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| HEALTH TRIBUNE | Wednesday, December 6, 2000, Chandigarh, India |
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A special report hard talk Early signs of stress The anti-depressant armoury Parents-child bonding: some tips When attacked alone
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A special report India is likely to have 198 million elderly people by 2015 and 326 million by 2050.
The
UN estimates that by 2015 the world's population of 60-plus will nearly double itself to one billion. India is likely to have 198 million such people by 2015 and 326 million by 2050. To focus attention on the problems of the growing population of senior citizens, the UN declared 1999 as the Year of Old and October 1, every year, as Senior Citizens' Day. Accordingly, the Government of India has announced a national policy for the elderly, aiming at providing them with financial security, health-care, shelter and protection against abuse and exploitation. As a sequel to globalisation, industrialisation and urbanisation, more and more elderly members of families get abandoned and stranded. The traditional joint family system is rapidly giving way to nuclear families. The City Beautiful, well-known for its green hedges (now being axed by the "Enforcement Directorate") and grey beards, is proud of its 12 per cent (of over one million population) mostly elite, senior citizens. Adam be blessed; this tribe is likely to increase to 15 per cent by 2020. First in many things, no wonder, Chandigarh is (again) first to have a Rs 50 lakh, imposing, three-storey Senior Citizens' Home in Sector 43, thanks to the Chandigarh Administration. A gurdwara and a mandir, to make an excellent spiritual retreat in for the elders, flank the home! Completed in record time, the building was inaugurated by the Administrator, Lt-Gen JFR Jacob (retd) in June, 2000. The admission process is on for about 50 inmates at a very moderate boarding and lodging tariff. Every room and dormitory has been aesthetically and tastefullly furnished personally by Ms Madhvi Kataria, the thoughtful Director of Social Welfare, as if she has done this for her own parents. A brain-child of the trinity, Ms Vineeta Rai, Ms Neeru Nanda and Ms Madhvi Kataria, the Adviser to the Administrator, the Secretary, Social Welfare, and the Director of Social Welfare, respectively, several NGOs have been entrusted with the day-to-day care of this unique rendezvous for senior citizens. The sprawling lawns and the flower-beds around the building are being maintained by the Environment Society of Chandigarh. The Day-Care Centre, the humming hub of activity for not only the inmates but also for all senior citizens of Chandigarh, Mohali and Panchkula (with a very nominal membership fee), is being organised by the Chandigarh Senior Citizens' Association, under experienced elders like the national hero, Maj-Gen J.S. Bhullar, the doyen of the elite bureaucracy, Mr P.H. Vaishnav, former Chief Secretary of Punjab, and Mr K.D. Arora, IAS (retd). The unique feature of the Home is its own Health-Care Centre on the ground floor. It caters to round-the-clock health needs of the inmates. Besides a consultancy service, it provides a well-equipped laboratory, a comprehensive x-ray service and an instant ECG system. The lab is equipped to conduct more than 150 types of tests, including blood sugar estimation, a complete lipid profile, kidney, liver and cardiac function tests, a full haemogram, a complete urine and stool examination and various miscellaneous tests. The x-ray plant is powerful enough to scan the entire body from head to toe, including the skull, the cervical and lumbo-sacral spines, the chest, the abdomen, and all bones and joints. This Health Care Centre, including its equipment worth several lakhs of rupees, is a gift of love and good health from the Senior Citizen's Health-Care Centre functioning for over a decade at Lajpat Rai Bhawan, Chandigarh. The same team will operate it. The inmates are required to make only a one-time token payment that does not cover even a fraction of the cost of the equipment or the recurring expenses. The services of this centre can be utilised by senior citizens of Chandigarh, Mohali and Panchkula, in general. On November 22, 2000, the Day-Care Centre and the Health-Care Centre were humming with activity when hundreds of senior citizens from Chandigarh, Mohali and Panchkula came over to avail themselves of facilities at the Hypertension and Diabetes Camp. The Lajpat Rai Bhawan centre has also gifted a similar Health-Care Centre, including full equipment, as a millennium gift of brotherhood to the Senior Citizens' Centre in Sector 15, Panchkula, this year. It was inaugurated by Swami Pitambaranandaji Maharaj, head of the Ramakrishna Mission, Chandigarh. We, inspired by Baba Nanak, installed a similar gift of brotherhood and good health at Gurdwara Kalgidhar Sahib, Phase IV, Mohali, on November 11, 2000, the holy day of Gurpurb. Our own team from Lajpat Rai Bhawan has been blessed with the responsibility of operating both of these health-care centres at Panchkula and Mohali. The serving team prays: O Lord, bless us all to continue to serve! Dr (Brig) M.L. Kataria, the honorary consultant, and his team, are operating 14 health-care projects in urban, rural and slum areas in Chandigarh and the adjoining states of Haryana and Punjab. A brief report on the Sector 43 Home appeared in Health Tribune last week.
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hard talk the
extraordinary achievements of medical practice and clinical successes of the earlier part of the 20th century led to the control of many infectious killers, particularly those of early life, and to a remarkable increase in the life-span of the population. At the global level, the idealistic World Health Organisation aimed at "Health for All by the Year 2000". Have we achieved the goal? It is ironic that at a time when the country is experiencing prosperity with increased income and funds for development and investment, in medicine it is glaringly lacking. Despite all advances, many lives are lost annually owing to easily preventable diseases. Social changes have been the most important factor in improving health and longevity of the people of the western world. Methods of combating infectious conditions have been accomplished by two major developments — the introduction of immunotherapy and vaccines; and the discovery of chemicals capable of destroying micro-organisms. Such vaccines have been developed as can ensure life-long immunity to a wide range of common infectious diseases. Poliomyelitis, for so long a scourge of the young, causing death and often leaving behind paralysis and major disability was found to be preventable by oral vaccine. At the end of the 20th century parents can be assured that many of the infectious illnesses that plagued their children a century ago would no longer trouble them. The total eradication of smallpox is a remarkable example of what can be achieved by the unity of the human will. In 1980, the WHO was able to make the solemn declaration that the world and all its people had won freedom from smallpox. Similarly, the Oral Rehydration Therapy in diarrhoeal illnesses in children, a common cause of death in our part of the world, has saved innumerable lives. Important advances in the understanding of nutrition is also a significant contribution. How have we fared in the face of these notable achievements? Sadly, there has been a downslide in these achievements. Hygiene was given an important place even in ancient Indian medicine! Another milestone in the evolution of medicine is the great sanitary awakening which took place in the mid-19th century. Micro-organisms and parasites have a remarkable capacity to develop resistance to the substances engineered to attack them: an increasing problem for all engaged in the control and treatment of infectious diseases! Malaria is a typical example. Mosquito-control measures are not fruitful because of several reasons which include technical, administrative and operational failure, apart from the appearance of resistant strains. These strains cause more serious diseases with potentially fatal complications. We often hear about illnesses caused by food. The fact is that bacteria survive — and sometimes thrive — despite the best controls available. Can we boast of getting truly safe food supplies? Have we ever bothered to know about the health of all those who cook our food, who clean our hoses and who look after our children? Are we ever keen to know about the status of the kitchens in the hostels, restaurants and fast food joints — and the raw material procured? Nearly everyone knows about the health hazards of smoking and drinking. Why then our countrymen do not give up these habits? Ads link smoking with sophistication. With each puff, your blood pressure rises, your lungs suffer damage and the chances are high that you may have to suffer lung or mouth cancer. Your confidence in your ability to quit smoking or drinking is a more powerful and lasting force than outside pressures. Mark Twain said: "We do not throw old habits out of the window; we walk them down the stairs very slowly". The only way to fail is to stop trying. There is a need to curb humanity's urge for self-indulgence. Damage to life and limb caused by rash and erratic driving is a new disease with which we have to cope. All these are preventable cases provided we follow the time-tested and established guidelines. Where have we faltered and what should we do? Is it an organisational failure or is it the indicator of the lack of effort at the individual level? The greatest benefit may be achieved when education and enforcement come together to create a cultural climate. Individuals must inculcate in themselves an attitude of following a healthy life-style. Seemingly minor measures like hand-washing, general cleanliness, the cleaning of water, the cleaning of the surroundings and ensuring the correct disposal of waste can go a long way in fighting disease. The progress has been slow in our country in these respects. We had mass awakening in the early part of the last century which brought us freedom from the British. Today we need another awakening — within ourselves — to achieve freedom from disease. The fight against disease is a joint medical and societal effort. We have, indeed, come quite far but there is still a long way to go. The participation of the community must be an important supportive activity if we have to make a headway in our fight to achieve the target of health for all even by the year 2020. Dr Wig continues his crusade against disease from the PGI, Chandigarh.
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Early signs of stress
Mental overload can often be predicted by physical symptoms of stress, such as headaches and migraines, says Neasa MacErlean in London. RECOGNISE that your body is probably more intelligent than your mind and that it is designed to provide an early warning system on stress. Headaches and migraines are very common symptoms of mental overload. Skin rashes or other problems are also good indicators since the same hormones relate to both stress and skin. All sorts of other physical problems will develop if you are under serious pressure, including digestion difficulties and chest pain. Remember there is growing evidence relating persistent long hours at work to heart attacks and premature death. LOOK at how your parents coped with stress and see if you are following any similar patterns. “If the dad comes home and reaches for a glass of beer, the chances are that one of the kids will one day start doing that as well,” says Dr Malcolm Vandenburg of stress consultancy Positive at Work. EXAMINE your environment. Your susceptibility to stress is likely to increase if, for instance, you are worried about getting the sack; if you don’t have access to natural light at work; if you work unsocial hours; or if your workplace is noisy or uncomfortable. Long hours culture among solicitors is making the law an unhappy profession. Certain types of personality — the impatient, ambitious type-A’s — often seek out stressful situations and have difficulty relaxing. WATCH your own behaviour. Disturbed sleep patterns are a flashing light in the warning system. Eating more or less and increasing the alcohol, nicotine or drug intake are also clear signs of problems. Less dramatic are simple signs of unhappiness — withdrawal from social situations and getting angry with colleagues. CONSIDER giving yourself a break if your emotions are also in turmoil. Guilt and a sense of being overwhelmed are also clear indicators of strain. You do not have to be a wimp to experience this; even the most able and intelligent people will crack in this way if they push themselves too far. Doctors show particularly high alcoholism and suicide rates. LISTEN carefully to colleagues and friends who have a more objective view of your behaviour. “You need people around you to say that you are drinking too much,” says Vandenburg.
— Observer News Service |
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The anti-depressant armoury depression, the commonest scourge of modern life, is hitting everyone hard. The number of Indians, who have become victims of depression, has multiplied alarmingly during the last two decades. Owing to the fast-growing pressures, living in urban as well as rural areas is becoming highly stressful. Drug treatment continues to be an important way of tackling various shades and types of depression. An increasingly large number of physicians and psychiatrists take the help of drugs generally called "anti-depressants" to treat depressed patients. Until a few years back, the number of anti-depressants was quite limited and they had many unpleasant side-effects. The commonly used anti-depressants included imipramine (Depsonil), amitriptyline (Tryptomer), doxeipin (Spectra), desimipramine (Sensival), dothepin (Prothiadin) and amoxapine (Demolox). The common anti-cholinergic side-effects of these drugs were constipation, dryness of the mouth, giddiness, postrual hypotension (fall in blood pressure while getting up), problems in reading small print, difficulty in passing urine, etc. Because of these, many patients discontinued drug treatment. These drugs took 10 to 15 days to show their beneficial effect. Then came a wonder drug called fluoxetine, popularly known in the western world as Prozac. In India, it was known by the trade names Fludac and Nuzac. This drug was supposed to take a shorter time for starting its anti-depressant effect and did not have common anti-cholinergic side-effects. The loss of appetite, gastric discomfort, the feeling of anxiety and the loss of sleep were, however, seen in fluoxetine-users. Then another important drug, sertraline, (Serodep, Serlift) entered the Indian market. Recently three new drugs, venlafaxine (Venlor and Venlift), muclobemide (Rimarex) and fluvoxamine (Fluvoxin) have been introduced. Newer drugs are better tolerated. These have fewer side-effects and take a shorter period to start their clinical effect. One thing remains clear: there is not a single anti-depressant medicine which is effective in all cases of depression. For many patients who do not show significant improvement with drug and non-drug therapies, there is still a long road ahead. And self-medication is a dangerous vice. The author is a Ludhiana-based psychiatrist and health educator. (Phones: 0161-472822, 0161-472899) |
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Parents-child bonding: some tips bonding
implies psychological and emotional attachment between the parents and the child. It includes love, affection and the attitude of mutual caring on a lifetime basis, and begins the moment the child is born. The lack of development of bonding is responsible for the high incidence of child-bashing (the Battered Child Syndrome), delinquency and school dropouts. These very children, when they become adults, are responsible for old-parent bashing. Positive steps (A) At birth in the delivery room:
During childhood:
Negative steps (A) At birth, in the delivery room, the following factors should be avoided:
(B) During infancy:
Dr Anil Thapar is an Ireland-trained paediatrician, based in Ambala City. |
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let's
say it's 6.15 p.m. and you're driving home, (alone of course) after an unusually hard day on the job. You're really tired, upset and suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw. You are only about five miles from the hospital nearest your home; unfortunately, you don't know if you'll be able to make it that far. What can you do? You've been trained in Cardio Pulmonary Resuscitation (CPR) but the guy that taught the course neglected to tell you how to perform it on yourself. (Recently trained first-aiders, please note!) Without help, the person whose heart stops beating properly and who begins to feel faint, has only about 10 seconds left before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let-up until help arrives, or until the heart is felt to be beating normally again. Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a phone and, between breaths, call for help. (Since many people are alone when they suffer a heart attack, this note seems in order. Here are possible signs of a heart attack:
(Courtesy: Health Cares, the newsletter of the Rochester General Hospital, and the Regional Institute of Health, Chandigarh.) |
