Dear Omar
Have you worked in the govt hospitals of India..? Our healthcare can't be compared with US or UK's. Because of healthcare burden being by and large on govt, it collapsed and private hospitals mushroomed. NICU & paediatric ITUs are out of bounds of most of the hospitals. In govt hospitals there are limited beds in ITUs they can;'t accomodate transfers on large scale from outside. US & UK already have massive infrastructure and central command of healthcare in place.
The only way out in Gujarat is an amicable solution through dialogue between striking doctors and the govt. Why state govt can't pay a stipend of even Rs 30 000/month when the same in Delhi is Rs 55000. This mess is because of decentralized PG training. Anyway health is the last area govt looks into. When big talks about IT/MBA/ India inc is going in who cares about health care..? huh..!
PS: Govt's hand is a must in truma care. I think Delhi already has one in place, so has hyderbad and Bombay. We urgently need to address problems of healthcare..!
http://www.delhi.gov.in/wps/wcm/connect ... Home/CATS/
http://www.hindu.com/2009/03/01/stories ... 520900.htm
http://www.rxpgnews.com/diaspora/Mumbai ... 2714.shtml
Indian Health Care Sector
Re: Indian Health Care Industry
Last edited by IndraD on 01 Aug 2009 21:59, edited 2 times in total.
Re: Indian Health Care Industry
http://news.bbc.co.uk/2/hi/south_asia/4222076.stmDespite its alarmingly high road-accident rate, the Indian city of Mumbai (Bombay) has until now had no emergency medical service to treat victims in the vital first hour.
In India overall, medical assistance eludes 80% of victims in the so-called "golden hour" of trauma treatment.
Many have to wait for a good Samaritan or are bundled into available transport, aggravating their injuries.
Now 10 non-resident Indian trauma specialists working in the United States are seeing their proposal for a new service in Mumbai come to fruition.
In the US, trauma victims have an easy-to-remember emergency number. Within minutes, paramedics arrive in advanced life-support ambulances and provide on-the-spot treatment.
At an alerted hospital, a surgeon is ready in a special operating room. In fewer than 30 minutes, the injured are in safe hands.
More than one-third of those who would otherwise have died are saved by the system.
India is a huge contrast. Someone dies on the roads every six minutes with another 10 injured.
According to the India Injury Report 2005, road traffic injuries caused losses of 550bn rupees ($12.5bn), or 3% of GDP.
India has 1% of the world's vehicles, but 6% of vehicular deaths
Currently the ninth leading cause of deaths in India, trauma will take third spot by 2020, warns the World Health Organisation's World Health Report.
A trauma service has certainly long been needed in Mumbai, with its 591 vehicles per kilometre and up to 15 deaths a day in as many as 35 accidents.
And trauma care does not stop at road accidents - as the recent floods and building collapses testify.
The proposal for Mumbai is the brainchild of Maryland-based urologist, Navin Shah, and Los Angeles-based trauma specialist, S Balasubramaniam.
It involves an emergency telephone number, eight fully manned and equipped ambulances, dedicated facilities and round-the-clock staff at the city's eight major and four medical school hospitals.
Three years after the specialists' initial proposal, Maharashtra Chief Minister Vilasrao Deshmukh signalled his backing on a recent US visit.
"We wanted to begin with Mumbai because it has the money and the required hospitals," says Dr Shah.
"India has 1% of the world's vehicles, but 6% of vehicular deaths."
It is estimated the Mumbai plan will initially cost 130m rupees (nearly $3m) and then 40m annually.
GS Gill, principal secretary of the Maharashtra government's medical education and drugs department, says: "That is not an impossible amount for Mumbai."
Trauma will become India's third biggest killer by 2020, says WHO
Keen on establishing a chain of such centres, India's federal health minister, Anbumani Ramadoss, is reported to have assured Maharashtra of funding assistance.
Mr Gill's department has prepared an internal status paper and is bringing all concerned agencies on to one platform.
The entire process, Mr Gill says, will take around three to four months.
The US-based experts will help establish the facilities, central command and communication centre and train paramedics and surgeons, all for free.
Each of the specialists will spend two to four weeks in Mumbai and return every year to upgrade the facilities.
It is hoped the Mumbai model will become a pathfinder for other Indian cities.
Although under Supreme Court laws Indian hospitals can no longer turn away accident victims, efficient care and formal emergency training are non-existent.
Public hospitals are woefully short of resources and equipment.
Dr Shah and Dr Balasubramaniam are confident they can enlist more non-resident Indian specialists to help expand the model.
"The best way to enhance medical education and patient care in India is to involve the 30-odd alumni groups of Indian medical colleges, 40,000 practising physicians, 15,000 doctors in training and 10,000 medical students of Indian origin in the US," says Dr Shah.
Re: Indian Health Care Industry
http://www.educationforhealth.net/EfHAr ... 994291.pdf
this was a good /land mark paper
this was a good /land mark paper
Problem of Internship
Many students do not take internship period seriously but would rather study
for their pre-PG examination (Simon, 1992; Lal, 1999; Chaturvedi & Aggarwal,
2001). Some of them succeed after one or more attempts. However, the limited
number of PG seats ensures that majority of doctors remain as basic medical
graduates. It has been aptly stated that internship is one of the weakest links of
the teaching program. In fact internship is considered by some as a vacation
period or paid holidays (Lal, 1999). Thus, there is an urgent need for reshaping
and planning this phase of education (Simon, 1989, 1992).
Graduating doctors enter into medical practice as private entrepreneurs, on
salaried posts or proceed for specialization studies. This practice has grave
consequences for doctors, whether generalists, i.e. basic medical graduates or
whether specialists, as they have largely missed out on the basic crucial training
component of internship. I feel that there is a need to ensure that interns take
this training period seriously. How can we best address this crucial issue?
Possible Solutions
One of the suggestions is the introduction of a post-internship examination for
certification before permanent registration by the Medical Council of India
(Vaidya, 1992) or strict enforcement of the scoring system of internship by the
training department. Another suggestion is for medical graduates to undergo
compulsory rural postings, usually of a duration of two years or more after
graduating, in order to become eligible to compete for admission to postgraduate
courses (Dutta, 1998). The implementation of both of these
suggestions may ensure that interns pay attention to the internship training
Need for strengthening of internship in India 335 period. The latter suggestion may lead to a furthering in their settling down period and could be resisted by medical students and junior doctors. However,both of these suggestions bypass the root cause of the problem, the need to study during the internship period to succeed in the theoretical examination for
entry to post-graduate or specialist courses.
Alternatively we could hold the common theoretical first, second and third
professional examinations simultaneously for all of the medical colleges in
India and admit students for post-graduate studies based on the scores
obtained in these examinations. This can eliminate the need for pre-PG
examination and thus students could pay attention to their training during
internship period.
Re: Indian Health Care Industry
IndraD:
No I havent and I realize that. I also understand from the paper which you linked to on the forum that interfacility transfer agreements between hospitals are not in place between because nothing like that exists in India yet.Have you worked in the govt hospitals of India..? Our healthcare can't be compared with US or UK's.
US does have massive infrastructure but we don't really have a central command of healthcare.US & UK already have massive infrastructure and central command of healthcare in place.
Re: Indian Health Care Industry
Warning.KFC meals cause "brain damage"!
http://www.timesonline.co.uk/tol/news/w ... 737005.ece
Kentucky Fried Chicken meal 'caused brain damage'
(WARD ADAM)
Monika and her brother Abanoub before she fell ill
Image :1 of 2
Anne Barrowclough in Sydney
An 11-year-old Australian girl is suing Kentucky Fried Chicken for Aus$10 million (£5 million), claiming that she suffered brain damage and was left crippled after eating a contaminated product in a Sydney outlet.
Monika Sumaan was seven years old when she developed salmonella encephalopathy and salmonella septicaemia brain damage, allegedly after eating a chicken twister — a meal consisting of fried chicken in pita bread.
She is now confined to a wheelchair with spastic quadriplegia. The court heard that her condition was a result of eating the meal at a KFC restaurant in Villaood, a suburb in southwest Sydney.
A day after eating the product, Monica began vomiting and had diarrhoea. Her parents and brother were also sick after sharing her twister, the court heard.
The family's lawyer, Anthony Bartley, SC, told the court that Monika Sumann had been an extremely bright and active young girl before her illness.
She was a victim of "disturbing" and "unsettling" practices at the fast-food giant, he said.
"Your honour will hear that, if the store was particularly busy, then if chicken dropped on the floor near the burger station it would on some occasions simply be put back into the burger station from where it had fallen," Mr Bartley said.
"The evidence, comes from employees of KFC at the relevant time both in the shop at Villawood and other stores," he said.
Mr Bartley said in the same month that Monika became ill, another 10 people who ate at Villawood KFC reported having food poisoning.
"There is no doubt in this case that what poisoned Monika and left her in the physical condition that she now is [in] is salmonella," Mr Bartley said.
"And there is little or no doubt that chicken was reported by all scientists, at the time of these unhappy events occurring, as being the source of that salmonella," he said.
The court heard that in the months before the incident the restaurant had scored badly in internal audits on food preparation and handling.
As recently as last week a company review had discovered that cross-contamination of foods was present in the store, which had scored an overall performance mark of 41 per cent — regarded as a breakdown standard — the barrister said.
The hearing continues.
http://www.timesonline.co.uk/tol/news/w ... 737005.ece
Kentucky Fried Chicken meal 'caused brain damage'
(WARD ADAM)
Monika and her brother Abanoub before she fell ill
Image :1 of 2
Anne Barrowclough in Sydney
An 11-year-old Australian girl is suing Kentucky Fried Chicken for Aus$10 million (£5 million), claiming that she suffered brain damage and was left crippled after eating a contaminated product in a Sydney outlet.
Monika Sumaan was seven years old when she developed salmonella encephalopathy and salmonella septicaemia brain damage, allegedly after eating a chicken twister — a meal consisting of fried chicken in pita bread.
She is now confined to a wheelchair with spastic quadriplegia. The court heard that her condition was a result of eating the meal at a KFC restaurant in Villaood, a suburb in southwest Sydney.
A day after eating the product, Monica began vomiting and had diarrhoea. Her parents and brother were also sick after sharing her twister, the court heard.
The family's lawyer, Anthony Bartley, SC, told the court that Monika Sumann had been an extremely bright and active young girl before her illness.
She was a victim of "disturbing" and "unsettling" practices at the fast-food giant, he said.
"Your honour will hear that, if the store was particularly busy, then if chicken dropped on the floor near the burger station it would on some occasions simply be put back into the burger station from where it had fallen," Mr Bartley said.
"The evidence, comes from employees of KFC at the relevant time both in the shop at Villawood and other stores," he said.
Mr Bartley said in the same month that Monika became ill, another 10 people who ate at Villawood KFC reported having food poisoning.
"There is no doubt in this case that what poisoned Monika and left her in the physical condition that she now is [in] is salmonella," Mr Bartley said.
"And there is little or no doubt that chicken was reported by all scientists, at the time of these unhappy events occurring, as being the source of that salmonella," he said.
The court heard that in the months before the incident the restaurant had scored badly in internal audits on food preparation and handling.
As recently as last week a company review had discovered that cross-contamination of foods was present in the store, which had scored an overall performance mark of 41 per cent — regarded as a breakdown standard — the barrister said.
The hearing continues.
Re: Indian Health Care Industry
Swin flu spreads in India, Pune worst hit.
http://www.dnaindia.com/mumbai/report_p ... ls_1278077
Panic in Pune as swine flu spreads to six schools
The swine flu pandemicTwelve more persons tested positive for swine flu on Tuesday. Two more schools reported one case each, taking the number of affected institutions to six. The count of confirmed cases in the city stands at 72.
Several schools have gone into prevention overdrive, asking students to go through blood tests and get certificates from doctors confirming that they have not contracted the H1N1 infection. But the schools are clearly misinformed because nasal and throat swabs are needed for flu tests, not blood samples.
The fresh cases comprise three students, three parents and the son of a couple that had tested positive earlier. Additional municipal commissioner MS Devnikar told DNA that they suspect that the parents caught the infection from children.
The source of the infection at the two schools -- Bal Shikshan Mandir and Springdale School -- is yet to be ascertained.
Devnikar said though both the schools have been told to temporarily close down, a final decision will be taken only on Wednesday after an inspection by members of the coordination committee for flu.
Four schools -- Abhinava Vidyalaya, Symbiosis School, Sevasadan School and New India School -- have already been closed after students there tested positive over the last week.
Devnikar appealed to parents to quarantine their children at home if they show symptoms of flu such as cold and cough.
Private clinics and doctors, meanwhile, say that several schools have asked students to go through tests for H1N1 virus.
"I've been getting enquiries from parents about H1N1 tests," said Dr Nilanjan Banerjee, who is on the panel of a couple of schools in the city. Some schools have created a "totally unwanted situation", he said.
According to Dr Dilip Sarda, president of the Pune chapter of the Indian Medical Association (IMA), doctors, too, are haphazardly referring normal influenza cases to the Naidu Hospital for Infectious Diseases.
"Forced by schools, parents are insisting that doctors conduct tests for H1N1 infection even in cases of normal influenza," Sarda said. There is too much of pressure on doctors, he said.
Another IMA member said they have told health officials how misinformed some of the schools are.
Smita Joshi, vice-principal of Vibgyor School, admitted that they have asked parents to get their children screened for H1N1 virus and also get a certificate from a doctor.
"Ours is an international school and many students and parents are NRIs," Joshi said, justifying the measures. "A few of our students who were to join in August have been told to stay put at their places for at least 10 days."
The Delhi Public School located at Mohammadwadi has also asked its students, especially those suffering from cough or cold, to get certificates from doctors certifying that they are not suffering from swine flu.
Principal Neelam Chakrabarty said they have asked parents to send the blood samples of their children to National Institute of Virology for tests.
A school located in Kondhwa area of the city has issued a circular, asking parents not to worry as a vaccine for H1N1 flu will soon be ready.
http://www.dnaindia.com/mumbai/report_p ... ls_1278077
Panic in Pune as swine flu spreads to six schools
The swine flu pandemicTwelve more persons tested positive for swine flu on Tuesday. Two more schools reported one case each, taking the number of affected institutions to six. The count of confirmed cases in the city stands at 72.
Several schools have gone into prevention overdrive, asking students to go through blood tests and get certificates from doctors confirming that they have not contracted the H1N1 infection. But the schools are clearly misinformed because nasal and throat swabs are needed for flu tests, not blood samples.
The fresh cases comprise three students, three parents and the son of a couple that had tested positive earlier. Additional municipal commissioner MS Devnikar told DNA that they suspect that the parents caught the infection from children.
The source of the infection at the two schools -- Bal Shikshan Mandir and Springdale School -- is yet to be ascertained.
Devnikar said though both the schools have been told to temporarily close down, a final decision will be taken only on Wednesday after an inspection by members of the coordination committee for flu.
Four schools -- Abhinava Vidyalaya, Symbiosis School, Sevasadan School and New India School -- have already been closed after students there tested positive over the last week.
Devnikar appealed to parents to quarantine their children at home if they show symptoms of flu such as cold and cough.
Private clinics and doctors, meanwhile, say that several schools have asked students to go through tests for H1N1 virus.
"I've been getting enquiries from parents about H1N1 tests," said Dr Nilanjan Banerjee, who is on the panel of a couple of schools in the city. Some schools have created a "totally unwanted situation", he said.
According to Dr Dilip Sarda, president of the Pune chapter of the Indian Medical Association (IMA), doctors, too, are haphazardly referring normal influenza cases to the Naidu Hospital for Infectious Diseases.
"Forced by schools, parents are insisting that doctors conduct tests for H1N1 infection even in cases of normal influenza," Sarda said. There is too much of pressure on doctors, he said.
Another IMA member said they have told health officials how misinformed some of the schools are.
Smita Joshi, vice-principal of Vibgyor School, admitted that they have asked parents to get their children screened for H1N1 virus and also get a certificate from a doctor.
"Ours is an international school and many students and parents are NRIs," Joshi said, justifying the measures. "A few of our students who were to join in August have been told to stay put at their places for at least 10 days."
The Delhi Public School located at Mohammadwadi has also asked its students, especially those suffering from cough or cold, to get certificates from doctors certifying that they are not suffering from swine flu.
Principal Neelam Chakrabarty said they have asked parents to send the blood samples of their children to National Institute of Virology for tests.
A school located in Kondhwa area of the city has issued a circular, asking parents not to worry as a vaccine for H1N1 flu will soon be ready.
Re: Indian Health Care Industry
PRC owns up to supplying spurious anti-malarial drugs falsely labelled as “Made in India”, to Nigeria:
Wednesday , August 12 , 2009
China admits to fake ‘made in India’ drugs: Official
New Delhi, Aug. 11 (PTI): China has admitted that its pharmaceutical companies were involved in shipping fake drugs labelled “made in India” to Nigeria.
“The Chinese authorities have accepted this position (that Chinese firms were involved),” an official said.
“The Indian government took up the matter with Nigerian authorities. On further probe it was found that the drugs had actually originated in China, not India,” he added.
In June, Nigeria’s drug regulatory authority, the National Agency for Food And Drug Administration And Control, had reported the seizure of a large consignment of fake anti-malarial generic pharmaceuticals labelled “made in India”. ……………
Telegraph
Re: Indian Health Care Industry
First-of-its-kind Lung Surgery
A surgery to remove a lung abnormality, described as a first in medical history, was successfully performed on a 48-year-old person at Billroth Hospitals, Shenoy Nagar, here {Chennai}.
Following a CT pulmonary angiography, it was observed that there were unusual and excessive collateral blood vessels arising from the heart to the left lower lobe of the lung, which caused blood loss while coughing at over 1.5 litres per minute,” explained Dr Thiagarajamurthy, cardiothoracic surgeon.
With a multidisciplinary team approach, he was treated in two stages by the hospital. His abnormal blood vessels were first blocked using special coils. “In all, 11 coils had to be placed and they were embolised by this surgery.
After 48 hours of monitoring, lobectomy and lingulectomy (excision of the infected lobe) were conducted, while the patient breathed only with his right lung,” explained Pulmonogist Dr Jayaraman V.
His condition, which is said to have no precedence in medical history, does not have an official name as yet, the team of doctors said.
Re: Indian Health Care Industry
http://www.theglobeandmail.com/news/wor ... le1268690/
Globe Focus
India's troubling miracle
New HIV infections in much of India have dropped by half since 2000, a globally unmatched achievement. But some of the reasons make it a less-appealing example
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Stephanie Nolen
Chennai, India — From Saturday's Globe and Mail
Last updated on Saturday, Aug. 29, 2009 02:58AM EDT
When government health workers gave Thenmozhi and her friends condoms, they would blow them up and bat them back and forth in the streets of their slum in Chennai, giggling. It didn't really occur to her that she ought to use the condoms with her clients, the neighbourhood men who paid her for sex, to protect herself from AIDS.
That was a disease of other people, other countries. Thenmozhi (who like many in her community uses only one name) had many problems – a drinking, philandering husband who once set her on fire when he got angry, and feeding her children with no job and a Grade 3 education – but AIDS was not one of them.
And then five years ago, a different kind of health worker dropped by her two-room flat – a woman Thenmozhi knew, who made about $50 a month selling sex like she did. She sat on the cement floor, helped Thenmozhi pick through some rice and told her there was AIDS in India – in fact, right there in their crowded fishermen's slum in the capital of the southern Tamil Nadu province. It had recently killed a man they both knew.
She invited Thenmozhi to a community centre, where she heard informal lectures about the virus and how sex workers must band together to insist clients use protection. When she left, her handbag was full of condoms and the results of her free HIV test: negative.
Thenmozhi went on to do a most remarkable thing: “After that, I always used a condom. With every man who paid.” And when she passed the age of 40 last year and transitioned into the role of madam – renting her bedroom to younger women and their clients – she handed each of them a condom, too.
Although her actions may seem logical and obvious, AIDS-education programs around the world have found that people rarely do the logical, obvious thing and use condoms once they learn about the risk of HIV. They may use condoms sometimes, in some cases. They almost never use them with the zealousness of Thenmozhi.
And yet she is no aberration. She is simply one example of the way the country has cut its rate of AIDS infection in half in the last decade, moved away from the brink of catastrophe and quietly achieved a great but unheralded public-health victory.
I married at 13, and had two children, but my husband left us two years later. That year I married again – but my second husband was not a good man. He set me on fire in an argument. I was going to go to the police, but he pleaded for forgiveness. I thought it was a question of my prestige in society, so I stayed, but then he left us. My children never went to school because I could not afford proper clothes for them. I started in sex work when I was 18 – I needed to pay the bills. Now I rent my room to friends who need a place to work discreetly. I want an income for myself. If a woman charges 500 rupees [$11] for a half hour, I get 200 [$4.50] rupees of that for the room. Now that we have learned about AIDS, even if someone gives us more money for sex without a condom, we refuse. A woman who is very desperate might be tempted – but in case we indulge in that, we go immediately after for a blood test. – Thenmozhi, 40, in Chennai, India
In southern India, HIV incidence (the rate of new infections) was 2 per cent per year in 2000; by 2007 it was just below 1 per cent. In the north, where HIV is far less prevalent, there was no large decline, but also no increase.
Only much-smaller Thailand, which implemented a mandatory-condom campaign in its sex industry in the 1990s, has ever posted similar declines.
What has happened here is starting to draw global attention. Yet so much of this story is unique to India, with its strengths (such as pro-active governments) and its weaknesses (particularly the rigid control kept over its female citizens) that it's questionable how much its example can be applied anywhere else.
When India announced in 2007 that it had 2.3 million people living with HIV, rather than the 5.7 million reported the year before, the government first attributed much of the change to better data collection. Many in the AIDS field were skeptical.
“We and all the other AIDS organizations think the number of people accessing services is increasing, so why are the infection numbers so low?” says Anjali Gopalan, head of the Delhi-based Naz Foundation and one of India's most prominent AIDS activists.
Northern states have weak mechanisms for reporting AIDS cases, while marginalized populations such as the transgender sex workers and drug users she works with are never part of door-to-door surveys, she says, so tens of thousands of cases may be missing from the official statistics. And in all regions, many people are still going without adequate treatment.
Nevertheless, more and more research points to a substantial change in sexual behaviour and with it a decline in the spread of HIV. Syphilis infections, which closely mirror HIV, have had an almost-identical drop.
“The decline is real. The numbers have plausibility and credibility,” says Prabhat Jha, an epidemiologist who directs the Centre for Global Health Research in Toronto, and was an architect of India's early AIDS-control program. “There has been a profound change in behaviour among clients and sex workers that accounts for most of the drop.”
While India has a significant population of intravenous drug users – as many as half of whom, in some areas, have HIV-AIDS – the bulk of the HIV transmission in this country happens through heterosexual sex. Men, often married, pay professionals for sex, get infected and then pass the virus to their wives or regular partners, who infect children at birth.
In 1997, Prof. Jha – who is Indian-born but grew up in Winnipeg – found himself in Kamithipura, the teeming red light district of Mumbai. He had just been hired by the World Bank to design a national AIDS intervention for India, and with him was another Manitoban, Frank Plummer.
Now the director of the national Centre for Infectious Disease Prevention and Control in Ottawa, Dr. Plummer was then a microbiologist renowned for his work in the early days of HIV in East Africa. Prof. Jha wanted his assessment of India's situation.
“Frank looked around, and he said, ‘This looks just like Nairobi in 1984,'” Prof. Jha recalls. Those words made him shudder: He was well aware of the horrifying swath of destruction AIDS went on to cut through the slums of Kenya and so many other African nations.
But the parallel was obvious: In India in 1997, HIV infection was exploding among sex workers, drug users and truck drivers in congested urban areas. But almost no one knew about the disease and no one was doing anything to protect themselves or their other partners.
In a country of this size, with a frail public health system, it was an unfolding disaster. The newly-formed National AIDS Control Organization said the country's infection rate was the fastest-growing in the world. Prof. Jah ran mathematical models that predicted more than 20 million Indians with HIV by 2010.
But it didn't happen. The aversion of this crisis has many who work in AIDS control feeling justifiably proud – theirs is a significant achievement in a field notable for its rare victories. Billions of dollars and 15 years of effort in the worst-affected nations in Africa have yielded declines in HIV infection of at best 5 or 6 per cent (except possibly in Uganda, which saw a very sharp drop in the late 1980s – the reasons are hotly debated today).
Ask those involved, such as Prof. Jha – who had a $200-million budget from the World Bank to try to stop infections – what worked, and they list mass distribution of free condoms; the use of “peer educators” such as the sex worker who visited Thenmozhi; and a media campaign full of frank messages.
All of which have been tried, and tried, and tried in Africa, with only meagre impact. So why did they work in India?
Windows of opportunity
The first difference is timing. HIV was spreading quickly in Africa by the mid-1960s, yet it was 20 years before anyone tested an African for it.
By the time real efforts to stop the virus got under way, hundreds of thousands of people had already died and in many countries 10 to 15 per cent of the general population was infected.
The first HIV cases in India, on the other hand, were not found until 1986, here in Chennai, when two men tested positive. For the next few years, there were only a handful of cases.
By the time some far-sighted bureaucrats got on the job in the mid-1990s, HIV was just at the 1-per-cent rate which epidemiologists consider its viral tipping point – and, most critically, not yet in the general population but still largely confined to high-risk groups.
“We still had a window of opportunity,” recalls S. Ramasundaram.
Today he heads the department of public works in Tamil Nadu's state government, but back then, he was a director in the health department, and was handed the new AIDS file.
He had a background in demography – and looking at Prof. Jha's models of projected spread of HIV, he had a similar full-body shudder of horror.
“I argued with the government. Very rarely in development do you get a crystal ball. I said, ‘If you don't do something, it's going to be doomsday.'”
Mr. Ramasundaram was talking – urgently and often – to state leaders, and that is the next key difference from Africa. Tamil Nadu is the state that has posted the greatest gains on HIV and its government has been active and engaged since the day those first cases were reported – in sharp contrast to the denial with which many African leaders first confronted HIV.
(The huge sizes of Indian states – Tamil Nadu's population is 64 million, larger than three-quarters of African countries – and the differences between them make comparing Indian states and African nations more accurate than using India as a whole.)
Mr. Ramasundaram launched an AIDS-control organization at arm's length from the government, to minimize bureaucratic slowdowns and corruption.
He brought in the best private advertising agencies in the state, gave them a budget bigger than Coke or Pepsi (then the biggest spenders) and had them vet all their ads with people living with HIV.
Then he blanketed the state: billboards, cricket stadiums, movies and newspapers in every language.
“There were so many messages on HIV then – the Chief Minister called me and said, ‘You're frightening people.' I said, ‘Sir, that's the point.' He said, ‘It looks like we have a big epidemic!' I said, ‘No, we want to prevent a big epidemic.'”
Next he turned to community groups that were already working in slums and with sex workers, and tasked them with going door-to-door to spread the word.
The leader was Lakshmi Bai, a fast-talking, whirling-sari-clad social scientist with years of experience with sex workers, including not only women but gay and transgender men.
She eschewed the idea of a straight-up AIDS program; instead, she involved the sex workers in projects to build their self-esteem, organized them into collectives with food and clothing banks, and pushed them to confront government with their needs.
“You don't think only about just one disease. You can't talk just about AIDS,” explains Ms. Bai, who now runs the non-governmental Tamil Nadu AIDS Initiative. “But when you are doing all these things together, they are going to listen to what you are saying about HIV.”
“My body is a temple and I have to take care of it – the director has told us we are precious people and God's spirit lives in us,” says Thenmozhi, speaking with the kind of reverence that many sex workers seem to have for Ms. Bai. So, she added, condoms only make sense.
High-risk focus
The Tamil Nadu program benefited from bitter experience in Africa, where the thinking had been that for each dollar of AIDS prevention funding, 20 cents should be spent on the high-risk groups and the rest on the general population.
By the late 1990s, Mr. Ramasundaram explained, research had made clear that there would be far more impact from spending the whole dollar on those high-risk groups – and keeping the virus out of the general population. Condom use by sex workers rose from 40 per cent to 90 per cent in three years.
Meanwhile, the billboards and movie ads were addressing a particular population: “Don't treat Tamil Nadu as an African country … the literacy level is higher, the adaptation to change is faster and the technology absorption is higher,” Dr. S. Vijayakumar, now head of the state AIDS agency, says (with a certain smugness that often characterizes the reflections of those in the field here).
However, in terms of one key bit of technology, there was indeed a crucial difference in India: Condoms had been actively promoted here since Indira Gandhi's population-control policies of the 1970s.
Also, there was little of the cultural distaste and discomfort that has greeted condom campaigns in Africa – and no conservative Christian church to lead a public outcry about abstinence.
There were, however, plenty of trained lab technicians and statisticians and the sort of qualified staff an AIDS program needs, the human resources that are so often lacking in Africa.
And there was cash. When Mr. Ramasundaram set up his new state AIDS organization, the World Bank offered up millions of dollars, which meant he didn't have to compete for scarce state-health resources.
“It was crucial that we had that source of funding,” he says.
International agencies rushed to support India's AIDS response in its infancy; the Bill and Melinda Gates Foundation alone pledged $342-million (U.S.) over 10 years from 2004, its largest program anywhere.
I was married at 14, and had a daughter at 16, but my first husband drank himself to death after two years. When I was 20 I married again but my husband kicked me out when I complained about his rowdy behaviour. Now I support my two children. At home I do tailoring for people in the neighbourhood, and that earns about $100 a month, but it’s not enough for our expenses, which are $250 a month. So I work out of a [madam’s] house – there’s no other option. I’m trying my best to feed my kids and give them everything – so on other things I compromise. I will stretch myself to any level to make sure my kids are fine. My mother lives with me, and she knows what I do – she cries about it a lot, and hopes I will be able to stop soon. I have about 10 clients a month – it was a client who first wooed me into it. After just a few months I met the people from the Tamil Nadu AIDS initiative and they told me about condoms. Most of our clients are middle-aged men whose wives are old with no inclination for sex. They come to us for oral sex, for a kind of sex they don’t get at home with a wife – they can’t try out different positions – with us in a half hour they have us jump upside down. All of us, every time, use a condom. We’ve got the message and we listen. Whether a man admits he goes to others for sex or not – I say, I have sex with several people and I might give it to you and you’re going to take it to your wife. - Sivagami, 33
Darker side
But there are also less-pleasant truths about India's victory over HIV. Beyond literacy, condoms, blunt ads and brilliant bureaucrats, one thing more than any other has checked the spread of the virus here: the oppression of Indian women.
The extreme control exerted over women's personal lives – first by their parents, then by their husbands and in-laws – means that very few ever have the opportunity to have a sexual partner other than their husbands.
Where 25 per cent of men report more than one sexual partner, less than 2 per cent of women do. Married women get infected by their husbands, and sometimes pass HIV to their children, but the virus stops there: They do not have other partners to pass HIV on to.
This is a marked contrast to Africa, where it is now clear that the “concurrent sexual network” – the tendency for both men and women to have overlapping partners rather than serial ones – has been the key driver of the epidemic.
(Meanwhile, discrimination has played a sharply different role in the spread of HIV among men who have sex with men – it has extremely limited AIDS organizations' ability effectively to provide these men condoms and information. As a consequence, they have HIV infection rates 10 times those of the general population.)
There is, in fact, a broader issue of culture at play in India's AIDS success story, the sort of squishy subject that makes AIDS researchers flinch because it lies so far outside tidy quantifiable data.
But many in the field agree that Indian society remains rigidly hierarchical, still infused with the powerful role of the caste system, and people are accustomed to the strong role of government in their lives.
That's a contrast to many African countries with weaker states and more egalitarian societies. And it meant that when the Indian government sternly told people to use condoms and cut back on partners, they listened.
Zero patient
Mr. Vijayakumar believes that in the next couple of years, his AIDS control agency can drive new infections down to zero. It's a breathtakingly ambitious goal – it has never been done anywhere else – but he brandishes an impressive array of maps, charts and software programs to demonstrate just how he is going to do it.
His office collects data from every possible source – from blood banks to maternity hospitals to neighbourhood clinics for sex workers – and can pinpoint where each new infection comes from.
He has a three-pronged strategy based on continued prevention messages, better reach of the interventions that prevent parents from infecting children, and continued work with the high-risk groups.
“We should be able to do this,” he says, working long past dark in an office where a steady flow of assistants ebbed in and out bearing yet more charts and data sets.
“I have a plan in place – my problem is my high-risk groups. If I can bring them into the health fold we'll certainly be able to do it.”
But Mr. Vijayakumar is watching his budget shrink, and government, donor and public attention shift away from HIV, as success itself eases the sense of panic.
Many say the shift in government funds is justified, given how few people HIV kills in comparison with basic public-health problems such as water-borne diarrhea, child malnutrition, smoking or road accidents. The Gates Foundation is redirecting its funding to issues such as maternal and newborn care.
Yet HIV remains of critical concern here: With 2.3-million infected people, this country has the third-largest burden of HIV-AIDS in the world, and has succeeded in getting treatment to fewer than half of the people who need it.
The successes achieved have been mostly in the richer south of the country. The outstanding question is the north, with much weaker governments and health systems that have yet to embark on serious AIDS-control programs.
Other factors make the north vulnerable too. “There are large numbers of migrant workers from Uttar Pradesh and Bihar, and they are a huge worry,” says Mr. Ramasundaram. A major factor in the African pandemic has been workers spending months or years away from their wives and paying for sex in their host cities.
Overall, the precise situation with HIV in the north is unknown – mother-child transmission could be exploding.
India's AIDS interventions have been relatively cheap – a tenth the cost of Thailand's sex-worker and condom intervention – but they are not free. “The era of ‘Big HIV' in India may be over, and we know that once condoms become common in commercial sex, they stay common,” says Prof. Jha. “But there is a huge ‘if' – the Indian government has to continue to pay for the cheap and effective ways to curb HIV for at least the next decade, especially in North India.”
In Chennai, Lakshmi Bai, who has lived through a rare, radical shift in sexual behaviour, is as often gloomy as she is encouraged. “So much life has been lost,” she says – a fact often glossed over by the bureaucrats and researchers excited about the falling infection rates. While many HIV-related deaths are not reported as AIDS, at minimum several hundred thousand Indians have already died of the disease, Prof. Jha estimates.
“Everything is not rosy here,” says Ms. Bai. “There is so much to do! I'm quite worried about sustainability, with the funders leaving. Even now, with all this ‘empowerment' blah-blah, sexual decisions are taken by men.”
There are 50,000 Tamil Nadu sex workers on her books today, but new young girls – and young men – show up all the time. “If you're not going to continuously address, what will happen? If these things are not done – disaster only.”
But when Thenmozhi sits in a circle with the women at the drop-in centre, when they joke and gently mock their clients, the married men “who say they can't eat the same food every day,” disaster seems far away. The women bemoan their troubles – shirking husbands and mounting bills. But AIDS is not one of them.
Globe Focus
India's troubling miracle
New HIV infections in much of India have dropped by half since 2000, a globally unmatched achievement. But some of the reasons make it a less-appealing example
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Stephanie Nolen
Chennai, India — From Saturday's Globe and Mail
Last updated on Saturday, Aug. 29, 2009 02:58AM EDT
When government health workers gave Thenmozhi and her friends condoms, they would blow them up and bat them back and forth in the streets of their slum in Chennai, giggling. It didn't really occur to her that she ought to use the condoms with her clients, the neighbourhood men who paid her for sex, to protect herself from AIDS.
That was a disease of other people, other countries. Thenmozhi (who like many in her community uses only one name) had many problems – a drinking, philandering husband who once set her on fire when he got angry, and feeding her children with no job and a Grade 3 education – but AIDS was not one of them.
And then five years ago, a different kind of health worker dropped by her two-room flat – a woman Thenmozhi knew, who made about $50 a month selling sex like she did. She sat on the cement floor, helped Thenmozhi pick through some rice and told her there was AIDS in India – in fact, right there in their crowded fishermen's slum in the capital of the southern Tamil Nadu province. It had recently killed a man they both knew.
She invited Thenmozhi to a community centre, where she heard informal lectures about the virus and how sex workers must band together to insist clients use protection. When she left, her handbag was full of condoms and the results of her free HIV test: negative.
Thenmozhi went on to do a most remarkable thing: “After that, I always used a condom. With every man who paid.” And when she passed the age of 40 last year and transitioned into the role of madam – renting her bedroom to younger women and their clients – she handed each of them a condom, too.
Although her actions may seem logical and obvious, AIDS-education programs around the world have found that people rarely do the logical, obvious thing and use condoms once they learn about the risk of HIV. They may use condoms sometimes, in some cases. They almost never use them with the zealousness of Thenmozhi.
And yet she is no aberration. She is simply one example of the way the country has cut its rate of AIDS infection in half in the last decade, moved away from the brink of catastrophe and quietly achieved a great but unheralded public-health victory.
I married at 13, and had two children, but my husband left us two years later. That year I married again – but my second husband was not a good man. He set me on fire in an argument. I was going to go to the police, but he pleaded for forgiveness. I thought it was a question of my prestige in society, so I stayed, but then he left us. My children never went to school because I could not afford proper clothes for them. I started in sex work when I was 18 – I needed to pay the bills. Now I rent my room to friends who need a place to work discreetly. I want an income for myself. If a woman charges 500 rupees [$11] for a half hour, I get 200 [$4.50] rupees of that for the room. Now that we have learned about AIDS, even if someone gives us more money for sex without a condom, we refuse. A woman who is very desperate might be tempted – but in case we indulge in that, we go immediately after for a blood test. – Thenmozhi, 40, in Chennai, India
In southern India, HIV incidence (the rate of new infections) was 2 per cent per year in 2000; by 2007 it was just below 1 per cent. In the north, where HIV is far less prevalent, there was no large decline, but also no increase.
Only much-smaller Thailand, which implemented a mandatory-condom campaign in its sex industry in the 1990s, has ever posted similar declines.
What has happened here is starting to draw global attention. Yet so much of this story is unique to India, with its strengths (such as pro-active governments) and its weaknesses (particularly the rigid control kept over its female citizens) that it's questionable how much its example can be applied anywhere else.
When India announced in 2007 that it had 2.3 million people living with HIV, rather than the 5.7 million reported the year before, the government first attributed much of the change to better data collection. Many in the AIDS field were skeptical.
“We and all the other AIDS organizations think the number of people accessing services is increasing, so why are the infection numbers so low?” says Anjali Gopalan, head of the Delhi-based Naz Foundation and one of India's most prominent AIDS activists.
Northern states have weak mechanisms for reporting AIDS cases, while marginalized populations such as the transgender sex workers and drug users she works with are never part of door-to-door surveys, she says, so tens of thousands of cases may be missing from the official statistics. And in all regions, many people are still going without adequate treatment.
Nevertheless, more and more research points to a substantial change in sexual behaviour and with it a decline in the spread of HIV. Syphilis infections, which closely mirror HIV, have had an almost-identical drop.
“The decline is real. The numbers have plausibility and credibility,” says Prabhat Jha, an epidemiologist who directs the Centre for Global Health Research in Toronto, and was an architect of India's early AIDS-control program. “There has been a profound change in behaviour among clients and sex workers that accounts for most of the drop.”
While India has a significant population of intravenous drug users – as many as half of whom, in some areas, have HIV-AIDS – the bulk of the HIV transmission in this country happens through heterosexual sex. Men, often married, pay professionals for sex, get infected and then pass the virus to their wives or regular partners, who infect children at birth.
In 1997, Prof. Jha – who is Indian-born but grew up in Winnipeg – found himself in Kamithipura, the teeming red light district of Mumbai. He had just been hired by the World Bank to design a national AIDS intervention for India, and with him was another Manitoban, Frank Plummer.
Now the director of the national Centre for Infectious Disease Prevention and Control in Ottawa, Dr. Plummer was then a microbiologist renowned for his work in the early days of HIV in East Africa. Prof. Jha wanted his assessment of India's situation.
“Frank looked around, and he said, ‘This looks just like Nairobi in 1984,'” Prof. Jha recalls. Those words made him shudder: He was well aware of the horrifying swath of destruction AIDS went on to cut through the slums of Kenya and so many other African nations.
But the parallel was obvious: In India in 1997, HIV infection was exploding among sex workers, drug users and truck drivers in congested urban areas. But almost no one knew about the disease and no one was doing anything to protect themselves or their other partners.
In a country of this size, with a frail public health system, it was an unfolding disaster. The newly-formed National AIDS Control Organization said the country's infection rate was the fastest-growing in the world. Prof. Jah ran mathematical models that predicted more than 20 million Indians with HIV by 2010.
But it didn't happen. The aversion of this crisis has many who work in AIDS control feeling justifiably proud – theirs is a significant achievement in a field notable for its rare victories. Billions of dollars and 15 years of effort in the worst-affected nations in Africa have yielded declines in HIV infection of at best 5 or 6 per cent (except possibly in Uganda, which saw a very sharp drop in the late 1980s – the reasons are hotly debated today).
Ask those involved, such as Prof. Jha – who had a $200-million budget from the World Bank to try to stop infections – what worked, and they list mass distribution of free condoms; the use of “peer educators” such as the sex worker who visited Thenmozhi; and a media campaign full of frank messages.
All of which have been tried, and tried, and tried in Africa, with only meagre impact. So why did they work in India?
Windows of opportunity
The first difference is timing. HIV was spreading quickly in Africa by the mid-1960s, yet it was 20 years before anyone tested an African for it.
By the time real efforts to stop the virus got under way, hundreds of thousands of people had already died and in many countries 10 to 15 per cent of the general population was infected.
The first HIV cases in India, on the other hand, were not found until 1986, here in Chennai, when two men tested positive. For the next few years, there were only a handful of cases.
By the time some far-sighted bureaucrats got on the job in the mid-1990s, HIV was just at the 1-per-cent rate which epidemiologists consider its viral tipping point – and, most critically, not yet in the general population but still largely confined to high-risk groups.
“We still had a window of opportunity,” recalls S. Ramasundaram.
Today he heads the department of public works in Tamil Nadu's state government, but back then, he was a director in the health department, and was handed the new AIDS file.
He had a background in demography – and looking at Prof. Jha's models of projected spread of HIV, he had a similar full-body shudder of horror.
“I argued with the government. Very rarely in development do you get a crystal ball. I said, ‘If you don't do something, it's going to be doomsday.'”
Mr. Ramasundaram was talking – urgently and often – to state leaders, and that is the next key difference from Africa. Tamil Nadu is the state that has posted the greatest gains on HIV and its government has been active and engaged since the day those first cases were reported – in sharp contrast to the denial with which many African leaders first confronted HIV.
(The huge sizes of Indian states – Tamil Nadu's population is 64 million, larger than three-quarters of African countries – and the differences between them make comparing Indian states and African nations more accurate than using India as a whole.)
Mr. Ramasundaram launched an AIDS-control organization at arm's length from the government, to minimize bureaucratic slowdowns and corruption.
He brought in the best private advertising agencies in the state, gave them a budget bigger than Coke or Pepsi (then the biggest spenders) and had them vet all their ads with people living with HIV.
Then he blanketed the state: billboards, cricket stadiums, movies and newspapers in every language.
“There were so many messages on HIV then – the Chief Minister called me and said, ‘You're frightening people.' I said, ‘Sir, that's the point.' He said, ‘It looks like we have a big epidemic!' I said, ‘No, we want to prevent a big epidemic.'”
Next he turned to community groups that were already working in slums and with sex workers, and tasked them with going door-to-door to spread the word.
The leader was Lakshmi Bai, a fast-talking, whirling-sari-clad social scientist with years of experience with sex workers, including not only women but gay and transgender men.
She eschewed the idea of a straight-up AIDS program; instead, she involved the sex workers in projects to build their self-esteem, organized them into collectives with food and clothing banks, and pushed them to confront government with their needs.
“You don't think only about just one disease. You can't talk just about AIDS,” explains Ms. Bai, who now runs the non-governmental Tamil Nadu AIDS Initiative. “But when you are doing all these things together, they are going to listen to what you are saying about HIV.”
“My body is a temple and I have to take care of it – the director has told us we are precious people and God's spirit lives in us,” says Thenmozhi, speaking with the kind of reverence that many sex workers seem to have for Ms. Bai. So, she added, condoms only make sense.
High-risk focus
The Tamil Nadu program benefited from bitter experience in Africa, where the thinking had been that for each dollar of AIDS prevention funding, 20 cents should be spent on the high-risk groups and the rest on the general population.
By the late 1990s, Mr. Ramasundaram explained, research had made clear that there would be far more impact from spending the whole dollar on those high-risk groups – and keeping the virus out of the general population. Condom use by sex workers rose from 40 per cent to 90 per cent in three years.
Meanwhile, the billboards and movie ads were addressing a particular population: “Don't treat Tamil Nadu as an African country … the literacy level is higher, the adaptation to change is faster and the technology absorption is higher,” Dr. S. Vijayakumar, now head of the state AIDS agency, says (with a certain smugness that often characterizes the reflections of those in the field here).
However, in terms of one key bit of technology, there was indeed a crucial difference in India: Condoms had been actively promoted here since Indira Gandhi's population-control policies of the 1970s.
Also, there was little of the cultural distaste and discomfort that has greeted condom campaigns in Africa – and no conservative Christian church to lead a public outcry about abstinence.
There were, however, plenty of trained lab technicians and statisticians and the sort of qualified staff an AIDS program needs, the human resources that are so often lacking in Africa.
And there was cash. When Mr. Ramasundaram set up his new state AIDS organization, the World Bank offered up millions of dollars, which meant he didn't have to compete for scarce state-health resources.
“It was crucial that we had that source of funding,” he says.
International agencies rushed to support India's AIDS response in its infancy; the Bill and Melinda Gates Foundation alone pledged $342-million (U.S.) over 10 years from 2004, its largest program anywhere.
I was married at 14, and had a daughter at 16, but my first husband drank himself to death after two years. When I was 20 I married again but my husband kicked me out when I complained about his rowdy behaviour. Now I support my two children. At home I do tailoring for people in the neighbourhood, and that earns about $100 a month, but it’s not enough for our expenses, which are $250 a month. So I work out of a [madam’s] house – there’s no other option. I’m trying my best to feed my kids and give them everything – so on other things I compromise. I will stretch myself to any level to make sure my kids are fine. My mother lives with me, and she knows what I do – she cries about it a lot, and hopes I will be able to stop soon. I have about 10 clients a month – it was a client who first wooed me into it. After just a few months I met the people from the Tamil Nadu AIDS initiative and they told me about condoms. Most of our clients are middle-aged men whose wives are old with no inclination for sex. They come to us for oral sex, for a kind of sex they don’t get at home with a wife – they can’t try out different positions – with us in a half hour they have us jump upside down. All of us, every time, use a condom. We’ve got the message and we listen. Whether a man admits he goes to others for sex or not – I say, I have sex with several people and I might give it to you and you’re going to take it to your wife. - Sivagami, 33
Darker side
But there are also less-pleasant truths about India's victory over HIV. Beyond literacy, condoms, blunt ads and brilliant bureaucrats, one thing more than any other has checked the spread of the virus here: the oppression of Indian women.
The extreme control exerted over women's personal lives – first by their parents, then by their husbands and in-laws – means that very few ever have the opportunity to have a sexual partner other than their husbands.
Where 25 per cent of men report more than one sexual partner, less than 2 per cent of women do. Married women get infected by their husbands, and sometimes pass HIV to their children, but the virus stops there: They do not have other partners to pass HIV on to.
This is a marked contrast to Africa, where it is now clear that the “concurrent sexual network” – the tendency for both men and women to have overlapping partners rather than serial ones – has been the key driver of the epidemic.
(Meanwhile, discrimination has played a sharply different role in the spread of HIV among men who have sex with men – it has extremely limited AIDS organizations' ability effectively to provide these men condoms and information. As a consequence, they have HIV infection rates 10 times those of the general population.)
There is, in fact, a broader issue of culture at play in India's AIDS success story, the sort of squishy subject that makes AIDS researchers flinch because it lies so far outside tidy quantifiable data.
But many in the field agree that Indian society remains rigidly hierarchical, still infused with the powerful role of the caste system, and people are accustomed to the strong role of government in their lives.
That's a contrast to many African countries with weaker states and more egalitarian societies. And it meant that when the Indian government sternly told people to use condoms and cut back on partners, they listened.
Zero patient
Mr. Vijayakumar believes that in the next couple of years, his AIDS control agency can drive new infections down to zero. It's a breathtakingly ambitious goal – it has never been done anywhere else – but he brandishes an impressive array of maps, charts and software programs to demonstrate just how he is going to do it.
His office collects data from every possible source – from blood banks to maternity hospitals to neighbourhood clinics for sex workers – and can pinpoint where each new infection comes from.
He has a three-pronged strategy based on continued prevention messages, better reach of the interventions that prevent parents from infecting children, and continued work with the high-risk groups.
“We should be able to do this,” he says, working long past dark in an office where a steady flow of assistants ebbed in and out bearing yet more charts and data sets.
“I have a plan in place – my problem is my high-risk groups. If I can bring them into the health fold we'll certainly be able to do it.”
But Mr. Vijayakumar is watching his budget shrink, and government, donor and public attention shift away from HIV, as success itself eases the sense of panic.
Many say the shift in government funds is justified, given how few people HIV kills in comparison with basic public-health problems such as water-borne diarrhea, child malnutrition, smoking or road accidents. The Gates Foundation is redirecting its funding to issues such as maternal and newborn care.
Yet HIV remains of critical concern here: With 2.3-million infected people, this country has the third-largest burden of HIV-AIDS in the world, and has succeeded in getting treatment to fewer than half of the people who need it.
The successes achieved have been mostly in the richer south of the country. The outstanding question is the north, with much weaker governments and health systems that have yet to embark on serious AIDS-control programs.
Other factors make the north vulnerable too. “There are large numbers of migrant workers from Uttar Pradesh and Bihar, and they are a huge worry,” says Mr. Ramasundaram. A major factor in the African pandemic has been workers spending months or years away from their wives and paying for sex in their host cities.
Overall, the precise situation with HIV in the north is unknown – mother-child transmission could be exploding.
India's AIDS interventions have been relatively cheap – a tenth the cost of Thailand's sex-worker and condom intervention – but they are not free. “The era of ‘Big HIV' in India may be over, and we know that once condoms become common in commercial sex, they stay common,” says Prof. Jha. “But there is a huge ‘if' – the Indian government has to continue to pay for the cheap and effective ways to curb HIV for at least the next decade, especially in North India.”
In Chennai, Lakshmi Bai, who has lived through a rare, radical shift in sexual behaviour, is as often gloomy as she is encouraged. “So much life has been lost,” she says – a fact often glossed over by the bureaucrats and researchers excited about the falling infection rates. While many HIV-related deaths are not reported as AIDS, at minimum several hundred thousand Indians have already died of the disease, Prof. Jha estimates.
“Everything is not rosy here,” says Ms. Bai. “There is so much to do! I'm quite worried about sustainability, with the funders leaving. Even now, with all this ‘empowerment' blah-blah, sexual decisions are taken by men.”
There are 50,000 Tamil Nadu sex workers on her books today, but new young girls – and young men – show up all the time. “If you're not going to continuously address, what will happen? If these things are not done – disaster only.”
But when Thenmozhi sits in a circle with the women at the drop-in centre, when they joke and gently mock their clients, the married men “who say they can't eat the same food every day,” disaster seems far away. The women bemoan their troubles – shirking husbands and mounting bills. But AIDS is not one of them.
Re: Indian Health Care Industry
How I got well in India for $50
My cheap, fast and effective treatment in New Delhi reminded me of everything wrong with American healthcare
By Aruna Viswanatha
Re: Indian Health Care Industry
[youtube]ce7SOdVzgj4&feature=channel_page[/youtube]
[youtube]i09seFMiCWE&feature=channel_page[/youtube]
[youtube]i09seFMiCWE&feature=channel_page[/youtube]
Re: Indian Health Care Industry
India-made Cardiac Pacemakers to hit the market
Made-in-India artificial cardiac pacemakers could be in the market in the coming months, at 3-5 times lower the cost of the imported devices. . . .Over half of the country’s cardiac related deaths are due to arrhythmia. A pacemaker gives these patients a new lease of 8-10 years. . . . an indigenously made pacemaker could cost Rs 60,000-Rs 1.5 lakh compared to an imported pacemaker costing $7,000-10,000 (around Rs 3.5-5 lakh.
Re: Indian Health Care Industry
should appreciate Chidu initiating/carrying forward or completing these steps,
1) creating a networked database between police stations
2) reducing superfluous NSG cover to politicians
3) not sure if this is his initiative,
http://www.ptinews.com/news/286241_Cond ... e-Ministry
1) creating a networked database between police stations
2) reducing superfluous NSG cover to politicians
3) not sure if this is his initiative,
http://www.ptinews.com/news/286241_Cond ... e-Ministry
Re: Indian Health Care Industry
Thalassaemia cured with brother's cord blood
. . . a group of doctors and specialists in Chennai and Coimbatore have registered the first successful treatment of thalassaemia in a child using a sibling's umbilical cord blood.
Re: Indian Health Care Industry
India's TB treatment strategy stands vindicated
India has been facing much criticism for treating patients by using a different regimen, especially since it has a huge disease burden. China is only other country that follows the same regimen as India.
India and China have opted for a thrice-a-week regimen during the six-month therapy period. Most developed countries have gone in for the daily regimen.
“There was little evidence of difference in failure or relapse with daily or intermittent schedules of treatment administration,” is one of the main findings of the paper.
There are several reasons why India chose the thrice-a-week regimen. “It is convenient, reduces the cost by more than half, and adverse reactions are less when given intermittently,” said Dr. Kumaraswami. “It also enables the implementation of DOTS.”
Re: Indian Health Care Industry
Country's first split-liver transplant
CHENNAI: India’s first successful split liver transplant was performed at the Global Hospitals here on September 16.
According to the hospital authorities, the transplantation involved dividing a cadaver donor liver into two halves for transplantation on two patients as life saving procedures.
The donor procedure and the two transplant operations took over 20 hours and involved a team of six surgeons, six anesthetists and a large number of support staff.
Re: Indian Health Care Industry
The Challenge of Managing Heart Attacks Dr. I.Sathyamurthy
Excerpts
Excerpts
When it comes to managing heart attacks, is India on a par with the developed countries of the West yet? The answer, unfortunately, is ‘not yet.’ India has state-of-the-art hospitals, expertise and the latest hardware, but most of the heart attack victims are still being treated with ‘clot buster’ medicines. These drugs are certainly effective, if given within the first three hours of an attack occurring. Some of these drugs have side-effects such as allergic reactions and lowering of blood pressure.
But in the West, most of the heart attacks are being treated by balloon angioplasty and stenting — the so-called ‘primary angioplasty.’ This procedure is effective even when the patient reports after the golden hour or after the window period of one to three hours of a heart attack occurring. The principle is to mechanically clear the clogged coronary arteries (the arteries carrying blood to heart muscle), to restore patency and blood flow. Any major damage to the heart muscle is prevented by restoring the blood flow, which helps preserve the heart’s pumping capacity. This, in turn, prevents the development of heart failure and gives the patient a chance for a better quality of life.
The faster the procedure is done, the better are the patient’s chances of survival: you could say, ‘time is muscle.’ The time taken for the first medical contact after a heart attack to the balloon dilatation is called the ‘door to balloon’ time. In Europe and the U.S., a lot of efforts are being taken to reduce this time so as to improve the chances of survival. Though this is practised in a small way in India, the time has come to popularise this procedure in a major way.
Step I here involves the patient factor. The patient must recognise the symptoms and report at the earliest to the nearest medical facility.
Step II has to do with the first point of medical contact. This could be a general practitioner, a family physician or the nearest nursing home. The physician should not delay taking an electrocardiogram (ECG) to confirm the diagnosis of heart attack and to decide on the need for primary angioplasty. The patient should be referred to the nearest cardiac centre capable of performing primary angioplasty.
Step III has to do with emergency ambulance services. The patient should be transported by ambulance at the earliest to the cardiac interventional facility. Paramedical staff can administer the necessary medication during the transportation and provide information to the receiving hospital regarding the medical history and the condition of the patient. Ambulances can be equipped to transmit ECGs for expert opinion and guidance regarding emergency care through telemetry.
Step IV involves interventional care. . . . The surgical team should be readily available as standby in the event of surgery being needed to save a patient’s life. A well-equipped catheterisation laboratory with machines such as the intra-aortic balloon pump (IABP) to support the pumping of the heart is mandatory.
(I. Sathyamurthy is an interventional cardiologist and the Director of the Department of Cardiology, Apollo Hospitals, Chennai. He received the Padma Shri in 2000, the Dr. B.C. Roy National Award in 2001 and a D.Sc (Honoris Causa) from the Dr. M.G.R. Medical University in 2008.)
Re: Indian Health Care Industry
Mumbai docs 'suspend brain' in a rare heart operation
Excerpts
Excerpts
When Matunga resident Pankaj Parikh was discharged from Hiranandani Hospital in Powai a couple of days ago, he walked out fully aware that he had just survived a rare heart complication that had been rectified using an equally rare technique.
Ganesh Kumar, the cardiologist who looked after Parikh while cardiac surgeon Dilip Doshi performed the operation, said, ‘‘his illness was rare, but doctors used a once-in-their-lifetime approach to cure him.’’
Parikh, who had been popping pills for hypertension for nearly a decade, never suspected that his aorta - the most important artery in the human body - was developing a tear along its inner wall. Just one patient in a million in any year has aortic dissection, as the condition is called. Till 1950, says Dr Doshi, aortic dissection was mainly a post-mortem diagnosis.
The doctors decided to use suspended animation for reasons of “extra-caution about the carotid artery, which supplies blood to the brain and arises from the aortic arch we were replacing,’’ explains Doshi. The idea was to reduce brain activity to the extent that the surgeon had time to remove the diseased part of the aorta and fix a synthetic one.
Re: Indian Health Care Industry
Cockroach inspires £1,500 heart created by Indian doctor Sujoy Guha.
A ground-breaking £1,500 artificial heart inspired by the anatomy of the cockroach could revolutionise human cardiac care, scientists in India believe.
The development of a robust, affordable and safe synthetic heart remains one of the holy grails of biomedical engineering amid a shortage of donated organs and rising levels of heart disease.
In Britain, critically ill adults wait an average of 103 days and children 143 days for a donated heart, according to the NHS.
In India, heart disease will end more lives per year than all infectious illnesses combined, including diarrhoea, tuberculosis and malaria, by 2015, World Health Organisation figures suggest, as Western lifestyle diseases take a grip.
The heart may appear quite a simple organ: a powerful muscle that acts as a pump to move blood around the body. But efforts to replicate it have floundered.
The two artificial hearts available in the US today are expensive, costing at least $50,000 (£30,000) apiece. Both have problems, with patients vulnerable to infections and strokes, experts say.
Sujoy Guha, a biomedical engineer at the Indian Institute of Technology, Kharagpur, believes that the most critical problems are a result of artificial hearts attempting to mimic the real thing.
The human heart has four chambers, but only the left ventricle is responsible for building the pressure that moves blood around the body. Depending on one chamber to do the hard work places this part of an artificial heart under enormous strain.
Dr Guha likens the process to trying to scale a four-foot rise in just one bound. “Do it too often and your knees will give way,” he said. “Much better to use a series of small steps.”
The sudden build-up of pressure inside conventional artificial hearts can also damage blood cells, Dr Guha said. This can lead to clotting and strokes, and means that patients must be given anti-coagulants, which place them at risk of severe bleeding.
By contrast, his prosthetic heart builds pressure in stages, through five chambers — a model based on the anatomy of a cockroach. He has been working on his prototype heart, which is made from titanium and plastic and runs on batteries that can be recharged from outside the body, since the early 1960s.
The heart of the cockroach has 13 chambers, which build pressure in a series of steps. If one fails, the animal still continues living. “When I was learning my biology I became fascinated by the cockroach,” Dr Guha told The Times. “It is hardy [and] survives extreme conditions. It came into this world before humans and will survive beyond us.”
Dr Guha is testing his device on goats, and hopes to move on to humans in the next 18 months.
He believes that his artificial heart could be available in five years. He hopes to make one available for about £1,500, a feat he says is possible because his project is government-funded and will not have to pay research costs.
A ground-breaking £1,500 artificial heart inspired by the anatomy of the cockroach could revolutionise human cardiac care, scientists in India believe.
The development of a robust, affordable and safe synthetic heart remains one of the holy grails of biomedical engineering amid a shortage of donated organs and rising levels of heart disease.
In Britain, critically ill adults wait an average of 103 days and children 143 days for a donated heart, according to the NHS.
In India, heart disease will end more lives per year than all infectious illnesses combined, including diarrhoea, tuberculosis and malaria, by 2015, World Health Organisation figures suggest, as Western lifestyle diseases take a grip.
The heart may appear quite a simple organ: a powerful muscle that acts as a pump to move blood around the body. But efforts to replicate it have floundered.
The two artificial hearts available in the US today are expensive, costing at least $50,000 (£30,000) apiece. Both have problems, with patients vulnerable to infections and strokes, experts say.
Sujoy Guha, a biomedical engineer at the Indian Institute of Technology, Kharagpur, believes that the most critical problems are a result of artificial hearts attempting to mimic the real thing.
The human heart has four chambers, but only the left ventricle is responsible for building the pressure that moves blood around the body. Depending on one chamber to do the hard work places this part of an artificial heart under enormous strain.
Dr Guha likens the process to trying to scale a four-foot rise in just one bound. “Do it too often and your knees will give way,” he said. “Much better to use a series of small steps.”
The sudden build-up of pressure inside conventional artificial hearts can also damage blood cells, Dr Guha said. This can lead to clotting and strokes, and means that patients must be given anti-coagulants, which place them at risk of severe bleeding.
By contrast, his prosthetic heart builds pressure in stages, through five chambers — a model based on the anatomy of a cockroach. He has been working on his prototype heart, which is made from titanium and plastic and runs on batteries that can be recharged from outside the body, since the early 1960s.
The heart of the cockroach has 13 chambers, which build pressure in a series of steps. If one fails, the animal still continues living. “When I was learning my biology I became fascinated by the cockroach,” Dr Guha told The Times. “It is hardy [and] survives extreme conditions. It came into this world before humans and will survive beyond us.”
Dr Guha is testing his device on goats, and hopes to move on to humans in the next 18 months.
He believes that his artificial heart could be available in five years. He hopes to make one available for about £1,500, a feat he says is possible because his project is government-funded and will not have to pay research costs.
Re: Indian Health Care Industry
Sorry
Shoot and scoot. The topic came up in the nuke thread
http://www.deccanherald.com/content/287 ... uring.html
Shoot and scoot. The topic came up in the nuke thread
http://www.deccanherald.com/content/287 ... uring.html
Over 400,000 newborns die within the first 24 hours of their birth every year, the highest anywhere in the world, a study by an international non-government organisation, ‘Save the Children’, has declared.
According to the NGO, despite a decade of rapid economic growth, India’s record on child mortality at 72 per 1,000 live births is worse than that of neighbouring Bangladesh, one of the poorest countries in the world.
Two million children under five years of age die—one every 15 seconds—each year in India, also the highest anywhere in the world, it said. Of these more than half die in the first month of their birth.
Moreover, one-third of all malnourished children live in India, 46 per cent of children under three are underweight in the country, and over two-thirds of infants die within the very first month of their birth. Ninety per cent of these deaths occur due to easily preventable causes like pneumonia and diarrhoea.
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Re: Indian Health Care Industry
Morning-after pill prescription drug? Govt panel to examine
The Drug Controller General of India (DCGI) said on Monday that a committee will be set up to examine whether Unwanted 72 and i-pill, two morning-after contraceptive pills, now sold over the counter, should be reclassified as “prescription drugs.” Unwanted 72 is made by Mankind Pharma, Cipla manufactures the i-pill.
...
Re: Indian Health Care Industry
Bah, 400,000... beat this Shiv, we better than US!shiv wrote:Sorry
Shoot and scoot. The topic came up in the nuke thread
http://www.deccanherald.com/content/287 ... uring.html
Over 400,000 newborns die within the first 24 hours of their birth every year, the highest anywhere in the world, a study by an international non-government organisation, ‘Save the Children’, has declared.
According to the NGO, despite a decade of rapid economic growth, India’s record on child mortality at 72 per 1,000 live births is worse than that of neighbouring Bangladesh, one of the poorest countries in the world.
Two million children under five years of age die—one every 15 seconds—each year in India, also the highest anywhere in the world, it said. Of these more than half die in the first month of their birth.
Moreover, one-third of all malnourished children live in India, 46 per cent of children under three are underweight in the country, and over two-thirds of infants die within the very first month of their birth. Ninety per cent of these deaths occur due to easily preventable causes like pneumonia and diarrhoea.
http://www.usatoday.com/news/health/200 ... aths_N.htm
More than 1 million babies die each year because they're born too soon, according to the first report to estimate the global burden of premature births.
Re: Indian Health Care Industry
http://news.rediff.com/report/2009/oct/ ... -india.htm
I had heard of similar type of extortion, but hadn't believed it. For example in some government hospitals, doctors and nurses will ask for money from the patient's relatives saying "If you dont want us to hurt the patient while cleaning the wound and dressing it, pay us xxx Rs."
Makes you wonder why such people became doctors in the first place.
What does this mean? They ask the person in labour?Niraja N, a health worker who routinely accompanies pregnant women to health facilities so they can give birth, told Human Rights Watch, "Nothing is free for anyone. What happens when we take a woman for delivery to the hospital is that she will have to pay for her cord to be cut, for medicines, some more money for the cleaning. The staff nurse will also ask for money. They do not ask the family directly."
I had heard of similar type of extortion, but hadn't believed it. For example in some government hospitals, doctors and nurses will ask for money from the patient's relatives saying "If you dont want us to hurt the patient while cleaning the wound and dressing it, pay us xxx Rs."
Makes you wonder why such people became doctors in the first place.
Re: Indian Health Care Industry
Unfettered by regulation, India pulls ahead on stem cell treatments
A controversial New Delhi clinic deploys advanced therapies that are unavailable in the U.S. to cure Americans suffering from MS, diabetes, paralysis, Alzheimer's, Lyme disease and cerebral palsy.
http://www.globalpost.com/dispatch/indi ... treatments
A controversial New Delhi clinic deploys advanced therapies that are unavailable in the U.S. to cure Americans suffering from MS, diabetes, paralysis, Alzheimer's, Lyme disease and cerebral palsy.
http://www.globalpost.com/dispatch/indi ... treatments
Re: Indian Health Care Industry
Once again, the miracle cure of stem cells is back. "Unfettered by regulations" is a curse rather than a cure. Unfortunately there is no short cut in researches. Due to desperation of patients, the mushrooming of private stem cell facilities are cheating patients & their relatives. Most of them have absolutely no ethics.
csubash
csubash
Re: Indian Health Care Industry
Cross post from Pokhran thread as reply is OT there
http://timesofindia.indiatimes.com/indi ... 125659.cmsUmrao Das wrote:What is this obsession with Mega Tons?
We have mega millions to feed, mega million babes to deliver, lets get busy on that front.
Highlighting that safe disposal of faeces is critical for reducing the number of diarrhoea cases, United Nations on Wednesday
stressed on the need for hygienic sanitary practices to combat the disease, the second greatest killer of children after Malaria.
A joint study by the World Health organisation and UNICEF 'Diarrhoea: Why Children Are Still Dying and What Can Be Done', also pointed out that India has the largest number of persons that defecate in the open worldwide.
Out of a total of 2.5 billion people worldwide that defecate openly, 665 million belong to India. Some 88 per cent of diarrhoeal deaths worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene.
Re: Indian Health Care Industry
World Bank approached for Health Management Information System in Government's Health Care Centres
After the successful implementation of Health Management Information System (HMIS) in 40 Secondary Care Government Hospitals for a year, the Health Department is making efforts to secure funds from the World Bank for the mass roll out of it in 232 more hospitals in the next 12 months. . . Similarly, the Health Department recently completed the roll out of HMIS in five Primary Health Centres (PHCs) and it will be extended to 15 more PHCs by November end.
“with the introduction of HMIS, an out-patient can walk into any of the designated hospitals in the State and furnish his or her identification number to get the treatment. With the help of computer generated slip, the doctors will be able to know the case history of the patient and will take the same time to diagnose, get lab test results and provide prescription.”
“On an average, 8,000 patients are getting registered every day and 4,000 lab tests with result are being put in the system. Over 500 doctors have been provided with a PC,”
“TCS is developing the software for us. After testing it in the 20 PHCs, it would become the property of the Health Department. Then, we will gradually extend it to the remaining 1,416 PHCs in the State {of Tamilnadu}."
Re: Indian Health Care Industry
'Made in India' dominates the US AIDS Scheme
Indian drug companies have cornered an overwhelming majority of drug approvals under the US President's Emergency Plan for AIDS Relief (Pepfar).
Out of the 100 approvals by the US drug regulator Food and Drug Administration (FDA) so far, close to 95 per cent are for Indian companies.
The Pepfar programme, started in 2003, aimed at the prevention, treatment, and care of people infected with HIV/AIDS worldwide.
On October 6, the Food and Drug Administration approved the 100th anti-retroviral drug under the Pepfar programme.
Re: Indian Health Care Industry
'Made in India' dominates the US AIDS Scheme
Indian drug companies have cornered an overwhelming majority of drug approvals under the US President's Emergency Plan for AIDS Relief (Pepfar).
Out of the 100 approvals by the US drug regulator Food and Drug Administration (FDA) so far, close to 95 per cent are for Indian companies.
The Pepfar programme, started in 2003, aimed at the prevention, treatment, and care of people infected with HIV/AIDS worldwide.
On October 6, the Food and Drug Administration approved the 100th anti-retroviral drug under the Pepfar programme.
Re: Indian Health Care Industry
Over 50 Million Diabetes patients in India
India leads the world in the number of people suffering from diabetes and by 2030, nearly 9 per cent of the country’s population is likely to be affected from the disease, the International Diabetic Federation (IDF) has warned.
About 50.8 million people are now suffering from the looming epidemic of diabetes, followed by China with 43.2 million.
“Diabetes has become a development issue and it threatens the health and economic prosperity of people in low and middle-income countries,” the IDF report said.
It also predicted that diabetes would cost the world economy at least $376 billion in 2010, or 11.6 per cent of the total world health care expenditure.
According to the report, India currently spends $2.8 billion or one per cent of the global total expenditure.
Re: Indian Health Care Industry
SRS bulletin OCT 2009
Prior years
IMR is improving rapidly in TN. It has surpassed MH in the last year. Getting better in Gujarat, while IMR in Delhi has been stagnant at 35 for 11 years (since 1997).
Prior years
IMR is improving rapidly in TN. It has surpassed MH in the last year. Getting better in Gujarat, while IMR in Delhi has been stagnant at 35 for 11 years (since 1997).
Re: Indian Health Care Industry
TN Government planning to set up an Institute for Anaesthesia
The State government is considering setting up an institute for anaesthesia, Health Secretary V.K. Subburaj said here on Sunday.
“Each maternity centre should have a gynaecologist, an anaesthetist and a paediatrician but we have a shortage of doctors. The only option is equipping the doctors with skills to administer anaesthesia,” he said. The State government’s efforts at training MBBS graduates in anaesthesia after stiff opposition from the specialists had paid off, he said. So far, 125 doctors had been trained in administering anaesthesia and another 40 were undergoing the training, he said.
Re: Indian Health Care Industry
Japanese Technology for treating blood cancer
Treating blood cancers such as aplastic aneamia and thalassemia by stem cells engineered in the lab will be possible in the near future, according to Yukio Nakamura, stem cell scientist and head of bio resources centre, Riken Institute, Japan.
Delivering a lecture at an international stem cells meeting in commemoration of the fourth anniversary of Nichi-In Centre for Regenerative Medicine (NCRM) here on Saturday, he said “the Induced Pluripotent Stem Cells technology discovered by Japanese scientists would pave the way for such a breakthrough as this technology doesn’t involve usage of embryonic stem cells and therefore is devoid of ethical conflicts.”
P. Thangaraju, Vice-Chancellor, TANUVAS, said that they were proposing to set up a world-class facility for animal stem cell research treatment and banking in Chennai in collaboration with NCRM.
Re: Indian Health Care Industry
50 Crore Japanese assistance for the Instt. of Child Health, Egmore
he Japanese government has agreed to extend Rs.50 crore financial assistance to the Institute of Child Health and Hospital for Children, Egmore, for constructing a nine floor new out-patients block.
“We are very much impressed at the services offered by the hospital. I am confident the fund will be released early next year, most probably in March,” said the Japanese Consul-General Kazuo Minagawa “So many small children from all parts of the country are being brought here for treatment. I could see the machines donated by our government earlier were still working,” he said.
P.Murugan, Professor at the Institute, said in one decade nearly 60 lakh newborn and poor children had been benefited by the grant given by the Japanese government. About 5000 children with cardiac problems had a new lease of life after corrective cardiac surgeries.
Re: Indian Health Care Industry
A Forgotten Killer - Pneumonia
Excerpts
Excerpts
Nearly one in ten children born in India will not live to see their fifth birthday, the under-5 mortality, on an average, for India, being 85 per 1000. Nearly half these deaths occur in the first month of life. If one survives that period, the two ma in causes of death are diarrhoeal disease and pneumonia.
However, the deaths due to pneumonia have only recently been acknowledged, pneumonia being identified as the “forgotten killer of children” by the UNICEF
Pneumonia is an easily treatable condition, and the organisms that cause these illnesses respond well to available antibiotics. The danger to life arises because of late presentation to health care facilities. Is health care access a problem in India? Does India have inadequate healthcare resources? On the contrary, there has been a tremendous growth in healthcare resources and health related manpower, with an adequate doctor patient ratio. There is however, a misdistribution with concentration of resources in urban settings, and a distancing of health care access from the population, geographically, socio-economically and even by gender.
The two newer vaccines targeting pneumonia (and meningitis), available in India in the private sector, are the Hib conjugate vaccine and the Pneumococcal Conjugate Vaccine (PCV). These vaccines are relatively expensive, costing approximately Rs. 200-300 per dose for the HiB vaccine and over Rs. 3000 per dose for the Pneumococcal vaccine.
The protection given by Hib vaccine varies from 22 to 44 per cent in various studies across the world. The Government of India, based on available evidence, has made a decision to introduce the Hib vaccine into the national immunisation schedule, in a phased manner. This would be done as a pentavalent injection, combining diphtheria, tetanus, whooping cough, hepatitis B and Hib conjugate vaccine.
As for the pneumococcal vaccine, the pneumococcal organism has many different types (serotypes) and a vaccine is denoted by its valency, i.e. the number of serotypes it covers. The serotypes that cause disease vary in different countries and the same vaccine may not work with equal measure in all countries. The version of this expensive vaccine currently available in the private sector in India is seven valent, and there is some concern that this vaccine does not cover all of the locally prevalent serotypes.
The existing immunisation programme is not optimally utilised, immunisation rates being as low as 50 per cent in some areas. Even with financial support from agencies outside the country, vaccine programmes involve a great commitment in terms of finance, organisation, manpower and other resources. There are already pressing issues like water and sanitation that need to be addressed. Should the money be spent instead in making health care access more equitable?
Re: Indian Health Care Industry
World Pneumonia Day
Continuing with the post above, some more info.
Continuing with the post above, some more info.
According to a new World Health Organisation data published in the September issue of medical journal The Lancet, every minute one child dies of pneumonia in India.
Two bacteria, Streptococcus pneumoniae and Haemophilus influenza type B (HiB), are considered the leading causes of pneumonia.
The {Tamilnadu} State government has proposed to include the HiB vaccine in the expanded universal immunisation programme from next year. . . . the vaccine would be administered to babies after they completed 45 days, 75 days and 90 days. A booster dose would also be prescribed after 18 months. The cost of vaccine in private hospitals is Rs.500 a dose.
Re: Indian Health Care Industry
Diabetes Centre gets global recognition
With the notion that education is the key to prevent diabetes, the International Diabetes Federation (IDF) has declared the Dr Mohan’s Diabetes Specialties Centre (DMDSC) and Madras Diabetes Research Foundation (MDRF) as an IDF Centre of education on diabetes.
It is a matter of pride for the country as only six institutions have been selected of the 40 applications worldwide and India is one among the prestigious few. “The aim of this initiative is to internationally collaborate to ensure high-quality education for healthcare professionals in diabetes,” explained Prof. Jean Claude Mbanya
Re: Indian Health Care Industry
Massive malaria vaccine trial has begun in Africa
phase 3 trials, if it works, the vaccine could be one of the most important advances in medicine...
phase 3 trials, if it works, the vaccine could be one of the most important advances in medicine...
Re: Indian Health Care Industry
Muthulakshmi Reddy Scheme gets national attention
The Dr. Muthulakshmi Reddy Maternity Benefit Scheme of the Tamil Nadu government has received the attention of the Centre, which is contemplating adopting a similar scheme at the national level.
Under the Muthulakshmi Reddy Scheme, an assistance of Rs. 6,000 each is given to pregnant women of the Below Poverty Line (BPL) to compensate the wage loss during pregnancy and enable them to get nutritional food, avoiding the birth of low-weight babies.
Now, the Union government has framed Indira Gandhi Matritava Sahayog Yojana (IGMSY), which envisages payment of Rs. 4,000 each to pregnant and lactating women. Except government employees, the scheme is intended to be applicable to others who are aged 19 years and above for first two live births.
Re: Indian Health Care Industry
Needed 'Basic Doctors' of modern medicine
India is the largest supplier of foreign medical graduates to the United States and the United Kingdom. Yet, its own rural areas have remained chronically deprived of professional doctors. The historical antecedents of these shortages could be traced to a landmark health policy document, the Bhore Committee Report of 1946. That report constructed the concept of a ‘basic’ doctor as one trained through five-and-a-half years of university education. An alternative cadre of Licentiates who were trained over a shorter duration and who formed two-thirds of the country’s medical practitioners then, was abolished, in spite of strong dissent from several members of the committee. These dissenting comments must be revisited in the context of India’s persistently poor health indices and inadequate health services for the majority.
In October 1943, the Government of British India appointed the committee to survey the state of public health in the country, and make recommendations for future development. The committee chaired by Sir Joseph Bhore, a senior civil servant, comprised eight British and 16 Indian members. The Bhore Committee Report, published in 1946, was meticulously drafted and reflected its members’ profound understanding of health matters. They presented statistics on the disease burden and attributed the poor state of health in the country not only to inadequacies in medical services and health personnel but also to the prevailing social ills — poverty, illiteracy, poor nutrition and unsanitary conditions.
The report is best known for providing the blueprint for a modern public health delivery system in India, along with the training of its personnel. Foremost among these was the ‘basic’ doctor of modern medicine who would be central to the delivery of primary healthcare. These were far- reaching recommendations and shaped the course of public health and medicine in independent India. But on closer examination, a number of flaws are revealed.
There were two classes of medical practitioners of Western medicine at the time of the Bhore survey: graduates who underwent a five-and-a-half-year course in the medical colleges, and Licentiates (LMPs) who underwent a three-to-four-year course in medical schools. Of the 47,524 registered medical practitioners at that time, nearly two-thirds (29,870) were Licentiates and one- third (17,654) were graduates.
The report informs us that in the rural areas health care was delivered through sub-divisional hospitals and dispensaries that were managed mostly by Licentiates. Besides, there were large numbers of indigenous practitioners providing affordable and accessible healthcare to the masses.
The Bhore Committee proposed a three-tier district health scheme. A primary unit would be at its periphery, a secondary unit at the sub-divisional headquarters would provide more specialised services, and a district organisation would be in charge of the overall supervision of district-level health activities.
Though conceptually well-organised, the scheme was designed to cover only a fourth of the population in the first five years (78,080,000 out of a projected 315 million in the report) and less than half (156,200,000 out of a projected 337.5 million) over the next 10 years. The report was silent on how the needs of the rest of the country would be met.
Nonetheless, the committee recommended that the Licentiate qualification be abolished, all medical schools be upgraded to colleges, and all available resources be directed into the production of only one type of doctor. He or she would have the highest level of training — a five-and-a-half-year university training, similar to what the Goodenough Committee had proposed for Great Britain as the gold standard. The committee believed that there was no role in the modern medical scheme for indigenous systems of medicine and its practitioners: these systems were considered “static in conception and practice.”
Six members of the committee, five Indians and one Briton, put up a brave dissent. They repeatedly argued that in view of the manpower shortages, the country should use every possible means, including the shorter Licentiate course, to increase the number of trained medical personnel. They pointed out that England had abolished Licentiate teaching only after 100 years and Russia relied extensively on ‘feldshers’ (medical assistants) to run 48,000 dispensaries. They noted with anguish that since the new scheme would benefit only a section of the Indian population, “Public health over the remaining four fifth to one-half of the country… will atrophy. There will be no personnel like the licentiates even to help the regions and institutions which will come under neglect.”
The dissenters’ views proved prophetic. They said that the “basic doctor would not willingly fit into the rural scheme.” India’s six decades of chronic shortages of doctors in the rural areas are grim testimony to this fact. They argued that “while a majority on the committee can abolish the licentiate, they cannot prevent other practitioners, practising a variety of systems of medicine, taking his place.” Time has proved this also to be a prescient observation. Studies show that since Independence and even today, much of health care at first contact in rural India is delivered not by qualified doctors but by informally trained and unlicensed private practitioners.