Health Sector is demanding and is not a 9 to 5 Job: P K Pradhan

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In an interaction with IMAS, Sh P K Pradhan Former Health Secretary Govt. of India said that MCI should be reconstituted this year, reports Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal National Vice President Elect IMA.

The interaction was held on Wednesday at IMA 20th Feb IMA hall and was moderated by Dr Narender Saini Secretary General IMA. I too was present at this interaction.

Other present were Dr D R Rai, Dr Atul Arora, Dr   S Roy, Dr V K Narang, Dr Ajay Gambhir, Dr Ghulam Abbas Zaidi and Dr Zainab Zaidi.

Following is the gist of the interaction.

About the health budget

1.      Government of India under NRHM and other schemes gives 75% grants to the States and 25% has to be raised by them. Many states are not being able to utilize the funds quickly and avail their grant in full.  Bihar has come up very well in healthcare infrastructure during last few years. Performances as well as health care in UP, Chhatisgarh and Jharkhand are still a matter of concern.

2. When it comes to release of funds under health schemes, the releases are made purely on performance and no other considerations. If money is not used by the states, it is due to lack of performance and inefficiency. There are no political considerations.

3.    Many States like Madhya Pradesh, Orissa, Tamil Nadu, Karnataka, Haryana, Himachal Pradesh, J & K and Rajasthan were provided additional funds under NRHM during the last few years.

4.  Most of the Plan budget of the States, even up to 80%, goes towards salaries.

About health infrastructure in different states

1.      Tamil Nadu health services are one of the best in the country. Health care is available at the lowest cost.  Governance is a good factor for implementation of healthcare services. Assam, Madhya Pradesh, Rajasthan and Orissa among the high focus states have picked up very well. Andhra Pradesh needs to improve the primary healthcare system.

2.      The quality of services in medical colleges needs to improve substantially. In some of the district hospitals, the care may be better than medical colleges as senior doctors in medical colleges are often busy in private practice.

About vacant posts at rural setups

Wherever medical officer posts are to be filled by state PSCs, there is considerable delay. Many States have started doing selection directly to overcome this problem and to place doctors in position.

IMA image

1.      It is not correct that IMA has an image of anti-governance.

2.      It is only that IMA representatives and documentation do not reach the right people in the right time.

3.      In the eyes of the government, IMA is at a high standing image.

4.     Since IMA is taking up various projects, it should build a stronger partnership with Government both at the Center as well as State level to build capacity and improve the health care in the country.

About MCI

As things stand, Medical Council of India should be reconstituted after the term of the present BoG is over. There is need for two amendments in its old format.

1. One will not be able serve for more than two terms.

2.  More representation from state health science universities where there are a large no. of medical colleges.

About Dr B C Roy Awards

Dr. BC Roy Awards issue needs to be raised with the Medical Council of India.

About Capacity building and BSc community health courses

1. Everybody in the hospital, from ward boy, person doing waste disposal and other service providers need to be skilled and can be provided six months courses by accredited institutions.

2.  The need is to constitute a paramedical council. IMA can facilitate this, prepare a draft and approach the health ministry.

3. The Government today is proposing BSC Community Health Programme to create mid level health providers who can be groomed as public health personnel.

4. IMA point of view is that MCI or DNB should not develop the curriculum and become an accredited institution to impart such courses and register them. Government however is envisaging the same as there is no council at the moment available for the same. The government is choosing them on the philosophy unless you register you cannot be de-registered. IMA feels that a separate paramedical council should be made to recognise them.

5. A community health worker will provide better preventive health care than an ANM.

6.  The introduction of the courses will depend on States. It is possible that southern and western States may not go for BSC Community Health Courses.

7.  The BSc Community Health workers will be required more in the remote rural areas to strengthen the public health and where it takes more than few hours to reach for primary care.

8. IMA approved paramedical courses can be recognized by states and the centre.

About public health

1. Non-doctors should also be allowed to become public health professional.

2. The burden of diabetes, old age problem and mental health are going to assume very high proportion in the coming years and it is time be fully prepared to cope with the situation.

About IMA as NGO

IMA can think of building dialyses centers and blood banks in different district and can approach State Govt. and Center for support.  The government is planning to have diagnostic centre in each district hospitals.

About Generic Drugs

The MRP of drugs is not controlled by the government. Government is trying to regulate prices of only essential drugs.

About Medical colleges

Several reforms have been undertaken to facilitate setting up new medical colleges and augment both UG and PG seats. This includes rationalization of land and infrastructure requirements, having colleges in two campuses etc. The no. of seats should go up substantially now.

What about an offer to be a friend of IMA

I can support activities of IMA to improve health care in the country as “Friends of IMA”.

Requirement of Heath Sector

1.      Health sector is extremely complex, demanding and is not a 10 to 5 job.

2.      It requires passion and commitment to work for long hours.

Tackling Bomb Blasts

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Powerful bomb exploded in Hyderabad took over 15 lives. Heart Care Foundation of India today releases guidelines for the medical practitioners and the public as to how to handle a bomb explosion.

  1. Half of all early casualties seek medical care over first hour. To know the total number of casualties, double this number after one hour. This formula is often used by the media and the authorities to predict the tolls. It is also useful to predict demand for care and resource needs.
  2. The most severely injured arrive after the less injured who need transport to the closest hospitals, so always expect upside down triage.
  3. It is important that we as doctors know how bomb blast cause injuries in order to tackle its repercussions of bomb blasts.
  4. Bomb blast injuries can be categorized into four types:
  5. The most important aspect is not to waste energies and resources on patients with non-serious injuries.
  6. Look for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non serious injury.
  7. If the ear drums are intact, the patient can be discharged with first aid treatment.
    1. If ear drum is ruptured, immediately do an X ray chest. Keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation.
    2. Otoscopic ear exam is the screening procedure for triage. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.
  • Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. It involves injuries to the hollow gas filled organs like the lungs, ear drum or intestines leading to their rupture.
  • Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
  • Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
  • Quaternary blast injuries are due to direct effect of burn or crush injuries.

10. Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture.

11.  With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA []