Loss of Sense of Well Being

Masking Depression

Masking Depression

When feelings of extreme despondency overtake the psyche it marks the onset of depression. The state brings on low moods and possibly aversion to activity. Depression affects thoughts, feelings and behavior. A person with a depressed mood is sad, anxious, hopeless, helpless, irritable and restless in turns. There is loss of interest in everyday activities. Alternately one could be hyper active. Also a person may experience loss of appetite or conversely continually overeat.

Such a state of mind, if allowed to continue for long, leaves you in a shambles. You cannot concentrate, take decisions or think clearly. Excessive melancholia may even push someone to the brink of life. Other maladies could involve insomnia, excessive sleeping, fatigue, aches, pains, digestive problems and of course reduced energies. The persistence of sadness along with unexplained feelings of worthlessness may lead one towards drinking and pessimism making matters worse.

Often depression may not exhibit any external signs and be present in covert forms. Feelings of fatigue, constant worrying and feelings of doom or guilt are other attributes. Experiencing imagined or actual pains, aches and digestive troubles may also occur. Also there may not be really any specific disorder and one can suffer from physiological conditions – what are commonly now known as psychosomatic disorders. It leaves one feeling at a loss, unable to explain their condition.

Depression leads people to withdraw and hide behind their fears, imaginary or otherwise, but they do suffer from real mental trauma. This makes them shun personal contact, become reclusive till they might gradually shut out life. You may be sure to find depressive personalities hiding behind their surreal personas. The clinical condition may range from miserable mood swings to terribly debilitating mood disorders. So we must not be quick to dismiss people suffering from depression thinking it is an insignificant problem. All of us get depressed once in a while but the prolonged affair with melancholia requires due treatment. The thing is that such mental conditions are not taken as seriously as a physical disorder simply because you do not acknowledge the unseen pain.

The person hiding behind excessive internet usage could be a prime suspect for depressive disorders.  Content taking a backseat in his virtual world, his sleep patterns become disrupted making him more prone to depression. Check out the woman crying excessively for the most simplest of causes, creating a disconnect to remain aloof in a bid to numb her unmentionable pains. Watch out for people who stop grooming themselves. The unkempt youngster in shabby clothes may manifest a disordered personality.  Make note of eating habits of people around you – if they eat too little or a lot more – both are symptoms of appetite problems due to depression.

Depression is a psychiatric syndrome that hampers normal life. The fact is that some minds cannot cope with life events and changes that affect their psyches. From death of near and dear ones, disasters, isolation, relationships, emotional upheavals or catastrophic injury – anything might affect equanimity. If a person cannot bounce back to normalcy in two weeks time after an event and relapses into a state of chronic depressed mood, it may lead to severe clinical impairment. Such conditions include bipolar disorder, borderline personality disorder and so on. India has a sizeable percentage of clinical patients who need doctors and specialists helping them to cope through.

Fixing Depression

Fixing Depression

 

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Status of Eyecare Health in India

Stand Alone Eye Clinics - Need of the Hour

Stand Alone Eye Clinics – Need of the Hour

Our country is the second most populous in the world, having 23.5% of the world’s blind population. The prevalence of blindness and visual impairment remains a major problem. Cataract, corneal opacities, glaucoma and posterior segment conditions are key reasons for blindness. These conditions can be treated only by skilled eye doctors in a hospital setting. We need to establish evidence for occurrence of eye problems by conducting baseline surveys to understand precise prevalence of specific conditions.

A national program for control of blindness was started in 1976 in India. Unfortunately it has not been possible to generate enough information for all of the country. However detailed information has been gathered in certain areas through research studies by concerned eyecare agencies. All such studies have shown that prevalence of cataract as the most common cause of blindness. Up until quite recently prevention of blindness was therefore largely cataract-focused.

Of late now ophthalmologists are being trained to increase emphasis on focusing on other critical causes of blindness like refractive errors, childhood blindness, corneal blindness and glaucoma. An ophthalmic workforce and infrastructure survey was undertaken to provide a valid evidence base for human resource and infrastructure requirements for elimination of avoidable blindness. This was the first time that such an extensive survey has been undertaken.

The study was conducted by Ophthalmology Cell, Ministry of Health and Family Welfare, Government of India from April 2002 to March 2003. Pre-tested questionnaires were administered to all district-level blindness officials and ophthalmology training institutions and supplementary data sources were used too. Data analysis and projections of existing ophthalmologists and dedicated eye beds were made for the entire country using the mean, median and range for each individual state.

The study ascertained that more than half the eye care facilities were located in the private sector. Sixty-nine per cent of the ophthalmologists were employed in the private and non-governmental sectors. 71.5% of all dedicated eye beds were managed by these two sectors. Five states -Maharashtra, Uttar Pradesh, Karnataka, Andhra Pradesh and Tamil Nadu had half the practicing ophthalmologists in India. There was a wide disparity in access to ophthalmologists and dedicated eye beds across the country.

In order to meet these requirements India will have to work hard to achieve the goals of Vision 2020. Some states and certain regions will be needing special attention. Instead of an across-the-board increase in ophthalmologists and eye beds, regions which are deficient will need to be prioritized and concerted action initiated to achieve an equitable distribution of available resources.

Shockingly, as per this study an estimated 9031 ophthalmologists worked in eye care facilities in our country. Of these 69% (6235) worked in the private sector and 31% (2796) worked in government sector. This clearly shows the disparity in availability of ophthalmologists. We need to increase the efficiency of eye care system in India by increasing the availability of ophthalmologists. Also we need to generate more eye doctors and eye specialists. It is only appropriately skilled ophthalmologists and trained technical staff that can respond to eyecare health in India.

Preventable Child Blindess

Preventable Child Blindness

Universal Health Coverage

Universal Health Coverage

                             Universal Health Coverage

On December 12, 2012, a unanimously passed United Nations resolution marked the day for Universal Health Coverage. It has now been two years since the endorsement for universal health coverage, that has since become the pillar for sustainable development and global security. The goal of Universal Health Coverage is to ensure that all people obtain health services they need without financial hardship.This requires a strong, efficient and well-run health system.

Such a system of financing health services includes access to essential medicines, technologies, along with a cadre of well-trained and motivated health workers. India’s efforts in these directions had already begun since 2005 with the advent of the National Rural Health Mission, launched to offer accessible, affordable and quality health care to rural populations. The intent was to cater to the most vulnerable sections. The focus of the Mission is to reduce Maternal Mortality Ratio, Infant Mortality Ratio and Total Fertility Rate.

The United Nations in India supports the Government of India to move forward towards Universal Health Coverage. For this purpose it provides evidence, technical and policy advice on effective interventions as well as mechanisms to monitor all progress. The WHO Country Office in India works in conjunction with ten leading world organizations for the purpose. These are Department for International Development (DFID), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), International Labour Organization (ILO), UNAIDS, United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), United States Aid for International Development (USAID), and the World Bank.

All these organizations work together to promote better support and commitment to Universal Health Coverage in India. Both the NRHM and the recently launched National Urban Health Mission (NUHM) are now included under the National Health Mission (NHM). Although some progress is made in bits and spurts, especially after formation of NHM there remain widespread challenges that need to be tackled. Some home truths emerge, that need to be taken cognizance of:

  • Inadequacy of availability of health care services (both public and private sectors).
  • Questionable quality of healthcare services (both in public and private sector).
  • Regulatory standards for public /private hospitals are inadequately defined and remain ineffectively enforced.
  • Affordability of health care remains a serious handicap, more so for majority of impoverished populations.
  • Most people incur heavy expenses for medical services purchased from the private sector.
  • The total expenditure on health care (both public and private together) is 3.7 per cent of the GDP.

The first-ever Universal Health Coverage Day was observed in New Delhi to mark the two-year anniversary. The high-level event convened by the Public Health Foundation of India and World Health Organization, was supported by Rockefeller Foundation and Oxfam India as part of a coalition having over 500 health and development organizations. They are all attempting to accelerate reforms that ensure health services be provided to all citizens. The quality of health services, medicines and diagnostics will hopefully be improved, thereby facilitating efficacy of National Health Assurance Mission. For doing this successfully the entire medical fraternity at all levels needs to pitch in to make a go with combined efforts.

Health For All

                                       Health For All

Sushruta – Medical Pioneer of Ancient India

Sushruta – Medical Pioneer of Ancient India

Sushruta – Medical Pioneer of Ancient India

Sushruta is considered one of the earliest surgeons in recorded history and has been the first individual to describe plastic surgery in his famous ancient treatise ‘Sushruta Samhita’. He is said to have lived nearly 150 years before Hippocrates, and his renowned compendium written in 600 B.C. spells out surgical procedures in minutest detail. He is also credited to be the first surgeon to perform plastic surgery!

Many believe plastic surgery to be a new specialty. However its origins are ascertained to have existed over 4000 years back in India. The Vedas compiled in Sanskrit language between 3000 and 1000 B.C. comprise of the oldest sacred books of the Hindu religion. Of the four Vedas – ‘Sushruta Samhita’ is a part of Atharvaveda. The treatise describes ancient Indian tradition of surgery and remains a most brilliant compilation in Indian medical literature.

The treatise contains detailed descriptions of teachings and practice elucidated by this great ancient surgeon said to have been practicing in Varanasi. It also provides surgical knowledge that is of relevance to this day. As a pioneer in the field of surgery, Sushruta expounds prolifically on the healing arts that were grounded on physiology and medicine. He studied human anatomy with the help of dead bodies! Much as in medical colleges today.

The Samhita specifically describes methods for selecting and preserving dead bodies to be studied. Cadavers of elderly or severely diseased were not taken up for purposes of study. Bodies needed to be perfectly clean and were preserved with barks. They were placed in cages, hidden carefully in the river for currents to soften them. After seven days they were retrieved, cleaned with brushes for inner and outer body parts to be seen clearly.

Over 1100 diseases are mentioned in this ancient tome including 26 types of fevers, 8 kinds of jaundice and 20 different urinary disorders. There are 760 plants inclusive of roots, bark, juice, resin, flowers etc. that are described in detail for treatments. These also include common household remedies like cinnamon, sesame, peppers, cardamom, ginger and more. Additionally the treatise offers descriptions of 101 instruments used in surgery.

Sushruta’s greatest contributions were in the fields of plastic surgery and removal of cataracts. In a time when cutting of nose or ears was a common punishment, restoration of these parts and even limbs lost in wars was a common medical practice. There are detailed and accurate step-by-step descriptions of such operations. Strikingly these are the very steps followed by modern surgeons doing plastic surgery even today.

Serious procedures were undertaken like drawing fetuses out of wombs, repairing damaged rectums and removing stones from bladders. Surgical techniques included incisions, probing, extraction of foreign bodies, cauterization, tooth extraction, excisions, draining abscess, draining hydrocele, removal of prostate gland, urethral stricture dilatation, hernia surgery, management of haemorrhoids, fistulae, intestinal obstruction, perforated intestines, and accidental perforation of abdomen. Students were given knowledge of relevant branches of medicine to attain proficiency in allied subjects.

Sushruta Samhita remains an important text on medicine that is also a foundational text for Ayurveda. This seminal text was translated to Arabic as Kitab-i-Susrud in the 8th century. The Arabic translation was received in Europe by the end of the medieval period when Renaissance Italy became familiar with the techniques of Sushruta Samhita. Among other translations since then, more recently in 1999, P. V. Sharma undertook an English translation of this ancient Indian medical treatise.

First Surgeon Performing Plastic Surgery!

First Surgeon Performing Plastic Surgery!

The Saga of Medical Camps Going Wrong

Unfortunate Medical Camp - 60 People lose Vision

Unfortunate Medical Camp – 60 People lose Vision

As an integral part of the medical fraternity we are naturally mortified and concerned about the way in which some medical camps have recently been organized. Just as we were getting over the tragedy of the Chhattisgarh mass sterilization debacle here comes another tragedy where sixty senior persons lost their vision after eye operations at a medical camp organized in Punjab. One can only wonder at the lax manner in which such free medical camps get organized.

Unknowingly people suffer these shocking calamities every once in a while, and when such morbid instances gain epic proportions, one can only surmise that planning and preparations were haywire. These recent cases have drawn much flak, from both national and international media, and also great deal of debating  has occurred amid the district medical authorities and medical groups in these areas.

It therefore becomes very essential to gain an understanding of the role of free camps or continuing medical education programmes as the case may be, to carefully examine the proprieties of holding such camps. We know for sure that it is largely poor and weaker sections of society that come to such camps. More often than not the implementing agencies are either adhering to targets, or fulfilling agendas or even using such opportunities for effective marketing gambits. But unwittingly they often backfire by some wrong or incorrect planning.

Whatever their intention – one thing is definite that participating crowds of mainly poor patients do benefit from the ministrations of medical doctors and even get free medications for their treatments. HERD Foundation has a history of organizing such medical camps since the past several years, and it has been with a sense of commitment that we have literally reproduced hospital like setting in the outdoors. In our experience such camps have to be planned meticulously right down to the smallest detail to be tapped properly.

Hand in hand with Lata Mangeshkar Hospital, our sister concern, we have catered to the medical needs of large numbers of poor, weak, and marginalized people both in villages and in city slums. It has been no mean task to delegate responsibilities at every level for day long health camps providing free medical checkups to over 2000 registered people. We include eight medical departments ( Medicine, Obstetrics & Gynecology, Pediatrics, Orthopedics, Ophthalmology, Surgery, Dental and ENT Departments) from our hospital with matching teams of doctors, interns, nurses and attendants providing due support to examine and treat patients.

HERD Foundations innovative approaches have attempted such health care delivery in deep rural-tribal areas close to Nagpur. We have been able to provide the best health facilities and services to the poor tribal populations, until quite recently absolutely free of cost. Referral cases get patients treated in hospital for which they are duly charged so that a value based model of health care becomes available. Our own strategy has been to focus on key elements of effective risk management to endeavor to anticipate what could possibly go wrong, work towards reducing chances of it going wrong and plan what to do when it does go wrong. Understanding the essence of “risk management” sees to it that medical camps pre-assess and manage these risks.

Chattisgarh Sterilization Camp Debacle

Chattisgarh Sterilization Camp Debacle

Fate of HIV and AIDS (Prevention and Control) Bill 2014 Still Hangs

December 1 observed as World AIDS Day

December 1 Observed as World AIDS Day

The AIDS epidemic in India is not hidden anymore. We know for a fact that now our villages too are affected by the scourge. As per the U.N. AIDS Programme India, at the end of 2013 had the third-largest number of people living with HIV in the world. This accounts for over half of the AIDS-related deaths in the Asia-Pacific region. It is time we sat up to take stock of the situation.

Today December 1, is observed as World AIDS Day. We in India, have managed to create awareness and made strident efforts towards combating the dreaded disease. We have involved local governments, NGOs, educational institutions, schools and the civil society to get support for the cause. And it has been with all such support that we have been able to reach out to the people.

Nearly 9 lakh Indians are dependent on ART drugs to lead relatively healthy lives. Affected people start therapy with required medicines that are needed to be taken daily as per proper adherence. Failing this the drugs rapidly become ineffective. Once this happens they then have to switch to a second line of treatment which is five-times more expensive than first-line drugs.

Even for the first line medication urgent intervention are needed to ensure that people living with HIV and AIDS get these life-saving anti retroviral Therapy drugs. While being able to get the drugs remains a major area of concern, it is the long-pending HIV Bill that’s needs to be passed by the Indian Parliament is also a grave area of concern. The Bill drafted in 2006 aims to protect the rights of people infected and affected by HIV. It would hopefully provide protection of HIV-positive people and their family members from stigma and discrimination.

It is therefore very imperative that the decision makers agree to pass the HIV and AIDS (Prevention and Control) Bill 2014. All along stakeholders have been focusing on spreading awareness about access to drugs as well as diagnostics for People Living with HIV. Positive public support has also been acquired for resolving this issue. HIV is now long past been a medical problem. It now cuts across social, economic, psychological, medical parameters to move into the domain of human rights.

The HIV bill provides protection against human rights violations and since having been tabled in the Rajya Sabha (Upper House) of Parliament, has now to be passed as law. Experts urge that the government should urgently pass the HIV and AIDS Prevention and Control Bill 2014 as soon as possible to provide drugs and diagnostic services for free to those who are affected. According to the United Nation’s, India has around 2.2 million people being affected by HIV AIDS.

Life-Saving Anti Retroviral Therapy Drugs

And The Band Played On

And_the_band_played_on_Varese_VSD_5449

Produced in 1993 “And the Band Played On” is an American documentary based on the best-selling 1987 book entitled “And the Band Played On: Politics, People, and the AIDS Epidemic” by Randy Shilts. The film is directed by Roger Spottiswoode and written by Arnold Schulman and has a cast of well known actors. The docudrama weaves around the discovery of the AIDS epidemic and the political infighting of the scientific community obstructing the early fight with it.

The film takes you back to the days when the undetected disease was considered a mysterious threat but one that no one dared face up to. The fight for the affected many was being fought by but a few. No one wanted to even speak of it. Many still feel the same way about AIDS even today. However, recent years have lent due attention to the malady by donor agencies and philanthropists who have kept the fight up for affected people and to combat its spread.

It is with a sense of gratefulness that one watches the film that had first premiered on September 11, 1993. The prologue of the film takes you back to 1976 when American epidemiologist, Don Francis arrives in a village on the banks of the now famous Ebola River in Zaire, where he discovers several residents and doctors working with them to have died from a mysterious illness later identified as Ebola hemorrhagic fever. This initial exposure to an epidemic becomes a haunting leitmotif when he subsequently becomes involved with HIV and AIDS research at Centers for Disease Control and Prevention.

It is only in 1981 that Francis becomes aware of a growing number of deaths from unexplained sources among gay men in Los Angeles, New York City and San Francisco that prompts him to begin an in-depth investigation of the possible causes. Working with no money, limited space, and outdated equipment, he interacts with politicians, the medical community and gay activists. But many people resent his involvement because of their personal agendas.

Bill Kraus a gay activist supports him but several others dislike unwanted interference in their lifestyles. However Don Francis pursues his theory that AIDS is caused by a sexually transmitted virus on the model of feline leukemia. His efforts are stonewalled by CDC itself that is not keen on proving the disease to be transmitted through blood as blood banks would become suspect, as eventually they were. Albeit later CDC itself came to compete with French and American scientists squabbling over credits for discovering the virus!

Meanwhile death toll from the virus keeps climbing rapidly. The film closes with footage of a candlelight vigil march in San Francisco, followed by a series of images of persons dead and affected with HIV and those who have since then been involved with HIV education and research. The film takes you back in time to bring out the facts and figures of the history of AIDS. It is inspirational in a sense how few committed souls played a role in understanding and combating AIDS infection.

HIV-treatment