The first wave of Covid-19 last year had caught India unprepared and the lockdown provided an extended period in which they could try to ramp up the health infrastructure in the country. With the deadly second wave of Covid-19 hitting the country unexpectedly, it exposed the inadequate preparedness and the absence of the systems thinking approach to combat a highly infectious disease that took a heavy toll on lives.
The Covid-19 pandemic is a dynamic problem and there is no real or absolute solution. In this fast-changing environment, every day people come across new interpretations, multiple variants of truth, misinformation, and rumours. It is far too aggressive for any existing healthcare system, anywhere in the world, to tackle the crisis with a predetermined or existing model of treatment. Instead of blaming the governments, it is an important time for all stakeholders to adopt systems thinking in managing the second or future waves of Covid-19.
With regards to Covid-19, what is currently happening in India is not only the country’s problem alone. The United Kingdom, United States, Europe, and Brazil also faced tough times in 2020, but their problems and pains were realised by the entire world. It’s now India’s turn to fight the pandemic head-on.
If what affected the world in 2020 can be termed as CoV-1 then India is undergoing a deadly CoV-2 crisis. It appears that the country would be fully occupied with its implications and impact in 2021 because this variant is evasive and more infectious, thus causing the disease to transmit faster. Moreover, this variant is infecting both young and children resulting in more loss of life. And, it doesn’t respect “herd immunity” either. Back in January 2021, Delhi had declared that they were close to reaching herd immunity, with over 50% of its population having CoV-1 antibodies (Welle, 2021). But now, it is one of the most affected cities in India.
India is learning its lessons fast through the experiences documented in other countries. Some systemic problems do need to be addressed with systems thinking which will require a major shift in mindset, away from linear to circular. Ultimately, the core principle of this shift is that everything is interconnected.
For the response and management of a complex and severe pandemic, like Covid-19, decision-makers need to navigate with an approach to problem-solving that considers each issue as part of a wider and dynamic system. Therefore, India needs to involve much more than a reaction to present outcomes. They need to look into a deeper understanding of the linkages, relationships, interactions, and behaviours among the elements that characterise this dynamic situation and system.
As more and more people become infected, the number of frontline healthcare workers will most likely drop due to the overwhelming exposure to Covid-19. This drop would be a result of workers needing to be quarantined or isolated for a certain period. “Reports from affected countries have revealed in the past that 22% of health care workers were affected in hospitals across Hong Kong, with the initial wave managing to infect 80% of the staff working in the medical wards of Prince Wales Hospital. This is just one example of the magnitude with which this virus has taken a toll on the health workforce” (Nagesh, S., & Chakraborty, S., 2020).
Furthermore, this thinking is not just a healthcare problem. It is a bigger psychological and fear-psychosis problem whereas the moment one is tested positive, he or she panics and feels like they need to be admitted directly to the hospital. It is empirically evident now that with the support of the Covid Care Program run by health-tech service providers such as DayToDay Health India (DTDHI), the majority of patients with mild and moderate severity can be efficiently managed while recovering at home. Over 60% of the hospital beds are currently occupied by Covid patients in India, who are both suspect and positive, as per The New Indian Express, 2020 news report. Moreover, these types of services also address their families’ stress and anxiety by creating a means of holistic management of the patient’s entire care journey while they are sick.
Dealing with a dynamic Covid crisis requires systems thinking, not knee-jerk point solutions. Systems that get implemented during a crisis, are not supposed to be designed in a non-fluid way because of how quickly things change. And, blaming governments is of no use because we are all in this together. The government is in a position where they need to maintain a balance between an economic shutdown and tackling the virus spread as a whole. Even if the decision-makers adopt systems thinking approach, responsible citizens should join the fight against the Covid in the right spirit. We all need to combat the crisis as an individual, family, society, or nation and simply do our part in preventing the spread.
If India adopts systems thinking in its healthcare delivery, it would certainly transform the way Covid is being managed currently. At DTDHI, we believe that tech-enabled human-driven solutions would not only strengthen the country’s fight against the pandemic but also result in proactive and efficient population health management.
The writer is Founder & CEO, DayToDay Health India (DTDHI).
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CAN NATURAL SUPPLEMENTS FIGHT ANXIETY?
Anxiety is the body’s natural response to stress. People suffering from extreme anxiety have experienced a constant feeling of fear, uneasiness, dread, and are almost always worried.
A common question asked by those who seek some relief from anxiety is, “Are there any natural remedies that can help my stress and anxiety?” Yes, there are many naturally found herbs, vitamins and minerals that can give assistance in anxiety, some of which have been utilised for eras and are now certainly earning recognition from doctors and researchers.
Most people think that anxiety is merely a piece of their character or produced by tension in their lives. However, biology also has a crucial function in how you manage your anxiety. Your neurotransmitters, hormones, inflammation levels and reaction to situations all determine how you control your anxiety levels during stressful situations. Unlike medications, which work on a single issue at a time and provide only symptom control, natural herbs, nutraceuticals and supplements for anxiety can help manage multiple systems working together to reach a natural destination at once without resulting in addiction or the body depending on them in the long term.
Nowadays, the general population is progressively embracing a healthy, more natural lifestyle. People are shifting their food habits to organic and natural ingredients. Similarly, when it comes to medication to help manage their stress and anxiety, most people opt for nutraceuticals, food supplements and herbs that are readily available. Here are some popular herbs to alleviate stress and anxiety:
Ginger, a source of naturally found nutraceuticals and healthy enzymes, is known to help stall the brains ageing process. Persistent inflammation and anxiety are factors that influence your brain health. Ginger has naturally found antioxidants and bioactive compounds that assist the fight against inflammation and improve the functioning of the brain as we age and deal with excessive stress.
Ginseng is a resourceful herb listed as an adaptogen. It signifies that Ashwagandha has a notable influence on controlling the body’s reaction to stress. Adaptogens, are agents that influence the hormones and bodily systems to improve how a person reacts to stress and anxiety. It is a commonly recommended herb suggested to women who need assistance to help manage their stress-related issues. It has also proven efficient and helpful in controlling other body ailments such as low thyroid and blood pressure.
Omega 3 rich foods are a source of healthy, natural vitamins and minerals that help the brain stay healthy and combat degenerative brain-specific symptoms. By diminishing the manifestations of anxiety and depression, omega 3 helps the brain function adequately and stay robust. In addition, these foods also help resist memory loss and other age-related brain issues.
Multiple studies have proven that the long-term use of chamomile extract assists in reducing the symptoms of moderate to severe levels of stress and anxiety. Chamomile is a flowering plant commonly used in tea. There are two varieties of Chamomile: Roman and German. Used as an extract, tablet, and as an ingredient in skincare, chamomile has proven to be effective as a stress and anxiety-relieving ingredient.
Co Q-10 is a naturally produced nutrient in our body. It aids energy production and fights off cell-damaging free radicals. Low Coenzyme Q10 levels can be one of the reasons patients suffer from anxiety, depression, bipolar disorder or other neurological disorders. CoQ10 supplementation has helped patients with low coenzyme Q10 levels manage their symptoms and, in some cases, reverse the effects of their ailments.
All these can be naturally sourced or can be consumed through nutraceuticals and supplements available in the market. Many patients believe that anxiety is something that they have to live with permanently. In reality, anxiety is often a consequence of biological irregularities that can be managed and regulated by including the correct supplements and ingredients in their diets. When used with other techniques from meditation, yoga, therapy and integrative nutraceuticals and food supplements can help patients on their path towards an anxiety-free.
The writer is a health expert and founder of Zyropathy.
EXPERT DECODES FACTORS AFFECTING FERTILITY HEALTH
The fertility health of a couple is important for conception. Fertility is the ability to conceive and bear children and to become pregnant through normal sexual activity. When a couple has been trying to conceive for more than a year with unprotected sex without any success, it is time to consult a fertility expert.
Besides biological factors, various other factors like social, environmental, occupation and lifestyle habits affect the fertility health of the couple.
The fertility rate of a population is defined as the average number of children born to a woman of childbearing age (15 years to 44 years). The birth rate is defined as the number of live births per 1000 of the population each year. In the last 30 years, India has seen a marked decline in the fertility rates of the country. According to recent numbers, the fertility rate in India has dropped from 4.82 in 1980 to 2.2 per woman in 2020. This helps in the population stabilisation of the country. On the other hand, subfertility and infertility are on the rise in India and it is a matter of concern for society.
FACTORS AFFECTING FERTILITY HEALTH
Age- With advancing age, the number and quality of the eggs decrease in women. As they approach the mid to late 30s, the decrease becomes more profound. Experts also emphasise that male fertility also decreases with age.
Previous Pregnancy- Couples who have conceived once have a higher chance of getting pregnant again
Duration of Subfertility- Experts say that couples who have been trying to conceive for a shorter duration have a higher success rate for pregnancy than couples with a longer duration of subfertility.
Timing and Frequency of Sexual Intercourse- Menstrual cycle is of 28-days for most women. Women are most fertile between 12 to 16 days of the cycle. Ovulation occurs usually in the mid-cycle around 14th day in a 28 days cycle.
Weight- Overweight and obese women might have irregular periods and face difficulty in getting pregnant. However, experts say that by reducing 5% to 10% of their weight, they can restore a regular menstrual cycle and increase the chance of getting pregnant. Obesity in males also decreases sperm numbers and quality.
Smoking- As per scientific evidence smoking is harmful both in males and females. It decreases sperm quality. According to data, smoking increases the chances of difficulty getting pregnant by 300% (three times).
Alcohol- There are conflicting reports on how alcohol consumption might affect fertility. Some reports suggest that drinking more than five units of alcohol may decrease fertility in women. Excessive Alcohol intake in males is harmful to sperm quality and increases the chances of male infertility.
Medical Conditions- There are some medical conditions like thyroid issues and vitamin D deficiency—these decrease fertility in both men and women.
The fertility rate is dependent on several factors like medical, social, environmental and lifestyle of couple. Lifestyle modification with exercise and healthy diet and a stress-free environment can go a long way in ensuring fertility. Prevention is always better than cure.
The writer is Consultant & Advisor, Birla Fertility & IVF.
DIABETES AND TECHNOLOGY: ENABLING POSITIVE HEALTH OUTCOMES
Technology is enabling diabetes management in several ways, certain apps have simplified it. Compact medical equipment helps in continuous glucose management. There is also remote patient monitoring (RPM) especially with regard to home healthcare companies.
The incidence of diabetes has increased manifold in India and it is one of the most widespread lifestyle diseases even on a global level. Estimates suggest that at least 10% of India’s population will be affected by the condition by 2025. Diabetes requires continuous monitoring and management, the lack of which can cause complications including amputations, blindness, neuropathy, etc. This makes ongoing management, as well as patient education and supports extremely critical, more so during a time when Covid-19 has made things more difficult. However, it is also during these times that technology has emerged as an enabler in managing diabetes. The development of advanced technologies, including apps, glucometers, etc., is enabling people living with diabetes and specialists to manage the condition in a better manner. Technology has also come to the fore in helping with remote patient monitoring (RPM) especially with regard to home healthcare companies. Telemedicine and its benefits in managing diabetes have reached a stage of adoption that would have been unimaginable in an earlier scenario. In fact, a report by IQVIA highlights how the pandemic is an opportunity to transform diabetes care through digital innovation.
Continuous glucose management.
There are several ways in which technology is enabling diabetes management. For instance, compact medical equipment that helps in continuous glucose management has a small sensor that is changed in 10 to 14 days. This is inserted on the abdomen or upper arm and helps take readings in real-time. People with diabetes can thus avoid finger pricking and simply scan the sensor for results. Other advantages of CGM include identification of nightly fluctuations, data storage, reduction of HbA1C levels, and help keep blood glucose levels in a healthy range. Apart from these, there are apps that have simplified diabetes management and control. According to statistics, the usage of such apps is expected to increase at a CAGR of 21% by 2027.
Going forward, technology is set to play a larger role in the treatment and management of diabetes to keep track of vital parameters while limiting face-to-face contact. According to a report, the market for AI in diabetes management will reach $1264.7 million by 2024. It will be possible to enhance the lives of people living with diabetes through algorithms connecting glucose monitors and insulin pumps. This will help in automatically regulating blood glucose to healthy levels.
Digital and data-driven solutions are the future and have the potential to reduce mortality, morbidity, and complications; provide a better quality of life and safety to patients; as well as enable effective diagnosis and management of diabetes in people with the condition. For a better and far-reaching impact, investment in improving existing infrastructure and policies, interoperability, among other things are the need of the hour. The future will be all about innovations in digital health, smart data, telemedicine, and home care models. These will transform and facilitate triaging of those who visit hospitals, need supportive care at home, and even in the realm of mobile clinics for support care.
Last but not the least, regular checkups and monitoring and a healthy lifestyle are the cornerstones of diabetes management. As with anything else, knowledge is power in managing diabetes and increasing your lifespan. Arming yourself with the basics can help you live happily and in better health without letting diabetes affect you adversely.
The writer is President, Medical Services, Portea Medical.
DENGUE FEVER DURING PREGNANCY CAN HAVE SERIOUS EFFECTS TO THE FETUS
Dengue is caused by the bite of an infected Aedes Aegypti mosquito and presents as a high-grade viral fever. Pregnant women need to protect themselves from getting infected with the disease as the occurrence of dengue in pregnant women is on the rise due to a heavy increase in mosquitoes in densely populated areas.
Worldwide there are 190 million cases of dengue, while our country is seeing a 25% increase each year mainly due to ineffective preventive steps to control mosquito breeding. As we look at the statistics, it becomes extremely important to keep your surroundings clean to stay away from dengue. Here are some important things about dengue that pregnant women need to keep in mind.
BEING CAREFUL WHILE YOU ARE PREGNANT
While you are pregnant, it is important to be careful of the places you travel to as dengue is fairly common in more than 100 countries, including tropical countries. Before you set out on your journey, ensure to find out if dengue is prevalent in that country. Also, do not forget to talk to your gynaecologist before travelling. Prevention is better than cure as far as dengue is concerned as an expecting mother infected with dengue has the possibility to pass the infection to her fetus during pregnancy or at the time of birth. Dengue can have serious effects on the fetus including low birth weight, premature birth and even death.
However, if you happen to reside or need to travel in an area with risk of dengue, do remember to protect yourself from mosquito bites by wearing long-sleeved clothes, using a safe mosquito repellent, staying at a place with screens on windows and doors and most important is to take adequate steps to keep your surroundings clean to control mosquitos in and around your locality.
EFFECTS OF DENGUE ON MOTHER
For expectant mothers who happen to contract the infection—adequate fluid intake is the first thing to be prescribed as hydration is crucial to maintain embryonic fluid level. In addition to antipyretics, careful monitoring is important by medical experts.
Besides high-grade fever, persistent vomiting, fluid accumulation, intense headache, retro-orbital pain, abdominal pain, mucosal bleeding, lethargy, liver enlargement, and increasing haematocrit with decreasing platelets are some other symptoms. haemorrhage, severe plasma leakage, or organ failure are some of the presentations of severe dengue. Also, pregnant women infected with dengue have a possibility of pre-term delivery, low birth weight babies and pre-eclampsia.
Effects of dengue on the fetus or newborn vary with possibly less fetal harm occurring earlier in pregnancy. Early detection of dengue in pregnancy and appropriate medical care reduces fatality to below 1%. In view of the risk of vertical transmission, newborns with mothers who had dengue just before or at the time of delivery need to be closely monitored.
In summation, dengue fever also known as a break-bone disease results in severe weakness in patients which can be very dangerous for pregnant women. Timely treatment is the key to controlling the infection in its early stages. Any delay in treatment could result in multi-organ infection, acute respiratory distress syndrome and internal bleeding which can lead to spontaneous abortions and other complications in expectant mothers.
The writer is Gynaecologist, Obstetrician, and IVF Expert, Nurture IVF Clinic.
Pregnant women need to protect themselves from getting infected with the disease as the occurrence of dengue in pregnant women is on the rise due to a heavy increase in mosquitoes in densely populated areas.
Worldwide there are 190 million cases of dengue, while our country is seeing a 25% increase each year mainly due to ineffective preventive steps to control mosquito breeding.
DEPRESSION AND ITS PHYSICAL MANIFESTATIONS
“Our mind controls our body” is true to a great extent as a lot of people having mental illnesses have physical expressions of the same. Of all the mental illnesses it’s primarily depression and anxiety which have physical manifestations to a greater extent. Depression is a mental illness that affects the mood of people, leads to a feeling of hopelessness, reduced attention and concentration. Beyond that, it also leads to a variety of physical symptoms. Some of the physical manifestations which point towards depression are as follows:
Weight Changes: Appetite changes are most seen in depression and people can have either weight gain or weight loss. Some patients feel excessive craving for food and hence they end up gaining a significant amount of weight due to their binge eating. This increase in weight further like a ripple effect leads to various health conditions like heart disease and diabetes. On the other hand, a few people give up food completely owing to their depression and thus experience fatigue, exhaustion and other health issues.
Sleep deprivation: Insomnia is one of the most reported symptoms of depression. The patients who experience sleep deprivation for a long time start seeing effects on their cognition, experience weight gain, have cardiac manifestations and it is also reported to lead to various serious health issues like cancer.
Chronic Pain and Inflammation: Another frequently reported symptom especially in the Asian Population is chronic joint and muscle pains when people are depressed. Breast tenderness in females and headaches which can be debilitating at times are also reported by patients. In these patients, pain affects more due to decreased pain tolerance. Depressive patients also report repeated inflammations or worsening of inflammatory conditions like arthritis, inflammatory bowel disease, and type 2 diabetes. There is some relationship between worsening of these conditions and research is still on to figure out what causes what?
Gastric Problems: As mentioned above, eating patterns start changing in any person who is emotionally deprived or distressed. Eating problems can lead to nausea, vomiting, diarrhoea and constipation. Some patients experience IBS symptoms and treatment of depression will not lead to improvement in these symptoms and treatment requires a lifestyle change. The gut is considered as the second brain so gastric problems are very commonly seen in depression, as the change in the bacteria in the gastric tract precipitate both anxiety and depression. Eating a balanced diet with probiotics can solve this issue.
Heart Disease: Change in sleeping, eating predisposes a patient to cardiac conditions as depression leads to major lifestyle changes and a sedentary lifestyle.
Sexual health problems: The major treatment of infertility as explained by most of the experts is destressing the couple. Depression is seen to affect the libido of people, having a less pleasurable sexual life and hence the effect on fertility is seen.
Worsening of underlying chronic health issues: Diabetes, hypertension, and a lot of other chronic conditions worsen in depression. Hence, it’s mandatory to manage both things simultaneously as depressed patients are not able to follow the advised treatment plans and compliance becomes an issue due to forgetfulness.
Overexpression of physical symptoms is one of the reasons for an increase in the number of patients being reported to the psychiatrist by general physicians and there is a strong connection between physical complaints and depression.
The writer is a Consultant Psychiatrist, Masina Hospital, Mumbai.
TECHNOLOGY IS REVOLUTIONISING INDIA’S PRIMARY HEALTHCARE SYSTEM
Health-tech innovators are building IoT-centric connected solutions enabling patients to manage their health more affordably.
Improving the accessibility, affordability, and quality of care should be the heart of the primary healthcare system. While the Covid-19 pandemic crippled India’s primary healthcare system, it also accelerated digital health transformation across the industry. Digital health tools like point-of-care diagnostic devices, teleconsultation applications, EMR/EHR systems etc., facilitated a rapid response and in turn saw a huge uptake—which has laid a foundation for changes in the delivery of care to improve accessibility, affordability, and quality of care.
Accessibility: About 75% of all healthcare resources such as doctors, hospitals, and diagnostic facilities are concentrated in the urban areas which house less than 30% of the population. This has resulted in a tremendous lack of primary healthcare access for the rural population. People need to travel to address minor concerns which costs them both, time and money, over and above actual medical expenses. It’s easier, in this scenario, to ignore health concerns until serious intervention is warranted. Easily curable conditions like Malaria or Breast cancer lead to mortality due to delay in seeking intervention. Thus, there is a prevalent tendency to ignore health conditions until one becomes sick enough to warrant urgent medical care. This challenge of providing ‘care near home’ is now being effectively overcome by integrated digital healthcare support where point-of-care diagnostic devices, telemedicine consultations, and preventive management of diseases. For example, eSanjeevani OPD, a doctor to patient telemedicine system developed by the Centre for Development of Advanced Computing (C-DAC) in Mohali under the Ayushman Bharat Scheme of the Government of India has improved healthcare access in rural communities. Daily over 40,000 patients use eSanjeevaniOPD to seek health services remotely.
Affordability: India has one of the lowest per capita healthcare expenditures in the world. In fact, it is less than even 10% of the global average. While government healthcare facilities offer free treatment, the cost of medicines and diagnostics is still required to be managed out-of-pocket by the public. Due to the lack of doctors and facilities at government-run hospitals, people prefer private hospitals. Further, the government sector accounts for only about 1/3rd of the overall healthcare ecosystem, and the majority of the services especially in the diagnostics arena are managed by the private sector.
In such a scenario, there is an urgent need to develop and deploy affordable cutting-edge technologies. Health-tech innovators are building IoT-centric connected solutions enabling patients to manage their health more affordably by encouraging preventive lifestyle changes, facilitating disease self-management, and lowering the direct and indirect costs of clinic visits, travel or unpaid time off work.
Quality of care: The application of artificial intelligence (AI) and data analytics in healthcare has significantly improved the outcomes and quality of care. AI’s biggest benefit comes in the form of the ability to repeatedly process data and conduct tasks such as analysis of lab tests, evaluation of scans, offering data-driven medical consultations and customisations as per a patient’s medical history. Computerised patient records can reduce medical errors, improve patient safety, and promote quality improvement in diverse patient settings. AI and Big Data are streamlining the operational process of clinical trials resulting in the development of medicines at a faster pace.
Digital health is vital to strengthen any country’s primary healthcare system. As per World Health Organisation, to make digital health a reality in primary health care, countries must address its key components. These include: building the physical infrastructure, deploying appropriate services and applications, developing a capable health workforce, ensuring a sound legal and regulatory environment, and improving governance, policy, standardisation and interoperability.
Undoubtedly, India has embarked on a path to build a digital healthcare ecosystem There will be greater emphasis on out-of-hospital healthcare for disease treatment and prevention. Handheld and personalised IoT devices will lead the diagnostic and disease management efforts and with the unveiling of the NDHM, integration with health insurance and other components is the next step in this direction.
It remains to be seen if the pipe dream of equal and affordable universal healthcare for all will become a reality courtesy of the digital healthcare innovations taking place in India!
The writer is the CEO of HealthCube.
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