As I said in my previous post I was happy and satisfied during my early years in Government service. Then why I left it? Let me try to explain my reasons.
As the days and months went by my workload began to increase. The number of patients crowding in to the Medicine out patient department of the hospital became too much to be handled by me alone. Most of the other doctors were also busy. A few were experts in shirking work and nobody could make them see patients.
A similar but smaller crowd waited for me at my house each afternoon. Slowly as the quantity of work increased the quality began to suffer. Knowingly or unknowingly the quality suffered more in the hospital. Attempt to take history from the patients was time consuming and was shelved. My examination became cursory and prescriptions mere symptomatic remedies. In my private practice [which gave me direct income] I was more careful. Being an ordinary human being it was natural for me to be more sincere in that part of my work where I get more incentive.
One day I realized the extend of loss of quality of my work in the Hospital. A patient with a Cardiac murmur came to the Hospital OP. I did not detect the murmur and gave a symptomatic prescription. Not satisfied with the way I examined him; he came to my house one day later. Then only I could find out my mistake.
I tried to be more careful in my Hospital work. It was time consuming and tiring. The rule in any Government Hospital was the more sincere you are the more work you get, with out any added incentive. Actually you will earn less as you spend less time for your private practice.
Later I was transferred to a bigger hospital. There I thought I would be able to do quality work. Here also the first year was good, with fewer crowds to see me, as I was new there. As years passed the quantity of work increased. I tried hard to maintain quality. I was careful in my examination of patients so as not to miss anything.
But my satisfaction level was low. I like to talk to patients. I usually explain the illness and also about the treatment I am planning to give in detail. I had to compromise on that as I could usually spend less than 5 minutes with each patient in the hospital. If I spend more time the patients waiting in the queue will suffer. The lab stops taking samples by 11am and the Pharmacy closes by 1 pm. So if my OP run late many will not be able to use those services provided free of cost by the Government.
The relatives of those admitted under me in the Hospital will come to my house during my private practice as if to enquire about the patient's condition. Then they will try to give me an envelope with money as a form of bribe [or 'gratitude/incentive']. As a rule I will not accept it. More smart among them will get themselves examined by me for vague complaints, get a prescription from me and then give me the envelope. I will be confused and may accept it. Soon I will question myself why I accepted that. One half of my mind will tell me it is only a token of gratitude. The other half will tell me it is unethical and against the law to accept such bribe.
Many of my patients who used to consult me at my house would need admission. They were not willing to get admitted under me in the Government Hospital because of poor infrastructure and cleanliness there. They used to urge me to look after them in the nearby private hospital. Then I used to say sorry, I can’t come there as it is against the rules. But the pressure continued.
The District Medical Officer used to send me to different parts of the district for various Government activities. I was always reluctant to say no. In a way it was a change from the monotony of Hospital work. But soon I realized that most of such activities were useless and a huge wastage of Government money. Once I was send on an emergency basis to a Tribal colony in a rural village to give a report about the typhoid outbreak there. The local MLA [member of legislative assembly] had given a written question about it in the State Assembly. I was not even allowed to complete my ward rounds as the authorities wanted immediate report. I reached there an enquired about the epidemic. Actually there was no such epidemic. A press report based on rumor was the reason for all this.
When a VVIP visits our District I was usually posted for duty. Waking up early in the morning the medical team will have to wait outside the Government Guest House. When VVIP is ready to travel we will be the last vehicles in the motorcade accompanying wherever the VVIP goes. The ordeal may end only late in the night.
All these increased my unhappiness and dissatisfaction in Government service. I realized that my character itself is changing. I was slowly becoming more and more rude to patients. Work quality was going down by each passing day. I stopped enjoying my work.
At the same time my ideological commitment to Government health service prevented me from getting out. One half of my mind was saying I should stay and fight the system to change it. The other half urged me to quit so that I can start enjoying my work again.
I was indecisive, not brave enough to decide either way. Fortunately a tiff with the authorities on a matter of ethics and quality helped me to decide. I quit.
Looking back I feel I did the right thing. I did not have the guts to fight it out to try to change the system. You can call me a selfish doctor who turned away from the poor. Still I am more happy and satisfied now than I would have been in Government service.
Wednesday, February 18, 2009
Thursday, February 5, 2009
Why I joined Government Health Service?
Walking out proud from the Medical College with a post-graduate degree in Internal Medicine I had the Government job waiting for me in my home District.
Did I had any second thoughts in joining the service?
Never.
Many of my friends were trying to pass the exam to get admission for further specialisation.
But by then I wanted to taste real work,not more and more knowledge about less and less[as sub specialisation is rightly termed].
During my post graduate days, watching the endless number of patients referred from peripheral hospitals to the Medical College, I realised that there was a serious shortage of quality hands in many Districts,especially in my own. Also I was a strong believer of equity in health and always raised my voice for more Government spending in health care. The right to healthy living free of illnesses is a fundamental right which should be ensured by the Government,that was my motto.
With all this background it was natural that I never entertained second thoughts on my decision to join Government Health Service. The low salary structure did not deter me from my decision.
The hospital where I started working was a Taluk[sub-District] Hospital. It had bare minimum facilities,was under-staffed and always overcrowded with poor patients. Being an Internal Medicine MD, the patients I looked after where mainly having chronic Lung diseases,Tuberculosis,Cardiac diseases,all kinds of fevers including Leptospirosis and Typhoid,Gastro intestinal infections,all complications of Diabetes,suicidal poisoning etc.In between I also had to do suturing of minor wounds,conduct deliveries when Gynecologist was on leave and do Post mortem in case of uncontroversial but unnatural deaths.
The crowd was not knew to me[as I faced similar crowd in Medical College OP] but the lack of facilities and inability to consult a senior member of my speciality was problematic in the beginning. Soon I settled down and took my work as a challenge. To come to a working diagnosis with barest possible examination time,do the minimum but essential and affordable investigations,and treat with least expensive but effective and available medicines is always a big challenge for any doctor working in Government Hospital in small towns and villages. I was up to the challenge and did reasonably well.
I was pleasant to patients, looked up to their face and tried to listen to their complaints. I tried to practise what I learned in Medical College. The ques of patients in front of me began to grow. I started my Private practise at my place of residence [as per the Government rules]. There also patients began to flock. Money started coming in and I was overall satisfied with my decision to join Government service.
I took part in many free medical camps during holidays serving the needy in remotest part of the District. I was given training in many subjects varying from HIV/AIDS to Torture Medicine.I also imparted training to my co-workers in many subjects.
Being a doctor in Government Service gives the satisfaction of serving the poor. At the same time one can earn more money in a legal way with our hard work through the private practise.
I felt only happiness and satisfaction during those early years.
Then why did I left the Government service? That I will tell in my next post.
Did I had any second thoughts in joining the service?
Never.
Many of my friends were trying to pass the exam to get admission for further specialisation.
But by then I wanted to taste real work,not more and more knowledge about less and less[as sub specialisation is rightly termed].
During my post graduate days, watching the endless number of patients referred from peripheral hospitals to the Medical College, I realised that there was a serious shortage of quality hands in many Districts,especially in my own. Also I was a strong believer of equity in health and always raised my voice for more Government spending in health care. The right to healthy living free of illnesses is a fundamental right which should be ensured by the Government,that was my motto.
With all this background it was natural that I never entertained second thoughts on my decision to join Government Health Service. The low salary structure did not deter me from my decision.
The hospital where I started working was a Taluk[sub-District] Hospital. It had bare minimum facilities,was under-staffed and always overcrowded with poor patients. Being an Internal Medicine MD, the patients I looked after where mainly having chronic Lung diseases,Tuberculosis,Cardiac diseases,all kinds of fevers including Leptospirosis and Typhoid,Gastro intestinal infections,all complications of Diabetes,suicidal poisoning etc.In between I also had to do suturing of minor wounds,conduct deliveries when Gynecologist was on leave and do Post mortem in case of uncontroversial but unnatural deaths.
The crowd was not knew to me[as I faced similar crowd in Medical College OP] but the lack of facilities and inability to consult a senior member of my speciality was problematic in the beginning. Soon I settled down and took my work as a challenge. To come to a working diagnosis with barest possible examination time,do the minimum but essential and affordable investigations,and treat with least expensive but effective and available medicines is always a big challenge for any doctor working in Government Hospital in small towns and villages. I was up to the challenge and did reasonably well.
I was pleasant to patients, looked up to their face and tried to listen to their complaints. I tried to practise what I learned in Medical College. The ques of patients in front of me began to grow. I started my Private practise at my place of residence [as per the Government rules]. There also patients began to flock. Money started coming in and I was overall satisfied with my decision to join Government service.
I took part in many free medical camps during holidays serving the needy in remotest part of the District. I was given training in many subjects varying from HIV/AIDS to Torture Medicine.I also imparted training to my co-workers in many subjects.
Being a doctor in Government Service gives the satisfaction of serving the poor. At the same time one can earn more money in a legal way with our hard work through the private practise.
I felt only happiness and satisfaction during those early years.
Then why did I left the Government service? That I will tell in my next post.
Wednesday, February 4, 2009
History
First Generation of Vaccines (pre-1950s)
1798 Smallpox
1885 Rabies
1897 Plague
1917 Cholera
1917 Typhoid vaccine (parenteral)
1923 Diphtheria
1926 Pertussis
1927 Tuberculosis (BCG)
1927 Tetanus
1935 Yellow Fever
1940s DTP
1945 The first influenza vaccines (flu) began being used.
1950s-1960s
1955 Inactivated polio vaccine licensed (IPV).
1955 Tetanus and diphtheria toxoids adsorbed (adult use, Td)
1959 World Health Assembly passes initial resolution calling for global smallpox eradication.
1961 Monovalent oral polio vaccine licensed.
1963 Trivalent oral polio vaccine licensed (OPV).
1963 The first measles vaccine licensed.
1964 Advisory Committee on Immunization Practices (ACIP), designed to provide CDC with recommendations on vaccine use, holds its first meeting.
1964-1965 20,000 cases of Congenital Rubella Syndrome occurred during the largest rubella epidemic in the United States.
1966 U.S. Measles eradication goal enunciated.
1967 Mumps vaccine licensed.
1969 Rubella vaccine licensed - 57,600 rubella cases reported this year.
1970s
1970 Anthrax vaccine manufactured by the Michigan Department of Public Health.
1971 Routine smallpox vaccination ceases in the United States.
1971 Measles, Mumps, Rubella vaccine licensed (MMR).
1976 Swine Flu: largest public vaccination program in the United States to date; halted by association with Guillain-Barré syndrome.
1977 Last indigenous case of smallpox (Somalia).
1978 Fluzone, the current flu vaccine that is made by Aventis pasteur, was licensed.
1979 Last case of polio, caused by wild virus, acquired in the United States.
1980s
1980 Smallpox declared eradicated from the world.
1981 Meningococcal polysaccharide vaccine, groups A, C, Y, W135 combined (Menomune)
1982 Hepatitis B vaccine becomes available.
1983 Pneumococcal vaccine, 23 valent
1986 The National Childhood Vaccine Injury Act establishes a no-fault compensation system for those injured by vaccines and requires adverse health events following specific vaccinations be reported and those injured by vaccines be compensated.
1988 Worldwide Polio Eradication Initiative launched; supported by WHO, UNICEF, Rotary International, CDC and others.
1989-1991 Major resurgence of measles in the United States - 55,000 cases compared with a low of 1,497 cases in 1983. Two-dose measles vaccine (MMR) is recommended.
1990s
1990 The Vaccine Adverse Reporting System (VAERS), a national program monitoring the safety of vaccines established.
1990 Haemophilus influenzae type B (Hib) polysaccharide conjugate vaccine licensed for infants.
1990 Typhoid vaccine (oral)
1991 Hepatitis B vaccine recommended for all infants.
1991 Acellular pertussis vaccine (DTaP) licensed for use in older children aged 15 months to six years old.
1993 Japanese encephalitis vaccine
1994 Polio elimination certified in the Americas.
1994 Vaccines for Children (VFC) program established to provide access to free vaccines for eligible children at the site of their usual source of care.
1995 First harmonized childhood immunization schedule endorsed by ACIP, the American Academy of Family Physicians and the American Academy of Pediatrics is published.
1995 Varicella vaccine licensed; before the vaccine an estimated 4 million infected annually in the United States.
1995 Hepatitis A vaccine licensed.
1996 Acellular pertussis vaccine (DTaP) licensed for use in young infants.
1998 First rotavirus vaccine licensed.
1999 Rotavirus vaccine withdrawn from the market as a result of adverse events.
1999 Lyme disease vaccine approved by the FDA.
1999 FDA recommends removing mercury from all products, including vaccines. Efforts are begun to remove thimerosal, a mercury based additive, from vaccines.
2000s
2000 Worldwide measles initiative launched; 800,000 children still die from measles annually. Measles declared no longer endemic in the United States.
2000 Pneumococcal conjugate vaccine (Prevnar) recommended for all young children.
2001 September 11 results in increased concern of bioterrorism. The United States establishes a plan to re-introduce smallpox vaccine if necessary, a vaccine thought never to be needed again.
2002 Lyme disease vaccine withdrawn from the market by the manufacturer because of lawsuits and lack of demand for the vaccine.
2003 Measles declared no longer endemic in the Americas.
2003 First live attenuated influenza vaccine licensed (FluMist) for use in 5 to 49 year old persons.
2003 First Adult Immunization Schedule introduced.
2004 Inactivated influenza vaccine recommended for all children 6 to 23 months of age.
2004 Pediarix,a vaccine that combines the DTaP, IPV, and Hep B vaccines, into one shot, is approved.
2005 Rubella declared no longer endemic in the United States.
2005 Boostrix and Adacel, Tdap vaccines, are approved for teens.
2005 Menactra, a new meningococcal vaccine is approved for people between the ages of 11 to 55 years of age.
2006 RotaTeq is a new rotavirus vaccine from Merck.
2006 ProQuad is a new vaccine that combines the MMR and Varivax vaccines for measles, mumps, rubella, and chicken pox into a single shot.
2006 Gardasil, the first HPV vaccine is approved.
2007 A booster dose of Varivax, the chickenpox vaccine, is now recommended for all children.
2007 The recommended age for Flumist, the nasal spray flu vaccine, was lowered to two years.
2008 Outbreaks of measles increasing across the U.S. as vaccination rates drop among some communities over vaccine safety fears.
2008 Rotarix, a two dose rotavirus vaccine is approved.
2008 Pentacel, a combination of DTaP, IPV and Hib is approved.
2008 Kinrix, a combination of DTaP and IPV that can be used for children between the ages of 4 and 6 as approved.
1798 Smallpox
1885 Rabies
1897 Plague
1917 Cholera
1917 Typhoid vaccine (parenteral)
1923 Diphtheria
1926 Pertussis
1927 Tuberculosis (BCG)
1927 Tetanus
1935 Yellow Fever
1940s DTP
1945 The first influenza vaccines (flu) began being used.
1950s-1960s
1955 Inactivated polio vaccine licensed (IPV).
1955 Tetanus and diphtheria toxoids adsorbed (adult use, Td)
1959 World Health Assembly passes initial resolution calling for global smallpox eradication.
1961 Monovalent oral polio vaccine licensed.
1963 Trivalent oral polio vaccine licensed (OPV).
1963 The first measles vaccine licensed.
1964 Advisory Committee on Immunization Practices (ACIP), designed to provide CDC with recommendations on vaccine use, holds its first meeting.
1964-1965 20,000 cases of Congenital Rubella Syndrome occurred during the largest rubella epidemic in the United States.
1966 U.S. Measles eradication goal enunciated.
1967 Mumps vaccine licensed.
1969 Rubella vaccine licensed - 57,600 rubella cases reported this year.
1970s
1970 Anthrax vaccine manufactured by the Michigan Department of Public Health.
1971 Routine smallpox vaccination ceases in the United States.
1971 Measles, Mumps, Rubella vaccine licensed (MMR).
1976 Swine Flu: largest public vaccination program in the United States to date; halted by association with Guillain-Barré syndrome.
1977 Last indigenous case of smallpox (Somalia).
1978 Fluzone, the current flu vaccine that is made by Aventis pasteur, was licensed.
1979 Last case of polio, caused by wild virus, acquired in the United States.
1980s
1980 Smallpox declared eradicated from the world.
1981 Meningococcal polysaccharide vaccine, groups A, C, Y, W135 combined (Menomune)
1982 Hepatitis B vaccine becomes available.
1983 Pneumococcal vaccine, 23 valent
1986 The National Childhood Vaccine Injury Act establishes a no-fault compensation system for those injured by vaccines and requires adverse health events following specific vaccinations be reported and those injured by vaccines be compensated.
1988 Worldwide Polio Eradication Initiative launched; supported by WHO, UNICEF, Rotary International, CDC and others.
1989-1991 Major resurgence of measles in the United States - 55,000 cases compared with a low of 1,497 cases in 1983. Two-dose measles vaccine (MMR) is recommended.
1990s
1990 The Vaccine Adverse Reporting System (VAERS), a national program monitoring the safety of vaccines established.
1990 Haemophilus influenzae type B (Hib) polysaccharide conjugate vaccine licensed for infants.
1990 Typhoid vaccine (oral)
1991 Hepatitis B vaccine recommended for all infants.
1991 Acellular pertussis vaccine (DTaP) licensed for use in older children aged 15 months to six years old.
1993 Japanese encephalitis vaccine
1994 Polio elimination certified in the Americas.
1994 Vaccines for Children (VFC) program established to provide access to free vaccines for eligible children at the site of their usual source of care.
1995 First harmonized childhood immunization schedule endorsed by ACIP, the American Academy of Family Physicians and the American Academy of Pediatrics is published.
1995 Varicella vaccine licensed; before the vaccine an estimated 4 million infected annually in the United States.
1995 Hepatitis A vaccine licensed.
1996 Acellular pertussis vaccine (DTaP) licensed for use in young infants.
1998 First rotavirus vaccine licensed.
1999 Rotavirus vaccine withdrawn from the market as a result of adverse events.
1999 Lyme disease vaccine approved by the FDA.
1999 FDA recommends removing mercury from all products, including vaccines. Efforts are begun to remove thimerosal, a mercury based additive, from vaccines.
2000s
2000 Worldwide measles initiative launched; 800,000 children still die from measles annually. Measles declared no longer endemic in the United States.
2000 Pneumococcal conjugate vaccine (Prevnar) recommended for all young children.
2001 September 11 results in increased concern of bioterrorism. The United States establishes a plan to re-introduce smallpox vaccine if necessary, a vaccine thought never to be needed again.
2002 Lyme disease vaccine withdrawn from the market by the manufacturer because of lawsuits and lack of demand for the vaccine.
2003 Measles declared no longer endemic in the Americas.
2003 First live attenuated influenza vaccine licensed (FluMist) for use in 5 to 49 year old persons.
2003 First Adult Immunization Schedule introduced.
2004 Inactivated influenza vaccine recommended for all children 6 to 23 months of age.
2004 Pediarix,a vaccine that combines the DTaP, IPV, and Hep B vaccines, into one shot, is approved.
2005 Rubella declared no longer endemic in the United States.
2005 Boostrix and Adacel, Tdap vaccines, are approved for teens.
2005 Menactra, a new meningococcal vaccine is approved for people between the ages of 11 to 55 years of age.
2006 RotaTeq is a new rotavirus vaccine from Merck.
2006 ProQuad is a new vaccine that combines the MMR and Varivax vaccines for measles, mumps, rubella, and chicken pox into a single shot.
2006 Gardasil, the first HPV vaccine is approved.
2007 A booster dose of Varivax, the chickenpox vaccine, is now recommended for all children.
2007 The recommended age for Flumist, the nasal spray flu vaccine, was lowered to two years.
2008 Outbreaks of measles increasing across the U.S. as vaccination rates drop among some communities over vaccine safety fears.
2008 Rotarix, a two dose rotavirus vaccine is approved.
2008 Pentacel, a combination of DTaP, IPV and Hib is approved.
2008 Kinrix, a combination of DTaP and IPV that can be used for children between the ages of 4 and 6 as approved.
IMMUNIZATIONS
Immunizations help protect you or your child from disease. They also help reduce the spread of disease to others and prevent epidemics. Most are given as shots. They are sometimes called vaccines, or vaccinations.
In many cases when you get a vaccine, you get a tiny amount of a weakened or dead form of the organism that causes the disease. This amount is not enough to give you the actual disease. But it is enough to cause your immune system to make antibodies that can recognize and attack the organism if you are ever exposed to it.
Immunizations are heralded as one of the 20th century's most cost-effective public health achievements. Immunizations protect both individuals and the larger population, especially those people who have immune system disorders and cannot be vaccinated. In their role as guardian of the public's health, states play a significant role in determining immunization policies.
High vaccination coverage rates and low incidences of diseases indicate a successful immunization program.
Why should you get immunized?Immunizations protect you or your child from dangerous diseases. They help reduce the spread of disease to others. Getting immunized costs less than getting treated for the diseases that the shots protect you from. Vaccines have very few serious side effects. They are often needed for entrance into school or day care. And they may be needed for employment or for travel to another country. If you are a woman who is planning to get pregnant, talk to your doctor about what immunizations you have had and what you may need to protect your baby. And if you live with a pregnant woman, make sure that your vaccines are up to date. Traveling to other countries may be another reason to get immunized. Talk with your doctor 6 months before you leave, to see if you need any shots.
What immunizations are recommended for children and adolescents?
Ask your doctor what shots your child should get. The immunization schedule includes vaccines for:
-Anthrax
-Diphtheria
-Haemophilus Influenzae type b (Hib)
-Hepatitis A-Hepatitis B-Human Papillomavirus (HPV)
-Influenza
-Lyme Disease
-Measles
-Meningococcal disease
-Mumps
-Pertussis (Whooping Cough)
-Pneumococcal disease
-Polio
-Rabies
-Rotavirus
-Rubella
-Shingles (Herpes Zoster)
-Smallpox
-Tetanus
-Tuberculosis
-Typhoid Fever
-Varicella (Chickenpox)
-Yellow Fever
Sunday, January 18, 2009
It seemed they all wanted her to die.Part 3
Yes, they all wanted her to die,may be even myself.And she died.
The girl I mentioned in 2 of my earlier posts [November,December]died few days ago. Not seeing her come for review for last 2 months, I called the cell number I had obtained from Hospital records again.The person who answered immediately gave it to the girl's mother.
Why you are not bringing her to me?How is she? I asked in an accusing tone.
She is no more,died few days ago', was the matter of fact reply.
I was shocked.
' Did you take her to any doctor?'
'No, She was better with your medicines'.
'Did she die in a hospital or home?'
'She died at home'.
I held the line for a few seconds not knowing what to do.Then I disconnected.
Sense of depression engulfed me.And guilt.May be I should have been more pro-active.Should have telephoned that number more regularly and threatened them of action if they did not bring the girl to me.Or I should have asked one of my acquaintance in the District Positive network[an NGO of Positive ppl] to go and find out where she lived and try to interact with the family.
I hid an important fact in my first posting about that girl.The fact was her father died few years ago due to HIV/AIDS and she might have been a victim of incestuous relationship[.Her mother was negative.]This was one of the most important factor that made her family want her to die.For them her death means an end to their humiliating secret.
She was severely ill,with her CD 4 count 20[indicating very advanced AIDS] at the time of diagnosis.Still with proper care there was a 40/60 or on the pessimistic side 20/80 chance that she will recover.
But they never wanted her to recover.Should I blame them? For them she was a dirty stain on the family,someone they wanted to forget fast.
May be I should have been able to ask some NGOs to take her under their wings.Take her out of the house where she is not wanted.If she was an orphan I might have done that before discharge from the hospital.But she was not an Orphan.She had a mother,sister and brother, and Uncles.
I wish she was an Orphan.Then she might have survived.
The girl I mentioned in 2 of my earlier posts [November,December]died few days ago. Not seeing her come for review for last 2 months, I called the cell number I had obtained from Hospital records again.The person who answered immediately gave it to the girl's mother.
Why you are not bringing her to me?How is she? I asked in an accusing tone.
She is no more,died few days ago', was the matter of fact reply.
I was shocked.
' Did you take her to any doctor?'
'No, She was better with your medicines'.
'Did she die in a hospital or home?'
'She died at home'.
I held the line for a few seconds not knowing what to do.Then I disconnected.
Sense of depression engulfed me.And guilt.May be I should have been more pro-active.Should have telephoned that number more regularly and threatened them of action if they did not bring the girl to me.Or I should have asked one of my acquaintance in the District Positive network[an NGO of Positive ppl] to go and find out where she lived and try to interact with the family.
I hid an important fact in my first posting about that girl.The fact was her father died few years ago due to HIV/AIDS and she might have been a victim of incestuous relationship[.Her mother was negative.]This was one of the most important factor that made her family want her to die.For them her death means an end to their humiliating secret.
She was severely ill,with her CD 4 count 20[indicating very advanced AIDS] at the time of diagnosis.Still with proper care there was a 40/60 or on the pessimistic side 20/80 chance that she will recover.
But they never wanted her to recover.Should I blame them? For them she was a dirty stain on the family,someone they wanted to forget fast.
May be I should have been able to ask some NGOs to take her under their wings.Take her out of the house where she is not wanted.If she was an orphan I might have done that before discharge from the hospital.But she was not an Orphan.She had a mother,sister and brother, and Uncles.
I wish she was an Orphan.Then she might have survived.
Thursday, January 15, 2009
Why some Doctors discriminate against patients?
He,let us call him Mr M, is 30 years old,single working in a Bank in one of India's big Cities.His native place is near my clinic and I know him for last 6 years. I know him because he is positive for Hepatitis B Virus.
I remember him coming to me in distress as the technician in the Blood Bank had rejected his donated blood and asked him to see a Physician.He was told he is having jaundice.
I understood what the technician meant.Such rejection meant the blood is positive for either Hepatitis B or Hepatitis C Virus.
I ordered a whole series of tests on his blood. Results showed he was harbouring Hepatitis B Virus in his blood,but all the other tests were negative.
Both Hepatitis B and C are transmitted by inoculation of infected blood and blood products or body fluids.Unprotected sex, unhygienic medical procedures and unsafe blood can cause transmission.Once the virus enters the body it lives and replicates in the Liver causing hepatitis which may or may not produce jaundice.In most patients the immune system kills the virus completely and the person becomes negative to the test for virus.
But in a minority of patients the virus persists in the Liver and blood in a dormant form.Such a person is called a carrier in whom the virus will not produce any problem but can potentially transmit it to others. Our Mr M was such a carrier.Later in life [may be after 10 or 20 years] in a small percentage of carriers,the virus may again become active producing severe permanent Liver damage and even Liver cancer.So Mr M will have to undergo periodic lab tests to assess the activity of the virus.
While I explained all this his face revealed a depressed mood.
'I never had any unprotected sex doctor.Also never received blood donation'.
Any major medical procedures or injections? I asked.
'I had a few shots for various reasons.Also few dental procedures'.
If he was speaking the truth, probably we the health care personnel might have carelessly passed the virus in to his blood.I stopped that discussion there.
From then on he had came to me every year doing a series of lab tests confirming that the virus is there but not doing any harm to him.
Today Mr M was before me again.After reviewing the lab tests I gave him a smile saying everything is all right except that he is continuing as a carrier. I asked him about plans for marriage.
'Family is after me, pushing for marriage',M said.'But I do not want to hide my carrier state'.
'You can immunise your future wife with vaccine.Then you need not worry about transmitting the virus', I reassured him.
'Will anybody willingly come for an arranged marriage with a Hep B carrier?' M asked.
'Then love somebody,that may solve your problem', I replied.He gave me a shy smile.
'I have another problem doctor',he hesitantly said.
'Tell me' I encouraged him.
'I need some dental procedure done.I went to 3 different dentists in the City where I work.When I revealed my Hep B positive status they became very hesitant in doing the procedure.They came with excuses like we do not have separate instruments,or we do not want to take a risk of transmission of virus to other patients etc..'M said.' I do not want anybody else to suffer like me,that's why I am revealing my Hep B positive status'he added.
I was ashamed but not shocked.
I have seen this behaviour many times in doctors[both dentists and other doctors] when confronted with Hep B or more often with HIV.These docs will do the procedure gleefully and pocket the fees if Mr M was not so truthful.And they are doing countless procedures on un tested or untruthful positive patients day in and day out.If the Universally accepted precautions are properly taken all procedures are safe.Why these doctors discriminate like this? Are they not confident about the safety measures they are taking in their clinics?
More over in case of M, he must have got the virus from an unsafe injection or procedure.So health professionals are even more to be held responsible.
I immediately send him to a Dentist friend, with a letter in such strong words that he will not even think about rejecting Mr M. I hope he will get the required treatment and will not ever be rejected again for being truthful.
I remember him coming to me in distress as the technician in the Blood Bank had rejected his donated blood and asked him to see a Physician.He was told he is having jaundice.
I understood what the technician meant.Such rejection meant the blood is positive for either Hepatitis B or Hepatitis C Virus.
I ordered a whole series of tests on his blood. Results showed he was harbouring Hepatitis B Virus in his blood,but all the other tests were negative.
Both Hepatitis B and C are transmitted by inoculation of infected blood and blood products or body fluids.Unprotected sex, unhygienic medical procedures and unsafe blood can cause transmission.Once the virus enters the body it lives and replicates in the Liver causing hepatitis which may or may not produce jaundice.In most patients the immune system kills the virus completely and the person becomes negative to the test for virus.
But in a minority of patients the virus persists in the Liver and blood in a dormant form.Such a person is called a carrier in whom the virus will not produce any problem but can potentially transmit it to others. Our Mr M was such a carrier.Later in life [may be after 10 or 20 years] in a small percentage of carriers,the virus may again become active producing severe permanent Liver damage and even Liver cancer.So Mr M will have to undergo periodic lab tests to assess the activity of the virus.
While I explained all this his face revealed a depressed mood.
'I never had any unprotected sex doctor.Also never received blood donation'.
Any major medical procedures or injections? I asked.
'I had a few shots for various reasons.Also few dental procedures'.
If he was speaking the truth, probably we the health care personnel might have carelessly passed the virus in to his blood.I stopped that discussion there.
From then on he had came to me every year doing a series of lab tests confirming that the virus is there but not doing any harm to him.
Today Mr M was before me again.After reviewing the lab tests I gave him a smile saying everything is all right except that he is continuing as a carrier. I asked him about plans for marriage.
'Family is after me, pushing for marriage',M said.'But I do not want to hide my carrier state'.
'You can immunise your future wife with vaccine.Then you need not worry about transmitting the virus', I reassured him.
'Will anybody willingly come for an arranged marriage with a Hep B carrier?' M asked.
'Then love somebody,that may solve your problem', I replied.He gave me a shy smile.
'I have another problem doctor',he hesitantly said.
'Tell me' I encouraged him.
'I need some dental procedure done.I went to 3 different dentists in the City where I work.When I revealed my Hep B positive status they became very hesitant in doing the procedure.They came with excuses like we do not have separate instruments,or we do not want to take a risk of transmission of virus to other patients etc..'M said.' I do not want anybody else to suffer like me,that's why I am revealing my Hep B positive status'he added.
I was ashamed but not shocked.
I have seen this behaviour many times in doctors[both dentists and other doctors] when confronted with Hep B or more often with HIV.These docs will do the procedure gleefully and pocket the fees if Mr M was not so truthful.And they are doing countless procedures on un tested or untruthful positive patients day in and day out.If the Universally accepted precautions are properly taken all procedures are safe.Why these doctors discriminate like this? Are they not confident about the safety measures they are taking in their clinics?
More over in case of M, he must have got the virus from an unsafe injection or procedure.So health professionals are even more to be held responsible.
I immediately send him to a Dentist friend, with a letter in such strong words that he will not even think about rejecting Mr M. I hope he will get the required treatment and will not ever be rejected again for being truthful.
Thursday, January 1, 2009
Rheumatoid Arthritis a risk factor for Heart Attack and Stroke
My Aunt died suddenly few years ago due to a massive Heart Attack[Myocardial Infarction]. She was suffering from Rheumatoid Arthritis[RA] for a long time.Her Arthritis was fairly under control and was active in life when she was suddenly taken away by death. Her sudden death was a shock to me.It made me research the literature to find out any connection between Rheumatoid Arthritis and Heart Attack.The findings were very revealing.
Several studies have found out that those who are suffering from RA has double the risk for Cardiovascular disease [which includes heart attack and stroke] than General Population.The risk is almost same as those who have Type2 Diabetes.
As more more and more such studies were published an expert committee was appointed by European League against Rheumatism[EULAR], the professional body of Rheumatologists in Europe.Now the Task Force has come out with its recommendations which can be read here. This was published at EULAR 2008 the Annual Congress of the European League Against Rheumatism in Paris, France in June 2008.
The EULAR Task Force’s multidisciplinary steering committee comprised 21 members, including rheumatologists, cardiologists, internists and epidemiologists, from across nine European countries.
This recommendations are applicable not only to RA patients but also to Ankylosing Spondylitis[AS] and Psoriatic Arthritis[PsA] patients.
What does this recommendations mean for RA,AS,PsA patients?
Persons suffering from RA,AS orPsA have very high risk of getting a Heart Attack or Stroke when compared to those who do not have RA,AS or PsA.
Any one having the above rheumatological diseases should undergo active screening for other Cardiovascular risk factors like Diabetes,High Blood Pressure,High Cholestrol etc.If any such risk factors are present they should be actively managed by lifestyle modification including diet and exercise,medicines and frequent monitoring. They should refrain from using tobacco.They should also undergo frequent screening for Coronary Artery disease by Electrocardiography[ECG/EKG],Exercise Stress Test[Treadmill Test] and or Angiography which ever is applicable in a particular patient.
Though the task force have not specified a target value,it can be inferred that the target values for Blood Pressure, HDL and LDL Cholesterol should be similar to the target for Type 2 Diabetes patients.
So RA patients should keep their
Blood Pressure below 130/80
LDL Cholesterol below 100mg/dL
HDL Cholesterol above 40mg/dL
It is hoped that the Task Force recommendations will directly contribute to improved clinical practice and better the life of Rheumatoid Arthritis patients.
I wish such recommendations were there 5 years ago.If so my Aunt might have been still alive.
Several studies have found out that those who are suffering from RA has double the risk for Cardiovascular disease [which includes heart attack and stroke] than General Population.The risk is almost same as those who have Type2 Diabetes.
As more more and more such studies were published an expert committee was appointed by European League against Rheumatism[EULAR], the professional body of Rheumatologists in Europe.Now the Task Force has come out with its recommendations which can be read here. This was published at EULAR 2008 the Annual Congress of the European League Against Rheumatism in Paris, France in June 2008.
The EULAR Task Force’s multidisciplinary steering committee comprised 21 members, including rheumatologists, cardiologists, internists and epidemiologists, from across nine European countries.
This recommendations are applicable not only to RA patients but also to Ankylosing Spondylitis[AS] and Psoriatic Arthritis[PsA] patients.
What does this recommendations mean for RA,AS,PsA patients?
Persons suffering from RA,AS orPsA have very high risk of getting a Heart Attack or Stroke when compared to those who do not have RA,AS or PsA.
Any one having the above rheumatological diseases should undergo active screening for other Cardiovascular risk factors like Diabetes,High Blood Pressure,High Cholestrol etc.If any such risk factors are present they should be actively managed by lifestyle modification including diet and exercise,medicines and frequent monitoring. They should refrain from using tobacco.They should also undergo frequent screening for Coronary Artery disease by Electrocardiography[ECG/EKG],Exercise Stress Test[Treadmill Test] and or Angiography which ever is applicable in a particular patient.
Though the task force have not specified a target value,it can be inferred that the target values for Blood Pressure, HDL and LDL Cholesterol should be similar to the target for Type 2 Diabetes patients.
So RA patients should keep their
Blood Pressure below 130/80
LDL Cholesterol below 100mg/dL
HDL Cholesterol above 40mg/dL
It is hoped that the Task Force recommendations will directly contribute to improved clinical practice and better the life of Rheumatoid Arthritis patients.
I wish such recommendations were there 5 years ago.If so my Aunt might have been still alive.
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