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| HEALTH TRIBUNE | Wednesday, February 9, 2000, Chandigarh, India |
Sick step-children of life Freemasons’ contribution By Dr M.L. Kataria The sprawling City Beautiful has also certain not-so-beautiful facets. There are more than 20,000 rickshaw-pullers. There is also an equal number of wandering and wayside vendors. There are more than a lakh of unskilled and semi-skilled labourers. If we also count their family members or children only, they are a sizeable population. They come from all over India to this demographical "mini-India" at an average of 500 a day. The dead serve the living Pain Society’s
depressed half |
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Sick step-children of life The sprawling City Beautiful has also certain not-so-beautiful facets. There are more than 20,000 rickshaw-pullers. There is also an equal number of wandering and wayside vendors. There are more than a lakh of unskilled and semi-skilled labourers. If we also count their family members or children only, they are a sizeable population. They come from all over India to this demographical "mini-India" at an average of 500 a day. Where do they live? In the verandahs of almost all the markets in all sectors, roadside bus stands, temporary polythene shelters — anywhere. Their motto is: "Late to bed and early to rise". They roll their apology for a bed before dawn, tuck it in any nook or corner and set out in search of morsels of food. In due course of time, they find their way into one of the already established "J.J. Slums" (jhuggi-jhompri clusters). Or, they hopefully wait for the next election and create a new slum. There are more than two dozen clusters of such slums in and around this metropolis. They are nearly three lakh, more than 20 per cent of the total population of the coveted dream-city and its two satellites, Mohali and Panchkula. What about their health-care? For numerous obvious and unkind factors, practically all of them suffer from one ailment or the other — men, women and children. Even horrors like tuberculosis and leprosy hit them. Chest infections and gastro-intestinal infections are common. Owing to the lack of bathing facilities all of them suffer from skin diseases. Besides livelihood, primary health-care is their requirement. No wonder, their morbidity and mortality rates are very high. It was for the Chandigarh Masonic Lodge of Freemasons of India, an international NGO, to rise to the occasion and provide health-care to these unfortunate have-nots. Many years ago, an extraordinary Freemason, a man of infinite vision and compassion, Worshipful Brother Gurcharan Singh, a retired Chief Engineer, extended the lodge in Sector 18, Chandigarh, in the heart of the city, at his own expense, for a multi-service health-care centre for these hapless people. It was named Yadvindra Polyclinic. This sapling planted and nurtured by the Worshipful Brother has rapidly grown into a shady tree. It is a haven for the ailing have-nots. Rickshaw-loads of men, women and children from near and far-flung slums, labourers, hawkers, pavement dwellers and others come here for the free gift of health and happiness. Under an able administrator, another devoted and selfless Freemason, Worshipful Brother S.S. Saluja, a retired Chief Engineer, assisted by a devoted social worker, Sardar Trilok Singh, a retired Divisional Railway Officer, this unique health-care centre provides free expert consultation and dispensary, laboratory, X-ray and ECG services. With their presence, this health centre is like an oasis in the desert of disease, deprivation and destitution for the ailing poor of Chandigarh. It is also a popular health-care centre for the residents of all the neighbouring sectors of Chandigarh who benefit in abundance from Freemasonry services. The Masonic Lodge of Chandigarh is a landmark and a lighthouse for other NGOs, urging them to come forward and share the health-care and scores of other problems of this unmanageable flood of humanity — the deprived and disinherited sons and daughters of Mother India. Dr (Brig) Kataria, the dedicated healer of the slum-dwellers, has been an honorary consultant to the Have-Nots Health-care Centre for several years. Prominent Freemasons
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The dead serve the living A post-mortem examination (autopsy) was considered the gold standard for diagnosis in the early 20th century. The practice of conducting a post-mortem is apparently the victim of a vast cultural delusion of denial. People are not bothered to know the truth. Many clinicians contend that modern technology allows us to see inside the body cavities and they believe that there is no need for an autopsy in this era of newer technology. There is much debate about the usefulness of autopsies. Despite technological advances, the number of inaccurate clinical diagnoses remains alarmingly high. A post-mortem documents the high discordant rate between the clinical and the autopsy diagnosis. This rate is as high today as it was from the early to the middle-20th century. Autopsy has been said to be a fundamental principle of all clinical research. Above some autopsy room entrances you will find these Latin words: "Hic locus est ubi mors gaudet succure vitae" (This is the place where death delights to serve the living). An autopsy thus should be incorporated in the diagnostic process to benefit all. The value of an autopsy includes the identification of the pathology which accounts for clinical signs and symptoms, confirms a clinical diagnosis, determines the pathology that accounts for imaging and endoscopic findings and determines the effectiveness of the treatment. A post-mortem examination still remains the most reliable laboratory test, even though it is the harshest and most exacting of all standards. We need to know when we have missed a critical diagnosis. We also need to know when and why our treatment has failed. An autopsy may be a painful process but it is a tool that will guide us to do better. Indeed, an autopsy does serve the living, especially when diseases that may be inherited or familial are detected during the post-mortem. Informing the family that such conditions have been found at the autopsy can literally be life-saving since appropriate diagnostic tests and follow-up measures may then be initiated. In these days of organ transplantation (cadaver transplants), the transplant surgeons are alerted to the existence of a malignant process and this information is useful for the follow-up of the transplant recipient. When tissues other than whole organs are donated for transplantation (bones, skin, etc), they may often be stored and the transplantation delayed until the autopsy results are available. The fear in the mind of clinicians that autopsy findings may lead to "malpractice suits" is unfounded. Autopsies help eliminate any suspicion to the effect that the clinician is trying to hide something. At times families wonder why the clinician did not make a request for an autopsy. Autopsies often strengthen a physician's defence, becoming extremely helpful in difficult cases. Courts view the request for an autopsy as a measure of the clinician's conscientiousness. The role of an autopsy in medico-legal death investigations benefits society in many ways related to law enforcement, justice and public health. Autopsy-findings are thus helpful in consoling the family and ending the suspicion of malpractices and "avoidable death". Despite its low technological nature, an autopsy remains the best standard in determining the causes of death, clarifying clinical issues and resolving enigmas. It also provides possible explanations for why diagnostic tests during life did not detect the fatal condition, and gives information with a firm foundation for explaining fully to the family the patient's clinical course and the final cause of death. An autopsy identifies new diseases also. Clinicians are instrumental in obtaining consent for an autopsy from family members. We need to have a high autopsy rate as the best indicator in our search for excellence. Physicians and the public should recognise the value of an autopsy. The data obtained through it is an invaluable educational tool which will create better clinicians. It is vital for our understanding of the disease-processes. It is time to confess humbly our ignorance and make a request for an autopsy to be certain that we had learnt all that we could from the loss. Dr Wig is a
renowned surgeon, teacher, clinician and writer based at
the PGI, Chandigarh |
Pain Pain is a subjective phenomenon and it is difficult to measure the feeling of aversion, illness, threat and fear with which it is associated. It is a personal experience influenced by culture, learning, attention and psycho-sociological variables. The major differences between acute and chronic pain are its cause, pathogenesis and principles of management. Acute pain is typically associated with acute disease or injury. It has a well-defined onset. It usually subsides with time as healing progresses. Chronic pain occurs when an acute episode does not get resolve within the expected time-frame. It may also occur with no precipitating factors. Chronic pain may persist for months or years unlike acute pain and does not serve any biological purpose. By definition, unrelieved pain which is continuous over a period of time, is referred to as chronic pain. The appreciation of pain involves much more than the transmission of pain impulses. These mechanisms produce actions leading to aversive behaviour and these are often associated with anatomical and emotional responses. Some of the states resulting in chronic pain are mentioned below: Arthritis is a disease of (or because of damage to) the joints. The cause may be inflammatory, osteoarthritis, and or rheumatism. It is a common worldwide problem and has no respect for age, sex, race country. It may start suddenly without an obvious cause at any age. While drug treatment does help, pain therapy using modern techniques and equipment greatly enhances the quality of life. Spondylosis and/or spondylitis can inflict any part of the vertebral column — cervical (neck), lumber (low back) and/or thoracic spine (chest). It is not related to age and occurs as a result of the formation of marginal osteophytes on the vertebral bodies of the spine. Medical management includes specific medicines to relieve pain, physiotherapy and controlled exercises done under the supervision of an expert pain therapist. Fibrositis: Some patients, often women, complain of multiple pains in the neck, arms, elbows, down the back and on the outside of the thighs, either occurring simultaneously or in succession. Often, these sites are tender to touch and may result into sleep disturbances. This syndrome is considered to be somatic expression of tension and day-to-day stress. Medically guided psychotherapy, reassurance along with drugs and specific exercising bring relief to the suffering. Disc prolapse: It usually occurs following weight-lifting and sudden jerky movements of the spine but may occur spontaneously also. Back pain normally responds to complete bed rest, analgesics, traction and deep-heat application, TENS and/ or US massage. Painful shoulder: It is often referred to as "frozen shoulder". It is a common occurrence and is usually due to mechanical strain or the inflammation of a tendon and other structures of the shoulder joint. Continuous supervised physiotherapy and pain relief help one to regain full pain-free movement over a period of time. Hip pain: Hip osteoarthritis is generally of unknown etiology. It may occur because of bony degeneration, i.e, osteoporosis with advancing age or maybe secondary to inflammation or aseptic necrosis. Supervised management with drugs and exercises not only prevents osteoarthritis from developing but also helps in attaining a good quality of life. It may even prevent joint replacement surgery in some cases. The other causes of chronic pain include trauma, fractures, post-herpes conditions and cancer. Aches and pains may be the only presenting symptoms in some patients suffering from depression and anxiety. The majority of chronic pain-sufferers do not know where to go and often have been told that nothing can be done for them making many of them live with pain for the rest of their lives. However, with advances made in pain therapy it is gratifying to see today that a large number of these sufferers can be helped, their pain can be reduced and their life can be made comfortable. The various techniques and methods which are used to alleviate pain are: Medication/drug therapy Nerve blocks TENS Physiotherapy-exercise oriented programmes Ultrasonic massage Wax therapy Psychotherapy Acupuncture/acupressure High-frequency magnetic therapy The use of injectible steroids, etc. The model of a Pain Clinic was initially evolved at the University of Washington and has since become the forerunner for numerous other pain centres to come up all over the world. The concept of Pain Clinic is based on the conviction that the management of difficult pain patients is possible through coordinated efforts on the part of specialists, specially trained in this branch. A Pain Clinic is usually a multi-disciplinary centre or a place where most of the primary therapeutic facilities exist and nerve blocks can also be provided. In India, about a decade ago, the Indian Society for Pain Research and Therapy (ISPRAT) and the Indian Society for the Study of Pain (ISSP) were established. The membership included Anaesthesiologists, physiologists, neurologist, neuro and orthopaedics surgeons, oncologists and others. The majority of the anaesthesiologists are actively involved in the management of acute and chronic pain and are the primary base-line specialists providing specific and comprehensive therapy with referral facilities to superspecialist centres. Dr (Mrs) S.
Kaushik is a senior anaesthesiologist with wide teaching
and clinical experience at Lucknow, Chandigarh and
abroad. |
Society’s depressed half Depression, the bane of modern life, has been more unfair to women than to men. Hospital statistics and community surveys throughout the world clearly reveal that depressed women outnumber depressed men. Many attempts have been made by research scientists to find out the possible reasons for this gender difference. Psychological factors have been blamed for female preponderance of depression. The multidimensional role of women in society is held responsible for their proneness to the disease. Medical experts have tried to explain this difference because of a number of hormonal changes that take place during various phases in the life of a woman. In this two-part article I have tried to make an attempt to give readers better insight into this widely prevalent but less identified psychological problem. It is important to realise that the timely diagnosis and treatment of depression can help reduce immense human suffering. Psycho-social reasons: It is a well-documented observation that women experience more events than men. In most of societies, the training of females is quite different from that of males. In oriental societies they are traditionally trained to be "home birds" and are imparted a lesser degree of freedom, education, career options, a say in spouse selection and other decision-making opportunities as compared to men. Since the advent of human civilisation, women have faced restrictions in many areas of life. In certain societies, they have to keep themselves completely covered, to the extent that the exposure of their face or arms is also a cognisable offence. In our own country, in most of the families, the birth of a female child indicates some kind of loss. It is hardly welcomed or celebrated. For decades, female infanticide was quite a prevalent practice. The fast declining number of females in Punjab is a clear indication of the love, affection and respect which Punjabis give to the female sex. Thanks to the widely available sex determination techniques, today the state has the lowest male-female ratio in the country. There is sufficient evidence to show that the female member continues to be badly suppressed and treated as an inferior being. It is a common experience that women are expected to perform stereotyped chores and even a slight deviation from their traditional role is not taken lightly. On the contrary, for males, such deviations are considered sighs of muscularity and are promoted by the families and the community. In spite of the rise in the educational level and the number of working women, women repeatedly face more conflicting situations than men. There are innumerable instances of highly qualified and well-placed working women being badly treated by their husbands and in-laws. I, however, personally feel that on the surface, the role of women is changing but beneath it the societal perception continues to be stereotyped. Such a situation may sow seeds of conflicts and depression among them. Despite the stringent anti-dowry laws, the tradition of dowry continues to haunt the parents of girls. Irrespective of their educational level, dowry ensures a better-placed and higher-priced groom. The trading in grooms of certain coveted central and provincial services and professions is no longer a secret. Both in rural and urban areas, physical and mental torture of women continues unabated, creating causes for future depression Hormonal changes: Hormones are the enzymes that govern a number of biological functions in the human body. The difference in the structure of the hormones forms the basis of the physical and emotional characteristics of the sexes. Women experience more hormonal upheavals than men. These changes are marked at various biological stages of their lives. Changes like menarche, pre-menstrual, menstrual and post-menstrual periods, pregnancy, childbirth, lactation and premenopausal as well as menopausal phases lead to a long chain of hormonal changes which may increase their vulnerability to depressive states. Loaded with this vulnerability, even a minor psycho-social stress can lead to acute or chronic depression. Oestrogen, which is important for the reproductive activity of a woman's body, is responsible for the depressive proneness. When its levels suffer imbalance, there may be a negative effect on the activity of some of the brain chemicals known as transmitters. As a result, the transmitters may not regulate the mood properly. Progesterone, another important hormone, may also play a role in mood regulation. [To be concluded] The author is a
Ludhiana-based psychiatrist, medical editor and
consultant for the poor on the website —
www.meditrackindia.com |
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Dear God, grant me Bestow Thy healing art
so that I may Give my hands the
healing touch, Fill me with faith and
teach the joy of healing, Give strength to my
faith Courtesy :—
Dr Rakesh Malhotra and Stride Healthcare, Ahmedabad |
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