Categories
Healthcare Delivery

Can pharmacists reduce the disease burden of doctors?

The following is a guest post by Pharmacists and Medical Expert Katta Anand Srinivas

Problem: There is one doctor for every 1,445 Indians as per the country’s current population estimate of 135 crore, which is lower than the WHO’s prescribed norm of one doctor for 1,000 people. This is a known stat and this problem has been highlighted over and over again. My attempt with this writeup is to highlight if we can manage our existing talent resources of Pharmacists (PharmD graduates or Post-graduates / Doctorate in Pharmacology only) professionals to reduce the burden on Physicians.

Facts: Before going into the details of how Pharmacists can contribute to the subject under discussion, it is worthwhile to look at the current health status of Indians in workforce.

  • Lifestyle diseases are hitting India where it hurts — its workforce
  • Over 61 per cent of all deaths in India are due to lifestyle.
  • 33% of the population above 30 are suffering from one or more lifestyle diseases.
  • Every 12th Indian a diabetic — India ranks second in the list of countries with highest diabetes patients.
  • Nearly 26% of deaths in India are caused due to heart ailments.
  • The number of overweight and obese people in India doubled.
  • 42.5% of corporate employees suffer from depression
  • 52 per cent of corporate employees are afflicted to lifestyle diseases
  • lifestyle habits of employees result in productivity loss worth Rs 24,000 crore to the IT sector in Bengaluru every year which is around 7% of the IT sector’s total revenue in the city.
  • Employees in the age group of 30-40 years of age contributes to highest share which is 42 per cent of total cost to IT sector due to productivity loss.
  • 23% of women and 19% of men in the workforce are obese.

Discussion: This lifestyle diseases are mostly caused in the younger population due to Metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These

conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.

High Blood Pressure: White coat hypertension is a condition affecting patients whoexperience stress or anxiety at a medical setting such as doctor’s office or hospital. This results in a higher than normal blood pressure reading during their visit. White coat hypertension is reported to occur in as many as 25 per cent of the population, increasing the risk of misdiagnosis.

Undiagnosed Hypertension: As per one of the study 10.1 % among the study population were not even aware that they have hypertension until they observe symptoms related to heart disease, makes the scenario rather grim. When left undetected, hypertension can cause damage to the cardiovascular system and internal organs, such as the kidneys.

Globally, 51% of stroke (cerebrovascular disease) and 45% of ischaemic heart disease deaths are attributable to high systolic blood pressure. At any given age, the risk of dying from high blood pressure in low- and middle-income countries is more than double that in high-income countries.

A patient might visit a doctor’s office maybe twice a year or sometimes only when they are sick, unlike their visit to their local chemist. Chemist / Medical stores are visited by the patients at least 3-4 times a month for buying prescription medicines, OTC, Diapers, Feminine hygiene, cosmetics and patients might see the pharmacist / pharmacy when they pass by, as they reside in the same community. This increases the comfort level and reduces the anxiety hence less chances of white coat hypertension. Additionally, hypertension screening at the local chemist shop as they are frequently visited by people (above the age of 30) for minor ailments like diarrhoea, headache, muscle sprain, band aid, vomiting thus reducing the cases of undiagnosed hypertension.

Diabetes Mellitus (“diabetes”) is one of the fastest growing chronic diseasesworldwide, and is associated with significant morbidity, mortality, and health care costs. Diabetes is characterized by high levels of glucose in the blood (hyperglycaemia).

The statistics related to diabetes mellitus globally are alarming. The International Diabetes Federation (IDF) Diabetes Atlas, Seventh Edition, 2015, provides the following estimates: one in 11 adults have diabetes (416 million), nearly half (46.5%)

of adults with diabetes are undiagnosed, and a person dies from diabetes every 6 seconds.

Adults with diabetes have a two- to threefold increased risk of suffering a heart attack or stroke compared to those without diabetes. The microvascular complications of diabetes mellitus make it the leading cause of preventable blindness (Diabetic Retinopathy), renal disease (Diabetic Retinopathy), and amputation (Peripheral Neuropathy and vascular disease) in developed countries.

Diabetes has widespread effects, for every 4 people who have Type 2 DM, about one is undiagnosed. Some of the factors that put a person at risk for diabetes include a family history of the disease, obesity, physical inactivity, high blood pressure, and high cholesterol.

Pharmacists are in a prime position to identify these and other risk factors in patients. Routine and simple tests such as blood glucose testing conducted at health fairs and wellness clinics at pharmacies across the country are an example of how a simple test conducted in the pharmacy or by the pharmacy team may provide an efficient method for identifying a patient with a potential diagnosis and help direct them to appropriate medical attention.

For those who are diagnosed, pharmacists can provide counselling about monitoring glucose levels and how to manage out-of-range levels, including developing an action plan for what to do for hypoglycaemic episodes. Pharmacists can counsel on an appropriate diet and exercise routine to compliment medication management in treating diabetes. This can be especially useful in underserved areas where access to nutritionists or dieticians may be unavailable.

The number of treatment options for diabetes has increased substantially over the past few years, and pharmacists are best positioned to help patients understand the fundamentals and intricacies regarding the medication. For patients requiring insulin, the pharmacist can help instruct the patient on how to administer the medication, as well as answer common questions and concerns.

Community pharmacists are the most accessible health care professionals, as no appointments are required to see them, and to have the highest level of patient contact. Pharmacists are key players in the betterment of patients’ health, not just in terms of screening but in the lifelong management of the disease.

Lifestyle Modifications: it is reported that being overweight or obese contributessignificantly to the burden of diabetes (44%), ischemic heart disease (23%), and certain cancers (range 7%–41%). Yet, obesity is preventable, and strategies to prevent diabetes and cardiovascular disease both include the common goal to optimize peoples’ weight through diet and exercise.

Obesity is currently a worldwide pandemic. Of the world’s population, an estimated 35% of adults are overweight – defined by the World Health Organization (WHO) as a body mass index (BMI) of ≥25 kg/m2. Globally, an estimated 12% of adults are obese (BMI ≥30 kg/m2), half of whom live within just a handful of countries, including the United States of America, People’s Republic of China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.

The rise in obesity can be attributed to multiple factors, most notably modern lifestyles, which allow for easy access to inexpensive unhealthy foods, sedentary lifestyle, and environmental factors that limit access to healthy diet and exercise management. Effective management of the obesity pandemic requires the promotion and fundamental acceptance of healthy lifestyle habits, which in turn depend upon the availability of resources such as affordable nutritious food options and access to venues that promote exercise. In addition, counselling and guidance by health care professionals is necessary for disease state prevention and treatment. The WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases outlines several objectives to be attained by 2020, including increasing physical activity; decreasing the risk of premature mortality from cardiovascular disease, cancer, diabetes, and chronic respiratory diseases; and halting the rise in diabetes and obesity.

Pharmacists were well suited to delivering weight management services, especially given their regular contact with patients. Participants felt that pharmacists were already well trained to perform basic physical assessments such as weight, waist circumference, blood glucose monitoring, and pharmacotherapy counseling, while additional training could be easily obtained for services that would encompass dietary counseling, guidance on physical activity, and behavioral counseling. Programs that have been developed exist either within community pharmacies alone or as part of collaborative agreements between pharmacists, physicians, and other health care providers. Pharmacists have demonstrated that they can improve drug therapy for patients through medication therapy management (MTM) for chronic diseases such as hypertension, diabetes, and dyslipidemia. Increasing the awareness and knowledge of lifestyle modification strategies may help pharmacists implement more comprehensive MTM services.

Other Areas: A Pharmacists goes through a gamut of questions in his everyday work. They can range from which medication to use for a rash, which is a preferred diabetic meter, demonstrating an asthmatic patient as to how to use an inhaler. An elderly gentleman who came to pick up his blood thinner medication wanted to know which foods he needs to avoid when he is on this medication and a teenager required insights from the pharmacist on which acne cream needs to be used. There was also a concerned mother of a 5 yr old boy who needed recommendation of which medication she can use for her son’s diarrhoea and vomiting. Pharmacists can be a valuable resource of smoking cessation.

Conclusion / Summary: Pharmacy is a profession that is expanding beyond the traditional compounding and dispensing of medication towards a more professional advisory and primary health care role. They are an integral part of the community and serve as an important source of knowledge. Pharmacists are dynamic, patient-centric professionals committed to fulfilling the health care requirements of their patients and they would serve in reducing the burden of our Doctors for treating minor ailments, answer queries related to medicine and medical devices and also provide guidance in disease management.

About the Author

Katta Anand Srinivas is a Pharmacologist, Clinical Pharmacist, Medication Counsellor, Marathoner, and Yoga Practitioner. He has received his MS in Pharmacology from the University of Toledo, Ohio, USA. He is a licensed pharmacist in Washington State and North Carolina, USA and a
a certified reviewer of Elderly Medications from American Pharmacists Association, USA. Anand also runs a website http://www.askyourpharmacist.in.

You can contact Anand at contact@askyourpharmacist.in

References:

  1. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/white-coat-hypertension/faq-20057792
  1. https://www.business-standard.com/article/pti-stories/doctor-patient-ratio-in-india-less-than-who-prescribed-norm-of-1-1000-govt-119111901421_1.html

https://www.medbroadcast.com/channel/medications-and-your-health/how-your-pharmacist-can-help/the-role-of-a-pharmacist

Categories
Mental Health Wellness

Let’s Talk: Managing your mental health during Covid 19

Man is a social animal and given this day and age, we have been used to getting around across geographies and interacting regularly with other people. But with the current lockdown this is an area that is directly impacted.

While people in lockdown in India have done the right thing to protect them from Covid 19 but their mental health is definitely suffering. Anxiety, depression, Insomnia among others have become common. In this situation, Mental Health Helplines are the best way out.

Lets Talk, a Mental Health Support Helpline is a free volunteer supported project initiated by a group of collaborators to help people cope with emotional impact of Covid-19 pandemic.  

It aims to help those facing dramatic psychological conditions such as panic attacks, anxiety / stress and those suffering mentally and emotionally due to quarantine / isolation /lockdown.

Lets Talk helpline number is 844 844 9428 and has a team of 120+ volunteers who are supporting this initiative, including Psychologists from across the country.

The project has been powered by different International and National Partners in the space of Mental Health, Helpline Support, Social Organizations and Outreach Support. Partners already on boarded include Global Dignity, Arogya World India Trust, Life Surfers, Suicide Prevention India Foundation, Oust Labs, Hope Network, Global Shapers Community, Ria and Manah wellness.

The team behind Lets Talk commented on this initiative

“We are grateful to the volunteers who have come forward to help and support the community at this critical juncture. We believe that mental health impact of this pandemic is going to be significant and will have long lasting impact.

At Lets Talk, we are continuously looking at multiple outreach channels, who could collaborate with us in our initiative to help all those who are worried about the uncertainty of events, a deep sense of meaningless at the moment, missing our loved ones and some of us, our freedom.

At this difficult time, we can’t help you to be in a different place, but we can help you be in a different mind space. So, Lets Talk.”

Categories
Wellness

10 Tips To Improve The Digestive System

Modern lifestyles, improper dietary habits and eating junk food all place a huge strain on the digestive system. Problems with digestion can affect every other part of your body and bring down your quality of life. As the English author Samuel Johnson said, “He who does not mind his belly, will hardly mind anything else.” Caring for your digestion is not difficult. Here are a few simple ways to do it.

Eat A High Fiber Diet

Eating lots of vegetables, fruits and grains that are rich in fiber will enable food to move smoothly through the digestive system and reduce the strain on it. This also helps to prevent Irritable Bowel Syndrome and Hemorrhoids.

Eat The Right Balance Of Fiber

Insoluble fiber or roughage cannot be digested by the system and so it adds bulk to the stools, making a bowel movement easier. Soluble fiber absorbs excess water and keeps the stools from becoming too liquid. A balance of both types of fiber is important.

Control Fat Intake

The more fat in your diet, the slower the digestive process which results in constipation and other problems. However, some amount of fat intake is required for good health and energy. Balancing fatty foods with high fiber foods helps to control the fat intake.

Ensure Probiotic Intake

Not all bacteria are bad. Probiotics are a type of healthy bacteria that helps to support the digestive process, strengthen the immune system and accelerates the natural breakdown of food by the body.

Eat Lean Meat

Proteins are an essential part of a healthy diet and can be found in lentils, grains and vegetables. If you are a non-vegetarian, meat is a good source of protein. Avoid fatty cuts of meat that place an increased strain on the digestion and consume only lean cuts.

Drink Lots Of Water

Staying hydrated by drinking enough water has all kinds of health benefits, including on the digestive system. Water acts as a lubricant, enabling the smooth digestion of food and elimination of waste from the body.

Keep Regular Mealtimes

Eating your breakfast, lunch and dinner at as near as possible at the same time every day means that your body is provided nourishment at the right interval thereby preventing the digestion from being overloaded by sudden large food intakes and also by not allowing the stomach to remain empty for long periods, which results in acidity and other problems.

Get Enough Exercise

Exercise is usually looked on as a way to lose weight and not being overweight is good for overall health. More than this, exercise supports the digestive system and the movement of the body keeps pushing food through the digestive system, which enables good bowel movements and prevents constipation.

Reduce Stress

Mental stress and anxiety place a great strain on the digestive system and prevent it from functioning properly. It can cause all kinds of digestion-related medical conditions including the development of ulcers in the stomach. Make stress-reducing activities like Yoga a part of your daily schedule.

Avoid Bad Habits

Smoking, excessive consumption of alcohol and tea or coffee all interfere with the smooth functioning of the digestion. If the habits cannot be totally removed from your life, then very moderate consumption is the next best step.

Caring for your digestion has a positive impact on all aspects of your wellbeing. If you are suffering from a digestion-related medical condition or simply suffer from one or more of the common symptoms of digestive problems, contact Kauvery Hospital where the Gastroenterology Center of Excellence gives you access to the Best Gastroenterologist in Chennai, medical technology and treatment protocols to provide world-class treatment and care.

Categories
Public Health

Covid 19: Reality check for India

By Dr Sumeet Kad

Today, India steps up its battle against Covid-19 by implementing a 12 hours self-imposed curfew across the nation, Many states have already declared the extended lockdown till March 31 and this could continue for even a longer period of time as the new cases keep rising. India’s approach has ranged from screening people at airport arrivals, evacuating citizen from foreign affected areas, shutdown of mass gathering and public places, requesting people with mild symptoms for undergoing self-quarantine and widening the criteria for testing to avoid spreading of community transmission.

But are these steps enough? The more important question being why India didn’t take any proactive steps to boost its healthcare system? India’s dismal health infrastructure can come under severe stress if the cases continue to rise. Clearly, with a bed: population ratio of nearly 1:1000 and less than 100,000 ICU beds, India is hardly prepared to confront this pandemic which can lead to severe consequences. Italy, the US, and China have 3.2, 2.8 and 4.3 hospital beds per 1000 people respectively and they are struggling to handle the coronavirus cases.

With inadequate insurance penetration, India population is largely dependent on public sector hospitals which are severely inadequate. Nearly, 75% of private corporate hospitals are located in less than 40 districts and over 80% of hospitals have less than 30 beds. Infection control, patient management and isolation standards are under severe doubts. There is also a huge deficiency of skilled healthcare professionals adding to the existing woes (doctor-populations ratio of 1:10000 which is way below the WHO norm of 1:1000).

India’s healthcare system is devoid of integrated and inter operable data systems and platforms. This along with non-standardisation and inadequate mobility of health records and data is a vital hurdle in deploying targeted, continuous and connected care. Digital infrastructure needs to be strengthened and monitored regularly. Such technologies can be very effective in isolating and diagnosing positive cases, as shown by state of Kerala.

From pharma side, India is overly dependent on China for bulk drugs or APIs (active pharmaceutical ingredients), around 70% of APIs need of India is catered by China. Now, with China being under indefinite lockdown, India will struggle to produce basic medicines for cancer, malaria, HIV and even antibiotics for its own usage. There is an imminent need to make India a manufacturing hub for APIs. India needs to invest in setting up R&D facilities and provide tax incentives to encourage API manufacturing within the borders.

For these steps to be implemented India needs to increase the budgetary spend on health from current 2% of GDP to 5% in next 5 years. This crisis does provides an opportunity to reflect on the failures and issues within India’s weak healthcare policies. A huge chunk of the government healthcare spending goes into urban-based infrastructure whereas the primary healthcare centers are being neglected since decades.

In this article, I have listed these challenges and measures that need to be taken by India to establish a robust healthcare ecosystem in the coming years. Time is right to evaluate and assess in these trying times and look into the future.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Medical Education

Growth of digital learning in Healthcare

Digital transformation has changed the way we interact with the world. The field of medical education has also changed with that. Today digital platforms are being used in healthcare to prepare healthcare professionals to manage both infectious and non-infectious conditions. So what have been some of these changes and how does it affect the field of learning.

To find answers to these questions we spoke to Dr. Balasubramanyam V (Dr. Bala), Multimedia Educationist: Medical E-learning Pioneer, Professor, and Head of Anatomy, St Johns Medical College Bangalore.

Dr Bala has over 69 research papers, 7 chapter contributions in books, co-author of one text bookand over 200 conference presentations in the field of:
o Medical and health care E learning
o Anatomical sciences

Dr Bala has also created a histology video channel on YouTube …called VBS HistoMed and has been honored by many awards. Dr Bala was also the medical director for an e-learning startup.

Here are some excerpts from the discussion.

Healthcare India: What is the growth and development that you have seen in the digital learning space in the last decade?

Dr Bala: There have been many new areas of growth in the digital learning space, the three main among them are

a.      Use of Learning Management Systems (LMS)

b.     Massive Open Online (MOOC)

c.      Gamification of the learning experience

Healthcare India: How has that changed the way healthcare is taught in medical colleges?

Dr. Bala: These are some of the changes that I have observed on how Healthcare is taught in

a.      Learning Management Systems gives the confidence of supervised and well mentored learning. 

b.     Massive Open Online (MOOC) courses  provide value added exposure for updating knowledge – specially recent advances.

c.      Interactive digital ecosystems offer the advantage of experimental and participatory learning. This is ideally suited for case studies.  

Healthcare India: What are the practical advantages of using digital learning platforms in healthcare?

Dr. Bala: Availability of authentic pre-validated information at the desired level of granularity at the point of care

Healthcare India: What are the recommendations towards education policy that you would recommend that can be done to take things forward?

Dr Bala: In my opinion the following steps are important

a.      Curricular content for healthcare courses needs to be developed, validated and recommended as authentic course material by universities.

b.     University supervised technology-based evaluation need to be introduced at appropriate levels. This will make the practical and bedside skill evaluation more focussed and objectives clearly defined. There is the scope of digital evaluation for nearly 40 % of the curriculum

In conclusion there is a lot of potential for digital learning in healthcare. Right from increasing access to education and delivering the right details at a granular level anytime, anywhere.

Categories
Public Health

Combating ‘infodemic’ to tackle a pandemic

By Dr Sumeet Kad

As the global population is marred by the pandemic coronavirus outbreak, a flurry of websites, dashboards, online services and apps related to COVID1-19 are being encountered across the globe. These tools developed by tech giants, start-ups, govt bodies, and healthcare organizations provides relevant information about the symptoms, prevention methods, screening steps, tracking virus spread and offer advice to limit the risk to exposure. However, it is important for us to be aware of which are the most authentic ones to be visited.

Here are some of the latest ones which are out for all us to utilize:

Tech giant Microsoft has launched a new interactive dashboard to provide information on the spread of the virus. The map highlights the total number of cases so far (218, 400 as of today with 8500+ deaths in over 164 countries) which is further broken down into cases per country. The tool pulls live data from variety of sources such as WHO, the US Centers for Disease Control and Prevention (CDC), the European Centre for Disease Prevention and Control (ECDC), and Wikipedia.

Quro is a Covid-19 risk assessment tool developed by Medius Health, an AI digital health company in Australia. This easy to use online conversational platform is in accordance with WHO guidelines, and aids in determining  your level of risk based on your symptoms, medical & travel history. It thereby provides accurate education to the public on the virus and collects data for healthcare providers for early intervention.

As increasing number of countries are shutting down schools and colleges, there are various online tools available which can be used by students and educators. Ekstep, an on-demand open learning platform, that facilitates creation and consumption of educational content. Plenty of educational content is available on the app which can be used by students in a self-paced manner. Online tutoring platform Vedantu is providing free live classes for all its courses including IIT preparation modules. Latest ed-tech unicorn, Byju’s, is offering free access to its learning app till the end of April.

Apart from this pandemic, populations have to address another menace in the form of false news, videos and content that are flooding social channels. To counter these, Facebook owned WhatsApp has launched a coronavirus-related information website in partnership with WHO, UNICEF and UNDP. This page has latest and accurate info for general population, governments and healthcare professionals enabling them to communicate efficiently in these tragic times.

Regional language content start-ups have started publishing accurate content in local languages related to coronavirus in order to tackle misinformation. Josh Talks has added advisories to all its videos on eight different languages and has also initiated a series of videos by doctors and healthcare professionals spreading more awareness about the disease. These videos are dubbed in local languages for people to easily understand. Local news platform Lokal, which delivers local news, information and classifieds to 900 million non-English speaking users in India, is amplifying awareness through sharing relevant and accurate info, emergency contact numbers, videos etc.

The novel coronavirus global pandemic is a medical emergency that requires a substantial individual effort as well to combat its spread and impact. We should make sure that only authentic information is gained and spread for the benefit of all.

About the author

Dr Sumeet Kad is a Healthcare and Artificial Intelligence Leader, focusing on leveraging technology to create a model for affordable care.

Categories
Healthcare Delivery

Introduction to Psychiatric Conditions

By Dr Kiran Manduva

Mental health is an often ignored aspect of overall health. It is a truism that there is no health without mental health. In fact, mental health is so crucial to one’s overall well being that a physically disabled or otherwise afflicted person can still be a happy and productive member of society if his mental health is taken care of. There are many examples of such people who ‘ve beaten tremendous odds in life to come up and make their mark on society. That is simply not possible without a robust psychological state of being. Thus, despite health being a holistic entity, if I had to choose, I will place psychological health a notch above physical health.

Instead of going into technical details and statistics, I will try to present a bird’s eye view of the problem at hand. At the risk of sounding simplistic, I will divide the psychological disorders into six groups, for the purposes of the present article. These are

  1. Major psychiatric disorders including schizophrenia, bipolar disorder, severe depression etc.
  2.  Minor psychological conditions including anxiety, minor depressions, stress-related conditions,
  3. Personality disorders, marital discord.
  4. Substance abuse including tobacco chewing and smoking, alcohol addiction, cannabis abuse etc.
  5. Neuro-developmental disorders like Mental retardation, autism, ADHD, SLD
  6. Dementias especially Alzheimer’s disease.

The above is an informal classification presented here for the sole purpose of simplifying the subject matter for the laypeople so that a better understanding of the issue can be achieved. This is not meant to an exhaustive list and some of the rarer conditions are not covered in the classification. These categories are not watertight and many conditions span the different groups based on their severity and other variables. Often, a person can suffer from multiple conditions from different groups because psychological disorders are not discrete entities, as categorised below. Rather, psychological disturbance can manifest itself in multiple ways and quite often in more than one form, simultaneously, in the same person.

Below, I shall dwell upon each of these groups of disorders in brief- how they arise, how they impact the person and how they can be treated.

The disorders in the first category, the major psychiatric disorders, like schizophrenia, bipolar disorder, severe depression etc can loosely be termed ’psychoses’, in which, the person develops delusions and hallucinations, which cause him to lose touch with reality. These disorders usually have a heavy genetic component and also depend on the maternal health (especially fevers etc) when the patient was ‘in utero’. These can normally be treated only with medication with adequate psychological, social and occupational support for reintegration into the society. In many cases, the patient may need to be on the medications for a fairly long period of time.

The second category, the minor psychological conditions like anxiety, depression and stress related conditions arise mainly due to two reasons. One – as a genetic accompaniment to major psychiatric disorders that someone else is suffering from in the larger family. Two – due to various interpersonal issues, family disharmony and social conditions like school and work related stresses, poverty, unemployment etc. Many of these patients need a variable period of treatment with psychological medicines that ameliorate the neurotic symptoms. These conditions can also be treated with better coping skills, self empowerment, breathing exercises, Yoga etc. Once the person is better, the medicines can be slowly tapered off and allow the natural defences of the person to deal with the issue.

The third category is that of personality disorders and its consequences. These are people who have a particular pattern of seeing themselves or relating to others, and many times, these might result in interpersonal disharmony and suffering to either the patient himself or to the others. A frequent cause of marital discord is the existence of some traits of any personality disorder in one or both the partners. Many violent crimes, including domestic violence, child sexual abuse and other criminal violence can also be due to personality disorders in the perpetrator. This often needs a comprehensive approach including medication, counselling and the intervention of other agencies like child care services and law enforcement services including the police

The fourth category is that of substance abuse. There is a steep hike in the number of people addicted to various substances like nicotine (smoking tobacco), alcohol and cannabis. The youth of the society are more prone to it due to their innate impulsive and rebellious nature of their behaviour. This can result in significant damage to ones long term health and productivity, apart from causing family disharmony. This needs treatment with medication, counselling and in many cases a relatively long period of treatment in a rehab centre.

The fifth category is that of neurodevelopmental disorders that afflict children right from their very early age. This is due to the altered brain structure and includes conditions like mental retardation, autism, attention deficit hyperactivity disorder, specific learning disability. These children have a different trajectory of development of milestones, behavioural and academic problems. They need lot of intensive psychological intervention.

The sixth category is that of dementias, the most common being Alzheimers dementia. This is a disorder of the elderly brain degenerating and is more prevalent in the community as the proportion of the elderly increases in the society. It is a problem that is only going to increase in the country and needs lot of family support, medication and institutional old age care.

It is imperative that any person suffering from any kind of emotional or behavioral problem approach a mental health professional without delay or stopping oneself due to the stigma normally attached to psychological conditions. With proper treatment, many are able to lead a near-normal and productive social and occupational life. The public health strategies for different conditions need to be tailored to the particular subgroup of disorders and is an uphill task for the country to ensure the availability and effective delivery of health care services to all the needy.

About the author

Dr Kiran Manduva did his MBBS in 2001 and studied Psychiatry from NIMHANS in 2005. He is interested in deaddiction, psychotherapy for victims of sexual abuse and neuroscience. He is especially interested in novel public health approaches to make psychiatric care accessible to all.

Categories
Public Health

The next 2 weeks are critical to stopping the spread of Corona Virus in India

As I write this the official government of India website is giving us the figures of 110 cases in India. Interesting the cases have doubled by the week. Most schools are shut and offices have been encouraging professionals to work from home.

Many in India feel that the worst is behind us but that’s not the case. Currently our testing rate is around 1.2%, this is higher than UK or France as we are specifically testing those coming from the affected countries, or those in direct contact with these individuals. Our next wave will come from those infected in India itself.

Source: http://truthdive.com/2020/03/13/covid-19-india-has-30-days-to-stop-the-start-of-stage-iii-says-dg-icmr-india-news/ and ICMR

If you refer to the diagram above you can clearly see that India is at STage 2 where we see local transmission from positive cases. But the next stage is where the infection spreads locally.

I had written a piece earlier on the similar guidelines for quarantine for keeping the infection in Stage 2 of STage 3. We also would have to stop mass gatherings, being prepared for the inevitable. Here is the link to the article. https://healthcare-in-india.net/uncategorized/key-steps-for-home-quarantine-during-the-corona-virus-epidemic/

Also, I believe it is important to refer to government sources when it comes to accurate data. I get most of my information from the Ministry of Health and Family Welfare Site or from other government sites like ICMR (Indian Council of Medical Research).

Most of our cases are in states like Kerala and Maharashtra which have a sound health infrastructure and would be able to prevent the spread of the disease. But at the same time, Awareness and Preparation are the two weapons we have that we have in our arsenal.

Please take care and please follow these simple steps to understand if you need testing at all.

https://www.mohfw.gov.in/FINAL_14_03_2020_ENg.pdf

Categories
Public Health

Key steps for home quarantine during the Corona Virus Epidemic

As I write this we have 83 cases of Covid (Novo Corona Virus) cases in India with 2 fatalities. So far I believe the government has done a great job considering the global nature of the epidemic and the fatalities.

Unfortunately during these crises I see many news and internet channels spreading misinformation and rumors. I would advise everyone only to rely on the government of India Sites. In this case the site of the ministry of health and family welfare site, https://www.mohfw.gov.in/

One of the things that I learned on the site is the procedure for self-quarantine. Here are some of the key steps.

  1. Stay in a well-ventilated single-room preferably with an attached/separate toilet.
  2. If another family member needs to stay in the same room, it’s advisable to maintain a distance of at least 1 meter between the two.
  3. Needs to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household.
  4. Restrict his/her movement within the house.
  5. Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc. He should also follow the under mentioned public health measures at all times:
  6. Wash hand as often thoroughly with soap and water or with alcohol-based hand sanitizer
  7. Avoid sharing household items e.g. dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with other people at home.
  8. Wear a surgical mask all the time. The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused.
  9. Masks used by patients / caregivers/ close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial. •
  10. The used masks should be considered as potentially infected. •
  11. If symptoms appear (cough/fever/difficulty in breathing), he/she should immediately inform the nearest health center or call 011-23978046.

For more details on the steps please visit the GOI site for the Ministry of health and family welfare. The link is on the side- https://www.mohfw.gov.in/DraftGuidelinesforhomequarantine.pdf

Please also note the following numbers and email for communication on Corona Virus

The Helpline Number for corona-virus : +91-11-23978046

The Helpline Numbers of States & Union Territories for corona-virus

The Helpline Email ID for corona-virus : ncov2019@gmail.com

Please stay safe and prevention is better than cure.

Categories
Wellness

12 easy steps to manage your foot care in diabetes

(The following is a guest post by Dr Anuj Chawla)

Diabetes is a health problem that can affect several body parts, one by one. One in six people with diabetes resides in India with an estimated number of 77 million and the number is projected to rise to 125 million by 2040. It has been observed that 10-15% of people with diabetes will develop a foot ulcer at some point in time. A survey done in 2014 revealed that only 54% of diabetics in India were aware that diabetes could lead to foot problems and only 22% had their feet examined by a health worker or doctor.

Do you know that it can affect your feet too? If you have a minor cut on your feet, it can turn into a significant wound because diabetes impairs wound healing in your body. Also, you may not be able to feel anything in your feet because of nerve damage. Because of diabetes, blood flow to your feet is obstructed as well. This will cause a small wound to amplify into a stubborn infection, due to which you face the risk of amputation.

In case you suffer from diabetes, you need to take precautions to protect your feet and hence avoid any serious foot problems. Guidelines you need to follow to avoid Diabetic foot problem are as follows:

  1. Soaking your feet in lukewarm water: You must always keep your foot clean. Treat your foot like you will take care of a newborn baby. Use lukewarm water to soak in your foot and clean them. Avoid excessively hot water.
  2. Regular inspection of your feet: You need to check your feet regularly for blisters, cuts, swelling, redness, or nail problems. You can use a magnifying hand mirror to check the bottom of your feet. Do seek help from your doctor if you notice something suspicious.
  3. Be gentle with your feet while cleaning it: Use a soft sponge and washcloth to wipe your feet. Dry your feet by gently patting it, especially between the toes. 
  4. Trimming nails carefully: You need to cut your nails straight across. Also, do not forget to file the edges of your nails. Don’t trim your nails too short as it risks the development of ingrown toenails. If you are worried about your toenails, then you can seek the advice of your foot and ankle specialist. 
  5. Moisturizing your feet but not between the toes: Always use a moisturizer to prevent itching and cracking of your dry skin. But you must always keep in mind that the place between your toes should not be moisturized as this may risk the development of a fungal infection. 
  6. Proper treatment of the corns or calluses: If there are corns and calluses, then you should not try to treat them all by yourself. You must visit your doctor to get rid of them.
  7. Getting your foot examined periodically: This is one of the essential guidelines that you need to follow if you want to avoid Diabetic foot problems. You must get your feet regularly examined from your foot and ankle expert.  
  8. Keeping your diabetes under control: It is always necessary to keep a check on your blood sugar level to prevent Diabetic foot problems.  
  9. Quit smoking: Smoking will accentuate the worsening of blood flow in your feet. Hence if you are a diabetic person and also have a habit of smoking, then it is high time that you quit smoking forever.
  10. Wearing slippers or shoes while walking: You cannot afford to walk barefoot even at your home. You must wear a sandal or boots to avoid any cut or injury at your feet.
  11. Inspect inside of the shoe before wearing: Always shake and feel for the inside of the shoe to look for any pebbles or nail inside as you may not feel it when you wear it.
  12. Exercise: Walking helps in controlling weight and improves circulation. Wear properly measured and fitted shoes as the size and shape of your foot may change with time.

In India, barefoot walking, lack of awareness, the paucity of regular proper exercise, delay in seeking appropriate care, and shortage of trained healthcare providers and foot care services are the principal factors that add to the burden of foot disease in diabetes. Hence, prevention and initial management of diabetic foot are of paramount importance. Please visit the nearest foot and ankle expert to learn more and avoid any future complications.

Dr. Anuj Chawla is one of the leading Orthopedics and foot & ankle surgeons in India. He has extensive overseas experience of managing diabetic foot and its complications. He can be contacted at dranujchawla@gmail.com.

For a consultation with Dr. Anuj, book an appointment by visiting the website: http://dranujchawla.com/

Categories
Healthcare Technology Public Health

Is India taking care of its senior citizens

Last week I was at Hyderabad for a conference where the focus was on the elderly. India has roughly 120-130 million citizens above the age of 60, and this number is going to rise further due to better healthcare facilities and greater awareness of health. I also got a chance to visit my aunt, who had just recovered from fluid in the lungs. The whole visit to Hyderabad was an eye-opener for elderly care. I think we have a serious challenge in this space and currently, we have more questions than answers.

During the conference, I spent some time connecting with other healthcare professionals like Varma from Intel Health Innovation Group and Vikas Bhalla from Philips. I also had the opportunity to lead a panel discussion on how technology is helping increase access for senior citizens.

In the panel with me were, Dr. Mahesh Joshi, CEO Apollo Homecare, Vikas Bhalla – Director (Ultrasound,) Philips India and Rajagopal G – Founder CEO, KITES Senior Care. Raj and Dr. Joshi have worked extensively in senior care, both at the hospital level and services. The crux of the discussion was the breakdown of the family system that has led to a serious problem, with regards to caring for the elderly. This is more of a social problem. But it gets compounded by the fact that there is no one to care for the elderly. No one to care includes no one to monitor if they have taken their medicines on time or if they are keeping up their doctor’s appointment.

Also, we just don’t have the right number of qualified people to care for the elderly. Medical and Nursing schools are producing professionals who mostly cater to emergency cases and those that need chronic conditions. We are grossly under-equipped to take care of the physical and mental wellbeing.

To add to this we just don’t have the process in place to take into account, continuous monitoring using wearable devices. Also, there is no structure to incorporate that data into the health data to make the right decisions.

While there are many questions there have been some efforts in this space. A leading hospital in Bangalore is working on a model for remote patient monitoring of senior citizens at an old age home.

Gurgaon based Suvida is another venture in this direction where the Suvida Care Manager accompanies the elderly care recipient to the medical facility, takes detailed notes, including a personalized Visit Summary, and accompanies the care recipient back home, Suvida to become the first end-to-end medical coordination company, with a built-in unified user-first EMR (electronic medical record) system, so users don’t have to depend on individual medical facilities for their records.

While these are all steps in the right direction, the scale is clearly not enough to meet the demands of the nation. So the question to you is, is India really taking care of its senior citizens?