GAYS Die Young!

Until the recent Delhi High Court judgment decriminalizing homosexuality, this subject was seldom discussed in public.  Sex between 2 people of the same sex was considered unlawful, immoral and hence remained clandestine. The extensive media coverage of exuberant gays and lesbians hugging and petting each other in the open, after the judgement, has made many wonder if being gay has become the latest “in thing”.

Homosexuality poses a hazard to health. In a study of 5406 homosexual men in Canada, Dr Robert Hogg noted that their life expectancy was reduced by 8 to 20 years (http://ije.oxfordjournals.org). Through another recent study, researchers from Center for Disease Control (CDC), USA, reconfirmed that gays die around 10-20 years younger than those who engage in normal sexual practice. “These sobering results of our research should encourage our society to reaxamine what it’s doing with those who engage in homosexuality”, says Dr Paul Cameron, President of the Family Research Institute, who headed the study. He went on to say “schools are doing a fine job educating students about the dangers of smoking and use of illegal drugs, but are increasingly teaching that homosexuality is normative and safe as heterosexual behaviour. It is NOT. Homosexual activity is much more dangerous to health than smoking” (LifeSite News.com).

The most common health problems in homosexual men are:

1.      Increase in infections: especially HIV / AIDS, syphilis, gonorrhea, pubic lice, Hepatitis B, papilloma and warts.

2.      Increase in cancers: especially of large intestine (colon), prostate, and testes.

3.      Increased incidence of eating disorders such as bulimia, anorexia nervosa and obesity

4.      Increased incidence of psychological problems: such as anxiety and depression. Suicides are 6 times more common among homosexuals than straight people.

5.      Increased incidence of addiction problems especially: tobacco (50% more than in straight men) alcohol, drugs.

In addition, problems with body image are more common among gay men. They more often indulge in muscle building, ear piercing, tattooing, and use substances like anabolic steroids and supplements that can adversely affect their health.

Lesbians also have increased similar health risks; they are particularly prone to breast and gynecological cancers.

In India, atleast 2.5 million men self identify as exclusively homosexual; the actual number could be much higher. It is postulated that while 95% of people get attracted to the opposite sex from the time they become adolescent, 5% are sexually oriented to the same sex. Environmental pressures probably contribute in shaping sexual preferences; it is common knowledge that homosexuality is more prevalent in same sex hostels, jails and barracks, and when opportunities for normal heterosexual exposure are denied for prolonged periods.

As published in HT City ( Hindustan Times) 

Making Hospitals Better Places

In this column last Saturday, we discussed how hospitals, which most citizen behold as morbid,  frightful places can be transformed into  pleasant , stress free, clean places, where people take care not only of the sick patients, but provide opportunities for the “healthy” attendants to check the staus of their health as well.  This could be your wish list from your hospital:

1.       The whole hospital environment becomes “health promoting”; for example a patient who comes with a minor skin problem also gets an opportunity to get his BP, blood sugar, weight checked and get gets to know if he is overweight or has a cardiac risk.

2.       While waiting for your doctor, you watch a glow screen or CCTV informing  about the benefits of taking the 3 shots of Hepatitis B vaccine, and are reminded to vaccinate your children and spouse as well.

3.       The hospital is spotlessly clean with no gun toting or paan-chewing goons. None of the hospital staff consumes tobacco, and colorful posters confront and remind you of the risk you run and confer to your family in continuing with your smoking habit or by remaining obese.

4.       The hospital respects your time: you do not have to wait long, as you have prior information of which doctor will meet you, when and for what, all sorted out through a telephone or e-mail helpline.

5.       The doctor is understanding and answers all your questions with clarity, backed by scientifc data. He is not affronted when asked how many such surgeries, he has performed, and their outcome and risks. He also seems, stragely for UP, willing to discuss alternative forms of treatment, and is, in fact, willing to suggest names of experts should you want a second opinion.

6.       The tests he advises are easy to book and undertake. Your blood sample is collected with disposable needles and syringes that are destroyed and discarded after use, and the results of the tests are accurate and arrive quickly. You could even ask how the laboratory maintains and ensures its standards.

7.       If you are an attendant of a sick admitted patient, you have a cafeteria where you can get a healthy meal, opportunities to meet the treating team for periodic updates and opportunities like a mediatation room or soothing music or counseling to help you tackle your own stress.

8.       If your relative is a diabetic for instance, your hospital teaches, trains and prepares you to test his blood sugar when he goes home, provides you a chart to record his sugar values and insulin doses, look out for signs of low or high sugar and an opportunity to contact and seek help when in trouble.

9.       For all this and more can be achieved only with community participation. Every responsible citizen of Lucknow should join in the “Friends of SGPGI” forum to provide his observations and suggesions. Did you know that SGPGI (www.healthpromotion.in) has been the pioneer in this endeavour in India? And you could play a crucial role in shaping your hospital?

As published in HT City ( Hindustan Times) dated 22 november, 2009.

Are You Scared of hospitals?

You wouldn’t probably go visiting a hospital on a free evening, or be called a luny if you did. And if an ambulance parks outside a neighbour’s door in the colony, your heart would pound as you wonder whom you might lose soon. 

Yes, hospitals are necessary evils you can’t wish way. They often become common bashing topics at parties. And the variety of sub topics that hospitals provide are varied enough to keep a converstaion going for ages: attitude of doctors, the way nurses behave, the bedsheets, the long waits for investigations, the gentry, the inconvenience and long queues for payment, the escalating cost of care, how last time a person you knew went to that place and died (never mind if he had a terminal cancer and went there gasping), or if anyone who went in critically ill and came out better did so in spite of the hospital rather than due to it! And add to it the topics of unnnecessary investigations, delay in response, or that or that how cruel it was of the doctor to say that there was no cure for this disease, and you have your day.

 TV serials have added another aspect of this changing patient-doctor relationship. Every time a doctor faces anxious relatives overwhelemed with emotions,to say that the patient is critical or dead,  gets his collars pulled and shoved around in disbelief. If Ekta Kapoor has her way, doctors will soon become extinct.

What am I getting at? Can hospitals become friendly places that you may care to visit without feeling so nauseous? And if hospitals are essential to the society we live in, can we put in our small efforts to improve them?

The World Health Organization has initiated a new concept called Health Promoting Hospitals. They could play a larger role, not just tending to sick patients but in promoting positive health to friends and relatives who accompany the patients. For instance, a patient admitted with terminal lung cancer due to years of smoking, may have smoker friends and relatives who come calling; hospital could be a perfect setting for providing simple, attractive, IEC (Information, education and counselling) packages. This, in fact, may be the best time and place for the smoker friend to be motivated to quit smoking.

Promting Health is unfortunately much more than putting signage and passing orders. “No Smoking” does not convey quite the same meaning. Charts, pictures and friendly counselling services can achieve much more!

And what has been your role in improving the hospital in your city? It is a nasty question to ask in a party, but the responses are predictable. Businessmen say “It is the government’ job” , beaurocrats say  how they sanctioned funds to the hospital when they were in the concerned department, but sing praises of the private hospitals where they go for their own treatment nowadays, ladies aah –ooh and say “how unfortunate” , while many simply walk away to join another group.

Do you really care? You can make a difference!

 As published in HT City ( Hindustan Times) dated 15 november , 2009.

Heartburn and Acidity

Do you get burning sensation behind your chest bone, or have sour food come into your mouth? Do you wake up at night with “heartburn” or “acidity”, and need to drink water or take antacids for relief? If this happens more than once a week, you are suffering from GERD (Gastro-Esophageal Reflux Disease) one of our modern day maladies.

GERD is caused by refluxing of acid that is normally produced by the stomach, into the food pipe or esophagus, due to malfunctioning of the one-way valve located at the stomach-foodpipe junction (GE valve). A recent nation-wide survey from 25 centers, conducted by the Indian Society of Gastroenterology, found that 8.4% of Indians suffer from this disorder. If you are a sufferer, you have 80 million in India for company!

GERD is a lifestyle disorder, and hence a phenomenon of our times. Those who are overweight or obese, tend to have loose GE valves and are prone to reflux. Alcohol, nicotine (in tobacco), caffeine (in coffee and tea), fatty food ( pastries, fried food, cheese, cream),chocolates, and pungent spices cause relaxation of the GE valve and are notorious for causing GERD, accounting for the early morning “heartburn” often experienced after that perfect late night party. An aspirin or pain killer swallowed to clear the headache can worsen the reflux.

Diagnosis of GERD is fortunately not difficult as the symptoms are quite specific for this disorder. The commonest test advised is an endoscopic examination, during whcih the doctor assesses whether ulcers have formed in the foodpipe (esophagitis) by the refluxing acid chyme. In many with severe symptoms, the changes on endoscopy are surprisingly mild, prompting specialists to coin a term ENRD (endoscopy negative reflux disease).In few however, ulcers form in the foodpipe, often leading to scarring and narrowing, and sometimes to cancer. Lower esophageal cancer is on the rise in most parts of the world due to increasing frequency of GERD.

Changes in life style certainly help; the problem today is the practical feasiblity to adhere to them. Regular exercises, maintainance of ideal body weight, avoiding all the predisposing foods and beverages, a small early dinner of “sukhi roti” and boiled veggies, and elevating the head end of the bed, do work. Those who can’t change their ways, prefer to take pills that reduce acid production in the stomach (Proton Pump Inhibitors or PPIs) or tighten the GE valve. They work well, but only as long as you keep taking them.  Pharmaceutical companies claim they are safe when taken for as long as15 -20 years. Longer studies are needed as many youngsters start on them from their teens and have 50 years ahead.

Recent research has identified a phenomonon called Rebound Hyperacidity Syndrome in people who have been on PPIs for long periods. On stopping, their stomachs produce large amounts of hydrochloric acid on the rebound, making them dash back for their pills, creating a kind of dependence. Refluxers are often confronted with a life of “Pleasure and Pill”or that of a “Frugal Pauper”. Not easy!

 As published in HT City ( Hindustan Times) dated 8 november , 2009.

Let's say NO to PLASTIC BAGS

Many accused the Delhi Government‘s banning of the ubiquitous plastic bags in shops and hotels since January 2009 as overkill and unmindful of its many benefits.The court however observed that plastics had indeed become a serious hazard and upheld the decision.

Plastic carry bags that are so liberally doled out by grocers and store-keepers are emerging a major killer. They are made of polythene, a product of petroleum and can be seen littered on roadsides, drains and fields while you travel by car or train. They choke landfills and drains and have even caused floods. They block the intestines of cattle and marine animals when they are ingested mistakenly while grazing, and kill around 10, 00,000 each year by painfully strangulating their intestines or by choking. Disposing these bags is not easy; their burning releases toxins that are harmful to environment and us. Burying them causes the landfills to choke as polythene does not breakdown and decompose easily, and when they do, release toxins into the soil that find their way into the food chain.

Sometimes plastic bag litter can have even further consequences. According to Nobel Peace Prize winner, Professor Wangari Mathaai, discarded bags fill up with rainwater and become perfect breeding grounds for malaria-bearing mosquitoes. Researchers from United Nations Environment Program have recommended banning of plastic bags to check malaria and save lives in several such countries. Social costs of plastic litter add up as well; countries lacking comprehensive waste management often sprout underground economies of ragpickers — typically children who wander refuse heaps and collect potentially recyclable materials for sale to shady businessmen operating from official dump sites.

The problem with plastic bags is that it has become the victim of its own success. It is cheap, light, impervious and convenient with around 5 trillion produced each year. Their menace can be contained by the 4-Rs — Reduce, Recycle, Re-use, Repair. Encouraging the use of locally-made cotton or jute bags is more environment friendly.  Several developed countries have concentrated on re-use. Unfortunately the disposal, collection and recycling of used plastic bags in poor countries pose logistic problems with less than 1% ever been recycled.

Visionary governments may follow the Delhi’s example, but till such time, what can we do as responsible citizen? If we take our jute or cotton “jholas” when we go to the grocers, it would reduce the use of plastics. Celebrities could make it a fashion statement and the media can publicize it. Retailer chains could offer an option of jute bag carry aways, at a little extra price; many of us wouldn’t mind it. And if we could ensure clearing of the littered bags in our vicinity, we could reduce the breeding places of mosquitoes and the harm they cause to cattle. A difference, no matter how small, is urgently worth making, and we can set examples and inspire others to join in.

 As published in HT City( Hindustan Times) 

Are You Depressed ?

When Sunita, a 20 year old engineering student, was brought to my clinic by her father a few years ago, nothing seemed grossly out of place in the nvestigations that she had gone through. Yet nothing was going right for her. While she had been a topper of her batch in school, she was now struggling to pass the year ending examinations, had developed a repulsion to the college, her books and the hostel, had stopped chatting or going out with friends, and had even started avoiding going home on holidays. She was not sleeping well at night, had lost her appetitie and could not remember the last movie she had seen. My suggestion that she could be depressed met with strong disapproval from her father. He demanded that I certify Sunita to be free of any serious disease, and insisted that she had to work hard and exell in studies to compensate for all he had struggled and invested to get her to become an engineer. I heard that Sunita unable to cope and pull on, ended her life a year later. She was one of the 16000 students who committed suicide in India between 2004-8.

Depression is no longer a rare remote disease; it could be affecting someone in your home or vicinity. Its frequency in youth has increased from 2% to 12% in the last 5 years. WHO has labelled it as the No 1 occupational disease of the 21^st century and estimates that 1 of every 3 individuals will suffer it at least once in their lifetime, and could be serious enough in 1 of every 7 individuals to require specialized attention and treatment.

While life has its ups and downs, a rather prolonged, disproportionate phase of lowness should arouse concern about depression. It is characterized by sadness, hopelessness, loss of interest in usual activities, difficulty in concentrating, poor self esteem, feeling of guilt, over reaction to criticism, and sometimes anger or rage. Sleep and appetite are often disturbed. Affected people often start abusing alcohol and drugs.Friends and relatives can often recognize it if they are aware of the symptoms.

Ability to laugh becomes a casualty in this disorder. While children laugh around 300 times, adults laugh only15 to 100 times a day. Depressed people find it difficult to muster a laugh, and when they do, seem to do it sardonically. Also, vague persistent physical symptoms could have their origin in the reduced levels of energy that underlie depression.

Of further concern are studies showing that upto 50% students could be stressed or depressed, 10% seriously so, of whom 72%  admit being unaware of how to deal with their feelings. Depression and suicidal feelings are treatable disorders: the child or adolescent needs to have his or her illness recognized and treated. Encouraging group activities, social and family bonding, freqent merrymaking and laughter, and keeping career goals in proper perspective are essential preventive tools.

For parents, it is essential to remain approchable and maintain openness so that their children can share their feelings without inhibition, fear or embarrassment. And if you notice an adverse change in their nature or hear them they say they are feeling low or depressed, please do take them seriously, before it gets too late! If only Sunita’s father had listened!

As published in HT City ( Hindustan Times ) dated 1 november , 2009.

The Morning After Pill

More than a year after its introduction into India as an over the counter (OTC) drug, the Emergency Contraceptive pill seems to have become quite popular. Marketed by atleast 2 pharmaceutical companies, namely Cipla (i-pill) and Mankind (Unwanted-72), awareness about their existence among women who can watch TV has become widespread. 

Emergency contraceptive pills (ECPs)—sometimes simply referred to as emergency contraceptives (ECs) or the "morning-after pill"—are drugs that act both to prevent ovulation or fertilization and possibly post-fertilization implantation of a embryo. Hence they are distinct from medical abortion methods that act after implantation. As its name implies, EC is intended for occasional use, when primary means of contraception fail. Since EC methods act before implantation, they are medically and legally considered forms of contraception.

ECPs contain the hormone levonorgestrel, a progestin, alone in a single dose of 1.5 mg (as in i-pill) or a high dose combination of estrogen and progestin that are contained in routine contraceptive pills. When taken within 72 hours of unprotected sex, the pill offers 89 per cent protection from an unwanted pregnancy. Its effectivity is better if taken early after the intercourse. It is available without a prescription at all chemist outlets. Some side effects do occur: although they are usually mild: around 50% of women experience nausea. Some vomit or may have mild abdominal pain, dizziness, mild swelling of breasts or irregularity in the next period. Patients witha rare disorder called porphyria,can experience serious side effects. The drug is contraindicated in women with thrombotic conditions, history of stroke, liver disease or breast cancer. The pill does not protect from HIV infection.
The reason for the pill’s popularity among women is the following statistics. Around 78 % of the prgnancies in India are unplanned. The woman is faced with the choice of continuing with the unwanted pregancy or to seek an abortion, facilities for which are not easily available everywhere. Apart from being expensive and risky even in the best of centers, preganant women land up getting 5 million unsafe abortions in India every year, many dieing of their consequences. The ECP taps into the need for emergency contraception in this scenario, as a safer, cheaper and more effective option. The pill provides the woman an opportunity to decide for herself on her reproductive life and physical and emotional consequences coming off her sexual act. It could be a great saviour for victims of rape, forced sex or contraceptive failure
Concerns have however been raised about promoting the “Pop-a-pill the morning after’ culture which could popularizing and encourage sexual promiscuity, risky sexual behaviour and adventurism especially among young women. These could help spread diseases like AIDS. Further, many women frequently resort to this pill as a substitute for planned long term contraception.In England, teenage school girls can freely ask for the pill by sms after an unprotected sexual intercourse. Many conservatives would argue that teaching responsible behaviour and traditional values to young girls would be more appropriate. The Vatican has discouraged the doling out of these pills in many parts of the world.
The pill, atleast for the present, seems to be here to stay, breathing a spirit of liberalization and control in women who feel better equipped to modify their destinies with it. The long term societal consequences of the pill will however become more clear with time.

 As published in HT City ( Hindustan Times)

Ragging and Inferiority Complex

College freshers and their parents might wonder what Prof Rajender Kachroo might have felt when his son Aman was beaten to death by his seniors a year ago in the name of ragging. One may also wonder what made four “senior” medical students, aged perhaps 19 and who had chosen medicine as their carreer, gang up and beat a lone helpless fresher to death in a display of their might and supremacy.

Ragging in Indian campuses has existed for atleast 3- 4 decades. It was agonizing and humiliating even in our times in the early 70s. I recall how some students loved to rag, and were at their liveliest during the days when freshers came in. They would  terrorize trembling new comers who had just ventured out of protected homes.

In the initial days and weeks of our joining,  we saw these “senior” raggers to exude confidence and power but as we settled down and got our bearings over the next few months, we realized that most of them were phonies, repeaters or perverts of some sort. Very few were scholastically good, had any kind of leadership quality (apart from rousing a mob of frustrated raggers like themselves) or ever subsequently served as role model for their juniors.

A year later when the next batch arrived, we were surprised to find some of the quiet mates suddenly turn aggressive raggers; they were not the achievers,  leaders or the friendly types, but  the ones who had gone unnoticed the whole year, had stuck in small groups, indulged in drinking or drugs, or had come from “problem” homes. They had not attained much recognition amongst their class mates or peers the whole year, due perhaps to lack of any special skill or ability, and even gone unnoticed by girl students. Instead, as though to atone for their inadequacy, they dispalyed insatiable energy in ragging helpless freshers, and threw their weight and strength at them in desperation to be noticed and feared by atleast someone.

Raggers suffer from the INFERIORITY COMPLEX, in which they consider themselves, in their heart-of- hearts (unconscious mind) to be inferior to those of their own match. This constant gnawing feeling of inferiority drives them to bully or rag those who are younger or more vulnerable, so that they may experience a perverted sense of superiority.  Bullies in school are no exception. They indulge in fights or use force against younger and weaker kids with whom they run no risk, shying away cowardly from those who are their equals.

Apart from banning ragging, bullies and raggers should be compulsorily sent for psychiatric help. Perhaps making them understand the complex they suffer from may help restrain them from harming others and themselves.  And would medical students who rag and harbour this trait, be ever able to emerge as kind doctors who will tend to ailing and weak patients with respect and concern?

 As published in HT City ( Hindustan Times)