Immuno-compromised by Malnutrition

One of my favorite quotes is that by William Osler about the usage of medicine.

Unfortunately, almost all of us believe that medicines are the elixir of life. And when we take medicines, we want quick relief. Almost all over the country, quacks and non-qualified practioners have thrived on this and one of the major challenges in the healthcare scenario of the country is the unbridled use of medicines especially antibiotics and steroids. Of course, the pharmaceutical industry all the more promotes such usage. 

And as doctors we fail to understand the inherent nature of the body to heal itself, which is very evident by the way many of us prescribe medicines.

This becomes a major issue in poor and marginalized communities of the world as it is quite a fashionable thing to resort to medicines and injections and get well. A very dangerous trend when we look at the fact that issues of sanitation and nutrition are hardly given any serious thought.

I personally believe that in India, malnutrition is the most serious form of immune-compromised state. As medical students, we were trained to think of only HIV patients and patients on immune-suppressive medicines to be immunosuppressed. I hope to see a change in the attitude that many of our medical colleges have towards malnutrition. We don’t see many HIV patients or patients on immunosuppressive medicine, but we see so many malnourished.

In Barwadih, the population of which comprises mainly on permanent residents of the Kherwar tribe and a migrant population of people from Bihar and Munda tribals from the Ranchi plateau, we are stunned by the amount of malnutrition we see. We did a rough survey of children who come to us and it was quite alarming to find that almost 70-80% of under-fives who come to us are at least moderately malnourished. I’m sure the situation would be worse if we do a community based survey.

And I dream to do a community based survey to highlight the gravity of the problem in hard-to-reach areas. I’m sure that there are going to many determinants of this health issue which could be different from other regions.

The challenge is to find long term solutions especially in a situation where more than half of the nation’s under fives are malnourished. 

Warning Bells

About a week back, we got a rude shock when one of our patients with a laboratory diagnosis of bacterial meningitis did not respond to our routine choice of Ceftriaxone. And to our horror, responded so well to Piperacillin-Tazobactum. 

Yes, I would have purists who would say that Crystalline Penicilline and Chloramphenicol should have been tried. Unfortunately, both these antibiotics are quite labour intensive and with the shortage of competent staff we have, it’s quite a challenge.

Now, there has been quite mind-boggling research going on in the area of antibiotics.

However, I’m sure that unless we are prudent in the usage of antibiotics, how much ever research we do, nothing much is going to change.

But, today I was quite surprised to find a news item about the dangers of unscrupulous use of antibiotics. 

I hope our communities and quacks would take note . . . However, I wonder who is going to rein in the pharmaceutical companies and their representatives . . .