Non-communicable diseases - 'Ottamooli'

Sometime in the middle of last month, the United Nations had convened a high level meeting on Non-Communicable diseases (NCDs). It is praise-worthy that the world has recognised the burden that NCDs poses to communities.

Even in a remote community where I serve, NCDs are turning out into a major force to deal with. Along with diabetes and hypertension, the most recent phenomenon that we had been witnessing is the huge number of young adults and children in whom we are diagnosing Bronchial Asthma. 

Today, in the outpatient department, I diagnosed 6 new cases of bronchial asthma. In the Indian context, one of the most challenging facets in the management of NCDs is the concept of the 'single drug concept' present in Ayurveda. I'm not sure if there is English word for that. In Malayalam it's called 'Ottamooli'

When we explain to the patient that he/she may need to be continuously on some form of treatment for his condition, the family is very much crestfallen. With bronchial asthma, it is a bit easy as I also have it - and most of the time, I take out my Inhaler and show them that I regularly use it. 

Coming to Bronchial Asthma, it is disease with quite a lot of stigma. Couple of weeks, I had a young couple who had brought their 5 year old son whom I diagnosed to have Bronchial Asthma. When I prescribed them an inhaler with a spacer, they did not realize what I had prescribed. When they brought it and came back for helping them use it, the mother started to sob, when I opened the packet and took out the inhaler. 

She told me that if anybody finds her son use it, her son would have difficulty finding a bride when he grows old. Well, it was terrible to hear that. She wanted me to cancel the prescription for the spacehaler and instead give them tablets. According to her, nobody would know that her son is on tablets. The father also ultimately started to beg me to change the prescription. No amount of counselling could help them. 

Coming back to diabetes, the attitude towards finding out a 'ottamooli' prevails. Quite a lot of practitioners have been claiming to bring about a radical cure for the disease. I've had enough patients who have come in a very uncontrolled state of diabetes after having being misled about such treatments.

With the number of patients which we encounter in our outpatient department with conditions such as diabetes, hypertension and chronic lung diseases such as bronchial asthma on the increase, the burden it is going to pose to poor agrarian communities is massive. I wonder what do we have to offer them. Or would it ultimately end up as a major business opportunity to the pharmaceutical industry - there are already signs of such a phenomenon.