The ongoing Russia- Ukraine conflict has generated a discussion about a sub-plot, which links to India’s medical education. There have been reports that there are 18000 Indian medical students in Ukraine. People are wondering why Medical Students from India need to go to Ukraine for studying medicine. Answer is quite simple and does not need an Einstein Brain. It is the steep fee that private medical colleges charge from students which is unjustified and beyond any logic. It just needs a sincere ‘Government Will’ to implement the justified fee for MBBS seats in private medical colleges in India. Medical colleges in Ukraine, Georgia, Kyrgyzstan, Bangladesh, Philippines and China have been benefitted because of the severe exploitation of medical students in India.
It needs a sincere and honest assessment of the fee and expenditure of medical college and education rather than a permission for heavy profiteering. If honest calculations are carried out, the fee should not be more than one fifth of present rates, taking into account the hospital services expenditure.
Why do Indian students go to Ukraine to pursue courses, especially MBBS? Because of affordability, says Manjula Naidu, proprietor of a firm that helps send students to Ukraine’s Bukovinian State Medical University. Usha Rani, an Anekal resident whose son is in first-year MBBS at Zaporizhzhia State Medical University, said she wouldn’t have sent him to Ukraine had she been able to pay nearly Rs 80 lakh for an MBBS course in Karnataka. Though Karnataka has more than 9,000 MBBS seats, government quota seats account for not even 40%, forcing many aspirants to opt for countries like Ukraine, Georgia and Kyrgyzstan. What students and their parents find attractive is the Rs 25-30 lakh package for the entire course. Besides there are consulting agencies to help them with loans and the medium of instruction is English. On the other hand, the first fee slab for an MBBS seat in a government college is Rs 59,000 per year, followed by the second slab of government quota seats in private colleges (Rs 1.4 lakh per annum). The next fee slab is of private seats (management quota) in private colleges that varies from Rs 10 lakh to Rs 25 lakh a year. Even more expensive are the NRI quota seats and those in deemed universities.
With the evolving medical science and health care getting intertwined with business, braided changes in medical regulation and law are not an unexpected development. New models of medical regulation, business and law in health care have emerged and progressed in last few decades. Despite a wish to govern and regulate medical profession strictly, the laws and regulations still have to go a long way to provide real justice to everyone. No one really knows how to regulate this difficult area, which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and relief , sadness and happiness, smiles and sorrow and other uncountable emotions, all intertwined with financial aspects.But the wish of administrators to govern medical profession strictly with punishments is not new. Hammurabi (5000 years back) at the start of civilization believed that doctors needed to be punished in case there was a poor outcome. Strangely it was at a time, when no one understood the complexity of human body and the limitations of medical science; even basic anatomy and physiology of body was not discovered.
Considering the limitations of medical science along with uncertainties and complexities of human body, regulation of medical profession and system of punishments still remains somewhat unfair to doctors, even after 5000 years. It is still based on principles of revenge and retributions rather than developing a robust system by learning from mistakes. By application of an average wisdom, doctors can be easily blamed for poor outcomes, as they are always and universal a common visible link between treatment and poor outcome.
One of the examples of easy punishments for doctors is Medical consumer protection act that was implemented in 1995 for medical services. Patients were defined as consumers and hence doctors were converted to service providers in lieu of some money. Consequently the changed definitions altered the doctor-patient relationship in an irreversible way.
The reality is that neither doctors, nor patients are ready for such a legal relationship. More-over the system is not robust enough for such a change. To work with weak infrastructure, non-uniform medical education, poor numbers of support staff, inept health system along with legal complexities has pushed doctors into a shell and predisposed them to harassment.
Rather than developing a system to promote good doctor-patient relationship, Medical Consumer Protection Act has created a situation of ‘us versus them syndrome’. It caused erosion of doctor-patient relationship and escalated cost of care. Propagation of stray and occasional incidents about negligence case in court or their outcomes are given disproportionate wide publicity in media. The patients are unable to understand the correct application of such stray incidents to themselves. Such cases may be frivolous, just one in million or a rarity, but people always try to imagine themselves being in the hospital chaos due to the scenario projected. It gives a negative projection about medical services and enhances patients’ fear to seek treatment at right time.
There is a growing mutual mistrust; doctors too have started looking at every patient as a potential litigant. Especially while dealing with very sick ones, practice of defensive medicine is a natural consequence. This may manifest as excessive investigations, more use of drugs, antibiotics and even reluctance or refusal to treat very sick patients.
With the mandate to practise evidence based medicine, doctors need to document everything and to offer everything possible, leading to skyrocketing medical costs. To save themselves, doctors have to do mammoth paper work, leading to consumption of time that was meant for real deliberations for the benefit of patients.
Consequently insurance companies, medical industry and lawyers have become indispensable and have positioned themselves in between doctor and patients. Besides creating a rift between doctor and patient, they charge heavily from both sides; from patients (medical insurance, lawyer fee) and doctors (indemnity insurance, lawyer’s fee) alike. The vicious cycle of rising costs, need for insurance, medicolegal suits, and high lawyer fee (for patients and doctors) goes on unabated. All these contribute significantly to overall inflated cost of health care.
Not uncommonly doctors are used as scape goats to have a concession on the patient’s treatment from administrators.
Medical consumer protection act has increased the anxiety and insecurity among medical professionals. Doctors can be dragged to courts for trivial reasons, for example the sense of revenge, simply for non-satisfaction, to extract money or simply for avoiding paying for services. In an era where family members, brothers and sisters fight for money, it will be naïve to think that idea of making money from doctors does not exist. These money-making ideas are further stoked by the much publicized incidents of high compensations granted by courts.
Medical lawsuits and complaints (right or wrong) are breaking medical professionals from within, not to mention the toll it takes on their confidence and belief, which takes a lifetime to build.
Whenever there is adverse outcome in any patient, all the doctors involved start looking for whom to blame among themselves. Due to legal pressure they try to pinpoint each other’s mistakes. Mutual understanding takes a back seat and the teamwork is spoiled permanently. Administrators in a bid to be safe, encourage putting doctor’s concerns against each other, creating a strange sense of enmity among medical professionals.
The ease with which doctors can be harassed has led to rampant misuse of medical consumer protection act and it has instilled a sense of deep fear and insecurity in the mind of medical professionals. The act has been used as a whip against the doctors by all, including medical industry, law industry and administrators. Only doctors are visible as those who deliver care, so they remain at receiving end for poor outcomes and all these industries remain invisible. The industry has used the protective systems against medicolegal cases to gain maximum benefits out of doctors’ hard work.
In court cases, a certain element of doubt always remains in mind of a doctor whether he will get justice in the long run, or will end up being a victim of sympathy towards patient or clever lawyering. So taking medical decisions in critical situations is becoming more difficult in view of the future uncertainty of disease.
Windfall profits for lawyers is a strong incentive for law industry to promote instigation of patients by against doctors . One can see zero fee and fixed commission advertisements on television by lawyers in health systems even in developed countries. They lure and instigate patients to file law suits and promise them hefty reimbursements on ‘sharing and commission basis’. There is no dearth of such relatives and lawyers who are ready to try their luck sometimes in vengeance and sometimes for the lure of money received in compensations.
Consequently doctors are now an easily punishable human link for poor outcomes. Medical professionals work with continuous negative publicity, poor infrastructure, and preoccupied negative beliefs of society and burden of mistrust.
Strangely Medical Consumer Protection Act applies only to doctors, that too selectively. All other professions and services are out of it, not even other constituents of health services. Selective application is what is demoralizing the doctors. Considering the uncertainty and kind of work done by medical professionals, actually it should be other way around.Mistakes are always easy to be picked with retrospective analysis and with lawyers pondering over it for years. In such situations, doctors are sitting ducks for any kind of blackmail.
Nothing else has ever distracted doctors more than medico-legal cases and punishments. In certain circumstances, saving themselves becomes more important than saving a patient. Decision making also becomes difficult by uncertainty of prognosis, grave emergencies, split second lifesaving and risky decisions that may later be proved wrong by retrospective analysis with wisdom of hindsight with luxury of time and fault-finding approach. The possibility of complex medico-legal situations in doctor’s mind are enough to distract doctors from their primary point of intentions ‘the treatment’.
Therefore increasingly, financially secure doctors are staying away from the riskier jobs. No wise person will like to face medicolegal complexities in older age. Taken to court for a genuine decision is enough to spoil and tarnish health, wealth and fame that was earned by slogging the entire life.
Patients can have poor outcomes for many reasons. It can be severe disease, poor prognosis, rare or genuine complications or even unintentional mistake or human errors, system errors or deficiency. Whatever court decides, while consuming years, the harassment of doctor is full and permanent. Even if court decides in favour of the doctor, there is no compensation possible for the sufferings and agony spanning over years. Therefore, a single mistake can undo all the good work of past, and the illustrious future work that could have been accomplished.
If the decision to decide or act or help someone in an emergency situation, puts one’s own life and career at risk, why would anyone put himself in that difficult position?
Medical Consumer Protection Act has become a tool to harass doctors and money making tool for lawyers, medical industry or administrators. But it would be naïve to assume that by whipping doctors and regulating them in such a harsh manner will be helpful to patients in long run. The consequent insecurity among doctors, practise of defensive medicine, enhanced costs, excessive documentation and the distraction from the primary point of intention (treatment) are few of the side effects, which will definitely be passed on to the patients inadvertently. After all doctors have to save themselves as well. As a result, now the battle of life and death will be fought with less zeal, with subdued and demoralized soldiers.
Patients are unable to realize their loss for punishing their saviours. For doctors, no rewards if you win, but sword hanging if one loses. Fear factors on doctors and impact of present legal complexities is already at par with that of Hammurabi’s era. Consequently being consumer may be overall a loss making deal for the patients.
Many have woken up to India’s plastic waste generation problem after worrying data was presented in Parliament. But alarm bells have been ringing for a long time. According to the Centre, plastic waste generation has more than doubled in the last five years, with an average annual increase of 21.8%. A 2018-2019 Central Pollution Control Board (CPCB) report puts India’s annual plastic waste generation at 3.3 million metric tonnes. This, according to experts, is an underestimation. Seven states — Maharashtra, Delhi, Karnataka, Uttar Pradesh, Gujarat, West Bengal, and Tamil Nadu — contribute to 66% of the country’s total plastic generation. And, Goa and Delhi’s per capita plastic use is six times higher than the national average. A 2018 study by IIT Kharagpur found that 49% of waste in Delhi drains was plastic.
There is need for robust national plan, ensure transparency and to involve every stakeholder- from Government and industries to every last citizen.
New Delhi [India], February 18 (ANI): Taking forward the commitment to eliminate single-use plastics, the Environment Ministry has notified comprehensive guidelines on Extended Producer Responsibility (EPR) for plastic packaging under Plastic Waste Management Rules, 2016.
According to the Ministry of Environment, Forest and Climate Change, the guidelines on extended producer responsibility coupled with the prohibition of identified single-use plastic items, which have low utility and high littering potential, with effect from July 1, 2022, are important steps for reducing pollution caused by littered plastic waste in the country.
The minister said that the guidelines provide a framework to strengthen the circular economy of plastic packaging waste, promote the development of new alternatives to plastics and provide further next steps for moving towards sustainable plastic packaging by businesses. “Reuse of rigid plastic packaging material has been mandated in the guidelines to reduce the use of fresh plastic material for packaging,” Yadav said.
The Ministry said that the enforceable prescription of a minimum level of recycling of plastic packaging waste collected under EPR along with the use of recycled plastic content will further reduce plastic consumption and support the recycling of plastic packaging waste.
The EPR guidelines will give a boost for formalization and further development of the plastic waste management sector. As a significant first, the guidelines allow for the sale and purchase of surplus extended producer responsibility certificates, thus setting up a market mechanism for plastic waste management.
“The implementation of EPR will be done through a customized online platform which will act as the digital backbone of the system. The online platform will allow tracking and monitoring of EPR obligations and reduce the compliance burden for companies through online registration and filing of annual returns. In order to ensure monitoring on fulfilment of EPR obligations, the guidelines have prescribed a system of verification and audit of enterprises,” it said.
The guidelines prescribe a framework for the levy of environmental compensation based upon the polluter pays principle, with respect to non-fulfilment of extended producer responsibility targets by producers, importers and brand owners, for the purpose of protecting and improving the quality of the environment and preventing, controlling and abating environment pollution, the Ministry added.
It further said that the funds collected shall be utilized for collection, recycling and end of life disposal of uncollected plastic waste in an environmentally sound manner.
Under these producers, importers and brand owners may operate schemes such as deposit-refund system or buy-back or any other model in order to prevent the mixing of plastic packaging waste with solid waste. (ANI)
NEW DELHI: Has the Covid-19 pandemic worsened addiction to the internet among children? The footfall at psychiatric out-patient departments in hospitals, especially those offering help to kids hooked to the net, be it for online gaming, chatting with friends or sharing videos, offers a glimpse of the problem. At AIIMS, the number of parents seeking help for their children, among them the most being those addicted to online gaming, has increased significantly after the pandemic. The special clinic was inundated with requests from parents seeking help, nearly 80% of them are related to online gaming, 15% about excessive use of social media and the remaining 5% related to problems like pornography”.
The parents of a Class XI student — name withheld on request — approached AIIMS because their son was gaming online for hours, and wasn’t willing to give up the habit. The son even hit his father when the latter tried to take away the laptop. In another case, a Class IX student hooked to online gambling spent Rs 75,000 in a single week on his parent’s credit card. Children have developed mental and emotional issues due to addiction to online streaming services. The girl would stay awake all night to finish the TV series and sleep during the day. It continued for six to seven months. She developed insomnia and began hallucinating, which is when the parents panicked and brought her to hospital. We had to put her on psychiatric medications and counselling. During the pandemic, however, the problem increased multiple times. The schools were closed and classes were being held online. This increased the children’s access to digital technologies. Secondly, social interactions shifted online due to restricted physical movement forced by Covid. They Spend more time online led to the addiction. As for online gaming, doctors said these activities were designed to attract young people and were addictive in nature. Online gaming causes the same kind of craving and withdrawal that you see with any other addiction such as substance abuse.
What is the solution to this? Internet use is one of the important pillars of learning and growth in today’s time and, therefore, it may not be advisable to prevent school children from using it. It may be prudent to promote safe usage of the internet. Very importantly, parents should be aware of the warning signs in their children, for example behavioural changes, reduced interaction with family members, children spending most of their time in their rooms, irregular sleeping or eating habits and mood changes that may signal troublesome usage of the technologies. If the habit persists and worsens, it may be advisable to seek expert help. The problem of internet addiction isn’t limited to children belonging to particular social strata, the doctors said. “We need to have more cyber addiction clinics in government hospitals so even those who cannot afford private treatment can seek timely help,” said one senior medico. “It can help prevent serious mental health issues in children and even save lives.” The doctor added that most children suffering from internet addiction improved with behavioural therapy and counselling. It was only in rare cases that medical management became necessary, he added.
In an era when doctors are being punished for small mistakes or merely perceived negligence, the blunders committed by administrators are not even noticed. Doctors are not paid for four months and for protesting the same, they were given termination letters. It seems that doctors need to live with blatant injustice all their lives.
Any punishment for the administrators for mismanagement? Looks impossible but punishment to the sufferers is on the cards.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world.
Doctors pleadings even for their rightful issues and routine problems are paid deaf and indifferent ears. It is disheartening to see that they receive apathetic attitude and dealt with stick or false assurances even for the issues which should have been solved automatically in routine even by average application of governance.
It is discouraging for the whole medical fraternity to see that even the rightful is not being given what to expect the gratitude and respect.
The indifferent behaviour has also unveiled the approach of tokenism such as ‘mere lip service’ showing respect to corona warriors.
The strong political and legal will is absent to solve Doctors’ problems.
New Delhi: Doctors, nurses and paramedical staff of East Delhi Municipal Corporation-run hospitals continued their protest on Thursday as well over non-payment of salaries for four months. Meanwhile, an order issued by the medical superintendent of Swami Dayanand Hospital, Dr Rajni Khedwal, stated that services of all senior and junior resident doctors would be considered terminated from February 4 and fresh interviews would be conducted accordingly. The order also stated that all Diplomate of National Board (DNB) residents and contractual doctors would be marked absent.
“We all were there in the protest, none of us went for our duties. We have also asked the administration to speak on our behalf because they are too part of the hospital. Maybe the matter will be resolved tomorrow. Unless we get a concrete statement regarding salary, we will continue the protest,” said Dr Atul Jain, president of the hospital’s resident doctors’ association.
Meanwhile, EDMC commissioner Vikas Anand said that no order had been issued regarding the termination/suspension of the striking doctors’ services so far. The termination order is only for the DNB workers and for the rest of the medical staff, it is based on ‘no work no pay’ as per the SC rule, he clarified.
“The salaries will be provided at the earliest. We have a very good team of doctors at Swami Dayanand Hospital. The only request is that they should join back and resume services,” said the commissioner.
Anand also said that the salaries for the months of February and March would be paid on time. “EDMC is going through a financial crisis and even in such difficult times, the corporation is sensitive towards the interests of its employees. Their due arrears will be paid in the month of May as per the availability of the funds,” he added.
Asthma is a major noncommunicable disease (NCD), affecting both children and adults.
Inflammation and narrowing of the small airways in the lungs cause asthma symptoms, which can be any combination of cough, wheeze, shortness of breath and chest tightness.
Asthma affected an estimated 262 million people in 2019 and caused 461000 deaths.
Asthma is the most common chronic disease among children.
Inhaled medication can control asthma symptoms and allow people with asthma to lead a normal, active life.
Avoiding asthma triggers can also help to reduce asthma symptoms.
Most asthma-related deaths occur in low- and lower-middle income countries, where under-diagnosis and under-treatment is a challenge.
What is asthma?
Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms: cough, wheeze, shortness of breath and chest tightness. These symptoms are intermittent and are often worse at night or during exercise. Other common “triggers” can make asthma symptoms worse. Triggers vary from person to person, but can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.
The impact of asthma on daily life
Asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.
People with under-treated asthma can suffer sleep disturbance, tiredness during the day, and poor concentration. Asthma sufferers and their families may miss school and work, with financial impact on the family and wider community. If symptoms are severe, people with asthma may need to receive emergency health care and they may be admitted to hospital for treatment and monitoring. In the most severe cases, asthma can lead to death.
Causes of asthma
Many different factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause.
Asthma is more likely if other family members also have asthma – particularly a close relative, such as a parent or sibling.
Asthma is more likely in people who have other allergic conditions, such as eczema and rhinitis (hay fever).
Urbanisation is associated with increased asthma prevalence, probably due to multiple lifestyle factors.
Events in early life affect the developing lungs and can increase the risk of asthma. These include low-birth weight, prematurity, exposure to tobacco smoke and other sources of air pollution, as well as viral respiratory infections.
Exposure to a range of environmental allergens and irritants are also thought to increase the risk of asthma, including indoor and outdoor air pollution, house dust mites, moulds, and occupational exposure to chemicals, fumes, or dust.
Children and adults who are overweight or obese are at a greater risk of asthma.
Reducing the burden of asthma
Asthma cannot be cured, but good management with inhaled medications can control the disease and enable people with asthma to enjoy a normal, active life.
There are two main types of inhaler:
bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and
steroids (such as beclometasone), that reduce inflammation in the air passages. This improves asthma symptoms and reduces the risk of severe asthma attacks and death.
People with asthma may need to use their inhaler every day. Their treatment will depend on the frequency of symptoms and the different types of inhalers available.
It can be difficult to coordinate breathing using an inhaler – especially for children and during emergency situations. Using a “spacer” device makes it easier to use an aerosol inhaler and helps the medicine to reach the lungs more effectively. A spacer is a plastic container with a mouthpiece or mask at one end, and a hole for the inhaler in the other. A homemade spacer, made from a 500-ml plastic bottle, can be as effective as a commercially-manufactured inhaler.
People with asthma and their families need education to understand more about their asthma, their treatment, triggers to avoid, and how to manage their symptoms at home. It is also important to raise community awareness, to reduce the myths and stigma associated with asthma in some settings.
In an era, when even licensed and qualified doctors are finding it difficult to practice medicine, it is strange that unqualified and unlicensed are having a field day. Why strict regulations do not apply to them, is beyond any reasoning and logic. If a medical facility or clinic is functional, it is difficult for the patient, especially in emergency, to check or even doubt its credentials. How such facilities are open, functional and thriving. Sadly our regulation is trying to regulate, who are already regulated. It is trying to punish those who are qualified and licensed, but turns a blind eye towards unlicensed and unqualified doctors.
Such fake doctors own medical set ups, may conduct surgeries, sometimes run hospitals with little help from qualified doctors and do procedures. Another problem is that they promote fake rumours about genuinely qualified doctors and create a mist of mistrust to propagate their fake medical business.
The glans of an infant’s penis shrivelled and fell off after a quack tied a horse’s hair around it ‘to prevent bleeding’ after a ritual of circumcision. The child was rushed to hospital, where a surgery was performed to ensure that the baby will be able to urinate normally, but the boy has lost his glans.. A quack had conducted the religious ritual of circumcision on November 22, 2021, and tied a horse hair to the child’s penis. He then bandaged it and told the family to go home.
The child was born in October 2021. Ten days later, the family members noticed that the glans had come off along with the dressing. Families choose to get their male infants circumcised by neighbourhood quacks. This is not just unhygienic, but can lead to major complications as well. Other unhealthy practices like sprinkling ash on the wound after circumcision are also prevalent.
A toddler has died and his baby brother has required life-saving surgery in hospital after a medical procedure, understood to have been a circumcision, went horribly wrong in Perth’s south-east. The brothers were rushed to hospital in Armadale by family Tuesday evening following the surgeries. The West Australian reports a two-year-old boy was pronounced dead at the hospital’s emergency department. His infant brother – aged between seven and eight months – was rushed to Perth Children’s Hospital for emergency surgery.7NEWS reports he has since been discharged from hospital. WA Police have confirmed the toddler’s death is not being treated as suspicious. “It can be confirmed the boy underwent a medical procedure at a registered medical centre prior to his death,” a police spokeswoman said.
Circumcisionis one of the oldest surgical procedures and one of the most commonly performed surgical procedures in practice today. Descriptions of ritual circumcision span across cultures, and have been described in ancient Egyptian texts as well as the Old Testament. In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by paediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.
Evolution of Medical profession-Extinction of good doctors 