Tag: media

#NEET:Society deserves the doctors, it chooses and nurtures. Musk-melon stem will not grow apples


Doctors are just as offshoots of a tree called as society. They essentially are the same as rest of the society. It is a specialized branch of tree which helps other offshoots of tree to save others. As part of same tree, they resemble the parent society, of which they are part. Society needs to choose and nurture a force of doctors carefully with an aim to combat for safety of its own people.

Since it is a difficult path to be a good doctor, there has to be some reason why someone will choose to be a doctor. The path will require sacrificing golden years of his life in studies and working hard for the benefit of others thereafter.

Our society fails to develops a robust system of choosing and nurturing good doctors and therefore itself responsible for decline in standards of medical profession.

  1. Exorbitantly expensive medical education and lowered merit: aspiring doctors are now forced to pay exorbitant fee, in millions. Many go under heavy debt to pay medical colleges fee. Children with lower ranks in merit pay millions and can become doctors. The real problem here is that real deserving will be left out.

Medical students from the very onset are victim and witness to these practices and exploitation. They see their parents pay this unreasonable fee through their noses or take loans. Such blatant injustice will have an everlasting effect on the young impressionable minds. Society gives them lessons of corruption and exploitation.

  1. Discouragement of medical fraternity: The adage “To err is human” probably does not apply to the doctors anymore. Hence they are harassed often for any adverse clinical outcome even though it may be because of poor prognosis of patient. They work under continuous fear and stress and are punished and assaulted for each small or big error. Society has failed to support them in their difficult times. Best and talented may try to shun away from the profession.
  2. Industry earns, but blames doctor: Till now, doctor patient interaction was the central point of the health industry, a core around which medical industry revolved. But now this interaction, treatment and almost everything is controlled by industry. By provoking controversy about doctors for varied reasons, medical industry and law has positioned themselves between the doctor and patient and taken a center stage in health care. Every one associated with industry like medical education, pharmaceutical, suppliers, insurance, administrators, managers, equipment industry, insurance earn from the medical sector, but remain invisible. Blame for all the cost and sufferings is conveniently put on the doctor hence causing diminution of respect. Loss of respect for the profession is a bad advertisement for good talent to the profession.
  3. Overzealous regulation of medical profession: because of falling standards, every one is feels a need for stricter punishing regulation of medical profession. Time and resources which should have been utilized for treatment of patients, has to be used for complex documentation, frivolous medical lawsuits and communication. It is not uncommon to use doctors as scapegoats to save the weak health system causing further oppression of medical profession.
  4. Exploitation by law industry: Even in few advanced countries, one can see instigating advertisement of lawyers on zero percent fee. While doctor is paid miniscule amount of money by patients, he will be sued for millions. And lawyers change in lakhs. Money earned by medical lawsuit is divided between client (so called patient) and lawyer. Doctor will definitely divert their energies to save themselves from such practices rather than focusing on treatment of patient. In an era, where brothers and sisters fight for money, doctors are easiest target to extract money.
  5. Defining the patient as consumer has created fear in mind of doctors and deterioration of doctor patient relationship.
  6. Wrong projections by media: Painful retrospective analysis of work of doctor by media, courts and public continue. One stray incidence of even alleged or perceived negligence is projected as generalization. Whole profession is painted in poor light. Whole community looses respect because of irresponsible behavior of some people in media to earn quick money and fame. Ultimately it will help everyone except doctor and patient and discourage the excellence in medical care.
  7. Doctor’s assault: the inability and lack of support of society to prevent assault against their savior will hit the enthusiasm of doctors towards patients. It will propagate children’s unwillingness to enter the profession amidst chaotic conditions.

Apple tree will have apples and musk melons plant will grow muskmelons only. One should not expect apples to grow on muskmelon stem. If society has failed to demand for a good and robust system, failed to save them, 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.

Therefore 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.

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India expenditure on health 1 %, of GDP, Lower than Bhutan, Nepal, Sri Lanka


  •  India’s per capita public expenditure on health increased from Rs 621 in 2009-10 to Rs 1,112 (around $16 at current exchange rate) in 2015-16
  • According to National Health Profile (2018), around 43 crore individuals or 34% of the population were covered under any health insurance in 2016-17

It is not difficult to diagnose the ailments of health system. System that requires more input, is suffering  due to  decades of neglect.  It  reflects  a lower priority to health sector.

India’s public health expenditure — 1% of its gross domestic product (GDP) — may have witnessed a marginal improvement from 0.98% in 2014, but it is still way behind even the low-income countries that spend 1.4% on an average, shows National Health Profile 2018.

India is spending even less than some of its neighbors countries such as Bhutan (2.5%), Sri Lanka (1.6%) and Nepal (1.1%), according to the annual report released on Tuesday by the Central Bureau of Health Intelligence, the health intelligence wing of the directorate general of health services in the Union ministry of health and family welfare.

In World Health Organization’s South-East Asian Region, which includes 10 countries, India finishes second last, above only Bangladesh (0.4%), when their health expenditure is compared. Maldives spends 9.4% of its GDP to claim the top spot in the list, followed by Thailand (2.9%).

India’s National Health Policy 2017 proposes raising the public health expenditure to 2.5% of the GDP by 2025.

India currently spends a little over 1% of GDP on health, far below Singapore which has the lowest public spend on health at 2.2% of GDP among countries with significant universal health coverage (UHC) service, according latest National Health Profile (NHP) data.

India’s per capita public expenditure on health increased from Rs 621 in 2009-10 to Rs 1,112 (around $16 at current exchange rate) in 2015-16. However, it is still “nominal”, compared to other countries. Switzerland spends $6944 on health per capita, whereas the US spends $4802 and UK spends$3500.

Government  plans to launch its ambitious National Health Protection Scheme (NHPS)- Ayushman Bharat – to cover over 10 crore poor families with an annual health cover of Rs 5 lakh per family. A successful implementation may bring some positive change to the ailing system.

Real challenge is to provide basic health facilities to remote areas.  Even good preventive care and primary care to under privileged can also  bring a significant change.

 

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Digital Gaming addiction defined as a mental disorder by World Health Organisation


  • WHO described the addiction as a “pattern of persistent or recurrent gaming behaviour” that becomes so extensive it “takes precedence over other life interests”
  • Gaming disorder can lead to disturbed sleep patterns, diet problems and deficiency in physical activities

 

Digital Gaming  Addiction

Although   substance addiction with  drugs or alcohol is well recognized, newer  addictive behaviors are now being realized as well. As  digital and vedio gaming has been quite popular now, compulsive gaming and  severe withdrawal symptoms in game addicts are getting commoner. A child/ adult needs more of a  game  to keep him going. If the child does not get more of the game, he becomes irritable and miserable.

If parent try to prohibit gaming, children exhibit  anger, violence, or depression. The children cry, sit in the corner and cries, refuses meals or sleep.

For  compulsive gamers, it is  the fantasy world that makes them feel better.

The lure of a fantasy world is especially pertinent to online role-playing games. These are games in which a player assumes the role of a fictional character and interacts with other players in a virtual world. As  A child can  show his dominance in the game. There fore virtual life becomes more appealing than real life.

possibility of harm: gaming addiction can ruin lives. Children who play few hours per day have  no time left for socializing, studies, or sports. Social development is poor.

In older people or adults  it can have effect on professional life and relationships.

 

Warning signs for  gaming  addiction include:  The important  issue here is  whether one is  able to control  gaming activity or not:

  • Playing for increasing amounts of time
  • Thinking about gaming during other activities
  • to choose gaming to escape from real-life problems, anxiety,  depression
  • Lying to friends and family to conceal gaming
  • Feeling irritable when trying to cut down on gaming

Gaming addicts tend to become isolated, giving up other hobbies and  withdrawn from other activities.

Parents need to be careful

Parents need to be careful and not take it as another routine phase of childhood.  Keep  track of  child’s gaming behavior, including:

  • for how long and frequently  the child plays.
  • Problems resulting from gaming
  • How the child reacts to time limits

to get rid of the game addiction, these children need to be taught about the advantages of real life excitement as opposed to online achievements.

Addiction to digital and video gaming has been classified as a mental health disorder by the World Health Organisation (WHO) in its new International Classification of Diseases (ICD).

The agency described the addiction as a “pattern of persistent or recurrent gaming behaviour” that becomes so extensive it “takes precedence over other life interests

The classification is aimed at alerting health professionals and systems to the existence of this condition and ensuring that people suffering from these conditions can get appropriate help.

“Gaming disorder” has three main characteristics. One, that the gaming behaviour takes precedence over other activities to the extent that other activities are pushed to the periphery.

 

If the condition leads to significant distress and impairment in personal, familial, social, educational or occupational functioning.

Gaming disorder can lead to disturbed sleep patterns, diet problems and deficiency in physical activities.

The 11th edition of ICD covers 55,000 injuries, diseases and causes of death. Researchers across the world use it as reference for data, whereas doctors and other medical practitioners use it to diagnose disease and other conditions. The ICD is also used by health insurers in some countries to claim reimbursements based on ICD coding.

Besides, the classification is used by national health program managers; data collection specialists; and others. The new ICD-11 also reflects progress in medicine and advances in scientific understanding.

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Expensive dream or a disaster self bought: Pay millions to be a doctor (#NEET)


Reluctance of candidates to wrap up  expensive medical college seats is just an indicator of aspiring medical student’s   better understanding of  the cruel reality about medical education. Becoming a doctor is not easy these days. Paying crores is like  getting into a trouble zone and getting yourself entrapped into a system of exploitation. It  may be alright for candidates who are from rich backgrounds.  But for the candidates whose families are not  strong financially, it may be self bought disaster. Steep rise in fee of medical colleges has been huge, beyond logic and is injustice to the meritorious.  One advantage of inappropriate media bashing of doctors, recent assaults against doctors has  given some wisdom to  innocent students, who  used to just enter into a system of entrapment unknowingly. Choosing medical career and then trying to place your feet into post graduation, spending crores in all these situations is akin to  falling victim to  a system of entrapment.  Some one paying for it in millions and  crores is an absurd thought  and  highly ill advised. For the candidates who are not financially strong, it may be difficult to even recover the money spent, what to say about the time and youth wasted in  getting a degree which may or may not be that worth.

Therefore it may become  dream turning into nightmare  for the people who can not afford.  Lower merits combined with not so good medical colleges   may produce thousands of degree holders but not good doctors.  Recent sporadic campaign of stray cases projected as generalization  by media has definitely diminished respect for profession. Individually most of the doctors may be working hard honestly but they are uniformly painted in the same colours due to misplaced priorities of the media. Society has already developed a prejudiced mind towards doctors.   Since these projections are created by outside agencies, doctors even with hard work and doing work honestly  may not be able to change the perception that has been created. Damage to profession has been immense and it is nearly impossible  task to reverse the mistrust generated and  undo the damage. If individually doctors are doing good and media continues the negative projection, the sad situation will persist. All efforts by doctors  in this direction are like oil  on the sand.

In  nutshell, this toil and trouble for years, buying a seat, paying millions or crores and becoming a doctor does not save you from vulnerability of court cases and wrath of public. Rather suboptimal training and capabilities makes them  more vulnerable to problems. It may be alright if some one with strong financial background  decides to be a health manager or administrator.

Real problem of mediocrity remains as such. Candidates with higher merit will be left behind as candidates who can buy and pay more will get in. This process  will be called as “lawful selection” along with diluted merit .This process makes count number of degrees distributed under various conditions attached to it other than merit.  But  just number of   degrees will not provide better doctors for future.

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Quack menace: Patient killed by quack (Delhi): qualified doctors regulated strictly but not unqualified?


 

In an era, when even licensed and qualified doctors are finding it  difficult to practice medicine, it is strange that unqualified and unlicensed are having a field day. Why a strict regulation does not apply to them, is beyond any reasoning and logic. If a medical facility or clinic is functional, it is difficult for the patient, specially in emergency, to check or even doubt its credentials. How such facilities are open, functional and thriving, which does not have a qualified medical person is beyond logic. Sadly our regulation is trying to regulate, who are already regulated. It is trying to punish those who are qualified and licensed, but turns a blind eye towards unlicensed and unqualified doctors.

Such fake doctors own medical set ups, may conduct surgeries,  sometimes run with little help from qualified doctors,  and do procedures. Another problem is that they   promote fake rumours about genuinely qualified doctors and create a mist of mistrust to propagate their fake medical business.

If this is state of medical affairs prevalent in heart of capital and such facilities are functional and thriving, what will be state of affairs in peripheral or remote areas. Again it does not need an Einstein brain to guess.

The Delhi Medical Council (DMC) on Wednesday ordered criminal action against a quack whose “treatment” resulted in the death of a patient in November last year.

The hospital in which the patient was treated was also not registered with the Directorate of Health Services, Delhi. The patient was treated by an unqualified person in an unregistered hospital and did not receive proper treatment, which led to his death. The man, who had pretended to be a doctor, had been practising medicine for almost 12 years in Delhi and was a member of the Indian Medical Association (IMA), a pan-india representative organisation of doctors, and the Indian Academy of Paediatrics (IAP), a renowned association of paediatricians.

The 45 years old patient  had an undiagnosed liver disease. He went to a private hospital in Munirka ( New Delhi) around 2 pm on noticing blood in his vomit and stool. Within nine hours, the condition of the patient deteriorated and he was taken to Safdarjung hospital New Delhi , where he was declared dead on arrival at 2 am.

The patient was just put on a saline and given some antibiotics and pain medication. No diagnostic test was done to find the source of the bleeding, neither was any blood given to the patient. Any doctor can tell you the treatment was wrong. First he gave a DMC number, but the number corresponded to someone else. So, he provided  a registration number of the Goa Medical Council, again it belonged to someone else.

 

This is an  example of  how modern medicine is detrimental in unsafe hands, that are functional without proper training. How these fake doctors openly call themselves doctors, use prefix of Dr and register themselves somehow.   It is no less than fraud with lives of innocent public.

Neglect towards this sad reality  is akin to playing with health of innocent people. Medical organizations and media  has either  not taken it seriously or not able to take any constructive step  in curbing this menace by quacks.

Although genuine doctors face many problems from system of quackery. Misuse of antibiotics, local goonism and nuisance, all kinds of malpractice, misguiding the patient are few examples. But ultimately it is the society who is  the sufferer. Therefore resistance to such practices and  a wish to have good health system is  actually need of society. Unless people themselves make a true effort towards a robust health system, this menace of quackery is likely to persist, due  to prevalence  of  vested interests.

0

“NEET – NOT So NEAT” : Courtesy switch to Percentile system?

Govt cuts NEET-PG cutoff by 15 percentile In a move that is likely to boost uptake in vacant post-graduate medical seats and also improve availability of specialists in future, the health ministry has slashed the cutoff for NEET-PG 2021 by 15 percentile across all categories. The ministry issued a letter to the National Medical Commission on Saturday giving a go-ahead to the proposal. The revised qualifying cutoff now stands at 35 percentile for the general category, 30 percentile for persons with disabilities (PwD) general, 25 for SC/ST and OBC and 25 for PwD (SC/ST/OBC), the letter said. The reduction in the cut off percentile is expected to allow more MBBS passouts to apply for post-graduate courses, an official said. “The move aims to prevent seat wastage. With this reduction in percentile, approximately 25

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 20 -25 % marks also becomes eligible to become a doctor. What is the need to dilute and shortlist around half a million for few thousand seats. Answer to that is simple.  To select and find only those students from millions, who can pay millions to become doctors.  

      Although the whole effort and huge expenditure to become doctors in this way may be really worthless in today’s scenario, considering the difficult times and vulnerability of medical profession. By allowing a intentional dilution of quality  can be advantageous only to  few and detrimental to others.

  • Beneficiaries are rich candidates, medical colleges who collecting fee and may be public who will get numbers of doctors. Surplus of doctors is thought to be an advantage to society. But here quality is least of the consideration.
  • Disadvantage to students, who are meritorious but can’t pay, and possibly society in long run, who is deprived of good quality doctors.

 

 

  •      A lower eligibility cut-off would mean that students with even lower percentage       of    marks will be eligible for MBBS
  • Last year, 11,114 students who scored 270 or less out of 720 got admission into medical colleges, mostly in private colleges
  • By the percentile system, last year, a student scoring 270 was within the 80th percentile

NEW DELHI: The results of the National Eligibility cum Entrance Test (NEET) for MBBS admissions for 2018 announced on Monday showed even lower cut-offs than last year. The cut-off for the unreserved category is down from 131 out of 720 marks last year to 119 this year, while the one for the reserved categories has dropped by a similar margin from 107 to 96. Over 7 lakh students from the 13 lakh plus who appeared for the exam have qualified to join medical college.

A lower eligibility cut-off for NEET would mean that students with even lower percentage of marks will be eligible to get admission for MBBS. In case you thought just being eligible would not allow those with poor scores to get admission, here’s what happened last year. Over 4,300 students who scored 180 or less in NEET actually got admission to MBBS. The overwhelming majority of them in private colleges, where high fees make it difficult for those with meagre means to join even if they have the marks.

A score of 180 out of 720 is the minimum mark a student would get if they got 40% of the answers right, even if they got all the rest wrong, with the negative marking scheme in place in NEET. Of course, 40% is the pass percentage in most exams. In terms of percentage, 180 out of 720 is a mere 25%. But going by the percentile system of NEET, 180 in 2017 meant the student was within the 64th percentile, well above the 50th percentile cut-off for the unreserved category.

Last year, 11,114 students who scored 270 or less out of 720 got admission into medical colleges, once again mostly in private colleges. If a student got half the answers right, he could not have got less than 270. Before NEET, the minimum eligibility criteria for MBBS admission was 50% through various entrance exams though the quality of some of the exams conducted by colleges themselves was dubious. By the percentile system, last year, a student scoring 270 was within the 80th percentile.
Incidentally, because there are no cut-offs specified for individual subjects within NEET, there were several cases last year of people who qualified and got admission into medical colleges with scores of zero or even negative marks in chemistry or physics. With the cut-offs dropping further this year in terms of percentage marks (though remaining the same in percentile terms), chances are we will see a repeat of worse this year.

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, 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.  So children have to be careful while choosing medical careers from the beginning.

A famous axiom “as you sow so shall you reap” has an application to health system in this scenario, so people should not rue scarcity of good doctors.  

Advantages-Disadvantage of being a doctor

25 factors- why health care is expensive

     REEL Heroes Vs Real Heroes

     21 occupational risks to doctors and nurses

     Covid paradox: salary cut for doctors other paid at home

   Medical-Consumer protection Act- Pros and Cons

Expensive Medical College  seat- Is it worth it?

49

Lawlessness strike docs: doctor attacked by mob SGM Hospital, Delhi


In reality violence against doctors is a law and order problem. But cleverly blame is put on doctors. Doctors can not treat mobs. That too with limited resources. Recent attack on doctors at  hospital is another example of lawless and uncivilized society.  Doctors have become punching bags for  all the malaise and inadequacy of prevalent health system. It is really appalling to see the impunity with which these incidents are happening.

Resident doctors of Sanjay Gandhi Memorial hospital in Mangolpuri   Delhi  are on  strike  for the second day. The doctors went on a flash strike on Monday after one of the  doctors  was attacked by a mob. They were  carrying  knives  and wanted to kill the doctor.

Government ‘s unwillingness or failure  to assure doctor’s protection will have deep ramifications on future of medical profession.  Role of organizations like Human right commission and other right’s bodies is also questionable.  Doctor bodies have also failed to take some concrete action other than showing some concern.  Role of media, celebrities, film stars in spreading the hatred against medical profession as a whole is unpardonable.

Every incident of verbal, legal, physical assault is a trust breaker.  It will hit  trust  and empathy of doctors  towards patients. Patients will get their revenge for naturally occurring disease, but society will be looser in the long run. Since the authorities, who matter have chosen to remain silent on the issue, doctors will have to find some way to save themselves.

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Nipah Virus : Karnataka at high alert: suspected cases of rare virus, fanning fears


The Karnataka ( south India) state is on high alert, especially in areas bordering Kerala, after 11 people died of the mysterious Nipah Virus in Kozhikode over the last few days.

The Karnataka Health and Family Welfare Department has directed primary healthcare centres in Chamarajnagar and Mysuru districts, which share the border with Kerala, to be alert and to report any patients from Kerala with suspected Nipah cases. A team from Delhi has been sent to Kerala and based on the report, national guidelines will be issued.

Those travelling to Kerala should be cautious when and if they come in contact with Nipah-infected people. Avoid eating fruits fallen on the ground and drinking raw date palm sap in Kerala. Avoid coming in contact with sick domestic animals and pigs.

Nipah Virus infection is zoonotic, which means the disease has spread from animals to humans, and can causes severe conditions in animals and humans. The natural host of the virus are fruit bats of the Pteropodidae family, Pteropus genus. The virus transmits through direct contact with infected bats, pigs or from other NiV-infected people through touch or body fluids. Disease is contagious and can spread from person-to-person.

The infection in humans can cause a wide range of clinical presentations, from asymptomatic (no symptoms) to acute respiratory syndrome (cough, breathlessness and respiratory distress) and fatal encephalitis (inflammation of the brain). After exposure to virus, symptoms start after an incubation period of 5-14 days. Usual symptoms are fever and headache for 3-10 days followed by drowsiness, confusion, seizures and altered sensorium. Signs and symptoms can progress rapidly to coma and death in 24-48 hours. Nipah Virus encephalitis is fatal with a high mortality rate.

Stressing should be on precautions. The people in affected areas should avoid eating or drinking date palm sap (raw date palm sap, a sweet drink popular in the winter, when the sap is easy to tap from trees pierced with a spigot. A bat clings to a palm tree as it eats sap just above a collection jar). Disease can be prevented by avoiding animals that are known to be infected and using appropriate personal protective equipment.

There is no vaccine for the Nipah virus, carried by fruit bats and spread  through contact with bodily fluids, the World Health Organization (WHO) says. Treatment for the virus, which has a mortality rate of about 70 percent, is supportive care.

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Nipah virus scare: prevention and control of deadly virus


The National Virology Institute, Pune, confirmed that the contagious fever that has killed several people in Kozhikode and Malappuram districts over the last fortnight is due to Nipah virus ( NiV). Six more people succumbed to symptoms suspected to be that of Nipah virus on Sunday.
    It is the first detection in Kerala of the Nipah virus which has a high fatality rate and spreads mainly through bats, pigs and other animals. Its symptoms include fever, vomiting, headache, drowsiness, coma and respiratory problems.
Virus has an incubation period of 4 to 18 days. Health workers  need to  take the highest level of protection while handling patients. No specific treatment is available but intensive care support is required.

Origion and History of initial identification:

Nipah virus (NiV) is a member of the family Paramyxoviridae, genus Henipavirus. NiV was initially isolated and identified in 1999 during an outbreak of encephalitis and respiratory illness among pig farmers and people with close contact with pigs in Malaysia and Singapore. Its name originated from Sungai Nipah, a village in the Malaysian Peninsula where pig farmers became ill with encephalitis. Given the relatedness of NiV to Hendra virus,  bat species were quickly singled out for investigation and flying foxes of the genus Pteropus were subsequently identified as the reservoir for NiV .

In the 1999 outbreak, Nipah virus caused a relatively mild disease in pigs, but nearly 300 human cases with over 100 deaths were reported. In order to stop the outbreak, more than a million pigs were euthanized, causing tremendous trade loss for Malaysia. Since this outbreak, no subsequent cases (in neither swine nor human) have been reported in either Malaysia or Singapore.

In 2001, NiV was again identified as the causative agent in an outbreak of human disease occurring in Bangladesh. Genetic sequencing confirmed this virus as Nipah virus, but a strain different from the one identified in 1999. In the same year, another outbreak was identified retrospectively in Siliguri, India with reports of person-to-person transmission in hospital settings (nosocomial transmission). Unlike the Malaysian NiV outbreak, outbreaks occur almost annually in Bangladesh and have been reported several times in India.

Symptoms and investigation

Nipah virus’s (NiV) symptoms in humans are similar to viral fever such as fever, headache and muscle pain. Perhaps, these symptoms should be taken seriously as they were a part of rare viral fever – identified as the Nipah virus (NiV) – that claimed lives in Kerala.

NiV infection is associated with encephalitis (inflammation of the brain) and can lead to disorientation and mental confusion, or coma in some cases – encephalitis may present as acute or late onset. While the later may be difficult to diagnose, those who may have recovered from an acute episode may also have a relapse.

Since the symptoms of Nipah virus are similar to that of influenza, it can be difficult to determine whether the person is affected by NiV based on symptoms alone. According to WHO, procedures for laboratory diagnosis of Nipah virus include a series of tests – serology, histopathology, PCR and virus isolation. Serum Neutralization Test, ELISA, RT-PCR are used for laboratory confirmation. Also, magnetic resonance of the brain can help differentiate Nipah encephalitis from other encephalitis as well as in defining between acute and late-onset or a relapsed form of the disease.

Prevention and control

Till date, there is no effective vaccine for Nipah virus disease, treatment is mostly focused on managing fever and the neurological symptoms. Ribavarin may help alleviate the symptoms of nausea, vomiting, and convulsions. Severely ill patients require hospitalisation and may require the use of a ventilator. Therapeutics and vaccine are said to be under development.

Adopting standard infection control practices is vital in preventing the spread of person-to-person transmission of the disease. As the main strategy is to prevent NiV in humans, establishing appropriate surveillance systems is necessary to detect the disease outbreaks quickly so that appropriate control measures are initiated in time.

Research is needed to better understand the ecology of bats and Nipah virus, investigating questions such as the seasonality of disease within reproductive cycles of bats. Surveillance tools should include reliable laboratory assays for early detection of disease in communities and livestock, and raising awareness of transmission and symptoms is important in reinforcing standard infection control practices to avoid human-to-human infections in hospital settings (nosocomial infection).

A subunit vaccine, using the Hendra G protein, produces cross-protective antibodies against HENV and NIPV has been recently used in Australia to protect horses against Hendra virus. This vaccine offers great potential for henipavirus protection in humans as well.

https://www.cdc.gov/vhf/nipah/prevention/index.html

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Doctors at J J Hospital Mumbai assaulted: Indicator of lawless and uncivilized society


           Attacks and assaults on doctors appears to be  one of the indicators of  a lawless,uncivilized society, poor governance and  health system. Doctor have become punching bags for all the malaise prevalent in the system. A failing system which is unable to provide health to people and security to doctors. The system  hides behind their working children and doctors and presents them as punching bags. The  impunity with which attendant easily and brutally assault doctors is really appalling, that too  all over the country should be  shameful  to law enforcing agencies. Are we a lawless society? More problematic is the government apathy and silence of human right commission. Here comes the point that what is the role of our doctor’s organizations and parent hospital and institute.

         Why  in each and every case of doctor’ s assault, doctor’s bodies and organization do not file a case in the court against the  responsible  authority for security. Non action by Doctor’s Associations, bodies and organizations, not able to take a stand for their children is  most disappointing.

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

 Discussion always revolves around the trust of the patients on the doctor. But in reality, situation is getting opposite gradually. Empathy, sympathy, compassion and trust  of the doctor towards the patient, will definitely get a hit after these incidents. Everyday  the news of assaults on doctors, court cases against doctors, negative projection of the medical profession   in the media are viewed  by doctor’s community anxiously.  Attack  on doctor  at  J J Hospital Mumbai is just another shameful incident today. 

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

          Formal and informal discussions among medical professional at various forums  have taken a centre stage about the changing scenario. It  gives a perception that patients are loosing faith in doctors. That perception is not incorrect. But what remains hidden is that every incidence of verbal, legal, and physical assault  brings some kind of feeling of insecurity in minds of all doctors, who deal with patients.

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

  Every incidence of verbal, legal, and physical assault is a trust breaker. It is not only erosion of patient’s trust on doctors but the vice versa is also true.  As  a rule of nature, as violence increases, compassion decreases.

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

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