Thursday, August 25, 2016

No. of India’s TB patients may be double the estimate: Lancet

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India's tuberculosis nightmare could be much worse than feared. A new study analysing the sale of anti-TB medicines across India has estimated that there could be two times more drug-sensitive TB patients than currently assumed.

While it was assumed that India's annual burden of TB cases stands at roughly 2.2 million a year, the study to be published in The Lancet Infectious Diseases journal on Thursday pegs this number at over 3.8 million in 2014. This excludes drug-resistant TB cases. The study, jointly done by the Indian government, the Imperial College of London and the Bill & Melinda Gates Foundation, confirmed what has long been suspected: more Indian TB patients seek treatment in the private sector than the public sector.

Dr Sunil Khaparde, who heads the Central TB Division and is an author of the Lancet study, said, "We realised the number of patients coming to the private sector were underestimated, but the new study looked at medicine sales and found that this number alone could be as high as 2.2 million as against the 8 lakh we had previously estimated."

It translates into a three times jump in the number of cases in the private sector. The study's main author Dr Nimalan Arinaminpathy, who is from the School of Public Health at Imperial College, said, "TB is a major global health issue, and India bears a large proportion of the world's TB burden." In fact, it is estimated that India accounts for a fourth of all TB cases.

"The private healthcare sector is a major issue in controlling India's TB epidemic, but so far we haven't had a clear idea of the size of the problem: how many patients are being treated in the private healthcare sector, and how does this compare with the public sector? We have so far relied largely on informed opinion, but in this study we aimed to address this question through quantitative data," he said.

Using data of drug sales collected by IMS Health, he found that India's TB burden in 2014 was 3.8 million instead of 2.2 million. Santacruz-based private practitioner Dr Yatin Dholakia said the fact that India has a higher burden of TB is an "open secret". In a study published in the Indian Journal of Tuberculosis in 2004, Dr Dholakia had found that "in just one Mumbai ward of Andheri," for the 94 cases registered with the government programme, there were 363 cases in laboratories and radiology centres.

AIIMS resident docs hold protest over work, hostel issues

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Scores of resident doctors at the AIIMS here today held a protest on the campus over their demands including those related to working hours and hostel facilities, and threatened to intensify their stir from Friday if these are not addressed. 

Carrying placards and raising slogans like 'Heal the Healers', they took out a march from the coffee shop to the bungalow of the institute's director.

"We have three pending issues, drawing of blood samples, which has been a nagging matter for long time. Drawing samples is the work of trained technicians and not doctors, and since we are also asked to prepare vials and barcode them, it leaves us with little time to attend to patients," General Secretary, Residents Doctors' Association, Dr Harjit Singh Bhatti said. 

The other issues include additional hostels for resident doctors and fixing of duty hours, he said. 

"Our hostels, we were told were supposed to be completed over two years ago, but the construction is still pending. Also, our working hours have not been fixed. So, these three major issues should be addressed by the authorities, otherwise protests would continue," he said. 

The AIIMS campus has about 1,500 resident doctors and the premier institute gets a huge rush of patients, both in the Out-patients Department (OPD) as well as the Emergency Department. 

"We met the AIIMS Director and the Deputy Director Administration and both have assured that our issues would be addressed. 

"They have given us a few verbal assurances that vial preparations would be done by the staff and we would be drawing blood samples only till the next two months, as technicians would be hired for the same by that time," he claimed. 

"We have asked for that assurance in writing in the next few days, failing which from Friday, we would intensify the stir," he said. 

Also, if our hostels are not built by November 30, we will launch an indefinite strike over that issue from that time onwards, he said.

PGI resident doctors in Chandigarh call off strike

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THE TWO-DAY-LONG strike by more than 1,200 resident doctors of PGI to press their demands was called off by the Association of Resident Doctors (ARD) late on Tuesday night.
This followed a three-hour-long meeting with the ARD representatives and senior faculty members, headed by PGI director Yogesh Chawla.
ARD said that the strike was called off after their demands were accepted by the PGI administration during the meeting. However, there was resentment among a group of residents who did not favour calling off the strike.
“We have called off the strike as our demands have been met. We have been given various deadlines by the administration regarding our demands,” Dr Seran Kumar Reddy, president of ARD, told Chandigarh Newsline late on Tuesday night. “From Wednesday, resident doctors will resume their duties.”
However, the PGI administration didn’t invite the residents for any talks till late afternoon.
Around 1,200 resident doctors had gone on a strike since Sunday night in protest against assault on a resident doctor by a family member of a 72-year-old woman who died during treatment at the institute. The strike affected the work at OPDs which caused harassment to thousands of patients. Residents posted in the OPD emergencies and trauma centre were the only ones working.
Thousands of patients were again left disappointed on Tuesday after the PGI administration didn’t issue any registration card after 9 am. According to PGI, only 4,000 patients were examined at the out patient departments on Tuesday.
“People are suffering and administration is not doing anything. It is surprising that resident doctors are behaving like this which is causing harassment to people,” said Ram Singh, a Yamunanagar resident who had come for the treatment of his 10-year-old daughter at the OPD. “The administration should take steps to end the stalemate.”
“My father needs immediate medical intervention. But we were informed that doctors are on strike,” said Gurmakh Singh, a Moga resident who waited for one hour at the OPD. “I never expected that such things can happen in PGI.”
Earlier in the day, ARD, which represents 1,500 junior and senior residents of the institute, served a notice on PGI saying that they would stop providing emergency services at the premier health institute from Tuesday evening. They, however, continued the services till late Tuesday night.
All the heads of PGI departments met twice to discuss the issue. During the meeting, strategies were devised to deal with the patient care if the residents stopped working in the emergencies.
During a press briefing in the afternoon, ARD blamed the PGI administration for creating a “divide” among the residents. “Administration is doing propaganda that what we have done is wrong. They are using a divide-and-rule policy, they are dividing the residents,” said Dr Reddy.
It “pains”, he said, to continue the strike for the second day. “The doctor-patient relations are worsening a lot. There is no proper infrastructure in the hospital; it lacks beds and space,” he said.
Reddy said that the administration had been informed from time to time, but they had given only assurances. “In August 2013, we had taken up the same issues which we have raised today. If we compare both the meetings, the issues are the same. It is three years but nothing has happened. They are falsely claiming that they have sorted out all the problems,” he said.
“Administration is clearly diverting the issue that the resident doctors are affecting the patient care services, which is not true,” said ARD general secretary Dr Saravanan. “The patient care has been affected due to lack of action and ignorance of the administration.”
Asked about a senior faculty member holding some “elements” responsible for the protest, Dr Reddy said, “They have already started the divide-and-rule policy.”
PGI director Yogesh Chawla said that they had agreed to all the demands. However, he added that the administration might invoke the Essential Services Maintenance (ESMA) Act in the institute. “We will have to take a call on it. I cannot alone think about it. We have that in mind. Certainly, we might,” he said.
Asked about the anger among the residents, he said they were overburdened with work. He added that he was unaware if the same demands were raised in 2013.
On the emergency rush, Chawla said that the institute would make a huge emergency and trauma centre at Sarangpur

Wednesday, August 24, 2016

Plea filed in SC against MCI Oversight panel led by Justice Lodha

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A petition has been filed in the Supreme Court accusing an apex court-appointed Oversight Committee led by former Chief Justice of India R.M. Lodha of over-stepping its given job of monitoring the work of Medical Council of India (MCI).
A Constitution Bench of the Supreme Court led by Justice Anil R. Dave, in a judgment in May 2016, had invoked its rare and extraordinary powers under Article 142 of the Constitution to set up a three-member committee, headed by Justice Lodha, to oversee the functioning of the Medical Council of India (MCI) for at least a year. The 165-page verdict had endorsed a Parliamentary Standing Committee report of March 2016 that medical education and profession in the country is at its “lowest ebb” and suffering from “total system failure” due to corruption and decay.
The Committee, also comprises Professor (Dr.) Shiv Sareen (Director, Institute of Liver and Biliary Sciences) and Vinod Rai (former Comptroller & Auditor General of India).
In his writ petition, Vyapam whistleblower Anand Rai, alleged that the Committee overshot MCI and the Health Ministry's disapproval of hundreds of applications made by medical colleges without conducting any “fresh” inspection or assessment.
The petition claimed that the panel, in August, went on to grant recognition and allowed colleges to increase student intake and even extended the time schedule for colleges to remove deficiencies based on which MCI had recommended disapproval of their applications.
Besides its actions being in violation of the strict orders of the Supreme Court, the petition claimed that the Committee acted “not only in contravention of Articles 14 and 21 of the Constitution” but also exhibited its failure to “take decisions which fulfil the test of reasonableness and which are in the larger interest of the public”.
“The impugned decisions of Respondent No 3 (Lodha Committee) have the effect of compromising the standards in medical education and training in India and shall have an adverse influence on the career interests of students undertaking the undergraduate and post-graduate courses in the field of health and medicine,” the petition alleged.
The petition said that MCI had processed several proposals from medical colleges - varying from establishment of new medical colleges to renewal of permissions to increase in seats to grant of recognition to medicine courses for 2016-17.
Of this around 150 proposals for new undergraduate courses and 118 for super-specialty courses for 2016-17 were disapproved by the ministry on the recommendations of MCI after independent verifications had found several deficiencies in the colleges.
On June 13, the petition said, the Oversight Committee intervened to give these colleges a fresh opportunity to furnish their compliances by June 22 to deficiencies pointed out by the MCI.
The MCI was then asked to conduct inspections and send reports of each of these colleges to the ministry before July 20. The MCI did so, reiterating its disapproval.
The petition alleged that the Committee, at this juncture, without conducting any fresh inspection, proceeded to approve the applications of these medical colleges.
Further, the petition alleged, the Committee, on August 12 and 13, approved a “majority” of applications by medical colleges seeking renewal of permission for 2016-17 , grant of recognition for undergraduate courses and increase in intake for 2016-17.

Over 1,200 resident doctors of PGI go on indefinite strike

SERVICES IN the northern region’s premier health institute — PGIMER — were hit Monday as more than 1,200 resident doctors went on a flash strike after one of them was assaulted by a patient’s attendant. The patient, a 72-year-old woman from Ludhiana, died during treatment late Sunday evening.
The strike affected thousands of patients who came to PGIMER OPDs from various states including Punjab, Haryana, Himachal Pradesh, Jammu and Kashmir.
The situation looks set to continue as talks between hospital administration and doctors on Monday failed to end the strike. PGIMER has threatened to act against the doctors if they do not return to work on Tuesday.
The hospital authorities announced that OPD registration would close at 9 am on Tuesday in view of the ongoing strike. On a normal day, OPD registration continues until 11 am.
It was probably for the first time in the history of PGIMER that its main entrance gates were shut for more than two hours late Sunday night and patients were sent back by the resident doctors. However, some of them could gain access to PGIMER emergency from alternative entries. It was only when the doctors were persuaded back inside the emergency OPD for talks that the gates were opened.
Besides a demand for their security, the resident doctors raised several other issues regarding their daily duties asking the PGI administration to implement all those demands instantly.
“The strike continues because our demands have not been completely fulfilled. The administration has only given us assurances rather than fulfilling our demands,” said Dr Amit Sharma, vice-president, Association of Resident Doctors, PGIMER.
There are nearly 1,500 resident doctors, both junior and senior in PGI. Barely 150 of them, mostly senior resident doctors, attended to patients throughout the day on Monday. Strengthening of security with a police post and armed security in emergency OPD, triage system to classify patients based on sickness levels, appointment of phlebotomists for sampling, alternative arrangement for report collections and limiting maximum number of patients admitted to emergency OPD and stopping unnecessary referrals were some of the prominent demands raised by the protesting doctors.
After Sunday night’s chaos, patients who reached hospital early in the morning on Monday and stood in queues for OPD registration were informed that no registration cards shall be made after 8.30 am. Many of them had to return without treatment. “I left home at 6 am and I was not even aware that we will face such harassment,” said Sukhbir Singh, a Himachal Pradesh resident. Singh, who was lying on a stretcher near OPD block, had an appointment at the ortho department after he underwent a surgery last month.
“How can the doctors act like uneducated people? They are beating plates which is very shocking,” said Kuldeep Singh, a resident of Ludhiana. “My mother is unwell. Who will be responsible if something happens to her?”
PGIMER issued a statement in the evening that read, “Resident doctors went on indefinite flash strike on Monday, following which it was decided to reduce the OPD registration timings at the institute. Registration timings of Radiotherapy OPD dealing with cancer patients was not reduced. 4,110 patients were registered in different OPDs of the institute out of which 1,124 were new patients.” However, on average, PGIMER records around 10,000 patients in various OPDs on a daily basis.
The PGI authorities added that ICU emergency and trauma services functioned normally on Monday.
PGI campus is a “silence zone”. Showing no concern for thousands of patients, the doctors carried out a protest march on the roads of the campus, including outside cardiac centre, shouting anti-PGI administration slogans and beating steel utensils.
Regarding inconvenience caused to thousands of patients in the last 24 hours, PGI director Yogesh Chawla said, “We shall investigate it. We shall see how many ambulances returned on Sunday night when the main gate of the institute was closed by the protesting doctors. The moment we came to know of it, we persuaded the protesting doctors not to indulge in such a thing and got the gates reopened.”
Asked what action would be taken against the doctors for creating “indiscipline” inside the campus, head of the Medical Microbiology Department, PGI, Dr Arunaloke Chakrabarti, who was present with the director, blamed “few elements who are disturbing the area”. “We are trying to locate them. This is not PGI’s culture,” he said.
Dr Chawla said if the residents continued the strike, “disciplinary action would be initiated as per rules”.
Sources in the administration said all the heads of departments would meet on Tuesday morning to discuss the measures needed to be taken in view of the strike. A source said that the administration had also decided to deduct the salary of the protesting residents for the number of days they would not work.
In a related development, the Chandigarh Police arrested Harpreet Singh, who had assaulted resident doctor Mani on Sunday night that led to this protest. However, Harpreet and his family have also lodged a formal complaint of medical negligence against Dr Mani and other doctors holding them responsible for his mother’s death. The police have lodged a DDR.
The police also registered a case in another incident in which a resident doctor was allegedly beaten up by an attendant at PGI recently.

Saturday, August 20, 2016

AIIMS docs, nurses fight bloody war over samples

Who should draw the blood sample of a patient: the doctor or the nurse? There seems to be a tug of war between doctors and nurses over this with the administration failing to clarify the issue.
Resident doctors have, in fact, gone ahead and declared they would stop doing it from August 26.
"No resident will draw blood samples of patients or generate barcodes as it is the duty of the nursing staff. It is for the administration to make sure that the nursing staff adhere to their duties and that patient care as well as resident training are not compromised," AIIMS RDA wrote to the director on Tuesday.
RDA general secretary Dr Harjit Singh Bhatti said resident doctors now have to generate barcodes too.
"We end up spending most of our time in the morning drawing and sending samples alone. There is little time left to look at in-patients and addressing their grievances and we have to rush to OPD," he said.
In the US and other developed nations, Dr Singh added, hospitals have specialists to draw blood samples and nurses, too, are well-trained to do it.

Friday, August 19, 2016

Post-reform India produced too many (unemployable) engineers, too few doctors

The doctor- engineer ratio keeps declining among younger people and falls to 15.7 for the 20-24 year age-group. It is commonly believed that more women opt for medicine while men go for engineering. Photo: Mint
The doctor- engineer ratio keeps declining among younger people and falls to 15.7 for the 20-24 year age-group. It is commonly believed that more women opt for medicine while men go for engineering. 
Economic reforms have been blamed by some critics for widening the gap between the rich and the poor in India. They have also created another divide: between doctors and engineers. According to the 2011 census, India has 35 doctors for every 100 engineers in the 60-plus age-group. The doctor- engineer ratio keeps declining among younger people and falls to 15.7 for the 20-24 year age-group. It is commonly believed that more women opt for medicine while men go for engineering. The data confirms this as the doctor-engineer ratio is higher for women across all age-groups. However, the fall in this ratio from the oldest to youngest age-cohorts has been much sharper among women.
To be sure, the ratio was skewed in favour of engineers in the 2001 census as well. However, this gap increased further between the 2001 and 2011 census. In 2001, there were 29.7 doctors per 100 engineers, which fell to 20.7 in 2011. The data also suggests that women became more open to careers in engineering after the 1950s. There were more women doctors than engineers in the 60-plus age-group in the 2001 census. This trend reversed itself in the 2011 census. But as mentioned above, the fall in this ratio from the oldest to youngest age-cohorts is also sharpest among women -- perhaps a function of a rapid strides the IT services business has made in India. Women account for almost a third of the employees in Indian IT services companies
Does this mean the post-reform generation has shunned the medical profession for engineering? There are currently 28000 seats in government medical colleges in India. According to the AICTE website, the sanctioned intake for under graduate course in government engineering and technology colleges for 2015-16 was 67,571. So, it is more difficult to get into a government medical college than an engineering college. To be sure, one can always get into a private college where capitation fees can be paid to get admission. Even through this route, medical college capitation fees are much higher than for engineering colleges, making it difficult to get admission in the latter.
What explains the deterioration in the doctor-engineer ratio? Growth in medical college seats has been a fraction of the growth in the number of engineering college seats. In 1985, 57,888 seats were on offer in engineering colleges in India. By 2016-17, the number had increased almost 27 times to 1,553,711. The 1985 numbers are from a 1989 paper published in the Indian Journal of History of Science, while the 2016-17 numbers are taken from the All India Council for Technical Education’s website. Contrast this with the number of seats in medical colleges. They have risen less than three times from 19,745 in 1985 to 52,205 by 2016, shows data available on the Medical Council of India (MCI) website. To put it differently, India added more than 48,000 seats per year to its engineering colleges in these 31 years. For medical colleges, the increase was just above 1,000 per year. In fact, the medical college seats available in India have only increased by 14 times since independence.
India’s scarcity of doctors is a big problem. The World Health Organisation (WHO) recommends one doctor per thousand people in a country. The latest figures for India are below this benchmark, and much behind that for countries such as China and Brazil. The rapid growth in the number of engineering graduates suggests that India should be ahead of its peers in cutting edge research in technology. Even that does not seem to be true. World Bank data suggests that India’s progress in increasing the number of researchers (in R&D) has been insignificant compared to that made by China and Brazil.
These findings seem to be in keeping with many surveys which describe the bulk of Indian engineers as unemployable. The PG Times reported in January 2016 that more than 80% of Indian engineers remained unemployable. These figures also underline the challenge of maintaining even a minimum standard of education with increasing privatisation. The Medical Council of India (MCI) has been accused of being miserly in granting affiliation to medical colleges; yet, it is scary even to contemplate what the situation may have been in the event of a rapid increase in the number of medical schools, were it to produce results similar to that in engineering. To be sure, a check on increasing private medical colleges has not helped us create a commendable medical education set-up. A Reuters report published last year exposed fraudulent practices in India’s private medical colleges. A Washington Post story published by NDTV showed that more than half of India’s medical schools had not produced a peer-reviewed research paper in a decade.
The government think tank NITI Aayog recently released a draft bill to overhaul the state of medical education in the country. The bill calls for radical reforms including scrapping of the MCI, allowing for-profit medical colleges after doing away with capitation and other hidden fees, and tapping the pool of qualified doctors to meet a shortage of faculty . While there is bound to be a debate on the effectiveness of such regulation in ensuring quality private medical education, there can be little argument over the fact that all such strategies should ultimately keep in mind the inability of a majority of poor people to pay for healthcare.