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Pandemic Blowback on Indian Rural Healthcare

InnoHEALTH magazine digital team — Tue, 05 Apr 2022 05:13:32 +0000

Three consecutive waves of COVID-19 have evidently expressed an insufficient rural health infrastructure In India three consecutive waves of COVID-19 have exposed the seriously compromised state of rural health infrastructure. Interestingly, non-government organizations, enterprises and charities contributed to the dire situation by way of providing personal protective equipment, medical supplies, appliances, rapid testing kits, including monetary aid. Their participation did provide some respite to the struggling rural healthcare setups in confronting the SARS Cov-2 onslaught, but it pointed towards the need for improved strategic policies to build up the rural healthcare systems to face future unforeseen emergencies.

Rural children in general and, girl child in particular due to prevalent gender discrimination, tend to face worst health outcomes.

It is well-known that in India there exist substantial differences between the urban and rural areas, with poverty affecting lives of people starting from early childhood and increasing as one grows older. Living conditions aside, rural areas also suffer from the lack of social sector services in general. Rural children in general and, girl child in particular due to prevalent gender discrimination, tend to face worst health outcomes. The health disparities between rural and urban children, as well as interstate disparities in health status go hand-in-hand to projecting concerning scenarios for the country. Again, the rural and tribal areas have fewer movement and connectivity options than urban areas. The settlements are dispersed more than urban areas. This necessitates evolving location-specific healthcare service delivery systems for rural areas.

The first pandemic wave in the country affected health and social welfare aspects of women and children, belonging to poorer section of society, adversely. Many pregnant women, without access to proper medical care during childbirth, lost their lives; while some gave birth to underweight and stunted children. These children obviously got subjected to life-long health problems. As observed, in ordinary times, the Indian healthcare systems, more so rural health facilities, face operational challenges, and the challenges observably grew manifold during the pandemic causing catastrophic effects on socio-economic spheres.

The rural healthcare system in rural India, primarily developed on the suggestions of Bhore Committee Report, guided Government of India in adopting population-based norms for establishing the three-tier public health care facilities, as Sub-Centre (SC), Primary Health Centre (PHC), and Community Health Centre (CHC). The current status, of these rural health facilities, as obtained from latest Ministry of Health & Family Welfare statistical data upload in their website, indicate shortfall at the three-tier set up as, 18% at the SC level, that consist of 158417 SCs, 22% at the PHC level that consist of 25743 PHCs and 30% at the CHC level that total 5624 CHCs. According to the National Health Profile 2021, in government hospitals one allopathic doctor is available to cater to 11,082 people, one bed per 1,844 people is the current allocation, and one state-run hospital available for every 55,591 people.

In spite of the elevation in rural health facilities over the years, the manpower availability is notably underneath the wanted tiers, as per World Health Organization suggested levels.

In spite of the elevation in rural health facilities over the years, the manpower availability is notably underneath the wanted tiers, as per World Health Organization suggested levels. Of the sanctioned posts, at the SC level 14 per cent posts of Health Workers (Female)/ ANM, and 37 per cent of Health Workers (Male) were vacant, as Government Rural Health Statistics (RHS)2019-20 indicated. The RHS also stated that the number and post-wise shortage in rural health set up as, 1,704 posts of doctors in PHCs across the rural areas, as well as 5,772 posts of nursing staff, 5,066 positions in female health workers, 6,240 posts of pharmacists, and 12,098 posts of laboratory technicians. The report further added that- of the total 155404 Sub Centre across the country, only 5383 SCs was functioning as per IPHS norms, only 8514 PHCs were functioning on 24×7 basis out of existing 24918 PHCs, and just 4957 CHCs, of the sanctioned 20732 CHCs, were currently functioning in rural areas. An International Journal paper published in December 2020 found that rural India has 3.2 government hospital beds per 10,000 people and that some big states such as, Uttar Pradesh with 2.5 with beds, Rajasthan 2.4 with beds, Jharkhand 2.3 with beds, Maharashtra with 2.0 beds and Bihar with 0.6 beds respectively, stood below the national average. Evidently, the rural healthcare set-up does not provide assuring state of affairs, currently. Besides, there is among the states, dissimilarity as far as access to medical care, appropriation of public health expenditure as well as achieving health outcomes. Obvious therefore that even without the pandemic or unforeseen emergencies, the rural health infrastructure is always stressed, while historically having less access to health services as the figure below will indicate.

Source: Ministry of Health and Family Welfare

The rural public health service management, especially in preventing, controlling or eliminating major communicable diseases, such as Tuberculosis, Malaria, and in reducing the risk of deaths in maternal and perinatal diseases has remained a challenge. In India, endemic diseases caused by infection or lack of nutrition still account for over two-thirds of mortality and morbidity. With rural areas lacking access to elementary healthcare, there remain abundant challenges to setting up strong emergency medical services, as well.

Both increases in government spending and private sector initiatives have improved the health infrastructure, but given the rising demographic pressure in India, this increase does not seem to make the desired difference. It is the extension of life expectancy that has a direct impact on many households. The rising healthcare cost exacerbates the problem for lower- and middle-class households, as well. The suggestive way forward, at this juncture, at empowering rural healthcare systems and building healthy rural communities, can be as follows-

Maximize the implementation of Health and Wellness at the Sub Centres and Primary Health Centres levels–

The health and wellness concept under Ayushman Bharat was an excellent start, as the same advocated a more comprehensive, well-equipped, and well-staffed model of primary healthcare in government sub-centres and primary health centers. Updating them in rural areas will undoubtedly enable in achieving the degree of readiness required in rural India in the event of a pandemic or other unforeseen emergency.

Extended public-private partnerships (PPP) to support healthcare inclusion-

PPP partnerships evidently have potential to revolutionize the rural healthcare system in India, while simultaneously ensuring a long-term viable solution. As the country’s population is growing, government efforts will not be enough to strengthen the healthcare system. PPP can assist in overcoming monetary, specialized, pedagogy, and human capital constraints. Private players can also ensure that Government policies at improving rural healthcare infrastructure are implemented appropriately. Continuing partnerships will improve access to healthcare, especially in the inaccessible rural areas, because individual actors’ extensive expertise, experience and financial resources may aid in the development of novel solutions.

Organise a supervisory committee on the ground–

a local supervision committee formation needed for developing a centrepiece masterplan for improving access to better healthcare and overseeing the implementation of rural healthcare projects. Though the majority of rural healthcare programs often get off to a terrific start, the outcomes are not always as anticipated. To revive rural healthcare service systems, through efficient monitoring of rural healthcare strengthening operations, the local supervisory committee is required.

Doctors working in rural areas encounter several problems when it comes to accessing training opportunities due to their location.

Continuous competency development and mentoring-

Another key concern in rural regions is skill development and mentoring. The CHCs, which acts as a referral of PHCs in rural areas, currently have a 76.1 percent shortage of specialists, as the Ministry of Health and Family Welfare recent report indicated. Doctors working in rural areas encounter several problems when it comes to accessing training opportunities due to their location. In that scenario deployed Doctors can benefit from skill development courses, and ongoing learning programs to assist address the dearth of trained doctors in rural areas. A focused mentoring program, including online or offline sessions, skill upgradation and exchange programs could be extremely helpful in this situation.

Coherent machine upgrade and paramedic training-

Essential amenities, such as most up-to-date medical equipment and skilled medical personnel to operate them, are lacking in rural areas. While medical equipment can still be upgraded on a regular basis, training courses for nurses and paramedical workers on how to handle, operate and manage these machines are also necessary. As new technologies become available, the requirement for training becomes more pronounced and required to be recognized.

In summing up, it needs to be pointed out that it is difficult to overhaul the country’s rural healthcare system within a short timeline, and that a piecemeal approach to improving rural healthcare facilities will be futile. But, with the ongoing dedication and regular efforts can a sturdy rural healthcare system be developed. Implementing the procedures outlined above will have positive benefits in the long run and will contribute to the development of a robust rural health care management system. Beyond COVID, the central objective should be to devise preparedness strategies for unforeseen emergencies, rather than focusing simply on short-term fixes that will return the system to its previous state once external help is withdrawn.

Composed by: “Dr. Gautam Kr Ghosh, is Ph.D in sociology with PG diploma in Reproductive and Child Health Management, and is research scientist at ICMR NICED, Kolkata, India.”

Composed by: “Aprita De, holds Masters in Public Health degree, and is working as Junior Consultant, NHSRC, Ministry of Health and Family Welfare, New Delhi.”

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Snakebite: A Public Health Problem

InnoHEALTH Magazine — Tue, 04 Jun 2019 09:54:48 +0000

India used to be dubbed as a country of snake charmers in just decades ago, but few would know about the darker side of snakes – snakebite. An estimated 28 lakh cases of snake bites occur in India and about 50,000 Indians die due to snakebites every year. Yet it remains a neglected public health problem.

Many of the deaths and disabilities due to snake bites can be averted if health authorities take steps to prevent snake bites as well as improve facilities for treating those bitten by venomous snake bites. Snakebite mitigation needs concerted efforts just like other public health problems such as malaria and tuberculosis.

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Poor health facilities in rural areas are a major reason due to which snakebite victims do not get adequate care. First, people don’t reach health facilities in time due to lack of transport and even if they do so, healthcare personnel have inadequate knowledge of snakebite management and lack effective antivenom, according to a new study published last month in the medical journal, The BMJ.

“Most snakebite victims die before they reach a health facility because they first approach a traditional healer for treatment. The quality of available antivenom in health facilities is another problem,” pointed out Dr. Ravikar Ralph, a member of the research team from Christian Medical College Vellore, while presenting his findings at a meeting here.

The antivenom manufactured inIndia is exclusively against venoms offour major snake species and is not effective against other species prevalent in different regions. It has also been seen that there is an intra-species variation of venom of the four major species. In addition, the antivenom products available vary in their neutralization efficacy and clinical effectiveness, the study pointed out. The quality of liquid antivenom is also compromised due to problems in maintenance of cold chain during transportation as it must be stored between 2 to 8 degrees.

The call to end the neglected tropical diseases (NTDs) under the Sustainable Development Goals framework has brought the problem of snakebite into focus, and this could be an opportunity to take up research in this neglected public health problem, the study has said.

The special issue of the medical journal has focused on neglected diseases such as lymphatic filariasis, kala-azar, neonatal sepsis, and multidrug-resistant enteric fever. It was supported by the Drugs for Neglected Diseases initiative (DNDi). “This collection highlights the notable successes of public health programs in neglected diseases in South Asia and identifies areas where research and supportive policy are needed to sustain plans for control or elimination,” said Dr. Suman Rijal, Head of DNDi, India.

Credits: India Science Wire

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Malaria Control Eradication Program Against Malaria in Odisha

InnoHEALTH Magazine — Wed, 29 May 2019 10:13:57 +0000

ASHAs were progressively involved in malaria control activities in Odisha. “They are the backbone of the program. We trained and then they trained more volunteers,” pointed out by Dr. N. Dhingra.

Involving ASHAs (Accredited Social Health Activists) in the malaria eradication program has proved to be fruitful in bringing down the number of malaria cases in Odisha.

Malaria control efforts in the state were intensified from 2008 onwards as Odisha is one of the worst-hit states due to malaria. In 2010, malaria services were expanded with the involvement of ASHAs. With scaling up coverage of interventions together with active program management and better administration, the introduction of ASHAs led to a dramatic reduction in malaria burden in the state.

The utilization of malaria services in the intervention areas improved as the ASHAs and other service providers had the required commodities and skills to diagnose and treat patients at the village level. The death toll reported in Odisha in 2014 was 89. In contrast to this high number, the 2018 data shows a reduction in number up to 4. Consequently, the state registered 85% decline in the malaria burden in the intervention blocks.

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“Various countries have followed this module though with variation in the approach and the outcomes. In India too, we have strengthened malaria case management system through community-based interventions,” said Prof Balram Bhargava, Director General, Indian Council of Medical Research.

“In the control areas, malaria services were provided within the constraints of the routine program. In the intervention areas, various measures were undertaken to improve the coverage and quality of malaria services” said Dr. Anup Anvikar, Scientist, National Institute of Malaria Research. The supply chain management system was strengthened up to the village level to ensure uninterrupted supply of drugs and diagnostics. Buffer stocks were maintained at the block level in the Comprehensive Case Management Program (CCMP) areas, rather than at the district level in the routing system. It was ensured that there should be adequate stocks in remote areas before the arrival of the rainy season since it is the time when the transmission is at peak and it becomes difficult to access remote villages.

Along with the drug and diagnostic kit supplies, several steps were taken for the smooth working of the program, such as additional microscopy centers were opened at the primary center level to complement the ones at the block level. This helped in providing supportive supervision to ASHAs and other providers and also aided in confirming the diagnosis and posttreatment parasitological clearance.

Credits: India Science Wire

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Mosquito Net may Prevent Malaria

InnoHEALTH Magazine — Mon, 22 Apr 2019 09:02:20 +0000

A novel mosquito net that contains insecticides could prevent millions of cases of malaria, according to a Lancet study. A two-year clinical trial in West Africa involving 2000 children showed that the number of cases of clinical malaria was reduced by 12% with the new type of mosquito net compared to the conventional one used normally. Scientists including those from Durham University and Liverpool School of Tropical Medicine in the UK found that sleeping under the new bed nets were 52% less likely to be moderately anemic than those with a conventional net. Malaria anemia is a major cause of mortality in children under the age of two. The nets used in the study contain a pyrethroid insecticide which repels and kills the mosquitoes as well as an insect growth regulator, pyriproxyfen, which shortens the lives of mosquitoes and reduces their ability to reproduce. In areas with the new combination bed nets, there was a 51% reduction in the risk of a malaria-infective mosquito bite compared to areas with conventional nets.

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This study is important because malaria control in sub-Saharan Africa has stalled, partly because the mosquitoes are adapting and becoming resistant to the pyrethroid insecticides used for treating the old bed nets. A trial carried out in Burkina Faso where the new types of the net, that had a pyrethroid plus an insect growth hormone, was used and it showed significant protection than the old net type.

The researchers said that if they had scaled-up their trial to the whole of Burkina Faso, they would have reduced the number of malaria cases by 1.2 million. Female Anopheles mosquitoes are increasingly becoming resistant to the most common insecticides, called pyrethroids, used to treat traditional bed nets.

Latest figures from the World Health Organization (WHO) show that after a dramatic decrease in malaria since the start of the millennium, progress has stalled, and the number of people infected with malaria is now going up in some areas, with insecticide-resistant vectors as one of the possible causes of this.

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The researchers suggest the use of bed nets with a combination of chemicals, to be explored for areas where mosquito resistance is a problem. The ingredients on the nets kill more mosquitoes and reduce the number of infective bites than conventional nets treated only with a pyrethroid. As it is less likely that mosquitoes become resistant to both chemicals in the combination bed nets, they are considered a better alternative to tackling malaria in areas where mosquitoes have become resistant to the single chemical used in traditional bed nets. The latest figures from WHO show that in 2016 malaria infected about 216 million people across 91 countries, up to five million from the previous year. The disease killed 445,000 which was about the same number as in 2015. Most deaths were in children under the age of five in the poorest parts of sub-Saharan Africa.

Source: www.indiatoday.in

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Artificial Intelligence Coming Big Way in Healthcare Sector

InnoHEALTH Magazine — Mon, 19 Nov 2018 10:13:51 +0000

Brig Arvind Lal, CMD of Dr Lal Path Labs, is a pioneer in bringing laboratory services in India at par with the western world. In 1977, he took charge of the medical diagnostics laboratory founded in 1949 by his late father. Under his expert guidance and leadership, the initiative has become one of the most reputed laboratories in Asia, having to its credit quality accreditations from various national and international bodies.

The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

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‘Wearable Tech is another area which I am personally very excited about. It has the potential to change the world as it helps people understand their own bodies by using mass data collected on a daily basis. From fitness bands to smartwatches to eye based wearables, they are being adopted widely. Take the case of Zephyr’s Anywhere Bio Patch which is an FDA-approved, small device that is attached to a patient’s chest and monitors their vitals minute-by-minute and collects medical-grade data for doctors’ use. These devices will connect our organs digitally, enabling disease detection at very early stages. It has the potential to bring down cardiac and other deaths drastically. This offers immense potential to do remote testing, monitoring and thus assisting the doctor in timely treatment’.

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Point of Care Testing: Technological advancements in laboratory automation, including POCT, and initiatives to increase patient satisfaction are transforming the clinical laboratory market. POCT has come a long way from a handful of simple tests to a multibillion-dollar global market that holds great promise for the future. Not so long ago, laboratory data would often arrive at the bedside too late to be of significant use in the active, continuing care of critically ill patients. Now, most clinicians acknowledge that POCT is a prerequisite for early recognition of life-threatening conditions as they require that laboratory results are made available in real-time and, if possible, at the critically ill patient’s point of care. The College of American Pathologists defines POCT as tests designed to be used at or near the site where the patient is located, that do not require permanent dedicated space, and that are performed outside the physical facilities of the clinical laboratories.

Examples include kits and instruments that are hand-carried or transported to the vicinity of the patient for immediate testing at that site (e.g. capillary blood glucose) or analytical instruments that are temporarily brought to a patient care location (like operating room, intensive care unit). In many cases, the simplicity was not achievable until technologies developed that was simple and affordable. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable and widespread until recently. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, non-invasive, affordable way today, but in earlier eras, this required an intra-arterial needle puncture and a laboratory test. Thus, over decades, testing continues to move toward the point of care.

The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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Environment is in Peril – Unknown Enemy on Prowl

InnoHEALTH Magazine — Mon, 04 Jun 2018 10:22:23 +0000

Introduction

In the 21st century, we are all connected. Population growth, mass urbanization, deforestation, climate change and increased travel have dramatically increased the risk that familiar diseases will spread and mutate, and new ones will emerge. As people enter new spheres of biodiversity, they come in closer contact with other species, increasing the risk of viruses jumping from animals to humans, and then spreading more widely.

It all sounds scaring, but it is stark reality facts on the ground which are almost ready for such a grim situation if corrective measures are not affecting in time.

She is not a wizard in crystal grazing to forecast future events, but certainly, she is a visionary and envisions that the spectre of diseases will loom over the planet earth in future. She is no one else but Janet Tobia who has won laurels for her documentary ”Unseen Enemy”.

The Emmy award-winning filmmaker Janet Tobia told InnoHEALTH Magazine that her movie Unseen Enemy examines why in the 21st century we are experiencing a rash of diseases that were once only outbreaks but have now become full-blown epidemics.

This year, the world recalls nightmarish memories of 1918 pandemic of influenza and screen through a popular movie “Unknown Enemy” on its first anniversary. “I had a little bird, its name was Enza, I opened the window, and in–flu-enza, was a popular rhyme for children while skipping ropes in those outrageous days.

Informatively, the 1918 flu pandemic (January 1918 – December 1920) was an unusually deadly influenza pandemic. Researchers say it infected 500 million people around the world, including people on remote Pacific islands and in the Arctic, and resulted in the death of 50 to 100 million (three to five percent of the world’s population).

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Disease had a greatly limited life expectancy in the early 20th century. Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast, the 1918 pandemic predominantly killed previously healthy young adults. There are several possible explanations for the high mortality rate of the 1918 influenza pandemic. Some research suggests that the specific variant of the virus had an unusually aggressive nature. One group of researchers recovered the virus from the bodies of frozen victims and found that the transinfection in animals caused a rapid progressive respiratory failure and death through a cytokine storm (overreaction of body’s immune system).

More recent investigations, mainly based on original medical reports from the period of the pandemic, found that the viral infection itself was not more aggressive than any previous influenza. But that the special circumstances (malnourishment, overcrowded medical camps and hospitals, poor hygiene, etc.) promoted bacterial superinfection that killed most of the victims typically after a somewhat prolonged deathbed.

To maintain morale, wartime censors minimized early reports of illness and mortality in France, Germany, United Kingdom and the United States. Examining the recent epidemics of Ebola, Influenza and Zika; unseen enemy makes it clear that epidemics bring out the best and worst of human behaviour, and that their effect goes far beyond the terrible tolls of sickness and death.

‘‘We are all connected to any person, animal, and insect that may have an infectious disease incubating in them. And that connection is either incredibly dangerous or a powerful force for good. It is our choice which of those becomes true.’’

She says political leaders all over the world should address the problem. And play a key role in combating pandemics threats. There must be early detection and warning systems in place to detect outbreaks faster. Countries must work in close rapport both in the field of vaccines and drugs distribution, availability of diagnostic tools and research work in the discipline. Leaders will have to chip in together. Make strong health architecture at a global level – as a threat is looming on everyone.

We also need to use new mobile technology to reach out to affected and vulnerable populations, mobilize healthcare and make long-term investments in scientific research.

Finally, it is critical to invest in flu research both to improve the effectiveness of the current vaccine. And, more importantly, to develop a universal flu vaccine – one that would work against all types of flu, including potentially a new pandemic strain.

She recalls that the 1918 influenza pandemic killed more than 50 million people around the world. In India alone, 17 million lost their lives and so her movie cameras rivet around a potential global scenario. Emerging epidemics have a propensity to burst anywhere and anytime because of the fast changing global environment.

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She visualizes a scenario where India can play a major role because of its expertise in carrying out past massive health care programmes. Smallpox eradication and polio vaccination programme vindicate the fact about country’s efficacy to turntables. It is the need of the hour that such an expert was implemented for the elimination of infectious diseases to stave off the threat of the outbreak of pandemics in the global village.

In addition to urbanization and living in a highly connected world, deforestation is leading to closer contact with animals, which may infect us with deadly viruses. With climate change, vectors like mosquitoes are moving up north into newer regions. Suppose, antimicrobial resistance is added to this mix, and then there will be a new virus and drug-resistant infections. If we don’t have antibiotics that work, then you would be infected and untreatable.

The Director of the film minces no words to articulate her views on the unseen enemy. Ebola, for example, may have emerged in West Africa, a new part of Africa, because of deforestation there. AIDS moved out of the forests of Africa to spread around the world. Today there are over 20 million people living with HIV-AIDS. In addition to the new virus, we now also have new drug-resistant strains of once badly feared tuberculosis and malaria developing.

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She says reports are in circulation that new strains of influenza are infecting birds in China. But the day might not be far away. When these microbes may learn the clandestine art of migrating from birds to human beings.

In populous countries, people live in dense pockets in the overburdened urban swathes. Not only that they travel in crowded public transports and if an infected, suffering from a contagious infection, sneezes or coughs, there is an instant spreading of the infection. The virus, the unseen enemy, infects people who are generally oblivious of the lurking threat.

During the outbreak of such epidemics, people are advising to be cautious to mount their own defence to protect themselves. In India, a sea of humanity moves every day from one place to another. And in case of the outbreak of such diseases, travelling of infection can be very fast.

In case of India, there is a heavy burden of noncommunicable diseases and chronic diseases that often compromise immunity. Deaths from flu are higher in diabetics than the general population.

The seasonal flu shot is the best tool. There is some evidence to show that taking the flu shot two years in a row gives you more protection than if you skipped a year. There is also some evidence on how people receiving a flu shot for the first time. And have the strongest immune protection reaction, while other studies say this isn’t true.

India’s smallpox eradication campaign is the most successful healthcare drive in history. During the time more than 100,000 health workers visited over 100 million households to eradicate smallpox. So, India has a blueprint to deal with a future pandemic.

Filmmakers had looked at previous epidemics and infections. AIDS was lurking in their minds. But the sudden spurt of Ebola and Zika virus’ cases turned the film into a real-time saga. And both AIDS and SARS slipped into the background.

In the global village narrative, every citizen is open to risk factors in case of pandemics. The diseases assail everything whatever comes into their way – may it be health or wealth. When a pandemic happens, people don’t work, economies collapse, and the even social fabric is dismembered. People attempt to avoid their own infected close relatives and friends. Out of fear that they will be the next seizure if precautions were not clamped.

In case of pandemics, whatever happens on the front line in Liberia affects people in Europe and North America. We all share knowledge platforms, travel frequently and export and import cheaper goods so microbes also travel freely. For her, Ebola is the test case. According to the Director, Ebola was not handled swiftly at the stage of the outbreak. Otherwise, it could have been bridled at that stage rather it turned into the epidemic.

She recalls that Zika virus too had sprung a surprise. It was never visualized. No one thought that a virus first identified in the 1940s in Uganda would travel halfway across the world. First to the South Pacific and then to South America, and now to North America. We are still trying to understand, why this virus that particularly dangerous would in Brazil produce such terrible birth defects.

Zika is essentially a pandemic as it affects so many countries and continents. It could affect more because the mosquitoes will be able to move further north as the globe warms up.

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Travelling abroad

InnoHEALTH Magazine — Thu, 25 Jan 2018 10:54:46 +0000

Protect Your Health When Far From Home

By Jennifer Foss

Less than 100 years ago, world travel was a rare treat reserved mostly for the wealthy. Today, retirees cruise to South America, college students study in foreign and and modem day adventurers journey through the wilderness of Africa.

But as small as the world has become, there are still health concerns to be aware of when you travel abroad:

Get your shots If you travel to countries other than Western Europe, Canada, Austra1ia, New Zealand or Japan, you will probably need additional vaccines and medication.
Sometimes these shots must be given weeks or months before your departure to allow than time to take effect, so visit your doctor early.
If you visit countries in the Indian sub-continent, East Asia and South America, you will probably need vaccinations for Hepatitis A and B, Japanese encephilitis, typhoid and malaria.
Visitors to the Middle East and Africa will need the above vaccinations along with meningitis and yellow fever vaccines. Pack the medicine cabinet although it may feel like you’re packing everything but the kitchen sink, there are certain items you’ll need while traveling internationally, including: An extra pair of eye glasses (or contact lenses. along with a current eye prescription. A medical identification bracelet to alert others about any health problems you may have. Any prescriptions medications and a signed and dated statement from your physician indicating the proper dosage and explaining why you take the medication. Over-the counter medications and treatments that you may need, such as diarrhea medicine, cough syrup, allergy medicine, aspirin, eye drops sunscreen and insect repellant. While traveling, avoid buying over-the-counter medicine unless you’re familiar with the product. Not all countries have the same quality and safety standards for medications as required and many standard medicines are known with different brand names.
Stop Stomach Bugs No one wants to spend his or her vacation in the bathroom, but the risk of intestinal infections can be high in non industrialized countries with poor sanitation. To avoid traveler’s diarrhea, it is recommended that you: Drink only canned, bottled or carbonated beverages. Also, wipe off bottle and can rims to avoid contamination.
Don’t drink beverages with ice. Wouldn’t know in water the ice has been produced. Don’t eat food purchased from street vendors. Don’t eat pasteurized dairy products. Boil, peel and cook all raw food, including vegetables.
If you’re going to be in an area where you won’t be able to boil your water, you can purchase disinfecting iodine tablets from your local sporting goods/camping store or pharmacy . Insure your health If you break your leg while hiking through the jungles of Thailand, you’re going to need more than a suitcase full of antacids and aspirin. However, a trip to a local hospital usually requires payment up front in advance of treatment.
A short-term health insurance policy for travelers may help protect you from these large out-of pocket expenses. A travel policy may also be invaluable if you need to be transferred to another city or country for a medical emergency. If your health insurance company won’t cover you outside the country of your residence, there are insurance companies that specialize in travel health insurance.

Want to write for InnoHEALTH? send us your article at magazine@innovatiocuris.com

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Testing Times for India

InnoHEALTH Magazine — Thu, 23 Nov 2017 07:34:34 +0000

Brig (Hony) Arvind Lal is a pioneer in bringing laboratory services in India at par with the international world. He has modernized Indian medical diagnostics and initiated the first Public Private Partnership (PPP) in the field of laboratory testing in India. Under his guidance, Dr Lal PathLabs (LPL) has become one of the most reputed laboratories in Asia having to its credit quality accreditations from various national and international bodies. Currently they operate over 172 labs, including Asia’s biggest lab at Rohini, New Delhi with 1,500 collection centers and pick-up samples from another 7,000 medical establishments all over India. The lab tests over 50,000 patients every day or nearly 10 million patients in a year.

He holds the honorary rank of a Brigadier in the Indian Army and the Government of India conferred him Padma Shri (Indian national award) in 2009, for his contributions to Medicine.

In an interview with KANIKA CHAUHAN InnoHEALTH , he sheds light on the evergrowing demands of quality testing and test labs in the country and shares his vision of a healthier future for India and every Indian.

Q1. When the Lal Path Labs started 68 years back, what was the scenario of Indian healthcare industry? How do you see the market now? And how has been the journey?

My late father Dr. Major S.K Lal started this lab in April 1949. He was a displaced person from the partition and came to India from Rawalpindi in 1947. After coming to Delhi he worked in a government lab for one-and-a-half years and then started the first pathology lab in North India. At that point of time there were hardly any pathology tests as we know neither there were any routine tests like, HP, TLC, ESR, Urine Test, Blood sugar Test, Cholesterol test. So there was not any competition then.

Q2. What is your future business plans both at National and International level?

We are running 1700 laboratories in India and about 1600 collection centers. In addition we take another 5000 collections of blood samples from our pick up points. For example Medanta, Fortis, Moolchand and Apollo are some of the pick-up points we have.

Last year we tested about 1.35crore patients, so the average of the samples we can test is about 55000 in a day. We are the biggest Histopathology Biopsy Centre in the world.

Histopathology Biopsy is a test basically to detect cancer. Suppose if a lady has a lump in her breast, so she feels something has to be done about the lump, a part of the lump is surgically taken out which is known as the biopsy, it is the biopsy we test and find out the results. There is a possibility of two things either the tumor is benign (Non-Cancerous) or malignant (Cancerous). If the lady has malignancy she under goes with further tests, chemotherapy and radioactive therapies as per clinical requirement. We are the largest Histopathology in the world. We test about 1000 biopsies in one day and we are the second largest kidney biopsy center in the world. We are the only laboratories in India which have their own electro-microscope for very high end testing. We have our centers in all the major cities of India.

Our next step would be to set up another comprehensive laboratory in Lucknow. We have such research center in Kolkata and next year we will make one in Lucknow. With this we will provide high end services for the people in the region for whom the services are not available.

Q3. With so many market players why people should opt for Dr. Lal? What additional value you bring to the table?

We have many reasons, first of all people know that we are not fly by night operators and also they have faith in us since last 70 years plus people come to us for their pathological tests because 70% of all the medical decisions are nbased upon the pathology test of a patient, hence if the pathological tests result aren’t in place 70% of the medical decision can’t be taken. Gone were the days when people used to visit the “vaids” and doctors and they felt the nerves and pulse gave medicines, now it is evidence based medication. If someone has fever the doctor would suggest the person to get a blood test because it could be malaria, chikungunya, dengue or it could be anything. And if the person is diagnosed with anything she or he will get the treatment for the same. Now the medicines are completely evidence based, there is no hit and trial. These are the reasons why people come to us.

Q4. With Dr. Lal Path labs entering into the international market with operations in countries like Middle East, Malaysia, Bangladesh, Nepal and many more, where do you see the potential for growth of your organization?

The first reason is, India is not having the kind of quality labs that it should have. There is a demand and supply problem. That is because there are no large laboratories. There are lots of facilities that claim to do testing, but they are not testing laboratories but testing shops. This is what is to be changed and people give the example of our establishment and say that “they should be like Dr. Lal’s laboratory.” All these countries you have mentioned, we are getting their samples for testing but only one lab is set up in Nepal and next would be in Bangladesh and then we will go to other countries. The reason we are slow on this is because our own country is huge. I usually say to people that if we will take out Uttar Pradesh and put it in the Indian Ocean, India would be the 5th largest country in the world. So this is the reason that we want to look at our country first and then look at the outside market.

Q5. What kind of environment does your organisation provide to patients?

Our organisation provides a very sterile kind of an environment, it doesn’t smell, and blood is not spilled around, there are no flies buzzing around the surroundings. This is a kind of a place where anyone would like to go to.

Q6. Now days there so many machines available in the market for test like sugar, BP etc, which we can be used by the patients themselves. How good is that? What are your views?

These are known as point of care testing and people can test a few things but in India people can only test blood sugar. For which we suggest the patient to check his or her blood sugar on a regular basis of 15 or 20 days, so these are called Point of Care Testing (POCT).

The POCT in India is not established because firstly, it is very expensive and secondly the Indian people aren’t savvy. There are seven types of care testing which is emanated by a lady. A lady can go to the bathroom and test her pregnancy by a UPT (urinal pregnancy test) in which she gets to know whether she is pregnant or not then in this case there is no need of a pathological test. When I was young we never had cats and dogs as pets but we had rabbits , so I never couldn’t understand why my father killed those rabbits and I got my answer when I was studying medicine. The reason why rabbits were killed during that time i.e, in early 1950s people used to check the pregnancy through it. A pregnant woman’s urine was injected into a female rabbit and after killing them they use to dissect the abdomen area to find ovulating ovaries. This is how pregnancy test were conducted.

Q7. Now a days Dr. Lal Path labs is focusing on inorganic growth; how beneficial it is to patients?

The growth in any sphere or in any business is either organic or inorganic, organic means when a person is creating his own set up, say if a person is doing well in Delhi so he decides to open a set up in Uttar Pradesh and then in Uttarakhand, and inorganic growth is when other person is ready to give up her or his lab to somebody else irrespective of any reason the former will give some certain amount of money to the latter in position of the lab this is called inorganic growth. We have done 10 inorganic growths till now and yes we will buy some more from south of India and west of India.

Q8. What innovations you think can bring down cost, keep quality and improve efficiency on which researchers and start-ups concentrate?

There is no start-up in my line, if one is a qualified pathologist either he can work in a pathology lab or can start his own lab. The start-up in Delhi is difficult because Delhi has become a saturated city. there are many people who are running many pathology labs and they shouldn’t run these pathology labs and the reason they are running the labs is because it is very lucrative, which is very unethical and should not be done.

So the government of India has also started the voice to our ways and they said that we are going to have a clinical establishment act which has been passed by the parliament in 2010. Since the healthcare is state subject so all the 29 states have not adopted it or implemented it. There are a chain of pathology labs which are not run by the pathologists they are run by the non-pathologists they are not even doctors they are quacks. So this brings out the quality and efficiency of the whole industry.

They are many diseases which affect the mankind these days and these diseases are called the non-communicable diseases. The non-communicable diseases can’t communicate with others, whereas malaria, chikungunya and dengue are communicable diseases because it happens through a mosquito bite. TB is a communicable disease too and if a person’s lungs are infected by TB people around them will get infected. In India we lose two patients of TB in every three minutes, India has a burden of communicable diseases which includes Hepatitis A.

But a bigger set of diseases have come out which are called NCDs (Non Communicable Diseases) and the NCDs are killing 65% of our people and if we will not control the NCDs it will also affect the two per cent of our GDP. The NCDs are headed by the high blood pressure, obesity, smoking, cardiac diseases, lung diseases, cancer, kidney diseases and stroke. Why it is becoming so important to us because it is also called the life style diseases, it changes the lifestyle of the person which has suddenly come up. India has large number of cancer patients and also large number of blood pressure patients. There is an element of genetic transfer of physical appearance of a person but some diseases are also transferred which only run in families.

The problem with Indian people is they only come in illness, but they should know that they should get their self-check on a regular basis to keep a check on their health, my main point is to make people aware of the annual healthcare which is very important for one’s health which is in between the doctor and a patient and also make them aware of the testing in wellness not in illness.

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