The Making and Story of a Rural Physician

Neonatal Resuscitation Lecture

noreply@blogger.com (Bipin Kumar) — Thu, 12 Nov 2009 06:50:12 PST

We are being visited this week by a pediatrician from the United States. She took a two hour lecture on neonatal resuscitation. Yesterday's topic as respiratory distress.

Oh! Her confidence was visible. You could just feel it.

Must say, it was very informative.

Staff crunch makes Gujarat PHCs ill

noreply@blogger.com (Bipin Kumar) — Thu, 29 Oct 2009 09:46:09 PDT

Staff crunch makes Gujarat PHCs ill

DNA article

What about Bihar, Jharkhand, Uttar Pradesh and other poorer states?

Kids of migrant labourers getting poilo vaccine

noreply@blogger.com (Bipin Kumar) — Sun, 25 Oct 2009 13:05:12 PDT

Migration for job-seeking behaviour is common in any society. But, due to lack of 'domestic' opportunities, this is rampant in Bihar and Uttar Pradesh of India. This leads to expose the communities to different set of diseases.

The government of Tamil Nadu is considering vaccination for the kids of such migrant labourers who otherwise remain neglected.

"The special immunisation drive would target children of workers coming from northern States such as Uttar Pradesh and Bihar and engaged in construction activities in Tamil Nadu, according to S. Elango, Director of Public Health and Preventive Medicine."

Read more on The Hindu website.

World's youngest mother

noreply@blogger.com (Bipin Kumar) — Sun, 25 Oct 2009 12:54:05 PDT

Posted a comment here:

http://maldiveshealth.wordpress.com/2007/03/10/worlds-youngest-mother/#comment-10085

Unite For Sight volunteer

noreply@blogger.com (Bipin Kumar) — Sun, 25 Oct 2009 12:45:34 PDT

Jessica Qu volunteered for Unite For Sight, an India based NGO:

WHO on Artemisinin sale and Indian pharma

noreply@blogger.com (Bipin Kumar) — Tue, 20 Oct 2009 05:49:13 PDT

In a previous post, there was an account on Malaria in the Herbertpur Christian Hospital. This area was considered low risk for malaria, but we saw the change.

Artemisinin derivatives are one of the good drugs available for combination-therapies for chloroquin-resistant (Falcparum) malaria. Monotherapy with this drug is not approved by the World Health Organization.

On May 2006, the WHO had published that there are some pharmaceutical companies which have agreed not to market single-drug artemisinin pills in favor of Artemisnin combination-therapy (ACT).

See, it is well in the year 2006, and you can still find single-drug artemisinin in India. Another thing is due to unregulated sale, anyone can purchase virtually any medicine in India; needless to add that in most of such purchases you do not need any prescription. Many of us know it is bad, but it is happening in a full-blown state here.

As Indian primary health-care structure is very poor, a big chunk of the villagers (and many urban poor) have to rely upon unlicenced medical practitioners who come in names of 'Dactar babuu', 'Bangali dactar' (no offence meant to my Bengaly family), 'gaon ka dactar', 'chhota-mota dactar' and all.

This leads to unregulated abuse of medications.

These led a thought if the above appeal by the WHO applies to Indian pharmaceutical companies. Perhaps not. And, there you find many patients getting monotherapy both from "qualified" and "unqualified" medical practitioners.

Online Health Library

noreply@blogger.com (Bipin Kumar) — Thu, 08 Oct 2009 03:40:01 PDT

I heard about the HELINET last year.

It is an online resource for medical journals by the Rajiv Gandhi University of Health Sciences (RUGHS).

Today, I inquired them if I can avail the HELINET. But the response came that the HELINET is not available outside Karnataka for the time being!

Alas! Such a great asset not available to many a students! Although India is one of the developing nations, OVID access is NOT free for Indians (both as individuals or as institutions).

As you know that many a journals are not Open Access; the HELINET should be made available to institutions and individuals outside Karnataka.

Indian health system aping the expensive US way: Pitroda

noreply@blogger.com (Bipin Kumar) — Thu, 08 Oct 2009 03:44:25 PDT

Mr. Sam Pitroda is a valuable member of the Knowledge Commission in India. A learned person by himself, he has at last spoken about the ailing health care infra-structure of India.

Thank you for that Mr. Sam.

The Deccan Herald article:

http://www.deccanherald.com/content/29272/indian-health-system-aping-expensive.html

Dr. Vikram R Lotwala: MCI finally awakens and how ( Part 1 )

noreply@blogger.com (Bipin Kumar) — Thu, 01 Oct 2009 07:38:11 PDT

Dr. Vikram R Lotwala: MCI finally awakens and how ( Part 1 )

Another MCI trick

noreply@blogger.com (Bipin Kumar) — Wed, 30 Sep 2009 12:04:12 PDT

I have no idea why Dr. Vikram is so much crazy about the MCI.

http://lap-surgery.blogspot.com/2009/09/mci-finally-awakens-and-how-part-3.html?showComment=1254337019207#c8173976986860745356

Sir William Osler Then and Now: Thoughts for the Osteopathic Profession -- Calabrese 105 (5): 245 -- Journal of the American Osteopathic Association

noreply@blogger.com (Bipin Kumar) — Tue, 29 Sep 2009 18:33:18 PDT

Sir William Osler Then and Now: Thoughts for the Osteopathic Profession -- Calabrese 105 (5): 245 -- Journal of the American Osteopathic Association

Shared via AddThis

Describing life of Sir Osler.

Africa speaks on DOTS

noreply@blogger.com (Bipin Kumar) — Tue, 29 Sep 2009 06:05:00 PDT

In a recent blog by the staff of the Infectious Disease Center for the Global Health Policy, Dr Robin Wood is delivering lectures on the failure/success of he DOTS in South Africa.

Science Speaks on the Wordpress is a blog who write about them as "Thoughts, news and analysis from the staff of the Infectious Diseases Center for Global Health Policy on the latest developments in tuberculosis and HIV/AIDS."

They write about Dr. Robin Wood, director of the Desmond Tutu HIV Center in Cape Town who is delivering lectures and holding discussions with policy makers on tuberculosis control on a global aspect. Some of his recommendations include very practical statements like:

“If you live in a sea of TB,” as so many South Africans do, DOTS is just not enough to control the disease''

"There’s good ventilation, for starters, in the shacks and other buildings where TB is now being transmitted at shockingly high rates. Simple steps, like adding a window grid and fan to these tiny homes, churches, and other places where many poor South Africans live, could make a huge difference."

"community care"

Even though the WHO has declared TB as a medical emergency in the Africa and asked people to take extraordinary measures, Dr. Wood is in denial of any such "extraordinary measures".

Read more here:

DOTS Not Enough When it Comes to TB in South Africa

The American Journal of Medicine Blog: “Common Sense Is Not So Common” (What We All Need to Remember)—Part One

noreply@blogger.com (Bipin Kumar) — Sat, 26 Sep 2009 19:25:43 PDT

The American Journal of Medicine Blog: “Common Sense Is Not So Common” (What We All Need to Remember)—Part One

Just now I 'discovered' this blog! And hey, it found space in my blog-roll.

Says great things. Makes a good read.

Added Drs. Vijay and Bruno

noreply@blogger.com (Bipin Kumar) — Thu, 24 Sep 2009 05:03:47 PDT

Dr. Vijay is a consultant radiologist based at Salem in Taml Nadu in India. His blog has been added to my blog-roll.

Bruno is a famous personality especially in south India. Recently, he entered his residency in neurosurgery. He authors many a books for post-graduate medical entrances in India and has a keen interest in blogging.

Testing for Multi-drug Resistant Tuberculosis in private laboratories

noreply@blogger.com (Bipin Kumar) — Thu, 24 Sep 2009 04:44:59 PDT

As per an Indian Express news article, in a recent decision, the Government of Mumbai (Maharashtra) has taken to take a public -private-partnership for testing multi-drug resistant tuberculosis (MDR-TB).

Under this, Hinduja hospital in Mumbai is undergoing training on it. We see many patients who just fail treatment by Directly Observed Treatment Short-Course (DOTS); an strategy recommended by the World Health Organization. These patients, after testing, if found resistant to the first line anti-tubercular drugs, undergo treatment by second-line drugs.

I heartily appreciate this decision. It will help early identification of more number of such cases.

Drug-resistance in tuberculosis bacteria is an increasing problem and data say that India is having the highest numbe of MDR-TB cases. This has been attributed to misuse of antibiotics.

In our hospital at Herbertpur, we see some of such MDR-TB cases. And they belong to many a adjoining districts. Many of them come from the bordering district of Saharanpur of Uttar Pradesh, which predominantly inhabits Muslim population and is famous internationally for wood carving industry. Most of our MDR-TB patients are not HIV/AIDS positive! This retrospectively indicates that in the past and even currently, there is misuse of antibiotics as well as the tuberculosis control program has not been up to the mark.

Another thing, there is a need to set-up DOTS-Plus (an strategy to fight the MDR-TB) program in such an area.

Malaria in Herberpur Christian Hospital

noreply@blogger.com (Bipin Kumar) — Thu, 17 Sep 2009 11:38:07 PDT

I joined my residency after working in an area of hyper-endemic transmission of malaria. I also belong to Jharkhand where Plasmodium falciparum is a big problem.

When I joined my residency, I asked people if they see malaria here. People were negative in their response.

And, here is an outbreak here! Well, this month alone in September 2009 till today (17th) we saw 21 malaria cases of which 10 are Plasmodium falciparum (a hopping 50%). All of us are surprised! Our lab in-charge says he never expected this much of malaria in this hospital.

I read somewhere is that even in India malaria is increasing its wings and falciparum which causes severe illness, is becoming a big problem. This can be in one way related to migration of population from endemic areas for job seeking behaviour.

Dehradun has its industrial area called Selaqui. Sirmour (bordering Dehradun, and Herbertpur) in Himachal Pradesh has Paonta Sahib. There are many a industries here and people from many a malaria endemic states in India (like Jharkand, Orissa, Bihar, Chhatisgarh etc) come here for job.

Well, as Sir William Osler said:

Humanity has but three great enemies: Fever, famine and war; of these by far the greatest, by far the most terrible, is fever.

Tuberculosis treatment course challenged

noreply@blogger.com (Bipin Kumar) — Tue, 15 Sep 2009 09:22:59 PDT

The WHO recommends 6 months directly observe treatment course for most of the tuberculosis patients.

In a recent PLoS Medicine article by Dick Menzeis of the McGill university, Canada and others, this protocol has been challenged.

The article:
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000146

Tomorrow's doctors by the GMC

noreply@blogger.com (Bipin Kumar) — Tue, 15 Sep 2009 07:37:38 PDT

When the General medical Council of the United Kingdom is coming up with a clear cut documents on expectations from the doctors of tomorrow, the Medical Council of India has miserably failed to do so in its life time.

http://www.gmc-uk.org/education/undergraduate/undergraduate_policy/tomorrows_doctors/tomorrows_doctors_2009.asp

Another thing, if we compare population wise, the UK gets some 39,000 doctors a year but in India, around half this number. And you know the population of India, don't you?

People, we Indians definitely are in bad shape when it comes to the (quality) medical service. Another thing, they are merging organizations to avoid confusion and ambiguity regarding medical education and here, we have two systems of post-graduate medical education.

And, some of my friends say, both of them need drastic improvement.

At Your Cervix: Delicate heart surgery - rare condition

noreply@blogger.com (Bipin Kumar) — Fri, 11 Sep 2009 07:04:55 PDT

Posted a comment here!
At Your Cervix: Delicate heart surgery - rare condition

This is about an Indian cardiothoracic surgeon (Dr. A. K. Bisoi of All India Institute of Medical Sciences, New Delhi) repairing ectopia cordis, a condition in which the heart lies outside of the body.

Comments onVikram's post

noreply@blogger.com (Bipin Kumar) — Fri, 28 Aug 2009 06:15:15 PDT

Posted a comment on the MCI scrapping issue.

Great decision by the union government of India. Hope they come out with better team and good ideas.

Medical Council of India to be scrapped

noreply@blogger.com (Bipin Kumar) — Fri, 28 Aug 2009 02:17:31 PDT

I a recent decision, the union government of India has decided to scrap all the councils regulating medical education in the country. This include Medical Council of India, Dental Council of India, Pharmacy Council, Nursing Council.

The Times of India published the news and the Times Now video is below:

In my opinion, it is a grand welcome step by the current government. To know more about the Indian medical education system and the state it is under now, please read the responses of the newsreaders.

noreply@blogger.com (Bipin Kumar) — Thu, 27 Aug 2009 07:27:49 PDT

As per a Dutch study:

The effect of dissatisfaction among the general physicians and its impact on patient care.
These feelings affect the quality of care. While such physicians take more time for consultations,
they are also more careful while consulting mental health problem.

Many a residents are overworked in many of the places including institutes in the USA and other developed nations.
I was wondering if this does not also apply to physicians in India.

Anon Doc

noreply@blogger.com (Bipin Kumar) — Tue, 25 Aug 2009 10:54:34 PDT

Posted a comment here where the Anonymous Doc tells his story about untouchability:

http://anondoc.blogspot.com/2009/08/dont-touch-me.html?showComment=1251222753665#c1714329821186868688

Flavoxate

noreply@blogger.com (Bipin Kumar) — Wed, 05 Aug 2009 16:44:59 PDT

Flavoxate, an antispasmodic drug, used to provide symptomatic relief in urinary tract infection causing dysuria, nocturia, incontinence, suprapubic pain, urgency should be taken in empty stomach.

The drug, commonly available with trade name URISPAS™ has interactions with anticholinergic medications and alcohol.

The drug is contraindicated in patients with GI hemorrhage, GI obstruction, bladder outlet obstruction (benign prostatic hypertrophy or BPH), and of course if the patient is hypersensitive to it.

In addition, there are other precautions, which we need to take care of.

Time with Dr. Symon Satow

noreply@blogger.com (Bipin Kumar) — Mon, 03 Aug 2009 10:36:13 PDT

Today, we had a get together with Dr. Symon Satow. He worked in Herbertpur Christian Hospital (my current training hospital) for many years. He started his talk asking what do we think of when the term "rural" comes to our mind. And many came up with replay "something which is resource poor".

For sure, our small (still 100 bedded) hospital is one of the resource poor hospital in northern India. We are in a rural area.

He discussed the lack of resources in a rural hospital set-up. How can we work together as a team for the most important part of he hospital that is the patients. We discussed together we can be a family and be in joys and sorrows of our colleagues and co-workers. He recalled how they used to treat patients in those days when there were not many a staffs nor very "fancy" and equipped laboratory nor a good operation theater, but for sure they did marvelous job! And saved innumerable lives and made them smile!

He repeated, it is not necessary that good training programs make good doctors or persons. For sure! I agree you Dr. Satow.

Dr. Satow had a vision of training doctors in a rural set-up. And, the dream is true today! This hospital is training medical graduates in programs serving mostly the poor and the down-trodden! Our institute's library has been named after him. Yes, you guessed right, "Dr. Symon Satow Library".

It was a pleasure to see you and your wife in person sir. You speak Hindi very fluently even now! Thank you for paying us a visit.