Urgent need to address air pollution through Private Public Partnership: IMA

Urgent need to address air pollution through Private Public Partnership: IMA International Meet on Combating Air Pollution commences to take place on March 10-11thin New Delhi Globally, an estimated 24% of the burden of disease and 23% of all deaths can be attributed to environmental factors. New Delhi, March 10, 2017: The International Meet on combating air pollution will be held in Delhi in on March 10 & 11 2017 to address the global burden of air pollution. The environment is the most important social determinant of health, causing morbidity and mortality in a given population. Further, globally, non-communicable diseases (NCDs) deaths, attributable to air pollution, are amounting to 8.2 million of the total 12.6 million deaths. The Global Burden of Disease (2010) data showed that household air pollution was ranked at the 3rd position and ambient air pollution at the 9th position among the leading risk factors that contribute to morbidity and disability adjusted life years (DALYs). Air pollution has witnessed a dramatic upsurge since the last two years, in 2015 the Annual PM 2.5 level of Delhi was 220 pg/m3 while the safe levels for PM according to the WHO's air quality guidelines are 20 μg/m3 (annual mean) for PM10 and 10 μg/m3 (annual mean) for PM2.5. Shri Anil Madhav Dave, Hon’ble Minister of Environment, Forest & Climate Change, Government of India applauded the initiative and said, “The strategy for pollution control should involve reinforced measures at three main levels- tackling of the pollutants, controlling the pollution at source and identifying polluted areas. A holistic strategy will be an optimal combination of these three steps”. “Dr Ketan Desai, President, World Medical Association, added, “There is a urgent need for body like Indian Medical Association and other CMAAO countries to address the problem of air pollution in India with the objectives of creating awareness on the burden of health effects of air pollution, discussing main sources of air pollution in India (source apportioning), facilitating the mitigation of the health impacts of air pollution through private public partnership and finally examining preparedness and capacities of respective ministry to address the problem of air pollution emanating from development driven activities”. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) and Dr RN Tandon – Honorary Secretary General IMA, stated that, “NCDs, such as cardiovascular diseases including stroke, cancers and chronic respiratory disease, now claim nearly two-thirds of the total deaths caused by unhealthy environments. Air pollution needs to be addressed in right earnest. Air Pollution is the leading cause of mortality and disability in Indian settings and there is a need to reduce sources of emissions, improve access to clean fuel and raise public awareness on health effects of air pollution. Inefficient cooking methods using solid fuels like wood, charcoal, coal, dung, crop wastes lead to indoor air pollution especially in houses that are poorly ventilated. Indoor air pollution leads to not only health effects but also has adverse social and environmental effects.” Clearly, it is a major public health issue; the following data may help emphasize: • Each 10 mcg/m3 increase in PM 2.5 levels can increase the chances of death from heart disease by 1.76 times and each decrease in PM 2.5 levels by 10 mcg/m3 life can increase life expectancy by 0.77 year. • For every increase of 10 μg/m3 in PM10, the lung cancer rate rises by 22% and for PM 2.5 by 36%. • Asthma is linked to high NO2 levels and bronchitis is linked to high levels of SO2. A PM <2.5 reduction of 6.8 mcg/m3 can decrease asthma prevalence by 15.4% and a median reduction in NO2 of 4.9 parts per billion can decrease asthma prevalence by 10 percent. • By reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre (μg/m), air pollution-related deaths could be reduced by roughly 15%. There is emerging evidence which suggests that household air pollution in developing countries may also increase the risk conditions such as: low birth-weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer and cervical cancer. Dr Yoshitake Yokokura, President of JMA and President-elect of WMA and Dr Mari Michinaga, Executive Board Member of JMA and Secretary General of CMAAO, in a joint statement said, “Exposure to poor quality air is now an inescapable part of urban life throughout the globe. Air pollution is no longer just a public nuisance but a grave health problem and a threat to many environmentally sensitive areas areas on the worldwide. Clearly, everyone stands to benefit from an international collaboration in this regard”. Shri Ajay Narayan Jha, Secretary, IAS, Ministry of Environment, Forests & Climate change, Govt. of India further said, “We have come a long way in our fight for cleaner air, despite major setbacks. However, there is still a long way ahead and the goal can only be achieved through continuous dedicated efforts of the pollution control agencies, commitment of the polluters and due participation of public.” Shri Chandrakar Bharti, IAS Secretary, Environment, GNCTD added, “India is the first country, to have provided a provision for environmental protection in its constitution. The constitution casts a duty on the State for taking steps for protection and improvement of the environment and also makes obligatory on every citizen of India to protect and improve the natural environment. It is time for us to revisit these moral duties.” Several distinguished dignitaries will be present including Dr. A B Akolkar Member Secretary, CPCB, GoI,Dr. Ravi Wankhedkar, National President (Elect), IMA; Dr A Marthanda Pillai, Past National President, IMA and Dr P K Sharma, MOH, NDMC. The following measures might go a long way in the fight against air pollution: • Understand the concept of Reduce, Reuse and Recycle: Do not throw away items that are of no use to you. In-fact reuse them for some other purpose. For e.g. you can use old jars to store cereals or pulses. • Emphasis on clean energy resources: Clean energy technologies like solar, wind and geothermal are on high these days. Governments of various countries have been providing grants to consumers who are interested in installing solar panels for their home. This will go a long way to curb air pollution. • Use energy efficient devices: CFL lights consume less electricity as against their counterparts. They live longer, consume less electricity, lower electricity bills and also help you to reduce pollution by consuming less energy.

Why look for alternative means of earning to compensate for subsidy provided in consultation fee

Why look for alternative means of earning to compensate for subsidy provided in consultation fee Many doctors claim that they charge only Rs100 or 200 as consultation fee. Can they survive with this subsidy? Probably not… So, they try to find some alternative sources of income. Some of them may be ethical and some unethical. Medicine is regarded as the most noble of all professions. And, a doctor is accorded a status next to God. Hence, a doctor is duty bound to practice ethical medicine, which also includes ethical earning. We are professionals… we have a professional degree, which gives us a privilege to practice medicine … we are registered with a professional regulatory body … we follow a Code of Ethics as prescribed by the council. Our privileges to practice can be withdrawn in case of breach of the ethical code. We are also required to charge a legitimate and ethical professional fee for consultation or for skilled procedures. To earn ethically, it is important to understand the economics of a consultation. A consultation charge is not the fee for consultation alone. It also includes non treatment costs in addition to professional charges for services provided such as consultation, diagnostic/therapeutic procedure and interpretation of X-ray/lab reports. The billing process begins right at the time when the patient arrives at your clinic or hospital, with registration charges. Patient may also be billed for facilities provided in the clinic or hospital. Charges for making patient summary, charges for the assistant/nursing staff/paramedical staff, charges for drugs and materials used, issuing a certificate, point of care investigations with no subsidy, dispensing medicines with no subsidy, Administrative charges, charges for utility services etc. are other heads under which the patient can be charged. Accepting rebates and commission from diagnostic centers/laboratories and hospitals or fee splitting without involving any service for the referring, recommending or procuring of any patient is unethical. And, any income generated out of such practices is unethical earning. So, why not earn lawfully and ethically instead of trying to create income from illegal and unethical practices, which only corrodes the trust in a doctor-patient relationship. Why give subsidy in the fee charged and at the same time, try to make up the deficit by other means, which may be unethical? If it is not possible to survive on a fee of Rs 200/- per patient, let us try to change it nationally and come out with a valid sustainable fee. Remember, even in temples, the charges for darshan and aarti differ depending on the time of the darshan/aarti or the type of pooja offered. Let us all charge our legitimate fee and pass on the benefits of concessions on diagnostics etc. to the patients. Keep in mind the following: • I have a right to charge rationally for my fee. • I have a right to charge for every consultation, even the same day. • I have a right to charge extra for emergency appointments, same day appointments and routine appointments. • I have a right to charge extra for night visits. • I have a right to charge extra for long consultations. • I have a right to charge for accompanying a patient for diagnostics. • I have a right to charge for briefing my senior specialist. • I have a right to charge for visiting my patients when they are admitted in a hospital under a specialist. • I have a right to charge for legal certificates. • I have a right to charge for telephonic consultation. • I have a right to charge for reviewing reports. • I have a right to charge for only giving opinions on reports.

Ten golden rules for preventing chronic kidney disease

Ten golden rules for preventing chronic kidney disease Kidney diseases are silent killers. There are several easy ways to reduce the risk of developing kidney disease. New Delhi, March 9, 2017: Today is world Kidney Day. Kidneys play an important role in the daily workings of your body and help maintain your general health and wellbeing Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) and Dr RN Tandon – Honorary Secretary General IMA, stated that, “Common non-prescription pills like ibuprofen and naproxen (NSAID’s) can cause kidney damage if taken too regularly over a prolonged period. Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease (CKD). Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon).” “Often, your kidneys simply become affected by other medical conditions. The most important thing you can do to keep your kidneys safe is to take care of your body to reduce your chances of developing diseases that put a strain on your kidneys. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis. Optimal hydration is the key to maintaining good kidney health. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body, which in turn, results in a “significantly lower risk” of developing chronic kidney disease. ”, add Dr K K Aggarwal. Following are some key points for tackling kidney diseases: 1. Keep active: Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease. “On the move for kidney health” is a worldwide collective march involving the public, celebrities and professionals moving across a public area by walking, running and cycling. 2. Keep fasting sugar < 80 mg%: About half of people who have diabetes develop kidney damage. Kidney damage from diabetes can be reduced or prevented if detected early. 3. Keep lower BP < 80 mm Hg: High blood pressure is also the most common cause of kidney damage. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases. 4. Keep your abdominal circumference < 80 cm: Eat healthy and keep your weight in check. This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease. Reduce your salt intake. The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). Limit the amount of processed and restaurant food and do not add salt to food. 5. Drink adequate fluids: Drink 1.5 to 2 litres (3 to 4 pints) of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, in turn, results in a “significantly lower risk” of developing chronic kidney disease, according to researchers in Australia and Canada. Do not advocate “aggressive fluid loading”, which can cause side effects. In addition, people who have already had a kidney stone are advised to drink 2 to 3 litres of water daily to lessen the risk of forming a new stone. 6. Do not smoke: It slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50 percent. 7. Do not take over-the-counter pain killers: Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly.

Do CPR for 30 mins before transporting cardiac arrest victims to hospital

Do CPR for 30 mins before transporting cardiac arrest victims to hospital Quite often we read about people collapsing due to a cardiac arrest. Former President APJ Abdul Kalam collapsed while he was addressing students in Shillong. He was immediately rushed to the hospital but could not be revived. More recently, Mr E Ahamed, Member of Parliament collapsed in the Parliament after he suffered cardiac arrest and passed away. Such instances bring CPR or cardiopulmonary resuscitation back into the spotlight. The first instinct is to immediately rush a person to the hospital when you see somebody collapse suddenly. But at times, a first responder CPR may help revive the person until medical help arrives or a defibrillator is available. Recently, a story was reported at WPRI News in February (Feb 16, 2017) about a major change in prehospital protocol policy in Rhode Island, USA for First Responders for the management of victims of cardiac arrest, which said: “Starting March 1, as dictated by the Rhode Island Department of Health, emergency response personnel will be required to conduct 30 minutes of cardiopulmonary resuscitation, or CPR, on cardiac arrest victims before transporting them to the hospital.” The American Heart Association (AHA) has published updated Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2015 in the journal Circulation, with some updates while continuing to emphasize on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression (avoid leaning on the chest between compressions), minimizing interruptions in compressions, and avoiding excessive ventilation. • The recommended chest compression rate have been updated to 100-120/ min from the earlier at least 100/min. • The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). The earlier recommendation was at least 2 inches (5 cm). • Chest compression should be started first before rescue breaths (C-A-B rather than A-B-C). The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths. While the updated AHA guideline has refrained from recommending a duration of resuscitation, it does state as follows: “While investigators can define neither an optimal duration of resuscitation before the termination of efforts nor which patients may benefit from prolonged efforts at resuscitation, extending the duration of resuscitation may be a means of improving survival in selected hospitalized patients.” The premise of a successful cardiopulmonary resuscitation (CPR) is earlier the better and longer the better. When you come across a victim of cardiac arrest, three simple rules must be followed: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives. Don’t stop CPR too soon … Dr KK Aggarwal National President IMA and HCFI

IMA’s viewpoint on the Delhi budget 2017

IMA’s viewpoint on the Delhi budget 2017 With an allocation of Rs 5,736 crores for the health care, budget highlights indicate that healthcare infrastructure is a key priority for the AAP government. New Delhi, March 8, 2017: AAP ruled Delhi government allocated more than half of this planned expenditure on healthcare, education and civic infrastructure development. This is the second consecutive year that healthcare and medical infrastructure has been a priority in Delhi budget. Focus on sanitation and natural resource improvements also shine through the budget. To promote eco-friendly public transport system, subsidy to battery-operated vehicles was proposed. Action plan for cleaning of Yamuna River and the water sector also got a generous allocation of Rs 2,100 crore. 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, “Focus on primary healthcare especially in quality-healthcare lacking regions of the city seems to be the top agenda and rightfully so. A significant proportion of the total budget outlay seems to be allocated to improving medical infrastructure so we expect to see multiple reforms and initiatives in this area. Focus on waste management through waste disposal reforms is also a welcome move. Proper standards of hygiene are imperative in the control measures against infectious diseases and last year’s Dengue, Chikungunya and flu outbreaks are a testimony to this fact. It seems clear that the government is taking good lessons from past mistakes.” “A shortage of hospital beds has been on the radar and on the list of promises since last year’s budget. This year the promise comes full circle with 15,000 additional beds being rolled out in major medical facilities. Moreover, the city’s primary healthcare has always struggled to catch pace with the tertiary facilities; however, the proposal to build over 1,000 mohalla clinics will have a reinforcing impact on primary healthcare and will surely seek to bridge this care gap”, adds Dr K K Aggarwal. Following are some key highlights with respect to healthcare: • Number of beds in Delhi Government hospitals will be increased from 10,000 to 25,000. • Patient capacity to be increased by adding seven hospitals and remodeling 10 existing hospitals. • A dedicated allocation of Rs 15 crore for medical tests. • Government tie up with 21 private laboratories to provide 13 expensive tests like MRI, CT scan, PET-CT which will reduce the unavailability and long queues at hospitals. • Plan to roll out 5 de-addiction centers. • Focus on improving air quality and resources for waste management • 150 mohalla clinics to be fully functional by the end of the year. Currently, 110 such clinics are functional across the city. • 150 polyclinics with a variety of specialties to be rolled out by the end of the financial year.

Greet your friends & colleagues with “Namaste” instead of handshake

Greet your friends & colleagues with “Namaste” instead of handshake Greeting people with a handshake is routine accepted practice, especially in formal settings. And, the quality of handshake, firm or limp, may be a potential indicator of the personality type and creating a good first impression. However, on the downside, a handshake can spread bacteria and/or viruses directly between individuals. Respiratory infections such as flu or common cold, diarrhea, skin and eye infections can spread through contaminated hands. Although the cold and flu viruses spread via air-borne droplets by coughing or sneezing, they can also spread by direct contact with contaminated surfaces such as table tops, drawer handles, and door knobs or by shaking hands with someone who has the infection. Flu viruses tend to live longer on surfaces than cold viruses do. The cold and flu viruses live longer on nonporous surfaces such as plastic, metal or wood than they do on porous surfaces like fabrics, skin or paper. Many GI infections such as salmonellosis, shigellosis, hepatitis A, giardiasis, amebiasis can also spread through contaminated hands. These microorganisms can survive on the environmental surfaces for hours to days. In its August 2014 issue, the American Journal of Infection Control published a report stating that nearly twice as many bacteria were transferred during a handshake vs a high five; a fist bump consistently gave the lowest transmission. The high transmission level observed for handshakes was found to also depend on duration and strength and not just the size of contact area. Hand hygiene has been acknowledged as the single most important, simplest and least expensive method to reduce the spread of infections. The ‘My 5 Moments for Hand Hygiene’ approach devised by the WHO has defined the key moments when health-care workers should perform hand hygiene. • Before touching a patient • Before clean/aseptic procedures • After body fluid exposure/risk • After touching a patient • After touching patient surroundings Washing hands with simple soap and water prevents infections and also their spread to others. Maintaining hand hygiene also addresses the problem of antimicrobial resistance. A high five or fist bump represents popular culture and not our traditional culture. Hence, in addition to advocating the principles of hand hygiene, the Indian Medical Association (IMA) will also promote the concept of “Namaste” or “Salaam Aalaikum” instead of shaking hands as a simple and traditional approach to check spread of infections by avoiding unnecessary physical contact among people. Renowned Odissi dancer and Padma Vibhushan Awardee Sonal Mansingh will be the Brand Ambassador of “India Swachh Bharat, Swasth Bharat” project and IMA Kayakalp project of swachh medical establishments. Our concept of Namaste will be called “Sonal Namaste”. Dr KK Aggarwal National President IMA and HCFI

Mindful eating helps to control impulsive eating

Mindful eating helps to control impulsive eating "You are what you eat" is an old saying. This is based on a teaching from our shastras including Yoga Sutras of Patanjali, Bhagwad Gita and the various Upanishads. To acquire health and happiness, one needs to live a balanced life. This message is illustrated in Chapter 6 Shloka 17 of the Bhagwad Gita where Krishna says to Arjuna "Yukaharaviharasya yuktachestasya karmasu. Yuktasvapnavabodhasya yoga bhavati duhkhaha". It means "the one, whose diet and movements are balanced, whose actions are proper, whose hours of sleeping and waking up are regular, and who follows the path of meditation, is the destroyer of pain or unhappiness." The Bhagwad Gita also explains how to eat: "While eating, one should concentrate only on eating as the food is served to one's consciousness" (9.27). This message in our ancient texts has stood the test of time and is never more relevant than today in view of the rising numbers of lifestyle diseases such as diabetes, hypertension, obesity, metabolic syndrome, etc. A new study published online February 24, 2017 in the Journal of the Academy of Nutrition and Dietetics led by Rachel Tumin, of the Ohio Colleges of Medicine Government Resource Center in Columbus has highlighted the benefits of mindful eating on health. Analysis of the cross-sectional 2012 Ohio Medicaid Assessment Survey (OMAS) did not show any association of frequency of family meals with obesity; those who ate family meals most (6-7) days were as likely to be obese as those who ate family meals few (1-2) days. • Sixty two percent of study participants ate home-cooked family meals and they had 26% lower risk of obesity than those who ate some or no home-cooked family • Thirty-six percent of subjects never watched television or videos while eating family meals. These adults had 37% lower chances of obesity than those who always did, regardless of family meal frequency. Mealtime practices influence health. Distractions like TV are a hindrance to mindful eating and lead to impulsive eating. This is the message from the above study. Mindful eating is ‘eating with awareness’ i.e. using all the five senses while eating. These include noticing the colors (eye), smells (nose), flavors (taste), textures (touch) and sound while chewing (ear) of the food. If you follow the principle of mindful eating, you eat less as you are more aware of hunger and satiety cues. You also eat less, if you chew your food well. What is more, you will also enjoy every bite and relish the flavors of food. Dr KK Aggarwal National President IMA and HCFI