Choosing medical career or being a doctor has become a struggle in present era. Aspiring doctors need to first think- why they want to be a doctor in such circumstances-enduring all kind of exploitation- from all corners of society?
Unable to give doctors their rightful, there has been an administrators’ wish to enslave medical profession. Arm chair preachers would just say “yes, as a doctor, they should do it as moral duty.” In a new era of consumerism, when patient is defined as consumer and medical industry controls medical profession and the financial boundaries. All components of medical industry want their pound of flesh from hard work of doctors and nurses. Every day routine issues turning into medico-legal hassles have put doctors in the corner, resulting in severe distraction from real point of intention-treatment of patients.
Struggling to get admission in medical college, slogging in wards to learn and earn degrees, work in inhuman conditions, listen to endless abuses, tolerate the false media criticism, dragged in courts for alleged negligence, work with fear of physical assaults, work without proper infrastructure and manpower, endangering their own lives, exploited by medical industry and administrators, poorly paid and still not respected.
The Myth of cost of spending on medical education needs to be made transparent.
Instead of often repeated statements about high expense on running medical college and projecting it as a hard fact, the amount spent on medical students by all medical colleges should be made transparent by all institutions. The frequent statement is made that cost of making a doctor is very high and gleefully propagated by the private medical colleges to extract millions out of young medical students .
Such statements without any actual public data is repeated to the extent that it is firmly entrenched in public mind without any real evidence.
Projection of high cost of making a doctor is the reason with an intention to exploit the young doctors in various ways to get cheap labour and extract millions from aspiring doctors by medical colleges.
MBBS medical students protest against Haryana Govt bond policy detained
In a crackdown on MBBS students protesting against Haryana government’s bond policy for government medical colleges, the Rohtak Police detained around 300 students in the early hours of Saturday and registered a First Information Report in this connection.
The police action came ahead of the visit of Governor, Chief Minister and Home Minister to PGI campus for the convocation of Pt. Bhagwat Dayal Sharma University of Health Sciences, Rohtak.
He added that the students were now co-operating with the administration and a meeting was being facilitated between them and the Chief Minister soon after the convocation.
The Haryana government had come out with a policy to incentivise doctors to opt for government service in the State on November 6, 2020, saying that the candidates selected for MBBS degree course in government medical colleges need to execute an annual bond for ₹10 lakh minus the fee at the start of every academic year. The candidate can pay the entire bond amount without recourse to the loan or the State government will facilitate them for availing an education loan for this bond amount. As per the policy, the government will repay the annual instalments of the loan if the candidate obtains employment with the State government.
However, in view of the protests, the CM had three days ago announced that students need not pay the ₹10 lakh bond amount at the time of admission, but instead have to sign a bond-cum-loan agreement of the amount with the college and the bank.
Blowin’ In The Wind Yes, and how many times can a man turn his head
And pretend that he just doesn’t see?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
Yes, and how many times must a man look up
Before he can see the sky?
And how many ears must one man have
Before he can hear people cry?
Yes, and how many deaths will it take ’til he knows
That too many people have died?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
An eight year old child –scared, sitting terrified in mother’s lap, feeling breathless and feeling a bit dizzy. News about rising levels of smog and pollution send shivers down her spine every year. Her mother closing all the doors of house and trying to avoid the fumes entering the room like ghosts from every small crevices, peepholes and slits. The mother prays for the smooth sail through these days as she knows very well that the season has come when the environment will be full of pollutants. The child will writhe with suffocation due to air pollution in the same proportion. The reasons for dangerous levels of air pollution can be multiple like vehicles, crackers or farm waste burning, but accumulate near the some cities due to geographical distribution and environmental factors.
Irony is that it is someone else’s problem like farm waste burning and ball of a time with polluting crackers adds to child’s suffering. Here the sufferer is not the real cause pollution. Unlike if someone smokes or drinks alcohol, it is the doer who is sufferer. But here the root cause of her trouble emanates from poor governance and administrative failure to control the irresponsible behaviour of few.
Every year, many factors collectively add to enormous pollution and air becomes thick with smog and suspended particulate matter at a predictable time. It is a cause of breathlessness in children and adults and vulnerable to asthmatic attacks.
Like this one child, there are thousands of them and people from all ages suffer during this season because of mistakes and thrill of others. These sufferers, who are frustrated due to their plight, with no fault of theirs, have to undergo treatment and visit emergencies of the hospitals. This irresponsible behaviour of people puts burden on the medical services and the doctors, who are already overstretched due to workload. But it is only the doctors and nurses, who are visible round the clock, whereas people who have polluted the air and the administrators remain invisible. For many, it is very hard to understand the complexity of the situation. Patients many a times will rather tend to blame the doctors for their sufferings, poor treatment and difficulty in treatment, without realizing that constant pollution is the reason for poor response to treatment.
Why all of us cannot keep in mind the plight of such patients? Why the administrators wake up and come out of their slumber every year when AQI is more than 500 already?
There are no punishments for repeated administrative failures.
But inconsequential pleasure and poor governance should not be allowed to inflict health and life of others.
Delhi Air Pollution: AQI more than 500. Apart from climate change, air pollution is just another biggest environmental threat to human health at present. And with pollution levels worsening in the national capital and neighbouring regions, residents of Delhi have started complaining of several health problems like difficulty in breathing, tightness of chest, asthmatic symptoms, runny nose, sore throat, itchy and watery eyes. As the city has been waking up to a thick blanket of hazardous smog every morning since Diwali, Delhi hospitals are also witnessing a surge in the number of patients coming to OPDs with health issues. And it’s the elders and children, who have lower immunity levels, complained of breathing issues. The hazardous level of air pollution towards the end of October triggered a series of official measures such as shutting down construction work across Delhi and smoke-emitting factories.
It requires sincere administrative will and not merely tokenism to control such hazardous pollution.
Reaction to ‘Death’ in this new era of consumerism has become a story of paradox. Massive civil negligence and 141 deaths but there are no punching bags as are doctors for revenge in case of a hospitalized death. Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence to the one hospital death by disease.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease.
Multiple Deaths in healthy people by civic negligence:
Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods etc. The number of people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of negligence here is massive and these deaths are unpardonable. Timely action could have prevented these normal people from death.
Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.
Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.
Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.
The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.
Single Death in Hospital due to disease:
Reaction to single “in Hospital” medicalized death is a paradox. The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault.
In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.
Point to ponder-Misplaced priorities:
Who is to be blamed for the deaths of healthy people which occur because of civic negligence? Here relatives are actually helpless and the vital questions may go unanswered . There are no punching bags as are doctors for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by Doctors.
It is time to check the emotional reactions to single hospital death due to a disease as compared to hundreds of death of healthy people due to civil negligence.
Instead of often repeated statements about high expense on running medical college and projecting it as a hard fact, the amount spent on medical students by all medical colleges should be made transparent by all institutions. The frequent statement is made that cost of making a doctor is very high and gleefully propagated by the private medical colleges to extract millions out of young medical students .
Such statements without any actual public data is repeated to the extent that it is firmly entrenched in public mind without any real evidence.
High cost is the reason with an intention to exploit the young doctors in various ways to get cheap labour and extract millions from aspiring doctors by private medical colleges.
The basis of such calculation should be transparent for every medical college and all institutions.
In any medical college, only the Departments of Anatomy and Physiology are purely for medical students. The remaining subjects taught in medical colleges across the country are related to patient
care and medical education is only a by-product. All the medical teachers are actually doctors involved in treatment of patients, running the hospital and students observe the treatment and learn medicine. The interns and postgraduate students provide the cheap and labour and actually save the costs of running the hospital.
Therefore if some college is actually spending millions to produce one MBBS doctor , it is a either an inefficient model or costs are inflated and exaggerated to exploit the young doctors.
The average cost of producing a doctor or nurse went down across most parts of the world between 2008 and 2018, but almost tripled in China and doubled in India, a Lancet study shows. Despite this, the estimated expenditure per medical graduate in China at $41,000 is higher only than in sub-Saharan Africa and about 42% lower than in India ($70,000) against a global average of $114,000. The pattern was the same for nurses with the estimated expenditure per nursing graduate dropping across the world while it went up by 167% in China and doubled in India. The only other region where the per graduate cost went up was in North Africa, where cost per doctor went up by 47% and by 25% for nurses. Approximately $110 billion was invested globally by governments and students’ families in medical and nursing education in 2018. Of this, $60.9 billion was invested in doctors and $48.8 billion was invested in nurses and midwives, the study estimated.
The paper looks at important developments in medical education to assess potential progress and issues with education of health professionals after the Covid-19 pandemic. Mean costs in 2018 were $114,000 per doctor and $32,000 per nurse. In 2008, China had the lowest estimated expenditure per medical graduate at just $14,000 (Rs 6 lakh) followed by India, where it was just $35,000 (Rs 15 lakh at the 2008 exchange rate of Rs 43 to a dollar). This is much lower than the estimate of Rs 1 crore or more that Indian colleges widely claim as expenditure per medical graduate.
Take example for cough syrup related 66 deaths at Gambia or Injection Propofol related deaths at PGI Chandigarh. If deep investigations are not done, poor quality medicines will continue to be marketed and doctors would be held responsible for the adverse reactions and deaths. Strict regulations for quality of pharmaceutical agents is need of the hour.
Usually every problem related to health is called medical malaise, but that is a misnomer. In fact health care comprises tens of different industries. Complex interplay of various industries like pharmaceutical, consumable industry and other businesses associated with health care remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain largely unregulated. Collective malaise of all these is conveniently projected as medical problems as blame is conveniently passed on to doctors, as they are only visible component of mammoth health business. Rest all remain invisible, earn money and doctors are blamed for the poor outcome of the patient, as doctor is the only universal link that is visible with patient. By an average application of wisdom, it is easier to blame doctors for everything that goes wrong with patient.
Cough syrup related deaths at Gambia or Injection Propofol related deaths at PGI Chandigarh – two examples are only a tip of the iceberg. In routine, if patient gets fake or low quality medicines and does not get well, gets side effects, doctor will face harassment. Whereas people involved and industry will be sitting pretty and make money.
Therefore strict administration and quality check is required to correct Pharma malaise. It may be a complex issue because of complexity involved in implementation and execution of policies. But recognition and beginning to think of the problem is also an important step.
The WHO has issued an alert over four cough and cold syrups made by Maiden Pharmaceuticals in India, warning they could be linked to the deaths of 66 children in The Gambia
The World Health Organization (WHO) on Wednesday issued a warning over four cough and cold syrups made by an Indian company, saying that they could be linked to the deaths of 66 children in The Gambia. The WHO said that the cough and cold syrups, made by Maiden Pharmaceuticals in Haryana, could be the reason for serious kidney injuries. “Please do not use them,” the WHO said in its advisory.
The four cough and cold syrups that have been linked to the deaths of 66 children in The Gambia are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup. In a release, the WHO has said that the Indian company has not yet provided guarantees on the safety and quality of these products.
“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” the WHO said in a medical product alert. The WHO also warned that while the products had so far been found in The Gambia, they could have been distributed to other countries.
According to the WHO, diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove fatal. Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death, the WHO said.
New Delhi-based Maiden Pharmaceuticals declined to comment on the matter.
The World Health Organization also said that it was conducting further investigation with the company and regulatory authorities in India regarding the cough syrup linked to deaths of 66 children.
Last month, Gambia’s government said that it has also been investigating the deaths. The government statement came as a spike in cases of acute kidney injury among children under the age of five was detected in late July.
“While the contaminated products have so far only been detected in the Gambia they may have been distributed to other countries,” WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Wednesday.
The WHO Director General added that WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients.
Meanwhile, the DSCO has already taken up an urgent investigation into the matter with the regulatory authorities in Haryana.
CHANDIGARH: Five patients had died after they were sedated before surgeries on a single day last week at PGI, prompting doctors to sound a red alert to Central Drugs Standard Control Organisation (CDSCO)on Propofol injection – an anesthetic given before any major surgery. In this case, the drug was taken from the chemist shop in the hospital emergency. “Following a complaint from PGI doctors, we came with a CDSCO team to collect samples. The samples have been sent to Central Drugs Laboratory, Kolkata,” said Sunil Chaudhary, senior drug control officer, UT. He said, “The suspected batch of drugs has been stopped for supply till reports are received.” Sources said test analysis will take around two-three weeks and final report will be submitted by the CDSCO team. The five patients had to undergo orthopaedic and neurosurgeries. On deliberating the cause of deaths, doctors found Propofol injection as the common thread.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. It’s an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions.
The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death.
Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?
Before the 12th century he describes a period of “Tamed death,” where death was familiar, and people knew how to die. The dying and their families accepted death calmly; they knew when death was coming and what to do; dying was a public event attended by children.
Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. The great success with antibiotics vaccines has perhaps further fuelled the fantasy that science can defeat death. But this temporary success as only has been the result of discovery of germ theory and antibiotics.
In true sense, Death still remains invincible.
The fear of death also involves the fear of separation.
As families and communities want more and more hospital care, when critically sick, health systems have occupied the centre stage in the process of dying. Dying people are whisked away to hospitals or hospices, and whereas two generations ago most children would have seen a dead body, people may now be in their 40s or 50s without ever seeing a dead person. The language, knowledge, and confidence to support and manage dying are being lost, further fuelling a dependence on health-care services.
Death systems are the means by which death and dying are understood, regulated, and managed. These systems implicitly or explicitly determine where people die, how people dying and their families should behave, how bodies are disposed of, how people mourn, and what death means for that culture or community.
Death systems are unique to societies and cultures.
The increased number of deaths in hospital means that ever fewer people have witnessed or managed a death at home. This lack of experience and confidence causes a positive feedback loop that reinforces a dependence on institutional care of the dying.
Medical culture, fear of litigation, and financial complexities contribute to overtreatment at the end of life, further fuelling institutional deaths and the sense that professionals must manage death. Social customs influence the conversations in clinics and in intensive care units, often maintaining the tradition of not discussing death openly. More undiscussed deaths in institutions behind closed doors further reduce social familiarity with and understanding of death and dying.
How people die has changed radically over recent generations. Death comes later in life for many and dying is often prolonged. Futile or potentially inappropriate treatment can continue into the last hours of life. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost.
At first only the rich could expect that doctors would delay death. However, by the 20th century this expectation had come to be seen as a civic right.
‘Natural death’ is now the point at which the human organism refuses any further input of treatment.
Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an illogical distribution of health care. People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.
Death is not so much denied but has become invisible to people. People now have less understanding and less acceptance of death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.
The potential penalty by India’s fair trade regulator could be steep. The CCI (The Competition Commission of India) investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated free of regulation so far.
A four-year investigation by India’s fair-trade regulator has concluded that some of India’s largest hospital chains abused their dominance through exorbitant pricing of medical services and products in contravention of competition laws.
The Competition Commission of India (CCI) will soon meet to weigh in on the responses by Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital. It will then decide whether to impose penalties, said people familiar with the matter.
The CCI can impose a penalty of up to 10 percent of the average turnover for the past three preceding financial years of an enterprise that has violated competition laws. The penalties could be steep. Apollo Hospitals posted an average turnover of Rs 12,206 crore and Fortis Rs 4,834 crore in the past three financial years.
The CCI’s director-general found that 12 super-speciality hospitals of these chains that operate in the National Capital Region abused their positions of dominance by charging “unfair and excessive prices” for renting rooms, medicines, medical tests, medical devices, and consumables, according to a copy of the summary report that Moneycontrol reviewed.
Some hospital room rents exceeded those charged by 3-star and 4-star hotels, according to the findings by the DG, who examines anti-competitive practices.
Significance of the investigation
The CCI investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated unencumbered by regulation so far. The watchdog’s action could potentially rein in the prices of medicines and healthcare equipment, or at the very least, bring transparency in the way hospitals sell these items, according to competition lawyers.
Of the 12 hospitals that faced CCI scrutiny, six belonged to Max and two to Fortis.
The CCI and the hospital chains had no comment for this article.
Overcharging without checks
Exorbitant pricing is a common thread running through the CCI investigation report. The hospitals were found to charge more for certain medical tests as well as for X-rays, MRI and ultrasound scans than rates offered by other diagnostic centres. For consumables such as syringes and surgical blades, hospitals charged rates that were higher than those of other consumable makers, according to the CCI report.
The only exception was medicines, which hospitals sold at the maximum retail price, although they earned significant profits by procuring them at lower prices.
The CCI selected the hospitals for investigation on the basis of the number of doctors, paramedics, beds, and turnover for the period 2015-2018. The investigation found that these hospitals do not allow the use of purchase of consumables, medical devices, medicines and medical test results from outside, adding that patients use the service of in-house pharmacy and laboratories for ease of convenience.
Investigative reports pertaining to each of the hospital chains were submitted by the DG to the CCI on December 24, 2021. The CCI forwarded a copy of these reports to the hospitals on July 12, 2022, and sought their responses, according to the people, who did not want to be identified.
The CCI has been examining the pharmaceutical sector in India for years, scrutinising the pricing of medicines by healthcare companies. On April 19, 2020, it cautioned businesses, including healthcare companies, against taking advantage of Covid-19 to contravene competition laws.
Depending on the travel destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. In some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist.
As many of such diseases are infections, general precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered.
Modes of transmission and general precautions
The modes of transmission for different infectious diseases are diverse:
Foodborne and waterborne diseases transmitted by consumption of contaminated food and drink.
Vector-borne diseases transmitted by insects such as mosquitoes and other vectors such as ticks.
Diseases transmitted to humans by animals (zoonoses), more particularly through animal bites or contact with animals, contaminated body fluids or faeces, or by consumption of foods of animal origin, particularly meat and milk products.
Sexually transmitted diseases passed from person to person through unsafe sexual practices.
Bloodborne diseases transmitted by direct contact with infected blood or other body fluids
Airborne diseases involving droplets and droplets nuclei. Droplet nuclei <5 µm in size are disseminated in the air and breathed in. These droplet nuclei can remain suspended in the air for some time. Droplet nuclei are the residuals of evaporated droplets. Droplet transmission occurs when larger particles (>5 µm) contact the mucous membranes of the nose and mouth or conjunctivae of a susceptible individual. Droplets are usually generated by the infected individual during coughing, sneezing or talking.
Diseases transmitted via soil include those caused by dormant forms (spores) of infectious agents, which can cause infection by contact with broken skin (minor cuts, scratches, etc).
The main infectious diseases to which travellers may be exposed, and precautions for each, are detailed in the Chapter 5 of the International travel and health situation publication. The most common infectious illness to affect travellers, namely travellers’ diarrhoea, is covered in Chapter 3 of the International travel and health situation publication (WHO). Because travellers’ diarrhoea can be caused by many different foodborne and waterborne infectious agents, for which treatment and precautions are essentially the same, the illness is not included with the specific infectious diseases.
Information on malaria, one of the most important infectious disease threats for travellers, is provided separately (WHO).
The infectious diseases listed below have been selected on the basis of the following criteria:
Diseases that have a sufficiently high global or regional prevalence to constitute a significant risk for travellers;
Diseases that are severe and life-threatening, even though the risk of exposure may be low for most travellers;
Diseases for which the perceived risk may be much greater than the real risk, and which may therefore cause anxiety to travellers;
Diseases that involve a public health risk due to transmission of infection to others by the infected traveller.
Amoebiasis
Angiostrongyliasis
Anthrax
Brucellosis
Chikungunya
Coccidioidomycosis
Dengue
Giardiasis
Haemorrhagic fevers
Hantavirus diseases
Hepatitis C
Hepatitis E
Histoplasmosis
HIV/AIDS and other sexually transmitted infections
Legionellosis
Leishmaniasis (cutaneous, mucosal and visceral forms)
Leptospirosis (including Weil disease)
Listeriosis
Lyme Borreliosis (Lyme disease)
Lymphatic filariasis
Malaria
Onchocerciasis
Plague
SARS (Severe Acute Respiratory Syndrome)
Schistosomiasis (Bilharziasis)
Trypanosomiasis
Typhus fever (Epidemic louse-borne typhus)
Zoonotic influenza
Some of the diseases included in this chapter, such as brucellosis, HIV/AIDS, leishmaniasis and TB, have prolonged and variable incubation periods. Clinical manifestations of these diseases may appear long after the return from travel, so that the link with the travel destination where the infection was acquired may not be readily apparent.
Special feature
Vaccine-preventable diseases
Vaccine-preventable diseases
Cholera
Hepatitis A
Hepatitis E
Japanese encephalitis
Meningococcal disease
Rabies
Tick-borne encephalitis
Typhoid fever
Yellow fever
Information about available vaccines and indications for their use by travellers is provided in the pdf entitled vaccine-preventable diseases and vaccines beside. Advice concerning the diseases for which vaccination is routinely administered in childhood, i.e. diphtheria, measles, mumps and rubella, pertussis, poliomyelitis and tetanus, and the use of the corresponding vaccines later in life and for travel, is also given in the section Vaccines.
Brucellosis is a common zoonotic infection caused by bacterial genus Brucella. Brucellosis is an old disease known by various names including undulant fever or Mediterranean fever. This is one of the infectious diseases transmissible between animals and humans.
Global distribution of Brucellosis-
This infection is more common in Mediterranean areas, the south and the center of America, Africa, Asia, Arab peninsula, Indian subcontinent and the Middle East. The maximum incidence in the world had been reported in Syria.
Other names:
Brucellosis, undulant fever, Mediterranean fever, Cyprus fever, and goat fever.
Summary:
‘Malta fever’ is a bacterial disease caused by various brucella species, which mainly infect cattle, swine, goats, sheep and dogs.
Malta fever is transmitted to humans through direct and indirect contact with infected animals.
Infection is most likely caused by ingesting unpasteurized milk or cheese from infected goats or sheep.
It causes flu-like symptoms, including fever and lethargy.
There is no human vaccine to prevent Malta fever, but it is important to take precautions to avoid it.
Overview:
Malta fever is a bacterial disease caused by various brucella species. Infection is transmitted to humans through direct and indirect contact with infected animals. It mostly affects individuals who work in the livestock sector. The consumption of raw milk and cheese made from raw milk (fresh cheese) is the major source of infection in man; however, human-to-human transmission is very rare. On the other hand, Malta fever remains a problem globally, because it is the most common bacterial infection spread from animals to humans around the world, as animals may be carrying the bacteria without showing any symptoms of illness.
Types of Brucella bacteria:
Types of brucella bacteria:
There are 8 known species of the brucella bacteria, but only four of them cause brucellosis in humans:
Maltese Brucellosis (B. melitensis): This type is the most common and most severe, and is found in lambs.
Pig Brucellosis (B. suis): This type infects individuals who come in contact with animals. It has a severe impact on humans.
Brucella abortus (B. abortus): It infects cows and is moderately severe.
Canine Brucellosis (B. canis): It infects individuals who come in contact with dogs and is moderately severe.
Other animals are also considered a primary source of the Brucella bacteria, including wild animals.
Cause:
Brucellosis is the result of being infected with the brucella bacteria.
Transmission:
Humans contract brucellosis by consuming unpasteurized dairy products and undercooked or raw meat of infected animals.
Direct contact with an infected animal or its bodily discharge (such as tissues, blood, urine, vaginal discharge, aborted fetuses, and placentas), via cracked skin, can also occur.
The disease can also be transmitted to humans through inhaling airborne agents in barns, stables, and sometimes laboratory and slaughterhouse.
Rare Means of Transmission:
From mother to fetus through the placenta
Sexual contact
Blood transfusion or marrow transplant from a person infected with Brucella
Few cases result from accidental pollination of an animal with brucellosis.
Incubation Period:
Symptoms usually appear within 5 to 60 days, and sometimes they takes several months to appear.
Who is at risk?
Vets
Livestock farmers
Slaughterhouse workers
Hunters
Microbiologists
Medical lab workers
Symptoms:
Malta fever can cause several symptoms. Some of them last for a long period of time. Initial symptoms include:
Fever
Sweating
Chills
Loss of appetite
Headache
Muscle, joint, and back pain
Fatigue and lethargy
When to see a doctor?
When a rapid rise in temperature, muscle pain or unusual weakness and persistent fever occurs. It is also crucial to see your doctor if you are among the groups at a higher risk of contracting the disease.
Complications:
Endocarditis (an infection of the endocardium, which is the inner lining of the heart or valves)
Arthritis
Orchitis (inflammation of the testicles)
Spleen or liver inflammation
Central nervous system inflammation.
Diagnosis:
Clinical examination
Laboratory tests: They involve searching for the bacteria in samples of blood, bone marrow, or other body fluids.
Treatment:
Treatment aims to relieve symptoms and prevent complications. It depends on the timing and severity of the disease. The disease may take a few weeks to several months to be cured. Patients take antibiotics for at least six weeks.
Prevention:
There is no human vaccine that can prevent Malta fever, so it is important to take precautions to prevent it with the following steps:
Make sure to cook meat well at a temperature of 63-74°C.
Do not drink or eat unpasteurized dairy products, including milk and cheese.
Take safety precautions at workplaces (e.g. during handling samples in laboratories).
Wash your hands before and after handling animals.
Wear rubber gloves and protective clothing and glasses if you work in a field where you come in contact with animals.
Ensure that wounds are covered with a bandage.
FAQs:
How long do brucella bacteria live outside the body?
Brucella bacteria are resistant to natural conditions, and they can survive for several hours up to over 60 days if the surrounding environment is moist.
How long should meat be cooked?
Meat and liver should be well cooked at 63°C for half an hour.
Women who are pregnant and have been exposed to Brucella should consult with their obstetricians/healthcare provider for evaluation. Prompt diagnosis and treatment of brucellosis in pregnant women can prevent complications including miscarriage.
Anne Heche, 53, had spent several days in a coma at the Grossman Burn Center at West Hills (California) Hospital and Medical Center after her Mini Cooper ran off the road Aug. 5 and smashed into a two-story home.
On Friday- Anne Heche (Hollywood actress ) had been declared brain dead, although she remained on life support for organ donation, a rep for the actress told The Hollywood Reporter on Friday. According to the actress’ publicist Holly Baird, Heche is “legally dead according to California law.” However, her heart is still beating and she has not been taken off of life support so that “OneLegacy can see if she is a match for organ donation.”
The actress’ team had previously shared an update on her health Thursday, stating that she suffered a severe anoxic brain injury and wasn’t expected to survive following an Aug. 5 car crash.
According to Baird, the star had been hospitalized in a coma and in critical condition since the accident. The actress crashed her car into a two-story home in L.A.’s Mar Vista neighborhood, sparking a fire, according to a Los Angeles Fire Department report.
In the statement Thursday from Heche’s rep, it “has long been her choice to donate her organs” and she was being kept on life support to determine whether her organs were viable.
The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries even in Asia. It is not that there aren’t enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.
Situation of shortage of organs in India
There is a wide gap between patients who need transplants and the organs that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only. An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant. Hence about 25-30 thousand liver transplants are needed annually in India but only about one thousand five hundred are being performed. Similarly about 50000 persons suffer from Heart failures annually but only about 10 to 15 heart transplants are performed every year in India. In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.
The legal Framework in India
Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA is now adopted by all States except Andhra and J&K, who have their own similar laws. Under THOA, source of the organ may be:
Near Relative donor (mother, father, son, daughter, brother, sister, spouse)
Other than near relative donor: Such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorisation committee.
Deceased donor, especially after Brain stem death e.g. a victim of road traffic accident etc. where the brain stem is dead and person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other type of deceased donor could be donor after cardiac death.
Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs Act, like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver and lungs.
Despite a facilitatory law, organ donation from deceased persons continues to be very poor. In India there is a need to promote deceased organ donation as donation from living persons cannot take care of the organ requirement of the country. Also there is risk to the living donor and proper follow up of donor is also required. There is also an element of commercial transaction associated with living organ donation, which is violation of Law. In such a situation of organ shortage, rich can exploit the poor by indulging in organ trading.
Government of India initiated the process of amending and reforming the THOA 1994 and consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted. Some of the important amendments under the (Amendment) Act 2011 are as under:-
Tissues have been included along with the Organs.
‘Near relative’ definition has been expanded to include grandchildren, grandparents.
Provision of ‘Retrieval Centres’ and their registration for retrieval of organs from deceased donors. Tissue Banks shall also be registered.
Provision of Swap Donation included.
There is provision of mandatory inquiry from the attendants of potential donors admitted in ICU and informing them about the option to donate – if they consent to donate, inform retrieval centre.
Provision of Mandatory ‘Transplant Coordinator’ in all hospitals registered under the Act
To protect vulnerable and poor there is provision of higher penalties has been made for trading in organs.
Constitution of Brain death certification board has been simplified- wherever Neurophysician or Neurosurgeon is not available, then an anaesthetist or intensivist can be a member of board in his place, subject to the condition that he is not a member of the transplant team.
National Human Organs and Tissues Removal and Storage Network and National Registry for Transplant are to be established.
There is provision of Advisory committee to aid and advise Appropriate Authority.
Enucleation of corneas has been permitted by a trained technician.
Act has made provision of greater caution in case of minors and foreign nationals and prohibition of organ donation from mentally challenged persons
In pursuance to the amendment Act, Transplantation of Human Organs and Tissues Rules 2014 have been notified on 27-3-2014
Directorate General of Health Services, Government of India is implementing National Organ Transplant Programme for carrying out the activities as per amendment Act, training of manpower and promotion organ donation from deceased persons.
National Organ Transplant Programme with a budget of Rs. 149.5 Crore for 12th Five year Plan aims to improve access to the life transforming transplantation for needy citizens of our country by promoting deceased organ donation.
Issues and Challenges
High Burden (Demand Versus Supply gap)
Poor Infrastructure especially in Govt. sector hospitals
Lack of Awareness of concept of Brain Stem Death among stakeholders
Poor rate of Brain Stem Death Certification by Hospitals
Poor Awareness and attitude towards organ donation— Poor Deceased Organ donation rate
Lack of Organized systems for organ procurement from deceased donor
Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
Prevention and Control of Organ trading
High Cost (especially for uninsured and poor patients)
Regulation of Non- Govt. Sector
Objectives of National Organ Transplant Programme:
To organize a system of organ and Tissue procurement & distribution for transplantation.
To promote deceased organ and Tissue donation.
To train required manpower.
To protect vulnerable poor from organ trafficking.
To monitor organ and tissue transplant services and bring about policy and programme corrections/ changes whenever needed.
NOTTO: National Organ and Tissue Transplant Organization
National Network division of NOTTO would function as apex centre for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of Organs and Tissues Donation and Transplantation in country. The following activities would be undertaken to facilitate Organ Transplantation in safest way in shortest possible time and to collect data and develop and publish National registry.
At National Level:
Lay down policy guidelines and protocols for various functions.
Network with similar regional and state level organizations.
All registry data from States and regions would be compiled and published.
Creating awareness, promotion of deceased organ donation and transplantation activities.
Co-ordination from procurement of organs and tissues to transplantation when organ is allocated outside region.
Dissemination of information to all concerned organizations, hospitals and individuals.
Monitoring of transplantation activities in the regions and States and maintaining data-bank in this regard.
To assist the states in data management, organ transplant surveillance & Organ transplant and Organ Donor registry.
Consultancy support on the legal and non-legal aspects of donation and transplantation
Coordinate and Organize trainings for various cadre of workers.
For Delhi and NCR
Maintaining the waiting list of terminally ill patients requiring transplants
Networking with transplant centres, retrieval centres and tissue Banks
Co-ordination for all activities required for procurement of organs and tissues including medico legal aspects.
NOTTO will assign the Retrieval Team for Organ retrieval and make Transport Arrangement for transporting the organs to the allocated locations.
NOTTO will maintain the waitlist of patients. needing transplantation in terms of the following:-
Hospital wise
Organ wise
Blood group wise
Age of the patient
Urgency ( on ventilator, can wait etc.)
Seniority in the waitlist (First in First Out)
Matching of recipients with donors.
Allocation, transportation, storage and Distribution of organs and tissues within Delhi and National Capital Territory region.
Post-transplant patients & living donor follow-up for assessment of graft rejection, survival rates etc.
Awareness, Advocacy and training workshops and other activities for promotion of organ donation
ROTTO: Regional Organ and Tissue Transplant Organization
Name of ROTTO
States covered
Seth GS medical college and KEM Hospital, Mumbai (Maharashtra)
Maharashtra, Gujarat, Goa, UTs of DNH, Daman, Diu, M.P., Chhattisgarh
Govt. Multispecialty Hospital, Omnadurar, Chennai (Tamil Nadu)
TN, Kerala, Telangana, Seem Andhra, Karnataka, Pondicherry, A & N Islands, Lakshadweep
Institute of PG Medical Education and Research, Kolkata (West Bengal)
SOTTO: State Organ and Tissue Transplant Organization
It is envisaged to make 5 SOTTOs in new AIIMS like institutions.
Govt. supported Online system of Networking
A website by the name www.notto.nic.in has been hosted where information with regards to the organ transplantation can be obtained. An online system through website is being developed for establishing network for Removal and Storage of Organs and Tissues from deceased donors and their allocation and distribution in a transparent manner. A computerized system of State/Regional and National Registry of donors and recipients is also going to be put in place.
Evolution of Medical profession-Extinction of good doctors 