Mother Teresa's LESSON OF LOVE

As the world is celebrates the 100^th bitrh anniversay of Mother Teresa, who has become the lasting symbol of caring and loving for the sick and the poor, I wish she had gone around in her younger days inspiring medicos to add empathy to the medical science they practice. What is often forgotten in these arrogant hi-tec days is that modern medicine needs all its 3 legs – science, skills and caring, to stand firmly in society. Ironically, although photographs of Mother Teresa  often adorn the walls of rich homes and institutions, her spirit of humanitarism seems wanting, especially in hospitals and clinics, where it is needed most.

There was a time not long ago, when physicians and nurses didn’t have much else to offer patients other than personal attention, comfort, compassion and concern for their ailments. Medical professionals were revered and respected for that and for what little they could do in regard to symptomatic treatment for incurable conditions.

The Twenty-First Century has thrust health care into an era of modernization, precipitated by advances in medical technology and computerization of everything in sight. We have made fantastic strides in the diagnosis and treatment of many serious illnesses. Patients are living longer and more productive lives as a result of these wonderful advances.

However, concomitant with these changes, we have experienced the indisputable depersonalization of patient care. Patients are often treated as diseases or numbers. We often hear medical personnel referring to a patient as “the gallbladder in room 6” or “the COPD in ward B”. We order test after test instead of taking a history because if we don’t “prove” our diagnosis with a test, we may be subjected to a lawsuit later if something goes wrong. And in spite of all these patients are often dissatisafied and litigations are on a steep rise.

What could make Mother Teresa tick? Her home for the sick and destitutes, called Nirmal Hriday, was crowded and lacked adequate medical facilities. I understand that Mother Teresa had infact, during her life time, come under criticism from some quarters, for running a hospice with substandard facilities. Despite these, patients thronged there, received love and care, lived their last days with dignity and died with a smirk of satisfaction on their faces. And their relatives did not shout at the staff or file litigations in courts.

I remember listening to her Nobel Prize acceptance speech in 1979 that spoke only of love. Her Nirmil Hriday was described as “a place of hope, a house built on courage and faith, a home where love reigns, a home filled with love." I wish our hospitals could say that of themselves!

One of her quotes that I have had pasted on the back of my clinic door and which has reminded me from time to time is “Let no one who comes to you ever leave without feeling happier and better”. Try it on your door and see the difference.

As published in HT City ( Hindustan Times) dated 29 august, 2010.

Violence Against Doctors

If what is shown in TV soap operas, widely considered to reflect the mood and pulse of the society, is any indicator to go by, then doctors being held by the collar by anxious relatives, is not surprising.  Aggression against doctors is on the rise and is imapacting the way doctors deal with patients.

If you ever had an emergency at home and wished the doctor would come running with just a phone call, you must have been disappointed. One of the direct fallouts of increased aggression has been the discontinuation of “home visits” by most GPs. The official explanation is the difficulty and inadequacy of organizing tests and medical support for a critically ill patient at home, but  at heart most doctors shudder at  being trapped in a sick patient’s home with anxious relatives demanding miracles, and threatening them if things don’t work out well. 

Physicians are nowadays wary of giving injections to seriously ill patients at homes and clinics lest his condition deteriorates and relatives ascribe it to the injection. This fear is costing lives as injectable emergency interventions such as adrenaline for severe allergic reactions, terlipressin for blood vomiting, anti-epileptics for fits are deferred till the patient reaches hospital, often a good 2 hours late, and sometimes just  too late.

Aggression against doctors is increasing in parallel to the increase in violence in society. Doctors report verbal abuses and threats, pulled by the collar or jostled, punched, stabbed with knives, have furniture thrown at them, hit with sticks or even shot with guns. In a survey of GPs in England reported in the Journal of Royal Society of Medicine, 73% reported aggression in a year and 87% worried about violence at work.

Vandasim is another form of violence and seems particularly common in India. Recently a mob smashed panes and set fire to a hospital in Kolkata for refusing to entertain a road traffic accident victim. A similar event that occured in Mumbai sometime ago sent fear waves down the spine of their staff.

Agression although encountered most commonly in Psychiatry clinics and in Accident and Emergency wards, can occur in any department. The typical agrressor patient is usually young, ofmale sex and often under the effect of alcohol or drugs. In emergency wards, the aggressors are usually relatives or companions of patients, often in large groups. The suddenness of the event such as a fatal accident, makes acceptance difficult, often leading to aggression. A long waiting time

 As published in HT City ( Hindustan Times) dated 22 august , 2010.

Foundations boost India's Health

If college students  and truck drivers in India know that  condoms protect from HIV infection or if mothers know that the best strategy to save their children when struck with diarrhea is to feed them ORS (oral rehydration solution), it has been largely due to awareness waves generated by  foundations  and non-governmental organizations. They have often provided the much needed boost to our government’s resource-crunched meagre efforts at public awareness and health promotion.

Some of them such as the Wecome Trust that has supported research on diarrhea, and the Bill and Melinda Gates Foundation has stemmed the tide of HIV infection in this country. In fact Mr Bill Gates’ concept of corporate philanthropy and his recent enthusiasm in giving back to society from which he made his big bucks has infected many billionnaires such as  Mr Warren Buffet who has pledging a sizeable part of his wealth for similar work.

 Bristol-Myers Squibb Foundation (BMSF) is one such philanthropic wing of a giant corporate with the mission to help mobilize communities in the fight against disease.  Its great success story called “Secure the Future” made a big dent in the AIDS endemic in Africa through community action.

One of the leaders of the project and presently the BMS Foundation’s director Ms Phangisile Mtshali is now spearheding a major project that aims to tackle Hepatitis in Asia, Delivering Hope: Awareness, Prevention and Care program, with its main focus on Hepatitis Band C.

The 4 projects on Hepatitis B that BMSF is supporting in India are all unique and innovative. One is based at the Christain Medical College, Vellore, and uses tele-network to link and spread expertice and awareness to 500 doctors and hospitals. Another in West Bengal  uses “quack s” in rural areas with the belief that if you can’t get rid of them, might as well educate and use them for controlling Hepatitis B. A third in Tripura, is partnering with a very supportive lcal government and organizing massive vaccination camps to root out Hepatitis B. Amazingly, the people, now convinced of its utility through public awareness  strategies, don’t mind paying for their vaccines.

In Uttar Pradesh, they are working with HOPE Initiative (www.hope.org.in) to create awareness in school children with the belief that a school-to- community approach will improve the health not just of the children but of their family members too,  as health messages are taken home by the young health ambassodors.  It has reached out to 3 lac children through 520 schools across 9 districts of the state.

Mr John Damonti, President of BMSF who will be on a tour to India next week should be a satisfied man to see how his support is changing the lives of millions in India.

As published in HT City ( Hindustan Times) dated 15 august , 2010.

How Safe is our Food?

When food procured from the local grocer and prepared for serving to the Prime Minister during his recent visit to Kanpur was found to contain impurities, it made headlines for a day. That a billion Indians eat the same food considered unsuitable for the prime minister’s consumption, every day, does not seem to arouse us.

A wide variety of chemicals, pesticides, impurities, hormones, toxins, additives and insecticides find their way into our bodies through the food we eat. It begins with chemical fertilizers and pesticides used in farming. Of late, our farmers have discovered that injecting a hormone called oxytocin, which is normally produced by the human body for making the uterus contract or express milk from breasts, can enhance farm produce and make the fruits and veggies look fatter, bigger and garden-fresh. Another chemical agent, calcium carbide, is commonly used to ripen fruits.

There is growing concern what they might be doing to us when we consume them. The dangers this time are not the cliched “cancer scares” but possible links to nervous breakdowns, sterility and neurotic disorders. A disorder of children being increasingly linked to toxic food additives is Attention Deficit Hyperactivity Disorder or ADHD. Children manifesting this disorder are unable to sit still and concentrate, are restless and show impaired learning. Several chemicals, coloring agents and preservatives such as glutamate and benzene are suspect. Glutamate is commonly present in monosodiumglutamate or MSG, preservatives and canned foods, while benzene is used as a preservative in cola drinks and fruit juices.

Pesticides, insecticides and rat poisons used at various stages of food production and storage can be harmful too. If the Bhopal gas tragedy is any reckoner, it was leakage of these poisons from the Union Carbide insecticide plant that killed thousands of humans and maimed many others. Their harmful effects may not be readily evident, but regular small doses can be bad for our nerves and brains. Heavy metals, such as lead or aluminium, often present in garnishings of sweets, can lead to dementia or foggy brains.

Several developed countries such as Scandinavia, Australia and Germany have therefore banned food additives, artificial flavours and colouring agents from use. Germany boasts that its lager and cheese are totally free of impurities and taste-enhancers.

Organic farming, in which grains, veggies and fruits are grown naturally without any fertilizers, chemicals or hormones, has already become the fashion statement of the rich and the evolved. Organic food looks lean, wrinkled, and lustreless but is healthier than our artificially fattened brinjals or painted deep green bulgy cabbages.They also cost much more as the yield is smaller as they are grown without fertilizers and other chemicals.

 In most parts of India, plump and clourful is still in and hence safe food on our tables seems quite a way off. It is time we looked beyond size and looks and paid attention to our health.

As published in HT City ( Hindustan Times) dated 8 august, 2010.

Medicine & Media : A Bumpy Marriage

That medical gossip makes interesting news was clearly evident when the headlines and front pages of major dailies blared about Mr Amitabh Bachhan’s intestinal diverticuli or Mr Manmohan Singh’s blocked coronaries, dispeling the daily din and clamour of politicians and criminals to corners of its remote pages. While politics is their staple diet, a glance through the pages of the morning papers or magazines display a good dose of medical news, be it beauty tips, cancer scares or hot news from the oven of medical research.

Of the several types of health news, “tragic tales” of individuals who have lost their limbs, livers or lives due to medical negligence is the type of story that the novice reporter feels most excited to file. “Happy case reports” of how a child from Pakistan successfully underwent a heroic corrective surgery for a rare heart disease, and went happily back home, comes next. It brings with it a “feel good factor” and comes as a whiff of freshness amidst the scandals, murders and political rallies.

A new facilitiy inaugurated in a hospital, is another type of news that the reader may find useful. The focus is often however on the celebrity who inauguarated the facility and the moronish words he uttered in the function, rather than the utilty of the machine, experience of those likely to operate it.

“Scary news”, the fourth category is exemplified by reportage on the spread and risks of Swine Flu that made many people panic. Reports of medicines being in short supply added helplessness to fear, and made people feel doomed.

Celebrity news is the most exciting with readers devouring every single detail of what is printed or said. Every reader new about lethal drug cocktails in the aftermath of Michael Jackson’s death, about schizophrenia that took the toll of the once pretty Parveen Babi or about kidney transplantation after Mr Amar Singh’s return to the TV studios.

Profiling doctors and hospitals is another kind of coverage that sometimes borders on promotion. The doctors and hospitals, usually private, must be engaging well with the media as only heart-touching stories of success and greatness seem to find their way in the pages, while audits and failures never do. And as public opinion is craftily shaped, readers often travel long distances in search for the dream destination.

The most impact of media that I have seen, has been patients of Hepatitis B or C who were proclaimed untreatable by their physicians, come to my clinic with newspaper cuttings and renewed hopes of cure. “Till we read this, we were just waiting for death” said one with tears in her eyes. From being the society’s conscience keeper to a harbinger of change, that is the positive power of the media. Three cheers!

As published in HT City ( Hindustan Times) dated 1 august, 2010.