Depending on the travel destination, travellers may be exposed to a number of infectious diseases; exposure depends on the presence of infectious agents in the area to be visited. The risk of becoming infected will vary according to the purpose of the trip and the itinerary within the area, the standards of accommodation, hygiene and sanitation, as well as the behaviour of the traveller. In some instances, disease can be prevented by vaccination, but there are some infectious diseases, including some of the most important and most dangerous, for which no vaccines exist.
As many of such diseases are infections, general precautions can greatly reduce the risk of exposure to infectious agents and should always be taken for visits to any destination where there is a significant risk of exposure, regardless of whether any vaccinations or medication have been administered.
Modes of transmission and general precautions
The modes of transmission for different infectious diseases are diverse:
Foodborne and waterborne diseases transmitted by consumption of contaminated food and drink.
Vector-borne diseases transmitted by insects such as mosquitoes and other vectors such as ticks.
Diseases transmitted to humans by animals (zoonoses), more particularly through animal bites or contact with animals, contaminated body fluids or faeces, or by consumption of foods of animal origin, particularly meat and milk products.
Sexually transmitted diseases passed from person to person through unsafe sexual practices.
Bloodborne diseases transmitted by direct contact with infected blood or other body fluids
Airborne diseases involving droplets and droplets nuclei. Droplet nuclei <5 µm in size are disseminated in the air and breathed in. These droplet nuclei can remain suspended in the air for some time. Droplet nuclei are the residuals of evaporated droplets. Droplet transmission occurs when larger particles (>5 µm) contact the mucous membranes of the nose and mouth or conjunctivae of a susceptible individual. Droplets are usually generated by the infected individual during coughing, sneezing or talking.
Diseases transmitted via soil include those caused by dormant forms (spores) of infectious agents, which can cause infection by contact with broken skin (minor cuts, scratches, etc).
The main infectious diseases to which travellers may be exposed, and precautions for each, are detailed in the Chapter 5 of the International travel and health situation publication. The most common infectious illness to affect travellers, namely travellers’ diarrhoea, is covered in Chapter 3 of the International travel and health situation publication (WHO). Because travellers’ diarrhoea can be caused by many different foodborne and waterborne infectious agents, for which treatment and precautions are essentially the same, the illness is not included with the specific infectious diseases.
Information on malaria, one of the most important infectious disease threats for travellers, is provided separately (WHO).
The infectious diseases listed below have been selected on the basis of the following criteria:
Diseases that have a sufficiently high global or regional prevalence to constitute a significant risk for travellers;
Diseases that are severe and life-threatening, even though the risk of exposure may be low for most travellers;
Diseases for which the perceived risk may be much greater than the real risk, and which may therefore cause anxiety to travellers;
Diseases that involve a public health risk due to transmission of infection to others by the infected traveller.
HIV/AIDS and other sexually transmitted infections
Leishmaniasis (cutaneous, mucosal and visceral forms)
Leptospirosis (including Weil disease)
Lyme Borreliosis (Lyme disease)
SARS (Severe Acute Respiratory Syndrome)
Typhus fever (Epidemic louse-borne typhus)
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.
Information about available vaccines and indications for their use by travellers is provided in the pdf entitled vaccine-preventable diseases and vaccines beside. Advice concerning the diseases for which vaccination is routinely administered in childhood, i.e. diphtheria, measles, mumps and rubella, pertussis, poliomyelitis and tetanus, and the use of the corresponding vaccines later in life and for travel, is also given in the section Vaccines.
Brucellosis is a common zoonotic infection caused by bacterial genus Brucella. Brucellosis is an old disease known by various names including undulant fever or Mediterranean fever. This is one of the infectious diseases transmissible between animals and humans.
Global distribution of Brucellosis-
This infection is more common in Mediterranean areas, the south and the center of America, Africa, Asia, Arab peninsula, Indian subcontinent and the Middle East. The maximum incidence in the world had been reported in Syria.
Brucellosis, undulant fever, Mediterranean fever, Cyprus fever, and goat fever.
‘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.
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.
Brucellosis is the result of being infected with the brucella bacteria.
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
Blood transfusion or marrow transplant from a person infected with Brucella
Few cases result from accidental pollination of an animal with brucellosis.
Symptoms usually appear within 5 to 60 days, and sometimes they takes several months to appear.
Who is at risk?
Medical lab workers
Malta fever can cause several symptoms. Some of them last for a long period of time. Initial symptoms include:
Loss of appetite
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.
Endocarditis (an infection of the endocardium, which is the inner lining of the heart or valves)
Orchitis (inflammation of the testicles)
Spleen or liver inflammation
Central nervous system inflammation.
Laboratory tests: They involve searching for the bacteria in samples of blood, bone marrow, or other body fluids.
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.
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.
How long do brucella bacteria live outside the body?
Brucella bacteria are resistant to natural conditions, and they can survive for several hours up to over 60 days if the surrounding environment is moist.
How long should meat be cooked?
Meat and liver should be well cooked at 63°C for half an hour.
Women who are pregnant and have been exposed to Brucella should consult with their obstetricians/healthcare provider for evaluation. Prompt diagnosis and treatment of brucellosis in pregnant women can prevent complications including miscarriage.
Death is an evolving and complex concept. Philosophers and theologians from around the globe have recognised the value that death holds for human life. Death and life are bound together: without death there would be no life. Death allows new ideas and new ways. Death also reminds us of our fragility and sameness: we all die.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Even though all societies throughout history have realized that death is the certain fate of human beings, different cultures have responded to it in different ways. Through the ages, attitudes toward death and dying have changed and continue to change, shaped by religious, intellectual, and philosophical beliefs and conceptions. In the twenty-first century advances in medical science and technology continue to influence ideas about death and dying.
Archaeologists have found that as early as the Paleolithic period, about 2.5 million to 3 million years ago, humans held metaphysical beliefs about death and dying—those beyond what humans can know with their senses. Tools and ornaments excavated at burial sites suggest that the earliest ancestors believed that some element of a person survived the dying experience.
Ancient Hebrews (c. 1020–586 B.C.), while acknowledging the existence of the soul, were not preoccupied with the afterlife. They lived according to the commandments of their God, to whom they entrusted their eternal destiny. By contrast, early Egyptians (c. 2900–950 B.C.) thought that the preservation of the dead body (mummification) guaranteed a happy afterlife. They believed a person had a dual soul: the ka and the ba. The ka was the spirit that dwelled near the body, whereas the ba was the vitalizing soul that lived on in the netherworld (the world of the dead). Similarly, the ancient Chinese (c. 2500–1000 B.C.) also believed in a dual soul, one part of which continued to exist after the death of the body. It was this spirit that the living venerated during ancestor worship.
Among the ancient Greeks (c. 2600–1200 B.C.), death was greatly feared. Greek mythology—which was full of tales of gods and goddesses who exacted punishment on disobedient humans—caused the living to follow rituals meticulously when burying their dead so as not to displease the gods. Even though reincarnation is usually associated with Asian religions, some Greeks were followers of Orphism, a religion that taught that the soul underwent many reincarnations until purification was achieved.
THE CLASSICAL AGE
Mythological beliefs among the ancient Greeks persisted into the classical age. The Greeks believed that after death the psyche (a person’s vital essence) lived on in the underworld. The Greek writer Homer (c. eighth century–c. seventh century B.C.) greatly influenced classical Greek attitudes about death through his epic poems the Iliad and the Odyssey.Greek mythology was freely interpreted by writers after Homer, and belief in eternal judgment and retribution continued to evolve throughout this period.
Certain Greek philosophers also influenced conceptions of death. For example, Pythagoras (569?–475? B.C.) opposed euthanasia (“good death” or mercy killing) because it might disturb the soul’s journey toward final purification as planned by the gods. On the contrary, Socrates (470?–399? B.C.) and Plato (428–348 B.C.) believed people could choose to end their life if they were no longer useful to themselves or the state.
Like Socrates and Plato, the classical Romans (c. 509–264 B.C.) believed a person suffering from intolerable pain or an incurable illness should have the right to choose a “good death.” They considered euthanasia a “mode of dying” that allowed a person’s right to take control of an intolerable situation and distinguished it from suicide, an act considered to be a shirking of responsibilities to one’s family and to humankind.
THE MIDDLE AGES
During the European Middle Ages (c. 500–1485), death—with its accompanying agonies—was accepted as a destiny everyone shared, but it was still feared. As a defense against this phenomenon that could not be explained, medieval people confronted death together, as a community. Because medical practices in this era were crude and imprecise, the ill and dying person often endured prolonged suffering. However, a long period of dying gave the dying individual an opportunity to feel forewarned about impending death, to put his or her affairs in order, and to confess sins. The medieval Roman Catholic Church, with its emphasis on the eternal life of the soul in heaven or hell, held great power over people’s notions of death.
By the late Middle Ages the fear of death had intensified due to the Black Death—the great plague of 1347 to 1351. The Black Death killed more than twenty-five million people in Europe alone. Commoners watched not only their neighbors stricken but also saw church officials and royalty struck down: Queen Eleanor of Aragon and King Alfonso XI (1311–1350) of Castile met with untimely deaths, and so did many at the papal court at Avignon, France. With their perceived “proper order” of existence shaken, the common people became increasingly preoccupied with their own death and with the Last Judgment, God’s final and certain determination of the character of each individual. Because the Last Judgment was closely linked to an individual’s disposition to heaven or hell, the event of the plague and such widespread death was frightening.
From the fourteenth through the sixteenth centuries, Europe experienced new directions in economics, the arts, and social, scientific, and political thought. Nonetheless, obsession with death did not diminish with this “rebirth” of Western culture. A new self-awareness and emphasis on humans as the center of the universe further fueled the fear of dying.
By the sixteenth century many European Christians were rebelling against religion and had stopped relying on church, family, and friends to help ease their passage to the next life. The religious upheaval of the Protestant Reformation of 1520, which emphasized the individual nature of salvation, caused further uncertainties about death and dying.
The seventeenth century marked a shift from a religious to a more scientific exploration of death and dying. Lay people drifted away from the now disunited Christian church toward the medical profession, seeking answers in particular to the question of “apparent death,” a condition in which people appeared to be dead but were not. In many cases unconscious patients mistakenly believed to be dead were hurriedly prepared for burial by the clergy, only to “come back to life” during burial or while being transported to the cemetery.
An understanding of death and its aftermath was clearly still elusive, even to physicians who disagreed about what happened after death. Some physicians believed the body retained some kind of “sensibility” after death. Thus, many people preserved cadavers so that the bodies could “live on.” Alternatively, some physicians applied the teachings of the Catholic Church to their medical practice and believed that once the body was dead, the soul proceeded to its eternal fate and the body could no longer survive. These physicians did not preserve cadavers and pronounced them permanently dead.
THE EIGHTEENTH CENTURY
The fear of apparent death that took root in the seventeenth century resurfaced with great intensity during the eighteenth century. Coffins were built with contraptions to enable any prematurely buried person to survive and communicate from the grave.
For the first time, the Christian church was blamed for hastily burying its “living dead,” particularly because it had encouraged the abandonment of pagan burial traditions such as protracted mourning rituals. In the wake of apparent death incidents, more long burial traditions were revived.
THE NINETEENTH CENTURY
Premature and lingering deaths remained commonplace in the nineteenth century. Death typically took place in the home following a long deathbed watch. Family members prepared the corpse for viewing in the home, not in a funeral parlor. However, this practice changed during the late nineteenth century, when professional undertakers took over the job of preparing and burying the dead. They provided services such as readying the corpse for viewing and burial, building the coffin, digging the grave, and directing the funeral procession. Professional embalming and cosmetic restoration of bodies became widely available, all carried out in a funeral parlor where bodies were then viewed instead of in the home.
Cemeteries changed as well. Before the early nineteenth century, American cemeteries were unsanitary, overcrowded, and weed-filled places bearing an odor of decay. That began to change in 1831, when the Massachusetts Horticultural Society purchased seventy-two acres of fields, ponds, trees, and gardens in Cambridge and built Mount Auburn Cemetery. This cemetery was to become a model for the landscaped garden cemetery in the United States. These cemeteries were tranquil places where those grieving could visit the graves of loved ones and find comfort in the beautiful surroundings.
Literature of the time often focused on and romanticized death. Death poetry, consoling essays, and mourning manuals became available after 1830, which comforted the grieving with the concept that the deceased were released from worldly cares in heaven and that they would be reunited there with other deceased loved ones. The deadly lung disease tuberculosis—called consumption at the time—was pervasive during the nineteenth century in Europe and the United States. The disease caused sufferers to develop a certain appearance—an extreme pallor and thinness, with a look often described as haunted—that actually became a kind of fashion statement. The fixation on the subject by writers such as Edgar Allan Poe (1809–1849) and the English Romantic poets helped fuel the public’s fascination with death and dying. In the late twentieth and early twenty-first centuries the popularization of the Goth look is sometimes associated with the tubercular appearance.
By the mid-nineteenth century the romanticizing of death took on a new twist in the United States. Spiritualism, in which the living communicate directly with the dead, began in 1848 in the United States with the Fox sisters: Margaret Fox (1833?–1893) and Catherine Fox (1839?–1892) of Hydesville, New York. The sisters claimed to have communicated with the spirit of a man murdered by a former tenant in their house. The practice of conducting “sittings” to contact the dead gained instant popularity. Mediums, such as the Fox sisters, were supposedly sensitive to “vibrations” from the disembodied souls that temporarily lived in that part of the spirit world just outside the earth’s limits.
This was not the first time people tried to communicate with the dead. Spiritualism has been practiced in cultures all over the world. For example, many Native Americans believe shamans (priests or medicine men) have the power to communicate with the spirits of the dead. The Old Testament (I Samuel 28:7–19) recounts the visit of King Saul to a medium at Endor, who summoned the spirit of the prophet Samuel, which predicted the death of Saul and his sons.
The mood in the United States in the 1860s and 1870s was ripe for Spiritualist s´ances. Virtually everyone had lost a son, husband, or other loved one during the Civil War (1861–1865). Some survivors wanted assurances that their loved ones were all right; others were simply curious about life after death. Those who had drifted away from traditional Christianity embraced this new Spiritualism, which claimed scientific proof of survival after physical death.
THE MODERN AGE
Modern medicine has played a vital role in the way people die and, consequently, the manner in which the dying process of a loved one affects relatives and friends. With advancements in medical technology, the dying process has become depersonalized, as it has moved away from the familiar surroundings of home and family to the sterile world of hospitals and strangers. Certainly, the institutionalization of death has not diminished the fear of dying. Now, the fear of death also involves the fear of separation: for the living, the fear of not being present when a loved one dies, and for the dying, the prospect of facing death without the comforting presence of a loved one.
In the last decades of the twentieth century, attitudes about death and dying slowly began to change. Aging baby boomers (people born between 1946 and 1964), facing the deaths of their parents, began to confront their own mortality. Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?
The works of the psychiatrist Elisabeth K¨bler-Ross (1926–2004), including the pioneering book On Death and Dying (1969), have helped individuals from all walks of life confront the reality of death and restore dignity to those who are dying. Considered to be a highly respected authority on death, grief, and bereavement, K¨bler-Ross influenced the medical practices undertaken at the end of life, as well as the attitudes of physicians, nurses, clergy, and others who care for the dying.
During the late 1960s medical education was revealed to be seriously deficient in areas related to death and dying. However, initiatives under way in the late twentieth and early twenty-first centuries have offered more comprehensive training about end-of-life care. With the introduction of in-home hospice care, more terminally ill people have the option of spending their final days at home with their loved ones. With the veil of secrecy lifted and open public discussions about issues related to the end of life, Americans appear more ready to learn about death and to learn from the dying.
In the Middle Ages hospices were refuges for the sick, the needy, and travellers. The modern hospice movement developed in response to the need to provide humane care to terminally ill patients, while at the same time lending support to their families. The English physician Dame Cicely Saunders (1918–) is considered the founder of the modern hospice movement—first in England in 1967 and later in Canada and the United States. The soothing, calming care provided by hospice workers is called palliative care, and it aims to relieve patients’ pain and the accompanying symptoms of terminal illness, while providing comfort to patients and their families.
Hospice may refer to a place—a freestanding facility or designated floor in a hospital or nursing home—or to a program such as hospice home care, in which a team of health-care professionals helps the dying patient and family at home. Hospice teams may involve physicians, nurses, social workers, pastoral counsellors, and trained volunteers.
WHY PEOPLE CHOOSE HOSPICE CARE. Hospice workers consider the patient and family to be the “unit of care” and focus their efforts on attending to emotional, psychological, and spiritual needs as well as to physical comfort and well-being. With hospice care, as a patient nears death, medical details move to the background as personal details move to the foreground to avoid providing care that is not wanted by the patient, even if some clinical benefit might be expected.
THE POPULATION SERVED. Hospice facilities served 621,100 people in 2000; of these, 85.5% died while in hospice care. Nearly 80% of hospice patients were sixty-five years of age and older, and 26.5%were eighty-five years of age or older. Male hospice patients numbered 309,300, whereas 311,800 were female. The vast majority (84.1%) was white. Approximately half (46.6%) of the patients served were unmarried, but most of these unmarried patients were widowed. Nearly 79% of patients used Medicare as their primary source of payment for hospice services.
Even though more than half (57.5%) of those admitted to hospice care in 2000 had cancer (malignant neoplasms) as a primary diagnosis, patients with other primary diagnoses, such as Alzheimer’s disease and heart, respiratory, and kidney diseases, were also served by hospice.
MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level.
Such decisions appear to be cruel joke to the life of patients. A wise decision would be to review into reasons for vacant seats for example- policies, fee structure, facilities, demand for the course, and disillusionment of students by existing system or falling percentages to be a super-specialist doctor.
Imagine, an opportunity is available to a patient, to decide the doctor as based on his route or marks for entry into medical college. Whether patient will like to get treated by a doctor, who secured 20% marks, 30 % marks or 60% marks or 80% marks for medical college. Even an illiterate person can answer that well. But strangely for selection of doctors, rules were framed so as to dilute the merit to the minimum possible. So that a candidate who scores 15-20 % marks also becomes eligible to become a doctor. That is now further diluted to nearly Zero percentile. Answer to that is simple. To select and find only those students, who can pay millions to become doctors, and hence marks and quality of doctors don’t matter?
If the society continues to accept such below par practices, it has to introspect, whether it actually deserves to get good doctors. Paying the irrational fee of medical colleges may be unwise idea for the candidates, especially those who are not from strong financial backgrounds. But at the same time unfortunately, it may be a compulsion and entrapment for students, who have entered the profession and there is no way forward.
Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people. If society has failed to demand for a good doctors and robust system, it should not rue scarcity of good doctors. Merit based cheap good medical education system is the need of the society. This is in interest of society to nurture good doctors for its own safety. The quality of doctors who survive and flourish in such system will be a natural consequence of how society chooses and nurtures the best for themselves.
MUMBAI: With hundreds of medical super specialty course seats vacant, the authorities have removed the qualifying mark criterion for aspirants. So, rock-bottom scores or a zero percentile would be acceptable for a course at this level. “Seats have been going vacant every year. The government felt that as a one-time measure, in the larger context of things, we can even accept students with a zero percentile. This will not have any precedence. It is being taken up as a test case. After all, the entrance test was not conducted to eliminate students, but merely to grade them,” said a senior officer from the health ministry. With 748 super speciality seats unfilled after four rounds of admission this year, the Medical Counselling Committee (MCC) took the drastic step. As a one-time measure, any candidate who had taken the NEET super speciality 2021 exam can participate in the special mop-up admission round irrespective of his/her scores.
When admissions began this year, two rounds conducted by the MCC got a cold response. This led to a special mop-up round with the qualifying bar lowered by 15%. Yet, there weren’t many takers. Now the second mop-up round is open to all aspirants. India has about 4,500 super specialty medical seats. There is more vacancy in the surgical branches than the clinical ones. “Candidates have realised that having a broad speciality gives them a good career and money. Hence, many do not want to spend more time in pursuing a super specialty course,” said Dr Pravin Shingare, former head of the Directorate of Medical Education and Research (DMER). “If you look at Grant Medical College, 80% seats in super specialty have been lying vacant for 10 years. At GS Medical College, 40% seats in the last 4-5 years have been unfilled,” he added. But the trend has extended to the non-surgical branches too in the past three years. The bias in selecting programmes often is dictated by considerations that in the case of a surgical branch, a candidate needs to work with a team, have an operation theatre, but a clinical course allows the doctor to work independently out of a clinic.
Parent representative Sudha Shenoy said the problem also lies with the long bond that candidates need to serve if they join a government college. “Any candidate who joins a super specialty programme would be at least 30 years old. If they have to serve a 10-year bond, when will they start earning? So, government hospitals go off most students’ choice list. And when it comes to private and deemed institutes, the fee is out of bounds for most,” explained Shenoy
Dr Raj Bahadur, the vice-chancellor of Baba Farid University of Health Sciences (BFUHS) in the state’s Faridkot district Punjab, submitted his resignation to the Chief Minister’s Office late on the night of Friday, July 29. He has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.
Administrators, who have never treated a patient in their lifetimes, not only try to control treatment of thousands of patients, but project themselves messiah by demonizing doctors. Lowly educated celebrities and administrators have found a new easy way to project themselves on higher pedestrian by publically insulting highly educated but vulnerable doctors. The biggest tragedy to the medical profession in the present era is the new fad of administrators to discourage and demonize the medical profession for their popularity gains. Being so distant from the ground reality, their role should not have been more than facilitators, but they have become medical administrators. To control the health system, administrators have a tendency to pretend that shortcomings in the patient care can be rectified by punishing the doctors and nurses. Such vulnerability to insult is intrinsic to the doctors’ work, makes them sitting ducks, an easy target for harassment and punishments, if administrators wishes to do so. This vulnerability is exploited by everyone to their advantage. Administrators use this vulnerability to supress them. It is used by media and celebrities who projected themselves as Messiah for the cause of patients, and sell their news and shows by labelling the whole community of doctors as king of fleece tragedy based on just one stray incident.
The painful incident of Dr Raj Bahadur’s humiliation unmasks the everyday struggle of the doctors in the present era. His resignation after the public insult depicts the plight of doctors – being undervalued and demonized by administrators, forced to work as a sub-servant to bureaucrats, irresponsible policing, blackmail by goons and vulture journalism-all have become an accepted form of harassment. The incident has unveiled the despondency, moral burden of mistrust that doctors carry.
Sadly, the society is unable to realize its loss.
Bullied by administrative systems, indifference of Government and venomous media has made it impossible for health care workers to work in a peaceful environment. Is there any punishment for the administrators for mismanagement or poor infrastructure or lack of funds? Looks impossible but punishment to the sufferers is on the cards.
Medical students or aspiring doctors should be carefully watching the behaviour and cruelty by which doctors are governed, regulated and treated by administrators. Mere few words of respect and false lip service during Covid-pandemic should not mask the real face of administrators, indifference of courts and harshness of Government towards medical profession. Choosing medical careers can land anyone into the situations, which are unimaginable in a civilized world. Role of doctor associations, parent institutes has remained more or less weak, spineless and not encouraging.
Hence by selective projection the blame for deficiencies of inept system, powerful industry, inadequate infrastructure and poor outcomes of serious diseases is shifted conveniently to doctors, who are unable to retaliate to the powerful media machinery.
Hours earlier state health minister Chetan Singh Jouramajra had asked him to lie down on a dirty mattress during an inspection of Faridkot’s Guru Gobind Singh Medical College and Hospital, which comes under the BFUHS.
A video clip of the incident that circulated on the social media, showed Jouramajra place a hand on the veteran surgeon’s shoulder as he pointed towards the “damaged and dirty condition” of the mattress inside the hospital’s skin department.
The minister then allegedly forced Bahadur to lie down on the same mattress.
Though the vice-chancellor himself did not confirm his resignation, highly placed sources in the health department confirmed the same to multiple outlets. When approached for comments, reports that The Tribune Bahadur said, “I have expressed my anguish to the Chief Minister and said I felt humiliated.”
Reports have it that chief minister Bhagwant Mann has expressed his displeasure over the incident and spoken to Jouramajra. Mann has also asked Bahadur to meet him next week.
Speaking to The Indian Express, Bahadur additionally said: “I have worked in 12-13 hospitals so far but have never faced such behaviour from anyone till now. I shouldn’t have been treated this way… it affects this noble profession. It is very painful. He showed his temperament, I showed my humility.”
Bahadur is a specialist in spinal surgery and joint replacement and a former director-principal of Government Medical College and Hospital in Chandigarh. He has also been the head of the orthopaedic department at PGIMER, Chandigarh.
Asked whether new mattresses had been ordered for the hospital, he said: “Two firms sent their quotations and the rate finalisation needs to be done. It is a 1,100-bed hospital and not all mattresses are in bad condition. This mattress shouldn’t have been there but hospital management is the prerogative of the Medical Superintendent.”
Speaking to reporters at the hospital, Jouramajra said: “My intention was not to do any inspection. In fact, I am visiting various hospitals to see what the requirements are so that we can fulfil them.”
Various quarters, including the Indian Medical Association, have criticised Jouramajra.
PCMS Association, a doctors’ body in Punjab, to, in a statement, strongly condemned the “unceremonious treatment” meted out to Bahadur. PCMSA said the way the V-C was treated was “deplorable”, its reason notwithstanding.
The body expressed its “deep resentment” over the incident and said “public shaming of a senior doctor on systemic issues is strongly condemn-able.”
The English nurse Florence Nightingale pioneered efforts to use a separate hospital area for critically injured patients. During the Crimean War in the 1850s, she introduced the practice of moving the sickest patients to the beds directly opposite the nursing station on each ward so that they could be monitored more closely. In 1923, the American neurosurgeon Walter Dandy created a three-bed unit at the Johns Hopkins Hospital. In these units, specially trained nurses cared for critically ill postoperative neurosurgical patients.
The Danish anaesthesiologist Bjørn AageIbsen became involved in the 1952 poliomyelitis epidemic in Copenhagen, where 2722 patients developed the illness in a six-month period, with 316 of those developing some form of respiratory or airway paralysis.Some of these patients had been treated using the few available negative pressure ventilators, but these devices (while helpful) were limited in number and did not protect the patient’s lungs from aspiration of secretions. Ibsen changed the management directly by instituting long-term positive pressure ventilation using tracheal intubation, and he enlisted 200 medical students to manually pump oxygen and air into the patients’ lungs round the clock.At this time, Carl-Gunnar Engström had developed one of the first artificial positive-pressure volume-controlled ventilators, which eventually replaced the medical students. With the change in care, mortality during the epidemic declined from 90% to around 25%. Patients were managed in three special 35-bed areas, which aided charting medications and other management.
In 1953, Ibsen set up what became the world’s first intensive care unit in a converted student nurse classroom in Copenhagen Municipal Hospital. He provided one of the first accounts of the management of tetanus using neuromuscular-blocking drugs and controlled ventilation.
The following year, Ibsen was elected head of the department of anaesthesiology at that institution. He jointly authored the first known account of intensive care management principles in the journal Nordisk Medicin, with Tone Dahl Kvittingen from Norway.
For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring, care, and resources. It became rapidly evident, however, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. In 1962, in the University of Pittsburgh, the first critical care residency was established in the United States. In 1970, the Society of Critical Care Medicine was formed.
The number of hospital admissions was more than the staff had ever seen. And people kept coming. Dozens each day. They were dying of respiratory failure. Doctors and nurses stood by, unable to help without sufficient equipment.
It was the polio epidemic of August 1952, at Blegdam Hospital in Copenhagen. This little-known event marked the start of intensive-care medicine and the use of mechanical ventilation outside the operating theatre — the very care that is at the heart of abating the COVID-19 crisis.
In 1952, the iron lung was the main way to treat the paralysis that stopped some people with poliovirus from breathing. Copenhagen was an epicentre of one of the worst polio epidemics that the world had ever seen. The hospital admitted 50 infected people daily, and each day, 6–12 of them developed respiratory failure. The whole city had just one iron lung. In the first few weeks of the epidemic, 87% of those with bulbar or bulbospinal polio, in which the virus attacks the brainstem or nerves that control breathing, died. Around half were children.
Desperate for a solution, the chief physician of Blegdam called a meeting. Asked to attend: Bjørn Ibsen, an anaesthesiologist recently returned from training at the Massachusetts General Hospital in Boston. Ibsen had a radical idea. It changed the course of modern medicine.
The iron lung used negative pressure. It created a vacuum around the body, forcing the ribs, and therefore the lungs, to expand; air would then rush into the trachea and lungs to fill the void. The concept of negative-pressure ventilation had been around for hundreds of years, but the device that became widely used — the ‘Drinker respirator’ — was invented in 1928 by Philip Drinker and Louis Agassiz Shaw, professors at the School of Public Health in Boston, Massachusetts. Others went on to refine it, but the basic mechanism remained the same until 1952.
Iron lungs only partially solved the paralysis problem. Many people with polio placed in one still died. Among the most frequent complications was aspiration — saliva or stomach contents would be sucked from the back of the throat into the lungs when a person was too weak to swallow. There was no protection of the airway.
Ibsen suggested the opposite approach. His idea was to blow air directly into the lungs to make them expand, and then allow the body to passively relax and exhale. He proposed the use of a trachaeostomy: an incision in the neck, through which a tube goes into the windpipe and delivers oxygen to the lungs, and the application of positive-pressure ventilation. At the time, this was often done briefly during surgery, but had rarely been used in a hospital ward.
Ibsen was given permission to try the technique the next day. We even know the name of his first patient: Vivi Ebert, a 12-year-old girl on the brink of death from paralytic polio. Ibsen demonstrated that it worked. The trachaeostomy protected her lungs from aspiration, and by squeezing a bag attached to the tube, Ibsen kept her alive. Ebert went on to survive until 1971, when she ultimately died of infection in the same hospital, almost 20 years later.
The plan was hatched to use this technique on all the patients in Blegdam who needed help to breathe. The only problem? There were no ventilators.
Very early versions of positive-pressure ventilators had been around from about 1900, used for surgery and by rescuers during mining accidents. Further technical developments during the Second World War helped pilots to breathe in the decreased pressures at high altitudes. But modern ventilators, to support a person for hours or days, had yet to be invented.
What followed was one of the most remarkable episodes in health-care history: in six-hour shifts, medical and dental students from the University of Copenhagen sat at the bedside of every person with paralysis and ventilated them by hand. The students squeezed a bag connected to the trachaeostomy tube, forcing air into the lungs. They were instructed in how many breaths to administer each minute, and sat there hour after hour. This went on for weeks, and then months, with hundreds of students rotating on and off. By mid-September, the mortality for patients with polio who had respiratory failure had dropped to 31%. It is estimated that the heroic scheme saved 120 people.
Major insights emerged from the Copenhagen polio epidemic. One was a better understanding of why people died of polio. Until then, it was thought that kidney failure was the cause. Ibsen recognized that inadequate ventilation caused carbon dioxide to build up in the blood, making it very acidic — which caused organs to shut down.
Three further lessons are central today. First, Blegdam demonstrated what can be achieved by a medical community coming together, with remarkable focus and stamina. Second, it proved that keeping people alive for weeks, and months, with positive-pressure ventilation was feasible. And third, it showed that by bringing together all the patients struggling to breathe, it was easier to care for them in one place where the doctors and nurses had expertise in respiratory failure and mechanical ventilation.
So, the concept of an intensive-care unit (ICU) was born. After the first one was set up in Copenhagen the following year, ICUs proliferated. And the use of positive pressure, with ventilators instead of students, became the norm.
In the early years, many of the safety features of modern ventilators did not exist. Doctors who worked in the 1950s and 1960s describe caring for patients without any alarms; if the ventilator accidentally disconnected and the nurse’s back was turned, the person would die. Early ventilators forced people to breathe at a set rate, but modern ones sense when a patient wants to breathe, and then help provide a push of air into the lungs in time with the body. The original apparatus also gathered limited information on how stiff or compliant the lungs were, and gave everyone a set amount of air with each breath; modern machines take many measurements of the lungs, and allow for choices regarding how much air to give with each breath. All of these are refinements of the original ventilators, which were essentially automatic bellows and tubing.
Commercial sale of mother’s milk under Ayush licence has thrown up ethical questions. You can buy literally anything these days, even human breast milk. India is home to the only company in Asia that sells mother’s milk for profit, Bengaluru-based Neolacta Lifesciences Pvt Ltd. After activists objected to the commercialization of mother’s milk, the Food Safety and Standards Authority of India (FSSAI) cancelled the company’s licence stating that sale of mother’s milk was not permitted under its regulations. However, an FSSAI inspection revealed that the company continues to sell mother’s milk by obtaining an Ayush licence in November 2021 for its product dubbed ‘Naariksheera’ (breast milk). Neolacta, which was established in 2016, had originally obtained a licence from the Karnataka office of the FSSAI in the category of dairy products. “It is absolutely shocking that a company is being allowed to collect breast milk from young mothers and sell it like a dairy product with a huge price tag claiming to have added value to it,” said Nupur Bidla of the Breastfeeding Promotion Network of India (BPNI), which had alerted the government to this in 2020.
Saurabh Aggarwal, MD of Neolacta, told TOI that the company has significant experience in the human milk space supplying technology to set up the first milk bank in Australia. He said that NeoLacta had, over the past five years, “benefited over 51,000 plus premature babies across 450 hospitals.” Donated breast milk is mainly used to feed premature or sick babies when mothers are unable to nurse them for a variety of reasons. Usually, the milk is sourced through milk banks set up as non-profits. Milk collected from donors (healthy lactating mothers) is pasteurised, analysed for nutrient content and checked for contamination of any kind and is then frozen and stored. In most milk banks, especially those attached to government hospitals, the donated milk is given free of cost. However, in many others it might be free for a few poor patients but those who can afford it are usually charged a few hundred rupees for 50 ml of donated breast milk. There are over 80 non-profit human milk banks in India. Neolacta charges Rs 4,500 for 300 ml of frozen breast milk. A pre-term baby could require about 30 ml per day while a baby on full feed could need as much as 150 ml per day. It also sells human milk-derived powder that is readily available on ecommerce sites as well as its own. President of the National Neonatology Forum (NNF).
Dr Siddarth Ramji told TOI that “as a principle we do not support commercialisation of breast milk” but pointed out that NNF was not a regulatory body. Dr Satish Tiwari, national convenor of the Human Milk Banking Association of India, described it as a shame. “Does the company pay the mothers who are donors? Do they take it free and sell it at such a high cost? No one knows. The government should look into this.” In a research article published in December 2020 titled, ‘Nurture commodified? An investigation into commercial human milk supply chains’, social scientist Dr Michal Nahman and economist Prof Susan Newman from the UK examined the way Neolacta functioned. Speaking to TOI, Prof Newman said their research consultants had found evidence that women, mainly in rural areas, were actively being pursued by NGOs and associated ‘health workers’ and paid either with cash or with food packets. She pointed out that in the initial news reports on Neolacta, they freely admitted to collecting milk from women across four states but have since become more cagey about how they source the milk. The article adding that in 2016, an attempt by NeoLacta to collect breast milk from the largest government hospital for women and children in Bengaluru, Vani Vilas, was abandoned after serious concerns over the “commercial exploitation of breast milk”. “It was evident from our interviews with NeoLacta donors, intermediaries such as NGOs and community health workers and NeoLacta employees, donor milk is not framed as a commodity in spite of the marketisation of NeoLacta product. Rather, the way in which donor milk is operationalised as a ‘gift’ (or ‘daan’ in the Indian context) is built in to how it is commodified,” stated the article. Remuneration would depend upon the volume that women provide and 80% of the revenue would be paid to the mother with the NGO worker taking a 20% cut, it added.
At the time of going to press, the Ayush ministry had not responded to this reporter’s queries. BPNI wrote to the health ministry in February 2020 that “Neolacta has been involved in commercializing human milk” even though the guiding principles for using donor human milk in India in the health ministry’s ‘National Guidelines on Lactation Management Centers in Public Health Facilities’ clearly states, “DHM (donated human milk) cannot be used for any commercial purpose”. With the ministry not responding, BPNI wrote to FSSAI asking how the licence was issued. Neolacta was established in 2016, a year after Cambodia banned selling of breastmilk after a public outcry about an American for-profit company Ambrosia sourcing breast milk from poor women in Cambodia and selling it in the US. A letter from the Cambodian government was quoted as stating: “Although Cambodia is poor and (life is) difficult, it is not at the level that it will sell breast milk from mothers.” In the context of Cambodia, UNICEF had said in a statement that the trade in breastmilk was “exploiting vulnerable and poor women for profit and commercial purposes”. Most countries do not allow the commercial sale of breastmilk.
Dr Arun Gupta of BPNI alleges that Neolacta aggressively markets its products on social media. “It is using the tactics of the infant formula industry in the way it is targeting healthcare providers to gain legitimacy. Infant formula companies harp on mothers not having enough milk and Neolacta goes on about mothers producing ‘excess breastmilk’ which they can donate. It claims that its products do not come under the IMS Act, which regulates the marketing of infant milk substitutes, but it does,” said. BPNI complained to the National Neonatology Forum (NNF) in February 2021. The NNF responded in April 2021 to state that the NNF had already taken a decision in its executive board meeting to abstain from providing any form of encouragement to Neolacta Lifesciences and that a letter communicating this decision had been sent to all the members of the forum. Officials from the Bengaluru branch of FSSAI inspected the Neolacta unit on April 22 and found stocks of packing materials bearing the suspended FSSAI License, which they seized. The local FSSAI office has also asked the company to recall from the market all its products which have used the FSSAI licence and to disable online selling of such products. The company was also issued a notice for carrying out food business without a valid FSSAI license. A commercial company selling breast milk would court healthcare providers including doctors and hospitals to become their suppliers, which would increase the cost to the healthcare system and create ethical dilemmas, warned public health researcher Sarah Steele of the University of Cambridge in a piece she wrote about commercial human milk banks in October 2021. She added that if mothers moved from donating to non-profit milk banks to such companies, healthcare providers would be forced to enter into contracts with such companies and this could result in the privatization of a previously public service. Dr Sushma Nangia, professor and head of the neonatology department in Lady Hardinge Medical college who established a human milk bank, explained that donated breast milk might be better than infant formula but was inferior to mother’s own milk. “Even for pre-term babies their own mother’s milk is best for them to thrive. Donated human milk is inferior to mother’s milk as milk from different sources is pooled and vital nutrients are lost when it is pasteurized. Obviously, there are cases where donated breast milk is needed and that is why we started a bank but we do not prescribe it for all pre-term or sick babies. Neonatologists and the increase in the business of neonatal ICUs in the private sector are behind the push for donated breastmilk. It has become a lucrative business. This menace (push for commercial donor milk) can be curbed if neonatologists invest time and resources in ensuring mother’s own milk for her baby rather than going for commercial donor milk and also providing unambiguous information to families that donor milk is not the same as their own mother’s milk. The government needs to step in and enquire where the milk is being sourced from,” said Dr Nangia.
One of the ugliest and unethical human studies in the history, Tuskegee Study raised a host of ethical issues such as informed consent, racism, paternalism, unfair subject selection in research, maleficence, truth telling and justice, among others. It is really unbelievable to understand the heinous nature of the Tuskegee study.
The Public Health Service started the study in 1932 in collaboration with Tuskegee University (then the Tuskegee Institute), a historically Black college in Alabama. In the study, investigators enrolled a total of 600 impoverished African-American sharecroppers from Macon County, Alabama.
The goal was to “observe the natural history of untreated syphilis” in black populations. But the subjects were unaware of this and were simply told they were receiving treatment for bad blood. Actually, they received no treatment at all. Even after penicillin was discovered as a safe and reliable cure for syphilis, the majority of men did not receive it.
The study initially involved 600 Black men – 399 with syphilis, 201 who did not have the disease. Participants’ informed consent was not collected. Researchers told the men they were being treated for “bad blood,” a local term used to describe several ailments, including syphilis, anemia, and fatigue. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance.
By 1943, penicillin was the treatment of choice for syphilis and becoming widely available, but the participants in the study were not offered treatment.
The purpose of the study was to observe the effects of the disease when untreated, though by the end of the study medical advancements meant it was entirely treatable. The men were not informed of the nature of the experiment, and more than 100 died as a result.
None of the infected men were treated with penicillin despite the fact that, by 1947, the antibiotic was widely available and had become the standard treatment for syphilis.
Of these men, 399 had latent syphilis, with a control group of 201 men who were not infected.As an incentive for participation in the study, the men were promised free medical care. While the men were provided with both medical and mental care that they otherwise would not have received, they were deceived by the PHS, who never informed them of their syphilis diagnosisand provided disguised placebos, ineffective methods, and diagnostic procedures as treatment for “bad blood”.
The men were initially told that the experiment was only going to last six months, but it was extended to 40 years. After funding for treatment was lost, the study was continued without informing the men that they would never be treated.
The study continued, under numerous Public Health Service supervisors, until 1972, when a leak to the press resulted in its termination on November 16 of that year. By then, 28 patients had died directly from syphilis, 100 died from complications related to syphilis, 40 of the patients’ wives were infected with syphilis, and 19 children were born with congenital syphilis.
The 40-year Tuskegee Study was a major violation of ethical standards, and has been cited as “arguably the most infamous biomedical research study in U.S. history.” Its revelation has also been an important cause of distrust in medical science and the US government amongst African Americans.
Later in 1973, a class-action lawsuit was filed on behalf of the study participants and their families, resulting in a $10 million, out-of-court settlement in 1974.
On May 16, 1997, President Bill Clinton issued a formal Presidential Apology for the study.
On May 16, 1997, President Bill Clinton formally apologized on behalf of the United States to victims of the study, calling it shameful and racist.“What was done cannot be undone, but we can end the silence,” he said. “We can stop turning our heads away. We can look at you in the eye, and finally say, on behalf of the American people, what the United States government did was shameful and I am sorry.”
CBI has arrested Joint Drugs Controller for allegedly taking a ₹4 lakh bribe to clear injections made by Biocon Biologics .The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a Rs 4 lakh bribe from a conduit to waive the Phase 3 clinical trial of the ‘Insulin Aspart’ injection, an under development Biocon Biologics product to manage Type 1 and Type 2 diabetes, officials said on Tuesday.
The incident may be just a tip of the iceberg, to indicate collusion between administrators and various industries. It is the time to regulate all important components of health industry including health administrators as doctors are regulated – to achieve real cost effective health care.
In last few decades, as doctor-patient relationship has been getting more complex and medical industry has controlled the financial interaction, the medical costs have become expensive. Hence the health insurance industry is gradually becoming indispensable. As doctors are at the front and remain the visible component, they are blamed for the expensive medical treatments. The tremendous rise in health care expenses is usually borne by the government, taxpayer, insurance or patient himself. Therefore there has been an increasing dependence on investors in health care, along the lines of an industry to ensure its financial viability. 25 factors- why health care is expensive
Complex interplay of various industries like pharmaceutical, consumable industry and other businesses associated with health care remain invisible to patients. Various important components for example pharma industry, suppliers, biomedical, equipment, consumables remain unregulated. There is large number of administrators involved in such processes. Although doctors are strictly regulated and kind of over-regulated but such administrators and financial controllers who play important part in medicine, cost, sale and purchase, remain largely unregulated. Because of such undeserved criticism, doctors have actually been alienated from financial aspect but still they are often perceived as culprits for cost escalation.
The CBI has arrested Joint Drugs Controller S Eswara Reddy for allegedly receiving a ₹4 lakh bribe to waive the phase three clinical trial of the Insulin Aspart injection, a product of Biocon Biologics under development to manage Type 1 and Type 2 diabetes, officials said on Tuesday.
Biocon Biologics is a subsidiary of the Biocon. The company has denied allegations.The agency has also arrested director at Synergy Network India Private Limited, who was allegedly giving Reddy a bribe, they said.
After completing the necessary paperwork, the CBI has arrested Reddy and Dua, nabbed during a trap operation on Monday while the alleged bribe exchange was going on, the officials said.
The CBI has also booked Associate Vice President and Head-National Regulatory Affairs (NRA), Biocon Biologics Limited, Bangalore, L Praveen Kumar, as well as Director, Bioinnovat Research Services Private Limited, Delhi, Guljit Sethi in the case under IPC sections of criminal conspiracy and corruption.
Nachman Ash rails at ‘atmosphere that permits blood[shed] of healthcare providers’; nurses’ union announces it will join work slowdown
Violence against doctors has become a serious issue across the globe. The underlying basic reason for the omnipresent malaise is the altered doctor-patient equation globally and growing mistrust in the saviours. The mistrust is propagated by opportunist medical industry, media and law industry for their selfish motives as doctors are shown as front men for the failures. Poor outcomes are projected because of medical errors and mistakes. Every death is thought to be because of negligence rather than a natural complication of the disease. Because of the instigation and poor law enforcement in favour of doctors, the response of lay public to these unfortunate incidents has become extremely erratic and out of proportion. As Governments remain more or less indifferent, and doctors have become punching bags for inept health systems. Law industry has been enormously benefitted financially due to medico-legal cases against doctors. Media has sold their news items not by good ground work, but by sensationalizing and mischaracterizing the real basic issues, airing one single incident as generalizations. An atmosphere of mistrust has been generated against medical profession. Administrators and Industry have put themselves on higher pedestrian by selectively projecting the genuine failures and mistakes of doctors. There is a little token action by police after routine incident of violence against doctors.
Consequently violence (legal, verbal or physical) against doctor has acquired an epidemic proportion, omnipresent world-wide. As a result, medical business has thrived whereas medical profession is suffocated and art of medicine has been dying a slow gradual death.
But in Israel, doctors, nurses and health care workers seem to be united against this menace and their associations are actively pursuing the issue. More-over the Government also seem to be sensitive to the issue in Israel.
Health Ministry Director-General Nachman Ash on Wednesday sharply criticized the ongoing violence against healthcare providers, a day after a doctor was badly beaten by a patient at a community clinic.“It’s a general atmosphere that permits the blood[shed] of healthcare providers and for no reason,” Ash told the Ynet news site. “A doctor was busy and couldn’t see a patient so he broke into a room with an iron bar and hit her on repeatedly on the head and other parts of her body.
“I talked to the doctor and I understand that it was very fortunate that it ended the way it did [and wasn’t worse],” he said.
“It’s just shocking, and this violent discourse and behavior must be stopped.”
Ash also linked repeated incidents of violence against healthcare providers to anti-vaccine discourse that became prevalent during the coronavirus pandemic. “The connection exists because any discourse that encourages violence ultimately also leads to violence. These are two things that until now we did not want to link,” Ash said. “The violence toward [officials] is one matter and this violence toward healthcare providers is a second issue. But everything is connected.”
A number of top officials and doctors have faced verbal abuse and threats from anti-vaccine activists. Most notably, Dr. Sharon Alroy-Preis, the Health Ministry’s head of public services and a top COVID adviser to the government, has been repeatedly threatened by anti-vaccine activists and conspiracy theorists who view her as the public face of the health system’s inoculation effort. Ash noted that while there were newly announced plans to station police at hospitals, community clinics were more of an issue.
“It really is a much bigger challenge. I want to say that having police in hospitals will not solve everything either. It is impossible to put a police officer in every clinic — that is clear. I believe that punishment is the key, to create deterrence,” AAsh’s comments came as the suspect in Tuesday’s attack on a doctor in the central city of Be’er Yaakov appeared in court on Wednesday for a remand hearing. Police were seeking to charge him with attempted murder.
According to the Kan public broadcaster, the court was told that the suspect is alleged to have attacked the doctor with a meat tenderizer.According to police, the suspect, a resident of the town in his 30s, went to the clinic for medical treatment. While at the clinic he began to behave wildly. He refused to leave when asked by the doctor to do so, and instead grabbed a weapon and hit her on the head.
The doctor was moderately wounded and taken to a nearby hospital for further treatment. The man was apprehended by police shortly afterwards.Tuesday’s attack was the latest in a string of acts of violence in hospitals and clinics in recent months. In the wake of the latest attack, the doctor’s union announced staff at public hospitals and clinics will go on a two-day strike to protest violence against medics, by operating on a weekend schedule with reduced services for all of Thursday and Friday.
“We have made it clear over the past year unequivocally that any case of violence will encounter zero tolerance on our part,” the chairman of the Israel Medical Association, Prof. Zion Hagay, said on Tuesday.
“The most recent strike has led to an important government decision to place police in emergency rooms and allocate the necessary manpower, but we must look solely at how things are implemented on the ground. As long as we do not see real action in the immediate term, we will intensify our actions until someone here wakes up and understands that violence in the health system is a real epidemic,” he said. The nurses union said Wednesday that it will be joining the strike.
The upcoming strike is the second initiated by the doctors’ union in recent weeks. A labor action was called last month after family members of a patient who died at a Jerusalem hospital attacked medical staff and caused significant damage to an intensive care unit after they were informed of his death.