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Healthcare system a sinking ship: Says Niti Aayog


A chaotic and non-uniform system, after years of neglect cannot be corrected overnight or by change in piecemeal policies. It needs to be revamped from the roots. To do it from grass root  level especially with financial constraints,  it will need a  sincere will to develop  the system.

                     India’s top think tank said Thursday that the country’s healthcare system resembled a “sinking ship”and desperately needs more private participation in smaller towns to run the government’s ambitious Ayushman Bharat program efficiently.

“We would require all hands on deck, as they say,” Niti Aayog adviser Alok Kumar said at the Healthcare Federation of India’s Sixth Annual Summit, referring to the poor state of healthcare in India. The Ayushman Bharat’s insurance program, Pradhan Mantri Jan Arogya Yojana (PMJAY), has been facing constraints in smaller cities due to a dearth of hospitals.

“We can’t have all the patients being transported to tier-1 and tier-2 cities for treatment because that is not a model which is sustainable,” Kumar said.

The Lancet, the world’s oldest and most prestigious journal, had last year ranked India’s healthcare system at a dismal 145 out of 195 countries, worse than even North Korea and Syria. The ranking was worse than its smaller Asian peer Philippines and neighbour Sri Lanka, a fact also pointed by Kumar.

Kumar said that a number of hospitals in smaller cities, including those run by public sector enterprises, are under-utilized even though there is strong demand for their services in these regions, especially because of the insurance program.

“Singrauli, for instance, the power capital of India, has hospitals of NTPC, Coal India Ltd; all of them underutilized (like) shells standing. Railway hospitals (are like) shells standing but not being utilized efficiently enough,” Kumar said.

He urged large private hospital chains to manage the hospitals run by state enterprises better by widening the scope of their services to beyond their own employees.

The PMJAY was introduced last year, and aims to provide health insurance cover of 5 lakhs per family per year for secondary and tertiary care hospitalization to over 10 crore poor and vulnerable families, which would total around 50 crore beneficiaries.

Ayushman Bharat is the umbrella program, with PMJAY for secondary and tertiary hospitalization, and health and wellness centres for primary healthcare facilities. Under the Ayushman Bharat, the government aims to create around 1.5 lakh health and wellness centres.

While the Indian government aims to increase the share of public health spending to 2.5% of GDP by 2025 under the National Health Policy, currently it is still only around 1%.

Another major problem for the poor state of the sector is the lack of health insurance for patients, leading to an out of pocket expenditure making up for 61% of total health expenses for households, as of 2015-16, latest National Health Accounts data showed.

To reduce out of pocket expenses, the government introduced the Ayushman Bharat insurance scheme, but large private hospital chains have shown resistance to participating in it due to ‘low package rates’ for various treatment procedures. Kumar said that the government was willing to listen to hospitals and other private entities and make changes to policy if they were ready to invest in the sector.

 

Risk to health workers working in remote areas (specially-Women; Doctors & Nurses)


 

Often  an issue is raised that doctors and nurses  are hesitant to go to  remote places.  Brutal rape and murder of Hyderabad vet doctor  is an evidence of the  dangers lurking because of  preying eyes   and lack of security, specially to women health workers (doctors and nurses).

 A  ghastly  incident that highlights the dangers associated with entering unfamiliar places, unsecured environment  and a dark world with  no one to listen to   heart wrenching cries of the unassuming victim. With no serious policing activities, it may turn out to be unthinkable nightmare.

       But  the lady doctor  went  to a place where transport was difficult and paid the price. A  women  is being  posted to an area where transport and security  were not provided and thereby  assigned  an unsafe posting.

         Doctor   should consider these factors before joining at unsafe places.

          Problem is that the system does not take into account the risk to health workers, their convenience  and  family obligations. Their difficulty in transport,  the security issues, providing basic amenities are  not considered important by  administrators.

  The system  that failed to  provide proper transport and security is the  real culprit.

 Till  some one  puts a question to  the  system and makes them accountable, there will be  more cases of this kind.

  Had  the  deceased  not been  a doctor, or from  some  other profession,  there was no compulsion  for her to go to remote areas.

        Lack of medical facilities  and infrastructure add to the  risk, as the health workers are held responsible for  all the short comings. Not infrequently they become the punching bags for the  inept system and infra structure deficiencies.     Females doctors and nurses are at greater  risk for obvious reasons and strangely there are no special provisions made for their security. Usually they are allotted a place where  they have to fend for themselves.  If one thinks it seriously, risk is even  greater than anticipated.

   Women -Doctors & Nurses- need to take precautions and save themselves in view of system insensitivity.

 

21  occupational-risk factors – for doctor and nurses

Real story of female doctor assault- serving uncivilized society

Work life balance problem for female doctor and nurses

Disadvantage of being a doctor

Who killed Hyderabad  Vet Doctor? Answer : “OUR SYSTEM”


 

      A vet doctor  was subjected to   brutal rape and death in Hyderabad.  An incident that filled  our hearts with  grief  and  pain.

Who are culprits? The four men, caught and will be given punishment. But are they alone the culprits?

       No; there are culprits who will not be even named. Our system is the biggest culprit.             

 Often  an issue is raised that doctors do not go to  remote places.

 But  the lady doctor  went  to a place where transport was difficult and paid the price. A female is posted to an area where transport and security  were not provided. She was given an unsafe posting with no security  and no transport.   The person who gave her  such posting is also the  culprit

         The system  that failed to  provide proper transport and security is the  real culprit. Till  some one  puts a question to  the  system and makes them accountable, there will be  more cases of this kind.

        May  the departed soul rest in peace. 

       Doctor   should consider these factors before joining at unsafe places.

 

 female  doctor  assault ; serving uncivilized society

Young veterinarian murdered, set on fire near Hyderabad after her vehicle broke down

The victim, who had left her house in Shadnagar for Kolluru village to attend her duties at a veterinary hospital, called her sister on Wednesday night to inform that her two-wheeler had broken down while returning home.

A young veterinarian has been murdered by unknown persons, while her burnt body was found on Thursday in Shadnagar town close to the Telangana state capital, police said.The charred body of the victim was found at Chatanpally bridge near Shadnagar town in the Ranga Reddy district.The victim, who had left her house in Shadnagar for Kolluru village to attend her duties at a veterinary hospital, called her sister on Wednesday night to inform that her two-wheeler had broken down while returning home.She told her sister that she was feeling scared and that somebody had offered to help her and taken her vehicle for repair. When her family members tried to contact her later, her mobile phone was found to be switched off.Police said the charred body of a female, aged between 20-25 years, was found near the bridge. Sridhar Reddy identified victim’s body as being that of his daughter.Senior police officers rushed to the scene for launching their investigations and were scanning CCTV footage from a nearby toll gate for clues.It may be recalled that in another gruesome incident earlier this month in the same district a man burnt alive a woman revenue official inside her office near here, but in the process also suffered critical burn injuries himself. The shocking incident occurred in the Abdullapurmet Tahsil Office in Ranga Reddy district on the outskirts of Hyderabad.

 

 

 

An Urban Jungle: where animals hunt Humans


Danger of stray dogs is increasing every day around us. As the strays population in increasing, now they are grouped and see vulnerable humans as easy prey. Packs of dogs have become dangerous and difficult to control. Protected by Dog lovers and animal right laws, the danger to normal people of being hunted even around their homes is real. Human right of being in a safe environment is being ignored. Is it not hypocritical that you care for a violent stray who is a threat to the society? Problem is not about loving and feeding dogs, but simultaneous apathy towards safety of humans. Such dog lovers most of the time, totally ignore the fact that these dogs are a threat to children and older people. An immediate sense of hatred towards such dog lovers is a consequence and a natural thought.

Just one of uncountable examples. An 80-year-old woman was attacked by stray dogs while she was going to a temple in Ludhiana city on Tuesday. She was admitted to DMC Hospital for treatment. Residents claimed that a group of 15-20 stray dogs has created terror in the area. The pack of dogs often attacks people including children. The said despite their repeated complaints to the authorities they have not got any kind of relief from this problem.

It is not uncommon dogs chasing children and older people. In a recent incident and a common one , the loud barking sounds were intermixed with cries of a child, who was running and screaming for his life. Two stray dogs were near him, trying to hunt him as a prey. As they got nearer to him, I somehow managed to get some stick from a plant and managed to save the child and shoo away the dogs. The nine year old child just clung to me, almost pale, dizzy and his eyes closed with fear. His football was in his lap, which he was trying to use as shield. A shield which society, government, courts and so called “dog-lovers” failed to provide. This child must be the life for his parents and could have been in a great trouble that day because of apathy of few “Animal Lovers”. For whom animal love is like a hobby to be projected for hollow public applause. I looked around, a gentleman was comfortably sitting with his small dog and reading newspaper. He did not even bother to look at what was happening. He was the person, who used to feed these stray dogs and claimed himself to be a “Dog lover”. He was totally unperturbed by the fact that a child was about to lose his life because of these wolf like dogs roaming freely. Similar apathy has been displayed by government and courts with a result that thousand suffer from dog bite every day.

Apart from the injury part, Rabies is a disease spread by dog bite, which is not treatable. Getting anti-Rabies serum becomes another Herculean task.

Courts have also upheld animal rights. That is right but they did not formulate policies to ensure safety of humans from these violent strays.

Government has not made out any policy to safeguard public from such attacks nor have courts come up with any solid guidelines, which can save public, children, women and older people from such bites.

Animal lovers while pretending of “dog love” have formed NGOs and have donations and accumulate money. But have failed to create shelters for stray dogs. Neither have any steps been taken to save people from dog bites. So consequently, people especially vulnerable are children and older people who are mauled and eaten alive by stray dogs. What responsibility and accountability these animal lovers and NGO bear towards such incidents? Why people who collect money in name of animals do not take care and form shelters for these strays? every single death from such preventable cause raise a question on this issue.

Apathy of these so called dog lovers towards humans is appalling.

Besides dog bite and injuries, animal and dog poop is an health hazard. Following are the diseases which occur in community because of animal poop.

Problem of animal poop with dust : It is all around us. It is actually even a bigger health problem than open defecation by humans. Humans defecate in country side and in open fields. But stray animals and dogs are everywhere. Even owner of pet dogs make them defecate outside their own houses and on the roads and wherever their dogs chooses. This poop dried and mixed with dust, acts a source of infection to the community.

Life threatening infections : dog’s and animal faeces is a big health hazard. It is even worse than a dog bite since it spreads infection in entire community. A dog’s digestive system can handle just about anything that it eats and this makes its poop very toxic. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. These heavy loads of bacteria increase the risk of infections in the community. But pregnant women, children and people with suppressed immune systems may are more prone to these infections. Many diseases may be spread by millions of these dogs and other animals like pigs, cattle as their faeces contain parasites, bacteria and viruses. These include life threatening bacterial infections by E. coli, MRSA, Leptospira, Salmonellosis, Campylobacteriosis, brucellosis, Rickettsia and parasitic infections like Giardiasis, Whipworm, Hookworm, Roundworms, Tapeworms, Cryptosporidiosis, Echinococcosis, Leishmaniasis etc. Viral infections like rabies, influenza and other viruses may also spread through these animals.

Environmental health Hazard: Storm water runoff due to extensive rainfall can wash off all these droppings into drains, many of which are connected to river systems and water sources in our country. This can lead to a widespread source of waterborne illnesses. Dry poop on the roads is mixed with dust particles and in the air. So everyone is living in a highly infectious environment. This may be an important cause of high rates of community acquired infections among our population.

SUGGESTION: the Government, NGOs and people who claim to be “animal lovers” should create shelters to save strays “as well as people”. It should be mandatory that all the dog and animal (stray or pet) droppings are properly collected and disposed off. This single step can do wonders as it will reduce infections, people’s suffering, save lives and eventually reduce use of antibiotics. A rationale mind will definitely appreciate the danger due to strays, and can initiate proper steps rather criticizing above said facts in the name of animal rights. An animal has no sense of responsibility, so rights should be limited accordingly.

dog poop: obstacle to Swatch Bharat

How to implement bridge course, if necessary: A suggestion #NMC


Crosspathy is dangerous to human race and potential global catastrophe because of antibiotic resistance.  All  allopathic medicines are hazardous chemicals in inexperienced hands. Incorrect and massive use of antibiotics will  cause antibiotic resistance, which has global ramifications. From this angle, it is a retrograde step. When all over the world, need is being felt that there has to be better control of antibiotic prescription.  We are entering an era, where antibiotics are getting useless and more so because of rampant misuse of antibiotics.  Rather than exercising a better control, it will be a catastrophic to human race world over by causing antibiotic resistance.

Will  thousands or lac   of alternate medicine graduate will dispense all antibiotics,  anticancer , anti diabetic , cardiac medications? It is hard to think about hundreds of potentially dangerous medicines being given without structured training and  proper exams in this system of crosspathy.

   Although it appears to be an avoidable decision, but still if required can be done by creating “doctors for area of need.

Following steps should be taken before implementation:

 Main Aim; to create doctors  for area of need. (AON doctor)

  1. To identify areas of need; most basic step is to identify the areas of need, where doctors are not available. Government should identify area of need and implement the scheme in selected areas, and with  selected simple drugs. Such areas should be such that which do not have medical facilities or lack doctors. Areas which already have doctors will not accept the diluted  or sub-optimal care, for example urban population.
  2. Limited seats-To identify the number required; let us say start with pilot project of  selecting 500 to1000 such doctors. All the lakhs of alternate doctors  can not be allowed to prescribe allopathic medicines. It will put the community at risk.

Each and every seat of AON and its doctor needs to be identified , earmarked and  trained for the particular seat.

  1. To identify the skills required for the area; for example emergency, for paediatrics or obstretics and gynaecology, trauma.
  2. Willingness to work in area of need- to identify the doctors: have a written competition from all candidates who apply for bridge course. To identify doctors who have given willingness to work in these areas of need. People who perform well should be taken for bridge course  only on limited seats. Bridge course should not  free for all.
  3. To develop a structured bridge course, which should be around one year after comparing the course of MBBS and the course done by the candidate.
  4. Admission and exit in the bridge course should be through exam and limited seats.
  5. Bridge course and allopathic medicines should not be made free for all, that any body can dispense it. We can get benefit only if is specific to needs of people. If everyone is allowed to practice allopathy in all locality, it will be a global hazard besides our community .
  6. These trained doctors will have an undertaking to serve in area of need only. For a period at least 10 to 20 years.
  7. Number should be limited but training should be good.
  8. A special course needs to be designed separately for one year, so that people in area of need do not get substandard care

Without proper planning and implementation and identification of area of need, this bridge course will not benefit anyone, rather it can be disastrous.

 

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