The day after I wrote about Stigma and Discrimination I had to listen to a tale full of that.
She was working in a Government run rural pre-school centre. Her 4 year old son [who was always sick] was diagnosed to have AIDS. He succumbed to his disease.Both she and her husband were tested 'positive'.The news got around and the parents of the kids under her care and even some of her co-workers began whispering. Finally they told her not to come for her job.
The District Health authorities intervened and tried to pacify the parents.After few months She went back to work but still had to face lot of problems. So she stopped going though
she continued to be employed there officially.
Now she is sick and came to see me.She first saw me few months ago at the Positive Network's office where I was there for my health class. There she saw me sharing food with the 'positives'.So she had confidence in me.As soon as she settled in her chair in my room she revealed that she is 'positive'.Then she told her story.
Her immunity was low for quite some time and she should have started ART[Anti HIV treatment] a year ago. But psychologically down due to her troubles in her work place she did not go to the ART centre.
She was really ill,most probably suffering from multiple infections due to her low immunity. She wanted some immediate relief but again refused to go to ART Centre. After listening to her whole story I talked to her explaining that there is no short cuts.She will get relief only if she start the correct treatment. I reassured her that there wont be any discrimination at the ART centre. At the end she promised me she will go and get the treatment.
I hope she will.Otherwise I don't think she can survive another year.
Sunday, June 29, 2008
Thursday, June 26, 2008
Stigma and Discrimination
Why there is so much fear,stigma and discrimination among some health care professionals towards HIV Positive persons?
You may think the main reason is fear of getting the infection.But there are other serious infectious diseases which are much more easily transmitted to health care workers like Hepatitis B, Hepatitis C and Open Tuberculosis.Patients suffering from these diseases are usually not stigmatised or discriminated. Then why against HIV/AIDS?
This website summarises the reasons well.If you have any views or comment please be free to express it here.
You may think the main reason is fear of getting the infection.But there are other serious infectious diseases which are much more easily transmitted to health care workers like Hepatitis B, Hepatitis C and Open Tuberculosis.Patients suffering from these diseases are usually not stigmatised or discriminated. Then why against HIV/AIDS?
This website summarises the reasons well.If you have any views or comment please be free to express it here.
Wednesday, June 25, 2008
Negative thoughts about 'Positives'
Recently I was attending a dinner and having small talk with my doctor friends. A doctor was talking about how lucky he was in finding out one of his patient was HIV positive just in time to refer him to a Government Medical College without causing any 'damage' to his nursing home. He was patting himself in the policy of his Nursing Home to screen all patients for HIV and to refer all patients who were found 'positive'. At the same time he was lamenting that these 'positive brutes' always hide their 'Positive' status.
Why do they hide the 'positive' status?Especially why do they hide in front of that doctor?
None of them hide their 'positive' status from me.Because they knew from their friends or relatives or other doctors that I never discriminate. So why they hide their status elsewhere? Because they fear stigma and discrimination. They know that the moment the 'positive' status is known they will be discriminated and stigmatised.If there is so much stigma and discrimination among medical community what can you expect from common people?
Why do they hide the 'positive' status?Especially why do they hide in front of that doctor?
None of them hide their 'positive' status from me.Because they knew from their friends or relatives or other doctors that I never discriminate. So why they hide their status elsewhere? Because they fear stigma and discrimination. They know that the moment the 'positive' status is known they will be discriminated and stigmatised.If there is so much stigma and discrimination among medical community what can you expect from common people?
Tuesday, June 24, 2008
Avoid Gatifloxacin in Diabetes
Gatifloxacin [Tequin,Gatt,Gatri,Gutsi] a Fluoroquinolone antibiotic is now discontinued or banned in most developed countries. The major problem with this antibiotic is Dysglycemia [meaning abnormal Glucose metabolism] resulting in either high or sometimes very low blood sugar in Diabetic patients.It can also produce cardiac rhythm disturbances in some patients.
Unfortunately it is widely available in India. As it attains good concentration in urine and eyes it is still widely prescribed by Ophthalmologists and Urologists.Lack of awareness among doctors about Gatifloxacin's above mentioned adverse effects reflects the sad state of drug information system in India.The situation is made worse by laboratory culture reports which show sensitivity of the organism only to one oral drug,Gatifloxacin.
I had some bad experiences with this drug.Many of my diabetic patients went in to either Hypoglycemic[low sugar] coma or dangerous hyperglycemia[high blood sugar] after taking Gatifloxacin prescribed by other doctors.
It is high time for the Drug Controller in India to either ban or display black box warnings on the label of Gatifloxacin so that no further harm is caused to the patients.
Unfortunately it is widely available in India. As it attains good concentration in urine and eyes it is still widely prescribed by Ophthalmologists and Urologists.Lack of awareness among doctors about Gatifloxacin's above mentioned adverse effects reflects the sad state of drug information system in India.The situation is made worse by laboratory culture reports which show sensitivity of the organism only to one oral drug,Gatifloxacin.
I had some bad experiences with this drug.Many of my diabetic patients went in to either Hypoglycemic[low sugar] coma or dangerous hyperglycemia[high blood sugar] after taking Gatifloxacin prescribed by other doctors.
It is high time for the Drug Controller in India to either ban or display black box warnings on the label of Gatifloxacin so that no further harm is caused to the patients.
Monday, June 23, 2008
Home work for Patients
When you decide to consult a doctor, should you do some preparations before consultation? I think so. It will help in getting the maximum out of the consultation.
Imagine you are referred by your family doctor to a consultant for expert evaluation.
1.Before leaving your family doctor's consulting room, make sure that you have a referral letter to be taken to the consultant. Also ask your family doctor to tell roughly how much expensive the consultation and relevant investigations will be so that you can be prepared.
2.Try to get the contact information of the consultant's clinic. Ring up and fix an appointment.
3.Take all your past medical records with you, even those you think is not relevant.
4.Write down all the problems you face in a paper so that you will not forget anything.
5. Try to tell the consultant your symptoms in the order at which each appeared[chronologically]
6.Don't forget to mention any drug intolerance or allergies you have.
7.After the examination is over, listen carefully to what the doctor have to say about your illness.
8.If he/she is not forthcoming with an opinion ask directly, ' what do you think is wrong with me?'
9.If asked to do investigations, ask when and where to do and when to come back with the results.
10.If a prescription is given, you can ask how long it will take for the symptoms to get better and when to come for review
11.Ask for an emergency contact number at the clinic or the hospital.
12. Get back to your family doctor and give an account of what happened.
If you do all this, you can be assured that you had made maximum out of the expert consultation.
Imagine you are referred by your family doctor to a consultant for expert evaluation.
1.Before leaving your family doctor's consulting room, make sure that you have a referral letter to be taken to the consultant. Also ask your family doctor to tell roughly how much expensive the consultation and relevant investigations will be so that you can be prepared.
2.Try to get the contact information of the consultant's clinic. Ring up and fix an appointment.
3.Take all your past medical records with you, even those you think is not relevant.
4.Write down all the problems you face in a paper so that you will not forget anything.
5. Try to tell the consultant your symptoms in the order at which each appeared[chronologically]
6.Don't forget to mention any drug intolerance or allergies you have.
7.After the examination is over, listen carefully to what the doctor have to say about your illness.
8.If he/she is not forthcoming with an opinion ask directly, ' what do you think is wrong with me?'
9.If asked to do investigations, ask when and where to do and when to come back with the results.
10.If a prescription is given, you can ask how long it will take for the symptoms to get better and when to come for review
11.Ask for an emergency contact number at the clinic or the hospital.
12. Get back to your family doctor and give an account of what happened.
If you do all this, you can be assured that you had made maximum out of the expert consultation.
Saturday, June 21, 2008
'I prefer Insulin injections to tablets'
Recently I had a patient with a strange preference.
She is 31 year old newly wed, wife of a factory worker. She was diagnosed to have Diabetes 7 months ago. The prescription she got from a Government run hospital was for Insulin, and she pricks herself twice a day for last 7 months. Her blood sugars were still high. Someone might have suggested my name. Thus, she turned up in my clinic.
When I asked her family history, I was surprised to hear that 2 of her sisters and one of her brother were Diabetic. That meant she most probably had Type 2 Diabetes which occurs in family, in contrast to Type 1 where family members are not usually that much affected. Type 2 Diabetes is mostly due to Insulin resistance [Insulin is there but not working efficiently]. Initially it is treated with oral tablets which improves Insulin efficiency, but she was prescribed for Insulin which is clearly not helping to reduce the blood sugars. Why?
Her story was like this. As she had very high blood sugars at the time of detection, she was given both tablets and Insulin injections. After controlling her blood sugar, her doctor asked her to continue on tablets. The tablet that was prescribed was not available in the Govt pharmacy, on the other hand Insulin was available free of cost. She comes from a poor family and is recently married to a lowly payed factory worker. She did not want to burden her new family. So, she opted for Insulin which she thought was the superior treatment.
I explained to her that, for her tablets are better option.I assured her that I can reduce her blood sugars with cheap tablets available in the market. Somehow I was able to make her understand that the 'free Insulin' [which is expensive in open market] is not good for her.
Still there was a problem. She already had 3 vials of Insulin with her and she did not want to waste it. So, we reached a compromise. I asked her to continue Insulin at a reduced dose, but started her on oral medicine for better control of sugars. I am sure when she come for follow up visit her sugars will be much lower.
In India[may be everywhere else also] it is tough to be poor especially, if ill.
She is 31 year old newly wed, wife of a factory worker. She was diagnosed to have Diabetes 7 months ago. The prescription she got from a Government run hospital was for Insulin, and she pricks herself twice a day for last 7 months. Her blood sugars were still high. Someone might have suggested my name. Thus, she turned up in my clinic.
When I asked her family history, I was surprised to hear that 2 of her sisters and one of her brother were Diabetic. That meant she most probably had Type 2 Diabetes which occurs in family, in contrast to Type 1 where family members are not usually that much affected. Type 2 Diabetes is mostly due to Insulin resistance [Insulin is there but not working efficiently]. Initially it is treated with oral tablets which improves Insulin efficiency, but she was prescribed for Insulin which is clearly not helping to reduce the blood sugars. Why?
Her story was like this. As she had very high blood sugars at the time of detection, she was given both tablets and Insulin injections. After controlling her blood sugar, her doctor asked her to continue on tablets. The tablet that was prescribed was not available in the Govt pharmacy, on the other hand Insulin was available free of cost. She comes from a poor family and is recently married to a lowly payed factory worker. She did not want to burden her new family. So, she opted for Insulin which she thought was the superior treatment.
I explained to her that, for her tablets are better option.I assured her that I can reduce her blood sugars with cheap tablets available in the market. Somehow I was able to make her understand that the 'free Insulin' [which is expensive in open market] is not good for her.
Still there was a problem. She already had 3 vials of Insulin with her and she did not want to waste it. So, we reached a compromise. I asked her to continue Insulin at a reduced dose, but started her on oral medicine for better control of sugars. I am sure when she come for follow up visit her sugars will be much lower.
In India[may be everywhere else also] it is tough to be poor especially, if ill.
Friday, June 20, 2008
Medicine addiction
Can I ever stop this medicine once it is started?
I hear this question from my patients over and over again.It is asked when you give a prescription for a medicine to be used for a long time or even indefinitely. Medicines given for controlling blood sugar in Diabetes and those given for controlling Blood Pressure in Hypertensive patients etc receive such question.
Many believe that once such medicines are started the patient get addicted to it and will never be able to stop it because of that.Is there any addiction potential for such medicines? Not at all. Then why such belief?
These medicines are usually started after trying out non-pharmacological methods to control blood sugar and blood pressure.Non-pharmacological methods include changes in diet and life style,exercise regimens and measures to reduce stress.Reduction in body weight will also help a great deal.If the sugar value or the blood pressure do not get controlled by these methods medicines will be prescribed.As Diabetes and Hypertension are not curable but only controllable, most patients have to take the medicines indefinitely.
So what is the answer for my patient's question?
Most probably you cant stop the medicine,unless a profound change in lifestyle, diet, body weight etc bring the sugar and blood pressure values to acceptable levels with out medicines.
And what happens when you suddenly stop the medicine on your own? May be nothing for few days.Your blood pressure or your blood sugar starts rising steadily to your pretreatment level or even more. Over a time an elevated blood sugar or blood pressure causes damages to your body.Thus stopping the medicines will definitely have deleterious effect on your health.
So better not to stop such medicines on your own.
I hear this question from my patients over and over again.It is asked when you give a prescription for a medicine to be used for a long time or even indefinitely. Medicines given for controlling blood sugar in Diabetes and those given for controlling Blood Pressure in Hypertensive patients etc receive such question.
Many believe that once such medicines are started the patient get addicted to it and will never be able to stop it because of that.Is there any addiction potential for such medicines? Not at all. Then why such belief?
These medicines are usually started after trying out non-pharmacological methods to control blood sugar and blood pressure.Non-pharmacological methods include changes in diet and life style,exercise regimens and measures to reduce stress.Reduction in body weight will also help a great deal.If the sugar value or the blood pressure do not get controlled by these methods medicines will be prescribed.As Diabetes and Hypertension are not curable but only controllable, most patients have to take the medicines indefinitely.
So what is the answer for my patient's question?
Most probably you cant stop the medicine,unless a profound change in lifestyle, diet, body weight etc bring the sugar and blood pressure values to acceptable levels with out medicines.
And what happens when you suddenly stop the medicine on your own? May be nothing for few days.Your blood pressure or your blood sugar starts rising steadily to your pretreatment level or even more. Over a time an elevated blood sugar or blood pressure causes damages to your body.Thus stopping the medicines will definitely have deleterious effect on your health.
So better not to stop such medicines on your own.
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