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Dear Friends medico,s non medicos
The modern life style and materializm has made the present generation emotionless. Evey day we hear cases of accident victims lying on the road with no help coming for anywhere.The result the victim dies for want of medical care.
We don,t stop to look at the victim.Everyone wants to reach at his workplace and to avoid delays.Are we so much insensitive ?
Remeber it could be you,your family member and your distant realtive who is in need of urgent medical attention.
Sometimes I feel why it is happening? Is it we don,t want any situation where we are asked to come as witness or police questioning us?
or there are some other reasons.
Even I don,t feel like looking at a place where there is a crowd - it may be accidnet victim or any case of criminal striking an innocent person
The judicial system in India is so time consuming that you don,t want to loose you sleep for helping some one.Many of us have read a story- Baba Bharti and his horse" and dacoit Kharag singh?
Baba Bharti - pleading to dacoit Kharag singh that he should not tell this incident of dacoity to any one one - So that people don,t stop trusting the lepers and sick is coming true?
I wish that medical community can do something. I intend to take an initiative in this regard. So dear friends come out with some incidences in your life where u wanted to help some one but did not?
The reason why and your suggestions " How can we do it ?
I will look forward to your experiences
With regards
Dr.Bajaj
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With all due respect to my fellows countrywide, there are increasing incidents of doctors, intensivists, physically abused ,two of them in a month in gujarat..one of them, a20year old ,post op. deteriorated boy,ventilated, prognosis told, consents taken, expired, and relatives damage the whole intensive unit, take the qualified intensivist on the road ,beat him up brutally untill he becomes critical,nobody on the gathering comes to his rescue..his CCTV catches up all live!! and no media highlights it.....
Another incident in which the pediatrician admits a Severe Birth Asphyxia neonate ,explains prognosis,risk-one the day of holi a relative of the pt.is drunk and enters the NICU,is advised to go outside, and three days later he enters the doctors OPD, and brutally beats him!!!and poor doc.gets a humerous #and scapula #.....
what are we doing all this intensive care for...we go and update ourselves every year so that we benefit our pts..we spend sleepless nights when we ventilate our babies...we keep ourselves in tremendous stress when they are critical,sometimes are questioned by our family about being irregular and workoholics...
And worse, we play the blamegame amongst eachother even when we know that both of us are right in treating...of which the relatives of the patient take full advantage......
summarizing,,KEEP ETHICS INTACT,BE UNITED AS COLLEAGUES, AND COME TO EACHOTHERS HELP ...........
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"ABC hospital holds free medical camp. 400 patients examined and distributed free medicines.
Present on the occassion was chairman and other members of the management committee”. This news is visible in newspapers almost every day with photos of smiling faces of the organizers. One needs to examine the usefulness of such camps. The main attraction is free tests and medicines. It is more like “Behti Ganga mein haath dho lo” Majority of the people come as passerby’s lured by free medicines. Many walk in for tonics. They can get free tests like Hb, bloodsugar,ECG etc. but are either reluctant to go for further investigations required to make a proper diagnosis or want these too to be done free of cost. If the doctors ask the camp organizers to get these done at concessional rates the latter are often found wanting or look the other way. There are many negative points detrimental to the patients in these so called camps
• A huge number of patients to be examined by just 1-2 doctors of the concerned specialty in a matter of few hours. Humanly impossible. Mostly it ends up with small verbal examination. No justification to the patients rather it appears to be a rude joke with them.
• Only some basic tests like Hemoglobin is carried out. Does not it set aside the ethical and professional approach in diagnosis and treatment of an anemic patient?
• Only cheap and generic Medicines (Spurious!) are distributed free of cost, kind of playing havoc with the life of poor patients. Some pharmaceutical companies do put up their stalls at the campsites and distribute some free samples. However the doctors are then repeatedly pressurized later on to prescribe these products in their regular prescriptions. Ain’t these marketing tactics for these companies?.
• Children are given some free (very cheap ones only) vaccines. But after this they are never brought back for he next shots on due dates as the subsequent vaccinations are payable after the camps.
• Similarly patients hardly ever come for follow-up in the regular OPD and if some do venture to come back, expect free treatment for the rest of their life.
In my view these camps are just a hoax meant for ego satisfaction or religious disbeliefs of the organizers. Instead the needy patients should be provided treatment at concessional rates and help of some charitable organizations or philanthropists may be sought to help the economically weaker sections of the society.
Dr.Jasbir S. Chugh
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Title
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are jholachap doctors damaging image of qualified doctors in the society.
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Author
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tarun goel On : 08 Feb 2008
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Medical practice
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Dear Fellows;
Every day we pick up newspaper and find a news saying'profession ko sharamsar kiya'.and at the end of news it says that he was jhola chap,or most of the time they dont even mention.Like in kidney case so called (dr).Amit is not M.B.B.S..Then what is the denition of jhola chap?I feel who is BAMS and practising allopathy and vice- versa;is a jhola chap also,and are more deadly than unqualified ones.
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Plus too exams.... entrance exams...... with great difficulty and might be little interest driven by parents wish, you enter medicine... thinking its fascinating
Toil yourself in govt medical college with poor infrastructure and deteriorating teaching... with greatest difficulty pass out final MBBS..... work like a clock in CRRI thinking life outside is wonderful. Slowly at the end of CRRI period get into the field of depression, competition, work for few thousands in private clinics..
Next the greatest hurdle.... the PG entrance. Toil at the first end and get MD/MS or with ease enter DNB to toil at the last end... PASS or FAIL?
get few more thousands.
Exams dont leave you now too. Yeah we are in a world of superspecialities...... get settled when its the age for your kids to settle..... this is doctors life i feel in india. Where do we go?
In between your own kith and kin fall ill. You cant afford (the treatment)... because now too you are a student getting stipend and not a practitioner.
So many expectations from a doctor. So many hurdles. SO much of stress. At the end of the game meet your school friends.... well settled compsci eng... ready to get anything with money.
AM FORCED TO THINK Y I CHOSE TO BECOME A MEDICO???
Now people want to enhance our basics by making it six and half years.
Yeah a doctor is too service minded that he will serve with nothing.
WHERE ARE WE MARCHING TOWARDS??
am sure if this is projected before each plus too student..... no one will step into this noble profession.
Why dont the higher authorities take all these things into consideration? Why dont they spend their energy in modifying the curriculum and making MBBS self sufficient to handle all problems? Why the demand for superspecialisation? why the doctors are not paid in par with other profession?
IS THIS THE FRUIT OF STANDING FIRST IN PLUS TWO? (i prefer my kids to stand last in the class, get the best job later and have a cool life).
Give him so many hurdles.. to shape him. Pay him less, drag him to the court for all possible things.
After he s a doc born to serve.
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The incidences of a mob fury, hitting doctors and breaking hospitals seems to be increasing with more and more hospitals and doctors being targeted. Is it because doctors are easy ducks and can be manhandled??? It is very convenient to blame a doctor for a patient's death and say it was MEDICAL NEGLIGENCE. But what about the mob and their 'SLAPPING TACTICS'? Who is responsible for the injury, the damage to the hospital and taking justice into their own hands... Why is no one who does this violence ever arrested? This is too disheartening that even after the doctor/hospital asks for police protection, often that is delayed and not provided because of so called political connections.
The doctors need to unite and medical associations and bodies should take a strong stance against this violence. If required PIL should be filed and the court of law should pass laws that prevent these so called justified mobs from behaving the way they behave. There have been instances where a patient does not wish to pay a high hospital bill and has got a mob and condemned the hospital for malpractice! Why should the doctors take this lying down. And when the doctors go on strike to make their case heard, then so called VIPS declare their strike as INHUMAN and doctors as INDIFFERENT. Where are these VIPS when doctors are hit or doctors are mobbed?
It is time for doctors to put their foot down. These mobs do not represent the general population and due to the violence of a few, a large population suffers. Its high time the medical associations fought for this case for tomorrow it could be one of you...
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As a young doctor when you pass out of a medical college with a postgraduate degree you feel on the top of the world as you think you have fulfilled your dreams. Just the next day when you ask the question Now What? and then research into the possibilities you would soon realize that this profession is a wrong one to choose in this country.
I don’t know how many would agree on this? But let us guess on the possible opportunities and also suggest few solutions (though in vain) if it reaches the bureaucrats.
First option- to join a medical college and continue your life as a teacher grooming new students.
ADVANTAGES: serve the poor, be in touch with your subject, involved in academics and more important politics, may have a say in the system and a chance to make policies and contribute to the future, time for family.
DISADVANTAGE: meager salary, not in the limelight, considered as scared of the private world, may become complacent and go downhill in knowledge.
Second option- private practice
ADVANTAGES: fantastic income, can live a luxorious life, can be in news, considered brave and sweet
DISADVANTAGES: no time for family, no ethics or principles, involved in third grade business deals (cut system), can be considered god as patients but killing yourself with stress, may get restricted to the edition of NELSON you studied for your exams and knowing nothing since then.
SOLUTIONS: very simple but in the complexities of politics, corruption and poverty very difficult and seems impossible.
Let say to get into a government job what do you need. No merit friends, just politics and reservation. Do you have someone to pull you, if not forget about it. Even if you managed to get through are you rich enough to sustain that low salary else you won’t afford a meal on the shopping malls. You can sustain your family only if you decide for a simple living. Did you think you would get this after being cream and your fellow engineer friends even in INDIA are earning 3-4 times. So I guess solution is to choose on merit, increasing the salaries and removing the hierarchy, simple isn’t it?
Private world- this is a world of educated business men and not ethical doctors. You can think of ethics only if you are a millionaire. At least in your early days (actually always) you need to get involved in cut practice, and practice different medicine. I really say god help them as all people think that these private doctors are so rich with such luxorious cars. I always think them to be RICH SAD DOCTORS. You know how much they have to compromise on their personal life for this-unbelievable?
I don’t understand why everyone wants to earn more and more and get so busy that they have no time to think about anything not self nor even the patients. I think indirectly private practice is more harmful to patients and I feel good for the poor, who at least get logical treatment in govt hospitals.
The solution here is pretty simple again-GROUP PRACTICE. The seniors can absorb juniors in their practice so that everyone can earn, enjoy family life, involve in discussions, participate in conferences and be update. But the problem is short sight of the seniors who don’t want to part away their money for god knows what?
If no solutions obtained to the above two- what is actually happening in INDIA is BRAIN DRAIN. That’s the third logical option. Come on, doctors are too humans so they do need a decent lifestyle apart from working.
I don’t know how the wave is going to go in the next 10-20 years, I hope the Politicians (new generation) realize that and intervene or as fellow colleagues we should plan something for this great country.
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Traditional Infant rearing Practices In India. Myths & Reality
Dr. Vinayak Deshmukh, MD. (Ped)
Dr Jayant Wagh, MD (Ped)
Dr.C.S.Bhavana Lakhkar.MD (Ped.)
“Just after birth child cries loudly, not only because of glaring lights or harsh sounds around, but he is scared of adults who will introduce many odd things to him”
In this article I have tried to “ live with nature”. We are under strong influence of traditions on child rearing. It is made clear that health education is essential to correct malpractices. Thinking behind all those traditional practices was “ prevention of diseases”. It is amazing to see how much time our ancestors have spent on prevention aspect. Fortunately we pediatricians also have adopted this aspect very well. Exchange of thoughts between old & new thinking will definitely improve, service to our community.
Traditions are also called as social and cultural practices. Some of these traditional practices are still useful to us, some are neither beneficial nor harmful, but unfortunately many of these traditional practices are harmful and have outlived their time. Indices of family background and child rearing practices were highly related to developmental outcome. Traditional and customary child rearing practices are still prevalent in slums, rural areas, & certainly not to the advantage of growth & development of children. Only education on infant health & nutrition imparted to young mothers would correct such age-old infant feeding practices.
Care of umbilical cord: - In olden days and still in some areas of our country delivery attendants cut the umbilical cord with a kitchen knife or any sharp instrument available in house. I’ve seen tribal people cutting umbilical cord with a sharp stone. Cow dung ash or Ghee application on umbilical cord was a routine practice. Application of cow dung ash or ghee was most harmful as it used to cause tetanus in many newborn babies. Amongst all diseases tetanus neonatorum had highest mortality rate. Now a day we cut umbilical cord with a sterile blade & apply antiseptic solution to it, the net result is tetanus neonatorum has virtually disappeared. Hand wash with soap water or alcohol based antiseptic solutions are equally effective.
Keeping the baby warm: - Soon after birth the child is left unattended because the people conducting delivery are busy attending the mother. This is a common practice amongst traditional people & delivery room staff. At the time of delivery the newborn is wrapped in wet clothing. There is plenty of liquor & some blood around. Soon baby loses temperature, as temperature-regulating mechanism is not fully developed in him. He becomes cold & to fight cold he has to burn a lot of calories, resulting into caloric deprivation, hypoglycemia & metabolic derangement. There is a need for second attendant at birth that will take care of the newborn. Trained health workers reduce infant mortality at least by 50%. Fortunately new generations of people are well aware of this & they do make arrangements to keep the baby warm. Our traditional practice is to keep the mother in warm room where visitor’s entry is restricted. In this room kangaroo care, oil massage & warm clothing keeps the baby warm. This traditional practice is very useful.
Baby bath: - Child bathing soon after birth is a common practices leading to a significant drop in baby’s temperature. Still this practice is common amongst traditional workers & medical staff. The idea behind cleaning was good, but it is worth remembering that the baby is in mother’s womb at 38 degrees to which the child is well accustomed, this sudden fluctuation of temperature after bath puts a lot of metabolic stress on the newborn. Ideally soon after birth, no bath and baby is only dried properly & wrapped in dry warmed clothing. Baby should always be kept at a warm place to maintain the temperature. At birth the baby is covered with a cheesy material called Vernix caseosa, which prevents heat loss. This cheesy material should not be washed away & it should be maintained as far as possible, to prevent heat loss from the newborn. Ideally first baby bath should be after the fall of umbilical cord. Baby sponging should be after 48 hrs. Of birth.
Baby clothing: - Baby linen used to be of small pieces of old cotton saris. This linen is ideal because it is very soft, warm, non-allergic, & had good absorbent properties. Every time baby soils it mother could see the soiled nappy and promptly it was changed. Now it’s the era of readymade diapers. They are very popular amongst women, particularly working mothers. Diapers are required to be changed every after 2hrs. If child has soiled it then his urine or stool remains there for 2hrs. Without cleaning, which causes rashes in the groin region. It sounds very unhygienic to me. Homemade cotton nappies and clothing are definitely better. Some studies have claimed "Disposable diapers with super absorbent material are better".
Baby Swaddling -Many countries have got the tradition of swaddling the child. It is a common experience that after swaddling the child goes to sleep peacefully. Probably it restricts baby’s movements so he can enjoy a peaceful sleep. Swaddling should be only for 15min. & not for more than 3 times a day. Swaddling for a long period is occasionally associated with hypotension, hypovolemia, hyperthermia, shock, & rarely a fatal outcome. In our area young babies are put in to rope swing for better sleep. I think it is parallel to swaddling
Breast-feeding: - Soon after birth the child should suckle mothers breast as early as possible. Because of delivery stress, child is low on blood glucose level, & his glycogen stores are limited. His basic need is for high calories, which is fulfilled by breast milk. Traditional belief was withholding breast milk for 2-3 days. Newborn is fed with plain water in which sugar, jaggery, honey, Ajwain or goats or cows milk is added according to availability. Many people were routinely using cows milk diluted with water. All these things were given to the baby by spoon, manually or by cotton swab. Prelacteal feeds delayed lactation &delayed lactation encouraged prelacteal feeds. These are unhygienic practices. People thought mothers do not have milk for first 2-3 days and whatever thick yellow milk comes out of mother’s breast is not suitable for the baby. Ideally this milk is most suitable for baby’s requirement of high calories. Ironically this wonderful gift of god was rejected by our customs. Now it has been conclusively proved that breast milk has enough water to fulfill baby’s requirements for first six months of life. Global health recommendation is exclusive breast-feeding for first six months of life. They do not need sugar, water, jaggery or honey. By introducing all this we increase the chances of having diarrhea in a newborn baby. It has been conclusively proved by a multi centric study carried out all over India that those babies who are exclusively breast fed for first six months of life are the healthiest ones. They suffer from minimum number of illnesses than those babies who were given water or bottle- feeding in addition to breast milk. Net result of these harmful practices was many newborn babies had hypoglycemia, convulsion, brain damage & higher morbidity & mortality. I think this is partially responsible for lowering of I.Q. amongst Indians. Clearly better health education is called for early initiation of breast-feeding and importance of colostrum.
Certain communities have ceremonies to start first breast feed but nobody cared for mother’s diet, as it was very poor. Fortunately mothers start secreting milk during last days of pregnancy. As pediatricians we spend lot of time in convincing mothers to breast- feeding, as early as possible. Silver lining of our traditional practice is mothers were advised to continue breast feeding as much times as she can or as long as possible. This still holds true scientifically today also. I think this is the best piece of traditional practice. Breast milk should not be discontinued for any illness as practiced by some traditional health workers. Earlier cessation of breast-feeding had obvious deleterious effect on child. Breast milk substitute e.g. diluted milk always has low nutritional values. Starving the baby in any illness was one more harmful practice, which should be stopped immediately. Breast-feeding and weaning practices are crucial for the optimal growth and development during infancy. There is no absolute contraindication to breast milk.
PACIFIERS – Pacifiers are used to satisfy the sucking urge of the baby, so that baby stops crying & goes to sleep. Pacifiers are less harmful than thumb sucking in causing dental problems. In some babies it can be habit forming. Pacifiers help in management of gastro-esophageal reflux. Baby friendly hospital initiative advices no pacifiers to be given to breast-fed infants but pacifier’s use may protect against sudden infant death syndrome. In our rural areas usually pacifiers get soiled & causes diarrhea.
Vomiting & regurgitation: - Every time we feed the baby he brings out small quantity of milk. This is not vomiting but it’s regurgitation, as if child spits out excess of milk. Our traditional thinking is that a child having regurgitation is a healthy child and this proves good milk supply from mother. This peace of traditional practice is very true. If child has good weight gain then we should not bother about his vomiting. Reducing the frequency & quantity of breast- feeding after regurgitation in infants was a routine advise by traditional health workers. This was a wrong advice.
Oil massage: - Oil massage has lot of importance in our culture & in many other cultures on the earth. Many scientific studies have been carried out with good results. Massage improves weight gain, length, peripheral blood flow, & induces post massage sleep in newborn babies. Sunflower oil is rich in linolate. It enhances skin barriers function. Mustered oil has some toxic effect on the development of skin barriers. Coconut oil massage has beneficial effects on weight gain in pre-term neonates compared to mineral oil massage.
In India lot of oil is applied to babies scalp, thinking that it will result in early closure of anterior fontanel. But it is not so. Oil massage definitely gives some comfort and sense of well being to the babies, but it cannot be a substitute to mother’s milk. Probably it is more of complimentary to breast-feeding. Basically skin is an excretory organ of our body. It can absorb minor amount of some nutrients or drugs. A light massage with simple coconut oil is as effective as any other oil available in market.
At times massage is so vigorous that I have seen a fractured collarbone or injury to the soft tissues as most illiterate women carry out massage. Massage is basically for the comfort of baby. Infant should not cry during the massage. Most prevalent practice amongst massage professionals is Hasli Nikalna. If the child is crying he stops crying with simple massage & goes to sleep. There is nothing like Hasli. Instilling oil drops in the nose or ear is one more harmful tradition, as it can cause pneumonias or ear damage. Natural ecosystem of ear or nose should not be disturbed.
Kajal & Surma application to eyes-Now we will discuss about the famous tradition of applying Kajal to the eyes. Baby’s eyes should be big and beautiful was the basic concept behind Kajal use. Beauty of the eyes depends on the genetic make up of the parents. Kajal application has only a cosmetic importance. Many babies develop conjunctivitis, Dacrocystitis or watering from the eyes after Kajal application. It is a chemical irritant to the eyes. Occasionally a fingernail by which Kajal is applied to the eyes can cause injury. Surma application can cause high Sr. lead levels in babies. We should avoid this cosmetic plumbism. Traditionally some people try honey or a drop of mother’s milk instillation in baby’s eyes. It has no beneficial effect but it causes lot of irritation to baby’s eyes.
Milk mixed with pulse or wheat powder is used for bathing the baby. Its application improves the skin texture but some children develop skin rash and even dermatitis. Similar skin reactions can occur with the use of baby soap.
Application of black Kajal spots on babies cheeks, forehead or on soles to protect him against all evils has no scientific basis. It’s a question of faith only.
Janamghutti & Balkadu: - let us discuss over the famous practice of administering Janamghutti and Balkadu. These are traditional herbal preparations to improve baby’s digestion, to reduce frequency of colic, and to regularize their motions. These preparations can be readymade or homemade. Our experience is they cause frequent diarrhea in infants. It seems the concept is outdated now.
Gripe water: - Imagination behind using gripe water was it takes care of abdominal colic. Some gripe water contains small percentage of alcohol and some contains sodium bicarbonate that has some soothing effect on stomach. Alcohol puts infants to sleep. At times contaminated gripe water bottle can cause serious infections. Every time child cries people think child has colic, but there are many causes of crying and a very small percentage is due to abdominal colic. Carrying the baby around as colic therapy gives good results. If crying is due to abdominal colic then traditional method of applying oiled and warm beetle leaf to baby’s abdomen and keeping the child in prone position is usually effective. With this method gases in the baby’s intestine expand and easily passed out. This is one of the finest traditional exercises. Children with infantile colic have some problem in family relationship, which should be managed properly. Many parents and even personnel are very enthusiastic about using antispasmodic drops available in market. At times these medications can cause abdominal distension, intentional peristalsis is disturbed and infant becomes more uncomfortable. Use of Such medications should be avoided.
Miscellaneous: -
Tying a black thread around the neck, wrist or waist is a very common practice, which is prevailing in all communities. This sacred thread is supposed to be a protection against all evils. This is the most unhygienic way of fighting against evils as the sacred thread gets soiled in stool, urine, & many other things every now & then.
Many children pass small quantities of stool every now & then. Our traditional thinking is child has bad stomach & so his feedings are decreased. Breast fed babies does have frequent small semi liquid motions, which are perfectly normal. They should not be treated.
Infants make funny, throaty noises & make funny faces. Everybody thinks child is in agony. It is not so. Those throaty noises become meaningful by 4-6 months of age. One can make out his mood from those throaty noises. As the child becomes 8-9 months old for the first time he starts babbling ba. ba.. and ma..ma…
The idea behind this article is to know about our traditional practises, which are acceptable & which are not. With due respect to our ancient traditions we must continue to practice the useful ones and follow the path of modern science.
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We all know about the wonderful difference (in fact between life and death) that breast feeding makes in LBW and VLBW neonates and yet we find that Paediatricians and gynecologists in general do not make that little bit of extra effort to motivate the mother to breast feed and breast feed exclusively. They often take the support of the supposedly special formula available for LBW babies. I cannot think they are all being supported by the Infant Milk Substitute industry , but more so that they do not have solutions to the complaints of mothers that they 'do not have enough milk' and that they want to 'increase their milk supply' or start 'relactation'
the medical fraternity must realize that Lactation Specialist and Human Lactation Management is a science akin to Nephrology or neurology for example and that these cases should be referred to Lactation Consultants. Also there is a need to train both Gynaecogists and Paediatricians in this Specialty.
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Occasionally we come across situations where a decision for ventilatory care of continuation of life support system needs to be taken.
Patients with progressive fatal neurological diseases such as spinal muscular atrophy or even patients with inborn errors of metabolism may present with respiratory failure and then the difficult decision comes whether to put them on the ventilator or not. After all, are we just prolonging the suffering or are we justified in not doing all that is possible- this dilemma always continues. Also with shortage of ventilators all the time, are we preventing a child who needs a ventilator and can be saved by getting the ventilator occupied by a child in whom the outcome is not favorable?
Another area of probing and questioning our conscience is when patients with Stage 3 tuberculous meningitis, patients with downs syndrome and even mentally retarded cerebral palsy patients are not provided ventilator support is because they are “Mentally retarded!!!”. What makes us decide who requires critical care support and who doesn’t. It is very essential to respect the feelings of the parents, help them to make correct decisions which are towards minimizing the patient’s suffering and not on an emotional decision just to hold on. Such decisions are painful and situations need to be handled delicately. We as doctors cannot make the decision, whether a patient should be placed on a ventilator or not… we can also err. Remember all deserve a chance, parents deserve a chance and we need a chance so that no one ever has a guilty conscience. We may not always save a patient but we can always minimize the suffering.
Ira Shah
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