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HOW FEMALE DOCS ARE BALANCING THEIR WORK AND WELL-BEING IN COVID TIMES

Five female doctors open up about dealing with the pandemic while adhering to the Covid-19 norms, battling stress, anxiety, and concerns about the safety of their family.

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Not just male doctors but female doctors too stepped up during the coronavirus pandemic at the cost of their own well-being and mental health for the welfare of the patients. While dealing with the pandemic for almost an year now, they have realised the need to take care of themselves is as crucial as it is to treat and care for their patients. The lady doctors gave us a peek into the issues they face while being on Covid duty and how they fight the fears at home.

The thought that by going for a job, I was potentially endangering my family at home, an ageing mother, and a small child, was terrifying

When the Covid-19 cases started rising in 2020, the fear and apprehension were palpable, it was in the air, and as much as we train ourselves to turn off the noise before we go home, it just wasn’t possible this time. The thought that by going to do a job that was an essential service, I was potentially endangering my family at home, an ageing mother and a small child, was terrifying. But we had a strong department and great co-workers who understood that as women, we now have the added responsibilities of online schools and housework, in addition to longer hours at work and emergency calls. Chores like cleaning, sanitisation, and cooking was sometimes overwhelming. It was at this time that another woman physician told me something that will stay with me: Imagine that life is like juggling two types of balls, some are rubber, and some are glass. Learn how to let the rubber ones fall as they will bounce back but hold on to the glass ones, take time and energy to keep them from breaking. For me, one of those glass balls was my mental health and peace of mind. I learned to identify small things that gave me peace. It was a small haven of normalcy where I didn’t have to think about Covid or the fear, apprehension, and sadness that came with being a first-hand witness to its effects on patients and friends in the hospital.

– Dr Lakshmi Vaswani, Assistant Pathologist, Bhatia Hospital, Mumbai

We can’t let our guards down and have to be vigilant

Doctors are at higher risk of contracting Covid-19. To reduce the risk of infection, patients are screened for temperature and signs of respiratory infection before they enter the OPD and they are tested for Covid before admitting them for an operation or a patient procedure. Doctors are wearing gowns, face mask, face shield and are sitting behind plastic screens to keep the person to person contact minimal. Hygiene is maintained and surfaces are cleaned regularly. There is always a risk of infection and we may carry it home and infect our family members.

I maintain social distance, wear a mask and use a hand sanitiser. In the hospital premises, overcrowding is avoided and patients are called on appointed time. After going home I change my hospital clothes, take a bath and then interact with my family. I have received the first dose of vaccine and elderly people also have started getting vaccinated so I hope that things come under control and we can relax a little bit but we can’t let our guards down and have to be vigilant.

– Dr Navneet Kaur, General Physician, Apollo Spectra Hospital, Nehru Enclave, Delhi

We are working hard for the welfare of the patients since last year to control the damage caused by the deadly virus

Coronavirus pandemic wreaked havoc worldwide. Even today, the world continues to battle the virus despite assumptions that “Covid is over”. When the crisis first spread, the frontline healthcare workers faced challenges and apprehensions. Besides coping with coronavirus, we were calming Covid positive patients and their families. We are working hard for the welfare of the patients since last year to control the damage caused by the deadly virus. It has been a war-like situation where the enemy is an invisible force. Along with attending patients we also updated their families via video conferencing.

In all this chaos, we needed to take utmost care of ourselves as the risk of catching the infection and infecting the family loomed over us. We worked straight for 14-15 hours while wearing PPE kits. Some of us had to even shift to solitary accommodations to ensure the safety of our family and take rest. To reduce the risk of transmission we had to quarantine ourselves. We took safety measures like sanitisation of the house, wearing a mask at home, and maintaining a safe distance from family. Many of my colleagues including me are Covid warriors, we kept on serving society and helping people get back on track.

The government, healthcare workers, and scientists showed their resilience in the face of the pandemic. Without the tireless work of the vaccine researchers, we wouldn’t be able to get a way out of the global crisis this fast. Slowly, the scenario is improving and we hope for the best. -Dr Manjusha Agarwal, Internal Medicine Expert, Global Hospital, Mumbai

Our only focus is to provide uninterrupted medical care to the patients

India is fighting the Covid-19 crisis for over a year now but the situation has improved when compared to the previous year. Doctors encountered challenges during last year like working day and night to control the damage wreaked by the pandemic. We needed to keep a constant check on the patients via telecommunication and video conferencing. Even doctors were under pressure and overwhelmed because of the spurt in the Covid cases. We were gruelling inside their PPEs and eating, drinking, or going to washroom seemed like a task. At times I used to blackout due to the continuous inhaling of my own CO2 in the PPE. Our only focus is to provide uninterrupted medical care to the patients. We feared that we would get infected which kept us away from our family for days.

We continued to give joy by delivering babies during the pandemic. I was fortunate to get good support from my husband and kids and that kept me going through the pandemic. We had to comfort the patient so that he/she doesn’t feel lonely and recover fully. We counselled the patients and helped them beat their postpartum blues. We also supported and took over a lot of our elder doctors workload to keep them safe as they were more vulnerable and being in the right age bracket of having experience but having a bit less vulnerability increased our workload.

I opt for double masking , avoid taking any equipment from the hospital to home, sanitise my hands and the house, and disinfect all the frequently touched surfaces at home. I also exercise and follow healthy eating habits to enhance immunity.

-Dr Surabhi Siddhartha, Consultant, Obstetrician & Gynaecologist, Motherhood Hospital, Kharghar

There’s a constant fear that what if we are bringing the virus to our homes and infecting our children

We have been adversely affected by the pandemic. As the coronavirus outbreak began to infiltrate our daily lives, doctors face daily risks and can’t even take a step back. The challenge is not only to cope with the virus but also to calm the patients affected by the virus. So, like anybody else, we also seek help from family and friends. When we are working, we ensure that we take small breaks in between to unwind ourselves and take a stroll inside the corridor of the hospital even as we adhere to all public health protocols since we are testing Covid samples too.

We have a highly motivated team that makes these tough times bearable. The chances of contracting the infection in us are more as compared to other people but we hardly pay attention to such thoughts and keep doing our work. When we visit home, there is a constant fear that surrounds us what if we are bringing the virus to our homes and infecting our children. That stress is always there. But now our kids have also become equipped with the situation and they don’t come near us till the time we don’t scrub ourselves.

-Dr Gauri Agarwal, Founder, Genestrings Diagnostic Centre and Seeds of Innocence

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Health & Wellness

IMPORTANCE OF EATING HEALTHY AND NUTRITIOUS FOOD FROM CHILDHOOD

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Nutrition plays a crucial role in the wholesome growth of a child—both physically and mentally. A balanced diet is recommended for children so that they do not suffer from cognition and immunity-based health hazards.

Children’s brains are capable of developing at a very fast cadence. Interestingly, by the time children reach a stage where they begin to attend primary school, their brains already progress at a very high pace compared to any other point in their life cycle. We frequently make use of the terms “growth” and “development” synonymously while discussing children growing up, but in fact, these are two very different qualities. Growth implies a quantifiable enlargement in dimensions of the body, such as height and weight; on the other hand, development implies the acquisition of perceptions towards surroundings, attitude, behaviour patterns, and socialising skills. Apart from growth and development, the third most crucial dimension is maturation, which refers to the progression of a child into adulthood at a certain time, depending on the sex of the child, and other biochemical factors. All three aforementioned dimensions of progress in children are facilitated by good nutrition.

When children are deprived of essential nutrients in food, they get malnourished or undernourished. Malnutrition is a state when an individual’s diet is not capable enough to make available sufficient nutrients required for optimal health. It can be due to a variety of underlying socio-economic reasons—low-income sources, difficulty in obtaining food, and other physical and mental health circumstances. Malnutrition severely affects growth, development, and maturity amongst children. In the 2020 Global Hunger Index report, India was ranked 94th out of 107 countries. India harbours more than one-third of the world’s malnourished children. 50% of children, below 5 years of age die because of sheer undernourishment. Most of these children belong to underprivileged and destitute families.

The Government of India considers the health of children an important concern. Hence, various central and state schemes are being executed in full swing, to eradicate hunger. They consist of Integrated Child Development Services (ICDS), National Children Fund (NCF), National Health Mission, Midday Meals Scheme, amongst many others. Under the government’s supervision, various steps have been taken in the direction of nutritional security amongst children and vulnerable citizens. These include setting up community kitchens, adding protein-rich supplements to the Public Distribution System, which includes pulses and millets, etc. Various Non Profit Organisations are also executing hunger annihilation projects in the same direction. It requires a partnership between all the entities involved in hunger annihilation in order to actually help the country progress.   

The children of today become the powerful and progressive youth of tomorrow. They must be protected and nourished adequately. Our efforts as individuals must never fell short when it comes to the children of our country, and hence it is important to join forces and work together for a brighter future for our children. Food must always remain a fundamental necessity and not a luxury!  

The writer is the Founder and President, Wishes and Blessings NGO.

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Health & Wellness

WHAT ARE THE CAUSES AND TREATMENTS OF ACNE AND PORES?

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Acne or pimples as it is commonly known is not just a teenage problem. It can happen to anybody at any time! Men and women included. The zit that you have been itching to pop happens when the skin pores become blocked with oil, dead skin cells, debris and even bacteria.

This is why it is important to keep the skin pores clean. When clogged, the skin can not breathe and oil and bacteria find a merry ground to cultivate and cause different kinds of acne. There are millions of pores on the skin and they keep the skin healthy, ensure even distribution of sebum (aka keeps its moisturised) and keeps the skin cool.

The cause of acne and enlarged pores

The pores open outwards to a follicle that has hair and a sebaceous gland. Any disturbance in its function can cause the pores to become enlarged, clogged and turn into blackheads, whiteheads, pimples and other kinds of acne. The common well-known causes of acne and enlarged pores includes

• High level of sebum production

• Loss of elasticity of the skin around the pores

• Hormonal imbalance

• Dirt and pollution

• Sun damage

• Reduction of collagen

• Genetics

• Medications

• Stress

• Diet high in processed food and refined carbs

Of course, we all know or have heard about period pimples but there are some little known reasons that also might be causing those unsightly zits. Some of these are:

• Hair products coming in contact with the skin

• Not removing makeup or using the incorrect makeup remover

• Facial hair removal using topical products

• Too many skincare products and switching products too often

• Heavy sunscreens

• Your cell phone. The surface can transfer bacterial on the skin

Not treating acne or relying solely on home treatments will not bring in the much-needed relief. Acne and large pores are not a threat to your life but can be a bit of a downer for self-esteem and sometimes physically painful too.

Most of the time if you are careful in not popping the zit, it will go away in some time but if there is a pattern to the appearance then your dermatologist is the go-to person for long time relief.

The good news is that simple home care and some professional treatments can help get clean the pores and remove the acne without leaving any scars behind. Treatment depends on the type of acne, your age, the severity of acne and type of acne. Here are some popular treatments recommended by skin specialists worldwide to control acne:

• Medications – There are two types of acne medications one that is applied topically and the other that you have to take orally. Topical medications include:

Benzoyl peroxide cream and gel. This helps in killing the bacteria and drying out the pimple. Use it only on the pimple.

Salicylic acid is a common name for over-the-counter acne medications. This helps by removing the dead skin cells and keeping the pores clean.

Azelaic acid kills the microorganism and reduces swelling and inflammation

Vitamin A derivatives include retinol products that not only prevent clogged pores but also get rid of the signs of ageing. These can be used on the entire face safely.

Glycolic acid works by exfoliating the skin and improving collagen production and thus keeping the pore size in check.

Niacinamide is a popular vitamin B derivative it controls inflammation and reduces excess oil production and thus keeps moderate acne in control.

Oral medications include antibiotics, oral contraceptives and isotretinoin. Contraceptives are commonly given to women and contain a combination of estrogen and progesterone and they target the underlying cause of acne, that is, hormonal imbalance.

• Dermabrasion and microdermabrasion – these professional techniques remove the top layer of the skin using a rotating tip. These are mostly used to remove the dead skin cells (preventive measure) and treat acne scars.

• Photodynamic therapy – Using lasers and lights to reduce oil production in the follicles and preventing bacterial development

• Chemical peels – Specially formulated chemicals are applied to the skin to exfoliate the top layer. This treatment is not a permanent solution.

• Removing blackheads and whiteheads – the blackhead and whiteheads are removed using a special tool to keep the skin pores clean and breathing.

• Cystic acne – For Cystic acne, Cortisone steroid injections are used to bring immediate relief and improve acne healing.

● • Micro-needling – This treatment is specifically used to make the pores appear smaller and improved collagen production. This indirectly helps in controlling acne.

At home, you can do simple things like using skin suitable cleanser morning and night, protecting your skin from the sun, avoid contact with friction such as phones, hats, helmets etc., avoid using greasy products, drinking an adequate amount of water and avoiding ‘breakout’ food to keep the acne and enlarged pores at bay.

The writer is a Consultant Dermatologist, Cosmetic Dermatologist & Dermato-Surgeon, The Esthetic Clinics.

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FROM PROMISE TO FULFILMENT: HEALTHCARE STARTUPS WILL BUILD INTERNET OF MEDICAL THINGS IN INDIA

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Even before the Covid-19 pandemic, healthcare was one of the most critical issues in India, from both access and cost viewpoints. Having limited resources means doing more with less, and nothing enables that better than technology. In the last 18 months, the emergence of healthcare and health-tech startups has demonstrated that admirably.

Here is the scale of the challenge in healthcare: India’s allopathic doctor-to-patient ratio is 1:1596, compared to the WHO standard of 1:1000. India is ranked 145 out of 195 countries on the Health Access and Quality (HAQ) index, a global metric created by the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington in Seattle, USA.  

At the same time, in June 2021, India had 5,705 startups that focus on healthcare, according to Traxcn, a research firm that tracks technology investments. According to the same firm, investment in India’s health-tech sector from 2014 amounts to roughly $3.4 billion.

As our 2020 report “Igniting Startups with Investor Insights”–that we wrote in partnership with KPMG–said, health and technology would be the fastest growing sectors that startups and private equity investors would be betting on.

SURVEYING THE LANDSCAPE

India’s health-tech universe is a widely varying one, and experts identify several areas. Most, however, are concentrated in a limited group: telemedicine, online pharmacies, homecare, and diagnostics. In other words, they focus on improving access and care.

Telemedicine was one of the areas where the impact of health-tech was most visibly felt during the pandemic. A report by IAMAI-PRAXIS found that telephonic and video consultations with doctors went up by 300% during the pandemic (still ongoing). Orders from e-pharmacies went up 200%, mostly from patients with chronic conditions.

Apollo Health, a healthcare player with a large presence, has set up teleclinic centres in rural locations; video chat technologies allow patients to consult doctors directly. But several health-tech companies offer more than just teleconsultations. Consider Practo, that helped to create scale in direct-to-patient, app-based solutions. This startup offers a whole package of services that includes insurance claims filing, electronic health records, and even links patients to a network of doctors and hospitals.

Other health-tech startups that enable more efficient doctor-patient consultations include Lybrate, DocsApp, and MFine. A report by the McKinsey Global Institute estimates that by 2025, telemedicine will account for half of all patient-doctor consultations in India. There’s a bonus: it will save $4 to $5 billion in costs since telemedicine visits are 30% cheaper.

Access to medicines has been another challenge. According to a 2018 report from Research and Markets, a market intelligence provider, India’s 850,000 retail pharmacies are still only able to meet 60% of total demand. Firms like 1mg, PharmEasy, Netmeds, Medlife, etc., have emerged to address that gap. 

FROM HEALTH-TECH TO DEEPTECH

In recent years, people have started paying greater and more regular attention to personal health management. Health tracking apps like Maya and PregBuddy, for example, help women monitor their periods and their conditions during pregnancy.

Many fitness and nutrition startups have emerged as wellness gained importance. Fitternity, Cure.fit, HealthifyMe, GoQii, and HealthKart are among the prominent ones. There are several business models, for example, GoQii has a wearable device with remote trainers. Yourdost and InnerHour focus on mental wellbeing.

The home healthcare segment continues to evolve, from simple testing, taking care of the elderly, cancer support, pathology sample collection–many remember the flurry of RT-PCR testing at home during the pandemic–to physiotherapy and home nursing.

More than 75% of all clinical decisions depend on diagnostics, so it is only natural that health-tech goes there too.

This is where artificial intelligence and data analytic—the high-tech end of health-tech—come in. Qure.ai, NIRAMAI Health Analytix, and SigTuple enable faster, better diagnosis, using deeptech to analyse radiology, pathology, and medical imaging reports. 

Some innovations address indirect health issues. The BabyLabel LLP, for example, makes CO2Care, which are small canisters to be placed in any masks to protect against airborne virus infections like Covid-19. These canisters have the material in them that absorbs CO2. It addresses concerns over CO2 buildup in masks worn for extended periods. Research indicates that increased CO2 concentration could result in people suffering from fatigue, headaches, and a loss of concentration. 

There are other areas in which health-tech startups become deeptech or IP-driven, innovator firms: medical devices, biotech R&D, biopharma, healthcare IT services, even genomics. The possibilities seem almost endless, integrating healthcare and technology to make the extraordinary possible. 

FUTURE OF HEALTH-TECH IN INDIA

Viewed in terms of size, the market for healthcare technology does not seem impressive, at an estimated $2 billion or roughly Rs 15,000 crore. That’s less than 1% of the overall healthcare market which according to many analysts, will be $372 billion in 2025.

But it’s the impact that healthcare startups and health-tech will create that matters. Health-tech is expected to grow at 39% on a compounded annual growth rate and create 40 million new jobs by 2030. The government has introduced several elements of a national digital health ecosystem that, when it all comes together, will have exponential network effects. 

In July 2015, while launching the Digital India Initiative, Prime Minister Narendra Modi said, “I dream of a Digital India where quality healthcare percolates right up to the remotest regions powered by e-healthcare.” Health-tech startups will reshape how healthcare is delivered in the next decade and make the realisation of that vision possible.

Aman Gupta is Co-founder & Managing Partner at SPAG and Christina A. D’souza is the Healthcare Practice Lead at SPAG.

Health-tech is expected to grow at 39% on a compounded annual growth rate and create 40 million new jobs by 2030. The government has introduced several elements of a national digital health ecosystem that, when it all comes together, will have exponential network effects.

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Health & Wellness

WHY PRE AND PROBIOTICS WILL PROTECT YOU AGAINST INFECTIONS LIKE COVID

Ajoy Prabhu

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Did you know that an infant cannot digest about 30% of the nutrients in mother’s milk? Wasted calories, we scientists thought. But in nature, nothing goes to waste; there is a reason for everything. Recent studies have shown that mothers produce this nutrition, not for the infant, but the bacteria and other microorganisms that live in the infant’s gut. This is the first fertiliser that the infant’s gut bacteria get- its first prebiotic shot!

In my earlier articles, I have explained how the gut (more correctly, the microorganisms in the gut), control most functions in animals, not just humans. They control the brain, the lungs and probably many other organs systems that we have not yet discovered. Here, I am hoping to shed some light on the best ways to feed and nurture our gut microbes and why it is important to do so.

More than a hundred years ago, a Bulgarian scientist by the name of Metchinkof noticed that those that ate fermented products such as pickles and yoghurts, tend to live longer, had greater protection from diseases (remember, this is before antibiotics were discovered), and if infected, would recover faster! How apt is his observation in today’s day when we are ravaged by Covid-19?

Let’s revisit what happens when we eat something. Part of what we eat goes to our human cells and is used for our growth and repair. The other part is used by the gut microbes. One must wonder why “waste” this food on them, and why eat it, to begin with. The reason is that these gut microbes do way too many things for us, human beings. To start with, if their numbers are high, then other “bad” microbes (pathogens) that accidentally find their way into our bodies cannot grow. They are simply crowded out by these “good guys”.

Another benefit they provide is by metabolising food into compounds that we as humans cannot produce. A primary example of this is vitamin B12. There are other similar compounds of course, but we needn’t worry about them.

A third but extremely important function they do is be the gatekeepers of what comes in contact with our gut cells so that they can be properly absorbed? This helps keep the gut lining intact and does not lead to what is now known as the “leaky gut” phenomenon. Leaky guts are the primary cause of tiny pockets of inflammation (more on this topic in another article).

Finally, these microbes produce—neurotransmitters and immunomodulators – just fancy words for chemicals that control some of our nervous system, our brain functions and our immune system.

If these little guys can do so much for us, shouldn’t we feed them right? These foods are what we call prebiotics. Simply put, prebiotics is the food that gut bacteria thrive on. Feed them right, and they will help us fight infections like Covid-19.

And what about probiotics? These are the actual gut bacteria taken in capsule, liquid or even spray form. How do we know that these microbes are the “right” ones?

For that, let me go back a bit. When I went to medical school, studying advanced microbiology, I had an old Russian professor that made us do an experiment that, at the time, I thought was weird. He told each of us to go to specific areas, find the type of microbe to expect there and to try and grow it. I remember I was assigned to a small pond outside another campus. To find the bacteria in the water was not an issue at all. The problem was in growing the bacteria. No matter how hard we tried, we could see them under the microscope, but we could not grow them! The lesson we learnt from it was that similarly there are billions of bacteria all around us and inside us that we cannot grow, but only observe.

That was in the ‘80s; science has come a long way since then. Instead of trying to grow these bacteria, we can now sample our gut and look for genetic sequences to identify what bacteria they belong to. It is like having a wet dog in a dark room with you. From the smell, you know, there is a wet dog in there somewhere, but you can’t catch it! Similarly, we can now “smell” these bacteria out, even if we cannot catch all of them.

Notice I said, we can’t catch all of them? So, therefore, it is reasonable to assume that we have some beneficial bacteria that we have grown that are certainly found in our gut. These have already been put into capsules, gels and liquids to be taken as a probiotic supplement to add to what we already have. Think of this process as adding new friends into our gut.

The question is if we already have these in our gut, why are we adding them? The answer lies in antibiotics. Antibiotics are like little bombs going off in our system! Contrary to popular belief, they wipe out not just the pathogens, but all other bacteria that are very similar. Some studies have shown that after a single dose—not just a set of tablets—after a single tablet, the time taken for our gut to completely come back to the original state is—are you ready? One full year! Think about the damage that this causes! The best way to avoid this is not to take antibiotics for trivial things such as a viral infection; for antibiotics work only on bacteria, and secondly, if the bacterial infection is mild, we should allow our body’s defence mechanism to do the job so that it learns. If we just cannot avoid antibiotics, then we always recommend probiotic supplementation with the good bacteria we have been able to grow in the lab.

How about the ones we cannot grow? The answer lies in the prebiotics. Think of the vegetables and fruits we eat as prebiotics—fertiliser for the microbes. Most times, we’d recommend adding fertiliser to these in the form of vegetables and fruits- mostly anything with a high amount of fibre and a compound called oligosaccharide. In actual practice, what that means is that we should eat foods containing high amounts of these compounds.

Fortunately for us, there are some scientists, unlike me, that are still working in labs. Enter Professor Gibson and Professor Rastall, both of Reading University, UK. They have painstakingly ranked fruits and vegetables (for meat, dairy and fish do not carry the compounds that these microbes need) that have the highest compound that the gut microbes love. Their results show that garlic, onion, spinach, cabbage, cauliflower, broccoli, citrus fruits, watermelon and all types of berries will probably be superfoods for the gut microbes. Right from birth, we learn that our mothers are always right! Eat those prebiotics and take probiotic supplements as needed and Covid-19.

The writer is Co-Founder & CTO, Circee Health Pvt. Ltd as well as a medical scientist, innovator, and serial entrepreneur.

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Health & Wellness

IMPACT ON NON COVID TREATMENT DURING PANDEMIC

Dr Pankaj Anand

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Corona

The Covid-19 pandemic has tested the entire world with numerous unprecedented challenges and in a resource-limited country like ours, the pandemic has had a devastating effect on people and all the services especially, it has overburdened the healthcare system. While battling with the pandemic, another silent pandemic might emerge in the coming days because Covid has adversely impacted the non-Covid treatments ranging from cancer surgeries to teeth and eye issues, heart surgeries, kidney and liver diseases, diabetes, hypertension, and so on. In 2021, during the second and more virulent wave, when hospitals were struggling with oxygen supply and non-Covid beds were also occupied by Covid patients, many people with pre-existing comorbidities had suffered due to inadequate medical attention. The pandemic has transformed our lifestyle completely. This has forced people to stay indoors, work from home for long hours, depending on online services and therefore, the sedentary routine has accelerated the growth of various non-communicable diseases.

Non-communicable diseases (NCDs) refer to a group of diseases that affect individuals over an extended period and are the result of a combination of genetic, physiological, environmental, and behavioural factors. Some of the behavioural risk factors include an unhealthy diet, lack of physical activity, and tobacco and alcohol use. Factors such as ageing, rapid unplanned urbanisation, pollution, and globalisation also are contributing to the rise of NCDs around the globe. As the pandemic has become a global threat, NCDs are also one of the major challenges for public health in the 21st century, not only in terms of human suffering, but they are also causing a socio-economic burden to the nation. The Indian population has high rates of gastroenterological & liver diseases, uncontrolled hypertension and diabetes. All these either are risk factors for severe Covid-19 and mortality or Covid itself can lead to serious systemic consequences affecting major organs.

According to a WHO report, 61% of all deaths in India every year are because of NCDs. Given that Covid-19 is here to stay for an extended period, India needs to have an equal focus on treating NCDs as coronavirus becomes fatal in people living with pre-existing non-communicable diseases, and many people who have lost their lives due to Covid had some of the other pre-existing non-communicable diseases. It is crucial to remember before any further pandemic waves hit the country, besides treating the Covid patients and securing a particular percentage of manpower resources, ICUs, and beds for them, hospitals should prioritise treating the critical cases of NCDs given that ENT specialists, nephrologists, cardiologists, oncologists, etc. can’t be involved in Covid treatment. The resources and the bed and other required facilities should be equally divided among Covid and non-Covid treatment to prevent the wave of the non-Covid pandemic shortly. It is important to focus and invest in better management of NCDs. Since the scale of risk for NCDs essentially depends on timing and outcomes, the necessity of the hour is robust preventive measures, screening, and timely diagnosis, particularly, the urgency lies in protecting the vulnerable groups. Digital interventions need to be developed and disseminated fully in remote parts of the country to enhance the accessibility of health services. A better, resilient, and sustainable health system can be built with the successful implementation of AI and predictive models to predict stroke, cardiac arrests, etc.

The sheer population of our country throws an enormous burden on our modest healthcare infrastructure.

As the best practice to prevent any further complicated disease, patients should continue to follow a balanced diet, exercise regularly, and not skip their regular medication. Moreover, Indian populations need to shift the mindset from reactive to preventive because many Indian populations miss out on regular health checkups as they don’t feel the urgency unless they suffer. A more conscious approach should be taken towards regular diagnostics checkups to reduce the NCD burden. People should know the shutdown of routine clinical procedures will certainly lead to another catastrophe.

The writer is a Senior Consultant Critical Care & ICU at Fortis Escorts Hospital, Jaipur.

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Health & Wellness

THE ANTICIPATED NUTRITIONAL CRISIS CAUSED BY PANDEMIC IS CONCERNING: DR DESAI

Dr Anish Desai, Director, Intellimed Healthcare Solutions & Chief – Expert Medical & Scientific Advocacy Board, ENAC spoke to The Daily Guardian about major issues around nutritional problems of India and much more.

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Q. Tell us more about the theme of National Nutrition Week for this year “feeding smart right from start”?

The theme for National Nutrition Week 2021 is “feeding smart right from start”. Early complete, balanced nutrition in children is necessary for growth, brain development and strong immunity. Emerging evidence suggests that nutrition during early life may have consequences extending into adulthood. Poor maternal and early infant nutrition is linked to several diseases including cardiovascular disease, obesity, diabetes mellitus, allergy and other immune diseases, some forms of cancer, mental health problems, osteoporosis, chronic respiratory disease, and musculoskeletal conditions. 

Nutrition for kids is based on the same principles as nutrition for adults. Everyone needs the same types of nutrients—such as vitamins, minerals, carbohydrates, protein and fats. Children, however, need different amounts of specific nutrients at different ages. Deficiencies in macro and micronutrients might influence a child’s growth and body processes. Vitamin D and calcium are well-known for helping children develop strong, healthy bones. A lack of these essential micronutrients has an impact on bone formation and other body functions.

Q. What are the key issues around nutrition in India that need to be addressed?

According to the Comprehensive National Nutrition Survey report (2016-2018), 35% of Indians children aged 0-4 years were stunted, 17% were wasted and 33% were underweight. Poor nutrition can cause growth faltering or even stunted growth leading to illness and cognitive development issues which can have consequences later in life for children. Preventing those nutritional gaps can help children reach their full growth potential. 

Breastfeeding optimally throughout the first year, as well as supplemental feeding strategies can save about one-fifth of mortality in children under the age of five. One of the most critical behaviours for baby survival is breastfeeding within the first hour of life. Despite this, just 56.6 % of Indian infants begin nursing within the first hour of life. Infants who are exclusively breastfed have a lower risk of infections like diarrhoea and pneumonia, which are important causes of death in children under the age of five. An infant who is not exclusively breastfed has a 14-fold higher risk of dying from any cause than an infant who is exclusively breastfed.

A little less than half of the Indian infants aged six to nine months receive complementary foods in addition to mother’s milk. Less than one child in ten between the ages of 6 and 24 months is fed optimally, according to approved standards. In India, ensuring that children are provided nutritionally rich complementary foods at the appropriate age, at the appropriate frequency, and with proper feeding, hygiene procedures is a huge concern.

Good nutrition in the first “1000 days” including nursing and appropriate supplemental foods, helps to prepare children and adults for a healthy childhood and adult life, as well as avoiding the double burden of malnutrition. 

The anticipated nutritional crisis caused by the Covid-19 pandemic is concerning, as millions of children and women will be harmed as a result of a lack of access to nutritious foods and micronutrients. By 2022, an estimated 9.3 million children would be impacted, with 20-25% of them suffering from stunted growth. Children who are malnourished are more vulnerable to pandemic complications, as Covid-19 and other infectious and inflammatory disorders, such as pneumonia, can cause more sickness and death. 

Each year, about 380,000 children in Uttar Pradesh die before the age of five years, falling victim to malnutrition, diarrhoea etc.6 India bears a disproportionate burden of malnutrition. Response to the pandemic has disrupted routine nutrition programmes such as the ICDS and the Mid-Day Meal Programme. 

If diet alone is not enough, dietary supplements can help replenish essential nutrients. The Food Safety and Standards Authority of India (FSSAI) recently issued a document containing recommended dietary allowance (RDA) of different vitamins and minerals. RDA is theaverage daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people. 

Q. How can the national nutrition week help the cause?

Nutrition contents in a person’s body are very essential for the proper functioning of the body and avoid deficiencies. And for this, a proper nutrition intake is in our diet is also necessary. While various awareness activities are usually conducted to educate people on the need for nutrition in our bodies, National Nutrition Week being one such important event. 

The National Nutrition Week is observed every year from 1 to 7 September all across the country to spread awareness and encourage everyone to understand the importance of nutrition and adopt a healthy, sustainable lifestyle. It is a collaborative effort to improve and expand the reach of critical nutrition interventions. The transformation will be driven by increasing community participation and educating moms, families, and communities.

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