Friday, 20 October 2017

IMA is change maker: Medical voice is heard

Dr KK Aggarwal

As clinicians, doctors prescribe treatments for patients so that they get better. Making the right diagnosis and then prescribing the right treatment is the primary responsibility of doctors. This is what they have been trained for. But, a doctor however plays multifaceted roles. A doctor is not simply a medical expert; he/she is also a communicator, collaborator, manager, health advocate, scholar, professional, community leader. Doctors therefore are also change agents in the community.

The words of a doctor carry weight and they can bring about change that is appropriate to the need. This requires them to be aware of the needs of the community they practice in, the resources available to their patients and any problems regarding these.

Drug shortage, due to multitude of reasons, is one such crisis that rears up time and again. Recently, there was a shortage of two drugs in the market, d-penicillamine (DPEN) and penicillin G potassium (Pentid-Abbott).

D-penicillamine is used to treat patients with Wilson’s disease (copper overload) with liver, neurological and psychiatric manifestations. And, patients have to be on this drug lifelong.

Indian Medical Association (IMA) raised the issue of shortage of the two drugs in its digital platform. The medical voice was heard and consequent to this, earlier DPEN (D-penicillamine) was made available in no time and now, Pentid is also freely available again.
Doctors should use their voice to influence positive change in health care. However, any complaint regarding any health issues and concerns prevailing in the community should not only be proper and in a constructive manner, it should also be voiced at an appropriate platform such as IMA.
It is important to voice concerns and needs of the patients and the community in time before they become too big to handle. Medical voice works…

Disclaimer: The views expressed in this write up are entirely my own.

Thursday, 19 October 2017

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

WMA TB & HIV-AIDS Resolutions revised in coordination with IMA

Dr KK Aggarwal

In the recently concluded Annual General Assembly in Chicago held from October 11-14, 2017, the World Medical Association (WMA) passed two resolutions on Tuberculosis (TB) and HIV-AIDS, after undergoing major revisions.

Indian Medical Association (IMA) volunteered to be the coordinating national medical association for these resolutions. This was only the right thing to do given the high prevalence of the two diseases in the country and hence, of great public health concern to us.

India accounts for one-fourth of the global TB burden, including MDR TB, as reported in Global TB Report 2016. And, India is among the top three countries with the highest number of people living with HIV. The total number of people living with HIV in India is estimated at 21.17 lakhs (17.11 lakhs–26.49 lakhs) (India HIV Estimation 2015 report). Of these, only 14 lakh are diagnosed.

As the coordinating national medical association for both these resolutions, suggestions from all member national medical associations were sent to IMA, who compiled and finalized the resolutions, which were then passed by the recent Assembly at Chicago.

Both these Resolutions on TB and HIV-AIDS were first adopted in October 2006 by the WMA Annual General Assembly in South Africa.

WMA Assembly also passed a Revised Declaration of Geneva incorporating various changes and additions. IMA was a part of the workgroup that worked on the amendments to ‘The Physician’s Pledge’.

IMA is also coordinating revisions to another WMA document on Reproduction Rights.

Some salient points of the two resolutions are as below:

WMA Resolution on TB

• “Screening of high risk groups including PLHIV (people living with HIV) and vulnerable populations including migrants, prisoners, and the homeless should be considered within each national epidemiological context as a component of tuberculosis prevention.

• Rapid diagnosis with molecular tests and supervised daily treatment started early should help arrest the spread of disease.

• The WMA supports the WHO “End TB Strategy” and its visions, goals and milestones.

• The WMA calls on National Medical Associations to support their National TB Programmes by generating awareness among healthcare professionals about TB management and early reporting of cases in the community.”

WMA Resolution on HIV-AIDS

• “In addition to representing a staggering public health crisis, HIV/AIDS is also fundamentally a human rights issue.

• Discrimination against HIV / AIDS patients by physicians is unacceptable and must be eliminated completely from the practice of medicine.

• Patients with HIV/AIDS must be provided with competent and appropriate medical care at all stages of the disease.

• Physicians must ensure that patients have accurate information regarding the treatment options available to them.”

Better be safe than sorry during the festival of lights

Better be safe than sorry during the festival of lights

Those with cardiac and respiratory ailments should be particularly careful

Eating and drinking should be healthy and in moderation, with adequate physical activity

New Delhi, 18 October 2017: Diwali, the festival of lights and harbinger of prosperity and cheer, is characterized not just by this. It is also that time of the year when health risks escalate. From the ghee-laden sweets to the pollution-inducing crackers, there is a lot to think about in terms of one’s health. According to statistics, the annual carbon dioxide emissions from fireworks is 60,000 tonnes. The IMA says that this is not only to the environment but also to the health. Add to this the sweets and savories and alcohol binge, and one’s weight is sure to catapult.

Diwali is that time of the year when people lose track of their eating, drinking, and fitness habits. Apart from this, noxious gases such as carbon monoxide from crackers can be detrimental for those with asthma or heart ailments.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is a sudden change in both eating and sleeping patterns during Diwali. Late night parties binge-eating, alcohol, and lack of exercise affect health in many ways. People also do not drink enough water to keep themselves hydrated. White sugar in sweets can lead to uncontrolled diabetes and gain weight in individuals. Adulterated khoya can cause GI upset. Artificial coloring in sweets can cause cancer in long run. Those with COPD (adult asthma) need to be careful as the smoke from crackers can worsen respiratory illnesses. Excessive noise pollution during Diwali can cause hearing loss, high blood pressure, and mental irritation. It can also exacerbate heart ailments in people sometimes leading to a cardiac arrest as well. One should also be careful of candle pollution as petroleum is a known human carcinogen and can cause indoor pollution.”

Diwali fire hazards are also not uncommon and can result in burns and loss of life. Particlesof crackers can cause eye burn and irritation. People also indulge in excessive consumption of alcohol which is injurious to health.

Adding further, Dr Aggarwal, said, “The best item for Diwali is fruits and dry fruits. Avoid ‘chhena’ and ‘khoya’ sweets, along with sweets and milk products from roadside shops. One should not drive after consuming more than 30 ml in one hour. While gambling one should not argue with others as someone under the influence of alcohol may cause harm. Those with COPD should use wet clothes whenever they are exposed to smoke. It is imperative to remember that health is above all and no festival or occasion should be an excuse to compromise on health.”

Here are certain things one can observe to stay away from harm and ensure good health during Diwali.
Limit the use of firecrackers and avoid loud explosives. Those with asthma should wear face masks to prevent inhaling the poisonous mix of gases. Those with cardiac problems and hypertension should wear ear plugs to prevent the impact of the cracker explosions.
Check the manufacturing and expiry dates of sweets and snacks before buying them. Avoid buying anything from roadside shops.
Replace oily snacks with a combination of fresh fruits, curd dips, raw salads, roasted food items and nuts like almonds and pistachios. Replace carbohydrates and proteins with fibre and vitamins in your diet. Ensure that you stay hydrated by drinking lots of water through the day.
In case of burns, the affected part should be put in running water till the burning sensation disappears. Blisters should not be punctured, as they work like a natural dressing.

Wednesday, 18 October 2017

Trauma-related deaths can be prevented by timely action

Trauma-related deaths can be prevented by timely action

Need for more trauma centres across cities that are up-to-date and organized

New Delhi, 17 October 2017:In India, one person dies of a road accident every minute, indicate statistics. Road accidents account for about 1,50,000 deaths every year. Injuries and the resultant trauma rank fourth in the causes of death across all age groups children, adolescents, and young adults. These are also reasons for more premature deaths than cancer, heart disease or other such diseases.[1]On World Trauma Day, there is a need to raise awareness on the fact that majority of these trauma-related deaths can be prevented through timey action and medical care.

Many deaths occur either within minutes of the injury, at the scene of accident or injury, before the victim is taken to the medical facility, or immediately upon arrival at the hospital. Some of the reasons for death include massive hemorrhage or severe neurological injury.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “There is still a long way to go in terms of immediate trauma care in India. There are many issues in offering critical care to injury victims. India lacks significant pre-hospital care in most cities with the golden hour concept still an ambiguity for many. This is further exacerbated by poor ambulances services and the lack of a centralized agency to monitor them. Hospitals need to ensure availability of casualty medical officers who can do more than just resuscitation. Add to this the fact that there are no dedicated trauma surgeons in India, which often causes delays in clinical decision making. This is because various aspects are handled by various departments and not a single entity. Last but not the least, there is no central trauma registry in any institute.”

In a survey, it was found that the risk of deaths in injured people can be reduced by about 25% if a trauma victim is treated at a dedicated trauma centre.[2]Trauma centres are classified into four levels based on the available resources and the number of patients admitted.

Adding further, Dr Aggarwal, said, “There is a need to have dedicated trauma centres in cities throughout the country that can provide the best emergency services and have up-to-date trauma systems. This means that such a hospital should have high-quality intensive care ward and an operating theatre, learned and dedicated personnel, and updated and latest equipment. Apart from this, it is imperative to make efforts to prevent injury or reduce the severity of injuries, as this will help in preventing many cases of immediate death.”

Prevention is always better than cure. Trauma can be prevented by staying alert at an individual level.

Some do’s and don’ts to consider with regard to accidents and injuries are as follows.

Follow the road safety rules and be aware of warning signs and traffic signals.
Do not forget to wear a helmet and take a break if you are driving for a long distance.
Do not use the mobile phone while driving or listen to loud music.
Keep a first-aid kit ready at home and in your vehicle.
Do not drive if you are sleepy, tired, or have had drinks.
If you notice a person with head or spinal injury, move the person from the site only with professional help to avoid serious back or neck injuries.
Do not give fluids to any unconscious or semi-conscious traumatized person.
Learn basic life support techniques and help the injured.

Global issues discussed during the WMA General Assembly

Global issues discussed during the WMA General Assembly

Dr KK Aggarwal

The World Medical Association (WMA) concluded its annual General Assembly in Chicago held from October 11-14. More than 50 national medical associations attended the annual General Assembly and discussed various global issues.

Dr Yoshitake Yokokura, President of the Japan Medical Association, was installed as President of the WMA for 2017-18. Dr Leonid Eidelman, President of the Israel Medical Association, was elected President elect. He will take office in a year’s time to serve as President in 2018-19.

Hunger strikes: The Assembly agreed that the WMA would support any physician who faces political pressure to take part in forced feeding of hunger strikers against their ethical advice. In a revision of its policy on hunger strikers, the WMA says that national medical associations ‘have a responsibility to make efforts to prevent unethical practices, to take a position against ethical violations, and to investigate them properly’. Delegates agreed that where physicians are pressured to take part in torture, the WMA would protest internationally and publicize information about the case.

Bullying: A policy of zero tolerance towards bullying and harassment in the medical profession was supported by the meeting. Delegates agreed a statement condemning bullying under any circumstances and encouraging all national medical associations members, medical schools, employers, and medical colleges to establish and implement anti-bullying and harassment policies.
WMA President, Dr. Yoshitake Yokokura said: ‘Bullying in the health workplace is entirely unprofessional and destructive, and should not be tolerated. It is time the profession took steps to prevent, confront, report and eliminate such behaviour at any level’.

Armed conflict: Against a background of armed conflicts in many parts of the world, the Assembly issued a strongly worded statement reminding governments of the human consequence of warfare. It says that armed conflict should always be a last resort and physicians should encourage politicians, governments, and others in positions of power to be more aware of the consequence of their decisions to start or continue armed conflict. Efforts to avoid conflicts are often insufficient and inadequate and country leaders may not seek all alternatives. Delegates stressed that avoiding war and seeking constructive alternatives is always desirable.

Access to health care: A call for ethical codes for recruiting health professionals was agreed in a bid to reduce inappropriate recruitment activities by states. The Assembly approved a new policy to combat the problems of a global maldistribution of health care workers. It declared that the global movement of workers, especially from less developed to better developed countries, is leading to continuing shortages. It said that ethical recruitment codes were needed for both governments and commercial recruitment agencies to ensure that countries did not actively recruit from other states.

Alcohol: A worldwide drink drive limit of no more than 50 milligrams per 100 millilitres of blood was called for by the Assembly in a new drive to reduce excessive alcohol consumption. In a statement, the WMA says that key deterrents should be implemented for driving while intoxicated, including a strictly enforced legal maximum blood alcohol concentration for drivers of no more than 50mg/100ml, supported by social marketing campaigns and the power of authorities to impose immediate sanctions. WMA President Dr. Yoshitake Yokokura said: ‘The human cost of drunk driving across the world is appalling. The daily tragedy of death and injury caused by drivers who drink while over the limit is unforgivable. I hope that governments will act to reduce the drink drive limit’.

Child abuse: Guidance to physicians on dealing with child abuse were agreed. In a new policy document, the WMA says that child abuse in all its forms, including exploitation of children in the labour market, is a world health problem and that physicians have a unique and special role in identifying and helping abused children and their families. All physicians should be educated about the overriding importance of the welfare of children. They should act in the best interests of children in all of their contacts with children, young people, families, policy-makers and other professionals.

Fair trade: The Assembly condemned the abuses of labour standards, evidence of modern slavery and unethical working conditions that have been uncovered in the manufacture of many medical products around the world. In a new Declaration, the WMA calls for a fair and ethical purchasing policy for medical goods. It urges all its national medical association members to advocate for human rights to be protected throughout the global supply chains of products used in their healthcare systems.

New members: Five new members were admitted – the Czech Medical Chamber, the Belarusian Association of Physicians, the Pakistan Medical Association, the National Medical Chamber of Russia and the Belize Medical and Dental Association. This increases the total number of medical associations and constituent members in the WMA to 114.

All the policies adopted by the Assembly can be found on the website of the WMA.

(Source: WMA, October 16, 2017)

Tuesday, 17 October 2017

AHA guidance on improving employee health and engagement

AHA guidance on improving employee health and engagement

Dr KK Aggarwal

The American Heart Association (AHA) has released an evidence review report titled “Resilience in the Workplace: An Evidence Review and Implications for Practice”, with practical actionable guidance for employers looking to implement resilience training programs. According to the report, resilience is an emerging, innovative strategy to improve employee health and productivity, and organizational performance.

The CEO Roundtable is the AHA’s leadership collaborative with 30-plus member CEOs who represent some of the nation’s largest employers who are committed to applying evidence-based approaches to improve their employees’ overall health.

Studies suggest resilience training may be a useful primary prevention strategy for employers to improve employee health and engagement. Although there is no consensus on how to define resilience, the report says that “resilience can be considered, in general, the ability to withstand, recover and grow in the face of stressors and changing demands”.

Resilience training aims to develop or strengthen a person’s ability to withstand, recover and bounce back from adversity and may improve the ability to cope with, and recover from negative workplace stressors.

In an online employee of 1,001 working adults within the US, which has also been included in the report, 73% said that their participation in resilience training programs improved their health a great deal or fair amount; specifically, they reported having more energy (51%), exercising regularly (45%), and improved quality of life (41%).

(Source: AHA News Release, October 11, 2017)

IMA stands in solidarity with junior doctors on strike in Poland

IMA stands in solidarity with junior doctors on strike in Poland

New Delhi 16 October2017: Junior doctors in Poland are on hunger strike protesting the poor pay and conditions including poor healthcare funding. Supporting their protest, the World Medical Association (WMA) delegates passed an emergency resolution on October 13, 2017 expressing serious concern about the dispute at the annual assembly of the Association in Chicago. The resolution also urged the Prime Minister of Poland to intervene and negotiate an acceptable solution and further said, ‘It is essential that a resolution is found before these physicians suffer irreversible harm, or die, as they seek to improve working conditions for their colleagues and a better financial basis for health care provision for the population’.

According to the Polish Chamber of Physicians and Dentists, they made several appeals, unsuccessfully, to the Government to take action on all the above issues; hence, the hunger strike. The current level of expenditure did not cover the justified needs of the population and was insufficient to ensure proper working conditions for health care professionals.

Commenting on this, Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon Honorary Secretary General IMA in a joint statement, said, “As part of WMA, the IMA supports the Junior doctors in Poland. Our demands are also similar. Health care spending in India too needs attention as India continues to be among the countries with the lowest relative public expenditure on healthcare. This is very evident from the Union budget for the year 2017-18, which has allocated only 1.3% of the GDP for healthcare. The National Health Policy 2017 has proposed increasing public health expenditure to 2.5% of the GDP. But this is just not enough. Every citizen of this country has a right to receive affordable or free preventive and emergency health care and the best of treatment. The health budget should be 5% of the GDP for universal health coverage. No to adhocism, pay parity and uniform service conditions for service doctors all across India is another of our major demand. ”

Indian Medical Association (IMA) is the only representative, national voluntary organization of doctors of modern scientific system of medicine, which looks after the interest of doctors as well as the well-being of the community at large. IMA represents the collective consciousness of over 3 lakh doctors of modern medicine, spread across 1,700 local branches and 31 State and Territorial branches.

Adding further Dr KK Aggarwal said, “In addition to these, there are several important issues and concerns of doctors that need to be addressed urgently. Criminal prosecution of doctors, increasing violence against doctors, uncapped compensation in negligence cases, unrealistic laws like CEA and PCPNDT, to name a few. Doctors are feeling insecure and live in fear of criminal prosecution or violence. IMA has been fighting for a solution to these problems and had organized the “Dilli Chalo” movement on 6th June this year followed by a Dawn to Dusk fast on 2nd October to bring to the attention of the nation the many problems faced by the doctors today. We had also published an open letter to the Prime Minister prior to the fast seeking his immediate intervention in resolving these issues to better protect the health of the public, which we still await. We also hope that the WMA also passes a resolution supporting our demands.”