IMA White Paper Stop Child Sexual Abuse

Protection of Children from Sexual Offences (POCSO) Act,

• Child means any one below the age of 18 years.

• The act applies to all cases of sexual assault to  a child.

• Any sexual activity with a child (boy or girl) is a crime.

• The act defines sexual offences against children and prescribes the punishment for the same

• Sexual offences can be penetrative sexual assault (Sec. 3), sexual assault (non-penetrative – Sec. 7), sexual harassment (Sec. 11), and use of a child for pornography (Sec. 13)

• A person commits Penetrative Sexual Assault of a child below 18 years if he inserts his penis or any other object into the vagina, anus, urethra or any part of the body of the child, or causes any other person to do so to the child, or applies his mouth to any such part of the body of the child.

• Penetrative sexual assault of a child below 18 years is punishable with imprisonment of a minimum of seven years, up to imprisonment for life.

• If a person touches the penis, vagina, anus, breast or any other part of the body of a child below 18 years of age with sexual intent, or causes any other person to do so, or causes the child to do so to him or any other person, he is said to commit (non-penetrative) Sexual Assault.

• Sexual assault of a child below 18 years is punishable with imprisonment for three to five years.

• Sexual assault and penetrative sexual assault of a child below eighteen years of age are considered to be aggravated when committed by a person in a position of trust or authority such as police/army/security personnel, public servants or family member, persons in management or staff of educational, medical or religious institution or persons in management or staff of jail, remand home, protection home, observation home, or any other place of custody or care and protection.

• Aggravated penetrative sexual assault of a child below 18 years is punishable with imprisonment of a minimum of ten years, up to imprisonment for life.

• Aggravated sexual assault of a child below 18 years is punishable with imprisonment for five to seven years.

• A person commits sexual harassment when, with sexual intent, in respect of  child below 18 years of age, he utters a word or makes a sound or a gesture exhibits a part of his body or any other object or makes the child exhibit a part of his body, or shows an object or any form of media to the child for pornographic purposes, or repeatedly follows the child or watches him directly or through digital, electronic or other means, or threatens to use any part of the body of the child or the involvement of the child in a sexual act in any form of media, or entices the child for pornographic purposes or gives the child gratification for this.
• Sexual harassment of a child below 18 years of age is punishable with imprisonment of three years.

• A person commits the offence of pornography if he uses a child below 18 years of age in any form of media for sexual gratification. This includes the representation of the sexual organs of the child, images showing the child in real or simulated sexual acts, or the indecent or obscene representation of the child.

• Use of a child below 18 years of age for pornographic purposes is punishable with imprisonment of five years.
 


What every doctor must know

• Every case of sexual assault is a medical emergency.

• Child sexual abuse has lifelong consequences on the physical and mental health of the child. The impact of the abuse will depend on the duration and frequency of the exposure to abuse, the age of the child and the support network available.

• No medical facility, public or private, can deny emergency medical care and medical examination to a victim of suspected sexual assault.

• Treatment has to be provided free of cost by government as well as private medical facilities.
• Not providing free emergency medical care or medical examination to a child who has been or is suspected of having been sexually assaulted can result in imprisonment for one year or fine or both for the doctor (Section 357C CrPC).

• Not reporting a case of sexual assault or suspected sexual assault of a child can result in imprisonment of six months, or fine or both for the doctor (Section 19[1] ). The report has to be made to the nearest police station or Special Juvenile Police Unit

• Medical examination of a child with sexual assault must be conducted in the presence of the parent or guardian of the child or some other person in whom the child has trust and confidence. If there is no such person available, the head of the medical institution must nominate a woman to be present during the examination.

• Medical examination of a victim with sexual assault must be conducted, in the case of a female child, by a female doctor.

• FIR or permission from a magistrate, police or any other authority cannot be demanded by any medical facility or centre for providing emergency medical care to a child who has been or who may have been sexually assaulted.

• In a case of sexual assault informed consent must be taken from the child above 12 years of age, or, where the child is below 12 years of age, the child’s parent/ guardian, before medically examining the child. In case consent is not given, informed refusal must be documented by the doctor.

• Lack of medical evidence DOES NOT mean no sexual offence was committed. Evidence may have been lost due to healing of older injuries, use of condom by the offender, and post-assault activities such as washing, douching, urination and defecation.

• Doctors must protect children from sexual assault and its consequences. They should teach parents about safe, unsafe and uncomfortable touch and how to keep their children safe.

• Doctors must teach children how to protect themselves from sexual assault.

• Doctors must provide appropriate care and treatment to the survivor of sexual assault.

• Doctors should give social, psychological and legal guidance to the sexual assault survivor and the family.

• In a case of sexual assault doctors should help the process of justice delivery by conducting accurate and complete forensic medical examination and be willing to testify in court.

• Forensic examination needs to be conducted within 96 hours and requires evidence collection such as blood, semen, sperm, hair etc. linking to perpetrator.

• With timely medical care and mental health support, a child who is a survivor of sexual abuse can resume a normal and healthy life.

• Doctors should prominently display the Childline number (1098) in their clinics and hospitals. Any case of known or suspected child abuse or neglect can be reported to this number.

• It is the duty of the doctor to prevent the occurrence of child sexual abuse by teaching parents how to talk to their children about safe, unsafe and uncomfortable touch, and teaching children about personal safety.

Every pharmacist must know certain MCI Rules: IMA

IMA White Paper: Every pharmacist must know certain MCI Rules

Not only doctors, Pharmacists too have a role in ethical dispensing of prescription medicines. Safe and effective use of medicines is a complementary effort.

MCI Code of Medical Ethics ( Indian Medical Council (Professional conduct, Etiquette and Ethics) Regulations, 2002 and subsequent amendments) has some provisions in it that are of relevance to the pharmacists.

• Regulation 5.3 states that physicians should recognize and promote the practice of pharmacy as profession and should seek their cooperation wherever required.

• According to Regulation 3.7.1, a doctor’s prescription should also make clear if he/she has himself or herself dispensed any medicine to the patient.

• Regulation 7.10 states that a registered medical practitioner shall not issue certificates of efficiency in modern medicine to any unqualified or non-medical person but he/she can issue such certificates to dispensers after proper training.

• No physician, as per Regulation 6.3, can run an open shop for sale of medicine for dispensing prescriptions prescribed by other doctors or for sale of medical or surgical appliances. Drugs prescribed by a physician or brought from the market for a patient should explicitly state the proprietary formulae as well as generic name of the drug.

• Regulation 1.5 stipulates that as far as possible, drugs should be prescribed with generic names. Every doctor should make sure that there is a rational prescription and use of drugs.

• A Pharmacist should be aware that it is improper for a doctor to affix his/her signboard at a pharmacist’s shop. This is as per Regulation 7.13.

• Regulation 7.19 does not allow doctors to use touts or agents for procuring patients. So, a pharmacist should not indulge in such activities.

• A pharmacist should know that according to Regulation 1.1.3, no person other than a doctor who holds qualification/s that are duly recognized by MCI and is registered with MCI or State Medical Council can practice allopathic medicine. A practitioner of other systems of medicine cannot practice allopathic medicine. A pharmacist cannot practice and prescribe drugs.

• Regulation 1.4.1 requires that every prescription should carry the registration number of the prescribing doctor. The pharmacist should check every prescription he comes across while dispensing medicines.

• A pharmacist should also know that according to Regulation 1.4.2, doctors can add as suffixes only those degrees/ certificates/diplomas that are recognized by the regulatory bodies or those memberships/honours which confer professional knowledge or recognizes any exemplary qualification/achievements.

• Regulation 1.9 requires all doctors to abide by the laws of country that regulate the practice of medicine and also follow the provisions of State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and Psychotropic substances Act, 1985; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954. Neither the doctor nor the pharmacist should be a party to helping others evade these laws.

• A pharmacist should check that all the drugs prescribed by a physician are carrying a proprietary formula and clear name. Regulation 6.5 prohibits dispensing of secret remedial agents by doctors whose composition they do not know. This regulation also considers their manufacture or promotion of their use as unethical.

• According to Regulation 6.7, practicing euthanasia is regarded as unethical conduct for the doctor. The pharmacist has a responsibility to check that every prescription is ethical.

• As per regulation 7.20, a Physician shall not claim to be specialist unless he has a special qualification in that branch.

• As per regulation 7.3 not displaying the registration number accorded to a physician by the State Medical Council or the Medical Council of India in his or her prescriptions violates the provisions of MCI regulation 1.4.2.

• As per Regulation 7.8 a registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act and regulations made there under. Accordingly,  Prescribing steroids/ psychotropic drugs when there is no absolute medical indication and or selling Schedule ‘H’ & ‘L’ drugs and poisons to the public except to his patient shall constitute gross professional misconduct on the part of the physician.

eMedinewS and IMA Congrates and Salutes all Padma Awardee Doctors of the year 2015

Padma Bhushan

1. Dr. Ambrish Mithal (Medicine), Delhi

2. Dr. Ashok Seth (Medicine), Delhi

Padma Shri

1. Prof. Alka Kriplani (Medicine), Delhi

2. Dr. Harsh Kumar (Medicine), Delhi

3. Dr. Manjula Anagani (Medicine), Telangana

4. Dr. Rajesh Kotecha (Medicine), Rajasthan

5. Dr.Tejas Patel (Medicine), Gujarat

6. Dr. Narendra Prasad (Medicine), Bihar

7. Prof. Yog Raj Sharma (Medicine), Delhi

8. Dr. Nikhil Tandon (Medicine), Delhi

9. Dr.Hargovind Laxmishanker Trivedi (Medicine), Gujarat

10. Prof. (Dr.) Yogesh Kumar Chawla (Medicine), Chandigarh

11. Dr. Sarungbam Bimola  Kumari Devi (Medicine), Manipur

12. Dr.  Randeep  Guleria (Medicine), Delhi

13. Dr. K. P. Haridas (Medicine), Kerala

14. Smt. Jayakumari Chikkala (Medicine), Delhi

15. Dr. Dattatreyudu Nori (NRI/PIO) (Medicine), USA

16. Dr. Raghu Rama Pillarisetti (NRI/PIO) (Medicine), USA

17. Dr. Saumitra Rawat (NRI/PIO) (Medicine), UK

18. Dr. Gyan  Chaturvedi (Literature and Education), Madhya Pradesh

Politician should declare their health record too

Like their financial health all politicians should also declare their physical  health said Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General Indian Medical Association and President Heart Care Foundation of India.

It is the right of the voter to know their candidates health status and whether or not they will be able to bear the stress of politics for the next five years.

Politicians are icon celebrities of the society and their habits influences the younger generation.
If they are out of shape, have abdominal obesity, if they smoke or drink the younger generation will get a wrong message.

Even if they are suffering from a disease disclosing it makes sense. We know Dr Venugopal who did first heart transplant in India operated for bypass 7 days later his own bypass. The message went loud and clear to the society that after bypass one can be active in one week.

Bharat Ratna Awardee Atal Ji when got operated for knee replacement in India the quality of Ortho surgery in Indi took a positive turn.

When somebody wants to join a public sector or any other high-level job, he or she is required to go through a fitness test.  And if their medical examination reveals any pre-existing serious disease then he or she is disqualified for the job. No cricketer or any other sportsperson is allowed to play without undergoing a vigorous and methodical medical fitness test.

Then how come a politician who is responsible for the governance of one of the largest democracies in the world is allowed to fight an election without his/her health checkup to ascertain his/hers medical fitness?

The time has come for a mandatory medical fitness test at every level whether it is a job or a public service or a political career.  When one has to declare one’s financial & criminal record, it should also be mandatory that one declares one’s previous health record prior to contesting an election.

Somebody may argue that politicians are advisors and they have to be only mentally sound and that it does not matter if they have any physical ailments. But this is not true.  The politicians should not only be mentally but physically sound too.  If they are not physically sound and only intellectually of use to the community, they can become advisors to the government but not active political leader.

The job of a politician is to work at the grass root level and provide services to the community.  They are supposed to be physically active people who can reach places of disaster in no time, walk for miles to reach the community and provide for what the public wants.

What Keeps The Politicians Alive?

It’s the power and love for limelight that makes the heart of the politicians beat, said Padma Shri Awardee Prof Dr K K Aggarwal Honorary Secretary General Indian Medical Association and President Heart Care Foundation of India.

Late Sh. P.V. Narasimha Rao, the former Prime Minister, is a sure case for that matter. Ailing with a severe heart problem, he strived to fight the elections despite cardiologists repeated instructions for rest. Physically, too weak, the weaning for power made him the PM of this biggest democracy in the world.

Such cases don’t reveal the politician’s lust for power but the proven biological phenomenon among living beings. It was first observed among chimps. The study revealed that any chimp who was made the leader of the group, behaved entirely in a different way from his fellow beings. This was termed as “The Itch of Power”. The biological reason behind this change in temperament was due to the rise in the secretion of Serotonin (Neurochemical). The more the secretion the more vigour it produces. The increase in the secretion of neurochemicals is spontaneous with the power one accumulates.

Many studies revealed that most of the U.S. Presidents were different in their power tenure than otherwise in their later or former years. Human system is such, that limelight brings a potential, which radiates confidence and vitality in the individual.

Amazingly, speeches over the audio and video media present a personality differently from what he is in front of a large audience. Applause from the gathering most automatically gives the individual that spirit and gaiety, which is a characteristic of any man in power.

Power brings positivity into the life. One gets boosted by the strength of his inner self and out lives the diseases and aliments which otherwise were quite prevalent in this physical stature.

Indian Medical Association, Indian Academy of Pediatrics, National Neonatology Forum and Federation of Gynecology Societies of India to join hands to reduce the infant mortality rate in the country

New Delhi, January 24, 2015: The 52^nd Annual Conference of Indian Academy of Pediatrics is ongoing in the city and aims to discuss and debate one of the most crucial aspects of healthcare in our country – the quality development of children. Attended by over 8,000 doctors the PEDICON 2015 is the largest gathering of pediatrics in the country.

In a special session Padma Shri Awardee and Honorary Secretary General IMA, Professor Dr K K Aggarwal said that no infant should die just because preventive and infrastructure facilities are not available. For every infant death someone should be accountable. He added that every infant’s death should be made a public outcry.  Our country has in the recent past woken up to violence and abuse against women, they must now also come together and raise their voice against preventable infant deaths.

“Why report a rare Congo- Hemorrhagic death and not report a preventable infant death", Dr Aggarwal asked the hall full of doctors listening to his talk.

Talking about children in the age group of 0-5 years, Dr Aggarwal added that, “Today over 2 lakh children die of diarrhea and 3 lakh from pneumonia every year. This is not acceptable to the medical profession. IMA will take up the task of sensitizing over 2.5 lakh of its member doctors on these subjects. Bangladesh, one of the world’s poorest countries, is a leader in the fight against diarrhea. There is no reason why India should not too”.

In addition to this IMA will also open 1700 adolescent clinics in the country to educate girls on lifestyle, reproductive and mental health.

Congratulating this initiative and discussing the existing problem, Dr. Ajay Gambhir Organizing Chairperson of PEDICON 2015 said, “There has been a decline in infant and neonatal mortality rates in our country but the rates are still relatively high in urban slums and rural areas. It is our aim to bring this number down by 2020 in accordance with the millennium development goals through programs on immunization, women empowerment and reduction in female feoticide and infanticide. I thank the Indian Medical Association for supporting this initiative and look forward to working with them towards this cause.

Adding to this, Dr Anupam Sachdev, Organizing Secretary, PEDICON 2015 said,” It is unfortunate that India has the highest newborn mortality and it is a need of the hour to tackle this situation. The PEDICON 2015 has been unique for it has brought together not only doctors but also government leaders, NGO’s and International organizations to discuss a cause of national importance under one roof. I thank the Indian Medical Association for their support and hope that we can together put an end to preventable child deaths’.

Bangladesh, one of world’s poorest countries, is a leader in the fight against diarrhea, which is the number two killer of children under age 5 worldwide after pneumonia. Diarrhea claims 1.5 million kids annually – more than AIDS, malaria and measles combined. There is no reason why India should not lead over Bangladesh in this issue.

IMA releases white paper on Crimean-Congo Hemorrhagic Fever

Zee News New Delhi:  The Indian Medical association (IMA) today sought to inform the public about preventive measures to counter Crimean Congo Hemorrhagic (CCHF) after tests confirmed that a patient who recently died at AIIMS here had contracted the disease.

The white paper compiled by Dr KK Aggarwal, the IMA Secretary General, explains what the disease is and what preventive measures should be taken to check it. The advisory came after tests at National Institute of Virology (NIV) at Pune confirmed that the patient, who was referred to AIIMS from a hospital in Jodhpur, had succumbed to CCHF.

As per the white paper, CCHF is a severe, potentially fatal disease in humans caused by tick-borne virus (Nairovirus) and mainly occurs in Africa, Asia, Eastern Europe and Middle East.

CCHF was first confirmed in a nosocomial (originating in a hospital) outbreak in 2011 in Gujarat. Another outbreak occurred in July, 2013, in Karyana village of Amreli district in Gujarat, IMA said.

"There is no vaccine available for either people or animals. Preventions that one can take include reducing the risk of human-to-human transmission in the community, avoiding close physical contact with CCHF-infected people, wearing gloves and protective equipment while taking care of ill people, washing hands regularly after caring or visiting ill people," stated the white paper.

Health workers caring for patients with suspected or confirmed CCHF, or those handling specimens from them, should implement standard infection-control precautions. These include basic hand hygiene, use of personal protective equipment, safe injection practices and safe burial practices.

Transmission of CCHF in humans occurs through tick bites, contact with a patient with CCHF during the acute stage of infection or contact with blood or tissue from infected livestock.

"Human-to-human transmission can occur resulting from close contact with the blood, secretions organs or other bodily fluids of infected persons. The four distinct phases of the disease are incubation, pre-haemorrhagic, hemorrhagic and convalescence," it added.

The incubation period that follows a tick bite is usually short and lasts for between three to seven days. The pre- hemorrhagic period is characterized by the sudden onset of fever, headache, myalgia, and dizziness. Additional symptoms of diarrhea, nausea and vomiting are also seen in some cases.

"Nearly three days later, hemorrhagic manifestations from petechiae, large haematomas and frank bleeding (vaginal, gastrointestinal, nose, urinary, and respiratory tracts) usually follows.

"The convalescence period begins in survivors about 10 to 20 days after onset of the illness," the white paper says.

The disease is diagnosed by ELISA and immunofluorescence assays from about seven days after its onset.

Treatment of CCHF is mainly supportive. Ribavirin is effective, to be given for 10 days (30 mg/kg as an initial loading dose, then 15 mg/kg every six hours for four days, and then 7.5 mg/kg every eight hours for six days).

Meanwhile, the report said that a study on Vector Borne and Zoonotic diseases looked at the prevalence of CCHFV among bovine, sheep and goat populations from 15 districts of Gujarat and found antibodies in all the 15 districts surveyed; with positivity of 12.09 per cent in bovine, 41.21 per cent in sheep and 33.62 per cent in goats.

"Anti-CCHF virus (CCHFV) immunoglobulin G (IgG) antibodies were detected in domestic animals from the adjoining villages of the affected area, indicating a considerable amount of positivity against domestic animals," the white paper said.

PTI