Category: Healthcare

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General Healthcare

The Unending Nightmare of Violence Against Women

As a father of two daughters, the recent rape and murder of a young medical student in Kolkata has resulted in despair and anger https://www.thehindu.com/news/national/west-bengal/in-kolkata-rape-murder-and-rampage/article68532922.ece.  My initial response was to ignore the news and the commentary – this after all didn’t happen in Bengaluru – the city I live in. But the protests by the medical fraternity across India forced me to face the reality – if it can happen in Kolkatta – it can happen anywhere.

The details of the crime are too gruesome to recount. But the image of that young woman, her dreams and aspirations extinguished in an act of unimaginable cruelty, will forever haunt me. It is a chilling reminder of the vulnerability of women in our society, even within the supposed safety of a hospital.

The statistics paint a grim picture. India reports over 87 rape cases every day, and the actual number is likely much higher due to underreporting. Every 15 minutes, a woman is subjected to some form of sexual violence. These are not just numbers; they represent the shattered lives of countless women, their families, and their communities.

The problem is not a lack of laws. India has some of the strictest anti-rape laws in the world. The problem is the lack of implementation, the lack of accountability, the lack of empathy. We live in a society where victim-blaming is rampant, where women are told to dress modestly, to stay indoors, to not venture out alone. This is not the solution. The solution lies in changing mindsets, in holding perpetrators accountable, in creating a safe and secure environment for women.

We need to raise our voices against this injustice. We need to educate our sons to respect women, to treat them as equals. We need to hold our leaders accountable for ensuring the safety of women. We need to create a society where women can walk freely, without fear, without shame.

Here are a few actions that I have listed that we can all take:

  1. Demand justice for the victim and her family: Sign petitions, participate in protests, and make our voices heard. These protests have resulted in the Supreme Court of India taking suo moto notice of the case and setting up a task force on safety – https://www.ndtv.com/india-news/will-set-up-national-task-force-of-doctors-on-hospital-safety-chief-justice-6375831
  2. Educate our children about gender equality and respect for women: Teach them to challenge harmful stereotypes and to stand up against violence. We should have modules on this in in schools and colleges.
  3. Support organizations working towards women’s safety:  Donate our time, money, or resources to NGOs and initiatives that are working to create a safer environment for women.
  4. Speak up against victim-blaming and slut-shaming: Challenge these harmful narratives whenever we encounter them.

As a father, I dream of a world where my daughters can walk freely, without fear, and pursue their dreams and aspirations without being subjected to violence or discrimination. A world where they are treated with the respect and dignity they deserve.  This dream can become a reality if we all work together to make it happen. Let us be the generation that creates a society where women are safe, empowered, and free.

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General Healthcare Movies

Movie Review: “Three of Us”

“Three of Us” is a poignant and visually captivating film that delicately explores themes of memory, nostalgia, and personal reconciliation. Set against the backdrop of the serene coastal town of Vengurla in the Konkan region, the movie adeptly utilizes its picturesque landscapes to complement the emotional depth of its storytelling.

The narrative primarily revolves around a woman portrayed by the talented Shefali Shah, whose life takes an unexpected turn with an early diagnosis of dementia. However, the movie refrains from making the illness the focal point, using it instead as a subtle backdrop against which the characters’ stories unfold.

Shah’s character, along with her husband (played by Swanand Kirkire), embarks on a journey to Vengurla, where she reconnects with her school friend, portrayed by the versatile Jaideep Ahlawat. The movie delves into the complexities of their relationship, hinting at unresolved feelings and unspoken emotions that linger beneath the surface. The film intertwines her present struggles with dementia with her attempt to come to terms with a personal tragedy from her past that is connected to the town.

One of the standout aspects of “Three of Us” is its brilliant cinematography, which captures the breathtaking beauty of Vengurla, a coastal town nestled along the Arabian Sea. The visuals not only serve as a scenic backdrop but also add depth to the emotional landscape of the narrative.

Director Avinash Arun masterfully navigates the storyline, allowing the characters’ emotions and relationships to take center stage. While all three actors—Shefali Shah, Jaideep Ahlawat, and Swanand Kirkire—deliver commendable performances, the standout portrayal is by Shefali Shah. Her portrayal infuses the character with a depth that resonates powerfully, anchoring the emotional core of the narrative.

Dr. Peter Attia in his  book “Outlive,” calls heart disease, cancer, neurodegenerative disease(dementia) & type 2 diabetes  as the Four Horsemen – as they will account for the death of a majority of people. I have recently been coming across more cases of dementia in my known circles. This film subtly raises awareness about dementia without overstating its presence, offering a nuanced portrayal that resonated with me. The relationship between Shefali and her husband Kirkire who will eventually need to take on a significant role as her caretaker was beautifully portrayed in a scene where he gives her a hair massage.

I found “Three of Us” to be a touching cinematic experience that skillfully navigates emotional landscapes, aided by stellar performances and breathtaking visuals. It’s a film that gracefully tackles profound themes while highlighting the importance of memories and personal journeys.

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General Healthcare Politics

Covid Surge in India

I had written 4 months back about the India’s Covid Vaccine rollout plans. Even to someone who is not in public health, the enormity of the challenge was obvious. At 3 million vaccines a day and assuming children would need to be vaccinated too, I had said it would take over 2 years to get the country vaccinated. It was critical to have plans for managing the pandemic during those 2 years. The surge of cases that has now hit India has shown the inadequacy of the preparation. Indian healthcare system is struggling to cope with the increases in the hospitalizations – lack of Covid beds, ICU beds & Oxygen. In my view, India needs to do the following:

  • Continue to work on the Vaccination roll-out. While India has hit a milestone of 100 million doses, it is still far behind the over 2 billion doses required. India needs to clear any bottlenecks on the supply side. In parallel, India needs to educate the citizens on the need to get vaccinated.
  • As the vaccine roll-out will take more than a year, India needs to plan assuming the worst – that there would be other Covid surges.
    • Increase the medical supply to handle any surges – beds, ventilators, pharmaceuticals for treating patients
    • Continue mask requirements, social distancing and ensure small public gatherings
  • Support the economy – the surges & lockdowns will impact the economy over the next 2 years – the government will need to provide stimulus as required.
  • Support people impacted negatively by the economy – social welfare schemes need to be bolstered.
  • The Central & State governments need to be transparent with the public. This is not the time for politicking and scoring brownie points at the cost of transparency. That will damage the trust of the citizens with the system

As the April 2021 surge has shown, we cannot be complacent with this pandemic – while we should hope for the best, lets prepare for the worst!

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Fire Safety Healthcare

Indian Hospital Fires in the last few months!!

It was so sad to see the newsflash about the death of 10 new born babies in a hospital fire in Bhandara, Maharashtra on 9th of Jan, 2021. What is shocking, is that in the last few months there have been over 50 deaths in hospital fire accidents across India. In addition, there have been other hospital fires which fortunately did not result in deaths. In total, I have come across 12 hospital fire incidents since May 2020. Here is a list:

There have been other large hospital fire incidents in the past including at AMRI Kolkatta which killed over 90 people – https://www.outlookindia.com/website/story/from-mumbais-andheri-hospital-to-calcuttas-amri-a-list-of-major-hospital-fire-outbreaks-in-india/321919

Unfortunately, as a nation we do not seem to be learning from these tragedies. There is usually a flurry of media attention post the fire, there is a call for investigations, panels are created and reports are submitted to the government, but post that, nothing happens. These hospital fire incidents are primarily because of the following reasons:

  • Not compliant with fire safety rules & regulations – cases of wrongful ‘No Objection Certificates(NOCs)’ being issued to hospitals, have been well documented.
  • Compliant but not doing enough to take precautions – for example periodic checking of electric connections – short circuits are a leading cause of fires in hospitals
  • Inadequate training to handle fire accidents – regular drills with hospital staff are a must and usually, this is not taken seriously. Also the fire-fighting infrastructure is below capacity in many parts of India

These hospital fire accidents can be prevented to a large extent, if regular fire safety audits are done. In Bengaluru, Beyond Carlton(https://www.beyondcarlton.org/) had been making the case for fire safety audits in hospitals for many years and in 2016, the Karnataka fire department had actually done that – https://www.thehindu.com/news/cities/bangalore/Fire-safety-audit-across-all-hospitals-in-the-State/article15624433.ece.  

Last month, the Supreme Court of India, after taking suo motu cognizance of the hospital fire accident in Rajkot, asked the State governments to form committees to undertake fire safety audit of all hospitals  – https://timesofindia.indiatimes.com/india/form-committees-to-undertake-fire-safety-audit-of-all-hospitals-supreme-court-directs-states/uts/articleshow/79791808.cms. I hope that all state governments follow the Karnataka example and take this up seriously.  

It is indeed ironic that a patient comes to a hospital to get treated, but dies because of a fire accident. As we mourn the loss of ten infants, let us come together as a nation and put pressure on our state governments to ensure that all hospitals take fire safety seriously!!

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Healthcare

Covid Vaccine Distribution in India

India recently announced the approval of two vaccines – a) Oxford – Astra Zeneca & b) Bharat Biotech  – https://www.bbc.com/news/world-asia-india-55520658 . The big challenge now facing India is, how to vaccinate 1.3 billion people in the shortest time possible.

The numbers are staggering – both these vaccines are double doses and hence 2.6 billion doses need to be administered. Even if 3 million doses are administered a day, it will take over 2 years for the entire population to get vaccinated. The US, one of the first countries to start the vaccine rollout, is administering around 250,000 doses per day and the plan is to get to 1 million per day – https://www.businessinsider.com/fauci-us-vaccine-rollout-timeline-million-people-per-day-2021-1

While India has a good track record on vaccination, the infrastructure is primarily to vaccinate children (for example – no adult flu shots like in the US). Over 27 million new-borns are targeted annually for immunization under Mission Indradhanush, though the coverage is around 80% and varies across states – https://www.unicef.org/india/what-we-do/immunization. For Covid-19 vaccination, at 3 million per day, we are talking over 90 million per month!

In Aug, 2020, Nandan Nilekani, the Chairman of Infosys, had written an article on how to go about this mammoth task – https://www.hindustantimes.com/analysis/how-to-secure-india-against-covid-19/story-0HGNCAvDfFHtG9O8CBmDqL.html. He talked about building a vaccination infrastructure at scale(over 100,000 points), use Aaadhar to authenticate; issue digital vaccination certificates and have a workforce of over 200,000 people for this job.

The Indian government(GOI) hasn’t yet published a detailed plan on the vaccine rollout – there is mention of 300 million people being vaccinated by July https://www.hindustantimes.com/india-news/centre-draws-plan-for-vaccine-roll-out/story-8etCcg99dqlqnX6ysTVjOJ.html. The GOI will be working closely with each state government in the roll-out. In my view, the following are needed to make the roll-out a success:

  • Leverage Aadhaar to reach out to citizens and ensure that everyone is getting the vaccine dose – issue digital vaccination certificates
  • Involve private enterprises in the roll-out – private hospitals, clinics & diagnostic centers
  • Set-up dedicated vaccination centers across the cities – this will also give employment to thousands of people who are currently affected by the pandemic
  • Leverage private groceries for strengthening the supply chain including storage
  • Have a clear and transparent plan on who gets vaccinated when – jumping the queue should be treated harshly. Also ensure that disenfranchised societies don’t lose out
  • Address vaccine misinformation by being very transparent – time to leverage social media especially Whatsapp positively?

This is a grand challenge that India faces, but by planning and executing well, India can pull this off.

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Healthcare

Doctor Protests!!

There have been protests across the country by the doctors over the last few days, triggered by the disgraceful beating up of a junior doctor in a government hospital in Kolkatta. This crime against a doctor, unfortunately, is not an isolated incident. Many such incidents have been reported across the country in government as well as private hospitals.

Doctors have expressed the feeling of being let down by society – while they have been trained to handle anxious patients & family members, how can they deal with violence? Just imagine the mental state of a doctor if he or she doesn’t feel secure in their workplace. What if the same happens to any of us – say a banker or a hotel manager or an IT professional?? At this rate, apart from learning very difficult subjects in medical college, they have to be trained in self-defence!!

As citizens, we may feel frustrated with our Indian healthcare system – but doctors are not the reason for the many issues which affect our healthcare system:

  • Acute shortage of Doctors esp. in Government Hospitals – As of 2017,  India had around 10 lakh registered allopathic doctors and with an assumed availability of 80%, the Government of India, has said that we have 0.62 doctors for every 1000 persons. This is lower than the WHO norm of 1 doctor for every 1000 persons. The average population served per government allopathic doctor is 11,039.
  • Shortage of hospital beds – There are around 7.1 lakh hospital beds out of which 2.8 lakh are in the rural areas(which has 60% of India’s population). For rural, this translates to around 0.37 beds per 1000 people as against WHO norms of 3.5 beds per 1000 people!!
  • Poor insurance coverage making healthcare expensive. The government has launched Ayushman Bharath recently which is a great move towards insurance coverage for the poor. Many states also have various programs to cater to this aspect of healthcare. However cost of treatment is still a big issue for many patients and they are forced to opt for non-optimal health treatments.

As you can see above, these issues are not because of our doctors!! They are doing their best with the hand they are dealt with. Healthcare outcomes in such a situation are not going to be ideal. In addition to that, medicine by its very nature cannot give a 100% probability of success – some diseases can be complex and outcomes depend on patient attributes. That doesn’t mean, that there is no medical negligence – but to blame everything that goes bad, on the doctor is very unfair and to resort to violence against the doctor is criminal!!

What the doctors need are as follows : a) Security in the hospitals b) Law to be strictly enforced for violence against doctors c) Awareness campaign to sensitize the citizens that Doctors need to be treated with a lot of respect. In my view the awareness campaign is critical because ultimately the community has to rise against any person who wants to harm the doctor. It is imperative that West Bengal and other state governments as well as the central government take up the issue of doctor safety on priority – otherwise, our healthcare system will regress instead of progressing!!

References:

https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/less-than-one-doctor-for-1000-population-in-india-government-to-lok-sabha/articleshow/59697608.cms

https://www.cbhidghs.nic.in/WriteReadData/l892s/Chapter%205.pdf

Categories
Healthcare

Deaths of children in Bihar because of Encephalitis

It has been shocking to read that over 100 children have died in Muzaffurpur and nearby districts in Bihar.( https://www.indiatoday.in/india/story/encephalitis-fever-bihar-1550297-2019-06-17). They were affected by Acute Encephalitis Syndrome (AES).

On checking the central government data on this disease( https://www.cbhidghs.nic.in/WriteReadData/l892s/Chapter%203.pdf) , the deaths over the last few years have been primarily in the Assam, Bihar, UP & West Bengal as per table below:

State Year-2013 Year-2014 Year -2015 Year-2016 Year-2017
Assam 272 360 260 187 178
Bihar 143 355 90 102 51
UP 609 627 479 621 593
West Bengal 226 348 351 256 153
Other States 23 29 30 135 35
India Total 1273 1719 1210 1301 1010

 

In 2016, the Other States is high, because there were 115 deaths in Orissa. This was also the year where 125 children died in one hospital in Gorakhpur, UP which happened to be the constituency of the Chief Minister, Yogi Adityanath.

Even in the previous years, according to a research report “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644291/” between 2008 and 2014, there were 44,000 cases reported over 6000 deaths from encephalitis, mainly in UP and Bihar.

While Japanese encephalitis virus (JEV) is the leading cause of acute encephalitis, there could be other causes including other viruses. While there is a vaccine for JEV which is being administered to children, clearly the outbreaks indicate that there are other unidentified causes. In fact, one of the theories is that a toxin in litchi fruit can cause this – as Muzaffarpur is a litchi fruit growing region, and cases tend to peak during the harvesting season.

The central government has apparently allocated over 4000 crores over the last few years specifically to address Acute Encephalitis Syndrome. The number of deaths across these years and the current epidemic in Bihar, clearly demonstrates that more needs to be done on an urgently basis to prevent this!