Monday, June 25, 2012

How to prevent Monsoon related diseases

Monsoon brings joy to the farmers and relief from the scorching summer heat. But it also brings a host of diseases which cause suffering and death. 

According to World Health Organization, an estimated 18 million people die from diarrheal diseases every year. This accounts for about 17% of all deaths among children in the developing countries. And not just deaths, the number of cases are a whopping 4 billion every year. That’s a huge amount of loss if we take physical suffering, work/business/school days lost, and the treatment costs into account. Therefore, even as we or the national health programs are focused on ‘bigger’ health conditions like Cancer, Diabetes, Reproductive Health, Family Planning etc.; common ailments like flu or diarrhea are still the major causes of morbidity and mortality because of the much larger number of people who suffer from them. These common conditions however are often neglected. What hurts most however is that conditions like diarrheal diseases can be easily treated at very low cost and we still let thousands and millions die from them every year. 

Monsoon provides breeding grounds for a host of vector borne diseases like Malaria, Dengue, Japanese Encephalitis, Chikungunya, etc. Pot holes, open tanks, clogged drains, construction sites, and other stagnant water bodies are where mosquitoes breed. Flooding, leakage of sewage/drains, increased temperature also poses hazards for contamination of food directly or through flies and other carriers. Typhoid, Cholera, Hepatitis A, food poisoning, etc are increased during this season and they are transmitted through the faeco-oral route. 

During Monsoon, incidence of accidents also rise due to injury during work in paddy fields, landslides, electrocution due to water dripping on live electric wire, fall due to slipping, etc. Due to growth of fungus on furniture and cloths, asthmatic attacks and other allergic conditions can be triggered.

Farmers can’t afford to be sick during monsoon, especially the terrace rice cultivators, or else there will be no harvest. It has been seen that they work through sickness and pain and towards the end of monsoon come flooding to the health centres and hospitals. Children are more likely to fall sick and this adds to loss of working-days. Sicknesses which keep adults just a couple of days from work can be life-threatening in children. Therefore, how do we take care of ourselves and what should we do to stay healthy through the monsoon? I’d like to state some preventive and control measures which individuals and communities can take to prevent the monsoon-related illnesses.

  1. Remove breeding grounds for mosquitoes. Clear stagnant drains, culverts, water containers, potholes, and all water-logged bodies where mosquitoes breed. Put a few drops of kerosene or phenyl in places which cannot be drained off. Mass social works can be conducted during the season.
  2. Use mosquito nets or repellents to avoid mosquito bites. While working in the jungle, wear full-sleeve clothes and apply mosquito repellent cream on exposed parts. Mosquito shields can be put in windows/doors to prevent mosquitoes from entering the house.
  3. Be careful with the water that you drink. Don’t drink water which is not boiled or properly stored. Most of the illnesses during the season are water borne and gastro-intestinal infections. Storing of water in steel or copper vessel kills germs and sterilizes water.
  4. Food poisoning due to ingestion of stale food is common. Prepare only the amount of food which is sufficient and do not store for long use. Be careful with the food you eat from restaurants, parties, camps, mass feasts, etc; they are common source of food poisoning outbreaks. Stale jam, salads and chutneys are also common sources of food poisoning.
  5. Proper washing of hands cannot be over-emphasized. After going to the toilet and before eating, wash hands with soap. Hand sanitizers are widely available in the market.
  6. In all types of diarrhea, oral rehydration is the cornerstone of management. In fact, it may be the only treatment required. ORS powder/solution is available in the shops and pharmacies. Home based fluids can also be used. Rice water, fruit juice, vegetable soup, etc can be used. ORS solution can be prepared at home with 2 spoons of sugar with a pinch of salt in a glass of potable water. Drinking plain water is not advised as it may lead to electrolyte imbalance. Solutions/drinks containing sugar and salt are preferred. The aim is to replace the fluid lost due to loose-motion. Don’t stop feeding with ORS/fluids even if there is vomiting. Rest for a while and feed again in small sips or with a spoon. Consult doctor quickly if the condition worsens. Renal failure can happen due to severe dehydration leading to death.
  7. Indoor Residual Spray of insecticides is carried out by the National Vector Borne Disease Control Program in the high risk areas based on epidemiological reports. Cooperation with the program on the technicalities of spraying will help in reducing the vectors. Spraying at will without following guidelines or refusal for spraying in one’s house will reduce the effectiveness of such exercises and also cause harm to the environment or community.
  8. Early diagnosis and treatment is also one of the preventive measures. It is called secondary prevention because it prevents the disease from further transmission and also reduces chances of disabilities/impairments in the sick person. Disease like malaria is easy to diagnose and treatment is free in the government health centres. But delay in diagnosis and treatment result in complications like cerebral malaria which is difficult to treat, can lead to impairment of mental function even after recovery, and fatality rate is high.
  9. The monsoon related diseases are prone to break out in epidemics. An outbreak is the occurrence of a disease which is more than the expected for that place at that time. Bigger outbreaks involving large areas are called epidemics. If there is any clustering of a particular illness or any unusual health event, contact the nearest health centre. Health centres reports to the Integrated Disease Surveillance Project (IDSP) on a weekly basis and from the weekly reports, early warning signals are detected to alarm about impending outbreaks. There are Rapid Response Teams to investigate such suspected outbreaks. Sounding the alarm bell for any outbreak can be done by any individual and many lives can be saved on timely intervention.
In the paper ‘Burden of Disease in Rural India’, Chattopadyay Aparajita and

Agnihotram V. Ramanakumar stated that beyond a certain level, National Health Programs are not able to bring down the number of deaths due to diseases. Due to intervention of various health programs, incidence and death of many of the communicable diseases have declined. But such programs can only do so to a certain level. The paper says that further reduction will depend on the improvement of infrastructure, planning for improvement of sanitation, availability of safe drinking water, and healthy living conditions. The department of health and family welfare alone cannot bring good health to our society. It has to be multi-pronged actions involving government and private agencies, community initiative and participation, and individual decision and action. For the long term, larger questions like, ‘why do monsoon affect the health of the poorer and rural populations more than others?’, also need to be put into discussion.
Dr. Sao Tunyi
(for my newspaper column Health et al.

Sunday, June 24, 2012

Confessions of a Formula1 racing fan

The problem with being an F1 racing fan is that every time a car overtakes you, you don’t take it very well…But I keep myself grounded knowing that I drive one of the cheapest cars available in the market.

I have been a fan of formula1 racing for about 9 years now. From the start, I followed Fernando Alonso of Renault then, now of Ferrari. The sound of the v8 engines is music to my ears and I sit on the edge of my seat as I watch the five red lights illuminate and the cars dash towards the first corner.

It’s the skill of the drivers, the quality of the car, the strategy, and luck which determine who wins the race. Teammates driving similar cars can produce very different results. It’s important to push hard but also to slow down and conserve tyres and stick to strategy. Bad strategy can backfire on the best guys, as seen in Canada this year. The guys at the pit stops can also determine the race, as we’ve seen one too many times this season at the McLaren team. Luck also favors during safety car period, extreme weathers, etc.

Sometimes, I feel guilty that I passionately follow a very expensive sport. But wouldn’t it be nice to drive at over 300 km/hour before you die?

Probably one of those silly posts

Monday, June 18, 2012

The threat of resistance to antibiotics

Antimicrobial Resistance (AMR) simply means that the antimicrobial medicine (say, antibiotic) you used before is not effective anymore against the disease you are suffering from; even if given at the right dose for the right duration. It means that you have developed resistance to that particular antibiotic. One disease may develop resistance to a number of antibiotics (e.g. Muti Drug Resistant TB) that in the course of time, the choice of antibiotics available for that disease becomes limited.

AMR is posing a serious threat to the treatment  of  malaria,   TB, sexually  transmitted  infections,  hospital  associated  infections,  epidemic  prone  diseases  like  cholera, typhoid, acute respiratory infections, etc. People with AMR stay sick longer, duration of treatment is longer and treatment cost also increases.

Among a number of factors responsible for the rise of AMR, inappropriate use of antibiotics is one of the most common causes. 50% of the patients do not comply with the treatment advised and 50% of the antibiotics are prescribed inappropriately. In a study conducted in and around Delhi, 25% of the responders said that they would stop the antibiotics once they start feeling better before the completion of recommended course. 53% would prescribe antibiotics for self and family members and 18% would save unused antibiotics for later use. Doctors sometimes prescribe antibiotics unnecessarily in cases of cold and diarrhea. Common cold or diarrhea can be of viral origin and antibiotics may be unnecessary in such cases. Sometimes, antibiotics are prescribed on patients’ demand or to please the patient. Lack of laboratory facilities for culture and sensitivity test (to detect the causative organisms and test their sensitivity to antibiotics) compels practitioners to go for blanket treatments using broad spectrum antibiotics.

In Nagaland, AMR is a reality although data is less and there are only a few laboratories to directly detect AMR. In a recent (2011) study conducted among 34 doctors in 8 district hospitals in Nagaland, 97% of the respondents think that they may be missing cases of AMR for lack of laboratory facilities. 30% of the respondents said that they have detected AMR in their hospital in the last 12 months. Although there is no data, it’s a fact that many people go directly to the pharmacies. They ask for certain antibiotics, or explain their illness to the pharmacist who prescribes on the spot. Some of these pharmacists may not be trained but through experience know a few about what to give in some illnesses. Many opt to go to pharmacies straightaway to avoid hospital’s long queues, laboratory tests, etc to save time and money. The issue of poor health care delivery system is a complicated and a long standing issue. But the point here is that antibiotics procured directly through pharmacies can be a factor causing AMR. In Nagaland, I think this is a serious area which needs study, spread of awareness and legislation if necessary.

The economic impact of AMR is huge. WHO lists them as loss of productivity (loss in income, diminished worker productivity, time spent by family) and increased cost of diagnostics and treatment (consultation, infrastructure, screening, cost of equipment, drugs). Health care is already strained due to rising non-communicable diseases (like Diabetes, Cancers, Cardio- Vascular Diseases), emerging and re-emerging communicable diseases (HIV/AIDS, Bird/Swine Flu, Malaria) and other conditions adverse to health like Accidents, Ageing population, Global Warming, Disasters, etc. In addition to these, the threat that AMR poses to health is of the enormity that health care can be pushed back by about a century to the pre-antibiotic era.

What can we do about the threat of AMR? Next time you catch a cold or suffer from loose motion, think twice before you decide to go for that familiar antibiotic. Common cold and Diarrhea are often of viral origin in which antibiotics may be of no use. So, consult your doctor and don’t self medicate. Then, what the doctor prescribes, complete the course even if you are already feeling better. For the caregivers, some of the things that can be done are: Study of the trend of AMR and improved surveillance; provide laboratory facilities to hospitals for AMR detection; have a Standard Treatment Protocol for doctors; sensitization of doctors and (more importantly) private pharmacists on the problem of AMR; legislations to check antibiotic use without prescription and overzealous advertisement/promotion of brands by pharmaceutical companies; rationalize antimicrobial use in veterinary sector, promote rational use through sensitization and education; etc.

Antimicrobial agents, like other natural resources are limited and should be used judiciously and rationally. Individuals’ decision to misuse this ‘common good’ put whole communities and future generations in jeopardy.