Pain management should be integrated in the medical curriculum

Health Care, Heart Care Foundation of India, Medicine Comments Off

Only about 1% to 2% people have access to palliative care in India

New Delhi, 05 August 2018:The Lancet Commission on Access to Pain Relief and Palliative Care in 2017 finds that 61 million people around the world have ‘serious health-related suffering’ (SHS) which necessitates palliative care. At least 10 million of them are in India. However, only 1% to 2% people have access to such care or pain management in the country. Although there is a national programme for palliative care, medical students do not learn pain management from the curriculum.

Palliative care is treatment aimed at improving the quality of life of patients and their family members when they face serious health problems. That suffering can be physical such as breathlessness, pain, a nasty wound or psychological, social, or spiritual such as depression, social isolation.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The palliative approach is one that looks not just at the difficult symptoms of an illness, but also on the overall benefits and/or side effects of possible treatments. Above everything, such care addresses the emotional, physical, and financial stresses of a person dealing with a serious, perhaps life-threatening, disease. Though there is an understanding of this concept, it is yet to take off in India, barring few private entities that are into home-based care. One reason for this could be that medical practice in India is disease based and not person based. Doctors and healthcare establishments carry on treatment fearing the wrath of the patient’s family, a case that has even led to violence against doctors several times. Kerala has been a pioneer in this regard, followed by Karnataka and Maharashtra.”

Estimates suggest that there are about 3 million patients with cancer in India at any point in time. About two-thirds of them are in pain and one-third in severe pain needing strong analgesics. It is estimated at least 60% to 80% of these patients need palliative and end-of-life care.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “It is not an uncommon wish to attain a peaceful death especially in those with a critical/terminal illness. Many cultures and religious beliefs offer practical ways to enhance having a peaceful death. Dying in an intensive care unit is unnatural and oftentimes painful for the patient and their loved ones. Caregivers and nurses can help promote peaceful death through a three-dimensional process: awareness of dying, creating a caring environment, and promoting end-of-life care.”

It is the Vedantic principle of “welfare of the society” which makes doctors special and different in the society. The day this aspect of welfare is lost, society may not accord us the same respect as they have been doing so till now. Principles involved in acting towards the welfare of the society includes giving 10% of our time to charity; not charging any fee from those who cannot afford; charging less from the middle class and charging normal from people who can afford and where reimbursements are available. Integrating training in palliative care into the medical curriculum will also pave the way for better trust on doctors by patients.

All about Indian tick typhus

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  1. Indian tick typhus is a disease of the spotted fever group of Rickettsiae caused by Rickettsia conorriisubsp indica.
  2. In India, the Indian tick typhus is prevalent in hilly forest areas. Infection has been seroepidemiologically reported from various parts of the country such as Nagpur, Jabalpur, Jammu and Kashmir, Kanpur, Sagar, Pune, Lucknow, Bangalore and Kangra.
  3. The brown dog tick (Rhipicephalus sanguineus is the reservoir of infection and is infective at all stages of its life. Infection in nature is maintained by transovarian and trans-stadial passage. The rickettsiae can be transmitted to dogs, rodents. Man is an accident host and acquires the infection by the bite of infected tick.
  4. The incubation period is usually 3 to 7 days.
  5. The patient will give a history of a recent tick bite.
  6. Clinically, the infection presents as acute onset of moderate to high grade fever, which may persist for 2-3 weeks, malaise, headache, deep muscle pain. A maculopapular rash appears on the 3rd day of fever. Unlike the rash in other rickettsial diseases, in Indian tick typhus, the rash is first seen on the extremities (ankles and wrists), moves centripetally and involves the rest of the body.
  7. Unlike other spotted fever group, the maculopapular rash in Indian tick typhus is frequently purpuric, absence of inoculation eschar at the site of the bite (eschar if present, is always single) and absence of lymphadenopathy.
  8. Diagnosis is based on Weil-Felix test, 4-fold rise in agglutinin titer in paired sera or single titer of more than equal to 1:320 is considered diagnostic for infection.
  9. Doxycycline is the drug of choice
  10. Prevention: Avoid known tick-infested areas. People exposed to risk infection should  do daily inspection of the body for ticks, disinfection of dogs.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA