Helmets , Bikes and Cops

Shubham, a 17 year old student of Modern School and son of our colleague, died in a two wheelr accident last week, sending shock waves, sorrow and remorse in our hearts yet again.

We all know that two-wheelers are the backbone of the middle class especially of its youth. With 45 lac new two wheelers hitting Indian roads every year and 12000 new registrations every day accidents are bound to rise. The number of precious young lives being lost is however disproportionaly high with 115,000 deaths every year in Delhi alone.

The recurring and haunting theme that runs through all these tragedies is that they were not wearing helmets while riding their two wheelers.

Why then do riders not wear helmets? Road research instistute cite these as the common excuses:

1.         “I am a good driver. It cant happen to me”

2.         “There are no cops on this route at this time”

3.          “I am going a very short distance”

4.          “Where do I keep it?”

5.          “It is so hot and uncomfortable”

6.          “Helmets are a useless expenditure”

7.          “I belive in destiny. Helmet can’t change that”

That helmets protect lives in case of two wheeler accidents has been proven beyound doubt. Several studies have shown that wearing a helmet reduces the fatality rate (chances of dying) from accidents by as much as 50-80%. Injury to the head and the brain is the commonest cause of death  which the helmet cushions and protects.

History too supports the use of helmets. When helmet legislation was relaxed in UK in 1979, there was a significant spurt in deaths from two wheeler accidents, necessitating a quick re-implementation. On the other hand strict enforcement in California resulted in saving of $ 35 miilion from hospital costs.

Cops indeed have a vital role to play. Enforcing helmet legislation is of proven value in reducing deaths. Paradoxically, the prime reason why young Indian riders wear helmets, when they do, is to escape being caught by cops; hence they often buy cheap substandard helmets, wear them selectively at crossings where cops are spotted, and take them off soon after having outsmarted them.

Parents need to be a lot stricter with their children too. If caught by the cops for defaulting, it does not help to support their kids and fight with the cops. It might bring their children to harm tomorrow.

Through HOPE Initiative (www.hope.org.in) we have been striving for the last 5 years to stress the benefit of wearing helmets, among students. School authorities have been trying their best too. And yet a road traffic accident continues to occur every 7 minutes in India, and we continue to loose young and promising lives. Parents, employers, academic administration and the traffic police need to join hands to prevent this wasteful and tragic loss of young lives.

As published in HT City (Hindustan Times) dated 18 july ,2010.

Gutkha Blitz

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When Mahadev, a 35 year old father of 3, who works in our department as an attendant, had consulted me 2 years ago for an ulcer on one side of his tongue that was refusing to heal, I recall how sad and worried I had felt telling his family that he was suffering from cancer. Fortunately, the stage was early and surgical removal offered hopes of a cure.

When we called on him after surgery, he was in some pain, with one half of his toungue chopped off and stiched. He had difficulty articulating, but seemed relieved that the cancer was gone. Subsequently, he had to undergo radiation therapy to kill any possible remaining cancer cells in the vicinity of his mouth. Two years later, he seems fine except of the asymmetry of his mouth, but fearful whether the disease might return. He has resolutely kicked his Gutkha habit and wishes that he had done it much earlier before the cancer had struck.

India leads the world in mouth cancer with 65,000 people getting it each year, almost 90% of which are due to tobacco. Chewing tobacco either as Gutka or rolled in betel leaf with areca nut, is the primary cause in the majority, smoking, bad oral hygiene or a sharp tooth being the others.

The syptoms of mouth cancer could be any of the fllowing:

• A sore on the lips, gums, or inside of your mouth that bleeds easily and doesn't heal
• A lump or thickening in the cheek that you can feel with your tongue
• Loss of feeling or numbness in any part of your mouth
• White or red patches on the gums, tongue or inside of mouth
• Difficulty chewing or swallowing food, or a constant sticky feeling in the throat

Dentists and doctors can often spot pre-cancerous changes in the mouth such as leucoplakia (a whitish discoloured patch) or submucosal fibrosis (thickening of the inside of cheeks that restrict full opening of the mouth) before cancer actually develops during a routine check-up

With the popularity of chewable tobacco, particularly among the young, doctors are already reporting a rise in this disease. But what is the reason for this?

		It is only in the last 2 decades that tobacco companies have started selling tobacco ready-packaged in small sachets, called Gutkha. It can cost as little as half a rupee - which means one could buy 90 sachets for the price of US$1.One brand of Gutkha does not say it contains tobacco. Some Gutkha are chocolate flavoured; others are sold as mouth fresheners. In addition, some manufacturers package Gutkha as if it were a sweet - bright colours and children's faces decorate the wrappers.
			Mr Sharad Pawar, who was a tobacco and Gutkha addict, had contracted mouth cancer in 2004 for which he underwent surgery, and subsequently converted to an avid ant-Gutkha campaigner. His face tells it all. It would do us well to learn from his experience. As published in HT City ( Hindustan Times) dated 11 july, 2010.

Vaccine Mania

When a crop of blisters had appeared on my wife’s skin two years ago, the thought of chicken pox had not even crossed my mind. Like many who take their responsibilities seriously, I had ensured that my wife and children had received all their vaccination shots, and that was ten long years earlier.

“And that precisely is the problem” said my dermatologist friend Dr Ajit, who took just a few seconds to diagnose it as varicella (chicken pox). Protection from vaccination is not strong and lasts for only 5 to 10 years, requiring booster shots. And when I asked how long I had to give these booster shots, he merely shrugged his shoulders and said, “probably for life”. In fact I was probably better protected than she was, as like most kids of my time. I had had a natural attack of varicella in my childhood.
While there are over 20 vaccines available in the market, there is no denying that 7 of them given to babies have saved many lives and prevented much suffering. Poliomyelitis, diphtheria, whooping cough (pertussis), tetanus, measles, mumps and rubella have become so uncommon, thanks to vaccination,that a modern pediatrician would find it hard to diagnose them if they see a patient. Small pox is dead and gone, almost entirely due to vaccination. Hepatitis B, is a late entrant to the Indian infant immunization program, and is universally accepted as a ‘must have’. BCG, that is supposed to protect against tuberculosis, and is ceremonially given to each newborn infant, is in fact the weakest one, as questions are being raised about its efficacy.

With the range of vaccines widening and with multinationals promoting their brands among pediatricians and doting parents all for protecting their children further,the shelf is getting crowded. Although labeled “optional” (which parent would deny it to his baby if the pediatrician says it is safe and protective, never mind the cost!) Hepatitis A and chicken pox vaccines are both expensive and are yet to prove their worth in India, more so in adults. Another one, the pneumoccal vaccine, is touted to protect against potentially fatal chest and brain infections with pneumococcus. The vaccine indeed protects well against the 23 strains that are encountered in the west where it is recommended and has been shown to be of value. There is however no evidence that it protects against Indian strains that comprise the remaining 67, many of which are the real culprits here.

The scenario of vaccination in adults is a lot complex than it is for infants. The Human Papilloma Virus vaccine, 3 doses of which are recommended to adolescent girls, offer protection against cervical warts and cancer, diseases that are getting infrequent anyhow. Fortunately, despite our escalating enthusiasm, the rabies vaccine is still recommended only to those who have been bitten by stray or mad dogs! Let us not let vaccine companies convince us that all our children would be better off with it too.

As published in HT City ( Hindustan Times) dated 27 june, 2010.