A Challenge

Over the last few weeks, we have had quite a lot on how India’s ancient were quite progressive in science and technology and it was only an irresponsible government coupled with left wing ideologues who suppressed such information.

I’m sure that there were quite a few things we knew about India’s contribution to science and technology. I’m very familiar with the names of Sushruta and Aryabhatta from childhood. And of course later names such as JC Bose, CV Raman, S. Chandrashekhar, Hargobind Khorana etc. are quite familiar.

However, as of now, we all know that our country is struggling with a myriad number of issues which can be solved. The Mangalyan exploration proves that we have quite innovative and brilliant scientists who will excel if given the right environment.

Last year saw a lot of challenges. In this post, I challenge my countrymen to come up with 5 issues which need to be addressed by Indian scientists as a priority. Here is my list of 5 challenges to each one of us, especially those of us who are students of science - - -

1. Tuberculosis continues to be a major killer in our country and other developing countries. We still rely on sputum microscopy which is quite an ancient test by medical standards for routine diagnosis. To make matters worse there has not been much change in the drugs which are used to treat the disease. We need faster and cheap diagnostic techniques and newer drugs which can be taken for shorter duration and has low drug resistance.

2. We depend quite a lot on fossil fuels. We’re yet to increase our reliance on non-conventional and environmental friendly sources of energy. In fact, we seem to have joined the race of development at the expense of the livelihood and existence our many traditional people groups who live in areas of fossil fuel deposits. We need research on solar energy and other possibilities of energy sources.

3. The human race generates lots of waste. And waste pollutes. Could we have research on minimizing and recycling waste?

4. Non-communicable diseases are a major scourge. Traditional systems of medicine promise quite a lot forprevention and treatment. However, there is very poor research done on their efficacy.

5. Our eco-diversity is under threat. Even some of the foodstuff which was common is not seen of recent. Traditional foods are slowly on the way out. Whatever research was done on them have shown them in good light. More research needs to be done. Can we look at our ancient texts about spices, vegetables and cereals used in ancient times? We not only need to conserve them but also popularise them. It can only be done through proper research.

Few reasons I can think about as reasons for non-acknowledgement of our contribution to science and technology.

a. We don’t document anything. Whatever is documented is done in a language which is not understood by much of the population. Therefore, the first step can be to translate all Sanskrit documents into a commonly used language.

b. We bicker among ourselves. We are famous for pulling each other down. I hope you heard about the story of the Indian crabs.

c. Whatever we discover, we do not share with the wider population. The discovery remains with a few elite and the technology is not shared for common benefit. Documentation in an elite language ensures the knowledge being limited to a certain group of the population.

If we are so sure of our scientific capabilities, I challenge the government and our scientists to take these issues seriously. If we do, I’m sure that the next century is going to be that of India. 

Strokes - blocked/burst arteries

Other than tuberculosis, the next disease group that has sort of overwhelmed us at Kachhwa is Non-communicable diseases. 2 things stand out – stroke and diabetes.

First, I shall narrate about strokes as it has sort of overwhelmed us. Since the last 2 months, we’ve had only two patients with myocardial infarction (heart attack), but over a dozen stroke patients. Quite a high number for a small hospital like ours considering into fact that we have quite good quality healthcare facilities in the nearby towns and cities.

It is a bit concerning that when it comes to strokes, it is the hemorrhagic variety that predominates. Now, when it comes to strokes, there are 2 aspects that have stuck me.

The first one is the stark poverty that many a family is in that prevents them from taking the patient to a higher centre when there is a complication like a stroke. The definitive management starts only once you have a CT Scan.

Even, when they take to a higher centre, the costs are too high that they return early with a discharge against medical advice. Although, Kachhwa is only about 40 kilometers from Banaras where there are quite a few private and government healthcare facilities, the cost of seeking care for a diagnosis of stroke is quite high. The cost is all the more considering into fact that the 40 kilometer journey costs nothing less than 1500 INR.

The second aspect that we remember when we see strokes is the number of diabetes and hypertension patients that we see who don’t have faith in the medicine we give them. I hardly find even one patient who does not have some sort of belief in some root or fruit which they think will heal their disease in one go.

I had the experience of telling a new diabetic about his condition. He was accompanied by his elder brother. As soon as I told the patient that he was a diabetic, the elder brother started a babble on how easy it is to treat both diabetes and hypertension by special diets of juice extracts of gooseberry, jamun and jujube (ber). He told me that he was diagnosed hypertensive few years back and his hypertension was well controlled with regular consumption of these juices.

However, he was gracious enough not to stop me from helping his brother understand a diabetic diet as well as get prescriptions for some medicines.

As both of brothers stood up to leave, the elder one (supposedly hypertensive) requested if I could check his blood pressure. I obliged. It was 200/120. I assured him that so high a value could be because of the stress he must be in of knowing that his brother has diabetes. He was quick to agree. I told him that maybe he lies down for sometime before I took his pressures again.

A repeat after a 20 minute rest showed 180/110. He mumbled that he will go back to his doctor and he left.

I’m sure that lot of my colleagues can identify with me of having such conversations.

There is enough evidence that control of hypertension decreases incidence of stroke.

However, I still struggle with the first issue that we face - - - about poverty. The best bet for the poor is to prevent stroke. Availability of affordable drugs to treat hypertension and diabetes should be a priority.

The other option would be to look at a set of criteria that will help us to distinguish between ischemic stroke and a hemorrhagic stroke. Many have been proposed but none are foolproof.

As for diabetes, I shall write in detail in my next post. We explore options of starting a diabetic clinic soon. Pray for our team . . . 

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.