Month: January 2014

Neuro and Spine

My daily dose of Air Pollution in Hyderabad

Past few weeks I have been observing municipal employees in Hyderabad burning waste in open in the stretch between Road no 10, Jubilee Hills and the areas around the KBR park, my route for going to work. I see at least 10-12 heaps of waste burning just in this 4 km stretch everyday and that is just a small part of the larger picture across other areas of Hyderabad and other cities in India. Open burning constitutes up to 20% of overall air pollution in some of the big cities in India.

I am sure we guys from India are so used to such open burning of waste, that our brain has just stopped responding to the sight and the discomfort of suffocation caused by it. Many a times we just pass by a burning pile of waste holding our breath pretending that
we didn’t inhale that smoke full of carcinogens, failing to realize that it is not just the momentary exposure which will kill us but the overall degradation of air quality in and around our locality, our workplace and the places we visit on regular basis. It is that daily silent dose which is doing the work as we speak.


The worst part is that the open burning of waste is being done by the employees of the municipal authority which is supposed to regulate the air quality in the city (posting the pics along).

For those who are not aware, typically smoke constitutes mainly of particulate matter, hydrocarbons, carbon monoxide, sulphur dioxide and carcinogenic dioxins/furans. Air pollution is a significant risk factor for various diseases including increased frequency of respiratory infections, chronic heart diseases, hypertension and lung cancer, according to the WHO. Apart from our health, our actions are also catalyzing climate change (read here how air pollution from Asia is affecting world’s weather).

Of all the causes of air pollution, I guess it is relatively easier to prevent open burning of waste. Even then, I am not aware of any regulation against the open burning of wastes in India neither are there any awareness campaigns or at least some advertisements in mass media which can change this behavior of people around.

Hope somebody takes a notice of this!

Do share this post and your stories too so that our voice can be heard. 

The Arogyada
www.arogyada.in
January 27, 2014 / by drsandeep.net

The story of 10,000 new MBBS seats and the diminishing skills of budding Indian doctors

Recently the Union Cabinet approved a proposal for increasing nearly 10,000 MBBS seats at government medical colleges across the country. The financial allocation required for the additional MBBS seats was also cleared. The proposal is aimed at increasing the number of doctors to help bring down the doctor-patient ratio from the current 1:2000 to 1:1000.
From theoretical perspective this should be considered as a welcome move. But just increasing MBBS seats without increasing PG seats (Medical Specialty) is definitely gonna have big implications on the future of doctors who will be occupying these seats. 
A fresh MBBS graduate typically has limited skills and even if they are skillful they are usually not confident enough to practice independently. They usually have to work in hospitals to practice these skills and gain confidence. 
Low salaries are a big blocking factor to even think of settling down just after MBBS. And these fresh graduates find very limited usage in today’s modern hospital where their work is mostly limited to patient monitoring, ward rounds and night duties. Almost all of the decision making lies in the consultants’ hand. Owing to these factors, majority of fresh MBBS doctors actually do not start practicing after completing MBBS but they take a drop, join a coaching and prepare for PG entrance examinations. 

The system of PG entrance exam in itself is a immensely broken system with uncountable number of exams with each having its own pattern. Owing to the high number of graduates and less number of PG seats the competition is intense with approximately 10-15 MBBS graduates fighting for 1 PG seat! 
The preparation for PG entrance for most doctors lasts for 1-2 years (usually without practicing) which breaks the continuum and dilutes the clinical skills of our budding physicians.
Most of the Indian MBBS doctors can be seen in hospitals cramming, more interested in MCQ guides than taking care of patient on the bed side. And why is that?? Because none of the Indian PG entrance exam puts any stress on clinical skills, patient interactions or professional aspects of the practice.   
So in this mess, what do we need to do in the coming future?
-PG seats to be increased in the same proportion
-Pattern of entrance examination should be changed such that it favors practicing MBBS graduates who are actually doing the real clinical practice. As William Osler said – “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all”
-There should be knowledge and technical support initiatives from MCI, State Governments and the Central Government  to help the MBBS graduates to establish their own clinics. This will have lasting impacts on both equitable distribution and easy access to healthcare  
The Arogyada
www.arogyada.in
January 24, 2014 / by drsandeep.net

Fortis launches state of the art, multi super-specialty hospital in Ludhiana

January 17, 2014: Fortis Healthcare Limited (Fortis), launched its state of the art, 260 bed green-

field hospital in Ludhiana. The multi super-specialty facility underscores the significant commitment by Fortis to bridge the gap for quality healthcare services in the region. Mr. Sukhbir Singh Badal, Honorable, Deputy Chief Minister, Punjab inaugurated the hospital.

Dedicating the facility to the service of patients, Mr. Sukhbir Singh Badal, said, “We are happy to see Fortis strengthening its commitment to Punjab by bringing world class infrastructure and medical care to Ludhiana. We applaud their efforts and wish them success in taking healthcare to the people and in further elevating the quality of healthcare in the region.”

At a separate ceremony, Mr. Sukhbir Singh Badal also laid the foundation stone for Fortis La Femme, yet another green-field facility that will come up in the City, by 2016. Located on the Mall Road, this will be a 100 bed Centre for Women, dedicated to meet their medical needs through various stages of their life.

Fortis has committed significant investments in creating capacity of over 1,000 beds in Punjab. These include the newly commissioned hospital in Ludhiana; existing facilities in Mohali and Amritsar; the soon to be launched Fortis Cancer Institute in Mohali and the green-field project, Fortis La Femme in Ludhiana.

The Arogyada
www.arogyada.in
January 21, 2014 / by drsandeep.net

eVaidya.com : Virtual doctor consultations in India


e Health Access Pvt Ltd., a telemedicine company recently announced launch of their new Healthcare webportal eVaidya.com. This will provide virtual Doctor Consultation to patients apart from providing free personal health record storage. Company already provides a similar service via ehealthaccess.com, eVaidya.com will be considered as the main brand going forward.

According to Jayadeep Reddy, CEO “eVaidya.com is more user friendly and works on all mobile devices and platforms. Apart from consulting our panel doctors via phone and email, we want our customers to store and check their Health trends on our portal and adopt more preventive measures to stay fit & healthy. Health record storage is a free service from eVaidya.com and going forward we will be working to sync multiple health gadgets for storing data and giving valuable health advice to the users.”

Developed with latest technology, a user will be able to create consultation with a doctor in less than 45 seconds. eVaidya mobile application will be available shortly for Android, iPhone and Windows smartphones. eVaidya app will help users to have quick and instant connectivity with doctors apart from storing valuable health data for notification and alerts from our virtual health center. Company is aimed at helping users in understanding their health trends with the network of specialists across India. Company believes that Health analytics is going to be an important tool in constantly encouraging users to adapt a healthy living. Also people adapting to preventive health care in India is increasing at a constant pace and it is expected to grow faster with internet and mobile penetration and via health gadgets.

Courtesy:  India PRwire

The Arogyada
www.arogyada.in
January 19, 2014 / by drsandeep.net

Differences between Healthcare Systems of India and the UK

Continuing with our series on comparison of Indian healthcare system with various healthcare systems across the  globe, here are some gross differences.

The Indian healthcare system, though evolved from its colonial roots of the British empire, started with many similarities but has not been able to maintain the strength of its public arm and consequently the private arm has far overtaken and established deep roots in the Indian healthcare scenario.

——–
UK:
A healthy proportion of 9.6% of the GDP is spent towards healthcare expenditure.Public spending contributes to 81.7 percent of overall healthcare expenditure.

India:
4.1% of the GDP is spent on healthcare expenditure while the public spending is as low as 1.2% of the GDP or 26.2% of the total expenditure(2010).

——–
UK:
Healthcare is publicly funded from general taxation, and is free to all permanent residents.There is also a thriving private healthcare sector which is considerably smaller than its public equivalent. The cost of private healthcare is mainly covered via private health insurance.

India:
Majority of healthcare expenses are out of pocket with private sector playing a major role. There is no single universal scheme covering the entire population. Though there are a multitude of health benefit schemes at central and state level for specific sections within the population.


———
UK:
Fifteenth best in Europe and eighteenth in the world (amongst 191 member states in the World Health Report, 2000)

India:
Ranked at 112 in the world (amongst 191 member states in the World Health Report, 2000)

———
UK:
Coordinated care is a norm. For elective care, patient has to visit a General Practitioners (GPs) first who acts as a referral authority for referral to specialists and super-specialists as necessary.

India:
Coordination of care is weak, almost non existent. Anybody can directly approach any specialist or super-specialist without proper referral system in place.

———
UK:
Single holistic health services under National Health Services(NHS) England cover entire spectrum of primary to tertiary healthcare, acute to chronic services and vaccination to adult screening programs.

India:
Multiple centre and state level programs which cover same issues amongst the same set of beneficiaries on one end. For instance, maternal health has schemes such as Janani Shishu Suraksha Karyakram (JSSK), Janani Suraksha Yojna (JSY)  and Indira Gandhi Matritva Sahyog Yojna (IGMSY) running in parallel apart from innumerable schemes in every state. On the other hand there is no focus on other set of health issues like geriatric health.

———
UK:
Pharmacies (other than those within hospitals) are privately owned but have contracts with the NHS to supply prescription drugs. Systematic and only on prescription sale of drugs is the standard practice.

India:
Pharmacies are predominantly privately owned by single owners with no affiliation to public health systems except for licensing
formalities. There is indiscriminate sale of drugs over the counter including antibiotics leading to a very imminent risk of widespread bacterial resistance

The Arogyada
www.arogyada.in
January 17, 2014 / by drsandeep.net

Five Key Challenges for Indian Health Insurance Industry

In the current scenarios Indian health insurance industry can be considered to still be in its infancy. The next few years posit a plethora of challenges. Have highlighted key five areas of concern.

1. Lack of standardised transactions between the insurer and hospitals or the insurer and insured. This often results in individual interpretation and methodology for processes like claims and pre-authorization

2. Use of non-standard terminologies with regards to treatment protocols and care plans. In fact absence or minimal documentation and implementation of standard care pathways become a cause of conflict with regards to services covered/not covered for payment via the insurer. This gets further aggravated with extremely poor usage and implementation of ICD codes

3. Skewed penetration (much higher in urban India than rural) of private health insurers within the Indian population leading to asymmetric distribution of risk. This ultimately on one hand bleeds the insurer, on other hand hits the insured due to higher premiums and finally also the hospitals due to higher rejection rates

4. Non SLA based transactions between hospitals and insurers. Response time and request closure time for crucial transactions like pre-auth filling, pre-auth approval, claim filling, and claim approval is still not a strictly followed dimension.

5. Both hospital and insurer hold sensitive patient data but we are still far from having any form of implementable India specific law or guidelines to protect and securely exchange patient data between two major pillars of healthcare industry

The Arogyada
www.arogyada.in
January 8, 2014 / by drsandeep.net