Disposal of the Dead after Death-Environment Impact & Carbon Cost


     Burning the bodies of the dead was an ancient rite and practice in India. It was observed among Buddhists, Hindus and Jains from well before the start of the Common Era, and was later adopted by Sikhs. Burning the dead historically helped demarcate these religious communities from Muslims and Christians, for whom burial was the norm, and from India’s Parsi community who exposed their dead on Towers of Silence.   Burning  bodies after death, originating at a time when India was still heavily forested, cremation may also have been environmentally more appropriate and sustainable than, for instance, the mummification practised in the dry desert air of ancient Egypt.

Burning Issues: Cremation and Incineration

    In India, one estimate reveals that funeral pyres consume 6 crore trees annually and play a huge role in deforesting the country. Air pollution and deforestation are not the only environmental threats of cremation. They also generate large quantities of ash – around 50 lakh tonnes each year – which is later thrown into rivers, adding to their waters’ toxicity.  The prolonged burning of fossil fuels for cremation results in around 80 lakh tonnes of carbon dioxide or greenhouse gas emissions per year, according to one estimate. It creates different hazardous gases, including dental mercury, which is vaporised and released into the environment leading to health hazards in the surrounding area. Many of these toxins can bio-accumulate in humans, including mercury – often from dental amalgams, but also from general bioaccumulation in the body. Cremation results in various other toxic emissions including persistent pollutants such as volatile organic compounds, particulate matter, sulphur dioxide, nitrogen oxides and heavy metals. An IIT Kanpur study in 2016 found that open-air cremations contribute 4% of Delhi’s carbon monoxide emissions. There are concerns for crematorium workers as well, who may be exposed to nuclear medicine treatments (chemotherapeutics/radiation), orthopaedic (implants) and pacemaker explosions, and nanoparticles.

. In order to tackle the environmental problems stemming from these sites, the Indian government and environmental groups have over the years tried to promote the use of electric crematoriums as an alternative way of cremation. Electric crematoriums largely unsuccessful, are expensive to run, and crucially, traditional rituals are made impossible.

   Carbon Cost estimation -When people are cremated after death, the burning releases carbon into the air. Alkaline hydrolysis, in which the body is dissolved, has about a seventh of the carbon footprint of cremation, and the resulting fluid can be used as fertiliser. A Dutch study of the disposal of bodies found that the lowest amount of money that it would theoretically cost to compensate in terms of the carbon footprint per body was €63·66 for traditional burial, €48·47 for cremation, and €2·59 for alkaline hydrolysis. Composting or natural burial are alternatives.

New Delhi: The National Green Tribunal (NGT) has questioned the centuries-old tradition practised by Hindus to cremate dead bodies at the river banks, saying the method of burning wood leads to air pollution and also effects natural water resources.

Keeping in mind the growing level of pollution, the NGT said that there was a need to adopt environment-friendly methods like electric crematoriums and use of CNG and change the ‘mindset of the people’.

The NGT bench headed by Justice UD Salvi also directed the Union Environment Ministry and the Delhi government to initiate programmes to provide alternative modes of cremation of human remains, saying the traditional emitted hazardous pollutants in the environment.

  “It is also the responsibility of the government to facilitate the making of the mindset of the citizens as well as to provide environment-friendly alternatives for cremation to its citizenry,” the bench further said.

   The green panel said the traditional means of cremation caused adverse impact on environment and dispersal of ashes in the river led to water pollution.

   If we are to survive the climate crisis then almost everything will have to change, including health care, end-of-life care, and how we dispose of the dead.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

SC Rejects Greedy decision by Govt & Private Medical College-Fee Hike


 

    The Supreme Court set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

The Supreme Court in a judgment on Monday held that education is not a business to earn profit as it set aside an Andhra Pradesh government order of 2017 prescribing a seven-fold increase in MBBS fees that made it ₹24 lakh per annum.

Directing the private colleges to refund the amount collected in excess of the fees last fixed by the state government in 2011, a bench of justices MR Shah and Sudhanshu Dhulia said, “Education is not the business to earn profit. The tuition fee shall always be affordable.”

The order came on a petition filed by the Narayana Medical College challenging a September 2019 decision of the Andhra Pradesh high court striking down the fee increase and ordering refund to students admitted in the college since the academic year 2017-18. The apex court dismissed the petition with cost of ₹5 lakh to be borne equally by the petitioner college and state government and deposited in court within six weeks. The amount was directed for use in legal services by the Supreme Court Mediation and Conciliation Committee and the National Legal Services Authority.

The top court agreed with the conclusion made by the high court and said, “To enhance the fee to ₹24 lakh per annum, I.e., seven times more than the fee fixed earlier was not justifiable at all.” The aggrieved medical students who had to pay through their nose had said that the government order raising the fees issued on September 6, 2017 was done without awaiting the recommendation of the Admission and Fee Regulatory Committee (AFRC).

The bench held the order passed by the state government to be “wholly impermissible and most arbitrary”. The court even went to the extent of saying that the hike was done “only with a view to favour or oblige the private medical colleges.”

“Any enhancement of the tuition fee without the recommendation of the AFRC shall be contrary to the decision of this court in case of P.A Inamdar in 2005 and the relevant provisions of the 2006 AFRC Rules (prevailing in the state). The high court has rightly quashed and set aside the GO dated September 6, 2017.”

The students pointed out that in 2011, the tuition fee hike was introduced by the state after consulting AFRC. However, in 2019, the state acted solely on representations received from private medical colleges. Rule 4 of the Admission and Fee Regulatory Committee (for Professional Courses offered in Private, Unaided Professional Institutions) Rules, 2006 mandated the state to seek a prior report from AFRC before altering the fee.

This rule required AFRC to factor in the location of the institution, nature of professional course, cost of available infrastructure, expenditure on administration and maintenance, reasonable surplus required for growth and development of the institution, revenue foregone on account of waiver of fee in respect of students from reserved category or economically weaker sections (EWS) of the society.

The top court said, “Determination of fee/review of fee shall be within the parameters of the fixation rules and shall have the direct nexus on the factors mentioned in Rule 4 of the 2006 Rules…the state government enhanced the tuition fee at an exorbitant rate of ₹24 lakh per annum, almost seven times the tuition fee notified for the previous block period.”

The next question arose regarding refund as ordered by the high court in its order of September 24, 2019. The high court said that the colleges cannot take benefit of the unjust enrichment in fees that was wrongly increased. Accordingly, it asked the colleges to refund the students after adjusting the amounts payable under the earlier fee structure recommended by AFRC and issued in June 2011.

The bench upheld this part of the high court order and said, “The medical colleges are the beneficiaries of the illegal GO which is rightly set aside by the high court.” The bench was conscious of the hardships faced by students who arranged to pay the amount by obtaining loan from banks and financial institutions at high rate of interest. “The management cannot be permitted to retain the amount recovered or collected pursuant to the illegal GO,” it held.

The college told the Supreme Court that between 2011 and 2017, they incurred added expenses due to the requirement introduced in 2016 to pay stipend to students even as the fee remained unchanged since 2011. The bench told the college that this component would be compensated as and when the higher tuition fee is fixed by AFRC. However, the court did not permit the college to retain the illegally collected amount.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

How to Reduce Social Media Addiction-Digital Minimalism


         The Demons of social media and online gaming  has rewired the people’s mind to live life and  remain in virtual world. The chaos and turmoil in the society can be linked to social media that exploits the deep wired craving of masses to know more about the “realities”. Once a curiosity  is fired, each one at social media starts feeding something or other.   In the mad game of TRP’s, clouts and engagements, these players cross ethical lines and create rifts. They literally hunt and scavenge news items that suit their narrative. They embellish it with more provocative words and share it with their name hoping to drive more engagement Conspiratorial and alarmist thinking is likely to keep people glued to social media.

     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.

Digital Minimalism- break free from “internet compulsions”

                                       
     Freedom, Cold Turkey, RescueTime, Toggl, StayFocusd, FocusMe, SelfControl, AntiSocial… They are not random words pulsed together in a blender, but names of some of the top apps that, ironically, help you stay away from your digital addictions. As Thakur said in Sholay, “loha lohe ko kaat-ta hai”, so now we need apps to stay away from apps. This farcical situation hides a deeper reality – too many of us are spending too much time online. So, amid the launch of 5G and other high-speed tech, a growing army of people doesn’t want to be addicted to social media and googling. They aspire to live frugal, almost ascetic, digital lives without completely switching off from the internet. It’s a trend called ‘digital minimalism’, and it is different from a ‘digital detox’ where you unplug completely. To illustrate, detox is what Mohityanche Vadgaon village in Maharashtra’s Sangli district does. A siren goes off at 7pm, and residents put their electronic devices away for 90 minutes. Children are encouraged to read while the older people meet and chat.

Digital minimalism, however, does not require complete withdrawal. Coined by author Cal Newport, it is a way of using technology in which you focus your online time on a few carefully selected tasks that strongly support the things you value. It advises against excessive use of gadgets.

Digital Minimalism- break free from “internet compulsions”

       Digital minimalism is based on three tenets: clutter is expensive, optimization is critical, and intention is satisfying. The objective is that the usage should be intentional and controlled for a limited period of time. And the apps mentioned above are meant to stop you from jumping from one attention-diverting push notification to another. They can block other apps from operating, create blocklists, schedule apps to run only during a specific time of the day, and alert you about the excessive time spent online.

       This philosophy is being discussed now, especially after the pandemic when people began spending more time online, adding that children aged 13-18 years have become more prone to digital addiction since the pandemic. The parents are taking their children to counsellors as they have become addicted to screens and feel isolated and tense when they have to interact with people in the real world. For them, online networking is secure and simple.” He advised gradually introducing such children to digital minimalism, to reduce their reliance and time spent on digital platforms. He also said it is critical for parents and adults to see if those who are addicted to digital devices have any anxiety issues. Because digital addiction has been observed in people who already have anxiety issues, these issues must be addressed first.  WHO has classified excessive use of the internet and mobile phones as screen addiction, and provided a set of guidelines. There is certainly a 50% increase in screen time addiction cases post-pandemic, we should be more concerned about the changes that will occur with advancements, like the metaverse.  Need to first introduce minimalistic practices, and then, in some cases, recommend mild medication to help people break free from their “internet compulsions”.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

A Child is Born Free till he chooses to be Doctor # Rohtak-Medicos-fight-Unjust-Bonds


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.

MBBS  medical  students protest against Haryana Govt Bond Policy-Rohtak

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   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-Rohtak

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.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Blowin’ In The Wind-Delhi Air Pollution: Colossal Administrative failure


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.

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

NEET- Not so Neat- percentile system

 

Projection of  Inflated Cost of Medical Education- Global Exploitation of Young Doctors


The  Myth  of  cost of  spending  on  medical  education needs to be made  transparent.

Educating a doctor cost less what   medical colleges  claim- a global phenomenon.

   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.

Educating a doctor cost less what   medical colleges claim

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.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Transition from   ‘Natural death’ to Medicalized Death- Paradox  of dying process


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.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

Travel Associated Infections & Diseases


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). 

General precautions to prevent infections are outlined in the Chapter 5 of the international travel and health situation publication

Non vaccine-preventable diseases

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.

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Malta Fever- Brucellosis- Mediterranean fever


           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.

What is the risk to pregnant women?

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.

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Anne Heche’s (Hollywood Actress) Accident-Brain Death & Organ Donation


  Brain dead patients are potential organ donors. 

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.

 

National Organ Transplantation Programme (India)

Background

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 enactedSome of the important amendments under the (Amendment) Act 2011 are as under:-

  1. Tissues have been included along with the Organs.
  2. ‘Near relative’ definition has been expanded to include grandchildren, grandparents.
  3. Provision of ‘Retrieval Centres’ and their registration for retrieval of organs from deceased donors. Tissue Banks shall also be registered.
  4. Provision of Swap Donation included.
  5. 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.
  6. Provision of Mandatory ‘Transplant Coordinator’ in all hospitals registered under the Act
  7. To protect vulnerable and poor there is provision of higher penalties has been made for trading in organs.
  8. 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.
  9. National Human Organs and Tissues Removal and Storage Network and National Registry for Transplant are to be established.
  10. There is provision of Advisory committee to aid and advise Appropriate Authority.
  11. Enucleation of corneas has been permitted by a trained technician.
  12. 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:

  1. Lay down policy guidelines and protocols for various functions.
  2. Network with similar regional and state level organizations.
  3. All registry data from States and regions would be compiled and published.
  4. Creating awareness, promotion of deceased organ donation and transplantation activities.
  5. Co-ordination from procurement of organs and tissues to transplantation when organ is allocated outside region.
  6. Dissemination of information to all concerned organizations, hospitals and individuals.
  7. Monitoring of transplantation activities in the regions and States and maintaining data-bank in this regard.
  8. To assist the states in data management, organ transplant surveillance & Organ transplant and Organ Donor registry.
  9. Consultancy support on the legal and non-legal aspects of donation and transplantation
  10. Coordinate and Organize trainings for various cadre of workers.

For Delhi and NCR

  1. Maintaining the waiting list of terminally ill patients requiring transplants
  2. Networking with transplant centres, retrieval centres and tissue Banks
  3. Co-ordination for all activities required for procurement of organs and tissues including medico legal aspects.
  4. NOTTO will assign the Retrieval Team for Organ retrieval and make Transport Arrangement for transporting the organs to the allocated locations.
  5. NOTTO will maintain the waitlist of patients. needing transplantation in terms of the following:-
  6. Hospital wise
  7. Organ wise
  8. Blood group wise
  9. Age of the patient
  10. Urgency ( on ventilator, can wait etc.)
  11. Seniority in the waitlist (First in First Out)
  12. Matching of recipients with donors.
  13. Allocation, transportation, storage and Distribution of organs and tissues within Delhi and National Capital Territory region.
  14. Post-transplant patients & living donor follow-up for assessment of graft rejection, survival rates etc.
  15. Awareness, Advocacy and training workshops and other activities for promotion of organ donation
  16. ROTTO: Regional Organ and Tissue Transplant Organization
Name of ROTTOStates 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)West Bengal, Jharkhand,Sikkim, Bihar and Orissa
PGIMER Chandigarh(UT of Chandigarh)Punjab, Haryana, HP, J &K , Chandigarh , Rajasthan, Uttar Pradesh and Uttarakhand
Guwahati Medical College (Assam)Assam, Meghalaya, Arunachal Pradesh, Manipur, Nagaland, Mizoram, Tripura.
  • 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.

     Advantages-Disadvantage of being a doctor

     25 factors- why health care is expensive

REEL Heroes Vs Real Heroes        

 21 occupational risks to doctors and nurses

Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons              

Expensive Medical College  seat- Is it worth it? 

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