Hepatitis: Act before it's too late

If Shakespeare was alive today, the theme of one of his modern-day dramas could well be the tragic tale of Hepatitis.

The tragedy however is not that 40 million Indians harbour the virus, and thosands die of it every year, but the fact that very effective prevention and treatment are available for this illness. If, and only if, people knew and acted on time!!

Hepatitis B and Hepatitis C are the names of 2 of the 5 viruses that attack the liver. Why they are usually under the spotlight is because of their propensity to lodge in the liver and nibble away at its cells for years after enetring the body, often finally damaging it completely. This advanced stage is called Liver Cirrhosis. Also both these viruses are notorious in causing Liver Cancer, a deadly disease that usually defies tretament.

In contrast Hepatitis A and E, the viruses that spread through contaminated water or food, often cause a transient illness of “Acute Hepatitis” that abates in 4 to 6 weeks, do not require specific drugs,and never lead on to cirrhosis or cancer.

Ironically, Hepatitis B is a easily preventable disease. The Hepatitis B vaccine, available since 1982, is one of the safest and most effective vaccines ever produced. More than 150 countries have used it in their immunization schedules since the late 80’s and 90’s to protect their children and citizen. The disease has virtually disappeared from America, Europe and Japan where it is diagnosed only in immigrants and travellers. It is being ushered out in more than 100 other countires with the use of mass vaccination. All it requires is 3 injections of the vaccine, the 2nd after one and the third after 5 months,

Why are we lagging behind? To start with, India was one of the late starters to include Hepatitis B vaccination in its immunization programme. The second hurdle seems to be the poor level of awareness among people. Many educated people are still blissfully unaware. Some, ofcourse, knowor have heard, but do not take heed!

World Hepatitis Day will be celebrated on July 28 to create this much needed awareness that could help individuals take small steps to protect themselves and their loved ones. This day coincides with the birthday of Prof Blumberg, who won the Nobel Prize in 1976 for discovering the Hepatitis B virus. Documentary movies in schools, messages aired on radio, rallies by school children, ads in newspapers and health camps in several hospitals in the city, will be some of the ways we hope to reach out to you, and urge you to get protected.

It could be a good day to take the 1^st shot of the Hepatitis B vaccine and gift one to each member of your family for a life-time of protection from this disease.

As published in HT City( Hindustan Times) dated 24 July, 2011.

HOW DO WE REACT TO EMERGENCIES!

Emergencies do not give us much time to think but our response at that crucial moment can be fateful. 

This incident is an example. On seeing a student getting hit by a car while crossing the road near school, a school teacher reacted by stopping another car, loading the unconscious child into it, and requesting the driver to rush her to a nearby hospital. The well-meaning teacher however did not get into the car herself, and in panic, forgot to take down the details of the obliging driver or the car number.

Minutes later, when the girl’s parents got the news and called to know where the child had been taken, the school teacher had no answers!! After rushing form one hospital to another in a beweildered state, the parents finally located their daughter in a nearby hospital. Fortunately this strory had a happy ending: the child recovered, and most important, the Samaritan in retrospect, turned out to be a good one!

As major accidents and terror attacks are nowadays no longer confined to thriller novels or crime movies, emergencies are becoming a part of our daily lives. But are we prapered?

Last week we surveyed around 100 people at random to find out if they knew the emergency numbers to call in case of fire, or the police. Only 48% knew the numbers (for Fire call 101, for Police 100), while more than half of the responders from the educated middl class did not !! The informed ones were largely office-going men and working women.

To find out how they would respond  to a medical emergency, we further enquired what they would do if someone suddenly became very sick at home or office. One of 5 (20%) said they would contact their local physician, 33% would rush to the nearest hospital and 16% to the Trauma Centre. One of 3 responders (33%) however had not thought of how they would respond and said they would decide if and when an emergency occured.

Medical emergencies come without notice, and a prompt timely repsonse can save lives. Most cities in developed countries have dedicated helpline numbers which respond promptly with trained paramedical staff and resuscitation capability, along with an ambulance for transportation to hospital.

Lucknow does not yet have an organized medical emergency helpline. The Trauma Centre (9415007710) is inundated with around 200 emergencies a day, and caters well to trauma cases that constitute 70% of them.

For transportation, a charitable ambulance service (tel 6560000) is available for Lucknowites. It has only 7 ambulances (compare with London’s 400) and comes bare of trained staff or resuscitation facilities. It can however be useful in dire need.

While both medical facilities and expectations of citizen are rising steeply, and the threat of unforseen dangers are looming large in present times, Lucknow needs to develop and sharpen a better organized response system to deal with emergencies. 

As published in HT City( Hindustan Times) dated 17 July, 2011.

Does The Dress Matter?

I learnt how the dress of a doctor sometimes affects relationship with his patient, the hard way. Mrs Sinha (name changed), who had been in and out of  hospital several times due to a chronic liver problem, confided that her confidence sapped each time Dr A was on duty. The reason: he dressed shabbily in crumpled loud-cloured audaciously printed T-shirts, jeans and chappals, kept dirty stubble on his face, and had a sweaty odour. “How can I trust and confide in a dcotor who dresses so carelessly, and expect him to be careful with my treatment?”

 A person’s nature, attitude and character are often reflected through his attire. A doctor’s dress may help convey a subtle message to his patients and their relatives.

In present times when fashion and dress codes change so frequently and radically, doctors are often confused on how to dress appropriately yet smartly. Some stick to the classic “old look” of wearing dull coloured loose pleated trousers, standard white regular collared tucked shirts and black shoes. This vintage look make many patients wonder if the doctor’s medical knowledge is as old as his dress code.

Or take the one in the clumsily-tailored safari suit. You can bet that this officious “babu doctor” knows the government  rule- book with its loopholes upside down, pays home visits to the local brand of VIPs around town, but is many steps behind time in his medical knowledge and skills.

At the other end, some doctors dress to hospital as they would to a beach party, with flashy batiqued silk shirts, striped pants and shocking white shoes, their dress evoking gasps and stirring up discussion among patients waiting their turn.

Young doctors sometimes come to hospital dressed too youthfully in jeans, T-shirts and sneakers, many genuinely believing that competence and knowledge are all that matter. Imagine trying to counsel shocked parents of a child with blood cancer, in that dress! What  they overlook is that appearance and attitude create the first impression on the patient and his relatives, knowledge and skills are tasted later.

“I expect a doctor to dress smartly and formally, so that the first look instills confidence iin me”, says Asma Hussain, the fashion designer.  Light colured plain or pin-striped shirts, trousers (not jeans!), and shoes are the basics. A neck-tie adds to the professional look especially in metros; it may however make doctors look formidably un-reachable to poor and rural patients.

A visiting medical student from England shared how British hospitals insist on a strict dress code. They even forbid doctors from wearing “marks” or indicators of their ethnic and religious background, such as a cross, so that patients do not perceive them as biased.

The issue here is not about a doctor’s freedom. It is about how he can look professional and make his patient feel comfortable, relaxed and trusting.

As published in HT City( Hindustan Times) dated 10 July, 2011.

Vegetarianism

 The attitude of medical science towards vegetarianism has changed dramatically in recent years from concern about nutritional adequacy to exploring its health benefits. Recent evidence nails red meat as a major health hazard of modern times, and recognizes the virtue of plant based diets.

Although the proportion of vegetarians in Europe and America is still small, constituting 1 -6% of the population, the group seems to enjoy healthier and longer lives than their meat eating counterparts. Studies have shown that mortality from ischaemic heart disease was 30% lower among vegetarians.

Vegetarians tend to have lower body mass index, lower levels of cholesterol, lower blood pressure, and less incidence of hypertension, type 2 diabetes, renal disease, metabolic syndrome, dementias such as Alzheimer’s disease and other disorders.Further, the risk of three common cancers, that of the large intestine, breast and prostate, partly attributed to red meat consumption, is substantially less.

The American Dietetic Association and Dietitians of Canada have stated that a properly planned vegetarian diet is "healthful, nutritionally adequate, and provides health benefits in the prevention and treatment of certain diseases". Necessary nutrients, proteins, and amino acids for the body's sustenance can be found in vegetables, grains, nuts, soymilk, eggs and dairy. Vegetarian diets offer lower levels of saturated fat and cholesterol and higher levels of carbohydrates, fibre, magnesium, potassium, folate, and antioxidantssuch as vitamins C and E.
There are a number of types of vegetarianism, which exclude or include various foods.
· Ovo vegetarianism includes eggs but not dairy products.
· Lacto vegetarianism includes dairy products but not eggs.
· Ovo-lacto vegetarianism (or lacto-ovo vegetarianism) includes animal/dairy products such as eggs, milk, and honey.

· Veganism excludes all animal flesh and animal products, including milk, honey, and eggs, and may also exclude any products tested on animals, or any clothing from animals. Perhaps the only ingredient lacking in his form of “pure and strict” vegetarian diet is vitamin B12 and iron.

· Buddhist vegetarianism (also known as su vegetarianism) excludes all animal products as well as vegetables in the allium family (which have the characteristic aroma of onion and garlic): onion, garlic, scallions, leeks, or shallots.

· Jain vegetarianism includes dairy but excludes eggs and honey, as well as root vegetables.

· Pescetarianism, which includes fish and sometimes other seafood. This diet is associated with longest life span.
Vegetarianism started from ancient India and ancient Greece in the 6th century BC. The diet was closely connected with the idea of nonviolence towards animals (called ahimsa in India) and was promoted by religious groups and philosophers. Emperor Asoka decreed “One animal is not to be fed to another”. It practically disappeared from Europe during the Roman Empire.

The International Vegetarian Union was founded in 1908. In the Western world, the popularity of vegetarianism has grown considerably in the last century as a result of nutritional, ethical, and more recently, environmental and economic concerns.

It is time we Indians re-discovered the virtues of a practice that was once ours.

As published in HT City ( Hindustan Times) dated 3 July, 2011.