Death…. I have experienced you.

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Cut practise ( referal charges ) in medical practise.

My next blog will be on the cut practise system amongst the medical professionals in India.

Inviting all of you to share your experiences regarding this. Need all of your inputs.

Please state whether you approve of this practise or not.

Your views are important and shall be incorporated in the blog. So put up your comments in the comment section or mail them to anilroy2000@yahoo.com

The blog will not be against or for the system, it is for placing realistic facts about the cut practise followed and to remove misconceptions that appear in the media.

Looking forwards to maximum inputs.

Increasing violence against doctors in India …. a frightening phenomenon.

One the most common news in Indian the print or digital media today is about violence against doctors and of hospitals being vandalized. A doctor beaten up, a hospital ransacked, another doctor shot at and yet another lynched by the mob, for reasons best known to the assailants. This is now a common phenomenon across all states in India.

The violence is seen both against the medical professionals both in the government sector as well as private sector, neither has been spared. This violence ranges from verbal abuse at workplace or even over the phone, manhandling of doctors, physical dangerous assault, use of weapons and fire arms and vandalizing of the clinic or hospitals.

There was a time when doctors in India were worshiped and revered. Not long ago they were gods or demi gods. What has gone wrong??? Why this sudden and sustained events of attacks. Here I am making an attempt to analyze some of the probable causes as observed by me in my 34 years of the medical profession. The blame game is perpetual, is the doctor or hospital wrong or is it the citizens/ patient and his relatives at fault for this violence. Let me make it very clear in most of the cases the attacks are unwarranted and the doctor is rarely at fault. I am not denying that in a few cases, very minuscule number of cases the fault has been with the medical professionals.

Did the doctors and medical profession bring this upon themselves or is it that patient attitudes and expectations have changed with time. Has there been a loss of trust in the medical profession, are half baked knowledge of patients regarding medicine responsible, is poor communicating skills of doctors responsible, is it the arrogant behavior of the medical profession with the patients and relatives or vice versa, is it the financial angle, huge bills, is it political interference or is it lack of adequate facilities that has led to this state of affairs or is it plain misunderstanding.

Unrealistic expectations coupled with poor medical awareness……

          One the major causes for this unprecedented violence is poor medical knowledge amongst patients and relatives. They fail to understand the situation, the need for the treatment, they do not realize that the doctors can only diagnose and treat patients with the best of their judgment with available facilities and medicines. The doctors are not magicians, each illness will follow a course, and there is no shortcut to treatment and recovery. A magic cure or an immediate recovery is their usual expectation. They are bewildered if B-complex is given for oral thrush when last time it was given for plain debility, they are not satisfied if paracetmol is prescribed for pain when on another occasion it was given for fever, one doctor prescribed tab stemetil for emesis and another for migraine and so on.

Take this case where a person hanged himself, his relatives get to know of it after half an hour, they break open the door, take him down and a mob now collects and carries the body to the hospital. First thing on reaching the hospital is the mob barges into the doctor’s room and pleads for him to attend immediately as it is an emergency case, though knowing very well that person was dead even as they had brought down the hanging body. Yet the expectation is the doctor should do something to revive him. The doctor feels for the pulse…none felt…blood pressure not record-able…he auscultates…. No respiration …no heart beats…pupils are dilated , rigor mortis is setting in… the person is dead for sure, the doctor knows it, the mob knows it, but the moment the doctors declares the person dead, the verbal abuses begin…. Doctor you******* you did nothing to save our patient, you rotten***** we shall ***** your happiness. What could the doctor have done when a person who is dead by hanging is brought to him after an hour?   This is one classical case of unrealistic expectations.   Many a times these verbal abuses turn into physical assault and later to vandalizing the whole place.. Who was wrong, was it the doctor, definitely not. There had been violence.

The lady was wheeled in, she was full term, the young resident attended to her, and she examined her carefully. Oh! She had a transverse lie, there was meconium stained liquor, the fetal heart sounds were erratic and low, the lady would need an emergency caesarean. The resident explained to the relatives. No they wouldn’t hear of it, the husband retorted that his wife had a normal delivery last time, so why a caesarean now, the young resident explained, all in vain, they wouldn’t hear her out, they accused her of making a fool of them to increase the bills, they were adamant a caesarean was not warranted and the choicest abuses began. A tear trickled down the young lady doctors eye, how could they not understand, why didn’t they trust her, after all she was trying to save two lives. She had put in innumerable hours of hard work and study, burnt her energy to get to this position today, she wanted to serve the people coming to her, she was meticulous in her work , then why this,She cursed the day she had decided to become a doctor. There was mayhem until the security stood round her and the senior doctor arrived and ultimately convinced them that the surgery was necessary. There had been violence.

A middle aged known diabetic and ischemic heart disease patient who is on irregular treatment is brought to a primary health centre. The doctor sees him records his history and complaints, gets his ECG done. It is showing changes indicative of massive infarct, the doctors gives the primary treatment and refers him to the higher centre or cardiac centre.   Again the abuses begin…. Why can’t you treat him here, are you a real doctor, we shall leave with our patient now but we shall be back to see you. Similarly in this case had the patient passed away during primary examination all hell would have broken loose. Is it the doctor’s fault that the patient does not follow up regularly or not take his treatment, if the patient is non-compliant, does not follow the doctor’s instructions and ends up with a massive infarct, how one can blame the doctor? There had been violence.

Large number of patients in government hospitals, lack of adequate manpower, facilities and medicines.

Lack of adequate finances are the reason for the large number of patients turning to government centers for treatment. Inadequate manpower puts a huge strain on the available medical and paramedical staff. Many a time equipment is not available or not functioning, medicines too are in short supply leading to clashes and arguments and later to violence at these centers.

The man had brought his father all of 80 years to the hospital for his monthly checkup and medicines. The old man was a hypertensive. As the queue was big it took him an hour before he got into the doctors cabin. He had been coming here for the last 7 years and was happy with the hospital and doctor. The doctor saw him and recorded his blood pressure and was happy to note that his blood pressure was well controlled, he prescribed the medicines and went on to see his next patient. It was then that he heard the commotion, abuses were being hurled, a window was smashed, and there was a banging of the doors. He rushed out of his cabin, nearly another 50 to 60 patients were coolly waiting for their turn, he walked towards the area where the sounds came, it was in front of the pharmacy, the pharmacist was being manhandled, he walked across and placed himself in front of the pharmacist, other employees too had gathered around.  Reason….. The stock of anti hypertensive medicines was over and the old man was requested to come two days later as the stocks would come by then. The man lunged at the doctor, you rotten fellow, why you run the hospital if you have no medicines, the doctor tried to explain, he wouldn’t listen, the old frail security guard just stood there watching, the younger staff managed to pull away the person and take him out of the building.  Whose fault was it, definitely not the doctors, but suffer, he did. No gratitude in treating a person for 7years.  There had been violence.

Similarly at times there would be a staff nurse in the injection room on leave and none to replace her, dressing of wounds could take time, a doctor not well and hence not on duty would lead to more waiting time at the other doctors consulting rooms, an ECG machine would suddenly malfunction, at times patient demand medicines which the doctors feels is not necessary and hence refuses, patients demand injections where there is no need for one. Any refusal will lead to abuses. If an emergency case is taken out turn there will be a big hue and cry as to, is that a patient a VIP. Then again influential people want immediate attendance, if refused again verbal abuses. The doctor and his staff are always at the receiving end.

Political interference and pressure

Another major reason for violence stems from political interference in the medical and health system.

The man walked in with a case paper for a medical fitness certificate. The doctor looked up and asked who was the person mentioned on the case paper. He said he is at home but needs a medical fitness certificate. The doctor refused, he couldn’t possibly issue such a certificate in absentia, the man pulled out his cell phone and connected to the local politician and informed him that the doctor was unwilling, he passed on the phone to the doctor who explained that he could issue the certificate without examining the patient and the expletives started, abuses were hurled at him, the doctor sat grim faced, he couldn’t possibly hurl back abuses at him. What was the doctor supposed to do, he stood his ground, and he refused. In half an hour the Politician and his cronies came and started a ruckus, the police had to be called in There had been violence..

She had been admitted 8 hours ago, she was a primi gravida, she was in labor. She was being monitored regularly, she would deliver normally. The senior consultant too had seen her. No problems. Just then the phone rang, the on duty nurse picked up the phone, and he asked to speak to the doctor. The doctor took the phone, the politician demanded as to why the lady hadn’t delivered yet, the doctor explained how long it would take as she was a primi gravida, the politician was in no mood to listen, he demanded that she be delivered immediately, the doctor explained it is a natural process and it would take its own time, the politician demanded that she be injected to fasten the process, the doctor refused and the abuses began. There had been violence.

It was a 100 bedded private corporate hospital. They had a 20 bedded ICU. The beds were full, so was the ICU. A road traffic accident patient was brought into the casualty. The on duty doctor examined him, he was given initial treatment, the specialist saw him, and he would need an ICU bed with a ventilator. The doctors explained that as no ICU beds were available they would have to shift the patient to another hospital, nothing doing said the relatives and friends, and you have to provide us an ICU bed. They wouldn’t see reason, the patient was sinking, and he would be needed to put on a ventilator in the ICU, the mob refused. They called for their local politician who rushed in. He demanded that a patient be removed from the ICU so that this patients could get in. No explanation was enough to convince them, they wouldn’t shift the patient, precious time was lost, the patient breathed his last and the violence began, they thrashed the doctors and staff on duty, broke windows smashed computers and printers, broke the chairs, this continued till the police came in , as usual they were too late, the damage had been done. There had been violence.

Similarly these politicians demand medical unfit certificates for their cronies when they are hale and hearty, they want false medical certificates to get their henchmen in jail out on parole, they demand their patients be seen on priority, they demand hospitals give huge concessions arbitrarily, they demand that certificates in medico legal cases be issued as per their directions and what not. Any refusal by the hospital administrations invites verbal abuses and at times violence. Will this ever change, if it does not very soon lesser and lesser intelligent people in India will opt for medicine as a career or they will look for greener pastures abroad. This violence has to stop.

A newly married lady was rushed to a small nursing home; she had apparently consumed some organophosphororus compound due to some domestic violence. Luckily she hadn’t taken much, the doctor and nurse immediately gave her a gastric lavage and started the treatment, soon she was out of danger. The doctor got down to preparing his case sheets and informing the police. He was legally bound to inform every medico legal case to the police. The husband, the in-laws of the lady objected, they knew she was out of danger, they didn’t want to mess up with the police. The doctor coolly explained the law, they wouldn’t budge, the doctor a law abiding one went ahead, and the husband snatched the papers, slapped the doctor and shook him by the collar. The staff called in the police, the doctor filed his complaint, the cross complaint by the husband stated that the doctor had molested his wife, luckily the lady refused to support the husbands statement.       There had been violence. 

Misunderstanding and distrust in doctors

The doctors of yesterday, the gods and demigods of society have seen the trust in them being slowly eroded. Unlike previously when there was blind faith in the doctor, today with advent of internet, they are being questioned, misunderstanding and distrust has crept into the system.

Every diagnostic test advised by doctors is questioned, the patient has a misconception that he is being fleeced; he feels all those tests were not necessary. He takes opinions of friends, paramedics, other doctors and even Google’s out knowledge and then concludes he is right and the doctor wrong. This develops in to gross distrust in the doctor and grave misunderstandings.

When advised any surgery the patient and his relatives will follow the same route of multiple opinions and then feel surgery is unwanted. This mistrust in the doctor leads to misgivings, apprehensions and later violence if something goes wrong.

Inflated bills and unwarranted tests.

Perhaps the only place where a doctor or hospital might be the reason for abuse and assault is the hospital bills or the battery of tests done. We must understand that with the bringing of the medical profession under the ambit of the consumer protection act, the doctor needs to be doubly careful. He will definitely advise all test which perhaps he would otherwise have not advised. Cases in consumer forums always finds fault with the doctor for not having a test done, hence the cautious doctor will do every test remotely related to the disease or diagnosis, he can’t take chances, he can’t afford to not do it. This is mist rued as the doctor or hospital trying to make a fast buck by fleecing the patients and is a major cause of arguments, abuses and violence.

The doctor or hospital needs to take extra care and time in explaining to the patient and the relatives regarding the need for the tests and the approximate costs. The daily room charges, consultation charges , administrative charges, oxygen, procedure charges and ICU charges all need to explained to the patients and relative in advance and on a daily basis if any violence later is to be avoided.

One grey area where most of the violence is seen is when a patient unfortunately passes away and the relatives refuse to pay the bills especially when it is a large sum. Legally they have to pay up, ethically and morally the hospital administration should take a lenient view and either give major discounts or waive off the bill on humanitarian grounds. This is not always possible considering the financial aspects. Patient relatives should settle for a reasonable discount and pay up. But they are prodded, by friends, politicians, anti social elements and so called social organizations not to pay up. Most of the activists do not care about the patient or relatives, they just want some cheap publicity, the politician feels it’s his birthright to demand waiver of the bill. The hospital administration too is at times unyielding and refuses to hand over the dead body unless the full amount is paid up. This invariably leads to violence at the hospital with large adverse media coverage for the medical profession. Immediate steps need to be taken to address this and find an amicable solution.

It is high time society learns to pay up services rendered. If you to travel by air, rail or road you always pay up first and then travel, the lawyer takes his fees first and only proceeds with his case; the passport office takes their fees and then gives you a passport. All fields and business the dictum is pay up first, but not at doctors and hospitals, no one wants to pay up, they haggle over fees and bills. Even the best criminal lawyer can lose a case but his fees are not waived off, then why the violence against doctors only. Simple …..The doctor fraternity is a peace loving community and are sitting ducks for everyone, patients, relatives, friends, social organizations and anti-social elements.

 Can the violence be avoided

Attitude of patients towards doctors has to change, behavioral change is very necessary. Medical and doctors associations have to take the lead to bring about this.

The trust which has been eroded has to be reestablished. Doctors need to give adequate time to their patients good counseling and improved communication skills needs to be established. Unnecessary tests and inflated bills should be curtailed. The patient should not feel he is being fleeced. Many a times the patients relatives feel that the doctors are not discharging the patient on time and that the purposeful overstay is to increase bills, this misunderstanding can only be removed through proper counseling and detailed explanation of the situation to the relatives. In cases of deaths hospitals need to take a more humanitarian view regarding payment of bills and handing over of bodies.

Patients should go only to doctors they trust and place all their faith in them, they should not dictate how a patient is to be treated, the doctor has spent a life time learning the intricacies of diagnosing and treating patients. Politicians should desist from interfering in the treatment process and stop dictating terms to these highly qualified doctors. In fact no one should interfere with the way the health system functions, the doctors know best to handle it.

There are laws for violence against doctors in India; they need to be made more stringent, better is to have them actually implemented. Hospital should have CCTV systems and good security men. Hospitals have to invest into the aspect of security heavily. The government has to improve manpower and equipment and medicine availability at all their health centers. The doctors attending to patient should never be rude; they should be kind and empathize with their condition. They need to instill the confidence in the patient that they are in proper and good hands. When the doctor/hospital and the patient / relatives change their present attitudes we shall see an India where there shall no more be any violence against the medical fraternity.

Looking forwards with hope to that day when violence against doctors shall be unheard of in India.

The Indian family doctor………. an institution on the brink of extinction

The family doctor is synonymous with primary health as well as comprehensive health care in India. Scattered all across India, be it towns, villages and even cities, they were always the first line of contact of a patient with the health system. Highly respected, revered, and loved. They came from different faculties of the medical system; some were Allopath graduates, some Ayurveda graduates, yet others Homeopaths and others Unani graduates. Alongside also flourished a breed called RMPs or registered medical practitioners some of whose credentials were definitely doubtful. They had a basketful of varying degrees, MBBS, BAM&S, BAMS, BMS, DAMS, LCEH, BUMS, GFAM, not that the patient ever cared for his family doctors degree, he in fact never even understood what those letters meant. Crosspathy was the norm, each one practiced a mix of all pathies in their endeavor to give their best to the patients. His mode of transport in the towns and cities was invariably the ‘Hamara Bajaj’ scooter and in villages mostly the Rajdoot motorcycle which could take on any terrain.

The family doctor ensured both primary and emergency treatment and continuing medical care to the patient. He knew all his patients well, their families, their economic and social problems, their habits and vices. He knew their genetic dispositions which made diagnosis of any illness very easy for him. The family doctor was perhaps never wrong in his diagnosis. He didn’t need to take any detailed family history; he already knew it. He was well aware of all their dispositions, his hand percussed well, his palpation dug out hidden indispositions; his stethoscope heard any note that was not in tune with good health. His clinical acumen helped him to diagnose perfectly with these few methods and give good and ethical treatment to his patients. In short, he provided for very affordable treatment which was also very easily accessible.

Not for him were the multiple diagnostic tests as of today, only if he was unable to come to a conclusion would he advise any test, definitely not a battery of them. There was a very limited use of technology in his diagnosis.

He would diagnose and treat your fevers, diarrhea’s, respiratory tract infections, urinary tract infections, renal calculi, monitor your pregnancy, any skin infections, in fact he could and would treat everything. He was the jack of all trades, you had a fall, and he would clean and dress it with a jab of tetanus too. If it was a bigger contused, lacerated wound that too he would clean, suture and dress. Any foreign body in the eye, he would easily remove, similarly with foreign bodies in the ear or nose. if you had corns that too would be easily removed by him, so would he easily remove a sebaceous cyst or even a lipoma. Any lady needed an auroplasty, at  that too he was an expert. There was nothing he didn’t know nor could not do and that too for a minuscule payment.  He was the physician and surgeon rolled into one. He would even provide day care if necessary and would administer intravenous fluids. His clinic or dispensary was of mediocre settings, maybe 2 or three rooms. A table, a chair, an examination table, a few posters on the walls, a calendar, stools for his patients. It was a sparse but well-equipped setup. An electric sterilizer in the corner, his shelves would be filled with medicines, cotton, dressing material, suture material, intravenous fluids, iv sets, sticking tape and all necessary accessories. There would be an emergency tray at one corner, a Xray viewer, his stethoscopes, hammer, forceps and scissors all well stacked, a small refrigerator in one corner for the vaccines. In short, he was well equipped to handle any type of patient.

He doubled up as a gynecologist, obstetrician and pediatrician too. Immunization of the children too was his responsibility. As he stocked and dispensed medicines too he was also the pharmacist. Everything under one roof. His patients were a happy lot, after all he was part of their family, and he joined them in their household celebrations as also in their sorrows. He could be called for house visits regularly, he never refused. There were long queues but no prior appointments were necessary. If you had monetary problems, you could pay later or even the kind doctor would many a time just waive it off. He family doctor also gave advise to families on the education of their children, he counseled his patients and family members to give up smoking, alcohol, drugs if they were addicted to it and successfully too. Family squabbles too would be settled by the shrewd doctor. He provided his services for both acute and chronic illnesses. He provided rehabilitation advice and care. The family doctor gave quality time and advises to his patients, he always avoided unnecessary investigations. He was a boon to the community. He was a trusted person. Even if a patient needed a referral to a secondary or higher center, he would facilitate that too. No wonder he was called the family doctor.

But as usual good things never last forever. The early eighties and later decades saw the influx of the specialist doctors. They specialized in different fields. There were physicians, pediatricians, gynecologists, skin specialists, ophthalmologists, ENT specialists etc. Slowly some patients who were better educated and financially stronger began preferring to see a specialist rather than the family doctor. Of course, the specialists too were very good doctors in their respective fields, but they cost more, prior appointments were needed, long lists of tests were asked to be done, yet the patients had the satisfaction of having gone to a specialist to get the right treatment, but at odd times and hours they still rushed to the family doctors in times of emergency.

A foreign body removal from the eye would cost a few hundred rupees at the family doctors place, it cost a few thousands at the ophthalmologist, but the satisfaction that a specialist took it out was in the patient’s mind. Similarly, all the small surgeries and suturing of wounds he conducted very skillfully at nominal cost would cost ten time more at the specialist but the trend had begun, the out flux at least for specialized treatment’s was towards specialist doctors. People began visiting specialists even for trivial illnesses and began killing the concept of the family doctor. Now he had begun losing these patients and with that his skill too in these matters began to rust.

As he started losing these patients it now was affecting him financially too. The newer generations unlike their older generations didn’t think much of the family doctor, they were happy going to specialists and newer hospitals if treatment was needed. Then came the super specialists. DM, McH and what not. They were masters in different systems and organs, heart, liver, kidney, hand foot, neck, spine, practically every part and organ of the body was catered to by a super specialist. Trends kept on changing; now even for a minor headache patients would line up outside the neurologist’s consultation place, any with UTI would travel to a nephrologist, even the slightest burning sensation in the chest would need a visit to the cardiologist. To make matters worse soon came the corporate hospitals which had every faculty under one roof. They offered all diagnostic services too. The hospitals were swanky, centrally air-conditioned with five-star facilities. The financial status of the patients too had improved drastically coupled with it were huge medical allowances paid for by employers and also the insurance policies offered which ensured cashless treatment. All of this led to the declining number of patients going to the family doctor, some of them mostly the seniors silently wound-up business and went into retirement, the middle-aged formed groups to set small size hospitals, younger ones put money into bigger hospitals as partners, slowly the family doctors both in towns and cities began vanishing.

Those old enough had retired, the younger ones had shifted to newer hospitals, the patients lost out, it was their loss, no more the luxury of calling a doctor home to see his bedridden parents, no more walk-in emergency services, no more cheap quality services, no more heart-to-heart talks with a doctor, the patients unknowingly and unfortunately lost out.

It’s not that only the patients have lost out, the health system has lost out. We need a strong primary health treatment base which is both accessible and affordable to patients if we have to lift up our quality of health services and the key to it is the family doctor. Today no doctor seems to be inclined to do this, none is willing to set up a practice as a family doctor, it doesn’t give any good returns in the current scenario. What every new doctor is interested in today is forming groups, opening a new hospital with diagnostics facilities. There is no more any motivation to work as a family doctor anymore.

Urgent steps need to be taken by the government and medical associations to revive this system immediately before it finally disappears. The trust in the family doctor needs to be reinvented to keep the primary health vibrant. Nothing can replace this very important link at the primary level, lets hope the new generation of doctors realize this and develops the ground for a stronger first point of contact for all patients as their predecessors did.

Another virus…. ZIKA…another attack, this is not from any laboratory

As we are slowly coming to terms with the after math of the covid pandemic, a new virus poses a threat to us. Zika.

Covid 19 many say was man-made by the researchers and scientists at Wuhan and deliberately let upon us, was hence difficult to tackle. Many of course do not agree with that theory, howsoever, it is still looming around us, a third wave is predicted but luckily not yet to be seen, touch wood, no idea when it will be back to haunt us.

But Zika has made a comeback. From Kerala where it popped its ugly head now to my home state of Maharashtra in India. Looks like it’s a virus’s year out, as one recedes another raises its ugly spike.

Zika virus was first discovered in 1947 and is named after the Zika Forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands.

What can we as citizens do??? Well, we have to first understand the virus and the mode of transmission and its vectors to tackle it.

Zika virus is a single-stranded RNA virus of the Flaviviridae family, genus Flavivirus. Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito Aedes aegypti and Aedes albopictus. The Aedes mosquitoes usually bites during the day, peaking during early morning and late afternoon or evening. This is the same mosquito that transmits dengue, chikungunya and yellow fever.

Zika virus is transmitted primarily through the bite of an infected female mosquito. Mosquitoes become infected when they bite a person who is infected with the virus. The virus then replicates and spreads within the mosquito so that when the infected mosquito bites again, the virus is spread to another person.

The one good thing is, it can be prevented as the epidemiology is known and studied.

Zika has begun affecting some in the district of Pune in Maharashtra and the government is taking all necessary measures to counter and stop it from spreading.

This, season gives an advantage for its breeding. Eggs of these mosquitoes can remain alive for more than a year and even tiny collections of water is sufficient for it to breed, hence all measures to avoid collection of water has to be looked into.

The way we collect unwanted bottles, broken furniture,scraps of utensils, tires in our backyard, surroundings and roof tops, all spell danger for us. Water in our house planters, pots, in roof drains are all going to help the mosquitoes breed leading to dengue chikungunya and Zika. Hence it is each individual’s responsibility to see that all such unwanted stuff is cleared off immediately.

Care should be taken that water during these rains drain off properly and does not collect giving space for the mosquitoes to breed. All residents should follow certain preventive measures including proper garbage disposal, integrated pest management, and make a collective effort to keep the areas mosquito-free.

Spraying activities and fogging if needed shall be taken care of by the government authorities. Use of larvicides, adulticides, space sprays will help to prevent breeding of mosquitoes and also help eliminate adult mosquitoes. Our responsibility is to see that no mosquito breeds, we should be giving them no chance.

Of course, all the mosquitoes can’t be wished away, hence other measures are also equally important, like prevention of mosquito to human contact, use of long sleeves shirts, full length pants, mosquito repellents and nets are some of them. If breeding and the prevention of mosquito contact with humans is achieved, we will have won half the battle of Zika.

Most people infected by the virus won’t have symptoms or will have mild symptoms like fever, rash, headache, joint pain, red eyes, muscle pain. The symptoms can last for several days, and if it continues for long, the patient might need admission to a hospital.

Though in most cases, there are no symptoms. in a few cases, Zika can trigger paralysis (Guillain-Barré Syndrome). In pregnant women, it may cause subsequent birth defects.

 While there is no specific treatment, paracetamol and rest may help.

Zika is a virus that can cause serious problems during pregnancy. If a pregnant lady gets infected with Zika virus, she can pass it to her baby. Zika infection during pregnancy causes a birth defect called microcephaly and other brain problems. It is also linked to other serious problems in the baby.

There is no specific medicine or vaccine for Zika virus. Treat the symptoms, take plenty of rest, get hospitalized if needed.

Zika virus has been identified in several body fluids of infected individuals. In most cases, it remains detected in blood from few days to one week after the onset of symptoms, and is known to persist longer in urine and in semen.

Zika can be passed through sex from a person who has Zika to his or her sex partners. Use of condoms is recommended to reduce the chance of getting Zika from sex.

Yet the fact remains that the major mode of transmission is from the bite of the infected female mosquito, so our focus should be on mosquito control and prevention of mosquito human contact and thereby bites.

To achieve this citizen compliance and cooperation is most necessary. We don’t just save ourselves from Zika but also dengue and chikungunya. Looking forwards to a government citizen collective and combined all out effort in not letting Zika spread. This will give succor to all of us as well as the already overburdened and nearly burnt-out health personnel.

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The next covid wave………myth or reality. Will it spell disaster

The world witnessed the back-to-back waves of covid 19, bringing with it devastation of human lives and sufferings unimaginable. As we await a next possible wave to swoop down upon us each one is keeping their fingers crossed, will it come or will it not?? No one is sure, but what if it does, are […]

The next covid wave………myth or reality. Will it spell disaster

The next covid wave………myth or reality. Will it spell disaster

The world witnessed the back-to-back waves of covid 19, bringing with it devastation of human lives and sufferings unimaginable. As we await a next possible wave to swoop down upon us each one is keeping their fingers crossed, will it come or will it not??

No one is sure, but what if it does, are we prepared to face it, how will it strike us, when will it come if it ever does.  We all are all hoping possibly against hope that it will never come.

From where I come, the beautiful district of Pune in Maharashtra, India, the same thoughts are at the back of all our minds. We too have borne the brunt of covid, especially the city of Pimpri Chinchwad in Pune where I live.

 Ever since covid struck us in the March of 2020, we have gone through ups and downs, increasing and decreasing cases, deaths initially not much but later so many.

 We faced similar problems as in the whole of India, lock downs, restrictions on movements and businesses, shut down of educational institutions, closed markets. Shut down of all entertainment places, no cinema, no restaurants and many more Travel was restricted, you couldn’t move in groups or gather, sporting events were a no no, even gyms and gardens were closed. People wore long beards as the barber shops too were shut down.

As of today, we have had over 2.65 lakh cases, have tested over nearly 15 lakh people with a positivity rate of over 5% and have had nearly over 4300 deaths. Not a really happy state of affairs. The government, local self-body, the private health care system, the police all slogged it out 24 by 7 to take care of the sick, to help prevent spread, to implement the lock down. The doctors, paramedics, the police, ambulance drivers, NGOs all strove hard to help out those in need. It was a massive collective effort. Holidays were unheard of, it was work and only work, no Sundays no weekly offs.

 Today the cases are hovering around 150 to 250 daily in this city, that’s like a plateau for some time now. Deaths are less, the odd 1 or 2 daily but people have become complacent, perhaps the health system too is taking a sigh of relief.

Every one is talking about and anticipating a third wave soon, but no one knows when and how it will strike us, if at all it does.

The government and the health system are on high alert not knowing exactly what is coming or when and how it will come. People have grown complacent, traveling has increased, crowding is common, the guard indeed is down. Fear is no more seen among most of us, some laugh it out, yet some others are scared and the remaining don’t care. Many are confident that now as they are vaccinated the virus cannot touch them anymore, they don’t need to fear.

 Each one though has taken note that vaccination is important, vaccinations centers are crowded, yes, vaccine is in short supply, yet over 10 lakh people in this city have had their first dose already, that means more than a third of the eligible population is now vaccinated at least for the first dose.

Preparations are up to the mark here, ample beds, oxygen storage tanks, oxygen generators, logistics, manpower, pediatric wards, medicines, ICUs, ventilators vaccination centers, testing centers with augmented capacities. Daily and weekly meetings of the bureaucrats at all levels are having brainstorming sessions on what else need to be done. They believe they are ready to face the virus if it comes in whatever variant or form it decides to.

Are all our efforts good enough is the question we should be asking ourselves. No idea in what form, variant this next wave will come, will it be more dangerous, will it be fast spreading, more infectious, will it be really lethal or will it just come infect some and go. Will the vaccine be able to stop the virus? How can we predict this? Not many answers to our questions.

Positive cases keep hovering above 150 daily, will the virus strike out of the blue as we take comfort in the present status that cases are not increasing, will the situation be as in the second wave, sudden spurt in cases over a short period of time and deaths too, or will it be faster than lightening putting all our efforts and preparation to naught. Are our preparations good enough? We know not.

One scenario is it never comes, another is it does strike again but won’t be as infectious and lethal, but yet another possibility that scares me is it could be worse than the previous and break through all our defenses. Whom will it take away, as it is so many doctors have lost their lives to covid, the back bone of the medical system that is that nurses and paramedics have faced the brunt of the previous two waves and a tired lot?

Will the story of the boy who cried wolf repeat itself, if we ignore the signs of an impending wave, we shall be in for a major disaster?

Even as I conclude there is news the next wave will be upon us this month of August itself. It is estimated to peak by October 2021. Deaths it is being predicted will be less and daily cases might cross 100000.

Yes, we are ready to face this belligerent virus gifted to us by Wuhan. Man will win, we shall overcome unless the virus mutates to put all our efforts to naught.

The next covid wave………myth or reality. Will it spell disaster.

The world witnessed the back-to-back waves of covid 19, bringing with it devastation of human lives and sufferings unimaginable. As we await a next possible wave to swoop down upon us each one is keeping their fingers crossed, will it come or will it not?

No one is sure, but what if it does, are we prepared to face it, how will it strike us, when will it come if it ever does.  We all are all hoping possibly against hope that it will never come.

From where I come, the beautiful district of Pune in Maharashtra, India, the same thoughts are at the back of all our minds. We too have borne the brunt of covid, especially the city of Pimpri Chinchwad in Pune where I live.

 Ever since covid struck us in the March of 2019, we have gone through ups and downs, increasing and decreasing cases, deaths initially not much but later so many.

 We faced similar problems as in the whole of India, lock-downs, restrictions on movements and businesses, shut down of educational institutions, closed markets. Shut down of all entertainment places, no cinema, no restaurants and many more Travel was restricted, you couldn’t move in groups or gather, sporting events were a no no, even gyms and gardens were closed. People wore long beards as the barber shops too were shut down.

As of today, we have had over 2.65 lakh cases, have tested over nearly 15 lakh people with a positivity rate of over 5% and have had nearly over 4300 deaths. Not a really happy state of affairs. The government, local self-body, the private health care system, the police all slogged it out 24 by 7 to take care of the sick, to help prevent spread, to implement the lock down. The doctors, paramedics, the police, ambulance drivers, NGOs all strove hard to help out those in need. It was a massive collective effort. Holidays were unheard of, it was work and only work, no Sundays no weekly offs.

 Today the cases are hovering around 150 to 250 daily in this city, that’s like a plateau for some time now. Deaths are less, the odd 1 or 2 daily but people have become complacent, perhaps the health system too is taking a sigh of relief.

Every one is talking about and anticipating a third wave soon, but no one knows when and how it will strike us if at all it does.

The government and the health system are on high alert not knowing exactly what is coming or when and how it will come. People have grown complacent, traveling has increased, crowding is common, the guard indeed is down. Fear is not seen among most of us, some laugh it out, yet some others are scared and the remaining don’t care. Many are confident that now as they are vaccinated the virus cannot touch them anymore, they don’t need to fear.

 Each one though has taken note that vaccination is important, vaccinations centers are crowded, yes, vaccine is in short supply, yet over 10 lakh people in this city have had their first dose already, that means more than a third of the eligible population is now vaccinated for the first dose at least.

Preparations are up to the mark here, ample beds, oxygen storage tanks, oxygen generators, logistics, manpower, pediatric wards, medicines, ICUs, ventilators vaccination centers, testing centers with augmented capacities. Daily and weekly meetings of the bureaucrats at all levels are having brainstorming sessions on what else need to be done. They believe they are ready to face the virus if it comes in whatever variant or form it decides to.

Are all our efforts good enough is the question we should be asking ourselves. No idea in what form, variant this next wave will come, will it be more dangerous, will it be fast spreading, more infectious, will it be really lethal or will it just come infect some and go. Will the vaccine be able to stop the virus? How can we predict this? Not many answers to our questions.

Positive cases keep hovering above 150 daily, will the virus strike out of the blue as we take comfort in the present status that cases are not increasing, will the situation be as in the second wave, sudden spurt in cases over a short period of time and deaths too, or will it be faster than lightening putting all our efforts and preparation to naught. Are our preparations good enough? We know not.

One scenario is it never comes, another is it does strike again but won’t be as infectious and lethal, but yet another possibility that scares me is it could be worse than the previous and break through all our defenses. Whom will it take away, as it is so many doctors have lost their lives to covid, the back bone of the medical system that is that nurses and paramedics have faced the brunt of the previous two waves and a tired lot?

Will the story of the boy who cried wolf repeat itself, if we ignore the signs of an impending wave we shall be in for a major disaster? Even as I conclude there is news the next wave will be upon us this month of August itself. It is estimated to peak by October 2021. Deaths it is being predicted will be less and daily cases might cross 100000.

Yes, we are ready to face this belligerent virus gifted to us by Wuhan. Man will win, we shall overcome unless the virus mutates to put all our efforts to naught.

Covid 19- A pandemic of Covid, an epidemic of lies, deceit and corruption.

Covid hit the world some time in late 2019, initially at Wuhan and then slowly spread its tentacles to spread to every country in the world devastating human lives.

After Auschwitz now Wuhan became the most cursed city in the world history. Covid brought misery and suffering to mankind, but not to all. A few or many flourished. They made the pandemic to work to their advantage, many lost their lives, many cashed on them. Doctors, paramedics, traders, bureaucrats, politicians NGOs all went for the kill.

Even as lock-downs hurt business, people lost jobs and found it difficult to make ends meet the unscrupulous made merry. As the second and third waves followed the first the series of deceit, lies and corruption kept on mounting.

In the initial stages of the pandemic especially in the first wave, everything from gloves, sanitizers, N95 masks, PPE kits were being bought and 5 to ten times the cost, argument being we have to provide. Equipment was need to tackle the pandemic, the suppliers managed to sell equipment both wanted and unwanted at twice or thrice the cost and in quantities perhaps which wasn’t needed. Right from hand sanitizers to funny equipment that promised to clear the atmosphere of the virus was purchased, not to tackle the epidemic but to fill one’s pockets. All knew opportunity knocks only once! Then came the testing kits sold at exorbitantly high costs. Rapid antigen kits sold then at above 500 rupees are now available for less than 50 rupees, but the killing had been made. Money had exchanged hands, every one in the system was happy, to hell with the patients, covid must stay now, it was their bread and butter.

Some where somebody frantically searched for an oxygen bed an ICU or a ventilator while the pimps in the system bought oxygen from their greedy suppliers at a premium. What normally cost 12 to 15 rupees a unit was purchased at 25 to 40 rupees. that’s because the kickbacks traveled from the lowest clerks to the highest officers.

Reasons given were that it was in short supply, in a disaster or emergency they had no other option, so they weren’t wrong. Then again people kept moving from one hospital to another on search of an ICU bed for their loved ones, literally none were available, many died for lack of an oxygen or ICU bed. Another opportunity grabbed, hawk eyed officers saw it immediately, buy more ventilators, buy many more oxygen generation machines, buy more jumbo cylinders, HFNO, syringe pumps, ICU beds,defibrillators etc. of course all at highly inflated price ranging from 100 to 200 percent of the original peace time costs.

Non-medical bureaucrats took over the control measures for the epidemic. They prided themselves in their knowledge of medicine mostly acquired from the internet, google and some from the doctors. They shared their newly acquired knowledge with the political class and then they together took decisions which in the eye of citizens seemed to be so citizen friendly and proactive. Half-baked ideas took the forefront not knowing the outcomes or implications of their decisions.

Meanwhile, the doctors and the paramedical staff slogged, especially from the government sector and so also the private sector. Long endless hours of duty, no leaves, they had to save peoples lives. The private sector too was overburdened as the flow of patients and deaths went on rising. Beds were scarce so were medicines like remdesivir and tocilizumab. The black market thrived. Deaths kept on rising. Some died {the poor and the downtrodden} some passed away {the rich and the elite}. Each person had a tale to tell as to why the deaths occurred, lack of medicines, not getting a hospital bed. No oxygen beds available or no ventilators available. There wasn’t a single person who hadn’t lost a near one, maybe a friend, an acquaintance, parent, child or sibling. The wrath of the virus took them all away.

Some of the private and corporate hospital too jumped into the fray of making a fast buck, exorbitant bills were passed on to patients, medicines in short supply were being sold at a heavy premium, patients were being over charged or wrongly charged. Not all hospital owners though were as unethical, there were those who did an excellent job treated their patients well never fleeced them but the ones who fleeced patients overshadowed the work of the good ones. Some of them earned money that they wouldn’t have earned in their lifetime had covid not come. The money they generated was unbelievable, of course the common man, the patients lost out. Governments made a feeble attempt or was it a show bringing prices under control but never succeeded, in fact it looks like they never intended to.

 The rush at the crematoriums were huge, waiting period to get on to the traditional pyres or the electric crematoriums was long, indeed a sorrowful state of affairs. It took hors hours for ones turn to come. There was no dignity in death too. Relatives too shied away from accompanying their dead, the fear of contacting covid kept them outside the crematoriums. A handful of good Samaritans came forward to cremate or bury the dead for no remuneration, God bless these kind souls. The people who looked after the crematoriums too found a chance to make a fast buck, payments if made got the dead and early cremation, even in death no one gave up the opportunity to make a fast buck.

Social media like Facebook was daily filled with obituaries of people who had succumbed to covid, of course soon to be forgotten. This made no difference to the wolves in the system whose only aim was to find newer avenues to make more money. Suppliers of plastic death bags too were happy at the increasing deaths; they could sell more at a cost they and the system decided.

The silver lining in the whole situation was the advent of the vaccines, the scientist worked overtime to get them ready, excellent research by them. The manufacturers got their work going fast, were able to provide succor to a frightened population. Of course, they shall make their profits but one thing is certain, they kept the prices affordable. At least they did not take advantage of the situation, thank God for this.

All said and done covid played havoc with lives of many families while it came as boon to others. Who is to blame, China? The virus? God? Or the system of the country and state?

Answers to this cannot be readily got, but the human being’s natural instinct of greed to make more and more money by whatever means without respect for lives of their own brethren is the root cause for the suffering during this pandemic.

Whether it, the virus and the illness itself could have been prevented or controlled is another debate.

One thing is for sure, had the political class left the management of the pandemic in the hands of the medical fraternity rather than the bureaucrats , the picture would have been different

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