Ever since the coronavirus outbreak engulfed the world, healthcare professionals have emerged as the real heroes of this crisis. Across the world, these heroes have led from the front, putting themselves at significant risk, yet going all out to save lives. According to estimates, as many as 548 doctors, nurses and paramedics across India were found infected by the disease till the first week of May. If we could draw one positive from the calamitous tragedy, it is the fact that the much maligned healthcare sector has found much needed respect from people. It has also made governments realise the need for investing liberally in healthcare and establishing robust healthcare systems.
In India, governments have traditionally been unsympathetic, if not, hostile to private healthcare. However, the public and private sector are working in a close partnership today to fend off this crisis. In March, people across India responded to Prime Minister Narendra Modi’s call to clap and applaud healthcare workers and other corona warriors from their balconies. We are grateful for this gesture. However, we hope these symbolic gestures are also translated into action and concrete policy interventions to help the healthcare sector overcome the crisis. We also hope the government-private partnership that has been achieved in this crisis continues during peacetime as well.
For the healthcare providers, who are experiencing financial stress, it is very critical to survive the short term. We need policies that will help us overcome the shock. The challenge right now is to plan in a manner that economic stability can be restored.
Huge economic losses
The healthcare sector is fighting this war but it is also facing heavy financial losses. The private healthcare sector, which has stood by the government firmly to contain the virus, is facing a double whammy. On one hand, there has been a significant rise in expenditures to create Covid-19 treatment capacity, install safety measures, set up isolation centres, procure PPEs and other infrastructure needed to fight this battle. While on the other hand, there have been huge losses in revenues. Patient footfalls had started declining even before the lockdown. Gradually, as some private hospitals turned into Covid treatment centres, their OPDs were effectively closed for other patients, resulting in heavy losses.
The financial health of private healthcare is therefore poor. According to a FICCIEY study, private healthcare facilities suffered revenue losses of up to 70 percent during the last 10 days of March owing to low footfalls, declining flow of international patients as well as putting off of elective surgeries. The study found that many small hospitals and nursing homes, especially in tier 2 and tier 3 cities and towns, had been forced to shut down. According to estimates, the private healthcare industry lost a whopping Rs 7,000 crore in April. More worrying is the fact that the crisis does not seem to end any time soon and these losses will continue to mount, compromising the financial sustainability of organizations.
In this situation, the private healthcare sector needs financial support from the government through a direct stimulus package as well as indirect policy changes to help ease the financial stress.
With operating losses mounting, the healthcare sector will need financial help from the government in keeping the hospitals running, paying salaries and treating coronavirus patients. The sector needs an immediate liquidity push as well as subsidies to recover. In the US, a $2 trillion stimulus was launched for the healthcare sector including more than $100 billion in emergency funds to compensate healthcare providers for lost revenue and other costs associated with Covid-19. This has helped hospitals in that country stay functional to their best capacities. A significant part of this stimulus was also dedicated to replenish the stock of requisite medical gear including drugs, ventilators, and PPEs. India’s private healthcare sector is also waiting for a similar financial infusion from the government which will help the sector tide over the financial slump and stay at the forefront in tackling the pandemic. The sector must also continue to pay salaries on time to its dedicated doctors, nurses and other medical staffers who are working overtime in this emergency situation. We welcome the Prime Minister’s announcement of a Rs 20 lakh crore economic package for the economy. We hope the healthcare sector gets its due share in this.
The industry also expects tax waivers and other financial concessions from the government at this juncture. The government must immediately waive off customs duty and GST on essential medical inputs such as ventilators, medicines and other equipment needed for Covid-19 treatment. At the same time, giving long-term tax concessions to the healthcare sector such as exemptions on purchase of diagnostic equipment, medical devices and other essential hospital infrastructure will help medical entities recover from this slump and get back on track. Going forward the government must also consider further relaxing corporate tax rates for the healthcare sector for the next 2-3 years.
The author is the founder and director of Ujala Cygnus Healthcare.
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Kashmiri ASHA worker serves as inspiration by donating blood 28 times
A 32-year-old woman named Bilqees Ara, an ASHA worker, has donated blood 28 times since 2012. She has served as an inspiration to others across the nation.
Bilqees, who is from the Handwara Tehsil in the Kupwara area of North Kashmir, stated that she understands the “importance of blood”.
She said that by donating a pint of blood, she not only saves a precious life but an entire family.
She began donating blood in 2012 and has since given 28 pints.
She expressed her gratitude and pride at being the saviour of so many patients in the Kashmir valley.
I’ve seen people cry helplessly as they try to get blood to save their loved ones, but I’m proud of myself because I’ve arranged blood for them as well. “I felt an inner joy after that,” she said.
In Kashmir, she is known as the “Blood Woman of Kashmir”.
She is a registered blood donor. Whenever a need arises, the officials at the Blood Bank at Handwara hospital call her and, within the shortest span of time, she makes herself available to donate blood.
Women should come forward and do this as there is nothing to be afraid of. This is to be done for society, she said. She also said that she wondered who else would do it if she refused.
If a person has blood and courage, why can’t he give it to someone else in a time of need? She asked.
Covid facilities to reduce in Delhi amid drop in cases
The Delhi government has closed 11 Covid care facilities because to a consistent reduction in cases. Two Covid Care Centers are operational at Ambedkar Nagar Hospital, which has 50 beds, and Balak Ram Hospital, which has 25 beds, according to a government report. Only five admissions were registered at Ambedkar Nagar Hospital over the past three months, while there were none at Balak Ram Hospital.
The number of patients has steadily decreased at the remaining CCCs as well, according to reports.
According to officials, the Delhi Disaster Management Authority on Thursday decided to scale back the medical staff and infrastructure that had been deployed for COVID management in a planned manner. The health department will now formulate an action plan in response to this decision.
“The deven CCCs were closed and dismantled by Delhi government and one by the Centre and three others with total 4000 bed capacity- Radha Saomi Satsang ,Chattarpur, Sawan Kirpal, Burari , and Sant Nirankari, Burari- were closed but not yet dismantled”, officials said.
We Women Want: Focus on menstrual health
This week on We Women Want, we talk about menstrual health and awareness with Madan Mohit Bharadwaj, founder of She Wings, an organisation that works to end period poverty by working with rural women, teens, the homeless, and low-income people. We also had She Wings employees Savita and Mamta, as well as Gurvani, Chief Communication Officer, and Shubhendra Rajawat, Chief Planning Officer of She Wings, to tell us stories from the ground.
A former journalist, Madan founded She Wings once he realised the lack of awareness and also the lack of basics such as sanitary pads amongst low-income women. The foundation is doing a lot of good work in that they not only distribute pads amongst the poor but also educate women on the basics of menstrual hygiene. She Wings volunteers and workers also spend time with the men folk trying to deal with the biases and social taboos against menstruation.
As Madan said, it is a natural cleansing process and not something to be shunned and ostracised. He also recalled how a woman died due to a septic infection from a rusted hook while she was using an old blouse as a sanitary pad. That is when he realised the dire emergency of the situation for something as basic as menstrual hygiene and sanitary pads.
Both the audience in the studio and the entire team at We Women Want were very appreciative of the work that the She Wings team is doing, and indeed, it is efforts such as these that should be applauded and celebrated on the show. The show was moderated by NewsX Senior Executive Editor, Priya Sahgal, and will be on air this weekend on the channel.
Catch fresh episodes of “We Women Want” every Saturday at 7:30 PM on NewsX. The programme will also be streamed live on major OTT platforms-Dailyhunt, Zee5, MX Player, ShemarooMe, Watcho, Mzaalo, Jio TV, Tata Play, and PayTm livestreams.
83% pregnant women in South Kashmir anemic due to poor nutrition: Doctors
Lal Jan, an ASHA worker in Hapatnard Gogaldar village in Anantnag district, has helped out with at least 500 deliveries since she was appointed to the health department.
In 2005, Lal Jan (45) was appointed to the health department as an ASHA worker before her appointment. She has helped out with at least 250 deliveries at their homes. Lal Jan’s mother, Zaina Begam, was also doing this job and has helped out with at least 700 deliveries at their homes in normal delivery when there were no health facilities in their area.
Speaking to the reporter, Lal Jan said, “I have learnt from my mother. My mother was very well known in the area for helping pregnant ladies with home delivery.” Her mother died 30 years ago.
Lal Jan has had experience in deliveries for the last 30 years. She goes from house to house raising awareness about family planning.
In 2007, Lal Jan got an appreciation award from the office of block medical officer Bijbehara for her motivation to a number of beneficiaries for family planning and female sterilisation during the years 2007-2008 and 2009. Her performance, character, and conduct remained satisfactory for the said period, she said.
According to her, in the Hapatnard area and nearby villages, at least 300 women have done sterilisation and taken procedures after the birth of their 3rd and 4th children; some of them have their 6th and 7th children.
The Hapatnard village, which is located on the foothills of the Khovripora block, is about 35 km from the district headquarters in Anantnag.
In 2008, a PHC was established in the village, which was functional in 2018. Before the functionality of the PHC, the patients of the area either visited sub-district hospitals or MCCH hospitals in Anantnag.
The PHC of Hapatnard village caters to about seven thousand people in eight villages that are around the hospital. The hospital lacks basic facilities, including X-ray and diagnostic testing facilities, forcing patients to visit the See Sub District Hospital or MCCH Hospital Anantnag.
Due to the non-availability of a gynaecologist, pregnancy care has also been hit badly, and women in the area face severe hardships.
According to official data in Anantnag District, more women than men were opting for sterilisation in Anantnag District. Official data provided by the Chief Medical Officer of Anantnag reveals that from 2019 to date, 1369 women were operated upon for various permanent birth control methods, including laparoscopic sterilisation and mini-laparotomy, while only one man opted for permanent sterilisation in the period.
The same is true for spontaneous miscarriages in District Anantnag, where at least 3144 cases have been reported since 2019.
However, the only maternity and child care hospital in Anantnag district, which serves the entire south Kashmir region as well as Chenab and Pir Panjal Valley of Kashmir, has also provided data to this reporter, revealing that 913 women have been operated on in hospitals for permanent birth control methods through laparoscopic sterilisation and mini-laparotomy since 2019.
The hospital is presently housed in an old, worn and unsafe building in the congested Sherbagh locality of the old town in the Anantnag district.
The 40-bed hospital gets an average of 40,000 patients in the outpatient department (OPD) and about 7,000 indoor patients every month.
According to official sources, the ratio will be high in South Kashmir as most of the patients prefer to do sterilisation and miscarriages in private hospitals.
While talking to the reporter, Dr. Nawaz, HOD Gynecology in MCCH hospital Anantnag, while talking to the reporter, said that female sterilisation is the most preferred family planning choice here in south Kashmir›s Anantnag district.
The department witnesses hundreds of women undergoing sterilisation procedures for permanent birth control each year. Misconceptions and lack of awareness are the main factors in the urban as well as rural population›s poor uptake of family planning services in the Anantnag district. Other responsible factors include cultural and religious beliefs. He added that men generally don›t undergo vasectomy for sterilisation because they believe that it affects their manhood.
Anaemia is another problem in the country. According to a study conducted by the Department of Obstetrics and Gynecology at GMC Anantnag, almost 83% of pregnant and lactating women in South Kashmir were anaemic due to poor nutrition.
Anaemia can lead to multiple complications during pregnancy, labour, and the postpartum period, which include foetal growth restriction, abruption of the placenta, cardiac failure, and even death of mother and baby, Nawaz says. Women don›t take the recommended iron and folic acid supplements in adolescence and pregnancy. Short birth intervals and multiparity further add to the problem.
ASHA workers and primary care physicians should be involved in rural areas to address the issue. Another issue that is under-addressed in this part of the world is the emotional and mental well-being of pregnant women. Poor social support, bad pregnancy experiences and outcomes in the past are some of the few responsible reasons.
There are a number of women in hospitals in south Kashmir who suffer from mental health issues during their pregnancies, especially those expecting moms who have had a negative experience in the past.
Brain tumour: Management options and outcome
Brain tumours are abnormal growth of brain cells and can be benign or malignant (cancerous). In a broad sense, brain tumours can be primary or metastatic (from cancer of other parts of the body). Such tumours clinically manifest with various symptoms depending on their location, size, and histological variety. Common presentations of brain tumours are headaches, vomiting, and seizures, or epilepsy. Some may have focal neurological deficits like weakness of limbs, memory impairment, speech problems, restricted vision, gait disturbances etc.
The incidence of brain tumours is increasing and is 5 to 10 per 100,000 in the Indian population. They represent a substantial cause of morbidity and mortality and an overall decrease in productivity. The gradual increase in the incidence of brain tumours in young populations has also led to a significant financial burden on families. Early diagnosis and management has a better outcome in patients with brain tumours.
What are the causes of brain tumours?
The risk factors associated with brain tumours are ionising radiation, environmental factors, and mutations of genes controlling cell growth. Various hereditary conditions like neurofibromatosis and tuberous sclerosis are also associated with higher incidences of brain tumours.
What are the types of brain tumours?
The common primary brain tumours are gliomas, meningiomas, pituitary tumours and nerve sheath tumors. Gliomas are the most common intraparenchymal brain tumours and can be of low grade or highly malignant high grade. Secondary brain tumours or metastatic brain tumours originate from cancer in other parts of the body and spread to the brain through the blood or lymphatics. Cancers from lungs, breast, kidney, prostate, and melanoma commonly spread to the brain. The incidence of metastatic brain tumours is higher than primary tumors.
How are brain tumours diagnosed?
Brain tumours can be diagnosed on the basis of clinical symptoms. Some specific symptoms like early morning headache that subsides with vomiting, repeated seizures involving a particular area of the body (like hand, face, leg etc.), visual field restriction (narrowing of the visual field, being unable to see one half of the visual field) are characteristics of brain tumors. However, the diagnosis is confirmed with radiological evaluation. A CT scan of the head can grossly show the brain tumor. Additionally, various sequences of MRI provide details about the nature of tumour, like low grade or high grade. However, the exact nature of cellular origin and biological characteristics can be detailed by histopathological study of tumour tissue obtained from biopsy or surgery. This is also important in grading the tumour into the low grade or high grade variety.
What are the treatment options available for brain tumours?
There are several treatment options for brain tumors, including surgery, radiotherapy, chemotherapy, and gamma knife radiosurgery. Biopsy of the tumour may be considered for smaller intraparenchymal brain tumors. The MRI guided streotactic brain tumour biopsy provides accurate localisation of the brain tumour as well as tissue diagnosis or histopathological characterization of the brain tumour. Then, depending on the grade of tumour further therapy like radiation or chemotherapy can be planned for such patients. However, complete surgical excision is the best treatment for brain tumours and has a better long-term onco-functional outcome.
What are the risks involved in brain tumour surgery and how can they be reduced?
As the brain is the controller of entire body function, any additional injury to the nearby brain area during tumour surgery may result in functional impairment. Therefore, the brain tumour has to be resected out with minimal handling of the adjacent brain tissue. Various functional imaging techniques like functional MRI and diffusion tensor imaging are used to detect the functional brain areas around brain tumors. Again, such areas can be stimulated and preserved with the use of direct electrical stimulation in patients operated in awake conditions. Further use of intraoperative ultrasound also reduces the risk of injury to normal brain areas. Use of these advanced modalities allows better tumour removal even if the tumour is located in eloquent areas like insular glioma, brain stem glioma. A variety of brain tumour surgeries like glioma, vestibular schwannoma are also being used to minimise functional deficits after surgery.
Minimal invasive surgery for brain tumours like endonasal endoscopic procedures are now the standard of care for operating pituitary tumors.
Even large brain tumours located in the pituitary region can be operated safely through the nose using an endoscope.
What is gammaknife radiosurgery and which brain tumours are managed with this?
Gammaknife radiosurgery is a form of radiation therapy where radiation is precisely focused on the brain tumours with minimal effect on surrounding brain areas. Commonly, small, benign brain tumours like meningioma, vestibular schwannoma, cavernous hemangioma, cavernoma, etc. are treated with gamma knife radiosurgery. This has the ability to safeguard important functional brain areas like the cochlea (hearing apparatus), optic nerve (visual apparatus), and brain stem while giving an adequate dose to the brain tumour targeted for therapy. Apart from this gammaknife radiosurgery provides excellent results in patients with brain arteriovenous malformation.
What is the prognosis of a brain tumour?
The outcome of a brain tumour depends on the type (low grade vs. high grade), location, extent of tumour removal, and the patient’s clinical condition. Good tumour removal always has a better outcome in patients with low grade tumors. Therefore, maximal tumour removal is always attempted in these cases. However, high grade tumours like glioblastoma have a poor prognosis even after complete tumour removal and post-operative radiotherapy and chemotherapy. Apart from this, certain genetic mutations like TP53, IDH1/2, ATRX, 1p19q, etc also affect the prognosis.
Who should be screened for
Patients who have already been diagnosed with cancer of the lungs, breast, kidney, or prostate and develop symptoms such as headache, vomiting, or seizures should be evaluated for a brain tumor. Any metastatic lesion can be detected using a CT scan or an MRI of the brain. People with a family history of cancer or previously diagnosed with hereditary syndromes like neurofibromatosis, tuberous sclerosis, Von Hippel-Lindau disease, and multiple endocrine neoplasia are prone to developing brain tumours and should be screened regularly.
Dr Sushant Kumar Sahoo is an Associate professor at Department of Neurosurgery and Gammaknife, Radiosurgery at PGIMER, Chandigarh.
The right diet can go a long way in dealing with PCOS and PCOD
Women undergo various changes throughout their lifetime. These could be caused by hormonal fluctuations, a decreased ovarian reserve, or even an age-related decline in fertility. In fact, they face various health issues specifically related to their ovaries. Among them, the most common condition is Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD). People often confuse these two conditions. While PCOS refers to a group of symptoms, PCOD is an established condition.
As many of us know now, PCOS is common among women today, and lifestyle is often attributed to being the major cause behind this. Polycystic ovaries are associated with hormonal imbalance, irregular periods, including missed and delayed periods, acne or oily skin, dark or thick skin patches, obesity, abnormal facial hair growth, and, most importantly, infertility. It is an issue that affects 1 in 10 women of childbearing age. There is no’set’ cure as such for PCOD and PCOS, but one of the best ways to manage them is by introducing changes in your lifestyle and diet. Maintaining a healthy weight with a nutritious diet is an effective way to get your PCOD and PCOS under control.
Increase your intake of fruits and vegetables while minimising dairy-based foods. Many healthcare experts believe that dairy-based products may increase insulin levels, which may aggravate acne and other symptoms.
l Include lean meat like fish, and avoid red meat. Avoid sugary foods and drinks. If possible, put a complete stop to them.
l Saturated and hydrogenated fats should be avoided. Make sure to read the label. Saturated fats are a particular type of fat molecule that is naturally present in many foods, primarily those that are made from animal or dairy products. It can significantly increase cholesterol levels and increase calories. Always read the label because certain baked items also contain saturated fat.
l PCOD patients might experience water retention, and the best way to beat that would be to eat small, frequent meals and drink a lot of water throughout the day.
l There are some natural herbs you can take to help keep your hormones under control, such as meethi dana, flaxseeds, and cinnamon.
A low glycemic index (GI) diet: Foods with a low GI take longer for the body to digest, so they do not raise insulin levels as quickly as other foods, such as some carbs do. Foods in a low GI diet include whole grains, legumes, nuts, seeds, fruits, starchy vegetables, and other unprocessed, low-carbohydrate foods
An anti-inflammatory diet: Anti-inflammatory foods, such as berries, fatty fish, leafy greens, and extra virgin olive oil, may reduce inflammation-related symptoms, such as fatigue.
The DASH diet: Doctors often recommend the Dietary Approaches to Stop Hypertension (DASH) diet to reduce the risk or impact of heart disease and fertility issues.
It may also help manage PCOS symptoms. A DASH diet includes fish, poultry, fruits, vegetables, whole grains, and low-fat dairy products. Foods that are high in sugar and saturated fat should not be consumed.
Limit your intake of dairy and alcohol: According to a study published in the International Journal of Preventive Medicine, limiting your dairy intake may help certain women with PCOS lose weight and alleviate some of their hormonal PCOS symptoms.
Also, it is best to limit excess alcohol intake to manage the condition.
Dr Muskaan Chhabra is a
Consultant at Birla Fertility and IVF.
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