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| HEALTH & FITNESS |
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How healthy is the health care system?
Diabetic retinopathy can lead to blindness
Fish helps fight malaria
Aspirin’s benefits reiterated Intensive diabetes treatment halves heart disease risk
Ayurveda & you
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How healthy is the health care system?
There is a growing feeling that the Indian health care
system is poor and inadequate and that the US system is much superior
and needs to be emulated. This is far from the truth. Not even
American thinkers and consumers subscribe to the view. One analyst
wrote recently: "The US health care system almost defies
characterisation. It is immensely complicated, almost inexplicable,
costly beyond belief, seriously discriminatory, and often
unsafe." However, it is no solace to our people to know the
deficiencies of the US health system. Let us talk about India
first. It is time we gave a serious thought to the subject. What they
call as the public health care system today comprises a number of
ill-equipped poorly funded government hospitals that are hotbeds of
corruption and apathy. The services there being generally free of
charge, these government hospitals are unable to attract good doctors
or investment in modern facilities, while attracting a large number of
poor patients. While the services are woefully inadequate for the
majority of the people, the plight of the poor in general and women in
particular is more pronounced. There is urgent need to rejuvenate the
public health care system to ensure that the poor get access to
essential medical services. Though the budget resources are scarce,
there is certainly need to double the public expenditure on health,
given the long-term benefits. The emphasis should be on prevention and
making essential public health services available to the poor. It is
the time to move away from totally "free" medical care. The
involvement of the private sector in the public health care system
will be the necessary first step. Unfortunately, private hospitals are
beyond the reach of most people. The health insurance system, whatever
little it exists, is isolated from hospitals. These have to be brought
together into a coherent health care system. Women should get
priority Speaking at the inaugural function of a cancer seminar at
the PGI, Chandigarh, in April 2005, the Union Health Secretary stated:
"It is possible to save two lives at the cost of a couple of
thousands of rupees by providing for a safe delivery. On the other
hand, one episode of heart attack or a case of cancer for an aged
person (with only a few years of productive life remaining ahead) may
require several lakhs of rupees". It may well be that a very
large increase in expenditures on ante-natal care and paediatric care
in infancy and early childhood is the most effective way to improve
health over the entire life-cycle, by delaying the onset of chronic
diseases, alleviating their severity if they occur, and increasing
longevity. Research has shown that substantial medical expenditure
occurs during the last two years of a person’s life. A broad-based
hospitalisation insurance must be offered to protect individuals in
their old age. The state can fund this welfare measure, wherever
necessary. Public support for health care has been historically low
in India, averaging less than 1 per cent of the GDP, but what is worse
is that in the last decade public health investment and expenditure
has seen a declining trend. During the same period the private health
sector grew rapidly, from being about 3 per cent of the GDP in the
beginning of the 1990s to over 5 per cent today. In fact, the health
sector has been growing at the rate of 1.4 times that of the GDP. It
is estimated that 20 million people each year fall below the poverty
line because of indebtedness. This is worrisome given the fact that
more than two-thirds of the country’s population is already either
poor or living at the subsistence level. The total value of the
health sector in India today is over Rs 1,500 billion or $ 34 billion.
This works out to $34 per capita which is 6 per cent of the GDP. Of
this, 15 per cent is publicly financed, 4 per cent is from social
insurance, 1 per cent private insurance and the remaining 80 per cent
being out of pocket as user fees (85 per cent of which goes to the
private sector). Two-thirds of the users are purely out-of-pocket
users and 90 per cent of them are from the poorest sections. Only 17
per cent of all health expenditure in the country is borne by the
state, and 82 per cent comes as "out-of-pocket payments" by
the people. This makes the Indian public health system grossly
insufficient and inadequately funded. The writer, a
Chandigarh-based eye specialist, is the author of many medical books.
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Diabetic retinopathy can lead to blindness Diabetes is a fairly common disease that
interferes with the body’s ability to use and store sugar. It can
strike in childhood but usually the problem begins later in life.
Diabetes is a multi-system disease which affects the eyes and kidneys
commonly. Diabetes can cause many health problems, especially when it
is severe and not in control. One of the serious conditions caused by
diabetes is called diabetic retinopathy, and is one of the foremost
causes of blindness. Diabetic retinopathy is a disease affecting the
retina of the eye. Retina is a delicate, light sensitive lining of the
back of the eye. Diabetic retinopathy can weaken and cause changes in
the small retinal blood vessels. These blood vessels may then begin to
leak or swell or develop brush-like branches. This deterioration of
the retinal blood vessels causes hindrance in the supply of oxygen and
nutrition needed by the retina to remain healthy. Early stages of this
condition may cause symptoms like blurred vision. As the disease
progresses, one may notice cloudiness of vision, blind spots, floaters
or even sudden loss of vision. But usually diabetic retinopathy does not
produce visual symptoms strong enough to get noticed. Who gets
diabetic retinopathy? With the increase in the duration of
diabetes, the risk of developing diabetic retinopathy increases. It is
observed that about 80 per cent of the people suffering from diabetes
for more than 15 years do have some damage present in the blood vessels
of the retina. Severe and uncontrolled diabetes, fluctuating blood sugar
levels, high blood pressure (hypertension), high blood cholesterol and
diabetic kidney are all conditions which predispose a diabetic to
develop changes in the retina. Pregnancy and high blood pressure may
aggravate diabetic retinopathy. The problem occurs at a young age in
juvenile (childhood) diabetics. There are two main stages of diabetic
retinopathy. (1) Background retinopathy: In this stage, retinal
blood vessels start leaking, causing the retina to swell. It does not
cause major symptoms. In some cases, the leaking fluid collects in the
central part of the retina. This condition is called diabetic
maculopathy. This can lead to difficulty in reading, distortion in
vision and other activities involving close concentration. (2) Proliferative
retinopathy: This is the most serious stage or form of diabetic
retinopathy. In this condition, new branch-like blood vessels start
growing on the surface of the retina. These abnormal blood vessels can
lead to various complications, which could further lead to a detached
retina or glaucoma. Proliferative retinopathy affects up to 20 per cent
of all diabetics and can lead to a very severe loss of sight, resulting
in blindness. What is the procedure for the detection of diabetic
retinopathy? Regular eye check-up for diabetic retinopathy is a
must for all diabetic patients. Normally, an ophthalmoscope is used for
the purpose of examining the inner parts of the eye. Fundus
fluorescein angiography or FFA, which is a specialised technique, is
also used to get finer details of the retinal blood vessels. In FFA, a
fluorescent dye is injected through a vein in the arm. As this dye
travels through the bloodstream to reach the retinal blood vessels,
photographs are taken in quick succession. These photographs capture the
details of the dye leaking from the abnormal blood vessels. What is
the importance of early detection and treatment in diabetic retinopathy? Most
of the visual loss from diabetic retinopathy can be prevented, provided
it is diagnosed early. But once the damage has occurred, the effects are
usually irreversible. Early warning symptoms threatening and damaging
the eyesight are rare in diabetic retinopathy. Thus, it is extremely
important for every diabetic patient to undergo regular check-up of the
eye in order to detect the presence and extent of diabetic
retinopathy. What is the treatment for diabetic retinopathy? (1)
Laser treatment or laser photocoagulation is the most common line
of action in most sight-threatening diabetic problems. It is very
important to realise that laser treatment aims to save the existing
sight level and not to make it better. Laser is a beam of high intensity
light. Laser photocoagulation is used to seal the micro-aneurysms that
are leaking fluid into the retina. This is called the focal or grid
laser photocoagulation and is done in a single sitting. If new blood
vessels are growing then more extensive laser treatment has to be
carried out which is called pan retinal photocoagulation (PRP). PRP is
carried out over two or three sittings spread over a few weeks. In most
cases, laser treatment causes the new blood vessels to regress and the
swelling to subside. Laser treatment usually takes three to four months
to be fully effective. (2) Vitrectomy: Sometimes new blood
vessels bleed into the gel-like centre (vitreous) of the eye. This
condition called vitreous haemorrhage can lead to sudden loss of vision.
If the vitreous haemorrhage is persistent, then a procedure called
vitrectomy is recommended. This is a micro-surgical procedure, which
is undertaken to remove the blood and scar tissue from the centre of the
eye. A large majority of the patients notice an improvement in their
eyesight after vitrectomy. ——— The writer is Chairman and
Medical Director, Centre for Sight, New Delhi. E-mail: msachdev@bol.net.in
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Fish helps fight malaria
Bhubaneswar: Two diminutive species of fish have come to the rescue of health officials trying to control malaria in Orissa.
When all their efforts to control malaria and bring down deaths due to the disease failed, the unobtrusive “biological weapon” has proved effective at many places in the state, Executive Director, Voluntary Health Association (VHA), Mr Basudeb Panda, said. “The two species, Gamusia and Guppy, prefer eating mosquito larvae and keep mosquito population under control. It can also survive on algae and plankton,” he said, adding that malarial deaths in the state have come down from 467 in 2003 to 283 in 2004. Orissa is one of the high endemic states where malarial deaths are highest in the country. West Bengal and the north-eastern states also contribute to malaria-related deaths. Since it tastes bitter, the fish is not eaten. Extreme temperature, however, plays spoilsport and kills many of the 5 cm long creature. The two species are bred in tanks at the non-profit organisation’s office and then sold at Re 1 each only to be released in water bodies to keep the mosquito population under control, he said. “We do not generally release them (fish) in running water as it might get carried away with the stream and not solve the purpose,” Mr Panda said. About 2000 fish are distributed every year and released in water bodies in highly endemic areas of Nuapada, Khorda, Phulbani, Mayurbhanj, Keonjhar and Kolapur, Bolangir and Kalahandi regions, he said.
— PTI
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Aspirin’s benefits reiterated
London: Experts have reiterated the numerous health benefits of daily dozes of aspirin for people over 50, but feel that individuals should be well educated in its properties, to be able to make their own decisions. Peter Elwood and colleagues at Cardiff University believe that the evidence now supports more widespread use of aspirin, and there needs to be a strategy to inform the public and enable older people to make their own decision. As a general rule, daily aspirin is given only to people whose five-year risk of a vascular event, such as a heart attack or stroke, is 3 per cent or more. The authors show that, by age 50, 80 percent of men and 50 percent of women reach this level of risk and they suggest that 90-95 per cent of the population could take low dose aspirin without problems. Evidence is also growing that regular aspirin may reduce cancer and dementia. “The possibility that a simple, daily, inexpensive low dose pill would achieve a reduction in vascular events, and might achieve reductions in cancer and dementia without the need for screening, deserves serious consideration,” they write. “Although we judge that aspirin should be taken from around 50 years, we insist that the general public should be well informed and the final decision should lie with each person,” they added.
— ANI
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Intensive diabetes treatment halves heart disease risk Washington: A new study has shown that intensive treatment of patients diagnosed with diabetes reduces their risk of heart disease by nearly 50 per cent. The findings, which were announced at the annual scientific meeting of the American Diabetes Association, stem from a study of cardiovascular cases in patients who took part in the Diabetes Control and Complications Trial (DCCT) and a follow-up NIH study. “This is exciting news for those coping with diabetes. This intensive treatment of glucose control could allow them to live longer with less suffering,” said Dr. Stanley Schwartz, the principal investigator on the DCCT follow-up study, called the Epidemiology of Diabetes Interventions and Complications (EDIC). “The EDIC study examined the long-term effects of an average of 6.5 years of conventional insulin treatment versus intensive insulin treatment,” he said. According to researchers, with conventional treatments, the patient would receive 1-2 shots of insulin a day and occasional office visits and standard dietary reminders. But, in intensive treatment, patients are given 3-4 shots of insulin a day, frequent dietary reminders, monthly doctor’s appointments, and psychological support. Intensively treated patients had a 57 per cent reduction in the number of serious cardiovascular events such as heart attacks and strokes, compared to the conventionally treated group, researchers conclude. — ANI
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Ayurveda & you Grown throughout the plains and small hills of the subcontinent and scientifically known as trachyspermum ammi, ajwain is an inseparable part of the traditional Indian kitchen. Bitter and pungent in taste , it is light, dry, sharp and hot in effect. Ajwain owes its characteristic odour to the presence of two different types of oil in it and one of these called thymole is better known as “sat ajwain”. Ayurveda has counted ajwain among the 10 foremost herbs known for their anti-colic or anti-spasmodic action. Besides endowed with carminative, diuretic and diaphoretic (that produces sweating) properties, ajwain is also known for its stimulant action on the uterus and the digestive and circulatory systems. It also has moderately anti-pyretic and mildly antiseptic effect on the human body. Ajwain has long been used in India for colicky pains. It is also a much favoured drug for a number of gastrointestinal disorders like indigestion, flatulence, lack of appetite, diarrhoea and dysentery. Ajwain facilitates the expulsion of intestinal worms, helps to ease phlegmatic conditions and due to its anti-spasmodic action, removes the menstrual spasm. It is also used in many of the post-delivery complications. Some of its common household uses are as follows: Abdominal colic — Take 100 gm of ajwain, 50 gm of ginger powder and 25 gm of black salt and crush them together to be put in a dry container. As a ready remedy to manage mild-to-moderate abdominal spasms, take two gm of this powder with warm water two or three times a day or whenever required. Applying hot fomentation on the area of pain will bring faster relief. Gas trouble — To allay the retention of gas and flatulence, rural people use ajwain in a very classic way. One famous preparation is: take half kg of uncrushed ajwain and 20 gm each of the rock salt, black salt and table salt. Put all of these in half kg of lemon juice for a few days to be dried at its own. Taking with warm water half-to-one teaspoonful of this specially prepared ajwain is an excellent home remedy to treat abdominal gas, anorexia, nausea, vomiting and travel sickness. Other uses — Taking of indiscreet and incompatible food items may sometimes result in transient itchy patches (urticaria) on the body. To meet such situations administering half a teaspoonful of ajwain with a little of jaggery immediately controls the allergic reaction. This dose can be repeated two three times a day. In the flare-up phase of rheumatoid arthritis, regular use of ajwain in food helps to pacify “ama” or the endotoxins and inflammation along with many other allied symptoms. An infusion made of giloy and ajwain is also given in chronic fevers. As a single herb the average daily dose of ajwain is one to three gm. Apart from the ajwain that is commonly used in our kitchens, it also has many varieties and the most notable among them is called “ajmoda”. Some scholars consider it to be a separate herb, but it has identical properties as that of ajwain. On boiling, ajwain loses its active substance and if it is to be used in liquid form. The preferred preparation is ‘arq ajwain’ obtained by the steam extraction method. The writer is a Ludhiana-based senior ayurvedic physician.
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