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#Choosing-to-be-doctor in lawless society: A self inflicted disaster #uncivilized-society #Govt-apathy


There is increasing discontentment among doctors because of  present complex and punishing system. They are bound by so many factors that they finally end up at the receiving end all the time. They are under Hippocratic oath and therefore expected to work with very high morality, goodwill and kindness for the sufferings of mankind and dying patients.  They are also supposed to maintain meticulous documentation and also supposed to work under norms of  medical industry. They are supposed to see large number of patients with fewer staff and nursing support while still giving excellent care in these circumstances. And if these were not enough, the fear of courts and medico-legal cases, verbal threats, abuses, and physical assaults and show of distrust by patient and relatives further makes working difficult. Additionally there may be bullying by certain administrative systems at places, who use pressure tactics to get their own way.

Enslavement of doctors

NRS Hospital doctor assault

Young doctors  complete  training and find themselves working in a hostile environment, at the receiving end of public wrath, law, media for reasons they can’t fathom. They  face continuous negative publicity, poor infrastructure and preoccupied negative beliefs of society.

       They face physical assault , routine instances of verbal abuse and threat for no fault of theirs. Many become punching bags for the inept medical system and invisible medical industry. The threat of physical assault is quite real as well.  Even female doctors have not been spared by mobs. Silence of prominent social people, celebrities, human right commission  and society icons on this issue is a pointer towards increasingly uncivilized mind set of society. 

Being revengeful against doctor is very easy. They have become sitting ducks for revenge. Verbal abuse, physical harm, legal remedies, disciplinary actions, punishments, social mudslinging, court cases and legal harassment are common remedies easily available. In absence of support, lack of law and order enforcement, physical assaults and even murder is also not a distant possibility. Here it was just a treatment failure or may be a poor response to treatment, which resulted in killing of doctor’s family. If trying to treat some one can result in harm to one self, why should the doctors will choose to treat. More over why should one become a doctor at all. Such incidents of extreme violence are not merely disaster for a family, but  are warning signs to whole of profession.

     Many in such unfortunate situations must have a thought in mind “ why should one become a doctor  and serve an uncivilized society?”

 

Deadly doctor assault at #NRS-Hospital-Kolkata: doctors- save yourself


The condition of the intern, who was admitted to a hospital, was stated to be critical . After Death of Patient, Relatives Clash With Junior Doctors in  #NRS-Hospital-Kolkata-west-bengal Hospital Over ‘Negligence’

An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as clashes broke out over the death of a 75-year-old patient.

        Unwillingness or failure of government to prevent such attacks on doctors will have deep ramifications on future of medical profession. Silence of authorities, human right commission is really appalling.  Role of doctor associations, parent institutes have been spineless and not encouraging.  Media, celebrities, film stars in spreading the hatred against the medical profession and creating an environment of mistrust is unpardonable, where stray incidents were portrayed as normal routine just to earn money and fame. Ultimately doctors have been left to fend for themselves individually or with friend groups. 

Kolkata: A clash erupted between junior doctors and relatives of a patient at a state-run hospital here late Monday night after the 75-year-old died due to alleged negligence, police said Tuesday. An intern was injured in the clash and regular services at Nil Ratan Sircar Medical College and Hospital were disrupted as the junior doctors began a sit-in, demanding better security, they said.  Family members of Mohammed Shahid, a resident of Tangra, allegedly assaulted some junior doctors at around 11 pm last night after he died. As a result, a clash broke out, virtually turning the hospital premises into a battleground, the police said. Shahid’s family members were also angry over a delay in handing over his body, they added.

A large team of police personnel from Entally police station intervened and restored to lathicharge to bring the situation under control, a senior Kolkata Police officer said. More than 50 doctors shut the gates of the medical institution and began a sit-in on Monday night, demanding “protection”, the police said. The condition of the intern, who was admitted to a hospital, was stated to be critical, they said. Services at the hospital, including the emergency services, were affected on Tuesday as the junior doctors’ continued their protest.
West Bengal Medical Education Department director, Dr Pradip Kumar Mitra, visited the hospital and tried to persuade the doctors to withdraw their protest, but in vain.


    Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously. Recent senseless attack  on doctor  at NRS Hospital Kolkata again a warning to children, who wish to be doctors.

      Merely taking some token  action and showing  protest will not solve the problem. It does not compensate for the  damage done to medical profession. Sympathy, compassion and trust of the doctors towards patients will definitely reduce. Who will be  the ultimate sufferer, does not need a Einstein brain to predict.

                    This insecurity or fear of the uncertainty tends to affect the thinking process of doctors and the way they practice medicine or deal with the patients. Many will like to be defensive in practice, or try not to treat very sick patients.  Why would someone try complex surgeries with risk involved? Few will limit themselves to follow protocols. Going extra mile with risk, which not everyone will like to take. Many will become health managers or  do something else than do active clinical work. Who should risk his life while doing routine work?

     Patients might get their revenge for the  naturally occurring disease, but they will lose compassion and trust of doctors in the long run. If that is the way to impart justice in this era, doctors will have to find some way to save themselves.

 

#Expensive-modern-health-care: Reminiscent of an ancient realm of medical regulation #Medical-lawsuits


With the evolution of medical science and medical care intertwined with  medical business, braided changes in  medical  regulation is not an far off expectation. But reticulation of evolution to modern medicine  and health care has not happened  in  isolation. Simultaneously there has been  progressively complex emerging trends in medical business and changing patterns of health investments along with an era of corporate investments in health care  has also ushered.  Every one now wishes  to live longer  and  dreams of better quality of life with support of progressive medical care.  Opportunities projected by advancements in health care, have shown that these dreams can be a real possibility, in many cases. That kind of perception has given patients a hope in lieu of some money. With rich people willing to spend more, the insurance sector and corporate invested money into health care, which was unthinkable few decades back in the  past.  This reticulation of business and  health care really took away the profession from control  of doctors. As it is no more simply treating a disease and involves many more issues.  New model of business in  health care is  still  not a mature process. It has emerged and progressed in  just  for few decades, as compared to  medical treatments and systems that existed since ancient times. It is still in infancy and still has to go a  long way to do real justice to every one.   No one really knows how to regulate this difficult area,  which encompasses life and death, deals with extremes of poverty and riches, mortality and morbidity, pain and  relief , sadness and happiness, smiles and sorrows and uncountable emotions, intertwines with financial aspects. Most difficult part is  amalgamation of  intricacies of science with minds of  patient and doctor’s skill in  newly evolved milieu of financial complexities.  Results are not encouraging for the profession.

 An effort to govern or  regulate the medical profession  is not new. Hammurabi  had initiated to  write the rules of the game. This single professional species was managed with cruel regulation 5000 years ago, that initiated a change in the global perception and regulatory system in radical and unprecedented ways.

Hammurabi,  5000 years ago,  was  not even at the   doorstep of medical science, but he  promulgated some rules. It is difficult to say whether he was naïve or  brilliant  enough to make it more mathematical. He fixed  heavy prize for saving lives and used to  cut the hands of physicians for death or untoward incident. But he was still wise enough to pay heavily if life was saved.   After thousands of years, with some scientific advancements, our regulation has remained more or less similar in basics. It is still based on principles of revenge and punishments. Now clearly  knowing well the limitation of medical science and the uncertainties and complexities of human body in better way, it still  remains  somewhat  unfair to doctors.  In other words, it has not attained enough  evolution and maturity.

  Hammurabi at the start of civilization believed that doctors needed to be punished in case there was poor prognosis. He failed to understand the complexity of human body and the limitations of medical  science, most of which was unknown at that time. By an application of average wisdom, doctor can be easily blamed for poor outcome, because he is always a common link between treatment and poor prognosis. Stricter punishments were imposed to  regulate medical profession, even  when the medical science was not even developed enough to deal with most of diseases.  Children are always taught in school that medical profession is a noble one. But they are never told, about the cruelty this profession has faced since ancient times.  Almost universally, the earlier work or contribution of  a doctor  to society is  not taken into account.  Even for complexities of medical science and uncertainties of the outcome, blame can  conveniently be  passed on doctors by application of average wisdom.

    Hammurabi’s Codex specified the harshest form of deselection of health providers possible. If the physician erred through omission or commission, his fingers or hands were cut off, immediately stopping his practice. Therefore, a single mistake can undo all the good work of past or the future good work that could have been accomplished. Problem here is that who can differentiate with certainty the real cause of sufferings of patient, a poor prognosis or a mistake.  Such  regulatory systems will dissuade  other good people joining the profession, again  resulting in  further inhibition and flourishing of profession for the good.  Obviously,  harsher  penalties will discourage a physician surplus.

Today the global  system of medical regulation, is becoming somewhat  similar, to those ancient regulations in  terms of punishment and revenge. Differential payment system for health care also resembles the Code of Hammurabi in some respects. And this is despite the fact that now we are very well conversant with the known uncertainty and complexity of the human body and despite cognizance of the poor prognosis in many disease states.

In an effort to institute  a  well controlled  healthcare, our society is in a way re-entering the realm of an ancient medical regulatory  system. Certain aggrieved health care consumers may welcome a move toward harsh penalties in the name of justice and simply for revenge but we need to keep in mind the  poor outcomes in complex diseases, limitation of science and of course the idiosyncrasies of the human body. Evolution of medical legal system and medical regulation has to evolve and mature, to enjoy  benefits of medical advancement to the fullest. Fear factors and  Impact  of present legal complexities,  on doctors  is  already on a par with that of  Hammurabi  era.

Re-blogged

#Doctor-wife-killed-by patient #Warning to Doctor/medical profession- becoming a victim of easy revenge


Any patient who visits hospital carries a static or progressive risk of death, howsoever little his illness looks to be . A genuinely poor prognosis or progression of disease or routine complication can cause or result in death. But by application of average wisdom of the people who do not have an idea about complexity of medical field, can easily blame doctors. So doctor even when doing his best is at risk of revenge or harm from public as well as authorities. A fundamental question about such situations will come to doctor’s mind naturally. What happens when doing some good work by our self causes harm to ourselves? Here you are trying to save some one. It is a happy situation for him if you are successful. But due to some reason patient dies or there is poor outcome. He has all the rights to harm you in more than one way. What if he happens to be a powerful person, a VIP, criminal or a goon. What if he becomes revengeful towards you. Doctor will turn into an object of revenge. Money a doctor receives in “what so ever risky situations” or even for saving a life is peanut. But if patient decides to sue him, court may ask to pay something , doctor may not earn in his life time. Or in extreme cases physical violence and even killing the doctors is also some thing which is not unheard off and is on the rise. And this process can happen any minute, any day and continues for years till he continues to work the whole life. Even single mistake in entire career, that too unintentional is enough to cost name, fame or even life. Even it may not be a mistake, or just be a naturally poor prognostic disease, which can be interpreted as an error easily. For people who do not treat patients, how so ever learned they may be, are unable to recognize the difference between the negligence or genuinely poor prognosis. Thanks to media and our celebrities, who have created a doctor- patient mistrust for their own populist gains. An impression is being created, as the poor outcome is because of doctor’s mistake by selective projection in a certain manner.

not-satisfied-with-treatment-man-kills-doctor-s-wife Irritated that a doctor, who wasn’t able to cure his itch for six months, was away in Delhi, an Indore man stabbed to death the doctor’s wife and injured her son. According to the police, the incident happened at the clinic of Dr Ramakrishna Verma in the Malwa Mills area of Indore, on Thursday morning. The doctor ran his practice from home. Tukoganj city superintendent of police (CSP), BPS Parihar said, “The accused Rafiq Rasheed (45) was suffering from an itchy skin disease for which he was getting treatment from Dr Ramkrishna . Verma for the past six months, but without any results. When he went to the clinic at about 11 a.m, Verma’s wife Lata informed him that her husband was in Delhi. This apparently angered Rafiq who got into an altercation with Lata (50) and stabbed her repeatedly with a knife he was carrying. As Lata screamed for help, her son Abhishekh (19) came out and Rafiq stabbed him too and ran away. However, some people who came hearing the screams managed to nab Rafiq and handed him over to the police.” The locals took both mother and son to a nearby private hospital where Lata was declared brought dead. Abhishekh’s condition is said to be critical, police said.

Being revengeful against doctor is very easy. They have become sitting ducks for revenge. Verbal abuse, physical harm, legal remedies, disciplinary actions, punishments, social mudslinging, court cases and legal harassment are common remedies easily available. In absence of support, lack of law and order enforcement, physical assaults and even murder is also not a distant possibility. Here it was just a treatment failure or may be a poor response to treatment, which resulted in killing of doctor’s family. If trying to treat some one can result in harm to one self, why should the doctors will choose to treat. More over why should one become a doctor at all. Such incidents of extreme violence are not merely disaster for a family, but they are warning signs to whole of profession.

Many in such unfortunate situations must have a thought in mind “ why should one become a doctor and treat patients?”

1,000 people at Delhi’s RML Hospital for anti-rabies shot in a day #dogbite#straydogs


Until last year, Ram Manohar Lohia (RML) hospital used to get around 200 patients daily for anti-rabies vaccination. This number has grown manifold over the last six months and on Monday it crossed 1,000. Hospital authorities blamed the unavailability of anti-rabies vaccine at state and municipal corporation-run hospitals for this surge and said if the vaccine wasn’t made availabile at all centres soon, it could lead to a fullblown crisis

“There is a limit to how much we can stretch our resources,” said Dr V K Tiwary, the medical superintendent of RML hospital. At Safdarjung hospital also, which is run by the Centre, officials said there has been significant increase in the rush of patients for the vaccination. Anti-rabies vaccine is needed to prevent the development of disease in persons who have been bitten by an infected animal, The first dose of anti-rabies vaccine has to be injected within 24 hours of the bite — the sooner the better. However, people who had queued up at RML on Monday said they had been running from one hospital to the other in search of the vaccine but to no avail. “I went to two government hospitals in east Delhi. Both said they didn’t have the vaccine. I cannot afford private treatment,” said Kavita Singh, a resident of Mandavali, east Delhi. While government hospitals give anti-rabies vaccine for free, it costs nearly Rs 1,500 for five jabs at private facilities. For patients with severe and deep bite, the administration of anti-rabies serum is required in addition to the vaccines, which costs above Rs 2,000. Authorities in at least two big state-run hospitals — Guru Tegh Bahadur (GTB) in East Delhi and Lok Nayak in central Delhi — confirmed the crisis. “For the last two weeks, there is no anti-rabies vaccine in our hospital,” Dr Arvind Mohan, deputy medical superintendent of Lok Nayak hospital said. He claimed the shortage is from supply side itself. “The vaccine shortage has been there for almost six months but we were managing things by making local purchase initially. Now, even the local suppliers have given up,” Dr Mohan said. Dr Sunil Kumar, medical director of GTB hospital also confirmed they are also running short of anti-rabies vaccines. “We are issuing tenders to purchase the vaccine,” he said. There is no anti-rabies vaccine at municipal hospitals either, senior civic agency officials from both the north and the south corporation confirmed. “The government manufacturer is not supplying the vaccine from last few months due to nonavailability. Patients are either being told to purchase it privately or being referred to other hospitals,” said an official ,Delhi, as per the last annual report of all municipal corporations combined, had witnessed over 27,407 dog bite cases from February 2018 to February 2019. South Delhi was worst affected. Real numbers are expected to be much higher as the figures do not include patients that go to private clinic or hospitals that are not bound to report, said a source. In April, Safdarjung hospital had stopped accepting new cases of dog-bite due to the rush. “Situation has improved a little over the last few weeks. But steps are needed to restore or arrange supply of the vaccine in all anti-rabies clinics to avert crisis situation,” a doctor said.

Microplastic have found way into the human gut


In the next 60 seconds, people around the world will purchase 1 million plastic bottles and 2 million plastic bags. By the end of the year, we will produce enough bubble wrap to encircle the equator 10 times. Though it will take over 1,000 years for most of these items to degrade, many will soon break apart into tiny shards known as microplastics, trillions of which have been showing up in the oceans, fish, tap water and even table salt.

Now, we can add one more microplastic to the list: the human gut.

In a pilot study with a small sample size, researchers looked for microplastics in stool samples of eight people from Finland, Italy, Japan, the Netherlands, Poland, Russia, the UK and Austria. To their surprise, every single sample tested positive for the presence of a variety of microplastics.

“This is the first such study, so we did a pilot to see if there are any microplastics detectable at all,” said Philipp Schwabl, a gastroenterologist at the Medical University of Vienna and lead author of the study. “The results were astonishing.” There are no certain health implications for their findings, and they hope to complete a broader study with the methods they have developed.

Microplastics — defined as pieces less than .02 inches long, roughly the size of a grain of rice — have become a major concern for environ- mental researchers during the past decade. Several studies have found high levels of microplastics in marine life, and last year, they were detected in 83% of tap water samples around the world (the highest contamination rate was in US, where 94% of samples were contaminated).

Researchers have long suspected microplastics would eventually be found in human gut. One study estimated that people who regularly eat shellfish may be consuming 11,000 plastic pieces per year.

The new paper, which was presented  at a conference in Vienna, could provide support for marine biologists who have long warned of the dangers posed by microplastics in our oceans. But the paper suggests that microplastics are entering our bodies through other means, as well.

To conduct the study, they selected volunteers from each country who kept food diaries for a week and provided stool samples.

Up to nine different kinds of plastics were detected, ranging in size from .002 to .02 inches. The most common plastics detected were polypropylene and polyethylene terephthalate — both major components of plastic bottles and caps.

Still, Schwabl cautioned against jumping to conclusions. “It is highly likely food is being contaminated with plastics during various steps of processing or packaging.” Whether microplastics pose a health risk to humans is unknown, though they have been found to cause some damage in fish and other animals. Additionally, the ones detected in the study are too large to be a serious threat.

source

Working night shifts (#doctor&Nurses) may cause DNA damage, risk of cancer & Heart diseases


        Medical profession getting stressful is nothing new.  There are multiple dimensions to  the multi-pronged stress in present  era.  A new dimension has been discovered. Night shift are integral part of a hospital, doctors and nurses life. But it has shown to be having far reaching consequences. Night shifts have been linked to DNA damage and more serious illnesses.   If these kind of effects prove to be correct in future, it  needs a serious thinking over the issue.

    Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight.

Working night shifts can damage a person’s DNA, increasing the risk of cancer as well as cardiovascular, metabolic, and neuro-degenerative diseases, a study has found. For the study published in the journal Anaesthesia, researchers analysed blood samples of 49 healthy full-time doctors taken at different times.

“Although this work is very preliminary, it is clear from the results that even a single night of sleep deprivation can trigger events that may contribute to the development of chronic disease,” said Siu-Wai Choi, of the University of Hong Kong.

Researchers found that on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than those who did not work overnight. In these overnight on-site call doctors, DNA repair gene expression decreased and DNA breaks increased after sleep deprivation.

Damaged DNA increased after only one night of sleep deprivation. This DNA damage may help explain the increased risk for cancer and cardiovascular, metabolic, and neurodegenerative diseases associated with sleep deprivation, researchers said.

“Dog lover” but lack love towards human child? #straydogs #Rabies #dogbite #infections


In a very recent incident, while out  for a routine morning walk in a Delhi park, I was suddenly jolted by violent barking sounds of dogs. The loud barking sounds were intermixed with cries of a child. I just saw the child 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. Fed by him, the stray dogs were like friends to him and used to attack others who did not feed them, or were new or  oblivious to the danger. What was bothering was his apathy to the child and victims  and the fact that he continued to feed that violent stray, unperturbed during  the incident.  Similar apathy has been displayed by government and courts with a result that thousand suffer from dog bite every day.

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.

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 guard 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.

Millions of preventable disease deaths: whose moral burden is it?


Diseases can be  preventable or unpreventable, have  good  or  bad prognosis. But once patient  enters hospital,  what ever may be the reason or genesis of ailment, it becomes a moral responsibility of doctors.  Health care professionals  can be trash-talked   or ridiculed by media and anyone, even for worst prognostic cases.   But  large numbers of deaths   happen  due to preventable causes like accidents , drains, live electric wires, water contamination, dengue, malaria, recurring floods  etc. In fact the burden of   negligence here is massive and  these deaths are unpardonable.   Who ultimately carries the moral burden of millions of  preventable deaths?

Common causes of  such  disease, sufferings  and death , specially in developing and poor countries:

  1. Dietary risks and diseases spread by  water sanitation and hygiene.   These  have  direct  linked with bad sanitation and poor hygiene practices. Poor sanitation is the leading cause of diarrhea, malnutrition, cholera, jaundice ( hepatitis A and E) , worm infestations, typhoid and other enteric fevers, which lead to chronic malnutrition and lowered immunity that further feed the infectious disease cycle.  Apart from infectious disease like diarrhea, but also pneumonia and tuberculosis, which are leading killers across all age groups.
  2. Undernourishment in   children  will cause them to be  underweight, stunted and wasted, and makes them  more vulnerable to infections. They are at higher risk of dying of childhood infections.

Working sewage-disposal systems, waste disposal management, protection of water supply from contamination and hand-washing practices are essential components to reduce preventable deaths.

  1. Poor sanitation, unsafe water and low public health also increase drug-resistant infections in low-income and middle-income countries. Lowering of antibiotic consumption  can not be achieved  because superbugs ,  and antibiotic resistance  are already in the environment and continue to spread through contaminated food, water and hospital equipment.

Antibiotics overuse is rampant as they are  used to treat diarrhea and upper respiratory tract infections. Improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated can reduce infections.

  1. Air pollution : air pollution is a public health crisis.  Masses are forced to breathe in air which  contains pollutants  in  unsafe limits, some are carcinogenic. It  is a cause of  millions of deaths  It is besides many fold of this number live their life with morbidity. Polluting vehicles, industry, lesser trees and plantations, poor practices and not enough governance and policies have resulted in poisonous air to breathe. Diseases like COPD, asthma and lung cancer are few common ailments.
  2. A::Dog bite (rabies ), Animal poop and Human – animal interface:   Not properly disposed  animal poop is a  cause of generation of infections and diseases, requiring heavy use of antibiotics and consequently leads to emergence of further antibiotic resistance bacteria. This cycle of production of infections and use of antibiotics perpetuates a vicious cycle.  Stray animals still defecate at every place.  Poop of Stray dogs, cattle and pigs stays in environment and causes life threatening infections. Hundreds of diseases are described due to poor control of human animal interface.

But stray animals and dogs are everywhere. 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.

         B::   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. Animal faeces contain pathogens, which are known to cause severe diseases, infections and organ failure. 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.

               C:: 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.  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.

6.     Mosquito borne diseases: millions die because of vector borne disease , as mosquito control  has been inadequate.  Malaria, dengue,  chickengunya  and many other lethal  diseases spread  due to mosquitoes.

 

7.      Preventable natural disasters exacerbated by human activity: floods, famine, disease outbreaks.

8.      Road, rail  accidents and other accidents: are mostly  preventable errors.

         The role of health care professionals in present day circumstances remains misunderstood and underappreciated, as they assume the responsibility for continuous care of the sick or injured. People who have never treated a patient  in their life time influence health policies, which effects  millions. Excessive preventable deaths are  just a symptoms of a larger problem.  Who  is the one who feels moral burden of millions of preventable deaths?

     .

 

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