DIET lecture by Dr SREEJITH N KUMAR

Health manifesto

Health manifesto
An overview on the Health manifesto of both fronts in Kerala indicate that there is a welcome awakening but more attention is required.
UDF has included Health in its prime slogan (food, shelter and health for all), while the LDF has spelt out its priority for health in the manifesto. These are definitely welcome measures in a state where Health is yet to get due importance. This beginning is good, but the path is hazy and end is not in sight.
Health, by and large, is seen by many as merely treating diseases. The basic principles are often forgotten or ignored. It’s quite understandable as one gets glory for the diseases treated but only an intelligent society can appreciate the value of those prevented. Plenty of dialysis centres, cath labs, organ transplantation and medical colleges are promised whereas primary care gets largely ignored. How long can “an inverted pyramid” be stable?
UDF has health in its slogan but nothing more to cheer about in the detailed description. Its idea of declaring health as a right is the need of the hour. It lays more emphasis on public private mix, which again is a welcome initiative. The idea of eradication of communicable diseases by 2020 is only wishful thinking especially with no road map set. There are very few policy directions outlined in the manifesto which dwells primarily on few diseases and programmes. The idea of integrating different systems of therapy is most unscientific.
LDF, on the other hand, do spell out some clear policies though few lack clarity and some measures are detrimental. The promise to increase health expenditure to 5% is the most laudable measure in the entire manifesto. This was something which health activists had been demanding for quite some time now. The promises of improving staff pattern in Government hospitals and bringing in health insurance too are welcome measures. The suggestions that KSDP and similar drug manufacturing units will be promoted to produce quality drugs for the Government sector, inclusion of health topics in school curriculum, establishment of Medical service recruitment board and evidence based approach to traditional systems of Medicine will all be valuable if implemented. However the idea to start IP care in PHC and advanced treatment facilities like Cath lab in Taluk hospitals cannot be seen as scientific measures. The hub of preventive care today is the PHC, which is already fragile and no attempt to dilute the Primary care further should be done. Super Specialty services should be established and strengthened at district level. Private partnership should be encouraged in this area. It wouldn’t be wise to spend the meager resources in establishing too many specialty centres at the cost of compromising Primary care.
While the manifesto of both fronts have set some directions, much need to be done once the new ministry comes in. First and foremost will be formation of a huge health initiative incorporating all political parties, scientific organisations, voluntary and other health agencies. The first priority should be to delineate and declare a health policy with both short term and long term goals. A separate department for Public health (PH) is mandatory. DHS should be responsible for curative care and the PH department should be empowered for preventive care and public health. The four health determinants namely clean air, safe water, healthy food and safe environment should receive top priority. We urgently need a lifestyle policy, providing adequate allowances for safe food and exercise. We need to evolve effective strategies to combat the rising trend of communicable and non communicable diseases. Prompt promotion of Research and establishment of Mono faculty University for Modern Medicine are also required. Only Scientific medicine and methods should be promoted. Medical education policy has to be clearly spelt out. The young medicos should get quality Medical education and also adequate opportunity for higher education. Adequate utilisation of Medical manpower should be ensured. Cost of medical care should be curtailed and quality ensured. Drugs should be manufactured in public sector and distributed through public distribution system. Huge initiatives for health education and promotion should be ensured utilising all available resources.
It’s heartening to note that Health is beginning to get some attention but much more is due. With both fronts taking up health seriously let us hope that a new dawn will break in the state’s health scenario with primary health getting due priority and affordable quality care ensured for all citizens.

Yes! I am an Army Doctor.

Yes! I am an Army Doctor.

We were curious and excited when ‘Hisar' flashed on TV, that too on BBC. A small town in Haryana, three hours from Delhi, Hisar didn't have much to boast about, other than a famous Agriculture university and strong military presence. That day it seems, Hisar was the hottest spot in the whole subcontinent. Temperatures would easily touch 45 on some of the hottest days. That may not be unusual for many in North India, but as Army Doctors what we were to encounter was heat stroke in our soldiers as they were brought in red hot to the casualty. Few weeks back we heard about the extreme cold claiming lives of some valiant men in Siachen. Heat or cold, they work, they serve, they guard the nation and I am so very proud that I could be of some service to the Armed force.

I had never imagined that I will land up in Army with the hectic studies and campus politics which used to involve me fully in my college days. My sister and her husband working as civil staff in defence directorate those days had a strong role in motivating me to join the Army as a young medical graduate. I was also thrilled by the uniform, the shining stars, the huge repute and above all the handsome salary which made the pauper Medico extremely happy. Little did I know that I was to embark on one of the most exciting journeys of my life.

            After joining Trivandrum Military hospital as a Captain, we went for our basic course in Lucknow. Those two months of rigorous training rebuilt me from a weak civilian to a tough army man. Seldom did I do any exercise before that and would easily tire even while running to catch a bus, but after the training, jogging and long distance running became a passion. There was a camp in our course when we were even trained to use a deep trench latrine, two logs of wood kept over a trench, where we were supposed to relieve ourselves. Most of us found it very funny, least realising that even that would be a luxury in future. I still remember the tough training in the shooting ranges from where we all returned with heavy bruises on the shoulders. The trainers kept reminding us that “the more you sweat in peace, the less you bleed in war”. I was thrilled when we finished the course and I could obtain the awards as the best outgoing cadet and best shooter in the batch. We lost no time in packing our bags and reporting to our areas of service, mine being Hisar.

       

   In fact I was one of the lucky few who got posting to a reasonable town where we could reach by bus and train. Many were posted to remote areas in Arunachal and elsewhere at big heights and far off land, where even reaching the destination was a big challenge. Posting in a location in Army means that with that spot as centre you draw a huge circle of a few hundred kilometres, within which you will keep moving. Mine was a modest hospital setting in Hisar where I was one of the junior Doctors handling the causality and daily Op. We had some academic clubs as well. But frequently we had to move out, accompanying army units on exercise and firing missions. We used to spend months together in the firing ranges in remote Rajasthan and live in make shift tents. Officers have a small adjoining tent with a hole dug out, which was the toilet. Mostly, men and even officers used to go out in the fields in the dark to address nature’s call which was often risky as the deserts were full of dangerous reptiles. The tents used to be erected with snake trenches dug all around and on many mornings we used to wake up to find the deadly night visitors trapped in them. Those were not the days of mobile phones and communication to home was only once in a blue moon when we got access to some village with STD facility. We used to get free envelopes to write letters but replies would take weeks to reach. Getting back from the firing ranges and desert tracks after months of staying in the open, even a small bed room with a cot and a decent toilet seemed a luxury. Yet we loved it, the opportunity to serve the nation in uniform.

            Army did offer lot of aristocracy too. I had lived in Trivandrum all along but had never visited the palace. It was while I was serving as medical officer to a Madras regiment in Trivandrum that I got the opportunity to visit the palace. The royal family had hosted a dinner for all the officers of the unit. We used to have numerous parties and dinner nights as well. The one on promotion as Major, still remains sweet to me. Parties were there not just in the warm and cozy officer’s mess, but even out there in the wild. 

Life for the young Medico was truly exciting and adventurous. Army took me to see the country like never before. Whether it be the golden sand dunes of Jaisalmer, the historic forts of Rajasthan, the Chambal valleys of MP, the gorgeous Kullu Manali, the snow capped Himalayas, the breath taking Rohthang and Kunzumla pass, there were probably few spots left in north west India where Army didn't take me. We could pluck fresh apples form the orchards in Himachal, enjoy the love of people, travel in the Army trains and even tanks - life was full of vividly colourful experience. The numerous courses Army offered from warfare sessions to religious overviews could never have been experienced in any other world.

            Army did give me a great career too. Not only that it looked after me as an officer but also offered me chance to follow my passion and get trained for MD in Medicine in one of the prestigious Medical colleges of the country, the AFMC, under some of the best academicians. So, what was Army to me - service, adventure, fun, despair, achievement? Perhaps, it was a mixture of all. To me the Indian Army means a lot. Twenty years after wearing the uniform last, I am still very proud of having worn the olive green attire and the shining stars of the great Indian Army. It did give me so much that I will never be able to repay. I love my country, I love my Army.

Dr Sreejith N Kumar

Former Major Army Medical Corps

ഡോക്ടർമാർ രോഗികൾക്ക് വേണ്ടി തന്നെ

Reply to the questions posed by the article published by Manorama
ഡോക്ടർമാർ രോഗികൾക്ക് വേണ്ടി തന്നെ
Dr Sreejith N Kumar
ഡോക്ടർമാരുടെ പ്രതിബദ്ധത എന്നും സമൂഹത്തിനോടും, രോഗിയോടും തന്നെയാണ്. തെറ്റുകൾ ചൂണ്ടി കാണിക്കുമ്പോഴും മെഡിക്കൽ സമൂഹത്തിന്റെ മനോധൈര്യം തകരാതെ നോക്കണം. ഡോക്ടർമാർക്കു നേരയൂള്ള പല കുറ്റപെടുത്തലും അകാരണമാണെന്നു പറയാതെ വയ്‌യ.

ചികിത്സ ചിലവ് എന്നും പിടിച്ചു നിറുത്തിയിരുന്നത് ചെറിയ ആശുപത്രികളും, കുടുംബ ഡോക്ടരുമാണ്. ത്രിതല ശൈലി നമുക്ക് അനിവാര്യമാണ്. കുടുംബ ഡോക്ടറെ ആദ്യം കാണുക, റഫർ ചെയ്താൽ മാത്രം വലിയ ആശുപത്രികളിൽ പോവുക. രോഗങ്ങൾ പ്രതിരോധിക്കുവാനുള്ള ശാസ്ത്രീയ മാർഗങ്ങൾ സ്വീകരിക്കുക. സമീപ കാലത്ത് 500 ലധികം ചെറിയ ആശുപത്രികൾ പൂട്ടി പോയിട്ടുണ്ട്. സർക്കാർ എയ്ഡും , നികുതി ഇളവുകളും വഴി ഇവ നിലനിറുത്തിയെ മതിയാകൂ. ഡോക്ടർമാർ നടത്തുന്ന ചെറിയ ആശുപത്രികൾ അധികവും കച്ചവട കണ്ണിലാതെ തന്നെ ചികിത്സിക്കും. മരണ ശേഷവും വെന്റിലേറ്റർ ചികിത്സ നടന്നുവെങ്കിൽ തെളിവ് ഉടൻ IMA ക്കും മെഡിക്കൽ കൌണ്‍സിലിനും നല്കണം. നടപടി ഉറപ്പായും ഉണ്ടാവും. നൈതികമല്ലാത്ത ചികിത്സക്ക് ഒരു ഡോക്ടറും കൂട്ട് നിൽക്കില്ല, അത് അനുവദിക്കുകയുമില്ല.
ജനറിക് മരുന്നുകളുടെ പേരിൽ ഡോക്ടർമാരെ പഴിക്കുന്നത് ശരിയല്ല. സമൂഹത്തിലെ ഉന്നതർ എന്തിനു ബ്രാൻഡ് മരുന്നുകൾ ഉപയോഗിക്കുന്നു? ഡോക്ടർമാർ സ്വന്തം ആവശ്യത്തിനും ബ്രാൻഡ്‌ തന്നെ ഉപയോഗിക്കുന്നത് ഇവയ്ക്കു കൂടുതൽ ഗുണം ഉള്ളത് കൊണ്ടു തന്നെ. സ്വന്തം കുടുംബത്തിനു കൊടുക്കുന്ന മരുന്ന് സ്വന്തം രോഗിക്കും കൊടുക്കാം എന്ന് കരുതന്നതും ഇതിനാൽ തന്നെ. നിലവിലെ സർക്കാർ സംവിധാനത്തിന് മരുന്നുകളുടെ ഗുണനിലവാരം ഉറപ്പിക്കാൻ കഴിയുന്നില്ല. എല്ലാ മരുന്നുകൾക്കും തുല്യ നിലവാരം ഉറപ്പു നൽകാമെങ്കിൽ ജനറിക്ക് മരുന്ന് എഴുതാൻ തയ്യാറെന്ന് IMA നിരവധി തവണ വ്യക്തമാക്കിയിട്ടുളതാണ്. നിലവിൽ ജനറിക്ക് മരുന്ന് എഴുതിയാൽ ഏതു കൊടുക്കണം എന്ന് മെഡിക്കൽ സ്റൊറിൽ എടുത്തു കൊടുക്കുന്ന ആളാകും തീരുമാനിക്കുക. രോഗം മാറ്റുവാൻ ഉത്തരവാദി ആയ ഡോക്ടർ ഇതു തീരുമാനിക്ക്കുനതാകില്ലേ ഉചിതം. IMA ആവശ്യപെടുന്നത് സർക്കാർ തന്നെ ഗുണമുള്ള മരുന്ന് ഉത്പാധിപിച്ചു പൊതു ശ്രംഖല വഴി നല്കണം എന്നാണ്. എല്ലാ മദ്യകുപ്പിയിലും മുദ്ര പതിപ്പിച്ചു, സ്വന്തം ശ്രംഖല വഴി നൽകാമെങ്കിൽ മരുന്നിന്റെ കാര്യത്തിലും ഇതു ആകരുതോ? ചൊവ്വയില്ലേക്ക് ഉപഗ്രഹം അയക്കുന്ന രാജ്യത്തിനു മെഡിക്കൽ ഉപകരണങ്ങൾ നിർമ്മിക്കാൻ സാധിക്കില്ലേ? വേണ്ടത് രാഷ്ട്രീയ ഇഛാശക്തിയാണ്.

മരുന്നുകളുടെ ഭീമാമായ വിലക്ക് ഉത്തരവാദി ആരെന്നു നാമറിയണം. രാസ - വളം വകുപ്പിനു കീഴിലുള്ള NPPA (national pharmaceutical pricing authority ) ആണ് വില നിയന്ത്രിക്കുന്നത്‌, ഡോക്ടർമാർ അല്ല. ഉത്പാദന ചിലവിനനുസരിച്ച് മാത്രം വില നിശ്ചയിക്കുവാൻ ഇവര്ക് കമ്പനികളോട് നിർദേശിക്കാൻ കഴിയില്ലേ? സാധാരണ ഉപയോഗത്തിനു വേണ്ട മരുന്നുകൾ വില നിയന്ത്രണ പട്ടികയിൽ കൊണ്ട് വന്നു കൂടെ? ഇവർ സ്വാധീനത്തിന് വഴങ്ങുന്നുണ്ടോ? വില നിയന്ത്രണത്തിന് വേണ്ടതും രാഷ്ട്രീയ ഇഛാശക്തി തന്നെ.
രോഗികളോടും, സമൂഹത്തിനോടും ഏറ്റുവും പ്രതിബദ്ധത പുലർത്തിയാണ് ഡോക്ടര്മാരും, IMA യും പ്രവർത്തിക്കുന്നത്. നേപാളിലും, ചെന്നൈ യിലും അടക്കം നിരവധി മെഡിക്കൽ ക്യാമ്പുകൾ, സ്കൂളുകളെയും,ഗ്രാമങ്ങളെയും ദത്തെടുക്കുന്ന പദ്ധതി, നിർദ്ധന രോഗികൾക്കുള്ള ചികിത്സാ നിധി, വയോജന, സാന്ത്വന ശുശ്രുഷ, രക്ത ബാങ്കുകൾ തുടങ്ങി നിരവധി പദ്ധതികളാണ് ഡോകടർമാരുടെ സന്നദ്ധ സേവനത്തിലൂടെ IMA നടത്തുന്നത്. മെഡിക്കൽ രംഗത്തെ പരാതികൾ പരിഹരിക്കുവാൻ നൈതിക സമിതിയും, പരാതി പരിഹാര വേദിയും IMA നടത്തുന്നുണ്ട്. ഇവ ഉപയോഗിച്ച് തെറ്റുകാരായ ന്യൂനപക്ഷത്തെ കൂടി തിരുത്തുകയാണ് വേണ്ടത്. അതിനു മെഡിക്കൽ സമൂഹം തയ്യാറുമാണ്. ആത്മാർത്ഥവും, സത്യസന്ധവുമായി പണി ചെയ്യുന്ന ഭൂരിപക്ഷം വരുന്ന ഡോക്ടർമാരുടെ മനോധൈര്യം ചോരാതെ നോക്കേണ്ട ഉത്തരവാധിത്വം കൂടി സമൂഹത്തിനുണ്ട്.