HEALTH TRIBUNE Wednesday, December 5, 2001, Chandigarh, India
 

An eminent cardiologist holds out hope for the millions
CHD: prevention is possible — I 
Dr R.P. Sapru
T
he basic underlying cause of a heart attack is the disease of the coronary arteries, which are the blood vessels that supply blood to the heart muscle. Although such coronary artery disease may have been present for quite some time, often years, it usually comes to the attention of the patient, and thereafter to that of the doctor, in a rather dramatic manner at the time of a heart attack.

A clarion call to health personnel by a good samaritan 
Tubercular children in UT slums
Dr M.L.Kataria
B
harat, unfortunately, has been nurturing tuberculosis endemically since time immemorial. The disease has been mentioned even in ancient treatises by Dhanavantari, Charak and Sushruta.

AYURVEDA & TOTAL HEALTH
Mother of herbs
Dr R. Vatsyayan, Ayurvedacharya
I
t is believed that what gold is to the minerals, amla is to the herbs. Called amalaki, dhatriphala and vayastha in Sanskrit and Emblica officinalis scientifically, it is the most widely used herb in the ayurvedic system of medicine. Legends tell us that Chayavana Rishi regained his youthfulness because of the specific use of a herbal compound which primarily consisted of amla.

Mind and matter
The rights of the mentally ill
Annapurna Jha
I
gnorance about mental disorders, the stigma associated with them, the absence of adequate treatment facilities and the failure to effectively implement the relevant laws regarding mental health are responsible for the violation of the human rights of a large number of people suffering from these diseases, says Dr D S Goel, National Consultant on Mental Health to the Government of India, according to UNI.

 
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An eminent cardiologist holds out hope for the millions
CHD: prevention is possible — I 
Dr R.P. Sapru

The basic underlying cause of a heart attack is the disease of the coronary arteries, which are the blood vessels that supply blood to the heart muscle. Although such coronary artery disease may have been present for quite some time, often years, it usually comes to the attention of the patient, and thereafter to that of the doctor, in a rather dramatic manner at the time of a heart attack. Since people have become aware that the outcome of a patient following a heart attack is unpredictable, an understandable scare arises in the minds of the patients and their relatives.

The most obstinate of persons, who may otherwise believe that illness cannot strike him or her, wilts when mention is made of the possibility of heart disease; and rightly so. Far too many people have died in the prime of their productive lives, or are having to live with a seriously compromised quality of life that there is justified concern about the outcome when the disease strikes. Yet most people ignore the possibility of falling victim to this killer disease out of sheer ignorance or foolish bravado. There is good statistics that shows that the disease is spreading in our country at a rapid pace. Young and old, men and women, urbanites and ruralites are all at risk. Treatment at best provides relief — not cure! Bypass surgery or ballooning only provide relief, undoubtedly effective relief, but do not cure the disease; so also the available drugs or medicines. Under the circumstances, measures that could possibly prevent the disease or help to mitigate the consequences are worthy of attention by all persons who have a healthy concern about their health and well-being.

Concerted medical research from different parts of the world has consistently shown that certain circumstances are associated with an increased risk of falling victim to the disease or contribute towards a less favourable outcome should the disease strike. These are, therefore, called risk factors. They do not directly cause the disease but definitely increase the chances of contracting the same. What that means is that a person without any of the identified risk factors could still fall victim to the disease but that should such an event come to pass, the disease is likely to be less severe, the chances of survival greater, and the long term outcome more favourable. Further, if the same person were to have any of the identified risk factors, the outcome, both immediate and long term, is likely to be much more adverse and the disease is more likely to strike at an earlier age.

If more than one risk factor is present, the outcome is likely to be even worse. Clearly, there is an advantage in trying to control these risk factors for long-term benefit to one's own self. For us Indians, who, as research has shown, are even otherwise genetically more prone to suffer from this disease, the need to control such risk factors as best as possible cannot be overemphasised. Admittedly, it is not possible to do anything with some of these factors and these we must simply accept. Some persons are genetically predisposed to develop the disease. Such persons usually have a history of the same or similar illness in the near blood relatives. Being a male is another such risk factor. Women in the child-bearing age do not get this disease as often as men do and are, therefore, relatively well protected. However, after menopause, this difference melts rapidly. Likewise, older persons, men or women, are more likely to get the disease as compared to the younger ones. Clearly, it is not possible to change one's genetic make-up (as yet), or gender or age. Such risk factors are, therefore, called "unmodifiable risk factors".

However, there are other risk factors, equally important or even more so, about which we can do a lot, given a modicum of common sense and a desire to preserve one's own health. Perhaps one of the most important such risk factors is the smoking of tobacco. It matters little whether one smokes cigarettes, cigars, bidis, chillum or hukkah; they are all, without doubt, equally damaging. Volumes of evidence exist in support of this fact. The greater the quantity of tobacco smoked, in whatever form, the greater is the risk. Likewise, the earlier the smoking habit is acquired the greater is the risk. Even passive smoking (inhaling the tobacco smoke from other persons smoking in your presence) increases the risk of heart disease!It takes almost five years after giving up the smoking habit for the risk to return to that found amongst non-smokers! There is strong circumstantial evidence to suggest that smoking is perhaps the most important risk factor in the case of the rural poor.

(To be continued)
Dr Sapru, a former Head of the Department of Cardiology at the PGI, Chandigarh, and the reigning Medical Director of INSCOL, Sector 34, in the same city, has worked for long years, benefiting various Royal institutions in the UK. (Phones: (R) 598801; (O) 667903)

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A clarion call to health personnel by a good samaritan 
Tubercular children in UT slums
Dr M.L.Kataria

Bharat, unfortunately, has been nurturing tuberculosis endemically since time immemorial. The disease has been mentioned even in ancient treatises by Dhanavantari, Charak and Sushruta. Depending on the virulence of the disease, which ebbs and flows from age to age, the ancient medical men described the symptomatology in great detail. Besides palliative treatment, they had no specific cure for it; nor had they given its cause. Therefore, superstition-mongers attributed it to God's curse on the afflicted man and segregated him to gradually and consumptively wither a way to death as in the case of a leper.

Alas, this is still happening in many remote parts of India even though Koch discovered the mycobacterium tuberculosis, the causative organism, in the nineteenth century, and pharmaceutical sciences discovered and widely marketed the specific cure for it in the twentieth century.

With fifteen million positive cases and 20% of that number as its carriers in India, we are the largest harbourers (30%) of tuberculosis in the world. Five lakh people die of TBevery year, one every minute, in India! With the fast escalating number of positive AIDS population, these twin-sisters have, together, set up a vicious circle in which both are thriving rapidly to double their number as an alarming epidemic explosion by 2020.

The government of India and its Ministry of Health, headed at present by an eminent medical man, are aware of this serious health hazard. Both the tuberculosis AIDS control. programmes have been launched with countrywide detailed planning and vigorous implementation down to the grassroot level, involving also the NGOs, very few of whom have come forward.

The Union Territory of Chandigarh, including the "City Beautiful", nearly two dozen big and small neglected villages and almost a dozen clusters of slums, has a population of over 11 lakh of which more than two lakh live in slums.

One in every 12 persons is suffering from tuberculosis or is a silent carrier — mostly those below the poverty line living in slums and rural areas.

The Chandigarh Administration and the Health Department have established several nodal points in the city hospitals and health centres to implement the Government's tuberculosis programme.

In order to supplement the official effort, we have established a tuberculosis control centre exclusively for children, the neglected segment, on the north-eastern periphery of Chandigarh, at Karsan village, catering to the population residing in the Karsan colony, Ram Darbar and Hallo Majra, besides industrial labour slums.

A general survey of the region, including that of the schools, reveals a population of 400 children suffering from the disease who are now under treatment at this rural or slum paediatric tuberculosis centre.

A detailed history sheet of each child is being maintained. This includes his/her physical findings, the family history of tuberculosis, the diagnostic investigations carried out and the treatment being given, including the follow-up work.

A laboratory to examine the sputum and detailed blood tests — total and differential leukocyte counts, haemoglobin estimation, erythrocyte sedimentation rate, etc, and an x-ray plant for radiological examination of the chest, bones and joints have been established at the site in the colony itself.

We are holding weekly camps attended by not only the children under investigation and treatment but also by their parents. Following the treatment protocol, the Directly Observed Therapy(DOT), advocated by the WHO and the Government of India's TBControl Programme, we are issuing the week's quota of the multi-drug therapy to the parents of positive cases to ensure drug compliance. The response is encouraging and so are the results in every case.

Depending on category I, II or III of the disease, a multi-drug regime comprising four, three or two drugs is being followed, supplemented by iron and vitamin complements, for two, four and six or seven months. There are different dosage schedules and packs for paediatric tuberculosis, which are quite expensive. At the rate of Rs 300 per month per child, we need a budget of over Rs 3 lakh for the therapy for 400 identified TB-positive children now under our treatment at this centre on the north-eastern periphery of Chandigarh.

This is a clarion call for honorary doctors, social workers, donors and philanthropists to come forward and help us.

The soul and spirit of our children's TB Centre is Dr (Mrs) Bal Inder Sohi, MD, DCH, the author of four books on paediatrics and half a dozen volumes on religion and spirituality, an ex-Army Major, formerly an Associated Professor at Armed Forces Medical College, Pune, where her husband, Brig. A.S.Sohi, AVSM, a renowned dermatologist, venereologist and leprologist, was a Professor.

Dr Bal Inder Sohi, highly devoted, dynamic, awe-inspiring and young at 70, is known as the Mother Teresa of Uttaranchal, where she rendered yeoman service for many years and cured thousands of tubercular children, travelling from village to village in the Himalayan areas, carrying bags of free medicines. She still sits for long hours, without food under a tree at our health centre at Karsan with hundreds of tubercular children and their parents swarming around her for life's breath.

Truly, she is the Goddess of Tubercular Children!

Dr (Brig) M.L. Kataria, a one-man NGO, is operating 16 urban, rural and slum health care projects, along with a team of doctors, social workers and paramedics, for all the seven days of the week. One can contact him at 547748 before 8.30 a.m if one wants to volunteer for help.

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AYURVEDA & TOTAL HEALTH
Mother of herbs
Dr R. Vatsyayan, Ayurvedacharya

It is believed that what gold is to the minerals, amla is to the herbs. Called amalaki, dhatriphala and vayastha in Sanskrit and Emblica officinalis scientifically, it is the most widely used herb in the ayurvedic system of medicine. Legends tell us that Chayavana Rishi regained his youthfulness because of the specific use of a herbal compound which primarily consisted of amla.

The English name of amla — Indian gooseberry — denotes that it is indigenous to India. Its light green fruit growss on a small tree which is found in wet forests of hill areas throughout the Indian subcontinent. Though all parts of the tree have medicinal value, it is the fruit which constitutes the main drug.

There are two main varieties of amla — one is wild and the other is cultivated. These are called vanya and gramya respectively. In common parlance these are known as desi or banarasi. The wild amla fruit is small, hard and stony and contains a lot of fibre whereas the other one is big, smooth, fleshy and rich in juicy content. Dry amla is wrinkled and of grey-black colour.

Amla is a rare fruit which contains all tastes except salty. With sourness as the foremost taste, it is at the same time sweet, astringent, bitter and pungent. It is light, dry and cold in effect and the richest source of vitamin C. Laboratory tests show that every 100 gm of fresh amla provides up to 700 mg of this vitamin which is 20 times higher than what is found in an orange.

The fresh fruit contains more than 80 per cent water besides protein, minerals, carbohydrates and fibre. The mineral and vitamin contents include calcium, phosphorus, iron, carotene and vitamin B complex. Even if dried in shade, amla retains much of its vitamin C. The leaves and bark of the tree are rich in tannin.

The eminence of amla is so well recognised in Ayurveda that all the famous ancient texts have discussed its preventive, restorative and curative usefulness and extolled its extraordinary medicinal qualities. Charaka has specifically mentioned it as a great rasayana that helps protect people from disease and keeps away the manifestations of premature ageing. Since amla pacifies all the three doshas — vata, pitta and kapha — it has a wide range of corrective and curative effect on the human body. It is rightly called sarvadosha hara — a remover of all diseases. (Next week: Medicinal uses of amla).

Dr R. Vatsyayan is an ayurvedic consultant based at the Sanjivani Ayurvedic Centre, Ludhiana. (Phones: 423500 and 431500; E-mail- sanjivni@satyam.net.in).


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Healthy winter

Ayurveda recommends that in order to be optimally healthy we should attune our bodies to nature's master cycle. Ancient seers have divided the whole year in two large parts — adaan kala and visarga kala. Winter comes under the latter one. It is the time when the sun is relatively weak and the earth becomes cool due to clouds, rain and cold wind.

In this season, the digestive power of human beings possessing good health is enhanced. Accentuated vata should be countered by using rich, unctuous, sweet and salty food which includes preparations of wheat, gram, new rice, milk and milk products, dry fruits, jaggery, cane juice etc. Non-vegetarians have been told to take fish and meat. The daily massage of til oil (sesame), moderate exercise and wearing of woollen clothes are also recommended. Ayurveda believes that winter is the best season for the use of aphrodisiacs. — Source: Ayurvedic texts.

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Mind and matter
The rights of the mentally ill
Annapurna Jha

Ignorance about mental disorders, the stigma associated with them, the absence of adequate treatment facilities and the failure to effectively implement the relevant laws regarding mental health are responsible for the violation of the human rights of a large number of people suffering from these diseases, says Dr D S Goel, National Consultant on Mental Health to the Government of India, according to UNI.

“ Incidents like Eravadi in Tamil Nadu in which scores of people perished in a fire at a dargah where mentally ill persons were kept chained recur due to these basic reasons,” Dr Goel thinks.

The widespread ignorance, superstition and prejudice surrounding psychiatric problems even among the educated result in the delay and denial of treatment, rejection, discrimination, humiliation and isolation to the people suffering from mental disorders. They also lead to the high risk of human rights violation - especially to the most vulnerable sections such as those living below the poverty line - women and children, he says.

“Being unable to defend themselves these patients are most vulnerable to human rights abuse,” he points out. Though the country as mental health law, it is not being effectively implemented.

At present, custodial care in mental hospitals is the most prevalent method for managing these patients in the country. The families of the patients leave them there even after being cured due to the stigma associated with the disease. Among the 18,912 psychiatric beds in 37 government mental hospitals, half are occupied by long-staying patients - those who live there for more than two years. Three-fourths of them are in the hospitals for five years or more, and one-fourth for more than 15 years.

“ In most of these cases patients have recovered, with only signs of social withdrawal and apathetic attitude to day-to-day activities, but the families refuse to accept them because of the stigma,” says the doctor.

About 450 million people worldwide suffer from mental disorders. In India, the prevalence of major mental disorders like schizophrenia and bipolar depression, is about two percent while other psychiatric disorders account for another five per cent.

India has a significant proportion of epilepsy patients with about 8 to 10 million out of 50 million such patients globally. Mental retardation is also quite prevalent as three percent of children under 18 years suffer from this. Alzheimer's Disease has emerged as a major problem. The suicide rate which is a chronic manifestation of mental disorders and has a devastating effect on the families, is quite high at 11 per lakh in India and it is growing.

The country lacks trained manpower with only 3500 psychiatrists for one billion population. Training in psychiatry in mental colleges is still accorded a very low priority. The academic time allotted to the subject has declined recently. Most medical colleges do not have an independent department of psychiatry or dedicated psychiatric wards.

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Surgical Journal of North India

This is the official journal of the Northern Chapter of the Association of Surgeons of India. Its Vol. 17 No. 1, just published, is a remarkable work of research, planning, editing and designing. Dr JD Wig, MS, FRCS, FAMS, is the Editor in Chief. The articles in this issue are purely scientific and range from “Obesity — a formidable challenge” to “What is new in surgery?” The address for obtaining the journal is: The Department of Surgery, PGI, Chandigarh. Ph: 0172-747369. E-mail: jdwsjni@hotmail.com

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