Wednesday, October 20, 1999

Dental Fellowship

The worldwide health crisis
Exclusive from Red Cross and Red Crescent

The shrinking world, combined with economic hardship, rapid urbanisation and environmental factor, has given a wide range of diseases a new lease of life.

Population movements and lease of travel help to spread epidemics; respiratory infections, diarrhoeal diseases and TB prosper in densely populated urban areas — and in refugee camps; untreated water and poor sanitation are the major factors in the high incidence of water-borne diseases; and the rise in average temperatures means that malaria is now found at higher altitudes and in countries where it was previously unknown.

Newly emerging diseases such as Ebola and other haemmorhagic fevers are becoming more common. HIV/AIDS will most probably ramain one of the major public health concerns of the coming decade. Meanwhile, certain infectious diseases are re-emerging. Not only are they back with a vengeance, but the development of drug-resistant bacteria is now further complicating treatment. TB has become a serious threat to public health, and together with malaria has been identified by WHO as one of the major global challenges of the future. There has been a marked increase in the incidence of diphtheria, particularly in countries of the former Soviet bloc.

At the same time, as a result of the increased burden of disease and economic constraints, health care institutions find it increasingly difficult to meet even patients’ basic needs. The cocktail therapy for HIV costs $5 15-20,000 a year per person, while the annual per capita health budget in many countries is only $ 10-20. The prophylactic use of AZT to reduce the risk of vertical transmission to infants during birth costs $50 per woman. Even that amount far exceeds the national capacity in most developing countries, particularly in Africa.

Many of the world’s current health problems are related to poor water and sanitation. It is not only in the burgeoning slums that basic amenities are lacking, for access to water is deteriorating everywhere. This precious commodity, on which all life depends, needs to be used carefully and wisely. The Federation is therefore increasing its attention and resources in this domain.

The Federation and National Societies have also made significant contributions to the control of epidemics. During the Ebola crisis in the former Zaire in 1995, before the outbreak was finally suppressed, five volunteers themselves died from contact with the disease. In response to a diphtheria epidemic in Ukraine, Belarus and the Baltic States in 1995-1996, the Federation and the concerned National Societies joined forces with UNICEF and WHO to implement a massive immunization campaign reaching 23 million people. similar successful operations have been conducted to control meningitis in Africa and measles, showing that National Societies do have the necessary capacity and are of tremendous value to their governments.

Good health practices: Containing epidemics when they arise is all well and good, but there is truth in the old adage that prevention is better than cure. Education is the first step towards bringing about the behavioural changes necessary to stop the occurrence or spread of disease. Drinking safe water, building latrines, protecting food from insects, using mosquito nets, limiting alcohol consumption changing nutritional habits — these are all things that we as individuals can do to improve our own health.

One of the Movement’s greatest strengths lies in its volunteers, a vast human resource, and in its grassroots presence, which makes it enormously effective as means of communication. National Societies can play a very dynamic role in health education and the promotion of a healthy lifestyle.

Many countries where HIV/AIDS is prevalent cannot afford to provide treatment or long-term hospital stay. The sick person is therefore left in the care of the family, which is ill prepared to take on the task of nursing. One role for Red Cross and Red Crescent workers is to visit terminally ill patients in their homes and show their careers how best to meet their needs, thereby contributing to “death with dignity”. However, the surest way of stemming the spread of HIV/AIDS is still to promote knowledge leading to changes in behaviour.

TB is linked to poverty, poor living conditions, poor nutrition and certain behavioural patterns. As well as providing direct treatment, National Societies can help to alleviate the root causes. This can be done in a number of ways: through health education, nutritional assistance(e.g. soup kitchens), and ensuring that patients complete their full course of treatment, since failure to do so is the major cause of development of drug-resistant strains of the disease.

National Societies can also promote the timely and proper use of health services. All the technology, training and refrigeration of vaccines will serve no purpose if a mother does not bring her child to the health centre for immunization. National society volunteers can spread the word and, if necessary, act as partners to the health authorities on any monthly vaccination days. Cholera and other diarrhoeal diseases can be prevented by improving hygiene and providing safe drinking water. Here again, National Societies can play a vital role, in terms both of promoting hygiene measures and teaching people how to administer oral rehydration salts.

Simple solutions: Most health problems in under-served communities can be resolved with minimal input and personnel with basic skills. This is the basic tenet of primary health care. The concept was enthusiastically embraced in the seventies along with the notion of “community participation,” whereby the local community was encouraged to recognize its own health problems and develop appropriate responses. To educate and train everyone in the community to deal with their own basic health problems is a Movement strategy of the highest importance, relieving many unnecessary patient visits to medical facilities.

But investment in primary health care does not yield instant results, and may therefore take second place to investment in the economic sector. Needless to say, this view is short-sighted. Ill health means an economic loss, in terms both of the direct cost of medical care and the indirect cost of decreased productivity. Malnutrition stunts not only physical growth but also mental development, meaning less brainpower to fuel a country’s future economic development.

Reproductive health is also an area requiring increased attention. Programmes developed in recent years have focused on specific areas, such as the needs of raped women, safe motherhood, protection against HIV/AIDS and family planning.

Primary health care and the provision of basic health services are both a humanitarian issue and one way of contributing to the well-being of human resources-a fundamental factor in national development.

First comes first aid: First aid is about preventing, preparing for and responding to acute health risks and life-threatening situations. During a major emergency, there is a critical period between the time when an accident or disaster occurs and the arrival of organised help. It is therefore essential to develop not only effective response mechanisms and emergency services, but also the capacity of each person to serve the community.

First aid is a tool for people to help others and provides the basic skills needed to respond to the day-to-day threats of life. It can also be a vehicle for health education and prevention. Because it is simple and adaptable, it can be taught to schoolchildren. It can be tailor-made to different populations of the world as well as different environments and needs.

In a country where an ambulance is a short drive away, it is useful to teach cardiopulmonary resuscitation, because those ten minutes gained can save someone’s life. In a community where children die from diarrhoea, just instructing people to boil water and how to administer oral rehydration salts is more likely to prevent unnecessary death than teaching cardiopulmonary resuscitation. The administration of proper first aid following road accidents could save many lives and reduce the risk of permanent and/or debilitating disabilities. The Movement is present worldwide and has a long history of providing first-aid training. Given the right opportunities and circumstances, it can do a lot more by, for example, gaining permission to enter schools. First-aid instruction could be included as a subject in civic studies, made a prerequisite for getting a driver’s licence or made compulsory in the workplace.

First aid is the demonstration of an altruism and true sense of helping one’s fellow human beings — a simple gesture of humanity that can save a life.

How HIV infection is detected
by R.M. Joshi

The laboratory diagnosis of HIV infection is one of most important concerns both from the social and public health points of view. The complete laboratory diagnostic profile in HIV infection is rather complex and envisages tests for the impaired immunodeficiency state as well as tests to diagnose various opportunistic infections or malignancies which HIV-infected individuals are prone to.I shall give here a brief description of the specific laboratory tests. These are basically of three types: screening tests, supplemental tests and confirmatory tests.

Screening tests are designed to detect antibodies against HIV and are principally of three types — ELISA (enzyme-linked immunosorbent assay test), Rapid Tests and Simple Tests. The ELISA technique is highly sensitive and specific but it requires costly equipment and the result is available only after about four hours.

The ELISA technology is based on antigen-antibody and enzyme substrate reactions.

Rapid tests like Dot Blot and Latex Agglutination Tests produce result in less than half an hour. But the cost of a single serum sample test may be higher than that of the ELISA test (without considering the original capital investment on the ELISA equipment).

Simple tests like particle agglutination tests take between one to two hours; the report is quickly available. Both the rapid and simple tests do not require any costly equipment.

The Department of Microbiology, Government Medical College Hospital, Sector 32, is one of the four recently selected centres in the country for the HIV testing (voluntary blood testing and surveillance screening).

In India, three strategies are employed for HIV screening (testing for anti-HIV antibodies).

Strategy - I is used for blood transfusion safety. The serum of the blood donor is tested by one of the most sensitive technique (E/R/S i.e ELISA, apid and simple tests). If reactive, the sample is considered positive and if non-reactive, it is taken as negative.

Under Strategy-II, if the serum is reactive with one E/R/S, it is tested with a second E/R/S based on a different antigen and/or different test principle. If the second E/R/S is also found to be reactive, it is reported as positive; if it turns out to be non-reactive, it is reported as negative.

In Strategy-III, if the serum sample is found to be reactive with two E/R/S tests, it is retested with a third E/R/S. The antigen used or the test principle used here should be again different from the earlier two tests of the E/R/S.

The serum sample reactive with the three E/R/S tests is considered positive. If the third test is non-reactive, it is considered as an equivocal or a borderline case. Such cases should be retested after three weeks. If the sample is non-reactive again, it is considered as negative for HIV antibodies.

Whereas Strategy-II is applied for sero-surveillance of HIV, Strategy-III is used for the diagnosis of clinically suspected AIDS cases and for voluntary testing for HIV. However, the diagnostic kits used for Strategy II and III should have a high degree of specificity.

To validate the results obtained in screening tests, supplemental tests like Western Blot and Immunofluorescent Tests are used. Western Blot is a highly specific and sensitive test. In it, proteins of HIV are separated in polyacorylamide, get electrophoresis and then they are blotted on to a nitrocellulose membrane. A serum sample found to be positive by one of the screening tests is made to react with these proteins.

Antibodies, which have attached to the specific viral proteins, are detected by adding anti-human antibodies to which an enzyme is tagged. On the addition of a substrate, there is a colour change due to the breakdown of the substrate as a result of enymatic action. Different colour bands appear which correspond to different viral proteins.

The immunofluorescent test requires an immunofluorescence microscope. Virus-infected cells are fixed on the slide and the serum of the patient is poured over it. Further, fluorescein-labelled anti-human antibodies are added. If the patient's serum contains anti-HIV antibodies, apple-green fluorescene is observed. Both the screening and supplemental tests detect anti-HIV antibodies.

Confirmatory tests aim at the demonstration of viral antigen (P24), the isolation of HIV and the detection of viral nucleic acid by in situ hybridization and polymerase chain reaction. These are done now in reference centres as they are either too time-consuming and cumbersome or very costly. The confirmatory tests can diagnose HIV infection even during the initial two to three weeks — the window period, in which both the screening and supplemental tests fail to diagnose HIV infection.

The writer is the Professor and Head of the Department of Microbiology, Government Medical College and Hospital, Chandigarh.

Dental Fellowship

Dr Gautam Munjal, a practising orthodontist of Chandigarh, was honoured with "Diplomate of the Indian Board of Orthodontics" at the inaugural convocation of the "Indian Board of Orthodontics" held by the Indian Orthodontic Society at Hotel Ashok at Bangalore on October 2.The Indian Board of Orthodontics was established by the Indian Orthodontic Society in the year 1999 with the primary objective of recognising excellence in the practice of orthodontics by elevating the level of standards of clinical orthodontics on an all-India basis. It is to function as a national resource of quality professional competence in orthodontics.

There are more than 30 recognised postgraduate departments of orthodontics which bring out more than 100 MDS every year. While the Dental Council of India and the various universities maintain a standard level of orthodontic education, there is no national or state university which can assess their clinical excellence over a period of time.

With this objective, the Indian Orthodontic Society has established the Indian Board of Orthodontics, which will award Fellowships in Clinical Excellence. The Fellowship of the Indian Board of Orthodontics is a qualification in recognition of the candidate's achievement in clinical excellence in the practice of orthodontics, which will be duly recognised by all orthodontics and other dental and medical colleagues all over India.

The first examination to select candidates was held on September 29, 1999. Twelve candidates cleared this examination and were awardedDiplomate of the Indian Board of Orthodontics (DIBO). The majority of the successful candidates work as professors and heads of departments of orthodontics in dental colleges all over India.

Dr Gautam Munjal had the distinction of being the youngest full-time practitioner and the only one of this kind from the northern belt.

— Tribune News Service

Dangers of TV

Televisions are anything but environment-friendly. During their operating lives, they consume relatively large amounts of electricity. Upon reaching the end of their lives, they are consigned to dumps or are incinerated. With millions of TVs scrapped every year, they pose a major environmental problem.

Recycling, in turn, would be a good idea as TVs contain plastics, aluminium, glass, copper wire and circuit boards that can be recycled.

Help is on the way, in the form of a new "Blue Angel". Colour TVs bearing this German environmental label will be easy to recycle, will have low rates of energy consumption and screen-based radiation, and will have long operating lives. The amount of raw materials used to produce these TVs will be much below that of today's models.

Noise control

“Noise labelling”, that is, displaying the level of noise produced, will soon be made compulsory for all appliances and equipment, from mixers to bulldozers. This will enable consumers to choose products that are less noisy.

A decision to this effect was taken recently by the National Committee on Noise Pollution Control set up by the Central Pollution Control Board.

The move is aimed at forcing manufacturers to use noise abatement technologies to produce quieter appliances as noise pollution is a proven health hazard. The noise techniques developed at the Indian Institute of Science, Bangalore, has already been introduced in Indica, the car produced by TELCO.

That terrorist !

An environmental terrorist might be in your backyard right now, if your neighbourhood cat is on the prowl.

North America's 100 million domestic cats are estimated to kill one billion birds, and more than one billion small mammals each year. In fact, predation by cats may contribute to more bird species extinction worldwide than any other cause except habitat loss.

Redressal forum

If you are one of the harassed citizens who are unable to get redressal from noisy neighbourhood, soiled lanes, polluting industries and other environmental damages, help may soon be a phone call away. The Union Environment Ministry promises corrective action on all these soon.

An authority to be headed by a prominent, retired Supreme Court judge, with quasi-judicial powers, is being set up under Section 3 of the Environment Pollution Act. This will ensure that not only do people have a place where they can easily file such complaints, but also that action is taken within a three-month period. You may even send your complaints via e-mail.