Blowin’ In The Wind Yes, and how many times can a man turn his head
And pretend that he just doesn’t see?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
Yes, and how many times must a man look up
Before he can see the sky?
And how many ears must one man have
Before he can hear people cry?
Yes, and how many deaths will it take ’til he knows
That too many people have died?
The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind
An eight year old child –scared, sitting terrified in mother’s lap, feeling breathless and feeling a bit dizzy. News about rising levels of smog and pollution send shivers down her spine every year. Her mother closing all the doors of house and trying to avoid the fumes entering the room like ghosts from every small crevices, peepholes and slits. The mother prays for the smooth sail through these days as she knows very well that the season has come when the environment will be full of pollutants. The child will writhe with suffocation due to air pollution in the same proportion. The reasons for dangerous levels of air pollution can be multiple like vehicles, crackers or farm waste burning, but accumulate near the some cities due to geographical distribution and environmental factors.
Irony is that it is someone else’s problem like farm waste burning and ball of a time with polluting crackers adds to child’s suffering. Here the sufferer is not the real cause pollution. Unlike if someone smokes or drinks alcohol, it is the doer who is sufferer. But here the root cause of her trouble emanates from poor governance and administrative failure to control the irresponsible behaviour of few.
Every year, many factors collectively add to enormous pollution and air becomes thick with smog and suspended particulate matter at a predictable time. It is a cause of breathlessness in children and adults and vulnerable to asthmatic attacks.
Like this one child, there are thousands of them and people from all ages suffer during this season because of mistakes and thrill of others. These sufferers, who are frustrated due to their plight, with no fault of theirs, have to undergo treatment and visit emergencies of the hospitals. This irresponsible behaviour of people puts burden on the medical services and the doctors, who are already overstretched due to workload. But it is only the doctors and nurses, who are visible round the clock, whereas people who have polluted the air and the administrators remain invisible. For many, it is very hard to understand the complexity of the situation. Patients many a times will rather tend to blame the doctors for their sufferings, poor treatment and difficulty in treatment, without realizing that constant pollution is the reason for poor response to treatment.
Why all of us cannot keep in mind the plight of such patients? Why the administrators wake up and come out of their slumber every year when AQI is more than 500 already?
There are no punishments for repeated administrative failures.
But inconsequential pleasure and poor governance should not be allowed to inflict health and life of others.
Delhi Air Pollution: AQI more than 500. Apart from climate change, air pollution is just another biggest environmental threat to human health at present. And with pollution levels worsening in the national capital and neighbouring regions, residents of Delhi have started complaining of several health problems like difficulty in breathing, tightness of chest, asthmatic symptoms, runny nose, sore throat, itchy and watery eyes. As the city has been waking up to a thick blanket of hazardous smog every morning since Diwali, Delhi hospitals are also witnessing a surge in the number of patients coming to OPDs with health issues. And it’s the elders and children, who have lower immunity levels, complained of breathing issues. The hazardous level of air pollution towards the end of October triggered a series of official measures such as shutting down construction work across Delhi and smoke-emitting factories.
It requires sincere administrative will and not merely tokenism to control such hazardous pollution.
Reaction to ‘Death’ in this new era of consumerism has become a story of paradox. Massive civil negligence and 141 deaths but there are no punching bags as are doctors for revenge in case of a hospitalized death. Just Compare the media projection, burden of negligence and accountability of hundreds of healthy deaths by civic negligence to the one hospital death by disease.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease.
Multiple Deaths in healthy people by civic negligence:
Large numbers of death and morbidity happen amongst absolutely healthy population due to preventable causes like open manholes, drains, live electric wires, water contamination, dengue, malaria, recurring floods etc. The number of people dying are in hundreds and thousands, and are almost entirely of healthy people, who otherwise were not at risk of death. In fact the burden of negligence here is massive and these deaths are unpardonable. Timely action could have prevented these normal people from death.
Police in the Indian state of Gujarat have arrested nine people in connection with the collapse of a pedestrian bridge that killed at least 141 people. Four of those detained are employees of a firm contracted to maintain the bridge in the town of Morbi.
Hundreds were on the structure when it gave way, sending people screaming for help into the river below in the dark.
Hopes of finding more survivors are fading. Many children, women and elderly people are among the dead.
The 140-year-old suspension bridge – a major local tourist attraction – had been reopened only last week after being repaired.
Single Death in Hospital due to disease:
Reaction to single “in Hospital” medicalized death is a paradox. The media has instead, focused on the stray and occasional incidents of perceived alleged negligence in hospital deaths which could have occurred due to critical medical condition of patient. However an impression is created as if the doctors have killed a healthy person. It is assumed without any investigation that it was doctor’s fault.
In present era, the expectation of medicalized death has come to be seen as a civic right and Doctors’ responsibility. People now have less understanding and acceptance of hospital death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.
Point to ponder-Misplaced priorities:
Who is to be blamed for the deaths of healthy people which occur because of civic negligence? Here relatives are actually helpless and the vital questions may go unanswered . There are no punching bags as are doctors for revenge. Any stray incident of death of an already ill patient is blown out of proportion by media forgetting the fact that thousands of patients are saved everyday by Doctors.
It is time to check the emotional reactions to single hospital death due to a disease as compared to hundreds of death of healthy people due to civil negligence.
Instead of often repeated statements about high expense on running medical college and projecting it as a hard fact, the amount spent on medical students by all medical colleges should be made transparent by all institutions. The frequent statement is made that cost of making a doctor is very high and gleefully propagated by the private medical colleges to extract millions out of young medical students .
Such statements without any actual public data is repeated to the extent that it is firmly entrenched in public mind without any real evidence.
High cost is the reason with an intention to exploit the young doctors in various ways to get cheap labour and extract millions from aspiring doctors by private medical colleges.
The basis of such calculation should be transparent for every medical college and all institutions.
In any medical college, only the Departments of Anatomy and Physiology are purely for medical students. The remaining subjects taught in medical colleges across the country are related to patient
care and medical education is only a by-product. All the medical teachers are actually doctors involved in treatment of patients, running the hospital and students observe the treatment and learn medicine. The interns and postgraduate students provide the cheap and labour and actually save the costs of running the hospital.
Therefore if some college is actually spending millions to produce one MBBS doctor , it is a either an inefficient model or costs are inflated and exaggerated to exploit the young doctors.
The average cost of producing a doctor or nurse went down across most parts of the world between 2008 and 2018, but almost tripled in China and doubled in India, a Lancet study shows. Despite this, the estimated expenditure per medical graduate in China at $41,000 is higher only than in sub-Saharan Africa and about 42% lower than in India ($70,000) against a global average of $114,000. The pattern was the same for nurses with the estimated expenditure per nursing graduate dropping across the world while it went up by 167% in China and doubled in India. The only other region where the per graduate cost went up was in North Africa, where cost per doctor went up by 47% and by 25% for nurses. Approximately $110 billion was invested globally by governments and students’ families in medical and nursing education in 2018. Of this, $60.9 billion was invested in doctors and $48.8 billion was invested in nurses and midwives, the study estimated.
The paper looks at important developments in medical education to assess potential progress and issues with education of health professionals after the Covid-19 pandemic. Mean costs in 2018 were $114,000 per doctor and $32,000 per nurse. In 2008, China had the lowest estimated expenditure per medical graduate at just $14,000 (Rs 6 lakh) followed by India, where it was just $35,000 (Rs 15 lakh at the 2008 exchange rate of Rs 43 to a dollar). This is much lower than the estimate of Rs 1 crore or more that Indian colleges widely claim as expenditure per medical graduate.
Take example for cough syrup related 66 deaths at Gambia or Injection Propofol related deaths at PGI Chandigarh. If deep investigations are not done, poor quality medicines will continue to be marketed and doctors would be held responsible for the adverse reactions and deaths. Strict regulations for quality of pharmaceutical agents is need of the hour.
Usually every problem related to health is called medical malaise, but that is a misnomer. In fact health care comprises tens of different industries. 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 largely unregulated. Collective malaise of all these is conveniently projected as medical problems as blame is conveniently passed on to doctors, as they are only visible component of mammoth health business. Rest all remain invisible, earn money and doctors are blamed for the poor outcome of the patient, as doctor is the only universal link that is visible with patient. By an average application of wisdom, it is easier to blame doctors for everything that goes wrong with patient.
Cough syrup related deaths at Gambia or Injection Propofol related deaths at PGI Chandigarh – two examples are only a tip of the iceberg. In routine, if patient gets fake or low quality medicines and does not get well, gets side effects, doctor will face harassment. Whereas people involved and industry will be sitting pretty and make money.
Therefore strict administration and quality check is required to correct Pharma malaise. It may be a complex issue because of complexity involved in implementation and execution of policies. But recognition and beginning to think of the problem is also an important step.
The WHO has issued an alert over four cough and cold syrups made by Maiden Pharmaceuticals in India, warning they could be linked to the deaths of 66 children in The Gambia
The World Health Organization (WHO) on Wednesday issued a warning over four cough and cold syrups made by an Indian company, saying that they could be linked to the deaths of 66 children in The Gambia. The WHO said that the cough and cold syrups, made by Maiden Pharmaceuticals in Haryana, could be the reason for serious kidney injuries. “Please do not use them,” the WHO said in its advisory.
The four cough and cold syrups that have been linked to the deaths of 66 children in The Gambia are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup. In a release, the WHO has said that the Indian company has not yet provided guarantees on the safety and quality of these products.
“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants,” the WHO said in a medical product alert. The WHO also warned that while the products had so far been found in The Gambia, they could have been distributed to other countries.
According to the WHO, diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove fatal. Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death, the WHO said.
New Delhi-based Maiden Pharmaceuticals declined to comment on the matter.
The World Health Organization also said that it was conducting further investigation with the company and regulatory authorities in India regarding the cough syrup linked to deaths of 66 children.
Last month, Gambia’s government said that it has also been investigating the deaths. The government statement came as a spike in cases of acute kidney injury among children under the age of five was detected in late July.
“While the contaminated products have so far only been detected in the Gambia they may have been distributed to other countries,” WHO Director General Tedros Adhanom Ghebreyesus said at a press conference on Wednesday.
The WHO Director General added that WHO recommends all countries detect and remove these products from circulation to prevent further harm to patients.
Meanwhile, the DSCO has already taken up an urgent investigation into the matter with the regulatory authorities in Haryana.
CHANDIGARH: Five patients had died after they were sedated before surgeries on a single day last week at PGI, prompting doctors to sound a red alert to Central Drugs Standard Control Organisation (CDSCO)on Propofol injection – an anesthetic given before any major surgery. In this case, the drug was taken from the chemist shop in the hospital emergency. “Following a complaint from PGI doctors, we came with a CDSCO team to collect samples. The samples have been sent to Central Drugs Laboratory, Kolkata,” said Sunil Chaudhary, senior drug control officer, UT. He said, “The suspected batch of drugs has been stopped for supply till reports are received.” Sources said test analysis will take around two-three weeks and final report will be submitted by the CDSCO team. The five patients had to undergo orthopaedic and neurosurgeries. On deliberating the cause of deaths, doctors found Propofol injection as the common thread.
Death is the inevitable conclusion of life, a universal destiny that all living creatures share. It’s an age-old idea that a good life and a good death go together. Death and dying have become unbalanced in high-income countries, and increasingly in low-and-middle-income countries; there is an excessive focus on clinical interventions at the end of life, to the detriment of broader inputs and contributions.
The story of dying in the 21st century is a story of paradox. While many people are over-treated in hospitals, with families and communities relegated to the margins, still more remain undertreated, dying of preventable conditions and without access to basic pain relief. In this present era, process of dying represents unbalanced and contradictory picture of death.
Even though medical advances continue to increase life expectancy, they have raised an entirely new set of issues associated with death and dying. For example, how long should advanced medical technology be used to keep comatose people alive? How should the elderly or incapacitated be cared for? Is it reasonable for people to stop medical treatment, or even actively end their life, if that is what they wish?
Before the 12th century he describes a period of “Tamed death,” where death was familiar, and people knew how to die. The dying and their families accepted death calmly; they knew when death was coming and what to do; dying was a public event attended by children.
Death can occur through conflict, accident, natural disaster, pandemic, violence, suicide, neglect, or disease. The great success with antibiotics vaccines has perhaps further fuelled the fantasy that science can defeat death. But this temporary success as only has been the result of discovery of germ theory and antibiotics.
In true sense, Death still remains invincible.
The fear of death also involves the fear of separation.
As families and communities want more and more hospital care, when critically sick, health systems have occupied the centre stage in the process of dying. Dying people are whisked away to hospitals or hospices, and whereas two generations ago most children would have seen a dead body, people may now be in their 40s or 50s without ever seeing a dead person. The language, knowledge, and confidence to support and manage dying are being lost, further fuelling a dependence on health-care services.
Death systems are the means by which death and dying are understood, regulated, and managed. These systems implicitly or explicitly determine where people die, how people dying and their families should behave, how bodies are disposed of, how people mourn, and what death means for that culture or community.
Death systems are unique to societies and cultures.
The increased number of deaths in hospital means that ever fewer people have witnessed or managed a death at home. This lack of experience and confidence causes a positive feedback loop that reinforces a dependence on institutional care of the dying.
Medical culture, fear of litigation, and financial complexities contribute to overtreatment at the end of life, further fuelling institutional deaths and the sense that professionals must manage death. Social customs influence the conversations in clinics and in intensive care units, often maintaining the tradition of not discussing death openly. More undiscussed deaths in institutions behind closed doors further reduce social familiarity with and understanding of death and dying.
How people die has changed radically over recent generations. Death comes later in life for many and dying is often prolonged. Futile or potentially inappropriate treatment can continue into the last hours of life. The roles of families and communities have receded as death and dying have become unfamiliar and skills, traditions, and knowledge are lost.
At first only the rich could expect that doctors would delay death. However, by the 20th century this expectation had come to be seen as a civic right.
‘Natural death’ is now the point at which the human organism refuses any further input of treatment.
Corporatization of health care has projected medicine as a purchasable commodity and consequently resulted in an illogical distribution of health care. People, who can afford, spend millions in the last few days of their life, just to have only a few more days to live. Resources spent in such a futile quest are equivalent to thousands of times the money for food and medicines for the poor who lose lives for fraction of that expense.
Death is not so much denied but has become invisible to people. People now have less understanding and less acceptance of death. The death is more perceived as failure of medical treatment rather than an invincible power or a certain final event.
The potential penalty by India’s fair trade regulator could be steep. The CCI (The Competition Commission of India) investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated free of regulation so far.
A four-year investigation by India’s fair-trade regulator has concluded that some of India’s largest hospital chains abused their dominance through exorbitant pricing of medical services and products in contravention of competition laws.
The Competition Commission of India (CCI) will soon meet to weigh in on the responses by Apollo Hospitals, Max Healthcare, Fortis Healthcare, Sir Ganga Ram Hospital, Batra Hospital & Medical Research and St. Stephen’s Hospital. It will then decide whether to impose penalties, said people familiar with the matter.
The CCI can impose a penalty of up to 10 percent of the average turnover for the past three preceding financial years of an enterprise that has violated competition laws. The penalties could be steep. Apollo Hospitals posted an average turnover of Rs 12,206 crore and Fortis Rs 4,834 crore in the past three financial years.
The CCI’s director-general found that 12 super-speciality hospitals of these chains that operate in the National Capital Region abused their positions of dominance by charging “unfair and excessive prices” for renting rooms, medicines, medical tests, medical devices, and consumables, according to a copy of the summary report that Moneycontrol reviewed.
Some hospital room rents exceeded those charged by 3-star and 4-star hotels, according to the findings by the DG, who examines anti-competitive practices.
Significance of the investigation
The CCI investigation is the first such action against exorbitant prices of medicines and services fixed by hospitals, which have operated unencumbered by regulation so far. The watchdog’s action could potentially rein in the prices of medicines and healthcare equipment, or at the very least, bring transparency in the way hospitals sell these items, according to competition lawyers.
Of the 12 hospitals that faced CCI scrutiny, six belonged to Max and two to Fortis.
The CCI and the hospital chains had no comment for this article.
Overcharging without checks
Exorbitant pricing is a common thread running through the CCI investigation report. The hospitals were found to charge more for certain medical tests as well as for X-rays, MRI and ultrasound scans than rates offered by other diagnostic centres. For consumables such as syringes and surgical blades, hospitals charged rates that were higher than those of other consumable makers, according to the CCI report.
The only exception was medicines, which hospitals sold at the maximum retail price, although they earned significant profits by procuring them at lower prices.
The CCI selected the hospitals for investigation on the basis of the number of doctors, paramedics, beds, and turnover for the period 2015-2018. The investigation found that these hospitals do not allow the use of purchase of consumables, medical devices, medicines and medical test results from outside, adding that patients use the service of in-house pharmacy and laboratories for ease of convenience.
Investigative reports pertaining to each of the hospital chains were submitted by the DG to the CCI on December 24, 2021. The CCI forwarded a copy of these reports to the hospitals on July 12, 2022, and sought their responses, according to the people, who did not want to be identified.
The CCI has been examining the pharmaceutical sector in India for years, scrutinising the pricing of medicines by healthcare companies. On April 19, 2020, it cautioned businesses, including healthcare companies, against taking advantage of Covid-19 to contravene competition laws.
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.
Amoebiasis
Angiostrongyliasis
Anthrax
Brucellosis
Chikungunya
Coccidioidomycosis
Dengue
Giardiasis
Haemorrhagic fevers
Hantavirus diseases
Hepatitis C
Hepatitis E
Histoplasmosis
HIV/AIDS and other sexually transmitted infections
Legionellosis
Leishmaniasis (cutaneous, mucosal and visceral forms)
Leptospirosis (including Weil disease)
Listeriosis
Lyme Borreliosis (Lyme disease)
Lymphatic filariasis
Malaria
Onchocerciasis
Plague
SARS (Severe Acute Respiratory Syndrome)
Schistosomiasis (Bilharziasis)
Trypanosomiasis
Typhus fever (Epidemic louse-borne typhus)
Zoonotic influenza
Some of the diseases included in this chapter, such as brucellosis, HIV/AIDS, leishmaniasis and TB, have prolonged and variable incubation periods. Clinical manifestations of these diseases may appear long after the return from travel, so that the link with the travel destination where the infection was acquired may not be readily apparent.
Special feature
Vaccine-preventable diseases
Vaccine-preventable diseases
Cholera
Hepatitis A
Hepatitis E
Japanese encephalitis
Meningococcal disease
Rabies
Tick-borne encephalitis
Typhoid fever
Yellow fever
Information about available vaccines and indications for their use by travellers is provided in the pdf entitled vaccine-preventable diseases and vaccines beside. Advice concerning the diseases for which vaccination is routinely administered in childhood, i.e. diphtheria, measles, mumps and rubella, pertussis, poliomyelitis and tetanus, and the use of the corresponding vaccines later in life and for travel, is also given in the section Vaccines.
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.
ANCIENT TIMES
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.
Spiritualism
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.
Changing Attitudes
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.
Hospice Care
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.
New Delhi: The vice-chancellor of a medical college in Punjab has resigned after state health minister allegedly forced him to lie on a dirty mattress at a hospital.
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.”
Evolution of Medical profession-Extinction of good doctors 