Public health challenges in India:
Are a billion people too much to handle? Pessimistics will view the picture as crumbling infrastructure coupled with an ailing , albeit non existential primary health care sector. Optimists see it as a manpower driven nation on the revolution bandwagon. I see it as a nation that needs nurturing of appalling public health awareness levels. People endowed with knowledge can care for themselves. They do not need the powers that be to tell them what is good or bad for them. The critical public health issue with our nation is that clear cut guidelines are seldom implemented. Policy and advocacy matters are so clearly flouted that it is no wonder to see apathy of the common public to matters of grave public health importance. It is indeed sad to note that only panic mobilizes our populace. It is this callous image that we have of public health that needs a change for the better.
The biggest challenge is the twin epidemics of chronic diseases and infectious diseases that are steadily making inroads even into the bucolic communities. Sanitation and hygiene have improved considerably since the past 30 years only to be replaced by scarce facilities/resources for the burgeoning population. An ever growing middle class with burgeoning consumerism attracts it’s own pitfalls. Statistics are pointing to a trend of increasing lifestyle disorders, but that is just the tip of the iceberg. Primary prevention with adequate focus on public education will go a long way in reducing the increasing burden of cardiovascular and Lifestyle related diseases
Imparting education to grass root level health care workers makes an enormous difference. Oral rehydration therapy is a case in point. The scourge of infant related diarrheal diseases came down on account of widespread education of simple sugar and salt therapy imparted by Angan wadi workers. My initiation into public health started with this simple concept of imparting knowledge to the entire field staff involved in my rural communities. Medical knowledge needs to be simplified and demystified for the public to appreciate the fact that simple preventive measures can make a big difference in their quality of life care and medical costs.
It needs a good ear and a clear sight to look into the future and most importantly to share a common vision that has inputs from all those involved in the health care sector. For a country steeped in ignorance and economic impoverishment, education on public health issues is far paramount than allocating budgets. A case in example is the AIDS pandemic and MDRTB. A majority of CSW’s know about condoms, but they don’t bat an eyelid if a client pays them extra money for unprotected sex. Similar is the case with TB. RNTCP is making rapid strides in converting sputum positive rates thanks to the educative initiates taken by the local health workers. Educating that sputum conversion is important than X ray diagnosis to basic health workers has made such a difference.
Hence, I wish to write, communicate, pursue research and educate the common public and empower them. To achieve that, the lack of public attention to health, the persistence of the notion that health is a personal responsibility (and ill health a personal or cultural failure) needs to be changed.
Wednesday, August 27, 2008
Life and faith
I believe that faith comes from an understanding of our own selves. It is only in testing times that one's character comes out.. I have to take a leaf from Arjuna's travesty with destiny....some how the justice that the above one does to good ones counterbalances the very purpose for which he has created us..Life is a quagmire with an inverted mirage that seems so near with bifocal lens but which is clearly seen with a true conscience
Tubercular musings
A very eloquent and poignant article has been written and published in this week's NEJM on TB. Though the writing skills of this young Physician from India are extraordinary, what touches me the most are his narrative skills...""[life is] the existence of what, in actuality, has no inherent ability to exist, but only balances with sweet, painful precariousness on one point of existence in the midst of this feverish, interwoven process of decay and repair."
Poetic indeed..to describe the effects of TB !!!
http://content.nejm.org/cgi/content/full/358/11/1092?query=TOC
Do read through the entire document as his feelings of service in US are echoed by all of us who feel that our motherland needs more of the reverse brain drain...
Best Regards
Raghupathy Anchala
Poetic indeed..to describe the effects of TB !!!
http://content.nejm.org/cgi/content/full/358/11/1092?query=TOC
Do read through the entire document as his feelings of service in US are echoed by all of us who feel that our motherland needs more of the reverse brain drain...
Best Regards
Raghupathy Anchala
Nobel laureate thoughts
We at Pitt were fortunate to hear Nobel Prize winner for 2007 deliver a key note address on his ongoing research activities. Univ of Pittsburgh Medical school (UPMC) has had a rich history in that whomever they call to deliver the Hoffman Key note lecture has gone onto win the Nobel Prize in the field of Medicine/Physiology. (This is an ongoing probability tug of war that UPMC always beats the odds in calling the right person to deliver the speech for the past 7 yrs!!).
The atmosphere was so hallowed, the alumni hall was packed to the hilt, there was a genuine air of warm expectation in the wind, (which contrasted to the cold wave biting all of those who were not able to enter the hall..watching outside on the giant screen). Anyways, our Infectious dept Indian guys managed to wrangle out the black tickets( Trust me , habits really stick on and they help u when in need) and we were let in albeit with a bit of suspicion by the surly matron. The irony was that our sincere Profs were left out standing...The talk was on and the great man succintly talked on the Genetic models in mice modelled to develop human diseases. He tranfected the mice with oncogenic (cancerous) genes (in embryo)....and managed to develop histopatholgical and gross lesions that exactly resembled human cancer in vivo. Later on, came the exciting breakthrough acheived due to endless hardwork and night awakenings. They followed the same techniques and applied it to the brain circuits!!. They managed to transfect the mice with HOX genes...that caused pathological grooming (mice continously scratching and pulling out the hair, even to the extent of neglecting food and sex). This model was so akin to the human Obsesive compulsion disorder ...and lo..there was big breakthrough in the scientific world. The talk went on to describe the neuropsychiatric conditions that can be and on existing current models. It ended with a standing ovation and the house was thrown open for discusion. Nobody wanted to disturb the applecart ( so full of bountiful grants that may be denied if they questioned the great man!). Probably it might have the perennial itch to walk upto the podium and face the camera and look into his eyes / to prove to my advisor that all the goofs I do in Journal clubs can be excused with this grand entry of mine into the regal world of research/ to find out the passion which the great man had for his work..whatever may have been my state at that time.... I managed to muster the courage (my hands were literally tied down by my friends)..., nervously walked upto the mike and asked him (stammering came back to haunt me after a gap of 12 yrs) as to WHETHER HE EVER THOUGHT OF MODELLING ANIMALS TO FIND OUT PSYCHOLOGICAL MANIFESTATIONS OF POVERTY.
I managed to ask a real hard core basic sciences researcher on somethinh which even economists struggle to answer. Come to think of it...It must have been the position paper that I had to write for Public health overview 2 credit course on Poverty that must have been subconscioulsy working in my stupid grey cells at that point of time. There was stunned silence for a moment and then the audience slowly and nervously began to talk of the relevance of the question and on the goof up that I created. The over 65 +faculty sitting in the front row turned on their hind legs to find out who this champion of poverty was!. The fact that the nobel laureate should choose to drink water at that point of time added to the haunted silence of those 5 seconds. (How I wished the earth would swallow me). The desolation in the air was dispelled by him in the end. He started recounting his 8 childhood yrs which he spent on the streets of Italy. (For a brief period of 8 yrs, he was separated from his mother and spent his early childhood in penury). His apt reponse was that environmental factors and genetics are two issues which are distinct , but linked in a way by society. Mice kept in the same cage..one given food and the other starved..tend to be aggressive in the initial days, but later on come to accept their positions, very akin to our real worls situation. It is what is fundamentally called adaptation. He asked me to focus on the real world outside for this daunting question and to come back to him with data on socio economic conditions and behavorial adaptations to model the same in animals. So . in the end , it was DATA!!! and adaptation. All of us come from middle class background and we have never seen real poverty at close quarters. When we go back into our respective careers and look at the ground situation in India, I think we should be sensitised to the disparity in the diaspora of the Indian mentality and strive to negate the perceived notions of "Oh! It doesnt affectme". In the end, I was vindicated when my position paper on poverty received only 80% mks, because I have never experienced it. I have consciously tried to highlight my feelings so that I can sensitize many of you to show that Great people are indeed humble and always have a humble beginning like any one of us!!. Have a great weekend..but spare a thought to the social revolution on ur social outings this weekend. Bye for now.. I do ramble a lot!!
Raghupathy
The atmosphere was so hallowed, the alumni hall was packed to the hilt, there was a genuine air of warm expectation in the wind, (which contrasted to the cold wave biting all of those who were not able to enter the hall..watching outside on the giant screen). Anyways, our Infectious dept Indian guys managed to wrangle out the black tickets( Trust me , habits really stick on and they help u when in need) and we were let in albeit with a bit of suspicion by the surly matron. The irony was that our sincere Profs were left out standing...The talk was on and the great man succintly talked on the Genetic models in mice modelled to develop human diseases. He tranfected the mice with oncogenic (cancerous) genes (in embryo)....and managed to develop histopatholgical and gross lesions that exactly resembled human cancer in vivo. Later on, came the exciting breakthrough acheived due to endless hardwork and night awakenings. They followed the same techniques and applied it to the brain circuits!!. They managed to transfect the mice with HOX genes...that caused pathological grooming (mice continously scratching and pulling out the hair, even to the extent of neglecting food and sex). This model was so akin to the human Obsesive compulsion disorder ...and lo..there was big breakthrough in the scientific world. The talk went on to describe the neuropsychiatric conditions that can be and on existing current models. It ended with a standing ovation and the house was thrown open for discusion. Nobody wanted to disturb the applecart ( so full of bountiful grants that may be denied if they questioned the great man!). Probably it might have the perennial itch to walk upto the podium and face the camera and look into his eyes / to prove to my advisor that all the goofs I do in Journal clubs can be excused with this grand entry of mine into the regal world of research/ to find out the passion which the great man had for his work..whatever may have been my state at that time.... I managed to muster the courage (my hands were literally tied down by my friends)..., nervously walked upto the mike and asked him (stammering came back to haunt me after a gap of 12 yrs) as to WHETHER HE EVER THOUGHT OF MODELLING ANIMALS TO FIND OUT PSYCHOLOGICAL MANIFESTATIONS OF POVERTY.
I managed to ask a real hard core basic sciences researcher on somethinh which even economists struggle to answer. Come to think of it...It must have been the position paper that I had to write for Public health overview 2 credit course on Poverty that must have been subconscioulsy working in my stupid grey cells at that point of time. There was stunned silence for a moment and then the audience slowly and nervously began to talk of the relevance of the question and on the goof up that I created. The over 65 +faculty sitting in the front row turned on their hind legs to find out who this champion of poverty was!. The fact that the nobel laureate should choose to drink water at that point of time added to the haunted silence of those 5 seconds. (How I wished the earth would swallow me). The desolation in the air was dispelled by him in the end. He started recounting his 8 childhood yrs which he spent on the streets of Italy. (For a brief period of 8 yrs, he was separated from his mother and spent his early childhood in penury). His apt reponse was that environmental factors and genetics are two issues which are distinct , but linked in a way by society. Mice kept in the same cage..one given food and the other starved..tend to be aggressive in the initial days, but later on come to accept their positions, very akin to our real worls situation. It is what is fundamentally called adaptation. He asked me to focus on the real world outside for this daunting question and to come back to him with data on socio economic conditions and behavorial adaptations to model the same in animals. So . in the end , it was DATA!!! and adaptation. All of us come from middle class background and we have never seen real poverty at close quarters. When we go back into our respective careers and look at the ground situation in India, I think we should be sensitised to the disparity in the diaspora of the Indian mentality and strive to negate the perceived notions of "Oh! It doesnt affectme". In the end, I was vindicated when my position paper on poverty received only 80% mks, because I have never experienced it. I have consciously tried to highlight my feelings so that I can sensitize many of you to show that Great people are indeed humble and always have a humble beginning like any one of us!!. Have a great weekend..but spare a thought to the social revolution on ur social outings this weekend. Bye for now.. I do ramble a lot!!
Raghupathy
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