The state of global health requires a fundamental shift in healthcare training, education, and research, says Dr R. Kumar
WHEN large areas of the world are suffering from diseases, the developed world cannot live in peace and remain content with its development. No doubt the burden of infectious diseases is increasing. Polio, which was on way to eradication, has experienced a comeback in India. African sleeping sickness has re-emerged in the war-torn Angola, Congo and Sudan. The spread of anthrax in the US has served as another reminder of the crippling disease. The resurgence of mumps in the UK has come as a rude shock. HIV, tuberculosis (TB), and severe acute respiratory syndrome (SARS) do not respect geographic borders. Dr Margaret Chan, who took over as the new director-general, WHO, emphasised the importance of global health. "Health security brings benefits at both the global and community levels. Diseases are global threats to health that also bring shocks to economies and societies. Defence against these threats enhances our collective security."
In India it is a case of double whammy, where the infectious diseases and malnutrition continue to kill and maim large number of countrymen. Simultaneously, obesity, heart disease, diabetes, cancer and other lifestyle diseases are also on the rise. While in India people are denied reasonable healthcare delivery because of the overburden of numbers, in the US and other developed countries, the problem of health system becoming unaffordable, impersonal, complicated and bureaucratic is widely rampant. With Nar sewa – Narayan sewa approach, India has come forward with medical/surgical tourism to help the ailing humanity abroad. This means helping a person in distress is akin to worship of God.
Health indicators project the level of overall development of the communities. We can take pride in the fact that one of our states, Kerala, has outrun China, with a life expectancy of 76 (China 71) and an infant mortality rate of 10 (China 30) per 1000, with high levels of employment and women’s education. But there are vast areas in Bihar, UP and Orissa where poverty and disease abound. Underprivileged individuals, living in these areas with a number of diseases, accept their situation. They grab what happiness they can, and allow high mortality to go on. We need to be careful not to lose sight of the need for early intervention.
The state of global health necessitates a fundamental shift in training, education, and research. To adequately prepare our healthcare professionals, an institute of learning should be established to improve our capacity to respond to global health issues. Gates Foundation donated over $4 billion for this cause. Their portfolio includes not only the high-profile diseases like HIV, TB, and malaria, but also neglected diseases, such as hookworm, leishmaniasis, filariasis, measles, polio, guinea worm, trachoma and schistosomiasis. Additionally, The Global Fund to Fight AIDS, Tuberculosis and Malaria has committed $3 billion. The US government is also recognising the importance of funding such activities, as evidenced by the President’s Emergency Plan for AIDS Relief (PEPFAR) and a recent commitment to increased support for malaria control.
Only 10 per cent of the expenditure on research and development globally are devoted to health issues in developing countries with 90 per cent of the disease burden. Of the $56 billion spent annually on medical research worldwide, at least 90 per cent is spent on the health needs of the richest countries, which represent a mere 10 per cent of the world’s population. Only 1 pr cent of the nearly 1400 new drugs developed were devoted to tropical diseases. Clinical research is carried out on those populations that do not ultimately benefit from the research. The result is severely stunted health care in developing countries.
What can be done
Incorporate new control tools: new control tools such as bed nets, condoms, preventive drugs, and vaccines as well as health assessment instruments need to be incorporated.
Train healthcare professionals: Healthcare delivery should look more at issues that include economics, sociology, anthropology, and political science.
Augment the global health community: It has been noted that in many countries the demand of healthcare workforce is much more than the supply. Brain drain has been a perpetual problem with India.
Role of pharma industry
Its investment decisions are based on the need to maximise profits, rather than to fulfil human needs. It is necessary for the pharmaceutical industry to contribute in global health, particularly in the Third World, where up to 50 per cent of the people do not have access to even the basic drugs. The developed world has a duty to examine the ethics of the pharmaceutical industry. If there is any honesty of purpose, at least life-saving drugs should be available at cheap prices in the developing world.
Vibrant reds, flaming oranges and deep maroons are the bridal colours this wedding season, says Lochana Murthy
Festival celebrations are fast giving way to the wedding season and soon the country will be conducting, conservatively, five million weddings. This season, designers have decided on bright oranges, reds and maroons instead of neutral and muted colours. It is quite clear that they want the brides to look as bright as colour can make them.
Gold embroidery and embellishments are the main points of a bride’s dress, while the cuts and drapes are minimal. Floral motifs are no longer in. The trend now is to ensure that the fabrics and embroidery designs take an antique look.
One finds that designers have taken advantage of the colours of tie and dye prints. If you can combine purple and red, green and rust, or maroon and blue, these bright colours can be the background for beautiful beadwork surrounded by glittering crystals.
Designer Anju Jani has resurrected ancient patterns and tribal crafts to decorate the bride’s trousseau, while Deepika Gautam, well known for her formal outfits, has concentrated on chikankari, kundan, mirror work, mokaish and sequins to embellish the dress.
But it is the maestro Sabyasachi Mukherjee who has given the ‘art deco look" by cutting old brocade sarees, dyeing them, and decorating them with the grand embroidery.
Another designer concentrating on antique designs is Reena Pundit. Based on the trousseau patterns noticed in the wedding sarees preserved by erstwhile royals, she has designed brocade sarees with puff-sleeved blouses and frilled petticoats.
Besides sarees, ornate lehngas with crystals is a favourite bridal choice. If the price and exclusivity of design is not a problem, then you can opt for a bridal dress in net or lace and brocade with zardosi embroidery. Aimed at the glamour brigade and celebrities, designers ensure that these exclusive ghagra- cholis and sarees match with the bride’s skin tone, figure, height and the jewellery she plans to wear.
The bride’s skin colour is often the deciding point and, at times, it becomes necessary to avoid bright colours. But there are certain colour combinations like antique gold on beige and rust with ivory which suit almost all Indian skin tones and are preferred. Another point in favour of the above colours is that the trimmings of zardosi, crystals and sequins show off very well on them.
Designer Amita Mehta has used the idea of two odhnis in contrasting colours for her lehnga-cholis. Of these two, the lighter one, to be worn around the head is kept in bright colours like purple or chutney green, while the heavier one for the shoulders is usually red with gold trimmings.
If one has decided on sarees, then one has a lot of choice with Patolas and Paithanis. Somehow the ornate and traditional Baranasi and Kanjeevarams seem to have lost the grand appeal they once had. Designers like Shaina N.C can even have one of a kind saree designed for you.
One cannot forget that the bridal outfit has to be matched with suitable accessories and the jewellery you have bought. Many designers also ensure that the bridal trousseau matches well with the groom’s dress. It depends on what he has decided: sherwani, Jodhpuri suit or bundgala with kurta and churidar. — MF