HEALTH TRIBUNE Wednesday, October 18, 2000, Chandigarh, India

Preserving the inner light
By Dr. ( Brig) M .L. Kataria

ut of a total global blind population of nearly 20 million, India has the misfortune of having 10 million. While 80 per cent of these less fortunate are curable, there is an acute dearth of qualified ophthalmologists, or, for many reasons, these patients have no access to the centres of sight-restoration.

Conquer cancer
By Dr S.M. Bose
he danger of AIDS as a killer disease is looming large on the horizon but it is cancer which is taking a very heavy toll. The cause of AIDS is known and one can take precautions to a large extent to avoid the disease but unfortunately, the exact cause of cancer is not yet well known. 

Non-smokers have a fundamental right!
By Dr V.P. Gupta
ith every puff of tobacco smoke, you inhale millions of devastating free radicals which destroy you from within so dangerous are the silent killers at work!



Preserving the inner light
By Dr. ( Brig) M .L. Kataria

Out of a total global blind population of nearly 20 million, India has the misfortune of having 10 million. While 80 per cent of these less fortunate are curable, there is an acute dearth of qualified ophthalmologists, or, for many reasons, these patients have no access to the centres of sight-restoration. While a few NGOs do organise eye camps, mostly in and around urban areas, the state health-care services have no organised regular mobile eye-care facilities for the rural and remote pockets.

Therefore, there seems to be a permanent statistical stagnation at 80 per cent of even the curable blind sons and daughters of Bharat Mata.

The problem of visual impairment is not restricted to only a population of 10 million. The malady, in fact, is much more extensive. What about those who may not be totally blind, but their visual acuity is so low that they are " economically blind", because they cannot fend for themselves in the highly competitive social milieu. According to the norms laid down by the International Association for the Prevention of Blindness, a person is blind if he cannot count fingers at a distance of 1.5 metres or if his vision is less than 1/20 of normal vision ( in the USA, less than 1/10 of normal vision). The population, so affected, is nearly 50 million in India.

While curable blindness due to cataract, still constitutes more than 55 per cent of our blind population, preventable and controllable blindness, due to various kinds of bacterial, viral and fungal infections of the eye and injuries followed by infection, add yet another more than 20 per cent to the blind population.

Undetected and uncorrected gross errors of refraction, particularly during childhood and adolescence, resulting in squint and amblyopia, further add to the visual handicap and " economic blindness".

Malnutrition, especially protein - calorie and vitamin A deficiency is alarmingly common amongst children and the adolescent in the ever-increasing slum population and rural India.

Trachoma, glaucoma, diabetes and hypertension, which are curable and controllable, and many types of congenital and genetic disorders, are further adding to the blind load of society.

The most tragic aspect of blindness in this country is that more than 30 per cent of our blind persons lose their eyesight by the time they reach the age of 25 to 35 years.

With a resolute political will and a concerted and sustained drive by the state and NGOs, it is possible to wipe out preventable and curable blindness within a couple of decades.

However, the problem is much more complex, requiring long-term measures to uphold the totally and incurably blind population of more than 2.5 million in India at any time. It is society's moral responsibility to accommodate, support, train and rehabilitate them to a high degree of life-long self-sufficiency. More than mere sympathy, they need to be given an opportunity to stand on their own legs. NGOs can play a vital role in this direction.

In 1974, the WHO established the International Agency for Prevention of Blindness to coordinate the work of national agencies. In India, the National Association for the Blind, a voluntary organisation, was formed in 1952. The Central Government established the National Institute for the Blind at Dehra Dun to work out strategies for solving the national problem.

There are not may regional voluntary agencies for the blind. Chandigarh, which has the pride of being the first in many fields, established the Society for the Care of the Blind, a voluntary agency, in 1972. It started a school with only five children in a rented house. Today, the Institute for the Visually Handicapped caters to more than a hundred blind children, adolescent, persons, men and women, from Chandigarh, Punjab, Haryana, Himachal Pradesh and Jammu and Kashmir.

The institute has one of the best residential schools in the region from class 1 to classes 10+2. At present the girls are day scholars. However, the school is soon going to expand to a capacity of 150 (100 boys and 50 girls), with residential facilities for girls, also. It is unbelievably true that the school is consistently securing 100 per cent success rate in the first division, year after year, in the examinations conducted by CBSE. The credit goes to a live-wire principal, Mr K.R. Sood, a dynamic blind headmaster, Mr J.S. Jayara, and a dedicated team of 20 well qualified teachers, six of whom are blind.

Besides academics, the institute also conducts extensive vocational training prorammes like typewriting in English, Hindi and Punjabi, stenography, instrumental and vocal music, wax work, weaving of household articles, cane work, stitching, knitting and culinary skills. The institute is geared up to introduce computer education as well by the end of 2000. It has its own band, an orchestra and a dramatic club, which all perform admirably and regularly.

The institute is very fortunate in having Mrs Vineeta Rai, IAS, Adviser to the Administrator of Chandigarh, as its president. She takes keen interest in all its affairs. Maj-Gen Rajendra Nath PVSM, a man of vision, heads the administration of the society and its institute, assisted by a selfless honorary secretary, Col S.S. Bindra. They follow the motto: "Only those live truly who live for others".

Won't you, also, like to contribute your mite to this noble cause?

Dr (Brig.) M.L. Kataria, an honorary consultant, has been operating a health-care centre for the inmates of the Institution for the Blind in Chandigarh for several years. The centre also looks after the staff and their families.



Conquer cancer
By Dr S.M. Bose

The danger of AIDS as a killer disease is looming large on the horizon but it is cancer which is taking a very heavy toll. The cause of AIDS is known and one can take precautions to a large extent to avoid the disease but unfortunately, the exact cause of cancer is not yet well known. There are some risk factors which are said to be contributing to the causation of cancer smoking, radiation, genetic factors, etc, and there are some other factors which have also been incriminated. Some of the lesser known causes are described below. In the changing lifestyle of the next century, it would be advisable to be aware of these and take appropriate precautions to keep away the threat of the dreaded disease.

Chemical agents: For almost 80 years, it has been known that a number of chemical agents contain cancer-causing components and these agents are known as carcinogens. Coal tar, mercury, aniline dyes and asbestos are some of the chemicals which are definitely known to be carcinogenic. Persons handling these chemical agents must take precautionary measures by using gloves, masks, high boots, etc, so that they neither come in direct contact with these agents nor inhale fumes.

Alcohol: The relationship between the consumption of alcohol and the development of cancer is not well established but it is supposed to be one of the contributing factors for the cancer of the mouth and the oesophagus. The heavy consumption of alcohol definitely gives rise to cirrhosis of the liver, which is known for giving rise to the cancer of the liver and hence it can be said that alcohol gives rise to liver cancer.

Recently, some beneficial effects of a safe level of drinking ( not more than two small pegs a day), particularly for the heart, has been claimed but heavy drinking is definitely injurious to health.

Diet: A balanced and nutritious diet is necessary for our well-being but the type of diet we generally consume these days is far from ideal. We like to consume fast food which

has lots of facts, spices and condiments, and very little fibre; this is definitely not good for health. A high intake of fat has been associated with a number of cancers, more particularly with the cancer of the breast.

It has been also established that a high intake of fats along with a decreased intake of fibres definitely has a higher-risk incidence for the development of the cancer of the large intestine. It is presumed that people consuming less of fibres are usually constipated and, therefore, the stools remain in the large intestine for a long time. Some toxic products are always present in the stools and because of constipation these products remain in contact with the wall of the large intestine for a much longer period, during which it can have deleterious effects on the inner lining of the large intestine, resulting in the cancer of the colon.

It has been also pointed out that the prevalent custom of the consumption of smoked fish in far-eastern countries ( Japan, Korea, Philippines, etc.) is responsible for the high incidence of cancer of the stomach in these countries.

The use of colouring agents and preservatives in items of food should be at the bare minimum level. One should not consume too much of condiments and spices.

Hormones: Hormones have influence on the development of cancer, e.g. on breast cancer. It has been estimated that the following types of women are more prone to develop breast cancer : ( a) a spinster ( b) a woman who has not given birth to a child or has given birth to her first child after the age of 30 (c) a woman who has a long menstrual life ( early menarche, i.e. the onset of the menstrual cycle and late menopause, i.e. the cessation of menstruation), ( d) a mother who has not breast-fed her children. Under these conditions there is hormonal imbalance, which can give rise to breast cancer. Similarly women with the fibrocystic disease of the breasts ( which is also supposed to be due to hormonal imbalance) are more likely to develop breast cancer than those who are without this problem.

The cancer of the prostate in males is also linked to hormonal imbalance. Social, economic and ethnic factors: There seems to be a definite relationship between the socio-economic status and cancer frequency. For example, the cancer of the skin and the cervix are more common in low-income groups while breast cancer is more often found among women from high socio-economic groups. In our own country, it has been observed that the cancer of the cervix is the commonest cancer seen among females. But with modernisation, the cancer of the breast seems to be leading the list. This has particularly been observed in metropolitan cities.

Statistics reveal that some of the cancers are more commonly seen in a particular ethnic group. For example, the incidence of breast cancer in India is the highest in the Parsi community. The cancer of the penis is rarely seen among Muslims, probably because of the custom of circumcision in early childhood.

Environment: It is generally accepted that atmospheric pollution can increase the risk of cancer in man. Animal experiments using particulates collected from polluted air have resulted in the induction of benign tumours ( innocent, non-cancerous) and malignant tumours of the skin.

Chronic diseases of the organs: A number of benign, Chronic diseases of the organs, over a period of time, can develop into cancer, examples being the dysplastic lesions of the breast, the chronic inflammation of the uterine cervix, the chronic inflammatory lesions of the stomach, the chronic inflammation of the gall bladder, the multiple polyposis of the colon, the chronic inflammatory diseases of the colon like ulcerative colitis and Crohns disease, warts etc. It is therefore, mandatory that people having these diseases should have regular check-ups so that the development of cancer can be detected at an early stage and appropriate treatment is provided.

Prof S.M. Bose is a renowned cancer surgeon.


Non-smokers have a fundamental right!
By Dr V.P. Gupta

With every puff of tobacco smoke, you inhale millions of devastating free radicals which destroy you from within so dangerous are the silent killers at work!

Tobacco smoke consists of nicotine (a very poisonous stuff), tar, carbon monoxide gas and several other poisonous substances.

Tobacco, when smoked, passes through air passages and reaches the lungs and its alveoli. The tar, which is just like soot, irritates and deposits in the air passages and causes inflammation leading to bronchitis which may even progress to emphysema and asthma. Continuous smoker's air passages are irritated and narrowed with this tar (soot) deposit leading to permanent respiratory problems.

Nicotine, the other most dangerous part of tobacco smoke, is absorbed and thus damages the nervous system.

Another serious complication is the carcinoma (cancer) of the lungs. Heavy smokers are more likely sufferers. Smokers can get the cancer of the tongue and the throat as well.

Tobacco chewers are more likely sufferers from the cancer of the buccal cavity and food pipe.

The regular use of tobacco smoking leads to serious addiction. This is the most common mode of its use. Nicotine of the tobacco smoke, after absorption from the lungs, travels through circulation and causes myocardial ischaemia (poor circulation of the heart), may even cause clotting (myocardial thrombosis) leading to the death of a part of the heart called myocardial infraction. This condition is popularly termed as heart attack or stroke.

In some advanced cases of heavy smokers, it causes obstruction of the blood vessels supplying the legs and the feet leading to the stoppage of blood supply, precipitating gangrene. This condition is called thrombo - angiitis - obliterans (named as Buerger's Disease also). Here the patient gets acute pain and the legs have to be amputated and still the life of the sufferer is hard to save.

Tobacco, in all its forms, also gives rise to the inflammation of the stomach and duodenum called peptic ulcer. It has been thoroughly realised that the use of tobacco in all its forms is one of the most dangerous addictions.

Half-hearted steps have been taken and partial bans have been imposed. Statutory warning on every pack of cigarettes, "Cigarette smoking is injurious to health", speaks volumes about this dangerous addiction.

Apart from the fact, that the smoker is harmed and addicted, the other angle of the harm, passed on to non smokers, is of paramount concern to the nation. These poor afflicted ones are called passive smokers or second-hand smokers.

A smoker, after inhaling smoke, cannot hold it back in the lungs. Rather it has to be thrown out with an even more polluting effect.

Does this case not fall in the category of the case to be considered as an infringement of the Fundamental Rights of the non-smokers?

Everybody has a right to inhale pure and fresh air.

No addict has a right to spread addiction. But this is one killer, like a double-edged sword, killing the smoker and the non-smoker (passive smoker) alike.

Looking at the gravity of the problem, it appears to be a fit case where a total ban on tobacco consumption in all its forms, specially smoking, should be imposed to save the nation and the world from an unavoidable ruin.

If tobacco is totally banned, all the tobacco consumers can become completely normal in the course of time without any long-lasting ill effect.

Dr Gupta is the oldest practising physician of Chandigarh.