Wednesday,
July 15, 1998
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pains, no gains NARAYAN’S wife had a tough delivery. No one in the village knows the name her parent’s gave her, so until she has a child she is known as the wife of Narayan... Use anti-ulcer drugs cautiously ANTI-ULCER drugs are one of the most commonly misused drugs in clinical practice. These drugs are also called anti-acid secreting drugs... Cataract: from transparent to opaque CATARACT remains one of the leading causes of visual disability and blindness all over the world. There are about 12 million blind people due to cataract in India alone... The other side of Viagra VIAGRA (sildenafil) has crossed the international boundaries, much faster than any drug in recent times... Medical notes |
| All pains, no gains By Lindsay Barnes NARAYAN’S wife had a tough delivery. No one in the village knows the name her parent’s gave her, so until she has a child she is known as the wife of Narayan. Her husband isn’t poor, by village standards. He has a job in the coal mines, earns around Rs 3000 per month. His first wife had two daughters in three years, got beaten up severely and regularly, and finally cracked up and left him cursing, “Narayan, you are no man! You will only ever produce daughters.” She left her daughters with him.Naryan’s second wife was in her ninth month when her mother-in-law died. Forced to follow all restrictions following such a death, on top of all the normal restrictions that are imposed upon women during pregnancy, she acquired sores all around her mouth due to vitamin deficiency, on top of the chronic anaemia she already had. I was dreading her delivery.At midnight one day Narayan and his brother came to call me. When I saw her pathetic condition, and felt that the foetus seemed crooked, I tried to persuade her husband to take her to a hospital. “Where to get transport at this time of night?” he pleaded, “I’ll try in the morning.” I was half hoping she’d delay long enough, but she didn’t. At dawn the baby was born, another daughter for Narayan. The mother couldn’t care less, she’d been falling asleep in between contractions throughout the night. She even fell asleep with the bady’s head hanging out and the body still inside. She began to bleed excessively, and the placenta got stuck. I gave her an injection of methergine to stop the bleeding, which I shouldn’t have done until the placenta was out. But the choice was a retained placenta versus haemorrhage.Then we called the village ‘dai’ to manually remove the placenta from the uterus, which she did expertly with her unwashed, ungloved hands. The choice this time was between a nursing home where the doctor would have done much the same with unsterile equipment, with less patience and sympathy, with bigger hands and perhaps a bigger risk of rupturing the uterus, for much, much more money. The doctors always give antibiotics for all deliveries anyway, to pre-empt the inevitable infections. I, too, told Narayan to bring antibiotics for his wife.Anita’s delivery had much more ‘expert’ help. She was another delivery I was dreading, her legs, face and fingers were swollen, her blood pressure much too high - a condition known as pre-eclampsia. The doctor she’d been taken to see had advised her complete bed rest for one week, and then to return for her delivery in the hospital. Instead, her husband brought her back to her father’s house, much, much further away from the hospital, so her father, a colliery worker, could pay the bills. I told him not to call me for the delivery. Five days later Anita’s husband and cousin came at seven in the evening. The labour pains had started. When I saw her pressure was dangerously high I told them to arrange a vehicle quickly. Two hours later a jeep arrived, and by midnight we reached the big hospital 25 kolometres away, in Bokaro Steel City. Luckily Anita’s family had borrowed Rs. 1,500 to pay the admission fee, still it took me two hours to complete all formalities for getting her admitted. The driver was impressed, “If you hadn’t come it would have taken much longer, if they admitted at all.” Anita was pushed into a small room and her clothes and jewellery pulled off roughly by auxiliary staff who never ceased to curse her. Anita’s aunt, mother and I watched with apprehension as she was pushed into the labour ward — we were not allowed. It took me another two hours to find a doctor who would tell me her assessment of Anita’s condition, then I led a weeping mother back to the jeep to go back home. Anita’s aunt and husband stayed behind, continually being pushed away from the corridor that led to the ward where Anita was lodged by staff who complained bitterly about ignorant, dirty villagers who clutter up the place. One hour later Anita was found wandering around confused and upset, hoping to find her way home, in the cold corridors outside. Her aunt, more vigilant than the staff, led her back to her fate. After giving birth to a low-weight baby, Anita wasn’t allowed to breast-feed. One day later then began to allow her to feed her baby every four hours, during the day only. In-between, presumably, they were feeding the bady powdered milk. Three days later Anita was in tears, her breasts engorged and still separated from her baby. Six days later, under increasing pressure from Anita, mother, aunt, husband and all, against the doctor’s advice, I got them all released. None of them had bathed or eaten properly for six days, and all had big smiles of relief as we stepped out of the door of the hospital. Then there is Bhagirat’s wife who was given four injections of dangerous hormonal drugs after 10 hours of labour by a local quack, even though she knows they can cause the uterus to rupture or even death. For this was her choice. Whenever I am called to attend a delivery in these, not-really-so-remote village of south Bihar, it’s because there is no ‘choice’. I am not a doctor, not even a midwife, I don’t even encourage villagers to call me in the middle of the night to attend deliveries — but the fact that they still do is a sad reminder of their options. After attending my first delivery three years ago I asked the elderly village women what they did when things went wrong. I asked them about village dais. Weren’t there any skilled old women who could manage difficult births? They shook their heads, the ‘dai’ only comes after the baby has been born. What about private doctors, qualified or otherwise? They only come to give injections, they don’t wait around to attend the delivery, they said. Then what about the government hospital? There’s eight bedded Primary Health Centre with doctors, midwives and other staff only seven kilometres away. The women just looked at me blankly, no-one knew of its existence. Or the big hospital in Bokaro Steel City, 25 km away? That’s only for employees, they told me, unless you’ve got Rs 1,500 ready at hand. Well, then, private nursing homes? But how can we get there in the night, and then to pay the huge bills we’ll have to sell our land. So, I asked finally, what do you do then? They answered with their silence — Unnati Features. (The writer is a voluntary health worker.)  |
| Use anti-ulcer drugs
cautiously By Atima Gupta ANTI-ULCER drugs are one of the most commonly misused drugs in clinical practice. These drugs are also called anti-acid secreting drugs since they reduce/stop secretions of hydrochloric acid in the stomach. Acid production is normally there in all human beings. Presence of an optimal levels of acid is very essential for our digestion and it protects us from common food-brone infections like typhoid, protozoal and also against tuberculosis. Acid kills many disease causing bacteria and other organisms which are present in our food and can infect us. Our diet containing spices and masalas leads to higher acid secretion. Stresses and strains also increase the acid output. Regular intake of tea, coffee, cold drinks and fried food further adds to the woes of such cases. Some patients suffer from chronic acidity going for months and years together. Medical research in the past one decade has clearly established the role of H.pyloric infection in causing peptic ulcer. Patients of peptic ulcer have symptoms of increased acid secretion and pain in the abdomen. In the case of gastric ulcers pain becomes worse following intake of food. Acute stress is well known to precipitate acid peptic disease. The acidity component of acid peptic disease can be easily managed by commonly used antacids which directly neutralise the acid in the stomach. Regarding the role of anti-ulcer or anti-secretory drugs medical literature is very specific. Common anti-ulcer drugs are ranitidine, cimetidine, omeprazole and lansprazole. These drugs are marketed with trade names of Zinetac, Ocid, Topcid, Lan etc. Experts recommend use of these drugs in proven cases of peptic ulcer and severe reflux oesophagitis, where the stomach secretions regulate into food pipe. They are to be given in acute cases only for a period of six to eight weeks. It is generally agreed that these drugs are not to be given for maintenance therapy unless specifically indicated. If taken for prolonged periods extending for few months to few years, these drugs can lead to a pathological condition of absence of acid in the stomach, called as ‘achlorhydria’. Because of achlorhydria there is poor absorption of vitamins. This loss of acid also makes intestinal tract more vulnerable for a number of infections. Even cases of fungal infections of the gastrointestinal tract have also been reported following prolonged use of these drugs. Many patients with chronic acidity or pain abdomen take anti-ulcer drugs for months together without any medical advice. Such a practice should be highly discouraged. It is very commonly observed that many persons take anti-ulcer drugs following intake of alcohol or heavy meals. It is a not a scientific practice. Common side-effects of these anti-ulcer drugs are headache, cough, constipation and impotence. It has been well documented that long term use of omeprazole can cause tumors in the stomach of mice. For treatment of acid-peptic disease alone anti-acids and anti-ulcers drugs are not enough. Such cases have to be added antibiotics like clarithromycin, amoxycillin and drugs like tinidazole and bismuth salts. Today the dictum is, no H-pylori (bacteria)-no ulcer. So unless cover of antibiotic is given along with, patient of acid peptic disease is not going to be cured. But in general medical practice family physicians have yet to pick up the habit of prescribing antibiotics for this problem. Common drugs used in clinical practice which can make the patients of acid peptic disease worse are pain killers, oral contraceptives, steroids and antibiotics. Irregular sleeping habits can also lead to the problem. Since chronic acidity is quite a common problem it is being frequently observed that many patients indulge in completely irrational and unscientific use of anti-ulcer drugs. Simple antacids are ideal choice for problem of chronic acidity. Patients should also remember that unless they improve their dietary habits and reduce their life tensions, regular intake of acid reducing drugs and antacids are not going to solve their problem. |
Cataract: from transparent to
opaque
Symptoms of cataract are
entirely visual. Patients often say, ‘newsprint is
very indistinct these days’, they have to push chair
closer to TV set, glare make it hard to drive at night or
the house needs painting. Various pharmacological
strategies have been proposed for prevention and
treatment of senile cataract. But till day no
anti-cataract drug is approved for medical therapy of
cataract in the world. The only remedy at present is
extirpation of the cataractous lens through surgery. |
| The other side of Viagra By S.K. Kulkarni VIAGRA (sildenafil) has crossed the international boundaries, much faster than any drug in recent times. A record breaking 1.7 million prescriptions have been written in the USA alone since it hit the market in April 1998. In many countries, including India, it is available at phenomenal cost. Newspaper editorials and magazine columns have started discussing the drug. Even the topics for discussion in kitty parties has been around Viagra, said one report, where wives of middle-age to octogenarian husbands shared the new-found vitalities of their hubbies. Viagra (Pfizer trade name for sildenafil), is a phosphodiestrase V inhibitor used for the inability to obtain and sustain erection. This is a common problem in men and the prevalence increasing with age. This can be due to organic, psychological or often complicated by both the causes. It has to be distinguished from ejaculatory disorders including premature ejaculation and ejaculatory failure. Impotence could be a symptom of underlying diseases such as heart disease and diabetes. Many drugs including antihypertensives, cimetidine, antidepressants are reported to produce dysfunction. Viagra (25-100 mg/day orally) is reported to be well tolerated and highly effective in dysfunction due to organic, psychogenic or mixed causes. Patients and partners rated the effect as superior to placebo. The degree of satisfaction is reported to be higher in patients with Viagra as compared to placebo-treated group. However, side-effects are reported to be mild included headache, vasodilation, facial flushing, dyspepsia (indigestion) and diarrhoea. In a recent report the Food and Drug Administration (FDA) in the USA has warned about the deaths due to Viagra and maintained the possibility of dangerous drug interactions with other drugs as older patents (80 years) may be taking drugs for treatments of other ailments as well. More recently it has been observed that Viagra being mixed with other party stimulants and this could be a deadly cocktail. Three men reportedly died after Viagra as they were addicted to amphetamines. Whether hitting the bed early with Viagra is more revitalising or accepting the age related changed in sex life as a consequence of nature is matter of individual attitude. We are, anyway, in for a cultural change.
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