to resuscitate a dying person but the touch of love can surely let his pain be eased in the last few moments of survival. I don’t know if I will ever emerge as a stalwart in my professional arena, but what I am happy about is the fact that I have given all the love I could to my little friend who would always have a shining smile on his face upon catching a glimpse of me. Now he will rest in peace forever in my sweetest memories. But the war he fought so far should never go in vain. 

The money that I failed to give him before he breathed his last still lies in the locker of my bank account. And someday, I want to use it for building a centre for the welfare of HIV infected children. You can call me a dreamer because ingle headedly it’s surely a difficult task but I hope people from this very society will join me in this venture over time. I do believe angels exist—even today...

Courtesy: Dr. Avik Basu

New HIV infections down by 20 per cent in India: UN

http://timesofindia.indiatimes.com/india/New-HIV-infections-down-by-20-per-cent-in-India-UN/articleshow/48079039.cms via@timesofindia

India has been able to achieve a more than 20 per cent decline in new HIV infections between 2000 and 2014, reversing the spread of the virus, according to a UN report that says the world is on track to end the AIDS epidemic by 2030.

New HIV infections have fallen by 35 per cent and AIDS-related deaths by 41 per cent, while the global response to HIV has averted 30 million new infections and nearly 8 million AIDS-related deaths since 2000 (UNAIDS).

The report noted that India "literally" changed the course of its national HIV epidemic through the use of strategic information that guided its focus to the locations and population approach.

"This placed communities at the centre of the response through the engagement of non-state actors and centrally managed policy and donor coordination," it said.

HIV treatment coverage for people living with HIV and TB has also increased and in terms of numbers of patients, the largest increases in antiretroviral therapy among people living with both HIV and TB have occurred in India, South Africa, Tanzania and Zambia.

India accounts for more than 60 per cent of the Asia Pacific region's people living with HIV-associated TB.

The report noted that currently nearly 85 per cent of the antiretroviral medicines for HIV treatment come from India.

It said the Indian government had also succeeded in preserving the legislative and policy spaces that permit Indian companies that make generic medicines to consolidate their exporting capacities to other developing countries.

Currently, however, India is under pressure from several companies and governments of developed countries to dilute these provisions in free-trade agreements being negotiated with them, it said.

Physical activity Guidelines by WHO

WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs.

The recommendations address three age groups: 5–17 years old; 18–64 years old; and 65 years old and above.

Physical Activity and Young People (for children aged 5 - 17 years):

In order to improve cardiorespiratory and muscular fitness, bone health, and cardiovascular and metabolic health biomarkers:

1. Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
2. Amounts of physical activity greater than 60 minutes provide additional health benefits.
3. Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.

*For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

ü  These recommendations are relevant to all healthy children aged 5–17 years unless specific medical conditions indicate to the contrary.

ü  The concept of accumulation refers to meeting the goal of 60 minutes per day by performing activities in multiple shorter bouts spread throughout the day (e.g. 2 bouts of 30 minutes), then adding together the time spent during each of these bouts.

ü  For inactive children and youth, a progressive increase in activity to eventually achieve the target shown above is recommended. It is appropriate to start with smaller amounts of physical activity and gradually increase duration, frequency and intensity over time. It should also be noted that if children are currently doing no physical activity, doing amounts below the recommended levels will bring more benefits than doing none at all.

Physical Activity and Adults (physical activity for adults aged 18 - 64 years):

In order to improve cardiorespiratory and muscular fitness, bone health, reduce the risk of NCDs and depression:

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

ü  These recommendations are relevant to all healthy adults aged 18–64 years unless specific medical conditions indicate to the contrary. They are applicable for all adults irrespective of gender, race, ethnicity or income level. They also apply to individuals in this age range with chronic non-communicable conditions not related to mobility such as hypertension or diabetes.

ü  There are multiple ways of accumulating the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Pregnant, postpartum women and persons with cardiac events may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for this age group.

ü  Inactive adults or adults with disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Physical Activity and Older Adults (physical activity for adults aged 65 and above):

In order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:

1. Older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
2. Aerobic activity should be performed in bouts of at least 10 minutes duration.
3. For additional health benefits, older adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
4. Older adults, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
5. Muscle-strengthening activities, involving major muscle groups, should be done on 2 or more days a week.
6. When older adults cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

ü  These guidelines are relevant to all healthy adults aged 65 years and above. They are also relevant to individuals in this age range with chronic NCD conditions. Individuals with specific health conditions, such as cardiovascular disease and diabetes, may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older adults.

ü  There are a number of ways older adults can accumulate the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts, of at least 10 minutes each, spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.

ü  Older adults who are inactive or who have some disease limitations will have added health benefits if moving from the category of “no activity” to “some levels” of activity. Older adults who currently do not meet the recommendations for physical activity should aim to increase duration, frequency and finally intensity as a target to achieving them.

Note: These recommendations can be applied to people with disabilities. However, adjustments for each individual based on their exercise capacity and specific health risks or limitations may be needed.

Eight Millenium Development Goals

the disease map

This map shows which disease is most likely to kill you depending on where you live.

public health solution for malaria - Gene manipulated mosquitos?

British scientists have manipulated the genes of a specific type of mosquito so that only male offspring is produced and the animals are eliminated within several generations. "Nature Communications".

In order to inhibit the production of female offspring among the mosquitos (Anopheles gambiae), the researchers from Imperial College London used the enzyme I-Ppol. In males, it damages the DNA of the X chromosomes in sperm production. Thus, the modified mosquitos had almost no functional sperm with X chromosomes and produced 95 per cent male offspring.

The scientists mixed the genetically modified insects with five caged normal mosquito populations. Because of the lack of females, four of them were entirely eliminated within six generations. This way, malaria-carrying mosquitos could be eliminated in the wild. However, no research was undertaken as to which consequences this may have on the ecosystem.

"What is most promising about our results is that they are self-sustaining. Once modified mosquitoes are introduced, males will start to produce mainly sons, and their sons will do the same, so essentially the mosquitoes carry out the work for us", said study author Nikolai Windbichler.

Medical negligence and compensation, time to have more practical approach

From: thehindubusinessline.com

Body blow to the medical profession

Compensation for medical malpractice should be capped. Else, there will be no doctors left to perform surgeries
The recent Supreme Court ruling on medical compensation of ₹11 crore in Kolkata has raised several issues related to the medical profession and its practice. The Supreme Court has rightly upheld the law of the land.

In 2030 BC, during the Old Babylonian period, the Code of Hammurabi read: “If the doctor has treated a gentleman with a lancet of bronze and has caused the gentleman to die or has opened an abscess of the eye for a gentleman with a bronze lancet and has caused the loss of the gentleman’s eye, one shall cut off his hands”.

Chopping off doctor’s hand for making a mistake is definitely effective but after some time there will be few doctors left with the hands to operate. The current Indian law governing the medical negligence is not vastly different than that of Hammurabi’s Code.

Gynaecologists will retreat
And, what is the state of healthcare delivery in India? As many as 84 per cent of the hospitals in India are less than 30 beds in size, where more than 60 per cent of the children of this country are born. Among doctors, gynaecologists are most vulnerable to litigation.

A majority of these nursing homes do not even have a medical records department to protect them in the case of litigation. Any sincere effort to save the life of a patient, not backed by a well documented medical record, can never stand in the court of law.

A gynaecologist builds a typical 30-bed nursing home in a small town after slogging for decades and building a reputation for himself and the nursing home.

However, if an unfortunate incident occurs and someone sues the gynecologist for ₹2 crore — which is not a lot of money compared to ₹11 crore compensation offered in Kolkata — there will be a problem.

Even if the small town gynaecologist sells his nursing home, his house and farmland, if he has any, he will not be able to come up with ₹2 crore.

Doctors, in general, are in a very insecure profession, since they are dealing with human life. We are now adding an angle of financial insecurity, which can potentially bankrupt the doctor and his family.

One or two stray incidents across the country claiming a compensation of ₹1 or 2 crore against these gynaecologists in small towns is good enough to send shock waves among the medical community.

The media spotlight is bound to amplify the impact. In a very short time most gynaecologists taking care of pregnant ladies in small towns will move to big hospitals in cities where they are protected.

If the issue is not addressed soon, we can expect maternal mortality to double.

Get real
Our policymakers boast of India having 6 lakh doctors. What they have not realised is that nearly two lakh doctors, instead of seeking invaluable learning by the patient’s bedside, are busy mugging MCQs (multiple choice questions) for two to five years in Kerala or Kota in pursuit of one of those elusive PG seats.

As a result, junior doctors doing night duty in small towns simply do not exist. Specialists in small towns are handicapped with very little support from junior doctors, trained nurses and technicians.

In the early 1990s the medical profession in the US was reeling under the impact of astronomical compensation for malpractice.

As expected, malpractice insurance premium went up to three months of doctors’ salary. The doctors decided to stop conducting deliveries. As a result, the government had to airlift pregnant ladies during childbirth from small towns to bigger city centres. Obviously, it was unsustainable and risky.

So, several states in the US capped malpractice compensation at $ 250,000 (₹1.5 crore). This capping reduced malpractice suits significantly. Today, the US has one lawyer for every 300 people! No wonder, one in every seven doctors is sued there every year. India is not too far behind; Delhi has one advocate for every 300 citizens!

Change the law
Capping compensation is not new to Indian law. Government officers cannot be fined for more than 33 per cent of their basic salary. In the US and several European countries, capping the malpractice compensation is a norm.

Human life is precious. Leave alone ₹11 crore, even if the family is paid ₹1,000 crore it cannot compensate for the loss of life. The only question is: What can we afford?

Of course, medical malpractice deserves punishment. Doctors who have neglected the patient are punished through the Medical Council, which can remove their right to practice temporarily or permanently, and this is one of the worst punishments for a doctor. Added to that some financial compensation is definitely required.

However, if the compensation is going to ruin the doctor, his family and his future, we are not far away from the rule of Hammurabi.

As a country, we need to protect everyone’s life. But if we try to implement first-world regulatory structure with third-world infrastructure, we will be in trouble. We are a country short of one million doctors, two million nurses and three million beds.

With this scarcity, we should concentrate more on improving the infrastructure, creating the right regulatory framework to protect the life of the patients as well as an ideal working environment for the doctors. On this issue, governments’ mandate should be to cap the malpractice compensation.

Compensating the family by ₹2 crore instead of ₹20 lakh will not revive a lost life. But it can wreck the doctor’s family and close down small nursing homes in backward areas, putting the lives of thousands of people at risk.

Professional bodies such as the Indian Medical Association and Association of Healthcare Providers of India (AHPI) should write to the Minister of Health to request the Ministry of Law to cap the malpractice compensation.

The writer is founder and chairman, Narayana Health.