Will we be ready to tackle future epidemics?

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In the public debate on the Gorakhpur tragedy, several reasons were put forth as to why these deaths occurred. That several factors collectively led to this tragedy is the undeniable truth. Rather than trying to pinpoint who is to be blamed, our focus instead should be preventing further outbreaks in the future.

Dealing with the aftermath of a tragedy is important as also, how we choose to deal with it. And the question that we all should be asking ourselves in this regard is “what can we do to prevent future epidemics” and not “what should have been done and was not done”.

Will we be ready to tackle future epidemics? The answer to this depends on what corrective measures we take today.

A long-term strategy needs to be formulated to deal with such outbreaks. A well-planned surveillance and response system should be in place, which can be mobilized quickly when needed. We need better investment in preparedness.

We have to work together to stop the next outbreak, not only in Gorakhpur, but also any epidemic in the country. Dengue, for example, occurs in epidemic proportions every year.

The Indian Medical Association (IMA) has suggested the following to avoid more incidents like the Gorakhpur tragedy.

• There should be no shortage of staff – doctors, nurses and other supporting staff. Staff deficit affects patient care. Shortage of staff should be supplemented with the services of locum doctors.
• Private doctors can be hired, but only for locum jobs, not as regular doctors.
• The practice of “moonlighting” as is prevalent in the US should be allowed in India.
• There should be a uniform system for Govt. doctors: either practice is allowed or it is not allowed.
• All patients who are denied treatment at government hospitals should be reimbursed for the cost of treatment in the private sector at predefined rates.
• All hospitals should have back up of at least one-week supply of all essential drugs, investigations and oxygen.
• To reduce the cost of treatment, essential drugs and investigations – not non-essential drugs and tests – should constitute the bulk of the expenditure of the allocated budget.
• All payments for health care services should be made either in advance or in time.
• Insurance Regulatory and Development Authority (IRDA) has made it mandatory for all private hospitals to get NABH accreditation. The same should be extended to all government set ups.
• Every death should be audited to find out the probable cause of death and whether it was a preventable death so that future such deaths can be prevented from occurring.
• In any case of negligence, one should differentiate between administrative negligence and medical negligence.

Disclaimer: The views expressed in this write up are entirely my own.

Dr KK Aggarwal

Aao School Chalen: A national project undertaken by IMA

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School health is very important as schools are not just centers that impart formal education, they also influence overall development of a child. To enjoy good health during adulthood, healthy lifestyle including hygiene habits must be inculcated during childhood. These habits learned during childhood last through to adulthood and all their lives. Moreover, children are naturally inquisitive and keen learners. So, they are both beneficiaries of any health-related activity and agents of change in their family.

To this end, the Indian Medical Association (IMA) has adopted “Aao School Chalen Project” initiated by Delhi Medical Association in the recent past as a National Project. The 5th of every month has been designated for any activity related to this project.

Visit your old school if you can or any nearby school during the school assembly and interact with students and teachers to sensitize them on issues of public health importance. Speak to the principal of the school beforehand about this. It need not be long-drawn talk, but should be a short talk of 10-15 min duration. Get a certificate (proforma) signed by the Principal. Send the proforma to IMA HQs along with the photographs taken with students during assembly for records.

We have identified few topics for the coming months and there will be common points for discussion for uniformity.

The first topic for 5th August is “vector-borne diseases”. The 10 uniform messages for first lecture are as follows:

1. Mosquito-borne diseases are preventable and manageable if detected early.
2. Do not allow water to stagnate in or around the houses, particularly in plastic containers.
3. Wear full sleeves clothes during monsoon season.
4. All patients suffering from dengue, malaria, chikungunya, Japanese encephalitis should use bed nets while sleeping.
5. Treatment of malaria should be started early; it can be for 3 days or 14 days depending on the type of malaria.
6. All patients with dengue do not require platelet transfusion.
7. IMA Slogans: “Katwaieyga to nahi” (I hope you will not get me bitten by a mosquito) or “My premises are mosquito-free, you are invited at my premises”.
8. Look for mosquitoes: inside or outside the house; both small and big containers, during day or night; in the room or on the roof; floor or up on the walls; larvae or the mosquito.
9. Let all schools be declared by the principal as being mosquito-free.
10. Let every child speak a slogan: “From now onwards my house will be mosquito free”.

The schedule of the talks is as under:

• 5th September: Lifestyle
• 5th October: Menstruation myths
• 5th November: Health and Hygiene
• 5th December: Substance Abuse

States and Local Branches of IMA are requested to circulate this information to all the members.

Since, this is a national health project, IMA requests all its members to participate to make it a success.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Do not ignore “trends” in lab reports

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Laboratory tests have become routine. Not only do doctors order lab tests, often patients or even otherwise healthy people get them done of their own accord. What is important is how we interpret these reports.

Often the results of the tests are interpreted in relation to the normal reference range mentioned alongside, whether the values are within the reference range “normal” or fall outside it “abnormal”. Labs usually have their own reference range.

Generally, we tend to give too much weight to a normal result and are reassured by it. But, here it is important to keep in mind the fact that a normal result is just a picture at that point of time. It can change.

And, what is equally important is that instead of looking at a single test result, one should look for trends in the results. Always compare the results of a particular test with previous reports even when a result is normal. Results that show change over time i.e. show a rising or declining trend are important and should not be ignored.

Any result which has been in the low normal range for the last many years, but is now in the high normal range even though still normal, should be taken cognizance of and investigated accordingly.

This can be most commonly illustrated by blood sugar. A fasting blood sugar level higher than 126 mg/dL can be diagnosed as diabetes, according to the recommendations of the American Diabetes Association (ADA). Prediabetes is fasting blood sugar ranging between 100 and 125 mg/dL. If your patient usually has had his blood sugar around 80, but in the latest report, the blood sugar is now, say 98 or 106. This is still not higher than the diagnostic cut-off. But, this is the time, when you can advise lifestyle modifications to your patient – a healthy diet, increasing physical activity, quitting smoking etc. This will keep the blood sugar in check and prevent progression to prediabetes or even full blown type 2 diabetes.

Another example is thyroid stimulating hormone (TSH). The normal range is between 1.0 and 4.0. A TSH value greater than 2.5 indicates a risk of hypothyroidism and a value of 4.0 is an indicator of mild hypothyroidism.

PSA velocity is another important test in prostate cancer screening. It is the change in the level of prostate specific antigen (PSA) over time. It has been shown that PSA elevations can precede clinical disease by 5 to 10 years. PSA velocity greater than 0.75 ng/mL per year indicates a higher risk of a diagnosis of prostate cancer than the actual PSA level itself.

Liver chemistry, kidney function tests, electrolytes, lipid profiles, reticulocyte count, SGOT/SGPT ratio are some tests, which should be interpreted carefully, taking into consideration the previous reports, before labeling them as normal.

An example of declining trend is hemoglobin. If the hemoglobin has been slowly decreasing, but within the normal range, then evaluate the patient for the cause of anemia.

In dengue patients, more than the falling platelet count, it is the “rapidity” of fall in platelet count, which is significant. A rapid fall of platelets is a warning sign of impending severe dengue.

Be alert to changing trends in lab results even if within normal limits. Take note of the family history. Repeat the test and/or investigate your patient further. This is how diseases can be diagnosed early and treated timely.

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

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