Singed with hot rod to ‘cure pneumonia’- the child dies: Illogical distribution of health care


         In a heart wrenching and unfortunate incident from Bhopal (Madhya Pradesh), a 2.5 month child was singed with hot iron 50 times by a quack for treatment of pneumonia.  He died and   the incident appeared in newspapers, but similar kind of  treatments must be going on at many places and  gullible patients keep on suffering .The suffering is of two types; one, that they are deprived of correct treatment and other is the tremendous suffering because of such nature of cruel practices in the garb of  treatment.    

         That brings to the fore the basic question; why such type of treatments are being practiced and allowed to be conducted in 21th century. Why people allow  and consent for such treatments by quacks?

     These incidents simply reflect that the health system has not been able to travel  the last mile and  has failed to  touch the last man.

         Most important reason for such disparity is illogical distribution of health care.  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.

It seems humanity has legalized the hoarding of medical care; give it to the rich, bundled with consumerism though not necessarily the needy. It is the same as hoarding of the food that is sold to rich, letting the poor die somewhere in the world without food, which remains invisible to all.

          Another worrisome aspect of the incident is  that  avoidance of people to  seek treatment from appropriate  clinics and hospitals. Anganwadi worker was there in the village, so it was possible  to seek help from the health system. Is the mistrust and malice  generated  by media towards  doctors and  medical professionals is the reason to  avoid seeking help from them?

BHOPAL: A newborn has died after being singed more than 50 times with a red hot iron rod in a bizarre ritual to ‘cure pneumonia’ in MP’s Shahdol district. A local anganwadi worker saw this horror being inflicted upon the child by a quack and persuaded the parents to take her to a hospital, say sources. They did, but it was too late. The baby’s body was exhumed on Friday evening for post-mortem examination. Even as police were grappling with this horror, a similar case was reported in a nearby village. This infant is in hospital. Police are yet to arrest anyone in either case and it’s not yet known if the same quack, a woman, was behind singeing both babies. The Child Welfare Committee has written to police to take action under section 75 of Juvenile Justice Act, but nothing has been done. When TOI spoke with Singhpur police, they said they were taking legal opinion on how to proceed with the case. An officer said they are waiting for the autopsy report to see what charges can be pressed. The baby who died was two and a half months old and suffering from pneumonia. Her parents live in Kathotiya village, around 520km from Bhopal and close to Chhattisgarh. “The infant was ‘torched’ as a method of ‘treatment’ on January 10.” Singhpur police station in charge, MP Ahirwar told TOI. The second incident happened in Samtapur villagee. The baby’s parents deny they put the girl through the burning ritual.

     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.

Budget outlay on medical insurance up, public health infrastructure down


       Whether it is better to buy fish for years or provide people with fishing net? This applies to public health care system in India.  Times of India analysis points out the need to build and strengthen   the public health care system. Building of infrastructure for massive population requires funds, but ultimately the investment will bring down the cost of treatment and better delivery of health care to the country.

                     NEW DELHI: The health budget is good news for the private health sector as there has been a substantial increase in allocation for health insurance schemes such as the Central Government Health Scheme (CGHS), treatment for CGHS pensioners and the Ayushman Bharat scheme. Government’s own data has shown that the private health sector corners the bulk of the spending under these schemes, which saw a nearly 22% jump in allocation in the 2023-24 budget.

          In contrast, the allocation for schemes aimed at improvement in public health infrastructure has declined when adjusted for inflation. These include the National Health Mission (NHM), Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PMABHIM), human resources for health and medical education and Pradhan Mantri Swasthya Suraksha Yojana (PMSSY).

The overall allocation for health after rising during Covid, has come down in real terms though it seems like an increase in nominal terms from Rs 83,000 in the budget estimates (BE) for the current year to Rs 86, 175 crore in BE 2023-24. The revised estimates (RE) for the current year indicate a 9% decline from the BE to Rs 76,370 crore. The allocation for insurance schemes, however increased substantially in RE 2022-23; more than 75% hike in allocation for CGHS pensioners from Rs 2,645 crore to Rs 4,640 crore and for the first time since the launch of Ayushman Bharat scheme, the RE is the same as the BE at Rs 6,400 crore. In the past, only about half the budgeted amount for Ayushman was getting spent. However, the allocation for all the public infrastructure schemes put together has been slashed by 16% in the RE for the current year. In comparison to the Rs 13,266 crore allocated for insurance schemes, which cover only a section of the population, about Rs 30,000 crore has been allocated for the National Health Mission and a separate Rs 6,500 crore for human resources for health and medical education, which was earlier part of the NHM budget.

         Most of the allocation for the insurance schemes usually ends up in the coffers of the private sector. Despite private hospitals accounting for only 46% of empanelled hospitals under Ayushman Bharat, for instance, they accounted for 54% of hospitals admissions and since private healthcare is more expensive, that could account for a much higher proportion of the money spent. Most CGHS beneficiaries too go to private hospitals as noted by Dr Rakesh Sarwal, who was advisor health in Niti Aayog, in a study of the scheme. Dr Sarwal stated that CGHS had a higher cost of service because of its greater reliance on private facilities. Incidentally, though the finance minister announced a mission to eliminate sickle cell anaemia, there is no separate budget line for it. Thus even the money for a totally new scheme might have to come from within the NHM budget, further eating into the allocation. The tertiary care programme, which provides for transfer to states for implementing national programmes on control of blindness, tobacco control, capacity building for trauma centres and for prevention and control of non-communicable diseases such as cancer, diabetes, cardiovascular diseases and stroke, has had its allocation slashed to just Rs 290 crore, less than the actual spending of Rs 300 crore in 2020-21, and 42% less than the allocation of Rs 500 in the last budget.

The budget for the establishment and strengthening of the branches of the National Centre for Disease Control and for preparation and control of zoonotic and other neglected tropical diseases and for diseases surveillance, which had gone up during Covid, has been slashed from Rs 71.6 crore to just Rs 55.6 crore, despite the WHO asking countries to prepare for future pandemics by strengthening surveillance. Even the budget for the Indian Council for Medical Research, which played a crucial role during Covid, has been slashed along with a cut in the overall allocation for health research.

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.

Comparing airline industry & health care is fallacious, an oversimplification; apples to musk-melons


 

 

The issue of patient safety has been gaining increased traction year on year and the issue is in right direction.  Hospitals, doctors and administration need to vigorously address shortcomings and strive toward minimum errors and desired goals of safety.   Patient safety is of paramount importance; therefore it is an serious issue. It should be achieved by good ground work and not by sensationalizing and mischaracterizing the real basic issues, transparent safety culture, adequate number of staff and resources.

There is a recurrent old argument and temptation to ask about why healthcare can’t be as safe as airline travel.   There can be many apt comparisons that may be possible between aviation and health care especially taking into account the risk involved. But the doctors who treat critical emergencies,  have  insight looking at life and death situations directly,  know  that comparing both would be just an oversimplification of the real basic issues.

  At most of the points, the comparison is a complete fallacy; and like comparing apples to musk-melons.

It is beyond doubt that air-industry maintains truly an impressive system which is well-designed to achieve the safety results that it does.  But , the kind of  comparison  that  some health care safety leaders make in which they compare the  mortality data of acute hospital care and airline fatal accident rates is more of a word play and not so appropriate. This comparison is dangerous because it misses the key points for improvement. Such comparisons  merely present over-simplified and convenient tool for the health quality experts, who themselves have never been a front line health workers at any point of time, but still pretend to pioneer the  quality in health industry.  For the quality improvement the leaders need to be grounded in the reality of emergency front line medicine to be really effective.

  1. Aircrafts  are engineered to be in the best possible shape before they fly. Patients, on the other hand, patients  are in the worst shape when they enter the emergency of the hospital.

Medicine is by nature, a much more risky work than flying along with vulnerability to death always.

  1. The aircrafts are required to regularly demonstrate that the performance of their critical systems meets or exceeds strict standards. If systems are not operating well the plane will not be allowed to fly.

But all the patients, (aeroplane metaphor) are already sick; doctors are expected to fly such aeroplanes, who are in crashed condition universally. Doctors do not have the luxury to replace any part.  For example, when doctors treat an elderly with heart failure, chronic kidney failure and pneumonia, they try to keep them “flying” despite multiple sub optimally functioning critical systems.

  1.  In other words, doctors have to fly crashed planes always on every day basis, something that never happens even once in aviation industry.
  2. Has any Pilot ever tried to fly  a plane in which engine power is only 25 percent of normal with  other systems are functioning  sub optimally  and  the fuel tank is leaking?  What will be standard procedure (SOP)  for Pilot to fly this plane? But everyday doctors try to fly such planes and they have to fly it no matter how many systems are non-functional.  Moreover, doctors can be sued on some flimsy grounds in case they fail or an accident happens in an effort to keep this plane in the air.  Treating a critical illness is like an effort to keep such planes in air with suboptimal functioning systems.

Obviously the comparison is a bit overzealous.

  1.   What would be chances that a fully checked plane with a trained pilot will crash after flight takes off. Now compare the chances of patient who lands in emergency, and treatment is started.

By a simple common sense, are two situations comparable?

Former has no chance (almost Zero percent) of crash whereas in a critical emergency patient, the chances of crash are 100 % to start with.

  1. Communication of passengers to the pilot about what he should do and what he should not while flying the plane is nil. Whereas doctors are continuously bombarded with google knowledge of patients and interference by relatives and questioned about every action.
  2.   Doctors are expected to make future prediction about what can happen, how he will be able to keep the crashed plane in the air and take consent, based on few assumptions. Doctors can be harassed and dragged to courts if such predictions fail.
  3. Airlines will always have full staff to serve promptly during a flight. The pilot will be totally dedicated to flying the plane, and will not fly without the co-pilot and crew. On the other hand, front line healthcare workers know it well the fact that patient safety incidents and errors tend to occur when they are struggling with staffing levels and feel grossly overworked.

Fatigue and overwork is too common scenario among front line healthcare staff in clinical settings.

  1. A pilot is also only ever going to fly one plane at a time. It is not realistic for a doctor or nurse to be allocated to just one patient, but the workflow is very different, with healthcare tasks frequently interrupted with new clinical issues and emergency situations. Consequently, insufficient staffing can have an acute effect on outcomes and the ability to perform safely.
  2. Aviation industry is too predictable and on the contrary, health care is combination of uncountable unpredictable risk factors, be it allocation of staff or risk of death or resource prediction and complexity of communication.
  3. Aviation is more of mechanical milieu, whereas health care deals with emotion and compassion. The two industries are vastly heterogeneous, and to say that safety in medicine should follow in the path of flying airplanes, grossly oversimplifies a complex problem.
  4.    Last but not the least; health care involves lot of financial uncertainties and arrangements. Needless to say, doctors carry the blame for financial hardship of the patients, even if they are not responsible for costs. The mammoth industry remains hidden and doctors are blamed as they are the only front man visible.
  5. Basic difference lies in the fact that patients are real living people, whereas airplanes are simply machines, whose codes and protocols are well defined and limited to within human capabilities. The importance of human contact, empathy, compassion, interact and listen to concerns, and the ability to spend adequate time with patients,  should be  always be the first pillar of promoting a culture of safety.
  6.   Exhortations by armchair preachers to learn oversimplified improvement examples from aviation can provoke considerable frustration and skepticism among clinicians exposed to the unique challenges, difficult working conditions and everyday complexities.  Patients are not aeroplanes, and hospitals are not production lines.

Most unfortunate part is the assumption that every sick person who dies in a hospital from an adverse event is an example of a truly preventable death rather than clinicians trying their best to keep someone alive and eventually failing.

  1.  Checklists and documentation to improve systems are wonderful in mechanical areas like operative care and inserting central lines, but have limited role and can only go so far without the most important virtues of being a doctor or nurse. It means more than mechanically following protocols and doing paper work in real sense.

In health care merely providing check list and doing extra- paper work may be counterproductive for many reasons.  Increase in time for voluminous documentations will consume time and forces health care workers to focus on paper work and takes them away from patient’s real issues.

Completed paper work and excessive documentation provides a false assurance of quality work, which may or may not reflect true picture of patient care. Even after full documentation,  still  it will be required  to be carried out in a diligent manner, a  task which is different from mechanical  task of mere check list  of other  industries . Learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare, but its utility is limited only for documentation purposes and not real quality. Caring for patients is radically different from flying aeroplanes. Healthcare is unique in the intimacy, complexity, and sensitivity of the services it provides as well as the trust, compassion, and empathy that underpin it.

Merely completing protocols mechanically and excessive documentation will result in decline in quality actually.  Simply importing and applying a ready-made tool will lead to situation, where quality will exist only on papers and merely  reduced to a number to the satisfaction of so called ‘pioneers’ of quality.

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.

An Epidemic of Substandard drugs, Fake drugs, Pseudoscience & Counting


    A frightening scenario is emerging as there seems to be an epidemic about fake or substandard medicines, spurious drugs and heightened belief in marketed therapies by advertisements.  An epidemic of ignorance that causes people to believe in pseudoscience or merely in projected promise of cure. A hope of miracle is flashed to patients, who have been given a ‘no hope’ by scientific medicine. Such patients are an easy prey for such fraudsters. It is not uncommon that lethal substances like steroids, hormones and heavy metals are given in dangerous doses.

       In the absence of strict Government control, all kinds of dubious assertions are available about curing all types of ailments.  These alleged remedies, and the belief systems they are based on, are based on the facts that can neither be proved nor disapproved. They are dangerous to life of patients, which is why it is necessary to fight them and refute them.  But who should fight? Patients themselves are blinded by a projected faith and false belief about definite cure.

Drugs samples- declared not of standard quality

New Delhi: In its latest drug safety alert, the apex drug regulatory body, Central Drugs Standard Control Organization (CDSCO) has flagged 50 medicine batches for failing to qualify for a random drug sample test for the month of October,2022.

These drugs samples which are declared not of standard quality include Levocetirizine tablets manufactured by Hindustan antibiotics, Onkam (ondansetron Oral solution) manufactured by Gujarat Pharmalab, Pantop-DSR (Pantoprazole Sodium Gastro-resistant & Domperidone Prolonged release Capsules IP) manufactured by Aristo pharmaceuticals, Diacowin-plus Capsules (prebiotic & probiotics capsules) manufactured by Zee Laboratories and others.

In addition, other popular drug sample that is declared not of standard quality include Montek LC (Montelukast Sodium & Levocetirizine Hydrochloride Tablets IP) manufactured by Sun pharma laboratories due to failure of Identification and assay of Montelukast.

Also Read:Drug Alert: CDSCO flags 45 formulations as not of standard quality

This came after analysis and tests conducted by the CDSCO, Drugs Control Department on 1280 samples. Out of these, 1230 samples were found to be of standard quality while 50 of them were declared as Not of Standard Quality (NSQ).

A few of the reasons why the drug samples tested failed were the failure of the assay, failure of the disintegration test, failure of the dissolution test, failure of sterility test, etc. The samples collected were tested in five laboratories, namely CDL Kolkata, CDTL Mumbai, RDTL Chandigarh, RDTL Guwahati, and CDTL Hyderabad.

Syndicate Supplying Fake Cancer drug Busted #Spurious-Medicine

The rise in “falsified and substandard medicines” has become a “public health emergency”. A surge in counterfeit and poor quality medicines means that thousands of patient  a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control and regulations to make it easy for criminal gangs and cartels to infiltrate the market.

More are thought to die from poor or counterfeit vaccines and antibiotics used to treat or prevent acute infections and diseases. Beyond the fakes that are made and sold by criminal gangs are poor-quality medicines that lack sufficient active ingredients to work properly, or fail to dissolve correctly when taken. Sloppy manufacturing is often to blame, but others are sold past their shelf life or have degraded in poor storage conditions.

There is an  urgent  need for  effort to combat a “pandemic of bad drugs” that is thought to kill hundreds of thousands of people globally every year.

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.

Syndicate Supplying Fake Cancer drug Busted #Spurious-Medicine


The rise in “falsified and substandard medicines” has become a “public health emergency”. A surge in counterfeit and poor quality medicines means that thousands of patient  a year are thought to die after receiving shoddy or outright fake drugs intended to treat ailments. Most of the deaths are in countries where a high demand for drugs combines with poor surveillance, quality control and regulations to make it easy for criminal gangs and cartels to infiltrate the market.

There is an  urgent  need for  effort to combat a “pandemic of bad drugs” that is thought to kill hundreds of thousands of people globally every year.

More are thought to die from poor or counterfeit vaccines and antibiotics used to treat or prevent acute infections and diseases. Beyond the fakes that are made and sold by criminal gangs are poor-quality medicines that lack sufficient active ingredients to work properly, or fail to dissolve correctly when taken. Sloppy manufacturing is often to blame, but others are sold past their shelf life or have degraded in poor storage conditions.

    Governments and pharmaceutical companies had to improve the security of the drug supply chain in all countries from the point of manufacture to the patient. Regarding online pharmacies, there is poor public understanding of how to differentiate between a legitimate online pharmacy and an illegal one. Illegal online pharmacies and the sale of medicines via social media platforms pose the greatest risk to the  public.

Deadly Cocktail: to Make  Fake Cancer Drugs- Syndicate Manufacturing & supplying over 21 Spurious Medicines

To make big money, Pradhan got his cousin Shubham Manna and Ram Kumar involved in his plan and started making spurious cancer drugs. “He had been providing spurious medicines at a discounted 50% of market prices. He was manufacturing and supplying more than 21 spurious cancer medicines of various companies of different countries,” special commissioner (crime) Ravindra Yadav said. The syndicate comprised highly-qualified and well-earning individuals. Manna had completed his BTech and served in MNCs before joining hands with Pradhan. Police said his job was to generate barcodes, emboss batch numbers and expiry dates on medicines. He also looked after overall packaging of the spurious medicines. International syndicate used to procure capsules and manufactured fake medicines by filling them with starch.

     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.

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.

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.

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.

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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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   Medical-Consumer protection Act- Pros and Cons              

Expensive Medical College  seat- Is it worth it? 

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